Characteristics of Belgian 'life-ending acts without explicit patient request' : a large-scale death certificate survey revisited

BACKGROUND: “Life-ending acts without explicit patient request,” as identified in robust international studies, are central in current debates on physician-assisted dying. Despite their contentiousness, little attention has been paid to their actual characteristics and to what extent they truly represent nonvoluntary termination of life. METHODS: We analyzed the 66 cases of life-ending acts without explicit patient request identified in a large-scale survey of physicians certifying a representative sample of deaths (n = 6927) in Flanders, Belgium, in 2007. The characteristics we studied included physicians’ labelling of the act, treatment course and doses used, and patient involvement in the decision. RESULTS: In most cases (87.9%), physicians labelled their acts in terms of symptom treatment rather than in terms of ending life. By comparing drug combinations and doses of opioids used, we found that the life-ending acts were similar to intensified pain and symptom treatment and were distinct from euthanasia. In 45 cases, there was at least 1 characteristic inconsistent with the common understanding of the practice: either patients had previously expressed a wish for ending life (16/66, 24.4%), physicians reported that the administered doses had not been higher than necessary to relieve suffering (22/66, 33.3%), or both (7/66, 10.6%). INTERPRETATION: Most of the cases we studied did not fit the label of “nonvoluntary life-ending” for at least 1 of the following reasons: the drugs were administered with a focus on symptom control; a hastened death was highly unlikely; or the act was taken in accordance with the patient’s previously expressed wishes. Thus, we recommend a more nuanced view of life-ending acts without explicit patient request in the debate on physician-assisted dying

Exceptionally monotone models : the rank correlation model class for exceptional model mining

Exceptional Model Mining strives to find coherent subgroups of the dataset where multiple target attributes interact in an unusual way. One instance of such an investigated form of interaction is Pearson's correlation coefficient between two targets. EMM then finds subgroups with an exceptionally linear relation between the targets. In this paper, we enrich the EMM toolbox by developing the more general rank correlation model class. We find subgroups with an exceptionally monotone relation between the targets. Apart from catering for this richer set of relations, the rank correlation model class does not necessarily require the assumption of target normality, which is implicitly invoked in the Pearson's correlation model class. Furthermore, it is less sensitive to outliers

Pro/con debate: Should synthetic colloids be used in patients with septic shock?

You have recently heard reports that synthetic colloids may be associated with renal failure and other morbidities in certain populations of critically ill patients. You have been asked by the hospital chief of staff whether there should be a suspension of the use of synthetic colloids until further information is available. You need to make a decision

Adaptive neural reward processing during anticipation and receipt of monetary rewards in mindfulness meditators

Reward seeking is ubiquitous and adaptive in humans. But excessive reward seeking behavior, such as chasing monetary rewards, may lead to diminished subjective well-being. This study examined whether individuals trained in mindfulness meditation show neural evidence of lower susceptibility to monetary rewards. Seventy-eight participants (34 meditators, 44 matched controls) completed the monetary incentive delay task while undergoing functional magnetic resonance imaging. The groups performed equally on the task, but meditators showed lower neural activations in the caudate nucleus during reward anticipation, and elevated bilateral posterior insula activation during reward anticipation. Meditators also evidenced reduced activations in the ventromedial prefrontal cortex during reward receipt compared with controls. Connectivity parameters between the right caudate and bilateral anterior insula were attenuated in meditators during incentive anticipation. In summary, brain regions involved in reward processingboth during reward anticipation and receipt of rewardresponded differently in mindfulness meditators than in nonmeditators, indicating that the former are less susceptible to monetary incentives

A Fast EEG Forecasting Algorithm for Phase-Locked Transcranial Electrical Stimulation of the Human Brain

A growing body of research suggests that non-invasive electrical brain stimulation can more effectively modulate neural activity when phase-locked to the underlying brain rhythms. Transcranial alternating current stimulation (tACS) can potentially stimulate the brain in-phase to its natural oscillations as recorded by electroencephalography (EEG), but matching these oscillations is a challenging problem due to the complex and time-varying nature of the EEG signals. Here we address this challenge by developing and testing a novel approach intended to deliver tACS phase-locked to the activity of the underlying brain region in real-time. This novel approach extracts phase and frequency from a segment of EEG, then forecasts the signal to control the stimulation. A careful tuning of the EEG segment length and prediction horizon is required and has been investigated here for different EEG frequency bands. The algorithm was tested on EEG data from 5 healthy volunteers. Algorithm performance was quantified in terms of phase-locking values across a variety of EEG frequency bands. Phase-locking performance was found to be consistent across individuals and recording locations. With current parameters, the algorithm performs best when tracking oscillations in the alpha band (8–13 Hz), with a phase-locking value of 0.77 ± 0.08. Performance was maximized when the frequency band of interest had a dominant frequency that was stable over time. The algorithm performs faster, and provides better phase-locked stimulation, compared to other recently published algorithms devised for this purpose. The algorithm is suitable for use in future studies of phase-locked tACS in preclinical and clinical applications

Identification and mapping of project stakeholders: criteria and methods

A key issue for stakeholder management is to determine who, to what extent and why can influence a project. Proper identification of stake-holders and their classification according to the criteria adopted al-lows for defining their hierarchy, strength and impact on the project. This, in turn, conditions the development of a strategy for dealing with individual stakeholder groups. The definitions of the concept of a stakeholder have been reviewed to determine the identification crite-ria. The article also attempts to systematize methods of qualifying stakeholders, depending on the number of differentiation criteria. The methods used for the qualification of stakeholders are often presented graphically

Neural Correlates of Effective Learning in Experienced Medical Decision-Makers

Accurate associative learning is often hindered by confirmation bias and success-chasing, which together can conspire to produce or solidify false beliefs in the decision-maker. We performed functional magnetic resonance imaging in 35 experienced physicians, while they learned to choose between two treatments in a series of virtual patient encounters. We estimated a learning model for each subject based on their observed behavior and this model divided clearly into high performers and low performers. The high performers showed small, but equal learning rates for both successes (positive outcomes) and failures (no response to the drug). In contrast, low performers showed very large and asymmetric learning rates, learning significantly more from successes than failures; a tendency that led to sub-optimal treatment choices. Consistently with these behavioral findings, high performers showed larger, more sustained BOLD responses to failed vs. successful outcomes in the dorsolateral prefrontal cortex and inferior parietal lobule while low performers displayed the opposite response profile. Furthermore, participants' learning asymmetry correlated with anticipatory activation in the nucleus accumbens at trial onset, well before outcome presentation. Subjects with anticipatory activation in the nucleus accumbens showed more success-chasing during learning. These results suggest that high performers' brains achieve better outcomes by attending to informative failures during training, rather than chasing the reward value of successes. The differential brain activations between high and low performers could potentially be developed into biomarkers to identify efficient learners on novel decision tasks, in medical or other contexts

Wpływ pandemii COVID-19 na regulację działalności młodzieżowych rad w Polsce oraz ocena przyjętych rozwiązań

Młodzieżowe rady przy jednostkach samorządu terytorialnego działają praktycznie od 1990 r. Dopiero jednak od 2001 r. funkcjonuje podstawa prawna umożliwiająca powołanie takich organów, ale przez 20 lat pozostawała niezmieniona. Pandemia COVID-19 znacząco ograniczyła możliwość funkcjonowania młodzieżowych rad, które zmagały się z wieloma problemami (np. w wielu przypadkach kończyły się kadencje tych organów, a nie powoływano nowych). W rezultacie ustawodawca zajął się ustawową regulacją instytucji młodzieżowej rady i przyjął rządowy projekt ustawy (Dz. U. 2021 poz. 1038). W związku z tym autor starał się zbadać wpływ pandemii COVID-19 na liczbę funkcjonujących młodzieżowych rad. Ponadto przeanalizował najważniejsze rozwiązania zawarte w ustawie. Ostatecznie pozytywnie ocenił działania ustawodawcy, jednakże zwrócił uwagę na jego niezrozumiałe decyzje oraz na zdecydowany spadek liczby młodzieżowych rad między marcem 2020 r. a wrześniem 2021 r. Obecnie widoczna jest tendencja wzrostowa

The impact of carbon disclosure mandates on emissions and financial operating performance

We examine whether a disclosure mandate for greenhouse gas emissions creates stakeholder pressure for firms to subsequently reduce their emissions. For UKincorporated listed firms such a mandate was adopted in 2013. Using a difference- indifferences design, we find that firms affected by the mandate reduced their emissions – depending on the specification – by an incremental 14-18% relative to a control group. This reduction was accompanied by an average 9% increase in production costs. At the same time, the treated firms were able to increase their sales by an almost compensating amount. Taken together, our findings provide no indication that the disclosure requirement led to a significant deterioration in the financial operating performance of the treated firms, despite the significant carbon footprint reduction following the disclosure mandate