Withdrawal Of Support Research Articles

Campaigns, Mobilisation, and Composition Effects in the 2018 Irish Abortion Referendum

Referendums on issues usually thought to split along cleavage lines are least likely to see significant campaign effects because it is difficult to get voters to switch sides on such issues. We argue that even though campaigns might not be very effective at shifting people’s votes—persuasive effects—the campaign can influence the decision to vote or not—mobilising effects. Using the 2018 referendum to repeal the Irish ban on abortion, we test for mobilisation effects in which one campaign caused the withdrawal of support for its campaign and possibly motivated potential voters in the other side’s campaign. By remaining “on message” the pro-choice side’s arguably less interesting campaign allowed mainstream elites to come on board. We offer evidence that the campaigns mobilized some groups and suppressed turnout in others, leading to a larger victory for the repeal (the ban on abortion) side than most had expected.

Congenital Titinopathy: Comprehensive Characterization of the Most Severe End of the Disease Spectrum.

To better understand the presentation and clinical needs of the under-characterized extreme end of the congenital titinopathy severity spectrum. We comprehensively analyzed the clinical, imaging, pathology, autopsy, and genetic findings in 15 severely affected individuals from 11 families. Prenatal features included hypokinesia or akinesia and growth restriction. Six pregnancies were terminated. Nine infants were born at or near term with severe-to-profound weakness and required resuscitation. Seven died following withdrawal of life support. Two surviving children require ongoing respiratory support. Most cohort members had at least 1 disease-causing variant predicted to result in some near-normal-length titin expression. The exceptions, from 2 unrelated families, had homozygous truncating variants predicted to induce complete nonsense mediated decay. However, subsequent analyses suggested that the causative variant in each family had an additional previously unrecognized impact on splicing likely to result in some near-normal-length titin expression. This impact was confirmed by minigene assay for 1 variant. This study confirms the clinical variability of congenital titinopathy. Severely affected individuals succumb prenatally/during infancy, whereas others survive into adulthood. It is likely that this variability is because of differences in the amount and/or length of expressed titin. If confirmed, analysis of titin expression could facilitate clinical prediction and increasing expression might be an effective treatment strategy. Our findings also further-support the hypothesis that some near-normal-length titin expression is essential to early prenatal survival. Sometimes expression of normal/near-normal-length titin is due to disease-causing variants having an additional impact on splicing. ANN NEUROL 2025.

Corporate sponsorship as cultural policy: tax incentives in Brazilian contemporary art

ABSTRACT Unprecedented corporate intervention and the withdrawal of government support from the arts and culture characterized the 1980s. Driven by the Thatcher and Reagan administrations, which promoted corporate patronage and art sponsorship, this trend shaped cultural policies worldwide and was adopted by numerous countries. Following this global movement, Brazil introduced tax incentives in the early 1990s to encourage private companies to fund cultural events and institutions. While the literature on Brazilian cultural tax incentives is extensive, researchers have overlooked the connection between these incentives and the country’s artistic production fields. Drawing on data from the past decade of cultural funding and applying Natural Language Processing and machine learning techniques to isolate sponsorship patterns related to contemporary art, this paper examines the financial landscape of Brazil’s contemporary art circuit. The findings reveal that inequalities in resource distribution for contemporary art sponsorship exceed those in other fields, such as music and theater, highlighting the highly institutionalized nature of contemporary art, its reliance on corporate sponsorship, and the substantial costs associated with its production.

The Carceral Contradictions of Motherhood: How Mothers of Incarcerated Sons Parent in the Shadow of the Criminal Legal System

The expansion of the U.S. carceral system profoundly shapes motherhood for marginalized women, yet little is known about how mothers navigate a child’s incarceration. We use in-depth interviews with mothers of incarcerated men ( n = 69), most of whom identify as Latina, to understand how jail incarceration shapes women’s motherwork practices throughout the duration of their sons’ incarceration. Building on theories of decarceral motherwork, we find that women with incarcerated sons engage in multiple practices—including crisis, collective, and hypervigilant motherwork—similar to those of formerly incarcerated Black mothers. We advance these insights, revealing how motherwork operates among a different population of system-impacted mothers—those with sons incarcerated in jail. First, we highlight the temporal process of motherwork by documenting the specific practices mothers adopt before, during, and after their son’s incarceration. Second, we reveal how this motherwork process engenders substantial parenting role strains. Third, we find that cumulative parenting strains commonly lead mothers to engage in an additional motherwork strategy, distanced motherwork, which we define as the proactive—although often temporary—withdrawal of emotional, financial, and instrumental support to children. Thus, by illuminating patterns of motherwork in the context of a child’s jail incarceration, and by systematically linking motherwork to parenting role strains, we advance an understanding of parenting in the shadow of the criminal legal system.

The anesthetist perspective: optimization of cardiac allograft from withdrawal of life support to reperfusion in the controlled donation after circulatory death

The anesthetist perspective: optimization of cardiac allograft from withdrawal of life support to reperfusion in the controlled donation after circulatory death

Abstract 4145896: Terminal Rhythm of the Worldwide First Genetically Modified Porcine-to-Human Xenotransplantation

Background: The worldwide first genetically modified porcine-to-human cardiac xenotransplantation was successfully performed in January 2022 at the University of Maryland with the recipient surviving 60 days. Aim: Assess the ECG parameters and cardiac rhythm during the death of the worldwide first porcine-to-human xenotransplant. Methods: Continuous 6-lead ECG telemetry was used to analyze ECG parameters and cardiac rhythm during the final 9 minutes after withdrawal of life support. Results: At the time of withdrawal (W), the patient was in sinus rhythm (70bpm, PR interval 280ms, right bundle branch block (RBBB) with QRS 140ms, QT 400ms; Figure). PR prolongation up to 360ms with loss of P wave was noted at W+2:55min. Irregular junctional rhythm with blocked PACs and bradycardia (23 bpm) occurred around W+3:25min. At that time, widening of RBBB to 160ms with non-specific repolarization abnormalities and QT prolongation were observed. At W+4:30min, increasing pauses of up to 8.5s with mild QRS axis shift occurred. At W+6min, asystole (up to 20s) with rare PVCs from the left anterolateral LV base were seen. Final rhythm at W+6min consisted of ventricular escape beats from the infero-basal LV before electrical activity ceased at W+6:45min. No other atrial or ventricular arrhythmias were noted. Conclusion: The porcine-to-human cardiac xenotransplant showed a terminal rhythm of bradycardia, sinus arrest, and junctional and ventricular escape beats. This is consistent with ischemia-related failure of impulse generation, slowing intra-atrial/AV-conduction delay, and failure of impulse propagation. Notably, no tachyarrhythmias were seen despite ectopic atrial and ventricular beats with prolongation of depolarization and repolarization. This is similar to traditional terminal rhythms observed in humans and does not suggest unexpected arrhythmic proclivities between pig myocardium and the human environment (“pig heart in human body”).

Candidacy Decisions for Long-term Ventilation.

Decisions to initiate long-term ventilation (LTV) in children with severe neurologic impairment have recently been subject to candidacy determinations by home ventilation teams that exclude patients based on their neurologic status alone. Determinations of whether decisions are inappropriate require careful analysis of specific clinical circumstances and attention to the family's values. In this Ethics Rounds, we present a case of a previously healthy child who sustained an acute severe anoxic brain injury and was assessed by the medical team to have a high likelihood of remaining minimally conscious or unconscious. It was determined that he was not a candidate for LTV based on the severity of neurologic impairment. The family disagreed and declined withdrawal of ventilatory support. Drawing upon our backgrounds in intensive care, pulmonology, and bioethics, we offer commentary on utilizing a candidacy-based approach for LTV decisions in children with severe neurologic impairment from variable perspectives, including clinical determinations of inappropriate care, ablest biases and discrimination, and obligations to maintain a just process.

Impact of Cardiopulmonary Resuscitation on Donation after Circulatory Death Heart Transplantation: A United Network for Organ Sharing Registry Analysis

BackgroundThe criteria for evaluating donations after circulatory death (DCD) heart allografts, particularly donor cardiopulmonary resuscitation (CPR) status, remains underexplored. This study evaluates the impact of donor CPR on post-transplant outcomes in DCD heart transplants. MethodsThe UNOS registry was queried to analyze adult recipients who underwent DCD heart transplantation between 1/1/2019 and 3/31/2023, with a 1-year follow-up period extending to 3/31/2024. Primary outcomes were 90-day and 1-year post-transplant survival. 1:1 propensity score-matching was performed. Restricted cubic spline was used to model duration of CPR and likelihood of 1-year post-transplant mortality. Sub-analysis was performed to evaluate the effects of CPR duration on donor heart utilization. ResultsA total of 683 DCD recipients were included, and 378 recipients (55.3%) received hearts from donors that underwent CPR. Recipients with donors who received CPR had similar 1-year (92.1% vs 90.7%) post-transplant survival compared to recipients with donors who did not receive CPR. The comparable post-transplant survival persisted in a propensity score-matched comparison. The spline model demonstrated that longer duration of CPR was not associated with lower odds of 1-year post-transplant survival compared to the reference of 15 minutes. In the sub-analysis, longer CPR duration was not significantly associated with reduced donor heart utilization. ConclusionsDonors that received CPR requires consideration for DCD transplants since damage during cardiac arrest prior to withdrawal of life support may amplify warm ischemic injury during procurement. This study suggests that the use of DCD hearts that underwent CPR can expand the donor pool without compromising early post-transplant survival.

Study on Surrounding Rock Control of Withdrawal Space in Fully Mechanized Caving Mining of a 19 m Extra-Thick Coal Seam

The section span of the withdrawal space of fully mechanized top coal caving in an extra-thick coal seam is large, and with the gradual withdrawal of the hydraulic support, a series of strong dynamic pressure disasters occur in the withdrawal space, and the difficulty of surrounding rock support control increases sharply. In order to study the control mechanism of surrounding rock in the final mining withdrawal space in detail and put forward a reasonable support technology scheme, taking the large-section withdrawal space of an 8309 fully mechanized caving face in an extra-thick coal seam of a mine as the research object—through the theoretical investigation of whether the key blocks of the main roof are stably hinged under varied stopping coal caving distances and fracture locations of the main roof—the reasonable and optimal stopping coal caving distances and roadway formation time are determined. Using numerical simulation and similar simulation methods, the vertical stress and the maximum shear stress research indicators were introduced to verify the accuracy of the theoretical analysis results. The results show the following: (1) The reasonable stopping coal caving span is 1~2 times the cycle weighting interval, the best stopping coal caving distance in this geological condition is 30 m, and the best fracture position of the main roof is located above the goaf. (2) The migration of overlying strata in the withdrawal space has obvious zoning characteristics, and the zoning is as follows: a stopping coal caving area, support area of the hydraulic support, withdrawal channel area, and stopping coal pillar area. (3) According to the zoning characteristics of overlying strata movement, the asymmetric zoning support control scheme of the withdrawal space is proposed. The field monitoring results show that the maximum roof subsidence in the withdrawal space is 151 mm, the maximum internal squeezing amount of the stopping coal pillar is 82 mm, and the supporting and anchoring effect of each partition in the withdrawal space is good. The set of partition asymmetric support control schemes has been successfully applied to field practice.

Long-term outcomes after percutaneous withdrawal of HeartWare left ventricular assist device (HVAD) support: A 10-year update

Ten years have passed since we reported percutaneous decommissioning of an implantable left ventricular assist device (LVAD) using two Amplatzer vascular plugs in a 17 year-old male who was bridged to recovery after 22 months of LVAD support. Whilst his left ventricular (LV) dimensions never completely normalised and there has been persistent mild impairment of LV systolic function, the patient remains free of heart failure symptoms and his natriuretic peptide level has been well suppressed on guideline-directed medical therapy. He is anticoagulated with Warfarin. There have been no adverse events relating to either the decommissioned LVAD or the percutaneous driveline remnant, or anticoagulation. This case highlights the potential for long-term survival without adverse events in individuals who are left with a redundant implantable LVAD after successful percutaneous withdrawal of mechanical circulatory support.

Human foot cutaneous receptors function: clinical findings and prospects of using medical devices to stimulate mechanoreceptors in neurorehabilitation.

The effectiveness of the support stimulation of the mechanoreceptors of the feet has been first shown in space medicine. In space flight during support withdrawal with non-use of postural muscle, this method is a countermeasure against sensorimotor disorders. Later, it was applied in clinical practice as treatment of motor disorders after stroke, in Parkinson's disease, infantile cerebral palsy, neuropathies, and many others. The impact of such stimulation on motor control is due to spinal and supraspinal mechanisms, which are activated by creating an additional support afferent input through the plantar surface. Many studies confirmed the positive effect of support stimulation on motor control, but the protocols of such stimulation remain the subject of active discussion. This review includes (1) the features of sensitivity of the foot sole cutaneous afferents to the support mechanical stimuli, (2) data on spinal and supraspinal responses of the nervous system to support stimulation, and (3) the results of applying this approach in neurological practice via various techniques. Summarizing this information, the authors highlight the most promising ways and types of medical devices for foot support stimulation in neurology.

Defiant school choice? Educational freedom, access, and Arkansas’s AP African American studies controversy

On August 11, 2023, the Arkansas Department of Education (ADE) notified schools just before the fall semester’s start that they would no longer support the college-board-approved AP African American Studies (APAAS) course. Subsequently, all five districts offering the course declared their intent to proceed despite the lack of state funding and course credits. We conduct a document and qualitative thematic analysis in this mixed methods study. In documents, we find distinctive shifts in how the significance of APAAS is portrayed within differing contexts. Using interviews with Arkansas superintendents, teachers, students, and stakeholders, we find four major interview themes: the role of education in preserving democratic values, equity concerns, the significance of community support and advocacy, and the impact of political influences. Documents and stakeholders interviewed perceive the ADE’s withdrawal of support as politically motivated, while superintendents, teachers, and students are primarily motivated by the curriculum, student welfare, and community interests in offering APAAS. We conclude by suggesting that greater consideration of factual knowledge, coupled with choice within and between schools, could defuse such controversies.

Requesting Relatives' Consent for Intensive Care for Organ Donation: An Empirical Analysis of Spanish Transplant Coordinators' Practices.

Intensive care to facilitate organ donation (ICOD) involves the initiation or continuation of intensive care for patients with devastating brain injury for donation purposes. In the Spanish system, relatives undergo an early interview to request consent for this procedure. If they consent, a waiting time is agreed upon in the expectation that death by neurological criteria occurs and donation after brain death takes place. Otherwise, relatives can decide on donation after circulatory determination of death or withdrawal of life support. This study analyzes how Spanish transplant coordinators interact with relatives in early interviews and follow-ups on potential donation pathways. Semistructured interviews were conducted with a random stratified sample of 23 Spanish transplant coordination teams to explore strategies, practices, and perceptions of ICOD consent requests. The interviews were recorded, transcribed, and analyzed using content analysis. Previous coordination with other units and information retrieval regarding patient and relatives' situations is crucial. The development of early interviews includes an introduction to the family, identification of decision makers, empathizing with relatives and offering condolences, reaffirming the fatal prognosis, explaining the possibility of donating based on the patient's will, confirming the family's understanding and resolving doubts, and ensuring comfort and assessing family needs. Approaching families to obtain ICOD consent is a regular practice for Spanish coordination teams. It involves a highly professional and diversified set of strategies based on establishing a support relationship for relatives. Our study provides strategies that serve as a reference for obtaining ICOD consent from families in other settings.

National review of end-of-life care withdrawal guidelines for non-invasive advanced respiratory support using document analysis

ObjectivesThis study aims to understand the breadth of practice around end-of-life withdrawal of non-invasive advanced respiratory support (encompassing both continuous positive airway pressure and non-invasive ventilation) by analysing NHS-published guidelines...

Antecedent Cardiac Arrest Status of Donation After Circulatory Determination of Death (DCDD) Kidney Donors and the Risk of Delayed Graft Function After Kidney Transplantation: A Cohort Study.

The number of donors from donation after circulatory determination of death (DCDD) has increased by at least 4-fold over the past decade. This study evaluated the association between the antecedent cardiac arrest status of controlled DCDD donors and the risk of delayed graft function (DGF). Using data from the Australia and New Zealand Dialysis and Transplant, the associations between antecedent cardiac arrest status of DCDD donors before withdrawal of cardiorespiratory support, DGF, posttransplant estimated glomerular filtration rate (eGFR), and allograft loss were examined using adjusted logistic, linear mixed modeling, and cox regression, respectively. Among donors who experienced cardiac arrest, we evaluated the association between duration and unwitnessed status of arrest and DGF. A total of 1173 kidney transplant recipients received DCDD kidneys from 646 donors in Australia between 2014 and 2019. Of these, 335 DCDD had antecedent cardiac arrest. Compared with recipients of kidneys from donors without antecedent cardiac arrest, the adjusted odds ratio (95% confidence interval) for DGF was 0.85 (0.65-1.11) among those with kidneys from donors with cardiac arrest. There was no association between antecedent cardiac arrest and posttransplant eGFR or allograft loss. The duration of cardiac arrest and unwitnessed status were not associated with DGF. This focused analysis in an Australian population showed that the allograft outcomes were similar whether DCDD donors had experienced a prior cardiac arrest, with no associations between duration or unwitnessed status of arrest and risk of DGF. This study thus provides important reassurance to transplant programs and the patients they counsel, to accept kidneys from donors through the DCDD pathway irrespective of a prior cardiac arrest.

Association Between Whole Blood Transfusion and Mortality Among Patients With Hemorrhagic Shock and Traumatic Brain Injury.

Whole blood (WB) transfusion in trauma has been revisited, and recent studies have reported an association between WB and improved survival among patients with hemorrhagic shock. However, no evidence of a similar association exists for patients with hemorrhagic shock and traumatic brain injury (TBI). This study aimed to assess the association between WB and mortality among patients with hemorrhagic shock and TBI. This study retrospectively analyzed data obtained from American College of Surgeons-Trauma Quality Improvement Program during January 2020 to December 2021. Patients (age ≥18 years) requiring blood transfusion within 4 hours of hospital arrival and sustaining TBI (head Abbreviated Injury Scale >2) were included. Survival at 30 days were compared after performing 1:1 propensity score matching for demographics, injury type, vital signs on admission, TBI characteristics, injury characteristics, comorbidities, hemorrhage control procedures, hospital characteristics, and withdrawal of life support. A total of 15 967 patients were eligible for analysis. The median age was 42 years (interquartile range: 28-60 years); 11 789 (73.8%) patients were male, and 10 102 (63.2%) patients were White. Of them, 2725 (17.0%) received WB. After a 1:1 propensity score matching, 2720 matched pairs were compared. Matched patients had 1.0 as median shock index and 79 mm Hg as the lowest systolic blood pressure requiring immediate transfusion. WB was not associated with reduced 30-day mortality, compared with non-WB (34.0% vs 34.7%, odds ratio: 0.97, 95% confidence interval: 0.87-1.09). WB was not associated with reduced 30-day mortality among patients with hemorrhagic shock and TBI. These findings suggest that not all patients with hemorrhagic shock would benefit from WB.

Overview of Recent Cases Before the European Court of Human Rights and the European Committee of Social Rights (January–June 2024)

This case law report (January-June 2024) discusses six cases before the European Court of Human Rights (hereinafter: ECtHR) and one case before the European Committee of Social Rights (hereinafter: ECSR). 1 The first case ( O.R. v. Greece) concerned the lack of protection of an unaccompanied minor seeking international protection by the Greek government, in violation of the prohibition of torture in Article 3 ECHR. The second and fourth cases concerned possible violations of the right to a fair trial under Article 6 ECHR ( Bernotas v. Lithuania and Đurić v. Serbia), the applicant complained about the unfairness of the administrative and judicial review procedures. The third case, Shylina v. Ukraine, concerned the question of whether the obligation for a payment of social security benefits to a specific bank account at the Ukrainian State Bank violated the right to property under Article 1 Additional Protocol ECHR (hereinafter: AP ECHR). The case of Diaconeasa v. Romania concerned the withdrawal of support for a physically disabled person. The last case before the ECtHR that will be discussed in this case law report is B.T. v. Russia. In this case, the Court had to review the difference in treatment between men and women with regard to parental leave for police officers in the light of the prohibition of discrimination under Article 14 ECHR. This case law report only discusses one case before the ECSR. In collective complaint 187/2019, the ECSR had to review the reduction of survivor's benefits in Italy in the event of cumulation with other income with several provisions of the European Social Charter.

Early Occupational Therapy Intervention Programme and Coping Strategies and Burden in Caregivers of People with Sub-Acute Stroke: A Randomised Controlled Trial.

Caregivers of people who have suffered a stroke experience a great burden and may use disengagement coping strategies. We studied the influence of an early occupational therapy intervention programme in the process of hospital-to-home discharge after stroke (EOTIPS) in a Spanish cohort that improved patients' quality of life and caregivers' burden and coping strategies. EOTIPS was delivered by a single occupational therapist. We conducted a prospective randomised controlled trial that included 60 adults who suffered a stroke, of which 91.6% had a caregiver who agreed to be involved in their care (n = 55). Evaluations assessed the caregivers' burden and coping strategies within two weeks post-stroke and after a three-month follow-up. Statistical analyses included intent-to-treat analysis (considering dropouts as failures) and efficacy analysis, considering only end-of-treatment participants. The caregivers in the intervention group showed a significantly better evolution in the main outcome measure of burden (p = 0.019), as well as in the coping strategies of social support (p = 0.037) and social withdrawal (p ≤ 0.001), compared with the control group. EOTIPS was effective in improving the caregivers' burden and two coping strategies, and it could be considered as an applicable tool that can minimise the risk of suffering burden.

Palliative Extubation Protocol

Introduction: Palliative Extubation (PE) is considered to be the discontinuation of mechanical ventilation in patients whose death is inevitable, prioritizing comfort and respecting the patient’s wishes. This study focuses on definitions, ethical, and legal issues, as well as challenges faced by healthcare professionals.Objective: To explore PE as part of the transition in care, emphasizing symptomatic relief and continuity of PalliativeCare. A protocol and checklist for PE is proposed to guide professionals through the process.Method: Review of definitions, ethical, and legal aspects and presentation of a protocol and checklist for PE. Description of PE methods, including withdrawal of ventilatory support and the complexity of the decision.Results: The decision for PE must respect bioethical principles, patient autonomy and consider prognostic factors. The importance of analgesia and sedation is highlighted.Discussion: Ethical and legal aspects, such as Resolution 1805/2006 of the Federal Council of Medicine support PE, emphasizing the dignity of the patient and the right to therapeutic refusal. The updating of the Code of Medical Ethics in 2018 reinforces the provision of palliative care in terminal illnesses.Conclusion: PE is a complex and delicate practice in Intensive Palliative Care. The review highlights the importance of ethical and legal considerations and specific care when making decisions about PE, emphasizing quality in the dying process and relief of suffering.

Molecular Signaling Effects behind the Spontaneous Soleus Muscle Activity Induced by 7-Day Rat Hindlimb Suspension.

The elimination of ground reaction force (support withdrawal) vastly affects slow postural muscles in terms of their regulation and structure. One of the effects of support withdrawal in this study was an immediate postural muscle inactivation, followed by the daily gradual development of spontaneous activity of the slow postural soleus muscle in response to rat hindlimb suspension to mimic space flight. The origin of this activity is somewhat akin to muscle spasticity after spinal cord injuries and is the result of KCC2 content decline in the spinal cord's motor neurons. However, the physiological consequences of unloading-induced spontaneous activity remain unexplored. We have conducted an experiment with the administration of a highly specific KCC2 activator during 7-day unloading. For this experiment, 32 male Wistar rats were divided into 4 groups: C+placebo, C+CLP-290 (100 mg/kg b w), 7HS+placebo, and 7HS+CLP-hindlimb-suspended group with CLP-290 administration (100 mg/kg b w). The soleus muscles of the animals were dissected and analyzed for several proteostasis- and metabolism-related parameters. CLP-290 administration to the unloaded animals led to the upregulation of AMPK downstream (p-ACC) and mTOR targets (p-p70S6k and p-4E-BP) and an enhanced PGC1alpha decrease vs. the 7HS group, but neither prevented nor enhanced atrophy of the soleus muscle or myofiber CSA.