A reliability and validity study of the Palliative Performance Scale

<p>Abstract</p> <p>Background</p> <p>The Palliative Performance Scale (PPS) was first introduced in1996 as a new tool for measurement of performance status in palliative care. PPS has been used in many countries and has been translated into other languages.</p> <p>Methods</p> <p>This study evaluated the reliability and validity of PPS. A web-based, case scenarios study with a test-retest format was used to determine reliability. Fifty-three participants were recruited and randomly divided into two groups, each evaluating 11 cases at two time points. The validity study was based on the content validation of 15 palliative care experts conducted over telephone interviews, with discussion on five themes: PPS as clinical assessment tool, the usefulness of PPS, PPS scores affecting decision making, the problems in using PPS, and the adequacy of PPS instruction.</p> <p>Results</p> <p>The intraclass correlation coefficients for absolute agreement were 0.959 and 0.964 for Group 1, at Time-1 and Time-2; 0.951 and 0.931 for Group 2, at Time-1 and Time-2 respectively. Results showed that the participants were consistent in their scoring over the two times, with a mean Cohen's kappa of 0.67 for Group 1 and 0.71 for Group 2. In the validity study, all experts agreed that PPS is a valuable clinical assessment tool in palliative care. Many of them have already incorporated PPS as part of their practice standard.</p> <p>Conclusion</p> <p>The results of the reliability study demonstrated that PPS is a reliable tool. The validity study found that most experts did not feel a need to further modify PPS and, only two experts requested that some performance status measures be defined more clearly. Areas of PPS use include prognostication, disease monitoring, care planning, hospital resource allocation, clinical teaching and research. PPS is also a good communication tool between palliative care workers.</p

Electroplating of CdTe thin films from cadmium sulphate precursor and comparison of layers grown by 3-electrode and 2-electrode systems

Electrodeposition of CdTe thin films was carried out from the late 1970s using the cadmium sulphate precursor. The solar energy group at Sheffield Hallam University has carried out a comprehensive study of CdTe thin films electroplated using cadmium sulfate, cadmium nitrate and cadmium chloride precursors, in order to select the best electrolyte. Some of these results have been published elsewhere, and this manuscript presents the summary of the results obtained on CdTe layers grown from cadmium sulphate precursor. In addition, this research program has been exploring the ways of eliminating the reference electrode, since this is a possible source of detrimental impurities, such as K+ and Ag+ for CdS/CdTe solar cells. This paper compares the results obtained from CdTe layers grown by three-electrode (3E) and two-electrode (2E) systems for their material properties and performance in CdS/CdTe devices. Thin films were characterized using a wide range of analytical techniques for their structural, morphological, optical and electrical properties. These layers have also been used in device structures; glass/FTO/CdS/CdTe/Au and CdTe from both methods have produced solar cells to date with efficiencies in the region of 5%–13%. Comprehensive work carried out to date produced comparable and superior devices fabricated from materials grown using 2E system

Pomegranate inhibits neuroinflammation and amyloidogenesis in IL-1β stimulated SK-N-SH cells

Purpose: Pomegranate fruit, Punica granatum L. (Punicaceae) and its constituents have been shown to inhibit inflammation. In this study we aimed to assess the effects of freeze-dried pomegranate (PWE) on PGE2 production in IL-1β stimulated SK-N-SH cells. Methods: An enzyme immuno assay (EIA) was used to measure prostaglandin E2 (PGE2) production from supernatants of IL-1β stimulated SK-N-SH cells. Expression of COX-2, phospho-IκB and phospho-IKK proteins were evaluated, while NF-κB reporter gene assay was carried out in TNFα-stimulated HEK293 cells to determine the effect of PWE on NF-κB transactivation. Levels of BACE-1 and Aβ in SK-N-SH cells stimulated with IL-1β were measured with an in cell ELISA. Results: PWE (25-200 µg/ml) dose dependently reduced COX-2 dependent PGE2 production in SK-N-SH cells stimulated with IL-1β. Phosphorylation of IκB and IKK were significantly (p<0.001) inhibited by PWE (50- 200 µg/ml). Our studies also show that PWE (50-200 µg/ml) significantly (p<0.01) inhibited NF-κB transactivation in TNFα-stimulated HEK293 cells. Furthermore PWE inhibited BACE-1 and Aβ expression in SK-N-SH cells treated with IL-1β. Conclusions: Taken together, our study demonstrates that pomegranate inhibits inflammation, as well as amyloidogenesis in IL-1β-stimulated SK-N-SH cells. We propose that pomegranate is a potential nutritional strategy in slowing the progression of neurodegenerative disorders like Alzheimer’s disease

A phase II trial of bendamustine in combination with rituximab in older patients with previously untreated diffuse large B-cell lymphoma

Bendamustine in combination with rituximab (BR) has been associated with high response rates and acceptable toxicity in older patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Evaluation of BR is warranted in the front-line setting for DLBCL patients not eligible for anthracyclines or for the elderly. In this phase II study, we enrolled DLBCL patients aged ≥65 years who were poor candidates for R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) to determine the efficacy and safety of BR in previously untreated stage II–IV DLBCL. Twenty-three patients were enrolled with a median age of 80 years. 52% of patients presented with poor functional status (Eastern Cooperative Oncology Group performance score of ≥2). The overall response rate was 78% with 12 complete responses (52%). At a median follow up of 29 months, the median overall survival was 10.2 months and the median progression-free survival was 5.4 months. The most common grade 3/4 adverse events were haematological. Combination therapy with BR demonstrates high response rates as front-line therapy in frail older patients with DLBCL, but survival rates were low. BR should be used with caution in future clinical trials involving older DLBCL patients with poor functional status

The contribution of veterinary medicine to public health and poverty reduction in developing countries

Few studies have explicitly examined the linkages between human health, animal disease control and poverty alleviation. This paper reviews the contribution that veterinary medicine can make to poverty alleviation in sub-Saharan Africa. Our analysis attempts to explore aspects of this contribution under five themes: food production; food safety; impact and control of zoonotic infections; promotion of ecotourism; and environmental protection. While these areas of human activity have, more or less, fallen under the influence of the veterinary profession to varying degrees, we attempt to unify this mandate using a ‘One Health’ narrative, for the purpose of providing clarity on the linkages between the veterinary and other professions, livestock production and poverty alleviation. Future opportunities for improving health and reducing poverty in the context of developing African countries are also discussed. We conclude that veterinary science is uniquely positioned to play a key role in both poverty reduction and the promotion of health, a role that can be enhanced through the reorientation of the profession’s goals and the creation of synergies with allied and related professions.Le relazioni tra salute umana, controllo delle patologie animali e programmi di riduzione della povertà raramente sono state oggetto di analisi. Questo articolo analizza il contributo che la medicina veterinaria può fornire ai processi di riduzione della povertà nell’Africa sub‑sahariana. In particolare, vengono analizzate le implicazioni della medicina veterinaria su: produzione di alimenti, igiene alimentare, impatto e controllo delle zoonosi, promozione di ecoturismo e protezione dell’ambiente. Lo studio ha l’obiettivo di riconsiderare questi aspetti sulla base dell’approccio “One Health” e di chiarire le relazioni che la professione veterinaria ha con le altre professioni, gli allevamenti animali e i programmi di riduzione della povertà. L’articolo esamina le opportunità future per migliorare le condizioni di salute e ridurre il sottosviluppo nei paesi africani, evidenziando il ruolo determinante delle scienze veterinarie. Ruolo che può essere ancor più potenziato attraverso la ridefinizione degli obiettivi professionali e la creazione di sinergie con le altre professioni.http://www.izs.it/vet_italiana/issues_vet_it.htmhb201

Kolaviron was protective against sodium azide (NaN 3 )induced oxidative stress in the prefrontal cortex

Kolaviron is a phytochemical isolated from Garcina kola (G. kola); a common oral masticatory agent in Nigeria (West Africa). It is a bioflavonoid used - as an antivi- ral, anti-inflammatory and antioxidant - in relieving the symp- toms of several diseases and infections. In this study we have evaluated the neuroprotective and regenerative effect of kolaviron in neurons of the prefrontal cortex (Pfc) before or after exposure to sodium azide (NaN 3 ) induced oxidative stress. Separate groups of animals were treated as follows; kolaviron (200 mg/Kg) for 21 days; kolaviron (200 mg/Kg for21days)followedbyNaN 3 treatment (20 mg/Kg for 5days);NaN 3 treatment (20 mg/Kg for 5 days) followed by kolaviron (200 mg/Kg for 21 days); 1 ml of corn-oil (21 days- vehicle); NaN 3 treatment (20 mg/Kg for 5 days). Exploratory activity associated with Pfc function was assessed in the open field test (OFT) following which the microscopic anatomy of the prefrontal cortex was examined in histology (Haematoxylin and Eosin) and antigen retrieval Immunohis- tochemistry to show astroglia activation (GFAP), neuronal metabolism (NSE), cytoskeleton (NF) and cell cycle dysreg- ulation (p53). Subsequently, we quantified the level of Glucose-6-phosphate dehydrogenase (G6PDH) and lactate dehydrogenase (LDH) in the brain tissue homogenate as a measure of stress-related glucose metabolism. Kolaviron (Kv) and Kolaviron/NaN 3 treatment caused no prominent change in astroglia density and size while NaN 3 and NaN 3 / Kv induced astroglia activation and scar formation (astrogliosis) in the Pfc when compared with the control. Sim- ilarly, Kolaviron and Kv/NaN 3 did not alter NSE expression (glucose metabolism) while NaN 3 and NaN 3 /Kv treatment increased cortical NSE expression; thus indicating stress related metabolism. Further studies on enzymes of glu- cose metabolism (G6PDH and LDH) showed that NaN 3 increased LDH while kolaviron reduced LDH in the brain tissue homogenate (P<0.001). In addition kolaviron treatment before (P<0.001) or after ( P <0.05) NaN 3 treatment also reduced LDH expression; thus supporting its role in suppression of oxidative stress. Interestingly, NF deposition increased in the Pfc after kolaviron treatment while Kv/NaN 3 showed no sig- nificant change in NF when compared with the control. In furtherance, NaN 3 and NaN 3 /Kv caused a decrease in NF deposition (degeneration). Ultimately, the protective effect of KV administered prior to NaN 3 treatment was confirmed through p53 expression; which was similar to the control. However, NaN 3 and NaN 3 /Kv caused an increase in p53 expression in the Pfc neurons (cell cycle dysregulation). We conclude that kolaviron is not neu- rotoxic when used at 200 mg/Kg BW. Furthermore, 200 mg/Kg of kolaviron administered prior to NaN 3 treatment (Kv/NaN 3 ) was neuroprotective when com- pared with Kolaviron administered after NaN 3 treatment (NaN 3 /Kv). Some of the observed effects of kolaviron administered before NaN 3 treatment includes reduction of astroglia activation, absence of astroglia scars, anti- oxidation (reduced NSE and LDH), prevention of neu- rofilament loss and cell cycle regulatio

Antimalarial drug artemether inhibits neuroinflammation in BV2 microglia through Nrf2-dependent mechanisms

Artemether, a lipid-soluble derivative of artemisinin has been reported to possess anti-inflammatory properties. In this study, we have investigated the molecular mechanisms involved in the inhibition of neuroinflammation by the drug. The effects of artemether on neuroinflammation-mediated HT22 neuronal toxicity were also investigated in a BV2 microglia/HT22 neuron co-culture. To investigate effects on neuroinflammation, we used LPS-stimulated BV2 microglia treated with artemether (5-40µM) for 24 hours. ELISAs and western blotting were used to detect pro inflammatory cytokines, nitric oxide, PGE2, iNOS, COX-2 and mPGES-1. BACE-1 activity and Aβ levels were measured with ELISA kits. Protein levels of targets in NF-kappaB and p38 MAPK signalling, as well as HO-1, NQO1 and Nrf2 were also measured with western blot. NF-kappaB binding to the DNA was investigated using EMSA. MTT, DNA fragmentation and ROS assays in BV2-HT22 neuronal co-culture were used to evaluate the effects of artemether on neuroinflammation-induced neuronal death. The role of Nrf2 in the anti-inflammatory activity of artemether was investigated in BV2 cells transfected with Nrf2 siRNA. Artemether significantly suppressed pro-inflammatory mediators (NO/iNOS, PGE2/COX-2/mPGES-1, TNFα, and IL-6), Aβ and BACE-1 in BV2 cells following LPS stimulation. These effects of artemether were shown to be mediated through inhibition of NF-kappaB and p38MAPK signalling. Artemether produced increased levels of HO-1, NQO1 and GSH in BV2 microglia. The drug activated Nrf2 activity by increasing nuclear translocation of Nrf2 and its binding to antioxidant response elements in BV2 cells. Transfection of BV2 microglia with Nrf2 siRNA resulted in the loss of both anti-inflammatory and neuroprotective activities of artemether. We conclude that artemether induces Nrf2 expression and suggest that Nrf2 mediates the anti-inflammatory effect of artemether in BV2 microglia. Our results suggest that this drug has a therapeutic potential in neurodegenerative disorders

A Community-Based Multicenter Trial of Pharmacokinetically Guided 5-Fluorouracil Dosing for Personalized Colorectal Cancer Therapy

Pharmacokinetically guided (PK-guided) versus body surface area-based 5-fluorouracil (5-FU) dosing results in higher response rates and better tolerability. A paucity of data exists on PK-guided 5-FU dosing in the community setting

Equity and justice in climate change adaptation : Policy and practical implication in Nigeria

Over the past decade, justice and equity have become a quasi-universal answer to problems of environmental governance. The principles of justice and equity emerged as a useful entry point in global governance to explore the responsibilities, distribution, and procedures required for just climate change adaptation. These principles are designed primarily through the establishment of funding mechanisms, top-down guides, and frameworks for adaptation, and other adaptation instruments from the UNFCCC process, to ensure effective adaptation for vulnerable countries like Nigeria that have contributed least to the issue of climate change but lack adaptive capacity. Global adaptation instruments have been acknowledged for adaptation in Nigeria. Climate change has a detrimental impact on Nigeria as a nation, with the burden falling disproportionately on the local government areas. As Nigeria develop national plans and policies to adapt to the consequences of climate change, these plans will have significant consequences for local government areas where adaptation practices occur. Although the local government’s adaptation burden raises the prospects for justice and equity, its policy and practical implication remains less explored. This chapter explores the principles of justice and equity in national adaptation policy and adaptation practices in eight local government areas in southeast Nigeria. The chapter argues that some factors make it challenging to achieve equity and justice in local adaptation practices. With the use of a qualitative approach (interview (n = 52), observation, and document analysis), this chapter identified some of the factors that constraints equity and justice in local government adaptation in southeast Nigeria.publishedVersio