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)

Is demagnetization an efficient optimization method?

Demagnetization, commonly employed to study ferromagnets, has been proposed as the basis for an optimization tool, a method to find the ground state of a disordered system. Here we present a detailed comparison between the ground state and the demagnetized state in the random field Ising model, combing exact results in $d=1$ and numerical solutions in $d=3$. We show that there are important differences between the two states that persist in the thermodynamic limit and thus conclude that AC demagnetization is not an efficient optimization method.Comment: 2 pages, 1 figur

Adhesion-induced phase separation of multiple species of membrane junctions

A theory is presented for the membrane junction separation induced by the adhesion between two biomimetic membranes that contain two different types of anchored junctions (receptor/ligand complexes). The analysis shows that several mechanisms contribute to the membrane junction separation. These mechanisms include (i) the height difference between type-1 and type-2 junctions is the main factor which drives the junction separation, (ii) when type-1 and type-2 junctions have different rigidities against stretch and compression, the ``softer'' junctions are the ``favored'' species, and the aggregation of the softer junction can occur, (iii) the elasticity of the membranes mediates a non-local interaction between the junctions, (iv) the thermally activated shape fluctuations of the membranes also contribute to the junction separation by inducing another non-local interaction between the junctions and renormalizing the binding energy of the junctions. The combined effect of these mechanisms is that when junction separation occurs, the system separates into two domains with different relative and total junction densities.Comment: 23 pages, 6 figure

Phase diagram of the random field Ising model on the Bethe lattice

The phase diagram of the random field Ising model on the Bethe lattice with a symmetric dichotomous random field is closely investigated with respect to the transition between the ferromagnetic and paramagnetic regime. Refining arguments of Bleher, Ruiz and Zagrebnov [J. Stat. Phys. 93, 33 (1998)] an exact upper bound for the existence of a unique paramagnetic phase is found which considerably improves the earlier results. Several numerical estimates of transition lines between a ferromagnetic and a paramagnetic regime are presented. The obtained results do not coincide with a lower bound for the onset of ferromagnetism proposed by Bruinsma [Phys. Rev. B 30, 289 (1984)]. If the latter one proves correct this would hint to a region of coexistence of stable ferromagnetic phases and a stable paramagnetic phase.Comment: Article has been condensed and reorganized; Figs 3,5,6 merged; Fig 4 omitted; Some discussion added at end of Sec. III; 9 pages, 5 figs, RevTeX4, AMSTe

In situ observations of waves in Venus’s polar lower thermosphere with Venus Express aerobraking

Waves are ubiquitous phenomena found in oceans and atmospheres alike. From the earliest formal studies of waves in the Earth’s atmosphere to more recent studies on other planets, waves have been shown to play a key role in shaping atmospheric bulk structure, dynamics and variability1, 2, 3, 4. Yet, waves are difficult to characterize as they ideally require in situ measurements of atmospheric properties that are difficult to obtain away from Earth. Thus, we have incomplete knowledge of atmospheric waves on planets other than our own, and we are thereby limited in our ability to understand and predict planetary atmospheres. Here we report the first ever in situ observations of atmospheric waves in Venus’s thermosphere (130–140 km) at high latitudes (71.5°–79.0°). These measurements were made by the Venus Express Atmospheric Drag Experiment (VExADE)5 during aerobraking from 24 June to 11 July 2014. As the spacecraft flew through Venus’s atmosphere, deceleration by atmospheric drag was sufficient to obtain from accelerometer readings a total of 18 vertical density profiles. We infer an average temperature of T = 114 ± 23 K and find horizontal wave-like density perturbations and mean temperatures being modulated at a quasi-5-day period

Elasticity Theory and Shape Transitions of Viral Shells

Recently, continuum elasticity theory has been applied to explain the shape transition of icosahedral viral capsids - single-protein-thick crystalline shells - from spherical to buckled/faceted as their radius increases through a critical value determined by the competition between stretching and bending energies of a closed 2D elastic network. In the present work we generalize this approach to capsids with non-icosahedral symmetries, e.g., spherocylindrical and conical shells. One key new physical ingredient is the role played by nonzero spontaneous curvature. Another is associated with the special way in which the energy of the twelve topologically-required five-fold sites depends on the background local curvature of the shell in which they are embedded. Systematic evaluation of these contributions leads to a shape phase diagram in which transitions are observed from icosahedral to spherocylindrical capsids as a function of the ratio of stretching to bending energies and of the spontaneous curvature of the 2D protein network. We find that the transition from icosahedral to spherocylindrical symmetry is continuous or weakly first-order near the onset of buckling, leading to extensive shape degeneracy. These results are discussed in the context of experimentally observed variations in the shapes of a variety of viral capsids.Comment: 53 pages, 17 figure

Organized condensation of worm-like chains

We present results relevant to the equilibrium organization of DNA strands of arbitrary length interacting with a spherical organizing center, suggestive of DNA-histone complexation in nucleosomes. We obtain a rich phase diagram in which a wrapping state is transformed into a complex multi-leafed, rosette structure as the adhesion energy is reduced. The statistical mechanics of the "melting" of a rosette can be mapped into an exactly soluble one-dimensional many-body problem.Comment: 15 pages, 2 figures in a pdf fil

Effects of mechanical strain on thermal denaturation of DNA

As sections of a strand duplexed DNA denature when exposed to high temperature, the excess linking number is taken up by the undenatured portions of the molecule. The mechanical energy that arises because of the overwinding of the undenatured sections can, in principle, alter the nature of the thermal denaturation process. Assuming that the strains associated with this overwinding are not relieved, we find that a simple model of strain-altered melting leads to a suppression of the melting transition when the unaltered transition is continuous. When the melting transition is first order in the absence of strain associated with overwinding, the modification is to a third order phase transition.Comment: 4 pages, 5 figures, RevTe