Examining hospice enrollment through a novel lens: Decision time.

OBJECTIVE: No prior studies on hospice utilization have captured information about the amount of time between when one first learns of hospice as a potential option for care and when he/she actually enrolls. Little is in fact known about this decision-making process. The present study examines hospice enrollment by exploring relationships between hospice decision time and known barriers to care. METHOD: This was an exploratory cross-sectional study. Pearson's r was employed to identify bivariate relationships between barriers to care and decision time for hospice care. Independent-sample t tests and ANOVA were utilized to consider differences in decision time across key variables. RESULTS: Some 90 hospice patients, or their primary decision maker, participated in the study from a not-for-profit hospice located in the southern United States. Decision time was correlated with referral source, use of disease-directed treatment, functional status (on the Palliative Performance Scale [PPS]), age, diagnosis, income, race, and spirituality-suggesting that decision time is a pertinent variable when examining hospice utilization. Differences in decision time were found across diagnosis, race, income, and referral source. SIGNIFICANCE OF RESULTS: This study provides implications for policy and practice, particularly for clinicians faced with initial conversations about hospice care. Differences in decision time highlight ongoing needs related to overcoming healthcare disparities, the important role of including families in initial conversations, and the potential need for varied approaches to talking about hospice care based upon diagnosis. Results also highlight the need for policies supportive of concurrent care, where hospice can be accessed alongside curative care.

Tissue injuries of wistar rats treated with hydroalcoholic extract of Sonchus oleraceus L / Lesões dos tecidos de ratos Wistar tratados com extrato hidroalcoólico de Sonchus oleraceus L

The use of plant species is emerging as an important alternative in the treatment of injuries. Therefore, the extract of Sonchus oleraceus 10 percent was employed in the repair of skin lesions. A total of 36 male Wistar rats were subjected to a punch injury and divided into three groups: a negative control, receiving no treatment, a positive control, treated with Dersani, and the experimental group treated with the extract. The injury was assessed macroscopically and microscopically. Morphometric data was collected at the 3rd, 5th and 7th postoperative day, and the experimental group showed greater changes in shrinkage of the lesion compared to control groups. On the 3rd postoperative day, the injury in the experimental group showed less necrotic tissue, lower slough and more granulation tissue in relation to the positive control group. On the 7th and 10th postoperative day, the injury in the experimental group showed lower slough compared to the positive control group. Microscopic analysis of lesions on the 5th postoperative day revealed increased fibroplasia in the experimental group compared to control groups, while on the 14th postoperative day less neovascularization was evident in the experimental group and increased formation of hair follicles in the negative control group. The extract of S. oleraceus provided tissue repair in accordance with normal physiological patterns thus confirming empirical evidence for its use.

O emprego de espécies vegetais vem surgindo como alternativa no tratamento de lesões. Dessa forma, foi utilizado o extrato hidroalcoólico de Sonchus oleraceus a 10 por cento na reparação de lesões cutâneas. Trinta e seis ratos machos Wistar, foram submetidos a uma lesão com "punch" e distribuídos em três grupos: controle negativo, não recebeu tratamento; controle positivo, tratado com Dersani; e o experimental, tratado com extrato. A lesão foi avaliada macroscopicamente e microscopicamente. Os dados morfométricos mostraram que no 3º, 5º e 7º dia pós-operação (DPO), o grupo experimental apresentou maior evolução na retração da lesão em relação aos grupos controles. No 3° DPO a lesão do grupo experimental apresentou menor tecido necrótico, menor esfacelo e maior tecido de granulação em relação ao grupo controle positivo. No 7° e 10º DPO, a lesão do grupo experimental apresentou menor esfacelo em relação ao grupo controle positivo. A análise microscópica das lesões revelou no 5º DPO maior fibroplasia no grupo experimental em relação aos grupos controles; no 14º DPO ocorreu menor neovascularização no grupo experimental e maior formação de folículos pilosos no grupo controle negativo. O extrato hidroalcoólico de S. oleraceus propiciou reparo tecidual obedecendo a padrões fisiológicos normais e confirmando os dados empíricos de sua utilização.

Efeito do gel da babosa (Aloe barbadensis Mill. ) associado ao ultrassom em processo inflamatório agudo / Effect of aloe (Aloe barbadensis Mill. ) gel combined with ultrasound in the acute inflammatory process

O presente trabalho teve por objetivo analisar a ação antiinflamatória do gel da Babosa a 2 por cento (Aloe barbadensis Mill.) associado ao Ultrassom pulsátil no modelo de edema de pata. Foram utilizados 25 ratos Wistar, (200-250 g), divididos em 5 grupos de 5 animais cada. Grupo1 (controle): ratos tratados com solução salina a 0,9 por cento; Grupo 2: ratos tratados topicamente com gel de A. barbadensis Mill. a 2 por cento; Grupo 3: animais tratados com Ultrassom; Grupo 4: ratos tratados com gel de A. barbadensis Mill. a 2 por cento associado ao Ultrassom; Grupo 5 (controle positivo): ratos tratados com Indometacina na dose de 5 mg Kg-1. Os animais dos grupos 1 e 5 receberam os respectivos tratamentos por via intra-peritoneal 30 minutos antes da injeção intra-plantar de carragenina e os grupos 2, 3 e 4 foram tratados por aplicação tópica de gel de A. barbadensis Mill. a 2 por cento, Ultrassom pulsátil e gel de A. barbadensis Mill. associado ao Ultrassom respectivamente 15 minutos após a indução do edema. Os animais do grupo 04 demonstraram redução significativa do edema quando comparados ao grupo controle, ao mesmo tempo, que se mostrou comparável à indometacina. Observou-se que o gel de aloe associado à fonoforose é capaz reduzir a formação do edema de pata em ratos.

This work aimed to evaluate the anti-inflammatory action of 2 percent aloe (Aloe barbadensis Mill.) gel combined with pulsed ultrasound in the paw edema model. Twenty-five Wistar rats (200-250 g) were divided into 5 groups of 5 animals each. Group1 (control): rats treated with 0.9 percent saline; Group 2: rats topically treated with 2 percent aloe gel; Group 3: rats treated with ultrasound; Group 4: rats treated with 2 percent aloe gel combined with ultrasound; Group 5 (positive control): rats treated with indomethacin at 5 mg Kg-1. Animals of groups 1 and 5 were intraperitoneally treated 30 min before intraplantar carrageenan injection and groups 2, 3 and 4 were treated by topical application of 2 percent aloe gel, pulsed ultrasound and aloe gel combined with ultrasound, respectively, 15 min after edema induction. Animals of group 4 had a significant reduction in edema relative to controls and showed to be comparable to indomethacin. Aloe gel combined with phonophoresis is capable of reducing paw edema formation in rats.

Produção de mudas de manjericão (Ocimum basilicum L. ) em diferentes substratos e luminosidades / Sweet basil (Ocimum basilicum L. ) seedling production in different substrates and luminosities

Apesar de vários usos na cultura popular, poucos trabalhos vêm sendo desenvolvidos em relação ao cultivo do manjericão, sendo a maior parte dos estudos relacionada à identificação dos compostos químicos e à farmacologia. Este trabalho foi realizado com o objetivo de avaliar o efeito de diferentes luminosidades e substratos na emergência, crescimento inicial e qualidade de mudas de manjericão. Utilizaram-se três substratos (substrato comercial Plantmax®, mistura de terra + areia + cama de frango (1:1:1) e terra + areia + Plantmax® (1:1:1) e dois níveis de luminosidade (Pleno Sol e 50 por cento). O delineamento experimental foi de blocos casualizados em esquema fatorial 2 (Luz) x 3 (Substratos), com quatro repetições. Avaliou-se diariamente o percentual e o índice de velocidade de emergência, e aos 60 dias após a semeadura, o crescimento e a qualidade da muda. Os substratos e níveis de luz não alteraram a porcentagem de emergência das plântulas, entretanto a velocidade de emergência foi maior em Plantmax quando em pleno sol e não diferiu entre os substratos em 50 por cento de sombreamento. No substrato terra + areia + cama-de-frango e a pleno sol as mudas apresentaram maior crescimento e qualidade. Recomenda-se a semeadura direta do manjericão em terra + areia + cama de frango pois evita-se o transplante minimizando as perdas e a necessidade de mão de obra.

Although sweet basil has been frequently used in popular culture, few studies have been developed concerning its cultivation, and most of them are related to the identification of its chemical compounds and pharmacology. The aim of this study was to assess the effect of different luminosities and substrates on the emergence, initial growth and quality of sweet basil seedlings. Three substrates (Plantmax® commercial substrate, a mixture of soil + sand + chicken manure (1:1:1), and soil + sand + Plantmax® (1:1:1) were used, together with two light levels (Full sun and 50 percent). The experimental design was in randomized blocks, in 2 (Light) x 3 (Substrates) factorial arrangement with four replicates. The emergence percentage and velocity index were daily evaluated, and at 60 days after sowing seedling growth and quality were also evaluated. The substrates and light levels did not alter the percentage of seedling emergence; however, the emergence velocity was higher in Plantmax and full sun but did not differ among substrates under 50 percent shading. In the substrate soil + sand + chicken manure and full sun, seedlings had higher growth and quality. It is recommended thus that sweet basil be directly sown in soil + sand + chicken manure since it prevents transplanting, minimizing losses and the need of labor.

The Wilcoxon signed rank test for paired comparisons of clustered data.

The Wilcoxon signed rank test is a frequently used nonparametric test for paired data (e.g., consisting of pre- and posttreatment measurements) based on independent units of analysis. This test cannot be used for paired comparisons arising from clustered data (e.g., if paired comparisons are available for each of two eyes of an individual). To incorporate clustering, a generalization of the randomization test formulation for the signed rank test is proposed, where the unit of randomization is at the cluster level (e.g., person), while the individual paired units of analysis are at the subunit within cluster level (e.g., eye within person). An adjusted variance estimate of the signed rank test statistic is then derived, which can be used for either balanced (same number of subunits per cluster) or unbalanced (different number of subunits per cluster) data, with an exchangeable correlation structure, with or without tied values. The resulting test statistic is shown to be asymptotically normal as the number of clusters becomes large, if the cluster size is bounded. Simulation studies are performed based on simulating correlated ranked data from a signed log-normal distribution. These studies indicate appropriate type I error for data sets with > or =20 clusters and a superior power profile compared with either the ordinary signed rank test based on the average cluster difference score or the multivariate signed rank test of Puri and Sen. Finally, the methods are illustrated with two data sets, (i) an ophthalmologic data set involving a comparison of electroretinogram (ERG) data in retinitis pigmentosa (RP) patients before and after undergoing an experimental surgical procedure, and (ii) a nutritional data set based on a randomized prospective study of nutritional supplements in RP patients where vitamin E intake outside of study capsules is compared before and after randomization to monitor compliance with nutritional protocols.

On Mexican folk medicine.

In this paper traditional medical beliefs and practices in a Mexican village are described and interpreted. The analysis focuses on the notion that health is a balance of hot and cold within the body. Several lines of evidence are used to reveal the metaphorical meanings of hot and cold, and these meanings are then seen to be related to structural features of peasant society.