A prospective study of the efficacy of the physician order form for life-sustaining treatment

OBJECTIVES: The Physician Orders for Life-Sustaining Treatment (POLST), a comprehensive, one-page order form, was developed to convey preferences for life-sustaining treatments during transfer from one care site to another. This study examined the extent to which the POLST form ensured that nursing home residents' wishes were honored for Do Not Resuscitate (DNR) and requests for transfer only if comfort measures fail. DESIGN: The study used chart record data to follow prospectively a sample of nursing home residents with the POLST. SETTING: Eight geographically diverse, long-term, adult-care facilities in Oregon in which the POLST was in use. PARTICIPANTS: Nursing home residents (n = 180), who had a POLST recording DNR designation and who indicated a desire for transfer only if comfort measures failed, were followed for 1 year. MEASUREMENTS: For all subjects: treatment and disposition after significant health status changes; orders for narcotics and for provision or limitation of aggressive interventions. For hospitalized subjects: diagnosis, medical interventions, and DNR orders. For those who died: cause and location of death, life-sustaining treatments attempted, and comfort measures provided. RESULTS: No study subject received CPR, ICU care, or ventilator support, and only 2% were hospitalized to extend life. Of the 38 subjects who died during the study year, 63% had an order for narcotics, and only two (5%) died in an acute care hospital. A total of 24 subjects (13%) were hospitalized during the year. Hospitalized subjects' mean length of stay was 4.9 days, and the mean rate of hospitalizations for all subjects was 174 per 1000 resident years. In 85% of all hospitalizations, patients were transferred because the nursing home could not control suffering. In 15% of hospitalizations (n = 4), the transfer was to extend life, overriding POLST orders. CONCLUSIONS: POLST orders regarding CPR in nursing home residents in this study were universally respected. Study subjects received remarkably high levels of comfort care and low rates of transfer for aggressive life-extending treatments.     

Human DDX3X Unwinds Japanese Encephalitis and Zika Viral 5′ Terminal Regions

Flavivirus genus includes many deadly viruses such as the Japanese encephalitis virus (JEV) and Zika virus (ZIKV). The 5′ terminal regions (TR) of flaviviruses interact with human proteins and such interactions are critical for viral replication. One of the human proteins identified to interact with the 5′ TR of JEV is the DEAD-box helicase, DDX3X. In this study, we in vitro transcribed the 5′ TR of JEV and demonstrated its direct interaction with recombinant DDX3X (K_d of 1.66 ± 0.21 µM) using microscale thermophoresis (MST). Due to the proposed structural similarities of 5′ and 3′ TRs of flaviviruses, we investigated if the ZIKV 5′ TR could also interact with human DDX3X. Our MST studies suggested that DDX3X recognizes ZIKV 5′ TR with a K_d of 7.05 ± 0.75 µM. Next, we performed helicase assays that suggested that the binding of DDX3X leads to the unwinding of JEV and ZIKV 5′ TRs. Overall, our data indicate, for the first time, that DDX3X can directly bind and unwind in vitro transcribed flaviviral TRs. In summary, our work indicates that DDX3X could be further explored as a therapeutic target to inhibit Flaviviral replication     

Detection of water ingress in composite sandwich structures: a magnetic resonance approach

Water ingress inside honeycomb sandwich panels during service has been linked to in-flight failure in some aircraft. There is an ongoing effort to develop nondestructive testing methods to detect the presence of water within the panels. Magnetic resonance (MR) represents an attractive approach in that it is sensitive to moisture. Using a unilateral MR sensor, testing can be applied directly to the surface of the panel. The viability of MR is demonstrated through laboratory imaging of both water within sandwich panels, as well as the adhesive itself. The detection of water using a one-sided handheld MR sensor is presented. It is shown that simple detection, as well as spatial localization of water within sandwich panels is possible.     

Fatty acid composition of oils from 21 species of marine fish,freshwater fish and shellfish

The fatty acid composition of body lipids was determined by GLC for 14 species of saltwater fish, three species of freshwater fish and four species of shellfish. In addition, liver lipids of two species and egg lipids of one species were analyzed for comparison with the fish body lipids. The various species ranged from lean to fatty and contained from 0.7~15.5% oil in the tissues. Certain major fatty acids were found to vary widely among the species, as follows: 1.6~8.0% myristic, 9.5~33.4% palmitic, 2.0~11.2% palmitoleic, 5.2~29.1% oleic, 0.7~10.5% eicosenoic, 5.0~21.5% eicosapentaenoic, 0.2~11.6% docosenoic and 5.9~26.2% docosahexaenoic acids. Analyses of two separate mullet-oil samples illustrated the wide differences that are possible for a single species caught during different seasons. Significant differences in the amt of particular fatty acids were found in comparing freshwater-fish analyses with analyses for marine fish. Oysters and scallops showed large amt of pentaenoic and hexaenoic acids in their oils. Presented in part at the AOCS Meeting, New York, 1960.     

Cuticular hydrocarbons ofReticulitermes virginicus (Banks) and their role as potential species- and caste-recognition cues

The cuticular hydrocarbon components of four castes ofReticulitermes virginicus (Banks) have been identified and quantitated. Components identified includen-alkanes; 2-, 3-, 11-, 13-, and 15-methyl-alkanes; 11,15-dimethylalkanes, (Z)-9-alkenes; (Z,Z)-7,9-dienes; and (E/Z)-6,9-dienes ranging in carbon number from C₂₁ to C₄₀. All caste forms ofR.virginicus contained the same components, but showed caste-specific proportions. Comparison of these hydrocarbons with those of the sympatric termiteR. flavipes (Kollar) suggest that cuticular hydrocarbons might serve as species- and caste-recognition cues. A bioassay was developed to test this species-recognition hypothesis, with the experimental results supporting the hypothesis.Isoptera: Rhinotermitidae.     

Dis-Bond Detection and the Possibility of Interfacial Stiffness Measurement with Real-Time Impulsive Stimulated Thermal Scattering

We describe a new, real-time, noninvasive method for dis-bond (delamination) detection which is based on a technique known as impulsive stimulated thermal scattering (ISTS). We first explain the ISTS technique and compare data from polyimide films tightly bound to silicon substrates with data from unsupported polyimide films. The observed differences in the data from these two cases are readily understandable and offer an unmistakable signature for delaminations. We demonstrate ISTS dis-bond detection by locating and mapping out randomly-distributed and spatially-fine regions of delamination in a polyimide film-silicon substrate system. Finally, we present two simple physical models of the interfacial region which comprehensively describe acoustic data from the tightly-bound and the unsupported samples. With insight from simulations using these models, we suggest how ISTS might be used to determine interfacial adhesion quality and we show how ISTS sensitivity to interfacial effects can be adjusted.     

Characterization of the adipose tissue atrophy induced by peroxisome proliferators in mice

In the present study, we characterized the effects of peroxisome proliferators (PP) on adipose tissue in mice. Treatment with potent PP, such as perfluorooctanoic acid (PFOA), 2-methyl-2-(p(1,2,3,4-tetrahydroxy-naphthyl)-phenoxy)propionic acid, (4-chloro-6-(2,3-xylidino)2-pyrimidinylthio) acetic acid, and di(2-ethylhexyl)phthalate, caused dramatic decreases in adipose tissue weight, whereas the moderately potent PP, acetylsalicylic acid, had a relatively weak effect. This decrease in weight reflects a loss of fat from adipocytes rather than a loss of cells, as demonstrated by constant DNA content. The dose-dependency and time-course experiments indicate that peroxisome proliferation occurs simultaneously with or prior to adipose tissue atrophy. Thus, hepatic peroxisome proliferation might result in the increased mobilization of lipids and lipid utilization in liver. The enhanced adipose tissue hormonesensitive lipase (HSL) activity and down-regulated lipoprotein lipase (LPL) activity observed upon PP treatment might, at least in part, explain the loss of fat via increase FA release from adipocytes and/or decreased FA uptake from the circulation, respectively. In addition, the possible involvement of the increased tumor necrosis factor α expression found upon PFOA treatment in reducing the insulin sensitivity of adipose tissue and thereby altering LPL and HSL activities is discussed.     

Free-radical grafting of cellulose in N-methylmorpholine oxide: Water-soluble pam-g-cellulose copolymers

The homogeneous graft copolymerization of acrylamide (AM) onto cellulose initiated by t-butylperoxy-2-ethylhexanoate in a cellulose solvent, N-methylmorpholine oxide (NMMO), was investigated. The method afforded water-soluble PAM-g-cellulose copolymers in fair yields. The copolymers produced are of low molecular weight (50,000–100,000 M?_w). Little apparent homopolymerization was observed.