End-of-Life Care for Unauthorized Immigrants in the U.S.

The Universal Declaration of Human Rights recognizes the inherent dignity, the equal and unalienable rights to be universally protected for all humans irrespective of race, color, gender, language, religion, political or other opinion, national or social origin, property, birth or other status. Though this includes the right to dignity-conserving care for terminally ill unauthorized immigrants, access to quality end-of-life care eludes them. Most of the estimated 11.3 million unauthorized immigrants either entered the country without the knowledge of the U.S. Immigration and Customs Enforcement, or were admitted on a temporary visa and stayed past its expiration date. Unsafe living conditions, occupational hazards, lack of access to routine healthcare, scarceness of a social and financial support system, fear of deportation, discrimination and incarceration limit healthcare access of unauthorized immigrants. Lack of access to preventative primary care encounters often results in this population's dependence on acute emergency services for treatment. Lack of opportunity for advance care planning discussions and lack of eligibility to hospice services commonly contributes to poor end of life care. As unauthorized immigrants approach the last days of life, they may often die alone, away from their loved ones, with little-to-no psychosocial support in their final moments. This article provides an overview on end-of-life care for unauthorized immigrants and makes recommendations for potential strategies to providing humane care and support to this vulnerable population.

Inaccurate Assessment of Canine Body Condition Score, Bodyweight, and Pet Food Labels: A Potential Cause of Inaccurate Feeding.

The objectives were to investigate owners' ability to assign the correct bodyweight (BW) and body condition score (BCS) to their dog and to interpret wet and dry pet food labels by estimating how much to feed daily. One hundred and seventy-four questionnaires were completed. Owner estimated BW was compared to actual BW, correct being defined within ±10% of actual BW. Correct interpretation of the total amount of food required was determined by the number of cans (±25% of cans) required for wet food and grams (±20% of grams) for dry food, based on the dog's actual BW, the feeding guidelines on the label, and a comparison with the owner's estimate. Eleven percent of owners overestimated BCS and 19% overestimated BW. Only 48% of owners could correctly estimate their dog's BW. Only 23% and 43% of owners could correctly estimate how much wet and dry food to feed, respectively. Chi-square analysis demonstrated a significant positive association for owners correctly estimating their dog's BW and interpreting the wet pet food label. Many owners are not aware of their pet's BCS and BW and cannot accurately interpret pet food labels. Further owner education to improve these skills is needed if dogs are to be fed correctly.

Postsynaptic neuroligin enhances presynaptic inputs at neuronal nicotinic synapses.

Neuroligins are cell adhesion molecules that interact with neurexins on adjacent cells to promote glutamatergic and GABAergic synapse formation in culture. We show here that neuroligin enhances nicotinic synapses on neurons in culture, increasing synaptic input. When neuroligin is overexpressed in neurons, the extracellular domain induces presynaptic specializations in adjacent cholinergic neurons as visualized by SV2 puncta. The intracellular domain is required to translate the SV2 puncta into synaptic input as reflected by increases in the frequency of spontaneous mini-synaptic currents. The PDZ-binding motif of neuroligin is not needed for these effects. Together, the extracellular and proximal intracellular domains of neuroligin are sufficient to induce presynaptic specializations, align them over postsynaptic receptor clusters, and increase synaptic function. Manipulation of endogenous neuroligin with beta-neurexin-expressing cells confirms its presence; repressing function with dominant negative constructs and inhibitory shRNA shows that endogenous neuroligin helps confer functionality on existing nicotinic synaptic contacts. Endogenous neuroligin does not appear to be required, however, for initial formation of the contacts, suggesting that other components under these conditions can also initiate synapse formation. The results indicate that postsynaptic neuroligin is important for functional nicotinic synapses on neurons and that the effects achieved will likely depend on neuroligin levels.