What Is The Importance Of A Living Will or Health Care Directive?
Article by Bill Peterson
WHAT IS A LIVING WILL/HEALTH CARE DIRECTIVE?
When you are taken to a hospital in Minnesota from an accident or illness, it may be too late to prepare the documents to assure you the care you want or to provide access to your medical information for your loved ones.
The Terri Schiavo case in Florida several years ago provides a graphic example of why every adult should have a health care directive.
In that case, a 27 year-old woman went into the hospital for a simple medical procedure but fell into a coma and she lived for a number of years.
She had no health care directive so her family could not help decide her medical treatment. The case went all through the Florida courts as well as the Congress, the White House and the U.S. Supreme Court. It certainly was a very sad affair.
A Health Care Directive (HCD) under Minnesota law goes by many names? sometimes it is called a ?Living Will? or an Advance Care Declaration or Health Care Power of Attorney. They all mean the same thing.
A HCD identifies who you would want to make your medical treatment decisions if you?re not able to make those choices on your own. The choice of the health care agent or health care proxy is one you should carefully consider. It should be someone you trust, who is sensitive to your wishes regarding health care but, at the same time, a person who can make a tough decision on your behalf if it comes to that.
The HCD spells out what medical procedures and medications you would want and which ones you do not want. However, with the constant improvements in medicine, some procedures that were once may have been painful or intrusive may be more tolerable at the time your Health Care Agent must make a decision.
A HCD can also direct what you want to be done with your body after death including whether or not you want cremation or organ donation. You can also designate funeral arrangements and burial location.
Having a HCD is very important for you and your entire family. Talk to your attorney or your doctor about one soon.
The contents of this article are for information only and is not to be interpreted as legal advice. For personal legal advice you should consult with an attorney who is experienced in probate law or estate planning. The U.S. Treasury Department requires us to advise you that any written tax advice cannot be used and is not intended to be used by any taxpayer for the purpose of avoiding any penalties that may be imposed under the Internal Revenue Code. Written advice from our firm relating to any Federal Tax matters may not, without our express written consent, be used in promoting, marketing or recommending any entity, investment plan or arrangement to any taxpayer.
About the Author
Bill Peterson is a Minnesota Estate Planning Attorney with over 40 years of experience as a lawyer. His firm, Peterson Law Office, is pleased to help you with Minnesota Estate Planning. For more information, please visit http://www.mnestateplan.com or call toll free at 1-888-910-5297.
The contents of this article are for information only and is not to be interpreted as legal advice. For personal legal advice you should consult with an attorney who is experienced in probate law or estate planning.
Dana-Farber Cancer Institute scientists have successfully disrupted the function of a cancer gene involved in the formation of most human tumors by tampering with the gene's "on" switch and growth signals, rather than targeting the gene itself. The results, achieved in multiple myeloma cells, offer a promising strategy for treating not only myeloma but also many other cancer types driven by the gene MYC, the study authors say. Their findings are being published by the journal Cell on its website Sept. 1 and in its Sept. 16 print edition.
"Cancer is a disease of disregulation of growth genes in a cell, and MYC is a master regulator of these genes," says James E. Bradner, MD, of Dana-Farber, one of the study's senior authors. Previous attempts to shut down MYC by inhibiting it directly with drug molecules have been notably unsuccessful. "In this study, our idea was to switch MYC off, interfering with its ability to activate the cell-growth program."
They did so with a small molecule called JQ1, developed by Dana-Farber's Jun Qi, PhD, a co-author of the new study and namesake of JQ1. In multiple myeloma, MYC is hyperactive ? constantly ordering cells to grow and divide ? because it is in the wrong position in the cells' chromosomes. Instead of its normal, quiet neighborhood, MYC finds itself adjacent to a gene known as the immunoglobulin gene. This busy gene is switched on by bits of DNA known as immunoglobulin enhancers, which normally prompt the cell to begin producing disease-fighting antibodies. In myeloma, the immunoglobulin enhancers act on the out-of-place MYC gene like an impatient finger at a doorbell, repeatedly activating it.
Researchers found that the enhancers are loaded with a "bromodomain" protein called BRD4, which, they demonstrate, is used to switch on MYC. Conveniently, it is targeted by JQ1. When investigators added JQ1 to laboratory samples of myeloma cells, the bromodomain proteins fell off the enhancers and the enhancers abruptly stopped working. The result: a shutdown of MYC and a slowdown of cancer cell division.
"In a sense, the JQ1 molecule cuts the cable that activates MYC and also connects MYC to the cell-growth genes," Bradner says. "The signal is interrupted and growth abruptly stops."
When investigators administered JQ1 to laboratory mice harboring myeloma cells, the disease receded and the animals lived longer than those that had not been treated. The study authors emphasize that JQ1 is a protytpe drug and cannot be used immediately to treat myeloma or other cancers. Its success in the current study illuminates the promise of JQ1-based therapies that target bromodomain proteins in cancers dependent on MYC for their growth.
"Together, our findings show that BRD4 has an important role in maintaining MYC activity in myeloma and other blood-related malignancies," says the study's senior author, Constantine Mitsiades, MD, of Dana-Farber. "They also point to the potential usefulness of drug-like bromodomain inhibitors as novel therapies against these diseases."
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Dana-Farber Cancer Institute: http://www.dfci.harvard.edu
Thanks to Dana-Farber Cancer Institute for this article.
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WILKES-BARRE, Pa. ? Northern stretches of the swollen Susquehanna River began receding Friday after days of rainfall from the remnants of Tropical Storm Lee flooded communities from Virginia to New York, leading to evacuation orders for nearly 100,000 people.
The damage was concentrated along the Susquehanna in Binghamton, N.Y., in Wilkes-Barre, where more than 70,000 people were told to evacuate, and communities downstream in Maryland. The Susquehanna crested at 42.66 feet Thursday night in Wilkes-Barre ? beyond the design capacity of the city's levee system and higher than the record set in historic flooding spawned by Hurricane Agnes in 1972.
"They did what was right for them, the people down there," said Tom Vaxmonsky, a resident of West Pittson, just upstream from Wilkes-Barre. "But it's like everything else, for every action there's a reaction. And the reaction is that we got a lot more water than we did in `72 with the Agnes flood."
As flood waters that inundated the city of Binghamton, which the mayor called the worst in more than 60 years, and surrounding communities began subsiding, the first of the 20,000 evacuees began returning to their homes.
Robert Smith, 35, made it back around noon to his home in a struggling section of Binghamton. Mud and debris covered pavement, and water still blocked streets closest to the river. But he felt inspired by the time he spent in a shelter; when a woman collapsed on the floor there, he said, strangers rushed to tend to her.
"Everybody was helping each other out, just total strangers," he said. "You've never seen it before in your life."
The flooding was fed by days of drenching rains from what had been Tropical Storm Lee, and followed a little more than a week the dousing that Hurricane Irene gave the East Coast. In some areas of Pennsylvania, the rainfall totals hit 9 inches or more, on top of what was already a relatively wet summer.
Authorities in Pennsylvania closed countless roads, including some heavily traveled interstates, and evacuation shelters opened to serve the many displaced people.
In Wilkes-Barre, officials said the levees holding back the Susquehanna were under "extreme stress" but holding.
A broken flood gauge had hampered officials' ability to measure the river's height, but the U.S. Geological Survey on Friday estimated that the river had crested at 42.66 feet, well above earlier estimates and higher than the 1972 record of 40.9 feet.
Luzerne County Flood Protection Authority executive director Jim Brozena said the river was dropping Friday but that the flood control system was at its "extreme limits."
The heavy rains also shut down parts of the Capital Beltway in Fairfax County, Va., but some portions have reopened. As much as 10 inches of rain has fallen in some places in the area around Washington since Wednesday.
In Maryland, most of the 1,000 residents of Port Deposit were told to evacuate after the massive Conowingo Dam, upstream on the Susquehanna, opened its spill gates and flooded the town with 4 feet of water. Hundreds more were told to leave their homes in Havre de Grace, where the river meets the Chesapeake Bay.
The river at the dam crested Friday morning below record levels but wasn't expected to recede until into the night. Shelters opened in Perryville and Aberdeen, with river levels projected to be their highest since Agnes.
President Barack Obama declared states of emergency in Pennsylvania and New York early Friday, clearing the way for federal aid.
Evacuees had been told to expect to stay at least until Sunday or Monday, and it will be some time before officials get a handle on the damage that included a partial bridge collapse in northern Pennsylvania, vehicles and other property swept away, and failed sewage treatment plants.
"We're going to have some damage, but you won't know until it's over," said Wilkes-Barre Mayor Tom Leighton.
People in many small towns and rural areas in central Pennsylvania scrambled to get their families and their belongings out of harm's way as waters sometimes rose with frightening speed.
In West Pittston, unprotected by the levees, several hundred homes were under water ? many to the second floor, said former Mayor Bill Goldsworthy. Goldsworthy's own home was among those inundated.
It was the same story downriver in Plymouth Township, where floodwater swamped about 80 businesses and houses.
Farther down the Susquehanna in Bloomsburg, flood waters topped the height reached by Agnes and were expected to crest just short of the record set by a 1904 flood.
Harrisburg evacuated 6,000 to 10,000 residents in low-lying areas, while in Luzerne County, Pa., which includes Wilkes-Barre, the evacuation order covered all communities along the Susquehanna River that were flooded in the historic Hurricane Agnes deluge of 1972.
Late Thursday, Wilkes-Barre city crews scrambled to plug holes in the city's elaborate flood control system with sandbags. The river's dramatic rise began to slow, giving hope that the walls and earthen mounds would hold.
In nearby places unprotected by the levee system, however, emergency officials expected flooding of 800 to 900 structures, with the river likely to crest above some rooftops.
At least 12 deaths have been blamed on Lee and its aftermath: four in Pennsylvania; three in Virginia; one in Maryland; and four others killed when it came ashore on the Gulf Coast last week.
There were also mandatory evacuations in a neighborhood along the Housatonic River in Shelton, Conn., just as residents were mopping up from the mess Hurricane Irene left behind.
"I even have fish swimming in my garage, that's a first," Brian Johnson told the Connecticut Post. "There's minnows swimming in there."
Damage in parts of New Jersey that were inundated by Irene's rainfall was less than feared. About 300 residents waited to return home after Lee's remnants renewed flooding. Three houses were swept off their foundations by a mudslide, but no one was injured.
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Scolforo reported from Bloomsburg. Contributing to this report were Associated Press writers Michael Hill in Binghamton; Chris Carola in Albany, N.Y.; David Dishneau in Hagerstown, Md.; and Alex Dominguez in Port Deposit.
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Neuroscientists produce guide for ultrasound use to treat brain disorders in clinical emergenciesPublic release date: 8-Sep-2011 [ | E-mail | Share ]
Contact: Paula Byron paulabyron@vt.edu 540-526-2027 Virginia Tech
Roanoke, Va. The discovery that low-intensity, pulsed ultrasound can be used to noninvasively stimulate intact brain circuits holds promise for engineering rapid-response medical devices. The team that made that discovery, led by William "Jamie" Tyler, an assistant professor with the Virginia Tech Carilion Research Institute, has now produced an in-depth article detailing this approach, which may one day lead to first-line therapies in combating life-threatening epileptic seizures.
Status epilepticus is a condition in which the brain is in a state of persistent seizure and which, if not halted, can lead to Sudden Unexplained Death in Epilepsy (SUDEP). But, as the recent article by Tyler and colleagues shows, ultrasonic neuromodulation does not necessarily need to be focused to attenuate epileptic seizures, meaning that it can be quickly applied in neurocritical care situations.
"Imagine a device like an automatic external defibrillator except for the brain," said first author Yusuf Tufail, who is now a postdoctoral associate at the Salk Institute for Biological Sciences.
Published in the September issue of Nature Protocols, the article, "Ultrasonic Neuromodulation by Brain Stimulation with Transcranial Ultrasound," provides a guide for the further development and clinical application of ultrasonic neuromodulation. The authors Yusuf Tufail, Anna Yoshihiro, and Monica M. Li of Arizona State University's School of Life Sciences; Sandipan Pati of Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix, Ariz.; and corresponding author Tyler also published their earlier research into the feasibility of this approach in Neuron in 2010.
Ultrasound is an acoustic wave occurring at frequencies exceeding the range of human hearing. Uses range from food processing to communication and include medical imaging. Tyler and his research group have spent several years developing noninvasive methods for brain stimulation employing low-intensity, low-frequency (LILFU) ultrasound. "Much of our time had been spent on understanding the biological effects of LILFU on intact brain circuits and how to control neural activity using LILFU," Tyler said.
The team has observed that the mechanical bioeffects of ultrasound are indeed capable of stimulating neuronal activity, meaning that ultrasound could join other therapies for neurological disorders namely, implanted electrodes, such as those used in deep-brain stimulation, and external magnetic stimulators used for transcranial magnetic stimulation to treat disorders such as Parkinson's disease, major depression, and dystonia. The major advantage of using ultrasound for brain stimulation is that it can confer spatial resolution at millimeter precision while being focused through the skull to deep-brain regions without the need for invasive brain surgery, Tyler said.
"We have also shown that ultrasound can be used to stimulate synaptic transmission between groups of neurons within the brain in a manner similar to conventional implanted stimulating electrodes without generating significant heating of the brain tissue," said Tyler.
"Further studies are required to fully elucidate the many potential mechanisms underlying the ability of ultrasound to stimulate neuronal activity in the intact brain," the article states. However, while using ultrasound for brain stimulation represents a powerful new tool for clinical neuroscience, there are potential concerns, since high-intensity ultrasound is also capable of destroying biological tissues, the researchers write.
The article reports that ultrasound has been used for many hours across many weeks, "stimulating cellular circuits in the living brain without producing damage in mice as assessed with cellular, histological, ultrastructural, and behavioral methods." The researchers added a note of caution: "Additional investigations across animal species and dosage levels are required, however, before the safety can be fully ascertained."
Moving this technology forward will require scientists, engineers, and physicians spanning many disciplines. The impetus for the Nature Protocols article is to disseminate basic methods for conducting ultrasonic neuromodulation. "There is a major need for increased open communication among engineers designing ultrasound-based medical devices, neuroscientists studying the core biological effects of ultrasound, and clinicians implementing ultrasound for therapeutic interventions," said Tyler.
The Nature Protocols article poses specific questions needing to be addressed, such as how ultrasound affects neurons on a molecular and cellular level, how to correct for impedance mismatches between skin and skull interfaces, and the need for characterizing safety across different exposure times, applications, and disease states.
The research reported in the article provides the provocative demonstration that ultrasonic neuromodulation is capable of attenuating seizure activity during pharmacologically induced status epilepticus in rodents. "While other research groups have reported that focused ultrasound can modulate seizure activity in the brain, the approaches used in those earlier studies require timely preparations and the implementation of MRI to focus the ultrasound in an approach known as magnetic resonance-guided focused ultrasound," said Tyler. "Our findings show that clinicians may not need to take such complicated, costly, and time-consuming approaches to treating patients in critical situations."
###
Learn more about Dr. Tyler at http://research.vtc.vt.edu/employees/jamie-tyler/
Learn more about the research institute at http://research.vtc.vt.edu/
Link to the article at http://www.nature.com/nprot/journal/v6/n9/full/nprot.2011.371.html
Citation
Tufail Y, Yoshihiro A, Pati S, Li MM, Tyler WJ. (2011) Ultrasonic neuromodulation by brain stimulation with transcranial ultrasound. Nature
[ | E-mail | Share ]
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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Neuroscientists produce guide for ultrasound use to treat brain disorders in clinical emergenciesPublic release date: 8-Sep-2011 [ | E-mail | Share ]
Contact: Paula Byron paulabyron@vt.edu 540-526-2027 Virginia Tech
Roanoke, Va. The discovery that low-intensity, pulsed ultrasound can be used to noninvasively stimulate intact brain circuits holds promise for engineering rapid-response medical devices. The team that made that discovery, led by William "Jamie" Tyler, an assistant professor with the Virginia Tech Carilion Research Institute, has now produced an in-depth article detailing this approach, which may one day lead to first-line therapies in combating life-threatening epileptic seizures.
Status epilepticus is a condition in which the brain is in a state of persistent seizure and which, if not halted, can lead to Sudden Unexplained Death in Epilepsy (SUDEP). But, as the recent article by Tyler and colleagues shows, ultrasonic neuromodulation does not necessarily need to be focused to attenuate epileptic seizures, meaning that it can be quickly applied in neurocritical care situations.
"Imagine a device like an automatic external defibrillator except for the brain," said first author Yusuf Tufail, who is now a postdoctoral associate at the Salk Institute for Biological Sciences.
Published in the September issue of Nature Protocols, the article, "Ultrasonic Neuromodulation by Brain Stimulation with Transcranial Ultrasound," provides a guide for the further development and clinical application of ultrasonic neuromodulation. The authors Yusuf Tufail, Anna Yoshihiro, and Monica M. Li of Arizona State University's School of Life Sciences; Sandipan Pati of Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix, Ariz.; and corresponding author Tyler also published their earlier research into the feasibility of this approach in Neuron in 2010.
Ultrasound is an acoustic wave occurring at frequencies exceeding the range of human hearing. Uses range from food processing to communication and include medical imaging. Tyler and his research group have spent several years developing noninvasive methods for brain stimulation employing low-intensity, low-frequency (LILFU) ultrasound. "Much of our time had been spent on understanding the biological effects of LILFU on intact brain circuits and how to control neural activity using LILFU," Tyler said.
The team has observed that the mechanical bioeffects of ultrasound are indeed capable of stimulating neuronal activity, meaning that ultrasound could join other therapies for neurological disorders namely, implanted electrodes, such as those used in deep-brain stimulation, and external magnetic stimulators used for transcranial magnetic stimulation to treat disorders such as Parkinson's disease, major depression, and dystonia. The major advantage of using ultrasound for brain stimulation is that it can confer spatial resolution at millimeter precision while being focused through the skull to deep-brain regions without the need for invasive brain surgery, Tyler said.
"We have also shown that ultrasound can be used to stimulate synaptic transmission between groups of neurons within the brain in a manner similar to conventional implanted stimulating electrodes without generating significant heating of the brain tissue," said Tyler.
"Further studies are required to fully elucidate the many potential mechanisms underlying the ability of ultrasound to stimulate neuronal activity in the intact brain," the article states. However, while using ultrasound for brain stimulation represents a powerful new tool for clinical neuroscience, there are potential concerns, since high-intensity ultrasound is also capable of destroying biological tissues, the researchers write.
The article reports that ultrasound has been used for many hours across many weeks, "stimulating cellular circuits in the living brain without producing damage in mice as assessed with cellular, histological, ultrastructural, and behavioral methods." The researchers added a note of caution: "Additional investigations across animal species and dosage levels are required, however, before the safety can be fully ascertained."
Moving this technology forward will require scientists, engineers, and physicians spanning many disciplines. The impetus for the Nature Protocols article is to disseminate basic methods for conducting ultrasonic neuromodulation. "There is a major need for increased open communication among engineers designing ultrasound-based medical devices, neuroscientists studying the core biological effects of ultrasound, and clinicians implementing ultrasound for therapeutic interventions," said Tyler.
The Nature Protocols article poses specific questions needing to be addressed, such as how ultrasound affects neurons on a molecular and cellular level, how to correct for impedance mismatches between skin and skull interfaces, and the need for characterizing safety across different exposure times, applications, and disease states.
The research reported in the article provides the provocative demonstration that ultrasonic neuromodulation is capable of attenuating seizure activity during pharmacologically induced status epilepticus in rodents. "While other research groups have reported that focused ultrasound can modulate seizure activity in the brain, the approaches used in those earlier studies require timely preparations and the implementation of MRI to focus the ultrasound in an approach known as magnetic resonance-guided focused ultrasound," said Tyler. "Our findings show that clinicians may not need to take such complicated, costly, and time-consuming approaches to treating patients in critical situations."
###
Learn more about Dr. Tyler at http://research.vtc.vt.edu/employees/jamie-tyler/
Learn more about the research institute at http://research.vtc.vt.edu/
Link to the article at http://www.nature.com/nprot/journal/v6/n9/full/nprot.2011.371.html
Citation
Tufail Y, Yoshihiro A, Pati S, Li MM, Tyler WJ. (2011) Ultrasonic neuromodulation by brain stimulation with transcranial ultrasound. Nature
[ | E-mail | Share ]
?
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
The common goal of any channel distribution network is to increase profitability through the effective marketing and promotion of parent company products. In order to realize such goals, channel members must first share in a well-designed channel sales strategy. However, it is imperative that companies should understand the different types of customer relationships before anything else in order to design, create, and utilize a channel sales strategy effectively.
The first thing you have to do is to get to know your consumers and understand your relationship with them. This way, you can design a strategy that addresses their preference and needs more accurately which would in turn result in increased interest and patronage of your products. There are four types of customer relationships and they are business, partner, functional and tactical.
The business type is on a ?per sale? basis, meaning a person simply purchases a product from a particular retailer because of personal preference, cheaper costs, convenience, and so on. In other words, there is little interest for both sides to maintain or nurture the relationship. For example, a customer buys bread from one bake shop because its products are tasty and priced reasonably. If the bake shop suddenly shuts down one, the customer will think little of it and would simply move on and buy bread somewhere else.
The partner type of connection is significantly deeper and involves a certain degree of trust. Usually for this type, the customer is in need of the seller?s expert knowledge and opinion regarding a particular service or product. Confident of the seller?s integrity and genuine desire to assist, the consumer will ask the seller questions and would depend on what he or she will say in order to make important decisions. For example, a salesman sells the best food supplements in town, and he knows a lot about which products are of the highest quality. A certain fitness center continues to buy from and depend on him to provide them with best and most effective supplements for their clients.
The functional type on the other hand is an ongoing, developing relationship. The customer habitually purchases a particular product from the seller because it has always worked well or met his or her needs effectively. Moreover, if he or she continues to patronize that quality product, costs decrease substantially because as proven by experience, there is a guarantee that it will not fail. For example, you continue to buy a particular brand of anti-dandruff shampoo from this grocery store because it was the only brand that worked for you. Also, that store is the one nearest to your house. If that grocery store suddenly stops stocking up on your favorite brand of shampoo, you will feel highly inconvenienced.
Tactical is the last type. For this relationship, both parties are willing to invest in time and financial resources so that they will make more profit. For example, Chocolatier A provides Bakery A with the dark chocolate bars it needs to create the best chocolate cake in town. A tastier and richer dark chocolate results in a more mouthwatering cake. Chocolatier A and Bakery A would therefore exert a lot of effort to improve the quality of their products. If Bakery A sells a lot of chocolate cakes, then this means Chocolatier A sells a lot of dark chocolate bars. This success will bring both sides closer together and develop into a well-managed, ongoing strategic partnership.
About the Author
A computer graduate and loves to travel. Reading current news in the internet is one of his past times. Taking pictures of the things around him fully satisfies him. He loves to play badminton and his favorite pets are cats and walk with them in the park with some dogs.
You may want to take a look at a channel sales strategy web page for more information and details or you may call us directly at 877 226 2564 (TOLL FREE).
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SVP of Island Def Jam Records talks Sales Strategy
Atlanta Falcons WR Kerry Meier is listed as the fourth receiver on the team's first unofficial depth chart of the regular season behind WRs Roddy White, Julio Jones and Harry Douglas.
Click to continue reading this fantasy sports article at Footballguys.com News Blogger.
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Public release date: 8-Sep-2011
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