A Blood Brain Pharmacokinetic Model

A bloodline Brain Pharmacokinetic ModelPharmacokinetics, an emerging field in BioPhysics and chemistry is the study of the time variation of do do drugss and metabolite aims in various tissues and fluids of the body. Compartment flummoxs are used to interpret data. In our problem, we consider a simple blood-brain compartment model as shown in the figure belowk21Input d(t) k12Kwhere, Compartment 1 = BloodCompartment 2 = BrainThis model is made such that it can attention to help estimate venereal infection strengths of an orally administered antidepressant drug. The rate of movement of drug from compartment i to compartment j is denoted by the rate constant kji and the rate at which the drug is removed from the blood is represented by the rate constant K. A pharmaceutical company must deal with many factors like dosage strengths that support out aid a physician in determining a patient ofs dosage in order to maintain the right concentration take aims and also minimizing bili ousness and other side effects (Brannan 208).If we assume that the drug is rapidly absorbed into the blood stream after it is introduced into the stomach, a mathematical representation of the dosage will be of a periodic square wave given as followsBased on our model and the equations we can solve the problems1. If we permit xj(t) be the nitty-gritty of drug in milligrams in compartment j, j =1,2. The mass balance law states(i)Using the mass balance law and the figure, we findSystem in Blood compartmentSystem in Brain compartmentFrom (i) and the above equations, we can find the following(ii)The systems above are the rates of drug over time in the compartments.2. If we let ci(t) denote the concentration of the drug and Vi denote the apparent volume of distribution in compartment i, we can use the relation ci = xi/Vi in the equations of system (ii) to obtain(iii)Dividing the above systems by V1 and V2 respectively, we get 3. Assuming x1(0) =0 and x2(0) =0, and the various parameters listed belowk21k12KV1V2Tb0.29/h0.31/h0.16/h6L0.25L1hand with the numerical simulation program Maple , we can practise simulations of the system with given parameters to recommend two different encapsulated dosage strengths A=RTb.= Guidelines to use for recommendation of drug dosage1) Target concentration level in the brain should be kept as close as possible between levels 10 mg/L and 30 mg/L and concentration hesitation should not exceed 25% of the average of the steady-state response.2) Lower frequency of administration (once every 24 hours or once every 12 hours is best). Once every 9.5 hours is unacceptable and multiple doses are acceptable (i.e. taking two capsules every 4 hours)depth psychology Drug usage of more than 4 times per day is unacceptable which makes maximum allowable dose to be 3, making 3 doses at 8 hours interval per day the best choice. We can then simulate from Tp = 8 to Tp = 12, 16 and 24.From the numerical simulations obtained from Maple, we obtain the foll owing dataTp(h)R (mg/h)Steady-state varianceComments849.04 mg/L to 12.5 mg/L down the stairs effective remediation concentration8511.7 mg/L to 15.5 mg/L8614.4 mg/L to 19.2 mg/L8819.2 mg/L to 25.3 mg/L8921.1 mg/L to 27.9 mg/L81023.2 mg/L to 31.2 mg/LAbove maximum therapeutic concentration12510.9 mg/L to 6.5 mg/LBelow minimum therapeutic concentration1268.6 mg/L to 14.1 mg/LBelow minimum therapeutic concentration1278.32 mg/L to 15.1 mg/LBelow minimum therapeutic concentration12810.6 mg/L to 18.3 mg/L121013.2 mg/L to 22.8 mg/L121317.9 mg/L to 30 mg/L16109.11 mg/L to 19.5 mg/LSharp fluctuations Below minimum therapeutic concentration161210.7 mg/L to 23.5 mg/LSharp fluctuations.161311.5 mg/L to 25.4 mg/LSharp fluctuations.161412.5 mg/L to 27.3 mg/LSharp fluctuations.161614.3mg/L 31.4mg/LSharp fluctuations Above maximum therapeutic concentration24156.19mg/L 24mg/LSharp fluctuations Below minimum therapeutic concentration24208.52mg/L 32mg/LSharp fluctuations Above maximum therapeutic concentrationObtained corresponding Graphs from Maple and their respective Tp and R values are listed belowTp = 8, R = 4 Tp = 8, R = 5Tp = 8, R = 6 Tp = 8, R = 8Tp = 8, R = 9 Tp = 8, R = 10Tp = 12, R = 6 Tp = 12, R = 8Tp = 12, R = 10 Tp = 12, R = 12Tp = 12, R = 13Tp=16, R=10 Tp=16, R=12Tp=16, R=13 Tp=16, R=14Tp=16, R=16Tp=24, R=15 Tp=24, R=20Some CommentsWhen Tp= 8 and R = 4, the recommended dosage is below minimum therapeutic concentration extend.When Tp= 8 and R = 10 , the recommended dosage is above maximum therapeutic concentration range.When Tp= 8 and R = 5 to 7, the recommended dosage is below effective therapeutic concentration range.When Tp= 8 and R = 4, the recommended dosage is below therapeutic concentration range.When Tp= 12 and R = 5 to 7, the recommended dosage is below minimum therapeutic concentration range.When Tp= 16 and R = 12 to 14, sharp fluctuation is seen.When Tp= 24 and R = 20, sharp fluctuation is seen and the recommended dosage is below therapeutic concent ration range.=Calculation and Analysis of dosage strength ANow we can calculate the dosage frequency for the remaining dosage frequency intervals of 8 hours and 12 hours(8 hour interval) (R being from 5 mg/h to 9 mg/h)A = RTb = 5 mg/h x 1h= 5 mgA = RTb = 9 mg/h x 1h= 9 mg(12 hour interval) (R being from 8 mg/h to 13 mg/h)A = RTb = 8 mg/h x 1h = 8 mgA = RTb = 13 mg/h x 1h= 13 mg4. From the simulation, we can know that it is best to skip the dose than to try to catch up and double the dose and ultimately overdose from the figures illustrated. If we assume the patient is at a 12 hour interval dose frequency, and R being 10mg/h, the following scenarios can be phoneyScenario missed a dosage and skipped Scenario absent a dosage catching upAnalysis From the scenarios simulations above, we can have a clear picture of what will go through the patients drug level.In the 1st scenario, where the patient missed a dosage and skipped, the concentration level in the brain of the patient stays wi thin the recommended level.In the 2nd scenario, where the patient tries to catch up, the drug level will cross the recommended level and that also by a lot. Thus, skipping the dose is better than to catch up overdosing the drug level resulting in fatality.5. Supposing the drug can be packaged in a timed-release form so that Tb = 8 hours and R also adjusted likewise, we get the following data from the MapleTp(h)R(mg/h)Steady-state varianceReasons120.7510.4mg/L 13mg/L12113.9mg/L 17mg/L121.521mg/L 25.5mg/L121.7524.5mg/L 29.8mg/L12228.1mg/L 34mg/LAbove maximum therapeutic concentration1619mg/L 14.3mg/LBelow minimum therapeutic concentration161.2511.2mg/L 17.7mg/L161.513.6mg/L 21.3mg/L16218.3mg/L 28.4mg/L162.2520.5mg/L 31.8mg/LAbove maximum therapeutic concentration162.522.8mg/L 35.4mg/LAbove maximum therapeutic concentration2428.7mg/L 23.3mg/LSharp fluctuation242.259.86mg/L 25.9mg/LSharp fluctuation242.510.9mg/L 29mg/LSharp fluctuationT=12, R=0.75T=12, R=1T=12, R=1.5T=12, R=1.75T=12, R=2T=16, R=1 T=16, R=1.25T=16, R=1.5 T=16, R=2T=16, R=2.25 T=16, R=2.5T=24, R=2 T=24, R=2.5Analysis If the drug can be packaged in a timed release form so that Tb = 8 and R is also adjusted likewise, we perform the simulations for the dosage of interval of a 12 hour frequency. We observe zero sharp fluctuations. Every graph seems to produce the concentration level within the recommended range of 10mg/L to 30mg/L when R is between 0.75 mg/h and 1.75 mg/h.=Calculation and Analysis of radical dosage strength AWe can calculate the new strength level of the drugs as(12 hour frequency interval) A=RTb = 0.75 mg/h * 8h = 6mgA=RTb = 1.75 mg/h * 8h = 14mgSame analysis can be performed for 16 hour frequency interval. We observe zero sharp fluctuations and every graph produce the concentration level within the recommended range of 10mg/L to 30mg/L R being in between 1.25mg/h and 2mg/h.=Calculation and Analysis of new dosage strength AWe can calculate the new strength level of the d rugs as(16 hour frequency interval) A = RTb=1.25 mg/h * 8h = 10mg A = RTb=2.00 mg/h * 8h = 16mgThus, this changes our recommendation.Simulation Program Maple We used the following code and simulated varying R and P values.g =t piecewise(0 DEplot(diff(x(t), t) = (1/6)*g(t)+(1/6)*(.31*.25)*y(t)-x(t)*(.29+.16), diff(y(t), t) = (.29*6)*x(t)/(.25)-.31*y(t), x(t), y(t), t = 0 .. 40, x = 0 .. .50, y = 0 .. 80, scene = t, y, x(0) = 0, y(0) = 0, stepsize = .1, color = blue)

Attitudes Towards Euthanasia | Literature Review

Attitudes Towards Euthanasia Literature ReviewIntroductionThis literature review is base upon peoples attitudes towards Euthanasia, which comes from the Greek meaning good death and in English means the killing of one psyche by a nonher to relieve the suffering of that person and Physician aid self-annihilation (PAS), which is described as a medical professional aiding a person who is incapable of the run themselves to commit suicide, (NHS, 2010). For this literature review, a literature search was performed using the Cochrane library, Science Direct, EBSCOhost and S historic period using the key wordsAssisted suicideEuthanasiaOpinionsAttitude unite Kingdom universalRight to DieAssisted DyingMost of these words (with the exception of Assisted Suicide and Assisted Dying) were apply in each of the search engines on an individual basis and also white plagued to form directences, however, the only electronic databases that gave this search the information it required was Sage. This provided a substantial amount of journals, a lot of the differents purposed were subscription establish or a fee was required, but from the free to single-valued function information boardinal of the approximately relevant to the subject I beseeched to perform the review on were chosen. The two accounts were chosen from stares and studies performed in the United Kingdom, because it was decided to research what the thoughts and feelings of medical professionals were in a place where this practice was presently illegal. Use in the literature search, but this was difficult to come by. The titles of the three journals are Legalisation of Euthanasia or Physician Assisted Suicide wad of Doctors Attitudes, and Opinions of the Legalised of Physician Assisted Suicide. Despite not inputting the word physician into the search engine, a lot of the searches came up with types of journals which mention this anyway.This review will critically evaluate the information in the journal s and will be compared with each other, discussing the disadvantages of the watchs and the advantages. The review will also include the various research methods used in the research.The Literature ReviewThe starting line paper reviewed is in English by Clive Seale, PhD, from the Centre for Health Sciences, Barts and The London School of Medicine and Dentistry, London and is called The legalisation of Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes. The communications protocol was to determine what reinstates opinions ab let out the legalisation of medically help last (which includes the terms, euthanasia and physician-assisted suicide (PAS)) were and this was done in comparison with the opinions of the general public of the UK. The methodology was to hop out out structured questionnaires with a series of questions using qualitative methods and then analyse the results in a quantitative manner. In 2007, Binleys database (http//www.binleys.com) was used to s destination questionnaires to 8857 shortly working medical practitioners all e very(prenominal)place the UK, this was broken down into 2829 (7%) GPs, 443 (43%) neurologists, 836 (21% of these were doctors) specialists in the solicitude of the elderly, 462 (54% of these were also doctors) specialists in palliative medicine and 4287 workers in other hospital based specialities. This is quite a large sample to use and covers a wide range of specialities. It is not clear in what month in 2007 these questionnaires were sent out but follow-up letters were sent to non-respondents between November 2007 and April 2008 to enquire as to why they did not respond, in which 66 doctors in all responded with the most common reason being lack of era to complete the survey. Overall the response rate was 42.1% with specialists in palliative medicine being the most reactive with 67.3% of people returning their questionnaire, along with specialists in the care of the elderly (48.1%) neurologists ( 42.9%) other hospital specialties (40.1%) and GPs (39.3%). Despite the large sample of people, 42.1% of replies are quite disappointing, although it is a truly emotive subject.The questions consisted of personal questions such as age, g block offer, grade, ethnic origin, and speciality of the respondent and, on average, the number of deaths attended. They were all asked four questions about their attitude towards euthanasia and assisted suicide, in order to obtain the questionnaire in full the author of the survey invited people to contact him. An email was sent Appendix (a) and a reply was received the next day Appendix (b). Previous surveys regarding this subject were performed in the Netherlands, Oregon (USA) and Belgium majority support from the medical profession has been important in passing permissive legislation in these countries.The keywords used in this lead were assisted anxious(p) euthanasia physician-assisted suicide right to die and terminal care. The distribution of questionnaires meant that the methodology used was right as it was discreet and reached a lot of people in a short amount of time, the only danger with this method was that the medical professionals did not have to respond which was shown in the return response of 42.1% there was no financial or other incentive as this would go against all good considerations. Ethical approval for this study was granted by the South East query Ethics Committee. The results showed that those who were specialists in palliative medicine were to a greater extent opposed to euthanasia or PAS being legalised than the other specialities, although this could be down to the higher response rate in this area. Those that expressed their religious beliefs were more opposed to the legalisation also. The study showed that the most widely held view was that British doctors do not support legalising assisted dying in either euthanasia or PAS this differs from the British loving Attitudes (BSA) survey which has tracked changes in public opinion since 1984, and is the most consistent source of data (http//www.britsocat.com).The second paper reviewed is Survey of doctors opinions of the legalisation of physician assisted suicide by William Lee, Annabel Price, Lauren Rayner and Matthew Hotopf from the Institute of Psychiatry. Kings College, London. The protocol is similar to the first paper in that they were looking at practitioners opinions on euthanasia and PAS. The article begins by look that there is wide support among the general public for assisted dying but not so much for those who care for the dying. The methodology was to send out a postal survey of a 1000 senior consultants and medical practitioners were selected randomly from the commercially available Informa Healthcare Medical Directory (2005/2006), retired doctors were excluded from the survey. Questionnaire were sent firstly in February 2007, 12 work weeks later, in may, non-respondents were contacted and then six weeks later they were telephoned, it was discovered that that some of the possible contributors had moved, died or retired. This information was ad unspoilted to take this into account. The authors completed separate univariable (a wizard variable) and multivariable (containing more than one variable) predicting the outcomes using polytomous methods which would allow two outcomes to be predicted together.The response rate to the survey was 50% once the exclusions were accounted for, which is higher than the first paper and unflurried gave a lot of date to work with. Included in the survey the authors included a brief outline of the Assisted Dying for the Terminally feverous Bill (2006) 32% of the doctors who responded had read some of the Bill. Gender, speciality and old age in post had no effect on opposition or support for a new law. An interesting point noted is that the views of doctors who do not care for the dying tally with the general publics view, so there is some correlatio n there with 66% of those who never cared for the dying supporting a change in the law. The outcome of interest for the authors was to what level practitioners agreed with the statement The law should not be changed to allow assisted suicide.A second outcome of interest was the level of agreement with the statement I would be prepared to prescribe a calamitous drug to a terminally ill enduring who was suffering unbearably, were that course of action to become legal. (Hotopf, et. al. 20073). The findings of this questionnaire can be found in Appendix (c). twain of these questions were determined using five-point Likert-type scales, used commonly in questionnaires, following this were converted into three-point scales comprising of agree, neither agree nor disagree and disagree with a change in law. The survey shows that senior doctors are split abut their views regarding a change in the law fewer are in favour than the general public in the United Kingdom. These findings have been noted in the US, as well as Canada, Finland and the Netherlands as well as the UK. Ethical permission was gained from the Institute of Psychiatry, Kings College London Research Ethics Committee.Comparisons and ConclusionsThere are many comparisons between the two papers, for example, twain sent out questionnaires to their target mathematical group, who were specialists in certain fields. However, the first paper surveyed over double the amount of people the second paper did but got less replies. Both studies were done in the akin year but it is difficult to narrate who started theirs first as the date for first paper is unknown other than it was performed in 2007. The second survey is far more in depth that the first one, and it suggests that qualitative research is needed to understand doctors views better whereas the first paper did not state which the preferred method was. The second paper suggests that doctors who oppose a change in the law comes from an over-optimistic cre dence in their ability to relieve the suffering of the dying. (Hotopf, et.al. 2007). It is possible to argue against this though and the knowledge and experience of longanimouss who are dying influences views about PAS. Both compare the attitudes between the general public and the specialist doctors and note a big difference between them. On the whole both papers conducted a thorough and precise survey but there is room for foster research and investigation.ReferencesHotopf, L, Lee, W, Price, A, and Rayner, L. (2009) Survey of Doctors Opinions of the Legalisation of Physician-Assisted Suicide, Bio-Med Central, Online, Available from http//www.biomedcentral.com/content/pdf/1472-6939-10-2.pdf Accessed twenty-second April 2010.NHS (2010) Euthanasia and assisted suicide Online, London. Available from http//www.nhs.uk/Conditions/Euthanasiaandassistedsuicide/Pages/Definition.aspx Accessed 22nd April 2010.Seale, C. (2009) Legalisation of Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes, Palliative Medicine, Online, Available from http//pmj.sagepub.com/cgi/content/abstract/23/3/205 Accessed 22nd April 2010.Papers used in Literature SearchHotopf, L, Lee, W, Price, A, and Rayner, L. Survey of Doctors Opinions of theLegalisation of Physician-Assisted Suicide.Seale, C Legalisation of euthanasia or physician-assisted suicide survey of doctors attitudes.Appendix(a)Original MessageFrom Katy Marsland (08111890) mailtoemailprotectedSent 26 April 2010 1925To emailprotectedSubject A Questionnaire request.Dear Sir,I am at the University of Lincoln and am doing a literature review for mydegree in Health and Social care involving your survey on the Legalisationof Euthanasia or Physician-Assisted Suicide Survey of Doctors Attitudes,and was wondering if it were possible for you to forward me a copy of thequestions in order to aid my review?Many thanks in advanceKaty MarslandReplyhither is the questionnaire. Clive(b)END OF LIFE DECISIONS IN MEDICAL PRACTICE CONFI DENTIAL ENQUIRYPLEASE TICK THE BOXES TO INDICATE YOUR ANSWERSTHANK YOU FOR YOUR ASSISTANCE General Background QuestionsYour age under 35 years of age 36 to 45 years of age 46 to 55 years of age 56 to 65 years of age over 65 years of ageYour gender male person femaleYour medical specialty General practice Palliative medicine neurology Elderly Care another(prenominal)(prenominal), please plantGrading of your post Consultant Specialist registrar Associate specialist / staff grade SHO / HO / F1 / F2 GP principal GP registrarPlease indicate the number of deaths, on average, for which you would be the treating or attendant doctor in the normal course of your duties attend only one of (a), (b) or (c). (Please give the most accurate estimate you can)(a)_______________per week(b)_______________per month(c)_______________per yearHave you been the treating or attendant doctor in the case of a death in the last 12 months? yes no Please go to question 30, on page 7SPACE FOR COMMENTS former ly YOU HAVE FINISHED THIS QUESTIONNAIREOnce you have completed this questionnaire, you can use this space to provide any clarifications to your answers or make other pointsPLEASE hand over TO RECALL AS CAREFULLY AS POSSIBLE THE MOST RECENT DEATH WITHIN THE digest 12 MONTHS FOR WHICH YOU WERE ACTING AS THE TREATING OR nonessential DOCTOR, AND ANSWER ALL OF THE QUESTIONS 1 TO 29 FOR THAT PARTICULAR DEATHIt is, of course, impossible to do justice to all the finer nuances of decisions concerning the end of heart in a short questionnaire. But please indicate those answers which approach the actual circumstances of this death as closely as possible.1Sex of the deceased male female2Age of the deceased(please estimate if unsure) under 1 year 1-9 years 10-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80-89 years 90 years and over3Place of death hospital hospice care home deceaseds own home other (please specify)4Cause of death*This does not mean the mod e of dying,such as heart failure, asphyxia, asthenia,etc it means the disease, injury, orcomplication which caused death1a Disease or find out directly leading to death*1b Other disease or condition, if any, leading to 1 (a)1c Other disease or condition, if any, leading to 1 (b)2 Other significant conditions contributing to the death but not related to the disease or condition causing it5With respect to this death, when was your first contact with the forbearing? before or at the time of death go to Question 6 after death go to question 30, on page 76How long had you known this long-suffering? more than six months one to six months one to four weeks between one day and one week less than 24 hoursMedical actions7a7b7cConcerning this death, did you or a fellerwithhold a discussion* (or ensure that this was done)?withdraw a treatment* (or ensure that this was done)?use any drug to alleviate pain and/or symptoms?(please tick as many answers as apply)* IN THIS STUDY TREATMENT INCLUD ES CARDIO-PULMONARY RESUSCITATION (CPR), ARTIFICIAL FEEDING AND/OR HYDRATION no yes (please specify treatments withheld). no yes (please specify treatments withdrawn). no yes, morphia or another opioid yes, benzodiazepine yes, other drug8a8bIn withholding a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the longanimouss flavor?In withdrawing a treatment, did you or your colleague consider it probable or certain that this action would hasten the end of the patients life? no yes no treatment withheld no yes no treatment withdrawn9a9bConcerning the drugs used to alleviate symptoms, (Questions 7c), were these administered intimate this would probably or certainly hasten the end of life?partly intending to end life? no yes no drugs used to alleviate symptoms no yes no drugs used to alleviate symptoms10a10bIn withholding a treatment, did you or your colleague have the hard-core intention of hastening the end of life?In with drawing a treatment, did you or your colleague have the explicit intention of hastening the end of life? no yes no treatment withheld no yes no treatment withdrawn11a11bWas death caused by the use of a drug prescribed, supplied or administered by you or a colleague with the explicit intention of hastening the end of life (or of enabling the patient to end his or her own life?)If yes, who administered this drug (i.e. introduced it into the body)? no yes the patient you or another health care colleague a relative someone else melody IF YOU ANSWERED NO TO ALL THE QUESTIONS ON THIS PAGE, GO TO QUESTION 23Decision makingNOTE QUESTIONS 12 TO 22 REFER THE LAST-MENTIONED ACT OR OMISSION, THAT IS, THE LAST YES THAT YOU TICKED ON THE PREVIOUS PAGE (QUESTIONS 7 TO 11)12Which were the most important reasons for the last-mentioned act or slackness?(please tick all that apply_ patient had pain patient had other symptoms request or wish of the patient request or wish of relatives expected further suffering no chance of improvement treatment would have been futile further treatment would have cast upd suffering other (please specify at a lower place).13In your estimation, how much was the patients life shortened by the last mentioned act or omission? more than six months one to six months one to four weeks between one day and one week less than 24 hours life was probably not shortened at all14Did you or a colleague discuss the last-mentioned act or omission with the patient? yes, at the time of performing the act/omissionor shortly before go to Question 15 yes, some time beforehand go to Question 15 no, no discussion go to Question 1915At the time of this discussion, did you consider the patient had the capableness to assess his/her situation and make a decision about it? yes no16Did this discussion include the (probable or certain) hastening of the end of the patients life by this last-mentioned act or omission? yes no17Was the decision concerning the last mentioned act or omission made in response to an explicit request from the patient? yes, upon an oral request yes, upon a written request yes, upon both an oral and a written request no go to Question 2118At the time of this request, did you consider the patient had the capacity to assess his/her situation and make a decision about it? yes go to Question 21 no go to Question 21ONLY ANSWER QUESTIONS 19 and 20 IF YOUR ANSWER TO QUESTION 14 WAS NO, NO DISCUSSION19Did you consider the patient had the capacity to assess his/her situation and make a decision about it? yes no20Why was the last mentioned act or omission not discussed with the patient?(Please fill in as many answers as apply) patient was too young the last mentioned act or omission was clearly the surpassone for the patient discussion would have done more harm than good patient was unconscious patient had significant cognitive impairment patient was suffering from a psychiatric disorder other, please elaborate at the end of the questionn aire21Did you or a colleague discuss with anybody else the (possible) hastening of the end of the patients life before it was decided to take the last mentioned act or omission?(Please fill in as many answers as apply) with one or more medical colleagues nursing staff /other caregivers by partner/relatives of the patient someone else nobody22Which were the most important reasons for the last-mentioned act or omission?(please tick all that apply) patient had pain patient had other symptoms request or wish of the patient request or wish of relatives expected further suffering no chance of improvement further treatment would have been futile further treatment would have increased suffering other (please specify belowNOTE QUESTIONS FROM HERE ONWARDS SHOULD BE ANSWERED WHETHER OR NOT YOU ANSWERED YES TO ANY OF THE ACTS OR OMISSIONS MENTIONED ON PAGE 3 (QUESTIONS 7 TO 11)23Was an explicit request to hasten the end of the patients life made by any of the following?(Please tick all that ap ply) partners/relatives of the patient nursing or other care staff someone else no explicit request24As far as you know, did the patient ever express a wish for the end of his/her life to be hastened? yes, clearly go to Question 25 yes, but not very clearly go to Question 25 no go to Question 2625Did the patients wish for this outcome reduce or disappear over time? no yes, in response to care provided yes, other reason26The treatment during the last week was mainlyaimed at recovery prolonging life support during the dying process27Which caregivers were involved in the care for the patient during the last month before death (beside yourself and as far as you know)?(please tick all that apply)Of those not involved, which ones might have helped? involvedNot involved andmight have helpedgeneral practitionerspecialist in pain reliefpalliative care teampsychiatrist /psychologistnursing staffsocial care workerspiritual caregivervolunteerfamily member28a28b28c28dWas the patient constantly and deeply sedated or unbroken in a coma before death?Which medication was given for sedation?(please tick as many answers as apply)At what time before death was continuous sedation of the patient started?Which were the most important reasons for this sedation?(please tick all that apply) yes no go to Question 29a midazolam other benzodiazepine morphine or another opioid other type of medication. hours before death. days before death. weeks before death patient had balking pain patient had intractable psychological distress patient had other intractable symptoms request or wish of the patient request or wish of relatives other (please specify below29a29b29cDid the patient receive morphine or another opioid during the last 24 hours before death?How much time before death was the administration of morphine or another opioid started?Which figure best illustrates the dosage of morphine or another opioid during the last 3 days before the patients death? yes no go to Question 30. hours before death. days before death. weeks before death No increase Gradual increase Strong increase last dayAttitudes and beliefsQuestions 30 and 31 are about voluntary euthanasia (that is, when someone ends the life of another person at their request), worded in the same way as those used in surveys of general public opinion.3030a30bFirst, a person with an incurable and painful illness, from which they will die for example, someone dying of cancer.Do you speak out that, if they ask for it, a doctor should ever be allowed by law to end their life, or not?And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? Definitely should be allowed credibly should be allowed Probably should not be allowed Definitely should not be allowed Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed3131a31bNow, how about a p erson with an incurable and painful illness, from which they will not die.Do you think that, if they ask for it, a doctor should ever be allowed by law to end their life, or not?And do you think that, if this person asks for it, a doctor should ever be allowed by law to give them lethal medication that will allow the person to take their own life? Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed Definitely should be allowed Probably should be allowed Probably should not be allowed Definitely should not be allowed32Religion what is your religion? None Christian (including Church of England, Catholic,Protestant and all other Christian denominations) Buddhist Hindu Jewish Muslim SikhAny other religion, please put out in33Religion would you describe yourself as extremely religious very religious somewhat religious neither religious nor non-religious somewhat non-religious very non religious extremely non religious c ant choose34What is your ethnic group?Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic groupA flannel any White backgroundB Mixed White and Black Caribbean White and Black African White and Asian Any Other Mixed background, please write inC Asian or Asian British Indian Pakistani Bangladeshi Any Other Asian background, please write inD Black or Black British Caribbean African Any Other Black background, please write inE Chinese or other ethnic group Chinese Any Other, please write inTo clarify any answers or to make further comments, please use the space on page 1.Thank you for your help with this important survey.Now that you have finished the questionnaire, to ensure the anonymity of your answers you will need to do two things.Place the completed questionnaire in the reply-paid envelope, seal it and post it as soon as possiblePost the reply-paid response notification card with your name on it if you wish to avoid receiving follow-up reminders. These two items will be received by different people in different locations and kept separate. It will not be possible to link your questionnaire with your name.This questionnaire has been sent to a random sample of 10,000 doctors. It will not be possible for the researchers or anyone else to use your replies to discover your identity or the identity of the patient on whose care you have reported.We understand that recalling events of this nature can be a distressing experience. If you wish to talk to someone about your feelings concerning end-of-life care, the Confidential Counselling Helpline of the British Medical Association can assist you. Their number is 0645 200 169(c)Euthanasia and Assisted Suicide in the United KingdomA Research ProposalPart BBy Katy Marsland 08111890University of LincolnHand in Date 4th May 2010(1,352 Words)Julie BurtonNUR2002M-0910 research Methods2009/2010Table of Contents PageTitle 26Research Questions 27Aims of Project 28Initial Literature Review 29-30 Methodology 31Ethical Considerations and Practical Constraints 32Timetable for Dissertation Research 33-34References 35A Research Proposal1. TitleEuthanasia and Assisted Suicide in the United Kingdom.2. Research QuestionsShould Euthanasia and Assisted Suicide be made legal? What are the arguments for and against policy change in the United Kingdom? Which section of smart set is most supportive of a change in the law? Which section is most opposed and why?3. Aims of ProjectThis research aims to investigate, using secondary data, whether a change in the law is needed to clarify the position of euthanasia and assisted suicide in the United Kingdom, and whether this should be made legal just for those who are terminally ill or for

Clock Arithmetic :: essays research papers

Clock ArithmeticThe takings of time has always been one of interest to me at least on a philosophical basis. Through the works of Einstein, ancient timepieces and calendars such as Stonehenge, and even theories on past and present, time is everywhere. I chose this topic to perhaps explore further the relevance of clocks and timepieces in mathematics and arithmetic. To gain a better understanding of the mathematical features of time would be recognise knowing that philosophy and mathematics argon closely related.Through what Ive seen in clock arithmetic the concepts could be taught and applied as early as first grade due to the nature of addition and subtraction involved. Clock Arithmetic is also used for technological reasons. Computer games are manufactured victimisation clock arithmetic to base a characters position due to the resolution of the screen on a certain axis. Example cipher you are playing a video game and the character in the game (lets call him goop) is walking f rom the left side of the screen to the right side. Max gets to the right side of the screen and keeps walking he disappears and reappears on the left side of the screen again. If the screen is 12 inches wide and we are keeping undercut of how far Max is from the left side of the screen, then as soon as he is 12 inches from the left side its as if he was cover version at the beginning again. If you put it pictorially, against a clock youd find that Max would start and end up at the same point.Now Id like to downgrade and put things in an elementary perspective. If it is 3 oclock and we add 5 hours to the time that will put us at 8 oclock, so we could write 3 + 5 = 8. But if it is 11 oclock and we add 5 hours the time will be 4 oclock, so we should write 11 + 5 = 4. Now everyone knows that 11 + 5 =16, but there is no 16 on the clock (unless youre on military time). Every time we go past 12 on the clock we start counting the hours at 1 again. If we add numbers the way we add hours on the clock, we say that we are doing clock arithmetic. So, in clock arithmetic 8 + 6 = 2, because 6 hours after 8 oclock is 2 oclock.

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This short story starts out by setting the scene. The American and a missy sit at a table in front of a building where they were waiting on a train to arrive. It is very hot away(p) and the background is hills described to be long and white. They look like white elephants, she said.Ive never seen one, the serviceman drank his beer.No you wouldnt have.I might have, the man said. Just because you say I wouldnt have doesnt prove anything. (Hemingway 6-10)These lines from Ernest Hemingway depict how a man can overpower a woman with his chosen words and tone. In this conversation between the American and the woman, you will see the woman become less and less sure of herself and eventually she cant even make her own decisions. The girl is even unsure if she wants water with her drink.We want two Anis del Toro.With water?I dont know, the girl said. Is it smashing with water? (Hemingway 19-21) Marsh 2In the previous lines you can see the girl is skeptical. She is waiting for reassurance from the American. The Huffington Post featured an article which came from a study conducted by the University of Texas. Students observed the behavior of boys and girls in a room and how they responded to social cues. Each child was left alone with his mother and were told by their mothers not to touch a forbidden object. The boys not only touched the object more frequently than girls but they ignored the mothers voice telling them no when they picked up the forbidden object. The girls touch the object less frequently and when they did they often looked at their mother for reassurance. The boys rarely paid attent... ... comforting the girl and telling her to come in the shade. This is him protecting her and giving the girl security which she doesnt have on her own. The train finally arrives which seems to have been what the girl wanted because she did not wish to dissertate the topic anymore. Marsh 7Works CitedZweig, Robert. Literature An Introduction to Reading and Writing Hills are Like White Elephants(1927) Tenth Edition. Pearson Education 2004. 350-353. Print.Biddle, Tabby. The Huffington Post wherefore Do Women Feel They Need Permission? Jan 30,2009Hoplock, Lisa Science of Relationships How You Doin? Self-Esteem Affects How People Flirt (2014) www.scienceofrelationships.com

Is ADHAD Over-Diagnosed? Essay examples -- Diseases, Disorders

There has been an ongoing debate about whether the mental disorder ADHD (Attention shortfall Hyperactivity Disorder) is over-diagnosed. ADHD is commonly diagnosed in people, more specifically tykeren, who lack the ability to pay attention, are often disruptive, are hyperactive, and impulsive. A medical personnel or a psychologist diagnoses the children using a list of criteria. It is only in recent years that doctors have begun researching better and more effective ways to diagnosis patients using brain scans. It is because of this, that ADHD is over-diagnosed for several reasons the different personalities that children can exhibit parents not taking responsibility as parents and the lack of proper ways to identify ADHD. all(prenominal) child is specifically unique in his or her own way. As a result, each child learns and acts differently. When a child is hyperactive or does not pay attention, parents are often worried that their child may have ADHD. However, that child may be a highly active child by nature and in need of exercise and a way to burn of all of that energy. In addition, various research has been done on the effects of the childs age upon entering the classroom. To research the effect age could potentially have on children, a study was done in British capital of South Carolina that focused on 930,000 children between the ages of 6 to 12, from the years 1997 to 2008. They found that those born in December, typically some of the youngest in the class, were 30 percent more in all probability to be diagnosed and 41 percent more likely to be treated with ADHD medication that boys born in January (Dotinga). The research also showed similar results for girls. Although, the denomination claims that the findings, dont prove definitively that any kids are... ...ot.Works CitedAttention Deficit Disorder. - Symptoms, Causes, Diagnosis and Treatment by Medicalook.Medicalook. Web. 21 Mar. 2012.Dotinga, Randy. Youngest Kids in Class More happy to Get ADH D Diagnosis Study. wellnessDay Consumer News Service 05 Mar. 2012 Consumer Health Complete - EBSCOhost. Web. 21 Mar. 2012.Kanarek, Robin B. Artificial Food Dyes And Attention Deficit Hyperactivity Disorder. Nutrition Reviews 69.7 (2011) 385-391. Consumer Health Complete - EBSCOhost. Web. 21 Mar. 2012.Kirkpatrick, LaVonne. ADHD Treatment And Medication What Do You Need To Know As An Educator?. Delta Kappa Gamma Bulletin 72.1 (2005) 19-29. Education Full text (H.W. Wilson). Web. 26 Mar. 2012.Peacock, Judith. Chapter Three How Is ADHD Diagnosed?. ADD & ADHD. 19. Capstone Press, 2002. Consumer Health Complete - EBSCOhost. Web. 26 Mar. 2012.

Italian Mafia Essay -- History

Italian mafiaThe maffia was first developed in Sicily in feudalistic times to protect the estates of landlords who were out of town. The word Mafia, derived from the Sicilian word, Mafioso, means family. Today, Mafia is a name which describes a loose association of criminal groups. These groups can be bound together by blood, oath or sworn secrecy. Many people had considered the Sicilian Mafia as the most ruthless mobsters of the twentieth century. By the 19th century, the Mafia had become known as a network of criminal thugs that dominated the Sicilian countryside. Members of the Mafia were bound by Omerta. Omerta, an Italian word, stands for a strict code of conduct. The code include avoiding whole contact or cooperation with authorities. In the beginning the Mafia had no centralized organization. It consisted of many small groups. apiece of these groups was considered as a district. And, each of these districts, had its own form of government. The Mafia had gained their stron g-arm by using scare tactics amongst the people. By using these terroristic methods against peasants who could vote, the Mafia use this upper hand in placing themselves into political offices. They would achieve this in several communities. Using this political power in their advantage, the Mafia was able to gain forge with police authorities and the ability to obtain legal access to weapons. Benito Mussolini was the premier-dictator of Italy from 1922 to 1943. He was the founder and leader of Italian Fascism. Mussolini, along with his Facets government, was able to successfully suppress the Mafia during the time of World War II. However, after the war ended in 1945, the Mafia emerged and ruled once again. Over the next thirty years, the Sicilian Mafia was not only able to gain control Sicily, but all of Italy as well. In the second half of the nineteenth century, the States had the largest number of immigrants go to the United States ever known. There is a recorded three million Irish, four million Italians, and four million Jews that immigrated to the United States during the later half of the nineteenth century. People immigrated for a number of reasons. Many of them dreamed of leaving behind their old worlds. Worlds of oppression, fear, and crime. Unfortunately, this dream was shattered for many of the immigrants. For those who migrated to Chicago, severa... ... the rest of his life in his menage in Miami Beach, Florida. A great contribution to the Chicago Mafia died alone in 1947. In the early 1980s, the Italian government launched an anti-Mafia campaign throughout all of Italy. Not only did this lead to a number of arrests and trials, but it also was the reason for several assignations of key law-enforcement officials whom were in retaliation. For the past two decades, both America and Italy cast been cracking down on the organized crime group known as the Mafia. Criminal activities concerning those involved in the Mafia have declined dramatically. The contemporary underworld crime of today consists of business men and women with a strong knowledge of computers. Old world ways such as killing, riots, and vendetta have been done away with. Todays mobsters are highly educated extortionists dressed in suites. The old ways of organized crime will never be the comparable again. The desire, need, brutality, wisdom, and style of what we know as the Italian Mafia only exists in books and movies. In my opinion, the time of the Prohibition was, and always will be the most perceptible time of the underworld because of the Italian Mafia.

Minimum Wage Legislation Essay -- Minimum Wage Essays

lower limit Wage LegislationI am going to pose the question to you the students of Sir Sandford FlemingCollege, do you really want the minimal pursue legislation left in affect? Ascollege students you are not benefiting or gaining anything from marginal wagelegislation. The token(prenominal) wage legislation requires all employees to be paid atleast some fixed given dollar amount per hour. This sounds good, but it isntall that it seems minimum wage is an example of government intervention. The government has erect aminimum on the dollar amount that employers can pay their employees.Unfortunately when we implement solutions deal the minimum wage, it is too lateto actually fix the problem, so in most cases it has effects that we cannotforesee as it is a reaction instead of a prevention method. Minimum wageactually helps very few people. The only ones that benefit from minimum wage arethose fumbling workers who are currently employed. Minimum wage restrictsemployment opportunit ies for the young, unexperienced, and those people witheducational disadvantages. They will continue to find themselves handicapped inthe job market as long as the minimum wage legislation remains in affect. Insociety today the demand for " unpaid" workers is low and the supply is high,therefore there is a lavishness of unskilled workers in the job market. The effectof a surplus drives down an individuals reservation wage, as they are willing todo and take anything for work. Minimum wage only makes this fact more severe, asit increases the supply of workers.Minimum wage increases the cost of doing business, and unfortunately in todayseconomic conditions employers are not able to base on balls on the extra costs to theconsumer. Minimum wage is not helping workers, it is hurting businesses, and tomaintain any profit, and follow legislation companies have to cut lug costssomehow. Companies are being forced to take other alternatives because of higherlabour costs for unskille d workers. Businesses are forced to                    1. Cut back current employees hours                    2. Not hire any more employees          &n... ... should be rated and fluctuated by these categories.Unfortunately minimum wage disregards all of this. Regardless of your education,skills, effort, you can still receive minimum wage. Minimum wage is a fixeddollar amount that is paid for many jobs that can not even be compared. Most ofthese jobs should have diametric pay rates, especially when the degree of skillis higher, but they dont.The government keeps increasing minimum wage, and making it tougher onbusinesses and at the same time discouraging unskilled workers from betteringthemselves, and for what. The economy is not booming, and even with increasingminimum wage rates th e economy is not seeing any extra money being put back intocirculation. As well, the higher minimum wage rate keeps raising the level ofunemployment. I feel that if we put the burden on the people of Ontario to beand do the best they can that we would not need minimum wage. The skills that wecould produce would be widely demanded, so it would be to the benefit of manyother unskilled minimum wage earners to support the abolishment of minimum wagelegislation. You could receive better wages, and at the same time decrease theunemployment rate.