Continuous sedation until death: The everyday moral reasoning of physicians, nurses and family caregivers in the UK, The Netherlands and Belgium

Copyright © 2014 Raus et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Continuous sedation is increasingly used as a way to relieve symptoms at the end of life. Current research indicates that some physicians, nurses, and relatives involved in this practice experience emotional and/or moral distress. This study aims to provide insight into what may influence how professional and/or family carers cope with such distress. Methods - This study is an international qualitative interview study involving interviews with physicians, nurses, and relatives of deceased patients in the UK, The Netherlands and Belgium (the UNBIASED study) about a case of continuous sedation at the end of life they were recently involved in. All interviews were transcribed verbatim and analysed by staying close to the data using open coding. Next, codes were combined into larger themes and categories of codes resulting in a four point scheme that captured all of the data. Finally, our findings were compared with others and explored in relation to theories in ethics and sociology. Results - The participants’ responses can be captured as different dimensions of ‘closeness’, i.e. the degree to which one feels connected or ‘close’ to a certain decision or event. We distinguished four types of ‘closeness’, namely emotional, physical, decisional, and causal. Using these four dimensions of ‘closeness’ it became possible to describe how physicians, nurses, and relatives experience their involvement in cases of continuous sedation until death. More specifically, it shined a light on the everyday moral reasoning employed by care providers and relatives in the context of continuous sedation, and how this affected the emotional impact of being involved in sedation, as well as the perception of their own moral responsibility. Conclusion - Findings from this study demonstrate that various factors are reported to influence the degree of closeness to continuous sedation (and thus the extent to which carers feel morally responsible), and that some of these factors help care providers and relatives to distinguish continuous sedation from euthanasia.The Economic and Social Research Council (UK), the Research Foundation Flanders (BE), the Flemish Cancer Association (BE), the Research Council of Ghent University (BE), the Netherlands Organization for Scientific Research (NL) and the Netherlands Organization for Health Research and Development (NL)

The operational window of carbon nanotube electrical wires treated with strong acids and oxidants

Conventional metal wires suffer from a significant degradation or complete failure in their electrical performance, when subjected to harsh oxidizing environments, however wires constructed from Carbon Nanotubes (CNTs) have been found to actually improve in their electrical performance when subjected to these environments. These opposing reactions may provide new and interesting applications for CNT wires. Yet, before attempting to move to any real-world harsh environment applications, for the CNT wires, it is essential that this area of their operation be thoroughly examined. To investigate this, CNT wires were treated with multiple combinations of the strongest acids and halogens. The wires were then subjected to conductivity measurements, current carrying capacity tests, as well as Raman, microscopy and thermogravimetric analysis to enable the identification of both the limits of oxidative conductivity boosting and the onset of physical damage to the wires. These experiments have led to two main conclusions. Firstly, that CNT wires may operate effectively in harsh oxidizing environments where metal wires would easily fail and secondly, that the highest conductivity increase of the CNT wires can be achieved through a process of annealing, acetone and HCl purification followed by either H2O2 and HClO4 or Br2 treatment

Purification of nucleocapsid protein of Newcastle Disease virus for immunodiagnostic kit

The aim of the present study is to purify recombinant nucleocapsid (NP) protein of Newcastle disease virus (NDV) using microfitration fitration system and improve the processing conditions as well. A microporous membrane screening using two different sizes of membrane which are 0.1µm and 0.45µm was performed before further improvement on NP protein filtration was carried out. Several conditions of the independent variables that affect the microfiltration process such as the temperature, transmembrane pressure (TMP), and viscosity were observed. It turned out to be that 0.45µm membrane gave higher yield of NP protein than that of 0.1µm membrane. Thus, 0.45µm membrane was used to improve the filtration process for NP protein. Based on the Full Factorial Design (STATISTICA 8.0, Statsoft, Inc.), eight sets of experiment were designed to identify the best conditions for the NP protein filtration. From these experiments, the optimal conditions that gave the highest yield of NP protein are; TMP 4.5psi, viscosity 2.39cP at 4ºC. Based on ANOVA (analysis of variance), all the independent variables studied do not significantly affect the purification of NP protein. However, based on the lowest p value for each variable corresponding to the response, temperature has the largest effect for the NP protein yield

The involvement of cancer patients in the four stages of decision-making preceding continuous sedation until death: A qualitative study

BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews. SETTING/PARTICIPANTS: Interviews with 26 physicians, 30 nurses and 24 relatives caring for 24 patients with cancer who received continuous sedation until death in Belgium, the United Kingdom and the Netherlands. RESULTS: We distinguished four stages of decision-making: initiation, information exchange, deliberation and the decision to start continuous sedation until death. There was wide variation in the role the patient had in the decision-making process. At one end of the spectrum (mostly in the United Kingdom), the physician discussed the possible use of sedation with the patient, but took the decision themselves. At the other end (mostly in Belgium and the Netherlands), the patient initiated the conversation and the physician's role was largely limited to evaluating if and when the medical criteria were met. CONCLUSION: Decision-making about continuous sedation until death goes through four stages and the involvement of the patient in the decision-making varies. Acknowledging the potential sensitivity of raising the issue of end-of-life sedation, we recommend building into clinical practice regular opportunities to discuss the goals and preferences of the person who is dying for their future medical treatment and care

Moral enhancement: do means matter morally?

One of the reasons why moral enhancement may be controversial, is because the advantages of moral enhancement may fall upon society rather than on those who are enhanced. If directed at individuals with certain counter-moral traits it may have direct societal benefits by lowering immoral behavior and increasing public safety, but it is not directly clear if this also benefits the individual in question. In this paper, we will discuss what we consider to be moral enhancement, how different means may be used to achieve it and whether the means we employ to reach moral enhancement matter morally. Are certain means to achieve moral enhancement wrong in themselves? Are certain means to achieve moral enhancement better than others, and if so, why? More specifically, we will investigate whether the difference between direct and indirect moral enhancement matters morally. Is it the case that indirect means are morally preferable to direct means of moral enhancement and can we indeed pinpoint relevant intrinsic, moral differences between both? We argue that the distinction between direct and indirect means is indeed morally relevant, but only insofar as it tracks an underlying distinction between active and passive interventions. Although passive interventions can be ethical provided specific safeguards are put in place, these interventions exhibit a greater potential to compromise autonomy and disrupt identity

The Effect of Square Finned Conformal Cooling (SFCC) on Cycle Time for Plastic Injection Moulding / K. Kamarudin ...[et al.]

Cooling system is a significant factor in productivity and quality in the plastic injection moulding process. Numerous researchers demonstrated that conformal cooling channel yields significant improvement of productivity and quality of plastic injection moulding process. Apart from that, the advancement of Solid Free Form Technology (SFF) allows a mould designer to design a variety of conformal cooling channel geometry rather than conventional designs. This paper presents the research work to enhance the efficiency of square shaped groove conformal cooling channels which uses fins concept. Existing conformal cooling channel design that uses square shape groove was improved by incorporating fins to meet the best design that can reduce the cooling time. The effect of Square Finned Conformal Cooling (SFCC) design on cooling time was investigated by using Autodesk Moldflow Insight software. The simulation results indicated that different number of fins influences the cooling time. From the analysis, it was found that time to reach the ejection temperature was reduced by 19.4% for the cooling channels with 4 fins compared to existing cooling channel

Euro plus Med-Checklist Notulae, 11

This is the eleventh of a series of miscellaneous contributions, by various authors, where hitherto unpublished data relevant to both the Med-Checklist and the Euro+Med (or Sisyphus) projects are presented. This instalment deals with the families Anacardiaceae, Asparagaceae (incl. Hyacinthaceae), Bignoniaceae, Cactaceae, Compositae, Cruciferae, Cyperaceae, Ericaceae, Gramineae, Labiatae, Leguminosae, Orobanchaceae, Polygonaceae, Rosaceae, Solanaceae and Staphyleaceae. It includes new country and area records and taxonomic and distributional considerations for taxa in Bidens, Campsis, Centaurea, Cyperus, Drymocallis, Engem, Hoffmannseggia, Hypopitys, Lavandula, Lithraea, Melilotus, Nicotiana, Olimarabidopsis, Opuntia, Orobanche, Phelipanche, Phragmites, Rumex, Salvia, Schinus, Staphylea, and a new combination in Drimia.Peer reviewe

Effect Of Incubation Temperature On Ikta’s Quail Breed With New Rolling Mechanism System / Mohd Badli Ramli...[et al.]

Successful of hatching rates in incubation quails IKTA(Institut Kemahiran Ternakan Ayam) may differ between each hatchery. There is numerous factor that influence embryonic development, among the parameter is temperature, humidity, air movement, eggs placement etc., This factor may lead to high percentage of embryo hatching and healthy DOQ (day one quail). Nine incubations were performed with 3 set of different temperature to examine the effect of different setting temperature. For eggs placement, eggs were turns using rolling mechanism 360° for every hour. Eggs obtained from local breeder with same age broiler flocks and stored for 1 to 4 days prior to intimate other commercial ideal condition. All in and all out system was used in all incubation set, eggs were place 40 piece in tray from day one until day 17. Overall it was determined that the best setting temperature is 37°c 14day then 38°c 3day that can produce average 89.17% hatching, average first hatch is in the end of day 15 complete hatch in 16 day. Temperature set 38°c 14day, then 39°c3day is 84.17%, average first hatch is day 15.5 end 16 day, not harmful compared to 39°c14day, then 40°c3day with 76.67% hatching with average first hatch is day 15.5 end 16 day. With increasing setting temperature, up to 39°c to 40°c still not successful as 37°c to 38°c, excessive temperature did not affect hatchability neither drastically speed up the hatching days, but can cause detrimental effect, embryonic mortality to eggs development. First hatch in the end of day 14, average in day 15, complete hatching in the end of day 16 , this is faster than other incubator in the market that average 17 day/ cycle. This new faster cycle cause by the consistent heat flow and humidity inside incubation chamber surrounding the eggs shell. In conclusion, ideal setting temperature 37°c 14day 38°c 3day is the best setting temperature to incubate IKTA species quails, with the efficiency of machine supply consistence temperature, humidity and eggs movement are the main parameter to ensure high hatching rates of IKTA quails

Euro+Med-Checklist Notulae, 14

Abstract: This is the fourteenth of a series of miscellaneous contributions, by various authors, where hitherto unpublished data relevant to both the Med-Checklist and the Euro+Med (or Sisyphus) projects are presented. This instalment deals with the families Apocynaceae, Compositae, Crassulaceae, Cyperaceae, Euphorbiaceae, Gramineae, Leguminosae, Nyctaginaceae, Onagraceae, Orobanchaceae, Rubiaceae, Solanaceae and Umbelliferae. It includes new country and area records and taxonomic and distributional considerations for taxa in Acalypha, Bupleurum, Carex, Datura, Epilobium, Eragrostis, Galium, Leontodon, Mirabilis, Nerium, Orobanche, Phelipanche, Rhinanthus, Saccharum, Sedum, Trifolium, Tripleurospermum and Willemetia. Citation For the whole article: Raab-Straube E. von & Raus Th. (ed.) 2021: Euro+Med-Checklist Notulae, 14.-Willdenowia 51: 355-369. For a single contribution (example): Bergmeier E. 2021: Leontodon longirostris (Finch & P. D. Sell) Talavera-Pp. 356-357 in: Raab-Straube E. von & Raus Th. (ed.), Euro+Med-Checklist Notulae, 14.-Willdenowia 51: 355-369. https://doi.org/10.3372/wi.51.51304 Version of record first published online on 30 November 2021 ahead of inclusion in December 2021 issue