Content of health status reports of people seeking assisted suicide: a qualitative analysis

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue

967-21 Long Term Results of Balloon Expandable Slotted-Tube Nitinol Stents in Canine Coronary Arteries

This study evaluated delivery performance, quantitative angiographic parameters, intravascular ultrasound appearance. long term patency and vascular histology of radio-opaque, slotted-tube nickel titanium (nitinoll stents permanently implanted in canine coronary arteries. Dogs were treated with aspirin for 1 month. Follow-up angiography and histology were performed at 0.5, 1, 3, and 6 months (number of vessels = 2, 4, 6, and 26, respectively).ResultsThirty-eight of 39 (97%) stents were successfully implanted in the mid LAD and LCX of 20 dogs. One stent, which was undersized, was successfully removed by thermal recovery. Tandem stents were placed in 2 dogs without difficulty. Intravascular ultrasound of 6 stents showed symmetrical expansion with good wall contact. Acute angiographic parameters:nominal stent size (mm)ANOVA p3.03.54.0number42212–inflation pressure (atm)5.5±056.1±1.45.9±1.60.47minimal diameter (mm)2.93±0.073.24±0.143.48±0.160.0003balloon to artery ratio1.23±0.031.25±0.101.25±0.080.65stent to artery ratio1.09±0.031.14±0.091.13±0.070.30percent recoil11.0±1.88.4±1.89.9±1.80.05At follow-up, all vessels and 9 of 9 stented sidebranches were patent. The mean percent stenosis at 3 to 6 months was –1.6±5.2 and the late loss was 0.2±0.3 mm. All struts were covered with neointima at 2 weeks. At 6 months the maximal neointimal thickness was 260±50 μm and was located adjacent to the struts. No thrombi and only occasional areas of granulation tissue with rare inflammatory cells were seen.ConclusionsA slotted tube nitinol stent has delivery performance characteristics and recoil similar to stainless steel slotted-tube stents. Nitinol stents endothelialize rapidly and intimal proliferation is insufficient to create a stenosis in this animal model. These data suggest that a slotted-tube, balloon expandable nitinol stent is sufficiently reliable and biocompatible to warrant clinical trials

Reasons why people in Switzerland seek assisted suicide : the view of patients and physicians

Background: Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. Methods: We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). Results: The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Conclusions: Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians

Validation of the Thai version of the family reported outcome measure (FROM-16)© to assess the impact of disease on the partner or family members of patients with cancer

© The Author(s). 2019Background: Cancer not only impairs a patient's physical and psychosocial functional behaviour, but also contributes to negative impact on family members' health related quality of life. Currently, there is an absence of a relevant tool in Thai with which to measure such impact. The aim of this study was to translate and validate the Family Reported Outcome Measure (FROM-16) in Thai cancer patients' family members. Methods: Thai version of FROM-16 was generated by interactive forward-backward translation process following standard guidelines. This was tested for psychometric properties including reliability and validity, namely content validity, concurrent validity, known group validity, internal consistency, exploratory and confirmatory factor analysis. Construct validity was examined by comparing the Thai FROM-16 version with the WHOQOL-BREF-THAI. Results: The internal consistency reliability was strong (Cronbach's alpha = 0.86). A Negative moderate correlation between the Thai FROM-16 and WHOQOL-BREF-THAI was observed (r = - 0.4545, p < 0.00), and known group validity was proved by a statistically significant higher score in family members with high burden of care and insufficient income. The factor analysis supported both 3-factor and 2-factor loading model with slight difference when compared with the original version. Conclusions: The Thai FROM-16 showed good reliability and validity in Thai family members of patients with cancer. A slight difference in factor analysis results compared to the original version could be due to cross-culture application.Peer reviewedFinal Published versio

Microseismic Monitoring of the Mounds Drill Cuttings Injection Tests

This paper describes the microseismic mapping of repeated injections of drill cuttings into two separate formations at a test site near Mounds, OK. Injections were performed in sandstone and shale formations at depths of 830 and 595 m, respectively. Typical injection disposal was simulated using multiple small-volume injections over a three-day period, with long shut-in periods interspersed between the injections. Microseismic monitoring was achieved using a 5-level array of wireline-run, triaxial- accelerometer receivers in a monitor well 76 m from the disposed well. Results of the mapped microseismic locations showed that the disposal domti W= generally aligns with the major horizontal stress with some variations in azimuth and that wide variations in height and length growth occurred with continued injections. These experiments show that the cuttings injection process cm be adequately monitored from a downhole, wireline-run receiver array, thus providing process control and environmental assurance

Crinine-type alkaloids from Hippeastrum aulicum and H. calyptratum

An ongoing search for alkaloids in the Amaryllidaceae species using GC MS resulted in the identification of two crinine-type alkaloids, aulicine (1) and 3-O-methyl-epimacowine, (2) from the indigenous Brazilian species Hippeastrum aulicum and Hippeastrum calyptratum, respectively. In addition, two alkaloids, 11-oxohaemanthamine (3) and 7-methoxy-O-methyllycorenine (4) were both isolated from H. aulicum. Furthermore, we provide here complete NMR spectroscopic data for the homolycorine analogues nerinine (5) and albomaculine (6). The absolute stereochemistry of the 5,10b-ethano bridge in the crinine variants was determined by circular dichroism and X-ray crystallographic analysis, thus presenting the first direct evidence for the presence of crinine-type alkaloids in the genus Hippeastrum

The structure of the hydrodynamic plasma flow near the heliopause stagnation point

The plasma flow in the vicinity of the heliopause stagnation point in the presence of the H atom flow is studied. The plasma at both sides of the heliopause is considered to be a single fluid. The back reaction of the plasma flow on the H atom flow is neglected, and the density, temperature and velocity of the H atom flow are taken to be constant. The solution describing the plasma flow is obtained in the form of power series expansions with respect to the radial distance from the symmetry axis. The main conclusion made on the basis of the obtained solution is that the heliopause is not the surface of discontinuity anymore. Rather, it is the surface separating the flows of the solar wind and interstellar medium with all plasma parameters continuous at this surface

Localized precipitation and runoff on Mars

We use the Mars Regional Atmospheric Modeling System (MRAMS) to simulate lake storms on Mars, finding that intense localized precipitation will occur for lake size >=10^3 km^2. Mars has a low-density atmosphere, so deep convection can be triggered by small amounts of latent heat release. In our reference simulation, the buoyant plume lifts vapor above condensation level, forming a 20km-high optically-thick cloud. Ice grains grow to 200 microns radius and fall near (or in) the lake at mean rates up to 1.5 mm/hr water equivalent (maximum rates up to 6 mm/hr water equivalent). Because atmospheric temperatures outside the surface layer are always well below 273K, supersaturation and condensation begin at low altitudes above lakes on Mars. In contrast to Earth lake-effect storms, lake storms on Mars involve continuous precipitation, and their vertical velocities and plume heights exceed those of tropical thunderstorms on Earth. Convection does not reach above the planetary boundary layer for lakes O(10^2) mbar. Instead, vapor is advected downwind with little cloud formation. Precipitation occurs as snow, and the daytime radiative forcing at the land surface due to plume vapor and storm clouds is too small to melt snow directly (<+10 W/m^2). However, if orbital conditions are favorable, then the snow may be seasonally unstable to melting and produce runoff to form channels. We calculate the probability of melting by running thermal models over all possible orbital conditions and weighting their outcomes by probabilities given by Laskar et al., 2004. We determine that for an equatorial vapor source, sunlight 15% fainter than at present, and snowpack with albedo 0.28 (0.35), melting may occur with 4%(0.1%) probability. This rises to 56%(12%) if the ancient greenhouse effect was modestly (6K) greater than today.Comment: Submitted to JGR Planet

On the residual opening of hydraulic fractures

Hydraulic stimulation technologies are widely applied across resource and power generation industries to increase the productivity of oil/gas or hot water reservoirs. These technologies utilise pressurised water, which is applied inside the well to initiate and drive fractures as well as to open a network of existing natural fractures. To prevent the opened fractures from complete closure during production stage, small particles (proppants) are normally injected with the pressurised fluid. These particles are subjected to confining stresses when the fluid pressure is removed, which leads to a partial closure of the stimulated fractures. The residual fracture openings are the main outcome of such hydraulic stimulations as these openings significantly affect the permeability of the reservoirs and, subsequently, the well productivity. Past research was largely focused on the assessment of conditions and characteristics of fluid driven fractures as well as proppant placement techniques. Surprisingly, not much work was devoted to the assessment of the residual fracture profiles. In this work we develop a simplified non-linear mathematical model of residual closure of a plane crack filled with deformable particles and subjected to a remote compressive stress. It is demonstrated that the closure profile is significantly influenced by the distribution and compressibility of the particles, which are often ignored in the current evaluations of well productivity. © 2013 Springer Science+Business Media Dordrecht.Luiz Bortolan Neto, Andrei Kotouso

Health-related quality of life change in patients treated at a multidisciplinary pain clinic

Background Multidisciplinary pain management (MPM) is a generally accepted method for treating chronic pain, but heterogeneous outcome measures provide only limited conclusions concerning its effectiveness. Therefore, further studies on the effectiveness of MPM are needed to identify subgroups of patients who benefit, or do not benefit, from these interventions. Our aim was to analyse health-related quality of life (HRQoL) changes after MPM and to identify factors associated with treatment outcomes. Methods We carried out a real world observational follow-up study of chronic pain patients referred to a tertiary multidisciplinary outpatient pain clinic to describe, using the validated HRQoL instrument 15D, the HRQoL change after MPM and to identify factors associated with this change. 1,043 patients responded to the 15D HRQoL questionnaire at baseline and 12 months after the start of treatment. Background data were collected from the pre-admission questionnaire of the pain clinic. Results Fifty-three percent of the patients reported a clinically important improvement and, of these, 81% had a major improvement. Thirty-five percent reported a clinically important deterioration, and 12% had no change in HRQoL. Binary logistic regression analysis revealed that major improvement was positively associated with shorter duration of pain (Peer reviewe