Palliative Care in a Pandemic: A Retrospective Review of the Impact of Early Palliative Care Consultation During the Coronavirus Disease 2019 Pandemic.

During the coronavirus disease 2019 (COVID-19) pandemic, patients experienced rapid clinical decline requiring urgent conversations about their wishes for care. Palliative care advanced practice registered nurses developed a workflow to provide early palliative care consultation to every COVID-19 patient under investigation admitted to a 368-bed acute care hospital in the United States. A retrospective exploratory study was conducted on the initial surge from March 1 to May 31 of 2020. A nonrandomized 2-group design used descriptive and inferential statistics to compare elicitation of patient care preferences for patients who received early palliative care consultation with those patients who did not receive a palliative care consult. Early palliative care consultation resulted in a higher number of patients establishing a decision-maker (99%), changing code status (46%), changing goals of care (46%), and transitioning to comfort care (24%). In those patients not receiving palliative care, fewer patients established a decision-maker (10%), changed code status (7%), changed goals of care (4%), or transitioned to comfort care (3%). During the first COVID-19 surge, early palliative care consult performed by advanced practice registered nurses resulted in a higher number of patients establishing decision-makers and changing care preferences before decompensation due to COVID-19, thus helping patients avoid potential suffering caused by unwanted medical interventions.

On-Line Monitoring of Gas-Phase Molecular Iodine Using Raman and Fluorescence Spectroscopy Paired with Chemometric Analysis.

Molten salt reactors (MSRs) have the potential to safely support green energy goals while meeting baseload energy needs with diverse energy portfolios. While reactor designers have made tremendous strides with these systems, licensing and deployment of these reactors will be aided through the development of new technology such as on-line and remote monitoring tools. Of particular interest is quantifying reactor off-gas species, such as iodine, within off-gas streams to support the design and operational control of off-gas treatment systems. Here, the development of advanced Raman spectroscopy systems for the on-line analysis of gas composition is discussed, focusing on the key control species I2(g). Signal response was explored with two Raman instruments, utilizing 532 and 671 nm excitation sources, as a function of I2(g) pressure and temperature. Also explored is the integration of advanced data analysis methods to enable real-time and highly accurate analysis of complex optical data. Specifically, the application of chemometric modeling is discussed. Raman spectroscopy paired with chemometric analysis is demonstrated to provide a powerful route to analyzing I2(g) composition within the gas phase, which lays the foundation for applications within molten salt reactor off-gas analysis and other significant chemical processes producing iodine species.

Acute exacerbation of pulmonary fibrosis following single lung transplantation.

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Following single lung transplantation, patients receive maintenance immunosuppression, which could mitigate the development of acute exacerbations in the native lung. A 66-year-old man with fibrotic, nonspecific interstitial pneumonitis presented with fever, hypoxemia and parenchymal consolidation limited to the native lung four years after single lung transplantation. Investigations were negative for infection, heart failure and thromboembolic disease. The patient worsened over the course of one week despite broad-spectrum antimicrobial therapy, but subsequently improved promptly with augmentation of prednisone dosed to 50 mg daily and addition of N-acetylcysteine. Hence, the patient fulfilled the criteria for a diagnosis of an acute exacerbation of pulmonary fibrosis in his native lung. Clinicians should consider acute exacerbation of parenchymal lung disease of the native lung in the differential diagnosis of progressive respiratory deterioration following single lung transplantation for pulmonary fibrosis.

Burkholderia gladioli - a predictor of poor outcome in cystic fibrosis patients who receive lung transplants? A case of locally invasive rhinosinusitis and persistent bacteremia in a 36-year-old lung transplant recipient with cystic fibrosis.

There have been very few reports describing postlung transplant outcomes in patients' infected/colonized with Burkholderia gladioli pretransplant. A case involving a lung transplant recipient with cystic fibrosis who ultimately died as a result of severe rhinosinusitis due to B gladioli infection in the context of postlung transplant immunosuppression is reported.

Genetically defined inhibitory neurons in the mouse spinal cord dorsal horn: a possible source of rhythmic inhibition of motoneurons during fictive locomotion.

To ensure alternation of flexor and extensor muscles during locomotion, the spinal locomotor network provides rhythmic inhibition to motoneurons. The source of this inhibition in mammals is incompletely defined. We have identified a population of GABAergic interneurons located in medial laminae V/VI that express green fluorescent protein (GFP) in glutamic acid decarboxylase-65::GFP transgenic mice. Immunohistochemical studies revealed GFP+ terminals in apposition to motoneuronal somata, neurons in Clarke's column, and in laminae V/VI where they apposed GFP+ interneurons, thus forming putative reciprocal connections. Whole-cell patch-clamp recordings from GFP+ interneurons in spinal cord slices revealed a range of electrophysiological profiles, including sag and postinhibitory rebound potentials. Most neurons fired tonically in response to depolarizing current injection. Calcium transients demonstrated by two-photon excitation microscopy in the hemisected spinal cord were recorded in response to low-threshold dorsal root stimulation, indicating these neurons receive primary afferent input. Following a locomotor task, the number of GFP+ neurons expressing Fos increased, indicating that these neurons are active during locomotion. During fictive locomotion induced in the hemisected spinal cord, two-photon excitation imaging demonstrated rhythmic calcium activity in these interneurons, which correlated with the termination of ventral root bursts. We suggest that these dorsomedial GABAergic interneurons are involved in spinal locomotor networks, and may provide direct rhythmic inhibitory input to motoneurons during locomotion.

Synthesis of 5-deazaflavin derivatives and their activation of p53 in cells.

A family of 5-deazaflavin derivatives has been synthesised using a two-step convergent strategy. The biological activity of these compounds was evaluated in cells, by assessing their ability to stabilize and activate p53. These compounds may act as low molecular weight inhibitors of the E3 activity of HMD2 in tumours that retain wild-type p53. Importantly, we have demonstrated that the nitro group present in all three of the original lead compounds [1-3 (HL198C-E)] is not essential for observation of this biological activity.

TRPM2 is elevated in the tMCAO stroke model, transcriptionally regulated, and functionally expressed in C13 microglia.

We report the detailed expression profile of TRPM2 mRNA within the human central nervous system (CNS) and demonstrate increased TRPM2 mRNA expression at 1 and 4 weeks following ischemic injury in the rat transient middle cerebral artery occlusion (tMCAO) stroke model. Microglial cells play a key role in pathology produced following ischemic injury in the CNS and possess TRPM2, which may contribute to stroke-related pathological responses. We show that TRPM2 mRNA is present in the human C13 microglial cell line and is reduced by antisense treatment. Activation of C13 cells by interleukin-1beta leads to a fivefold increase of TRPM2 mRNA demonstrating transcriptional regulation. To confirm mRNA distribution correlated with functional expression, we combined electrophysiology, Ca2+ imaging, and antisense approaches. C13 microglia exhibited, when stimulated with hydrogen peroxide (H2O2), increased [Ca2+]i, which was reduced by antisense treatment. Moreover, patch-clamp recordings from C13 demonstrated that increased intracellular adenosine diphosphoribose (ADPR) or extracellular H2O2 induced an inward current, consistent with activation of TRPM2. In addition we confirm the functional expression of a TRPM2-like conductance in primary microglial cultures derived from rats. Activation of TRPM2 in microglia during ischemic brain injury may mediate key aspects of microglial pathophysiological responses.