The medical provision of hydration and nutrition: Two very different outcomes in Victoria and Florida

Decisions to withhold or withdraw medical hydration and nutrition are amongst the most difficult that confront patients and their families, medical
and other health professionals all over the world. This article discusses two cases relating to lawful withdrawal and withholding of a percutaneous endoscopic gastrostomy tube (PEG) from incompetent patients with no hope of recovery. Victoria and Florida have statutory frameworks that provide for advance directives, however in both Gardner; Re BWV and Schindler v Schiavo; Re Scliiavo the respective patients did not leave documented instructions. The article analyses the two cases and their outcomes from legal, medical and ethical perspectives.

Synthesis and structure of bis(para-methoxyphenyl)selenoxide and its monohydrate. theoretical considerations of the hydration of diorganoselenium oxides

The title compound was prepared by base hydrolysis of (p-MeOC₆H₄)₂SeCl₂ in water and isolated as the crystalline monohydrate, (p-MeOC₆H₄)₂SeO·H₂O, in which the water molecule is associated via hydrogen-bonding. Water-free (p-MeOC₆H₄)₂SeO was obtained crystalline after drying and recrystallisation from toluene. Both crystal phases were investigated by single crystal X-ray diffraction. Preliminary DFT calculations at the B3LYP/LANL2DZdp level of theory suggest that the hydrogen bonded complexes R₂SeO·H₂O (R = H, Me, Ph) are by 2.79, 3.36 and 11.10 kcal mol^-1 more stable than the corresponding elusive diorganoselenium dihydroxides R₂Se(OH)₂. The hydrogen bond energies of R₂SeO·H₂O (R = H, Me, Ph) are 5.98, 7.18 and 5.89 kcal mol^-1.

The reactivity of bis(para-methoxyphenyl)telluroxide towards triflic acid and diphenylphosphinic acid. Theoretical considerations of the protonation and hydration process of diorganotelluroxanes

The reaction of (p-MeOC₆H₄)₂TeO with two equivalents of HO₃SCF₃ and HO₂PPh₂ provided the tetraorganoditelluroxanes (F₃CSO₃)(p-MeOC₆H₄)₂TeOTe(p-MeOC₆H₄)₂(O₃SCF₃) (1) and (Ph₂PO₂)(p-MeOC₆H₄)₂TeOTe(p-MeOC₆H₄)₂(O₂PPh₂)·2 Ph₂PO₂H (2) in good yields. Compounds 1 and 2 were characterized by solution and solid-state ³¹P and ¹²⁵Te NMR spectroscopy, IR spectroscopy, electrospray mass spectrometry, conductivity measurements and single crystal X-ray diffraction. In solution, compound 1 undergoes an electrolytic dissociation and reversibly reacts with traces of water to give the mononuclear cation [(p-MeOC₆H₄)₂TeOH]⁺ and triflate anions. Theoretical aspects of the protonation and hydration of model telluroxanes R₂TeO (R = H, Me, Ph) were investigated by preliminary DFT calculations and compared to the corresponding selenoxanes R₂SeO. The tellurium dihydroxides R₂Te(OH)₂ seem to be more stable than the hydrogen-bonded complexes R₂TeO·H₂O.

Double-layer and hydration forces measured between silica sheets subjected to various surface treatments

Force measurements between silica surfaces in aqueous solutions of NaCl are reported. Silica is prepared with one of three surface treatments: (i) flaming, (ii) exposure to steam for 150 h, and (iii) brief exposure to ammonia vapor. Analysis of electrical double-layer interactions indicates that the surface density of silanol groups increases with steam treatment, and that exposure to ammonia etches the surface slightly and renders it porous. The force at short range is dominated by a strong repulsion which is attributed to hydration of the surface. The hydration component of the force is not significantly affected by the surface treatments, nor by electrolyte concentration over the range investigated (up to 0.1 M).

Water-soluble acrylamide sulfonate copolymer for inhibiting shale hydration

Here we report a water-soluble acrylamide sulfonate copolymer for inhibiting shale hydrate formation. The copolymer, denoted as PANAA, was synthesized via copolymerization of acrylamide (AM), N,N-diallylbenzylamine (NAPA), acrylic acid (AA), and 2-(acrylamide)-2-methylpropane-1-sulfonic acid (AMPS). The performance of this new water-soluble copolymer for inhibiting shale hydration was investigated for the first time. The retention ratio of apparent viscosity of 2 wt % PANAA solution can reach 61.6% at 130 C and further up to 72.2% with 12 000 mg/L NaCl brine. The X-ray diffraction studies show that the addition of copolymer PANAA (5000 mg/L), in combination with a low loading of KCl (3 wt %), remarkably reduces the interlayer spacing of sodium montmorillonite (Na-MMT) in water from 19.04 to 15.65 Å. It has also found that these copolymer solutions, blending with KCl, can improve the retention of indentation hardness from 22% to 74% and increase the antiswelling ratio up to 84%. All results have demonstrated that the PANAA copolymer not only has excellent temperature-resistance and salt-tolerance but also exhibits a significant effect on inhibiting the hydration of clays and shale. © 2014 American Chemical Society.

Water-soluble complexes of an acrylamide copolymer and ionic liquids for inhibiting shale hydration

Here, we report water-soluble complexes of an acrylamide copolymer and ionic liquids for inhibiting shale hydration. The copolymer, denoted as PAAT, was synthesised via copolymerisation of acrylamide (AM), acrylic acid (AA) and N,N-diallyl-4-methylbenzenesulfonamide (TCDAP), and the ionic liquids used were 3-methyl imidazoliumcation-based tetrafluoroborates. X-ray diffraction showed that compared with commonly used KCl, the water-soluble complex of PAAT with 2 wt% ionic liquid 1-methyl-3-H-imidazolium tetrafluoroborate (HmimBF4) could remarkably reduce the d-spacing of sodium montmorillonite in water from 19.24 to 13.16 Å and effectively inhibit clay swelling. It was also found that the PAAT-HmimBF4 complex with 2 wt% HmimBF4 could retain 75% of the shale indentation hardness and increase the anti-swelling ratio to 85%. 13C NMR revealed that there existed interactions between PAAT and HmimBF4. Moreover, the thermal stability of the PAAT-HmimBF4 complex is superior to PAAT, suggesting that this water-soluble complex can be used to inhibit clay and shale hydration in high-temperature oil and gas wells.

Fluid intake, hydration, work physiology of wildfire fighters working in the heat over consecutive days

PURPOSE: (i) To evaluate firefighters' pre- and post-shift hydration status across two shifts of wildfire suppression work in hot weather conditions. (ii) To document firefighters' fluid intake during and between two shifts of wildfire suppression work. (iii) To compare firefighters' heart rate, activity, rating of perceived exertion (RPE), and core temperature across the two consecutive shifts of wildfire suppression work. METHOD: Across two consecutive days, 12 salaried firefighters' hydration status was measured immediately pre- and post-shift. Hydration status was also measured 2h post-shift. RPE was also measured immediately post-shift on each day. Work activity, heart rate, and core temperature were logged continuously during each shift. Ten firefighters also manually recorded their food and fluid intake before, during, and after both fireground shifts. RESULTS: Firefighters were not euhydrated at all measurement points on Day one (292±1 mOsm l(-1)) and euhydrated across these same time points on Day two (289±0.5 mOsm l(-1)). Fluid consumption following firefighters' shift on Day one (1792±1134ml) trended (P = 0.08) higher than Day two (1108±1142ml). Daily total fluid intake was not different (P = 0.27), averaging 6443±1941ml across both days. Core temperature and the time spent ≥ 70%HRmax were both elevated on Day one (when firefighters were not euhydrated). Firefighters' work activity profile was not different between both days of work. CONCLUSION: There was no difference in firefighters' pre- to post-shift hydration within each shift, suggesting ad libitum drinking was at least sufficient to maintain pre-shift hydration status, even in hot conditions. Firefighters' relative hypohydration on Day one (despite a slightly lower ambient temperature) may have been associated with elevations in core temperature, more time in the higher heart rate zones, and 'post-shift' RPE.

Biodegradable polyethylene glycol-based ionic liquids for effective inhibition of shale hydration

A series of ionic liquids based on polyethylene glycol (PEG) with different molecular weights were prepared for inhibiting shale hydration and swelling. The antiswelling ratio was measured to investigate the effect of different PEG-based ionic liquids on bentonite volume expansion, and it has shown that the ionic liquid based PEG200, i.e. PEG with molecular weight of 200, exhibited superior inhibition. The structures of the PEG200-based ionic liquids were characterized by ¹H NMR studies. The XRD results indicated that the PEG200-based ionic liquids intercalated into sodium montmorillonite (Na-MMT) reducing the water uptake by the clay. The formation of complexes of Na-MMT and PEG200-based ionic liquids was also verified by FTIR spectroscopy. Thermal degradation analysis suggested that the PEG200-based ionic liquids accessed the interlamellar spaces of Na-MMT and reduced the water content of the complexes obtained. Moreover, no breaks and collapse were observed on the shale samples after immersion in PEG200-based ionic liquid solutions. All the PEG200-based ionic liquids showed biodegradability and potential application in effective inhibition for clay hydration.

Thermoregulation in young athletes exercising in hot environments.

Children are less efficient thermoregulators than are adults. During exercise, sweat evaporation is the most important physiological means of cooling the body. The sweat response in children, however, is less efficient than in adults, so children dissipate less heat though evaporative sweating and more through convection (the loss of heat through the skin) plus radiation. Children and adolescents with high levels of body fat and heavy builds are more susceptible to heat stress because they dissipate body heat less efficiently. Maintaining adequate hydration is crucial for preventing heat stress, Although water is often described as the best choice of fluid, studies on voluntary drinking habits and flavor preferences in children and adolescents suggest that greater consumption occurs when sports drinks are offered instead of water. Although a child's sweat contains less sodium and chloride than an adult's does, there appears to be no evidence that a child's performance improves when given beverages more diluted than those currently recommended for adults, More information is necessary to identify the optimal electrolyte and carbohydrate content of sports drinks for young athletes.

Gardner; re BWW: Victorian Supreme Court makes landmark Australian ruling on tube feeding

• The Victorian Supreme Court has decided that artificial nutrition and hydration provided through a percutaneous gastrostomy tube to a woman in a persistent vegetative state may be withdrawn.
• The judge ruled, in line with a substantial body of international medical, ethical and legal opinion, that any form of artificial nutrition and hydration is a medical procedure, not part of palliative care, and that it is a procedure to sustain life, not to manage the dying process.
• Thus, the law does not impose a rigid obligation to administer artificial nutrition or hydration to people who are dying, without due regard to their clinical condition. The definition of key terms such as “medical treatment”, “palliative care”, and “reasonable provision of food and water” in this case will serve as guidance for end-of-life decisions in other states and territories.
• The case also reiterates the right of patients, and, when incompetent, their validly appointed agents or guardians, to refuse medical treatment.
• Where an incompetent patient has not executed a binding advance directive and no agent or guardian has been appointed, physicians, in consultation with the family, may decide to withdraw medical treatment, including artificial nutrition or hydration, on the basis that continuation of treatment is inappropriate and not in the patient’s best interests. However, Victoria and other jurisdictions would benefit from clarification of this area of the law

Effect of storage on the biochemical and processing quality of Adzuki Bean (Vigna angularis)

Storage of adzuki beans and other pulse grains causes biochemical and physical changes that affect the hydration properties of the beans. This affects the quality of products made from the beans such as the Japanese bean paste “ann.” Storage, particularly under unfavourable conditions, leads to the “hard shell” phenomenon, where beans fail to imbibe water when soaked and remain hard, and the “hard-to-cook” phenomenon where the seeds hydrate normally, but the cotyledon fails to hydrate and soften during cooking. The hard shell phenomenon is attributable to impermeability of the seed coat to water, which is due to biochemical changes in the seed coat, such as the formation of protein-tannin complexes, and biophysical changes such as reduction in size or closure of the straphiole aperture in the hilum area—the main area for water entry into the adzuki bean. The hard-to-cook phenomenon is due to changes in the cotyledon tissue, which include formation of insoluble pectinates, lignification of the cell wall and middle lamella, interaction of condensed tannins with proteins and starch, and changes to the structure and functionality of the cellular proteins and starch.