Physician Involvement in Life-Ending Practices

This Article explains that we need to acknowledge physicians\u27 widespread involvement in ending patients\u27 lives by a variety of means, from withdrawal of life-sustaining treatment to euthanasia. Our inquiry should move from appearance and professional acceptance of practices to the conditions under which society allows physicians to be involved in ending patients\u27 lives

Nucleon-Nucleon Scattering in a Harmonic Potential

The discrete energy-eigenvalues of two nucleons interacting with a finite-range nuclear force and confined to a harmonic potential are used to numerically reconstruct the free-space scattering phase shifts. The extracted phase shifts are compared to those obtained from the exact continuum scattering solution and agree within the uncertainties of the calculations. Our results suggest that it might be possible to determine the amplitudes for the scattering of complex systems, such as n-d, n-t or n-alpha, from the energy-eigenvalues confined to finite volumes using ab-initio bound-state techniques.Comment: 19 pages, 13 figure

Electrocardiographic diagnosis of pacemaker catheter displacement

Displacement of permanent pacemaker catheters occurs in about 10 per cent of primary implantations, and can be a cause of "pacemaker failure." If movement of the catheter tip is 2 cm. or less there is usually no change of the stimulus artifact on the standard ECG, but marked changes in catheter position do result in changes of the amplitude and direction of the pacemaker stimulus artifact. Four episodes of catheter displacement resulted in changes of the stimulus artifact vector direction of greater than 90 degrees in either the frontal or horizontal planes. Rapid screening of the routine ECG is an effective means of detecting catheter displacement, with or without loss of pacing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33910/1/0000175.pd

Anodal stimulation as a cause of pacemaker-induced ventricular fibrillation

A review of animal investigations suggests that pacemaker-induced ventricular fibrillation usually occurs at the anode, and in fact is difficult to evoke at the cathode. A search of the literature showed that every documented episode of pacemaker-induced ventricular tachycardia/fibrillation in humans has been with a bipolar electrode system. Since the problem most often occurs during temporary pacing associated with myocardial infarction, bipolar catheter electrodes should not be used for temporary pacing, and the use of unipolar (cathodal) pacing systems should increase the safety of electrical pacing.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33978/1/0000250.pd

Bulletin No. 325 - An Economic Study of Sheep Production in Southwestern Utah

Range sheep production has been one of the major agricultural enterprises in Utah, particularly in the southwestern part of the state, since these areas were first settled. Stock sheep numbers in Utah were about 2,100,000 by 1890, which is approximately the present number in the state. Since 1890 the numbers have fluctuated between 2,000,000 and 2,775,000. This important industry has, from the time of its introduction, been closely associated with the use of public range lands. The unrestricted grazing of public range lands resulted in damage to a considerable area and was one of the important factors that led to the establishment of federal agencies to administer these properties

Lymphocyte Soluble Factors from Pregnant Cows Modulate mRNA Transcript Abundances Encoding for Proteins Associated with Trophoblast Growth and Development

This study was conducted to determine whether T cell populations are responsible for modulating placental development during gestation in cattle. It was hypothesized that CD4+CD25+ and γ/δ+ T cells modulate gene expression, based on mRNA transcript abundances, and promote proliferation and survival of trophoblast cells. Peripheral blood was collected from cows at 160 to 180 days of gestation and non-pregnant cows, T cell populations CD8+, CD4+, CD4+CD25+, CD24+CD25-, and γ/δ+ T cells were isolated, cultured for 48 h, and supernatant was collected. Placental samples were digested, and trophoblast cells were cultured for 24 h. Trophoblast cells were cultured with 50 μL of T cell-conditioned media and 50 μL of fresh culture media for an additional 48 h. Samples in control wells were treated with unconditioned media. Trophoblast cell proliferation, apoptosis, and mRNA transcript assays were conducted. There was no effect of T cell population on trophoblast apoptosis rate, proliferation, and relative mRNA transcript abundances. The T cell supernatant from pregnant and non-pregnant cows induced greater apoptosis rates in trophoblast cells than unconditioned media. Trophoblast cells proliferated less when treated with T cell supernatant from pregnant compared to unconditioned medium and non-pregnant cows. Treatment with the T cell supernatant from pregnant cows resulted in larger abundances of BMP5, IGF1R, PAG10, FGF2, RSPO3 and TMED2 and also a lesser abundance of FGF2 mRNA transcript than non-pregnant group and unconditioned media treatments. Supernatant from T cell derived from pregnant cows modulates trophoblast mRNA transcript abundances differently from T cell supernatant of non-pregnant cows

Impact of Type 2 diabetes prevention programmes based on risk identification and lifestyle intervention intensity strategies: a cost-effectiveness analysis

Aim To develop a cost-effectiveness model to compare Type 2 diabetes prevention programmes that target different at-risk population subgroups through lifestyle interventions of varying intensity. Methods An individual patient simulation model simulated the development of diabetes in a representative sample of adults without diabetes from the UK population. The model incorporates trajectories for HbA1c, 2-h glucose, fasting plasma glucose, BMI, systolic blood pressure, total cholesterol and HDL cholesterol. In the model, patients can be diagnosed with diabetes, cardiovascular disease, microvascular complications of diabetes, cancer, osteoarthritis and depression, or can die. The model collects costs and utilities over a lifetime horizon. The perspective is the UK National Health Service and Personal Social Services. We used the model to evaluate the population-wide impact of targeting a lifestyle intervention of varying intensity to six population subgroups defined as at high risk for diabetes. Results The intervention produces 0.0020 to 0.0026 incremental quality-adjusted life-years and saves £15 to £23 per person in the general population, depending on the subgroup targeted. Cost-effectiveness increases with intervention intensity. The most cost-effective options were to target South-Asian people and those with HbA1c levels > 42 mmol/mol (6%). Conclusion The model indicates that diabetes prevention interventions are likely to be cost-saving. The criteria for selecting at-risk individuals differentially has an impact on diabetes and cardiovascular disease outcomes, and on the timing of costs and benefits. The model is not currently able to account for potential differential uptake or efficacy between subgroups. These findings have implications for deciding who should be targeted for diabetes prevention interventions.NIH

SPHR Diabetes Prevention Model: Detailed Description of Model Background, Methods, Assumptions and Parameters

Type-2 diabetes is a complex disease with multiple risk factors and health consequences whose prevention is a major public health priority. We have developed a microsimulation model written in the R programming language that can evaluate the effectiveness and cost-effectiveness of a comprehensive range of different diabetes prevention interventions, either in the general population or in subgroups at high risk of diabetes. Within the model individual patients with different risk factors for diabetes follow metabolic trajectories (for body mass index, cholesterol, systolic blood pressure and glycaemia), develop diabetes, complications of diabetes and related disorders including cardiovascular disease and cancer, and eventually die. Lifetime costs and quality-adjusted life-years are collected for each patient. The model allows assessment of the wider social impact on employment and the equity impact of different interventions. Interventions may be population-based, community-based or individually targeted, and administered singly or layered together. The model is fully enabled for probabilistic sensitivity analysis (PSA) to provide an estimate of decision uncertainty. This discussion paper provides a detailed description of the model background, methods and assumptions, together with details of all parameters used in the model, their sources and distributions for PSA

Bremsstrahlung in Alpha-Decay

We present the first fully quantum mechanical calculation of photon radiation accompanying charged particle decay from a barrier resonance. The soft-photon limit agrees with the classical results, but differences appear at next-to-leading-order. Under the conditions of alpha-decay of heavy nuclei, the main contribution to the photon emission stems from Coulomb acceleration and may be computed analytically. We find only a small contribution from the tunneling wave function under the barrier.Comment: 12 pages, 2 Postscript figure

The diet-derived short chain fatty acid propionate improves beta-cell function in humans and stimulates insulin secretion from human islets in vitro

Aims: Diet-derived short chain fatty acids (SCFAs) improve glucose homeostasis in vivo, but the role of individual SCFAs and their mechanisms of action have not been defined. This study evaluated the effects of increasing colonic delivery of the SCFA propionate on β-cell function in humans and the direct effects of propionate on isolated human islets in vitro. Materials and Methods: For 24 weeks human subjects ingested an inulin-propionate ester that delivers propionate to the colon. Acute insulin, GLP-1 and non-esterified fatty acid (NEFA) levels were quantified pre- and post-supplementation in response to a mixed meal test. Expression of the SCFA receptor FFAR2 in human islets was determined by western blotting and immunohistochemistry. Dynamic insulin secretion from perifused human islets was quantified by radioimmunoassay and islet apoptosis was determined by quantification of caspase 3/7 activities. Results: Colonic propionate delivery in vivo was associated with improved β-cell function with increased insulin secretion that was independent of changes in GLP-1 levels. Human islet β-cells expressed FFAR2 and propionate potentiated dynamic glucose-stimulated insulin secretion in vitro, an effect that was dependent on signalling via protein kinase C. Propionate also protected human islets from apoptosis induced by the NEFA sodium palmitate and inflammatory cytokines. Conclusions: Our results indicate that propionate has beneficial effects on β-cell function in vivo, and in vitro analyses demonstrated that it has direct effects to potentiate glucose-stimulated insulin release and maintain β-cell mass through inhibition of apoptosis. These observations support ingestion of propiogenic dietary fibres to maintain healthy glucose homeostasis