Stepped Palliative Care for Patients With Advanced Lung Cancer: A Randomized Clinical Trial.

Importance: Despite the evidence for early palliative care improving outcomes, it has not been widely implemented in part due to palliative care workforce limitations.

Objective: To evaluate a stepped-care model to deliver less resource-intensive and more patient-centered palliative care for patients with advanced cancer.

Design, Setting, And Participants: Randomized, nonblinded, noninferiority trial of stepped vs early palliative care conducted between February 12, 2018, and December 15, 2022, at 3 academic medical centers in Boston, Massachusetts, Philadelphia, Pennsylvania, and Durham, North Carolina, among 507 patients who had been diagnosed with advanced lung cancer within the past 12 weeks.

Diabetic Kidney Disease: Diagnosis, Treatment, and Prevention.

Globally, approximately 20% of the 400 million individuals with diabetes mellitus have diabetic kidney disease (DKD). DKD is associated with higher cardiovascular and all-cause morbidity and mortality, so timely diagnosis and treatment are critical. Screening for early DKD is best done with annual spot urine albumin/creatinine ratio testing, and diagnosis is confirmed by repeated elevation in urinary albumin excretion.

Towards the Development of Artificial Bone Grafts: Combining Synthetic Biomineralisation with 3D Printing.

A synthetic technique inspired by the biomineralisation process in nacre has been previously reported to be effective in replicating the nanostructural elements of nacre in 2D chitosan hydrogel films. Here we evaluate the applicability of this synthetic biomineralisation technique, herein called the McGrath method, in replicating the flat tabular morphology of calcium carbonate and other nanostructural elements obtained when 2D chitosan hydrogel films were used, on a 3D porous chitosan hydrogel-based scaffold, hence developing 3D chitosan-calcium carbonate composites. Nozzle extrusion-based 3D printing technology was used to develop 3D porous scaffolds using chitosan hydrogel as the printing ink in a custom-designed 3D printer.

Migraine: Expanding our Tx arsenal.

Beyond tried-and-true therapies are new therapeutic targets on the horizon-giving you a bigger toolbox to help patients abort and prevent migraine episodes.

Deprescribing: A simple method for reducing polypharmacy.

Polypharmacy brings with it increased risks for adverse drug events and reduced functional capacity. This 4-step plan will help you safely deprescribe in older adults.

EMR-Based Intervention Improves Lead Screening at an Urban Family Medicine Practice.

Background And Objectives: Elevated blood lead levels have well-described detrimental effects to growth and development in children, yet screening rates remain low. We sought to determine if a reminder within the electronic health record (EHR) could change provider behavior and improve blood lead level (BLL) screening test ordering rates in an urban academic family medicine practice.

Methods: Baseline BLL test ordering rates were calculated for children ages 9-72 months.

Molecular Dynamics Simulation of β-Lactoglobulin at Different Oil/Water Interfaces.

Controlling and manipulating protein behavior at an interface is of immense relevance to a broad range of physicochemical and biological phenomena and technological processes. Although many experimental studies have contributed to rapid progress in the fundamental knowledge of protein behavior at interfaces, detailed molecular-level understanding of the mechanism of protein adsorption at an interface is still remarkably lacking. In this study, atomistic molecular dynamics simulations were used to characterize the adsorption of β-lactoglobulin at two different oil/water (O/W) interfaces, where the oil was either the marginally hydrophilic octanol or the more hydrophilic triolein, and the results were compared to those of a previous study utilizing the hydrophobic oil decane.

Deciphering β-Lactoglobulin Interactions at an Oil-Water Interface: A Molecular Dynamics Study.

Protein adsorption at liquid-liquid interfaces is of immense relevance to many biological processes and dairy-based functional foods. Due to experimental limitations, however, there is still a remarkable lack of understanding of the adsorption mechanism, particularly at a molecular level. In this study, atomistic molecular dynamics simulations were used to elucidate the approach and adsorption mechanism of β-lactoglobulin (β-LG) at a decane-water interface.

How does oil type determine emulsion characteristics in concentrated Na-caseinate emulsions?

Macroscopic properties and ensemble average diffusion of concentrated (dispersed phase 50-60 wt%) Na-caseinate-stabilised emulsions for three different oils (soybean oil, palm olein and tetradecane) were explored. On a volume fraction basis, pulsed gradient stimulated echo (PGSTE)-NMR data show that droplet dynamics for all three systems are similar within a region of the emulsion morphology diagram. The exact limits of the emulsion space depend however on which oil is considered.

How important is polyelectrolyte complex formation in biomimetic mineralisation? Manipulation via alcohol addition.

Understanding the formation of biominerals like nacre can lead to the fabrication of more advanced biomimetic materials. Several factors are known to influence the final form of both native nacre and biomimetic synthetic variants. Two important components in calcium carbonate biominerals such as nacre are the organic scaffold and the acidic proteins.

In situ continuous growth formation of synthetic biominerals.

Continuous self-assembled growth of both the organic and inorganic components of materials with nacre-like structure is achieved upon mineralisation of chitin and chitosan scaffolds using a combined soaking method and the inclusion of poly(acrylic acid) and chitosan oligomers as additives.

Continuing education module the courage to birth.

Childbirth educator Kathryn McGrath reflects on fear and courage and comes to see some levels of fear as a normal part of the process of pregnancy and birth and not something to be brushed aside. In this article, originally presented as a keynote address in 2005 at the Lamaze International Annual Conference, McGrath discusses fear during pregnancy and birth and presents ways in which the childbirth educator can acknowledge and accept women's fears, and help find the courage they need to give birth.

Size and charge characterisation of a submicrometre oil-in-water emulsion using resistive pulse sensing with tunable pores.

Resistive pulse sensing (RPS) with tunable pores (TPs) has been used to investigate an oil-in-water emulsion stabilised with β-lactoglobulin (BLG). The mode of the droplet size distribution steadily increased over four months, from less than 150 nm to more than 200 nm. Results suggest that the dominant growth mechanism was migration of oil to relatively large droplets, as in Ostwald ripening.

Na-caseinate/oil/water systems: emulsion morphology diagrams.

The concentrated (dispersed phase 50-70 wt%) composition space of Na-caseinate, a family of milk proteins, stabilised emulsions was investigated for three different oils: soybean oil, palm olein and tetradecane with pH 6.8 phosphate buffer continuous phase. The variation of emulsion stability and microstructure were explored using static light scattering, diffusion nuclear magnetic resonance, cryo-scanning electron microscopy, rheology and the time varying macroscopic phase separation of the emulsions.

Biomimetic approach to forming chitin/aragonite composites.

Biomimetic materials which display the complexity of biominerals like nacre are synthetically difficult to prepare. The formation of chitin/calcium carbonate composites, where CaCO(3) is present as aragonite, was achieved via reacetylation of preformed chitosan scaffolds followed by the combination of presoaking of chitin templates with mineral solutions in the presence of poly(acrylic acid). The as-synthesised composites are comprised of well-ordered ribbons of aragonite crystals held within an organic matrix, mimicking the structure of nacre.

Biomimetic mineralisation of polymeric scaffolds using a combined soaking approach: adaptation with various mineral salts.

Biomimetic strategies which utilise hydrogels have been targeted due to favourable hydrogel characteristics such as the presentation of a large surface area for crystal nucleation within a structured yet responsive scaffold. Chitosan hydrogels were prepared and mineralised using a combined method which involves alternate soaking of the films with precursor solutions, followed by treatment with saturated mineral solution. This method has been shown to be effective for the synthesis of calcium carbonate-chitosan composite materials with tensile strength comparable to nacre.

Biomimetic mineralisation of polymeric scaffolds using a combined soaking and Kitano approach.

Chitosan hydrogels are of considerable interest in synthetic biomimetic mineralisation strategies due to their favourable characteristics such as the presentation of a large surface area for crystal nucleation within a structured yet responsive scaffold. Chitosan hydrogels were prepared and subsequently calcium carbonate mineralisation was initiated using a method which combines alternate soaking of the films with precursor solutions followed by treatment with Kitano solution. This combined approach allows for increased extent of mineralisation, inducement of mineralisation uniformly throughout the hydrogel rather than only at the peripheral surface and ready scalability and shape manipulation.

Nonequilibrium 2-hydroxyoctadecanoic acid monolayers: effect of electrolytes.

2-Hydroxyacids display complex monolayer phase behavior due to the additional hydrogen bonding afforded by the presence of the second hydroxy group. The placement of this group at the position α to the carboxylic acid functionality also introduces the possibility of chelation, a utility important in crystallization including biomineralization. Biomineralization, like many biological processes, is inherently a nonequilibrium process.

Assembly of two- and three-dimensionally patterned silicate materials using responsive soft templates.

We report a soft and straightforward method for synthesizing two- and three-dimensionally patterned silicate materials by phase separation using nonionic emulsion templates. Our liquid-state method involves, under controlled atmosphere, the mixing of a condensed silica solution with an oil-in-water emulsion in the presence of a solution of a nonionic emulsifier, Triton X-100. The preparation is stabilized using an organic solvent.

The microstructural and rheological properties of Na-caseinate dispersions.

The self-diffusion coefficients of water and casein aggregates in aqueous Na-caseinate dispersions were measured using a pulsed gradient stimulated echo nuclear magnetic resonance technique (PGSTE-NMR). The results for water self-diffusion are discussed in terms of the cell model. The influence of Na-caseinate concentration on water self-diffusion can be explained by obstruction and tortuosity effects arising due to the presence of casein aggregates.

The role of subphase chemistry in controlling monolayer behaviour.

Intermolecular interactions lie at the root of many fundamental processes in nature. For example, they define membrane formation and crystallisation processes. Here, using Langmuir monolayers, we have investigated the role of intermolecular interactions in defining non-equilibrium monolayer structure and response, specific to a nucleating subphase chemistry.

Cell membrane structures during exocytosis.

Exocytosis is a key biological process that controls the neurotransmission and release of hormones from cells. In endocrine cells, hormones are packed into secretory vesicles and released into the extracellular environment via openings in the plasma membrane, a few hundred nanometers wide, which form as a result of fusion of the membranes of the granule and cell. The complex processes and dynamics that result in the formation of the fusion pore, as well as its structure, remain scantly understood.

Evolution of a lamellar domain structure for an equilibrating lyotropic liquid crystal.

Aerosol OT/water exhibits a lamellar phase over a wide range of concentrations. We show, by magnetic resonance (NMR) and scanning electron microscopy (SEM), that the morphology of the lamellar phase varies significantly across that range and that the rate of equilibration depends strongly on concentration (25, 33, and 50 wt %) with, paradoxically, the faster equilibration at higher surfactant concentrations. We find that the 25 wt % sample exhibits a defect-rich local structure, characteristic of a superposed L(3) character.

Effect of oil on emulsion characteristics: manipulating the interfacial domain.

In this paper, two ternary systems (water, Triton X-100, and octane or tetradecane) were investigated using freeze-fracture transmission electron microscopy, rheology, laser diffraction particle sizing, and pulse field gradient NMR (PFG-NMR). Oil-in-water dispersed droplet emulsions were prepared for Triton X-100 concentrations of 8-12 wt % while maintaining a surfactant-to-oil weight ratio of 1:5. The stability of the emulsions significantly increased with both the surfactant concentration and the chain length of the oil component.

Orientational anisotropy in the polydomain lamellar phase of a lyotropic liquid crystal.

Diffusion-diffusion correlation measurements by NMR are used to investigate the degree of orientational order in the lamellar phase of Aerosol OT (bis(2-ethylhexyl) sodium sulfosuccinate) and water at a range of surfactant concentrations (25, 33, and 50 wt %). We show that true isotropy of the domains is found at the lowest concentration but that at higher concentrations deviations from isotropy can be found, as evidenced by asymmetry on the 2D correlation distributions. We further discuss the significance of asymmetry in diffusion-diffusion exchange experiments, 2D distributions that should always be symmetric in steady state.