Palliative Care: A Novel Solution to the Healthcare Crisis. Syracuse Seminar Series on Aging.

Palliative care is specialized healthcare for anyone who is diagnosed with a serious and life-threatening illness, starting when they get the diagnosis, regardless of the prognosis. Although hospice is a form of palliative care, most palliative care is not end-of-life care or hospice, a common misperception that deters many people from using palliative care when they would benefit from it. Palliative care improves quality of care, reduces hospital costs, and helps clinicians address the needs and wants of patients and their families, which is why I refer to it as a 'novel' solution to the longstanding healthcare crisis.palliative care, hospice, patient autonomy, access to information, pain, distress, serious illness, cancer, depression, physical discomfort, medical education,

Drought at a coastal wetland affects refuelling and migration strategies of shorebirds

Droughts can affect invertebrate communities in wetlands, which can have bottom-up effects on the condition and survival of top predators. Shorebirds, key predators at coastal wetlands, have experienced widespread population declines and could be negatively affected by droughts. We explored, in detail, the effects of drought on multiple aspects of shorebird stopover and migration ecology by contrasting a year with average wet/dry conditions (2016) with a year with moderate drought (2017) at a major subarctic stopover site on southbound migration. We also examined the effects of drought on shorebird body mass during stopover across 14 years (historical: 1974–1982 and present-day: 2014–2018). For the detailed comparison of two years, in the year with moderate drought we documented lower invertebrate abundance at some sites, higher prey family richness in shorebird faecal samples, lower shorebird refuelling rates, shorter stopover durations for juveniles, and, for most species, a higher probability of making a subsequent stopover in North America after departing the subarctic, compared to the year with average wet/dry conditions. In the 14-year dataset, shorebird body mass tended to be lower in drier years. We show that even short-term, moderate drought conditions can negatively affect shorebird refuelling performance at coastal wetlands, which may carry-over to affect subsequent stopover decisions. Given shorebird population declines and predicted changes in the severity and duration of droughts with climate change, researchers should prioritize a better understanding of how droughts affect shorebird refuelling performance and survival

Discovery of a proto-white dwarf with a massive unseen companion

We report the discovery of SDSS~J022932.28+713002.7, a nascent extremely low-mass (ELM) white dwarf (WD) orbiting a massive ($> 1\,M_\odot$ at 2$\sigma$ confidence) companion with a period of 36 hours. We use a combination of spectroscopy, including data from the ongoing SDSS-V survey, and photometry to measure the stellar parameters for the primary pre-ELM white dwarf. The lightcurve of the primary WD exhibits ellipsoidal variation, which we combine with radial velocity data and $\tt{PHOEBE}$ binary simulations to estimate the mass of the invisible companion. We find that the primary WD has mass $M_1$ = $0.18^{+0.02}_{-0.02}$ M$_\odot$ and the unseen secondary has mass $M_2$ = $1.19^{+0.21}_{-0.14}$ M$_\odot$. The mass of the companion suggests that it is most likely a near-Chandrasekhar mass white dwarf or a neutron star. It is likely that the system recently went through a Roche lobe overflow from the visible primary onto the invisible secondary. The dynamical configuration of the binary is consistent with the theoretical evolutionary tracks for such objects, and the primary is currently in its contraction phase. The measured orbital period puts this system on a stable evolutionary path which, within a few Gyrs, will lead to a contracted ELM white dwarf orbiting a massive compact companion.Comment: 21 Pages, 8 Figure

Measuring The Mass-Radius Relation of White Dwarfs Using Wide Binaries

Measuring the mass-radius relation of individual white dwarfs is an empirically challenging task that has been performed for only a few dozen stars. We measure the white dwarf mass-radius relation using gravitational redshifts and radii of 137 white dwarfs in wide binaries with main sequence companions. We obtain the space velocities to these systems using the main sequence companion, and subtract these Doppler redshifts from the white dwarfs' apparent motions, isolating their gravitational redshifts. We use Gaia data to calculate the surface temperatures and radii of these white dwarfs, thereby deriving an empirical gravitational redshift-radius relation. This work demonstrates the utility of low-resolution Galactic surveys to measure the white dwarf equation of state. Our results are consistent with theoretical models, and represent the largest sample of individual white dwarf gravitational redshift measurements to date.Comment: 12 pages, 9 figure

A Research Agenda for Communication Between Health Care Professionals and Patients Living With Serious Illness

Importance Poor communication by health care professionals contributes to physical and psychological suffering in patients living with serious illness. Patients may not fully understand their illness, prognosis, and treatment options or may not receive medical care consistent with their goals. Despite considerable research exploring the role of communication in this setting, many questions remain, and a clear agenda for communication research is lacking. Observations Through a consensus conference and subsequent activities, we reviewed the state of the science, identified key evidence gaps in understanding the impact of communication on patient outcomes, and created an agenda for future research. We considered 7 broad topics: shared decision making, advance care planning, communication training, measuring communication, communication about prognosis, emotion and serious illness communication, and cultural issues. We identified 5 areas in which further research could substantially move the field forward and help enhance patient care: measurement and methodology, including how to determine communication quality; mechanisms of communication, such as identifying the specific clinician behaviors that patients experience as both honest and compassionate, or the role of bias in the clinical encounter; alternative approaches to advance care planning that focus on the quality of serious illness communication and not simply completion of forms; teaching and disseminating communication skills; and approaches, such as economic incentives and other clinician motivators, to change communication behavior. Conclusions Our findings highlight the urgent need to improve quality of communication between health care professionals and patients living with serious illness through a broad range of research that covers communication skills, tools, patient education, and models of care

DHODH modulates transcriptional elongation in the neural crest and melanoma

Melanoma is a tumour of transformed melanocytes, which are originally derived from the embryonic neural crest. It is unknown to what extent the programs that regulate neural crest development interact with mutations in the BRAF oncogene, which is the most commonly mutated gene in human melanoma1. We have used zebrafish embryos to identify the initiating transcriptional events that occur on activation of human BRAF(V600E) (which encodes an amino acid substitution mutant of BRAF) in the neural crest lineage. Zebrafish embryos that are transgenic for mitfa:BRAF(V600E) and lack p53 (also known as tp53) have a gene signature that is enriched for markers of multipotent neural crest cells, and neural crest progenitors from these embryos fail to terminally differentiate. To determine whether these early transcriptional events are important for melanoma pathogenesis, we performed a chemical genetic screen to identify small-molecule suppressors of the neural crest lineage, which were then tested for their effects on melanoma. One class of compound, inhibitors of dihydroorotate dehydrogenase (DHODH), for example leflunomide, led to an almost complete abrogation of neural crest development in zebrafish and to a reduction in the self-renewal of mammalian neural crest stem cells. Leflunomide exerts these effects by inhibiting the transcriptional elongation of genes that are required for neural crest development and melanoma growth. When used alone or in combination with a specific inhibitor of the BRAF(V600E) oncogene, DHODH inhibition led to a marked decrease in melanoma growth both in vitro and in mouse xenograft studies. Taken together, these studies highlight developmental pathways in neural crest cells that have a direct bearing on melanoma formation