Continuous sedation until death: The everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

Copyright © 2014 Raus et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress. Methods - This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology. Results - The participants’ responses can be captured as different dimensions of ‘closeness’, i.e. the degree to which one feels connected or ‘close’ to a certain decision or event. We distinguished four types of ‘closeness’, namely emotional, physical, decisional, and causal. Using these four dimensions of ‘closeness’ it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility. Conclusion - Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.The Economic and Social Research Council (UK), the Research Foundation Flanders (BE), the Flemish Cancer Association (BE), the Research Council of Ghent University (BE), the Netherlands Organization for Scientific Research (NL) and the Netherlands Organization for Health Research and Development (NL)

DNA Spools under Tension

DNA-spools, structures in which DNA is wrapped and helically coiled onto itself or onto a protein core are ubiquitous in nature. We develop a general theory describing the non-equilibrium behavior of DNA-spools under linear tension. Two puzzling and seemingly unrelated recent experimental findings, the sudden quantized unwrapping of nucleosomes and that of DNA toroidal condensates under tension are theoretically explained and shown to be of the same origin. The study provides new insights into nucleosome and chromatin fiber stability and dynamics

In situ observations of waves in Venus’s polar lower thermosphere with Venus Express aerobraking

Waves are ubiquitous phenomena found in oceans and atmospheres alike. From the earliest formal studies of waves in the Earth’s atmosphere to more recent studies on other planets, waves have been shown to play a key role in shaping atmospheric bulk structure, dynamics and variability1, 2, 3, 4. Yet, waves are difficult to characterize as they ideally require in situ measurements of atmospheric properties that are difficult to obtain away from Earth. Thus, we have incomplete knowledge of atmospheric waves on planets other than our own, and we are thereby limited in our ability to understand and predict planetary atmospheres. Here we report the first ever in situ observations of atmospheric waves in Venus’s thermosphere (130–140 km) at high latitudes (71.5°–79.0°). These measurements were made by the Venus Express Atmospheric Drag Experiment (VExADE)5 during aerobraking from 24 June to 11 July 2014. As the spacecraft flew through Venus’s atmosphere, deceleration by atmospheric drag was sufficient to obtain from accelerometer readings a total of 18 vertical density profiles. We infer an average temperature of T = 114 ± 23 K and find horizontal wave-like density perturbations and mean temperatures being modulated at a quasi-5-day period

Dynamics of a Driven Single Flux Line in Superconductors

We study the low temperature dynamics of a single flux line in a bulk type-II superconductor, driven by a surface current, both near and above the onset of an instability which sets in at a critical driving. We found that above the critical driving, the velocity profile of the flux line develops a discontinuity.Comment: 10 pages with 4 figures, REVTE

Rhythmogenic neuronal networks, pacemakers, and k-cores

Neuronal networks are controlled by a combination of the dynamics of individual neurons and the connectivity of the network that links them together. We study a minimal model of the preBotzinger complex, a small neuronal network that controls the breathing rhythm of mammals through periodic firing bursts. We show that the properties of a such a randomly connected network of identical excitatory neurons are fundamentally different from those of uniformly connected neuronal networks as described by mean-field theory. We show that (i) the connectivity properties of the networks determines the location of emergent pacemakers that trigger the firing bursts and (ii) that the collective desensitization that terminates the firing bursts is determined again by the network connectivity, through k-core clusters of neurons.Comment: 4+ pages, 4 figures, submitted to Phys. Rev. Let

Model fluid in a porous medium: results for a Bethe lattice

We consider a lattice gas with quenched impurities or `quenched-annealed binary mixture' on the Bethe lattice. The quenched part represents a porous matrix in which the (annealed) lattice gas resides. This model features the 3 main factors of fluids in random porous media: wetting, randomness and confinement. The recursive character of the Bethe lattice enables an exact treatment, whose key ingredient is an integral equation yielding the one-particle effective field distribution. Our analysis shows that this distribution consists of two essentially different parts. The first one is a continuous spectrum and corresponds to the macroscopic volume accessible to the fluid, the second is discrete and comes from finite closed cavities in the porous medium. Those closed cavities are in equilibrium with the bulk fluid within the grand canonical ensemble we use, but are inaccessible in real experimental situations. Fortunately, we are able to isolate their contributions. Separation of the discrete spectrum facilitates also the numerical solution of the main equation. The numerical calculations show that the continuous spectrum becomes more and more rough as the temperature decreases, and this limits the accuracy of the solution at low temperatures.Comment: 13 pages, 12 figure

Plasticity in current-driven vortex lattices

We present a theoretical analysis of recent experiments on current-driven vortex dynamics in the Corbino disk geometry. This geometry introduces controlled spatial gradients in the driving force and allows the study of the onset of plasticity and tearing in clean vortex lattices. We describe plastic slip in terms of the stress-driven unbinding of dislocation pairs, which in turn contribute to the relaxation of the shear, yielding a nonlinear response. The steady state density of free dislocations induced by the applied stress is calculated as a function of the applied current and temperature. A criterion for the onset of plasticity at a radial location $r$ in the disk yields a temperature-dependent critical current that is in qualitative agreement with experiments.Comment: 11 pages, 4 figure

Shear Alignment and Instability of Smectic Phases

We consider the shear flow of well-aligned one-component smectic phases, such as thermotropic smectics and lamellar diblock copolymers, below the critical region. We show that, as a result of thermal fluctuations of the layers, parallel ($c$) alignment is generically unstable and perpendicular ($a$) alignment is stable against long-wavelength undulations. We also find, surprisingly, that both $a$ and $c$ are stable for a narrow window of values for the anisotropic viscosity.Comment: To appear in PRL. Revtex, 1 figure