Euthanasia and assisted suicide for people with an intellectual disability and/or autism spectrum disorder : an examination of nine relevant euthanasia cases in the Netherlands (2012-2016)

BACKGROUND: Euthanasia and assisted suicide (EAS) have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: (a) voluntary and well-considered request; (b) unbearable suffering without prospect of improvement; (c) informing the patient; (d) lack of a reasonable alternative; (e) independent second physician's opinion. 'Unbearable suffering' must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees (RTE). The purpose of this study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. METHODS: The 416 case summaries available on the RTE website (2012-2016) were searched for intellectual disability (6) and autism spectrum disorder (3). Direct content analysis was used on these nine cases. RESULTS: Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient's perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. CONCLUSIONS: Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards

Low Dosages of Interleukin 1 Protect Mice against Lethal Cerebral Malaria

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Мотив протиставлення міста селу в українській літературі

У статті розглянуто мотив протиставлення міста селу в творах української літератури. Дослідження присвячено аналізу опозиції образів міста і села в творчості письменників. Простежено семантику лексем, їх стилістичне використання. Ключові слова: протиставлення образів, стилістика та семантика лексем.В статье рассматривается мотив противопоставления образа города и села в украинской литературе. В работе анализируется опозиция город – село в произведениях. Прослеживается семантика лексем, их стилистика. Ключевые слова: противопоставление образов, стилистика и семантика лексем.In the article reason of contrasting of city to the village is considered in works of Ukrainian literature. Research is devoted to the analysis of opposition of appearances of city and village in creation of writers. Semantics of lexemes is traced, them the stylistic use. Keywords: contrasting of appearances, stilistika and semantics of lexemes

First-order structural transition in the magnetically ordered phase of Fe1.13Te

Specific heat, resistivity, magnetic susceptibility, linear thermal expansion (LTE), and high-resolution synchrotron X-ray powder diffraction investigations of single crystals Fe1+yTe (0.06 < y < 0.15) reveal a splitting of a single, first-order transition for y 0.12. Most strikingly, all measurements on identical samples Fe1.13Te consistently indicate that, upon cooling, the magnetic transition at T_N precedes the first-order structural transition at a lower temperature T_s. The structural transition in turn coincides with a change in the character of the magnetic structure. The LTE measurements along the crystallographic c-axis displays a small distortion close to T_N due to a lattice striction as a consequence of magnetic ordering, and a much larger change at T_s. The lattice symmetry changes, however, only below T_s as indicated by powder X-ray diffraction. This behavior is in stark contrast to the sequence in which the phase transitions occur in Fe pnictides.Comment: 6 page

Lowering of ground state induced by core-shell structure in strontium titanate

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Dietary fish-oil supplementation in experimental gram-negative infection and in cerebral malaria in mice

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Investigation of early stage deformation mechanisms in a metastable β titanium alloy showing combined twinning-induced plasticity and transformation-induced plasticity effects

International audienceAs expected from the alloy design procedure, combined Twinning Induced Plasticity (TWIP) and Transformation Induced Plasticity (TRIP) effects are activated in a metastable β Ti-12(wt.%)Mo alloy. In-situ Synchrotron X-ray diffraction (XRD), electron backscatter diffraction (EBSD) and transmission electron microscopy (TEM) observations were carried out to investigate the deformation mechanisms and microstructure evolution sequence. In the early deformation stage, primary strain/stress induced phase transformations (β->ω and β->α'') and primary mechanical twinning ({332} and {112}) are simultaneously activated. Secondary martensitic phase transformation and secondary mechanical twinning are then triggered in the twinned β zones. The {332} twinning and the subsequence secondary mechanisms dominate the early stage deformation process. The evolution of the deformation microstructure results in a high strain hardening rate (~2GPa) bringing about high tensile strength (~1GPa) and large uniform elongation (> 0.38)