bluuebunny/crossref_metadata_2025 huggingface dataset:
Asparagine synthetase as a causal, predictive biomarker for l-asparaginase activity in ovarian cancer cells
Authors: Lorenzi Philip L. , Reinhold William C. , Rudelius Martina , Gunsior Michele , Shankavaram Uma , Bussey Kimberly J. , Scherf Uwe , Eichler Gabriel S. , Martin Scott E. , Chin Koei , Gray Joe W. , Kohn Elise C. , Horak Ivan D. , Von Hoff Daniel D. , Raffeld Mark , Goldsmith Paul K. , Caplen Natasha J. , Weinstein John N.
Published: November 2006

l-Asparaginase (l-ASP), a bacterial enzyme used since the 1970s to treat acute lymphoblastic leukemia, selectively starves cells that cannot synthesize sufficient asparagine for their own needs. Molecular profiling of the NCI-60 cancer cell lines using five different microarray platforms showed strong negative correlations of asparagine synthetase (ASNS) expression and DNA copy number with sensitivity to l-ASP in the leukemia and ovarian cancer cell subsets. To assess whether the ovarian relationship is causal, we used RNA interference to silence ASNS in three ovarian lines and observed 4- to 5-fold potentiation of sensitivity to l-ASP with two of the lines. For OVCAR-8, the line that expresses the least ASNS, the potentiation was >500-fold. Significantly, that potentiation was >700-fold in the multidrug-resistant derivative OVCAR-8/ADR, showing that the causal relationship between ASNS expression and l-ASP activity survives development of classical multidrug resistance. Tissue microarrays confirmed low ASNS expression in a subset of clinical ovarian cancers as well as other tumor types. Overall, this pharmacogenomic/pharmacoproteomic study suggests the use of l-ASP for treatment of a subset of ovarian cancers (and perhaps other tumor types), with ASNS as a biomarker for patient selection. [Mol Cancer Ther 2006;5(11):2613–23]
Chronic Activation of Dorsal Hindbrain Corticosteroid Receptors Augments the Arterial Pressure Response to Acute Stress
Authors: Scheuer Deborah A. , Bechtold Andrea G. , Vernon Kathy A.
Published: November 2006

Augmented cardiovascular responses to acute stress can predict cardiovascular disease in humans. Chronic systemic increases in glucocorticoids produce enhanced cardiovascular responses to psychological stress; however, the site of action is unknown. Recent evidence indicates that glucocorticoids can act within the dorsal hindbrain to modulate cardiovascular function. Therefore, we tested the hypothesis that the endogenous glucocorticoid corticosterone can act in the dorsal hindbrain to enhance cardiovascular responses to restraint stress in conscious rats. Adrenal-intact animals with indwelling arterial catheters were treated for 4 or 6 days with 3- to 4-mg pellets of corticosterone or silastic (sham pellets) implanted on the dorsal hindbrain surface. Corticosterone pellets were also implanted either on the surface of the dura or subcutaneously to control for the systemic effects of corticosterone (systemic corticosterone). The integrated increase in arterial pressure during 1 hour of restraint stress was significantly (
P
<0.05) greater in dorsal hindbrain corticosterone (912±98 mm Hg per 60 minutes) relative to dorsal hindbrain sham (589±57 mm Hg per 60 minutes) or systemic corticosterone (592±122 mm Hg per 60 minutes) rats. The plasma glucose response after 10 minutes of stress was also significantly higher in dorsal hindbrain corticosterone-treated rats relative to both other groups. There were no significant between-group differences in the heart rate or corticosterone responses to stress. There were no differences in baseline values for any measured parameters. We conclude that corticosterone can act selectively in the dorsal hindbrain in rats with normal plasma corticosterone levels to augment the arterial pressure response to restraint stress.
Exercise Capacity and Blood Pressure Associations With Left Ventricular Mass in Prehypertensive Individuals
Authors: Kokkinos Peter , Pittaras Andreas , Narayan Puneet , Faselis Charles , Singh Steven , Manolis Athanasios
Published: November 2006

Prehypertensive individuals are at increased risk for developing hypertension and cardiovascular disease compared with those with normal blood pressure. Early compromises in left ventricular structure may explain part of the increased risk. We assessed echocardiographic and exercise parameters in prehypertensive individuals (n=790) to determine associations between exercise blood pressure and left ventricular structure. The exercise systolic blood pressure at 5 metabolic equivalents (METs) and the change in blood pressure from rest to 5 METs were the strongest predictors of left ventricular hypertrophy. We identified the systolic blood pressure of 150 mm Hg at the exercise levels of 5 METs as the threshold for left ventricular hypertrophy. There was a 4-fold increase in the likelihood for left ventricular hypertrophy for every 10-mm Hg increment in systolic blood pressure beyond this threshold (OR: 1.15; 95% CI: 1.12 to 1.18). There was also a 42% reduction in the risk for left ventricular hypertrophy for every 1 MET increase in the workload (OR: 0.58;
P
<0.001). When compared with low-fit, moderate, and high-fit individuals exhibited significantly lower systolic blood pressure at an exercise workload of 5 METs (155±14 versus 146±10 versus 144±10;
P
<0.05), lower left ventricular mass index (48±12 versus 41±10 versus 41±9;
P
<0.05), and prevalence of left ventricular hypertrophy (48.3% versus 18.7% versus 21.6%;
P
<0.001). This suggests that moderate improvements in cardiorespiratory fitness achieved by moderate intensity physical activity can improve hemodynamics and cardiac performance in prehypertensive individuals and reduce the work of the left ventricle, ultimately resulting in lower left ventricular mass.
Spiral Wave Attachment to Millimeter-Sized Obstacles
Authors: Lim Zhan Yang , Maskara Barun , Aguel Felipe , Emokpae Roland , Tung Leslie
Published: November 2006

Background—

Functional reentry in the heart takes the form of spiral waves. Drifting spiral waves can become pinned to anatomic obstacles and thus attain stability and persistence. Lidocaine is an antiarrhythmic agent commonly used to treat ventricular tachycardia clinically. We examined the ability of small obstacles to anchor spiral waves and the effect of lidocaine on their attachment.

Methods and Results—

Spiral waves were electrically induced in confluent monolayers of cultured, neonatal rat cardiomyocytes. Small, circular anatomic obstacles (0.6 to 2.6 mm in diameter) were situated in the center of the monolayers to provide an anchoring site. Eighty reentry episodes consisting of at least 4 revolutions were studied. In 36 episodes, the spiral wave attached to the obstacle and became stationary and sustained, with a shorter reentry cycle length and higher rate. Spiral waves could attach to obstacles as small as 0.6 mm, with a likelihood for attachment that increased with obstacle size. After attachment, both conduction velocity of the wave-front tip and wavelength near the obstacle adapted from their pre-reentry values and increased linearly with obstacle size. In contrast, reentry cycle length did not correlate significantly with obstacle size. Addition of lidocaine 90 μmol/L depressed conduction velocity, increased reentry cycle length, and caused attached spiral waves to become quasi- attached to the obstacle or terminate.

Conclusions—

Anchored spiral waves exhibit properties of both unattached spiral waves and anatomic reentry. Their behavior may be representative of functional reentry dynamics in cardiac tissue, particularly in the setting of monomorphic tachyarrhythmias.
Integrin-Linked Kinase Expression Is Elevated in Human Cardiac Hypertrophy and Induces Hypertrophy in Transgenic Mice
Authors: Lu Huanzhang , Fedak Paul W. M. , Dai Xiaojing , Du Changqing , Zhou Yu-Qing , Henkelman Mark , Mongroo Perry S. , Lau Arthur , Yamabi Hideaki , Hinek Aleksander , Husain Mansoor , Hannigan Gregory , Coles John G.
Published: November 2006

Background—

Although numerous signaling pathways are known to be activated in experimental cardiac hypertrophy, the molecular basis of the hypertrophic response inherent in human heart diseases remains largely unknown. Integrin-linked kinase (ILK) is a multifunctional protein kinase that physically links β-integrins with the actin cytoskeleton, suggesting a potential mechanoreceptor role.

Methods and Results—

Here, we show a marked increase in ILK protein levels in hypertrophic ventricles of patients with congenital and acquired outflow tract obstruction. This increase in ILK was associated with activation of the Rho family guanine triphosphatases, Rac1 and Cdc42, and known hypertrophic signaling kinases, including extracellular signal-related kinases (ERK1/2) and p70 S6 kinase. Transgenic mice with cardiac-specific expression of a constitutively active ILK (ILK

S343D

) or wild-type ILK (ILK

WT

) exhibited a compensated ventricular hypertrophic phenotype and displayed an activation profile of guanine triphosphatases and downstream protein kinases concordant with that seen in human hypertrophy. In contrast, transgenic mice with cardiomyocyte-restricted expression of a kinase-inactive ILK (ILK

R211A

) were unable to mount a compensatory hypertrophic response to angiotensin II in vivo.

Conclusions—

Taken together, these results identify ILK-regulated signaling as a broadly adaptive hypertrophic response mechanism relevant to a wide range of clinical heart disease.
Free Fatty Acid Depletion Acutely Decreases Cardiac Work and Efficiency in Cardiomyopathic Heart Failure
Authors: Tuunanen Helena , Engblom Erik , Naum Alexandru , Någren Kjell , Hesse Birger , Airaksinen K. E. Juhani , Nuutila Pirjo , Iozzo Patricia , Ukkonen Heikki , Opie Lionel H. , Knuuti Juhani
Published: November 2006

Background—

Metabolic modulators that enhance myocardial glucose metabolism by inhibiting free fatty acid (FFA) metabolism may improve cardiac function in heart failure patients. We studied the effect of acute FFA withdrawal on cardiac function in patients with heart failure caused by idiopathic dilated cardiomyopathy (IDCM).

Methods and Results—

Eighteen fasting nondiabetic patients with IDCM (14 men, 4 women, aged 58.8±8.0 years, ejection fraction 33±8.8%) and 8 matched healthy controls underwent examination of myocardial perfusion and oxidative and FFA metabolism, before and after acute reduction of serum FFA concentrations by acipimox, an inhibitor of lipolysis. Metabolism was monitored by positron emission tomography and [
15
O]H
2
O, [
11
C]acetate, and [
11
C]palmitate. Left ventricular function and myocardial work were echocardiographically measured, and efficiency of forward work was calculated. Acipimox decreased myocardial FFA uptake by >80% in both groups. Rate–pressure product and myocardial perfusion remained unchanged, whereas stroke volume decreased similarly in both groups. In the healthy controls, reduced cardiac work was accompanied by decreased oxidative metabolism (from 0.071±0.019 to 0.055±0.016 min
−1
,
P
<0.01). In IDCM patients, cardiac work fell, whereas oxidative metabolism remained unchanged and efficiency fell (from 35.4±12.6 to 31.6±13.3 mm Hg · L · g
−1
,
P
<0.05).

Conclusions—

Acutely decreased serum FFA depresses cardiac work. In healthy hearts, this is accompanied by parallel decrease in oxidative metabolism, and myocardial efficiency is preserved. In failing hearts, FFA depletion did not downregulate oxidative metabolism, and myocardial efficiency deteriorated. Thus, failing hearts are unexpectedly more dependent than healthy hearts on FFA availability. We propose that both glucose and fatty acid oxidation are required for optimal function of the failing heart.
Analysis of Physiological Responses to a Social Situation in an Immersive Virtual Environment
Authors: Slater Mel , Guger Christoph , Edlinger Guenter , Leeb Robert , Pfurtscheller Gert , Antley Angus , Garau Maia , Brogni Andrea , Friedman Doron
Published: November 2006

An experiment was conducted in a Cave-like environment to explore the relationship between physiological responses and breaks in presence and utterances by virtual characters towards the participants. Twenty people explored a virtual environment (VE) that depicted a virtual bar scenario. The experiment was divided into a training and an experimental phase. During the experimental phase breaks in presence (BIPs) in the form of whiteouts of the VE scenario were induced for 2 s at four equally spaced times during the approximately 5 min in the bar scenario. Additionally, five virtual characters addressed remarks to the subjects. Physiological measures including electrocardiagram (ECG) and galvanic skin response (GSR) were recorded throughout the whole experiment. The heart rate, the heart rate variability, and the event-related heart rate changes were calculated from the acquired ECG data. The frequency response of the GSR signal was calculated with a wavelet analysis. The study shows that the heart rate and heart rate variability parameters vary significantly between the training and experimental phase. GSR parameters and event-related heart rate changes show the occurrence of breaks in presence. Event-related heart rate changes also signified the virtual character utterances. There were also differences in response between participants who report more or less socially anxious.
Sharing and Analyzing Data from Presence Experiments
Authors: Friedman Doron , Brogni Andrea , Guger Christoph , Antley Angus , Steed Anthony , Slater Mel
Published: November 2006

Presence research relies heavily on empirical experiments involving subjects in mediated environments. Since presence is a complex, multidimensional concept, experiments on presence can be extremely resource intensive and produce large amounts of data of different types. As the presence community matures, we would like to suggest that data collected in experiments be made publicly available to the community. This will allow the verification of experimental results, comparison of results of experiments carried out in different laboratories, and evaluation of new data-analysis methods. This will, eventually, lead to consistency in approaches and increased confidence in results. In this paper we present the complete dataset from a large-scale experiment that we have carried out in highly immersive virtual reality. We describe the data we have gathered and give examples of the types of analysis that can be made based on that data.
The Log of Gravity
Authors: Silva J. M. C. Santos , Tenreyro Silvana
Published: November 2006

Although economists have long been aware of Jensen's inequality, many econometric applications have neglected an important implication of it: under heteroskedasticity, the parameters of log-linearized models estimated by OLS lead to biased estimates of the true elasticities. We explain why this problem arises and propose an appropriate estimator. Our criticism of conventional practices and the proposed solution extend to a broad range of applications where log-linearized equations are estimated. We develop the argument using one particular illustration, the gravity equation for trade. We find significant differences between estimates obtained with the proposed estimator and those obtained with the traditional method.
Beyond exceptionalism
Authors: Nair Janaki
Published: November 2006

Despite many institutional restraints, several independent strands of research on south Indian history have developed and flourished in ways that significantly revise older and influential historiographical formulations. This article explores the ways in which historians of the geographical south have made productive use of the ‘incommensurability’ of geography and history. To begin with, I briefly sketch some of the historical and historiographical constructions of the ‘south’, usually as a space of difference from the dominant north (Section I). This has produced a series of ‘inclusions/exclusions’ vis-à-vis not just the north, but within the geographical south itself. I discuss three somewhat disparate sites in new and largely unpublished work on south India that move beyond the trope of ‘exceptionalism’ to generate new insights on Indian history: new modes of fashioning the self, as in new scholarship on Keralam; a new way of conceptualising a region such as Karnataka; and finally, new perspectives on even such well-known and researched historical figures such as Tipu Sultan. Such scholarship is relatively unencumbered by earlier laments either about the paucity of sources for histories of the geographical south, or about the ‘politics of mention’ in broader ‘Indian’ histories.
US Responses to Major Developments in the Arab-Islamic World
Authors: Halabi Yakub
Published: November 2006

The US policy towards the Islamic world since the beginning of the 1970s has experienced the challenge of responding to three major crises in the region: the Arab oil embargo of 1973 and the consequent accumulation of petrodollars in the hands of a few traditional, Arab monarchies; the Islamic Revolution of 1979 in Iran, coupled with the debt crisis of the 1980s; and the terrorist attacks of 11 September 2001. Each one of these crises generated a new set of ideas to address the roots of the crisis and construct a new reality that would best serve US interests. In that sense each set became embedded within formal US institutions, influencing the way American policymakers comprehended foreign policy, assessed problems, and formulated strategies toward the region. Such embedded ideas, in turn, regulated American relations with the Middle East—a political region where power and interests shape outcomes by virtue of the ideas that channel them.
Introduction to the Special Issue ‘Making Sense of Organizing: in Honor of Karl Weick’
Authors: Sutcliffe Kathleen M. , Brown Andrew D. , Putnam Linda L.
Published: November 2006

This collection of essays arose from a call for papers issued by Organization Studies in 2004 to celebrate and critically engage the scholarship of Karl Weick; to carry forward his thinking into new contexts and take stock of recent developments in the themes, issues and theories that have preoccupied Weick in his more than 40 years of scholarship. The first seven papers included here accomplish these objectives. In the final essay, in response to our request, Weick himself reflects on continuing themes in his work and major influences on his scholarship.
Making Sense with Institutions: Context, Thought and Action in Karl Weick’s Theory
Authors: Weber Klaus , Glynn Mary Ann
Published: November 2006

Karl Weick’s sensemaking perspective has proven to be a central influence on process theories of organizing. Yet, one persistent criticism levelled at his work has been a neglect of the role of larger social and historical contexts in sensemaking. We address this critique by showing how institutional context is a necessary part of sensemaking. We propose that there are salient but unexplored connections between the institutional and sensemaking perspectives. We explain how three specific mechanisms—priming, editing and triggering—bring institutional context into processes of sensemaking, beyond a more conventional notion of internalized cognitive constraint. Our contribution seeks to be forward-looking as much as reflective, addressing a critique of one of Karl Weick’s key theoretical contributions and offering amendments that extend its reach.
Karl Weick and the Aesthetics of Contingency
Authors: Eisenberg Eric M.
Published: November 2006

In this essay, I reflect on Karl Weick’s best-known texts as a means of tracing his influence on the field of organizational communication. From this perspective, his main contributions are: (1) recognizing the centrality of language and interaction in the social construction of organizational realities; and (2) focusing squarely on communicative praxis as a site for improving our understanding of cognition and culture. Beyond these substantive contributions, an ‘aesthetics of contingency’ pervades Weick’s writings. I maintain that this perspective presents a much needed alternative to seeking meaning and stability through the pursuit of various fundamentalisms.
Imagining Wales and the Welsh Language
Authors: Coupland Nikolas , Bishop Hywel , Evans Betsy , Garrett Peter
Published: November 2006

A survey of approximately 2,000 informants with links to Wales provided differentiated data on Welsh social identities and affiliation, engagement with Welsh cultural practices, and perceptions of the ethnolinguistic vitality of the Welsh language and of domain priorities for Welsh. The data were interrogated mainly in relation to “flowgroups” (participants with different patterns of lived history inside and outside Wales) and groups based on degrees of Welsh-language competence. Flows and competence were potent factors predicting felt affiliation to Wales and many other subjective stances. Strong affiliation to Wales and moderate levels of optimism about Welsh's future were expressed, feelings not restricted to informants within Wales. The Welsh diaspora in North America offers strong symbolic support for the project of Wales and for the Welsh language, as do returning émigrés. Perspectives on cultural flow challenge assumptions about cultural boundedness and authenticity. The data show the need to account for Welsh ethnolinguistic subjectivities in terms of demographic mobility and complexity.
Victim-perpetrator differences in reports of hurtful events
Authors: Feeney Judith A. , Hill Andrew
Published: November 2006

This research project addressed limitations identified in previous studies of role differences (victim vs. perpetrator) in evaluations of hurtful events. The study employed multiple methods (open-ended and structured retrospective reports and experience-sampling diary records), and involved a community sample of both dating and married couples. Retrospective reports indicated that the extent and direction of role-related differences varied markedly across dependent measures. Further, role differences were moderated by forgiveness, but not relationship status, relationship satisfaction, or event severity. Diary records pointed to the ambiguity inherent in many communication acts as contributing to differing perceptions of hurtful events. Results are discussed in terms of theories of interdependence and self-presentation and in terms of the complex and often ambiguous nature of couples’ communication processes.
The Effects of Race, Gender, and Marital Status on Giving and Volunteering in Indiana
Authors: Mesch Debra J. , Rooney Patrick M. , Steinberg Kathryn S. , Denton Brian
Published: November 2006

The purpose of this study is to examine the effects of race, gender, and marital status on giving and volunteering behavior. A second purpose is to examine these effects across different survey methodologies. Using data from Indiana households, a multimethod, multigroup research design was used to compare giving and volunteering across eight different survey methodologies. Results indicate important differences in philanthropic behaviors by gender, race, marital status, and survey methodology—even when controlling for differences in income, age, and educational attainment. These results highlight the importance of looking specifically at human and social capital variables, and survey methodology, when making assumptions about and interpreting the measurement of philanthropic behavior.
Who’s Watching Us Now? The Nonprofit Sector and the New Government by Surveillance
Authors: Walden Gwen I.
Published: November 2006

This article addresses the increasing use by the public sector of compliance monitoring and surveillance as modes of governance and the potential impact of it on the nonprofit sector. The article traces the origins of this shift in public sector governance to major events in the early 21st century, such as 9/11 and the corporate accountability scandals. The ramifications for nonprofit organizations are described, including more rigid reporting requirements, diminished capacity to innovate, and potential wariness of engaging in public policy. There are a number of ways for the sector to adapt to these changes. Closer collaboration with the business sector that is also being affected by the more stringent regulatory environment would help to broaden the message of nonprofits. Foundation support of advocacy and strategic communications would also assist the nonprofit sector in collaborating productively with government.
How the Private Food Assistance Network Evolved: Interactions between Public and Private Responses to Hunger
Authors: Daponte Beth Osborne , Bade Shannon
Published: November 2006

Delivery of assistance to the poor in the United States has changed drastically in the past 25 years. Although the availability of cash assistance has narrowed, the availability of food assistance has broadened. The most substantial change in assistance available to the poor has been the emergence of food pantries as a source of free food to prepare at home, which happened almost concurrent to changes in the operation of the Food Stamp Program. The authors argue that the cessation of the Food Stamp Program’s buy-in requirement contributed to a chronic demand for private food assistance and that, in many respects, private food assistance substitutes for an inadequate public food safety net. The authors conclude with recommendations for strengthening the domestic food safety net.
Preparation for Practice in the New Millennium: A Discussion of the Moral Implications of Multifetal Pregnancy Reduction
Authors: Begley Ann-Marie
Published: November 2006

This article approaches the problem of multifetal pregnancy reduction from a moral perspective. It is one of many complex moral issues arising from reproductive technology and is one with which midwives and nurses are faced more frequently with advancing technology. The work is intended to be used as an educational tool for those who prepare tomorrow’s nurses and midwives. The subject is discussed from three perspectives, the pregnant woman and her partner (clients), a midwife, and from a philosophical ethical perspective. In an attempt to introduce a degree of reality, the perspective of the clients is presented as a dialogue. The midwife’s moral position and her professional difficulties are also discussed. The dialogue and discussion are supplemented with notes in which the issues raised by the characters are critically analysed and discussed. This article is designed to encourage reflection and critical thinking in tomorrow’s health care professionals, and in those who have the responsibility of educating them for a future where reproductive technology is posed to generate more major moral quandaries.
The Influence of Clinical Supervision on Nurses’ Moral Decision Making
Authors: Berggren Ingela , Severinsson Elisabeth
Published: November 2006

The aim of this study was to investigate the influence of clinical supervision on nurse’ moral decision making. The sample consisted of 15 registered nurses who took part in clinical supervision sessions. Data were obtained from interviews and analysed by a hermeneutic transformative process. The hermeneutic interpretation revealed four themes: increased self-assurance, an increased ability to support the patient, an increased ability to be in a relationship with the patient, and an increased ability to take responsibility. In conclusion, it seems that clinical supervision enhances nurse’ ability to provide care on the basis of their decision making. However, the qualitative and structural aspects of clinical supervision have to be investigated further in order to develop professional insight into the way that nurses think and react.
‘They have to Show that they can Make it’: Vitality as a Criterion for the Prognosis of Premature Infants
Authors: Brinchmann Berit Støre
Published: November 2006

In this article, the vitality of premature infants will be described and discussed. Vitality was one of the main factors in a grounded theory study in which the aim was to generate knowledge concerning the ethical decision-making processes with which nurses and physicians are faced in a neonatal unit. Which assessments underlie decisions about whether to start, continue or stop medical treatment of very sick premature babies?

A descriptive study design, including 120 hours of field observations and 22 qualitative in-depth interviews with doctors and nurses, was chosen. Strauss and Glaser’s comparative method was used to analyse the field observations and interviews.

The findings indicate that life-and-death decisions are somewhat ambivalent; experience does not always make them easier. In situations of ambiguity, decisions also seem to be based upon the vitality of the babies concerned.
Eugenics and its Relevance to Contemporary Health Care
Authors: Iredale Rachel
Published: November 2006

Recently there has been a revival of interest in the theory and practice of eugenics by both academics and lay people. The ongoing revolution in biology and the increasing ability to acquire genetic information has led to concerns about genetics being used again for sinister eugenic ends. Although the goals behind traditional eugenics - the minimization of disease and the improvement of human health - remain unchanged, the means by which these goals should be achieved have altered significantly. However, in debates about the impact of human genetic research, eugenics is sometimes viewed as a purely historical phenomenon and its relevance to the current situation is minimized. This article outlines the history of the eugenics movement, describes some eugenic practices, and explores why an appreciation of these historical debates is important for nurses.
A Critique of a ‘Wrongful Life’ Lawsuit in Korea
Authors: Um Young-Rhan
Published: November 2006

This article reports and analyses a ‘wrongful life’ lawsuit brought against a genetic counsellor who failed to refer a woman for prenatal genetic testing despite her pleas to do so; this resulted in the wrongful birth of a child with a genetic abnormality. As a result of negligence, the mother did not have a termination and the baby was born. This is an event that reveals the troublesome nature of prenatal genetic testing applications in medical practice in Korea. The case presentation and critique illuminates how genetic research and its applications in practice influence human life and society. The central issues involved in the lawsuit are the discrepancies between present practice and the law, and lack of respect for the client’s request to make self-determined reproductive choices. The lawsuit is explored in terms of the ethical grounds for the court’s ruling, the responsibility of the genetic counsellor, the sociocultural impact of genetic testing in Korean society, and people’s ability to make informed choices about how this technology is applied in medical practice.
Ethical Dimensions of Supervision: the supervisors’ experiences
Authors: Agélii Ewy , Kennergren Bibi , Severinsson Elisabeth , Berthold Harriet
Published: November 2006

Group-orientated supervision is provided continually to student nurses during their education. In the supervision process it is necessary to create a relationship between the supervisor and the supervisee that is based on an ethical, trusting relationship. The aim of the study was to investigate supervisors’ ( n = 18) experiences of the ethical dimensions of ongoing group-orientated supervision. An additional aim was to describe the supervisors’ values by which they are guided in supervision. Data were collected by means of an open-ended questionnaire and analysed using the hermeneutic transformative process. The findings revealed the following themes: respect and responsibility; carefulness and sensitivity; reflection and confirmation; and genuineness and fairness. The values guiding the supervisors were dignity, normative ethics, privacy and confidentiality.
Determination of Moral Negligence in the Context of the Undermedication of Pain by Nurses
Authors: Hunter Susan
Published: November 2006

The problem of undermedication of pain in health care is widely recognized and acknowledged; however, there is an obvious lack of exploration of this problem from an ethical perspective. When undermedication is raised as a moral concern, the underlying premise is that a patient may experience harm or not benefit from ineffective pain management practices. I will argue that the harm is of a particular type, that is, moral negligence. My intention is to increase nurses’ awareness of both the type of moral harm they are causing, and their professional and moral duties to provide appropriate medication, more particularly to avoid undermedication. I hope that this heightened awareness will be incorporated into practice. As a nurse, I chose to focus on nursing for this article, but my claims are applicable to other health professions, such as medicine.
The Teaching of Health Care Ethics to Students of Nursing in the UK: a pilot study
Authors: Parsons Shaun , Barker Philip J , Armstrong Alan E
Published: November 2006

Senior lecturers/lecturers in mental health nursing (11 in round one, nine in round two, and eight in the final round) participated in a three-round Delphi study into the teaching of health care ethics (HCE) to students of nursing. The participants were drawn from six (round one) and four (round three) UK universities. Information was gathered on the organization, methods used and content of HCE modules. Questionnaire responses were transcribed and the content analysed for patterns of interest and areas of convergence or divergence. Findings include: the majority (72.8%) of the sample believed that insufficient time was allocated to the teaching of HCE; case studies were considered a popular, although problematic, teaching method; the ‘four principles’ approach was less than dominant in the teaching of HCE; and virtue ethics was taught by only 36.4% of the participants. The Delphi technique proved adequate and worth while for the purposes of this study. Further empirical research could aim to replicate or contradict these findings, using a larger sample and recruiting more university departments. Reflection is required on several issues, including the depth and breadth to which ethics theory and, more controversially, meta-ethics, are taught to nursing students.
Nurses’ Ethical Perceptions of Health Care and of Medical Clinical Research: an audit in a French university teaching hospital
Authors: Benhamou-Jantelet Ghislaine
Published: November 2006

Very few data exist in France on: (1) nurses’ knowledge and behaviour concerning ethical decisions in clinical practice; and (2) their knowledge of ethical rules in clinical research. This questionnaire-based audit tried mainly to assess these questions in a large French university teaching hospital. Of the 257 questionnaires distributed to nurses in 23 clinical units of the hospital, 206 were returned (80% response rate). When responding to the vignette describing a clinical situation requiring an ethical decision to be made, most nurses acted as the patient’s advocate although they have had no formal training in ethics. Indeed, 66% of nurses responding considered that the patients themselves should be the primary decision makers in situations that relate to their health and medical care. For children or comatose patients, the decision should be left to the relatives according to 72% of the responses. The results indicated that the role of health care professionals in ethical decisions made for a given patient should be marginal. Nurses’ knowledge concerning research protocols, particularly their ethical requirements and consequences, is poor at present and information from and communication with doctors should be improved.
Human Rights and Patients’ Privacy in UK Hospitals
Authors: Woogara Jay
Published: November 2006

The European Convention on Human Rights has been incorporated into UK domestic law. It gives many rights to patients within the National Health Service (NHS). This article explores the concept of patients’ right to privacy. It stresses that privacy is a basic human right, and that its respect by health professionals is vital for a patient’s physical, mental, emotional and spiritual well-being. I argue that health professionals can violate patients’ privacy in a variety of ways. For example: the right to enjoy their property; the right to protect their medical and personal information as confidential; the right to expect treatment with dignity during intimate care; and the right to control their personal space and territory. Some preliminary evidence indicates that many health care practitioners, including nurses, are presently unaware of the articles of the Convention and the implications of the Human Rights Act 1998. In order to prevent litigation for breaches of patients’ privacy, it is advocated that universities and other educational institutions, the Government and NHS trusts should help to produce a clear educational strategy and protocols so that students and practitioners are well informed in this field. Although 41 European countries are presently the signatories of the European Convention on Human Rights, including the UK, it is important to stress that the principles discussed in this article are applicable world-wide.
Are Patients Aware of Their Rights? A Turkish study
Authors: Zülfikar Fehime , Ulusoy M Filiz
Published: November 2006

The ability to differentiate between what is just and what is unjust may be considered as the precondition to demand one's own rights. Starting from this point, this research was carried out to describe the level of awareness of patients concerning their rights. The main hypothesis was: the higher the socioeconomic and cultural level of patients, the higher is their awareness of their rights.

This research was conducted in one of the state hospitals in Turkey in 1998. It is a descriptive study carried out on 128 inpatients in medical and surgical wards. The data were collected by a questionnaire, which included questions on the rights of patients and gave sample cases. The sample cases were designed by referring to the World Health Organization Declaration on the Promotion of Patients' Rights in Europe.

Only 23% of the participants were able to recognize patient rights, while 32% could not; the majority (45%) were undecided in recognizing patient rights. The awareness scores were statistically significantly different for educational level categories ( F = 5.84; p<0.001). A continuously declining trend was observed for patient rights awareness scores from the highest educational level to the lowest. This partly proves the hypothesis of the research. However, the awareness scores were not significantly different for the other background variables ( p>0.05). Most strikingly, 38% of the patients had no idea about their diagnosis and 63% of those who had undergone surgery did not know why they had had the operation.
Ethical Aspects of Phenomenological Research with Mentally Ill People
Authors: Usher Kim , Holmes Colin
Published: November 2006

Given the dramatic rise in the frequency of nursing research that involves eliciting personal information, one would expect that attempts to maintain the balance between the aspirations of researchers and the needs and rights of patients would lead to extensive discussion of the ethical issues arising. However, they have received little attention in the literature. This paper outlines and discusses some of the issues associated with qualitative research. The discussion converges on the specific case of phenomenological research, which involves the invasion of participants’ personal worlds, and draws attention to some of the ethical issues that arise when the participants are psychiatric patients.
Retired Registered Nurses’ Stories About Being in Ethically Difficult Care Situations
Authors: Melchert Eva , Udén Gigi , Norberg Astrid
Published: November 2006

Twelve retired nurses were asked to narrate a care situation in which it had been difficult for them as nurses to know what was the right and good thing to do. The transcribed interviews were examined by content analyses. Physicians were the central coactors in the nurses’ stories. Colleagues were seldom mentioned. Other ward staff were mainly called ‘the girls’. The patient was central and referred to with respect. All the nurses focused on experiential learning. Guiding ethical principles are listed.
Not for Resuscitation: two decades of challenge for nursing ethics and practice
Authors: Schultz Lorinda
Published: November 2006

Since the 1970s, the designation of some patients as ‘not for resuscitation’ (NFR) has become standard practice in many health care facilities. Considerable disquiet has subsequently arisen about the way these decisions are implemented in practice. Nurses, in particular, often find themselves initiating or withholding cardiopulmonary resuscitation (CPR) in situations characterized by verbal orders, euphemistic documentation and poor communication, and when consultations with patients about their CPR choices often do not take place. These practices have developed in large part because a clear legal foundation for withdrawal of treatment decisions such as NFR is still lacking in many countries. The problems with NFR were identified in the 1970s and 1980s and are not new, but, as yet, we have not been able to bring about the necessary changes, in effect to translate broadly accepted ethical principles into clinical practice. This paper explores some of the reasons for this and provides a review and analysis of the main issues, including NFR guidelines and the nursing role in NFR decision-making.
Selected Ethical Issues in Planned Social Change and Primary Health Care
Authors: Davis Anne J
Published: November 2006

This paper discusses two interrelated concepts: (1) the ethics of planned social change and (2) primary health care. It takes the World Health Organization’s definition of primary health care as a point of departure to examine four identified potential areas where ethical dilemmas may occur. In addition, questions are raised about nursing education, as well as about the class and status differences between nurses and patients and communities. It takes the position that our first task is to encourage more discussion and examination of ethical issues in the planned social change of primary health care.
Professional Solidarity Versus Responsibility for the Health of the Public: is a nurses’ strike morally defensible?
Authors: Tabak Nili , Wagner Nurit
Published: November 2006

The purpose of this article is to deliberate the moral and legal dilemma entailed in the weapon of the labour strike as a pressure tactic on the Israeli Finance Ministry regarding job slots, budgets and, in effect, violating the collective agreement signed by the nurses and impairing patients’ treatment, as opposed to refraining from striking and suffering the heavy burden of work, the lack of trained personnel, low wages, and the inability to give patients proper, high quality treatment.
Nursing: a spiritual perspective
Authors: Long Ann
Published: November 2006

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue.

To be spiritual is to become fully human, the article argues, and the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole.

The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.

Abstract themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving.

Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse.
A Baby-Friendly Hospital Initiative in northern China
Authors: Chamberlain Marie
Published: November 2006

In the People’s Republic of China, an approach has been adopted to ensure that all children born as a result of the one-child policy are healthy. The World Health Organization/United Nations Children’s Fund (WHO/UNICEF) has encouraged the Chinese Government to embrace this philosophy. Part of this approach has resulted in an attempt to increase the breastfeeding rates. This report describes a visit by two nursing faculty members of a Canadian university to an urban hospital maternity unit in the northeast of China, where the staff were attempting to incorporate this philosophy into their maternity care with the assistance of nursing faculty members from the local university. The method chosen to integrate this philosophy was the Baby-Friendly Hospital Initiative initiated by WHO/UNICEF.
Ethical Dilemmas in a Psychiatric Nursing Study
Authors: Latvala Eila , Janhonen Sirpa , Moring Juha
Published: November 2006

This article describes the ethical dilemmas encountered by the authors while conducting qualitative research with psychiatric patients as participants. The ethical conflicts are explored in terms of the principles of personal autonomy, voluntariness and awareness of the purpose of the study, with illustrations from the authors’ research experience. This study addresses the everyday life of psychiatric nursing in a psychiatric hospital as described by patients, nurses and nursing students. The data were collected in a university hospital in northern Finland, using videotaped observations and recorded interviews. Although no definitive resolutions are proposed to the conflicts, the article endeavours to enhance awareness of the ethically perplexing situations possibly encountered by researchers during a study process. The institution where the study was conducted has a Research Board entitled to resolve ethical questions. The Ethics Review Committee of the Medical Faculty at the University and the Research Board of the University Hospital’s Department of Psychiatry reviewed and accepted this research plan. They also recommended solutions to some specific ethical problems that occurred in the course of the study. Moreover, some ethical dilemmas required further study and debate during the process.
Autonomous or Automatons? an exploration through history of the concept of autonomy in midwifery in Scotland and New Zealand
Authors: Fleming Valerie EM
Published: November 2006

Through the World Health Organization’s definition of midwifery, midwives are frequently heard to describe themselves as autonomous practitioners. In this article this notion is refuted. An overview of individual and collective autonomy is first presented to contextualize the subsequent discussion. Then the notion of autonomy in relation to midwifery practice in Scotland and New Zealand is critiqued through tracing the history of midwives and midwifery in these two countries. Issues relating to midwifery registration, medicalization of birth and consumerism are discussed. Each of these categories is suggested as limiting to autonomous practice within midwifery.