There are various sex differences in sleep/wake behaviors in mice. However, it is unclear whether there are sex differences in sleep homeostasis and arousal responses and whether gonadal hormones are ...involved in these sex differences. Here, we examined sleep/wake behaviors under baseline condition, after sleep deprivation by gentle handling, and arousal responses to repeated cage changes in male and female C57BL/6 mice that are hormonally intact, gonadectomized, or gonadectomized with hormone supplementation. Compared to males, females had longer wake time, shorter non-rapid eye movement sleep (NREMS) time, and longer rapid eye movement sleep (REMS) episodes. After sleep deprivation, males showed an increase in NREMS delta power, NREMS time, and REMS time, but females showed a smaller increase. Females and males showed similar arousal responses. Gonadectomy had only a modest effect on homeostatic sleep regulation in males but enhanced it in females. Gonadectomy weakened arousal response in males and females. With hormone replacement, baseline sleep in gonadectomized females was similar to that of intact females, and baseline sleep in gonadectomized males was close to that of intact males. Gonadal hormone supplementation restored arousal response in males but not in females. These results indicate that male and female mice differ in their baseline sleep–wake behavior, homeostatic sleep regulation, and arousal responses to external stimuli, which are differentially affected by reproductive hormones.
Abstract Context The ability to predict survival accurately has implications in clinical decision making. Objectives We determined the association of phase angle obtained from multi-frequency ...bioelectric impedance analysis with overall survival in patients with advanced cancer. Methods We included consecutive patients with advanced cancer who had an outpatient palliative care consultation. Multi-frequency bioelectric impedance analysis assessed phase angle at three different frequencies (5/50/250 kHz) on each hemibody (right/left). Survival analysis was conducted using the Kaplan-Meier method, log-rank test, and multivariate Cox regression analysis. Results Among 366 patients, the median overall survival was 250 days (95% confidence interval 191–303 days). The mean phase angle for 5, 50, and 250 kHz were 2.2°, 4.4°, and 4.2° on the right and 2.0°, 4.2° and 4.1° on the left, respectively. For all six phase angles, a lower value was significantly associated with a poorer overall survival ( P < 0.001). After adjusting for cancer type, performance status, weight loss, and inflammatory markers, phase angle remained independently associated with overall survival (hazard ratio 0.85 per degree increase, 95% confidence interval 0.72–0.99; P = 0.048). Conclusion Phase angle represents a novel objective prognostic factor in outpatient palliative cancer care setting, regardless of frequency and body sides.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Trust influences healthcare through the willingness to seek care, disclose sensitive information, adhere to treatment, and satisfaction with care. Understanding factors that influence trust may help ...in physician-patient relationship particularly at end of life.
We explored the association between trust and other demographic and psychosocial factors. We also explored the performance of the single-item Degree of Trust scale (0 best to 10 worst) compared with the validated five-item Trust in Medical Profession scale (5 best to 25 worst).
A secondary analysis of prospectively collected data was performed. Trust scores completed by 100 patients were correlated with age, gender, ethnicity, educational level, anxiety, depression, and hopefulness (Herth Hope Index 12 best to 48 worst).
The study was conducted on 100 patients in an outpatient Supportive Care Center in a cancer center in Houston, Texas.
Median age was 57 years (49-65), depression was 6 (3-9), and hopefulness was 22 (20-25). Trust in Medical Profession score was 13, 11-14 (median, IQR) and Degree of Trust score was 2, 1-4 (median, IQR) with moderate correlation (r = 0.587, p < 0.001). On evaluating performance of Degree of Trust scale to the validated Trust in Medical Profession scale, a moderately high performance was found (Youden's J = 0.73; Topleft = 0.21). Older age (p = 0.02) lower depression scores (p < 0.01) and more hopefulness (p = 0.01) were associated with higher levels of trust.
Trust was associated with older age, less depressed, and more hopeful patients. A single 0-10 item trust scale was found to perform adequately compared with a multiple-item questionnaire.
Abstract Context Although off-label medications are frequently prescribed in palliative care, there are no published studies examining their use in the U.S. Objectives We examined the frequency of ...off-label medication use in cancer patients admitted to an acute palliative care unit (APCU). Methods This prospective observational study enrolled consecutive patients with advanced cancer admitted to the APCU of a tertiary care cancer center. We collected data on all prescription events, including indications for use, from admission to discharge. Off-label use was checked against the U.S. Food and Drug Administration–approved indications. Results Among the 201 patients, median survival was 10 days (95% CI 7–13), and 85 (42%) patients died in the APCU. We documented 6276 prescription events, and 2199 (35%) were off-label. Among off-label prescriptions, central nervous system agents ( n = 1606, 73%), hormones and synthetic substitutes ( n = 302, 14%), and autonomic drugs ( n = 183, 8%) were most commonly prescribed. Haloperidol ( n = 720, 33%), chlorpromazine ( n = 292, 13%), dexamethasone ( n = 280, 13%), glycopyrrolate ( n = 175, 8%), hydromorphone ( n = 161, 7%), and morphine ( n = 156, 7%) were most frequently prescribed off-label. The most common indications for off-label prescribing were delirium ( n = 783, 36%) and dyspnea ( n = 449, 20%). Seventy percent of all off-label prescription events had strong evidence supporting use, and 19% of prescription events had moderate or weak evidence for use. Conclusion One-third of prescription events in the APCU were off-label, with majority of off-label use having a strong level of supporting evidence. Our findings highlight the need for more research in key areas such as delirium and dyspnea management.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Ionic electroactive polymers (IEAPs) have received considerable attention for their flexibility, lightweight composition, large displacement, and low-voltage activation. Recently, many metal-nonmetal ...composite electrodes have been actively studied. Specifically, graphene oxide-silver nanowire (GO-Ag NW) composite electrodes offer advantages among IEAPs with metal-nonmetal composite electrodes. However, GO-Ag NW composite electrodes still show a decrease in displacement owing to low stability and durability during driving. Therefore, the durability and stability of the IEAPs with metal-nonmetal composite electrodes must be improved. One way to improve the device durability is coating the electrode surface with a protective layer. This layer must have enough flexibility and suitable electrical properties such that it does not hinder the IEAPs' driving. Herein, a poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) protective layer and 4-(1,1,3,3-tetramethylbutyl)phenyl-polyethylene glycol (Triton X-100) are applied to improve driving performance. Triton X-100 is a nonionic surfactant that transforms the PEDOT:PSS capsule into a nanofibril structure. In this study, a mixed Triton X-100/PEDOT:PSS protective layer at an optimum weight ratio was coated onto the GO-Ag NW composite-electrode-based IEAPs under various conditions. The IEAP actuators based on GO-Ag NW composite electrodes with a protective layer of PEDOT:PSS treated with Triton X-100 showed the best stability and durability.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Purpose
The Edmonton Classification System for Cancer Pain (ECS-CP) has been shown to predict pain management complexity based on five features: pain mechanism, incident pain, psychological distress, ...addictive behavior, and cognitive function. The main objective of our study was to explore the association between ECS-CP features and pain treatment outcomes among outpatients managed by a palliative care specialist-led interdisciplinary team.
Methods
Initial and follow-up clinical information of 386 eligible supportive care outpatients were retrospectively reviewed and analyzed.
Results
Between the initial consultation and the first follow-up visit, the median ESAS pain intensity improved from 6 to 4.5 (
p
< 0.0001) and the median total symptom distress score (0–100) improved from 38 to 31 (
p
< 0.0001). At baseline, patients with neuropathic pain (
p
< 0.001) and those with at least one ECS-CP feature (
p
= 0.006) used a higher number of adjuvant medications. At follow-up, patients with neuropathic pain were less likely to achieve their personalized pain goal (PPG) (29 vs 72%,
p
= 0.015). No statistically significant association was found between increasing sum of ECS-CP features and any of the pain treatment outcomes at follow-up.
Conclusion
Neuropathy was found to be a poor prognostic feature in advanced cancer pain management. Increasing sum of ECS-CP features was not predictive of pain management complexity at the follow-up visit when pain was managed by a palliative medicine specialist. Further research is needed to further explore these observations.
Two thermophilic 1,4-α-glucan branching enzymes (GBEs), CbGBE from Caldicellulosiruptor bescii and PhGBE from Pyrococcus horikoshii, which belong to the glycoside hydrolase family 13 and 57 ...respectively, were cloned and expressed in Escherichia coli. Two GBEs were identified to have α-1,6 branching activity against various substrates, but substrate specificity was distinct. Starch was modified by two GBEs and their in vitro digestibility and structural properties were investigated. Short-branched A chains with a degree of polymerization (DP) of 6–12 increased with CbGBE-modified starch, increasing the proportion of slow digestible and resistant starch (RS) fractions. PhGBE-modified starch resulted in an increase in the RS fraction only by a slight increase in part of A chains (DP, 6–9). Compared to the proportion of control not treated with GBE, the proportion of α-1,6 linkages in CbGBE- and PhGBE-modified starch increased by 3.1 and 1.6 times. 13C cross polarization/magic angle sample spinning (CP/MAS) NMR and XRD pattern analysis described that GBE-modified starches reconstructed double helices but not the crystalline structure. Taken together, CbGBE and PhGBE showed distinct branching activities, resulting in different α-1,6 branching ratios and chain length distribution, and double helices amount of starch, ultimately affecting starch digestibility. Therefore, these GBEs can be used to produce customized starches with controlled digestion rates.
There is currently no universally accepted outcome measure in cancer pain management. The personalized pain goal (PPG) has been shown to be a relevant outcome measure. We examined its use in routine ...outpatient practice and compared it with the clinically important difference (CID, ≥2 points or 30%), a pain outcome measure frequently used in several clinical studies.
Initial and follow-up clinical information of outpatients with advanced cancer pain were retrospectively reviewed. PPG response was defined as pain ≤ PPG and CID response as ≥30% or ≥2-point decrease in pain intensity at follow-up.
PPG was successfully completed in 375 of 387 eligible patients (97%) with cancer pain. The median baseline PPG was three for all patients and remained unchanged at follow-up. One hundred thirty-two of 375 (35%) had a PPG response and 243 of 375 (65%) were non-responders. The odds ratio for PPG non-response was 1.01 for each milligram increase in morphine equivalent daily dose (P = 0.001), 1.46 for each point increase in the number of adjuvant analgesics (P = 0.006), 2.63 for severe pain (P = 0.002), and 2.55 for moderate depression (P = 0.006). Using PPG response as the gold standard for pain relief, the overall sensitivity and specificity of CID response were 83% and 77%, respectively.
PPG was successfully completed in the vast majority of patients, suggesting its feasibility as a pain outcome measure in routine clinical practice. Higher baseline pain intensity, depression, opioid dose, and number of adjuvant analgesics were independent predictors of poor pain relief. Further research is needed to further evaluate its clinical importance in cancer pain management.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Additive interface materials for improved ionic polymer metal composite (IPMC) actuator performance are being investigated. In this study, three-dimensional carbon nanostructure/copper nanowire (3DC ...Cu-NW) with a novel structure was synthesized via low-pressure chemical vapor deposition. An IPMC actuator with a 3DC Cu-NW interface layer was fabricated, which exhibited improved actuation performance, long-term stability, and electrochemical properties. The proposed 3DC consists of carbon nanotubes (CNTs) and graphene, grown using an Fe catalyst and CH
gas, respectively. We optimized the growth conditions (Fe catalyst: 12.5 mg/L, CH
: 20 sccm) to achieve a 3DC with an appropriate thickness and a large specific surface area. The 3DC Cu-NW benefited from a Cu oxidation prevention property and a large specific surface area. The electrochemical properties and actuation performance of the IPMC actuator improved with an increased 3DC Cu-NW concentration. An IPMC actuator with a 0.6 wt% 3DC Cu-NW interface layer exhibited 1.3- and 5.6-fold electrochemical property and actuation performance improvement, respectively, over an IPMC actuator with no 3DC Cu-NW interface layer. These results show that the proposed 3DC Cu-NW has potential as an IPMC actuator interface material, and that 3DC Cu-NW synthesis and application technology can be applied to future research on sensor, actuator, and flexible devices.
The aim of this study is to apply a collision warning algorithm for a small fishing vessel in a fishing waterway to verify its alarm operation and to validate its feasibility. For this purpose, a ...scenario-based real ship test was conducted, and cases extracted from real sea data (Vpass data) were applied. Moreover, zones with frequent alarms and high-risk waters were compared. First, we installed millimeter-wave communication terminals in three small fishing vessels and applied our algorithm based on two scenarios. Furthermore, we applied the collision warning algorithm by extracting two cases encountered by multiple ships from the Vpass data. The results show that the algorithm triggered alarms continuously under risky situations. This study also compares waterway risk levels as assessed by maritime risk-assessment tools (potential assessment of risk model, environment stress model, and International Association of Marine Aids to Navigation and Lighthouse Authorities Waterway Risk Assessment Program MkII) and the locations having frequent alarms based on Vpass data collected for 7 days. Not only did the eastern sea of Yeongheung Island indicate that more alarms were triggered, but we found high-risk results from the risk-level assessment, indicating that the risky zones and the frequent alarm zones were identical. Additional research is necessary to develop an algorithm based on qualitative evaluation by actual ship operators. In addition, since fishing vessels navigate differently from general navigation methods during fishing, it is necessary to develop additional algorithms for this.
PDF
