Ethical difficulties in clinical practice : experiences of European doctors

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services. Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK. Results: Survey respondents (n = 656, response rate 43%) ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority (17.6%) reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decisionmaking capacity (94.8%), disagreement among caregivers (81.2%) and limitation of treatment at the end of life (79.3%). The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct (47.5%), someone capable of providing specific advice (41.1%), help in weighing outcomes (36%) and clarification of the issues (35.9%). Few of the types of help expected to be useful varied among countries. Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries

Space Vector Taylor–Fourier Models for Synchrophasor, Frequency, and ROCOF Measurements in Three-Phase Systems

Taylor-Fourier (TF) filters represent a powerful tool to design phasor measurement unit (PMU) algorithms able to estimate synchrophasor, frequency, and rate of change of frequency (ROCOF). The resulting techniques are based on dynamic representations of the synchrophasor, and hence, they are particularly suitable to track the evolution of its parameters during time-varying conditions. Electrical quantities in power systems are typically three-phase and weakly unbalanced, but most PMU measurement techniques are developed by considering them as a set of three single-phase signals; on the contrary, this peculiarity can be favorably exploited to improve accuracy and reduce the computational cost. In this respect, this paper proposes to directly perform the TF expansion of the space vector (SV) samples obtained from three-phase measurements. A new paradigm allows to independently estimate positive and negative sequence synchrophasors along with system frequency and ROCOF, leveraging the three-phase characteristics. The performance of the proposed technique is assessed by using test signals inspired by the standard IEEE C37.118.1-2011, including noise as well as magnitude and phase unbalance. Achieved results highlight the flexibility of the enhanced SV-based approach, which is capable to combine excellent dynamic performance together with an accurate estimation of both positive and negative sequence components

Clinical ethics consultation in Europe: A comparative and ethical review of the role of patients

Clinical ethics has developed significantly in Europe over the past 15 years and remains an evolving process. While sharing our experiences in different European settings, we were surprised to discover marked differences in our practice, especially regarding the position and role of patients. In this paper, we describe these differences, such as patient access to and participation or representation in ethics consults. We propose reasons to explain these differences, hypothesizing that they relate to the historic and sociocultural context of implementation of clinical ethics consultation services (Cecs), as well as the initial aims for which each structure was established. Then, we analyse those differences with common ethical arguments arising in patient involvement. We conclude that there is no unique model of best practice for patient involvement in clinical ethics, as far as Cecs reflect on how to deal with the challenging ethical issues raised by patient role and position.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Proneural-Mesenchymal Transition: Phenotypic Plasticity to Acquire Multitherapy Resistance in Glioblastoma

Glioblastoma (GBM) is an extremely aggressive tumor of the central nervous system, with a prognosis of 12\u201315 months and just 3\u20135% of survival over 5 years. This is mainly because most patients suffer recurrence after treatment that currently consists in maximal resection followed by radio- and chemotherapy with temozolomide. The recurrent tumor shows a more aggressive behavior due to a phenotypic shift toward the mesenchymal subtype. Proneural-mesenchymal transition (PMT) may represent for GBM the equivalent of epithelial\u2013mesenchymal transition associated with other aggressive cancers. In this review we frame this process in the high degree of phenotypic inter- and intra-tumor heterogeneity of GBM, which exists in different subtypes, each one characterized by further phenotypic variability in its stem-cell compartment. Under the selective pressure of different treatment agents PMT is induced. The mechanisms involved, as well as the significance of such event in the acquisition of a multitherapy resistance phenotype, are taken in consideration for future perspectives in new anti-GBM therapeutic options

Unimpaired Neuropsychological Performance and Enhanced Memory Recall in Patients with Sbma: A Large Sample Comparative Study.

Peculiar cognitive profile of patients with SBMA has been described by fragmented literature. Our retrospective study reports the neuropsychological evaluations of a large cohort of patients in order to contribute towards the understanding of this field. We consider 64 neuropsychological evaluations assessing mnesic, linguistic and executive functions collected from 2013 to 2015 in patients attending at Motor Neuron Disease Centre of University of Padova. The battery consisted in: Digit Span forwards and backwards, Prose Memory test, Phonemic Verbal fluency and Trail making tests. ANCOVA statistics were employed to compare tests scores results with those obtained from a sample of healthy control subjects. Multiple linear regressions were used to study the effect on cognitive performance of CAG-repeat expansion, the degree of androgen insensitivity and their interaction to cognitive performance. Statistical analyses did not reveal altered scores in any neuropsychological tests among those adopted. Interestingly, patients performed significantly better in the Prose Memory test's score. No relevant associations were found with genetic, hormonal or clinical patients' profile. Results inconsistent with previous studies have been interpreted according to the phenomenon of somatic mosaicism. We suggest a testosterone-related and the mood state-dependant perspectives as two possible interpretations of the enhanced performances in the Prose Memory test. Further studies employing more datailed tests batteries are encouraged

Nonlinear evolution of the magnetized Kelvin-Helmholtz instability: from fluid to kinetic modeling

The nonlinear evolution of collisionless plasmas is typically a multi-scale process where the energy is injected at large, fluid scales and dissipated at small, kinetic scales. Accurately modelling the global evolution requires to take into account the main micro-scale physical processes of interest. This is why comparison of different plasma models is today an imperative task aiming at understanding cross-scale processes in plasmas. We report here the first comparative study of the evolution of a magnetized shear flow, through a variety of different plasma models by using magnetohydrodynamic, Hall-MHD, two-fluid, hybrid kinetic and full kinetic codes. Kinetic relaxation effects are discussed to emphasize the need for kinetic equilibriums to study the dynamics of collisionless plasmas in non trivial configurations. Discrepancies between models are studied both in the linear and in the nonlinear regime of the magnetized Kelvin-Helmholtz instability, to highlight the effects of small scale processes on the nonlinear evolution of collisionless plasmas. We illustrate how the evolution of a magnetized shear flow depends on the relative orientation of the fluid vorticity with respect to the magnetic field direction during the linear evolution when kinetic effects are taken into account. Even if we found that small scale processes differ between the different models, we show that the feedback from small, kinetic scales to large, fluid scales is negligable in the nonlinear regime. This study show that the kinetic modeling validates the use of a fluid approach at large scales, which encourages the development and use of fluid codes to study the nonlinear evolution of magnetized fluid flows, even in the colisionless regime

Identification of biomarkers associated to 'Gala' apples ripening and postharvest quality .

Apple is, sociocultural and economically, on of the most important species in the world, and stands out for its high storage potential. However, the monitoring of factors that could result in fruit quality modifications during postharvest is essential to ensure the acceptability and for the development of new storage technologies in order to increase fruit shelf life. Approaches focused on molecular biology, such as RT-qPCR have been used to better understand the mechanisms involved in fruit development and maturation. In this study the use of RT-qPCR to monitoring apple quality during ripening and development in different postharvest conditions such as room temperature, cold storage with or without control of atmosphere and the 1-methylcyclopropene usage were proposed. The potential of genes involved in ethylene biosynthesis and response, cell wall modification and degradation, sugar and aroma metabolisms for employment as biomarkers of fruit development and quality were evaluated. Thus MdEXP4 is highlighted as biomarker for development and MdACO1, MdPG1, MdAF1, MdAF3 and MdAAT2 as potential biomarkers for ripening. MdACO1 and MdPG1 appear as suitable markers for quality, conservation technologies and storage time in apples. This work suggests that the study of gene expression by RT-qPCR may be an alternative for a better fruit characterization during the development and postharvest period. Keywords: Cold storage, gene expression, Malus x domestica, molecular analysi

Impact of stable angina on health status and quality of life perception of currently treated patients. The BRIDGE 2 survey.

OBJECTIVE: to explore 1) the perception of stable angina (SA) - impact on quality of life (QoL) and current condition related to SA; 2) SA burden - symptoms and frequency of anginal episodes; 3) impairment attributable to SA - limitations in daily activities and impact on work; 4) characteristics that might affect the patients' perception." METHOD: a proprietary questionnaire was administered on-line to SA patients selected using a purpose-built screening program from general population panels collaborating with IQVIA in Italy, Germany, Spain, and the UK. Exploratory analyses were performed: descriptive statistics on the total sample and different stratifications (gender, age class, time since diagnosis) were provided; we used Chi-square tests to compare subgroups. RESULTS: of more than 25,000 subjects who accessed the survey, 268 were eligible and completed the questionnaire: mean age was 61 years and women accounted for 30%. Despite being treated, about 40% of patients reported that SA impacted "completely" or "very much" their QoL, 10% rated their condition as "not good", and 45.1% stated that they felt "Fair". The majority of patients were still symptomatic and many of them perceived that SA had a major impact on their working life. Women, younger patients and those with a more recent diagnosis reported a worse self-assessment of their condition, QoL and symptom burden. CONCLUSIONS: the results of our survey provide new insights on how patients with SA perceived their own health status and suggest that any patient with SA deserves a more detailed and accurate evaluation by their physicians

Undamped electrostatic plasma waves

Electrostatic waves in a collision-free unmagnetized plasma of electrons with fixed ions are investigated for electron equilibrium velocity distribution functions that deviate slightly from Maxwellian. Of interest are undamped waves that are the small amplitude limit of nonlinear excitations, such as electron acoustic waves (EAWs). A deviation consisting of a small plateau, a region with zero velocity derivative over a width that is a very small fraction of the electron thermal speed, is shown to give rise to new undamped modes, which here are named {\it corner modes}. The presence of the plateau turns off Landau damping and allows oscillations with phase speeds within the plateau. These undamped waves are obtained in a wide region of the $(k,\omega_{_R})$ plane ($\omega_{_R}$ being the real part of the wave frequency and $k$ the wavenumber), away from the well-known `thumb curve' for Langmuir waves and EAWs based on the Maxwellian. Results of nonlinear Vlasov-Poisson simulations that corroborate the existence of these modes are described. It is also shown that deviations caused by fattening the tail of the distribution shift roots off of the thumb curve toward lower $k$-values and chopping the tail shifts them toward higher $k$-values. In addition, a rule of thumb is obtained for assessing how the existence of a plateau shifts roots off of the thumb curve. Suggestions are made for interpreting experimental observations of electrostatic waves, such as recent ones in nonneutral plasmas.Comment: 11 pages, 10 figure

All normal dispersion nonlinear fibre supercontinuum source characterization and application in hyperspectral stimulated Raman scattering microscopy

Hyperspectral stimulated Raman scattering (SRS) microscopy is a powerful label-free, chemical-specific technique for biomedical and mineralogical imaging. Usually, broad and rapid spectral scanning across Raman bands is required for species identification. In many implementations, however, the Raman spectral scan speed is limited by the need to tune source laser wavelengths. Alternatively, a broadband supercontinuum source can be considered. In SRS microscopy, however, source noise is critically important, precluding many spectral broadening schemes. Here we show that a supercontinuum light source based on all normal dispersion (ANDi) fibres provides a stable broadband output with very low incremental source noise. We characterized the noise power spectral density of the ANDi fibre output and demonstrated its use in hyperspectral SRS microscopy applications. This confirms the viability and ease of implementation of ANDi fibre sources tier broadband SRS imaging. (C) 2020 Optical Society of America under the terms of the OSA Open Access Publishing Agreemen