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From the urban to the civic: the moral possibilities of the city.

Relating bioethics to the philosophy of the city creates the possibility for developing the field along paths not yet explored. In the Western tradition, the city has been understood as the venue for two quite different forms of activity and two different types of moral possibility. In one guise, the city is an urbs, a center of commerce, market exchange, and social individualism. In another guise, the city is a civitas or polis, the space of active democratic citizenship, equality under law, and civic virtue. As civitas, classical philosophers regarded the city as the place of moral growth and full human self-realization. These two possibilities of human moral and political experience in the city have given rise to distinct traditions of political theory--liberalism and civic republican and democratic theory. This article traces these conceptual configurations into the domain of contemporary bioethics, arguing that most work in the field has drawn on the liberal tradition and hence has been insufficiently critical of the moral paradigm of market individualism and unduly inattentive to the values of civitas and the civic tradition. It argues for the creation of a form of civic bioethics and explores some of the theoretical foundations that type of bioethics would require.

Bioethics↗

Increased cytogenetic damage in a zone in transition from agricultural to industrial use: Comprehensive analysis of the micronucleus test in peripheral blood lymphocytes.

A complex situation of chemical exposure has been described in México in a zone that is in transition from rural activities towards intensive industrialization, which has brought environmental pollution: chloroform, methylene chloride, indigo and toluene are some of the pollutants found in the Atoyac and Xochiac rivers. A biomonitoring study was planned in order to establish whether there was a biological effect due to the environmental situation. Communities where leukaemia and thrombocytopenic purpura cases have been reported were included in the study, as well as other communities where such cases have not been described. Three occupations were distinguished, according to chemical exposure: industrial workers, agricultural workers and workers in households, education and commerce. A comprehensive analysis in the micronucleus (MN) test was used to study genotoxicity biomarkers. Two metabolic polymorphisms were determined, namely, glutathione transferase mu1 (GSTM1) and theta1 (GSTT1), which are relevant when oxidative responses are involved. Increased genotoxic damage was found, including cells with >1 MN, >1 chromatin bud, and nucleoplasmic bridges. The genotoxic damage was differentially distributed in the regions studied, being more affected those that are closer to the Atoyac and Xochiac rivers, indicating an effect due to environmental exposure to the contaminants present in the rivers. Further characterization of the exposure regimes in these communities will be done in order to contribute to the alleviation of the health risks that environmental pollution is posing on the inhabitants of this area.

Adult↗

A registry-based case-control study of risk factors for the development of multiple non-fatal injuries on the job.

Using compensation records of Taiwan, we conducted a case-control study nested within a cohort of 77,846 active workers who experienced at least one incidence of non-fatal work-related injury between 1994 and 1996 in order to explore factors associated with risk of sustaining multiple non-fatal injuries in the workplace. Cases (n = 2,616) were workers with more than three incidences of non-fatal injury during the study period and controls (n = 3,974) were randomly sampled from workers who experienced only one incidence of non-fatal injury during the same period. Compared with construction workers, workers employed in mining and quarrying (OR = 2.7), manufacturing (OR = 1.2), commerce (OR = 1.6), transport, storage and communication (OR = 1.3) and social, personal and community service (OR = 1.4) were all at significantly elevated risk of multiple non-fatal injuries. Both age and wage showed a significant dose-response effect on the risk of developing multiple non-fatal injuries. The preliminary analysis suggests that workers in certain industries are at significantly elevated risks of multiple work-related non-fatal injuries, in particular those in the mining and quarry industries. Additionally, further preventive measures should be aimed at protecting older workers from such injuries and further studies would help provide more specific interpretations on the positive association between higher wage earning and risk of multiple non-fatal injuries.

Accidents, Occupational↗

Resurgent and emergent disease in a changing world.

Emerging infectious diseases pose important public health problems for both the developed and developing world. Many new or previously unrecognized bacterial, fungal, viral, and parasitic diseases have emerged within the past two decades. At the same time, many once-controlled infections have re-emerged or become resistant to antimicrobial therapy. This emergence is the result of changes in society, technology, the environment, and the microbes themselves, and these changes have had often unpredictable consequences. Important factors influencing emergence include changes in human demographics and behaviour, changes in technology and industry, changes in economic development and land use, increasing and rapid international travel and commerce, microbial adaptation and change, and the breakdown of public health measures. Addressing emerging infectious diseases will require international and interdisciplinary partnerships to build an appropriate infrastructure to detect and respond to these often unanticipated threats to health.

Communicable Diseases↗

The virtual revolution: implications for academe.

The global expansion and acceptance of the Internet as been unprecedented. The emergence of the potential for distance learning (DL) has altered the way in which faculty, university administrators, and for-profit corporations view the educational process. In 1998, nearly 80% of public 4-yr institutions offered some DL courses. However, DL courses in agriculture and natural resources represented less than 1% of the total enrollment. Like any technology that ushers in a new era of change, DL has attracted enthusiastic supporters and detractors. Few view DL with neutrality. It is this divergence of opinion that has fueled the debate over the academic value of DL. A valid evaluation of the educational benefits or deficiencies of DL may require additional long-term studies. For some academic traditionalists, DL is viewed as the fusion of education and commerce and borders on the repugnant. Others embrace DL not only because it may provide a source of much needed revenue, but also because it allows for the low-cost delivery of information to a nontraditional pool of students. Well-funded, private, for-profit organizations and universities have developed a number of DL models. Some hybrid DL models exist in which public institutions have created independent for-profit corporations to develop and distribute their web-based courses. The question is not if DL will be a part of the educational landscape; it surely will. The challenge is to define the role DL can most effectively fulfill.

Computer-Assisted Instruction↗

Entertaining and instructing the public: John Zahorsky's 1904 incubator institute.

In 1904 American physician John Zahorsky managed an incubator institute at the Louisiana Purchase Expositiioon in St. Louis, Missouri. For Zahorsky the incubator became a focal point for organizing medical care, for evaluating existing practices and for developing new ones. His efforts resulted in markedly improved survival rates for premature infants. Despite his success, however, his findings never became part of the medical literature on prematurity. Zahorsky himself believed that physicians dismissed his work because of his association with showmen. This paper also suggests that his were not practical findings. The incubator was too heavy to be used for home births among middle class families and the equipment and nursing care were too expensive to be used with hospitalized infants from tenements. Zahorsky recognized that the incubator somehow diminished the humanity of premature infants, for parents sometimes did not reclaim infants lent to the exhibit. The infant on exhibit became a commodity at a time when babies were offered for sale by advertisement. The incubator institute illustrated the prevailing sensibility about infants, one context in which medical research took place, and the relationships among commerce, entertainment, medical practices, and medical science in the United States early in the twentieth century.

Child Care↗

Choline supplementation inhibits diethanolamine-induced morphological transformation in syrian hamster embryo cells: evidence for a carcinogenic mechanism.

DEA, an amino alcohol, and its fatty acid condensates are widely used in commerce. DEA is hepatocarcinogenic in mice, but shows no evidence of mutagenicity or clastogenicity in a standard testing battery. However, it increased the number of morphologically transformed colonies in the Syrian hamster embryo (SHE) cell morphologic transformation assay. The goal of this work was to test the hypothesis that DEA treatment causes morphologic transformation by a mechanism involving altered cellular choline homeostasis. As a first step, the ability of DEA to disrupt the uptake and intracellular utilization of choline was characterized. SHE cells were cultured in medium containing DEA (500 microg/ml), and (33)P-phosphorus or (14)C-choline was used to label phospholipid pools. After 48 h, SHE cells were harvested, lipids were extracted, and radioactive phospholipids were quantified by autoradiography after thin layer chromatographic separation. In control cells, phosphatidylcholine (PC) was the major phospholipid, accounting for 43 +/- 1% of total phospholipid synthesis. However, with DEA treatment, PC was reduced to 14 +/- 2% of total radioactive phospholipids. DEA inhibited choline uptake into SHE cells at concentrations > or = 50 microg /ml, reaching a maximum 80% inhibition at 250-500 microg/ml. The concentration dependence of the inhibition of PC synthesis by DEA (0, 10, 50, 100, 250, and 500 microg/ml) was determined in SHE cells cultured over a 7-day period under the conditions of the transformation assay and in the presence or absence of excess choline (30 mM). DEA treatment decreased PC synthesis at concentrations > or = 100 microg/ml, reaching a maximum 60% reduction at 500 microg/ml. However, PC synthesis was unaffected when DEA-treated cells were cultured with excess choline. Under 7-day culture conditions, (14)C-DEA was incorporated into SHE lipids, and this perturbation was also inhibited by choline supplementation. Finally, DEA (10-500 microg/ml) transformed SHE cells in a concentration-dependent manner, whereas with choline supplementation, no morphologic transformation was observed. Thus, DEA disrupts intracellular choline homeostasis by inhibiting choline uptake and altering phospholipid synthesis. However, excess choline blocks these biochemical effects and inhibits cell transformation, suggesting a relationship between the two responses. Overall, the results provide a plausible mechanism to explain the morphologic transformation observed with DEA and suggest that the carcinogenic effects of DEA may be caused by intracellular choline deficiency.

Animals↗

Correlating nanoscale titania structure with toxicity: a cytotoxicity and inflammatory response study with human dermal fibroblasts and human lung epithelial cells.

Nanocrystalline titanium dioxide (nano-TiO(2)) is an important material used in commerce today. When designed appropriately it can generate reactive species (RS) quite efficiently, particularly under ultraviolet (UV) illumination; this feature is exploited in applications ranging from self-cleaning glass to low-cost solar cells. In this study, we characterize the toxicity of this important class of nanomaterials under ambient (e.g., no significant light illumination) conditions in cell culture. Only at relatively high concentrations (100 microg/ml) of nanoscale titania did we observe cytotoxicity and inflammation; these cellular responses exhibited classic dose-response behavior, and the effects increased with time of exposure. The extent to which nanoscale titania affected cellular behavior was not dependent on sample surface area in this study; smaller nanoparticlulate materials had effects comparable to larger nanoparticle materials. What did correlate strongly to cytotoxicity, however, was the phase composition of the nanoscale titania. Anatase TiO(2), for example, was 100 times more toxic than an equivalent sample of rutile TiO(2). The most cytotoxic nanoparticle samples were also the most effective at generating reactive oxygen species; ex vivo RS species generation under UV illumination correlated well with the observed biological response. These data suggest that nano-TiO(2) samples optimized for RS production in photocatalysis are also more likely to generate damaging RS species in cell culture. The result highlights the important role that ex vivo measures of RS production can play in developing screens for cytotoxicity.

Cell Line↗

ABC codes: a new opportunity to capture CNS contributions to US healthcare.

A specialized set of insurance-related codes for integrative healthcare will increase the national influence and patient-specific effectiveness of clinical nurse specialists (CNSs) and others in the US healthcare system because virtually every participant in the healthcare system uses codes for some critical purpose. Inadequate codes prevent decision makers from having essential health-related information at their fingertips. ABC codes improve business processes and health industry efficiencies in the same manner that universal product codes (UPCs/bar codes) improved the retail operations and the retail industry. The codes are essential to research, management, and commerce. In healthcare, the combination of ABC codes with older medical and dental code sets allows many essential business processes (such as forecasting, practice management, insurance billing, claims processing, and third-party reimbursement) to be fully automated. The codes also help digitize information to simplify data collection, analysis, and reporting. This improves the quality of data and accelerates the speed with which conclusions can be drawn from those data about what works in US healthcare and why. By offering CNSs more complete, accurate, and precise information on best practices, ABC codes help ensure that CNSs and others can generate better outcomes in addressing health-related challenges faced by patients/clients, nurses, and nursing practices, and the nation's health-promoting organizations and systems.

Electronic Data Processing↗

Do the American Medical Association's campaign contributions influence health care legislation?

Despite the fact that ideology and party overshadow campaign contributions as determinants of congressional voting behavior, the thesis of this study is that the American Medical Association's contributions have an important policy impact. Their donations had a significant effect on an index of three votes in 1979 in the House of Representatives. The contributions of the AMA had more of an effect than did those of the AFL-CIO. The AMA's money was related to decision-making in the Ways and Means and Energy and Commerce Committees. While the medical lobby does not dominate health care policy, its power should not be underestimated.

American Medical Association↗

Using the Internet for patient education.

The Internet, especially the World Wide Web, has a wealth of health-related information easily accessible to patients and families. Commercial health-related Internet sites offer the "3 C's: content, commerce, and connectivity. Many are quickly adding the 4th "C": communication. A growing concern among health care professionals is the quality and the seemingly overabundance of patient education information available on the Internet. Certainly it is possible for nurses to use the Internet for patient education, but new skills and knowledge are needed by nurses who incorporate this technology into their practice. This article will briefly review the evolution of patient education on the Internet, provide a brief review of the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) Patient and Family Education Standards, and offer guidelines for nurses who choose to enhance their patient education efforts by using resources readily available on the Internet.

Confidentiality↗

Firearm injuries in children and adolescents: epidemiology and preventive approaches.

Firearm injury, now a leading cause of death in childhood and adolescence, had jointed the ranks of pediatric conditions that threaten child health and development. This paper reviews articles on epidemiology (of firearm injuries and the firearms themselves) and prevention. Epidemiology of injuries: 5356 Americans under 20 years of age died of firearm injuries in 1991; most of these were homicides, and most involved 15 to 19 years olds. The same year, firearm deaths exceeded motor vehicle deaths in seven states and the District of Columbia. Case-control studies showed that handguns in the home raised the risk of homicide threefold, and that handguns raised the risk of suicide ninefold; for suicide, the risk was greatest (13-fold) in those without psychiatric problems. In Iowa, handguns were used disproportionately often in suicides (as compared with other firearms). Hospitalized pediatric shooting victims often had social as well as medical problems. Epidemiology of firearms: gun ownership was higher among incarcerated youths than in community controls (83% vs 22%), but the patterns of gun acquisition were similar: mainly handguns for self-protection, most often from a friend or family member, or "off the street," cost under $100 per gun. Among 5000 families attending pediatric offices, 32% owned handguns or rifles; 13% of handguns and 1% of rifles were stored unlocked and loaded. In a school survey, three-fourths of first and second graders who knew there was a gun at home knew where it was. Gun sales are very loosely under the jurisdiction of the Bureau of Alcohol, Tobacco, and Firearms; no regulations affect gun design, and oversight of commerce is extremely lax.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

A survey of validated automated home blood pressure monitors available for the Internet shopper.

OBJECTIVE: Self-measurement of blood pressure using an automated home blood pressure monitoring (AHBPM) is increasingly used in hypertension management. Internet commerce increases dramatically each year. This study looked to identify the availability of validity of AHBPM and the correct cuff size to go with the AHBPM. METHODS AND RESULTS: Using the search engine 'Google.com', the author identified 124 consecutive unique sites offering at least one AHBPM. Validated AHBPM were those devices that had published studies showing that they had passed a recognized validation protocol. Each site was evaluated for all forms of sphygmomanometer, number of AHBPM, manual blood pressure devices, all cuff sizes available, additional cost of large adult cuff, number of validated AHBPM offered, and whether the site mentioned device validation. Of the 124 sites, 109 (81%) offered arm AHBPM and 66 (53%) offered one or more (range, 1-11) validated AHBPM. Only six of the 66 (9%) offering a validated AHBPM mentioned that fact; 58 of the 109 (53%) sites offering arm AHBPM offered more than one size of cuff; and 46 of the 58 (80%) charged extra for a large adult cuff (average US dollars 23.75, range, US dollars 4.80-98). CONCLUSIONS: Validated AHBPMs are readily available on the Internet. Currently, these sites do little to aid the consumer in purchasing a validated AHBPM. Large adult cuffs, commonly needed by hypertensive patients, are not always available for purchase. Charging extra for large adult cuffs is a potential hindrance to consumers purchasing the correct cuff size for accurate blood pressure measurement and should be eliminated.

Blood Pressure Determination↗

Managing the disposition of potentially radioactive scrap metal.

In 2002, the National Council on Radiation Protection and Measurements (NCRP) issued Report No. 141, Managing Potentially Radioactive Scrap Metal. The report evaluates management policy and related issues regarding scrap metal generated in regulated facilities that have been under radiological control or have radiological concerns. It has been estimated that more than 9 million metric tons of scrap metal of all types that have been associated with the production or use of radioactive materials will be generated during the coming decades at various facilities across the United States. Currently, disposition of such metal has encountered particular obstacles, primarily because of the lack of a consistent disposition policy, systematic regulatory provisions, and, above all, public understanding. Without clarity in the regulatory passage, much of the scrap metal, including metal that has not been contaminated, could be mischaracterized as low-level radioactive waste, resulting in a costly disposition operation. NCRP Report No. 141 identifies this general category of metal as "potentially radioactive scrap metal" (PRSM) and discusses the viable disposition options for facilitating its management. Because much of the PRSM has been found to contain very low residual radioactivity or even none at all, one consideration is to release such metal outside of the radiological control framework. This would require the development and implementation of a set of strict release standards in the United States that would necessarily be risk-based and supported by a comprehensive management scheme. Developing a policy of this kind, however, would entail the resolution of many issues, not the least of which would be public acceptance, including that of the metal industry, of the possible recycling of PRSM in the general commerce.

Decision Making↗

Scrap metals industry perspective on radioactive materials.

With more than 80 reported/confirmed accidental melts worldwide since 1983 and still counting, potential contamination by radioactive materials remains as a major concern among recycled scrap and steel companies. Some of these events were catastrophic and have cost the industry millions of dollars in business and, at the same time, resulted in declining consumer confidence. It is also known that more events with confirmed radioactive contamination have occurred that involve mining of old steel slag and skull dumps. Consequently, the steel industry has since undergone massive changes that incurred unprecedented expenses through the installation of radiation monitoring systems in hopes of preventing another accidental melt. Despite such extraordinary efforts, accidental melts continue to occur and plague the industry. One recent reported/confirmed event occurred in the Republic of China in 2004, causing the usual lengthy shutdown for expensive decontamination efforts before the steel mill could resume operations. With this perspective in mind, the metal industry has a long-standing opposition to the release of radioactive materials of any kind to commerce for fear of contamination and the potential consequences.

Decision Making↗

Ethics and skeptics: what lies behind ethical codes in occupational health.

OBJECTIVES: Ethical codes, or systems, are conditioned and their enforcement is permitted by social processes and attitudes. In occupational health, our efforts to adhere to our own ethical frameworks often are undermined by forces and interests outside the field. Failure to acknowledge the profoundly social nature of ethical codes impedes our ability to anticipate consequences, to legitimate decisions based on utility and benefit, and to find social structures that support, rather than invalidate, our view of ethical behavior. We examine three sets of social philosophies. METHODS: Jane Jacobs, the visionary urban planner, has written Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics, which is a restatement in modern terms of a critical passage in Plato's most important dialogue, the Republic. She (and Plato) postulate two major ethical systems, renamed here the "guardian system," which is characterized by loyalty, cohesiveness, and confidentiality, and the "marketplace system," which is characterized by trade, decentralization, and shared information. Occupational health, in this formulation, often runs afoul of the guardian mentality and also may be subject to inappropriate negotiation and compromise in the marketplace system. George Lakoff, a semiotician, has written Moral Politics: What Conservatives Know That Liberals Don't, which argues that there are two fundamental social paradigms based on concepts of the family. One, which he calls the Strict Father, emphasizes discipline, the positive aspects of taking risks, and the need to individuals to be self-sufficient. The other, which he calls the Nurturing Parent, emphasizes empowerment, the positive aspects of security, and the need for community and relationships. Occupational health practice violates aspects of both and therefore is supported by neither. Classical Chinese thought involved many schools of thought, including Confucianism and Legalism. It has been suggested that Confucianism provides little support for government regulation or occupational health, however this is questioned. CONCLUSIONS: Occupational health may improve its standing as a social priority by recognizing and maneuvering within social frameworks that accomodate it, rejecting social frameworks that invalidate it, and reinforcing positive cultural trends within society that support it.

China↗

Transplant tourism: Outcomes of United States residents who undergo kidney transplantation overseas.

BACKGROUND: Although international commerce in kidney transplantation is a reality, little is known about U.S. residents who travel abroad for kidney transplantation. METHODS: We retrospectively reviewed the clinical outcomes of patients who were evaluated at the University of Minnesota Medical Center or Hennepin County Medical Center, but then surreptitiously underwent kidney transplantation overseas. RESULTS: We identified 10 patients who underwent kidney transplantation outside the United States between September 16, 2002 and June 30, 2006 and then returned for care in our programs. Eight were transplanted in Pakistan (all Somali), one was transplanted in China (Chinese), and one was transplanted in Iran (Iranian). All but one had a living donor. Mean age was 36.8+/-12.5 years with median follow-up of 2.0 years (range 0.4-3.7). Three patients communicated their intent to travel abroad before transplantation. Induction immunosuppressive therapy (if any) was available in 3/10, and initial maintenance immunosuppression was known in 5/10. Complications were primarily infectious, with six potentially life-threatening infections in four patients. At last follow-up, mean serum creatinine was 1.13+/-0.34 mg/dL, acute rejection occurred in 2/10, 1/10 grafts failed due to acute rejection, and 9/10 patients were alive. CONCLUSIONS: Kidney function and graft survival were generally good after surreptitious overseas kidney transplantation. Major problems included incomplete perioperative information communicated to the posttransplant care facility and a high incidence of posttransplant infections. Longer follow-up and detailed cost analysis are needed to better understand the implications of the growing phenomenon of transplant tourism.

Adult↗

Data Grids: a new computational infrastructure for data-intensive science.

Twenty-first-century scientific and engineering enterprises are increasingly characterized by their geographic dispersion and their reliance on large data archives. These characteristics bring with them unique challenges. First, the increasing size and complexity of modern data collections require significant investments in information technologies to store, retrieve and analyse them. Second, the increased distribution of people and resources in these projects has made resource sharing and collaboration across significant geographic and organizational boundaries critical to their success. In this paper I explore how computing infrastructures based on Data Grids offer data-intensive enterprises a comprehensive, scalable framework for collaboration and resource sharing. A detailed example of a Data Grid framework is presented for a Large Hadron Collider experiment, where a hierarchical set of laboratory and university resources comprising petaflops of processing power and a multi-petabyte data archive must be efficiently used by a global collaboration. The experience gained with these new information systems, providing transparent managed access to massive distributed data collections, will be applicable to large-scale, data-intensive problems in a wide spectrum of scientific and engineering disciplines, and eventually in industry and commerce. Such systems will be needed in the coming decades as a central element of our information-based society.

Computer Communication Networks↗