The Right to Conscience vs. The Right to Die: Physician-Assisted Suicide, Catholic Hospitals, and the Rising Threat to Institutional Free Exercise in Healthcare

An imminent conflict is developing between religious healthcare institutions opposed to physician-assisted death (PAD) and their healthcare employees who wish to offer PAD to their patients. When these interests clash, institutional conscience claims must prevail over doctors’ desires and patients’ demands. This article catalogues the incomplete patchwork of conscience protections guaranteed to American healthcare workers and institutions, as well as the swiftly accelerating wave of PAD legalization sweeping the states. The article documents the tactical vocabulary—deployed with nearly identical language in every state PAD statute—that conspicuously anticipates con-science objections from the massive, and staunchly anti-PAD, Catholic healthcare system. Notably, in each state with legalized PAD, if a healthcare employee wishes to administer PAD to a patient, statutory loop-holes render employing hospitals powerless to object on the basis of institutional conscience. Finally, the article proposes a solution to this free exercise threat. In Hosanna-Tabor and Our Lady of Guadalupe, the Supreme Court recognized that religious institutions have a First Amendment right to hire and fire employees who personify their beliefs, free from government interference. The Court has expressly declined to limit the scope of this right, but it has strongly indicated that the proper approach requires deference to the religious institution itself to define which employees personify its beliefs. Be-cause healthcare workers personify the central Catholic mission of healing the sick, Catholic hospitals must be permitted to employ only healthcare employees willing to honor the Church’s sincere beliefs about certain medical practices, such as PAD, that violate Catholic institutional conscience

ACTIVITY SYSTEMS AND LIVELIHOODS IN EASTERN CAPE PROVINCE RURAL AREAS (TRANSKEI): HOUSEHOLD TYPOLOGIES AS SOCIO-ECONOMIC CONTRIBUTIONS TO A LANDCARE PROJECT

Consumer/Household Economics,

Feed Efficiency in Growing Steers: Relationships between Efficiency and Carcass Ultrasound Traits

Phenotypic correlations between feed efficiency and carcass traits were examined in growing steers. Two feed efficiency trials were conducted using 233 Santa Gertrudis steers. Steers were individually fed a roughage-based for 77days. Individual feed intake was recorded weekly and body weight was measured bi-weekly. Ultrasound measurements of the 12th rib fat thickness (back fat), longissimus muscle area (REA) and percentage intramuscular fat were obtained on day 0 and 77, Residual feed intake (RFIp) is a measure of feed efficiency that attempts to measure variation in feed intake beyond that needed for growth and maintenance. Residual feed intake was calculated as the difference between actual feed intake and expected feed intake predicted by a linear regression model of dry matter intake (DMI) on mid-test BW0.75 (MBW) and average daily gain (ADG) with trial, trial × MBW, and trial × ADG as random effects. Steers were ranked by RFI into low, medium, and high RFI groups \u3c0.5 SD, ± 0.5, \u3e 0.5 SD, respectively, from the mean RFIp of 0.0 ± 1.01 kg/d. Overall means for ADG and DMI were 0.38 (SD = 0.57) and 9.79 (SD = 1.03), respectively. Stepwise regression indicated that inclusion of gain in back fat (GBF) into the base model increased the r2 (0.29 vs. 31). RFIp was positively correlated (P \u3c 0.5) with DMI (r = 0.85), and FCR (r = 0.47), but not with MBW or ADG. Feed to gain ratio (FCR) was negatively correlated (P \u3c 0.05) with ADG (r = -0.82). Carcass adjusted for RFI (RFIc) was not correlated with ADG, DMI, MBW, or FCR. Carcass ultrasound traits were not correlated (P \u3e 0.05) with feed efficiency traits. Gain in back fat was positively correlated with (P \u3c 0.05) with RFIp (r = 0.17), but not correlated (P \u3e 0.05) with FCR or RFIc. Gain in REA was negatively correlated (P \u3c 0.05) with FCR (r = -0.21) and RFIc (r = -0.17), but not with RFIp. The Spearman rank correlation between RFIp and RFIc was high (r = 0.91). Results suggest that RFI is independent of growth rate and mature size, but related to DMI. Selecting for favorable RFIp phenotypes can potentially improve feed efficiency in cattle. Adjusting RFI for ultrasound carcass traits could also improve feed efficiency independent of growth, body size, and carcass composition

Poly(2-propylacrylic acid)/poly(lactic-co-glycolic acid) blend microparticles as a targeted antigen delivery system to direct either CD4+ or CD8+ T cell activation.

Poly(lactic-co-glycolic acid) (PLGA) based microparticles (MPs) are widely investigated for their ability to load a range of molecules with high efficiency, including antigenic proteins, and release them in a controlled manner. Micron-sized PLGA MPs are readily phagocytosed by antigen presenting cells, and localized to endosomes. Due to low pH and digestive enzymes, encapsulated protein cargo is largely degraded and processed in endosomes for MHC-II loading and presentation to CD4+ T cells, with very little antigen delivered into the cytosol, limiting MHC-I antigenic loading and presentation to CD8+ T cells. In this work, PLGA was blended with poly(2-propylacrylic acid) (PPAA), a membrane destabilizing polymer, in order to incorporate an endosomal escape strategy into PLGA MPs as an easily fabricated platform with diverse loading capabilities, as a means to enable antigen presentation to CD8+ T cells. Ovalbumin (OVA)-loaded MPs were fabricated using a water-in-oil double emulsion with a 0% (PLGA only), 3 and 10% PPAA composition. MPs were subsequently determined to have an average diameter of 1 µm, with high loading and a release profile characteristic of PLGA. Bone marrow derived dendritic cells (DCs) were then incubated with MPs in order to evaluate localization, processing, and presentation of ovalbumin. Endosomal escape of OVA was observed only in DC groups treated with PPAA/PLGA blends, which promoted high levels of activation of CD8+ OVA-specific OT-I T cells, compared to DCs treated with OVA-loaded PLGA MPs which were unable activate CD8+ T cells. In contrast, DCs treated with OVA-loaded PLGA MPs promoted OVA-specific OT-II CD4+ T cell activation, whereas PPAA incorporation into the MP blend did not permit CD4+ T cell activation. These studies demonstrate PLGA MP blends containing PPAA are able to provide an endosomal escape strategy for encapsulated protein antigen, enabling the targeted delivery of antigen for tunable presentation and activation of either CD4+ or CD8+ T cells

The impact of human-centric public transport design principles on the desirability and operational success of public transport in the Gauteng province

Papers presented virtually at the 41st International Southern African Transport Conference on 10-13 July 2023.Commuters in South Africa rely on a variety of public transport (PT) modes every day to access various social and economic opportunities like the workplace, academic institutions, and healthcare. However, captive, reliant commuters are disappointed on countless occasions by unsafe, unreliable transport services and feel transport authorities and modal operators remain indifferent towards their needs and complaints, as solutions being implemented fail to address the actual problems needing attention and commuters are not consulted during PT service design. There exists a need to permanently close this negative cycle by ethically providing for the travel demands of captive lower-income commuters and establish a transport culture based in making human needs the centre of design thinking. This research paper describes an investigation into whether the inclusion of human-centric design (HCD) in the service- and operational design of PT in the Gauteng Province (GP) of South Africa, would establish a customer-orientated transport culture, and whether more human-centric transport service provision would appeal to commuters and address their specific travel needs and desires. This includes investigating how the priorities of transport institutions can be aligned with the core needs and desires of the commuters they serve, so a harmonious yet practical relationship can be cultivated between these stakeholders. Devised from primary research and global literature findings, the study tested five principles that combine principles of HCD and PT that were validated by a sample of 300 Gauteng commuters. The findings show that for PT services to be supported, successful and harmonised in Gauteng, the following is necessary: authentic, collaborative stakeholder consultation between leaders, designers and commuters; integrated PT control centres; practical empathy for commuters; centralising human needs, desires, and feedback in the PT design process, and enhancing a commuter’s perception and perceived value of a PT service. These principles can be used in the PT design process to promote elevated customer satisfaction, desirability to use PT and, in turn, the operational success of Gauteng’s PT services

Effects of urodilatin on natriuresis in cirrhosis patients with sodium retention

BACKGROUND: Sodium retention and ascites are serious clinical problems in cirrhosis. Urodilatin (URO) is a peptide with paracrine effects in decreasing sodium reabsorption in the distal nephron. Our aim was to investigate the renal potency of synthetic URO on urine sodium excretion in cirrhosis patients with sodium retention and ascites. METHODS: Seven cirrhosis patients with diuretics-resistant sodium retention received a short-term (90 min) infusion of URO in a single-blind, placebo-controlled cross-over study. In the basal state after rehydration the patients had urine sodium excretion < 50 mmol/24 h. RESULTS: URO transiently increased urine sodium excretion from 22 ± 16 μmol/min (mean ± SD) to 78 ± 41 μmol/min (P < 0.05) and there was no effect of placebo (29 ± 14 to 44 ± 32). The increase of URO's second messenger after the receptor, cGMP, was normal. URO had no effect on urine flow or on blood pressure. Most of the patients had highly elevated plasma levels of renin, angiotensin II and aldosterone and URO did not change these. CONCLUSION: The short-term low-dose URO infusion increased the sodium excretion of the patients. The increase was small but systematic and potentially clinically important for such patients. The small response contrasts the preserved responsiveness of the URO receptors. The markedly activated systemic pressor hormones in cirrhosis evidently antagonized the local tubular effects of URO

Discussion of "Accelerated motion of a spherical particle"

In considering the accelerated motion of spheres in a viscous fluid, the author has restricted himself to consideration of only simple harmonic motions of the fluid field and the sphere. The author's equation of motion (Eq. 11) for a suspended sphere is true only when the solution yields a relative displacement (x- a) which is sinusoidal in time. Otherwise, the apparent mass factor k, and the damping coefficient A have no meaning, because they are both based on the Stokes solution for an oscillating sphere given in LAMB (1945, see References at end of published paper, p. 721}. Both k and A are functions of the circular frequency ω as they are defined by (1), (2), and (3)