Physician Assisted Dying: A Turning Point?

Physician Assisted Dying (PAD) has been lawful in some countries since the 1940s and in the United States since 1997. There is a body of social and scientific research that has focused on whether the practice has been misused and whether gaps exist in legislative safeguards. There are multiple concerns with physicians assisting patients to die: incompatibility with the physician’s role as a healer, devaluation of human life, coercion of vulnerable individuals (e.g., the poor and disabled), and the risk that PAD will be used beyond a narrow group of terminally ill individuals. Statutes in the United States have been drafted with these concerns in mind in an effort to mitigate the possible risks of PAD while still providing individuals with access. There seems to be a shift in attitudes towards PAD. Currently four states statutorily permit PAD and it is being discussed by multiple legislatures across the country. There also seems to be a shift in medical practice as demonstrated by a 2015 survey that showed for the first time that more than half of physicians surveyed favored medical assistance in dying. PAD is a deeply personal choice. The question is whether more states will authorize the practice and, if so, what safeguards will be put in place to ensure the practice is not misused and remains consistent with prevailing social and ethical thought

Forced Migration, The Human Face of a Health Crisis

Nearly 60 million refugees, asylum-seekers and internally displaced persons (IDPs) fled their homes in 2014, predominately from war-torn Syria, Afghanistan and Somalia. The global response to assisting this vulnerable group has been wholly incommensurate with the need given the profound health hazards faced by forced migrants at each stage of their journey. The majority of forced migrants are housed in lower-income countries that do not have the infrastructure to assist the significant numbers of individuals who are crossing their borders and the humanitarian organizations who seek to assist in the response are grossly underfunded and under-resourced. Countries have varying responsibilities to protect different classes of forced migrants based in international law, however there are significant gaps in existing agreements, leaving many individuals without protection or hope of assistance. There is a need to strengthen existing international agreements to ensure that all classes of forced migrants are entitled to protection and to ensure the enforceability of existing agreements where governments refuse to honor their existing obligations

The New EU Frontier: Perspectives on Enhanced Economic Integration

The central objective of this report is to identify the best forms of enhanced economic integration that could be pursued over the next 5-10 years between the EU and five of its important neighbour countries: Ukraine, Russia, Egypt, Morocco and Algeria. The report starts from reviewing existing forms of economic integration and time dependencies between them. It then discusses in more detail institutional requirements for alternative options of deepening co-operation with the EU neighbour countries. Subsequently, likely effects of economic integration are discussed. Special sections are devoted to the energy cooperation with Russia, Algeria and Ukraine and to the EU financial assistance to its neighbourhood. The report concludes with policy recommendations that could be relevant for the development of the European Neighbourhood Policy and also for pursuing business opportunities in the EU neighbourhood.ENP, economic integration, EU Neighbourhood

Trends in Characteristics, Mortality, and Other Outcomes of Patients With Newly Diagnosed Cirrhosis

Importance: Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population. Objective: To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis. Design, Setting, and Participants: A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019. Exposures: Age, cause of cirrhosis, and year of diagnosis. Main Outcomes and Measures: Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding). Results: A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2%] male). A 69% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20% per year (95% CI, 0.04% to 0.36%; P for trend = .02), and the proportion of those aged 65 years and older increased by 0.81% per year (95% CI, 0.51% to 1.11%; P for trend < .001). The proportion of patients with alcoholic cirrhosis increased by 0.80% per year (95% CI, 0.49% to 1.12%), and the proportion with nonalcoholic steatohepatitis increased by 0.59% per year (95% CI, 0.30% to 0.87%), whereas the proportion with viral hepatitis decreased by 1.36% per year (95% CI, -1.68% to -1.03%) (P < .001 for all). In patients younger than 40 years, 40 to 64 years, and 65 years and older, mortality rates were 6.4 (95% CI, 5.4 to 7.6), 9.9 (95% CI, 9.5 to 10.4), and 16.2 (95% CI, 15.2 to 17.2) per 100 person-years, respectively (P < .001). Mortality rates decreased during the study period (11.9 [95% CI, 10.7-13.1] per 100 person-years in 2004 vs 10.0 [95% CI, 8.1-12.2] per 100 person-years in 2014; annual adjusted hazard ratio, 0.87 [95% CI, 0.86 to 0.88]) and were lower in those with alcoholic cirrhosis compared with patients with viral hepatitis (adjusted hazard ratio, 0.89 [95% CI, 0.80 to 0.98]). Rates of hepatocellular carcinoma were low in patients younger than 40 years (0.5 [95% CI, 0.2 to 0.9] per 100 person-years). Liver transplant rates were low throughout the study period (0.3 [95% CI, 0.3-0.4] per 100 person-years). In patients with compensated cirrhosis, rates of hepatic decompensation were lower in patients younger than 40 years (adjusted subhazard ratio 0.78; 95% CI, 0.62 to 0.99) and in patients with nonalcoholic steatohepatitis (adjusted subhazard ratio, 0.51; 95% CI, 0.43 to 0.60). Conclusions and Relevance: The population of patients with newly diagnosed cirrhosis in Indiana has experienced changes in the age distribution and cause of cirrhosis, with decreasing mortality rates. These findings support investment in the prevention and treatment of alcoholic liver disease and nonalcoholic steatohepatitis, particularly in younger and older patients. Additional study is needed to identify the reasons for decreasing mortality rates

Optimising the spatial pattern of landscape revegetation

The spatial pattern of landscape reconstruction makes a substantial difference to environmental outcomes. We develop a spatially explicit bio-economic model that optimises the reconstruction of a heavily cleared landscape through revegetation. The model determines the spatial priorities for revegetation that minimises economic costs subject to achieving particular improvements in habitat for 29 woodland-dependent bird species. The study focuses on the Avoca catchment (330 thousand ha) in North-Central Victoria. Our model incorporates spatial pattern and heterogeneity of existing and reconstructed vegetation types. The revegetation priorities are identified as being: sites in the vicinity of existing remnants, riparian areas, and parts of the landscape with diverse land uses and vegetation types. Optimal reconstruction design is affected by opportunity costs due to the loss of agricultural production and the costs of revegetation. 1 Centre for Environmental Economics and Policy, School of Agricultural and Resource Economics, University of Western Australia, Crawley, WA, 6009 2 Department of Primary Industries, Rutherglen, RMB 1145 Chiltern Valley Rd, Rutherglen, Victoria, 3685 3 North Central Catchment Management Authority, PO Box 18, Huntly, Victoria, 3551landscape reconstruction, biodiversity, optimisation, habitat, Environmental Economics and Policy, Land Economics/Use, Q57,

Evidence that androstadienone, a putative human chemosignal, modulates women’s attributions of men’s attractiveness

Considerable research effort has focused on whether specific compounds found within human body odor influence the behavior or physiology of other individuals. The most intensively studied is 4,16-androstadien-3-one, a chemical which is known to modulate mood and have activational effects in the sympathetic nervous system in a context-dependent manner, but whose action in mate-choice contexts remains largely untested. Here we present evidence that this androgen steroid may modulate women’s judgments of men’sattractiveness in an ecologically valid context. We tested the effects of androstadienone at a speed-dating event in which men and women interacted in a series of brief dyadic encounters. Men were rated more attractive when assessed by women who had been exposed to androstadienone, an effect that was seen in two out of three studies. The results suggest that androstadienone can influence women’s attraction to men, and also that research into the modulatory effects of androstadienone should be made within ecologically valid contexts

Practical and Theoretical Underpinnings of INFFER (Investment Framework For Environmental Resources)

INFFER (Investment Framework for Environmental Resources) was developed to help investors of public funds to improve the delivery of outcomes from environmental programs. It assists environmental managers to design projects, to select delivery mechanisms, and to rank competing projects on the basis of benefits and costs. The design of INFFER and the activities of the INFFER projects are based on extensive experience of working with environmental managers and policy makers. This experience has highlighted a number of important practical lessons, that have strongly influenced the design and implementation of INFFER. These lessons include the need for simplicity, training and support of users, trusting relationships with users, transparency, flexibility, compatibility with the needs and contexts of users, and supportive institutional arrangements. In additions, the developers have paid close attention to the need for processes that are theoretically rigorous, resulting in a tool that deals appropriately and consistently with projects for different assets types, of different scales and durations, consistent with Benefit: Cost Analysis. The paper outlines theoretical considerations underpinning the way that INFFER deals with asset valuation, time lags, uncertainty, and the design of the metric used to rank projects.Environmental Economics and Policy,

Lessons from implementing INFFER with regional catchment management organisations

Investment in natural resource management (NRM) by regional organisations in Australia has been widely criticised for failing to achieve substantial environmental outcomes. The Investment Framework for Environmental Resources (INFFER) is a tool for developing and prioritising projects to address environmental issues such as water quality and biodiversity decline, environmental pest impacts and land degradation. It aims to achieve the most valuable environmental outcomes with the available resources. During 2008 and 2009 INFFER has been implemented with a number of catchment management organisations (CMOs) throughout Australia. In this paper, we report on lessons from and implications of this experience. Data on implementation were collected in formal and informal ways from staff of organisations that were using INFFER and state agencies, including: an on-line survey, benchmarking questions at training workshops, a formal on-going monitoring and evaluation process tracking the use of INFFER by CMOs, and comments made in correspondence and informal feedback to the INFFER team. In this paper we describe issues that arise when implementing INFFER with regions and organisations, and how the INFFER team has attempted to address these. Key issues include a desire to consider the community as an asset and emphasise capacity building, a rejection of the need for targeted investment, and various difficulties associated with specific aspects of the Framework. Existing institutional arrangements, and the legacy of past institutional arrangements, remain serious barriers to the adoption of methods to improve environmental outcomes from NRM investment. A lack of rigour in investment planning has become accepted as the norm, and resistance to processes to improve rigour is common. However, many CMOs want to achieve better environmental outcomes with their limited funds, and we report on our efforts to work with them to achieve this by using INFFER.Research and Development/Tech Change/Emerging Technologies,

Glomerulosclerosis in the Col1a2-deficient mouse model : homotrimer pathogenesis and MMP expression

Title from PDF of title page (University of Missouri--Columbia, viewed on Feb. 20, 2010).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Dissertation advisor: Charlotte L. Phillips.Vita.|Ph. D. University of Missouri--Columbia 2009.The Col1a2-deficient (oim) mouse model exclusively synthesizes homotrimeric type I collagen due to the lack of functional pro [alpha] 2(I) collagen chains. The mouse develops a type I collagen glomerulopathy that has previously been shown to initiate postnatally and progress in a gene dose-dependent manner, accumulating type I collagen within the renal mesangium, resulting in podocyte foot effacement and proteinuria. In this study we examine the pre- and post-translational expression of type I collagen and MMPs -2, -3, and -9 in wildtype, heterozygous and Col1a2-deficient glomeruli to determine whether the pathogenic collagen is homotrimeric in nature, and whether alterations in MMP expression play a role in disease progression. Analysis of whole kidney and isolated glomeruli by immunohistochemistry and CNBr peptide mapping suggest that homotrimer is the accumulating type I collagen isotype in sclerotic glomeruli of both affected and heterozygous mice. Steady state MMPs-2, and -3 mRNA levels exhibited significant increases by three months of age, with corresponding protein increases compared to age-matched wildtype mice. Steady state MMP-9 mRNA levels significantly increased by three months of age, but MMP-9 protein expression was significantly decreased. Our findings suggest that upregulation of MMPs-2 and -3 expression is not sufficient to prevent homotrimeric type I collagen deposition and that their induction does not appear to be an initiating event, but may represent a secondary wound response.Includes bibliographical reference