Identification of a major growth factor for AIDS-Kaposi's sarcoma cells as oncostatin M

Conditioned medium from human T cell leukemia virus type 2 (HTLV-II)-infected T cells supports the growth and long-term culture of cells derived from acquired immunodeficiency syndrome (AIDS)-associated Kaposi's sarcoma lesions (AIDS-KS cells). A protein of 30 kilodaltons was purified from conditioned medium that supports the growth of AIDS-KS cells. The amino-terminal sequence of this protein was identical to the amino-terminal sequence of Oncostatin M, a glycoprotein that inhibits the growth of a variety of cancer cells. Oncostatin M from conditioned medium stimulated a twofold increase in the growth of AIDS-KS cells at a concentration of less than 1 nanogram of the protein per milliliter of medium.

Report of the Second Equine Leucocyte Antigen Workshop, Squaw valley, California, July 1995

The final assignment of antibody clusters for leucocyte antigens and immunoglobulins, as described in detail in Sections 3 and 4, is summarized in Table 4. Together with other mAbs developed outside of ELAW II (Table 9) this pool of reagents represent a powerful array of tools for the study of equine immunity. The Second Equine Leucocyte Antigen Workshop made considerable advances in pursuing the objectives of establishing the specificities of mAbs and achieving consensus on the nomenclature for equine leucocyte and immunoglobulin molecules. Of equal importance, several productive collaborations were fostered among the participating laboratories and observers. Overall, enormous advances have been made in the past decade since mAbs specific for equine leucocyte antigens and immunoglobulins were first reported. There remains enormous scope and need for further studies of equine leucocyte antigens and immunoglobulins, both for the purposes of comparative immunology and for the good of the horse. In the future novel techniques will be required to develop reagents for specific target antigens such as the orthologues of the CD25 or CD45 isoforms. In studies of equine immunoglobulins the functional role of the IgG isotypes must be better established, reagents for IgE must be developed, and cloning of the immunoglobulin heavy chain genes will be essential if the complexities of the IgG sub-isotypes are to be elucidated. The tasks still facing the currently small group of equine immunologists throughout the world remain formidable, and will only be tackled successfully in a spirit of collaboration.

A 768-lane microfabricated system for high-throughput DNA sequencing

A 768-lane DNA sequencing system based on microfluidic plates has been designed as a near-term successor to 96-lane capillary arrays. Electrophoretic separations are implemented for the first time in large-format (25 cm x 50 cm) microdevices, with the objective of proving realistic read length, parallelism, and the scaled sample requirements for long-read de novo sequencing. Two 384-lane plates are alternatively cycled between electrophoresis and regeneration via a robotic pipettor. A total of greater than 172000 bases, 99% accuracy (corresponding to quality score 20) is achieved for each iteration of a 384 lane plate. At current operating conditions, this implies a system throughput exceeding 4 megabases of raw sequence (Phred 20) per day on the new platform. Standard operation is at "1/32x" Sanger chemistry, equal to typical genome center operation on mature capillary array machines, and a 16-fold improvement in scaling relative to previous microfabricated devices. Experiments provide evidence that sample concentration can be further reduced to 1/256x Sanger chemistry in the microdevice. Life-testing indicates a usable life of >150 hours (more than 50 runs) for the 384 lane plates. The combined advances, particularly those in read length and sample requirement, directly address the cost model requirements for adaptation of the new technology as the next step beyond capillary array instruments.

Brief group therapy following myocardial infarction: eighteen-month follow-up of a controlled trial

Sixty post-myocardial infarction (MI) subjects have been followed for up to eighteen months' time following their MI. Thirty-eight of these subjects completed a brief series of four to six group therapy sessions during their early rehabilitation phase; the others received no group therapy. Both groups were placed on otherwise identical schedules of outpatient follow-up. Group therapy patients have, to date, experienced significantly fewer cardiac complications than controls. Only one death has occurred, and that one patient was in the control group. A coronary heart disease teaching evaluation questionnaire was given to a sample of group therapy patients, a sample of controls, and a comparison group of men without MI. Following their group therapy sessions, these men demonstrated significantly greater knowledge of their disease and its optimal rehabilitation than did control or comparison subjects. Control patients' questionnaire results proved to be insignificantly different from those of the comparison group.

Cervical dystonia severity scale reliability study

Cervical dystonia (CD) is characterized by sustained contractions of the neck musculature, resulting in abnormal head postures. The Cervical Dystonia Severity Scale (CDSS) was developed to provide a reliable measure of treatment response in patients with CD. The CDSS uses a protractor and wall chart to rate the severity of the head's deviation from neutral in each of three planes of motion (rotation, laterocollis, anterocollis/retrocollis), which is then scored in 5 degree intervals (1 degree to 5 degrees deviation = 1; 86 degree to 90 degrees deviation = 18). To test the reliability of the CDSS, four centers, each with two independent examiners, evaluated 42 patients with CD. At each site, each of the two examiners used the CDSS to evaluate the head position of each patient twice, on the same day, for a total of four evaluations. The kappa value for intra-examiner agreement was 0.94 (95% confidence limit of 0.900-0.972), indicating excellent intra-examiner reliability. The kappa value for interexaminer reliability was 0.79 for the first evaluation and 0.86 for the second evaluation (95% confidence limits of 0.668-0.920 and 0.790-0.920) indicating excellent interexaminer reliability. Thus, the CDSS was highly reliable in both intra-examiner and interexaminer scoring comparisons.

A new method using ultrasound for measuring femoral anteversion (torsion): technique and reliability

This paper reports details of a new method using medical ultrasound for measuring femoral anteversion (strictly torsion), and a reliability study of the method separately on each of 10 healthy children and 20 adults. The method involves using a static-image B-mode ultrasound scanner to obtain scans at the hips and knees of the lower limbs. A technique using bone-surface contours is reported for defining, on each hip scan, the head-neck line and, on each knee scan, the transcondylar line. By superimposing the transcondylar line on the head-neck line, the angle of femoral anteversion (torsion) was calculated for each limb. In the reliability study, scans were obtained three times at both hips and knees of each subject. The femoral anteversion was measured for each limb. The intra-observer error was within +/- 2.3 degrees (95% confidence limits) between scans, which was not statistically significant for the measured anteversion in each of the right and left femora of children and adults separately. To test the validity of the tracing method used to calculate femoral anteversion, one set of scans from the hip and knee of each subject was measured four times; no significant difference was found between tracings for the measurements of femoral anteversion. The ultrasound method is recommended for clinical use. We consider the static-image B-mode scanner to be the instrument of choice for measuring femoral anteversion in living subjects.

Electing Full Code in Hospice: Patient Characteristics and Live Discharge Rates

BACKGROUND

It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates.

OBJECTIVE

To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns.

DESIGN

Retrospective cohort study of electronic medical record data.

SETTING/SUBJECTS

A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014.

MEASUREMENTS

Code status was defined as full code versus do-not-resuscitate (DNR) orders. Covariates include demographics, location (home, hospice facility, nursing home, and hospital), primary diagnosis, and length of stay. Hospice live discharge was defined as short (0-14 days), medium (15-179 days), and long (>179 days).

RESULTS

A total of 12.9% of hospice enrollees elected full code status. This was significantly (p < 0.05) predicted by male sex, younger age, nonwhite race, home setting of care, and cancer diagnosis. Those with full code status had 1.76 times the adjusted odds of hospice live discharge compared with those with DNR orders (95% confidence interval [CI] 1.44-2.16) and 2.47 times the odds of short live discharge (95% CI 1.69-3.62) with no significant difference in long live discharge. The association of full code orders with hospice live discharge was stronger for nonwhite enrollees, with a live discharge rate of 23.8% versus 11.6% for African Americans with full code versus DNR orders.

CONCLUSIONS

Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.

The Value of a Brief Thought for the Day Reflection on an Academic Consult Service

BACKGROUND

Work in hospice and palliative medicine can be stressful. A variety of methods have been used to mitigate workplace stress including mindfulness mediation, reflective writing, and physical activity. An intervention implemented at our institution is a "Thought for the Day," a short reflection on a piece of poetry, music, or religious writing. Although this practice may be commonplace in the field of hospice and palliative medicine, no literature has been published about its perceived utility by team members with various competing demands on their time.

OBJECTIVE

This study's objective was to obtain a better understanding about the perception and utility of a Thought for the Day held by clinicians rounding on an academic palliative medicine consult service.

METHODS

A survey, containing qualitative and quantitative elements was sent to faculty, staff, and learners who participated in a Thought for the Day over the 18 months between March 2013 and October 2014. Twenty-eight responses were returned and analyzed.

RESULTS

Most participants (23 of the 28) felt that the Thought for the Day was an important use of their time on the academic consult service. Differences were seen by gender and team role. Additionally, it was reported that the Thought for the Day improved the participants' perception of teamwork.

CONCLUSION

The use of a Thought for the Day reflection may be beneficial and constructive even for a busy academic consult service.

Dexmedetomidine as adjuvant therapy for acute postoperative neuropathic pain crisis

BACKGROUND

Dexmedetomidine is a potent α2-adrenergic agonist U.S. Food and Drug Administration (FDA) approved for sedation. While its use as an analgesic has been described in the palliative medicine literature, its use for managing an acute neuropathic pain episode is less well known.

METHODS

Here we describe the use of adjuvant dexmedetomidine in a patient with metastatic sarcoma suffering from an acute postoperative neuropathic pain crisis.

CONCLUSION

Among patients with acute neuropathic pain for whom additional opioids raises respiratory-related concerns, the use of dexmedetomidine should be considered as a viable treatment alternative.

Transparent Films Made of Highly Scattering Particles

Today, colloids are widely employed in various products from creams and coatings to electronics. The ability to control their chemical, optical, or electronic features by controlling their size and shape explains why these materials are so widely preferred. Nevertheless, altering some of these properties may also lead to some undesired side effects, one of which is an increase in optical scattering upon concentration. Here, we address this strong scattering issue in films made of binary colloidal suspensions. In particular, we focus on raspberry-type polymeric particles made of a spherical polystyrene core decorated by small hemispherical domains of acrylate with an overall positive charge, which display an unusual stability against aggregation in aqueous solutions. Their solid films display a brilliant red color due to Bragg scattering but appear completely white on account of strong scattering otherwise. To suppress the scattering and induce transparency, we prepared films by hybridizing them with oppositely charged PS particles with a size similar to that of the bumps on the raspberries. We report that the smaller PS particles prevent raspberry particle aggregation in solid films and suppress scattering by decreasing the spatial variation of the refractive index inside the film. We believe that the results presented here provide a simple strategy to suppress strong scattering of larger particles to be used in optical coatings.

Management of Wound Myiasis in the Hospice and Palliative Medicine Setting

Complex wounds are common complications in hospice and palliative medicine (HPM), especially in patients with aggressive malignancies. Myiasis, or an infestation of maggots, is a rare but significant complication of such wounds. While uncommon in the United States, many HPM patients have multiple risk factors and comorbidities that increase their vulnerability to this condition. Currently, there are no standard diagnostic or treatment guidelines for wound myiasis. In addition, common management strategies may not be easily accessible in HPM settings. We present this case of a patient with malignant squamous cell carcinoma of the neck complicated by myiasis while in hospice, and our experience diagnosing and managing her infestation. We also reflect on special considerations for HPM patients when addressing the physical and psychological symptoms of wound myiasis.

A new method using medical ultrasound for measuring femoral anteversion (torsion): technique and reliability. An intra-observer and inter-observer study on dried bones from human adults

The purpose of this study was to evaluate an ultrasound method on dried femora to decide if it is sufficiently reliable to consider its application to living subjects in health and disease. It reports the application of a standard static image B-mode ultrasound scanner to measure femoral anteversion (strictly torsion) on dried bones. The method involves creating images of bony surface contours at both the upper and the lower ends of the femur placed in a water bath. The calculation of femoral torsion involves measuring the angular difference between a head-neck line at the upper end and a transcondylar line at the lower end of the femur. This approach, using the surface contour of the bone at the upper end of the femur, is similar to that used by Lange & Pitzen (1921) and differs from conventional ways of measuring anteversion in dried bones using a central femoral head-neck axis. It is shown that in ultrasound scanning of the upper end of the dried femur to measure femoral anteversion, the head-neck line must be at, or rostral to, the base of greater trochanter. The intra- and inter-observer reliability was assessed in 10 femora, each scanned ten times by two observers. It is shown that femoral torsion can be measured by the ultrasound method to an accuracy of +/- 2 degrees (95% confidence limits) without a significant difference between the observers. The ultrasound method is compared with a new mechanical method for creating surface contours at both ends of the femur and found not to be statistically different in 37 femora. Two real-time ultrasound methods reported by other workers for measuring femoral anteversion in dried bones are reviewed. It is suggested that in applying ultrasound to measure femoral anteversion in living subjects, the B-mode static image scanner is superior to the use of real-time scanners.

OMIP-103: A 35-marker imaging mass cytometry panel for the co-detection of HIV and immune cell populations in human formalin fixed paraffin embedded intestinal tissue

We introduce a 35-marker imaging mass cytometry (IMC) panel for a detailed examination of immune cell populations and HIV RNA in formalin fixed paraffin embedded (FFPE) human intestinal tissue. The panel has broad cell type coverage and particularly excels in delineating subsets of mononuclear phagocytes and T cells. Markers for key tissue structures are included, enabling identification of epithelium, blood vessels, lymphatics, and musculature. The described method for HIV RNA detection can be generalized to other low abundance RNA targets, whether endogenous or pathogen derived. As such, the panel presented here is useful for high parameter spatial mapping of intestinal immune cells and their interactions with pathogens such as HIV.

The Role of Self-Care in Clinical Ethics Consultation: Clinical Ethicists' Risk for Burnout, Potential Harms, and What Ethicists Can Do

Clinical ethics consultants are inevitably called to participate in and bear witness to emotionally challenging cases. With the move toward the professionalization of ethics consultants, the responsibility to respond to and address difficult ethical dilemmas is likely to fall to a small set of people or a single clinical ethicist. Combined with time constraints, the urgent nature of these cases, and the moral distress of clinicians and staff encountered during consultation, like other healthcare professionals such as physicians and nurses, clinical ethics consultants could risk burnout. If it is true that clinical ethicists are at risk for burnout, an important strategy to avoid burnout is to develop sound self-care practices. This article reviews the goals and skills of ethics consultation and the role-specific reasons that clinical ethicists may be at risk for burnout, and argues that clinical ethicists may need to engage in self-care practices. Strategies to address burnout are reviewed and opportunities for future research are identified.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectives

INTRODUCTION

Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden.

METHODS

This qualitative study involved semi-structured interviews with prescribing hospice clinicians and caregivers of patients living with dementia who previously received hospice services. Interviews included questions regarding common behavioral symptoms observed at end of life, side effects of benzodiazepine and antipsychotic medications, perceived effectiveness of medications used, and non-pharmacologic treatment strategies. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major themes.

RESULTS

A total of 23 hospice clinicians and 20 family caregivers participated in interviews. Agitation, including physical and verbal aggression, irritability, and anger, was identified as the most concerning behavioral symptom of dementia at end of life; when discussing agitation, clinicians focused on the safety of the patient living with dementia and others, while caregivers were concerned because they perceived it as a change in personality of their loved one. When using antipsychotics and benzodiazepines to address behavioral symptoms, caregivers viewed sedation as a concerning side effect, while clinicians were less concerned and noted this as an anticipated outcome of treatment. Overall, family caregivers perceived medications as more effective than clinicians. Finally, non-pharmacologic interventions are generally preferred over pharmacologic treatments, but were reported as difficult to implement.

CONCLUSIONS

Study findings can help to inform dialogue between hospice clinicians and caregivers regarding anticipated behavioral changes, as well as risks, benefits, and limitations of medication treatment options for behavioral symptom management. Further work is needed to understand the appropriate level of use of psychotropic medications for end-of-life dementia care.

Factors Associated With Benzodiazepine and Antipsychotic Prescribing in Hospice: A Qualitative Study of Hospice Prescribers

OBJECTIVES

Benzodiazepine and antipsychotic medications are common components of the hospice toolkit and are routinely prescribed for behavioral symptom management at end of life. These medications have significant associated risks but, despite their frequent use, little is known about how clinicians weigh prescribing decisions for individuals in hospice. In this qualitative study, we examined the key factors that influence the decision to initiate a benzodiazepine and antipsychotic medication for management of behavioral symptoms at end of life.

DESIGN

A qualitative study using semi-structured interviews and descriptive qualitative analysis.

SETTING AND PARTICIPANTS

We conducted semi-structured interviews with prescribing hospice physicians and nurse practitioners working in hospice settings across the United States.

METHODS

Hospice clinicians were asked to describe factors that influence prescribing decisions to initiate benzodiazepine and antipsychotic medications for the management of behavioral symptoms. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major themes.

RESULTS

We completed 23 interviews with hospice physicians and nurse practitioners. On average, participants had worked in a hospice setting for a mean of 14.3 years (SD: 10.9); 39% had geriatrics training. Major themes related to benzodiazepine and antipsychotic prescribing were (1) caregiving factors strongly influence the use of medications, (2) patient and caregiver stigma and concerns regarding medication use limit prescribing, (3) medications are initiated to avoid hospitalization or transition to a higher level of care, and (4) nursing home hospice care brings unique challenges.

CONCLUSION AND IMPLICATIONS

Caregiver factors and the setting of hospice care strongly influence clinician decisions to initiate benzodiazepines and antipsychotics in hospice. Caregiver education about medication use at end of life and support in managing challenging behaviors may help promote optimal prescribing.