Continuous sedation until death: moral justifications of physicians and nurses─a content analysis of opinion pieces

pre-printContinuous Sedation until Death (CSD), the act of reducing or removing the consciousness of an incurably ill patient until death, often provokes medical-ethical discussions in the opinion sections of medical and nursing journals. A content analysis of opinion pieces in medical and nursing literature was conducted to examine how clinicians define and describe CSD, and how they justify this practice morally. Most publications were written by physicians and published in palliative or general medicine journals. Terminal Sedation and Palliative Sedation are the most frequently used terms to describe CSD. Seventeen definitions with varying content were identified. Continuous Sedation until Death was found to be morally justified in 73% of the publications using justifications such as Last Resort, Doctrine of Double Effect, Sanctity of Life, Autonomy, and Proportionality. The debate over CSD in the opinion sections of medical and nursing journals lacks uniform terms and definitions, and is profoundly marked by ‘charged language', aiming at realizing agreement in attitude towards CSD. Not all of the moral justifications found are equally straightforward. To enable a more effective debate, the terms, definitions and justifications for CSD need to be further clarified

Electrochemical reduction of indigo in fixed and fluidized beds of graphite granules

Reducing agents required in the dyeing process for vat and sulfur dyes cannot be recycled and lead to problematic waste products. The electrochemical reduction of indigo on a fixed bed cathode consisting of graphite granules has been investigated by spectrophotometric experiments in laboratory cells. Experiments yield information about the kinetics and show the possibility of this process for production of water soluble leuco indigo, which offers environmental benefits. The influence of noble metals deposited on the granules and of different pretreatment methods of the graphite is demonstrated. In addition, the immobilization of quinoid molecules on the graphite surface has been investigate

Direct electrochemical reduction of indigo: process optimization and scale-up in a flow cell

Reducing agents required in the dyeing process for vat and sulfur dyes cannot be recycled, and lead to problematic waste products. Therefore, modern economical and ecological requirements are not fulfilled. The industrial feasibility of the direct electrochemical reduction of indigo as a novel method has been determined and a preliminary optimization of electrolytic conditions was performed using a laboratory-scale flow-cell system. The role of current density, pH, temperature and the rate of mass transport are discussed. The influence of particle size reduction by the application of ultrasound is critically considere

Gradient-limited surfaces

A simple scenario of the formation of geological landscapes is suggested and the respective lattice model is derived. Numerical analysis shows that the arising non-Gaussian surfaces are characterized by the scale-dependent Hurst exponent, which varies from 0.7 to 1, in agreement with experimental data.Comment: 4 pages, 5 figure

Stellar Kinematics and Structural Properties of Virgo Cluster Dwarf Early-Type Galaxies from the SMAKCED Project. I. Kinematically Decoupled Cores and Implications for Infallen Groups in Clusters

We present evidence for kinematically decoupled cores (KDCs) in two dwarf early-type (dE) galaxies in the Virgo cluster, VCC 1183 and VCC 1453, studied as part of the SMAKCED stellar absorption-line spectroscopy and imaging survey. These KDCs have radii of 1.8'' (0.14 kpc) and 4.2'' (0.33 kpc), respectively. Each of these KDCs is distinct from the main body of its host galaxy in two ways: (1) inverted sense of rotation; and (2) younger (and possibly more metal-rich) stellar population. The observed stellar population differences are probably associated with the KDC, although we cannot rule out the possibility of intrinsic radial gradients in the host galaxy. We describe a statistical analysis method to detect, quantify the significance of, and characterize KDCs in long-slit rotation curve data. We apply this method to the two dE galaxies presented in this paper and to five other dEs for which KDCs have been reported in the literature. Among these seven dEs, there are four significant KDC detections, two marginal KDC detections, and one dE with an unusual central kinematic anomaly that may be an asymmetric KDC.The frequency of occurence of KDCs and their properties provide important constraints on the formation history of their host galaxies. We discuss different formation scenarios for these KDCs in cluster environments and find that dwarf-dwarf wet mergers or gas accretion can explain the properties of these KDCs. Both of these mechanisms require that the progenitor had a close companion with a low relative velocity. This suggests that KDCs were formed in galaxy pairs residing in a poor group environment or in isolation whose subsequent infall into the cluster quenched star formation.Comment: 14 pages, accepted for publication in Ap

An Automated Coronary Artery Occlusion Device for Stimulating Collateral Development in Vivo

Introduction: Repetitive, brief coronary artery occlusions produce collateral development in experimental animals. This model causes coronary collateralization in a highly reproducible fashion, but the process is very labor intensive. We report the design and use of a fully automated hydraulic coronary occlusion device capable of producing repetitive coronary occlusions and enhancement of coronary collateral development in dogs. Methods: The device consists of analog electronics that allow adjustment of occlusion number, frequency, pressure and duration, and mechanical components responsible for the coronary occlusion. The motor and piston of the device are coupled to a chronically implanted hydraulic vascular occluder placed around the left anterior descending coronary artery (LAD) of dogs instrumented for measurement of systemic and coronary hemodynamics. One group of dogs (n=6) underwent brief (2 min) LAD occlusions once per hour, eight times per day, 5 days/week for 3 weeks to stimulate collateral development (measured using radioactive microspheres). Another group of dogs (n=6) that did not receive repetitive occlusions served as controls. Results: The device reproducibly produced repetitive LAD occlusions for the duration, frequency, and time interval initially programmed. A time-dependent increase in transmural collateral blood flow was observed in dogs undergoing repetitive occlusions using the device. Collateral blood flow was unchanged in dogs that did not undergo occlusions. Discussion: The automated occluder device reliably produces repetitive coronary occlusions and may facilitate further study of coronary collateral development in response to chronic myocardial ischemia