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Abstract Objectives Many associations have recently recommended early integration of oncology and palliative care for more standard cancer care and better quality of life. We aimed to create a questionnaire to assess the opinion of medical oncologists and nurses about the clinical impact of the integrated palliative care and oncology (PCO) program. Methods A novel semi-structured questionnaire called Impact of Early Integration of Palliative Care Oncology (IEI PCO) questionnaire was developed and tested for validity and reliability then distributed to the oncologists and nurses working in Kuwait Cancer Control Center. Results After the pilot stage, testing the final questionnaire for validity and reliability was done with satisfactory results. Finally, the complete questionnaires were 170 out of 256 (response rate 66.41%). More awareness about the available palliative care services and the new available PCO services (p-value

Abstract Background Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Although many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. This study’s aim is to describe pain control, and the pattern of change in opioid and adjuvant medication prescriptions, before and after referral to the Palliative Care Center. Methods We conducted a prospective cohort study in adult cancer patients the Palliative Care Center between January 1, 2016 and December 30, 2017. We measured pain intensity and other associated symptoms via the Revised Edmonton Symptom Assessment System (ESAS-r) and documented detailed analgesics and adjuvant medication history before starting any palliative care and on days 0, 3, 6, and 14. Results The analysis included 240 patients whose cancer-related pain, anxiety, and depression scores meaningfully improved by day 6. The changes in the median (interquartile ranges) of Cancer-related pain, anxiety, and depression scores from day 0 to day 6 were: 6 (4–8) to 3 (1–4); 6 (4–9) to 2 (1–4); and 3 (2–6) to 2 (1–4), respectively, with p

Abstract Background Over the past five decades, palliative care has changed from helping patients at the end of life into a highly dedicated service focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. To date there is no common agreement on universally applicable measurement tool to know the areas of weakness in physicians’ understanding of palliative care and identifying misconceptions about palliative care. This paper describes the development of a reliable and valid questionnaire to provide a measure of the attitude and knowledge of physicians toward palliative care (PCAK). Methods Item pool was generated paying particular attention to content and face validity. The initial version of the questionnaire was piloted and assessed based on psychometric criteria. Items which did not reach acceptable validity were excluded, and the final 37 item version was administered to two groups differing in their palliative care attitude and knowledge on two occasions to assess the construct validity and test-retest reliability. Two hundred thirty two physicians working in primary care clinics and general hospitals completed the questionnaire at the piloting stage. The final version (PCAK) was administered to 35 oncologists and 76 physicians. SPSS v20 was used for statistical analysis. Results Of the Pilot study, 20 items were excluded because didn’t meet the criteria for item difficulty and discrimination. Item-to-total-score correlations (r) was ranging from 0.347 up to 0.806. Internal consistency (Cronbach’s alpha) was high ranging from 0.636 to 0.824. While testing the final PCAK, oncologist scored consistently higher than the other physicians on all sections of the questionnaire (P

Objectives: The benefits and risks of thromboprophylaxis usage in patients with advanced cancer at the end of their lives remain unknown, especially with the lack of randomized studies. This study aimed to describe the clinical use of thromboprophylaxis in those patients under palliative care. Methods: A retrospective cohort study. It was performed on patients admitted to the Palliative Care Center. Results: A total of 719 patients were enrolled in the study. The mean age was 62.97 (13.65) years. Venous thromboembolism (VTE) incidence was 5.4% (n = 39). At the time of admission, 31.29% (n = 225) of patients were on thromboprophylaxis. At death time, 17.5% (n = 126) of patients were on thromboprophylaxis (41.3% on primary and 58.7% on secondary thromboprophylaxis). The incidence of clinically suspected fatal VTE was 6.5% (n = 47). Surprisingly, clinically suspected VTE was higher statistically in patients with thromboprophylaxis rather than in non‐thromboprophylaxis (p <.001). By using linear regression, only higher PPI scores on admission were independent negative predictors of length of stay (OR:4.429, 95% CI: 5.460–3.398, p <.001). The development of clinically suspected fatal VTE, whatever the status of thromboprophylaxis, did not affect the length of stay. Conclusions: Thromboprophylaxis does not decrease the risk of clinically suspected fatal VTE in patients with advanced disease in their terminal phase. Patients with poor performance status and a short prognosis are unlikely to benefit from thromboprophylaxis. [ABSTRACT FROM AUTHOR]

Nutrient overloading resulting from digestate (effluent of anaerobic digestion process) application has become a major bottleneck for the development of the biogas industry and raised environmental concerns in regions with intensive animal husbandry. Due to this, it is imperative to find low cost and effective alternative to export nutrient from digestate. Among the numerous applications, indigenous microflora has recently been utilized successfully as a biofloc technology in aquatic systems for controlling ammonia and subsequent reduction of feeding cost. Accordingly, performance of the indigenous microflora in undiluted liquid digestate of chicken manure was evaluated in this study to recover nutrients and produce high-value biomass under aerobic heterotrophic mode in batch shaking experiments. The results showed that 68% of phosphate was recovered and 97% of total nitrogen was removed from the liquid digestate. Additionally, >6 g L−1 of dry biomass was simultaneously produced and featured with up to 65% crude protein without pathogens, 10.9% lipids, 10.7% ash and 19.6 MJ kg−1 gross energy. Therefore, the produced biomass could be used either as an alternative sustainable source for animal or fish feeding or as a substrate for energy applications. Unlabelled Image • Heterotrophic indigenous microflora grew in undiluted liquid digestate successfully. • Phosphate & total nitrogen recovery were 68% & 19%, total nitrogen removal was 97%. • >6 g L−1 of dry biomass was simultaneously produced without pathogens. • Biomass features with 65% crude protein, 10.9% lipids and 19.6 MJ kg−1 gross energy • Integrated production of microbial biomass and ammonium salts is recommended. [ABSTRACT FROM AUTHOR]

The use of various veterinary antibiotics (VAs) in animal husbandry raises serious concerns about the development of antibiotic resistance. Antibiotics such as tetracycline, oxytetracycline, sulfadiazine, norfloxacin, and enrofloxacin are the most frequently used antimicrobial compounds in animal husbandry and generate large eco-toxicological effects; however, they are still difficult to determine in a complex matrix such as swine manure. This study has developed an effective method for detecting five VAs in swine manure using Ultra-High-Performance Liquid Chromatography–Diode Array Detector (UHPLC–DAD) coupled with on-line solid-phase extraction (SPE). The results show that the mobile phase of ACN/0.01 M oxalic acid was the optimum at pH 3.0. VAs in a swine manure matrix were extracted using solid extraction buffer solution (T3) with 97.36% recovery. Sensitivity, accuracy, and precision were also evaluated. The validity study showed good linearity (R2 > 0.99). Limit of detection (LOD) was found to be from 0.1 to 0.42 µg mL−1 in the liquid fraction and from 0.032 to 0.58 µg g−1 dw in the solid fraction. The corresponding values of the limit of quantification (LOQ) ranged from 0.32 to 1.27 µg mL−1 for the liquid fraction and from 0.096 to 1.77 µg g−1 dw for the solid fraction. Therefore, the proposed method showed the potential applicability for detecting different antibiotic compounds from swine manure samples. [ABSTRACT FROM AUTHOR]

Low contents of water-soluble carbohydrates and/or low indigenous microbial activity in wilted maize stover (WMS) usually hinder the establishment of the ensiling process, thereby resulting in a low biogas production because of high loss of dry matter (DM). To enhance the biological activity and substrate biodegradability, this study applied the synergistic regulation of sucrose (carbon source) and increasing levels of urea (nitrogen source) during the ensiling process of WMS. Compared with the application of only sucrose, a higher organic acid content (lactic acid (85 g/kg-DM) and acetic acid (14 g/kg-DM)) and higher degradation ratios for lignocellulose (hemicellulose (28%), cellulose (22%), and lignin (17%)) were observed with urea applications of 1.7% (DM) and 3.9% (DM), respectively. This was caused by the enhanced activities of the hetero-fermenter (Weissella) and cellulolytic bacteria (Cellulosimicrobium). A simultaneous addition of urea and sucrose during the ensiling of WMS increased the specific methane yield by 11.2%–21.1% in comparison to raw WMS. Moreover, an economic cost estimation revealed that this approach could be an effective storage strategy for the efficient production of methane when employing a 1.7% (DM) urea application. Unlabelled Image • Ensiling WMS with sucrose and urea addition for efficient CH 4 yield was studied. • Hetero-lactic acid fermentation was enhanced by urea addition. • Activity of cellulolytic bacteria was promoted due to the addition of urea. • Urea-assisted ensiling process increased the CH 4 yield by 11.2%–21.1%. • Excessive urea caused butyric acid fermentation and a storage loss of up to 10%. [ABSTRACT FROM AUTHOR]

Phosphorus (P) loss from livestock and poultry industry causes serious threat to agro-ecological environments. Anaerobic digestion (AD), through recycling of P-containing resources and biogas production, prevails as a promising solution to the resource, energy, and environment trilemma. In this study, the dynamic transformation of P in batch AD processes fed with chicken, pig and dairy manures was investigated. Results showed that the Labile-P of total phosphorus (TP) in pig, chicken and dairy manure digestates decreased from 37.35% to 23.79%, 36.79% to 17.29%, and 60.47% to 20.39%, respectively, and was associated with an increase of NaOH-P during the AD process. However, the Labile-P in raw manures ranging from 64.67% to 81.10%, indicated that AD could reduce the pollution risk caused by the overuse of high Labile-P animal manure as fertilizer. Metal ions had a significant influence on P transformation because of their ability to combine with PO 4 3−/HPO 4 2−. During AD, the species of phosphates increased: AlPO 4 , FePO 4 , Mg 3 (PO 4) 2 , CaHPO 4 , Mg(NH 4)PO 4 ·6H 2 O and Ca 10 (PO 4) 6 (OH) 2 were the main phosphates qualified by X-ray diffraction (XRD). AD produced a satisfactory fertilizer for plants that were able to activate the precipitated P, which could provide readily available N and slow-release P. This study provides a meaningful theoretical guide for recycling P from animal manure resources. Unlabelled Image • The dynamic transformation of P in batch AD processes was investigated. • Labile-P content decreased by 13.6%–40.1% in AD process. • NaOH-P increased more significantly in chicken manure digestate than others. • Digestate application could reduce the risk of P loss in form of Labile-P. • Metal ions combining with P, influencing its transformation. [ABSTRACT FROM AUTHOR]