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PubMed1999

Moral problems among Dutch nurses: a survey.

This article reports on a survey of the moral problems that Dutch nurses experience during their everyday practice. A questionnaire was developed, based on published literature, panel discussions, in-depth interviews and participation observations. The instrument was tested in a pilot study and proved to be useful. A total of 2122 questionnaires were sent to 91 institutions in seven different health care settings. The results showed that nurses were not experiencing important societal issues such as abortion and euthanasia as morally the most problematic, but rather situations such as verbally aggressive behaviour of colleagues towards patients, keeping silent about errors, and medical treatment given against the wishes of patients. Moral problems occurred especially when nurses experienced feelings of powerlessness with regard to the well-being of patients. Moreover, these moral problems proved to be related to institutional organization, leadership, and collaboration with colleagues and other disciplines. Nurses appeared to have a limited awareness of the moral dimensions of their practice.

Adult↗
PubMed2005

At the edge of humanity: human stem cells, chimeras, and moral status.

Experiments involving the transplantation of human stem cells and their derivatives into early fetal or embryonic nonhuman animals raise novel ethical issues due to their possible implications for enhancing the moral status of che chimeric individual. Although status-enhancing research is not necessarily objectionable from the perspective of the chimeric individual, there are grounds for objecting to it in the conditions in which it is likely to occur. Translating this ethical conclusion into a policy recommendation, however, is complicated by the fact that substantial empirical and ethical uncertainties remain about which transplants, if any, would significantly enhance the chimeric individual's moral status. Considerations of moral status justify either an early-termination policy on chimeric embryos, or, in the absence of such a policy, restrictions on the introduction of pluripotent human stem cells into early-stage developing animals, pending the resolution of those uncertainties.

Animal Experimentation↗
PubMed1986

Consultation-liaison psychiatry and clinical ethics: a model for consultation and teaching.

The consultation-liaison psychiatrist is often expected to perform the role of clinical ethicist or moral arbiter in the course of responding to psychiatric consultations. This article develops the idea that certain aspects of good consultation-liaison skills make this appropriate and consultation-liaison psychiatrists ought not to shy away from helping with difficult ethical problems. However, a systematic approach to clinical ethics is usually not part of consultation-liaison training. Two simple conceptual models can provide such a systematic approach and can be used in any clinical setting. The two models can also be easily taught and lend themselves to use in structuring teaching or case conferences about clinical ethics. The first model comes from formal philosophy (summarized by Veatch) and is a four-step hierarchy of levels of moral discourse. The other model comes from clinical medicine, based on work by Siegler, and provides another four-point checklist, this time of areas that must be considered in each decision. This article presents each of these four-point frameworks, alludes to the large amount of work that underpins these ostensibly simple models, and offers a case for demonstration/discussion of how the consultation-liaison psychiatrist use the models for structuring clinical ethical decision making and teaching.

Aged↗
PubMed2005

Embryonic-stage-dependent changes in the level of eIF4E-binding proteins during early development of sea urchin embryos.

The eukaryotic initiation factor 4E (eIF4E)-binding proteins (4E-BPs) inhibit translation initiation by binding eIF4E and preventing recruitment of the translation machinery to mRNA. We have previously shown that fertilization of sea urchin eggs triggers eIF4E-4E-BP complex dissociation and 4E-BP degradation. Here, we show that microinjection of eIF4E-binding motif peptide into unfertilized eggs delays the onset of the first mitosis triggered by fertilization, demonstrating that dissociation of the eIF4E-4E-BP complex is functionally important for the first mitotic division in sea urchin embryos. We also show by gel filtration analyses that eIF4E is present in unfertilized eggs as an 80 kDa molecular mass complex containing 4E-BP and a new 4E-BP of 40 kDa. Fertilization triggers the dissociation of eIF4E from these two 4E-BPs and triggers the rapid recruitment of eIF4E into a high-molecular-mass complex. Release of eIF4E from the two 4E-BPs is correlated with a decrease in the total level of both 4E-BPs following fertilization. Abundance of the two 4E-BPs has been monitored during embryonic development. The level of the two proteins remains very low during the rapid cleavage stage of early development and increases 8 hours after fertilization. These results demonstrate that these two 4E-BPs are down- and upregulated during the embryonic development of sea urchins. Consequently, these data suggest that eIF4E availability to other partners represents an important determinant of the early development of sea urchin embryos.

Animals↗
PubMed1999

Tailoring a corporate compliance program for an IDS.

Integrated delivery systems (IDSs) face a particular challenge in implementing a corporate compliance program--that of ensuring the program addresses issues of compliance with payment rules and regulations consistently across every component of the health system. To successfully implement an effective compliance program, the various components of the IDS first must understand what such a program is intended to accomplish, and any internal resistance to developing the program must be overcome. The IDS then can undertake identifying and assessing areas of the health system at risk of being in noncompliance, designing and implementing the program, auditing claims processing and cost reporting throughout the health system to ensure systemwide compliance, and maintaining the program through ongoing monitoring and training.

Costs and Cost Analysis↗
PubMed2003

Listening begins at home.

Procter & Gamble has long been regarded as a major power of the marketing world and a prime training ground for marketers. But in the summer of 2000, with half of P&G's top 15 brands losing market share and employee morale in ruins, company executives realized that the marketing organization was in trouble. Training programs had been dramatically downsized and in some cases eliminated, employees were being fast-tracked up the career ladder without sufficient time to develop and hone their skills, mentoring had all but disappeared, and the marketing career path had lost its prestige. In an attempt to rebuild P&G's marketing strength, James Stengel, the heir apparent to the chief marketing officer position, began working with University of Cincinnati professors Chris Allen and Andrea Dixon on a new training program to fix the weaknesses in the marketing organization. But when the two professors began interviewing P&G senior executives, they discovered that the plans in motion for mapping out the marketing group's recovery were based not on data but on the intuition of a few individuals at corporate headquarters. So began the most comprehensive internal research endeavor in P&G marketing's history. Using the company's existing process for consumer research, Allen and Dixon shadowed employees, conducted one-on-one interviews, held focus-group sessions, and surveyed 3,500 members of the marketing staff to learn what the company was doing right--and wrong--and what mattered most to its people. The results led to the most sweeping redesign of P&G's marketing organization in 60 years. In this article, the authors explore the value of listening to employees--and truly hearing them. One of their conclusions: A structured research process can show you what's really on employees' minds.

Career Mobility↗
PubMed2001

Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development.

It is generally accepted that, in the face of certain family and social circumstances, a minor may need to be taken into care within an institution, a course of action that provides, at least, an alternative to the risks of abandonment and life "on the street". Nevertheless, the reality of life in childcare centres can lead to children undergoing an additional trauma after escaping the miserable situation of the family home. After the advances made in recent years (economic, healthcare, social, legal, etc.), it has been suggested that the institutionalization of a minor, as a rule, does not in itself represent a negative factor for the child's wellbeing. In order to test this hypothesis, we studied two groups of children in care. The first group comprised 101 children being cared for in a large traditional institution during 1986. The second group was composed of 66 children studied in 1996, resident in a smaller, charitable institution, providing a more family-like atmosphere. Growth evaluation methods were applied, including anthropometry (weight, height, weight/height ratio, body mass index, Rorer index and weight index), nutrition (skin folds, body density, percentage of body fat and weight of the fat) and development (psychometry: Boehm test, CMMS, Raven and EIT). The data were analyzed by means of the Student's t-test. The most important result obtained was the demonstration that the second group of children presented results that were clearly higher in nearly all the studied variables, thus showing that institutionalization in itself does not have a negative influence on child development.

Adolescent↗
PubMed1984

OCTOPUS--a church-based sex education program for teens and parents.

OCTOPUS is the acronym for a rural, church-based sex education program for teens and parents. The tentacles symbolize the agencies and individuals involved in this multi-faceted community outreach program designed to promote "Open Communication Regarding Teenagers Or Parents Understanding of Sexuality." Its purpose was to establish a forum for family discussion within a church setting to enhance communication skills, convey factual information, and cultivate the development of a decision-making process to help parents help their teenagers acquire appropriate morals and values. The OCTOPUS program was a team effort comprised of nurses, health educators, and counselors with experience serving adolescents, ministers who sought to integrate religious views with sex education, and church and community members interested in improving dialogue between parents and teenagers about sexuality. The team developed a comprehensive yet flexible program that could be modified to meet each church's preferences. Generally, the topics were arranged into four two-hour sessions. Presentation methods included a combination of lectures, films, and pamphlets. Large and small group discussions were used for clarification and communication skills development. While the results of this program were not quantifiable, feedback from four churches and one-hundred participants has been highly favorable.

Adolescent↗
PubMed2006

Suppressor of cytokine signaling (SOCS) 2, a protein with multiple functions.

Cytokine receptors act through a complex signaling network, involving Janus kinases (JAKs) and the signal transducers and activators of transcription (STATs), to regulate diverse biological processes which control growth, development, homeostasis and immune function, among others. The JAK/STAT signaling pathway is attenuated via three mechanisms controlling the initiation, magnitude, and duration of the signal: the PIAS proteins, which prevent STAT dimerization or DNA interaction, the SHP phosphatases, which dephosphorylate activating tyrosine phosphorylations, and the suppressors of cytokine signaling (SOCS), which are transcribed in response to cytokine stimulation and use several interconnected mechanisms to downregulate the signal. Specific studies targeting the SOCS genes in vivo have unveiled SOCS2 as the main regulator of somatic growth through regulation of GH/IGF-1 signaling. In addition, several studies indicate that SOCS2 also has important actions in the central nervous system, the regulation of metabolism, the immune response, the mammary gland development, cancer, and other cytokine-dependent signaling pathways. Consistent with the role of cytokines in human physiology, any SOCS2 imbalance could result in a broad range of pathologies such as cardiovascular diseases, insulin resistance, cancer, and severe infections, among others. Thus, determining the importance of SOCS2 in health and disease will no doubt aid in the development of novel therapeutic strategies. In this review, we attempt to summarize the available information, including our results, regarding the role of SOCS2 in several biological processes.

Animals↗
PubMed1997

Attitudes towards abortion in the Danish population.

This article reports the results of a survey, by mailed questionnaire, of the attitudes among a sample of the Danish population towards abortion for social and genetic reasons. Of 1080 questionnaires sent to a random sample of persons between 18 and 45 years, 731 (68%) were completed and returned. A great majority of the respondents were liberal towards early abortion both for social reasons and in case of minor disease. In contrast, there was controversy about late abortions for social reasons and in the case of Down syndrome. Further there was strong reluctance to accept late abortion in case of minor disease. An analysis of the response patterns showed that most of the respondents had gradualist views on abortion, i.e. they would allow all early abortions, but only abortions for some reasons later in pregnancy. It was also found that the number who would find an early abortion acceptable in general was much higher than the number who would accept it in their own case. These findings suggest that a great part of the resistance towards abortion does not rest on a concern for the rights and interests for the fetus. Instead it may be explained on a view according to which fetal life is ascribed intrinsic moral value.

Abortion, Eugenic↗
PubMed2006

Scientific rationality, uncertainty and the governance of human genetics: an interview study with researchers at deCODE genetics.

Technology development in human genetics is fraught with uncertainty, controversy and unresolved moral issues, and industry scientists are sometimes accused of neglecting the implications of their work. The present study was carried out to elicit industry scientists' reflections on the relationship between commercial, scientific and ethical dimensions of present day genetics and the resources needed for robust governance of new technologies. Interviewing scientists of the company deCODE genetics in Iceland, we found that in spite of optimism, the informants revealed ambiguity and uncertainty concerning the use of human genetic technologies for the prevention of common diseases. They concurred that uncritical marketing of scientific success might cause exaggerated public expectations of health benefits from genetics, with the risk of backfiring and causing resistance to genetics in the population. On the other hand, the scientists did not address dilemmas arising from the commercial nature of their own employer. Although the scientists tended to describe public fear as irrational, they identified issues where scepticism might be well founded and explored examples where they, despite expert knowledge, held ambiguous or tentative personal views on the use of predictive genetic technologies. The rationality of science was not seen as sufficient to ensure beneficial governance of new technologies. The reflexivity and suspension of judgement demonstrated in the interviews exemplify productive features of moral deliberation in complex situations. Scientists should take part in dialogues concerning the governance of genetic technologies, acknowledge any vested interests, and use their expertise to highlight, not conceal the technical and moral complexity involved.

Fear↗
PubMed1989

Towards a theory of age-group justice.

Norman Daniels' and Daniel Callahan's recent work attempts to develop and deepen theories of justice in order to accommodate intergenerational moral issues. Elsewhere, I have argued that Callahan's arguments furnish inadequate support for the age rationing policy he accepts. This essay therefore examines Daniels' account of age rationing, together with the complex theory of age-group justice that buttresses it. Sections one and two trace the main features of Daniels' prudential lifespan approach. Section three calls into question the theory's conformity to liberal tenets. The next section attempts to show that the outcome of the prudential approach fails to match our considered judgements. The brief final section offers a broader perspective on the task of articulating a liberal theory of age-group justice.

Age Factors↗
PubMed2004

Animal models for diisocyanate asthma: answers for lingering questions.

PURPOSE OF REVIEW: Diisocyanates are the leading cause of occupational asthma, the most commonly reported lung disease associated with the workplace. Clinical studies have implicated the immune system in the pathogenesis of occupational asthma, but ethical and moral issues prevent mechanistic investigations in humans. For this reason, the development and characterization of animal models are germane to further understanding of diisocyanate occupational asthma and to identify avenues for therapeutic intervention. This review will highlight important features of existing experimental animal models with emphasis on new developments. RECENT FINDINGS: Experimental animal models of diisocyanate occupational asthma have demonstrated an immunological basis for the disease. Mice can be sensitized by dermal or respiratory exposure, suggesting that either exposure route may be important in the workplace. Recent findings show that sensitized mice develop airway hyperreactivity and inflammation, reflective of human disease. The transfer of lymphocytes or serum from sensitized mice can cause clinical disease in naive mice. Transgenic animals have identified a role for specific immunity, including the involvement of T-helper type 1/2 responses as well as CD4 and CD8 T cells in diisocyanate occupational asthma. Recent animal models have shown that sensitization can occur through subchronic inhalation of vapor-phase diisocyanate at levels as low as 20 ppb. SUMMARY: Recent progress using animal models has been instrumental in furthering current understanding of the involvement of the immune system in disease pathogenesis. The demonstration of diisocyanate occupational asthma in a murine model after sub-chronic inhalation exposure at relevant exposure levels should provide opportunities for more accurate risk assessment data.

Air Pollutants, Occupational↗
PubMed2007

Relational ethics and advocacy in nursing: literature review.

AIM: The purpose of this paper is to analyse themes from accounts of nurses' experiences with advocacy that may expand our understanding of advocacy in nursing practice. BACKGROUND: Although the ethical obligation to advocate is universal, a lack of clarity persists about the nature of advocacy in nursing practice. METHOD: This discussion of advocacy is based on a synthesis of qualitative studies that focus on nurses' experiences with advocacy in practice. Empirical studies were retrieved through searches on the CINAHL and Academic Search Premier databases for the years 1993-2005. The search terms used were advocacy, advocate role, ethics, nursing practice and qualitative research. FINDINGS: Empirical studies related to the role of advocacy in nursing are limited in number. Nurses' experiences with advocacy reveal important themes in relation to factors that influence the application of advocacy in nursing practice. Evidence suggests that the nature and context of relationships plays a significant role in influencing the enactment of advocacy. CONCLUSION: The application of advocacy in nursing practice is complex. The philosophy of relational ethics emphasizes the contextual features of relationships. An examination of relational ethics as it applies to advocacy in nursing brings us closer to a deeper understanding of the process by which nurses make advocacy choices in practice, and raises implications for the development of advocacy in nurses' practice. Advocacy is universally considered a moral obligation in nursing practice, and thus advancement of our knowledge about its nature in nursing is relevant to nursing across multiple contexts and cultures.

Adult↗