Assessment and Management of Sleep Disturbance in Palliative Care Settings.

Background: Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negatively affect the person's functioning and quality of life. Objectives: We aimed to review the current practice of assessment and management of sleep disturbances in people with life-limiting illnesses in Australian and New Zealand palliative care settings, and to define areas for improvement in assessment and management of sleep disturbances and further research. Design: A cross-sectional, online survey was conducted with palliative care health professionals (PCHPs) to explore current approaches to routine assessment of sleep disturbances and PCHPs' awareness of, and perceived access to, evidence-based resources for assessing and managing sleep disturbances in their local settings. Results: Fifty-four PCHPs responded to the survey, including allied health professionals (44%), palliative care nurses (26%), and physicians (19%). Over 70% of PCHPs endorsed routine verbal screening of sleep symptoms, and >90% recommended management with basic behavioral strategies. However, none of PCHPs used validated patient-reported outcome measures for sleep, and <10% of PCHPs demonstrated awareness or use of sleep-specific interventions (including medications). Only 40% reported they had access to sleep specialist services for patients. Conclusion: Our findings provide a useful snapshot of current approaches to managing sleep disturbances in palliative care. Gaps in current practice are highlighted, including the lack of structured, clinical assessment, referral pathways, and PCHPs' perceived lack of access to targeted interventions for sleep disturbances.

Analysis of Genetic Diversity and Resistance to Foliar Pathogens Based on Genotyping-by-Sequencing of a Para Rubber Diversity Panel and Progeny of an Interspecific Cross.

Para rubber trees (Hevea brasiliensis) are the largest major source of natural rubber in the world. Its major pathogens are Phytophthora spp., Corynespora cassiicola, and Colletotrichum spp. A rubber diversity panel of 116 clones using over 12,000 single nucleotide polymorphisms (SNPs) from DArTSeq genotyping revealed clear phylogenetic differences in clones that originated from different geographical regions of the world. An integrated linkage map constructed with an F1 progeny of 86 from an interspecific cross between H. brasiliensis and H. benthamiana using 23,978 markers [10,323 SNPs and 13,655 SilicoDArTs] spanned 3947.83 cM with 0.83 cM average marker-interval. The genome scaffolds that were anchored to the linkage map, covering 1.44 Gb of H. brasiliensis reference genome, revealed a high level of collinearity between the genetic map and reference genome. Association analysis identified 12 SNPs significantly associated with the resistance against Phytophthora, Corynespora, and Colletotrichum in six linkage groups: 2, 6, 12, 14, 17, and 18. Kompetitive Allele-Specific PCR marker assays were developed for those 12 SNPs, screened with 178 individuals, and detected clear separation between two genotypes. Within the proximity to those SNPs, 41 potentially key genes that have previously been reported to associate with plant disease resistance were predicted with high confidence.

Sleeping-related distress in a palliative care population: A national, prospective, consecutive cohort.

BACKGROUND: Sleep, a multi-dimensional experience, is essential for optimal physical and mental wellbeing. Poor sleep is associated with worse wellbeing but data are scarce from multi-site studies on sleeping-related distress in palliative care populations. AIM: To evaluate patient-reported distress related to sleep and explore key demographic and symptom distress related to pain, breathing or fatigue. DESIGN: Australian national, consecutive cohort study with prospectively collected point-of-care data using symptoms from the Symptom Assessment Scale (SAS). SETTING/PARTICIPANTS: People (n = 118,117; 475,298 phases of care) who died while being seen by specialist palliative care services (n = 152) 2013-2019. Settings: inpatient (direct care, consultative); community (outpatient clinics, home, residential aged care). RESULTS: Moderate/severe levels of sleeping-related distress were reported in 11.9% of assessments, more frequently by males (12.7% vs 10.9% females); people aged <50 years (16.2% vs 11.5%); and people with cancer (12.3% vs 10.0% for other diagnoses). Sleeping-related distress peaked with mid-range Australia-modified Karnofsky Performance Status scores (40-60).Strong associations existed between pain-, breathing- and fatigue-related distress in people who identified moderate/severe sleeping-related distress, adjusted for age, sex and functional status. Those reporting moderate/severe sleeping-related distress were also more likely to experience severe pain-related distress (adjusted odds ratios [OR] 6.6; 95% confidence interval (CI) 6.3, 6.9); breathing-related distress (OR 6.2; 95% CI 5.8, 6.6); and fatigue-related distress (OR 10.4; 95% CI 9.99-10.8). CONCLUSIONS: This large, representative study of palliative care patients shows high prevalence of sleeping-related distress, with strong associations shown to distress from other symptoms including pain, breathlessness and fatigue.

Transcriptome- Assisted Label-Free Quantitative Proteomics Analysis Reveals Novel Insights into Piper nigrum-Phytophthora capsici Phytopathosystem.

Black pepper (Piper nigrum L.), a tropical spice crop of global acclaim, is susceptible to Phytophthora capsici, an oomycete pathogen which causes the highly destructive foot rot disease. A systematic understanding of this phytopathosystem has not been possible owing to lack of genome or proteome information. In this study, we explain an integrated transcriptome-assisted label-free quantitative proteomics pipeline to study the basal immune components of black pepper when challenged with P. capsici. We report a global identification of 532 novel leaf proteins from black pepper, of which 518 proteins were functionally annotated using BLAST2GO tool. A label-free quantitation of the protein datasets revealed 194 proteins common to diseased and control protein datasets of which 22 proteins showed significant up-regulation and 134 showed significant down-regulation. Ninety-three proteins were identified exclusively on P. capsici infected leaf tissues and 245 were expressed only in mock (control) infected samples. In-depth analysis of our data gives novel insights into the regulatory pathways of black pepper which are compromised during the infection. Differential down-regulation was observed in a number of critical pathways like carbon fixation in photosynthetic organism, cyano-amino acid metabolism, fructose, and mannose metabolism, glutathione metabolism, and phenylpropanoid biosynthesis. The proteomics results were validated with real-time qRT-PCR analysis. We were also able to identify the complete coding sequences for all the proteins of which few selected genes were cloned and sequence characterized for further confirmation. Our study is the first report of a quantitative proteomics dataset in black pepper which provides convincing evidence on the effectiveness of a transcriptome-based label-free proteomics approach for elucidating the host response to biotic stress in a non-model spice crop like P. nigrum, for which genome information is unavailable. Our dataset will serve as a useful resource for future studies in this plant. Data are available via ProteomeXchange with identifier PXD003887.

Residual SYNTAX score after PCI for triple vessel coronary artery disease: quantifying the adverse effect of incomplete revascularisation.

AIMS: There is some evidence to suggest that incompleteness of coronary artery revascularisation after PCI is associated with inferior outcomes. The SYNTAX score was developed as a tool to quantify the extent of coronary artery disease in the SYNTAX study. We aimed to use this score to quantify the completeness of revascularisation after PCI (the "residual SYNTAX score") and to determine its impact upon mortality. METHODS AND RESULTS: We studied 240 consecutive patients with native three-vessel disease who underwent PCI between 2003 and 2008. SYNTAX scores prior to, and after, PCI were calculated, the difference (ΔSYNTAX) being a measure of the relative completeness of revascularisation. Median follow-up was 2.6 (1.2-3.2) years; 21% of patients were surgical turndowns, and 38% were non-elective. A residual (rSYNTAX) score of zero (full revascularisation) was achieved in 40% and median rSYNTAX was 3.5 (0-10.9). At final follow-up reduced mortality was found in patients with rSYNTAX 0 vs. others (2.5 vs. 12%, respectively, p=0.003) and for those with rSYNTAXmedian (3 vs. 11%, p=0.003). rSYNTAX was an independent predictor of mortality in a multivariate analysis, whereas baseline SYNTAX score was not. CONCLUSIONS: The residual SYNTAX score is a useful method to quantify incomplete revascularisation in patients undergoing PCI for 3VD. Complete revascularisation (rSYNTAX=0) is achieved in only a minority and, for them, the mortality rate is low.

Non-invasive assessment of exhaled biomarkers in lung transplantation.

Biomarkers in exhaled breath condensate (EBC) and fractional exhaled nitric oxide (FeNO) have been widely evaluated in respiratory research as non-invasive methods of sampling the lungs. These methods are particularly attractive in lung transplantation (LTx) as they are simple, repeatable and sensitive. Chronic rejection, manifest by progressive airflow limitation and bronchiolitis obliterans syndrome (BOS), is currently the major limiting factor to long-term survival in LTx. Early detection of BOS and initiation of appropriate treatment could significantly improve survival. Exhaled breath biomarkers could allow early diagnosis of factors associated with chronic rejection. FeNO is elevated in LTx patients with infections and chronic rejection prior to clinical presentation, and several EBC biomarkers and volatile organic compound patterns also show promise in these areas. This review summarizes information on exhaled breath biomarkers in LTx and discusses their potential role in the management of LTx patients.

The economic value of lamotrigine as a mood stabilizer: a U.S. managed care perspective.

This study attempts to provide real-world evidence of the economic value of lamotrigine as a mood stabilizer for patients with bipolar disorder. Researchers examined longitudinal administrative claims data obtained for patients with a diagnosis of affective disorder between 1997 and 2001. The study compared outcomes for the 12 months preceding initiation of lamotrigine with the 12 months following initiation of lamotrigine in patients previously treated with lithium, carbamazepine or valproic acid, other anticonvulsants, selective serotonin-reuptake inhibitors, or other antidepressants. Outcomes were analyzed using logistic and Tobit regression models. The data suggest that initiation of lamotrigine is associated with reductions in hospital days, a reduction in hospital days of greater than 17 days for some patients, and net cost savings of more than $400 per patient per year.

Determination of critical micelle concentration by hyper-rayleigh scattering.

The critical micelle concentration (CMC) of several surfactants that contain an NLO chromophore, either at the hydrocarbon tail, or at the hydrophilic headgroup, or even as a counterion, was determined by hyper-Rayleigh scattering (HRS). In all cases, the HRS signal exhibited a similar variation with surfactant concentration, wherein the CMC is inferred from a rather unprecedented drop in the signal intensity. This drop is attributed to the formation of small pre-micellar aggregates, whose concentrations become negligible above CMC. In addition, a probe molecule, which upon protonation yielded a species with significantly enhanced HRS intensity, was developed and its utility for the determination of the CMC of simple fatty acids was demonstrated.