Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

AGRICULTURAL SPRAY DEPOSIT QUANTIFICATION METHODS

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da eficiência de filtros anaeróbios na remoção de coliformes fecais e ovos de helmintos

The technology of anaerobic reactors for sanitary wastewater treatment has been extensively developed in Brazil, and today it is practically consolidated. They present several advantages, such as low construction and operating costs, and low sludge production, the anaerobic reactors are an attractive alternative to minimize problematic lack of basic sanitation in urban areas, and also of the rural areas. The anaerobic filters have been widely used in Brazil. It produces an effluent with low concentration of organic matter and solids suspended, besides conserving the nutrients, therefore, it is good for use in irrigation, but the practice must be associated with knowledge of the pathogens presence. The main objective of this study was to evaluate the efficiency of anaerobic filters in removal faecal coliforms and helminth eggs, and to verify if the effluent can be used for agricultural purposes, according to the World Organization of Health (WHO, 1989). The protocol used to enumerate helminths eggs was the modified Bailenger method, (Ayres and Mara, 1996) recommended by WHO for evaluation of raw effluent and treated effluent. The membrane filtration method was utilized to determine the concentrations of faecal coliforms. Three different systems of sewer treatment composed by anaerobic filters were analyzed. The results, in a general analysis, showed that all the researched systems reached a larger removal than 93% to helminth eggs, resulting in an effluent with smaller average than 1 egg/L. One of these systems, Sistema RN, reached a larger removal than 99%, confirming the good performance of the anaerobic filters in removal helminths eggs. Even with low concentrations of eggs in the influent, the filters were capable to remove this parameter efficiently. About faecal coliforms, it was observed for all the researched systems an effluent with 106 CFU/100mL. The high concentrations to faecal coliforms in the effluent just allow reuse for restricted irrigation, in agreement with the guidelines of WHO. Although the researched systems have not removed faecal coliforms efficiently, the results indicated a good efficiency of the anaerobic filters in removal helminth eggs

Historical aspects of Belly Dance and its practice in Brazil

Dance is regarded as one of the oldest art forms, which is based on evidence from prehistoric paintings found in caves; man expressed himself through body language prior to the development of spoken and written forms of communication. Dance was then used during important events, common to their era and culture, and often in religious rituals, to ensure good harvests - their economic activity. Belly-dance appeared approximately eight thousand years B. C. E. as a sacred dance firstly practiced by priestesses, and after that, it was popularized amongst women from Mesopotamia. Virtually considered an ancient form of physical exercise, it is still practiced by Bedouin women as a preparation for spontaneous delivery. In Brazil, belly-dance is widely practiced and our corporal culture enables its learning and improvement, resulting in professional dancers.

Avaliação da capacidade de uso da terra da bacia do córrego do cavalheiro - Analândia, SP

Environmental factors are important in agriculture and need to be considered for getting good degree of development and reasonable efficiency, by reducing their operating costs. To this end, land use shall be appropriated to the conditions offered by the physical elements of the landscape. By facing such questions, this paper aims is to present of mapping the ability of land use of the hydrographic basins Cavalheiro Stream basin (in the city of Analândia - São Paulo State - Brazil) which presents serious erosion problems. Besides it aims to assess if the current land use in this area is consistent with the identified land use ability. For this we have made a cartographic document that spatializes the various classes of usability and its main restrictions. The correlative analysis between that document and land use data showed that Cavalheiro Stream's current use is predominantly inappropriate with the usability of land, which was identified from the physical attributes of the studied area, except for a few sites that are used for forestry and pasture placed in Western, Eastern and Central-South.

Modelling fungus dispersal scenarios using cellular automata

This study focused on representing spatio-temporal patterns of fungal dispersal using cellular automata. Square lattices were used, with each site representing a host for a hypothetical fungus population. Four possible host states were allowed: resistant, permissive, latent or infectious. In this model, the probability of infection for each of the healthy states (permissive or resistant) in a time step was determined as a function of the host's susceptibility, seasonality, and the number of infectious sites and the distance between them. It was also assumed that infected sites become infectious after a pre-specified latency period, and that recovery is not possible. Several scenarios were simulated to understand the contribution of the model's parameters and the spatial structure on the dynamic behaviour of the modelling system. The model showed good capability for representing the spatio-temporal pattern of fungus dispersal over planar surfaces. With a specific problem in mind, the model can be easily modified and used to describe field behaviour, which can contribute to the conservation and development of management strategies for both natural and agricultural systems. © 2012 Elsevier B.V.

Uso e manejo de plantas alimentares em ambientes agrícolas e florestais em Iporanga, SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

The rights-based approach to social protection in Latin America: From rhetoric to practice

This paper aims to contribute to developing the normative framework for rights-based social protection systems and discusses lessons learned in some emblematic programmes implemented in Latin America which have sought to advance a rights approach. The paper emphasizes the added value of the rights-based approach and describes the normative content of the right to social security. It then describes the basic elements of a rights-based approach and examines how it is operationalized in the design, implementation and evaluation of landmark social protection programmes in the region. The paper seeks to demonstrate that, despite the large gap that still exists between the rhetoric of a human rights approach and its implementation in specific policies, there have been significant achievements in some countries in Latin America. It argues that some of the good practices in the region can serve as policy examples to follow elsewhere. The paper concludes with a number of public policy recommendations with a view to consolidating the rights perspective in social protection programmes.

Polymeric and solid lipid nanoparticles for sustained release of carbendazim and tebuconazole in agricultural applications

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The importance of a good relationship between patient/dentist based on the obtaining of an informed consenr to prevent lawsuits

The increased number of law suits in the Dentistry field constitutes an international trend. Patients well informed by the media and supported by the law sue their dentists, when they judge they were victim of bad practice. Professionals even with all discussion about this subject do not have the habit of prevent themselves. It is known that for a defensive practice the best way to avoid litigation is a good relationship with patient, based on dialog and on informed consent. This relation is very important, since patients who rely on their dentists rarely take them to justice. Hence, this article discusses the importance of this relation, as well as the obtaining of informed consent in order to prevent lawsuits.

A Comparative Study of the Information-Seeking Behavior of Bachelor of Science and Master of Science Agricultural Extension and Education Students

This study compares information-seeking behavior of Bachelor of Science and Master of Science students in the fields of agricultural extension and education. The authors surveyed Iranian students in departments of agricultural extension and education at four universities in Tehran, Shiraz, Mollasani, and Kermanshah. This study focused on three aspects: (1) comparison of amounts of information-seeking behavior between Bachelor of Science and Master of Science agricultural extension and education students; (2) comparison of information-seeking behavior varieties in Bachelor of Science and Master of Science agricultural extension and education students; (3) Comparison of amounts of available information resources at four universities and its effectiveness on students' information-seeking behavior; and (4) comparison of research and educational outputs in Bachelor of Science and Master of Science students. Scale free technique, division by mean method, principal components analysis technique, Delphi method, t-test, correlation and regression tools were used for data analysis. This study revealed that Bachelor of Science students' information-seeking behavior is for improving educational output, but Master of Science students' information-seeking behavior is for promoting research output. Among varieties of Internet searching skills, library searching skills, and awareness of library information-seeking methods with students' information-seeking behavior, there are not significant differences between two groups of students.

Charcot foot: Skin temperature as a good clinical parameter for predicting disease outcome

Twenty-eight diabetics presenting with acute Charcot foot were immobilized and the temperature difference between limbs measured at each month. All patients had monthly follow-up visits for a year and the relapse rate was zero. We found that skin temperature is a good parameter to ensure safe immobilization withdrawal. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

EROSION LOSSES FROM RUNOFF: INTERACTION OF SOIL COVER AND EROSION CONTROL PRACTICE

The flow of sediment from cropped land is the main pollutant of water sources in rural areas. Due to this fact, it is necessary to develop and implement technologies that will reduce water and sediment discharges. Accordingly, an experiment was conducted in the Department of Biosystems Engineering - ESALQ / USP, Piracicaba - SP with the objective to evaluate the effect of different soil cover (bean, grass and bare ground) and erosion control practices (wide base terraces and infiltration furrows in slopes (no practices to control erosion)) while measuring water losses in runoff. The statistical design adopted was randomized blocks in a 3x3 factorial scheme resulting in 9 treatments with 3 replicates (blocks). The period of rainfall data collection was December 6, 2007 to April 11, 2008. A 21.1 cm diameter rain gauge was installed in the experimental area. Terraces were the most efficient practices for reducing erosion losses in the treatments with infiltration furrows being better than the control treatment. Bean was more effective than grass in reducing erosion. Bare ground was the least efficient.

Benefits from the use of a pimecrolimus-based treatment in the management of atopic dermatitis in clinical practice. Analysis of a Swiss cohort

BACKGROUND: Controlled studies established the efficacy and good tolerability of pimecrolimus cream 1% for the treatment of atopic dermatitis but they may not reflect real-life use. OBJECTIVE: To evaluate the efficacy, tolerability and cosmetic acceptance of a pimecrolimus-based regimen in daily practice in Switzerland. METHODS: This was a 6-month, open-label, multicentre study in 109 patients (55% > or = 18 years) with atopic dermatitis. Pimecrolimus cream 1% was incorporated into patients' standard treatment protocols. RESULTS: The pimecrolimus-based treatment was well tolerated and produced disease improvement in 65.7% of patients. It was particularly effective on the face (improvement rate: 75.0%). Mean pimecrolimus consumption decreased from 6.4 g/day (months 1-3) to 4.0 g/day (months 3-6) as disease improved. Most patients (74.1%) rated their disease control as 'complete' or 'good' and 90% were highly satisfied with the cream formulation. CONCLUSION: The use of a pimecrolimus-based regimen in everyday practice was effective, well tolerated and well accepted by patients.

Academic Intelligence is not Enough! WICS: An Expanded Model for Effective Practice in School and in Later Life

Is there a psychological basis for teaching and learning in the context of a liberal education, and if so, what might such a psychological basis look like? Traditional teaching and assessment often emphasize remembering facts and, to some extent, analyzing ideas. Such skills are important, but they leave out of the aspects of thinking that are most important not only in liberal education, but in life, in general. In this article, I propose a theory called WICS, which is an acronym for wisdom, intelligence, and creativity, synthesized. The basic idea underlying this theory is that, through liberal education, students need to acquire creative skills and attitudes to generate new ideas about how to adapt flexibly to a rapidly changing world, analytical skills and attitudes to ascertain whether these new ideas are good ones, practical skills and attitudes to implement the new ideas and convince others of their value, and wisdom-based skills and attitudes in order to ensure that the new ideas help to achieve a common good through the infusion of positive ethical values.