Being an end-of-life doula.

This article describes what an end-of-life doula is, the training involved and how these individuals can help someone achieve the death they want, reflecting on a role that has existed traditionally in communities for centuries without formal recognition. How end-of-life doulas work holistically but also practically will be considered, outlining how keeping the dying person's preferences and wishes at the heart of their care is the primary aim. Recent issues such as advance care planning, digital legacy and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) will be reflected on through the lens of the end-of-life doula, with the aim of encouraging open discussion and death oracy as a life skill and creating a space to make choices about the end of life. Also explored is how an end-of-life doula works within an integrative model of healthcare, working in partnership with health professionals.

Dealing with death in cancer care: should the oncologist be an amicus mortis?

The way death is (not) dealt with is one of the main determinants of the current crisis of cancer care. The tendency to avoid discussions about terminal prognoses and to create unrealistic expectations of fighting death is seriously harming patients, families and healthcare professionals, and the delivery of high-quality and equitable care. Drawing on different literature sources, we explore key dimensions of the taboo of death: medical, policy, cultural. We suggest that the oncologist, from a certain moment, could take on the role of amicus mortis, a classical figure in the past times, and thus accompanying patients towards the end of their life through palliation and linking them to psychosocial and ethical/existential resources. This presupposes the implementation of Supportive Care in Cancer and the ethical idea of relational autonomy based on understanding patients' needs considering their sociocultural contexts. It is also key to encourage public conversations beyond the area of medicine to re-integrate death into life.

Pilot study of a new online extracorporeal photopheresis system in patients with steroid refractory or dependent chronic graft vs host disease.

BACKGROUND: A new protocol has been developed on the Amicus Separator that enables the device to perform online extracorporeal photopheresis (ECP) procedures when used in conjunction with the Phelix photoactivation device and associated disposable kit. The objective of this study was to evaluate the safety and performance of the Amicus ECP System in adult subjects with steroid-refractory or dependent chronic graft vs host disease (cGVHD). STUDY DESIGN AND METHODS: Eight subjects with mild to severe cGVHD underwent 31 procedures. Subject safety evaluations were performed pre and post procedure and adverse events (AEs) were recorded during treatment and 24 hours after the last procedure. In vitro evaluations of the treated cells included hematology counts and lymphocyte apoptosis, viability and proliferation as measures for ECP procedure validation. RESULTS: For n = 23 evaluable procedures, median (range) procedure time was 88 (78-110) minutes, during which 2.9 (0.6-4.7) × 109 TNCs (approximately 90% MNCs) were treated and reinfused to the subjects. All subject safety evaluations (vitals, cell counts, plasma hemoglobin and bacterial and endotoxin testing) were within expected ranges. All device or procedure related AEs were mild in nature. After 24 hours in culture, 86 (52-98)% of treated lymphocytes were apoptotic compared to 27 (15-51)% in controls. Inhibition of lymphocyte proliferation was >91% in all procedures. CONCLUSION: ECP procedures were safely completed in adult subjects with SR-cGVHD treated using the new online Amicus ECP system.

Comparison of Amicus and COBE Spectra for allogenic peripheral blood stem cell harvest: Study from tertiary care centre in India.

INTRODUCTION: Most common source of stem cell graft for both autologous and allogenic haematopoietic transplants are peripheral blood haematopoietic progenitor stem cells. Adequate collection of the CD34+ cells and safety of the allogenic donor during the leukapheresis are of prime importance to an apheresis physician. Our retrospective analysis is a comparison between of two platforms namely, COBE Spectra and Amicus, for CD34+ mononuclear cell collection. MATERIAL AND METHOD: The study included the data of GSCF (Granulocyte-Colony-Stimulating Factor) mobilized allogenic PBSC collections at our centre from January 2015 to June 2016. The apheresis platforms used were COBE Spectra and Amicus. Blood cell counts were done using LH750 Beckman Coulter (Florida, Miami, USA). CD45+ & CD34+ cell counts were done using BD FACS Canto-II Flow-Cytometer by ISHAGE guidelines. RESULTS: A total of 170 PBSC (100 COBE Spectra & 70 Amicus) harvests were done on 143 donors, of which 116 completed the collection in a single session and 27 required a second session. Demographic details and pre harvest peripheral blood counts for both the groups did not show any statistical differences. Amicus processed higher blood volume with higher ACD exposure and procedure time compared to COBE Spectra. Higher platelets loss was with COBE Spectra harvests with higher product volumes collection. Collection efficiency (CE2), collection ratio, CD34+ cells dose was similar on both the platforms. RBC contamination, absolute lymphocyte and monocytes counts were significantly higher with Amicus harvest product compared with COBE Spectra. A total of 14 (8.2%; citrate toxicity) adverse reactions were reported out of 170 allogenic PBSC collections. DISCUSSION/CONCLUSION: Our study suggests that both Amicus and COBE Spectra platforms offer comparable results for allogenic PBSC collections. Amicus offers a concentrated PBSC product with lesser volume and platelets loss but higher RBC contamination.

Comparison of plateletpheresis on the Fenwal Amicus, Fresenius COM.TEC, and Trima Accel Cell separators.

Blood component donations by apheresis have become more common in modern blood transfusion practices. We compared three apheresis instruments (Fenwal Amicus, Fresenius COM.TEC, and Trima Accel) with regard to platelet (PLT) yield, collection efficiency (CE), and collection rate (CR). The single-needle or double-needle plateletpheresis procedures of the three instruments were compared in a retrospective, randomized study in 270 donors. The blood volume processed was higher in the COM.TEC compared with the Amicus and Trima. Also there was a significantly higher median volume of ACD used in collections on the COM.TEC compared with the Amicus and Trima. The PLT yield was significantly lower with the COM.TEC compared with the Amicus and Trima. Additionally, the CE was significantly lower with the COM.TEC compared with the Amicus and Trima. There was no significant difference in median separation time and CR between the three groups. When procedures were compared regarding CE by using Amicus device, it was significantly higher in single-needle than double-needle plateletpheresis. When double-needle Amicus system was compared with double-needle COM.TEC system, CE and PLT yield were significantly higher with Amicus system. When single-needle Amicus system was compared with single-needle Trima system, CE and PLT yield were significantly higher with Trima system. All instruments collected PLTs efficiently. However, the CE was lower with the COM.TEC compared with the Amicus and Trima. Also, we found Amicus single-needle system collected PLTs more efficiently compared with the double-needle system. CE and PLT yields were significantly higher with the single-needle Trima instrument compared with the single-needle Amicus device.

Egg and time limitation mediate an egg protection strategy.

The number of mature eggs remaining in the ovaries and the time left for oviposition determine the reproductive decisions of the hyperdiverse guild of insects that require discrete and potentially limiting resources for oviposition (such as seeds, fruits or other insects). A female may run out of eggs before all available oviposition sites are used (egg limitation), or die before using all of her eggs (time limitation). Females are predicted to change clutch size depending on whether eggs or time is the limiting resource. We extend this framework and ask whether the same constraints influence a strategy in which females modify eggs into protective shields. In response to egg parasitism cues, female seed beetles (Mimosestes amicus) lay eggs in vertical groups of 2-4, modifying the top 1-3 eggs into shields in order to protect the bottom egg from attack by parasitoids. We made contrasting predictions of how egg and time limitation would influence egg size and the incidence and level of egg protection. By varying access to seed pods, we manipulated the number of remaining eggs a female had at the time she received a parasitism cue. Although egg size was not affected, our results confirm that egg-limited females protected fewer eggs and time-limited females protected more eggs. Female body size explained the number of eggs in a stack rather than host deprivation or the timing of parasitoid exposure. Our results clearly show that host availability relative to female age influences the incidence of egg protection in M. amicus. Furthermore, our study represents a novel use of life history theory to explain patterns in an unusual but compelling defensive behaviour.

Storage of apheresis platelet concentrates after manual replacement of >95% of plasma with PAS 5.

BACKGROUND AND OBJECTIVES: Recently, a glucose- and bicarbonate-containing additive solution termed PAS 5 demonstrated acceptable 7-day platelet storage after >95% plasma replacement with PAS on the day of collection (Day 0). In this study, we examined platelet storage in >95% PAS 5 after manual washing of Day 1 apheresis platelets in plasma collected using either the Amicus or Trima plateletpheresis devices. MATERIAL AND METHODS: Triple platelet donations in plasma were obtained from Amicus (n = 10) and Trima (n = 10) plateletpheresis devices and stored overnight before being centrifuged and manually processed into three units with the following storage media: 100% plasma, >95% PAS 5 or 65% PAS 5/35% plasma. Platelet units were sampled on Days 1, 5 and 7 of storage using a range of tests recommended by the UK guidelines. RESULTS: The majority of in vitro assay results for platelets in PAS 5 were similar to results in paired 100% plasma platelets (controls). The pH of PAS 5 stored platelet units was above the UK recommended guidelines of 7·4 by Day 5. PAS 5 platelets were no more activated than controls as evidenced by comparable soluble P-selectin levels and CD62p and CD42b expression. PAS 5 platelets also exhibited adhesion and aggregation profiles higher than (Day 1) or comparable to (Days 5 and 7) controls as measured by Impact R. CONCLUSION: The 7-day in vitro storage parameters investigated were comparable between >95% PAS 5 and 100% plasma platelets derived from both Amicus and Trima plateletpheresis devices, with the exception that lactose dehydrogenase release rate and pH were significantly higher in PAS 5 units.

Comparison of double dose plateletpheresis on the Fenwal Amicus, Fresenius COM.TEC and Trima Accel cell separators.

BACKGROUND: A variety of apheresis instruments are now available on the market for double dose plateletpheresis. We compared three apheresis devices (Fenwal Amicus, Fresenius COM.TEC and Trima Accel) with regard to processing time, platelet (PLT) yield, collection efficiency (CE) and collection rate (CR). STUDY DESIGN AND METHODS: The single-needle or double-needle double plateletpheresis procedures of the three instruments were compared in a retrospective, randomized study in 135 donors. RESULTS: In the pre-apheresis setting, 45 double plateletpheresis procedures performed with each instrument revealed no significant differences in donor's age, sex, weight, hemoglobin, white blood cell and PLT count between three groups. The blood volume processed to reach a target PLT yield of ≥ 6 × 10(11) was higher in the COM.TEC compared with the Amicus and Trima (4394 vs. 3780 and 3340 ml, respectively; p < 0.001). Also there was a significantly higher median volume of ACD used in collections on the COM.TEC compared with the Amicus and Trima (426 vs. 387 and 329 ml, respectively; p < 0.001). There was a significantly higher median time needed for the procedures on the COM.TEC compared with the Amicus and Trima (66 vs. 62 and 63 min, respectively; p = 0.024). The CE was significantly higher with the Trima compared with the Amicus and COM.TEC (83.57 ± 17.19 vs. 66.71 ± 3.47 and 58.79 ± 5.14%, respectively; p < 0.001). Also, there was a significantly higher product volume on the Trima compared with the Amicus and COM.TEC (395.56 vs. 363.11 and 386.4 ml, respectively; p = 0.008). Additionally, the CR was significantly lower with the COM.TEC compared with the Amicus and Trima (0.092 ± 0.011 vs. 0.099 ± 0.013 and 0.097 ± 0.013 plt × 10(11)/min, respectively; p = 0.039). There was no significant differences in PLT yield between the three groups (p = 0.636). CONCLUSIONS: Trima single-needle device collected double dose platelets more efficiently than Amicus and COM.TEC double-needle devices. Blood volume processed, ACD-A volume, and median separation time was significantly higher with the COM.TEC. Also, the CR was significantly lower with the COM.TEC.

Evaluation of donor factors contributing to plateletpheresis yields among apheresis platelet donors.

BACKGROUND: The University of California, Irvine Blood Donor Center operates a plateletpheresis donor program utilizing the Amicus Cell Separator. Plateletpheresis donors may donate one or more apheresis platelet (PLT) units per collection event. This study seeks to characterize UC Irvine's donor pool by identifying biometric and demographic attributes predictive of double product (DP) collections. STUDY DESIGN AND METHODS: Biometric, demographic and procedural data from 1,786 apheresis donors were collected and entered into Excel spreadsheets. Of the 1,786 successful plateletpheresis procedures performed from January 2009 to April 2012, 1,442 of the donations were performed using double-needle (DN) kits. Only data from DN-kit collections were used for statistical analyses. The Classification And Regression Tree (CART) algorithm was used to help identify variables predictive of donating multiple PLT units in a single collection event. RESULTS: Donors weighing 75.7 kg or greater appear to be twice as likely to donate DPs as those weighing less than 75.7 kg. For donors weighing less than 75.7 kg, females appear to be twice as likely to donate DPs as males. Donors exhibiting platelet counts of 216.5 K/mcL or greater appear to be twice as likely to donate DPs as those with platelet counts fewer than 216.5 K/mcL. CONCLUSION: Weight, sex, and PLT count were identified as the most predictive donor attributes that separate UCI donors into DP donors and non-DP donors. Greater weights, greater PLT counts, and female sex confer to greater PLT yields per given amount of time.

Comparison of the efficiency of peripheral blood stem cell apheresis on the blood cell separators.

BACKGROUND: Stem cells apheresis is a key step in the process of the autologous stem cell transplantation. Available blood cell separators (BCS) have different efficiency due to the technical characteristics and influence of the operator. MATERIALS AND METHODS: Retrospectively, data were collected of the peripheral blood stem cells apheresis performed using available BCS manufactured by Fresenius (ComTec and Amicus) in the National Cancer Institute Ukraine from 2017 to 2020. The collection efficiency coefficient (CEC) was calculated, the formula for predicting the total volume of processed blood (TVPB) was adapted for each separator. RESULTS: The analysis included data from 60 patients (total of 92 apheresis procedures). The mean CEC was established at the level of (53.8 ± 36.6) % for the Amicus device and (44.2 ± 37.3) % for the ComTec device; P = 0.22. The lower product volume was obtained using the Amicus device compared to the ComTec device; P = 2×10-7. The amount of collected stem cells was comparable in both groups (5.8 ± 5.7) ×106/kg and (4.1 ± 3.1) ×106/kg, respectively; P = 0.064. The adaptation of the formula for predicting the TVPB to achieve the optimum amount of stem cells was performed. CONCLUSION: The CEC for each device was within the generally accepted limits of 30-50%, and did not differ significantly. Nevertheless, using of the Amicus BCS allowed to collect lower volumes of the product, maintaining other characteristics of the product competitive.

A Pandemic Term With "Highly Charged Issues": The U.S. Supreme Court 2020-2021.

The 2020-2021 U.S. Supreme Court Term was expected by experts to be uninteresting, but it proved to be quite the opposite. There were surprising unanimous decisions, and some unexpectedly "highly charged issues." Several of the decisions will be important to mental health professionals (foster care and the conflict of gay and religious rights, juvenile life sentences, and "community caretaking"), and to health care providers more generally (the Affordable Care Act, Pharmacy Benefit Managers, and COVID cases). Other decisions of general interest included immigration cases, election laws, and college athletics. Some of the most important cases arose in the "Shadow Dockets," an often-ignored series of orders by the Court. The article discusses the most important cases of the Term (including those in the Shadow Docket), analyzes the meaning of the Term, and looks to the cases to be decided next Term.