Conclusion. Increased synthesis of endothelin-1 mRNA and nitric oxide as well as a significant cytotoxic effect on tubular epithelial

cells under the influence of CsA might be related to the development of CsA nephrotoxicity.”
“Cactus pear fruit (Opuntia) are harvested from various species of the genus Opuntia of the cactus family (Cactaceae), and are produced and consumed in several countries. We have characterized the nutritional content and antioxidant capacity (AC) of the fruit of ten cultivars/lines of distinct pulp colors. ‘Camuesa’ had the highest betalains, total carotenoids, ss-carotene, ascorbic acid, and was one of the highest see more in total phenolic compounds, but its AC did not demonstrate outstanding differences with some other cultivars/lines that were not as rich in Alisertib concentration these compounds. ‘Roja Pelota’ had high AC when measured with the DPPH assay, but had low total carotenoids, ss-carotene and total phenolic content. ‘Reyna’ had slightly low AC as measured by the FRAP assay, practically no betalains, and low vitamin C, tocopherols, ss-carotene, and total phenolic content. (c) 2011 Elsevier Ltd. All rights reserved.”
“Vitamin D receptor (VDR) polymorphisms may confer susceptibility to immunologically mediated liver diseases. We aimed to verify whether recipient VDR polymorphisms might affect the incidence of acute cellular rejection (ACR) of the graft after

liver transplantation (LT). Two hundred and fifty-one liver-transplanted patients surviving at least 1 month were studied. ACR in the first post-LT year was graded according to the Banff score. Recipients genotyping for VDR polymorphic sites (FokI C>T, BsmI G>A, ApaI T>G, A-1331852 TaqI T>C) was performed. A significant difference was found between patients with and without ACR episodes in allele frequencies of BsmI (G: 0.660 vs. 0.545, P

= 0.017) and TaqI (T: 0.667 vs. 0.543, P = 0.010). Patients carrying the G-*-T/G-*-T diplotypes of the BsmI G>A, ApaI T>G and TaqI T>C experienced more frequently ACR: 33/79 Vs 42/172, P = 0.005. Carriage of G-*-T/G-*-T diplotypes was an independent predictor of ACR (OR 2.41, P = 0.006), with CMV reactivation (OR 2.34, P = 0.033) and HCV aetiology (OR 1.86, P = 0.036). In conclusion, recipient VDR polymorphic loci are strongly associated with ACR occurrence during the first year after LT. The knowledge of VDR genetic polymorphisms may be helpful in identifying recipients at higher risk of ACR and in selecting them for a more aggressive immunosuppressive therapy.”
“The foundations of proteomics are to study gene products and their regulatory roles within cells. Paradoxically, the only evidence that sperm cells make new proteins is through mitochondrial protein synthesis. Yet despite this, spermatozoa are the perfect candidates for mass spectrometry and hence, proteomic analysis.

We present here the development of mathematical, time-delay models for protein translation, based on PDE models, which in turn are derived through systematic approximations see more of first-principles mechanistic models. Theoretical analysis suggests that the key

features that determine the time-delays and the agreement between the time-delay and the mechanistic models are ribosome density and distribution, i.e., the number of ribosomes on the mRNA chain relative to their maximum and their distribution along the mRNA chain. Based on analytical considerations and on computational studies, we show that the steady-state and dynamic responses of the time-delay models are in excellent agreement with the detailed mechanistic models, under physiological conditions that correspond to uniform ribosome distribution and for ribosome density up to 70%. The methodology presented here can be used for the development of reduced time-delay models of mRNA synthesis and large genetic networks. The good agreement between the time-delay and the mechanistic models will allow us to use the reduced model and advanced computational methods from nonlinear dynamics in order to perform studies that are not

practical using the large-scale mechanistic models.”
“Implementation of the linear electro-optic (EO) effect in MDV3100 research buy thin film waveguides is expected to allow drastic reductions in the drive voltage, power, and dimensions of devices devoted to light modulation. It should also enable the realization of electrically tunable photonic crystal devices. In this paper we introduce a method

which eliminates systematically the sources of the unreliability which strongly affects thin film EO characterization. Based on a Fabry-Perot reflective configuration, the method enables characterizing simultaneously the EO, converse-piezoelectric, and electroabsorptive effects in a film. It provides the magnitude and sign of each of the involved coefficients, and allows accounting for the whole of experimental data versus angle of incidence for both transverse-electric and transverse-magnetic polarizations. At lambda=633 nm and room https://www.selleckchem.com/products/Nutlin-3.html temperature, the results obtained with an epitaxial strontium barium niobate (SrxBa1-xNb2O6, x=0.60) ferroelectric thin film, are: r(13)=+ 8.5 +/- 1.3 pm/V, r(33)=+38.9 +/- 0.5 pm/V, d(33) =Delta e/Delta V=+21 +/- 4 pm/V, and Delta k(o)/Delta V=(+9.8 +/- 0.6) x 10(-6), where r(13) and r(33) are two linear EO coefficients, d(33) is a converse-piezoelectric coefficient, and e, k(o), V represent, respectively, the film thickness, film ordinary extinction coefficient, and applied voltage. Converse-piezoelectric and electroabsorptive effects are found significant in the film response at a frequency below piezoelectric resonance. Diagonal and effective EO coefficients of the (Sr, Ba)Nb2O6 (SBN) film explored in the present work are larger than those of a crystal of lithium niobate (LN) at the same wavelength lambda=633 nm.

At the end of 8 weeks, the rats were placed under anesthesia, the hemodynamic GSK1120212 solubility dmso variables were recorded and blood samples were collected. Cardiac hypertrophy was evaluated using the left ventricular weight/body weight ratio, and the collagen volume fraction was assessed using histology.

RESULTS: The chronic heart failure trained group showed a reduction in left ventricular end-diastolic pressure, a lower left ventricular weight/body weight ratio and a lower collagen volume fraction compared with the chronic heart failure sedentary group. In addition,

exercise training reduced the plasma levels of TNF-alpha and IL-6 and increased the plasma level of IL-10.

CONCLUSION: An 8-week aerobic exercise training program improved the inflammatory profile and cardiac function and attenuated cardiac remodeling in chronic heart failure rats.”
“Objective: We determined whether baseline depressive symptoms, knee-related confidence and general psychological distress

influenced changes in pain and function during 2 years of follow-up.

Design: We included persons in the Osteoarthritis Initiative (OAI) dataset with baseline pain of 1 or greater on a 0-10 scale in at least one knee and no knee or hip surgery QNZ during the 2-year follow-up (n = 3407). The four outcome variables were repeated chair standing, 20 m walk and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Disability. Linear mixed effects models assessed the association of each mental health variable with the yearly change in each baseline adjusted outcome

measure after controlling for covariates.

Results: Depressive symptoms were significantly predictive of worsening in most outcomes. The magnitude of worsening predicted for each year was small. For example, the dichotomized WOMAC Pain model indicated that depressed persons experience more rapid worsening than non-depressed persons at an average rate of 0.59 WOMAC points per year (95% Cl 0.176, 1.013, P = 0.005). Similar significant but very small effects of depressive symptoms on other outcomes were observed. Knee confidence was not predictive of change. Metabolism inhibition General psychological distress was predictive of change in 20-m walk and WOMAC Pain.

Conclusions: The most consistent psychological predictor of yearly worsening was baseline depressive symptoms. Although a statistically robust predictor of outcome, given that change was very small and highly dependent on baseline status, our results indicate that a considerable degree of persistent depressive symptoms would be required to have a meaningful effect on future self-reported outcome. (C) 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.”
“The objective of this study is to investigate and optimize the co-digestion of scum with thickened waste activated sludge (TWAS) and primary sludge (PS) undergoing mesophilic anaerobic digestion.

Three micro-organisms were used: Staphylococcus aureus, Bacillus subtilis and Pseudomonas aeruginosa. Minimum

inhibitory concentration (MIC) of extracts was found at 1.56-50.0 ABT-737 supplier mg mL-1. Unlike the case of BS, adding PS to extracts from flowers of C. palustre and C. arvense enhanced their antimicrobial effect on S. aureus (MIC from 6.25-12.5 mg mL-1 to 1.25-5.0 mg mL-1). An MTT test was used to study toxicity effects. The extracts from C. palustre or C. arvense mixed with PS had a concentration-dependent, slightly cytotoxic or stimulating effect on the viability of normal human skin fibroblasts. The total phenolic content (TPC) of samples varied from 44 to 178 mg gallic acid equivalent per 1 g of extract. The highest TPC was observed in C. palustre (l) and C. oleraceum (f). Our results did not show any correlation between antimicrobial activities and TPC. Cirsium palustre (f) and C. arvense (f) extracts were analysed VEGFR inhibitor by gas chromatography/mass spectrometry (GC/MS). About 30 compounds were found to be present in extracts from two Cirsium species in amounts of not less than 0.2% of TIC.”
“Two new dibenzylbutane lignans, namely rel-methyl (2S)-2-hydroxy-2-2′-((2”R,3”R)-4”-guaiacyl-2”,3”dimethylbutyl)-5′-oxo-2′,5′-dihydro-2-furanylethnoate (1) and rel-methyl (2S)-2-hydroxy-2-2′-((2”R,3”S)-4”-guaiacyl-2”,3”dimethylbutyl)-5′-oxo-2′,5′-dihydro-2-furanylethnoate

(2), were isolated from the bark of Machilus thunbergii. Their structures were elucidated by spectral analysis. These two lignans exerted significant neuroprotective activities against glutamate-induced neurotoxicity in primary cultures of rat cortical cells. Compounds 1 and 2 represent a new type of lignan skeleton that has not been reported so far from nature.”
“Isolation of volatile concentrates from leaves, flowers and fruits of Vitex agnus-castus L. have been obtained by supercritical extraction with carbon dioxide. The composition of the volatile concentrates has been analysed by GC/MS. In all

STI571 concentration plant organs, the extracts are composed chiefly of -pinene, sabinene, 1,8-cineole, -terpinyl acetate, (E)-caryophyllene, (E)–farnesene, bicyclogermacrene, spathulenol and manool. The main difference observed was in the content of sclarene, which was not present in the samples from flowers or fruits. To complete the investigation, a comparison with the hydrodistilled oil has been carried out. The minimal inhibitory concentration (MIC) and the minimal lethal concentration were used to evaluate the antifungal activity of the oils against dermatophyte strains (Trichophyton mentagrophytes, Microsporum canis, T. rubrum, M. gypseum and Epidermophyton floccosum). Antifungal activity of the leaf essential oil was the highest, with MIC values of 0.64 mu L mL-1 for most of the strains.

Current scans performed with varying bias voltages described an unambiguous growth profile of current leakage spots. These leakage spots were observed to evolve in a self similar pattern with the bias, which implied a possible existence of fractal dimension in the pattern of their growth. Mass fractal analysis is therefore carried out to model the growth pattern. Evolution of the mass-fractal with respect to the applied bias is found to be a case of Rayleigh distribution on a two-dimensional Poisson field, in the limiting case. (c) 2010 American Institute of Physics. [doi:10.1063/1.3471815]“
“The

pathophysiological mechanisms underlying chronic constipation in both adults and children remain to be unravelled. This is a not inconsiderable check details challenge, but is fundamental to improving management of such patients. Rectal sensorimotor function, which encompasses both sensation learn more and motility, as well as biomechanical components (compliance, capacity), is now strongly implicated in the pathogenesis of constipation. Rectal hyposensitivity, rectal hypercompliance, increased rectal capacity, rectal motor dysfunction (phasic contractility and tone), and altered rectoanal reflex activity are all found in constipated patients, particularly in association with ‘functional’ disorders of defaecation (i.e. pelvic floor dyssynergia). This review covers contemporary

understanding of how components of rectal sensorimotor function may contribute to symptom development

in both adult and paediatric populations The complex interaction between sensory/motor/biomechanical domains, and how best to measure these functions are addressed, and where data exist, the impact of sensorimotor dysfunction on therapeutic outcomes is highlighted. (C) 2011 Elsevier Ltd. All rights reserved.”
“Evolutionary biology rejoices in the diversity of life, but this comes at a cost: other than working in the common framework of neo-Darwinian evolution, specialists see more in, for example, diatoms and mammals have little to say to each other. Accordingly, their research tends to track the particularities and peculiarities of a given group and seldom enquires whether there are any wider or deeper sets of explanations. Here, I present evidence in support of the heterodox idea that evolution might look to a general theory that does more than serve as a tautology (‘evolution explains evolution’). Specifically, I argue that far from its myriad of products being fortuitous and accidental, evolution is remarkably predictable. Thus, I urge a move away from the continuing obsession with Darwinian mechanisms, which are entirely uncontroversial. Rather, I emphasize why we should seek explanations for ubiquitous evolutionary convergence, as well as the emergence of complex integrated systems.

aureus) and the red blood cells (RBCs)) were demonstrated. Moreover, in situ detection of S. aureus was performed immediately after separation was completed. The results showed that, after 15 s of sample collection, the Raman signals of S. aureus were

detected and greatly enhanced through SERS effect. (C) 2013 American Institute of Physics. [http://dx.doi.org.elibrary.einstein.yu.edu/10.1063/1.4793224]“
“In this study, the inhibitory properties of some essential oils including citrus (Citrus sinensis L. Osbeck), laurel (Latin’s nob ills L.), myrtle (Myrtus communis L.), oregano (Origanum vulgare L.), and savory (Satureja thymbra L.) were investigated against the heat resistant selleck chemicals llc molds Aspergillus fumigatus and Paecilomyces variotii isolated from margarine in a previous study in order to assess the potential for using these essential oils as

a natural food preservative. In this study, the essential oils of the plants were obtained by steam distillation using Clevenger apparatus and were tested for antifungal activities at 0.25, 0.50, and 1.00% concentrations. Inhibitory effects of the essential oils on the growth of the fungi followed the sequence: oregano=citrus>savory>laurel>myrtle. P variotii was GS-9973 in vivo more resistant against the essential oils than A. fumigants.”
“Cell-free protein expression with bacterial lysates has been demonstrated to produce soluble proteins in microdroplets. However, droplet assays with expressed membrane proteins require the presence

of a lipid bilayer. A bilayer can be formed in between lipid-coated aqueous droplets by bringing these into contact by electrokinetic manipulation in a continuous oil Screening Library phase, but it is not known whether such interdroplet bilayers are compatible with high concentrations of biomolecules. In this study, we have characterized the lifetime and the structural integrity of interdroplet bilayers by measuring the bilayer current in the presence of three different commercial cell-free expression mixtures and their individual components. Samples of pure proteins and of a polymer were included for comparison. It is shown that complete expression mixtures reduce the bilayer lifetime to several minutes or less, and that this is mainly due to the lysate fraction itself. The fraction that contains the molecules for metabolic energy generation does not reduce the bilayer lifetime but does give rise to current steps that are indicative of lipid packing defects. Gel electrophoresis confirmed that proteins are only present at significant amounts in the lysate fractions and, when supplied separately, in the T7 enzyme mixture. Interestingly, it was also found that pure-protein and pure-polymer solutions perturb the interdroplet bilayer at higher concentrations; 10% (w/v) polyethylene glycol 8000 (PEG 8000) and 3 mM lysozyme induce large bilayer currents without a reduction in bilayer lifetime, whereas 3 mM albumin causes rapid bilayer failure.

Healthcare associated infections are the major source

of morbidity and mortality in NICU in the developed world. Most infections are caused by Gram-positive organisms, fulminant sepsis are often associated to Gram-negative organisms, fungal sepsis occurs frequently in ELBW infants. Hand hygiene is the most important preventive procedure, nevertheless hand hygiene compliance among HCWs remains low. Continuous educational strategies can improve hand hygiene and contribute to reducing the incidence of neonatal infections. Other important prevention strategies include early enteral feeding with human milk, minimization and safety in the use of invasive devices,

Copanlisib mw limiting unnecessary empiric broad-spectrum antibiotics, eventual use of lactoferrin bifidobacteria and lactobacilli, prophylactic administration of fluconazole in VLBW. Emergence of multi drug resistant organisms (MDRO) is a worrying perspective. Methicillin-resistant Staphylococcus aureus (MRSA) is an important healthcare-associated pathogen. Active surveillance culturing for MRSA carriers, in combination with contact precautions and decolonization in some hyperendemic settings, has been proved to reduce MRSA transmission and infection rates. Multidrug-resistant Gram-negatives are frequently reported. Overuse of antimicrobial drugs and cross-transmission via caregiver hands, contaminated equipment or inanimate objects are the major drivers ALK assay of selection and dissemination. Strategies to control outbreaks of MDRO colonization/infection

in the NICU may include performing hand hygiene, cohorting and isolating patients, screening healthcare workers BVD-523 clinical trial and performing admission and periodic surveillance cultures.”
“Tractography refers to the in vivo reconstruction of fiber bundles, e. g., in brain, via the analysis of anisotropic diffusion patterns measured by diffusion weighted magnetic resonance imaging (DWI). The data provides a probabilistic model of local diffusion which was shown to correlate with the underlying fibrous structure under certain assumptions. Deterministic tractography suffers from uncertainties at kissing and crossing fibers, at different levels depending on the diffusion model employed (e. g., DTI, HARDI), yet it is easy to interpret and use in clinic. In this study, a novel generic algorithm, split and merge tractography (SMT), is proposed that provides a real-time, interactive and reliability ranked assessment of potential pathways, communicating the true information content of the data without sacrificing the usability of tractography. Specifically, SMT takes in a precomputed set of tracts and the diffusion data (e. g.

Methods: We retrospectively reviewed the records of 62 patients who received an LVAD and rFVIIa at our center between January 2004 and November 2006. Patients who received a single dose of 10 to 20 mu g/kg (n = 32; 52%) constituted the “”low-dose”" cohort, and patients who received 30 to 70 mu g/kg (n = 30; 48%) constituted the “”high-dose”" cohort. Laboratory values obtained before and after rFVIIa administration, as well as patients’ Autophagy Compound Library high throughput transfusion requirements, were compared to determine

the effectiveness of rFVIIa in reversing coagulopathy and reducing blood loss. We also compared the incidence of thromboembolic events in the low- and high-dose groups.

Results: Administration of rFVIIa was associated with significant decreases in prothrombin time, activated partial thromboplastin time and transfusion requirements. find protocol This association was seen in both the low- and

high-dose groups. In addition, the incidence of thromboembolic events was significantly higher in the high-dose group (36.7%) than in the low-dose group (9.4%) (p <= 0.001).

Conclusions: Although rFVIIa administration seemed helpful in controlling life-threatening hemorrhage, patients requiring higher doses (30 to 70 mu g/kg) had a dramatically higher incidence of serious thromboembolic events. J Heart Lung Transplant 2009;28:785-90. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.”
“We report the results of

the optical spectra modeling for hydrogenated amorphous silicon (a-Si:H) thin films www.selleckchem.com/screening-libraries.html produced for photovoltaic cell applications, which allowed us to accurately determine the material’s optical gap (E(g)). While for thick films of a-Si: H, as well as for other amorphous semiconductors, Eg is normally estimated from a so called Tauc plot, this is hardly possible for thin films because of the interference effects. We developed a physically founded semianalytical model for the complex dielectric function of a-Si: H, valid below and above the optical gap and containing a small number of adjustable meaningful parameters, including E(g) and the characteristic energy scales of the optical transition matrix element distribution and the joint density of states in the absorption tail region. With this model and using the transfer matrix formalism for multilayer optics, we have achieved a good agreement between the calculated and experimental transmittance spectra, which allowed us to self-consistently determine the values of the above parameters. We found that both E(g) and the characteristic scale of the subgap absorption tail increase with the hydrogen addition.

Animals studied Fifteen mixed breed clinically normal dogs of both sexes. Procedures

Three groups of five dogs each were administered in the right eye, one drop of 0.005% latanoprost (group L), 2% pilocarpine (group Pfizer Licensed Compound Library P), and 0.005% latanoprost with 2% pilocarpine (group LP), respectively. The left eyes received placebo. Drugs were administered once a day at 8 a. m. over a period of 5 days. IOP and PD measurements were conducted daily at 8 a. m., 10 a. m., 12 noon, 2 p. m., and 4 p. m. from 1 day preceding treatment to 7 days following treatment, and the presence of blepharospasm and/ or conjunctival hyperemia was noted.

Results Compared to baseline values, mean diurnal IOPs significantly decreased during the treatment period, by 4.4 (24.4%), 5.8 (31.4%), and 6.1 mmHg (35%) in

the L, P, and LP groups, respectively. Compared to placebo-treated eyes, reductions of 2.1(14.1%), 3.2 (20.1%), and 4.1 mmHg (26.6%) were observed for the L, P, and LP groups, respectively. Although mean IOPs in the LP group decreased slightly more than the other two groups, these differences were not statistically significant. Miosis and conjunctival hyperemia were observed in the treated eyes of all three groups of animals during the treatment period.

Conclusions Although both 0.005% latanoprost and 2% pilocarpine individually produced significant decrease in IOP, the topical administration of a combination of latanoprost (0.005%) and pilocarpine (2%) was not associated with a statistically

significant synergistic reduction VX-770 manufacturer in AZD5582 mw IOP in dogs; and miosis was the most frequent side effect observed during treatment.”
“The purposes of this study were to observe bony orbital volume (OV) changes in pure blow-out fractures according to fracture location using a facial computed tomographic scan and to investigate whether the OV measurements can be used as a quantitative value for the evaluation of the surgical results of the acute blow-out fracture.

Forty-five patients with unilateral pure blow-out fracture were divided into 3 groups: inferior (group I), inferior medial (group IM), and medial (group M) orbital wall fracture. The OV and the orbital volume ratio (OVR) were prospectively measured before and 6 months after surgery with the use of 3-dimensional computed tomographic scans, and the Hertel scale was measured with a Hertel exothalmometer.

The preoperative OVR increased to the greatest extent in group IM, and the mean preoperative OVR was 121.46. The mean preoperative OVR in group I was significantly higher than that of group M (P = 0.005). The OV and OVR revealed a statistically significant decrease after the surgery (P = 0.000). The Hertel scale improved from -1.04 mm before the surgery to -0.78 mm after the surgery, but no significant difference was observed (P = 0.051).

In this work, a pharmacological approach is reported, aimed at deciphering the role of calcium as a second messenger in the transduction pathway leading to the inhibitory effect of 2,4-dichlorophenoxyacetic acid (2,4-D), selleckchem in regulating monoterpene indole alkaloid (MIA) biosynthesis in Catharanthus roseus cells. It is demonstrated here that auxin-dependent MIA biosynthesis is differentially

regulated by two distinct calcium release components from internal stores in C. roseus showing pharmacological profiles similar to those displayed by animal RyR and IP3 channels. MIA biosynthesis is stimulated by caffeine (Ca2+-release activator through RyR channels) and by heparin and TMB8 (Ca2+-release inhibitors of IP3 channels) whereas MIA biosynthesis is inhibited by mastoparan (Ca2+-release activator of IP3 channels) and by ruthenium red and DHBP (Ca2+-release inhibitors of RyR GDC973 channels). Furthermore, calcium,

as 2,4-D, acts on MIA biosynthesis by regulating the monoterpene moiety of the MIA biosynthesis pathway since calcium channel modulators preferentially modulate g10h expression, the gene encoding the enzyme of the secoiridoid monoterpene pathway, that is the major target of 2,4-D action. In addition, the simultaneous use of caffeine (an activator of RyR channel in animals) and TMB8 (an inhibitor of the IP3 channel) in 2,4-D treated cells triggers a synergistic effect on MIA accumulation. This finding suggests an opposite and co-ordinated action of multiple Ca2+-release pathways in 2,4-D signal transduction, adding a new level of complexity to calcium signalling in plants and questioning the existence of RyR and IP3 channels in plants.”
“Hulls from dry edible beans are rich in phenolic compounds recognized as possessing antioxidant

activity. The aim of this study was to characterize antioxidant properties of bean hull extract (BHE) and to determine whether BHE supplementation (at 400 or 800 mg/kg for 3 months) affects serum biochemical markers and bone structure in 12-month-old male C57BL/6 mice. Mice supplemented with 800 mg BHE/kg had lower serum tartrate-resistant acid phosphatase and parathyroid hormone concentrations than those on control diet or supplemented with 400 mg BHE/kg. BHE supplementation WH-4-023 clinical trial caused slight decrease in oxidized glutathione concentration in blood (P = 0.07). Compared to the control group, BHE supplementation at 800 mg/kg for 3 months improved bone structural indices, bone mineral density and trabecular thickness in the third lumbar vertebra. These results suggest that BHE supplementation may have beneficial effects on bone health in mice by decreasing bone resorption. Published by Elsevier Ltd.”
“Objective Non-disclosure of a cancer diagnosis is a common practice in many Asian cultures where family-based medical decision making is the norm.