A fate worse than death: The fear of changing.

Contends that resistance is not solely that which blocks the patient's full living—it is also what makes possible the ways in which the patient does "have life." The ways in which persons come to structure who and what they are and what is the nature of the world in which they live are at once the ways that make it possible for them to live their lives and the ways that limit experience and keep them in self-defeating patterns. A clinical example of a 53-yr-old male who drove recklessly on the highway in order to act out his fear of change is given. It is suggested that resistance arises when important life structures are imperiled. The way the therapist perceives the nature of the life structures and the attitude the therapist takes toward the patient's efforts to preserve those structures are essential considerations. The healing power derives from attitudes, empathy, and faith in the growth latent in the patient. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deciding life and death in the courtroom. From Quinlan to Cruzan, Glucksberg, and Vacco--a brief history and analysis of constitutional protection of the 'right to die'

This article analyzes judicial determinations on the "right to die" from Quinlan to Cruzan, Glucksberg, and Vacco. The body of law known as right-to-die cases extends ordinary treatment refusal doctrine to end-of-life decisions. The courts, having affirmed a right to refuse life-sustaining treatment, held that certain categorical distinctions that had been drawn lacked a rational basis. No rational distinction could be made between competent vs incompetent patients, withholding vs withdrawing treatment, and ordinary vs extraordinary treatment. The courts, however, had persistently affirmed one categorical distinction: between withdrawing life-sustaining treament on the one hand and active euthanasia or physician-assisted dying on the other. In Washington v Glucksberg and Vacco v Quill, the Supreme Court unanimously held that physician-assisted suicide is not a fundamental liberty interest protected by the Constitution. Notably, five members of the Court wrote or joined in concurring opinions that took a more liberal view. The Court powerfully approved aggressive palliation of pain. The Supreme Court, hinting that it would find state legalization of physician-assisted suicide constitutional, invited the nation to pursue an earnest debate on physician assistance in the dying process.     

AIDS, homosexuality, public opinion, and changing correlates over time

Comparing data from national Los Angeles Times surveys allows for an examination of changes in attitudes toward AIDS in 1985, when the crisis was first coming to public attention, and in 1987, when public opinion had a greater opportunity to stabilize. The primary predictors of public opinion did not change from 1985 to 1987, but there were somewhat less irrational attitudes among most segments of the population by 1987. However, among those who were conservative on the issue of homosexuality, personal concern for AIDS fell and support for repression grew.     

Evolution: the dialogue between life and death

Organisms have the ability to harness energy from the environment to create order and to reproduce. From early error-prone systems natural selection acted to produce present day organisms with high accuracy in the synthesis of macromolecules. The environment imposes strict limits on reproduction, so evolution is always accompanied by the discarding of a large proportion of the less fit cells, or organisms. Sexual reproduction depends on an immortal germline and a soma which may be immortal or mortal. Higher animals living in hazardous environments have evolved aging and death of the soma for the benefit of the ongoing germline.     

From replicators to reproducers: the first major transitions leading to life

A classification of replicators is proposed: life depends on replicators that can exist in an indefinitely large number of forms (unlimited heredity), and whose replication is modular rather than processive. The first template replicators would have increased at a rate less than exponential, because of self-inhibition arising from molecular complementarity. The result would be the survival of a varied population of replicators, rather than the victory of one type. This variability was important, because inaccurate copying meant that individual replicators were small (Eigen's paradox). The origin of cooperation between replicators, and the problem of molecular parasites, are discussed. Today, cooperation depends on cellular compartments, and on the linkage of genes on chromosomes, but we argue that at an earlier stage surface metabolism, in which replicators react only with neighbours, was important. The origin of translation and the genetic code is discussed. The essential step is the binding of amino acids to specific oligonucleotides. We suggest that this binding originated, not as a step in protein synthesis, but in the formation of coenzymes in a metabolically complex RNA world. Existing organisms are not replicators (that is, new individuals do not arise by copying), but reproducers that contain replicators. We outline Griesemer's concept of a reproducer, which brings out the essential role of development in evolution.     

Prolonging life and allowing death: infants

Dilemmas about resuscitation and life-prolonging treatment for severely compromised infants have become increasingly complex as skills in neonatal care have developed. Quality of life and resource issues necessarily influence management. Our Institute of Medical Ethics working party, on whose behalf this paper is written, recognises that the ultimate responsibility for the final decision rests with the doctor in clinical charge of the infant. However, we advocate a team approach to decision-making, emphasising the important role of parents and nurses in the process. Assessing the relative burdens and benefits can be troubling, but doctors and parents need to retain a measure of discretion; legislation which would determine action in all cases is inappropriate. Caution should be exercised in involving committees in decision-making and, where they exist, their remit should remain to advise rather than to decide. Support for families who bear the consequences of their decisions is often inadequate, and facilitating access to such services is part of the wider responsibilities of the intensive care team. The authors believe that allowing death by withholding or withdrawing treatment is legitimate, where those closely involved in the care of the infant together deem the burdens to be unacceptable without compensating benefits for the infant. As part of the process accurate and careful recording is essential.     

A matter of death and life: the significance of germ cell death during spermatogenesis

The significance of cell death occurring during spermatogenesis is a subject of interest because of its potential medical importance. Unfortunately, the field has been difficult for andrologists to penetrate, in part because of the difficulties of studying germ cells in vitro and the complexity of designing suitable models in which to dissect the molecular signalling pathways involved in control of germ cell apoptosis. As a result, the reasons for these deaths remain unclear despite considerable investigative effort. As developments which have occurred over the last few years in understanding of apoptosis can shed light on this important topic, this review focuses on what is currently known about germ cell apoptosis and outlines the emerging picture of what might be the causes and biological role of germ cell deaths in spermatogenesis.     

When life is ending, there is the right to death with dignity

BACKGROUND: This report summarizes an institutional review board-approved 6-month study with the NovaPulse carbon dioxide (CO2) laser utilizing the NovaScan handpiece in facial skin resurfacing applications. OBJECTIVE: This study comprised the initial clinical evaluation (pre-FDA approval) of this device. METHODS: A total of 54 patients underwent 56 laser procedures: 36 full face and 20 regional procedures. RESULTS: Following healing, there was a 91% satisfaction rate. The mean laser-on times were: full face, 27 min; perioral, 7 min; periorbital, 3 min; glabellar, 2.5 min; scar, 5 min; and epidermal lesions, 6 min. CONCLUSIONS: The NovaScan CO2 laser handpiece is a safe tool for skin resurfacing. In its initial use over a 6-month period there were no device-related complications.     

Liver transplantation: the death/life paradox

Chronic encapsulated intracerebral hematoma (CEIH) is a rare disease which is believed to be caused by angiographically negative vascular malformations. CEIH has the following characteristic findings: 1. It affects all age groups 2. Clinical symptoms progress slowly after sudden onset. Often there is a latency of months or years 3. There is no correlation with arterial hypertension 4. Imaging reveals a typical fibrous capsule with enclosed blood contents and signs of recurrent bleedings 5. Cavernoma was identified histologically as the cause of bleeding in 30% of cases. 6. All patients had a primary diagnosis of intracerebral tumor. To the best of our knowledge, 27 cases have been reported in the literature. We now add two cases, one of which is the first in the available literature which was not operated and could be followed by imaging.     

From angels to handmaidens: changing constructions of nursing''s public image in post-war Britain

The molecular and ionic mechanisms responsible for the regulation of mucus exocytosis in human airway gland cells remain poorly defined. To determine whether dynamic changes of intracellular free Ca2+ concentration [Ca2+]i can promote different exocytotic responses, we monitored dynamic changes in [Ca2+]i and secretory granule (SG) exocytosis in individual human tracheal submucosal serous gland (HTG) cells. These changes were in response to exposure of the cells to three different secretagogues associated with airway inflammation and disease: human neutrophil elastase (HNE), histamine, and ATP. Dynamic changes in [Ca2+]i from single cells were determined with Indo-1/AM using quantitative UV laser microspectrofluorometry. The rate of SG exocytosis was measured in single cells by fluorescence videomicroscopy of SG degranulation and by the ELISA method. Exposure of HTG cells to a low concentration of HNE (1.0 microM) caused a high rate of SG exocytosis (52% decrease in the initial quinacrine fluorescence) during the first 8-min stimulation period compared with that observed following exposure of the cells to 100 microM histamine (10% decrease) or 100 microM ATP (6% decrease). In contrast to a rapid and transient rise in [Ca2+]i induced by histamine (1.0-100 microM) and ATP (10-100 microM), HNE (0.01-1 microM) generated asynchronous oscillations in [Ca2+]i over the first 8-min period. Depletion of internal Ca2+ stores with thapsigargin (500 nM) induced a significant reduction (P < 0.01) in the observed increases in [Ca2+]i upon addition of each of the secretagogues, but did not greatly affect the SG exocytotic responses. Interestingly, the removal of extracellular Ca2+ (+5 mM EGTA) significantly reduced (P < 0.01) both the [Ca2+]i increases and the rate of SG exocytosis following exposure to the secretagogues. We also demonstrate that the influx of extracellular Ca2+ and [Ca2+]i oscillations rather than the absolute level of [Ca2+]i regulate the rapid onset and extent of exocytotic responses to HNE in airway gland cells. Taken together, these results provide strong evidence that [Ca2+]i is a critical intracellular messenger in the regulation of exocytosis process in human airway gland cells.     

Pediatric/adolescent AIDS: From disclosure to dialogue in psychotherapy.

Presents a case study that used a 3-step psychotherapeutic treatment to inform a 13-yr-old African-American boy that he had been infected with the HIV virus from birth. Step 1 consisted of establishing a supportive and trusting relationship with the S. In Step 2, the S was provided with concrete information about his diagnosis. In Step 3, the S was provided with an opportunity to emotionally process this information within a psychotherapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Translations in gerontology: From lab to life: Intellectual functioning.

Examines research evidence of intellectual change as a function of age and concludes that the notion of a universal decline in adult intelligence is not supported. Qualitative differences in the approach of old adults to intellectual performance are attributed to motivational factors and inappropriately designed tasks. Social policy implications of these findings for the programing of adult education specified. It is suggested (a) that specific educational programs be designed to provide the sociocultural skills which today's aged have missed, (b) that variable retirement policies be adopted, and (c) that segregation based on age cohorts be reduced. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)