The debate rages on: physician-assisted suicide in an ethical light.

The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from 'opposed' to forms of 'neutral'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK.

The genome of Schmidtea mediterranea and the evolution of core cellular mechanisms.

The planarian Schmidtea mediterranea is an important model for stem cell research and regeneration, but adequate genome resources for this species have been lacking. Here we report a highly contiguous genome assembly of S. mediterranea, using long-read sequencing and a de novo assembler (MARVEL) enhanced for low-complexity reads. The S. mediterranea genome is highly polymorphic and repetitive, and harbours a novel class of giant retroelements. Furthermore, the genome assembly lacks a number of highly conserved genes, including critical components of the mitotic spindle assembly checkpoint, but planarians maintain checkpoint function. Our genome assembly provides a key model system resource that will be useful for studying regeneration and the evolutionary plasticity of core cell biological mechanisms.

Megalithic tombs in western and northern Neolithic Europe were linked to a kindred society.

Paleogenomic and archaeological studies show that Neolithic lifeways spread from the Fertile Crescent into Europe around 9000 BCE, reaching northwestern Europe by 4000 BCE. Starting around 4500 BCE, a new phenomenon of constructing megalithic monuments, particularly for funerary practices, emerged along the Atlantic façade. While it has been suggested that the emergence of megaliths was associated with the territories of farming communities, the origin and social structure of the groups that erected them has remained largely unknown. We generated genome sequence data from human remains, corresponding to 24 individuals from five megalithic burial sites, encompassing the widespread tradition of megalithic construction in northern and western Europe, and analyzed our results in relation to the existing European paleogenomic data. The various individuals buried in megaliths show genetic affinities with local farming groups within their different chronological contexts. Individuals buried in megaliths display (past) admixture with local hunter-gatherers, similar to that seen in other Neolithic individuals in Europe. In relation to the tomb populations, we find significantly more males than females buried in the megaliths of the British Isles. The genetic data show close kin relationships among the individuals buried within the megaliths, and for the Irish megaliths, we found a kin relation between individuals buried in different megaliths. We also see paternal continuity through time, including the same Y-chromosome haplotypes reoccurring. These observations suggest that the investigated funerary monuments were associated with patrilineal kindred groups. Our genomic investigation provides insight into the people associated with this long-standing megalith funerary tradition, including their social dynamics.

TRPM8 as the rapid testosterone signaling receptor: Implications in the regulation of dimorphic sexual and social behaviors.

Testosterone regulates dimorphic sexual behaviors in all vertebrates. However, the molecular mechanism underlying these behaviors remains unclear. Here, we report that a newly identified rapid testosterone signaling receptor, Transient Receptor Potential Melastatin 8 (TRPM8), regulates dimorphic sexual and social behaviors in mice. We found that, along with higher steroid levels in the circulation, TRPM8-/- male mice exhibit increased mounting frequency indiscriminate of sex, delayed sexual satiety, and increased aggression compared to wild-type controls, while TRPM8-/- females display an increased olfaction-exploratory behavior. Furthermore, neuronal responses to acute testosterone application onto the amygdala were attenuated in TRPM8-/- males but remained unchanged in females. Moreover, activation of dopaminergic neurons in the ventral tegmental area following mating was impaired in TRPM8-/- males. Together, these results demonstrate that TRPM8 regulates dimorphic sexual and social behaviors, and potentially constitutes a signalosome for mediation of sex-reward mechanism in males. Thus, deficiency of TRPM8 might lead to a delayed sexual satiety phenomenon.

Testosterone and semen seasonality for the sand tiger shark Carcharias taurus†.

Understanding the fundamental reproductive biology of a species is the first step toward identifying parameters that are critical for reproduction and for the development of assisted reproductive techniques. Ejaculates were collected from aquarium (n = 24) and in situ (n = 34) sand tiger sharks Carcharias taurus. Volume, pH, osmolarity, sperm concentration, motility, status, morphology, and plasma membrane integrity were assessed for each ejaculate. Semen with the highest proportion of motile sperm was collected between April and June for both in situ and aquarium sand tiger sharks indicating a seasonal reproductive cycle. Overall, 17 of 30 semen samples collected from aquarium sharks from April through June contained motile sperm compared to 29 of 29 of in situ sharks, demonstrating semen quality differences between aquarium and in situ sharks. Sperm motility, status, morphology, and plasma membrane integrity were significantly higher (P < 0.05) for in situ compared to aquarium sand tiger sharks. Testosterone was measured by an enzyme immunoassay validated for the species. Testosterone concentration was seasonal for both aquarium and in situ sharks with highest concentrations measured in spring and lowest in summer. In situ sharks had higher (P < 0.05) testosterone concentration in spring than aquarium sharks. This study demonstrated annual reproduction with spring seasonality for male sand tiger sharks through marked seasonal differences in testosterone and semen production. Lower testosterone and poorer semen quality was observed in aquarium sharks likely contributing to the species' limited reproductive success in aquariums.

Natural environmental conditions and collaborative efforts provide the secret to success for sand tiger shark Carcharias taurus reproduction in aquaria.

Sand tiger sharks are an iconic large shark species held in aquaria worldwide. They rarely reproduce under managed care, with only seven aquaria reporting limited and sporadic success. For the first time in the Americas, a full-term young was born in an aquarium. The young was the result of breeding among a group of sharks purposefully brought together in 2016 for reproduction. Sharks were maintained in natural seawater and exposed to natural light and seasonal temperature fluctuations similar to their in situ counterparts. Decreased food consumption associated with breeding season and gestation was observed. Gestation time estimated from breeding observations and parturition was 321 days. Although the neonate was stillborn, this was a significant achievement. The husbandry details described within will be useful for other aquaria striving to support the reproduction of sand tiger sharks.

Human Exposure to Radioactivity From Tobacco Smoke: Systematic Review.

INTRODUCTION: Tobacco has been known to contain radioactive polonium and lead for 50 years but the literature is divided as to the public health significance. I review the data on tobacco radioactivity and its internalization by smokers. METHODS: Data sources: Reports of lead-210 and polonium-210 content of tobacco leaf, cigarettes, cigarette smoke, and human respiratory tissues, published between 1964 and September 2017. Study selection: Any identified study that reported values for lead-210 and polonium-210 content. Data extraction: Data quality was addressed by comparative review of analytic methods. RESULTS: The data about radiation content of tobacco and smoke are robust. Early reports suggesting microsievert lifetime doses of inhaled radioactivity to smokers were not borne out. The results remain sensitive to pharmacological assumptions around absorption and redistribution of inhaled radionuclides, and radiobiological assumptions about interaction with human tissues. CONCLUSIONS: Literature on tobacco radioactivity has not fully contended with pharmacological and radiobiological uncertainty, and is therefore divided as to health significance. This does much to explain regulatory inaction over the last half century. Before radiation safety law can offer a vehicle for tobacco control, more must be learnt about the pharmacology and radiobiology of inhaled radionuclides in tobacco smoke. IMPLICATIONS: This work makes it apparent that the study of tobacco smoke radioactivity has been scientifically stagnant for the last 40 years. The field cannot advance until we improve understanding of the pharmacology and radiobiology of inhaled radionuclides in tobacco smoke. Despite this, a subset of contemporary authors is still suggesting individual health risks about 1000 times higher than can be supported by internationally accepted models.

Investigation of polar organic chemical integrative sampler (POCIS) flow rate dependence for munition constituents in underwater environments.

Munition constituents (MC) are present in aquatic environments throughout the world. Potential for fluctuating release with low residence times may cause concentrations of MC to vary widely over time at contaminated sites. Recently, polar organic chemical integrative samplers (POCIS) have been demonstrated to be valuable tools for the environmental exposure assessment of MC in water. Flow rate is known to influence sampling by POCIS. Because POCIS sampling rates (Rs) for MC have only been determined under quasi-static conditions, the present study evaluated the uptake of 2,4,6-trinitrotoluene (TNT), RDX (hexahydro-1,3,5-trinitro-1,3,5-triazine), and 2,4- and 2,6-dinitrotoluenes (DNT), by POCIS in a controlled water flume at 7, 15, and 30 cm/s in 10-day experiments using samplers both within and without a protective cage. Sampling rate increased with flow rate for all MC investigated, but flow rate had the strongest impact on TNT and the weakest impact on RDX. For uncaged POCIS, mean Rs for 30 cm/s was significantly higher than that for 7 cm by 2.7, 1.9, 1.9, and 1.3 folds for TNT, 2,4-DNT, 2,6-DNT, and RDX, respectively. For all MC except RDX, mean Rs for caged POCIS at 7 cm/s were significantly lower than for uncaged samplers and similar to those measured at quasi-static condition, but except for 2,6-DNT, no caging effect was measured at the highest flow rate, indicating that the impact of caging on Rs is flow rate-dependent. When flow rates are known, flow rate-specific Rs should be used for generating POCIS-derived time-averaged concentrations of MC at contaminated sites.

REPRODUCTIVE HORMONE PATTERNS IN MALE AND FEMALE COWNOSE RAYS ( RHINOPTERA BONASUS) IN AN AQUARIUM SETTING AND CORRELATION TO ULTRASONOGRAPHIC STAGING.

Reproductive management of cownose rays ( Rhinoptera bonasus) under professional care plays an important role in conservation of the species, but hormone and ultrasonographic analyses of their 12-mo reproductive cycle have not been documented previously. Plasma reproductive hormone concentrations (17B-estradiol, progesterone, testosterone, and androstenedione) were measured monthly via radioimmunoassay for 1 yr in an aquarium-managed population of adult females ( n = 15) and males ( n = 5). Ultrasounds of the uterus were performed each month at the time of sample collection to identify gestation stage (0-5) based on a previously developed in-house staging system. Stages were correlated to hormone concentrations to track progression through pregnancy. Thirteen females were reproductively active, and each produced one pup in March-June, similar to timing for free-ranging populations. Female estradiol increased steadily throughout gestation from stages 0 to 5, while progesterone, testosterone, and androstenedione were increased only in early gestation (stages 1 and 2). Unlike month of year, gestation stage strongly predicted hormone concentration, but specific values to predict parturition date were not identified. Male testosterone and progesterone were higher in March-June (mating season) than July-January, while estradiol and androstenedione did not exhibit a seasonal pattern. Aquarium-managed cownose rays have similar reproductive patterns to what is reported in wild populations. Ultrasonographic monitoring with serial hormone analysis and accurate mating records will provide the most useful information for managing a reproductive population of cownose rays in an aquarium setting.

Pharmacokinetics of a Single Dose of Oral and Intramuscular Meloxicam in African Penguins ( Spheniscus demersus).

Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that has been used orally and intramuscularly in numerous avian species, but not studied to date, in African penguins ( Spheniscus demersus). The study describes the pharmacokinetic parameters of meloxicam after oral and intramuscular administration to African penguins. Several pilot studies were conducted initially where meloxicam (1, 0.5, and 0.25 mg/kg) was given intramuscularly to 4 birds, and orally (1 mg/kg) to 2 birds. Based on pilot study results, one group of 8 penguins was given meloxicam 0.5 mg/kg intramuscularly and one group of 8 penguins was given 1 mg/kg orally. Blood samples were collected at baseline and at 11 time intervals per group after administration of meloxicam. Meloxicam time to maximum plasma concentration (Tmax), maximum concentration (Cmax), and half-life (t1/2) after intramuscular administration were 1.00 hour, 8.03 µg/mL, and 31.87 hours, respectively, while oral administration produced a Tmax, Cmax, and t1/2 of 12.00 hours, 10.84 µg/mL, and 28.59 hours, respectively. Based on plasma meloxicam concentrations found to be therapeutic in other bird species and humans, the recommended dosage and frequency for African penguins is 1 mg/kg orally every 48 hours and 0.5 mg/kg intramuscularly every 24 hours. Further studies are needed to determine the multiple-dose pharmacokinetics of meloxicam in African penguins.

Suboptimal nutrition in early life affects the inflammatory gene expression profile and behavioral responses to stressors.

Nutritional conditions in early life can have a lasting impact on health and disease risk, though the underlying mechanisms are incompletely understood. In the healthy individual, physiological and behavioral responses to stress are coordinated in such a way as to mobilize resources necessary to respond to the stressor and to terminate the stress response at the appropriate time. Induction of proinflammatory gene expression within the brain is one such example that is initiated in response to both physiological and psychological stressors, and is the focus of the current study. We tested the hypothesis that early life nutrition would impact the proinflammatory transcriptional response to a stressor. Pregnant and lactating dams were fed one of three diets; a low-protein diet, a high fat diet, or the control diet through pregnancy and lactation. Adult male offspring were then challenged with either a physiological stressor (acute lipopolysaccharide injection, IP) or a psychological stressor (15 min restraint). Expression of 20 proinflammatory and stress-related genes was evaluated in hypothalamus, prefrontal cortex, amygdala and ventral tegmental area. In a second cohort, behavioral responses (food intake, locomotor activity, metabolic rate) were evaluated. Offspring from low protein fed dams showed a generally reduced transcriptional response, particularly to LPS, and resistance to behavioral changes associated with restraint, while HF offspring showed an exacerbated transcriptional response within the PFC, a reduced transcriptional response in hypothalamus and amygdala, and an exacerbation of the LPS-induced reduction of locomotor activity. The present data identify differential proinflammatory transcriptional responses throughout the brain driven by perinatal diet as an important variable that may affect risk or resilience to stressors.

Intrauterine inflammation induces sex-specific effects on neuroinflammation, white matter, and behavior.

Exposure to inflammation during pregnancy has been linked to adverse neurodevelopmental consequences for the offspring. One common route through which a developing fetus is exposed to inflammation is with intrauterine inflammation. To that end, we utilized an animal model of intrauterine inflammation (IUI; intrauterine lipopolysaccharide (LPS) administration, 50µg, E15) to assess placental and fetal brain inflammatory responses, white matter integrity, anxiety-related behaviors (elevated zero maze, light dark box, open field), microglial counts, and the CNS cytokine response to an acute injection of LPS in both males and females. These studies revealed that for multiple endpoints (fetal brain cytokine levels, cytokine response to adult LPS challenge) male IUI offspring were uniquely affected by intrauterine inflammation, while for other endpoints (behavior, microglial number) both sexes were similarly affected. These data advance our understanding of sex-specific effects of early life exposure to inflammation in a translationally- relevant model.

Empathy and affect: what can empathied bodies do?

While there has been much interest in the apparent benefits of empathy in improving outcomes of medical care, there is continuing concern over the philosophical nature of empathy. We suggest that part of the difficulty in coming to terms with empathy is due to the modernist dichotomies that have structured Western medical discourse, such that doctor and patient, knower and known, cognitive and emotional, subject and object are situated in oppositional terms, with the result that such accounts cannot coherently encompass an emotional doctor, or a patient as knower, or empathy as other than a possession or a trait. This paper explores what, by contrast, a radical critique of the Cartesian world view, in the form of a Deleuzean theoretical framework, would open up in new perspectives on empathy. We extend the framework of emotional geography to ask what happens when people are affected by empathy. We suggest that doctors and patients might be more productively understood as embodied subjects that are configured in their capacities by how they are affected by singular 'events' of empathy. We sketch out how the Deleuzean framework would make sense of these contentions and identify some possible implications for medical education and practice.

Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia.

Infant 13-valent pneumococcal conjugate vaccination (PCV13) was introduced to the UK in 2010. Its impact on serotypes implicated in adult non-bacteraemic pneumococcal pneumonia is not known. Beginning in 2008, a 5-year prospective cohort study of adults admitted to hospital with community-acquired pneumonia (CAP) was conducted. Pneumococcal serotype was established using a validated multiplex immunoassay (Bio-Plex; Bio-Rad, Hercules, CA, USA). The overall incidence for hospitalised CAP and pneumococcal CAP was 79.9 (95% CI 76.6-83.3) and 23.4 (95% CI 21.6-25.3) per 100,000 population, respectively. A decline in CAP (incidence rate ratio (IRR) per year 0.96, 95% CI 0.94-0.99; p=0.016) and pneumococcal CAP (IRR per year 0.84, 95% CI 0.80-0.89; p<0.001) was observed over the 5-year period of the study. Between the pre- and post-PCV13 periods of the study, the incidence of CAP due to serotypes included in the PCV7 declined by 88% (IRR 0.12, 95% CI 0.08-0.20; p<0.001), and CAP due to the additional 6 serotypes in PCV13 declined by 30% (IRR 0.70, 95% CI 0.51-0.96; p=0.024). Incidence of adult pneumococcal pneumonia declined over the last 5 years, with serotypes included in PCV13 declining post-PCV13 introduction, indicating early herd protection effects from PCV13 infant vaccination on adult non-bacteraemic disease. These effects may accrue over the coming years with implications for national pneumococcal vaccination policies in adults.

Pneumococcal serotypes in adult non-invasive and invasive pneumonia in relation to child contact and child vaccination status.

BACKGROUND: On a population level, pneumococcal conjugate vaccination in children has reduced the incidence of vaccine-type disease in all age groups, including older adults. Few individual level studies have been performed describing the pneumococcal serotypes associated with adult community acquired pneumonia (CAP) and quantifying associations with child contact and child vaccination status. METHODS: Pneumococcal serotypes were determined using a validated multiplex immunoassay (Bio-Plex) in a large prospective cohort of adults hospitalised with CAP. Child (<16 years old) contact history and child pneumococcal vaccination status were obtained from patients and public health records, respectively. RESULTS: Of 1130 participants, 329 (29.1%) reported child contact, and pneumococcal infection was identified in 410 (36.3%). Pneumococcal CAP was commoner in adults with child contact (148/329 (45.0%) vs 262/801 (32.7%); adjusted OR 1.63, CI 1.25 to 2.14; p<0.001). A serotype was determined in 263 of 410 (64.1%) adults with pneumococcal CAP; 112 (42.6%) reported child contact, 38 (33.9%) with a vaccinated child. Adults in contact with a vaccinated child were significantly less likely to have vaccine-type CAP compared with adults in contact with an unvaccinated child (6 of 38 (15.8%) vs 25 of 74 (33.8%), respectively; OR 0.37, 95% CI 0.14 to 0.99; p=0.044). CONCLUSIONS: Pneumococcal aetiology in adult CAP is independently associated with child contact and implicated serotypes are influenced by child vaccination status. This is the first study to demonstrate these associations at an individual rather than population level; it affirms that 'herd protection' from childhood vaccination extends beyond adult invasive disease to pneumococcal CAP.

In vivo analysis of dermal and systemic absorption of silver nanoparticles through healthy human skin.

BACKGROUND: Research into nanoparticles has increased markedly during the last decade, especially in light of their potential diagnostic and therapeutic use. While silver has been used since ancient times, a detailed understanding of the kinetics of its dermal absorption requires further study. Thus far, only in vitro and animal models have been used to analyse the absorption characteristics of nanocrystalline silver particles and no in vivo study using intact human skin has demonstrated silver absorption. METHOD: A nanocrystalline silver dressing was applied to a sample of 16 healthy patients with normal intact skin approximately 5 days prior to surgery. The treated skin samples, removed as surgical waste, were then analysed with a tissue mass spectrometry, light microscopy, scanning electron microscopy (SEM) and an X-ray diffusion spectrography (XRD). Silver serum levels were also analysed before and after application of the dressing. RESULTS: A limited amount of silver penetration could be noted even with light microscopy. However, definitive analysis required SEM and XRD confirmation. With SEM, metallic particles could be seen within the dermis. XRD confirmed that these were silver species, possible in oxide form. Furthermore, silver clusters as large as 750 nm could be discerned. In addition, there was no demonstrable rise in serum silver levels post-treatment with the silver dressing. CONCLUSION: Our results suggest that silver nanoparticles are able to penetrate intact human skin in vivo beyond the stratum corneum and can be found as deep as the reticular dermis. The absorbed silver might be in silver oxide form and the silver species appear to form sizeable clusters once absorbed across the epidermis. However, despite silver deposition into the dermis, the silver nanoparticles did not reach systemic circulation and should thus have no end organ consequences.

The ontological status of embryos: a reply to Jason Morris.

In various places we have defended the position that a new human organism, that is, an individual member of the human species, comes to be at fertilization, the union of the spermatozoon and the oocyte. This individual organism, during the ordinary course of embryological development, remains the same individual and does not undergo any further substantial change, unless monozygotic twinning, or some form of chimerism occurs. Recently, in this Journal Jason Morris has challenged our position, claiming that recent findings in reproductive and stem cell biology have falsified our view. He objects to our claim that a discernible substantial change occurs at conception, giving rise to the existence of a new individual of the human species. In addition, he objects to our claim that the embryo is an individual, a unified whole that persists through various changes, and thus something other than a mere aggregate of cells. Morris raises a number of objections to these claims. However, we will show that his arguments overlook key data and confuse biological, metaphysical, and ethical questions. As a result, his attempts to rebut our arguments fail.

Plasma proteins and selected acute-phase proteins in the whitespotted bamboo shark (Chiloscyllium plagiosum).

Plasma protein electrophoresis has been shown to be an important tool when recognizing disease in various species. Plasma was harvested from twenty captive whitespotted bamboo sharks (Chiloscyllium plagiosum) and gel electrophoresis was used to characterize the following protein fractions: total protein, prealbumin, albumin, α-1 globulin, α-2 globulin, ß globulin, γ globulin, C-reactive protein, serum amyloid A, and haptoglobin. The selected acute-phase proteins were assayed and reference intervals created for a population of captive whitespotted bamboo sharks, and then used to assess relationships between these protein concentration values, sex, and health status. There were significantly higher ß fractions and total protein in females than in males. There did not appear to be a relationship between physical examination abnormalities of individual sharks and their plasma protein levels. Further research is needed to characterize the clinical importance of this response.

Pharmacokinetics of cefovecin (Convenia) in white bamboo sharks (Chiloscyllium plagiosum) and Atlantic horseshoe crabs (Limulus polyphemus).

Cefovecin was administered to six healthy adult white bamboo sharks (Chiloscyllium plagiosum) and six healthy adult Atlantic horseshoe crabs (Limulus polyphemus) to determine its pharmacokinetics in these species. A single dose of cefovecin at 8 mg/kg was administered subcutaneously in the epaxial region of the bamboo sharks and in the proximal articulation of the lateral leg of the horseshoe crabs. Blood and hemolymph samples were collected at various time points from bamboo sharks and Atlantic horseshoe crabs. High performance liquid chromatography was performed to determine plasma levels of cefovecin. The terminal halflife of cefovecin in Atlantic horseshoe crabs was 37.70 +/- 9.04 hr and in white bamboo sharks was 2.02 +/- 4.62 hr. Cefovecin concentrations were detected for 4 days in white bamboo sharks and for 14 days in Atlantic horseshoe crabs. No adverse effects associated with cefovecin administration were seen in either species.