Speech and Suicide-The Line of Legality

While physician-assisted suicide legislation is being drafted and passed across the United States, a gray-area continues to exist in regard to the legality of a lay person's assistance with suicide. Several high-profile cases have been covered in the media, namely that of Michelle Carter in Massachusetts and William Melchert-Dinkel in Minnesota, but there is also a growing volume of anonymous pro-suicide materials online. Pro-suicide groups fly under the radar and claim to help those desiring to take their own lives. This paper aims to identify the point at which an individual or group can be held civilly or criminally liable for assisting suicide and discusses how the First Amendment can be used to shield authors from such liability.

Review of United States laws pertaining to the recovery and analysis of human skeletal remains

Human skeletal remains (HSR) are routinely excavated from archeological contexts and analyzed by experts in human osteology. Contrarily, HSR in medicolegal contexts are usually recovered by law enforcement officers and examined by pathologists with limited osteological training. To examine legal requirements for expertise, we reviewed laws in the United States regarding the recovery and analysis of HSR from archeological sites, unmarked graves, and medicolegal contexts. Of the 50 states, 19 (38%) have laws stating that an anthropologist with osteological training should be involved in the recovery or analysis of HSR from an archeological context. Fifteen of those 16 states have laws requiring a minimum level of education to be a qualified skeletal analyst. In contrast, only one state, Texas, requires an anthropologist who handles forensic cases to have a doctoral degree. Including Texas, only eight states (16%) have laws that encourage but do not mandate consultation with a forensic anthropologist for medicolegal skeletal cases. Louisiana and Washington have state-funded laboratories, expert forensic anthropologists, and effective protocols for handling forensic cases. Due process and human rights concerns at stake in criminal cases require that those recovering and analyzing modern HSR have an equal or higher level of expertise than those working with archeological remains. Yet, legislators assume that law enforcement and pathologists are adequately trained. Because court standards demand expert testimony based on accepted methodologies and standard levels of competency, forensic anthropologists have a professional responsibility to engage with lawmakers to draft legislation to ensure proper handling of all skeletal cases.

Immune checkpoint inhibition alters the inflammatory cell composition of human coronary artery atherosclerosis

BACKGROUND

Immune checkpoint inhibition (ICI) has emerged as a promising new approach to treat malignancy. Such therapies can result in autoimmune-related complications such as myocarditis and hepatitis. The impact of ICI on sites of preexisting chronic inflammation has been less clear. Atherosclerosis is a chronic vascular disease with a significant inflammatory component.

METHODS

To determine the effect of ICI on the inflammatory infiltrate in coronary artery atherosclerotic plaques, 11 patients who had recently been treated with ICI and subsequently underwent autopsy were matched with 11 cancer patients who had not received ICI treatment. The amount of CD3⁺ T-lymphocytes, CD8⁺ cytotoxic T-lymphocytes, and CD68⁺ macrophages and the ratios of the various cell types in the coronary artery atherosclerotic plaques were compared.

RESULTS

There was no significant difference in the absolute numbers of CD3⁺, CD8⁺, or CD68⁺ cells in the atherosclerotic plaques. In the plaques of the ICI-treated patients, there was a significant increase in the ratio of CD3⁺ cells to CD68⁺ cells (CD3/CD68) (P=.002) and a trend towards an increased CD8/CD68 ratio. The increased CD3/CD68 ratio in the ICI-treated patients resulted in 6 of the 11 patients having lymphocyte-predominate inflammation in contrast to the macrophage-predominate inflammation typically found in atherosclerotic plaques.

CONCLUSIONS

These findings indicate that ICI alters the inflammatory composition of human atherosclerotic plaque and, thus, may influence plaque progression and/or clinical coronary events.

SUMMARY

In cancer patients, treatment with immune checkpoint inhibition is associated with an altered inflammatory cell composition in coronary artery atherosclerotic plaques with an increased ratio of CD3⁺ T cells to CD68⁺ macrophages. Thus, immune checkpoint inhibition may influence plaque progression and/or clinical coronary events.

Structure-activity relationship studies of 4-[2-(diphenylmethoxy)ethyl]-1-benzylpiperidine derivatives and their N-analogues: evaluation of O-and N-analogues and their binding to monoamine transporters

In our effort to develop a pharmacotherapy for the treatment of cocaine addiction, we embarked on synthesizing novel molecules targeting the dopamine transporter (DAT) molecule in the brain as DAT has been implicated strongly in the reinforcing effect of cocaine. Our previously developed DAT-selective piperidine analogue, 4-[2-(diphenylmethoxy)ethyl]-1-benzylpiperidine, was the basis for our current structure-activity relationship (SAR) studies exploring the significance of the contribution of the benzhydryl O- and N-atoms in these molecules in interacting with the DAT. Thus, we replaced the benzhydryl O-atom with an N-atom, altered the location of the benzhydryl N-atom to an adjacent position, and in one other occasion converted the benzhydryl O-ether linkage into an oxime-type derivative. Furthermore, we also evaluated the important contribution of the piperidine N-atom to binding by altering its pK(a) value chemically. Novel analogues were tested for potency in inhibiting [3H]WIN 35,428, [3H]citalopram, and [3H]nisoxetine binding at the DAT, serotonin transporter (SERT), and norepinepherine transporter (NET). [3H]DA was used to measure DA reuptake inhibition. The results indicated that the benzhydryl O- and N-atoms are exchangeable for the most part. On the other hand, an enhanced interaction with the SERT was observed when the benzhydryl N-atom moved to an adjacent position (21a; DAT (IC(50)) = 19.7, SERT (IC(50)) = 137 nM, NET (IC(50)) = 1111 nM). In either cases, further alkylation of the N-atom reduced the activity for the transporter. The presence of a powerful electron-withdrawing cyano group in compound 5d expectedly produced the most potent and selective ligand for the DAT (DAT (IC(50)) = 3.7 nM, DAT/SERT = 615). Selected compounds were further analyzed in the dopamine reuptake inhibition assay. Preliminary behavioral assessment of some of the selected compounds in mice indicated that these compounds are much less stimulating when compared with cocaine at comparable doses. In drug-discrimination studies these selected compounds incompletely generalized from the cocaine stimulus in mice trained to discriminate 10 mg/kg cocaine from vehicle.

Triclosan: a review of effectiveness and safety in health care settings

Triclosan is a widely accepted antimicrobial ingredient because of its safety and antimicrobial efficacy. Triclosan is a unique antimicrobial well suited for use in the health care industry in which mildness is a necessity to protect the health care worker during repeated use and antimicrobial activity is a necessity to protect public health. Triclosan has demonstrated immediate, persistent, broad-spectrum antimicrobial effectiveness and utility in clinical health care settings. This review highlights the utility and effectiveness of a 1% triclosan formulation for use in high-risk, high-frequency handwashing.

Solution structure and dynamics of the Rous sarcoma virus capsid protein and comparison with capsid proteins of other retroviruses

The solution structure and dynamics of the recombinant 240 amino acid residue capsid protein from the Rous sarcoma virus has been determined by NMR methods. The structure was determined using 2200 distance restraints and 330 torsion angle restraints, and the dynamics analysis was based on (15)N relaxation parameters (R(1), R(2), and (1)H-(15)N NOE) measured for 153 backbone amide groups. The monomeric protein consists of independently folded N- and C-terminal domains that comprise residues Leu14-Leu146 and Ala150-Gln226, respectively. The domains exhibit different rotational correlation times (16.6(+/-0.1) ns and 12.6(+/-0.1) ns, respectively), are connected by a flexible linker (Ala147-Pro149), and do not give rise to inter-domain NOE values, indicating that they are dynamically independent. Despite limited sequence similarity, the structure of the Rous sarcoma virus capsid protein is similar to the structures determined recently for the capsid proteins of retroviruses belonging to the lentivirus and human T-cell leukemia virus/bovine leukemia virus genera. Structural differences that exist in the C-terminal domain of Rous sarcoma virus capsid relative to the other capsid proteins appear to be related to the occurrence of conserved cysteine residues. Whereas most genera of retroviruses contain a pair of conserved and essential cysteine residues in the C-terminal domain that appear to function by forming an intramolecular disulfide bond during assembly, the Rous sarcoma virus capsid protein does not. Instead, the Rous sarcoma virus capsid protein contains a single cysteine residue that appears to be conserved among the avian C-type retroviruses and is positioned in a manner that might allow the formation of an intermolecular disulfide bond during capsid assembly.

Ureteral rhabdomyosarcoma

Rhabdomyosarcoma is a malignant tumor well known to urologists. These tumors arise from the genitourinary system in 20% to 25% of cases, most commonly from the bladder, prostate, vagina, and paratesticular region. This is the first reported case of a rhabdomyosarcoma arising from the ureter. The radiographic findings and ureteroscopic appearance of this tumor suggested a benign fibroepithelial polyp; however, a ureteroscopic biopsy and subsequent nephroureterectomy revealed an embryonal rhabdomyosarcoma.

Prevalence and phenotype consequence of FRAXA and FRAXE alleles in a large, ethnically diverse, special education-needs population

We conducted a large population-based survey of fragile X (FRAXA) syndrome in ethnically diverse metropolitan Atlanta. The eligible study population consisted of public school children, aged 7-10 years, in special education-needs (SEN) classes. The purpose of the study was to estimate the prevalence among whites and, for the first time, African Americans, among a non-clinically referred population. At present, 5 males with FRAXA syndrome (4 whites and 1 African American), among 1,979 tested males, and no females, among 872 tested females, were identified. All males with FRAXA syndrome were mentally retarded and had been diagnosed previously. The prevalence for FRAXA syndrome was estimated to be 1/3,460 (confidence interval [CI] 1/7,143-1/1,742) for the general white male population and 1/4, 048 (CI 1/16,260-1/1,244) for the general African American male population. We also compared the frequency of intermediate and premutation FRAXA alleles (41-199 repeats) and fragile XE syndrome alleles (31-199 repeats) in the SEN population with that in a control population, to determine if there was a possible phenotype consequence of such high-repeat alleles, as has been reported previously. No difference was observed between our case and control populations, and no difference was observed between populations when the probands were grouped by a rough estimate of IQ based on class placement. These results suggest that there is no phenotype consequence of larger alleles that would cause carriers to be placed in an SEN class.

Cryptosporidium infection in acquired immunodeficiency syndrome: not always a poor prognosis

Chronic diarrhea and malabsorption accompanied by simultaneous infection with the protozoa Giardia lamblia and Cryptosporidium occurred in a 22-year-old homosexual man with antibody to human immunodeficiency virus (HIV). Small bowel biopsy demonstrated total villous atrophy and marked mononuclear infiltration in the lamina propria simulating celiac disease. Treatment with metronidazole resulted in resolution of diarrhea, clearance of parasites, and marked improvement in small bowel histology. Although diarrhea and malabsorption in immunocompromised patients with cryptosporidiosis are regarded as ominous, our patient remained disease free for the next 3 years. Thus, infection with Cryptosporidium in patients with HIV does not always lead to intractable diarrhea or death.

Intermittent use of an antimicrobial hand gel for reducing soap-induced irritation of health care personnel

We evaluated the effects of an antimicrobial hand gel (containing 60% ethanol plus emollients) on skin condition when used as a supplement to handwashing. Volunteers washed their hands 10 times per day for 5 days with a bar soap. Between washings one hand was treated with 1.0 ml of the gel while the other hand was untreated. By the conclusion of the study the gel-treated hands exhibited significantly lower (p less than 0.05) photographic scores for cracking, scaling, and erythema (redness), the major symptoms of dry, irritated skin. The gel treatment also helped to maintain normal skin hydration levels as measured by transepidermal water loss and skin impedance. By reducing soap-induced irritation, an alcohol gel with the appropriate emollients can help eliminate a major deterrent to handwashing among health care personnel.

Factors affecting skin condition in two nursing populations: implications for current handwashing protocols

Two different nursing populations--one from Phoenix, Arizona, and the other from Racine, Wisconsin--and a group of persons prone to dry skin from Racine were evaluated for the presence of scaling, cracking, and erythema, the major visible symptoms of hands with dry, chapped skin. The results provide insight into the effects of age, season, geographic locale, handwashing frequency, and work area on skin condition. Season (winter), geographic locale (northern locale), and age (over 30 years) were the most significant extrinsic factors influencing the manifestation of hands with dry, chapped skin. In the presence of these predisposing factors, a handwashing frequency of only one to two times per hour was sufficient to significantly increase the severity of dry skin. Among nurses those most susceptible to dry skin were over 30 years of age, were high-frequency (more than three washings per hour) hand washers, and were exposed to the winter climate of a northern locale.

Phase behavior of synthetic N-acylethanolamine phospholipids

Both saturated and unsaturated N-acylethanolamine phospholipids form lamellar structures when dispersed in buffer. The addition of excess Ca2+ (Ca2+/N-acylphosphatidylethanolamine greater than 0.5) results in precipitation. Freeze-fracture replicas indicate that the addition of Ca2+ to the unsaturated lipid results in a non-bilayer structure while the Ca2+-complex of the saturated lipid is lamellar. Since unsaturated phosphatidylethanolamine (PE) is a non-bilayer lipid, its N-acylation with a saturated fatty acid converts a non-bilayer lipid into an acidic bilayer lipid capable of interacting with Ca2+ to return to a non-bilayer structure. Ca2+ may thereby exert an influence on membrane phenomena by regulating phase behavior within certain membrane domains. Differential scanning calorimetry (DSC) indicates that N-acylation of unsaturated PE with a saturated fatty acid also results in changes in thermotropic phase behavior. Therefore, N-acylation may affect fluidity within certain membrane domains.

Further evidence for unidimensionality of measures of counseling performance

A number of previous studies have indicated that measures of counseling performance reduce to a unidimensional structure, based on the examination of relationships among measures from only a few instruments. That finding has persisted in spite of multidimensional theory and training. This study of the relationships among 12 commonly used measures of counseling performance provides further evidence of this unidimensional structure of “good-therapist” factor underlying performance. Implications for training are discussed.

Preliminary study of internal dialogue in a training setting

An investigation of task-distractive and facilitative dimensions of the internal dialogue of 30 counseling trainees in a laboratory setting was conducted. The correlations of internal dialogue to counseling performance, personality dimensions, and state/trait anxiety were examined and discussed.

Unequal homologous recombination between tandemly arranged sequences stably incorporated into cultured rat cells

Cultured rat cells deficient in endogenous thymidine kinase activity (tk) were stably transformed with a recombination-indicator DNA substrate constructed in vitro by rearrangement of the herpes simplex virus tk gene sequences into a partially redundant permutation of the functional gene. The recombination-indicator DNA did not express tk, but was designed to allow formation of a functional tk gene via homologous recombination. A clonal cell line (519) was isolated that harbored several permuted herpes simplex virus tk genes. 519 cells spontaneously produced progeny that survived in medium containing hypoxanthine, aminopterin, and thymidine. Acquisition of resistance to hypoxanthine, aminopterin, and thymidine was accompanied by the rearrangement of the defective tk gene to functional configuration. The rearrangement apparently occurred by unequal exchange between one permuted tk gene and a replicated copy of itself. Recombination was between 500-base-pair tracts of DNA sequence homology that were separated by 3.4 kilobases. Exchanges occurred spontaneously at a frequency of approximately 5 X 10(-6) events per cell per generation. Recombination also mediated reversion to the tk- phenotype; however, the predominant mechanism by which cells escaped death in the presence of drugs rendered toxic by thymidine kinase was not recombination, but rather inactivation of the intact tk gene.

Effects of varying the practice stimuli on clinical hypothesis-formation

The purpose of this study was to investigate the effects of varying the form of practice stimuli (written, videotaped, live client) on trainees' ability to formulate clinical hypotheses. 20 counselor-trainees were randomly assigned to a written, videotaped or live-client simulation. Each group was presented a training module for clinical hypothesis-formation and were then given an opportunity to practice developing clinical hypotheses. Participants receiving practice with live clients performed significantly better than those receiving the written client presentation.

A hazard rate approach to the timing of births

"This paper discusses two approaches that economists have taken in analyzing the timing of births. It formulates an empirical model appropriate for one of these approaches and demonstrates its usefulness using household survey data from Costa Rica. The hazard rate technique employed in this paper is a natural way of modeling a broad class of problems where the occurrence of an event is uncertain." The study also indicates that "historical data can be used to determine whether the strong trend in the relationship between regional mortality levels and the age at first birth is real or the result of inappropriate data. Additionally, data from other countries might be employed to determine whether the significant effect of male education levels on the risk of subsequent births is a general result. Finally..., the predictions of theoretical models dealing with the number and pace of births can be tested using data from younger women."

Do sex-role appropriate materials influence the Piagetian task performance of older adults?

The intent of this study was to assess the influence of sex-role appropriate materials on the utilization of logical competence among older persons, and to determine how such materials interact with subject's sex-role identity to affect cognitive performance. Thirty male and 30 female Ss (mean age = 71.3 years) were administered the Short Form of the Bem Sex-Role Inventory and either a male-oriented, a female-oriented, or a traditional version of two concrete operational and two formal operational Piagetian tasks. Gender was found to influence performance on one of the concrete tasks, task orientation influenced performance on one of the formal tasks, and sex-role classification interacted with task orientation to influence performance on both of the formal operational tasks. The pattern of results suggested that subjects may perform best on those versions of the formal operational tasks that do not match their own sex type. Possible explanations for these findings are discussed.

Calorimetric studies of lipid phase transitions in native and heat-denatured membranes of beef heart submitochondrial particles

The lipids in beef heart submitochondrial particles undergo a broad reversible endothermic phase change centered at about -10 degrees C. Following protein denaturation, a new reversible transition centered at about 20 degrees C appears. The extracted lipids from these membranes exhibit thermal behavior that is essentially identical to the lipid transition in the intact membrane after protein denaturation. A role for this latent pool of higher-melting lipids is proposed.