Michael Wilson

Background: Legal assisted dying is a rare event, but as legalisation expands, requests for it will likely increase, and the nurse most often receives the informal, initial request. Objectives: To assess the effects of attitude in interaction with normative and control beliefs on an intention to respond to a request for legal assisted dying. Ethical considerations: The study had the lead author’s institutional ethics approval, and participants were informed that participation was both anonymous and voluntary. Methodology: This was a cross-sectional correlational study of 377 Australian registered nurses who completed an online survey. Generalised linear modelling assessed the effects of independent variables against intended responses to requests for legal assisted dying. Results: Compared to nurses who did not support legal assisted dying, nurses who did had stronger beliefs in patient rights, perceived social expectations to refer the request and stronger control in that intention. Nurses who did not support legal assisted dying had stronger beliefs in ethics of duty to the patient and often held dual intentions to discuss the request with the patient but also held an intention to deflect the request to consideration of alternatives. Discussion: This study advances the international literature by developing quantified models explaining the complexity of nurses’ experiences with requests for an assisted death. Attitude was operationalised in interaction with other beliefs and was identified as the strongest influence on intentions, but significantly moderated by ethical norms. Conclusion: The complex of determinants of those intentions to respond to requests for an assisted death suggests they are not isolated from each other. Nurses might have distinct intentions, but they can also hold multiple intentions even when they prioritise one. These findings present opportunities to prepare nurses in a way that enhances moral resilience in the face of complex moral encounters.

Aims: To investigate the relationships between tobacco dependence, biomarkers of nicotine and carcinogen exposure and biomarkers of nicotine and carcinogen exposure per cigarette in back and white smokers. Design, setting and participants: A total of 204 healthy black and white smokers were enrolled into two clinical studies. Measurement: Nicotine equivalents, 4--1-pyridyl-1-butanol and polycyclic aromatic hydrocarbon metabolites were measured in urine. The Fagerström Test for Nicotine Dependence and time to first cigarette measured tobacco dependence. Findings: Average TFC and FTND for blacks and whites were not significantly different. Urine NNAL and nicotine equivalents increased with increasing FTND in whites but did not increase in blacks, FTND and TFC were not correlated significantly with urine nicotine equivalents and carcinogen exposure in blacks. We found moderate correlations between FTND and TFC and nicotine equivalents and carcinogen exposure among whites of low dependence and non-significant correlations among whites of high dependence. Conclusion: In the United States, tobacco dependence measures were related linearly to nicotine intake and carcinogen exposure in white but not in black smokers. The relationship between dependence measures and tobacco biomarkers in black smokers regardless of level of dependence resembled highly dependent white smokers. © 2012 Society for the Study of Addiction.

Hamster cheek pouches were exposed to 2-chloroethyl ethyl sulfide [CEES, half-mustard gas ] at a concentration of 0.4, 2.0, or 5.0 mg/ml for 1 or 5 min. Twenty-four hours post-HMG exposure, tissue damage was assessed by both stereomicrography and optical coherence tomography. Damage that was not visible on gross visual examination was apparent in the OCT images. Tissue changes were found to be dependent on both HMG concentration and exposure time. The submucosal and muscle layers of the cheek pouch tissue showed the greatest amount of structural alteration. Routine light microscope histology was performed to confirm the OCT observations. © 2010 Society of Photo-Optical Instrumentation Engineers.

Purpose: To assess noninvasive optical coherence tomography and optical Doppler tomography for early detection and evaluation of chemotherapy-induced oral mucositis. Experimental Design: Cheek pouches of 10 Syrian golden hamsters were imaged using OCT/ODT during development of chemotherapy-induced mucositis. I.p. injections of 5-fluorouracil and mechanical irritation induced oral lesions. At 2, 4, 7, and 11 days, one hamster was sacrificed and processed for histopathology. OCT images were visually examined; ODT results were semiquantified. Imaging data were compared with histologic findings. Results: During the development of mucositis, OCT/ODT identified the following events: change in epithelial thickness, loss of surface keratinized layer continuity, loss of epithelial and submucosal integrity, changes in axial blood flow velocity, and changes in blood vessel size. The semiquantitative imaging-based scoring system identified the severity of mucositis as defined by histopathology. The combination of imaging criteria used allowed for the detection of early, intermediate, and late mucositic changes. Imaging data gave higher scores compared with clinical scores early on, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. Conclusion: OCT/ODT identified chemotherapy-induced oral changes before their clinical manifestation, and the proposed scoring system for oral mucositis was validated for the semiquantification of mucositic change. © 2007 American Association for Cancer Research.

In an effort to further explore ostensible macroscopic psychokinesis (macro-PK) effects like those previously reported by Batcheldor (1966), Bourgeois (1994), Owen and Sparrow (1976), and Ullman (2001) in a sitter group setting, the first author designed and conducted a series of fifteen experimental sessions in which sitters claiming exceptional abilities attempted to generate a pseudo-spirit named "Daniel," to whom physical phenomena were attributed. To explore possible physical correlates of macro-PK, two approaches to measurement were utilized. In the first, sample data from a local random number generator (RNG) continuously running as part of the Global Consciousness Project were extracted and examined for statistical deviations from randomness occurring in conjunction with the sitter group sessions. In the second, the Multi-Energy Sensor Array (MESA) was used to collect onsite environmental data during one of the sessions. While displays of ostensible macro-PK were observed during several of the sitter group sessions, the RNG data did not show a significant overall correlation with the sessions. The MESA data indicated notable drops in infrared and visual light, as well as changes in DC magnetic field strength, that are comparable to those observed in field studies of haunts. Keywords: sitter groups--macroscopic psychokinesis (macro-PK)--random number generator (RNG)--Multi-Energy Sensor Array (MESA)

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Introduction: The emergency medical evaluation of psychiatric patients presenting to United States emergency departments, usually termed “medical clearance,” often varies between EDs. A task force of the American Association for Emergency Psychiatry, consisting of physicians from emergency medicine, physicians from psychiatry and a psychologist, was convened to form consensus recommendations for the medical evaluation of psychiatric patients presenting to U.S.EDs. Methods: The task force reviewed existing literature on the topic of medical evaluation of psychiatric patients in the ED and then combined this with expert consensus. Consensus was achieved by group discussion as well as iterative revisions of the written document. The document was reviewed and approved by the AAEP Board of Directors.Results: Eight recommendations were formulated. These recommendations cover various topics in emergency medical examination of psychiatric patients, including goals of medical screening in the ED, the identification of patients at low risk for co-existing medical disease, key elements in the ED evaluation of psychiatric patients including those with cognitive disorders, specific language replacing the term “medical clearance,” and the need for better science in this area.Conclusion: The evidence indicates that a thorough history and physical examination, including vital signs and mental status examination, are the minimum necessary elements in the evaluation of psychiatric patients. With respect to laboratory testing, the picture is less clear and much more controversial.