Beliefs in advance care planning among Chinese Americans: Similarities and differences between the younger and older generations

The purpose of this research is to explore behavioral, normative, and control beliefs in the discussion of advance care planning (ACP) among older and younger Chinese Americans. Ethnic minority groups have been identified as less engaged in ACP and this represents an ethnic and cultural gap. Older Chinese American adults often have different beliefs and values compared to the younger generation who are more acculturated to American mainstream culture. These differences may hinder the discussion of ACP with Chinese older adults. A qualitative design was used. The Theory of Planned Behavior guided the development of the interview guide. We recruited 60 Chinese Americans. Prior experience was identified as a theme that influenced attitudes about ACP. We found that older and younger Chinese participants had different beliefs in the norm and control related to ACP discussions, but not in the belief of attitudes about ACP discussions. Both younger and older Chinese American participants believed that ACP was important and necessary. Participants in both clusters expressed that they were ready and willing to engage in ACP discussions with their family members but hesitant to initiate these discussions. The reluctance in discussing ACP with Chinese older adults may be related to the expectations and obligations of Xiao (filial piety) in Chinese culture. This study describes the similarities and differences of beliefs in ACP between older and younger Chinese Americans. We identified barriers and facilitators in behavioral, normative, and control beliefs that can be used to promote ACP for Chinese Americans

Dramatic reduction of sequence artefacts from DNA isolated from formalin-fixed cancer biopsies by treatment with uracil-DNA glycosylase

Non-reproducible sequence artefacts are frequently detected in DNA from formalin-fixed and paraffin-embedded (FFPE) tissues. However, no rational strategy has been developed for reduction of sequence artefacts from FFPE DNA as the underlying causes of the artefacts are poorly understood. As cytosine deamination to uracil is a common form of DNA damage in ancient DNA, we set out to examine whether treatment of FFPE DNA with uracil-DNA glycosylase (UDG) would lead to the reduction of C>T (and G>A) sequence artefacts. Heteroduplex formation in high resolution melting (HRM)-based assays was used for the detection of sequence variants in FFPE DNA samples. A set of samples that gave false positive HRM results for screening of the E17K mutation in exon 4 of the AKT1 gene were chosen for analysis. Sequencing of these samples showed multiple non-reproducible C:G>T:A artefacts. Treatment of the FFPE DNA with UDG prior to PCR amplification led to a very marked reduction of the sequence artefacts as indicated by both HRM and sequencing analysis. Similar results were shown for the BRAFV600 region in the same sample set and EGFR exon 19 in another sample set. UDG treatment specifically suppressed the formation of artefacts in FFPE DNA as it did not affect the detection of true KRAS codon 12 and true EGFR exon 19 and 20 mutations. We conclude that uracil in FFPE DNA leads to a significant proportion of sequence artefacts. These can be minimised by a simple UDG pre-treatment, which can be readily carried out in the same tube as the PCR, immediately prior to commencing thermal cycling. HRM is a convenient way of monitoring both the degree of damage and the effectiveness of the UDG treatment. These findings have immediate and important implications for cancer diagnostics where FFPE DNA is used as the primary genetic material for mutational studies guiding personalised medicine strategies and where simple effective strategies to detect mutations are required

Limited copy number - high resolution melting (LCN-HRM) enables the detection and identification by sequencing of low level mutations in cancer biopsies

<p>Abstract</p> <p>Background</p> <p>Mutation detection in clinical tumour samples is challenging when the proportion of tumour cells, and thus mutant alleles, is low. The limited sensitivity of conventional sequencing necessitates the adoption of more sensitive approaches. High resolution melting (HRM) is more sensitive than sequencing but identification of the mutation is desirable, particularly when it is important to discriminate false positives due to PCR errors or template degradation from true mutations.</p> <p>We thus developed limited copy number - high resolution melting (LCN-HRM) which applies limiting dilution to HRM. Multiple replicate reactions with a limited number of target sequences per reaction allow low level mutations to be detected. The dilutions used (based on Ct values) are chosen such that mutations, if present, can be detected by the direct sequencing of amplicons with aberrant melting patterns.</p> <p>Results</p> <p>Using cell lines heterozygous for mutations, we found that the mutations were not readily detected when they comprised 10% of total alleles (20% tumour cells) by sequencing, whereas they were readily detectable at 5% total alleles by standard HRM. LCN-HRM allowed these mutations to be identified by direct sequencing of those positive reactions.</p> <p>LCN-HRM was then used to review formalin-fixed paraffin-embedded (FFPE) clinical samples showing discordant findings between sequencing and HRM for <it>KRAS </it>exon 2 and <it>EGFR </it>exons 19 and 21. Both true mutations present at low levels and sequence changes due to artefacts were detected by LCN-HRM. The use of high fidelity polymerases showed that the majority of the artefacts were derived from the damaged template rather than replication errors during amplification.</p> <p>Conclusion</p> <p>LCN-HRM bridges the sensitivity gap between HRM and sequencing and is effective in distinguishing between artefacts and true mutations.</p

Development of Interdisciplinary Communication Tools to Improve Handoffs for Emergent Airway Management

Project goal Improve response time from airway alert to intubation while ensuring pertinent critical patient information is communicated to the airway team to reduce negative patient outcomes and better mobilize anesthesia resources

The Fate of Binaries in the Galactic Center: The Mundane and the Exotic

The Galactic Center (GC) is dominated by the gravity of a super-massive black hole (SMBH), Sagittarius A$^*$, and is suspected to contain a sizable population of binary stars. Such binaries form hierarchical triples with the SMBH, undergoing Eccentric Kozai-Lidov (EKL) evolution, which can lead to high eccentricity excitations for the binary companions' mutual orbit. This effect can lead to stellar collisions or Roche-lobe crossings, as well as orbital shrinking due to tidal dissipation. In this work we investigate the dynamical and stellar evolution of such binary systems, especially with regards to the binaries' post-main-sequence evolution. We find that the majority of binaries (~75%) is eventually separated into single stars, while the remaining binaries (~25%) undergo phases of common-envelope evolution and/or stellar mergers. These objects can produce a number of different exotic outcomes, including rejuvenated stars, G2-like infrared-excess objects, stripped giant stars, Type Ia supernovae (SNe), cataclysmic variables (CVs), symbiotic binaries (SBs), or compact object binaries. We estimate that, within a sphere of 250 Mpc radius, about 7.5 to 15 Type Ia SNe per year should occur in galactic nuclei due to this mechanism, potentially detectable by ZTF and ASAS-SN. Likewise we estimate that, within a sphere of 1 Gpc$^3$ volume, about 10 to 20 compact object binaries form per year that could become gravitational wave sources. Based on results of EKL-driven compact object binary mergers in galactic nuclei by Hoang at al. (2018), this compact object binary formation rate translates to about 15 to 30 events per year detectable by Advanced LIGO.Comment: 8 pages, 3 figures, accepted by Ap

Stepping Responses of Young and Old Adults to Postural Disturbances: Kinematics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111171/1/j.1532-5415.1994.tb04972.x.pd