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  • 1
    ISSN: 1432-1238
    Keywords: Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design Prospective survey. Ethical approval was obtained. Setting ICUs in tertiary centres in London and Cape Town. Patients All patients who died or had life support limited. Interventions Data collection only. Results There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Twon. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Key words Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design: Prospective survey. Ethical approval was obtained. Setting: ICUs in tertiary centres in London and Cape Town. Patients: All patients who died or had life support limited. Interventions: Data collection only. Results: There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Town. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions: Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-2242
    Keywords: Key words Brassica napus ; C3-C4 intermediate photosynthesis ; Glycine decarboxylase ; Intergeneric hybrid ; Moricandia arvensis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract  An intergeneric hybrid plant was produced between the C3-C4 intermediate species Moricandia nitens and the C3 species Brassica napus by sexual hybridization and in vitro embryo rescue. The hybrid nature of the plant was apparent in its morphology and flower pigmentation and was confirmed by leaf isozyme patterns. The overall plant morphology and the shape and thickness of leaves of the hybrid plant were intermediate between those of the parent species. However, the bundle-sheath cells of the hybrid resembled those of the C3 parent and lacked the organelle development of the C3-C4 intermediate parent. Immunogold labelling for the presence of the P subunit of the mitochondrial glycine decarboxylase complex revealed a very similar labelling density on mitochondria in bundle-sheath and mesophyll cells in B. napus, while in  M. nitens the P subunit was only detectable in bundle sheath cells. In the hybrid the labelling density on mesophyll cell mitochondria was almost half of that on the bundle-sheath mitochondria. The CO2 compensation point of the hybrid was significantly less than that of the C3 parent but was not as low, nor as responsive to changes in light intensity, as for the C3-C4 parent.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-2242
    Keywords: Brassica napus ; Moricandia arvensis ; Somatic hybridisation ; C3-C4 intermediate ; Photorespiration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology
    Notes: Abstract The wild crucifer Moricandia arvensis is a potential source of alien genes for the genetic improvement of related Brassica crops. In particular M. arvensis has a C3-C4 intermediate photosynthetic mechanism which results in enhanced recapture of photorespired CO2 and may increase plant water-use efficiency. In order to transfer this trait into Brassica napus, somatic hybridisations were made between leaf mesophyll protoplasts from cultured M. arvensis shoot tips and hypocotyl protoplasts from three Brassica napus cultivars, ‘Ariana’, ‘Cobra’ and ‘Westar’. A total of 23 plants were recovered from fusion experiments and established in the greenhouse. A wide range of chromosome numbers were observed among the regenerated plants, including some apparent mixoploids. Thirteen of the regenerated plants were identified as nuclear hybrids between B. napus and M. arvensis on the basis of isozyme analysis. The phenotypes of these hybrids were typically rather B. napus-like, but much variability was observed, including variation in flower colour, leaf shape and colour, leaf waxiness, fertility and plant vigour. CO2 compensation point measurements on the regenerated plants demonstrated that 3 of the hybrids express the M. arvensis C3-C4 intermediate character at the physiological level. Semi-thin sections through leaf tissues of these 3 plants revealed the presence of a Kranz-like leaf anatomy characteristic of M. arvensis but not found in B. napus. This is the first report of the expression of this potentially important agronomic trait, transferred from Moricandia, in M. arvensis x B. napus hybrids.
    Type of Medium: Electronic Resource
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