Natural law, non-voluntary euthanasia, and public policy

© 2019 by Emerald Publishing Limited. Natural Law philosophy asserts that there are universally binding and universally evident principles that can be determined to guide the actions of persons. Moreover, many of these principles have been enshrined in both statute and common law, thus ensuring their saliency for staff and institutions charged with palliative care. The authors examine the often emotive and politicized matter of (non-voluntary) euthanasia – acts or omissions made with the intent of causing or hastening death – with reference to Natural Law philosophy. This leads us to propose a number of important public policy remedies to ensure dignity in dying for the patient, and their associates

High Density Lipoprotein (HDL) Promotes Glucose Uptake in Adipocytes and Glycogen Synthesis in Muscle Cells

Background: High density lipoprotein (HDL) was reported to decrease plasma glucose and promote insulin secretion in type 2 diabetes patients. This investigation was designed to determine the effects and mechanisms of HDL on glucose uptake in adipocytes and glycogen synthesis in muscle cells. Methods and Results: Actions of HDL on glucose uptake and GLUT4 translocation were assessed with 1- [ 3 H]-2deoxyglucose and plasma membrane lawn, respectively, in 3T3-L1 adipocytes. Glycogen analysis was performed with amyloglucosidase and glucose oxidase-peroxidase methods in normal and palmitate-treated L6 cells. Small interfering RNA was used to observe role of scavenger receptor type I (SR-BI) in glucose uptake of HDL. Corresponding signaling molecules were detected by immunoblotting. HDL stimulated glucose uptake in a time- and concentration-dependent manner in 3T3-L1 adipocytes. GLUT4 translocation was significantly increased by HDL. Glycogen deposition got enhanced in L6 muscle cells paralleling with elevated glycogen synthase kinase3 (GSK3) phosphorylation. Meanwhile, increased phosphorylations of Akt-Ser473 and AMP activated protein kinase (AMPK) a were detected in 3T3-L1 adipocytes. Glucose uptake and Akt-Ser473 activation but not AMPK-a were diminished in SR-BI knock-down 3T3-L1 cells. Conclusions: HDL stimulates glucose uptake in 3T3-L1 adipocytes through enhancing GLUT4 translocation by mechanisms involving PI3K/Akt via SR-BI and AMPK signaling pathways, and increases glycogen deposition in L6 muscle cells throug

Calf health from birth to weaning. I. General aspects of disease prevention

Calfhood diseases have a major impact on the economic viability of cattle operations. This is the first in a three part review series on calf health from birth to weaning, focusing on preventive measures. The review considers both pre- and periparturient management factors influencing calf health, colostrum management in beef and dairy calves and further nutrition and weaning in dairy calves

Zika virus protection by a single low dose nucleoside modified mRNA vaccination

Zika virus (ZIKV) has recently emerged as an explosive pandemic associated with severe neuropathology in newborns and adults1. There are no ZIKV-specific treatments or preventatives; thus, development of a safe and effective vaccine is a high priority. Messenger RNA (mRNA) has emerged as a versatile and highly effective platform to deliver vaccine antigens and therapeutic proteins2,3. Here, we demonstrate that a single low-dose intradermal immunization with lipid nanoparticle-encapsulated nucleoside-modified mRNA (mRNA-LNP) encoding the pre-membrane and envelope (prM-E) glycoproteins of a 2013 ZIKV outbreak strain elicited potent and durable neutralizing antibody responses in mice and non-human primates. Immunization with 30 μg of nucleoside-modified ZIKV mRNA-LNPs protected mice from ZIKV challenges at 2 weeks or 5 months post-vaccination, and a single dose of 50 μg was sufficient to protect non-human primates from a challenge at 5 weeks post-vaccination. These data demonstrate that nucleoside-modified mRNA-LNPs elicit rapid and durable protective immunity and thus represent a new and promising vaccine candidate for the global fight against ZIKV

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

The Equivalence Thesis and the Last Ventilator

The potential shortage of ventilators during the COVID-19 crisis has resulted in guidelines being published denying any moral difference between withholding and withdrawing medical treatment. This reflects some ethicists' support for ‘the equivalence thesis’, the idea that wherever it is permissible to withhold treatment, it is permissible to withdraw it, and vice versa. Some ethicists claim that doctors' opposition to the equivalence thesis discourages treatment withdrawal, leading to unnecessary loss of life amid pronounced scarcity. But first we need to ascertain whether the equivalence thesis is true. If it is, then we can work out what to do about the negative impacts of doctors opposing it. In this article, we argue that the equivalence thesis is false. There is a difference between withholding and withdrawing in that there can be instances in which an act of one type would be permissible while an act of the other type would be wrong, even though all other things are equal. We use Heidi Malm's distinction between comparison and conflict cases to show that equivalence proponents and opponents may be talking past one another, with proponents focussing on comparison cases and opponents rightly thinking of conflict cases as well.</p

Eliminating Summer Fallow Reduces Winter Wheat Yields, but Not Necessarily System Profitability

Summer fallow is commonly used to stabilize winter wheat (Triticum aestivum L.) production in the Central Great Plains, but summer fallow results in soil degradation, limits farm productivity and profitability, and stores soil water inefficiently. The objectives of this study were to quantify the production and economic consequences of replacing summer fallow with spring-planted crops on the subsequent winter wheat crop. A summer fallow treatment and five spring crop treatments [spring canola (Brassica napus L.), oat (Avena sativa L.) + pea (Pisum sativum L.) for forage, proso millet (Panicum miliaceum L.), dry bean (Phaseolus vulgaris L.), and corn (Zea mays L.)] were no-till seeded into sunflower (Helianthus annuus L.) residue in a randomized complete block design with five replications during 1999, 2000, and 2001. Winter wheat was planted in the fall following the spring crops. Five N fertilizer treatments (0, 22, 45, 67, and 90 kg N ha-1) were randomly assigned to each previous spring crop treatment in a split-plot treatment arrangement. The 3-yr mean wheat grain yield after summer fallow was 29% greater than following oat + pea for forage and 86% greater than following corn. The 3-yr mean annualized net return for the spring crop and subsequent winter wheat crop was $4.20, -$6.91, -$7.55, -$29.66, -$81.17, and -$94.88 ha-1 for oat + pea for forage, proso millet, summer fallow, dry bean, corn, and spring canola, respectively. Systems involving oat + pea for forage and proso millet are economically competitive with systems using summer fallow