Deprescribing in the Hospice Population, Who is Eligible and Who is Agreeable: A Quality Improvement Project

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications on the inpatient medication record equaled 80.5% for antihypertensives, 61.1% for statins, and 22.2% for oral diabetic medications for the sample. At hospice admission, 61.0 % of these patients were appropriately deprescribed, 13.8 % of patients were partially deprescribed, meaning some eligible medications were removed, and 25% of patients were not deprescribed. 64 % of patients were appropriately deprescribed target medications during the first four weeks of hospice enrollment. The results confirmed medication deprescribing is occurring but also identified missed opportunities for deprescribing in Sharp Hospice. These conclusions are beneficial and applicable to the next phase of project implementation to improve the organization\u27s deprescribing percentages

Loss, death, procreation and writing in the metafictive narrative of Rosa Montero

This work argues the purpose of writing for the female protagonists in Montero's Crónica del desamor, La hija del caníbal, La función Delta, Historia del Rey Transparente and La loca de la casa. This project attempts to uncover the connection between writing as a creative process and all its implications, such as its healing qualities for the protagonists. Finally, this study applies the feminist theories of Hélène Cixous, among others, to further connect women's personal and societal need to write. The first chapter of this paper includes a brief look at the author's life and her many accomplishments, as well as her role in women's narrative of post-Franco Spain. This chapter gives special attention to several commonalities of the women writers of the time, such as the use of metafiction, the form of writing fiction within a fiction, which Montero employs in all five novels. The second chapter encompasses the use of writing in order to confront loss. All the protagonists suffer from various losses, such as the loss of youth, love and innocence. Chapter three discusses the structure of the protagonists' writing within the scope of the novel as a metafiction. In the fourth chapter, I expand on the theme of death and how each protagonist uses writing to face their worries about dying, and how some of the protagonists employ writing to actually transcend death. Cixous' theory encourages women's writing through the body; in correlation with this theory, this chapter concentrates on the connection of the ability to procreate through writing. Finally, the conclusion illustrates how Montero actually portrays a positive outlook on life through the protagonists

Cryopreservation of equine mesenchymal stem cells in 95 % autologous serum and 5 % DMSO does not alter post-thaw growth or morphology in vitro compared to fetal bovine serum or allogeneic serum at 20 or 95 % and DMSO at 10 or 5 %

INTRODUCTION: Equine superficial digital flexor tendon injury is a well-accepted model of human tendon injury and is routinely treated with local injections of autologous mesenchymal stem cells (MSCs). Identification of a clinically safe medium for short-term cryopreservation of MSCs prior to cell implantation would streamline laboratory and clinical procedures for autologous regenerative therapies. Veterinary experience with short-term (MSCs prepared after the injury has occurred) cryopreserved MSCs in naturally occurring injury in the horse will be of value to human practitioners. METHODS: Equine bone marrow derived MSCs were cryopreserved in 6 different solutions consisting of 20 % serum, 10 % DMSO and 70 % media or 95 % serum and 5 % DMSO. Serum was autologous serum, commercially available pooled equine serum or fetal bovine serum (FBS). Cell survival, morphology and growth kinetics were assessed by total cell number, measurement of growth kinetics, colony-forming-unit-assay and morphology of MSCs after monolayer culture post-thaw. RESULTS: There were no significant differences in post-thaw viability, total cell number, morphology scores or growth kinetics among the 6 solutions. Post thaw viabilities from each group ranged from 80-90 %. In all solutions, there were significantly fewer MSCs and the majority (99 %) of MSCs remained in the original generation 24 hours post-thaw. Seventy two hours post-thaw, the majority of MSCs (50 %) were proliferating in the fourth generation. Mean colony count in the CFU-F assay ranged from 72 to 115 colonies. CONCLUSIONS: Each of the serum sources could be used for short-term cryopreservation of equine bone marrow derived MSCs. Prior to clinical use, clinicians may prefer autologous serum and a lower concentration of DMSO. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13287-015-0230-y) contains supplementary material, which is available to authorized users

Concert recording 2018-10-29

[Track 1]. The wolf\u27s aria from Little red riding hood / Seymour Barab -- [Track 2]. Die beiden Grenadiene / Robert Schumann -- [Track 3]. Jeanie with the light brown hair / Stephen Foster -- [Track 4]. Verborgenheit / Hugo Wolf -- [Track 5]. Ridente la calma / Wolfgang Amadeus Mozart -- [Track 6]. Allerseelen / Richard Strauss -- [Track 7]. Laurie\u27s song from The tender land / Aaron Copland -- [Track 8]. Come raggio di sol / Antonio Caldara -- [Track 9]. Gretchen am Spinnrade / Franz Schubert -- [Track 10]. La Spectre de la Rose from Les Nuits d\u27Ete / Hector Berlioz -- [Track 11]. Lied der Mignon / Franz Schubert -- [Track 12]. This is my beloved from Kismet / Robert Wright George Forrest -- [Track 13]. Dein blaues Auge [Track 14]. Wie Melodien zieht es / Johannes Brahms -- [Track 15]. The infinite shining heavens from Songs of travel / Ralph Vaughan-Williams -- [Track 16]. O stay, my love / Sergei Rachmaninoff -- [Track 17]. Il lacerato spirito from Simon Boccanegra / Giuseppe Verdi -- [Track 18]. There but for you I go from Brigadoon / Lerner and Loewe

Concert recording 2017-10-02

[Track 1]. Amarilli bella / Giulio Caccini -- [Track 2]. El sueño imposible from Man of La Mancha / Joe Darion -- [Track 3]. An Sylvia / Franz Schubert -- [Track 4]. O Isis und Osiris / Wolfgang Amadeus Mozart -- [Track 5]. Apres un reve / Gabriel Fauré -- [Track 6]. Dido\u27s lament from Dido and Aeneas / Henry Purcell -- [Track 7]. This in my beloved from Kismet / Robert Wright -- [Track 8]. Heidenröslein / Franz Schubert -- [Track 9]. Lord God of Abraham from Elijah / Felix Mendelssohn -- [Track 10]. Lieben, hassen, hoffen, sagen / Richard Strauss -- [Track 11]. Auch kleine Dinge from Italienischers Liederbuch / Hugo Wolf -- [Track 12]. Saper vorreste from Un ballo in maschera / Giuseppe Verdi -- [Track 13]. Ombra mai fu from Xerxes / George Frideric Handel -- [Track 14]. You\u27ll never walk alone from Carousel / Richard Rodgers and Oscar Hammerstein II -- [Track 15]. Les berceaux / Fauré -- [Track 16]. I remember from Evening primrose / Stephen Sondheim -- [Track 17]. Vaghissima sembianza / Stefano Donaudy -- [Track 18]. Moonfall from The mystery of Edwin Drood / Rupert Holmes -- [Track 19]. Stranger in paradise from Kismet / Robert Wright and George Forrest -- [Track 20]. Morire / Giacomo Puccini -- [Track 21]. Sorge infausta una procella from Orlando / Handel -- [Track 22]. Vi ravviso from La sonnambula / Vincenzo Bellini

Repeated intra-articular injection of allogeneic mesenchymal stem cells causes an adverse response compared to autologous cells in the equine model

BACKGROUND: Intra-articular injection of mesenchymal stem cells (MSCs) is efficacious in osteoarthritis therapy. A direct comparison of the response of the synovial joint to intra-articular injection of autologous versus allogeneic MSCs has not been performed. The objective of this study was to assess the clinical response to repeated intra-articular injection of allogeneic versus autologous MSCs prepared in a way to minimize xeno-contaminants in a large animal model. METHODS: Intra-articular injections of bone marrow-derived, culture-expanded MSCs to a forelimb metacarpophalangeal joint were performed at week 0 and week 4 (six autologous; six autologous with xeno-contamination; six allogeneic). In the week following each injection, clinical and synovial cytology evaluations were performed. RESULTS: Following the first intra-articular injection, there were no differences in clinical parameters over time. Following the second intra-articular injection, there was a significant adverse response of the joint to allogeneic MSCs and autologous MSCs with xeno-contamination with elevated synovial total nucleated cell counts. There was also significantly increased pain from joints injected with autologous MSCs with xeno-contamination. CONCLUSIONS: Repeated intra-articular injection of allogeneic MSCs results in an adverse clinical response, suggesting there is immune recognition of allogeneic MSCs upon a second exposure. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13287-017-0503-8) contains supplementary material, which is available to authorized users

Metabolomics-Based Discovery of Diagnostic Biomarkers for Onchocerciasis

Onchocerciasis, caused by the filarial parasite Onchocerca volvulus, afflicts millions of people, causing such debilitating symptoms as blindness and acute dermatitis. There are no accurate, sensitive means of diagnosing O. volvulus infection. Clinical diagnostics are desperately needed in order to achieve the goals of controlling and eliminating onchocerciasis and neglected tropical diseases in general. In this study, a metabolomics approach is introduced for the discovery of small molecule biomarkers that can be used to diagnose O. volvulus infection. Blood samples from O. volvulus infected and uninfected individuals from different geographic regions were compared using liquid chromatography separation and mass spectrometry identification. Thousands of chromatographic mass features were statistically compared to discover 14 mass features that were significantly different between infected and uninfected individuals. Multivariate statistical analysis and machine learning algorithms demonstrated how these biomarkers could be used to differentiate between infected and uninfected individuals and indicate that the diagnostic may even be sensitive enough to assess the viability of worms. This study suggests a future potential of these biomarkers for use in a field-based onchocerciasis diagnostic and how such an approach could be expanded for the development of diagnostics for other neglected tropical diseases