Utilisation of goals of care discussions and palliative care prior to image-guided procedures near the end of life.

AIM: To characterise image-guided procedures performed near the end of life and the use of goals of care discussions (GOC) and palliative care consultation (PCC) prior to these procedures. MATERIALS AND METHODS: Retrospective chart review of 3,714 consecutive inpatient procedures performed for 2,351 patients and 8,206 outpatient procedures performed for 5,225 patients within a suburban medical system. Data were collected on demographics, procedures performed, mortality, and use of GOC or PCC prior to the procedures. Procedures near the end of life were classified as emergent, elective, or palliative. Logistic regression was used to assess for demographic disparities in care. RESULTS: Nine percent of inpatients died within 30 days of their procedure, 57% of which were within the same hospitalisation. Of these patients, 59% had a documented GOC and 35% had a PCC. Similarly, 7% of outpatients died within 6 months of their procedure. A minority of these patients had a documented GOC (37%) or PCC (13%). There were few statistically significant demographic disparities in this care and the associated odds ratios were small. CONCLUSION: A wide array of image-guided procedures is performed near the end of life. GOC and PCC are underutilised prior to these procedures. Few demographic disparities exist in this care.

Genetic investigation of equine recurrent uveitis in Appaloosa horses.

Equine recurrent uveitis (ERU) is characterized by intraocular inflammation that often leads to blindness in horses. Appaloosas are more likely than any other breed to develop insidious ERU, distinguished by low-grade chronic intraocular inflammation, suggesting a genetic predisposition. Appaloosas are known for their white coat spotting patterns caused by the leopard complex spotting allele (LP) and the modifier PATN1. A marker linked to LP on ECA1 and markers near MHC on ECA20 were previously associated with increased ERU risk. This study aims to further investigate these loci and identify additional genetic risk factors. A GWAS was performed using the Illumina Equine SNP70 BeadChip in 91 horses. Additive mixed model approaches were used to correct for relatedness. Although they do not reach a strict Bonferroni genome-wide significance threshold, two SNPs on ECA1 and one SNP each on ECA12 and ECA29 were among the highest ranking SNPs and thus warranted further analysis (P = 1.20 × 10-5 , P = 5.91 × 10-6 , P = 4.91 × 10-5 , P = 6.46 × 10-5 ). In a second cohort (n = 98), only an association with the LP allele on ECA1 was replicated (P = 5.33 × 10-5 ). Modeling disease risk with LP, age and additional depigmentation factors (PATN1 genotype and extent of roaning) supports an additive role for LP and suggests an additive role for PATN1. Genotyping for LP and PATN1 may help predict ERU risk (AUC = 0.83). The functional role of LP and PATN1 in ERU development requires further investigation. Testing samples across breeds with leopard complex spotting patterns and a denser set of markers is warranted to further refine the genetic components of ERU.

SNP-based heritability and genetic architecture of tarsal osteochondrosis in North American Standardbred horses.

Osteochondrosis is a common developmental orthopedic disease characterized by a failure of endochondral ossification. Standardbred horses are recognized as being predisposed to tarsal osteochondrosis. Prior heritability estimates for tarsal osteochondrosis in European Standardbreds and related trotting breeds have been based on pedigree data and range from 17-29%. Here, we report on genetic architecture and heritability based on high-density genotyping data in a cohort of North American Standardbreds (n = 479) stringently phenotyped for tarsal osteochondrosis. Whole-genome array genotyping data were imputed to ~2 million single nucleotide polymorphisms (SNPs). SNP-based heritability of osteochondrosis in this population was explained by 2326 SNPs. The majority of these SNPs (86.6%) had small effects, whereas fewer SNPs had moderate or large effects (10% and 2.9% respectively), which is consistent with a polygenic/complex disease. Heritability was estimated at 0.24 ± 0.16 using two methods of restricted maximum likelihood analysis, as implemented in gcta (with and without a weighted relatedness matrix) and ldak software. Estimates were validated using bootstrapping. Heritability estimates were within the range previously reported and suggest that osteochondrosis is moderately heritable but that a significant portion of disease risk is due to environmental factors and/or genotype × environment interactions. Future identification of the genes/variants that have the most impact on disease risk may allow early recognition of high-risk individuals.

A high power microwave triggered RF opening switch.

A 4-port S-band waveguide structure was designed and fabricated such that a signal of any amplitude (less than 1 MW) can be switched from a normally closed state, <0.5 dB insertion loss (IL), to an open state >30 dB IL by initiating plasma in a gas cell situated at the junction of this waveguide and one propagating a megawatt level magnetron pulse. The 90/10 switching time is as low as 20 ns with a delay of ∼30 ns between the onset of the high power microwave pulse and the initial drop of the signal. Two ports of this device are for the high power triggering pulse while the other two ports are for the triggered signal in a Moreno-like coupler configuration. In order to maintain high isolation, these two sets of waveguides are rotated 90° from each other with a TE111 resonator/plasma cell located at the intersection. This manuscript describes the design and optimization of this structure using COMSOL 4.4 at the design frequency of 2.85 GHz, comparison of simulated scattering parameters with measured "cold tests" (testing without plasma), and finally the temporal waveforms of this device being used to successfully switch a low power CW signal from 2 W to <5 mW on a sub-microsecond timescale.

Rapid clinical diagnosis of pulmonary abnormalities in HIV-seropositive patients by auscultatory percussion.

A prospective, blinded study of pulmonary findings in hospitalized patients with HIV infection compared auscultatory percussion (AusP) with conventional percussion (ConP) and conventional auscultation (ConA) using chest radiographs as the gold standard. Sixty-three patients had chest radiographs and were examined by one to three examiners. Seventy of the 126 lungs had radiographic abnormalities (55.6 percent). Auscultatory percussion proved to be the most sensitive of all techniques for each examiner (range, 51.0 to 69.6 percent) for detecting radiographic abnormalities and also had higher likelihood ratios for two of the three examiners; AusP also had the highest likelihood ratio pooled across examiners. Of the 166 abnormal results of lung examinations, the combination of AusP and ConA detected 31 more abnormalities than ConP and ConA combined, with 14 of these being diagnosed with Pneumocystis carinii pneumonia. No abnormalities were detected by ConP that were not detected by AusP. These findings suggest that AusP, a rapid clinical maneuver, is more sensitive and specific than ConA and ConP in determining pulmonary abnormalities in HIV-infected inpatients.

The effect of writing after reading on college nursing students' factual knowledge and synthesis of knowledge.

The purpose of this experimental study was to investigate the effect of writing after reading on factual knowledge and synthesis of knowledge. College sophomore nursing students (N = 118) were randomly assigned to one of three groups: a control group which read, reviewed, but did no writing; a notetaking group; or an essay writing group. A 10-item multiple-choice test of factual knowledge was given to all subjects immediately after completing each reading and writing task and again 7 days later. At the later time, each student also wrote an essay to demonstrate synthesis of knowledge. Seven days later, students repeated the same reading and writing activities with a second text. Results of ANOVA showed that notetaking was significantly better than essay writing or no writing for recall of facts. Essay writing, on the other hand, helped students synthesize better than notetaking. However, there was no difference between essay writing and no writing on synthesis of knowledge.

Predicting success for baccalaureate graduates on the NCLEX-RN.

The purpose of this retrospective study was to identify predictors of success for baccalaureate nursing graduates on the National Council Licensure Examination-Registered Nurse (NCLEX-RN). Subjects (505) were graduates of a baccalaureate nursing program in the southeastern United States from 1993 to 1998. The outcome variable was pass/fail on the NCLEX-RN on the first attempt. Predictor variables included type of student (freshman admission, transfer, second degree), age at the time of licensing examination, gender, performance on selected prenursing courses, performance in all junior and senior nursing courses, cumulative grade point average (GPA) at graduation and the Mosby AssessTest score. Results showed a significant relationship between number of Cs, Ds, and Fs in nursing courses and NCLEX-RN results. Students who passed the NCLEX-RN had significantly higher average GPAs, made fewer grades of C or below, and scored higher on the Mosby AssessTest than students who failed. Nontraditional college-age students tended to have a higher passing rate than did traditional age students. A logistic regression model was developed that correctly predicted 76 per cent of the students who failed based on the information available by the end of the end of the first semester of the senior year. J Prof Nurs 17:121-127, 2001.

Design and testing of multi-standard waveguide couplers.

Most applications that use waveguides are designed for a single frequency or single band of frequency, and thus the waveguide dimensions are chosen for single mode operation. In special cases where multiple frequencies across multiple bands are needed (i.e., probing the temporal response of decaying plasma using a cw source that is generated by a pulsed source), special techniques must be used in order to implement both sources into a single waveguide structure. This paper presents two types of couplers designed to implement x-band frequencies into an s-band system with a large coupling coefficient (< -10 dB) and small reflection coefficient (> -10 dB) at the design frequency of 11 GHz. Along with a discussion on the design procedure, a detailed description on the parameter optimization and initial values estimation is presented. The custom waveguide structures were tested utilizing an Agilent E8364B PNA network analyzer, and showed reasonable agreement with the simulated performance over the frequency range of interest.