Content of health status reports of people seeking assisted suicide: a qualitative analysis

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue

Elevation gradients of European climate change in the regional climate model COSMO-CLM

A transient climate scenario experiment of the regional climate model COSMO-CLM is analyzed to assess the elevation dependency of 21st century European climate change. A focus is put on near-surface conditions. Model evaluation reveals that COSMO-CLM is able to approximately reproduce the observed altitudinal variation of 2m temperature and precipitation in most regions and most seasons. The analysis of climate change signals suggests that 21st century climate change might considerably depend on elevation. Over most parts of Europe and in most seasons, near-surface warming significantly increases with elevation. This is consistent with the simulated changes of the free-tropospheric air temperature, but can only be fully explained by taking into account regional-scale processes involving the land surface. In winter and spring, the anomalous high-elevation warming is typically connected to a decrease in the number of snow days and the snow-albedo feedback. Further factors are changes in cloud cover and soil moisture and the proximity of low-elevation regions to the sea. The amplified warming at high elevations becomes apparent during the first half of the 21st century and results in a general decrease of near-surface lapse rates. It does not imply an early detection potential of large-scale temperature changes. For precipitation, only few consistent signals arise. In many regions precipitation changes show a pronounced elevation dependency but the details strongly depend on the season and the region under consideration. There is a tendency towards a larger relative decrease of summer precipitation at low elevations, but there are exceptions to this as wel

Symbiotic N2 fixation by soybean in organic and conventional cropping systems estimated by 15N dilution and 15N natural abundance

Nitrogen (N) is often the most limiting nutrient in organic cropping systems. N2 fixing crops present an important option to improve N supply and to maintain soil fertility. In a field experiment, we investigated whether the lower N fertilization level and higher soil microbial activity in organic than conventional systems affected symbiotic N2 fixation by soybean (Glycine max, var. Maple Arrow) growing in 2004 in plots that were since 1978 under the following systems: bio-dynamic (DYN); bio-organic (ORG); conventional with organic and mineral fertilizers (CON); CON with exclusively mineral fertilizers (MIN); non-fertilized control (NON). We estimated the percentage of legume N derived from the atmosphere (%Ndfa) by the natural abundance (NA) method. For ORG and MIN we additionally applied the enriched 15N isotope dilution method (ID) based on residual mineral and organic 15N labeled fertilizers that were applied in 2003 in microplots installed in ORG and MIN plots. These different enrichment treatments resulted in equal %Ndfa values. The %Ndfa obtained by NA for ORG and MIN was confirmed by the ID method, with similar variation. However, as plant growth was restricted by the microplot frames the NA technique provided more accurate estimates of the quantities of symbiotically fixed N2 (Nfix). At maturity of soybean the %Ndfa ranged from 24 to 54%. It decreased in the order ORG>CON>DYN>NON>MIN, with significantly lowest value for MIN. Corresponding Nfix in above ground plant material ranged from 15 to 26g Nm-2, with a decreasing trend in the order DYN=ORG>CON>MIN>NON. For all treatments, the N withdrawal by harvested grains was greater than Nfix. This shows that at the low to medium %Ndfa, soybeans did not improve the N supply to any system but removed significant amounts of soil N. High-soil N mineralization and/or low-soil P availability may have limited symbiotic N2 fixatio

Nitrogen use efficiency of 15N-labelled sheep manure and mineral fertiliser applied to microplots in long-term organic and conventional cropping systems

Nitrogen (N) utilisation by crops has to be improved to minimize losses to the environment. We investigated N use efficiency of animal manure and mineral fertiliser and fate of fertiliser N not taken up by crops in a conventional (CONMIN) and a bio-organic (BIOORG) cropping system of a long-term field experiment over three vegetation periods (winter wheat-soybean-maize). Microplots planted with wheat received a single application of 15N-labelled slurries (either urine or faeces labelled) or mineral fertiliser. At the end of each vegetation period we tested whether higher microbial activity and larger microbial biomass in BIOORG than CONMIN soils, and lower long-term N input level in BIOORG, affected use efficiency and fate of fertiliser N not taken up by crops. Recovery of 15N in wheat was 37%, 10% and 47% from urine, faeces and mineral fertiliser, respectively, and decreased strongly in the residual years. In total 41%, 15% and 50% of 15N applied as urine, faeces and mineral fertiliser was recovered by the three crops. 15N recovered from originally applied urine, faeces and mineral fertiliser in the topsoil (0-18cm) at the end of the third vegetation period was 19%, 25% and 20%, respectively. Of urine-, faeces- and mineral fertiliser-15N, 40%, 61% and 29%, respectively, was not recovered by the three crops and in topsoil suggesting significant transport of 15N-labelled components to deeper soil layers. CONMIN and BIOORG differed neither in fertiliser N use efficiency by crops nor in 15N recovery in soil indicating insignificant difference in the turnover and utilization of the applied manure nitrogen in the conventional and the bio-organic cropping system

Cryptococcus gattii Meningoencephalitis in an Immunocompetent Person 13 Months after Exposure

Abstract : A 53-year old immunocompetent Swiss female is described who developed severe meningoencephalitis due to infection with Cryptococcus gattii 13 months following exposure on Vancouver Island, Canada. Diagnosis was based on cerebrospinal fluid (CSF) examination, i.e., positive India-ink staining, positive latex particle agglutination, and positive culture. Species identification was performed by growth on L-canavanine-glycine-bromthymol blue medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. After initial therapy with fluconazole by which the patient did not improve, therapy was changed to amphotericin B and flucytosine and later to high-dose fluconazole and amphotericin B. Despite long-term treatment and external drainage of the CSF, the patient's condition improved only slowly. The patient was discharged after 132 days of hospitalizatio

Magnetic moments of the 3/2 resonances and their quark spin structure

We discuss magnetic moments of the $J=3/2$ baryons based on an earlier model for the baryon magnetic moments, allowing for flavor symmetry breaking in the quark magnetic moments as well as a general quark spin structure. From our earlier analysis of the nucleon-hyperon magnetic moments and the measured values of the magnetic moments of $\Delta^{++}$ and $\Omega^{-}$ we predict the other magnetic moments and deduce the spin structure of the resonance particles. We find from experiment that the total spin polarization of the decuplet baryons, $\Delta\Sigma(3/2)$, is considerably smaller than the non-relativistic quark model value of 3, although the data is still not good enough to give a precise determination.Comment: 13 pages, REVTeX, 2 figures, minor clarifying change

Octet, decuplet and antidecuplet magnetic moments in the chiral quark soliton model revisited

We reanalyse the magnetic moments of the baryon octet, decuplet, and antidecuplet within the framework of the chiral quark-soliton model, with SU(3) symmetry breaking taken into account. We consider the contributions of the mixing of higher representations to the magnetic moment operator arising from the SU(3) symmetry breaking. Dynamical parameters of the model are fixed by experimental data for the magnetic moments of the baryon octet and from the masses of the octet, decuplet and of $\Theta^{+}$. The magnetic moment of $\Theta^{+}$ depends rather strongly on the pion-nucleon sigma term and reads $-1.19 {\rm n.m.}$ to $-0.33 {\rm n.m.}$ for $\Sigma_{\pi N} = 45$ and 75 MeV respectively. The recently reported mass of $\Xi^{--}_{\bar{10}}(1862)$ is compatible with $\Sigma_{\pi N} = 73$ MeV. As a byproduct the strange magnetic moment of the nucleon is obtained with a value of $\mu^{(s)}_N =+0.39$ n.m.Comment: RevTeX is used. 12 pages, 3 figures, final version for publication in Phys. Rev.

Reasons why people in Switzerland seek assisted suicide : the view of patients and physicians

Background: Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. Methods: We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). Results: The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Conclusions: Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians

Trophic factor BDNF inhibits GABAergic signaling by facilitating dendritic enrichment of SUMO E3 ligase PIAS3 and altering gephyrin scaffold

Posttranslational addition of a small ubiquitin-like modifier (SUMO) moiety (SUMOylation) has been implicated in pathologies such as brain ischemia, diabetic peripheral neuropathy, and neurodegeneration. However, nuclear enrichment of SUMO pathway proteins has made it difficult to ascertain how ion channels, proteins that are typically localized to and function at the plasma membrane, and mitochondria are SUMOylated. Here, we report that the trophic factor, brain-derived neurotrophic factor (BDNF) regulates SUMO proteins both spatially and temporally in neurons. We show that BDNF signaling via the receptor tropomyosin-related kinase B facilitates nuclear exodus of SUMO proteins and subsequent enrichment within dendrites. Of the various SUMO E3 ligases, we found that PIAS-3 dendrite enrichment in response to BDNF signaling specifically modulates subsequent ERK1/2 kinase pathway signaling. In addition, we found the PIAS-3 RING and Ser/Thr domains, albeit in opposing manners, functionally inhibit GABA-mediated inhibition. Finally, using oxygen-glucose deprivation as an in vitro model for ischemia, we show that BDNF-tropomyosin-related kinase B signaling negatively impairs clustering of the main scaffolding protein at GABAergic postsynapse, gephyrin, whereby reducing GABAergic neurotransmission postischemia. SUMOylation-defective gephyrin K148R/K724R mutant transgene expression reversed these ischemia-induced changes in gephyrin cluster density. Taken together, these data suggest that BDNF signaling facilitates the temporal relocation of nuclear-enriched SUMO proteins to dendrites to influence postsynaptic protein SUMOylation

MAR-Mediated transgene integration into permissive chromatin and increased expression by recombination pathway engineering.

Untargeted plasmid integration into mammalian cell genomes remains a poorly understood and inefficient process. The formation of plasmid concatemers and their genomic integration has been ascribed either to non-homologous end-joining (NHEJ) or homologous recombination (HR) DNA repair pathways. However, a direct involvement of these pathways has remained unclear. Here, we show that the silencing of many HR factors enhanced plasmid concatemer formation and stable expression of the gene of interest in Chinese hamster ovary (CHO) cells, while the inhibition of NHEJ had no effect. However, genomic integration was decreased by the silencing of specific HR components, such as Rad51, and DNA synthesis-dependent microhomology-mediated end-joining (SD-MMEJ) activities. Genome-wide analysis of the integration loci and junction sequences validated the prevalent use of the SD-MMEJ pathway for transgene integration close to cellular genes, an effect shared with matrix attachment region (MAR) DNA elements that stimulate plasmid integration and expression. Overall, we conclude that SD-MMEJ is the main mechanism driving the illegitimate genomic integration of foreign DNA in CHO cells, and we provide a recombination engineering approach that increases transgene integration and recombinant protein expression in these cells. Biotechnol. Bioeng. 2017;114: 384-396. © 2016 The Authors. Biotechnology and Bioengineering published by Wiley Periodicals, Inc