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Physician-assisted suicide (PAS) is typically associated with serious physical illnesses that are prevalent in palliative care. However, individuals with mental illnesses may also experience such severity that life becomes intolerable. In February 2020, the previous German law prohibiting PAS was repealed. Patients with severe mental illnesses are increasingly likely to approach physicians with requests for PAS.
Aims
To explore the ethical and moral perspectives of medical students and physicians when making individual decisions regarding PAS.
Method
An anonymised digital survey was conducted among medical students and physicians in Germany. Participants were presented with a case vignette of a chronically depressed patient requesting PAS. Participants decided on PAS provision and assessed theoretical arguments. We employed generalised ordinal regression and qualitative analysis for data interpretation.
Results
A total of N = 1478 participants completed the survey. Of these, n = 470 (32%) stated that they would refuse the request, whereas n = 582 (39%) would probably refuse, n = 375 (25%) would probably agree and n = 57 (4%) would definitely agree. Patient-centred arguments such as the right to self-determination increased the likelihood of consent. Concerns that PAS for chronically depressed patients might erode trust in the medical profession resulted in a decreased willingness to provide PAS.
Conclusions
Participants displayed relatively low willingness to consider PAS in the case of a chronically depressed patient. This study highlights the substantial influence of theoretical medical-ethical arguments and the broader public discourse, underscoring the necessity of an ethical discussion on PAS for mental illnesses.
In cervical dystonia (CD), outcome of treatment with botulinum neurotoxin (BoNt), is highly dependent on the correct identificationof the muscles involved. There are “simple” (in one plane) and “complex” (in two or more levels) forms of CD. The difficulty lies in the treatment of complex CD, requiring a more extensive analysis. For such analysis, different diagnostic methods are used. These include: ultrasound, CT neck soft tissue imaging (particularly the deep muscles of the neck), electromyography (EMG) of neck muscles, and standardized photographs of patients with measurements of angles (head, neck, thorax).
Cervical dystonia may occur in principle in three axes (rotation, lateral flexion and sagittal flexion). The head or the neck can be affected alone in each of these planes of movements. Therefore, eight clinical forms can be distinguished: torticollis, laterocollis, antecollis, retrocollis, torticaput, laterocaput, antecaput and retrocaput. In this chapter, involved muscles, their origins and insertions are presented in a table for each of these clinical forms. Injection under CT guidance is described.
This article discusses the relatively new phenomenon of corporate activism concerning the LGBT+ community in Central and Eastern Europe, particularly in Poland. It highlights how companies use various forms of corporate activism to show support and solidarity with LGBT+ people, especially during Pride Month. The authors note that there is a need to understand how these actions are perceived by civil society organizations (CSOs) that support LGBT+ people. To address this issue, a qualitative study was conducted to gather the perceptions of 11 CSO representatives from different organizations on the activities undertaken by companies for LGBT+ groups. The study intended to explore whether CSOs identified the support provided by businesses as activities to protect human rights, which business activities were valued most by the LGBT+ community, and what business actions in the public sphere are expected.
Decreased vision in the aged population poses significant morbidity and decreases quality of life. At least one third of the American population over age 65 has significant vision compromise due to ophthalmic disease. Decreased vision limits independence and poses significant economic and societal burdens. Ophthalmic disease in the elderly poses significant challenges to patients and providers due to the vast and diverse spectrum of ophthalmic conditions, and therefore requires specialized care by optometrists and ophthalmologists.
Ophthalmic diseases are seen at a higher frequency in aged patients and include structural changes, malignancies, and infections of the eyelids and orbit. In addition, diseases such as cataracts, age-related macular degeneration (ARMD), glaucoma, and ischemic optic neuropathy are seen at a significantly higher incidence in elderly patients and can result in severe vision loss. Routine ophthalmic care is required to identify, manage, and treat such diseases in order to prevent sequelae, optimize independence, and preserve vision. Medical therapies, surgical intervention, low-vision aids, and social support systems can be utilized to aid in treatment.
The core principle that should guide any health professional caring for older adults and their families is that the “secret of caring for the patient is in caring for the patient” (Peabody). Practitioners must understand the most up-to-date biomedical and psychosocial aspects of aging, health, wellness, and disease, and strive to support the older adult to remain as active, functional, and engaged as possible. At the same time, practitioners must recognize and help patients and families understand when a palliative approach will be most effective at meeting their goals. The Choosing Wisely campaign launched by the American Board of Internal Medicine provides targeted guidance to clinicians to provide care that is effective and efficient, consistent with the essential principles. Also, the 4Ms (what Matters, Medication, Mentation, and Mobility) proposed by The John A. Hartford Foundation and Institute for Healthcare Improvement provide a framework for an Age-Friendly Health System through which practitioners can deliver optimal care for older adults.
This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.
OBJECTIVES/GOALS: Misprescription of opioids has led to an epidemic of opioid use disorder (OUD). Females, among other differences, have increased susceptibility to the addictive properties of opioids. Yet, the exclusion of female subjects from many foundational studies on reward processing had hindered our ability to fully understand these disparities. METHODS/STUDY POPULATION: Estradiol (E2), a neuronal sex steroid, may play a role in sex differences in OUD. In this study, we used fadrozole, an aromatase inhibitor, to characterize the role of centrally produced E2 in heroin cue extinction memory retention (EMR, “remembering to forget”). Male and female rats self-administered heroin in a long-access paradigm (6hr/day) for 8 days, where a light/tone cue was co-presented with each infusion of heroin. This was followed by 1 day of cued extinction (6hr; light/tone but no heroin). Just prior to this session, fadrozole was infused into the basolateral amygdala (BLA) through implanted cannulas. The next day, subjects were given a cued EMR test (1hr; light/tone but no heroin) following another infusion of fadrozole. RESULTS/ANTICIPATED RESULTS: Females took more heroin than males (mg/kg) despite having similar active nose poke responding during acquisition. Regardless of aromatase inhibition, females had higher active nose pokes during the first hour of cued extinction relative to males. Both males and females treated with fadrozole in the BLA prior to cued extinction had impaired EMR on test, evidenced by increased active nose pokes and lower extinction indices relative to vehicle controls. Upon examination of the brains, we expect that aromatase inhibition will have impaired neuronal plasticity, as evidenced by decreases in numerous measures of plasticity. Furthermore, we expect to find sex differential expression of estrogen receptor (ER) subtypes throughout the BLA, suggesting a convergent sex effect of E2 on heroin EMR. DISCUSSION/SIGNIFICANCE: This study is the first to examine a behavioral role for central E2 in the BLA. Future studies will examine specific roles for ER subtypes on this behavior and synaptic plasticity. A better understanding of sex specific E2 signaling will promote further research on sex differences and allowing us to better address disparities in disorders like OUD.
Bibliometric methods were used to analyse the major research trends, themes and topics over the last 30 years in the parasitology discipline. The tools used were SciMAT, VOSviewer and SWIFT-Review in conjunction with the parasitology literature contained in the MEDLINE, Web of Science, Scopus and Dimensions databases. The analyses show that the major research themes are dynamic and continually changing with time, although some themes identified based on keywords such as malaria, nematode, epidemiology and phylogeny are consistently referenced over time. We note the major impact of countries like Brazil has had on the literature of parasitology research. The increase in recent times of research productivity on ‘antiparasitics’ is discussed, as well as the change in emphasis on different antiparasitic drugs and insecticides over time. In summary, innovation in parasitology is global, extensive, multidisciplinary, constantly evolving and closely aligned with the availability of technology.
Food cues modulate hunger and dictate nutritional choices. The omnipresent stimulus of palatable food promotes the epidemics of obesity and metabolic diseases. The aim of our study was to investigate the impact of visual stimulation with food pictures on appetite-related hormones as well as the functionality of the secreted hormones and its impact on macronutrient uptake and deposition in healthy subjects. Additionally, we sought to identify differences in response to visual food cues of total and active ghrelin to and to a meal followed by the stimulation.
Healthy, non-obese participants were recruited for two two-day studies. During the first study, the subjects were shown random non-food pictures on the first day and pictures of appetizing foods on the second day of the study. The second study followed the same schedule and additionally, following the picture session, the participants were asked to drink a milkshake. The subjects reported subjective hunger. Levels of glucose, triglycerides and hunger-related hormones were measured in blood. In addition, an animal study was performed, during which 4 hours fasted mice were submitted to visual and olfactory stimulation using chow, while not being able to access the food. Following the stimulation, oral glucose tolerance test was performed, gene expression and blood total, as well as acylated ghrelin, were measured.
Exposure to food pictures affected participant's blood glucose and incretin levels. Concentrations of several hormones in the blood were interdependent and in case of ghrelin and GIP as well as ghrelin and GLP-1 this co-occurrence relied on the visual cues. Changes of total ghrelin concentration following food stimulation was highly individual and participants could be grouped as ghrelin responders or non-responders. The responders showed upregulated total ghrelin and their total ghrelin levels correlated with food picture score revealing that in ghrelin non-responders reaction to food pictures was diminished. The concentration of active ghrelin decreased following a meal but was not affected by exposure to the pictures of food. Protein content and color intensity of food pictures correlated reversely with participants’ rating of the pictures. Sensory stimulation of mice resulted in increased blood glucose levels.
We conclude that observation of food pictures significantly influences blood glucose levels and concentration of several appetite-related hormones. The protein content of the observed foods and green color intensity in pictures may serve as a predictor of subjective attractiveness of the presented meal.
Acid sphingomyelinase (A-SMase) is a glycoprotein that functions as a lysosomal hydrolase, catalysing the degradation of sphyngomyelin to phosphorylcholine and ceramide. Several lines of evidence suggest its central role in all three types of apoptosis. The activation of neuronal A-SMase has been shown to be important in the stress-induced apoptotic death of hippocampal neurons. The aim of the present study was to investigate the association between the activity of A-SMase, hippocampal volume and memories function in healthy young volunteers.
Materials and Methods:
The activity of A-SMase was measured in peripheral blood mononuclear cells of 19 healthy female students of the University of Erlangen- Nuernberg (26,32 ± 3,95 years old, Body mass: 22,29 ± 2,63 kgr/m2). The hippocampal formation was outlined in high-resolution anatomical magnetic resonance imaging data. The memory function was assessed with the Inventory for Memory diagnostics (Inventar zur Gedaechtnisdiagnostik). Correlations between continuous variables were examined, using Spearman's rank correlation coefficient.
Results:
The activity of A-SMase did not correlate with hippocampal volume and memory performance.
Conclusions:
These findings indicate that the activity of the A-SMase influences neither the brain hippocampal volume of young healthy females, nor their memory performance.