"Farewell" to Prognosis in Shared Decision-Making.

Whether because of a cultural pattern or personal preference, palliative care clinicians encounter persons approaching the end of life who wish to limit or forego prognostic information relating to their situation. This scenario has received attention in a recent motion picture as well as a newly available advance directive modification-the Prognosis Declaration form. The ordinary expectation for end-of-life shared decision-making with a capable person is clinician disclosure of the best effort at prognostic assessment.

The Death Debate: Penumbra Conundrum.

Determination and declaration of death by neurologic criteria, brain death, is an established and legally accepted clinical practice with profound implications. Concerns regarding the accuracy of this diagnosis raise important clinical, ethical, and legal issues. A recent magazine article highlights these concerns by describing a poignant example of a patient meeting accepted clinical and ancillary testing criteria for brain death in the setting of post cardiac arrest hypoxic ischemic encephalopathy (CA-HIE).

A cargo-sorting DNA robot.

Two critical challenges in the design and synthesis of molecular robots are modularity and algorithm simplicity. We demonstrate three modular building blocks for a DNA robot that performs cargo sorting at the molecular level. A simple algorithm encoding recognition between cargos and their destinations allows for a simple robot design: a single-stranded DNA with one leg and two foot domains for walking, and one arm and one hand domain for picking up and dropping off cargos.

Compiler-aided systematic construction of large-scale DNA strand displacement circuits using unpurified components.

Biochemical circuits made of rationally designed DNA molecules are proofs of concept for embedding control within complex molecular environments. They hold promise for transforming the current technologies in chemistry, biology, medicine and material science by introducing programmable and responsive behaviour to diverse molecular systems. As the transformative power of a technology depends on its accessibility, two main challenges are an automated design process and simple experimental procedures.

Avian botulism and avian chlamydiosis in wild water birds, Benton Lake National Wildlife Refuge, Montana, USA.

In 1999, the U.S. Geological Survey (USGS) National Wildlife Health Center, Madison, Wisconsin, conducted a diagnostic investigation into a water bird mortality event involving intoxication with avian botulism type C and infection with avian chlamydiosis at the Benton Lake National Wildlife Refuge in Montana, USA.

Acute lung injury and acute respiratory distress syndrome requiring tracheal intubation and mechanical ventilation in the intensive care unit: impact on managing uncertainty for patient-centered communication.

A case of acute lung injury (ALI) progressing to acute respiratory distress syndrome (ARDS) requiring tracheal intubation and mechanical ventilation (ETMV) is presented. The palliative medicine service was asked to address concerns expressed by the patient's spouse reflecting uncertainty regarding outcome expectations. Acknowledging and confronting the uncertainties of a critical illness is an essential component of patient-centered communication.

Acute renal failure requiring renal replacement therapy in the intensive care unit: impact on prognostic assessment for shared decision making.

A 69-year-old female was receiving renal replacement therapy (RRT) for acute renal failure (ARF) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care. Clinician responsibility in shared decision making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match patient values with treatment options.

Caring for children with learning disabilities who present problem behaviours: a maternal perspective.

The theoretical cognitive model of stress and coping provides a structure to obtain and analyse maternal perceptions of caring for children with learning disabilities who present severe problem behaviours. The Family Fund database identified 18 families who met the sample criteria of children aged five years to 15 years with severe to moderate learning disability presenting severe problem behaviour. Physical aggression was reported to be the primary behavioural problem for 13 of the children.