Cardiovascular Autonomic Response to Orthostatic Stress Under Hypoxia in Patients with Spinal Cord Injury

High Altitude Medicine &Biology, Ahead of Print.


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Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS): prospective cohort study protocol

Abstract

Background

Advanced cancer significantly impacts quality of life of patients and families as they cope with symptom burden, treatment decision-making, uncertainty and costs of treatment. In Singapore, information about the experiences of advanced cancer patients and families and the financial cost they incur for end-of-life care is lacking. Understanding of this information is needed to inform practice and policy to ensure continuity and affordability of care at the end of life. The primary objectives of the Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) cohort study are to describe changes in quality of life and to quantify healthcare utilization and costs of patients with advanced cancer at the end of life. Secondary objectives are to investigate patient and caregiver preferences for diagnostic and prognostic information, preferences for end-of-life care, caregiver burden and perceived quality of care and to explore how these change as illness progresses and finally to measure bereavement adjustment. The purpose of this paper is to present the COMPASS protocol in order to promote scientific transparency.

Methods

This cohort study recruits advanced cancer patients (n = 600) from outpatient medical oncology clinics at two public tertiary healthcare institutions in Singapore. Patients and their primary informal caregiver are surveyed every 3 months until patients' death; caregivers are followed until 6 months post patient death. Patient medical and billing records are obtained and merged with patient survey data. The treating medical oncologists of participating patients are surveyed to obtain their beliefs regarding care delivery for the patient.

Discussion

The study will allow combination of self-report, medical, and cost data from various sources to present a comprehensive picture of the end-of-life experience of advanced cancer patients in a unique Asian setting. This study is responsive to Singapore's National Strategy for Palliative Care which aims to identify opportunities to meet the growing need for high quality care for Singapore's aging population. Results will also be of interest to policy makers and researchers beyond Singapore who are interested to understand and improve the end-of-life experience of cancer patients.

Trial registration

NCT02850640 (Prospectively registered on June 9, 2016).

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The Effect of Digested Manure on Biogas Productivity and Microstructure Evolution of Corn Stalks in Anaerobic Cofermentation

The anaerobic fermentation of crop straw and animal wastes is increasingly used for the biogas and green energy generation, as well as reduction of the environmental pollution. The anaerobic cofermentation of corn stalks inoculated by cow dung was found to achieve higher biogas production and cellulose biodegradation. In this study, the effect of mixing corn stalks with cow dung at five different fermentation stages (0, 7, 15, 23, and 31 days of the total fermentation cycle of 60 days) on the further cofermentation process was explored, in order to optimize the corn straw utilization rate and biogas production capacity. In addition, the straw microstructure evolution was investigated by the SEM and XRD methods to identify the optimal conditions for the straw biodegradation process enhancement. The five test groups exhibited nearly identical total biogas productivity values but strongly differed by daily biogas yields (the maximal biogas generation rate being 524.3 ml/d). Based on the degradation characteristics of total solids (TS), volatile solids (VS), and lignocellulose, groups #1 and #3 (0 and 15 days) had the most significant degradation rates of VS (43.73%) and TS (42.07%), respectively, while the largest degradation rates of cellulose (62.70%) and hemicellulose (50.49%) were observed in group #4 (23 days) and group #1 (0 days), respectively. The SEM analysis revealed strong microstructural changes in corn stalks after fermentation manifested by multiple cracks and striations, while the XRD results proved the decrease in peak intensity of cellulose crystal surface and the reduced crystallinity after cofermentation. The results of this study are assumed to be quite instrumental to the further optimization of the corn stalk anaerobic digestion by inoculation with digested manure for lignocellulose degradation enhancement and biogas productivity improvement.

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Dose effects of mycophenolate mofetil in Chinese patients with neuromyelitis optica spectrum disorders: a case series study

Neuromyelitis optica (NMO) spectrum disorder (NMOSD) is a devastating autoimmune inflammatory disorder of the central nervous system, which can result in blindness or paralysis. Currently, there is a dire need...

https://ift.tt/2Jk8361

Predictors of post-stroke fever and infections: a systematic review and meta-analysis

Fever after stroke is common, and often caused by infections. In the current study, we aimed to test the hypothesis that pneumonia, urinary tract infection and all-cause fever (thought to include at least some...

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Acquired modification of sphingosine-1-phosphate lyase activity is not related to adrenal insufficiency

Congenital sphingosine-1-phosphate (S1P) lyase deficiency due to biallelic mutations in SGPL1 gene has recently been described in association with primary adrenal insufficiency and steroid-resistant nephrotic syn...

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Take with Food: Study Tests Lowering Dose of Prostate Cancer Drug

In a small clinical trial, researchers compared the efficacy of a much lower dose of the cancer drug abiraterone (Zytiga) taken with a low-fat breakfast with a full dose taken on an empty stomach, as directed on the drug's label.

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