End of life decisions in immunocompromised patients with acute respiratory failure.

PURPOSE: To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure. MATERIAL AND METHODS: We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs. RESULTS: The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54-71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01-1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98-3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45-2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14-2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31-2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36-2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11-2.38, P = 0.012). CONCLUSIONS: A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.

Influence of Sweep Length on Rice Stink Bug (Hemiptera: Pentatomidae) Capture and Reliability of Population Density Estimates.

The rice stink bug, Oebalus pugnax (F.), is a key pest of heading rice, Oryza sativa L. (Poales: Poaceae), in the southern United States. Sweep net sampling is the recommended method for sampling rice stink bug in rice, but there currently exists no specific recommendation for sweep length, and a large amount of variation likely exists amongst samplers. The objectives of this study were to determine the role that sweep length plays in sampling accuracy and determine the feasibility of using sweep lengths smaller than 180°. When monitoring sweep lengths by consultants, producers, and researchers, a large amount of variation in sweep length and a significant linear relationship between sweep length and rice stink bug catch per 10 sweeps was observed. Sweep length was then controlled at three levels (0.8, 1.8, and 3.5 m) and a change from 0.8 to 1.8 m in sweep length led to an increase on average of 2.28 rice stink bugs per 10 sweeps. These data suggest knowledge of sweep length is vital, and paired with large amounts of observed variation in sweep length, recommending a specific sweep length is ideal. Using Taylor's values, it was determined that 1.8 m sweeps resulted in density estimates that were as reliable as 3.5 m (180°) sweeps, suggesting a longer sweep length was not necessary. A 1.8 m sweep length recommendation would create an easier sampling regimen that is still reliable, which could lead to more accurate action threshold decisions being made for rice stink bug if it increases adoption in consultants and producers.

Effects of Bauhinia forficata on glycaemia, lipid profile, hepatic glycogen content and oxidative stress in rats exposed to Bisphenol A.

Bisphenol A (BPA) is an abundant raw material applied in the production of daily necessities, such as food cans, baby bottles, electronic and medical equipment. Phytotherapeutic use of plant preparations has long been known for multiple target medicinal uses. The species Bauhinia forficata is widely used as hypoglycemic, anti-inflammatory, antioxidant, diuretic and hypocholesterolemic agent. The aim of this study was to verify the effects of B. forficata extract in association with BPA exposure on serological parameters, hepatic antioxidant status and glycogen store capacity in Wistar rats. B. forficata was able to reduce BPA-induced glucose levels; it also prevented the early glucose elevation in control and BPA-exposed animals after the glucose provocative test. This effect was related to the hepatic glycogen content; while BPA reduced the hepatic glycogen deposits B. forficata treatment contributed to minimize it. BPA and B. forficata singly caused elevation in triacylglycerol and VLDL levels and reduction in cholesterol and LDL concentrations. BPA increased hepatic malondialdehyde levels and reduced catalase activity, thus inducing liver oxidative stress. Conversely, B. forficata treatment reduced malondialdehyde concentration without interfering with catalase activity; this antioxidant capacity is attributed to the flavonoids content (e.g., kaempferol and myricetin). Based on these results, we demonstrated that B. forficata commercial extract has hypoglycemic and antioxidant properties capable of minimizing the effects of BPA. However, it should be considered that the consumption of herbal commercial extract must be judicious to avoid deleterious health effects.

The Cognitive Distortions Questionnaire (CD-Quest): Validation in a Sample of Adults with Social Anxiety Disorder.

Cognitive distortions are thought to be central to the development and maintenance of anxiety disorders and are a widely acknowledged treatment target in cognitive-behavioral interventions. However, little research has focused on the measurement of cognitive distortions. The Cognitive Distortions Questionnaire (CD-Quest; de Oliveira, 2015), a brief, 15-item questionnaire, assesses the frequency and intensity of cognitive distortions. The CD-Quest has been shown to have sound psychometric properties in American, Australian, and Brazilian undergraduate samples and one Turkish-speaking outpatient clinical sample. The current study aimed to provide the first evaluation of the psychometric properties of the English version of the CD-Quest in a clinical sample and the first evaluation of any version of the CD-Quest in a sample of adults diagnosed with social anxiety disorder (SAD). In a sample of treatment-seeking adults with SAD, the CD-Quest demonstrated good convergent validity, discriminant validity, known-groups validity, and treatment sensitivity. It also showed good internal consistency, and both confirmatory and exploratory factor analyses supported the previously reported unitary factor structure. Findings extend prior research indicating the reliability and validity of the CD-Quest.