Increased access to palliative care and hospice services: opportunities to improve value in health care.

Context: A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life.

Methods: This article examines data demonstrating the impact of the U.

An examination of kernite (Na2B4O6(OH)2·3H2O) using X-ray and electron spectroscopies: quantitative microanalysis of a hydrated low-Z mineral.

Mineral borates, the primary industrial source of boron, are found in a large variety of compositions. One such source, kernite (Na2B4O6(OH)2·3H2O), offers an array of challenges for traditional electron-probe microanalysis (EPMA)-it is hygroscopic, an electrical insulator, composed entirely of light elements, and sensitive to both low pressures and the electron beam. However, the approximate stoichiometric composition of kernite can be analyzed with careful preparation, proper selection of reference materials, and attention to the details of quantification procedures, including correction for the time dependency of the sodium X-ray signal.

A portable fiberoptic ratiometric fluorescence analyzer provides rapid point-of-care determination of glomerular filtration rate in large animals.

Measurement of the glomerular filtration rate (GFR) is the gold standard for precise assessment of kidney function. A rapid, point-of-care determination of the GFR may provide advantages in the clinical setting over currently available assays. Here we demonstrate a proof of principle for such an approach in a pig and dogs, two species that approximate the vascular access and GFR results expected in humans.

Fanconi anemia core complex gene promoters harbor conserved transcription regulatory elements.

The Fanconi anemia (FA) gene family is a recent addition to the complex network of proteins that respond to and repair certain types of DNA damage in the human genome. Since little is known about the regulation of this novel group of genes at the DNA level, we characterized the promoters of the eight genes (FANCA, B, C, E, F, G, L and M) that compose the FA core complex. The promoters of these genes show the characteristic attributes of housekeeping genes, such as a high GC content and CpG islands, a lack of TATA boxes and a low conservation.

Dimerization and charge order in hollandite K₂V₈O₁₆.

The metal-insulator transition occurring in hollandite K₂V₈O₁₆ has been studied by means of neutron and x-ray diffraction as well as by thermodynamic and electron-spin resonance measurements. The complete analysis of the crystal structure in the distorted phase allows us to identify dimerization as the main distortion element in insulating K₂V₈O₁₆. At low-temperature, half of the V chains are dimerized perfectly explaining the suppression of magnetic susceptibility due to the formation of spin singlets.

Theory of high-temperature multiferroicity in cupric oxide.

The incommensurate-commensurate phases reported in cupric oxide below 230 K are shown theoretically to realize an inverted sequence of symmetry-breaking mechanisms with respect to the usual sequence occurring in low-temperature multiferroic compounds. The sequence inversion results from a strong triggering-coupling mechanism between two antiferromagnetic order parameters inducing a first-order transition to the multiferroic phase. Such mechanism is favored by the large antiferromagnetic superexchange interactions, responsible of the high-T(N) temperature, and implies a preeminence of these interactions on the magnetocrystalline anisotropy.

The effect of tesofensine on appetite sensations.

Tesofensine (TE), an inhibitor of monoamine presynaptic reuptake, has produced twice the weight loss seen with currently marketed drugs. However, its long term effect on appetite in humans has not been studied. A multicentre phase II trial was divided into two parts (24 weeks each).

Neurovascular coupling is impaired in slow walkers: the MOBILIZE Boston Study.

Objective: Neurovascular coupling may be involved in compensatory mechanisms responsible for preservation of gait speed in elderly people with cerebrovascular disease. Our study examines the association between neurovascular coupling in the middle cerebral artery and gait speed in elderly individuals with impaired cerebral vasoreactivity.

Methods: Twenty-two fast and 20 slow walkers in the lowest quartile of cerebral vasoreactivity were recruited from the MOBILIZE Boston Study.

Prognostic value of reduced SMAD4 expression in patients with metastatic colorectal cancer under oxaliplatin-containing chemotherapy: a translational study of the AIO colorectal study group.

Background: SMAD4 is a polypeptide with tumor suppressor function being investigated as a prognostic biomarker in Union Internationale Contre le Cancer stages II and III in previous studies, but its role as a prognostic marker in stage IV colorectal cancer (CRC) is still undefined. We investigated the prognostic value of reduced SMAD4 expression in patients with metastatic (mCRC) under first-line oxaliplatin-containing combination chemotherapy.

Patients And Methods: Tumor samples were obtained from patients who took part in a prospective randomized phase III chemotherapy trial of the Arbeitsgemeinschaft Internistische Onkologie of the German Cancer Society colorectal study group, comparing the use of capecitabine plus oxaliplatin with infusional 5-fluorouracil (5-FU) plus oxaliplatin as first-line therapy in mCRC.

Material separation in x-ray CT with energy resolved photon-counting detectors.

Purpose: The objective of the study was to demonstrate that, in x-ray computed tomography (CT), more than two types of materials can be effectively separated with the use of an energy resolved photon-counting detector and classification methodology. Specifically, this applies to the case when contrast agents that contain K-absorption edges in the energy range of interest are present in the object. This separation is enabled via the use of recently developed energy resolved photon-counting detectors with multiple thresholds, which allow simultaneous measurements of the x-ray attenuation at multiple energies.

Mobility decline in the elderly relates to lesion accrual in the splenium of the corpus callosum.

In a previous cross-sectional study on baseline data, we demonstrated that the volume of brain white matter hyperintensities (WMH) in the splenium of corpus callosum (SCC) predicted the current mobility function of older persons. The primary aim of this follow-up study was to determine the relation of WMH volume change in SCC (SCC-∆WMH) with change in mobility measures. A secondary aim was to characterize the global and regional progression of WMH.

Palliative care's positive outcomes.

Timely, safe and patient-centered, palliative care meets quality standards.

MicroCT with energy-resolved photon-counting detectors.

The goal of this paper was to investigate the benefits that could be realistically achieved on a microCT imaging system with an energy-resolved photon-counting x-ray detector. To this end, we built and evaluated a prototype microCT system based on such a detector. The detector is based on cadmium telluride (CdTe) radiation sensors and application-specific integrated circuit (ASIC) readouts.

One year activity on subtraction MRI predicts subsequent 4 year activity and progression in multiple sclerosis.

Objective: To investigate the predictive value of 1 year subtraction MRI (sMRI) on activity and progression over the next 4 years in early phase multiple sclerosis (MS). To compare sensitivity of sMRI and contrast enhanced MRI towards disease activity.

Methods: The study was performed on 127 MS patients with brain MRI within 5 years of symptom onset (y0), after 1 year (y1) and after 5 years (y5).

Palliative care consultation teams cut hospital costs for Medicaid beneficiaries.

Patients facing serious or life-threatening illnesses account for a disproportionately large share of Medicaid spending. We examined 2004-07 data to determine the effect on hospital costs of palliative care team consultations for patients enrolled in Medicaid at four New York State hospitals. On average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care.

Identification and clinical impact of multiple sclerosis cortical lesions as assessed by routine 3T MR imaging.

Background And Purpose: Histopathologic studies have reported widespread cortical lesions in MS; however, in vivo detection by using routinely available pulse sequences is challenging. We investigated the relative frequency and subtypes of cortical lesions and their relationships to white matter lesions and cognitive and physical disability.

Materials And Methods: Cortical lesions were identified and classified on the basis of concurrent review of 3D FLAIR and 3D T1-weighted IR-SPGR 3T MR images in 26 patients with MS.

Strategies and innovative models for delivering palliative care in nursing homes.

The goals of palliative care address critical issues for individuals with complex and serious illness residing in nursing homes, including pain and symptom management, communication, preparation for death, decisions about treatment preferences, and caregiver support. Because of the uncertain prognosis associated with chronic nonmalignant diseases such as dementia, many nursing home residents are either not referred to hospice or have very short or very long hospice stays. The integration of palliative care into nursing homes offers a potential solution to the challenges relating to hospice eligibility, staffing, training, and obtaining adequate reimbursement for care that aligns with resident and surrogate's preferences and needs.

Simultaneous in vivo dynamic contrast-enhanced magnetic resonance and scintigraphic imaging.

In this study, we investigated the in vivo application of an integrated small-animal magnetic resonance (MR) and gamma-ray imaging system that consists of a semiconductor-based radiation detector, a parallel-hole collimator, and a specialized radiofrequency coil. Gadodiamide and (99m)Tc sestimibi agents were injected simultaneously into a mouse, and simultaneous dynamic contrast-enhanced MR and scintigraphic images of the kidneys were acquired. The time curves of both the MR signal intensity and radioactivity indicate a rapid uptake of the agents followed by a more gradual excretion, consistent with the previously reported literature.