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Decision to withdraw life-sustaining medical intervention(LSMI) is a common ethical issue in clinical practice. This paper reviews and analyzes the ethical arguments for withdrawing LSMI from three aspects: respect for autonomy, medical futility and patients' best interests. The authors argue that withdrawal of LSMI can be ethically justified when any of the following conditions is met: when patient gives valid consent, LSMI is judged to be medically futile, or it is in the patients' best interests. This paper proposes practical suggestions for the withdrawal of LSMI in clinical practice, and presents several policy suggestions. Finally, the authors identify several challenges of withdrawing LSMI in practice and possible approaches to addressing them.

The emerging issue of rising gabapentinoid misuse is being recognized alongside the lack of current evidence supporting the safe and effective deprescribing of gabapentinoids. This scoping review aimed to assess the extent and nature of gabapentinoid deprescribing interventions in adults, either in reducing dosages, or prescribing of, gabapentinoids. Electronic databases were searched on 23 February 2022 without restrictions. Eligible studies included randomized, non‐randomized and observational studies that assessed an intervention aimed at reducing/ceasing the prescription/use of a gabapentinoid in adults for any indication in a clinical setting. The research outcomes investigated the type of intervention, prescribing rates, cessations, patient outcomes and adverse events. Extracted outcome data were categorized as either short (≤3 months), intermediate (>3 but <12 months) or long (≥12 months) term. A narrative synthesis was conducted. The four included studies were conducted in primary and acute care settings. Interventions were of dose‐reducing protocols, education and/or pharmacological‐based approaches. In the randomized trials, gabapentinoid use could be ceased in at least one third of participants. In the two observational trials, gabapentinoid prescribing rates decreased by 9%. Serious adverse events and adverse events specifically related to gabapentinoids were reported in one trial. No study included patient‐focused psychological interventions in the deprescribing process, nor provided any long‐term follow‐up. This review highlights the lack of existing evidence in this area. Due to limited available data, our review was unable to make any firm judgements on the most effective gabapentinoid deprescribing interventions in adults, highlighting the need for more research in this area. [ABSTRACT FROM AUTHOR]

International organizations often come under pressure when states desire their reform. Some states threaten to leave international organizations unless their reform demands are met. But how often is threatening to withdraw associated with states demanding institutional reform? And under what conditions do states' withdrawal threats actually achieve institutional reform? We argue that withdrawal threats are more likely to result in institutional reform when they (1) are made by powerful states and (2) are limited reform demands rather than calls for broader reform. We examine whether threatening to exit institutions can be a catalyst for institutional reform using an original dataset of withdrawal threats from all international organizations and states since 1980 (N = 130). The analysis supports our argument that withdrawal threats are more likely to lead to reforms when their associated demands are made by powerful states and are limited in scope. Further, we find that less than half of exit threats are linked to reform demands: many states threaten to withdraw due to conflicts with another state or for face-saving purposes, without making reform requests. This contrasts with the conventional understanding that exit threats often represent a backlash against international organizations. Perhaps surprisingly, the dynamics of bargaining over reform suggest that some organizations may emerge more, rather than less, resilient after states threaten to withdraw. We conclude with policy implications for rethinking multilateralism. [ABSTRACT FROM AUTHOR]

Vernonia cinerea (VC) has been used for smoking cessation. A previous meta-analysis (MA) reported the efficacy of VC in smoking cessation. However, there have been updated randomized controlled trials (RCTs) on the efficacy of VC for smoking cessation, and the previous MA lacked pooled adverse events (AEs) related to VC. The objective of this study was to systematically review and perform an updated MA on the efficacy of VC for smoking cessation continuous abstinence rate (CAR), prevalence abstinence (PAR), and AE. The research articles were retrieved via electronic databases including PubMed, Science Direct, Web of Science, Thai-Journal Citation Index Center (TCI), and ThaiLis. Ten RCTs published prior to 2019 were included in this study. The number of participants in the studies ranged from 35 to 172, and the follow-up duration for the primary outcomes was 2-12 weeks. Our updated MA found that VC could significantly improve CAR2 (RR=1.54; 95% CI = 1.06, 2.23), CAR4 (RR=1.65; 95% CI = 1.25, 2.17), CAR 8 (RR=1.85; 95% CI = 1.25, 2.75), CAR12 (RR=2.56; 95% CI = 1.66, 3.95), and CAR16 (RR=2.21; 95% CI = 1.03, 4.73). Moreover, VC improved PAR2 (RR=1.47; 95% CI = 1.06, 2.04), PAR4 (RR=1.35; 95% CI = 1.02, 1.79), PAR8 (RR=1.60; 95% CI = 1.11, 2.31), and PAR12 (RR=1.70; 95% CI = 1.25, 2.30). There was no significant difference in the AE between the two groups. The study substantiates claims that VC products are effective in assisting with smoking cessation.

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The present study investigated the respective roles of withdrawal, language, and context-inappropriate (CI) anger in the development of emotion knowledge (EK) among a subsample of 4 and 5 year-old preschoolers (n = 74). Measures included parent-reported withdrawn behavior, externalizing behavior, and CI anger, as well as child assessments of receptive language and EK. Ultimately, findings demonstrated that receptive language mediated the relationship between withdrawn behavior and situational EK. However, CI anger significantly interacted with receptive language, and, when incorporated into a second-stage moderated mediation analysis, moderate levels of CI anger rendered the indirect effect of withdrawn behavior on situational EK via receptive language insignificant. Cumulatively, these findings demonstrate a mechanism by which withdrawal may impact EK. They also indicate that such an effect may be attenuated in children with moderate levels of CI anger. Implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Palliative sedation is a well-recognized and commonly used medical practice at the end of life for patients who are experiencing refractory symptoms that cannot be controlled by other means of medical management. Given concerns about potentially hastening death by suppressing patients' respiratory drive, traditionally this medical practice has been considered ethically justifiable via application of the ethical doctrine known as the Principle of Double Effect. And even though most recent evidence suggests that palliative sedation is a safe and effective practice that does not hasten death when the sedative medications are properly titrated, the Principle of Double Effect is still commonly utilized to justify the practice of palliative sedation and any risk—however small—it may entail of hastening the death of patients. One less common clinical scenario where the Principle of Double Effect may still be appropriate ethical justification for palliative sedation is when the practice of palliative sedation is pursued concurrently with the active withdrawal of life-sustaining treatment—particularly the practice of compassionate extubation. This case study then describes an unconventional case of palliative sedation with concurrent compassionate extubation where Principle of Double Effect reasoning was effectively employed to ethically justify continuing to palliatively sedate a patient during compassionate extubation. [ABSTRACT FROM AUTHOR]

Whenever a joint stock company or a limited partnership increases their capital by issuing new shares, existing shareholders have priority to participate in new shares. This right is expressed in the Turkish Commercial Code (TCC) as the right of preemption (Art. 461, 591). According to the Code, it is possible to restrict or withdraw the right. The sources of restriction are several: Firstly, and principally, the right may be restricted by decision of the authorized body. Secondly, the right may be prohibited by the law itself. For example, TCC 389. The last source of the restriction is articles of association. This type of restriction, as a rule, is void in joint stock companies. However, such restriction can occur indirectly, in case of issuing new privileged shares or beneficial interest certificates. On the other hand, in limited partnerships, TCC 591 allows restrictions by articles of association. We have three objectives in this article. The first one is figuring out, why restricting by articles of association is prohibited. Secondly, we examine the incompatibility created by the Code for limited partnerships. The last aim is determining the rules to be obeyed in exceptional cases, which cause an indirectly restriction by articles of association. [ABSTRACT FROM AUTHOR]

Abstract Background Withdrawal of disease-modifying anti-rheumatic drugs (DMARDs) once disease remission is achieved is endorsed by current international rheumatoid arthritis (RA) management guidelines. However, very little data exists concerning patients’ views of this practice. In this qualitative study, we aimed to explore patients’ perspectives on DMARD withdrawal in the setting of established RA. Methods In this qualitative interview study, patients with stable established RA were recruited from rheumatology outpatient clinics at a large UK teaching hospital. The perceived advantages and disadvantages of DMARDs and views on DMARD withdrawal were explored in semi-structured interviews. Interview transcripts were analysed using standard qualitative techniques to construct an analytical framework. Results Thirteen participants (8 female, median [IQR] age 65 [61–73]) expressed their views of DMARD treatment in the context of their “normal lives”. For some patients, disadvantages such as medication side-effects and the inconvenience of safety monitoring were sufficient hindrances to their lifestyle to justify DMARD withdrawal. However, patients who were vulnerable to loss of physical function, or who had prior experience of severe rheumatoid arthritis, expressed a strong preference against DMARD withdrawal, viewing the potential for increased pain and future disability as unacceptable risks. Conclusions Patients view DMARD withdrawal in the context of either restoring or threatening their “normal lives”. In this model, social and personal factors play a crucial role in influencing patients’ opinions of DMARD therapy beyond a simple consideration of medication side-effects alone. A formulaic approach to DMARD withdrawal determined and imposed by clinicians would not be successful. Instead, the discussion of DMARD withdrawal should take place with the identification of patients’ priorities and in the context of their personal disease experiences. Trial registration clinicaltrials.gov (NCT02064400), retrospectively registered 17 February 2014.

In order for land managers and policy makers to manage excessive soil phosphorus (P) concentrations and reduce the risk of this particular source of P from impacting water bodies, models of soil P decline under various scenarios are needed. We modelled the decrease in calcium chloride-extractable P (CaCl2-P), and sodium bicarbonate-extractable P (Olsen-P and Colwell-P) using data from six Australian grazed pasture soils with contrasting P sorption properties, over a period of 4.5 years. Each soil had four initial soil P concentrations (Pinit), each of which received four on-going rates of P fertiliser (Pfert). The model predicts the final P concentration (Pfinal) by taking into account the P concentration previously measured (CaCl2-P, Olsen-P or Colwell-P), Pfert applied since measurement, and time since previous measurement: Final P concentration = (previously measured P concentration + ep x P fertiliser applied) exp (-dp x years since previous P concentration measurement). Where ep is the increase in soil P for each unit of applied P and dp is the decay constant representing how quickly the soil P decreased. The greatest decreases in proportion to Pinit occurred for CaCl2-P, followed by Olsen-P, and then Colwell-P. The model tended to fit the dataset well for Olsen-P and Colwell-P, with mean overestimation (modelled Pfinal concentration greater than actual Pfinal) of the Pfinal concentrations of 6.1 (32%) and 4.3 mg/kg (10%), respectively. Although there was less CaCl2-P data, the model successfully described it, with a mean overestimation of Pfinal CaCl2 of 3.1 mg/kg (26%). The overestimation of Pfinal CaCl2 was possibly due to the high CaCl2-P concentrations of the low P buffering index soils. The model predicted an average of 32 years (ranging from 26 to 49 years) for Olsen-P concentrations of between 55 and 96 mg/kg to decrease to an agronomic optimum of 17 mg/kg. Agronomic optimum was not a reliable indicator of environmental risk as some soils did not exceed the CaCl2-P environmental threshold until Olsen-P concentrations were twice the agronomic optimum, whereas low P sorbing soils tended to exceed the threshold before reaching agronomic optimum. Further work with more soils is required to examine the influence of soil properties – such as P sorption – on decreases in soil P.

The debate over the removal of tactical weapons is not a simple one; linked with it are the debates over the utility of NATO and how to reach a global consensus on nuclear disarmament. Advocates of withdrawal view inaction regarding tactical nuclear weapons as just one example of general inertia within the alliance; the lack of a serious political discussion inside NATO, they argue, is a cause of concern for the true value of NATO. Belgian author Tom Sauer writes that such a debate has only stalled action, resulting in missed opportunities to remove the weapons from Europe. Looking at the arguments for and against the removal of tactical nuclear weapons in Europe, the author writes that the answers to this debate are to be found in the capitals of NATO member states. The time is ripe to withdraw all U.S. nuclear weapons from Europe; the arguments of the few opponents do not outweigh the benefits of withdrawal. The political climate—with a U.S. president who is personally committed to the nuclear weapons threat—is also ideal. The question is not if but rather how NATO will change its policy. [ABSTRACT FROM AUTHOR]

Background/Aims: In Taiwan, due to budget limitations, the National Health Insurance only allows for a limited period of biologics use in treating moderate to severe Crohn's disease (CD). We aimed to access the outcomes of CD patients following a limited period use of biologics, specifically focusing on the relapse rate and remission duration; also the response rate to second use when applicable.Methods: This was a multicenter, retrospective, observational study and we enrolled CD patients who had been treated with adalimumab (ADA) according to the insurance guidelines from 2009 to 2015.Results: A total of 54 CD patients, with follow-up of more than 6 months after the withdrawal of ADA, were enrolled. The average period of treatment with ADA was 16.7±9.7 months. After discontinuing ADA, 59.3% patients suffered a clinical relapse. In the univariate analysis, the reason for withdrawal was a risk factor for relapse (P=0.042). In the multivariate analysis, current smoker became an important risk factor for relapse (OR, 3.9; 95% CI, 1.2−14.8; P=0.044) and male sex was another risk factor (OR, 2.9; 95% CI, 1.1−8.6; P=0.049). For those 48 patients who received a second round of biologics, the clinical response was seen in 60.4%, and 1 anaphylaxis occurred.Conclusions: Fifty-nine percent of patients experienced a relapse after discontinuing the limited period of ADA treatment, and most of them occurred within 1 year following cessation. Male sex and current smoker were risk factors for relapse. Though 60.4% of the relapse patients responded to ADA again.

Tesco withdrew from the Korean market in September 2015. The withdrawal of Tesco has not generally been seen as being due to management failure, but instead as a strategic reallocation of resources by Tesco in the UK. Yet there may still be more to understand about this development. The tale of Tesco's arrival in and departure from Korea has not ended. We consider the relative performance of Tesco (Homeplus) stores and those of rival E‐Mart. We find that, in attempting to be authentically local, Tesco may have hampered its own long‐term success in an important overseas market. In an empirical study, we utilised the Logit model to contrast selection factors employed by local consumers in respect of both Tesco/Homeplus and E‐Mart. Our analysis reveals that product range (including private brands), store accessibility and convenience were the main factors on which consumers discriminated between these rivals. [ABSTRACT FROM AUTHOR]

The decision to continue or withdraw the antiepileptic drugs (AEDs) should be taken jointly by the patient, family and/or caregivers, and the specialist physician, after extensive information and discussion about the risks and benefits of withdrawing the AED. The patient and family members must understand that there is a risk of the recurrence of seizures with and without AED. The type of epilepsy, the prognosis, and the patient's lifestyle should be taken into account. Withdrawal should be carried out under the supervision of a specialist (clinical neurologist) and will be considered when the patient has been seizure free for at least 2 years. The treatment must be withdrawn gradually for a period of at least 2-3 months and the antiepileptics must be removed one by one. Withdrawal of benzodiazepines and barbiturates should be slower, in 6 months or more. An agreement must be made that in the event of a seizure relapse, the patient must return to taking the last dose before the dose in which the relapse was presented and request assessment by clinical neurologist. [ABSTRACT FROM AUTHOR]

Background Rates of manuscript retraction in academic journals are increasing. Papers are retracted because of scientific misconduct or serious error. To date there have been no studies that have examined rates of retraction in nursing and midwifery journals. Design A systematic review of Journal Citation Report listed nursing science journals. Data sources The Medline database was searched systematically from January 1980 through July 2017, and www.retractionwatch.com was manually searched for relevant studies that met the inclusion criteria. Review methods Two researchers undertook title and abstract and full text screening. Data were extracted on the country of the corresponding author, journal title, impact factor, study design, year of retraction, number of citations after retraction, and reason for retraction. Journals retraction index was also calculated. Results Twenty-nine retracted papers published in nursing science journals were identified, the first in 2007. This represents 0.029% of all papers published in these journals since 2007. We observed a significant increase in the retraction rate of 0.44 per 10,000 publications per year (95% CI; 0.03–0.84, p = .037). There was a negative association between a journal’s retraction index and impact factor with a significant reduction in retraction index of −0.57 for a one-point increase in impact factor (95% CI; −1.05 to −0.09, p = .022). Duplicate publication was the most common reason for retraction (n = 18, 58%). The mean number of citations manuscripts received after retraction was seven, the highest was 52. Most (n = 27, 93.1%) of the retracted papers are still available online (with a watermark indicating they are retracted). Conclusion Compared to more established academic disciplines, rates of retraction in nursing and midwifery are low. Findings suggest that unsound research is not being identified and that the checks and balances incumbent in the scientific method are not working. In a clinical discipline, this is concerning and may indicate that research that should have been removed from the evidence base continues to influence nursing and midwifery care. [ABSTRACT FROM AUTHOR]

In Kenya private prosecutions are governed by different laws. These are the Criminal Procedure Code, the Office of the Director of Public Prosecutions Act, the Constitution and case law developed by courts. The purpose of this article is to demonstrate how courts have invoked these laws to deal with the following issues that relate to private prosecutions: the right to institute a private prosecution, locus standi to institute a private prosecution, and measures in place to prevent or minimise the abuse of private prosecutions. The author recommends ways through which Kenyan legislation could be amended to strengthen the private prosecutions regime. [ABSTRACT FROM AUTHOR]

Introduction: The long time use of opium has some effects on serums biochemical factors, the determination of this variation is a new approach in understanding off addiction and relive of drug abuser health. Hence in this study, these indicators in person who were withdrawing of opium have been studied. Materials and Methods: In this cross-sectional study bloods biochemical factors such as fasting blood sugar (FBS), sodium (Na), calcium (Ca), uric acid (UA), blood urea nitrogen (BUN), creatinine, cholesterol, triglyceride, total protein, and fibrinogen in three groups serum were studied: (1) Who had been permanent opium users more than 2 years (case). (2) Dependent person who has taken one month addiction withdrawal course (control). (3) A healthy group that had been demographically similar to the other groups. Results: According to these study findings, FBS serum level in the case group is lower than control group. Serum level of Na, creatinine, and blood triglyceride (TG) in case study are higher than group control. Concentration of potassium, Ca, UA, BUN, cholesterol, total serum protein, fibrinogen, and thrombin time in case study and group control showed no significant difference. Also, in withdrawing case serum level of Na, Ca, UA, BUN, creatinine, and TG significantly increase and thrombin time decrease. Conclusion: According to this study not only the longtime use of opium but also opium with drawerin opium dependent people can change their serum biochemical factors. So recognition, treatment, and prevention of this change could be a new step in improving of health and condition of patients.

Purpose: Antiepileptic drugs (AEDs) can be discontinued in a subset of patients after surgery. We aimed to identify the factors related to successful AED withdrawal after surgery in pediatric patients with focal cortical dysplasia (FCD). Methods: The study included 134 patients who underwent resective surgery for FCD at Severance Hospital between 2003 and 2014. Age of seizure onset, epilepsy duration, and location and histopathological classification of the FCD were compared between patients who experienced seizure recurrence and those who did not. The interval between surgery and initiation of AED reduction was also compared. Results: In total, 134 patients were included. The median age at seizure onset was 1.0 year (interquartile range [IQR], 0.3-5.0). The median follow-up duration was 6.0 years (IQR, 1.0-13.0). AED withdrawal was attempted in 89 (66%), and 61 (69%) patients remained seizure-free. Of 61 patients, 38 (62%) were successfully weaned off all AEDs. Seizures recurred in 28 (31%) patients. The mean duration between surgery and initiation of AED reduction did not significantly differ between the seizure recurrence (4.5 months, IQR, 2.7-8.7) and non-recurrence groups (1.9 months, IQR, 0.5-5.4) (P<0.006). Patients who had FCD type IIb (39% vs. 7%, P=0.004) were more likely to be in the non-recurrence group than in the recurrence group (P=0.031). Conclusion: Surgical resection offers patients with FCD an opportunity to completely discontinue their AEDs. Early AED discontinuation may be pursued in patients with FCD in cases of complete resection. [ABSTRACT FROM AUTHOR]

Background: Time-limited trials of dialysis have been proposed as a third option in addition to initiation of treatment and comfort-care only in the setting of high uncertainty or discordance between the treating team and child/family or among the treating team. Case-diagnosis/treatment: The index case was noted antenatally to have severe kidney disease and pulmonary hypoplasia. In light of the guarded, but uncertain prognosis and a lack of consensus among the treating team, as well as between the treating team and the family, a time-limited trial of dialysis was initiated. Six days later the child developed bacteremia due to infection of the dialysis catheter. The treating team felt this was a failure of the trial and that future dialysis should be withheld, the family disagreed. Conclusion: A time-limited trial is a problematic option. Providers may be better suited by returning to the dichotomous choice of withholding or initiating treatment. Key management points: • Time-limited trials offer potential benefits in terms of alleviating the burden of decision-making in the setting of uncertainty, offering an opportunity to forecast a poor prognosis, help avoid interprofessional conflict, and providing support for patients, their families, and staff. • Time-limited trials have important limitations, including the use of time limits, difficulty in determining clear, meaningful endpoints, and different interpretations of a trial of therapy between parents and providers. • Decisions regarding the initiation, withholding, and withdrawal of dialysis should be made based on regular assessments of the benefits and burdens of the intervention for the child. • Pediatric nephrologists are better served to abandon the concept of time-limited trials. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol withdraw syndrome (AWS) and delirium tremens (DTs) are part of the clinical picture of alcohol dependence (AD). The mechanisms by which these conditions develop are not entirely understood, but there are data suggesting that several factors are largely responsible for the emergence of the AWS and DTs. According to some authors, with the prolongation of the AD and increasing tolerance, the AWS aggravates, somatic and neurovegetative manifestations worsen. Russian authors accept that the degree of clinical manifestations depends on the individual characteristics of the response to ethanol. Materials and methods: The present work is a systematic study of 28 alcohol-dependent patients that developed clinical signs and symptoms of pre-delirium and delirium during alcohol detoxification treatment. Results: The relationship between sex, age, type and duration for abuse, type of alcoholic beverage, and the clinical picture has been analyzed and discussed as well as the criteria for their diagnosis and follow-up. Conclusion: Our analysis of the development and the manifestations of pre-delirium and DTs, during detoxification of AD patients, underlines the protracted course of the illness and the need for multidisciplinary intensive care. Dynamic monitoring of the patients and timely correction of the therapeutic program guarantee the success of the detoxification. [ABSTRACT FROM AUTHOR]

As contributors to academic journals, we expect our submissions to be treated with a certain amount of respect by editors and dealt with expeditiously; we want to see our papers published. An editor who is allowing a submission to 'gather dust' is not acting in the best interests of either their authors or their journal. I recommend that authors sometimes review their list of papers ' in press,' ' in review,' and 'submitted,' and those that have stopped moving should be withdrawn and submitted elsewhere. An editor who fails to give their contributors timely support is not deserving of their papers. [ABSTRACT FROM AUTHOR]

Background: The risks of using leukotriene receptor antagonists (LTRA) as part of a strategy for stepping down inhaled corticosteroid (ICS) are not well known. Objective: To estimate the risk of asthma exacerbation in individuals with stable asthma who start LTRA when stopping ICS or reducing ICS dose. Methods: We identified articles from a systematic review of English and non-English articles by using a number of data bases. We included randomized controlled trials with a stable asthma run-in period of 4 weeks or more and a follow-up period of at least 3 months. We included studies of individuals with stable asthma who stopped ICS and substituted LTRA (versus continuing ICS) and who reduced ICS while starting LTRA (versus placebo). Results: The search strategy identified 1132 potential articles, of which 52 were reviewed at the full-text level, and four met criteria for inclusion. The single article that met the inclusion criteria for substitution of LTRA for ICS as a step-down strategy found a statistically increased risk of treatment failure of 30.3% for substituting LTRA compared with 20.2% for continuing ICS. The three articles that met the inclusion criteria for comparing LTRA versus placebo in patients with stable asthma who reduce ICS found a modestly decreased risk ratio that favored LTRA of 0.57 (95% confidence interval, 0.36-0.90; I2 = 0%) in studies that only included individuals >15 years old. Conclusion: Only one study addressed the risk of substitution of LTRA for ICS in stable asthma, which limited any strong conclusions about this step-down strategy. [ABSTRACT FROM AUTHOR]

Background: The long time use of opium has some effects on serums biochemical factors, the determination of this variation is a new approach in understanding off addiction and relive of drug abuser health. Hence in this study, these indicators in person who were withdrawing of opium have been studied. Methods: In this cross-sectional study bloods biochemical factors such as fasting blood sugar (FBS), sodium (Na), calcium (Ca), uric acid (UA), blood urea nitrogen (BUN), creatinine, cholesterol, total protein, and fibrinogen in three groups serum were studied: (1) Who had been permanent opium users more than 2 years (case). (2) Dependent person who has taken one month addiction withdrawal course (control). (3) A healthy group that had been demographically similar to the other groups. Findings: According to these study findings, FBS serum level in the case group is lower than control group. Serum level of Na, creatinine, and blood triglyceride (TG) in case study are higher than group control. Concentration of potassium, Ca, UA, BUN, cholesterol, total serum protein, fibrinogen, and thrombin time in case study and group control showed no significant difference. Also, in withdrawing case serum level of Na, Ca, UA, BUN, creatinine, and TG significantly increase and thrombin time decrease. Conclusion: According to this study not only the longtime use of opium but also opium with drawerin opium dependent people can change their serum biochemical factors. So recognition, treatment, and prevention of this change could be a new step in improving of health and condition of patients. [ABSTRACT FROM AUTHOR]

This meta-analysis reviews the findings of 74 studies (N = 14,255) examining the associations between the demand/withdraw pattern of interaction and individual, relational, and communicative outcomes. When both the individual behaviors of demanding and withdrawing and the pattern of demand/withdraw are considered collectively, the cumulative evidence indicates a moderate, meaningful relationship between demand/withdraw and overall outcomes (r=.360). Similar overall effect sizes were observed for wife demand/husband withdraw (r=.380) and husband demand/wife withdraw (r=.392), although the overall effect size for demand/withdraw patterns in studies that included distressed/clinical participants (r=.413) was greater in magnitude than that obtained for studies that included nondistressed participants (r=.345). On average, higher correlations were observed for relational (r=.423) and communicative outcomes (r=.418) than for demographic (r=.239) and well-being outcomes (r=.249). [ABSTRACT FROM PUBLISHER]

Artificial nutrition represents the whole set of medical therapies which totally or partially replace oral feeding when this is no longer possible. Artificial nutrition needs to be initiated and withdrawn depending on the balance between the advantages and disadvantages induced to the patient. The medical world frequently encounters dilemmas about initiating and withdrawing this treatment. Numerous controversies still exist regarding the appropriate use of enteral or parenteral nutrition in certain categories of patients, such as those with strokes, with persistent vegetative states, with dementia, with neoplasms or other terminal illnesses. The decision to initiate, withhold or withdraw this medical procedure needs to be based on the patient's autonomy. If the patient is no longer capable of making decisions and has not left previous clear directives, it is the responsibility of the patient's legal representative, of the family or of the Court to decide according to the medical data on the respective case and the legal provisions in force in each country. Other ethical issues are generated by the obligation to rationalize health care resources. [ABSTRACT FROM AUTHOR]

Abstract: Background/aims: Current international guidelines indicate that finite therapy with nucleos(t)ide analogues (NAs) is possible in chronic hepatitis B (CHB) patients. Here we evaluate the durability of efficacy after telbivudine (LdT) off-treatment. Methods: 39 CHB patients with normalized ALT, undetectable HBV-DNA and HBeAg seroconversion for at least 48 weeks were observed after telbivudine discontinuation. We analyzed the follow-up clinical condition of off-treatment, calculated the cumulative clinical relapse rate, and explored the predictive factors for clinical relapse. Results: Totally 8 patients encountered clinical relapse in the first 60 weeks after telbivudine discontinuation. The cumulative clinical relapse rates at week 24, 48, 60 and 204 were respectively 2.6%, 7.7%, 16.3% and 23.3%. No significant difference was found between cumulative clinical relapse rates of HBeAg(+) and HBeAg(−). No significant baseline or on-treatment factors for clinical relapse were found. Conclusion: The present study demonstrated that most CHB patients maintained sustained response and HBeAg seroconversion following telbivudine off-treatment. Clinical relapses may often occur in the early period, with low clinical relapse rate. More follow-up data will be on-going and complemented in the further studies. [Copyright &y& Elsevier]

The first year of college continues to be a critical period for student persistence, learning, and development. College students are under increasing pressure to make commitments to major and career plans at a very early stage in their undergraduate experience, often without the programmatic support to do so. First-year experience professionals, who are knowledgeable about student development theory and professionally committed to facilitating the transition of students to collee, are well position to fill the void in support for early academic and career decision-making. Provision of proactive and personalized support to meet the current demands for early educational and vocational decision-makingmay be pivotal for ensuring the success of today's first-year students in general, and today's growing number of first-generation students in particular.

Aim-Background: The severity of illness of patients who enter the intensive care unit (ICU) render it a setting where death is common. End-of-life decision-making for the ICU patient has been a hot topic in recent years. This paper presents our comments, concerns and thoughts for making the decision to withdraw or withhold life support in the ICU. What is the optimal approach to such decisions? What are the indications, benefits, and ethical dilemmas of either choice? What is the current preference worldwide? Methods: The databases that were searched included The Cochrane Library Database, Medline, and EMBASE. Articles were also identified through a general internet search using the Google search engine. Results: As a general principle, when the goals of care cannot be achieved with aggressive life-sustaining treatments, it is appropriate to withdraw these treatments and to allow death to occur. However, decisions concerning withdrawal of life support remain one of the most difficult emotional burdens for an ICU team given that these decisions encompass complex emotional and ethical questions that affect patients, family members, and care providers. Conclusions: Doctors must have the conscience or the 'courage' to stop a treatment which no longer makes sense, provides no further benefit to the patient, causes discomfort or pain and prolongs the use of limited resources. Doctors are privileged to be able to assist their patients in their final journey through the dying process. As such, they have a duty to ensure that their patients die with dignity. Although doctors may stop active treatment, they must never stop patient care; withdrawal of therapy does not mean withdrawal of care. [ABSTRACT FROM AUTHOR]

To determine what percentage of inner-city children with asthma would lose asthma control when taken off asthma controllers, a retrospective analysis was performed on inner-city asthmatic children who achieved asthma control in an asthma specific disease management program. Once disease control was achieved patients had stepwise reduction of asthma controllers based on the National Asthma Education and Prevention Program (NAEPP) Expert Review Panel (EPR) 2 guidelines. In patients who were taken off all controllers, probability of maintaining asthma control at the first visit after cessation of these medications was significantly lower compared to patients kept on inhaled corticosteroids. We conclude that cessation of asthma controllers in previously well controlled inner-city asthmatic children results in loss of asthma control in a significant number of these patients. Data support recommendations from national asthma guidelines to step down controller therapy, but clinical monitoring is important to reduce impairment due to loss of control. [ABSTRACT FROM AUTHOR]

The escape-conditioning model suggests that husbands experience greater physiological arousal during marital conflict than their wives. This greater arousal is hypothesized to lead to withdrawal from conflict in order to lessen the arousal. The present results, based on a U.S. sample of 64 heterosexual couples, found no support for this model. During problem-solving discussions, husbands did not exhibit greater skin conductance and did not report greater arousal than their wives. Furthermore, skin conductance was negatively linked to withdraw behavior. These results, while not consistent with the escape-conditioning model, are in line with recent studies that have explicitly examined gender differences in other types of physiological arousal during marital conflict. [ABSTRACT FROM AUTHOR]

In this paper I argue, against the current consensus, that the right to withdraw from research is sometimes alienable. In other words, research subjects are sometimes morally permitted to waive their right to withdraw. The argument proceeds in three major steps. In the first step, I argue that rights typically should be presumed alienable, both because that is not illegitimately coercive and because the general paternalistic motivation for keeping them inalienable is untenable. In the second step of the argument, I consider three special characteristics of the right to withdraw, first that its waiver might be exploitative, second that research involves intimate bodily access, and third that it is irreversible. I argue that none of these characteristics justify an inalienable right to withdraw. In the third step, I examine four considerations often taken to justify various other allegedly inalienable rights: concerns about treating yourself merely as a means as might be the case in suicide, concerns about revoking all your future freedoms in slavery contracts, the resolution of coordination problems, and public interest. I argue that the motivations involved in these four types of situations do not apply to the right to withdraw from research. [ABSTRACT FROM AUTHOR]

Studies consistently show sex differences in married couples' use of demand and withdraw behavior. The social structure hypothesis proposes that these differences are the result of power differentials between spouses. This study examined the link between 3 aspects of marital power and demanding and withdrawal behavior. Contrary to social structure predictions, results showed that wives did not possess less decision-making ability or access to resources and appeared to exhibit greater situational power (i.e., domineering and dominant behaviors) than did their husbands during problem-solving discussions. Furthermore, the spouse who exhibited the most demands also exhibited the most domineering and dominant behaviors, whereas the spouse who exhibited the most withdrawal exhibited the least domineering and dominant behaviors during problem-solving discussions. [ABSTRACT FROM AUTHOR]

Loneliness is generally a prevailing experience which is particularly familiar to adolescents and young adults. It is a subjective experience which is influenced by one's personality, life experiences, and situational variables. The present study examined the connection between drug cessation and the antecedents of loneliness. Drug abusers, during their stay in detox centers, were compared to drug abusers who participated in a methadone maintenance program and those two groups were compared to the general population who are non drug users. A total of 304 participants volunteered to answer a 30-item yes/no questionnaire, reflecting on their loneliness experiences and what caused them. The factors that comprise the causes of loneliness are: Personal inadequacies, Developmental deficits, Unfulfilling intimate relationships, Relocation/significant separations, and Social marginality. Results revealed significant differences between the scores of the three groups. [ABSTRACT FROM AUTHOR]

Background: The incidence of withholding and withdrawing life support from the critically ill has increased in recent years. The aim of this study was to assess the degree of consistency between the weight assigned by intensivists to different determinants and their relation to end-of-life decisions, and to evaluate the current concepts in withholding or withdrawing intensive care in Nordic countries.Methods: Forty-one intensivists from Nordic countries completed a questionnaire sent by e-mail: consistency between contributing factors and the decisions regarding 10 actual cases was evaluated by logistic regression analysis and by the classification (leave-one-out) method. Concepts in management after the withdrawal decision were also analyzed.Results: The median (range) number of withdrawals per physician was four (range 0-10) out of 10 cases. No single factor was an independent covariant of all decisions made. The classification method revealed that approximately 70% only of decisions could be predicted correctly. Different actions taken after a decision to withdraw intensive care varied from 9.8% (discontinuing ventilator therapy) to 97.6% (informing relatives).Conclusions: No generally accepted grounds for end-of-life decisions could be detected among Nordic intensivists. In addition, the current concept of management after decision to withdraw therapy varies markedly. This study has implications in further assessment of the individual decision-making process and the uniformity of actions after withdrawal decisions. [ABSTRACT FROM AUTHOR]