Goals of care communication and higher-value care for patients with advanced-stage cancer: A systematic review of the evidence

ContextGoals-of-care communication (GOCC) is recommended to increase the value of cancer care near the end of life (EOL).ObjectivesConduct a systematic review of the evidence that GOCC is associated with higher-value care.MethodsWe searched PubMed, Scopus, Ovid MEDLINE, EMBASE, EMB Reviews, CINAHL, and PsycInfo from inception to July 2019. We analyzed the population,design, and results and the authors’ definitions of GOCC. Risk of bias was assessed.ResultsThirty-two articles were selected. Ten articles reported results from 8 interventions; 17 characterized participants’ perspectives; and 5 were retrospective The topics, behaviors, timing, and anticipated outcomes of GOCC varied significantly and were indistinguishable from practices such as advance care planning. GOCC typically focused on treatment outcomes rather than patients’ goals. Four of 5 interventions increased evidence of GOCC after clinician training. Only one reported improved patient outcomes.ConclusionNo consensus exists about what GOCC entails. There is limited evidence that GOCC increases the value of EOL care.Practice implicationsFuture studies should focus on how to engage patients in conversations about their personal goals and integrate their goals into care planning. Clinicians can encourage GOCC by explaining how patients’ goals influence decisions especially as treatment options become limited.     

Neuropeptide Y and maternal behavior in the female native Thai chicken

Maternal care behaviors in birds include incubation and rearing behaviors. During incubating period, the hens stop laying and eating less due to food restriction as a natural fasting when compared with the rearing hens, resulting in low production of eggs and chicks. Neuropeptide Y (NPY), a neurotransmitter/neuromodulator, is very well known to be involved in food intake regulation in birds and mammals. The objective of this study is to elucidate the association between NPY and maternal behaviors in the female native Thai chicken. The distributions of NPY-immunoreactive (-ir) neurons and fibers in the brain of the incubating (INC), nest-deprived (ND), and replaced-egg-with-chicks (REC) hens at day 6 were determined utilizing immunohistochemistry technique. The results revealed that the distributions of NPY-ir neurons and fibers were observed within the septalis lateralis, nucleus rotundus, and nucleus dorsolateralis anterior thalami, with predominantly located within the the nucleus paraventricularis magnocellularis (PVN). NPY-ir fibers were located throughout the brain and the densest NPY-ir fibers were distributed in a discrete region lying close to the ventriculus tertius (third ventricle) through the hypothalamus. Changes in the number of NPY-ir neurons within the PVN of the INC, ND, and REC hens were compared at different time points (at days 6 and 14). Interestingly, the number of NPY-ir neurons within the PVN was significantly higher (P < 0.05) in the INC hens when compared with those of the ND and REC hens at day 14 but not day 6. In addition, the number of NPY-ir neurons within the PVN of the INC hens was significantly increased (P < 0.05) from day 6 to day 14 but not the ND and REC hens. These results indicated, for the first time, the asscociation between NPY and maternal behaviors in the femle native Thai chicken. Change in the number of NPY-ir neurons within the PVN during the transition from incubating to rearing behavior suggested the possible role of NPY in the regulation of the maternal behaviors in this equatorial species. In addition, the native Thai chicken might be an excellent animal model for the study of this phenomenon.     

Knowledge,Behaviors, and Social Factors That Influence Pregnancy Weight Gain among Youth Ages 16-24 Years

Study ObjectiveA large proportion (50%-75%) of youth (younger than 21 years old) who become pregnant gain more weight during pregnancy than is recommended by the National Academy of Medicine. Excess weight gain during pregnancy is a strong risk factor for long-term obesity among mothers and their infants. There is a significant gap in our understanding of youth's knowledge and behavior related to weight gain during pregnancy. To develop effective interventions for pregnant youth, it is necessary to understand their distinct needs and preferences. Using a youth-centered qualitative approach, the purpose of this study was to explore the knowledge, behaviors, and social factors that influence weight gain during pregnancy for youth.DesignParticipants completed weekly text message surveys and semistructured interviews to explore their perspectives of weight gain during pregnancy. Data were analyzed using qualitative thematic analysis on the basis of grounded theory.Setting and ParticipantsPregnant youth ages 16-24 years old recruited from 2 urban, low-income, primary care clinics in Southeast Michigan.Interventions, Main Outcome Measures, and ResultsAmong our sample (N = 54) 4 themes emerged. First, many youths were knowledgeable about healthy behaviors in pregnancy. However, the second theme showed that many youths reported barriers to engaging in these healthy behaviors, including stress, poor motivation, and issues of convenience. Third, they showed inadequate knowledge about exercise in pregnancy, and fourth, many endorsed food cravings that significantly influenced diet choices.ConclusionMany pregnant youths have appropriate knowledge about healthy behaviors during pregnancy, but face many youth-specific barriers to achieving these behaviors. Interventions should address logistical challenges (eg, food access, cost, transportation) to healthy behaviors in pregnancy to make healthy diet and exercise more convenient for pregnant youth.     

Advax adjuvant formulations promote protective immunity against aerosol Mycobacterium tuberculosis in the absence of deleterious inflammation and reactogenicity

The development of safe and effective adjuvants is a critical goal of vaccine development programs. In this report, we defined the immunostimulatory profile and protective effect against aerosol Mycobacterium tuberculosis infection of vaccine formulations incorporating the semi-crystalline adjuvant δ-inulin (Advax). Advax formulated with CpG oligonucleotide and the QS-21 saponin (Advax^CpQS) was the most effective combination, demonstrated by the capacity of CysVac2/Advax^CpQS to significantly reduce the bacterial burden in the lungs of M. tuberculosis-infected mice. CysVac2/Advax^CpQS protection was associated with rapid influx of neutrophils, macrophages and monocytes to the site of vaccination and the induction of antigen-specific IFN-γ⁺/IL-2⁺/TNF⁺ polyfunctional CD4⁺ T cells in the lung. When compared to the highly potent adjuvant combination of monophosphoryl lipid A and dimethyldioctadecylammonium bromide (MPL/DDA), Advax^CpQS imparted a similar level of protective efficacy yet without the profound stimulation of inflammatory cytokines and vaccination site ulceration observed with MPL/DDA. Addition of DDA to CysVac2/Advax^CpQS further improved the protective effect of the vaccine, which correlated with increased polyfunctional CD4⁺ T cells in the lung but with no increase in vaccine reactogenicity. The data demonstrate that Advax formulations can decouple protective tuberculosis immunity from reactogenicity, making them ideal candidates for human application.     

脑卒中住院患者健康素养与健康行为的相关性研究

目的探讨脑卒中住院患者健康素养与健康行为的相关性,为患者康复护理干预提供参考。方法便利选取贵阳市4所三级甲等医院卒中单元和康复医学科的康复期脑卒中患者508例,采用慢性病患者健康素养调查量表、健康促进生活方式量表Ⅱ、一般情况调查表进行调查。结果脑卒中患者健康素养总得分为(31.67±8.79)分,健康行为总得分为(127.18±24.19)分。患者健康素养水平与健康行为水平呈正相关(r=0.633,P0.01)。结论脑卒中患者健康素养与健康行为呈正相关,护理人员应采取措施提高患者健康素养,促使其形成良好的健康行为。     

父母喂养行为与其学龄前子女进食行为的作用关系

父母喂养行为与其学龄前子女进食行为之间关系甚密,但两者孰因孰果尚不明晰。本文就上述问题进行文献综述,着重梳理了学龄前儿童进食行为和父母喂养行为之间的作用关系,并尝试分析其中可能的原因,为今后开展深入研究提供理论依据。     

Effect of Fiber Content and Alignment on the Mechanical Properties of 3D Printing Cementitious Composites

This paper studies aligned glass fiber-reinforced composites for printing. To determine the influence of fiber content and alignment on the mechanical properties of this novel material, a large number of standard test specimens were prepared, which included samples fabricated by mold-casting, randomly dispersed fiber reinforced mixtures and aligned fiber cement composites containing 10 types of fiber volume ratios manufactured by nozzle sizes ranging of 24 and 10 mm (fiber length = 12 mm). Mechanical properties and failure modes of the specimens under compression and flexural tests were studied experimentally. The anisotropic behaviors of printed samples were analyzed by different loading directions. As a result, the compressive and flexural strength of printed samples showed obvious anisotropy. With the increase of fiber volume ratio, flexural strength of the fiber reinforced composite was elevated tremendously but its compression strength reduced slightly. Moreover, fiber alignment also had a significant influence on the mechanical properties of the fiber reinforced composite. The composite cement-based material with 1 vol.-% aligned fiber exhibited an excellent flexural strength of 9.38 MPa, which increased by 483% in comparison to that of the plain cement paste.