Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being.

SUMMARY The hypothesis that circulating cortisol levels influence the outcome of social interactions in rainbow trout was tested. Juvenile rainbow trout Oncorhynchus mykiss were given a single intraperitoneal (i.p.)implant containing either cortisol (110 mg kg–1 fish), or cortisol plus the glucocorticoid receptor antagonist RU486 (mifepristone; 1100 mg kg–1 fish), and sampled after 5 days of social interactions with either a similar sized (<1.5% difference in fork length)or smaller conspecific (>5% difference). Within size-matched pairs of fish,cortisol treatment significantly increased the probability that the treated fish within each pair became subordinate, an effect that was abolished by simultaneous administration of RU486. Cortisol treatment also reduced the usual success of the larger fish within a pair to preferentially become dominant from 86% to 40% of pairs. To investigate one potential mechanism underlying the apparent effect of cortisol in predisposing trout to low social status, fish were treated with cortisol or cortisol+RU486 for 5 days, after which brain monoamines [5-hydroxytryptamine (5-HT); dopamine (DA)] and their major metabolites [5-hydroxyindolacetic acid (5-HIAA);3,4-dihydroxy-phenylacetic acid (DOPAC)] were measured. Significant increases of serotonergic activity ([5-HIAA]/[5-HT] ratio) were detected in the telencephalon with cortisol treatment, an effect that was eliminated by simultaneous administration of RU486. Also, cortisol treatment significantly decreased dopaminergic activity in the telencephalon. Somewhat surprisingly,the effects of cortisol treatment on monoaminergic activity in the hypothalamus were opposite to those in the telencephalon. Moreover, in no case did administration of RU486 abolish these effects. These results suggest that the effects of cortisol on social status in rainbow trout may be mediated via the modulation of central signaling systems and subsequent changes in behaviour and/or competitive ability, although the exact site of action in the brain remains uncertain.

Background Advance care planning (ACP) is an under-utilized process that involves thinking about what kind of life-prolonging medical care one would want should the need arise, identifying a spokesperson, and then communicating these wishes. Objective To better understand what influences individuals to engage in ACP. Design Three focus groups using semi-structured interactive interviews were conducted with 23 older individuals from three diverse populations in central Pennsylvania. Results Four categories of influences for engaging in ACP were identified: 1) Concern for Self; 2) Concern for Others; 3) Expectations About the Impact of Advance Care Planning; and 4) Anecdotes, Stories, & Experiences. Conclusions The motivations for undertaking ACP that we have identified offer healthcare providers insight into effective strategies for facilitating the process of ACP with their patients.

No abstract

This study examined the bioaccumulation and dietary retention of 61 polychlorinated biphenyl (PCB) and four polybrominated diphenyl ether (PBDE) congeners in juvenile American kestrels (Falco sparverius). American kestrels were exposed to contaminants via egg injection and daily gavage dosing over the posthatch-to-fledgling period. Retention factors for PCBs were dependent on chemical hydrophobicity and chlorine substitution patterns and ranged from less than 1 to 16.4% for PCBs having vicinal hydrogen substitutions at meta-, para- carbons on at least one of the phenyl rings and between 13.2 and 81.5% for congeners containing chlorine substitutions at 4,4'-, 3',4,5'-, 3,4',5-, or 3,3',5,5'-positions. These results indicate that juveniles are capable of biotransforming PCBs according to the same structure-activity rules as adults. A toxicokinetic model, initially parameterized using adult toxicokinetic parameters, was used to describe concentration trends in juveniles over time. The adult model overestimated PCB concentrations but provided an adequate fit when elimination rate constants were increased by a factor of 12.7. Retention factors for the PBDE congeners 2,2',4,4'-tetrabromodiphenyl ether (BDE 47), 2,2',4,4',6-pentabromodiphenyl ether (BDE 100), 2,2',4,4',5-pentabromodiphenyl ether (BDE 99), and 2,2',4,4',5,5'-hexabromodiphenyl ether (BDE 153) were from 7.8 to 45.3% of the total dose. The retention of BDE 47 was similar that observed for readily cleared PCBs, whereas the remaining PBDEs exhibited retention factors consistent with those of persistent PCBs. Half-lives for PBDEs in juveniles were estimated to range from 5.6 to 44.7 d. Assuming differences in PBDE toxicokinetics between juveniles and adults similar to those measured for PCBs, adult American kestrel PBDE half-lives are expected to range from 72 to 572 d.