Refractory cachexia and truth-telling about terminal prognosis; A qualitative study

The purpose of this paper is to examine the consequences that medical practitioners’ decisions about whether or not to be candid about terminal prognosis have for those suffering from refractory cachexia and their families. It presents the findings of a qualitative study which used focus groups and semi-structured interviews of a volunteer sample of doctors, nurses and dieticians in a cancer centre of a large teaching hospital in Northern Ireland. Respondents reported that some physicians tended to avoid discussing terminal prognosis in a direct manner with their patients. Nurses and dieticians tended to be reluctant to engage in conversations about weight loss with patients with cachexia. One of the reasons they reported for their lack of acknowledgement of weight loss concerned the close association between refractory cachexia and terminal prognosis. Because they viewed the telling of bad news as an exclusive prerogative of medical practitioners, they did not feel in a position to discuss cachexia because they were concerned that this had the potential to raise end-of-life issues that lay outside the boundaries of their professional role. This meant patients and their families were provided with little information about how to cope with the distressing consequences of cachexia.

Molecular evolution of proadrenomedullin N-terminal 20 peptide (PAMP):evidence for gene co-option

Posttranslational processing of proadrenomedullin generates two biologically active peptides, adrenomedullin (AM) and proadrenomedullin N-terminal 20 peptide (PAMP). Sequence comparison of homologous proadrenomedullin genes in vertebrate evolution shows a high degree of stability in the reading frame for AM, whereas PAMP sequence changes rapidly. Here we investigate the functional significance of PAMP phylogenetic variation studying two of PAMP's better characterized physiological activities, angiogenic potential and antimicrobial capability, with synthetic peptides carrying the predicted sequence for human, mouse, chicken, and fish PAMP. All tested peptides induced angiogenesis when compared with untreated controls, but chicken and fish PAMP, which lack terminal amidation, were apparently less angiogenic than their human and mouse homologs. Confirming the role of amidation in angiogenesis, Gly-extended and free acid variants of human PAMP produced responses similar to the natural nonamidated peptides. In contrast, antimicrobial activity was restricted to human PAMP, indicating that this function may have been acquired at a late time during the evolution of PAMP. Interestingly, free acid human PAMP retained antimicrobial activity whereas the Gly-extended form did not. This fact may reflect the need for maintaining a tightly defined structural conformation in the pore-forming mechanism proposed for these antimicrobial agents. The evolution of PAMP provides an example of an angiogenic peptide that developed antimicrobial capabilities without losing its original function.

The C-Terminal Variable Region Specifies the Dynamic Properties of Arabidopsis Microtubule-Associated Protein MAP65 Isotypes

The microtubule-associated protein, MAP65, is a member of a family of divergent microtubule-associated proteins from different organisms generally involved in maintaining the integrity of the central spindle in mitosis. The dicotyledon Arabidopsis thaliana and the monocotyledon rice (Oryza sativa) genomes contain 9 and 11 MAP65 genes, respectively. In this work, we show that the majority of these proteins fall into five phylogenetic clades, with the greatest variation between clades being in the C-terminal random coil domain. At least one Arabidopsis and one rice isotype is within each clade, indicating a functional specification for the C terminus. In At MAP65-1, the C-terminal domain is a microtubule binding region (MTB2) harboring the phosphorylation sites that control its activity. The At MAP65 isotypes show differential localization to microtubule arrays and promote microtubule polymerization with variable efficiency in a MTB2-dependent manner. In vivo studies demonstrate that the dynamics of the association and dissociation of different MAP65 isotypes with microtubules can vary up to 10-fold and that this correlates with their ability to promote microtubule polymerization. Our data demonstrate that the C-terminal variable region, MTB2, determines the dynamic properties of individual isotypes and suggest that slower turnover is conditional for more efficient microtubule polymerization.

Retrodirective Terminal Antenna for Satellite and Terrestrial Mobile Communications

The potential for implementation of retrodirective arrays as antenna terminals for future integrated satellite and terrestrial mobile communications is discussed in this paper. Particularly, in the context of the Inmarsat L-band system we address the issues related to array antenna element capacity to produce high-quality circular polarized radiation pattern over large angles of arrival. We also discuss circuitry reduction methodologies and their effect on retrodirected beam characteristics. The possibility of circular polarization modulation of the re-transmit signal is also discussed.

Distribution of terminal nerve entry points to the flexor and extensor groups of forearm muscles:An anatomical study

The motor points of the skeletal muscles, mainly of interest to anatomists and physiologists, have recently attracted much attention from researchers in the field of functional electrical stimulation. The muscle motor point has been defined as the entry point of the motor nerve branch into the epimysium of the muscle belly. Anatomists have pointed out that many muscles in the limbs have multiple motor points. Knowledge of the location of nerve branches and terminal nerve entry points facilitates the exact insertion and the suitable selection of the number of electrodes required for each muscle for functional electrical stimulation. The present work therefore aimed to describe the number, location, and distribution of motor points in the human forearm muscles to obtain optimal hand function in many clinical situations. Twenty three adult human cadaveric forearms were dissected. The numbers of primary nerves and motor points for each muscle were tabulated. The mean numbers and the standard deviation were calculated and grouped in tables. Data analyses were performed with the use of a statistical analysis package (SPSS 13.0). The proximal third of the muscle was the usual part of the muscle that received the motor points. Most of the forearm muscles were innervated from the lateral side and deep surface of the muscle. The information in this study may also be usefully applied in selective denervation procedures to balance muscles in spastic upper limbs. Copyright © 2007 Via Medica.

Distributed MPC for Frequency Regulation in Multi-Terminal HVDC Grids

High Voltage Direct Current (HVDC) lines allow large quantities of power to be
transferred between two points in an electrical power system. A Multi-Terminal HVDC (MTDC) grid consists of a meshed network of HVDC lines, and this allows energy reserves to be shared between a number of AC areas in an efficient manner. Secondary Frequency Control (SFC) algorithms return the frequencies in areas connected by AC or DC lines to their original setpoints after Primary Frequency Controllers have been called following a contingency. Where multiple
TSOs are responsible for different parts of a MTDC grid it may not be possible to implement SFC from a centralised location. Thus, in this paper a simple gain based distributed Model Predictive Control strategy is proposed for Secondary Frequency Control of MTDC grids which allows TSOs to cooperatively perform SFC without the need for centralised coordination.

Cationic palladium(II) complexes as catalysts for the oxidation of terminal olefins to methyl ketones using hydrogen peroxide.

Ligated Pd(II) complexes have been studied for the catalytic oxidation of terminal olefins to their corresponding methyl ketones. The method uses aqueous hydrogen peroxide as the terminal oxidant; a sustainable and readily accessible oxidant. The choice of ligand, counterion and solvent all have a significant effect on catalytic performance and we were able to develop systems which perform well for these challenging oxidations.

N-terminal glycation of cholecystokinin-8 abolishes its insulinotropic action on clonal pancreatic B-cells

Monoglycated cholecystokinin octapeptide (Asp(1)-glucitol CCK-X) was prepared under hyperglycaemic reducing conditions and purified by reverse phase-high performance liquid chromatography. Electrospray ionisation mass spectrometry and automated Edman degradation demonstrated that CCK-8 was glycated specifically at the amino-terminal Asp(1) residue. Effects of Asp(1)-glucitol CCK-8 and CCK-8 on insulin secretion were examined using glucose-responsive clonal BRIN-BD11 cells. In acute (20 min) incubations, 10(-10) mol/l CCK-8 enhanced insulin release by 1.2-1.5-fold at 5.6-11.1 mmol/l glucose. The stimulatory effect induced by 10(-10) mom CCK-8 was abolished following glycation. At 5.6 mmol/l glucose, CCK-8 at concentrations ranging from 10(-11) to 10(-7) mol/l induced a significant 1.6-1.9-fold increase in insulin secretion. Insulin output in the presence of Asp(1)-glucitol CCK-8 over the concentration range 10(-11)-10(-7) mol/l was decreased by 21-35% compared with CCK-8, and its insulinotropic action was effectively abolished. Asp(1)-glucitol CCK-8 at 10(-8) mol/l also completely blocked the stimulatory effects of 10(-11)-10(-8) mol/l CCK-8. These data indicate that structural modification by glycation at the amino-terminal Asp(1) residue effectively abolishes and/or antagonises the insulinotropic activity of CCK-8. (C) 1999 Elsevier Science B.V. All rights reserved.

Composite hunting technologies from the Terminal Pleistocene and Early Holocene, Niah Cave, Borneo

Renewed archaeological investigation of the West Mouth of Niah Cave, Borneo has demonstrated that even within lowland equatorial environments depositional conditions do exist where organic remains of late glacial and early post-glacial age can be preserved. Excavations by the Niah Cave Research Project (NCP) (2000-2003) towards the rear of the archaeological reserve produced several bone points and worked stingray spines, which exhibit evidence of hafting mastic and fibrous binding still adhering to their shafts. The position of both gives strong indication of how these cartilaginous points were hafted and gives insight into their potential function. These artefacts were recovered from secure and (14)C dated stratigraphic horizons. The results of this study have implications for our understanding the function of the Terminal Pleistocene and Early Holocene bone tools recovered from other regions of Island Southeast Asia. They demonstrate that by the end the Pleistocene rainforest foragers in Borneo were producing composite technologies that probably included fishing leisters and potentially the bow and arrow. (C) 2009 Elsevier Ltd. All rights reserved.

Hunting in a Tropical Rainforest:Evidence from the Terminal Pleistocene at Lobang Hangus, Niah Caves, Sarawak

The Terminal Pleistocene zooarchaeological evidence from Lobang Hangus, an east-facing entrance to the Niah Cave complex, provides unique insights into the hunting habits of the human inhabitants of this cave. The composition and structure of the vertebrate accumulation indicates that a variety of locally available terrestrial, arboreal and aquatic taxa were being exploited, The age structure of the principal predated species, the presence of bone points and evidence from modern rainforest hunting combine to suggest that some form of projectile weaponry as well as trapping technologies were probably being employed by the hunters at Niah before the end of the Pleistocene. Copyright (C) 2009 John Wiley & Sons, Ltd.

Droop setting design for multi-terminal HVDC grids considering voltage deviation impacts

In multi-terminal high voltage direct current (HVDC) grids, the widely deployed droop control strategies will cause a non-uniform voltage deviation on the power flow, which is determined by the network topology and droop settings. This voltage deviation results in an inconsistent power flow pattern when the dispatch references are changed, which could be detrimental to the operation and seamless integration of HVDC grids. In this paper, a novel droop setting design method is proposed to address this problem for a more precise power dispatch. The effects of voltage deviations on the power sharing accuracy and transmission loss are analysed. This paper shows that there is a trade-off between minimizing the voltage deviation, ensuring a proper power delivery and reducing the total transmission loss in the droop setting design. The efficacy of the proposed method is confirmed by simulation studies.

Adaptive backstepping droop controller design for multi-terminal high-voltage direct current systems

Wind power is one of the most developed renewable energy resources worldwide. To integrate offshore wind farms to onshore grids, the high-voltage direct current (HVDC) transmission cables interfaced with voltage source converters (VSCs) are considered to be a better solution than conventional approaches. Proper DC voltage indicates successive power transfer. To connect more than one onshore grid, the DC voltage droop control is one of the most popular methods to share the control burden between different terminals. However, the challenges are that small droop gains will cause voltage deviations, while higher droop gain settings will cause large oscillations. This study aims to enhance the performance of the traditional droop controller by considering the DC cable dynamics. Based on the backstepping control concept, DC cables are modelled with a series of capacitors and inductors. The final droop control law is deduced step-by-step from the original remote side. At each step the control error from the previous step is considered. Simulation results show that both the voltage deviations and oscillations can be effectively reduced using the proposed method. Further, power sharing between different terminals can be effectively simplified such that it correlates linearly with the droop gains, thus enabling simple yet accurate system operation and control.