Bereavement and Loss: Understanding Grief in Older People.

Everyone experiences grief from time to time, but older people are more likely to experience grief simply because they live longer. Grief, bereavement, and mourning are different elements associated with death of a loved one. For most people, grief follows a fairly predictable trajectory, and over time resolves. One of the most used descriptions of grief was developed by Elizabeth Kubler-Ross and it is reviewed herein. However, for some people, grief becomes unbearable and chronic leading to prolonged grief disorder. For clinicians, it's essential to differentiate between prolonged grief disorder and major depressive disorder. Older people who experience unbearable grief often need medication to deal with some of its symptoms, which include depression, anxiety, hypertension, and lack of sleep. Older people also need considerable support as they deal with grief so that they do not become isolated, experience comorbidities, or spiral into physical and mental decline. Little specific research has examined pharmacists' opportunities to help older people who have prolonged grief, but some data suggest that these patients are more likely to visit the pharmacy and need medication more than others.

Clostridium tepidum sp. nov., a close relative of Clostridium sporogenes and Clostridium botulinum Group I.

Obligately anaerobic, Gram-stain-positive, spore-forming bacteria indistinguishable by pulsed-field gel electrophoresis were isolated from non-dairy protein shakes in bloated bottles. One of the isolates, strain IEH 97212T, was selected for further study. The strain was closely related to Clostridium sporogenes and Clostridium botulinum Group 1 based on 16S rRNA gene sequence similarities. Phylogenetic analysis also showed that strain IEH 97212T and strain PE (=DSM 18688), a bacterium isolated from solfataric mud, had identical 16S rRNA gene sequences. Strains IEH 97 212T and DSM 18 688 were relatively more thermophilic (temperature range for growth: 30-55 °C) and less halotolerant [growth range: 0-2.5 % (w/v) NaCl] than C. sporogenes and C. botulinum. They were negative for catalase, oxidase, urease and l-pyrrolidonyl-arylamidase and did not produce indole. The strains produced acid from d-glucose, maltose and trehalose, and hydrolysed gelatin, but did not hydrolyse aesculin. The end-products of growth included acetic acid, propionic acid, butyric acid, isobutyric acid, valeric acid, isovaleric acid, isocaproic acid, phenylpropionic acid, 2-piperidinone, 2-pyrrolidinone and gas(es). The predominant fatty acids were C14 : 0, C16 : 0 and C18 : 1ω9c. The genomic DNA G+C content of strains IEH 97212T and DSM 18688 was 26.9 and 26.7 mol%, respectively. According to the digital DNA-DNA hybridization data, the relatedness of these strains was 98.4 %, while they showed only 35.7-36.0 % relatedness to C. sporogenes. Based on the results of this polyphasic study, these strains represent a novel species, for which the name Clostridium tepidum sp. nov. is proposed, with the type strain IEH 97212T (=NRRL B-65463T=DSM 104389T).

Clinicopathologic correlations of genomic gains and losses in follicular lymphoma.

PURPOSE: To evaluate the clinical relevance of genomic aberrations in follicular lymphomas (FLs). PATIENTS AND METHODS: In this study, we analyzed 124 biopsy samples of patients with FL using comparative genomic hybridization. RESULTS: In 87 cases (70%), genomic imbalances were detectable. The most frequent aberrations were gains of chromosome arms 7p (21 patients), 7q (21 patients), Xp (16 patients), 12q (15 patients), and 18q (14 patients) as well as losses on 6q (21 patients). Grades 2 and 3 according to the World Health Organization classification correlated with a more complex karyotype (P <.0001). In a subset of 82 patients, a comprehensive clinical data set was available. In a multivariate analysis including all clinical risk factors of the International Prognostic Index as well as genomic aberrations, the loss of material on chromosomal bands 6q25q27 was the strongest predictor of a shorter survival (P =.0001; hazard ratio, 6.5), followed by elevated serum lactate dehydrogenase level (P =.0009; hazard ratio, 4.9), the presence of more than one extranodal manifestation (P =.017; hazard ratio, 4.2), and age greater than 60 years (P =.022; hazard ratio, 2.6). CONCLUSION: These data indicate that genomic aberrations may contribute significantly to risk assessment in patients with FL, the majority of whom are included in low-risk groups using established clinical prognostic scores.

Assigned versus self-set goals and their impact on the performance of brain-damaged patients.

The purpose of this study was to investigate the role played by goal difficulty and goal origin (i.e., self-set vs. assigned) on the performance of patients with brain injuries in a simple arithmetic task. Eighty-seven patients with either cerebral vascular accidents or traumatic brain injuries were investigated. Patients were randomly assigned to one of three conditions: (1) one in which a specific, high goal was assigned, (2) one in which a "do your best" goal was given, and (3) one in which a personal goal has to be stated. The results indicate that both goal difficulty and goal origin had an influence on performance. Assigned difficult goals lead to better performance than assigned easy goals. Self-setting a goal did not increase performance to the same level than the assignment of a difficult goal. This lower performance increase with self-set goals can be explained by the fact that participants selected goals which were not as difficult as the assigned difficult goal. Self-set goals were attained by most of the patients and only 1 patient showed a high discrepancy between self-set goal and actual performance. These findings suggest that goal origin and goal difficulty are important moderators in the goal setting process. Furthermore, patients with brain injuries do not necessarily set unrealistic high goals.