Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial.

Background: Early palliative care improves the quality of life (QoL) and satisfaction with care of patients with advanced cancer, but little is known about its effect on caregivers. Here, we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care. Patients and methods: Twenty-four medical oncology clinics were cluster-randomised, stratified by tumour site (lung, gastrointestinal, genitourinary, breast and gynaecological), to early palliative care team referral, or to standard oncology care with palliative care only as needed. Caregivers of patients with advanced cancer (clinical prognosis of 6-24 months, Eastern Cooperative Oncology Group 0-2) in both trial arms completed validated measures assessing satisfaction with care (FAMCARE-19) and QoL [SF-36v2 Health Survey; Caregiver QoL-Cancer (CQoL-C)], at baseline and monthly for 4 months. We used a multilevel linear random-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months. Results: A total of 182 caregivers completed baseline measures (94 intervention, 88 control); 151 caregivers (77 intervention, 74 control) completed at least one follow-up assessment. Satisfaction with care improved in the palliative intervention group compared with controls over 3 months (P = 0.007) and 4 months (P = 0.02). There was no significant improvement in the intervention group compared with controls for CQoL-C (3 months: P = 0.92, 4 months: P = 0.51), Physical Component Summary of the SF-36v2 Health Survey (3 months: P = 0.83, 4 months: P = 0.20), or Mental Component Summary of the SF-36v2 Health Survey (3 months: P = 0.87, 4 months: P = 0.60). Conclusion: Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer. ClinicalTrials.gov identifier: NCT01248624.

Transpupillary collagen photocrosslinking for targeted modulation of ocular biomechanics.

The central vision-threatening event in glaucoma is dysfunction and loss of retinal ganglion cells (RGCs), thought to be promoted by local tissue deformations. Here, we sought to reduce tissue deformation near the optic nerve head by selectively stiffening the peripapillary sclera, i.e. the scleral region immediately adjacent to the optic nerve head. Previous scleral stiffening studies to treat glaucoma or myopia have used either pan-scleral stiffening (not regionally selective) or regionally selective stiffening with limited access to the posterior globe. We present a method for selectively stiffening the peripapillary sclera using a transpupillary annular light beam to activate methylene blue administered by retrobulbar injection. Unlike prior approaches to photocrosslinking in the eye, this approach avoids the damaging effects of ultraviolet light by employing red light. This targeted photocrosslinking approach successfully stiffened the peripapillary sclera at 6 weeks post-treatment, as measured by whole globe inflation testing. Specifically, strain was reduced by 47% when comparing treated vs. untreated sclera within the same eye (n = 7, p=0.0064) and by 54% when comparing the peripapillary sclera of treated vs. untreated eyes (n = 7, p<0.0001). Post-treatment characterization of RGCs (optic nerve axon counts/density, and grading), retinal function (electroretinography), and retinal histology revealed that photocrosslinking was associated with some ocular toxicity. We conclude that a transpupillary photocrosslinking approach enables selective scleral stiffening targeted to the peripapillary region that may be useful in future treatments of glaucoma.

Energy, manpower, and the highway trust fund.

If energy conservation were a goal of a federal budget policy maker, such conservation could be achieved by reinvesting the highway trust fund in any of several other alternative federal programs (except criminal justice), especially in railroad and mass transit construction and national health insurance (see Table 1). Total employment would increase in each alternative program examined. For example, if construction monies were shifted from highways to railroads, the energy required for construction would be reduced by about 62 percent and employment would increase by 3.2 percent. By comparing the dollar, energy, and employment requirements of a highway transportation system with such requirements for a railroad transportation system, we obtained detailed information from which we concluded the following: 1) Passenger transport by railroad was much less dollar and energy demanding and required more labor than car transport in 1963. If the dollar savings had been respent in an average way by consumers, the net impact would have been to reduce the energy savings and further increase employment. A similar conclusion was reached in a study of bus substitution for automobiles in urban areas (20). If the marginal substitution effects would have held over the whole range of change, and the dollar savings had been spent on the construction of railways, then about 3.0 billion gallons of gasoline could have been saved annually and 1.2 million new jobs created. 2) Freight transport by railroad was less expensive, in terms of dollar, energy, and labor requirements, than was truck transportation in 1963. If, under a national shift to rail freight, the dollar savings had been absorbed as personal consumption expenditures, a net increase of labor and energy would have ensued. If the dollar savings had been absorbed as a tax and respent on railroad and mass transit construction, about 0.3 billion more gallons of gasoline (energy equivalent) would have been consumed annually and 1.2 million jobs created, under a complete shift to rail. Had there been a full shift from intercity car and truck transportation to transportation by railroad with dollar savings spent on railway construction, 2.7 billion gallons of gasoline (energy equivalent) could have been saved and 2.4 million new jobs could have been created in 1963.

Effects of energy conservation in residential and commercial buildings.

In 1977, heating, cooling, lighting, and other operations in residential and commercial buildings used 27 quads (1 quad = 10(15) British thermal units) of energy. This is more than one-third of the nation's total energy budget. Future trends in energy use in buildings are likely to depend strongly on fuel prices and government policies designed to save energy. Three scenarios are examined: (i) a base line in which fuel prices rise as projected by the Department of Energy; (ii) a conservation case that includes higher gas and oil prices plus the regulatory, financial incentive, and information programs authorized by the 94th Congress and proposed in the April 1977 National Energy Plan; and (iii) another conservation case that also includes new technologies (more efficient equipment, appliances, and structures). These scenarios are analyzed for changes in energy use, costs, and employment by means of detailed engineering-economic models of energy use in residential and commercial buildings developed at the Oak Ridge National Laboratory and input-output analyses developed at the University of Illinois.

Steel recycling and energy conservation.

The potential for energy conservation through increased use of steel scrap by the U.S. steel industry is examined. It is concluded that increased use of scrap would reduce energy use, but it is not economical, due mainly to volatile scrap prices. Other energy-saving technologies exist, but it is likely that energy will be conserved through reduced use of steel as rising energy costs are passed through to consumers.

Energy and labor in the construction sector.

An energy input-output model was used to investigate energy and employment in the construction industry. The model covered nearly 400 industrial sectors and was used to determine the impact of construction activities on total national energy consumption in 1967 and to study the patterns of total energy use and employment within various construction categories. For the construction of new buildings, total energy consumption could be reduced by 20 percent by selecting less energy-intensive building materials and assemblies for fixed programmatic requirements, by expending energy in construction to minimize the total lifetime energy cost of buildings, and by energy conservation in industries that supply direct and indirect inputs to the construction sector of the economy.

Anxiety and performance in elite non-professional athletes.

Anxiety is one of the main motivators with regards to performance of individuals in any given task, including sporting endeavours. Our study sought to assess state anxiety levels in elite non-professional sportsmen, and to investigate if anxiety correlated with sporting performance, the IDA-Q (irritability, depression & anxiety questionnaire) was used to assess 3 mental state variables in an inter-county hurling team as well as a matched non-sporting control group, and performance was judged by completion of a standard task in 2 different settings: a non-pressurised one and a highly pressurised setting. Subjects had significantly higher anxiety scores on the IDA-Q than the controls (p = 0.019). There were no significant differences and controls in the depression and irritability scales. There was a significantly negative correlation between anxiety scores and performance on the IDA-Q; spearman r = -0.57. High anxiety levels impair sporting performance.

Toward a theory of energetically optimal body size in growing animals.

Our objective was to formulate a general and useful model of the energy economy of the growing animal. We developed a theory that the respiratory energy per unit of size reaches a minimum at a particular point, when the marginal respiratory heat production rate is equal to the average rate. This occurs at what we defined as the energetically optimal size for the animal. The relationship between heat production rate and size was found to be well described by a cubic function in which heat production rate accelerates as the animal approaches and then exceeds its optimal size. Reanalysis of energetics data from the literature often detected cubic curvature in the relationship between heat production rate and body size of fish, rats, chickens, goats, sheep, swine, cattle, and horses. This finding was consistent with the theory for 13 of 17 data sets. The bias-corrected Akaike information criterion indicated that the cubic equation modeled the influence of the size of a growing animal on its heat production rate better than a power function for 11 of 17 data sets. Changes in the sizes and specific heat production rates of metabolically active internal organs, and body composition and tissue turnover rates were found to explain notable portions of the expected increase in heat production rate as animals approached and then exceeded their energetically optimum size. Accelerating maintenance costs in this region decrease net energy available for productive functions. Energetically and economically optimum size criteria were also compared.

New antibiotic U-64846: fermentation, isolation and characterization.

Antibiotic U-64846 is a new entity with the molecular formula C18H35C1N4O9 (MW 486). It is a very water soluble, reddish solid which decomposes above 300 degrees C and which is air-sensitive. The antibiotic is produced by Streptomyces braegensis and it inhibits a variety of Gram-positive bacteria. Acidic hydrolysis gave 3,7-diaminoheptanoic acid. The antibiotic gives 1H NMR, 13C NMR, IR and UV spectra which indicate it is not closely related to known antibiotic families.

Desertomycin: purification and physical-chemical properties.

Desertomycin was isolated from Streptomyces macronensis Dietz sp. nov. UC 8271. Extensive spectroscopic work led us to place desertomycin in the macrocyclic lactone family which contains monazomycin, scopafungin, primycin, azalomycin F4a and niphithricins A and B. The apparent molecular formula was determined by fast atom bombardment mass spectroscopy to be C57H109NO24 (MW = 1,191). Mild acid hydrolysis yielded mannose but contrary to published reports, glutamic acid is not a constituent of desertomycin.

Fermentation, isolation, characterization and structure of nitrosofungin.

The new antifungal agent nitrosofungin was isolated in high yields from a mixed culture of two organisms consisting of a bacterium of the genus Alcaligenes (UC 9152) and Streptomyces plicatus UC 8272. The bacterium produces the agent, the streptomycete enhances the production by providing a precursor or an inducer. Nitrosofungin in high concentrations inhibits a broad variety of pathogenic fungi in vitro. The agent is relatively non-toxic in small laboratory animals and high blood levels are obtained after either oral or systemic administration. Nitrosofungin is only the second N-nitrosohydroxylamine isolated from microbial sources to date. It has been identified as 2-N-nitrosohydroxylamino-1-propanol, an acidic and highly water-soluble compound.

Biological time value.

A measure of time value for living species, a natural discount rate, is proposed. It is the rate at which a species reveals its progressive disregard of the importance of future events. The discount rate is shown to be equal to the average (standard) metabolic rate for the species at a steady-state condition. The connection of the discount rate to standard empirical measures allows it to be assigned a numerical value. Knowing a species' discount rate should help determine its successional success and allow more meaningful solutions to optimality problems in biology.

Encoding specificity revisited: the role of semantics.

Three experiments examined the effects of semantic characteristics of word pairs on memory using the encoding specificity paradigm. The paradigm involved four phases: (a) an encoding phase to relate cues and targets, (b) a phase in which words were generated to new cues, (c) a phase for recognition of generated targets, and (d) a cued-recall phase using the original encoding cues. Encoding pairs were classified a priori as either semantically similar (e.g., alluring-PRETTY), semantically contrasting (e.g., drab-PRETTY), or semantically unrelated (e.g., sore-PRETTY). Generation pairs were classified a priori as either semantically similar (e.g., beautiful-PRETTY) or semantically contrasting (e.g., ugly-PRETTY). For recall, the results showed that both the semantic relations between the encoding cue and target and the reprovision of the encoding cue at retrieval were important factors. In the case of recognition, however, both the semantic congruence between the encoding and generation contexts and the amount of semantic elaboration provided by the encoding context were important factors.

A dynamic model of colonic concentrations of delayed-release 5-aminosalicylic acid (Asacol).

BACKGROUND: 5-ASA in a pH sensitive tablet (Asacol) is administered as three doses/day to treat ulcerative colitis. Once daily dosing may improve patient adherence. Simulation of colonic levels of 5-ASA can be used to compare dosing regimens. AIM: To create a dynamic model of colonic concentrations of delayed-release 5-aminosalicylic acid (Asacol). METHODS: Using published data, we created a computer model with STELLA software to simulate amounts of colonic 5-ASA in the total colon, right, transverse, descending and sigmoid/rectum after daily and three time/day Asacol. RESULTS: The model predicted similar total and regional amounts of 5-ASA with both regimens. Distribution of 5-ASA was 38% in the right colon, 33% in the transverse colon and 14% each in the descending and sigmoid/rectal colon. Simulated increases in colonic motility and defecation rate exaggerated this 5-ASA distribution, resulting in negligible amounts of 5-ASA in the sigmoid/rectal region. CONCLUSIONS: This computer model suggests that Asacol can be administered as a single daily dose. The model supports experimental and clinical observations that alternate dose or route of administration may be necessary to achieve adequate 5-ASA amounts in the distal colon during acute exacerbations of ulcerative colitis. This simulation cannot account for all sources of variability in the clinical setting, but provides a rationale for further investigation.

Susceptibility to semantic illusions: an individual-differences perspective.

When asked How many animals of each kind did Moses take on the ark?, people frequently respond "two" even though they know it was Noah, not Moses, who took animals on the ark. We replicate previous research by showing that susceptibility to semantic illusions is influenced by the semantic relatedness of both the impostor word and the surrounding context. However, we also show that the two text manipulations make independent contributions to semantic illusions, and we propose two individual-differences mechanisms that might underlie these two effects. We propose that the ability to resist the lure of a semantically related impostor word is related to the individual's skill at accessing and reasoning about knowledge from long-term memory. And we propose that the ability to resist the lure of the surrounding sentential context is related to the individual's capacity to simultaneously process and store information in working memory.

The energy cost of overweight in the United States.

We have calculated the total fossil energy equivalent of the food calories saved by reducing the present degree of overweight (2.3 billion pounds for the adult United States population) to optimum body weight and the annual fossil energy reduction once all Americans reached their optimum weight. The energy saved by dieting to reach optimal weight is equivalent to 1.3 billion gallons of gasoline and the annual energy savings would more than supply the annual residential electrical demands of Boston, Chicago, San Francisco, and Washington, DC.