bluuebunny/crossref_metadata_2025 huggingface dataset:
Beneficent Voluntary Active Euthanasia: a challenge to professionals caring for terminally ill patients
Authors: Begley Ann-Marie
Published: November 2006

Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia.

For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’.

This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community.

The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths.
Informed Consent in a Multicultural Cancer Patient Population: implications for nursing practice
Authors: Barnes Donelle M , Davis Anne J , Moran Tracy , Portillo Carmen J , Koenig Barbara A
Published: November 2006

Obtaining informed consent, an ethical obligation of nurses and other health care providers, occurs routinely when patients make health care decisions. The values underlying informed consent (promotion of patients’ well-being and respect for their self-determination) are embedded in the dominant American culture. Nurses who apply the USA’s cultural values of informed consent when caring for patients who come from other cultures encounter some ethical dilemmas. This descriptive study, conducted with Latino, Chinese and Anglo-American cancer patients in a large, public, west-coast clinic, describes constraints on the informed consent process in a multicultural setting, including language barriers, the clinical environment, control in decision making, and conflicting desired health outcomes for health care providers and patients, and suggests some implications for nursing practice.
Cultivating a Moral Sense of Nursing Through Model Emulation
Authors: Pang Mei-che Samantha , Wong Kwok-shing Thomas
Published: November 2006

This paper reports part of a longitudinal research project, which sought to capture students’ conceptualization of caring practice as they progressed to different levels of study in a nursing diploma programme in Hong Kong. Model emulation was found to be an effective means of focusing students’ learning processes on the moral aspects of nursing practice. The theory of model emulation from a Chinese perspective and how it is applied to create a learning context to allow students to acquire a moral sense of nursing are discussed. The participating students are invited to be sincere enquirers in the pursuit of the good embedded in practice through introspective self-examination and dialogue. They are asked to describe and share their experience of positive and negative examples of nursing in written accounts. Van Kaam’s phenomenological method was adopted to explicate the good and bad constituents of nursing from these examples, with the students assuming an active role in the explication process. The explication reveals that the students were able to articulate the good and bad practices in a variety of patient care situations.
What We Owe The Author: rethinking editorial peer review
Authors: Crigger Nancy J
Published: November 2006

Editorial peer reviewers play an important role in shaping the direction of knowledge growth of their discipline. Recent concern over reports of peer review misconduct has led some to advocate the establishment of a code of ethics for peer reviewers. Such a code should include guidelines for the discipline and for society at large, but it should also contain guidelines for the authors whose manuscripts are reviewed. Peer reviewers have a special obligation to show beneficence and fairness or impartiality towards the authors for whom they review. The practical application of these two ethical concepts is discussed.
Professional Ethics: are we on the wrong track?
Authors: Scott P Anne
Published: November 2006

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers?

This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely to be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers.
The Role of Nurses in Euthanasia: a Dutch study
Authors: van de Scheur Ada , van der Arend Arie
Published: November 2006

What role do nurses play in euthanasia? How do they experience this role and what should be their ideal role? These are the questions of a study undertaken to gain insight into the role of nurses in euthanasia. Answers to these questions were derived from 20 semistructured in-depth interviews with nurses employed in a Dutch hospital. To make clear the role of nurses in euthanasia, the issue was split up into four phases: observation of a request for euthanasia; decision making; carrying out of the request; and after-care. This article is a brief report on the most important results regarding these four phases. Special attention will be paid to nurses who have conscientious objections. To evaluate the study results, an unambiguous interpretation of the concept of ‘euthanasia’ is of most importance. For that reason, Dutch laws and other regulations concerning euthanasia will be explained.
Health Care, Ethics and Nursing in Bangladesh: a personal perspective
Authors: Begum Hasna
Published: November 2006

Health care in Bangladesh is in a sad condition, with not enough doctors and nurses available to serve its people, but, even with this limited number of health care professionals, better care would be possible if greed for money and unaccountability to the people were controlled by the Government. Conditions for members of the nursing profession are not acceptable for those who are dedicated to serving the sick. Acknowledgement of nursing’s professional dignity is almost completely absent. In addition, the salary earned is not enough to make a living. There are in existence professional associations who are struggling for the rights of the nursing community, although few concrete results have yet been seen. This article is written from the perspective of the author’s position as a member of the Board and Treasurer of the International Association of Bioethics, and her interest in feminism and bioethics, which justifies her link with oppressed nurses (because most are women) and unethical practices in the nursing profession in Bangladesh.
Nondirectiveness in Prenatal Genetics: patients read between the lines
Authors: Anderson Gwen
Published: November 2006

For decades questionnaires have been used to measure the cognitive and psychological effects of prenatal genetic testing, but little is known about why some women undergo testing and others decline. Research indicates that many factors influence decision making, including values and beliefs. What is often denied rather than recognized is that the professional and personal values and beliefs held by the health care provider influence the patient’s decision. It is assumed that, if genetic services are delivered in a nondirective manner, patients will not be affected by the provider’s personal and professional standpoint. The qualitative research data reported here challenge this assumption. Getting to know patients’ moral understanding and patterns of ethical reasoning by listening to their personal stories is recommended as a better way for nurses to help patients to make informed and autonomous decisions about prenatal genetic screening or diagnostic tests.
Acting from the Virtue of Caring in Nursing
Authors: van Hooft Stan
Published: November 2006

The author challenges the recently argued position of Helga Kuhse that caring is merely a preparatory stage to moral action and that impartial, principled thinking is required to make action moral, by suggesting a notion of caring as virtue. If caring is a virtue then acting from that virtue will be acting well. Acting from the virtue of caring involves eight features, which include not only that of being sensitive to, and concerned about, the patient, but also that of being aware of, and sensitive to, the relevant ethical principles. In this way, caring is seen as an overarching quality that gives action its moral character. The moral character of an action does not derive only from its having been performed in the light of principles.
Ethical Considerations in a Grounded Theory Study on the Dynamics of Hope in Hiv-Positive Adults and Their Significant
Authors: Kylmä Jari , Vehviläinen-Julkunen Katri , Lähdevirta Juhani
Published: November 2006

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researcher and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.
Nurse Practitioners in Developing Countries: Some Ethical Considerations
Authors: Stark Ruth , Nair N VK , Omi Shigeru
Published: November 2006

One of the principles of health care ethics is the principle of justice. An important expression of justice is equity. The provision of basic primary health care services to all people is the key to eliminating the gross inequities in health status existing in many countries. For many years nurses in developing countries have ‘led the way’ in bringing these essential services to poor rural communities, including the diagnosis and treatment of illnesses, and the prescribing and dispensing of medications. Nurses are the most appropriate health workers for this role, but most have not been prepared adequately for it. This is unsafe for patients and puts nurses at legal risk. Justice requires that patients should obtain access to safe health care and that nurses should receive appropriate education. Nurse practitioner programmes are being established to prepare nurses for this advanced practice role, but here again ethical considerations apply. Justice will be served only if nurse practitioner programmes are accessible to the nurses who are most likely to work in medically underserved communities where the need is greatest.
Elderly Japanese People Living in Small Towns Reflect on End-Of-Life Issues
Authors: Okuno Shigeyo , Tagaya Akira , Tamura Masae , Davis Anne J
Published: November 2006

This article, reporting on selected data from a larger study, discusses some responses to end-of-life questions that elderly Japanese people who were living in small towns gave in a questionnaire survey. Japan is now the country with the largest number of elderly people in the world and confronts numerous social and economic questions concerning how best to cope with its older population. Although it is a highly urbanized society, Japan also has large semirural areas. The focus here is on the questions in the survey that sought responses to ethical dimensions of end-of-life issues. The findings demonstrate the strength of traditional values that still exist throughout small towns in Japan.
The Bed Crisis of Winter 1995-1996 In The British NHS: An Illustration of Accountability Issues
Authors: Young Ann P
Published: November 2006

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward.

In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised.
Transforming Desolation into Consolation: the meaning of being in situations of ethical difficulty in intensive care
Authors: Söderberg Anna , Gilje Fredricka , Norberg Astrid
Published: November 2006

The purpose of this phenomenological-hermeneutic study was to illuminate the meaning of being in ethically difficult care situations. The participants were 20 enrolled nurses employed in six intensive care units in Sweden. The results reveal a complex human process manifested in relation to one’s inner self and the other person, which transforms desolation into consolation through becoming present to the suffering other when perceiving fragility rather than tragedy. The main point of significance here is for all health professionals to create an ethical work environment and strive for praxis that fosters ‘athomeness’, which renders us free to transform desolation into consolation. Consolation is of significance in ethics because it makes us available and helps us to fulfil the demands of life, while desolation makes us unavailable to others.
Achieving Moral Health Care: the challenge of patient partiality
Authors: Woodward Vivien
Published: November 2006

Illness and hospitalization are sources of vulnerability; they arguably endow nurses and midwives with the moral obligation to develop caring relationships with patients. Fairness and the equal treatment of patients are central to moral practice; current government publications are giving this political emphasis. This article argues that patient partiality is one factor that may result in insidiously unequal caregiving. Data generated during a qualitative study into professional caring suggest that patient partiality is an accepted part of everyday practice. Factors such as the patient’s personality, nurse-patient familiarity and the perceived level of patients’ understanding and interest in their illness emerged as possible sources of partiality and influence on practitioners’ interactions with patients. The article argues that patient partiality can be managed morally if practitioners develop self-awareness and constantly reflect on the moral integrity of everyday practice.

Throughout the article, unless it is stated that specific reference is being made to either nurses or midwives, reference to a nurse or practitioner denotes both. It is also emphasized that no implication is intended that any study participants provided unequal care. Rather, data are utilized solely to generate focused discussion around the concept of patient partiality.
Moral Problems Among Dutch Nurses: a survey
Authors: van der Arend Arie JG , Remmers-van den Hurk Corine HM
Published: November 2006

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.
An Orwellian Scenario: court ordered caesarean section and women’s autonomy
Authors: Cahill Heather
Published: November 2006

Between 1992 and 1996, a small number of women in the UK were forced by the courts to undergo caesarean section against their expressed refusal. Analysis of the reported cases reveals the blanket assumption of maternal incompetence and the widespread use of thinly veiled coercion. Such attitudes and practices are themselves frequently compounded by inadequate communication. Medical discretion in such problematic cases seems to err on the side of safety and so appears to favour the life of the fetus over maternal autonomy. Despite current policy’s placement of the pregnant woman at the centre of maternity care, obstetricians’ concerns appear to lie more with the unborn fetus. In other words, there seems to be a point at which the value of fetal life begins to outweigh, not so much the life of the woman, but her right to self-determination, her plans and her choices. While it is important to acknowledge that these court ordered caesareans represent an unusual extreme within contemporary maternity care in this country, that they have happened brings into sharp relief some of the stereotypical assumptions about women. These are assumptions that underlie much of current medical practice and may compromise or disempower women in other ways during their experience of pregnancy and labour.

Using the first and last of the six reported cases as contextual illustrations, this article focuses on the complex interplay of processes that have brought the medical profession to a position in which their own self-conviction and determination to do what they believe is best for their patients has resulted in gross denial of women’s autonomy and the use of the law to override pregnant women’s refusal of consent.
Visiting Nurses’ Situated Ethics: beyond ‘care versus justice’
Authors: Gremmen Ine
Published: November 2006

This article discusses Dutch visiting (district) nurses’ moral considerations of their daily work. It is based on an empirical study using extensive semistructured interviews. The study is informed by the theoretical debate on the ‘ethics of care’ and the ‘ethics of justice’. It is argued that this debate easily turns into an unfruitful contest between these two perspectives: which one is best? The results suggest that visiting nurses’ moral considerations of their day-to-day work can be described well in terms of an ethic of care. At the same time, however, concepts and issues central to an ethic of justice are also of crucial importance to their considerations. Nurses’ ways of managing to combine both perspectives, even in situations of apparent conflict between them, are described. Thus, clues are provided on how the debate on the ethics of care and the ethics of justice may be carried out in a more fruitful way apart from through hierarchically opposing both perspectives.
Being in the World of the Suffering Patient: a challenge to nursing ethics
Authors: Råholm Maj-Britt , Lindholm Lisbet
Published: November 2006

Ethics in caring is what we actually make explicit through our approach and how we invite the suffering patient into a caring relationship. This phenomenological study investigates suffering and health and how this presupposes a deeper reflection on ethics in caring. The aim was to try to discover, describe and understand how patients experience their life situation three years after undergoing surgery. The theoretical approach is based on central aspects of Eriksson’s caritative theory (i.e. the view of the person as body, soul and spirit). The informants were four women and four men aged between 55 and 77 years. The empirical material revealed suffering that was connected with both illness and life. Suffering involves experiences of grief, loneliness and struggling. Health implies a yearning for something beyond the current life situation, a yearning to experience some meaning in life. This leads to an awareness of unplumbed possibilities. Understanding the experiences of individual patients demands of us, as both researchers and nurses, to act, seeking after the scientific truth (i.e. a deeper reflection of the ontological, epistemological and methodological questions). The idea of responsibility helps us to interpret and meet the innermost desires of suffering patients in their true presence. Caritative caring ethics means ‘being there’, confirming patients’ absolute dignity; it is a manifestation of the love that ‘just exists’. Compassion requires an inner disposition to go with others to the places where they are weak, vulnerable, lonely and broken. An ontology of caring provides both a starting point and a context for reflection about ethics and the ethical life.
Systems of Innovation and Underdevelopment
Authors: Oyelaran-Oyeyinka Banji
Published: November 2006

This article examines institutions and their role in supporting technical change as part of the development process, and asks how institutions shape the system of innovation (SI). The context of underdevelopment exhibits distinct system characteristics that differ markedly from those found under advanced economic conditions and as such deserves close empirical scrutiny. SIs differ significantly under the two sets of conditions, leading to uneven structural changes. The article, therefore, explores what functions must be served by systems in developing countries in order to generate technical dynamism. To compare different contexts, it introduces the idea of a ‘system of learning innovation in development’ (SLID) that emphasises individual and organisational competence building. The differences between ‘advanced’ systems of innovation (ASI) and two types of SLID are discussed. Infrastructure, one of the key components of institutions involved in development, is used as an illustration. The study found that dynamic SIs function best in a regime of high-quality infrastructure (telephone, Internet, computers and reliable electricity supplies). The case of sub-Saharan Africa serves to illustrate the point.
Systemic Obstacles to Battered Women's Participation in the Judicial System
Authors: Gillis Joseph Roy , Diamond Shaindl Lin , Jebely Paul , Orekhovsky Victoria , Ostovich Ellis M. , MacIsaac Kristin , Sagrati Sandra , Mandell Deborah
Published: November 2006

The Canadian government has introduced numerous policies, guidelines, and mandates at the federal and provincial levels that recognize woman abuse as a serious social problem and violation of the law. Nonetheless, recent feminist research continues to expose laws and practices that fail woman abuse victims. The present study examined the experiences of women victims in domestic violence cases and the barriers they faced in dealing with the police, the courts, and social service agencies. Despite government initiatives, the study results corroborate previous findings indicating that many battered women feel further traumatized by ambivalent or discriminatory attitudes and practices prevalent within the system.
Evaluating the Cultural Validity of the Stressful Life Events Screening Questionnaire
Authors: Green Bonnie L. , Chung Joyce Y. , Daroowalla Anahita , Kaltman Stacey , DeBenedictis Caroline
Published: November 2006

Measures of psychological trauma are rarely evaluated for validity with disadvantaged populations. The authors used three qualitative methods to assess the cultural validity of the Stressful Life Events Screening Questionnaire (SLESQ) with low-income African American women. Focus groups ( n = 17), cognitive interviews ( n = 20), and videotape reviews of SLESQ interviews were conducted ( n = 16). Focus group participants spontaneously used similar language to the SLESQ items and tended to identify SLESQ events as traumatic. Most items were well understood in the interviews, with some criticism of wording. Tape reviews indicated little wording modification by interviewers. One item showed consistent problems. The interview was revised accordingly.
Public–Private Partnerships for Financing Federal Capital
Authors: Gallay David R.
Published: November 2006

This article examines whether public-private partnerships are useful for financing federal capital, defined as land improvements and buildings. The point of view is that of a federal agency. Because relatively few public-private partnerships have financed federal capital, this article analyzes the issue through a conceptual approach. It finds that pursuing a public-private partnership to finance federal capital may not necessarily be less costly than the routine federal budgeting approach, but it can allow an agency to meet its capital needs quicker and at no significant additional (equivalent) cost. Faster acquisition would likely lead to a net social benefit to the American people equal to the value of the agency’s additional public services produced with that capital. Consequently, the article concludes that public-private partnerships can be a useful approach for federal agencies to acquire federal capital.
When Personality and Culture Clash: The Psychological Distress of Allocentrics in an Individualist Culture and Idiocentrics in a Collectivist Culture
Authors: Caldwell-Harris Catherine L. , Ayçiçegi Ayse
Published: November 2006

Because humans need both autonomy and interdependence, persons with either an extreme collectivist orientation (allocentrics) or extreme individualist values (idiocentrics) may be at risk for possession of some features of psychopathology. Is an extreme personality style a risk factor primarily when it conflicts with the values of the surrounding society? Individualism-collectivism scenarios and a battery of clinical and personality scales were administered to nonclinical samples of college students in Boston and Istanbul. For students residing in a highly individualistic society (Boston), collectivism scores were positively correlated with depression, social anxiety, obsessive-compulsive disorder and dependent personality. Individualism scores, particularly horizontal individualism, were negatively correlated with these same scales. A different pattern was obtained for students residing in a collectivist culture, Istanbul. Here individualism (and especially horizontal individualism) was positively correlated with scales for paranoid, schizoid, narcissistic, borderline and antisocial personality disorder. Collectivism (particularly vertical collectivism) was associated with low report of symptoms on these scales. These results indicate that having a personality style which conflicts with the values of society is associated with psychiatric symptoms. Having an orientation inconsistent with societal values may thus be a risk factor for poor mental health.
Measures of Psychological Acculturation: A Review
Authors: Matsudaira Tomomi
Published: November 2006

This article reviews conceptual and methodological issues in the measurement of psychological acculturation. The major issues involve the question of dimensionality and the assessment of specific domains of cultural change. Bidimensional scales that cover both overt and internal domains are more informative for the assessment of general levels of psychological acculturation. The validity of such scales must be examined in terms of the actual exposure of individuals to and involvement in each culture, and the influence of sociocultural factors on the course of acculturation. The parallel application of qualitative and quantitative methods may be useful for validity studies. The complementary use of emic and etic approaches will enhance the psychometric soundness of acculturation scales.
Mental Disorders and the Symbolic Function of Therapeutic Rites in the Réunion Island Hindu Environment
Authors: Govindama Yolande
Published: November 2006

This article describes two therapeutic rituals in the Hindu milieu on Réunion Island - walking on fire and piercing parts of the body in the Feast of Cavedy - to underscore the cultural representation of madness and the symbolic function of these rites in treatment. Madness is considered to be the result of a rupture of genealogy through denial of the founder, and of psychic-somatic unity, which leads the afflicted person to develop a fantasy of immortality. The two therapeutic rituals aim at reestablishing the debt to the founding ancestor by the symbolic reactualization of the original chaos, and at restoring the genealogy through a relationship between the penitent and the officiant, which brings the subject to accept his human condition as a mortal being.
Leighton’s Theory of Sentiments: Explorations and Speculations on Barriers to Interpersonal Forgiveness
Authors: Kaplan Berton H. , Blazer Dan G. , Munroe-Blum Heather
Published: November 2006

In My Name Is Legion (Leighton, 1959), the basic assumption of Alexander H. Leighton’s theory of sentiment is as follows: ‘A given personality exists more or less continuously throughout life in the act of striving, and interference with that striving has consequences which in turn often lead to psychiatric disorder’ (p. 136). This commentary focuses first on selected sources of interference to interpersonal forgiveness and then elaborates a research agenda that aims to expand our knowledge of barriers to interpersonal forgiveness.
Analysis of the XRCC1 gene as a modifier of the cerebral response in ischemic stroke
Authors: Dutra Ana VC , Lin Hsiu-Fen , Juo Suh-Hang H , Mohrenweiser Harvey , Sen Souvik , Grewal Raji P
Published: November 2006

Background

Although there have been studies of the genetic risk factors in the development of stroke, there have been few investigations of role of genes in the cerebral response to ischemia. The brain responds to ischemia in a series of reactions that ultimately influence the volume of a stroke that, in general, correlates with disability. We hypothesize that polymorphisms in genes encoding proteins involved in these reactions could act as modifiers of this response and impact stroke volume. One of the pathways participating in the cerebral ischemic response involves reactive oxygen species which can cause oxidative damage to nucleic acids. DNA repair mechanisms are in place to protect against such damage and imply a role for DNA repair genes in the response of the brain to ischemia and are potential candidate genes for further investigation.

Methods

We studied two common polymorphisms in the DNA repair gene, XRCC1, C26304T and G28152A, in 134 well characterized patients with non lacunar ischemic strokes. We also performed a case control association study with 113 control patients to assess whether these variants represent risk factors in the development of ischemic stroke.

Results

Independent of etiology, the "T" allele of the C26304T polymorphism is significantly associated with larger stroke volumes (T-test analysis, p < 0.044; multivariate regression analysis, β = 0.23, p < 0.008). In the case control association study, we found that neither of these polymorphisms represented a risk factor for the development of stroke.

Conclusion

Our study suggests a major gene effect of the "T" allele of the C26304T polymorphism modulating the cerebral response to ischemia in non lacunar ischemic stroke.
BCR and its mutants, the reciprocal t(9;22)-associated ABL/BCR fusion proteins, differentially regulate the cytoskeleton and cell motility
Authors: Zheng Xiaomin , Güller Saskia , Beissert Tim , Puccetti Elena , Ruthardt Martin
Published: November 2006

Background

The reciprocal (9;22) translocation fuses thebcr(breakpoint cluster region) gene on chromosome 22 to theabl(Abelson-leukemia-virus) gene on chromosome 9. Depending on the breakpoint on chromosome 22 (the Philadelphia chromosome – Ph+) the derivative 9+ encodes either the p40(ABL/BCR)fusion transcript, detectable in about 65% patients suffering from chronic myeloid leukemia, or the p96(ABL/BCR)fusion transcript, detectable in 100% of Ph+ acute lymphatic leukemia patients. The ABL/BCRs are N-terminally truncated BCR mutants. The fact that BCR contains Rho-GEF and Rac-GAP functions strongly suggest an important role in cytoskeleton modeling by regulating the activity of Rho-like GTPases, such as Rho, Rac and cdc42. We, therefore, compared the function of the ABL/BCR proteins with that of wild-type BCR.

Methods

We investigated the effects of BCR and ABL/BCRs i.) on the activation status of Rho, Rac and cdc42 in GTPase-activation assays; ii.) on the actin cytoskeleton by direct immunofluorescence; and iii) on cell motility by studying migration into a three-dimensional stroma spheroid model, adhesion on an endothelial cell layer under shear stress in a flow chamber model, and chemotaxis and endothelial transmigration in a transwell model with an SDF-1α gradient.

Results

Here we show that both ABL/BCRs lost fundamental functional features of BCR regarding the regulation of small Rho-like GTPases with negative consequences on cell motility, in particular on the capacity to adhere to endothelial cells.

Conclusion

Our data presented here describe for the first time an analysis of the biological function of the reciprocal t(9;22) ABL/BCR fusion proteins in comparison to their physiological counterpart BCR.
Assessment of data quality in a multi-centre cross-sectional study of participation and quality of life of children with cerebral palsy
Authors: Dickinson Heather , Parkinson Kathryn , McManus Vicki , Arnaud Catherine , Beckung Eva , Fauconnier Jérôme , Michelsen Susan I , Parkes Jackie , Schirripa Giorgio , Thyen Ute , Colver Allan
Published: November 2006

Background

SPARCLE is a cross-sectional survey in nine European regions, examining the relationship of the environment of children with cerebral palsy to their participation and quality of life. The objective of this report is to assess data quality, in particular heterogeneity between regions, family and item non-response and potential for bias.

Methods

1,174 children aged 8–12 years were selected from eight population-based registers of children with cerebral palsy; one further centre recruited 75 children from multiple sources. Families were visited by trained researchers who administered psychometric questionnaires. Logistic regression was used to assess factors related to family non-response and self-completion of questionnaires by children.

Results

431/1,174 (37%) families identified from registers did not respond: 146 (12%) were not traced; of the 1,028 traced families, 250 (24%) declined to participate and 35 (3%) were not approached. Families whose disabled children could walk unaided were more likely to decline to participate. 818 children entered the study of which 500 (61%) self-reported their quality of life; children with low IQ, seizures or inability to walk were less likely to self-report. There was substantial heterogeneity between regions in response rates and socio-demographic characteristics of families but not in age or gender of children. Item non-response was 2% for children and ranged from 0.4% to 5% for questionnaires completed by parents.

Conclusion

While the proportion of untraced families was higher than in similar surveys, the refusal rate was comparable. To reduce bias, all analyses should allow for region, walking ability, age and socio-demographic characteristics. The 75 children in the region without a population based register are unlikely to introduce bias.
Rapid assessment of fine needle aspiration and the final diagnosis--how often and why the diagnoses are changed
Authors: Woon Carolyn , Bardales Ricardo H , Stanley Michael W , Stelow Edward B
Published: November 2006

Background:

On-site rapid interpretation (RI) of fine needle aspiration (FNA) has been shown to increase the diagnostic yield of FNA and decrease the need for repeat diagnostic procedures. Because the pathologist interprets only a fraction of the sample and has limited resources available at such times, an occasional RI diagnosis will be changed at the time of the final diagnosis. We investigated how often these changes in diagnoses occur and the possible reasons for the changes.

Methods:

All cytology reports from 1/1/02 to 12/31/03 from a single institution were reviewed. Cases with RI with discrepant final diagnoses were noted. The discrepant diagnoses were categorized depending on how they were changed. Possible sources for changed diagnoses were noted.

Results:

Between 1/1/02 and 12/31/03 there were 1368 RIs of FNAs. Of these 80 (5.8%) had discrepancies between the RIs and final diagnoses. Seventy-eight cases had additional slides and/or cell block at time of final diagnosis. 16 cases had ancillary studies available at final diagnosis. Consultant pathologists were used in 7 cases. Different pathologists interpreted the RI and final diagnosis in 31 cases.

Conclusion:

Although uncommon, discrepancies between RIs and final diagnoses occur 5.8% of the time at our institution. Most commonly, this involves a change of diagnosis from either non-diagnostic or benign to malignancy. Although much of this is likely due to the presence of additional material and information at the time of final diagnosis, the number of cases that had different pathologists involved in the RI and final diagnosis suggests that inter-observer variability may also play some role.
Validation of a Self-Administered, Computerized Tool for Collecting and Displaying the Family History of Cancer
Authors: Acheson Louise S. , Zyzanski Stephen J. , Stange Kurt C. , Deptowicz Amy , Wiesner Georgia L.
Published: November 2006

Purpose

A detailed family history is important for cancer risk assessment, but obtaining it is time consuming and infrequently accomplished in practice. The Genetic Risk Easy Assessment Tool (GREAT) conducts a computer-administered family history interview and immediately generates a pedigree diagram in digital form. The purpose of this study was to validate family cancer histories produced by patients using the computer tool in comparison with pedigrees made by genetic counselors.

Methods

Patients scheduled for genetics consultation recorded their family histories using the GREAT, separate from their genetic counseling session. The presence of each relative; presence, type, and age at diagnosis of cancers; and cancer geneticist's risk assessment were compared for 120 pairs of pedigrees produced by counselors versus computer tool.

Results

The automated telephone interview took a mean of 33.5 minutes and was highly acceptable to respondents. Ninety-four percent of first-degree relatives, 67% of second-degree relatives, and 38% of third-degree relatives were identical on paired pedigrees; computer-generated pedigrees included additional relatives. Sixty-three percent of all cancers were identified by both family histories, with 90% agreement on the type of cancer. There was very good agreement (κ = 0.70; correlation = 0.77) between the geneticist's breast cancer risk assessments based on computer versus counselors' pedigrees. In a subsample of 61 users, test-retest reliability for the computer-administered questionnaire was high (φ = 0.94 for cancers in first-degree and φ = 0.91 in second-degree relatives).

Conclusion

The GREAT computer-administered questionnaire provides an acceptable, reliable, and valid way of collecting an unverified but extensive family history of cancer and displaying it as a pedigree, in an entirely automated process.
Pathways and Prevention: Concepts and Controversies
Authors: France Alan , Homel Ross
Published: November 2006

For at least a quarter of a century the study of the developmental origins of crime and delinquency has been, in the words of Nagin and Tremblay (2005, p. 873), ‘both an important and contentious topic in criminology’. Indeed, as these researchers note, the contemporary international wave of research within this genre is ‘testimony to the central position of what has come to be called developmental criminology’(p. 874). We estimate that in the journal Criminology, since 1990, at least one third of the articles have been devoted to some aspect of developmental criminology, and many other journals, broader perhaps in their theoretical and methodological orientations than Criminology, are now devoting considerable space to issues like the effects of child abuse and family violence on children and young people's personal development, or the influence of poverty and social exclusion on pathways towards adulthood and perhaps toward crime.

Our aim with this special issue of the Australian and New Zealand Journal of Criminology is to add to this growing body of knowledge, particularly from an Australian and United Kingdom (UK) perspective, and to highlight some important theoretical and methodological debates. Woven through the eight articles in this issue are three core themes: improving the conceptual foundations of pathways research; applying the insights of pathways thinking to the design and implementation of preventive interventions; and deepening and widening our thinking about the methods that are used in pathways and prevention research.
Societal Access Routes and Developmental Pathways: Putting Social Structure and Young People's Voice Into the Analysis of Pathways Into and Out of Crime
Authors: France Alan , Homel Ross
Published: November 2006

Central to pathways research is the analysis of the social processes involved in human action and the influences that have shaping qualities. At the heart of these social processes are human beings who exercise agency and help construct themselves and their environments. Shaping influences include changing social structures; political ideologies and policy innovations; and changes taking place in the cultural sphere of social life. In studying the actions of individuals within changing social environments it is important to make a distinction between individual developmental pathways and societal access routes. Access routes appear in different forms to different people in terms of accessibility and attractiveness. Understanding this perceptual dimension requires listening to the voices of children and young people.This is illustrated by reference to the work of the United Kingdom (UK) Economic & Social Research Council (ESRC) research network, Pathways Into and Out of Crime, which shows how culture, structure and policy influence young people's everyday lives and decisions. It also shows that what young people really value is not programs but a supportive relationship with a nonjudgmental adult who is able to help them negotiate their way through difficult circumstances. The focus of prevention efforts should be on changing social arrangements to create opportunities and systems that facilitate the formation of such supportive structures.
Taking the Developmental Pathways Approach to Understanding and Preventing Antisocial Behaviour
Authors: Lawrence Jeanette A.
Published: November 2006

In this article I focus on the meaning of the pathways imagery from a contemporary developmental perspective and examine the contribution of a developmental pathways approach to understanding how young people become involved in crime. From a developmental perspective a ‘pathway’ focuses attention on people's experiences. As a heuristic devise for interpreting life events, it allows researchers to make sense of how patterns of criminal behaviour start, progress and stop. Such a developmental perspective undergirds crime prevention strategies by supplying a general normative description of the life-course and a way of analysing both typical and atypical patterns of experience in relation to normative life periods. It allows criminologists to link prevention strategies to interindividual and intra-individual variability in patterns of behaviour that have been broadly discussed as ‘antisocial’.
Young People, Pathways and Crime: Beyond Risk Factors
Authors: Kemshall Hazel , Marsland Louise , Boeck Thilo
Published: November 2006

Research and policy approaches to risk are recognised as falling into two cultures, most commonly referred to as artefact and constructionist. Moreover, within constructionism, a continuum of positions exists from weak constructionist in which risks may be viewed as cultural mediations of ‘real’ dangers or hazards, to strong constructionist in which the ‘dangers’ or ‘hazards’ are themselves perceived as socially constructed. In this article a similar continuum of epistemological positions in relation to pathways is developed, and then findings from projects in the ESRC Network ‘Pathways Into and Out of Crime’ demonstrate how constructionist perspectives have generated new insights into the way in which traditional risk factors operate for young people. Examples based on three classically identified risk factors are presented. First, the complex and multidimensional effects of school exclusion are highlighted. Second, the nature of social networks is explicated and the role of their components as both potential risk and protective factors proposed.Third, the need for drugs to be understood within their cultural and historical contexts is identified, and the potential role of drugs as a mediator between other life stresses and offending portrayed. In conclusion, the value of synthesising rather than disputing paradigms to produce different layers of knowledge is discussed.