bluuebunny/crossref_metadata_2025 huggingface dataset:
A Matter of Class
Authors: Murphey Kathleen A.
Published: May 2011

In the introduction to this volume, Eileen Tamura, Caroline Eick, and Roland Sintos Coloma state that their essays “are followed by responses by educational historians, some of whom have delved into theory in their historical works, while others have not.” I would describe myself as someone who has questioned the role of theory since I first began studying educational history several decades ago, who has attempted to use theory, and who, thus, warmly welcomes this discussion.
Anion/Cation Induced Optical Switches Based on Luminescent Lanthanide (Tb3+ and Eu3+) Hydrogels
Authors: Zhang Liguo , Tan Chaoliang , Wang Qianming , Zhang Cheng Cheng
Published: May 2011

Two novel silica based lanthanide complexes (Tb(a)2 and Eu(a)2) were encapsulated into poly(acrylic acid) host. Both Tb(III) and Eu(III) containing hydrogels have typical and easily distinguished narrow line emissions occurring in the green and red region respectively. Particularly, the excitation wavelength for Eu complex can be extended into nearly visible light range (λex = 395 nm). Interestingly, we discover that these target materials not only exhibit selective emission response towards HSO4− (detection limit 10−5 m) compared with CH3COO−, F−, Cl−, Br− and I− but also give unique quenching to Cu2+ (detection limit 10−5 m) (tested cations: Cu2+, Pd2+, Cd2+, Co2+ and Mn2+). More importantly, this kind of materials can be recycled more than 10 times.
A novel screening system for secretion of heterologous proteins in Bacillus subtilis
Authors: Trip Hein , van der Veek Patricia J. , Renniers Ton C. , Meima Rob , Sagt Cees M. , Mohrmann Lisette , Kuipers Oscar P.
Published: May 2011

High‐level production of secretory proteins in Bacillus subtilis leads to a stress response involving the two‐component system CssRS and its target genes htrA and htrB. Here, we used this sensing system in a reporter strain in which gfp is under control of PhtrA, the secretion stress responsive promoter of htrA. Overexpression of heterologous secretory proteins in this strain results in green fluorescent cells, which can be separated from non‐secreting, low fluorescent cells using a fluorescence‐activated cell sorter (FACS). Using this principle, genomic libraries of uncharacterized prokaryotic organisms, expressed in the reporter strain, can be screened for genes encoding secretory proteins.
Cellulose mediates attachment of Salmonella enterica Serovar Typhimurium to tomatoes
Authors: Shaw Robert K. , Lasa Iñigo , García Begoña M. , Pallen Mark J. , Hinton Jay C. D. , Berger Cedric N. , Frankel Gad
Published: May 2011

Fresh fruit and vegetables are important components of a healthy and balanced diet. However, they are increasingly being recognized as important vehicles for transmission of human pathogens that were traditionally classified as zoonotic. There is a significant gap in our knowledge and understanding of the mechanisms by which human pathogens colonize and survive on or in fruits and vegetables. In this study we investigated the binding of Salmonella enterica to tomato fruits (Solanum lycopersicum), which is becoming a major source of human infection. We report that Salmonella enterica serovars Typhimurium and Senftenberg bound to the surface of unripe tomatoes in an aggregative pattern, while serovar Thompson adhered diffusely. We found that while flagella did not have a role in binding, bcsC S. Typhimurim mutants, deficient in cellulose production, exhibited significantly reduced level of attachment to tomatoes. Trans complementation of the mutation restored adhesion to the wild‐type level.
Microbiology of the Red Sea (and other) deep‐sea anoxic brine lakes
Authors: Antunes André , Ngugi David Kamanda , Stingl Ulrich
Published: May 2011

The Red Sea harbours approximately 25 deep‐sea anoxic brine pools. They constitute extremely unique and complex habitats with the conjugation of several extreme physicochemical parameters rendering them some of the most inhospitable environments on Earth. After 50 years of research mostly driven by chemists, geophysicists and geologists, the microbiology of the brines has been receiving increased interest in the last decade. Recent molecular and cultivation‐based studies have provided us with a first glimpse on the enormous biodiversity of the local microbial communities, the identification of several new taxonomic groups, and the isolation of novel extremophiles that thrive in these environments. This review presents a general overview of these unusual biotopes and compares them with other similar environments in the Mediterranean Sea and the Gulf of Mexico, with a focus on their microbial ecology.
Noble gases in the Xinjiang (Armanty) iron meteorite––A big object with a short cosmic‐ray exposure age
Authors: AMMON Katja , LEYA Ingo , LIN Yangtin
Published: May 2011

Abstract– We measured the concentrations and isotopic ratios of the cosmogenic noble gases He, Ne, and Ar in the very large iron meteorite Xinjiang (IIIE). The 3He and 4He data indicate that a significant portion of the cosmogenic produced helium has been lost via diffusion or in a recent impact event. High 22Ne/21Ne ratios indicate that contributions to the cosmogenic 21Ne from sulfur and/or phosphorous are significant. By combining the measured nuclide concentrations with model calculations for iron meteorites we were able to determine the preatmospheric diameter of Xinjiang to 260–320 cm, which corresponds to a total mass of about 70–135 tons. The cosmic‐ray exposure age of Xinjiang is 62 ± 16 Ma, i.e., relatively short compared to most of the other iron meteorites. With the current database we cannot firmly determine whether Xinjiang experienced a complex irradiation history. The finding of 3He and 4He losses might argue for a recent impact event and therefore for a complex exposure.
Accounting for uncertainty in species delineation during the analysis of environmental DNA sequence data
Authors: Powell Jeff R.
Published: May 2011

1. Defining species boundaries represents a significant challenge in biodiversity studies, especially as these studies increasingly rely on high‐throughput DNA sequencing technologies. A promising approach for delineating species in environmental sequence data combines phylogenetics and coalescence theory to estimate species boundaries from distributions of lineage birth rates within multispecies coalescent trees.

2. Existing methods for interpreting these models utilize hypothetico‐deductive reasoning to identify thresholds associated with a mixed speciation‐coalescent model that fits the data better than a null model. Here, I describe an alternative approach that ranks and assigns weights to models based on their fit to the data using information criteria and then uses model averaging to estimate parameters and species probabilities.

3. This approach is applied to data from two independent studies that address (i) patterns of cospeciation in an aphid–bacterial symbiosis and (ii) diversity of bacterial communities associated with the human gut. In both of these cases, accounting for uncertainty during model selection allowed greater flexibility to detect variable (with respect to time) speciation‐coalescent thresholds among lineages.

4. The precision of the predicted species boundaries varied among the studies, and the variance‐to‐mean ratio for richness estimates ranged from 0.023 to 0.079. Sample‐based estimates of gut bacteria richness revealed that accounting for uncertainty during species delineation increased the variance in the estimates of population means (by individual from which the samples were taken or by sex of the individuals) by up to 7.5%.

5. In ecological and evolutionary studies, conclusions are highly dependent on the classification system that is adopted; given the uncertainty in species boundaries observed here, ignoring this source of error (as is common practice) likely results in inflated type I error rates. The approach described here represents an objective, theory‐based method for predicting species boundaries and explicitly incorporates uncertainty in the classification system into biodiversity estimation, thus allowing researchers to better address the causes and consequences of biodiversity.
The role of hyperpolarization‐activated cationic current in spike‐time precision and intrinsic resonance in cortical neurons in vitro
Authors: Gastrein Philippe , Campanac émilie , Gasselin Célia , Cudmore Robert H. , Bialowas Andrzej , Carlier Edmond , Fronzaroli‐Molinieres Laure , Ankri Norbert , Debanne Dominique
Published: May 2011

Non‐technical summary We determined here the role of the hyperpolarization‐activated cationic (h) current on the temporal organization of hippocampal activity in vitro. In CA1 pyramidal neurons the h‐current has three main actions. In addition to setting intrinsic resonance frequency at ∼4 Hz, the h‐current determines, through two main mechanisms, the temporal precision of action potentials evoked by excitatory postsynaptic potentials or following stimulation of inhibitory postsynaptic potentials (rebound spiking). We propose that h‐channels participate in the fine tuning of oscillatory activity in hippocampal and neocortical networks.
Co-Current Gas-Liquid Smooth-Stratified Flow in a Horizontal Reduced T-Junction Including Wavy and Slug Regime Transition Boundaries
Authors: Bowden Robert C. , Hassan Ibrahim G.
Published: May 2011

Experiments were performed in a horizontal reduced T-junction using a branch diameter of 6.35 mm and an inlet pipe diameter of 50.8 mm. The inlet length was 1.8 m and three branch orientations were tested at 0, 45, and 90 degrees down from the horizontal. Water and air, operating at 206 kPa, were used to provide an adiabatic two-phase environment. Both fluids flowed co-currently within the inlet towards the branch in the smooth-stratified regime. Results demonstrate the relationship between the interface height and the inlet and branch two-phase quantities, including the inlet superficial liquid and gas velocities, and branch two-phase mass flow rate and quality. In certain instances transitions to wavy-stratified or slug regimes were observed and these limits are quantified for each branch orientation. Flow visualization was used to identify the initiation of two-phase flow in the branch, including the onsets of gas and liquid entrainment. The critical height at the onset of gas entrainment was quantified as a function of the single phase liquid branch Froude number for the 45 and 90 degree branches, respectively. The branch quality results were scaled using the critical height and showed good agreement with selected models.
Integration of Activating and Inhibitory Receptor Signaling by Regulated Phosphorylation of Vav1 in Immune Cells
Authors: Mesecke Sven , Urlaub Doris , Busch Hauke , Eils Roland , Watzl Carsten
Published: May 2011

The extent of phosphorylation of a guanine nucleotide exchange factor determines the cytotoxicity of natural killer cells.
Reduction of Complex Signaling Networks to a Representative Kernel
Authors: Kim Jeong-Rae , Kim Junil , Kwon Yung-Keun , Lee Hwang-Yeol , Heslop-Harrison Pat , Cho Kwang-Hyun
Published: May 2011

An algorithmic approach enables the simplification of complex signaling networks and identifies potential therapeutic targets.
Cancer Cells Exploit the Eph-Ephrin System to Promote Invasion and Metastasis: Tales of Unwitting Partners
Authors: Wang Bingcheng
Published: May 2011

Eph receptors and their ephrin ligands regulate contact inhibition of locomotion and its evasion in cancer cells.
Food Fit for a Queen
Authors: Gough Nancy R.
Published: May 2011

A protein in royal jelly, which triggers development of a honeybee queen, is identified and activates the epidermal growth factor receptor pathway.
Notch and Sleep
Authors: Foley John F.
Published: May 2011

Notch signaling regulates sleep in flies and worms.
Hostile Takeover
Authors: Mueller Kristen L.
Published: May 2011

Human cytomegalovirus uses a host-encoded antiviral protein to its own advantage.
Involvement of Multiple Loci in Quorum Quenching of Autoinducer I Molecules in the Nitrogen-Fixing Symbiont Rhizobium (Sinorhizobium) sp. Strain NGR234
Authors: Krysciak D. , Schmeisser C. , Preuß S. , Riethausen J. , Quitschau M. , Grond S. , Streit W. R.
Published: June 2011

Rhizobium
sp. strain NGR234 is a unique alphaproteobacterium (order
Rhizobiales
) that forms nitrogen-fixing nodules with more legumes than any other microsymbiont. Since we have previously described the complete genome sequence of NGR234, we now report on a genome-wide functional analysis of the genes and enzymes involved in autoinducer I hydrolysis in this microbe. Altogether we identified five cosmid clones that repeatedly gave a positive result in our function-based approach for the detection of autoinducer I hydrolase genes. Of these five cosmid clones, two were located on pNGR234
b
and three were on cNGR234. Subcloning and
in vitro
mutagenesis in combination with BLAST analyses identified the corresponding open reading frames (ORFs) of all cosmid clones:
dlhR
,
qsdR1
,
qsdR2
,
aldR
, and
hitR-hydR
. Analyses of recombinant DlhR and QsdR1 proteins by using high-performance liquid chromatography-mass spectrometry (HPLC-MS) demonstrate that these enzymes function as acyl homoserine lactone (AHL) lactonases. Furthermore, we showed that these enzymes inhibited biofilm formation and other quorum-sensing-dependent processes in
Pseudomonas aeruginosa
,
Chromobacterium violaceum
, and
Agrobacterium tumefaciens
. Finally, our experimental data suggest that competitive colonization of roots in the rhizospheres of cowpea plants is affected by DlhR and QsdR1.
Sorption and Distribution of Copper in Unsaturated Pseudomonas putida CZ1 Biofilms as Determined by X-Ray Fluorescence Microscopy
Authors: Chen Guangcun , Chen Xincai , Yang Yuanqiang , Hay Anthony G. , Yu Xiaohan , Chen Yingxu
Published: June 2011

The spatial and temporal distribution of metals in unsaturated
Pseudomonas putida
CZ1 biofilms was determined using synchrotron-based X-ray fluorescence microscopy (XRF). It was found that Fe, Mn, and Ca were mainly distributed near the air-biofilm interface of a biofilm grown on 40 mM citrate, while there were two Fe-, Mn-, and Ca-rich layers within a biofilm grown on 10 mM citrate. The sorption of copper by biofilm grown in medium containing 10 mM citrate was rapid, with copper being found throughout the biofilm after only 1 h of exposure. Copper initially colocalized with Fe and Mn element layers in the biofilm and then precipitated in a 40-μm-thick layer near the air-biofilm interface when exposed for 12 h. Cu K-edge X-ray absorption near edge structure (XANES) analysis revealed that Cu was primarily bound with citrate within the biofilm, and the precipitate formed in the biofilm exposed to copper for 12 h was most similar to copper phosphate. LIVE/DEAD staining revealed that cells at the biofilm-membrane interface were mostly alive even when the copper concentration reached 80.5 mg copper g
−1
biomass. This suggests that the biofilm matrix provided significant protection for cells in this area. These results significantly improve our understanding of metal acquisition, transportation, and immobilization in unsaturated biofilm systems.
Influence of Environmental and Genetic Factors Linked to Celiac Disease Risk on Infant Gut Colonization by Bacteroides Species
Authors: Sánchez Ester , De Palma Giada , Capilla Amalia , Nova Esther , Pozo Tamara , Castillejo Gemma , Varea Vicente , Marcos Ascensión , Garrote José Antonio , Polanco Isabel , López Ana , Ribes-Koninckx Carmen , García-Novo Maria Dolores , Calvo Carmen , Ortigosa Luis , Palau Francesc , Sanz Yolanda
Published: June 2011

Celiac disease (CD) is an immune-mediated enteropathy involving genetic and environmental factors whose interaction might influence disease risk. The aim of this study was to determine the effects of milk-feeding practices and the HLA-DQ genotype on intestinal colonization of
Bacteroides
species in infants at risk of CD development. This study included 75 full-term newborns with at least one first-degree relative suffering from CD. Infants were classified according to milk-feeding practice (breast-feeding or formula feeding) and HLA-DQ genotype (high or low genetic risk). Stools were analyzed at 7 days, 1 month, and 4 months by PCR and denaturing gradient gel electrophoresis (DGGE). The
Bacteroides
species diversity index was higher in formula-fed infants than in breast-fed infants. Breast-fed infants showed a higher prevalence of
Bacteroides uniformis
at 1 and 4 months of age, while formula-fed infants had a higher prevalence of
B. intestinalis
at all sampling times, of
B. caccae
at 7 days and 4 months, and of
B. plebeius
at 4 months. Infants with high genetic risk showed a higher prevalence of
B. vulgatus
, while those with low genetic risk showed a higher prevalence of
B. ovatus
,
B. plebeius
, and
B. uniformis
. Among breast-fed infants, the prevalence of
B. uniformis
was higher in those with low genetic risk than in those with high genetic risk. Among formula-fed infants, the prevalence of
B. ovatus
and
B. plebeius
was increased in those with low genetic risk, while the prevalence of
B. vulgatus
was higher in those with high genetic risk. The results indicate that both the type of milk feeding and the HLA-DQ genotype influence the colonization process of
Bacteroides
species, and possibly the disease risk.
Identifying Vulnerable Pathways in Mycobacterium tuberculosis by Using a Knockdown Approach
Authors: Carroll Paul , Faray-Kele Marie-Claire , Parish Tanya
Published: June 2011

We constructed recombinant strains of
Mycobacterium tuberculosis
in which expression of specific genes was downregulated to identify vulnerable drug targets. Growth phenotypes in macrophages and culture were used to rank targets: the
dprE1
,
clpP1
, and
fadD32
operons were the best targets and
glnA1
,
glnE
,
pknL
,
regX3
, and
senX3
were poor targets.
Modulation of Morphogenesis in Candida albicans by Various Small Molecules
Authors: Shareck Julie , Belhumeur Pierre
Published: June 2011

The pathogenic yeast
Candida albicans
, a member of the mucosal microbiota, is responsible for a large spectrum of infections, ranging from benign thrush and vulvovaginitis in both healthy and immunocompromised individuals to severe, life-threatening infections in immunocompromised patients. A striking feature of
C. albicans
is its ability to grow as budding yeast and as filamentous forms, including hyphae and pseudohyphae. The yeast-to-hypha transition contributes to the overall virulence of
C. albicans
and may even constitute a target for the development of antifungal drugs. Indeed, impairing morphogenesis in
C. albicans
has been shown to be a means to treat candidiasis. Additionally, a large number of small molecules such as farnesol, fatty acids, rapamycin, geldanamycin, histone deacetylase inhibitors, and cell cycle inhibitors have been reported to modulate the yeast-to-hypha transition in
C. albicans
. In this minireview, we take a look at molecules that modulate morphogenesis in this pathogenic yeast. When possible, we address experimental findings regarding their mechanisms of action and their therapeutic potential. We discuss whether or not modulating morphogenesis constitutes a strategy to treat
Candida
infections.
Structure-Guided Investigation of Lipopolysaccharide O-Antigen Chain Length Regulators Reveals Regions Critical for Modal Length Control
Authors: Kalynych Sergei , Ruan Xiang , Valvano Miguel A. , Cygler Miroslaw
Published: June 2011

The O-antigen component of the lipopolysaccharide (LPS) represents a population of polysaccharide molecules with nonrandom (modal) chain length distribution. The number of the repeat O units in each individual O-antigen polymer depends on the Wzz chain length regulator, an inner membrane protein belonging to the polysaccharide copolymerase (PCP) family. Different Wzz proteins confer vastly different ranges of modal lengths (4 to >100 repeat units), despite having remarkably conserved structural folds. The molecular mechanism responsible for the selective preference for a certain number of O units is unknown. Guided by the three-dimensional structures of PCPs, we constructed a panel of chimeric molecules containing parts of two closely related Wzz proteins from
Salmonella enterica
and
Shigella flexneri
which confer different O-antigen chain length distributions. Analysis of the O-antigen length distribution imparted by each chimera revealed the region spanning amino acids 67 to 95 (region 67 to 95), region 200 to 255, and region 269 to 274 as primarily affecting the length distribution. We also showed that there is no synergy between these regions. In particular, region 269 to 274 also influenced chain length distribution mediated by two distantly related PCPs, WzzB and FepE. Furthermore, from the 3 regions uncovered in this study, region 269 to 274 appeared to be critical for the stability of the oligomeric form of Wzz, as determined by cross-linking experiments. Together, our data suggest that chain length determination depends on regions that likely contribute to stabilize a supramolecular complex.
Recognition of DNA by the Helix-Turn-Helix Global Regulatory Protein Lrp Is Modulated by the Amino Terminus
Authors: Hart Benjamin R. , Mishra Pankaj K. , Lintner Robert E. , Hinerman Jennifer M. , Herr Andrew B. , Blumenthal Robert M.
Published: June 2011

The AsnC/Lrp family of regulatory proteins links bacterial and archaeal transcription patterns to metabolism. In
Escherichia coli
, Lrp regulates approximately 400 genes, over 200 of them directly. In earlier studies,
lrp
genes from
Vibrio cholerae
,
Proteus mirabilis
, and
E. coli
were introduced into the same
E. coli
background and yielded overlapping but significantly different regulons. These differences were seen despite amino acid sequence identities of 92% (
Vibrio
) and 98% (
Proteus
) to
E. coli
Lrp, including complete conservation of the helix-turn-helix motifs. The N-terminal region contains many of the sequence differences among these Lrp orthologs, which led us to investigate its role in Lrp function. Through the generation of hybrid proteins, we found that the N-terminal diversity is responsible for some of the differences between orthologs in terms of DNA binding (as revealed by mobility shift assays) and multimerization (as revealed by gel filtration, dynamic light scattering, and analytical ultracentrifugation). These observations indicate that the N-terminal tail plays a significant role in modulating Lrp function, similar to what is seen for a number of other regulatory proteins.
The Campylobacter jejuni Transcriptional Regulator Cj1556 Plays a Role in the Oxidative and Aerobic Stress Response and Is Important for Bacterial SurvivalIn Vivo
Authors: Gundogdu Ozan , Mills Dominic C. , Elmi Abdi , Martin Melissa J. , Wren Brendan W. , Dorrell Nick
Published: June 2011

Campylobacter jejuniis the leading bacterial cause of human gastroenteritis worldwide. Despite stringent microaerobic growth requirements,C. jejuniis ubiquitous in the aerobic environment and so must possess regulatory systems to sense and adapt to external stimuli, such as oxidative and aerobic (O2) stress. Reannotation of theC. jejuniNCTC11168 genome sequence identified Cj1556 (originally annotated as a hypothetical protein) as a MarR family transcriptional regulator, and further analysis indicated a potential role in regulating the oxidative stress response. AC. jejuni11168HCj1556mutant exhibited increased sensitivity to oxidative and aerobic stress, decreased ability for intracellular survival in Caco-2 human intestinal epithelial cells and J774A.1 mouse macrophages, and a reduction in virulence in theGalleria mellonellainfection model. Microarray analysis of gene expression changes in theCj1556mutant indicated negative autoregulation ofCj1556expression and downregulation of genes associated with oxidative and aerobic stress responses, such askatA,perR, andhspR. Electrophoretic mobility shift assays confirmed the binding of recombinant Cj1556 to the promoter region upstream of theCj1556gene.cprS, which encodes a sensor kinase involved in regulation of biofilm formation, was also upregulated in theCj1556mutant, and subsequent studies showed that the mutant had a reduced ability to form biofilms. This study identified a novelC. jejunitranscriptional regulator, Cj1556, that is involved in oxidative and aerobic stress responses and is important for the survival ofC. jejuniin the natural environment andin vivo.
Synthesis and characterization of DMAP-modified NPY Y1 receptor antagonists as acyl-transfer catalysts
Authors: Weiss Stefan , Bernhardt Günther , Buschauer Armin , König Burkhard
Published: May 2011

Starting from the working hypothesis that specific chemical labelling may be an attractive approach to detect and study G protein-coupled receptors (GPCRs) we synthesized catalytically active antagonists of the neuropeptide Y1 receptor (Y1R). An argininamide-type Y1R antagonist scaffold was combined with a DMAP moiety via spacers of different length and chemical nature. These hybrid compounds have Y1R affinities in the two-digit nanomolar range and are capable of catalysing acyl-transfer reaction to surrogates of bionucleophiles, as demonstrated in the absence of cells by using esters of fluorescent dyes as substrates in buffer. By contrast, selective staining of Y1Rs on living MCF-7 cells was not achieved due to significant non-catalysed (Y1R ligand independent) reaction with biomolecules and the limited density of Y1R on the cell surface. Although this may also depend on insufficient selectivity of the staining reagents, the results of this study suggest that the general applicability of catalytic staining to GPCRs has to be reconsidered, as this approach is hampered by a very low portion of receptor of interest compared to the total amount of membrane proteins.
A new journal
Authors: Noble Bill
Published: May 2011

BMJ Supportive & Palliative Careis a journal for clinicians, researchers and other healthcare workers in all clinical services where supportive and palliative care is practised. The journal aims to link many disciplines and specialties throughout the world; promoting an exchange of research evidence and innovative practice by presenting high quality scientific reports, reviews, comment, information and news of international importance.
Advance care planning in life limiting illness
Authors: Judez J , Vivancos L , Antunez C , Quesada M , Novoa A , Feito L , Ogando B
Published: May 2011

In the Spanish advance care planning (ACP) Program ‘KAYRÓS- Helping Conversations’, inspired in Respecting Choices philosophy, we developed an innovative cluster research, NEURO-KAYRÓS, applied to two neurodegenerative diseases with contrasting trajectories: early Alzheimer's Disease (AD)-grant research project for clinical research ACP implementation in dyads (patient-surrogate)- and Amyotrophic Lateral Sclerosis (ALS)- stem cell non-commercial research grant clinical trial with clinical psychology follow-up. We monitor the ACP dyadic (patient-surrogate) interview with tools, combining quantitative with qualitative approaches, that allow us to gain insight in the process of living (and planning) with a threatening neurodegenerative illness/hoping for the best/preparing for the worst. Quantitative tools for: ACP knowledge; trends of preferences for goals of treatment in different potential (or experienced) losses during illness trajectory; congruence with surrogate; critical milestones marking transitions. Qualitative tools: discussion groups and in-depth interview.

AD and ALS although share some common features, leaning towards dependency, vary significantly in some key notes regarding both with the perception of the illness trajectory (related to patient's own biography) and, along it, with the potential support received from the ACP process.

Initial lessons from the first 6 months of the ongoing 2 year project.

Illness trajectory (perception AD vs ALS): (slow) cognitive versus (fast) physical decline; advanced versus middle-age; slow versus fast adaptation (subject, carers & environment); role of substituted decision.

ACP Process: in clinical versus research (clinical trial) setting; from ignorance to gratitude if initial anxiety and/or threat are overcome by a system that shows that cares and stands, come what may.
Sustainable ACP in aged care facilities with dedicated time and funding
Authors: Neale D , Mann J
Published: May 2011

Barwon Health is Victoria's largest regional health service. Alan David Lodge (ADL) is an Aged Care Facility providing high level care for approximately 105 residents.

Advance care planning (ACP) is included in the goals of care for residents at ADL but had not been fully implemented due to staff limitations, in particular the availability of time, for trained staff to facilitate the ACP process. The Respecting Patient Choices (RPC) program at Barwon Health provided funding for a dedicated 4 h per week over a 6-month period to allow staff that had previously completed RPC training/workshops to facilitate ACP at ADL.

RPC program provided education sessions and support for staff and this together with dedicated time to facilitate the process, produced a significant increase in participation of residents and families in ACP through consultation with familiar staff whereby there is an established rapport.

It was anticipated that improved quality of care for residents and a reduction in the incidence of family/staff conflict would result by ensuring medical treatment and personal wishes were known prior to a health crisis. The potential improvement in resource allocation through reduced acute admissions, dislocation and medical interventions was also highly probable but not measurable during the project period.

Overall there was a marked increase in ACP uptake and the outcomes of the project demonstrated that with a moderate amount of dedicated funding and allocated hours a sustainable model for ACP in aged care facilities is achievable.
Effective measures towards satisfactory and enjoyable retirement period in Nigeria
Authors: Imonikebe B
Published: May 2011

As one works for a paid job for many years there will come a time of rest. This is the period of retirement. Retirement is actually for elderly people. Retirement may involve leaving a paid job one has been engaged in for 10–35 years or more. There is really no need for an individual to be afraid of retirement if one is fully prepared for it. The most important thing is to retire at the right time when one actually needs it. In order to enjoy one's retirement period, it involves planning ahead one's working life. This also involves a change of attitude and perception of what retirement is. There is need to see retirement period as a time or stage in which an individual transits from working to earn money to a period in which money works for one. This study investigated the hindrances and measures for promoting satisfactory and enjoyable retirement period in Nigeria. The population comprised of Nutritionists, Home Economists, Nurses, Medical doctors, civil servants, retired men and women from five states in Nigeria (Oshun, Delta, Lagos, Edo and Ekiti States). A sample of 250 persons was randomly selected. Questionnaire was used for data collection. The data were tabulated and analyzed by computing the percentages, mean, SD and variance of the responses. T-test was the test statistics employed. Results showed the followings as major hindrances to successful retirement: Fear of retirement, unpreparedness for retirement, having little or no savings, owing of debts before retirement, having too much of financial commitment, negative attitude to retirement. Some of the measures for promoting satisfactory and enjoyable retirement are as follows; Understanding the concepts/purpose of retirement, planning and saving substantially ahead for retirement, seeing retirement as a period of reward when one does not work for money but when money works for one; Getting good ideas from older retirees; Adequate budgeting and purchasing only necessary items; taking up a less strenuous part-time or full-time job; Maintaining a healthy life style, (Exercising regularly, eating of balanced diet and keeping to principles of hygiene). There were some significant differences (p<0.05) between the responses of the medical practitioners (doctors/nurses) and the Home Economists/Nutritionists on the measures for promoting satisfactory/enjoyable retirement. It was recommended that workers should be retirement-conscious right from when they take up their appointment. They should plan and save ahead for retirement. Those who are about to retire should develop positive attitude towards retirement period. Retirement Education should be given to workers and retirees.
Deaths in older adults in England
Authors: Verne J , Ruth K , Pring A
Published: May 2011

We will present key results from the report, ‘Deaths in Older Adults in England' produced by the South West Public Health Observatory on behalf of the National End of Life Care Intelligence Network. This report describes differences in place and cause of death in older people and is part of work to provide information and evidence to support the End of Life Care Strategy.

The report analysed deaths in people aged 75 and over registered in England in 2006–2008 (source: ONS mortality data). There were differences in underlying cause of death and place of death according to age and sex. In people aged 75 and over, a higher proportion of deaths in females were from pneumonia (organism unspecified), stroke and dementia compared with males. Deaths from senility and dementia were more common with increasing age. In people aged 75 and over, a greater proportion of males than females died in hospital or in their own residence, while a lower proportion of males than females died in nursing homes and old people's homes.

It is important to consider the implications of these findings when planning end of life care services as two-thirds of deaths in England are in people aged 75 and over and, in the future, the proportion of deaths in the oldest age groups are expected to increase further.
Difference is opinion regarding end-of-life between older patients and their family, a Thai perspective
Authors: Kajornkijaroen A , Srinonprasert V , Kornbongkotmart S , Praditsuwan R
Published: May 2011

Making decision for the love ones toward the end-of-life is a sensitive and complex task. Having established advance care plan is rarely occurred in Eastern culture. The discordance among patients and decision makers has been documented in literature but never been explored in Thailand. We conducted a survey among geriatric patients using 5-category likert scale, 13-situation-based questionnaire. We also enquired the families to rate how they believed what older patients would have thought regarding issues in end-of-life care.

Elderly and their families demonstrated fairly similar attitude for most of the items inquired. However, significant higher proportion of patients wished not to be a burden to their families and not to prolong suffers when chance of survival is slim.

Of note, only 45.2% of patients wished to pass away at home while 70% of family believed that older patients would have wanted to die at home. Factor associated with agreeing to die at home were age less than 75, having education more than 4 years and being single with OR of 2.93 (1.39 to 6.16; p=0.005), 2.76 (1.30 to 5.87; p=0.009) and 2.78 (1.33 to 5.83; p=0.007),respectively
The survey of opinions regarding good death for geriatric patients from the perspectives of geriatric patients and physicians
Authors: Kornbongkotmas S , Srinonprasert V , Kajornkitjaroen A , Praditsuwan R
Published: May 2011

Nowadays growing concern over providing the best possible end-of-life care for geriatric patients has been raised worldwide. It is not uncommon that different perspectives of patients, families and caring physicians may result in unwanted suffering of dying patients. Learning the differences might lead to appropriate interventions and bring about better quality of care for older patients toward the end of life.

We conducted a survey on older patients and physicians at a university hospital inThailand. We elicited opinions on end-of-life care by applying 5-category likert scale, 13-situation-based questionnaire. Older people were asked to rate their agreement with those items while physicians were enquired to rate their opinions on what they believed older people would have thought. We also enquired participants to rank the most important aspects concerning good death.

Nearly 90% of physicians believed that older people would wish to be involved in decision-making and completing unfinished business while only 70% elderly really did. Being mentally aware was rated by older patients at much higher proportion than physicians. More importantly, one-fourth of older patient did not wish to die at home while only 6% of physician believed so. The only factor associated with not willing to pass away at home among these two groups after adjusted in multivariate analysis was sex. When it came to ranking the most important aspect, older patients place it on not to prolong suffering while this was not ranked on the top-three items by physicians.
‘Futility’ – let's put it out of its misery
Authors: Saul P
Published: May 2011

Though still on life support, George improved when his infected leg was amputated above the knee. But his wife, Annette, pleaded with the surgeon to withdraw intensive care treatment. George had made her promise that she would never let him have an amputation.

But who has the authority to make this choice? The surgeon believed it was the best medical practice to continue (as treatment was not ‘futile’), but George very clearly had a preference, and Annette a responsibility to promote it.

The concept of futility was introduced into this discussion to help resolve this dilemma (which rapidly became a dispute), and, as often happens, failed to produce a resolution.

The notion of futility has been dissected in countless law courts, medical journals and standard textbooks of medical ethics for a generation. But much of the discussion has, ironically, proved futile and numbers of publications in this area is rapidly falling. I suggest that futility, as originally conceived in a medical setting, is no longer a valid concept, and, like euthanasia, is a term better abandoned than further debated.

I suggest that, as in debates about ‘best interests’ (another term looking for a definition), all discussion eventually returns to what the patient or family might have seen as important. The very basis of futility, originally conceived as a medical judgement based on probabilities, has disappeared.

I contend that we abandon the term, and instead invest in fair and transparent processes that maximise authentic and justifiable decisions.
Investigation on the use of advance directives for patients attending a hospital in Japan
Authors: Miura H , Nishikawa M , Nakashima K , Hong Y J , Detering K , Jones D , Silvester W
Published: May 2011

Background

In Japan, living wills and advance directives (AD) are not commonly used, and there is no system or law to support the decision making of patients. Furthermore, there is no available law about the withdrawal of life-sustaining treatments or appointment of a medical attorney. Thus, medical staff must deal with ethical dilemmas related to medical decision making in end-stage disease.

Aim

To investigate the use of AD for patients attending a hospital of the National Centre for Geriatrics and Gerontology for treatment from May, 2008.

Methods

We examined the contents described in ADs and assessed the trend of the wishes.

Results

To date 127 people (67 female, average age 74.6) have participated. Many have respiratory diseases (26 people) and malignant disorders (21 people). Most people wished to nominate an attorney but only one had a medical attorney, 111 people did not wish for resuscitation. More than 90% did not wish for life-sustaining treatment (respirator, or tube feeding), whereas the wish for intravenous feeding was relatively high (32.3%). As for the place of death, 62 people wished to die in hospital and the least preferred place was at home (11 people).

Conclusion

We found that many Japanese, during their end-of-life care, want to die in hospital while receiving some kind of treatment such as intravenous feeding. The construction of the system to support the decision making of the patients is an urgent problem in Japan.
Advance Care Planning (PEACE) for care home residents in an acute hospital setting: impact on ongoing advance care planning and readmissions
Authors: Hayes N , Kalsi T , Steves C , Martin F , Evans J , Schiff R , Briant L
Published: May 2011

PEACE (Proactive Elderly Advance CarE) is an advance care planning (ACP) developed at two acute hospital sites in London, UK, for care home (nursing) residents prior to discharge. Patient's preferences are documented, or in the cases of mental incapacity, best interests decisions are made, to give clinical advice and escalation decisions for future medical care. The document is sent on transfer back to nursing homes, as agreed with GPs and care homes.

At Site 1, 20 patients were discharged with PEACE and 80% (N=16/20) were followed up at 2 weeks after transfer. 69% (N=11/16) of PEACE documents were in place in the nursing notes. ACPs had further been developed from PEACE in 73% (N=8/11). None of these residents were readmitted to the discharging hospital to date. However, of those residents whose ACPs were not further developed, 37.5% (N=3/8) were readmitted inappropriately (palliative plans), and 25% (N=2/8) were readmitted appropriately as judged by their original PEACE document in 3 months.

At Site 2, 12/37 patients discharged over 4 months were sent with a PEACE document. 25% (N=3/12) of patients with a PEACE document were readmitted within 6 months, only 8% (N=1/12) inappropriately. 56% (N=14/25) of nursing home residents discharged without PEACE in the same period were readmitted.

Our findings suggest that PEACE may reduce inappropriate readmissions. The results also suggest that PEACE is useful in supporting further ACP after transfer to care homes.
Variations in hospital death
Authors: Osinowo A , Pring A , Verne J
Published: May 2011

Background

Death largely occurs in old age and there are large variations in the proportion of hospital deaths by Local Authorities (LAs) in England. In the period between 2007 and 2009 deaths occurring in hospital ranged between 43% and 75% with about 12% of LAs having less than 50% hospital deaths. Funnel plots are powerful tools that can be adapted for use in showing and understanding the variations in hospital deaths in English LAs.

Aim

To explore variations in proportion of hospital deaths in LAs by age of population.

Methods

Age specific mortality data relating to place of death were extracted from ONS mortality files for years 2007–2009. Hospital deaths as a proportion of all deaths in LAs were calculated and funnel plots were used to study variations by population size and by age.

Results

The proportions of LA deaths in hospital are overdispersed, with more LAs lying outside the control limits of the funnel plot than would be expected if the size of a LA were the only factor predicting hospital death. Factors such as social deprivation, demographics and local End of Life (EOL) care service configuration contribute to the overdispersion for example, some LAs provide specialist palliative care services within hospitals while others provide this service elsewhere. EOL care in less well organised LAs may result in people near the EOL being unnecessarily admitted to die in hospital.

Conclusions

Place to place comparison of hospital deaths reveals stack differences which must be understood to ensure equality of care.
Religious affiliation on end-of-life decisions in intensive care units
Authors: Kleanthous E
Published: May 2011

Objective

End of life is frequently enforced in intensive care units in several countries. Recent surveys have shown that medical practices for end of life vary between countries among health care professionals. Religious affiliation has been included among other factors such as culture, attitudes of health care professionals, legislation, illness, quality of life and others. The determination and the affiliation of religion in end of life decisions in intensive care units is the objective of this review study. In addition in this review we are presenting the conventions and opinions of major religions regarding end of life care and decisions in intensive care units.

Design

For this review CINAHL, Pubmed and Medline were searched under the keywords ‘religion’, ‘end of life’ and ‘intensive care units’.

Results

There are several different opinions among health care professionals in the issue of religion which influence end of life decisions in intensive care units. Health care professionals must understand patients' and families' religion and culture in order to provide better end of life care in patients. Furthermore, understanding religious affiliation will enhance communication among health care professionals with patients and families. Religious affiliation may support the development of guidelines for end of life practices.
Keeping Vigil in hospital – the impact of a care of the dying pathway on non-palliative care staff in an acute hospital setting
Authors: Groves K , Hough J , Jack B
Published: May 2011

This study was of a qualitative design and consisted of semi-structured interviews of nursing and medical staff in a district general hospital in the northwest of England. The interviews were transcribed verbatim and then thematic analysis was then used to explore emerging themes.

16 interviews took place of non-palliative care staff of all grades and disciplines. Seven nurses and nine doctors were interviewed. Emergent themes were that the pathway is used across all the disciplines that took part with wide use in non-cancer patients. Participants generally felt that the pathway had a positive impact in care of the dying. Perceived barriers included difficulty in diagnosing dying and the review/discontinuation of unnecessary interventions. The amount of training in use of the pathway that participants had had was extremely varied.

Although, the pathway has a perceived positive impact in this acute hospital setting, there are still barriers to its use and variability in confidence and knowledge of those involved in it's use. It would appear that there is a need for mandatory training for health professionals involved in the care of dying patients and the ongoing support of a pathway coordinator.

As a result of this study and other work that has taken place, as well as having an end of life coordinator for the whole hospital, there is now going to be a nominated end of life team from each ward.
Developing an advance care planning tool – opportunities and challenges
Authors: Alleyne R , Vaughan J , Campbell H
Published: May 2011

The advance care planning document developed acts as a framework for opening up a discussion between patient and the health or social care professional, and maintains the patient at the centre of the discussion.

It comprises three main sections; advance statement, advance decisions and contact information. Collating this information in one document facilitates a potentially difficult discussion to have with patients; prompting the palliative care team into asking the relevant questions and recording them in a logical, complete yet succinct format. This work builds upon other documents used by palliative care teams to guide such discussions but our plan is novel in it's inclusion of both advance statement and advance decision sections.

We have already generated quantitative and qualitative data from users and facilitators of the document which we are currently piloting in Worcester by asking them to complete a questionnaire evaluating the usability as well as practical and emotional relevance from the perspectives of the facilitator and user respectively. This data can then be used to reflect upon the effectiveness of this document both for the patient and the palliative care team and its value as a county wide document.