Ethische kwesties in de mondzorg voor kwetsbare ouderen

Voor kwetsbare ouderen is vaak intensieve preventieve en curatieve mondzorg nodig ten behoeve van de kwaliteit van leven. Door fysieke en cognitieve beperkingen van de oudere kunnen behandelingen niet altijd lege artis uitgevoerd worden, wat tot praktische problemen leidt. Hieraan gerelateerd doen zich morele vragen voor. Mondzorg voor kwetsbare ouderen kan, zelfs met beperkingen, bijdragen aan hoge kwaliteit van leven als deze ethische kwesties vaker expliciet daarin betrokken worden. Daarmee zal ook de morele druk van ethische kwesties op de zorgverlener worden verlicht. Het gaat veelal om ‘alledaagse’ ethische kwesties, waarvoor de betrokkenen met elkaar oplossingen kunnen vinden in open overleg in een zorgethische benadering. Dat laatste betekent gerichtheid op ‘de goede dingen goed doen’ met inbegrip van alle relevante aspecten van de persoon en de omgeving. Voorwaarden zijn onder andere inbedding van de mondzorg in de zorg voor ouderen en voor zorgverleners betrokkenheid bij de oudere en kennis en vaardigheden om te reflecteren

Construction and testing of a novel host-range defective myxoma virus vaccine with the M063 gene inactivated that is non-permissive for replication in rabbit cells

Deletion of the M063 gene from myxoma virus produces a virus that is unable to replicate in rabbit cells in vitro or in live rabbits but can be propagated in non-rabbit cell lines. A targeted M063 deletion mutant was constructed in the attenuated Uriarra strain of myxoma virus and the ability of this virus to act as a safe, non-transmissible vaccine against myxomatosis was tested in outbred laboratory rabbits. Immunization with the M063 deletion vaccine provided good short-term protection against lethal challenge with virulent myxoma virus. Long-term protection was similar to reported results with heterologous live virus, with some rabbits protected but others succumbing to challenge. Replication-deficient poxvirus vaccines, like the Modified Vaccinia Virus Ankara (MVA) in man and the myxoma virus vaccine described here in rabbits, are very attractive from a safety perspective. Seasonal boosting would be predicted to provide long-term protection. Targeted host-range gene deletions could have potential for rapid development of poxvirus vaccines in general.This study was funded by the Pest Animal Control Cooperative Research Centre. Grant McFadden is an International Scholar of the Howard Hughes Medical Institute

Helping Made Easy: Ease of Argument Generation Enhances Intentions to Help

Previous work has shown that self-generating arguments is more persuasive than reading arguments provided by others, particularly if self-generation feels easy. The present study replicates and extends these findings by providing evidence for fluency effects on behavioral intention in the realm of helping. In two studies, participants were instructed to either self-generate or read two versus ten arguments about why it is good to help. Subsequently, a confederate asked them for help. Results show that self-generating few arguments is more effective than generating many arguments. While this pattern reverses for reading arguments, easy self-generation is the most effective strategy compared to all other conditions. These results have important implications for fostering behavioral change in all areas of life

Preoperative inhibition in patients with irresectable locally advanced stage III melanoma

Aim: Neoadjuvant treatment of locally advanced disease with BRAF inhibitors is expected to increase the likelihood of a R0 resection. We present six patients with stage III unresectable melanoma, neoadjuvantly treated with BRAF inhibitors. Methods: Patients with unresectable, BRAF-mutated, stage III melanoma, were treated with BRAF inhibitors between 2012 and 2015. Unresectability was determined based on clinical and/or radiological findings. At maximal response, resection was performed. The specimen was reviewed to determine the degree of response. Results: In five of six patients a radical resection was achieved. Postoperative complications were unremarkable. In five of six resected specimens, vital tumor tissue was found. Conclusion: Neoadjuvant BRAF inhibitor treatment of locally advanced melanoma is feasible and has the potential to facilitate an R0 resection

Field testing a novel high residence positioning system for monitoring the fine‐scale movements of aquatic organisms

1. Acoustic telemetry is an important tool for studying the behaviour of aquatic organisms in the wild. 2. VEMCO high residence (HR) tags and receivers are a recent introduction in the field of acoustic telemetry and can be paired with existing algorithms (e.g. VEMCO positioning system [VPS]) to obtain high‐resolution two‐dimensional positioning data. 3. Here, we present results of the first documented field test of a VPS composed of HR receivers (hereafter, HR‐VPS). We performed a series of stationary and moving trials with HR tags (mean HR transmission period = 1.5 s) to evaluate the precision, accuracy and temporal capabilities of this positioning technology. In addition, we present a sample of data obtained for five European perch Perca fluviatilis implanted with HR tags (mean HR transmission period = 4 s) to illustrate how this technology can estimate the fine‐scale behaviour of aquatic animals. 4. Accuracy and precision estimates (median [5th–95th percentile]) of HR‐VPS positions for all stationary trials were 5.6 m (4.2–10.8 m) and 0.1 m (0.02–0.07 m), respectively, and depended on the location of tags within the receiver array. In moving tests, tracks generated by HR‐VPS closely mimicked those produced by a handheld GPS held over the tag, but these differed in location by an average of ≈9 m. 5. We found that estimates of animal speed and distance travelled for perch declined when positional data for acoustically tagged perch were thinned to mimic longer transmission periods. These data also revealed a trade‐off between capturing real nonlinear animal movements and the inclusion of positioning error. 6. Our results suggested that HR‐VPS can provide more representative estimates of movement metrics and offer an advancement for studying fine‐scale movements of aquatic organisms, but high‐precision survey techniques may be needed to test these systems

Astrometry with the Hubble Space Telescope: Trigonometric Parallaxes of Selected Hyads

We present absolute parallaxes and proper motions for seven members of the Hyades open cluster, pre-selected to lie in the core of the cluster. Our data come from archival astrometric data from FGS 3, and newer data for 3 Hyads from FGS 1R, both white-light interferometers on the Hubble Space Telescope (HST). We obtain member parallaxes from six individual Fine Guidance Sensor (FGS) fields and use the field containing van Altena 622 and van Altena 627 (= HIP 21138) as an example. Proper motions, spectral classifications and VJHK photometry of the stars comprising the astrometric refer- ence frames provide spectrophotometric estimates of reference star absolute parallaxes. Introducing these into our model as observations with error, we determine absolute parallaxes for each Hyad. The parallax of vA 627 is significantly improved by including a perturbation orbit for this previously known spectroscopic binary, now an astrometric binary. Compared to our original (1997) determina- tions, a combination of new data, updated calibration, and improved analysis lowered the individual parallax errors by an average factor of 4.5. Comparing parallaxes of the four stars contained in the Hipparcos catalog, we obtain an average factor of 11 times improvement with the HST . With these new results, we also have better agreement with Hipparcos for the four stars in common. These new parallaxes provide an average distance for these seven members, = 47.5 pc, for the core a \pm 1 - {\sigma} dispersion depth of 3.6 pc, and a minimum depth from individual components of 16.0 \pm 0.9 pc. Absolute magnitudes for each member are compared to established main sequences, with excellent agreement. We obtain a weighted average distance modulus for the core of the Hyades of m-M=3.376 \pm 0.01, a value close to the previous Hipparcos values, m-M=3.33\pm 0.02.Comment: 21 pages, 7 figures, Astronomical Journal, accepted 2011-3-

Senescent Cells:A Potential Target for New Cancer Therapies in Older Oncologic Patients

Cellular senescence is a complex process and is one of the key elements of ageing [...]

De illusie van de maakbaarheid

Technologische ontwikkelingen waren decaden lang leidend in de samenleving in bredere zin en in de geneeskunde in het bijzonder. Mede daardoor leven we langer. In de wereld om ons heen lijkt alles maakbaar; gezondheid, schoonheid en soms ook geluk.Hoe schril is het contrast tussen die maakbare wereld en de realiteit van ziekte, ouderdom en sterfte, stelt Barbara van Leeuwen in haar oratie. Voordat een patiënt op een operatietafel terecht komt, heeft zich een selectieproces voltrokken. De patiënt is verwezen naar een chirurg, een diagnose is gesteld, een mogelijke operatie geopperd en geschikt bevonden. Daar is niet meer voor nodig dan een juiste diagnose in combinatie met een richtlijn en technische mogelijkheden.Dit ziektegedreven proces doet geen recht aan de individuele patiëntkenmerken of -voorkeuren en voldoet zeker niet voor de oudere patiënt. Dat blijkt in de praktijk door de soms teleurstellende uitkomsten na grote operaties bij patiënten op oudere leeftijd. De ziekte is genezen, maar de patiënt en diens familie worden geconfronteerd met de onbedoelde schade van de behandeling, complicaties, functieverlies en achteruitgang van de kwaliteit van leven.Als reactie op de soms teleurstellende uitkomsten van een operatie op oudere leeftijd is de laatste jaren de transitie naar waardegedreven zorg ingezet. Als we de zorg daadwerkelijk waardegedreven willen maken, dan hoort daar acceptatie bij van het feit dat - behalve genezing - ook andere uitkomsten van zorg van waarde zijn.Niet alles is maakbaar, dat is een illusie, maar waardegedreven zorg mag dat niet zijn

Thoughts on opportunities in high-energy nuclear collisions

This document reflects thoughts on opportunities from high-energy nuclear collisions in the 2020s.Comment: 10 pages, pd