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Context: Given that the composition of hospice patients’ terminal diagnoses has become increasingly diverse, understanding whether hospices provide quality care to patients, regardless of disease, is important. However, data comparing diagnosis and caregiver-reported outcomes remain scarce. Objectives: To analyze the association between the composition of patients’ terminal diagnoses and caregiver-reported quality measures. Methods: Using cross-sectional, publicly available data from the Centers for Medicare & Medicare Services (CMS), we analyzed data collected from 2015–2019. We conducted general linear model analyses to identify associations between hospice characteristics/practices and caregiver-reported outcomes. Results: Of the 2810 hospices, those that cared for a greater percentage of dementia patients had fewer caregivers, on average, who rated hospice a 9 or 10 (where 0 = low, 10 = high; β = −.094; 95% CI = −.147, −.038), reported they always received help for pain and symptoms (β = −.106, CI = −.156, −.056), and reported definitely having received the training they needed (β = −.151, CI = −.207, −.095). Those caring for more stroke patients had fewer caregivers, on average, who rated hospice a 9 or 10 (β = −.184, CI = .252, −.115), reported they always received help for pain and symptoms (β = −.188, CI = −.251, −.126), reported definitely having received the training they needed (β = −.254, CI = −.324, −.184), and reported that the hospice offered the right amount of emotional/spiritual support (β = −.056, CI = −.093, −.019). Conclusion: Hospices that cared for a greater proportion of dementia and stroke patients had poorer scores on caregiver-reported quality measures. These findings support efforts to identify mechanisms underlying these differences and to design strategies to ensure optimal outcomes for hospice patients regardless of diagnosis.

Context Given the high prevalence of burdensome symptoms in palliative care (PC) and increasing use of complementary and integrative medicine (CIM) therapies, research is needed to determine how often and what types of CIM therapies providers recommend to manage symptoms in PC. Objective To document recommendation rates of CIM for target symptoms and assess if CIM use varies by provider characteristics. Methods Nationwide survey of physicians (MD and DO), physician assistants, and nurse practitioners in PC. Results Participants (N=404) were mostly female (71.3%), physicians (74.9%), and cared for adults (90.4%). Providers recommended CIM an average of 6.82 times per-month (95% CI: 6.04-7.60) and used an average of 5.13 (95% CI: 4.90-5.36) out of 10 CIM modalities. Respondents recommended mind-body medicines (e.g., meditation, biofeedback) most, followed by massage, and acupuncture/acupressure. The most targeted symptoms included pain; followed by anxiety, mood disturbance and distress. Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g., aromatherapy for constipation) to occasional use (e.g., mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, non-inpatient practice setting, provider age, and proportion of effort spent delivering palliative care. Conclusion To the best of our knowledge, this is the first national survey to characterize PC providers’ CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of CIM but do so less frequently than patients report using CIM. These findings should be of interest to any provider caring for patients with serious illness.

Rabson-Mendenhall syndrome is a rare genetic disorder characterized by severe insulin resistance and hyperinsulinemia due to defects in signaling through the insulin receptor. Herein, we describe a new case of Rabson-Mendenhall syndrome in which investigations of the growth hormone (GH) – insulin-like growth factor (IGF) axis – reveal severe deficiencies in total and free insulin-like growth factor-I (IGF-I), IGF-II, IGF-binding protein-3 (IGFBP-3), and the acid labile subunit (ALS). Based on these findings, we anticipated significant bone deficits, as have been described in other clinical scenarios in which the IGF axis is significantly perturbed. Long-bone studies revealed no gross malformations. Paradoxically, DXA scanning revealed a total body bone density Z -score of +2.0 (0.8 gm/cm 2 ), suggesting an overall high-normal BMD for age and a high BMD corrected for bone or height age. The mechanisms by which BMD is protected from severe deficiencies in the IGF-axis are unknown, yet may involve enhanced IGF sensitivity, increased local production of IGFs, and/or supra-physiological concentrations of insulin substituting for the actions of IGFs in bone.

Humic and fulvic acid components in coal slurry transport wastewater (pipeline and laboratory generated) were fractionated by XAD-8 adsorption chromatography. The wastewaters were dominated by fulvic acids with humic acid contributing

Concentrations of reduced glutathione (GSH) and oxidized glutathione (GSSG) and 4 trace metals (Ni, Cu, Mn, Zn) were measured in livers from rats treated with sodium diethyldithiocarbamate (DDC, 0.67 or 1.33 mmol/ kg, i.m.) and NiCl 2 (0.25 or 0.50 mmol/kg, s.c.), singly or in combination. In rats treated with DDC or NiCl 2 , singly, hepatic GSH was diminished at 4 h and returned to control levels (or slightly above) at 17 h. In rats that received DDC plus NiCl 2 , hepatic GSH was not diminished at 4 h and was increased 1.4–1.8-fold at 17 h. Hepatic GSSG was diminished at 4 h after NiCl 2 treatment and returned to control values at 17 h; hepatic GSSG did not differ from control values at 4 h or 17 h after treatment with DDC, alone or combined with NiCl 2 . Hepatic Ni was below the detection limit (∼ 20 nmol/g) in control and DDC-treated rats; hepatic Ni was increased to 53 ± 26 (S.D.) nmol/g at 17 h after treatment with NiCl 2 alone, and was increased 6-fold (308 ± 63 nmol/g in rats that received Ni plus DDC. Under the same conditions, hepatic Zn was increased 33% or 41%, respectively, in rats that received NiCl 2 or DDC, singly, and was not further increased by combined treatment; hepatic Cu and Mn concentrations were unaffected by NiCl 2 or DDC, singly, but were diminished in rats that received NiCl 2 and DDC. This study suggests: (a) that increased hepatic uptake of Ni is largely responsible for the synergistic induction of heme oxygenase activity in rats treated with NiCl 2 and DDC; and (b) that increased hepatic uptake of Zn contributes to the induction of hepatic metallothionein by NiCl 2 and DDC.

Fractionations of /sup 63/Ni-constituents were performed by high-performance size-exclusion chromatography upon samples of renal cytosol and washed renal microsomes from rats that were killed 1 h after an im injection of /sup 63/NiCl2. Chromatography of renal cytosol on TSK-GEL SW-2000 and SW-3000 separated /sup 63/Ni into six fractions. The largest component (Fraction F) contained approximately 80% of cytosolic /sup 63/Ni. Since Fraction F was eluted near the total permeation volume of SW-2000 columns and beyond the total permeation volume of SW-3000 columns, its molecular weight could not be reliably estimated. The other components, which comprised collectively the remaining 20% of cytosolic /sup 63/Ni, had apparent molecular weights of 168,000 (Fraction A), 84,000 (Fraction B), 51,000 (Fraction C), 24,000 (Fraction D), and approximately 10,000 (Fraction E). Solubilized washed microsomes from kidneys of /sup 63/NiCl2-treated rats contained /sup 63/Ni in five components with elution profiles and /sup 63/Ni-contents that resembled Fractions A, B, D, E, and F of renal cytosol, based upon chromatography on SW-3000 columns. This study provides a rapid, convenient, and reproducible technique to fractionate /sup 63/Ni-components in tissue extracts, and it demonstrates in vivo binding of /sup 63/Ni to several constituents of renal cytosol and microsomes from /sup 63/NiCl2-treatedmore » rats.« less

Radioimmunoassay of erythropoietin (epo) was performed upon serum samples and kidney extracts from rats that received intrarenal injections of nickel subsulfide (Ni/sub 3/S/sub 2/, 20 mg/rat). Serum epo concentrations were significantly increased from 1 to 4 weeks after Ni/sub 3/S/sub 2/ injection; the highest values occurred at 3 weeks, when serum epo in 5 Ni/sub 3/S/sub 2/-treated rats averaged 230 mU/ml (range = 94 - 370 mU/ml); for comparison, serum epo in 21 vehicle-treated controls averaged 19 mU/ml (range =