Social Institutions for Preventing Suicidal Behavior of Adolescents

Research relevance: socialization includes all the processes of communication with culture, upbringing and education, thanks to which a person gets the opportunity to participate in public and social life. The whole environment of a person is involved in the process of socialization: family, neighbors, peers in children's institutions, schools, the media, etc. Research objectives: thus, we identified such requirements for the components of socialization, the specifics of the content of socialization tasks inherent in adolescence, and the level of personal development of adolescent students in accordance with the requirements of modern society. Research materials and methods: general medical interventions include treatment aimed at eliminating the somatic and neurological consequences of suicide attempts and preventing disability. Research results: reconstruction of the education system and public education will be successful only if it is the work of the whole society. Conclusions: it is important to focus all social life, social-cultural environment, education and training system on the younger generation.

Evolutionary Processes in Cancer

Cancer develops through the evolution of somatic cells in multicellular bodies. The familiar dynamics of organismal evolution, including mutations, natural selection, genetic drift, and migration, also occur among the cells of multicellular organisms. In some cases, but not all, these evolutionary processes lead to cancer. This has profound implications for both our understanding of cancer and our treatment of the disease, as well as its prevention. All of our medical interventions impose selective pressures on the heterogeneous populations of billions of cells in tumors, and tend to select for mutant cells that are resistant to the intervention, regardless of whether the intervention is a drug, radiation, the immune system, or anything else that has been tried. We will likely need evolutionary and ecological approaches to cancer to manage its evolution in response to our interventions. The field of the evolutionary biology and ecology of cancer is still young and relatively small. We are in the early stages of translating ideas and tools from evolutionary biology and ecology to study and manage cancers. There is a desperate need for more researchers with expertise in evolutionary biology and ecology to apply their skills and ideas to cancer. Currently, there are far more important questions that need to be addressed than there are people to address them.

Synthesis of Ti-Al-xNb Ternary Alloys via Laser-Engineered Net Shaping for Biomedical Application: Densification, Electrochemical and Mechanical Properties Studies

The lives of many people around the world are impaired and shortened mostly by cardiovascular diseases (CVD). Despite the fact that medical interventions and surgical heart transplants may improve the lives of patients suffering from cardiovascular disease, the cost of treatments and securing a perfect donor are aspects that compel patients to consider cheaper and less invasive therapies. The use of synthetic biomaterials such as titanium-based implants are an alternative for cardiac repair and regeneration. In this work, an in situ development of Ti-Al-xNb alloys were synthesized via laser additive manufacturing for biomedical application. The effect of Nb composition on Ti-Al was investigated. The microstructural evolution was characterized using a scanning electron microscope (SEM) equipped with energy dispersive spectroscopy (EDS). A potentiodynamic polarization technique was utilized to investigate the corrosion behavior of TiAl-Nb in 3.5% NaCl. The microhardness and corrosion behaviour of the synthesized Ti-Al-Nb alloys were found to be dependent on laser-processing parameters. The microhardness performance of the samples increased with an increase in the Nb feed rate to the Ti-Al alloy system. Maximum microhardness of 699.8 HVN was evident at 0.061 g/min while at 0.041 g/min the microhardness was 515.8 HVN at Nb gas carrier of 1L/min, respectively.

Are Young Adults Ready to Complete Advance Directives?

Introduction: The dual objective of this study is to examine the perspectives of young adults toward advance directives (ADs) and their preferences related to life-sustaining treatment and care options. Methods: Participants include graduate students (n = 30) attending a university in New York State. Data were collected using a structured survey questionnaire and Medical Orders for Life-Sustaining Treatment (MOLST) form. Bivariate summary statistics were performed to address the study aims. Results: The mean age of study participants was 24 years, 60% were female, 60% white, and 27% Black. Most (87%) participants reported being comfortable discussing death and end-of-life care and preferring to make their own decisions. Under the circumstance of no pulse and/or not breathing, 87% want CPR. With a pulse and respiration, 96% want artificially administered fluids and nutrition, 90% want a trial period of intubation and/or mechanical ventilation, 67% want to be sent to a hospital, 67% want antibiotics, and 53% want no limitations on medical intervention. Conclusion: Our findings extend upon previous research by quantifying young adults’ specific beliefs, experiences, and preferences regarding advance directives and life-sustaining interventions. Young adults in our study preferred maximum medical interventions for life-sustaining treatment and care. Given the troubling trends in unintended injury (eg, car crashes and drug overdose) as the leading cause of death among young adults, they should be given an opportunity to understand the options and treatments available and should be encouraged to complete an AD.

Going Telemental

Telemental health (TMH) is considered by many to be the future of mental healthcare, with some claiming that these methods should replace more traditional approaches. Early teletherapeutic initiatives demonstrate an immediate set of benefits for patients including improved access to care, reduced costs, better schedule flexibility, greater environmental familiarity, and higher rates of patient engagement. Notable limitations to TMH include enhanced privacy concerns, the variable digital literacy of certain populations/persons, and technological instability. However, other limitations regarding therapeutic relationships, experiences, and settings have gone undertheorized and are not sufficiently represented in the current research. This chapter surveys these considerations and argues that digital medical interventions are unable to effectively replicate the same degree of ‘contact' and ‘intimacy' available in physical care; providers should therefore be cautious in wholly replacing in-person methods or in implementing a standalone paradigm of digital care.

Consumer Medicine’s Origins and Harms

Consumer medicine consists of medical interventions pursued for non–health-related goals with the locus of the goals residing solely with the patient. Currently, contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia fall in this category. Consumer medicine originates from the fusion of expressive individualism with its sole focus on the subjective psychological well-being intersecting with an expansion of health now including well-being combined with an exaltation of autonomy. Expressive individualism is inward-focused and entirely subjective reducing the human to a psychologic self while instrumentalizing the biological and social dimensions and neglecting the spiritual dimension. Expressive individualism is currently manifested through economic activity (career and consumption) and particularly sexual expression. This contrasts with the holistic biopsychosocial-spiritual model of health with its deep inter-relationships and prioritization of the spiritual. Consumer medicine has damaged the profession of medicine. Physicians now have conflicting roles of healer versus body engineer, and conflicting obligations to do no harm while performing medical harms unrelated to objective health. There is now division within medicine and increasing external state regulations both seriously harming its professional status. The traditional teleologically driven ethical framework that is objectively disease-focused is now confused with a subjective list of non–health-related values as goals for medical interventions leading to an incoherent ethical framework. Biologic solutions best address biological problems and do not effectively address psychological, social, or even spiritual problems but rather make them worse. Medicine now reinforces and is complicit with expressive individualism and its attendant shallow and narrow understanding of what it means to be human with the current valuation of sexual expression and economic activity. Medical harms and social costs have resulted while challenging the value of those who are disabled, elderly, or marginalized. This shallow view has likely fueled the current existential crisis contributing to the marked increase in PAS/euthanasia in the West. Summary: Consumer medicine currently includes contraceptives, abortion, cosmetic procedures, and physician-assisted suicide (PAS)/euthanasia. These medical interventions are pursued for subjective non–health-related goals as opposed to the traditional goal of treating sick patients for their objective health. Consumer medicine’s origins lie in the intersection of expressive individualism, the exaltation of patient autonomy combined with health’s redefinition as subjective well-being. This has resulted in harms to the profession of medicine, ethical incoherence, and medical injury. Consumer medicine promotes a truncated understanding of the human at odds with the biopsychosocial-spiritual model and human flourishing. This has likely contributed to the rise of PAS/euthanasia.

Reciprocity and Resources

Reciprocity has been deployed as the moral concept underpinning an obligation to ensure that health care workers (HCW) who work during a pandemic have access to essential goods, such as personal protective equipment (PPE), and as a principle for giving priority to HCW for scarce resources, such as intensive care beds or ventilators. In this paper I examine the concept of reciprocity, arguing that it is best understood as a form of fairness, or “fair return for services rendered.” This interpretation works well in explaining our obligation to provide HCW with PPE and other risk-mitigation resources, but I give reasons to suggest that it does not support an obligation to prioritize HCW for scarce medical interventions.

Harnessing the Potential of MAIT Cells as Cellular Adjuvants in Mucosal Vaccines

<p>The development of vaccines is considered one of the most successful medical interventions to date, preventing millions of deaths every year. However, the majority of vaccines are administered peritoneally, despite the vast majority of pathogens invade the human host at mucosal sites. By vaccinating at distal sites, little to no protection is developed at the mucosa where the initial invasion occurs. There are however, a handful of licenced mucosally administered vaccines against infections such as poliovirus, influenza and Salmonella Typhi that are able to induce both a systemic and mucosal protective immune response. All but one of the current licenced mucosal vaccines are live attenuated due in part to the difficulty of developing new mucosal adjuvants. Recombinant cholera toxin subunit B is the only adjuvant used in the current licenced mucosal vaccines. While inactivated and subunit vaccines are considered safer as they are unable to revert back to virulent pathogens, adjuvants are required to boost their immunogenicity. This thesis therefore explores whether mucosal-associated invariant T (MAIT) cells which are found in mucosal tissues, are invariant in nature and have rapid activation, could be exploited as cellular adjuvants in mucosal vaccines. This thesis was able to show that intranasally administered MAIT cell agonist components, 5-A-RU and methylglyoxal (MG), are able to induce both MAIT cell and conventional dendritic cell (cDC) activation in the lung tissue and mediastinal lymph node (mLN). In this model CD40L and RANKL co-stimulatory interactions are involved in ICOSL expression on cDCs in the lung and associated with cDC activation. The MAIT cells within this model also maintained a RORyT and GATA3 phenotype after both one and three doses of the 5-A-RU + MG vaccine. Furthermore, a prime-boost intranasal vaccine scheme of 5-A-RU + MG and the model antigen OVA, was able to induce MR1-dependent accumulation of TFH cells and antigen-specific germinal center B cells in the mLN along with systemic antigen-specific IgG antibody production. This humoral response was also dependent on the presence of both cDC1 and cDC2 populations. Together, this thesis suggests MAIT cells have the potential to be utilised as cellular adjuvants in mucosal vaccines.</p>