Gert van Dijk

Background: Passive leg raising is used to predict who will benefit from fluid therapy in critically ill patients, including children. Patients with a Fontan circulation may have a different haemodynamic response to a fluid challenge by passive leg raising. Methods: The haemodynamic response of 31 paediatric patients with a Fontan circulation from the outpatient clinic (median age 14.0 years) and 35 healthy controls (median age 12.8 years) to passive leg raising was evaluated non-invasively by echocardiography for the assessment of, e.g., velocity time integral across the (neo)aortic valve, blood pressure measurements, and respiration. Participants were considered responders when the velocity time integral increased ≥ 10.0%. Results: Overall, patients and controls did not differ in the haemodynamic response. Twelve patients (38.7%) and 8 controls (22.9%) were responders, which was not statistically different ( P = 0.22). Responders in the patient and control group also had a similar echo-estimated velocity time integral increase of + 18.9% and + 15.2%, respectively ( P = 0.91). There was no difference in echo-estimated velocity time integral change between patient and control non-responders with a decrease of −1.4% and −6.4%, respectively ( P = 0.70) and no difference in the amount of patients who were negatively affected by passive leg raising, ith a decrease of ≤−10.0% in 7 patients (22.6%) and 9 controls (25.7%)( P = 0.77). Conclusion: The haemodynamic response of ambulatory paediatric patients with a Fontan circulation to passive leg raising is like that of healthy controls. Patients who did not respond were similarly affected as healthy controls. Whether the haemodynamic response is different in critically ill patients warrants further investigation. Trail registration: The Netherlands National Trial Register (NTR), Trial: NL6415; date of registration 20-07-2017; Trial information: https://www.trialregister.nl/trial/6415.

A relative high number of cases of organ donation after euthanasia (ODE) is performed in patients with a mental disorder. We feel there are morally relevant differences between people who receive euthanasia on grounds of somatic illness and those who receive it on grounds of a mental disorder. More research is needed before it can be assumed that patients with a mental disorder who have their requests for euthanasia granted may also be eligible for ODE without further testing. Until then, as a matter of prudence, a request for ODE from a patient with a mental disorder should also be reviewed by a psychiatrist.

In the era of globalization, where competition is growing intensively, the cooperation between small scale farmers can assist them to be sustainable and survive. However, the situation with cooperatives in Greece is found to be on a downward trend due to their poor economic performance, which is later expressed by the diminished commitment of their members. In order to address the described problem we employed a qualitative study consisted of 10 guided interviewees with “cooperative experts”. Through the interviews the participants were asked to clarify their opinions on two major themes: 1) Common Greek cooperative issues, and 2) Suggestions on strategies employed by cooperatives to enhance members’ commitment. Through our analysis we identified the issues related to the poor management of the cooperatives of the past as the major problems of cooperative in Greece. Regarding the strategies for enhancing commitment of members, the majority of participants highlighted the importance of improving the communication and quality of information provided by the coop to its members for building strong bond of trust and ultimately enhancing their commitment. Although, the improvement of communication takes time and requires consistent effort. Hence, cooperatives may act on employing the appropriate experts in order to improve their process of production and marketing. Strengthening the levels of expertise in the economic activities of the cooperative may assist on the satisfaction of members and enhance their commitment to the coop.

In this paper, we will present a case of organ donation after active euthanasia (ODE) in the Netherlands from a patient who had his life ended at his explicit and voluntary request. The form of ODE we describe here concerns patients who are not unconscious and on life support, but who are conscious and want to have their life ended because of their hopeless and unbearable suffering, for instance due to a terminal illness such as Amyotrophic Lateral Sclerosis (ALS) or Multiple Sclerosis (MS). This form of ODE is of course only possible in jurisdictions where euthanasia is allowed. In these jurisdictions, organ donation after euthanasia is an option that may be considered. We believe ODE is worthwhile to pursue, as it can strengthen patient autonomy, can give meaning to the inevitable death of the patient, and be an extra source of much needed donor organs. To ensure voluntariness of both euthanasia and organ donation and avoid conflict of interest by physicians, ODE does need strict procedural safeguards however. The most important safeguard is a strict separation between the 2 procedures. The paper discusses several ethical issues such as who should broach the subject of organ donation and who should perform the euthanasia, and how a conflict of interest can be avoided.

Background Several studies reported deficits in attention and inhibition in premanifest and manifest Huntington's disease (HD) but results are inconsistent. Understanding the nature of these deficits is important for disease monitoring and potential interventions targeting the earliest changes in HD. Simultaneous clinical and neurophysiological assessment can provide important insights in these complex cognitive processes. Go/No-go tasks are thought to measure attention and response inhibition. The event related potential P3 is hypothesised to be the neurophysiological substrate of attentional and inhibition processes. Aims To evaluate whether attention and inhibition characteristics in manifest HD patients (MHD) and premanifest HD gene carriers (PMGC) differ from controls. Methods We studied 14 MHD (mean age 51 years), 15 PMGC (mean age 43 years) and 15 controls (mean age 51 years) with a neuropsychological test and simultaneous EEG recording. The Sustained Attention to Response Task, a simple Go/No-go test hypothesised to measure attentional and inhibition processes, resulted in reaction time (RT) and accuracy data. The EEG assessment yielded data on P3 amplitudes and latencies. Results The RT pattern during the Sustained Attention to Response Task was remarkably different (pConclusion We demonstrated deficits in inhibition and attention in MHD compared with PMGC and controls. MHD showed a general slowing and a different pattern of RT which in combination with reduced neuronal activity and accuracy is hypothesised to reflect a reduced capacity to effectively allocate attention and diminished inhibition.