A novel scalable and stackable nonvolatile memory technology suitable for building fast and dense memory devices is discussed. The memory cell is built by layering a storage element and a selector. The storage element is a Phase Change Memory (PCM) cell [1] and the selector is an Ovonic Threshold Switch (OTS) [2]. The vertically integrated memory cell of one PCM and one OTS (PCMS) is embedded in a true cross point array. Arrays are stacked on top of CMOS circuits for decoding, sensing and logic functions. A RESET speed of 9 nsec and endurance of 10 6 cycles are achieved.One volt of dynamic range delineating SET vs. RESET is also demonstrated.
Background
Depression is prevalent in patients receiving hospice care. Standard antidepressant medications do not work rapidly enough in this setting. Evidence suggests that ketamine rapidly treats treatment refractory depression in the general population. Ketamine’s role for treating depression in the hospice population warrants further study.
Methods
A retrospective chart review of 31 inpatients receiving hospice care who received ketamine for depression on a clinical basis was conducted. The primary outcome measure was the Clinical Global Impression Scale, which was used retrospectively to rate subjects’ therapeutic improvement, global improvement, and side effects from ketamine over 21 days. Additionally, time to onset of therapeutic effect was also analyzed.
Results
Using the CGI, ketamine was found to be significantly therapeutically effective through the first week after ketamine dosing (p < 0.05), with 93% of subjects showing positive results for days 0 – 3 and 80% for days 4 – 7 post ketamine dosing. Subjects experienced global improvement during all four time periods post ketamine dosing (all p-values < 0.05). Significantly more subjects had either no side effects or side effects that did not significantly impair functioning at each of the four assessed time periods post ketamine dosing (all p-values < 0.05). Additionally, significantly more subjects experienced their first therapeutic response during days 0–1 post ketamine dosing (p < 0.001) than during any other time period.
Conclusions
These data suggest that ketamine may be a safe, effective, and rapid treatment for clinical depression in patients receiving hospice care. Blinded, randomized, and controlled trials are required to substantiate these findings and support further clinical use of this medication in hospice settings.
Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.
Because of the rapidly growing older population and increases in longevity, rates of dementia have been rising. Clinical challenges of treating dementia include limited resources and lack of curative therapies. Palliative care approaches improve quality of life and alleviate suffering for dementia patients at the end of life, although implementation may be limited by societal acceptance and feasibility. This review examines the published literature on pain assessments, pain and behavior interventions, tools for advanced care planning, and clinical concerns in dementia patients. Ultimately, modification of the traditional palliative care model may improve outcomes and functioning for dementia patients at all stages of their illness.
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