Do-not-resuscitate order. What happens after hospital discharge?

We observed 55 inpatients with "do-not-resuscitate" (DNR) orders to determine what happened to their DNR status after hospital discharge. All were admitted to the medical service of a Department of Veterans Affairs hospital. Of the 55 patients, 16 died in the hospital, 10 were discharged to inpatient hospice units, and 1 was transferred to an acute care hospital. An additional 19 patients were discharged to nursing homes. The other 9 patients (16% of the total) survived their hospital stays; 6 successful contacts were made with patients'' spouses. In 1 case the spouse thought a DNR order was no longer desirable. In the other 5 cases the spouse said the DNR status was "probably" or "definitely" still warranted, but only 1 spouse had a written DNR order at home. We contacted 9 of the 14 house officers who had cared for the patients in hospital. Only 2 had ever written a DNR order after hospital discharge. Two house officers said they routinely discussed with family members a patient''s expected dying process at home. Unwanted resuscitation is as undesirable at home as in the hospital. Physicians should discuss future resuscitation procedures with patients who have DNR orders at the time of hospital discharge. Physicians, paramedic service directors, and policymakers also should develop protocols and standardized home DNR orders so that paramedics can honor the wishes of patients in the prehospital setting.     

What really happens in the neutrophil phagosome?

Current viewpoints concerning the bactericidal mechanisms of neutrophils are reviewed from a perspective that emphasizes challenges presented by the inability to duplicate ex vivo the intracellular milieu. Among the challenges considered are the influences of confinement upon substrate availability and reaction dynamics, direct and indirect synergistic interactions between individual toxins, and bacterial responses to stressors. Approaches to gauging relative contributions of various oxidative and nonoxidative toxins within neutrophils using bacteria and bacterial mimics as intrinsic probes are also discussed.     

What really happens to dendritic cells during malaria?

As dendritic cells (DCs) initiate all adaptive and some innate immune responses, it is not surprising that DC function during malaria is the subject of intensive investigations. However, the results of these investigations have so far been controversial. Here, we discuss various aspects of these studies, including the influence of the species and strain of Plasmodium on DC function, the effects of Plasmodium infection on the activation of CD8(+) T cells by DCs, the effects of haemozoin and the effects of Plasmodium infections on DC Toll-like-receptor signalling.     

Can body mass index predict percent body fat and changes in percent body fat with weight loss in bariatric surgery patients?

The primary objective of this study was to assess the validity of body mass index (BMI) in predicting percent body fat and changes in percent body fat with weight loss in bariatric surgery patients. Twenty-two bariatric patients (17 female, five male) began the study designed to include 12 months of testing, including data collection within 1 week presurgery and 1 month, 3 months, 6 months, and 1 year postsurgery. Five female subjects were lost to the study between 6 months and 12 months postsurgery, resulting in 17 subjects (12 female, five male) completing the 12 months of testing. Variables measured in the study included height, weight, percent fat (% fat) by hydrostatic weighing, lean mass, fat mass, and basal metabolic rate. Regression analyses predicting % fat from BMI yielded the following results: presurgery r = 0.173, p = 0.479, standard error of estimate (SEE) = 3.86; 1 month r = 0.468, p = 0.043, SEE = 4.70; 3 months r = 0.553, p = 0.014, SEE = 6.2; 6 months r = 0.611, p = 0.005, SEE = 5.88; 12 months r = 0.596, p = 0.007, SEE = 7.13. Regression analyses predicting change in % fat from change in BMI produced the following results: presurgery to 1 month r = -0.134, p = 0.583, SEE = 2.44%; 1-3 months r = 0.265, p = 0.272, SEE = 2.36%; 3-6 months r = 0.206, p = 0.398, SEE = 3.75%; 6-12 months r = 0.784, p = 0.000, SEE = 3.20. Although some analyses resulted in significant correlation coefficients (p < 0.05), the relatively large SEE values would preclude the use of BMI in predicting % fat or change in % fat with weight loss in bariatric surgery patients.     

What happens to the DNA vaccine in fish? A review of current knowledge

The primary function of DNA vaccines, a bacterial plasmid DNA containing a construct for a given protective antigen, is to establish specific and long-lasting protective immunity against diseases where conventional vaccines fail to induce protection. It is acknowledged that less effort has been made to study the fate, in terms of cellular uptake, persistence and degradation, of DNA vaccines after in vivo administration. However, during the last year some papers have given new insights into the fate of DNA vaccines in fish. By comparing the newly acquired information in fish with similar knowledge from studies in mammals, similarities with regard to transport, blood clearance, cellular uptake and degradation of DNA vaccines have been found. But the amount of DNA vaccine redistributed from the administration site after intramuscular administration seems to differ between fish and mammals. This review presents up-to-date and in-depth knowledge concerning the fate of DNA vaccines with emphasis on tissue distribution, cellular uptake and uptake mechanism(s) before finally describing the intracellular hurdles that DNA vaccines need to overcome in order to produce their gene product.     

Future research in weight bias: What next?

The 2015 Canadian Weight Bias Summit disseminated the newest research advances and brought together 40 experts, stakeholders, and policy makers in various disciplines in health, education, and public policy to identify future research directions in weight bias. In this paper we aim to share the results of the Summit as well as encourage international and interdisciplinary research collaborations in weight bias reduction. Consensus emerged on six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination. These discussions highlighted three key lessons that were informed by the Summit, namely: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included.     

What do children think happens to the food they eat?

In this study, the explanations of two classes of 10-year old children about what happens to the food that they eat were explored, particularly in the context of theories about the development of children's concepts of the human body. These ideas were investigated in a number of ways: obtaining children's own writing and drawings; semi-structured individual interviews; and examining choices made between alternative explanations. The results suggested that children applied their knowledge of everyday materials to understand the initial stages of what happens to food, but their ideas about later stages were more tentative and within the group there was a range of different kinds of explanation preferred. The limitations and achievements of the children's thinking are considered in the context of the school curriculum.     

What is the status of reaction-diffusion theory thirty-four years after Turing?

Physicochemical explanations of phenomena are divisible into three classes: structure, equilibrium and kinetics. For the phenomena of biological development, many physical scientists have the preconception that the explanations must turn out to be principally kinetic. In this class of theory, reaction-diffusion is by far the most extensively developed, and is worthy of attention both for its own sake and because many of its features well exemplify the nature of the broader field of kinetic theory. Reaction-diffusion should be thought of as a class, rather than a species, of theory. This review addresses three aspects: first, the general nature of the two-morphogen interaction as first proposed by Turing and incorporated in many later models; second, the specifics of these later models and their probable relative scope; third, the current state of attempts to identify the chemical nature of morphogens. It is concluded that reaction-diffusion in particular, and kinetic theory in general, are now slowly emerging from the almost total neglect by biologists which reaction-diffusion suffered for its first 20 years.     

What happens to children when they grow up? How does the human body change after the age of 18

The present study answers the question on how the human body changes in two successive decades after its final height had been reached. One hundred and three individuals (56 males and 47 females) who were followed up longitudinally by a team of scientists from birth to 18 years of age were investigated anthropometrically by 18 body measurements again when they reached the age of between 35 and 39 years. The Carter-Heath somatotype was ascertained as a part of the study. The results of the investigation at the age of 35 to 39 years were compared with the Czech Standard and with those from 18 years of age. The means of all measurements in both sexes increased with age (with the exception of stature in females). Relative measurements and indices, which were calculated only in the groups of 35-39 year-olds were all on the average greater in males than in females with the exception of relative head circumferences and pelvis width, in the pelvis width in per cent of biacromial width, in the sum of skinfolds, and in the gross percent of body fat. Males as well as females increased from the age of 18 to 35-39 as a rule in weight, muscle, bone and fat mass, which were manifested by a shift towards endomorphic and mesomorphic components of their somatotypes away from the ectomorphic one.     

What to do in marine biotechnology?

During the symposium "Marine Biotechnology: Basics and Applications", held 25 February-1 March, 2003 in Matalasca?as, Spain, a special brainstorm session was organized. Two questions were addressed: 1, "What is the most desirable development in marine biotechnology"?; 2, "What is the most spectacular development in this field in your 'wildest' dreams"? The outcome of this session is reported in this paper. From the more than 250 ideas generated, concern for the environment and human health emerged as the most significant issues.     

Rodent‐mediated plant seed dispersal: What happens to the seeds after entering the gaps with different sizes?

In general, it is accepted that gap formation significantly affects the placement of scatter‐hoarded seeds by small rodents, but the effects of different forest gap sizes on the seed‐eating and scatter‐hoarding behaviors of small rodents remain unclear. Thus, we examined the effects of a closed‐canopy forest, forest edge, and gaps with different sizes on the spatial dispersal of Quercus variabilis acorns and cache placement by small rodents using coded plastic tags in the Taihang Mountains, China. The seeds were removed rapidly, and there were significant differences in the seed‐eating and caching strategies between the stand types. We found that Q. variabilis acorns were usually eaten after being removed from the closed‐canopy forest and forest edges. By contrast, the Q. variabilis acorns in the forest gap stands were more likely to be scatter‐hoarded. The dispersal distances of Q. variabilis acorns were significantly longer in the forest gap plots compared with the closed canopy and forest edge plots. However, the proportion of scatter‐hoarded seeds did not increase significantly as the gap size increased. In small‐scale oak reforestation projects or research, creating small gaps to promote rodent‐mediated seed dispersal may effectively accelerate forest recovery and successional processes.     

What happens to the sown species if a biodiversity experiment is not weeded?

Studies in experimental grasslands have extensively documented the effects of sown plant diversity on the colonization of new species, but the responses of the sown plant combinations themselves have rarely been investigated. We established experimental grasslands differing in species richness (1, 2, 4, 8, and 16) and functional group number and composition (1–4; legumes, grasses, small herbs, tall herbs), and we studied the changes in the abundance of sown species (residents) in both weeded and non-weeded subplots over a period of five years after sowing. The accumulation of new species through spontaneous colonization in the non-weeded treatment did not affect the number of resident species, but had increasingly negative effects over time on the cover of resident species and their aboveground biomass production at community level. Temporal stability of resident populations was lower and year-to-year changes in resident species composition were larger in non-weeded than in weeded subplots. Compositional dissimilarity between weeded and non-weeded treatments increased through time. These negative effects of the colonization of new species on the abundances and stability of resident populations depended on resident species identity and not on additional variation between different functional groups. The colonization of new species did not change the number of resident species emerging from seeds, but reduced seedling densities of residents. Colonization did not affect the structure of resident communities as measured by species evenness, functional trait diversity and mean trait values suggesting that colonization can destabilize the species composition of residents in terms of abundance while leaving them unchanged in terms of functional characteristics. Generally, negative impacts of colonizing species on residents which accelerated through time decreased with an increasing number of sown species. Sowing more diverse grassland mixtures increases their predictability in terms of ecosystem characteristics, which is important for ecological restoration and sustainable agriculture.