Research Report: A Preliminary Analysis of Medical Futility Decisionmaking: Law and Professional Attitudes

The debate in medical futility decisionmaking centers on the conflict between a patient insisting treatment and a doctor refusing to furnish it. Courts have taken two disparate approaches to the legal status of medical futility. Believing that such legal ambiguity may reflect ambiguity in the medical profession itself, this research report sought to identify any emerging consensus among professionals handling medical futility issues. The report explains the results of the Life Sustaining Treatment Survey, a nationwide survey of health care professionals at hospitals. Presented with a list of criteria, respondents assigned important ratings to the factors used in recent futility decisions at their institutions. The resulting data suggests that there is no consensus among professionals in medical futility decisionmaking. The data supports at least three distinct approaches for making futility decisions: emphasis on the patients’ preferences; providing for the patient and family; and adhering to objective medical and social norms. It is unlikely that the law will realize its full potential to regulate futility judgments until explicitly articulated professional standards emerge. This article advocates continued empirical research to document and test professional judgment principles. Such research may ultimately help identify factors that will form the basis for a consensus in medical futility decisionmaking

Profiling social, emotional and behavioural difficulties of children involved in direct and indirect bullying behaviours

Being involved in bullying places a child at risk of poor psychosocial and educational outcomes. This study aimed to examine the profile of behavioural, emotional and social functioning for two subtypes of bullying; direct and indirect (relational). Pupils aged between seven and eleven years old completed sociometric measures of social inclusion and bullying behaviour to identify 192 pupils considered to be involved in either direct, indirect, both or neither types of bullying. These pupils and their teachers completed a battery of assessments relating to behaviour, social competence and self-perception. All bully-groups experienced similar levels of significant social rejection. ‘Direct’ and ‘both’ groups showed the greatest number of behavioural, emotional and social difficulties, while the ‘indirect’ group showed weaknesses in self-perception, but no teacher-rated problems. Understanding the behavioural, emotional and social correlates of bullying is of particular importance for early identification of children at risk of becoming bullies and for developing targeted interventions

Magnetic Field Amplification in Galaxy Clusters and its Simulation

We review the present theoretical and numerical understanding of magnetic field amplification in cosmic large-scale structure, on length scales of galaxy clusters and beyond. Structure formation drives compression and turbulence, which amplify tiny magnetic seed fields to the microGauss values that are observed in the intracluster medium. This process is intimately connected to the properties of turbulence and the microphysics of the intra-cluster medium. Additional roles are played by merger induced shocks that sweep through the intra-cluster medium and motions induced by sloshing cool cores. The accurate simulation of magnetic field amplification in clusters still poses a serious challenge for simulations of cosmological structure formation. We review the current literature on cosmological simulations that include magnetic fields and outline theoretical as well as numerical challenges.Comment: 60 pages, 19 Figure

Physical Processes in Star Formation

© 2020 Springer-Verlag. The final publication is available at Springer via https://doi.org/10.1007/s11214-020-00693-8.Star formation is a complex multi-scale phenomenon that is of significant importance for astrophysics in general. Stars and star formation are key pillars in observational astronomy from local star forming regions in the Milky Way up to high-redshift galaxies. From a theoretical perspective, star formation and feedback processes (radiation, winds, and supernovae) play a pivotal role in advancing our understanding of the physical processes at work, both individually and of their interactions. In this review we will give an overview of the main processes that are important for the understanding of star formation. We start with an observationally motivated view on star formation from a global perspective and outline the general paradigm of the life-cycle of molecular clouds, in which star formation is the key process to close the cycle. After that we focus on the thermal and chemical aspects in star forming regions, discuss turbulence and magnetic fields as well as gravitational forces. Finally, we review the most important stellar feedback mechanisms.Peer reviewedFinal Accepted Versio

Avaliação do impacto da suplementação alimentar a gestantes no cotrole do baixo peso ao nascer no município de São Paulo, SP (Brasil)

A partir de estudo realizado em oito grandes maternidades do Município de São Paulo, SP (Brasil) que atendem clientela predominantemente de baixo nível sócio-econômico, objetivou-se analisar o impacto da suplementação alimentar durante a assistência pré-natal sobre a incidência de recém-nascidos de baixo peso ao nascer (peso < 2.500 g). Foram envolvidos no estudo 1.060 recém-nascidos de mães que receberam suplementação e 664 recém-nascidos de mães que não a receberam. Ã incidência de baixo peso ao nascer foi de cerca de 11%, considerada elevada e semelhante em ambos os grupos de recém-nascidos. A análise multivariada, realizada para controlar eventuais diferenças entre os grupos, que não a condição de suplementação, descartou qualquer associação significativa entre suplementação e peso ao nascer e revelou, por outro lado, que tabagismo e morbidade na gestação e determinadas características antropométricas e reprodutivas da mãe, prévias à gestação, são importantes fatores de risco para o baixo peso ao nascer. A aparente explicação para a ausência de impacto da suplementação alimentar na população estudada parece residir não na quantidade insuficiente da suplementação alimentar oferecida (370 Kcal/dia), mas no predomínio de fatores não alimentares na determinação do baixo peso ao nascer. São formuladas recomendações quanto ao controle do baixo peso ao nascer no contexto estudado

Separation of hormonal and exogenous iodine in serum by means of a cation exchange resin

The influence of iodine-containing compounds on the determination of iodoamino acids (IAA) and hormonal iodine (HI) in serum with a cation exchange resin has been studied. The IAA values were elevated by most of the compounds, though to a lesser degree than the protein-bound iodine. Of 15 chemically different iodinated radiopaques, only three caused false elevation of the HI, for periods varying from 2 to 14 days after the administration of the drug. Of a number of other iodine-containing compounds, only iodochlorhydroxyquin appeared to give variable results during its administration, all others being eliminated from the HI

Determination of thyroid hormones in serum by means of a cation exchange resin and chloric acid digestion

A simple and specific method for the determination of iodoamino acids (IAA) and hormonal iodine (HI) in serum is presented. 0.5 ml serum is allowed to run through a small column with a cation exchange resin. To isolate IAA, the column is washed with water and eluted with ammonia. To isolate HI, the column is washed with borate buffer, then with water and eluted with ammonia. After removal of the ammonia by heat, the organic iodine compounds are digested with chloric acid. Iodine is assayed by eerie sulphate-arsenious acid colorimetry. Normal values for IAA ranged from 3.6 to 7.2 μg iodine/100 ml serum (mean value 5.10 μg iodine/100 ml), and for HI from 3.0 to 6.0 /μg iodine/100 ml serum (mean value 4.30 μg iodine/100 ml)