Medical Aid in Dying, Hastened Death and Suicide:A Qualitative Study of Hospice Professionals' Experiences from Washington State

CONTEXT: Many jurisdictions around the world have passed medical aid in dying (MAID) laws allowing competent eligible individuals facing life-limiting illness to self-administer prescribed medication to control timing of death. These laws do not prevent some patients who are receiving hospice services from dying by suicide without assistance. OBJECTIVES: To explore hospice professionals' experiences of patients who die by suicide or intentionally hasten death with or without legal assistance in an area where there is legalized MAID. METHODS: Semistructured in-depth qualitative interviews were conducted with 21 home hospice professionals (seven nurses, seven social workers, four physicians, and three chaplains). Thematic analysis was carried out to analyze the data. RESULTS: Three primary themes were identified from the interviews: 1) dealing with and differentiating between hastened death and suicide, 2) MAID access and affordability, and 3) how patients have hastened their own deaths. Analysis of these data indicates that there are some patients receiving hospice services who die by suicide because they are not eligible for, have no knowledge of, or lack access to legalized MAID. Hospice professionals do not consistently identify patients' deaths as suicide when they are self-inflicted and sometimes view these deaths as justified. CONCLUSION: Suicide and hastened deaths continue to be an unexamined cause of death for some home hospice patients who may have requested MAID. Open communication and increased education and training is needed for palliative care professionals regarding legal options, issues of suicide, and suicide assessment

IRB perspectives on the return of individual results from genomic research

Return of individual research results from genomic studies is a hotly debated ethical issue in genomic research. However, the perspective of key stakeholders—Institutional Review Board (IRB) reviewers—has been missing from this dialogue. This study explores the positions and experiences of IRB members and staff regarding this issue

Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients

Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients

Depressive Symptoms in Children with Chronic Kidney Disease

To assess depression in children with chronic kidney disease (CKD) and to determine associations with patient characteristics, intellectual and educational levels, and health related quality of life (HRQoL)

When is hastened death considered suicide?:a systematically conducted literature review about palliative care professionals' experiences where assisted dying is legal

Background: Laws allowing assisted suicide and euthanasia have been implemented in many locations around the world but some individuals suffering with terminal illness receiving palliative care services are hastening death or die by suicide without assistance. This systematic review aims to summarise evidence of palliative care professionals' experiences of patients who died by suicide or hastened death in areas where assisted dying is legal and to understand when hastened death is considered to be a suicide. Methods: AMED, CINAHL Complete, PsycINFO, PubMED, and Academic Search Ultimate were searched for articles from inception through June 2018. Quality assessment used the Hawker framework. Results: A total of 1518 titles were screened resulting in thirty studies meeting eligibility criteria for this review. Published studies about professionals' experiences from areas with legalised assisted dying includes limited information about patients who hasten death outside legal guidelines, die by suicide without assistance, or if the law impacts suicide among palliative care patients. Conclusion: There are a range of experiences and emotions professionals' experience with patients who die by euthanasia, assisted suicide, or hasten death without assistance. The included literature suggests improved communication among professionals is needed but does not explicitly identify when a hastened death is deemed a suicide in areas where assisted dying is practiced. More research is needed to help clarify what hastened death means in a palliative care context and identify how and if assisted dying impacts issues of suicide in palliative care settings

Ashkenazi Jews: Overburdened and Overexposed?

Utilizing a closed-ended survey and three focus groups drawn from one Midwest city, this study examined attitudes of Ashkenazi Jews toward involvement in genetic research. The research is framed within an analysis of the extent of Ashkenazi involvement in research; factors that make this group an attractive object of genetic study; cultural, historical, and religious factors within the group that drive people\u27s attitudes toward being subjects of genetic research; community consent as a possible response to concerns within this population about research participation. Although some participants had concerns about discrimination and privacy, there was a clear sense of the potential benefits of genetic research and testing. The majority of respondents did not agree that genetic research could hurt the image of the Jewish community. Subjects expressed consensus that decisions about participation in research should be made by individuals, and not by the community. In conclusion, Ashkenazi Jews in this study did not feel overstudied and overexposed. They were not interested in community consultation or consent for genetic research on their ethnic group

Grau voluntário de divulgação do capital intelectual oculto e seu registro nas Normas Internacionais de Informação Financeira

This article reflects the problem of the lack of disclosure of Intellectual capital in some companies in the Cundinamarca-Bogotá area, in Colombia, in some of them due to ignorance and in others due to fear of generating taxes. Therefore, in this first stage, the purpose of the investigation is to determine the voluntary degree of disclosing hidden intellectual capital and its registration, especially in the International Financial Reporting Standards. Under the qualitative methodology with an exploratory study by reviewing the literature both on the measurement of intellectual capital in practice and the annual management reports of the 23 participating companies during the years 2017 to 202l. The Intellectus model is selected for the measurement of intellectual capital through the categories of human and structural capital and related to 52 subcategories, making a descriptive analysis from the "thematic" factor in the management reports of said companies. The results show that the intellectual capital disclosure index is 42% with a significant increase for each company in the period of the year, but it is only reflected in files, lists, figures, Excel documents. However, due to the "obligation" that currently exists in accounting regulations, many of the companies do not voluntarily disclose intellectual capital from the indicators of their categories that correspond to the majority of intangible assetsEste articulo refleja la problemática de la falta de divulgación del capital intelectual en algunas empresas de la zona Cundinamarca-Bogotá, en Colombia, en algunas por desconocimiento y en otras por el temor a generar algunos impuestos. Por ello, en esta primera etapa el propósito de la investigación es determinar el grado voluntario de divulgar el capital intelectual oculto y su registro, en especial en las Normas Internacionales de Información Financiera, bajo la metodología cualitativa con un estudio exploratorio al revisar la literatura tanto de la medición del capital intelectual en la práctica como los informes de gestión anual de las 23 empresas participantes durante los años 2017 a 202l. Se selecciona el modelo Intellectus para la medición del capital intelectual por medio de las categorías del capital humano estructural y las relaciona con 52 subcategorías, haciendo un análisis descriptivo desde el factor “temática” en los informes de gestión de dichas empresas. Los resultados arrojan un índice de divulgación del capital intelectual  de 42%, con un incremento significativo por cada empresa en un periodo del año, pero solo se refleja en fichas, listas, figuras, documentos Excel. Sin embargo, debido a la obligatoriedad que existe actualmente en la normatividad contable, muchas empresas no divulgan de manera voluntaria el capital intelectual desde los indicadores de sus categorías correspondientes a la mayoría de activos intangibles.Cet article montre le problème de l'absence de divulgation du capital intellectuel dans certaines entreprises de la région de Cundinamarca-Bogotá en Colombie, dans certains cas par manque de connaissances et dans d'autres par crainte de générer des impôts. Dans cette première étape, la recherche vise à établir le degré volontaire de divulgation du capital intellectuel caché et son enregistrement, en particulier dans les Normes Internationales d'Information Financière, selon la méthodologie qualitative avec une étude exploratoire en examinant la littérature de la mesure du capital intellectuel dans la pratique et les rapports annuels de gestion des 23 entreprises participantes au cours de la période 2017-202l. Le modèle Intellectus est choisi pour la mesure du capital intellectuel à travers les catégories du capital humain structurel et les relie à 52 sous-catégories, en faisant une analyse descriptive à partir du facteur "thématique" dans les rapports de gestion de ces entreprises. Les résultats montrent un taux de divulgation du capital intellectuel de 42%, avec une augmentation significative pour chaque entreprise sur une période d'un an, mais il n'est reflété que dans des cartes, des listes, des chiffres, des documents Excel. Cependant, en raison des réglementations comptables obligatoires actuelles, de nombreuses entreprises ne divulguent pas volontairement le capital intellectuel à partir des indicateurs de leurs catégories correspondant à la majorité des actifs incorporels.Este artigo mostra o problema da falta de divulgação do capital intelectual em algumas empresas da região de Cundinamarca-Bogotá, na Colômbia, em algumas por falta de conhecimento e em outras por medo de gerar alguns impostos. Nesta primeira etapa, a pesquisa visa estabelecer o grau voluntário de divulgação do capital intelectual oculto e seu registro, especialmente nas Normas Internacionais de Informação Financeira, de acordo com a metodologia qualitativa com um estudo exploratório, revisando a literatura da medição do capital intelectual na prática e os relatórios anuais de gestão das 23 empresas participantes durante o período 2017-202l. O modelo Intellectus é escolhido para a mensuração do capital intelectual através das categorias do capital humano estrutural e as relaciona com 52 subcategorias, fazendo uma análise descritiva a partir do fator "temática" nos relatórios de administração dessas empresas. Os resultados mostram uma taxa de divulgação do capital intelectual de 42%, com um aumento significativo para cada empresa ao longo de um período do ano, mas que apenas se reflecte em fichas, listas, números, documentos Excel. No entanto, devido à atual regulamentação contabilística obrigatória, muitas empresas não divulgam voluntariamente o capital intelectual dos indicadores das suas categorias correspondentes à maioria dos activos intengíveis

NUEVA CONCEPCIÓN DIDÁCTICA PARA EL PROCESO DE ENSEÑANZA - APRENDIZAJE DE LA ZOOLOGÍA DE LOS CORDADOS

This research proposes and validates a new Didactic Conception with an ecosystem approach for the teaching - learning process of the zoology of the chordates in the third year of the Regular Day Course, of the Bachelor Degree in Biology Education of the Faculty of Media Education "Félix Varela Morales" of the Central University "Marta Abreu" of Las Villas, Villa Clara, Cuba. The information for the diagnosis is obtained from the application of different empirical methods such as surveys, interviews, observation and review of documents. The Didactic conception is based on the Historical - Cultural Theory of LS Vygotsky and his followers, in which an ecosystem approach and confrontation to climate change is demonstrated, which, from its implementation in the aforementioned race, allows students to become even more aware of the imperative need to conserve biological diversity, as well as developing intellectual, practical and computer skills in them. To put this concept into practice, a new program was developed for the study of the zoology of the chordates with the textbook "Zoology of Chordates" using an ecosystem approach, a system of virtual practical classes for the study of external and internal morphology of different vertebrates never before introduced, and a collection of concept maps in electronic format. The new Didactic Conception is submitted for evaluation at the discretion of experts and was implemented in the academic courses 2017 - 2018 and 2018 - 2019, with satisfactory results. Key words: Concepcion Didactics – ecosystem approach – learning process – teaching – Zoology of the chordatesEn la investigación se propone y se valida, una novedosa Concepción Didáctica con enfoque ecosistémico, para el proceso de enseñanza – aprendizaje de la Zoología de los cordados en el tercer año del Curso Regular Diurno, de la Carrera de Licenciatura en Educación Biología de la Facultad de Educación Media “Félix Varela Morales” de la Universidad Central “Marta Abreu” de Las Villas, Villa Clara, Cuba. En la investigación se emplearon diversos métodos teóricos y empíricos en su interrelación dialéctica, los que permitieron identificar las carencias existentes y proponer la solución. La información para el diagnóstico es obtenida a partir de la aplicación de diferentes métodos empíricos como encuestas, entrevistas, observación y revisión de documentos. La concepción Didáctica se sustenta en la Teoría Histórico - Cultural de L. S. Vygotsky y sus seguidores, en ella se pone de manifiesto un enfoque ecosistémico y de enfrentamiento al cambio climático, lo que, a partir de su puesta en práctica en la carrera antes mencionada, permite a los estudiantes adquirir aún más conciencia sobre la necesidad imperiosa de conservar la diversidad biológica, además de desarrollar en ellos habilidades intelectuales, prácticas e informáticas. Para poner en práctica dicha concepción se elaboró un nuevo programa para la asignatura Zoología de los cordados, el libro de texto “Zoología de los cordados” con enfoque ecosistémico, un sistema de clases prácticas virtuales para el estudio de la morfología externa e interna de diferentes vertebrados, nunca antes introducidas y se incorpora además una colección de mapas conceptuales en formato electrónico. La nueva Concepción Didáctica se somete para su valoración a criterio de expertos y se implementa en los cursos académicos 2017 – 2018 y 2018 – 2019, con satisfactorios resultados. Palabras clave: aprendizaje – Concepción Didáctica – enfoque ecosistémico – Proceso de enseñanza – Zoología de los cordado