Physician Assisted Dying: A Turning Point?

Physician Assisted Dying (PAD) has been lawful in some countries since the 1940s and in the United States since 1997. There is a body of social and scientific research that has focused on whether the practice has been misused and whether gaps exist in legislative safeguards. There are multiple concerns with physicians assisting patients to die: incompatibility with the physician’s role as a healer, devaluation of human life, coercion of vulnerable individuals (e.g., the poor and disabled), and the risk that PAD will be used beyond a narrow group of terminally ill individuals. Statutes in the United States have been drafted with these concerns in mind in an effort to mitigate the possible risks of PAD while still providing individuals with access. There seems to be a shift in attitudes towards PAD. Currently four states statutorily permit PAD and it is being discussed by multiple legislatures across the country. There also seems to be a shift in medical practice as demonstrated by a 2015 survey that showed for the first time that more than half of physicians surveyed favored medical assistance in dying. PAD is a deeply personal choice. The question is whether more states will authorize the practice and, if so, what safeguards will be put in place to ensure the practice is not misused and remains consistent with prevailing social and ethical thought

The Markers Of Bone Metabolism And System Inflammation In Patients With Osteoarthritis Depending On Body Mass, The Influence Of Symptomatic Slow Acting Drugs

Aim. To assess the levels of markers of the bone synthesis and system inflammation in patients with osteoarthritis (OA) in combination with obesity and their dynamic under the influence of basic treatment.Materials and methods. The research included 40 women with OA, 46–78 years old (mean age – 59,8±1,5 years). Duration of the disease varied from 3 to 36 years (mean duration – 10,0±1,1 years). Mean body mass index (BMI) among patients was 30,6±0,7 [22,3; 39,5]kg/m2, according to which patients were divided in 3 groups: patients with OA without obesity (n=17), patients with OA with 1 degree of obesity (n=14), patients with OA with 2 degree of obesity (n=9). The level of osteochondral metabolism was assessed using quantitative measuring of the levels of procollagen IC-terminal propeptide (РІСР), (Cloud-CloneCorp. “procollagen IC-Terminal Propeptide”, USA) and osteocalcin (Roche Diagnostics «N-MID Osteocalcin», Switzerland) on analyzer «ELECSYS 2010» by the method of immune-enzyme analysis; the level of the system inflammation was assessed by the level of C-reactive protein (CRP) by the method of immunoturbidimetry. The clinical efficacy was assessed by the dynamics of intensity levels of pain syndromes at physical load and at rest by the visual-analogue scale (VAS). The measuring of РІСР, osteocalcin and CRP levels and also the assessment of clinical efficacy as to the decrease of pain syndrome were carried out twice – at the beginning and at the end of observation. The period of observation is 2 months.Results. The presence of direct correlation between РІСР and BMI (r=0,62; р=0,008) among patients with OA in combination with the normal body weight was established at the research, whereas among patients with OA in combination with obesity the analogous correlation was demonstrated between SRP and BMI (r=0,43; р=0,04) on the background of correlation of PICP and OC levels (r=0,46; р=0,03).Obesity in patients with OA was associated with the reliably higher levels of pain at both rest and physical load from the side of knee joints, with maximal intensity of the pain syndrome among patients with OA and 1 degree of obesity.Statistical analysis did not reveal the reliable dependence of РІСР and OC in patients with OA from the initial CRP level on the background of tendency to the higher РІСР level and lower OC level among patients with initially increased CRP level comparing with ones with normal CRP level. The therapy with basic preparations at OA during 2 months among patients with OA with increased CRP level led to the reliable decrease of РІСР level (р=0,0076) and the tendency to increase of OC level (р˃0,05), without the reliably significant difference between the initial and final РІСР and OC levels among patients with OA and normal CRP level.At the end of observation period the maximal analgesic effect was demonstrated as to the articulate pain at rest from the side of knee joints (р˂0,001) among patients with OA, who received diacerein, with clinically comparable effect from the side of other aticulate zones (р˂0,05), that was associated with reliable decrease of CRP level (р=0,013).Discussion. The received results testify that the control of the system inflammation level at OA is a target not only relative to the decrease of pain syndrome but also conditions the stable state of subchondral bone (SCB), providing the compensation of processes of destruction and synthesis in bone tissue. The significance of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) as the markers of bone synthesis that are able to reflect metabolic processes in SCB at OA, and also the discordant influence of CRP level on PICP level at the relative stability of OC level were demonstrated at the research.The received results allow consider the inflammatory process at OA as a target for preservance of the bone tissue, conditioning the expedience of taking into account the ability of OA basic preparations to realize the control influence on the level of system inflammation. Diacerein that in ESCEO recommendations (2014) is related to the preparations of the 1 step of treatment of patients with OA provides the control on inflammation and stability of osteocalcin level that testifies to the balance of catabolic processes in SCB.Conclusions. At OA the levels of procollagen IC-terminal propeptide (РІСР) and osteocalcin (OC) were not associated with obesity and did not depend on the initial CRP level at the presence of correlation between РІСР level and BMI among patients with OA with the normal body weight and BMI and CRP level among patients with OA in combination with obesity.The absence of reliable dynamics from РІСР side and maintenance of the stable OC level on the background of the reliable anti-inflammatory effect at using diacerein in patients with OA can testify to the compensatory adequacy of reparation processes in SCB

Forced Migration, The Human Face of a Health Crisis

Nearly 60 million refugees, asylum-seekers and internally displaced persons (IDPs) fled their homes in 2014, predominately from war-torn Syria, Afghanistan and Somalia. The global response to assisting this vulnerable group has been wholly incommensurate with the need given the profound health hazards faced by forced migrants at each stage of their journey. The majority of forced migrants are housed in lower-income countries that do not have the infrastructure to assist the significant numbers of individuals who are crossing their borders and the humanitarian organizations who seek to assist in the response are grossly underfunded and under-resourced. Countries have varying responsibilities to protect different classes of forced migrants based in international law, however there are significant gaps in existing agreements, leaving many individuals without protection or hope of assistance. There is a need to strengthen existing international agreements to ensure that all classes of forced migrants are entitled to protection and to ensure the enforceability of existing agreements where governments refuse to honor their existing obligations

The structure of strongly additive states and Markov triplets on the CAR algebra

We find a characterization of states satisfying equality in strong subadditivity of entropy and of Markov triplets on the CAR algebra. For even states, a more detailed structure of the density matrix is given.Comment: 11 page

The effect of temperature, soil nitrogen and gastropods on _Thuja plicata_ growth and reproduction

Humans are changing the environment. For example, nitrogen deposition, rising temperatures, and non-native species are influencing plant communities. These changes have and will continue to affect trees, thus, understanding the response of species to global change will help conservationists plan for the future. Urban areas already experience higher temperatures, elevated CO~2~, greater nitrogen levels, and more non-native species compared to rural areas. The response of trees to urban parks and park edges can therefore be used as a proxy for the net effects of global change on trees. We investigate the growth and reproduction of _Thuja plicata_, a native Pacific Northwest conifer, in both urban and rural forest fragments to understand global change impacts. Data collected from sites include hourly temperature, soil NO~3~^-^, seedling counts, and an increment core. After observing extremely low conifer germination rates across sites, we concluded that factors such as herbivory might be important. Gastropods have been shown to impact communities through consumption of plants at the seedling stage, and to limit seedling survival of a European conifer. The effects of soil moisture, soil nitrogen, and gastropod herbivory on _Thuja plicata_ seedlings was analyzed experimentally to determine the relative effect each might be having on the observed germination rate. Our results suggest that urban forest edges resemble future global change conditions of higher temperature and nitrogen. These global change factors appear to be positively influencing tree growth, suggesting that _Thuja plicata_ will benefit from future conditions. However, low seedling recruitment may be a concern, because it appears that urban and rural forests are currently failing to regenerate on their own. Introduced gastropods could play a role, as they have the ability to reduce seedling biomass significantly. The relative impacts of invasive slug herbivory and other global change factors on native conifer recruitment should be prioritized in future study

Dewetting of a solid monolayer

We report on the dewetting of a monolayer on a solid substrate, where mass transport occurs via surface diffusion. For a wide range of parameters, a labyrinthine pattern of bilayer islands is formed. An irreversible regime and a thermodynamic regime are identified. In both regimes, the velocity of a dewetting front, the wavelength of the bilayer island pattern, and the rate of nucleation of dewetted zones are obtained. We also point out the existence of a scaling behavior, which is analyzed by means of a geometrical model.Comment: to be published in PhysRevLet

Determination Of Consumer Preferences Of Different Groups Of Food

Marketing research of consumer preferences of consumers when purchasing various groups of food products are conducted, the factors affecting respondents when purchasing food products are studied. It is established that the consumer in its daily diet takes 10.5 % of bakery products; 7.1 % cereals and soups based on cereals and legumes. 9.5 % of respondents consume confectionery for breakfast and during snacks, and 6.2 % consume sweets. Meat is consumed daily by 5.8 % of respondents. Products based on meat –10.7 %. 8.1 % of respondents consume fish daily and fish-based products 3.1 %. 5.9 % consume milk every day, and milk-based products – 10.2 % of respondents. 12.8 and 10.1 % of the daily diet of respondents are vegetables and fruits (respectively). It is established that the recommended consumption norms are exceeded for such food groups as sweets, meat-based products, and confectionery. Diet within the norm for the consumption of bakery products, milk, fish and fish-based products. Inadequate consumption of cereals, legumes, meat, fruits. Based on the results, it is determined that the consumer prefers food products that have a pleasant (familiar) taste, without harmful, unnatural substances, high nutritional value at a low price. The studies are useful for specialists in food industry who work and develop new foods and diets