With Mandela, end-of-life care dilemmas magnified

FILE - In this Wednesday, May 30, 2012 file photo, South Africa's former President Nelson Mandela, left, receives a torch to celebrate the African National Congress' centenary from ANC chairperson Baleka Mbete, right, in Mandela's home village of Qunu in rural eastern South Africa. Mandela's wife Graca is at center. The emotional pain and practical demands facing Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Some choose to let go with little medical interference; others seek aggressive medical care. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say. (AP Photo/Lulamile Feni-Daily Dispatch, Lulamile Feni, File)

FILE - In this Wednesday, May 30, 2012 file photo, South Africa's former President Nelson Mandela, left, receives a torch to celebrate the African National Congress' centenary from ANC chairperson Baleka Mbete, right, in Mandela's home village of Qunu in rural eastern South Africa. Mandela's wife Graca is at center. The emotional pain and practical demands facing Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Some choose to let go with little medical interference; others seek aggressive medical care. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say. (AP Photo/Lulamile Feni-Daily Dispatch, Lulamile Feni, File)

FILE - In this Dec. 7, 2005 file photo, former South African President Nelson Mandela, 87, is in a jovial mood at the Mandela Foundation in Johannesburg. The emotional pain and practical demands facing Nelson Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say.(AP Photo/Denis Farrell, File)

FILE - In this Wednesday, July 18, 2012 file photo, former South African President Nelson Mandela celebrates his birthday with family in Qunu, South Africa. The emotional pain and practical demands facing Nelson Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say. (AP Photo/Schalk van Zuydam, File)

CHICAGO (AP) ? The emotional pain and practical demands facing Nelson Mandela's family are universal: confronting the final days of an elderly loved one. There are no rules for how or when the end may arrive. Some choose to let go with little medical interference; others seek aggressive treatment. Mandela's status as a respected global figure only complicates the situation, doctors and end-of-life experts say.

Mandela "is not only revered he is loved and profoundly admired by people all over the world and the sense of letting go must be difficult for everyone involved," said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

In much of Africa, people are considered fortunate to live past age 60. For those who reach old age, death is still seen as sad, but friends and family typically celebrate with big parties to honor a life well-lived. Taking extraordinary measures to keep that person alive would be considered dishonorable, said Dr. Sola Olopade, the Nigerian-born clinical director for the University of Chicago's Center for Global Health.

If such measures are being used for Mandela, many could consider it "quite painful," Olopade said, "because those are not the last memories you want to have for someone with such an exemplary life."

U.S. doctors said Mandela's lung infection is most likely pneumonia, a very common cause of illness and death in the elderly.

The infection is usually caused by bacteria and causes lungs to fill with fluid or pus, making breathing difficult and often causing fever and weakness. Treatment includes antibiotics and extra oxygen, often from a mechanical ventilator.

In the United States, an elderly person critically ill with pneumonia would typically be hospitalized in an intensive care unit and put on a mechanical ventilator, or breathing machine, said Dr. J.P. Kress. He is director of the University of Chicago's medical intensive care unit's section on lung and critical care. Ventilators often require a breathing tube down the throat, and patients need to be sedated because of the discomfort.

These patients typically are hooked up to feeding tubes, intravenous fluids and all kinds of monitoring machines to check heart rate, blood pressure and other functions. For long stays, lying prone in a hospital bed, they have to be periodically moved into different positions to prevent bed sores; their arms and legs have to be exercised to fight muscle wasting.

Mandela has been hospitalized several times since December for a recurring lung infection, and he has had tuberculosis.

In a hospitalization in March and April, doctors drained fluid from around his lungs, making it easier for him to breathe. He got care at home until he returned to the hospital on June 8.

For elderly patients hospitalized repeatedly with lung problems, the chances for recovery are often grim, Kress said.

"It's possible he's sitting in a chair asking, 'When am I going to get out of the hospital?' but that's very unlikely," he said.

Patients so critically ill may have ups and downs, and small changes like needing a little less help from a ventilator may be seen as a sign of improvement even when the outlook remains poor, Kress said.

Schaffner, the Vanderbilt doctor, said, "There are always little glimmers of hope. It's not a straight line down ... when you're so gravely ill."

Ada Levine faced end-of-life decisions with her mother, Maria Robles of Chicago. And it was difficult even though her mother had made her wishes known. Robles died two weeks ago at age 75 after 12 years of heart failure and other problems that had her in and out of the hospital.

"It was not going to get better," Levine said. "You're hopeful. You believe in miracles and 'maybe.' At some point you realize there is no miracle and you have to be strong and do the right thing."

Her mother did not want life support, but following that directive is easier said than done, Levine said.

"It's brutal, very difficult, hard, to watch this person decline and think now you're responsible for making their decisions."

Schaffner went through the same experience with his mother. She died 10 years ago at age 84 after several strokes and then pneumonia.

When she was still lucid, the family discussed end-of-life care. She did not want to be kept alive on a ventilator. So when she developed pneumonia and was hospitalized, she got comfort care ? fluids, antibiotics and sedatives to calm her anxiety over struggling to breathe ? but no intensive treatments with fancy machines.

After several days, when it became clear "there was zero chance she was going to turn around," the family brought her home, with hospice care, and she died less than two weeks after falling ill, Schaffner said.

Loretta Downs, former president of the Chicago End-of-Life Care Coalition, said decisions about life support should turn around the patient's wishes.

"Very often it's not the person who's dying's choice," but the family's, she said. "Now that we can prolong dying there's this whole question of are we prolonging dying versus prolonging living? It's not comfortable to be on life support."

___

AP Chief Medical Writer Marilynn Marchione contributed from Milwaukee and Andrew Meldrum contributed from Johannesburg.

___

Online:

End-of-life care: http://1.usa.gov/bPeFiT

__

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2013-06-28-US-MED-Mandela-End-of-Life/id-28d9776d934b4e6b85f2c7a5e3900b2e

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Will Channing Tatum, Jamie Foxx Go On Tour After Viral Vid?

'(I Wanna) Channing All Over Your Tatum' was a hit, and the 'White House Down' stars reveal to MTV News what's next.
By Todd Gilchrist

Source: http://www.mtv.com/news/articles/1709666/channing-tatum-jamie-foxx-viral-video-tour.jhtml

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Friends & Family Attend ?Sopranos? Star James Gandolfini?s Funeral (VIDEO)

Friends & Family Attend “Sopranos” Star James Gandolfini’s Funeral (VIDEO)

James Gandolfini’s family, friends, and co-stars gathered to remember the beloved “Sopranos” star, who passed away last week at the age of 51 of a heart attack in Italy. Gandolfini’s wife, Deborah Lin, described him as a person that “cared more for others than himself”. Deborah Lin said at the service, “Jim, one of the ...

Friends & Family Attend “Sopranos” Star James Gandolfini’s Funeral (VIDEO) Stupid Celebrities Gossip Stupid Celebrities Gossip News

Source: http://stupidcelebrities.net/2013/06/friends-family-attend-sopranos-star-james-gandolfinis-funeral-video/

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Many cancer patients expect palliative care to cure

By Kathryn Doyle

NEW YORK (Reuters Health) - In a survey of patients with terminal lung cancer, nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease.

Among the nationwide sample of patients with advanced lung cancers, four out of five thought the radiation would help them live longer and two in five believed it might cure their cancers.

"Radiation therapy can be used to relieve symptoms caused by metastatic lung cancer, such as pain from bony metastases, shortness of breath from lung tumors, or neurologic symptoms, such as weakness, from brain metastases," said the study's lead author, Dr. Aileen Chen of the Dana-Farber Cancer Institute in Boston.

Patients with metastatic lung cancer usually live less than a year, she told Reuters Health, and their radiation treatments are intended to improve quality of life for the time that remains, so Chen was surprised that so many patients believed they would cure them.

Previous studies have shown that cancer patients have unrealistic expectations for chemotherapy as well, according to Phyllis Butow, professor of psychology at the University of Sydney in Australia.

"Our experience is that it is common with many late stage cancers," Butow, who was not involved in the new research, told Reuters Health. "We have done studies with patients with all sorts of late stage cancers and found similar results," she said.

The current study included 384 people who were diagnosed with incurable lung cancer between 2003 and 2005 and were receiving radiation therapy. The patients answered questions about their expectations of the therapy.

Overall, 64 percent did not understand that radiation was not at all likely to cure them.

Older patients and ethnic groups other than whites were more likely to have inaccurate beliefs about their care, according to the results published in the Journal of Clinical Oncology.

Twenty percent of the patients expected radiation treatments were "very likely" to cure their cancer, and another 25 percent thought they were "somewhat likely." Less than 40 percent answered that the radiation was "not at all likely" to cure their cancer.

Seventy-eight percent believed radiation was "very" or "somewhat" likely to help them live longer.

There was no difference in overall survival time between patients who expected to be cured and those who did not.

Both patients and doctors may avoid conversations about prognosis for emotional reasons, which may drive these inaccurate beliefs, Butow said.

"It is bad, because it can lead to poor decision making where patients and their families feel driven to continue with toxic treatments that significantly reduce patients' quality of life and do not extend their lifespan," she said.

All cancer clinicians have probably come across this problem in their practice, said Dr. George Rodrigues, a radiation oncologist at the London Health Sciences Centre in Ontario, Canada.

"The more surprising finding of the study was the extent to which this phenomenon was detected, in nearly two thirds of patients," Rodrigues said in an email. "According to this data, nearly 2/3 of patients are agreeing to palliative radiotherapy with the misconception that this radiotherapy may cure their disease."

Lung cancer patients might be especially prone to misplaced expectations, he said, since they tend to have short survival times and 95 percent of cases are caused by cigarette or tobacco smoke, and those patients tend to have more guilt and shame about their disease and may be more emotionally susceptible.

"What needs to occur is specific research to identify evidence based strategies that can improve patient understanding of prognosis and goals of therapy," he said. "Just telling physicians to do a better job in communicating to patients is not likely to affect any meaningful change," he said.

SOURCE: http://bit.ly/172HIRs Journal of Clinical Oncology June 17, 2013.

Source: http://news.yahoo.com/many-cancer-patients-expect-palliative-care-cure-180523977.html

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Asia stocks gain on hopes Fed stimulus to stay

A man checks his mobile phone in front of the electronic stock board of a securities firm in Tokyo, Wednesday, June 26, 2013. Global stock markets staged a modest recovery Wednesday, boosted by strong data releases that portray a U.S. economy on the upswing. Japan's Nikkei 225 fell 1 percent to close at 12,834.01. (AP Photo/Itsuo Inouye)

A man checks his mobile phone in front of the electronic stock board of a securities firm in Tokyo, Wednesday, June 26, 2013. Global stock markets staged a modest recovery Wednesday, boosted by strong data releases that portray a U.S. economy on the upswing. Japan's Nikkei 225 fell 1 percent to close at 12,834.01. (AP Photo/Itsuo Inouye)

A man stands in front of the electronic stock board of a securities firm in Tokyo, Wednesday, June 26, 2013. Global stock markets staged a modest recovery Wednesday, boosted by strong data releases that portray a U.S. economy on the upswing. Japan's Nikkei 225 fell 1 percent to close at 12,834.01. (AP Photo/Itsuo Inouye)

HONG KONG (AP) ? Stock markets from Sydney to Shanghai extended gains for a second day Thursday after the U.S. said quarterly growth may be weaker than expected, raising investors' hopes that the Federal Reserve would delay plans to wind down its stimulus program.

Further signs of easing in China's money markets also helped lift stocks.

Japan's Nikkei 225 jumped 2.4 percent to 13,142.50 and Hong Kong's Hang Seng gained 1.3 percent to 20,607.27. South Korea's Kospi surged 3 percent to 1,837.45.

Australia's S&P/ASX 200 added 1.8 percent to 4,818.80. Benchmarks in New Zealand, Singapore and Taiwan also rose.

The U.S. government cut its estimate for second-quarter economic growth to 1.8 percent, down sharply from 2.4 percent because of lower than predicted consumer spending.

While news of the weakness in the world's biggest economy was disappointing, it was also positive for investors, who were rattled last week after Fed Chairman Ben Bernanke said the U.S. central bank would slow its bond-buying program if the U.S. economy continues to strengthen. That program has kept interest rates low and made stocks more attractive.

"This doesn't put a new spin on the outlook but it certainly makes one wonder all the more about the Fed's 'new and improved' outlook for 2014," economists at DBS Bank wrote in a commentary.

Mainland Chinese benchmarks opened sharply higher after a report that Chinese industrial profits grew strongly in May, though they pared their gains by midday. The Shanghai Composite Index advanced 0.4 percent to 1,959.25 and the smaller Shenzhen Composite Index rose 0.3 percent to 913.87.

Markets were also buoyed as interbank lending rates in China continue to ease after a pledge earlier in the week by authorities to shore up banks facing cash shortfalls.

"We expect the interbank rates will come down further in the coming weeks," J.P. Morgan analysts Haibin Zhu, Grace Ng and Lu Jiang said in a research report. But they said that they didn't expect the rates to fall to the level they were at previously.

The central bank had allowed rates that banks pay to borrow from each other to soar last week, part of an attempt by Beijing to clamp down on massive credit in the informal lending industry.

Fears of a credit crisis in the world's second-biggest economy had contributed to a rout in global markets that ended when policymakers in China softened their stance with the promise to provide "liquidity support" if needed.

Benchmark oil for August delivery was up 39 cents to $95.89 a barrel in electronic trading on the New York Mercantile Exchange. The contract rose 18 cents to end at $95.50 a barrel on Wednesday.

In currencies, the euro rose to $1.3031 from $1.3012 late Wednesday in New York. The dollar rose to 97.76 yen from 97.74 yen.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/f70471f764144b2fab526d39972d37b3/Article_2013-06-27-World%20Markets/id-bddb5007a55946d697b19d466d59e92b

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Car bomb kills army intelligence officer in Libya's Benghazi

BENGHAZI, Libya (Reuters) - A Libyan military intelligence officer was killed when a bomb exploded in his car on Wednesday in the latest attack on security forces in the eastern city of Benghazi, officials said.

The blast hit Lieutenant Colonel Giuma Misrati just after he left his home and was standing next to the vehicle, the authorities added.

Libya remains anarchic and awash with weapons nearly two years after a Western-backed uprising toppled dictator Muammar Gaddafi.

Government forces are still struggling to assert their authority on the major oil producer, but have been regularly challenged by regional militias who want to keep hold of the influence they gained during the revolution.

Benghazi, the cradle of the 2011 revolt, has became a particular focus of violence, mainly against security forces. Residents say some of the assaults may be revenge attacks by former prisoners.

Islamists, largely suppressed under Gaddafi, have also come to the fore.

"There are some people who are trying to use this city as an arena for settling scores," said the deputy head of Benghazi's local council, Saad al-Saity.

"This is impeding our plans for reconstruction and getting foreign companies to return," he added.

On Tuesday six soldiers were killed in an attack by unidentified gunmen on an army checkpoint south of the coastal city of Sirte.

Last week, bombs flattened a police station in Benghazi but there were no casualties as the building had been emptied for repairs following previous attacks.

The city remains a no-go area for foreigners, after a series of attacks on Western diplomats including last September's assault on the U.S. mission which killed the ambassador and three other Americans.

(Reporting by Feras Bosalum; Writing by Ghaith Shennib and Marie-Louise Gumuchian; Editing by Andrew Heavens)

Source: http://news.yahoo.com/car-bomb-kills-army-intelligence-officer-libyas-benghazi-160114413.html

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Cambridge Audio's Minx Air 200 Earns The Crown For Best Home ...

If you?re a high-end audio fan, you?ve probably heard of Cambridge Audio, the London-based firm that makes some of the best equipment in the business. The brand is currently undergoing some changes that involve targeting the growing number of users who are looking for wireless in-home and portable speaker solutions. Hence the new Minx line of devices, which borrows its name from Cambridge?s affordable home-theater speaker range, but adds goodies like AirPlay and Bluetooth.

The Minx Air 200 is part of this new effort. It?s a large home speaker that packs in AirPlay, Bluetooth, two 2.25-inch drivers and one 6.5-inch subwoofer, as well as direct access to up to five preset Internet radio stations without requiring a connection to an iPhone, smartphone or computer. The Minx Air 200 is a beast of a networked speaker system, and at $599 it compares price-wise to other higher-end options like the Bowers & Wilkins Zeppelin Air or the Libratone Live Speaker.

• AirPlay
• Bluetooth
• 3.5mm and RCA wired input
• 802.11 b/g
• Ethernet
• 200W amplifier output
• MSRP: $599
• Product info page

The Minx Air 200 is somewhat sober in its design choices if I had to pick one word to describe it. It?s white plastic, with a light gray front grill and metallic rim bordering the front grill. Unlike some of the competition like the Zeppelin, the Minx isn?t trying to draw too much attention to itself. The arc of it adds a little bit of design flare, but mostly this is a speaker that strikes you as subdued, and that?s just fine. The Air 200 isn?t bad looking, it just is. Which sets the stage for it to live or die based on its performance.

You?ll be able to connect to the Minx Air no matter what type of device you?re trying to use as your music source, and the AirPlay connectivity is solid (the protocol seems to have come a long way in terms of stability, which is a bonus for Cambridge, who are relative latecomers to the market). And Ethernet support is a hugely welcome addition if you?re the type that can?t even fathom the idea of an occasional drop-out. It?s probably not going to be much use to most looking for a wireless speaker, but the fact that it?s there at all is excellent.

Preset Internet radio stations is another huge advantage for the Minx Air 200. With the Minx Air app, you can change settings on your device and cycle through 10 preset stations. Minx sets these up automatically, but you can change them within the app. Best of all, you can switch between five presets on the Air 200 itself with hardware buttons, giving you access to Internet radio without any kind of connected device required. That?s a huge advantage versus the competition when it comes to features.

True to its audiophile roots, Cambridge has also included advanced audio signal-boosting technologies, including built-in digital to analog converters (DACs) and AAC decoding, as well as tech designed to maximize the quality of Bluetooth stereo streaming to CD-quality standards.

All those claims of better sound bring us to the money question: Is the?sound?actually better? Yes, yes it is. Put simply, this is the best-sounding AirPlay speaker I?ve reviewed, and the best-sounding Bluetooth one, too. AT $599, it isn?t cheap, but in this case you definitely get what you pay for. Bass performance is impressive, as is max volume, though even Cambridge admits this won?t go as loud as some of the competitors in the interest of preventing any kind of distortion even at the top end, something competitors aren?t necessarily as concerned about.

Cambridge may be trying to move into more mass-market products, but the Minx Air 200 still demonstrates the company?s audiophile roots. Audio clarity is great, even from streamed online sources like Rdio being streamed once again over the local network. The connection doesn?t seem to suffer from excess network traffic, either, and Bluetooth connections are likewise solid (with the usual limits on proximity), and sound quality also shines there. If you?ve been making do with even something as good as an Audyssey Audio Dock Air, you?ve been missing out. And that?s what Cambridge wants to do with the Minx line: Show a generation that hasn?t been particularly focused on audio quality what a difference it can make when someone pays attention to that above all. Mission accomplished.

This is an excellent choice for an AirPlay/wireless home speaker. A battery would be nice, as there?s a handle for easy enough portability, but in its category, it?s still by far the best choice at the current price, and probably a better option than some of the more expensive ones out there. Cambridge Audio may have waited and let its competitors get a head start in this category, but the wait paid off: The Minx Air 200 is a polished, well-designed piece of audio hardware that confidently tops the?competition.

Cambridge Audio designs products to make music sound amazing.

? Learn more

Source: http://techcrunch.com/2013/06/26/cambridge-audios-minx-air-200-earns-the-crown-for-best-home-airplay-speaker/

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