Nursing involvement in euthanasia: how sound is the philosophical support?

Abstract  Preference utilitarians are concerned to maximize the autonomous choices of individuals; for this reason, they argue that nurses ought to advocate for those patients who desire assistance with ending their lives. This approach prompts us to consider, then, the moral validity of nursing involvement in measures intended to end the lives of patients. In this article, the terms of preference utilitarianism are set out and considered in order to determine whether this approach offers sufficient philosophical support for sanctioning a role for nursing in euthanasia. Ultimately, it is found that preference utilitarianism is lacking in this respect, as well as in its fitness for guiding nursing activity in general. In particular, it is found that nurses are required to exchange a handmaiden relationship with the medical profession for an equally undignified relationship with patients. If nursing involvement in measures intended to end the lives of patients is to find sufficient philosophical support, then we need to look elsewhere.     

In vivo microdialysis and conditioned place preference studies in rats are consistent with abuse potential of tramadol.

The abuse potential of tramadol was investigated using both in vivo microdialysis measures of dopamine (DA) release within the nucleus accumbens (NAc) shell and the conditioned place preference (CPP) paradigm in rats. Tramadol (75 mg/kg, i.p.) induced a statistically significant increase (starting 80 min posttreatment) in DA release within the NAc shell, which was maintained for at least 120 min posttreatment. Tramadol (18.75, 37.5, and 75 mg/kg i.p.) produced a statistically significant CPP, with the effects of the two highest doses comparable to those induced by morphine (5 mg/kg, s.c.). The release of DA within the NAc shell may be responsible for the rewarding properties of tramadol and, together with the CPP results, provide evidence that tramadol may possess greater abuse potential than originally believed.     

Schedule-controlled brain self-stimulation: Has it utility for behavioral pharmacology?

We review evidence that schedule-controlled intracranial self-stimulation (ICSS) has properties in common with conventional reinforcements, such as food and water, but unlike the latter, animals will respond for ICSS for long periods of time at a near-constant rate. Schedule-controlled ICSS has proven to be more sensitive to drug-induced changes than has ICSS on a continuous reinforcement schedule, and it permits a more fine-grained analysis of the pattern of responding that results in the reinforcement. Evidence is accumulating that the schedule of ICSS itself leads to neurochemical changes in areas of the brain, such as the nucleus accumbens, in which reward processes occur. Results obtained from schedule-controlled ICSS would complement those obtained by drug self-administration studies which generally use intermittent reinforcement. A systematic examination of ICSS schedules at different brain sites would greatly facilitate our interpretation of drug effects and this would have utility for behavioral pharmacology.     

Creating a place for population health: Interpreting the spaces of a new School in Auckland,New Zealand

Although the reconfiguring of health care within the hospital sector has gained considerable attention by social scientists, the tertiary education sector's response to new health philosophies and practices has proceeded largely unexamined. This paper considers the new School of Population Health at the University of Auckland, accounts for its origins and considers the synergies between its design and workplace organisation. The results of a thematic analysis of narratives offered by 24 employees collected in 2004 are then presented. Findings suggest that the amassing of academics from a range of health-related backgrounds is advancing interdisciplinary dialogue even if the nature and purpose of population health remains unclear to some. A key concern of respondents was the openness of the workplace which encourages a collaborative atmosphere but also generates distraction. The degree to which conduct within the new building is perceived as regulated was also of concern. Place clearly matters in the story of the new School: the form of the building (featuring an architecture of openness) complements its function (generating new collaborations and creative thinking about health). However, the question of how ‘salutogenic’ a setting it is remains contested.     

Effect of surface conditioning methods on the bond strength of luting cement to ceramics

OBJECTIVES: This study evaluated the effect of three different surface conditioning methods on the bond strength of a Bis-GMA based luting cement to six commercial dental ceramics. METHODS: Six disc shaped ceramic specimens (glass ceramics, glass infiltrated alumina, glass infiltrated zirconium dioxide reinforced alumina) were used for each test group yielding a total number of 216 specimens. The specimens in each group were randomly assigned to one of the each following treatment conditions: (1) hydrofluoric acid etching, (2) airborne particle abrasion, (3) tribochemical silica coating. The resin composite luting cement was bonded to the conditioned and silanized ceramics using polyethylene molds. All specimens were tested at dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. The shear bond strength of luting cement to ceramics was measured in a universal testing machine (1 mm/min). RESULTS: In dry conditions, acid etched glass ceramics exhibited significantly higher results (26.4-29.4 MPa) than those of glass infiltrated alumina ceramics (5.3-18.1 MPa) or zirconium dioxide (8.1 MPa) (ANOVA, P<0.001). Silica coating with silanization increased the bond strength significantly for high-alumina ceramics (8.5-21.8 MPa) and glass infiltrated zirconium dioxide ceramic (17.4 MPa) compared to that of airborne particle abrasion (ANOVA, P<0.001). Thermocycling decreased the bond strengths significantly after all of the conditioning methods tested. SIGNIFICANCE: Bond strengths of the luting cement tested on the dental ceramics following surface conditioning methods varied in accordance with the ceramic types. Hydrofluoric acid gel was effective mostly on the ceramics having glassy matrix in their structures. Roughening the ceramic surfaces with air particle abrasion provided higher bond strengths for high-alumina ceramics and the values increased more significantly after silica coating/silanization.     

Acute selective serotonin reuptake inhibitors increase conditioned fear expression: blockade with a 5-HT(2C) receptor antagonist.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) effectively treat various anxiety disorders, although symptoms of anxiety are often exacerbated during early stages of treatment. We previously reported that acute treatment with the SSRI citalopram enhances the acquisition of auditory fear conditioning, which is consistent with the initial anxiogenic effects reported clinically. Here, we extend our findings by assessing the effects of acute SSRI treatment on the expression of previously acquired conditioned fear. METHODS: Rats underwent fear conditioning drug-free. Tone-evoked fear responses were tested after drug treatment the following day. This protocol more closely resembles the clinical setting than pre-conditioning treatment, because it evaluates effects of treatment on a pre-existing fear rather than on the formation of a new fear memory. RESULTS: A single pre-testing injection of the SSRIs citalopram or fluoxetine significantly increased fear expression. There was no effect of the antidepressant tianeptine or the norepinephrine reuptake inhibitor tomoxetine, indicating that this effect is specific to SSRIs. The SSRI-induced enhancement in fear expression was not blocked by tropisetron, a 5-HT(3) receptor antagonist, but was blocked by SB 242084, a specific 5-HT(2C) receptor antagonist. CONCLUSIONS: Enhanced activation of 5-HT(2C) receptors might be a mechanism for the anxiogenic effects of SSRIs observed initially during treatment.     

Heterotopic ischemic pain attenuates somatosensory evoked potentials induced by electrical tooth stimulation: diffuse noxious inhibitory controls in the trigeminal nerve territory.

The purpose of this study was to determine whether the late component of somatosensory evoked potentials (SEP) induced by electrical tooth stimulation and pain intensity are inhibited by heterotopic ischemic stimulation. The tourniquet pressure with 50 mmHg greater than the individual's systolic pressure was applied to the left upper arm for 10 min as ischemic conditioning stimulation. The late component of SEP and visual analogue scale (VAS) were recorded at 4 times and both were significantly decreased when ischemic conditioning stimulation was applied. The maximum reductions in SEP amplitude and the VAS value were 26.1% and 21.2%, respectively, during ischemic conditioning stimulation. After-effect was observed 5 min after removal of the conditioning stimulation. The present study revealed that heterotopic ischemic stimulation attenuated the late component of SEP induced by electrical tooth stimulation, triggering diffuse noxious inhibitory controls (DNIC) and after-effects in the trigeminal nerve territory. It was also suggested that the DNIC effect differs, depending on the intensity, kind, and quality of the test and conditioning stimuli.     

The striatal-enriched protein tyrosine phosphatase gates long-term potentiation and fear memory in the lateral amygdala.

BACKGROUND: Formation of long-term memories is critically dependent on extracellular-regulated kinase (ERK) signaling. Activation of the ERK pathway by the sequential recruitment of mitogen-activated protein kinases is well understood. In contrast, the proteins that inactivate this pathway are not as well characterized. METHODS: Here we tested the hypothesis that the brain-specific striatal-enriched protein tyrosine phosphatase (STEP) plays a key role in neuroplasticity and fear memory formation by its ability to regulate ERK1/2 activation. RESULTS: STEP co-localizes with the ERKs within neurons of the lateral amygdala. A substrate-trapping STEP protein binds to the ERKs and prevents their nuclear translocation after glutamate stimulation in primary cell cultures. Administration of TAT-STEP into the lateral amygdala (LA) disrupts long-term potentiation (LTP) and selectively disrupts fear memory consolidation. Fear conditioning induces a biphasic activation of ERK1/2 in the LA with an initial activation within 5 minutes of training, a return to baseline levels by 15 minutes, and an increase again at 1 hour. In addition, fear conditioning results in the de novo translation of STEP. Inhibitors of ERK1/2 activation or of protein translation block the synthesis of STEP within the LA after fear conditioning. CONCLUSIONS: Together, these data imply a role for STEP in experience-dependent plasticity and suggest that STEP modulates the activation of ERK1/2 during amygdala-dependent memory formation. The regulation of emotional memory by modulating STEP activity may represent a target for the treatment of psychiatric disorders such as posttraumatic stress disorder (PTSD), panic, and anxiety disorders.     

Socioeconomic differences in food preference and their influence on healthy food purchasing choices

Background: Studies have shown that socioeconomic groups differ in their dietary behaviours, and it has been suggested that these differences partly account for health inequalities between social groups. To-date, however, we have a limited understanding of why socioeconomic groups differ in their dietary behaviours. This paper addresses this issue by examining the relationship between socioeconomic status, food preference (likes and dislikes) and the purchase of 'healthy' food (i.e. food consistent with dietary guideline recommendations). Methods: This study was based on a dual-sample, dual-method research design. One sample was systematically selected from the Australian Commonwealth electoral roll and the data collected using a mail-survey methodology (81% response rate, n =403). The second consisted of a convenience sample of economically disadvantaged people recruited via welfare agencies (response rate unknown, n =70). A mail survey methodology was deemed inappropriate for this sample, so the data were collected by personally delivering the questionnaire to each respondent. Results: Socioeconomic groups differed significantly in their food purchasing choices and preferences. The food choices of respondents in the welfare sample were the least consistent with dietary guideline recommendations, and they reported liking fewer healthy foods (all results were independent of age and sex). Notably, socioeconomic differences in preference explained approximately 10% of the socioeconomic variability in healthy food purchasing behaviour. Conclusion: Whilst it is not clear why socioeconomic groups differ in their food preferences, possible reasons include: reporting bias, differential exposure to healthy food as a consequence of the variable impact of health promotion campaigns, structural and economic barriers to the procurement of these foods, and subculturally specific beliefs, values, meanings, etc.     

Influence of peripheral afferents on cortical and spinal motoneuron excitability.

The objective of this study was to establish to what extent muscle, cutaneous, and joint afferents alter the excitability of spinal and cortical motor neurons. This question was examined by studying the impact of electrical stimulation of the second and third digits, the median nerve at the wrist, and the recurrent thenar motor branch on the F/H and magneto-electrical cortical motor responses (MEPs) of the thenar muscles. The firing frequencies of single F/H motor unit action potentials were unaltered by the foregoing conditioning peripheral stimuli. MEPs conditioned by motor threshold stimulation of the median nerve at the wrist or the recurrent motor branch were significantly increased in size at conditioning to test intervals of 50 to 80 milliseconds. No significant change in MEP size resulted from conditioning stimulation of the digital nerves. We conclude that muscle afferents were primarily responsible for the increase in MEP size. Conditioning stimuli may allow examiners to assess central motor conduction where it would otherwise be impossible.