Trends in Medical Aid in Dying in Oregon and Washington.

ImportanceThe combined 28 years of data of medical aid in dying (MAID) between Oregon (OR) and Washington (WA) are the most comprehensive in North America. No reports to date have compared MAID use in different US states.ObjectiveTo evaluate and compare patterns of MAID use between the states with the longest-running US death with dignity programs.Design, setting, and participantsA retrospective observational cohort study of OR and WA patients with terminal illness who received prescriptions as part of their states' legislation allowing MAID. All published annual reports, from 1998 to 2017 in OR and from 2009 to 2017 in WA, were reviewed. A total of 3368 prescriptions were included.Main outcomes and measuresNumber of deaths from self-administration of lethal medication vs number of prescriptions written.ResultsA combined 3368 prescriptions were written in OR and WA, with 2558 patient deaths from lethal ingestion (76.0%). Of the 2558 patients, most were male (1311 [51.3%]), older than 65 years (1851 [72.4%]), and non-Hispanic white (2426 [94.8%]). The most common underlying illnesses were cancer (1955 [76.4%]), neurologic illness (261 [10.2%]), lung disease (144 [5.6%]), and heart disease (117 [4.6%]). Loss of autonomy (2235 [87.4%]), impaired quality of life (2203 [86.1%]), and loss of dignity (1755 [68.6%]) were the most common reasons for pursuing MAID. Time between drug intake to coma ranged from 1 to 660 minutes and time from drug intake to death ranged from 1 to 6240 minutes. In the 1557 patients for whom rates of complications were reported, 1494 (96.0%) did not experience a complication (592 of 626 [94.6%] in OR and 902 of 931 [96.8%] in WA). Eight patients (<0.5%) regained consciousness after drug ingestion in OR. Annual rates per year for percentage of patients who received a prescription ingesting the prescribed medication ranged from 48% to 87%, with no significant time trend in OR (adjusted odds ratio per year, 1.01; 95% CI, 0.99-1.02; P = .59) but with an increase over time in WA (adjusted odds ratio per year, 1.13; 95% CI, 1.08-1.19; P < .001). In both OR and WA there were increases in the number of patient deaths due to MAID per 1000 deaths over time.Conclusions and relevanceIn this study, MAID results in Oregon and Washington were similar, although MAID use measured as a percentage of patients prescribed lethal medications and then self-administering them increased only in WA. Most patients who acquired lethal prescriptions had cancer or terminal illnesses that are difficult to palliate and lead to loss of autonomy, dignity, and quality of life

Rye kernel breakfast increases satiety in the afternoon - an effect of food structure

<p>Abstract</p> <p>Background</p> <p>The structure of whole grain cereals is maintained to varying degrees during processing and preparation of foods. Food structure can influence metabolism, including perceived hunger and satiety. A diet that enhances satiety per calorie may help to prevent excessive calorie intake. The objective of this work was to compare subjective appetite ratings after consumption of intact and milled rye kernels.</p> <p>Methods</p> <p>Two studies were performed using a randomized, cross-over design. Ratings for appetite (hunger, satiety and desire to eat) were registered during an 8-h period after consumption of whole and milled rye kernels prepared as breads (study 1, n = 24) and porridges (study 2, n = 20). Sifted wheat bread was used as reference in both study parts and the products were eaten in iso-caloric portions with standardized additional breakfast foods. Breads and porridges were analyzed to determine whether structure (whole vs. milled kernels) effected dietary fibre content and composition after preparation of the products. Statistical evaluation of the appetite ratings after intake of the different breakfasts was done by paired t-tests for morning and afternoon ratings separately, with subjects as random effect and type of breakfast and time points as fixed effects.</p> <p>Results</p> <p>All rye breakfasts resulted in higher satiety ratings in the morning and afternoon compared with the iso-caloric reference breakfast with sifted wheat bread. Rye bread with milled or whole kernels affected appetite equally, so no effect of structure was observed. In contrast, after consumption of the rye kernel breakfast, satiety was increased and hunger suppressed in the afternoon compared with the milled rye kernel porridge breakfast. This effect could be related to structural differences alone, because the products were equal in nutritional content including dietary fibre content and composition.</p> <p>Conclusions</p> <p>The study demonstrates that small changes in diet composition such as cereal grain structure have the potential to effect feelings of hunger and satiety.</p> <p>Trial registration</p> <p>This trial was registered at clinicaltrials.gov as <a href="http://www.clinicaltrials.gov/ct2/show/NCT01042418">NCT01042418</a>.</p

Learning hardware using multiple-valued logic - Part 2: Cube calculus and architecture

For Part 1 see ibid. vol.22, no.3 (2002). A massively parallel reconfigurable processor speeds up the logic operators performed in the learning hardware. The approach uses combinatorial synthesis methods developed within the framework of the logic synthesis approach in digital-circuit-design automatio

Learning hardware using multiple-valued logic - Part 1: Introduction and approach

The authors propose a learning-hardware approach as a generalization of evolvable hardware. A massively parallel, reconfigurable processor speeds up logic operators performed in learning hardware. The approach uses combinatorial synthesis methods developed within the framework of the logic synthesis in digital-circuit-design automatio

Particle size heterogeneity in milled barley and sorghum grains: Effects on physico-chemical properties and starch digestibility

The average particle size of ground grains is known to influence properties related to processing (e.g. water absorption and solubility) and nutritional value (e.g. starch digestion rate) of human foods and animal feeds. The purpose of this study was to identify the contributions made by individual size fractions of hammer-milled barley and sorghum grains to average bulk compositional, hydration, rheological, and enzyme susceptibility properties. Barley and sorghum grains were each hammer-milled through a 4 mm screen and subsequently fractionated on a set of eight sieves ranging from 0.125 mm to 2.8 mm. Individual fractions were characterised for (1) starch, aNDF, and water content, (2) water absorption index (WAI) and water solubility index (WSI), (3) viscosity profile during cooking and cooling in excess water, and (4) in vitro starch digestibility. Weighted average values based on fraction yields and property values for WAI, WSI, and starch digestibility were not significantly different from values obtained for non-fractionated ground grains of both barley and sorghum. Glucose yields from starch digestion varied about ten-fold between the smallest and largest particle fractions, and WAI and WSI had value ranges of 1.9-2.8 g/g (sorghum), 2.1-4.0 g/g (barley) and 1.3-4.5% (sorghum), 0.7-10.3% (barley), respectively. Viscosity profiles for milled sorghum grain fractions were dominated by starch swelling which became increasingly restricted as particle sizes increased. Viscosity profiles for milled barley grain fractions did not exhibit typical starch-based behaviour and were most likely dominated by soluble fibres. Taken together, the results show that there is considerable potential for designing combinations of hydration, rheological and digestibility properties of ground grains through informed selection of appropriate grains and particle size distributions

Effect of extrusion temperature and pre-extrusion particle size on starch digestion kinetics in barley and sorghum grain extrudates

Barley and sorghum milled grains were separated into three size fractions (fine, 1.0. mm) and extruded at two temperature levels (maximum of 100 °C or 140 °C), to determine the effect of pre-extrusion fraction size on starch digestibility. Following extrusion, in vitro enzymatic starch digestibility was markedly enhanced with a first order rate, typically ten times greater than before extrusion, but following the same trend i.e. faster digestion for finer pre-extrusion grain sizes. For sorghum, the projected maximum digestibility was also reduced with pre-extrusion grain size. There were only minor differences in digestibility following extrusion at 100 °C compared with 140 °C. Grains were not pre-conditioned, so moisture uptake during extrusion may have been limited, resulting in extrudates containing residual ungelatinized starch granules. It is proposed that the main effect of extrusion processing was to open up the grain endosperm structure, thereby reducing the diffusion path lengths for amylase to digest starch. The results indicate that an efficient use of extrusion processing could be to target separated larger particles from milled grains for re-combination with finer ground grains for improved energy utilization in monogastric feeds