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Acetate Utilization Test: Principle, Procedure, and Results
Acetate Utilization Test Introduction
In the modern world, apart from life style changes, we come across many medical terms as a part of our daily activities, such as Lab test, diagnosis, vaccine, chemicals and so on, which became most common terms as a part of other things we hear.
Many tests are performed in a laboratory and in biochemical labs to detect the nature of the pathogen or a disease. Acetate utilization test is one such test which is used to determine whether the organism has the ability to use acetate as a sole source of carbon.
What is Acetate Utilization Test?
The acetate utilization test is generally used to test the ability of the organism to utilize the acetate as the single source of carbon.
This test is also performed as a qualitative test for the differentiation of the Gram-negative bacteria into fermentative and the oxidative group of bacteria.
This test is also being used to differentiate the species of Shigella from E. coli and the non-fermentative negative bacteria.
Acetate agar which contains sodium acetate as the sole source of nitrogen is used for inoculating the organism. Growth is indicated for the positive test of acetate utilization test.
When the bacteria metabolize acetate, the ammonium salts are broken down into ammonia, which increases the pH medium of the culture, this increase in pH turns the bromothymol blue indicator in the medium changes from green to blue.
Acetate Utilization Test Principle
In acetate utilization test, Acetate agar is employed as a test organism. This acetate agar has the ability to utilize acetate.
The culture medium is composed of Sodium acetate which acts as a sole carbon source and the inorganic ammonium salts as the source of the nitrogen. Where the growth of organisms suggests the positive results for the utilization of acetate.
During the metabolism process of acetate, by the bacteria, the ammonium salts are broken into ammonium, that elevates alkalinity.
The shift in the pH changes bromothymol blue indicator in the medium from green to blue. This medium is generally used for differentiating the Shigella spp from Escherichia coli.
As Shigella spp doesn't have the capability to metabolize the acetate, However, approximately of about 94% of Escherichia coli plays a major role in utilizing the acetate.
Acetate Utilization Test Reagents
Media: The culture media is composed of Sodium acetate agar.
Ingredients Gram/liter
Sodium Chloride 5.0
Magnesium sulfate 0.1
Ammonium phosphate-monobasic 1.0
Potassium phosphate-dibasic 1.0
Sodium acetate 2.0
Agar 20.0
Bromothymol blue 0.08
 Sterilized sticks and inoculating loops
 Sterile pipette
 Incubator
 Sterile saline.
Acetate Utilization Test Procedure
Procedure for Acetate utilization test involves two steps;
1. Preparation of media
2. Utilization test
For the preparation of media, 69.1 grams of the dehydrated powder is added in beaker along with 1000 milliliters of the deionized or the distilled water.
Instead of dehydrated powder lab-prepared media can also be used.
The prepared suspension is then heated till boiling; so that the medium is dissolved completely.
Then the dissolved medium is dispensed into tubes and they are sterilized in an autoclave at 121ºC for about 15 minutes.
After completing the process of autoclaving the tubes are taken out and cooled at a slanted position to a temperature of about 40 to 45º.
The position is then maintained in order to obtain butts of depth 1.5 to 2.0 cm.
The isolated colony is taken from an 18 to 24-hour culture with the help of a sterile inoculating needle.
A turbid suspension of saline is prepared by using 18-to-24-hour culture from a noninhibitor plate of culture.
The acetamide agar tube is inoculating by streaking the surface of a slant with the light inoculum which is picked from the culture.
The slant is then streaked back and froth with the loop or using an inoculating stick.
The cap or the test tubes are loosened to ensure whether the inoculum is getting sufficient aeration.
The tubes are then incubated aerobically at the temperature of about 35 to 37ºC for about seven days.
As incubation at 35 to 37ºC is not sufficient for thee Enterobacteriaceae, incubation at 30ºC is followed for seven days for the non-fermentation of Gram-negative rods.
The test tubes are examined regularly for at least 7 days before discarding the samples.
Acetate Utilization Test Result
For a positive result, the growth is represented as a change of color green to intense blue along the slant. Where as for negative result, the growth is absent and there will be no color change and the slant remain green as same.
Bacterial Control
Mostly two different organisms are taken for the positive and negative controls as the form of quality control for the acetate utilization test.
Control Incubation Results
Shigella flexneri Aerobic incubation is followed for 24 to 48 hours at temperature of about 33 to 37ºC Acetate negative, where there is no growth and no change in color and the medium remains green
Escherichia coli Aerobic incubation is followed for 24 to 48 hours at temperature of about 33 to 37ºC Acetate positive where the growth is shown and change of color to intense blue from green
Acetate Utilization Test Uses
• This test is usually used to test the ability of the organism to utilize acetate as the source of carbon.
• This test is also used in the form of qualitative test for differentiation of Gram-negative bacteria for fermentation and oxidative group of bacteria.
• Acetate agar can also be used as a selective media for the isolation of Escherichia coli.
Bile Solubility Test: Principle, Reagents, Procedure, and Result
Acetate Utilization Test Citations
Acetate tolerance and the kinetics of acetate utilization in diabetic and nondiabetic subjects. Am J Clin Nutr . 1990 Jan;51(1):112-8.
Acetate Availability and Utilization Supports the Growth of Mutant Sub-Populations on Aging Bacterial Colonies. PLoS One. 2014; 9(10): e109255.
Acetate utilization is inhibited by benzoate in Alcaligenes eutrophus: evidence for transcriptional control of the expression of acoE coding for acetyl coenzyme A synthetase. J Bacteriol . 1995 Oct;177(20):5826-33.
Categories: Bio LabBiologyStudy Materials
Tags: Acetate Utilization Test


We live in a time of great turmoil and change. Economically, socially, spiritually, and even biologically our nation is different every day. Our growing diversity should be a strength, not a weakness, if we can find ways to hold ourselves together by emphasizing the principles forged into traditions that made this nation great. But somehow, even simple decency and respect for each other often eludes us.
Why is this? I have come to believe that we have made our great principles far too intellectual, that the beliefs that should hold us together are exercises for the brain when they should be felt with every beat of our hearts. To change this we need more solid physical reminders in our every day life of who we are, as one people – because in the end we are all made as much in the image of the doubting Thomas as much as anyone.
The van Beethoven Monument in Vienna.
When I was working in Germany, I took a weekend off to visit Vienna. In the drive to take it all in quickly so much of the great city sadly just passed by me. There are statues all over this ancient capital, many of them standing as the bones of a once great empire, weathering softly in the passage of time. It's easy to let them whizz by in a blur.
As I came to simple pass by the statues of Graf Radetzky rampant on a horse, I turned a corner and saw a figure I knew. There was the gruff maestro Ludig van Beethoven, high on a pedestal with angels protecting him at the base. It suddenly dawned on me that these statues were not just ossified remains, but what people honestly believed in. They were daily reminders that were erected to instill values of loyalty and faith into a people who, just like any of us, can only truly believe what we see – can only bring into our hearts what is part of our daily routine.
The Lincoln Memorial still inspires.
In our modern American world, statues are considered silly and old fashioned. That's only because they were used to reinforce the "Great Man Theory" of leaders who were supposed to inspire us as if they were Gods from above. Some of them still inspire us because their deeds were so great, but others are detached.
Today, history is often taught as the stories of more ordinary people who did great things. In this view of our heritage there is a greater need for statuary, not less.
Let's take, as an example, the city of Saint Paul and my own community, which stretches out along West Seventh. Over the last 150 years many people have come to make this street what it is today, and it is under a lot of pressure to develop and "improve" – gentrify is a better word. More and more every day there is a need to keep the character that makes it great – in short, to "Keep West Seventh Weird".
Native son F Scott Fitzgerald, enshrined in bronze in Rice Park.
If we're going to put a lot of money into transit through my community, a big part of it has to be improvements in the urban street furniture that make a walkable, livable, and connected city. And some of that should include statues of the people that made us who we are.
For example, why is there no statue of our first governor, Alexander Ramsey, ideally in an action pose making a speech to a crowd? Or our founding rogue, voyageur Pierre "Pig's Eye" Parrant? Perhaps in front of the Czechoslavik Protective Society (CSPS) hall the group that founded this organization – or to stay with the "Great Man Theory", perhaps Antonin Dvorak, who visited in 1893. And many more ordinary people should be depicted, too, such as those who came with the Underground Railroad back when this was a safe Abolitionist town or some of the early Irish immigrants who came with nothing.
Such statues could be funded, at least in part, by businesses that would benefit from a cozier urban life connected through time and space. For example, the original Cossettas might make a good statue, ideally frozen in bronze preparing food, in part as an honor of the Italian community of the Levee – and we could hit Dave Cossetta up for part of the tab for the work on his sidewalk.
There's always room for abstraction, too, such as this sculpture depicting love.
And there are many more figures that could dot our street and remind us through our daily lives that we are one people – we have a history together of working hard to make a living for ourselves and a better community full of life and love.
More to the point, this would remind us of not just who we are, but what we believe in. They should inspire us to be more than just passers-by on our way to somewhere else, but active right here and now as part of this greater good.
At a national level it's harder to imagine just what we all need to remind us, but movements like this best start at a local level. The principle is a simple one – that we are each our own doubting Thomas that only really believes what we see and experience every day.
Though our lives may be changing and our values evolving, the basic principles of liberty, brotherhood, and unity are what make us a decent and respectful people. We need to be reminded of them so that we can feel them in our hearts. In a time when everything is changing, the need for statuary and other physical tokens of our beliefs does not diminish, it actually grows.
Let's start rendering in stone, bronze, and other materials those values that will help us get through these hard time. Let's not leave the exercise that our hearts desperately need entirely up to our sometimes fearful and selfish minds.
This entry was posted in People & Culture and tagged brotherhood, Culture, St Paul, Statues, unity, West End. Bookmark the permalink.
I don't know about a lot of statues around but maybe if they are different it would be good. There is a statue of peanuts characters somewhere in St Paul, is it Rice Park too? They were sitting on a bench where you could sit next to them. Things like that are fun.
The statues are Peppermint Patty and Marcy, and Patty is on a park bench. They are in Rice Park. I would LOVE more statues like those, although they are plastic and a bit cheesy. But yes, more fictional figures would be great!
I would definately support this. It would be very cool to have statues all along streets.


Below are 3D rendered images and a video of the substation.
Landpoint was on site to scan a power substation in North Texas to create detailed models, topographical survey control, and construction support information for engineers on a facility upgrade process in order to expand backup functions and increase higher electrical loads. The accuracy requirements for hard to reach areas of the facility necessitated the use of high precision scan data. From the point cloud we were able to create standard deliverables plus a complete model for facility engineering, training, archival, and presentation purposes.
To download a 3D PDF of a transformer click the button below.


We're so excited to announce the first ever NOLA School of Music Spring Break Day Camp! The 3-day camp will be held April 23rd-25th, from 9:00 AM to 12:00 PM each day.
Students will learn about reading music, rhythms, singing, playing instruments, improvisation, and more, all while playing games and having a spring break blast! Stay tuned as we announce the theme of each day of camp and our Camp Song that we'll be working on learning all week!!
Registration is now open for students ages 6-13. The rate for the 3-day camp is $130/student. The camp is open to everyone, regardless of whether or not you currently take lessons with us. Sign up below!
This camp is for students ages 6-13. Younger students may be admitted on a case-by-case basis, depending on maturity level. The camp is open to both current students of NOLA School of Music and to anyone not affiliated with our school!
This camp will focus on music concepts that will apply to students of all instruments. Students will learn singing, theory, rhythm, music reading in addition to learning about the different instruments that they may not normally be exposed to!
No experience in music is required to sign up for this camp! It will be a great introduction to music for children who are interested in learning an instrument but aren't sure which one they'd like to play.
Students will spend the day rotating through different classes to learn different topics such as rhythm, music theory, and more. Each lesson will incorporate music games, listening and ear training exercises (and maybe even some dancing!) Every day we'll end camp with a group jam session.
Students will learn about counting, note lengths, time signatures, different types of percussion instruments, and improvisation.
Students will learn about the parts of the voice, solfege singing, melody, harmony, and vibrato, as well as practicing singing our camp song and other tunes.
Students will learn about note names, reading music, the treble and bass clefs, high and low notes, major and minor scales, and different types of instruments and ensembles.
Every day of camp will end with a group jam session — so students can apply all their new skills!
Registration is open to students ages 6-13. The rate for the 3-day camp is $130/student. The camp is open to everyone, regardless of whether or not you currently take lessons with us. Fill out the form below to register.
Your child's instrument and experience level: Required field!
Is your child a student of NOLA School of Music? Required field! Yes, they are a current student No, they haven't taken lessons here before. No, but they have taken lessons here in the past.


On a beautiful sunny summer day there is nothing better than relaxing in the sunshine and enjoying a great picnic. Food eaten in the fresh air just tastes better! Also, having a picnic in a beautiful spot in a lovely way to relax with your friends and loved ones and enjoy the day – whether you are in a local park, on the beach or in your own backyard. Take a look at our collection of picnic mats so that you can find one that will work best for your needs.
We have a range of picnic mats that are high quality, durable and stylish. Take a look through our great collection and find a picnic mat that you love. These mats will make it much more comfortable to sit on the ground and enjoy your picnic. They are made from durable materials so they will stand up to the elements and last a long time.
If you have any questions about our picnic mats you can feel free to contact us at any time. We are always happy to help you find the right products for your lifestyle and we are devoted to offering you the best possible customer service.


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The one-year outcomes of life-sustaining treatments in intensive care units among cancer patients at the end of life stage in Taiwan: A retrospective design.
Fei-Hsiu Hsiao, Chen-Wei Lin, Shih-Chi Ku, Hao-Chien Wang, Lu-Cheng Kuo
posted 26 Feb, 2021
Terminal cancer patients' admission to intensive care unit (ICU) remains a controversial issue and there is a lack of information about their prognosis after ICU life-sustaining treatments. This one-year study aimed to compared the impacts of life-sustaining treatments and utilization of hospital care prior to ICU admission on mortality rates between cancer and non-cancer patients at the end of life stage.
This study adopted a one-year longitudinal retrospective design. Data from chart reviewing at the general hospital with 44 beds of ICU included the terminally ill patients' demographic background, diseases, DNR status and life-sustaining treatments, utilization of hospital care one-year prior to ICU admission, and death at ICU and one-year post-ICU discharge.
The higher mortality rates at ICU and one-year after ICU discharge were found in cancer group than non-cancer group (Odds ratio = 0.742; CI = 0.511–1.012, p = 0.043) (Odds ratio = 0.225; CI = 0.121–0.417, p < 0.001). Compared with non-cancer group (14%), there were lower withdrawal rates in cancer group (6.5%). No DNR designation prior to ICU admission and near half of families (49.4%) in cancer group refused to receive hospice care consultation in ICU. After adjusting for age and APACHE II scores, mechanical ventilation (Odds ratio = 2.242; CI = 1.354–4.705, p = 0.027), enteral nutrition (Odds ratio = 1.675; CI = 1.140–2.264, p = 0.004) and parenteral nutrition (Odds ratio = 1.460; CI = 0.747–2.626, p = 0.029) significantly increased the risk of ICU mortality rates among terminal cancer patients. Moreover, enteral nutrition also increased one-year mortality rates (Odds ratio = 1.558; CI = 1.112–1.985, p = 0.014). The higher usages of hospital care from general wards were found in cancer group than non-cancer group. There were no association between utilizations of hospital care and mortality rates.
Higher utilizations of hospital care and no DNR designation prior to ICU admission demonstrates the delay and barrier of Chinese patients and families' acceptance of hospice care at the end of life stage.
The higher ICU mortality rates and lower withdrawal rates urge professionals to develop cultural-sensitive family-centered hospice care program for terminal cancer patients in ICU.
Chinese families
terminal cancer patients
Withdrawal of life-sustaining treatments
The review study [1] indicated that increasing cancer patients were admitted to intensive care unit (ICU) for managing organ dysfunction and their in-hospital mortality rates were not higher than critically ill noncancer patients. This review also indicated that according to the policies for ICU admission, terminal cancer patients' admission to ICU remains a controversial issue and life-sustaining treatments in ICU are not recommended for them. The recent review study [2] revealed that although cancer patients at the terminal stage might not be benefit from ICU treatments, it was not uncommon that they were admitted to ICU for end of stage organ failure. However, it is not known about their mortality rates at ICU and after ICU discharge. Up to date, most studies evaluated the short-term one-month and rarely, 3 to 6-month survival rates. The recent review study [2] found that ICU treatments improve the short-term outcomes among cancer patients but the findings of the long-term mortality rates in cancer patients remain inconsistent. Moreover, there is a lack of study examining this issue among cancer patients at the end of life stage while their conditions are unlikely reversible under active treatments in ICU.
Because the quality of dying among terminally ill cancer patients might be more essential, it is better for them to receive palliative care and symptoms control in ICU than life-sustaining therapies [1]. Withdrawal of life-sustaining treatments is to help terminally ill patients receive hospice care in ICU [3]. However, the recent study indicated that the terminally ill patients often received high-intensity life-sustaining treatments [4]. The studies published in European countries found that the incidence rates of withdrawal of life-sustaining treatments were less than 10% [5-7]. In the global survey, withdrawal of life-sustaining treatments in ICUs in Asian countries were between 3% and 8% which were lower than the rates of 13% in both the United States and Europe [8]. Phua et al [9]. indicated that while there were the 25-30% incidences of withdrawing life-sustaining treatments in intensive care units among 16 Asia countries, Taiwan ranked 15th for the withdrawal rates of 3~4%. The results suggest that it is likely for Chinese patients with terminally ill condition to receive life-sustaining treatments in ICU. However, very few studies exist of examining the impacts of life-sustaining treatments on their ICU and long-term mortality rates. As a result, the limited information could be feedback to physicians, patients and families to make an end of life decision.
The global surveys found that mechanical ventilation and hemodialysis were the most withdraw treatments [8, 10, 11]. The inotropic agents were also identified as the most common withdraw treatments among the terminally ill patients [4]. Differently, physicians in Asia countries thought that mechanical ventilation was the most difficult to be withdrawn [9]. Withdrawing the following treatments are rarely discussed including antibiotics, nutrition, and intravenous fluids, and blood product transfusions [12]. Artificial nutrition considered as a way of expressing filial piety in Chinese societies is often not agreed to withdraw by families [9].
In 2009, in Taiwan, Hospice Palliative Care Act began to address that CPR and life-sustaining treatments should be withheld or withdrawn for patients who meet the criteria for Do Not Resuscitate (DNR) orders [8]. In Asian society, families often play the surrogates for ICU patients who are not able to participate in end of life discussion, and most families did not accept the limit life-sustaining treatments at the end of life. It is also the difficult experiences for western families to make end of life decision [13]. It is not clear about to what extent Chinese families accept to receive hospice care consultation at ICU and their decision to withdrawal after the consultation. Therefore, this study aimed to compare the mortality rates of ICU admission and one year after ICU discharge, families' acceptance of hospice consultation care in ICU and their decision of withdrawal, and hospital utilizations prior to ICU admission between terminal cancer and non-cancer patients. utilization of hospital care prior to ICU admission. The impacts of life-sustaining treatments on mortality rates were also examined in terminal cancer patients. Moreover, the impacts of utilization of hospital care prior to ICU admission and life-sustaining treatments on mortality rates were also examined in terminal cancer patients.
Design and setting
This study adopted a retrospective longitudinal design with chart review method to collect and analyze the one-year data between January and December 2016 among terminally ill patients at four ICU units at the major medical center in Taiwan. Study ethics approval was obtained on 29 Jun 2017 (Ethics Committee of National Taiwan University Hospital, IRB 201705120RINA). Data were analyzed without exposure of the patients' personal information. The primary objectives were to identify the mortality rates during ICU admission and one year after discharge and the impacts of life-sustaining treatments on mortality rates. The secondary objective was to assess the utilizations of hospital care prior to ICU admission on mortality rates.
Study population
Medical records of the patients who were diagnosed as terminally ill patients by two specialist physicians and signed a DNR form at the time of study were the inclusion criteria for our subjects. Data were analyzed based on total 326 patients: 154 cancer patients and 172 non-cancer patients.
Data were collected using REDCap (Research Electronic Data Capture) tool. Demographic data collected age, gender, marital status, religion, education, and insurance. Disease data included primary diagnosis, severity of disease condition (Acute Physiology and Chronic Health Evaluation [APACHE] II score, higher scores indicating more severe condition and a higher risk of death), DNR status before ICU admission, agreement on hospice care consultation, and life-sustaining treatments, utilization of hospital care from emergency department, ICU, and general wards one-year prior to ICU admission, durations of ICU stay, implementing of withdrawing life-sustaining treatments, and death at ICU and one-year post-ICU discharge.
SPSS Statistics Software 22.0 (SPSS Inc., Chicago, IL, USA) was used to analyze data, and p<0.05 was adopted as the measure of statistical significance. Inferential statistics of t-tests, chi-squared tests, logistic regression were applied to compare the clinical characteristics, use of hospital care prior to ICU admission, hospice care and life-sustaining treatments at ICU and mortality rates since ICU admission between cancer and non-cancer groups. To compare mortality between two groups and analyze the impacts of life-sustaining treatments on cancer patients' mortality in ICU, and at one-year ICU discharge, multivariate analysis using Cox regression adjusted for age, APACHE II score to calculate the hazard ratios (HRs) and their respective 95% confidence intervals. This association was also evaluated by a graphic representation of survival.
Table 1 indicated that there were the significant differences in age and marital status. Compared with non-cancer group, the patients in cancer group were younger and more cancer patients lived with partner. There were no significant differences in other demographic data, DNR status before ICU admission, and disease severity levels according to APACHE II scores. About the disease severity levels, over half of the patients in two groups were moderate and severe. The majority of the primary caregivers were the immediate family members (i.e., parents, spouse, or children). As noted, they all did not had a DNR designation prior to ICU admission. In cancer group, over 30% suffered from hematological cancer followed by lung cancer, gastrointestinal cancer and other types of cancer.
Outcome analysis
Table 2 indicated that compared with non-cancer group (14%), there were lower withdrawal group in cancer group (6.5%) (x2=4.84, p= 0.028). Families of terminal cancer patients showed lower agreements on receiving hospice care consultation than non-cancer terminal cancer patients (50.6% vs 60.5%, x2=4.05, p= 0.044). Moreover, for families receiving hospice consultation, major of families (91%) did not want to withdraw life-sustaining treatments and intended to have active treatments for the patients. Table 2 indicated that while there was no significant difference in the length of ICU admission, more death numbers during ICU and one-year after ICU discharge occurred in cancer group than non-cancer group (66.9% vs 54.7%, x2=5.084) (87.7% vs 79.1%, x2=4.227, p=0.039). As shown figure 1 and figure 2, the higher mortality rates at ICU and one-year after ICU discharge were found in cancer group than non-cancer group (Odds ratio = 0.742; CI = 0.511-1.012, p = 0.043) (Odds ratio = 0.225; CI = 0.121-0.417, p <0.001).
Table 3 showed that after adjusting for age and APACHE II scores, the multivariate Cox analysis indicated that mechanical ventilation and enteral nutrition significantly increased the risk of ICU mortality rates among terminal cancer patients. As shown in Figure 3, compared with the cancer patients without mechanical ventilation, ICU mortality rates were significantly higher in the cancer patients receiving this life-sustaining treatment (Odds ratio = 2.242; CI = 1.354 - 4.705, p = 0.027). Similarly, figure 4 and figure 5 indicated that higher ICU mortality rates occurred in terminal cancer patients with enteral nutrition (Odds ratio = 1.675; CI = 1.140-2.264, p = 0.004) and parenteral nutrition (Odds ratio = 1.460; CI = 0.747-2.626, p = 0.029). In Table 4 and Figure 6, the multivariate Cox analysis indicated that after adjusting for age and APACHE II scores, enteral nutrition significantly increased the risk of one-year mortality rates after discharge from ICU among terminal cancer patients (Odds ratio = 1.558; CI = 1.112-1.985, p = 0.014). On the other hand, Figure 7 showed that inotropic agents and vasopressor significantly decreased the one-year mortality rates among terminal cancer patients (Odds ratio = 0.544; CI = 0.133-2.372, p = 0.013).
Table 5 showed the utilization of hospital care one-year before they were admitted to ICU in two groups. The higher utilizations of hospital care were found in the cancer group than non-cancer group with only 5.8% not receiving the hospital care before they were admitted to ICU. Terminal cancer patients received more care from general wards than non-cancer terminal patients. Moreover, higher usage of care from general wards at five times and above was also found in cancer group than non-cancer group (x2=8.268, p= 0.004). On the other hand, the patients in non-cancer group used more ICU services than cancer patients. For emergency service, there were no significant between two groups. However, utilization of hospital care one year prior to ICU admission was not associated with terminal cancer patients' short-term and long-term mortality rates.
Our study found that the higher mortality rates at ICU (66.9% vs 54.7%) and one-year after ICU (87.7% vs 79.1%) occurred in cancer group than non-cancer group. Differently, the review study [1] indicated that there were no different ICU mortality rates between cancer and non-cancer patients. The inconsistent results suggest that the poor mortality rates in ICU likely occurred in cancer patients at terminal stage. Our mortality rates were comparatively higher than ICU mortality rates of 17.2% and a one-year mortality rate of 23.8% reported by Lobo et al [8], analyzing 84 countries. The cohort study found that compared with non-cancer group, Chinese cancer patients with stage IV after receiving CPR showed the lower post-discharge survival rates and poorer prognosis [14]. Cancer patients at stage IV predicting higher mortality rates in ICU was also observed in Western society [15]. Therefore, this study and our study supports that for terminal cancer patients, palliative care not CPR or life-sustaining treatment is more appropriate for their end of life quality [1].
This study indicated that compared with non-cancer group (14%), there were lower withdrawal rates at ICU in cancer group (6.5%). Terminal cancer patients' low withdrawal from life-sustaining treatments was significantly lower than the 13.9% [5], 17.8% [16], and 13.2% [8] reported in the recent studies on the ICU patients in western societies. Our study and the recent study indicated that the terminally ill patients often received high-intensity life-sustaining treatments [4]. Compared with families in non-cancer group (39.5%), near half of families (49.4%) in cancer group refused to hospice care consultation in ICU. Similar to the previous studies on end of life decision in Chinese society [17,18, 19], this study also indicated that the patients' family members were the primary decision makers for the withdrawal of life-sustaining treatments and most Chinese families of terminal cancer patients rejected the withdrawal of life-sustaining treatments in order to prolong the patient's life. The previous study also showed 79% Chinese families chose not to withdrawal life-sustaining treatments for their family members with critical illness [20]. The cohort study in Taiwan [19] found that patient-caregiver agreement on life sustaining treatment-preference was poor-to-fair and families more preferred aggressive treatments than patients' wish. The previous studies [17,18, 21] indicated that the value of filial piety based on Confucian teaching (a Chinese theory of virtue ethics and deontology) influences adult children' caregiving behaviors which focus on task fulfillments and emphasizes the novel treatments to prolong life for their parents at the end of life stage. Confucian ethics of filial piety defines the duties and obligations between parents and children in order to remain hierarchy within the family system and family harmony [22]. This value drives children's motivations of caregiving for their elderly patients at the end of life to show their love, respect, and appreciation for the care they had received from their parents, and to avoid shame and guilt for not being a good child in Chinese cultural context [17,18, 21]. The results suggest that cultural value might influence Chinese families not to withdrawal of life-sustaining treatment which might show doing nothing for their love one as a result of their sense of guilt.
After adjusting for age and APACHE II scores, the multivariate Cox analysis indicated that mechanical ventilation, enteral and parenteral nutrition significantly increased the risk of ICU mortality rates among terminal cancer patients. The recent review study [2] also found that invasive mechanical ventilation predicted the higher hospital mortality in cancer patients. The study [23] demonstrated the positive correlation of mechanical ventilation with mortality rates might suggest that there were the negative impacts of mechanical ventilation on barotrauma, oxygen toxicity, hemodynamic compromise, ventilator-induced lung injury, ventilator-associated pneumonia, as well as local and systemic effects of tumor. Our study also showed that enteral nutrition increased both ICU and one-year mortality rates. The cohort study in Taiwan also found that while terminal cancer patients preferred to reject all life-sustaining treatments, their families wanted to continue with nutritional supports by intravenous or/and tube feeding [19]. The review study revealed that providing nutrition and hydration was perceived by families as the humanistic end of life care for terminal cancer patients [24]. Feeding might be considered by family members as the fundamental supportive care for the patients' to be alive and also as the way of expressing filial piety in Chinese societies [9, 25]. Not providing nutrition support might be considered not behaving as a "filial piety" child. As a result, they might receive social blame. Moreover, without nutrition support, in Chinese culture, people dying in hungry status might lead them to become a ''starving soul'' or ''hungry ghost/spirit'' [24]. Accordingly, Chinese families are reluctant to withdrawal nutrition support for terminal cancer patients. However, our study revealed that the negative impacts of nutrition support on poor survival rates for terminal cancer patients.
This study found that there was no DNR designation prior to ICU admission for two groups. Moreover, higher utilizations of hospital care from general wards were found in cancer group than non-cancer group. The results suggest that terminal cancer patients and their families could have the opportunities to discuss and achieve the agreements about end of life decision including DNR and withdrawal of life-sustaining treatments in general wards. Discussing about life-withdrawal treatments between Chinese cancer patients and their families is likely a cultural taboo [26]. As a result, the patient-caregiver agreement on withdrawal life-sustaining treatment is unlikely achieved. Therefore, future intervention needs to be developed for terminal cancer patients and their families to facilitate their discussions not only DNR but also the preference to withdrawal life-sustaining treatments in general wards.
The study in Singapore also found that Chinese family was reluctant to accept their parent's cancer diagnosis at terminally stage and they chose for life-prolonging treatments over palliative care [18]. In Ho's case study showed that after understanding the impact of cultural value on the Chinese family making decision at the end of life with honor the family's wishes, this culturally sensitive communication can achieve a consensus and help the patient die peacefully. The study in the west [27] also emphasized that respecting the families' culture and belief and allowing their cultural practices and rituals such as care provided by traditional healers are considered as the form of supports for families with different ethnic groups. Moreover, helping families to be present with participating in direct care at the patient's bedside is also regarded as an effective form of support for families and communication between the family and the patient.
The main limitation of this study is related to the retrospective design with chart review method which depends on the availability and accuracy of the medical record. Future research with a prospective study design can also include the self-report of the patients and their families in data collection to explore their experiences of end of life decision and care.
Higher utilizations of hospital care at the general wards and no DNR designation prior to ICU admission, and lower acceptance of hospice consultation care demonstrates the delay and barrier of Chinese patients and families' acceptance of hospice care at the end of life stage. The higher ICU and one year after ICU discharge mortality rates and lower life-sustaining treatment withdrawal rates urge professionals to develop cultural-sensitive family-centered hospice care program for terminal cancer patients in ICU and the general wards. The training program for professionals needs to include conducting culturally sensitive communication about "good death" with patients and their families, assessment of the impact of cultural value on end of life decision, allowing cultural practices and rituals of traditional healers, involving families in participating in direct care, and providing bereavement care for family members.
This study was approved by the Institutional Review Board of National Taiwan University Hospital (201700512RINA) and conducted in accordance with the Declaration of Helsinki. The informed consent was waived by the same ethics committee that approved the study (National Taiwan University Hospital).
We declare that we have no competing interests.
This study was funded by National Taiwan University Hospital (107-S3798).
CWL, SCK, HCW, and FHH designed the study. CWL and FHH were the main writers of the manuscript. CWL and LCK reviewed and analyzed the data. All authors read and approved the final manuscript.
Correspondence to Fei-Hsiu Hsiao.
This study was supported by the grant from National Taiwan University Hospital (107-S3798).
Azoulay E, et al. Intensive care of the cancer patient: recent achievements and remaining challenges. Annals of intensive care. 2011;1(1):1-13.
Reddy DRS, et al. Triage and Prognostication of Cancer Patients Admitted to the Intensive Care Unit. Critical Care Clinics. 2021;37(1):1-18.
Council on Ethical and Judicial Affairs. Decisions near the end of life. JAMA. 1992; 267:2229-2233.
Chavez G, et al. Reversals and limitations on high-intensity, life-sustaining treatments. PloS one. 2018;13:e0190569.
Lesieur O, et al. Withholding or withdrawal of treatment under French rules: a study performed in 43 intensive care units. Annals of intensive care. 2015;5:15.
Nolin T, et al. Withdrawal of medical treatment in the ICU. A cohort study of 318 cases during 1994–2000. Acta anaesthesiologica scandinavica. 2003;47:501-507.
Wunsch H, et al. End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom. Intensive care medicine. 2005; 31:823-831.
Lobo SM, et al. Decision-making on withholding or withdrawing life-support in the ICU: A worldwide perspective. Chest. 2017;152:321-329.
Phua J, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA internal medicine. 2015;175:363-371.
Su WH, et al. Outcomes of Palliative Care Team Consultation for Ventilator Withdrawal from Terminally Ill Patients in the Intensive Care Unit. International Journal of Gerontology. 2016;10:156-158.
Lai CF, et al. Withdrawal from long-term hemodialysis in patients with end-stage renal disease in Taiwan. Journal of the Formosan Medical Association. 2013;112:589-599.
Downar J, et al. Guidelines for the withdrawal of life-sustaining measures. Intensive care medicine. 2016;42:1003-1017.
Ganz FD. Improving Family Intensive Care Unit Experiences at the End of Life: Barriers and Facilitators. Critical care nurse. 2019;39:52-58.
Lee MR, et al. Outcome of stage IV cancer patients receiving in-hospital cardiopulmonary resuscitation: a population-based cohort study. Scientific reports. 2019; 9(1):1-9.
Martos-Benítez, FD, et al. Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study. Journal of cancer research and clinical oncology. 2018;144(4):717-723.
Hoel H, et al. Decisions to withhold or withdraw life‐sustaining treatment in a Norwegian intensive care unit. Acta Anaesthesiologica Scandinavica. 2014;58(3):329-336.
Chan CL, et al. The blessings and the curses of filial piety on dignity at the end of life: Lived experience of Hong Kong Chinese adult children caregivers. Journal of Ethnic and Cultural Diversity in Social Work. 2012;21(4):277-296.
Ho ZJM, et al. Chinese familial tradition and Western influence: a case study in Singapore on decision making at the end of life. Journal of pain and symptom management. 2010;40(6):932-937.
Liu TW, et al. Terminally ill Taiwanese cancer patients' and family caregivers' agreement on patterns of life-sustaining treatment preferences is poor to fair and declines over a decade: results from two independent cross-sectional studies. Journal of pain and symptom management. 2017;54(1):35-45.
Buckley TA, et al. Limitation of life support: frequency and practice in a Hong Kong intensive care unit. Crit Care Med. 2004;32:415e420.
Li LB. Clinical review: Ethics and end-of-life care for critically ill patients in China. Crit Care. 2013 Dec 4;17(6):244.
Sung KT. An exploration of action of filial piety. Journal of Aging Studies, 1998;12:369–386.
Martos-Benítez, FD, et al. Performance of Three Prognostic Models in Critically Ill Patients with Cancer: A Prospective Study. Int J Cancer Clin Res. 2019;6:120.
Del Rı´o MI, et al. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psycho-Oncol 2012;21:913e921.
Chai HZ, et al. Feeding: what it means to patients and caregivers and how these views influence Singaporean Chinese caregivers' decisions to continue feeding at the end of life. Am J Hosp Palliat Care. 2014;31(2):166-171.
Yun YH, et al. The life-sustaining treatments among cancer patients at end of life and the caregiver's experience and perspectives. Support Care Cancer. 2010;18:189e196.
Kisorio LC, et al. Intensive care nurses' experiences of end-of-life care. Intensive Crit Care Nurs. 2016 Apr;33:30-8.
Table 1 Demographic and disease data between cancer and non-cancer patients
Non-Cancer
t/ x2/ p value
59.27±13.31
(21~92)
t= 91.57, p=0.025*
x2=0.439, p= 0.507
62(36%)
x2=8.23, p= 0.004**
With partner
Without partner
x2=0.041, p= 0.84
High school and below
Junior school and above
Medical decision person
x2=0786, p= 0.375
15(8.7%)
DNR status before ICU
154(100%)
DNR status after ICU
Neoplastic of hematologic
Neoplastic of malignant
APACHE II scores
26.39±8.24
26.5±8.825
t=34.741, p=0.811
*p<0.05 **p<0.01
Table 2 Withdrawal rates, hospice consultation care, death at ICU and one-year after ICU
Withdraw life-sustaining treatments
x2=4.84, p= 0.028*
Hospice consultation care
Discuss for hospice with family
Need to chew over
Days of ICU stay
15.49(11.5)
Days of ICU mortality
15.4(11)
12.53(11)
t=59.617, p=0.047*
Death at ICU
x2=5.084, p=0.024*
Death at one-year after ICU discharge
Death at fire-year after ICU discharge
19(100%)
*p<0.05
Table 3 The impacts of life-sustaining treatments on ICU mortality rates
Exp (B)
Standard error
(SE)
(p value)
Exp (B) 95% C.I.
Upper Lower
Inotropic agents and vassopressor
Renal replacement therapy
Antimicrobial therapy
Extra-corporeal membrane oxygenation
Table 4 The impacts of life-sustaining treatments on one-year mortality rates after ICU discharge
Table 5 Utilization of hospital care before admission to ICU
ER, ICU and general wards
x2=11.196,
p= 0.001***
General wards
p= 0.009**
1~2 times
5 and above
Emergency (ER)
x2=8.744, p= 0.033*
*p<0.05, **p<0.01
Additional Declarations
No competing interests reported.

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A group calling itself, Young Democratic Cadres (YODEC) has applauded the National Democratic Congress's Deputy National Organiser, Joshua Akamba for exposing the NPP government over the Free SHS implementation.
A viral video capturing Mr Akamba inciting some students at Tempane High School, against the president has generated mixed reactions. The video saw the politician describe as despicable what he saw at the school. He was slammed and asked to apologise but he refused saying: "Did you see the skins of the students? It's such a shame.
In a statement issued by the group and copied to GhanaWeb indicated that Joshua Akamba has done well for exposing the government over the Free SHS implementation for visiting the Tempane SHS to give listening ears to the deprive of the students.
The group said Akamba has done a supposed work which is expected from the media to do on the Free SHS implementation and its challenges.
"We applaud Comrade Akamba today for doing what was expected from the various media houses to do but adamant in doing so because a certain political party will lose political points when they perform their duties well".
The statement opined "Free SHS being a constitutional injunction meant to be carried out progressively, has over the past year seen a hasty super sonic implementation of the laudable policy due to selfish parochial political expediency and this has gradually made the laudable Free SHS policy turned into a curse instead of blessing. In the midst of all these disasters, the media has gone into hibernation and kept very mute".
The emphasized "Today because of the boldness of Comrade Akamba, the pandora box has been left opened and the good people of Ghana have seen and heard that our future leaders whom we are struggling for are sleeping outside at the mercy of bad weather and insects and sitting on bare floors to learn also".
In a related development, a group calling itself, the Crusaders have called on the government to as a matter of urgency to reinstate the suspended Headmaster of the school.
Their reason was that the Headmaster of the school at that was not around.
The executives of the youth wing applaud Comrade Joshua Hamidu Akamba, NDC Deputy National Organizer and an Aspiring National Organizer for his high humanitarian skills showcased in giving listening ears to the deprive Tempane SHS students.
Free SHS being a constitutional injunction meant to be carried out progressively, has over the past year seen a hasty super sonic implementation of the laudable policy due to selfish parochial political expediency and this has gradually made the laudable Free SHS policy turned into a curse instead of blessing. In the midst of all these disasters, the media has gone into hibernation and kept very mute.
YODEC's gratitude to Comrade Akamba is not because of his political affiliation being same as ours but on the basis of him being bold and very passionate in running to the aid of the voiceless SHS students of Tempane Senior High School students who are suffering as a result of this unplanned, shambolic and super incompetent way of the free SHS policy implementation.
We applaud Comrade Akamba today for doing what was expected from the various media houses to do but adamant in doing so because a certain political party will lose political points when they perform their duties well.
We (YODEC) again praise Comrade Akamba today because he has brought to bare the true state of condition of the free SHS policy which the vindictive NPP government is trying hard to hide from the good people of Ghana.
Today because of the boldness of Comrade Akamba, the pandora box has been left opened and the good people of Ghana have seen and heard that our future leaders whom we are struggling for are sleeping outside at the mercy of bad weather and insects and sitting on bare floors to learn also.
We thank Comrade Akamba for the revelation and call on Ghanaians to wake up because our future is at stake.


There is no exception to the rule of God. His commandments like Himself do not change. So many misguided people foolishly think that they are exempt from the laws and precepts of God. They and we are not. God does not wink at our sin. Any one who walks in perversion will inevitably fall and fall without warning. The good news however is that those who place their faith and obedience in Christ are seen by God as blameless. To walk blamelessly is to walk by obedient faith. This faith begins by doing the good that we know to do. And matures by learning the unadulterated will of God. This is not deep weighty theology. It is the clear, simple gospel of Jesus Christ. Our children are able to have this obedient faith. If there is perversion in your life repent of it and turn to the Blameless one, the Lord Jesus Christ.


At Gingersnap Creations for the month of November they are challenging us to visit down On The Farm.
Before I leave you this evening, I have to tell you I'm clapping again. The wonderful team at Gingersnap Creations has awarded me with another Ginger Gem. It is for GC124: Grays and Blacks and that was my Macbre Wedding card I entered. That was a fun one to create so it is really fun to win a recognition for it.
Congratulations on being chosen as a Ginger Gem in the Farm Fresh challenge, Beverly!


Another lovely day on Argo today. The morning started with some top notch cooking from our chef team for the day led by Eliza. After our banana bread, it was time for the leadership class. As a group, we ran through some discussion questions that certainly elicited some interesting conversations about what we value in a good leader and some examples we all have in our lives. Then it was time for passage prep. The crew ran through the checklist, inspecting steering gear, coiling and capsizing lines, and all the rest of it until Argo was ready to get off the dock. We made our way out of the marina, and then raised sails all together so we could turn off the engine and point our way to the San Blas Islands using only wind. Eliza and her chef team pulled out another winner with their pesto pasta dinner and the crew prepared for the evening as some moderate wind and swell are expected this evening.
Pictured: Views of our dinner sunset on Argo and Argo's rigging with beautiful clouds above.


text:
'What Is Justice?' Daunte Wright's Family Demands Full 'Accountability' In Wake Of Kim Potter's Arrest
"Unfortunately there's never going to be justice for us," Wright's mother said on Thursday.
Written By Charise Frazier
Source: KEREM YUCEL / Getty
The family of Daunte Wright responded to the inequities in the criminal justice system one day after his killer, former Brooklyn Center cop Kim Potter, was charged with second-degree manslaughter for the deadly police shooting on Sunday.
Family attorney Ben Crump joined them during a press conference Thursday afternoon and lamented that Daunte's mother Katie Wright now belongs to a sorority of women who have lost their Black sons at the hand of police. He said the family should receive some semblance of justice in court.
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The family, which previously described Daunte's death as a "driving while Black case," concluded that there is no sufficient form of justice for them because they have to venture through life without their loved one. However, they urged for "accountability at the highest level."
"Unfortunately there's never going to be justice for us," Wright's mother said.
"Neither one of them, not Eric Garner, not Michael Brown, nor Stephon Clark got their day in court, they got no due process," Crump added. In each case, the officers were either never brought to trial or acquitted.
"The blood of Stephon Clark, the blood of Eric Garner and the blood of Michael is on the hands of the American criminal justice system because there was no accountability for the police who killed them," Crump said.
"Justice? What is justice? Do we get to see Dante smile?" his aunt Naisha Wright asked.
She also scoffed at the second-degree manslaughter charges against Potter, who would face up to 10 years in prison and a $20,000 fine if found guilty.
"The highest accountability? I know the highest is going to be being judged by God. But can we get a conviction? Can we get something? Manslaughter!" she exclaimed while holding up side-by-side photos of a gun ands a Taser. Authorities claimed Potter confused her gun for a Taser during the shooting.
"Enough is enough that during the Derek Chauvin trial, regarding the killing of George Floyd, 10 miles from where this pivotal case of American jurisprudence is taking place…you would think that the police would try to do everything in their power to use the best standard of care," Crump said.
Crump also referenced Mohamed Noor, a former Somali-American police officer in Minneapolis who was sentenced to almost 13 years in prison for the fatal shooting of a white woman while responding to her 911 call.
Noor was one of the first public cases in the current social justice climate which served as a barometer regarding how Black officers would be sentenced for the use of excessive force when the victim is white.
Crump pointed to numerous examples of white suspects who are allowed to walk away with their lives.
"It has deadly consequences for us and our children," he said.
Daunte's 14-year-old sister Destiny said she was "very disappointed" over the loss of her brother and will miss his smile and jovial nature.
Aubrey Wright, Daunte's father, also spoke out, holding back unfathomable grief. "My son was a good son, he was a young man in the making," he said. "We were building my son up to be somebody. He was a good kid."
The family launched a GoFundMe page to help pay for Daunte's funeral and legal costs.
"On April 11th, our 20-year-old son, Daunte Wright Sr., was fatally shot and killed by a Brooklyn Center police officer during a routine traffic stop," the family states. "Our family is distraught as we struggle to understand why our loved one was taken away from us in such a senseless manner."
"All funds raised through this site will go towards covering funeral and burial expenses, mental health and grief counseling for Daunte's family, to help the Wright family in their fight for justice, and to provide support for Daunte's infant son, Daunte Wright, Jr. 100% of the funds raised on this site will go to the Wright family. NO PART OF THESE FUNDS WILL BE USED TOWARDS LEGAL FEES."
Crump announced Daunte's funeral will be held next Thursday, April 22, at 12 p.m. local time, when the Rev. Al Sharpton will preside.
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Violent White Folks Who Were Taken Into Custody With Loving Care By Police
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Catch the Drift, a local southern Delaware music duo, brings their love of music to the stage, performing a variety of pop, rock, blues, country and folk hits from the 60s to today top hits.
As a duo, Denise and Paul enjoy playing to audiences large and small throughout Delaware and beyond, bringing feel-good, danceable tunes to larger spaces, and an intimate acoustic vibe to smaller venues. Whether you want to rock out or sit back and drift away to some sweet, feel-good tunes, come hear the musical stylings of Catch the Drift on Saturday, January 19 from 6-9 p.m., and you'll see the kind of passion and professionalism these two put into what they do.


text:
American Gods' Yetide Badaki on Bilquis' Breakthrough: 'She Gets to Dance With the Ancestors'
By Kimberly Roots / January 31 2021, 6:00 PM PST
Courtesy of Starz
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It has been a week for American Gods' beleaguered Bilquis.
After men broke into her home and kidnapped her, she was taken to a server farm and tossed in a cell. Then she was tortured by Mr. World and his associates. Her crime? Endangering Mr. World's "close, strategic partnership" with Levittech, the company owned by the man Bilquis sex-absorbed a few episode back.
But one thing they forgot? (The goddess of) Love always wins in the end.
When Bilquis was reduced to sobs by her harassers, a tear hit the ground and seemed to create a protective cocoon of silence around the Old God. Then Oshun, one of the Orishas we've seen appear to Shadow in previous Season 3 episodes, showed up to provide BIlquis with a little divine pep talk.
"You are not who they say you are," Oshun told her. "You are whoever you want to be." The visit certainly bucked up Bilquis, who began moving her body in a joyful celebration of her identity. "I am she who has always been," she declared, dancing and parrying with Oshun. (Meanwhile, the guards watching Bilquis saw her shimmying to music only she could hear and assumed they'd broken her.)
In an interview with TVLine, Yetide Badaki says her Old God character "is rediscovering the Orishas" — after all, when you've been around since the dawn of man, you're bound to forget a face or two.
"I like to point to the fact that the ancestors are literally in our DNA," Badaki says. "That's not hyperbole. I am my mother. I am my grandmother. I am all the women within me. I am the current manifestation of them, and I stand on the shoulders of giants that have been sent by many before me."
In the torture scene, therefore, what we're witnessing is Bilquis going on an internal search. "She journeys into her DNA, she get to literally dance with the ancestors," she continues.
More food for celestial thought: "If you've lived for eons, are there moments you forget of your existence? Are there parts of you that start to become dormant if you don't pay attention to them?" Badaki wonders. "I think these are all very important questions, and to be able to see her rediscover these parts of herself, and know that she's not just the one thing that many have wanted to use her for, That many have wanted to take on for themselves, or twist. That is a part of her. But there is so much more."
Elsewhere in the episode:
* Shadow and Technical Boy teamed up, albeit unenthusiastically, to figure out Bilquis' whereabouts. Hilarity ensued.
* A man named Gilbert was tasked with removing Mad Sweeney's body from the crypt where it was found. He inadvertently stepped on the vial of elixir that Laura placed near the body. And when it mixed with her ashes, she was yanked from purgatory and brought back to life. She quickly ascertained that the leprechaun is really dead, and it was her fault. She eventually took Mad's ashes and hitched a ride to Cairo, Ill.
* Mr. Wednesday met with the Viking death metal singer Johan to remind him that they need all the disciples his music can pull in, and to suggest that Johan form a new band. Not long after, the bar that they're meeting in blew up. Wednesday staggered out of the wreckage, ripped off his clothes and then ran around in just his overcoat. When a worried Cordelia called Shadow to tell him that she's checking his father into a psychiatric facility, Shadow laughed. "About f–king time, right?" he said. Cordelia didn't think it was funny and asked him to come as soon as possible.
What did you think of the episode? Sound off in the comments!
TAGS: American Gods, Starz, Yetide Badaki
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