Wishes to die at the end of life and subjective experience of four different typical dying trajectories. A qualitative interview study

Research aims The motivations that lead to wishes to die (WTD) in palliative care patients with cancer are relatively well studied. But little is known about WTD in other pathologies and the relation between subjective understandings of dying trajectories and a WTD. We investigated the WTD of palliative patients in four different dying trajectories: neurological diseases, organ failure, frailty due to age, and cancer. Study population 62 palliative cancer (n = 30) and non-cancer (n = 32) patients (10 neurological disease; 11 organ failure; 11 frailty), their families and health professionals in different palliative care settings (248 interviews). Study design and methods Qualitative semi-structured interviews. Data analysis through Interpretive Phenomenological Analysis and Grounded Theory. Results In addition to personal motivations, we found that people dealing with similar trajectories were often confronted with similar questions and concerns due to similar challenges. For four trajectories we show typical patterns, similarities and differences that should be considered when talking with patients about their WTD. These illness-related considerations do not explain the WTD completely, but give important information on the challenges for particular patient groups that might experience a WTD. In all patient groups, there were clear moments that triggered a WTD: for neurological patients it was experiencing breathlessness, high-dependency care, or when considering tube feeding or respiratory support; for persons with organ failure it was an acute burdensome crisis; for patients with cancer after the initial diagnosis, it was the first relapse or the move into advanced palliative care; for elderly frail persons it was the move into care facilities, or the loss of important relationships or capabilities. The feeling of being a burden to others was reported in all patient groups. Interpretation WTD can be triggered within disease trajectories by specific conditions and transitional points that affect agency and self-understanding. A better understanding of the concerns and challenges of a particular dying trajectory as well as its characteristic trigger points can facilitate early and comprehensive communication about patients’ WTD, and the underlying motivations and protective factors

An empirically informed ethical discussion of how palliative care patients’ feelings of being a burden to others can motivate a wish to die. Moral challenges in clinics and families

The article explores the underlying reasons for patients’ self‐perception of being a burden (SPB) in family settings, including its impact on relationships when wishes to die (WTD) are expressed. In a prospective, interview‐based study of WTD in patients with advanced cancer and non‐cancer disease (organ failure, degenerative neurological disease, and frailty) SPB was an important emerging theme. In a sub‐analysis we examined (a) the facets of SPB, (b) correlations between SPB and WTD, and (c) SPB as a relational phenomenon. We analyzed 248 interviews with 62 patients, their family caregivers, and professionals using grounded theory and interpretive phenomenological analysis. SPB appeared as important empathic concern in care situations. Patients expressed many sorts of concerns for others, but also perceived an altered self‐understanding that did not meet mutual expectations within relationships. In SPB associated with WTD three constellations were found: (a) WTD to unburden others; (b) patients decided against hastening death to prevent being a further burden to others (in these cases, the SPB counteracted the wish to die); and (c) both wishes for and against dying were sustained by SPB. These patients often felt paralyzed and suffered deeply. Family caregivers felt emotionally touched by SPB and tried to unburden patients by caring and compassion. We concluded that the impact of SPB on a WTD and the various meanings the facets of SPB have in balancing relationships need to be worked out individually. An early palliative and narrative approach is warranted

Wishes to die at the end of life and subjective experience of four different typical dying trajectories. A qualitative interview study.

Research aimsThe motivations that lead to wishes to die (WTD) in palliative care patients with cancer are relatively well studied. But little is known about WTD in other pathologies and the relation between subjective understandings of dying trajectories and a WTD. We investigated the WTD of palliative patients in four different dying trajectories: neurological diseases, organ failure, frailty due to age, and cancer.Study population62 palliative cancer (n = 30) and non-cancer (n = 32) patients (10 neurological disease; 11 organ failure; 11 frailty), their families and health professionals in different palliative care settings (248 interviews).Study design and methodsQualitative semi-structured interviews. Data analysis through Interpretive Phenomenological Analysis and Grounded Theory.ResultsIn addition to personal motivations, we found that people dealing with similar trajectories were often confronted with similar questions and concerns due to similar challenges. For four trajectories we show typical patterns, similarities and differences that should be considered when talking with patients about their WTD. These illness-related considerations do not explain the WTD completely, but give important information on the challenges for particular patient groups that might experience a WTD. In all patient groups, there were clear moments that triggered a WTD: for neurological patients it was experiencing breathlessness, high-dependency care, or when considering tube feeding or respiratory support; for persons with organ failure it was an acute burdensome crisis; for patients with cancer after the initial diagnosis, it was the first relapse or the move into advanced palliative care; for elderly frail persons it was the move into care facilities, or the loss of important relationships or capabilities. The feeling of being a burden to others was reported in all patient groups.InterpretationWTD can be triggered within disease trajectories by specific conditions and transitional points that affect agency and self-understanding. A better understanding of the concerns and challenges of a particular dying trajectory as well as its characteristic trigger points can facilitate early and comprehensive communication about patients' WTD, and the underlying motivations and protective factors

Photoprogrammable organic light-emitting diodes

Enlightening the memory: The integration of a crosslinkable photochromic dithienylperfluorocyclopentene (DTE) into organic light-emitting diodes (OLED) allows for the individualization of the emissive area of the OLED device, for example, for signage applications. The operation principle is based on switching the injection barrier for holes (positive charge carriers). Very large ON/OFF ratios of up to 3000 for current as well as electroluminescence have been achieved

Highly color-stable solution-processed multilayer WOLEDs for lighting application

White organic and especially polymeric light emitting devices (WPLEDs) have received particular attention due to their potential to provide cost-effective and simply manufactured solid-state light sources. The largest acceptable variation of Commission Internationale de L'Eclairage (CIE) coordinates is typically specified as Δx,y < 0.01 for general illumination purposes and even down to Δx,y < 0.005 by the automotive industry. Over the last few years great progress has been made regarding color-stability of OLEDs. In the first publications large color shifts of about Δx,y = 0.2,0.1 were reported. Current publications present devices with CIE variations as small as Δx,y = 0.02,0.02 or better, even for polymeric OLEDs. Here, we present a highly color-stable white fluorescent multilayer OLED consisting of a two-layer (yellow EML/blue EML) stack. The devices show white emission with CIE values of 0.324,0.346. Because of their extremely well-balanced electron and hole distribution, these devices show nearly no change in their CIE values (± 0.009,0.006) between 100 and 10 000 nits. Brightness in that range can be obtained at low voltages (4–8 V), at the same time providing a high efficiency of 6 cd A−1. In addition, due to the broad spectral width of the emission the devices exhibit a color rendering index of 84. This value complies favourably with actual demands for ambient lighting. The extrapolated half-brightness lifetime at an initial brightness of 100 cd m−2 exceeds 1000 h. All systems include the crosslinking of each layer either photo-chemically or thermally to enable the solution-processed complex multilayer OLED-structures

Highly color-stable solution-processed multilayer WOLEDs for lighting application

White organic and especially polymeric light emitting devices (WPLEDs) have received particular attention due to their potential to provide cost-effective and simply manufactured solid-state light sources. The largest acceptable variation of Commission Internationale de L'Eclairage (CIE) coordinates is typically specified as Δx,y < 0.01 for general illumination purposes and even down to Δx,y < 0.005 by the automotive industry. Over the last few years great progress has been made regarding color-stability of OLEDs. In the first publications large color shifts of about Δx,y = 0.2,0.1 were reported. Current publications present devices with CIE variations as small as Δx,y = 0.02,0.02 or better, even for polymeric OLEDs. Here, we present a highly color-stable white fluorescent multilayer OLED consisting of a two-layer (yellow EML/blue EML) stack. The devices show white emission with CIE values of 0.324,0.346. Because of their extremely well-balanced electron and hole distribution, these devices show nearly no change in their CIE values (± 0.009,0.006) between 100 and 10 000 nits. Brightness in that range can be obtained at low voltages (4–8 V), at the same time providing a high efficiency of 6 cd A−1. In addition, due to the broad spectral width of the emission the devices exhibit a color rendering index of 84. This value complies favourably with actual demands for ambient lighting. The extrapolated half-brightness lifetime at an initial brightness of 100 cd m−2 exceeds 1000 h. All systems include the crosslinking of each layer either photo-chemically or thermally to enable the solution-processed complex multilayer OLED-structures

Advanced device architecture for highly efficient organic light-emitting diodes with an orange-emitting crosslinkable iridium(III) complex

No abstract

POU Homeodomain Protein Oct-1 Functions as a Sensor for Cyclic AMP*

Cyclic AMP is a fundamentally important second messenger for numerous peptide hormones and neurotransmitters that control gene expression, cell proliferation, and metabolic homeostasis. Here we show that cAMP works with the POU homeodomain protein Oct-1 to regulate gene expression in pancreatic and intestinal endocrine cells. This ubiquitously expressed transcription factor is known as a stress sensor. We found that it also functions as a repressor of Cdx-2, a proglucagon gene activator. Through a mechanism that involves the activation of exchange protein activated by cyclic AMP, elevation of cAMP leads to enhanced phosphorylation and nuclear exclusion of Oct-1 and reduced interactions between Oct-1 or nuclear co-repressors and the Cdx-2 gene promoter, detected by chromatin immunoprecipitation. In rat primary pancreatic islet cells, cAMP elevation also reduces nuclear Oct-1 content, which causes increased proglucagon and proinsulin mRNA expression. Our study therefore identifies a novel mechanism by which cAMP regulates hormone-gene expression and suggests that ubiquitously expressed Oct-1 may play a role in metabolic homeostasis by functioning as a sensor for cAMP