bluuebunny/crossref_metadata_2025 huggingface dataset:
Autoimmune aberration in sudden sensorineural hearing loss: association with anti-cardiolipin antibodies
Authors: Toubi E. , Ben-David J. , Kessel A. , Podoshin L. , Golan TD
Published: November 2007

In view of the presence of autoantibodies against inner ear antigens, the pathogenesis of sudden deafness (SD) and progressive sensorineural hearing loss (PSNHL) is suggested to be of an autoimmune nature. However, microthrombosis of the inner ear may result from pathogenic anti cardiolipin antibody (aCL) activity. We studied 30 patients (17 females and 13 males, age range 20-52 y), of whom 11 suffered from SD and 19 from PSNHL. All were clinically and serologically evaluated for association with autoimmune disorders (serological examination included: aCL, ANA, ENA, ANCA, proteinelectrophoresis, and complement levels). Twenty healthy matched subjects served as controls. None of the control group were aCL positive, whereas 8 out of 30 (27%) patients demonstrated low-moderate titers ( P < 0.02), of whom 5 out of 8 suffered from SD. In addition, 2 aCL negative patients with PSNHL demonstrated hypergammaglubolinemia accompanied by hypocomplementemia, whereas none with SD had such abnormalities. Our data suggests that aCL is detected in patients with sudden sensorineural hearing loss and therefore may play an important role in the pathogenesis of this disability. If sustained by additional studies, these findings would warrant the consideration of anticoagulant therapy.
Hepatitis B and C viruses serology in patients with SLE
Authors: Abu-Shakra M. , El-Sana S. , Margalith M. , Sikuler E. , Neumann L. , Buskila D.
Published: November 2007

Sera of 95 patients with SLE were tested for the presence of hepatitis B surface antigen (HBsAg) and anti-hepatitis C antibodies. The results show that HBsAg was not detected in the sera of all of the SLE patients. Only one patient was confirmed to have anti-HCV antibodies, suggesting that chronic infection with hepatitis B and C is not increased in patients with SLE compared with the general population.
Review : V region gene analysis of human IgM hybridoma monoclonal anti-Sm antibodies
Authors: Mahmoudi M. , Edwards JY , Bell DA , Cairns E.
Published: November 2007

Anti-Sm antibodies although highly specific for systemic lupus erythematosus can only be found in 10-25% of lupus patients and lupus-prone MRL/lpr mice. Molecular studies of these autoantibodies from mice have suggested that the anti-Sm response is Ag driven, its expression is controlled by stochastic events and may originate from the same B cell precursors as anti-DNA antibodies. However, relatively little information regarding the molecular characteristics of anti-Sm antibodies in man has been reported. We studied the V region genes of three IgM hybridoma monoclonal antibodies (BUD 45.12.8, BUD 114.4.11 and BUD 94.91.8) which were selected for Sm reactivity and derived from B cells of a healthy child. Two of these antibodies BUD 45.12.8 and BUD 114.4.11 also reacted with ssDNA, while the third (BUD 94.91.8) did not. Each of these anti-Sm/ RNP antibodies was encoded by different and predominantly unmutated Ig heavy chain germline genes (BUD 45.12.8 by VH3-23, DXP4 and JH4b; BUD 94.91.8 by VH3-33, D21-9 and JH6b; BUD 114.4.11 by VH 1-2, DK1 or DM1 or unknown D and JH4b) and light chain genes (BUD 45.12.8 by Humkv325 and Jκ2; BUD 94.91.8 by hsigg11150 (λIIIb) and Jλ2/3; BUD 114.4.11 by Humk18 and Jκ3). Many of these genes are also used by antibodies with other specificities including DNA. The two anti-Sm antibodies which also bound ssDNA shared an overall V region net positive charge, while the third antibody without ssDNA reactivity carried a negative V region net charge. These findings demonstrate that (1) normal individuals have the genetic potential to generate autoantibodies to Sm/RNP; (2) acquisition of Sm/RNP binding is not dependent on somatic mutations and (3) some human B cell clones exhibit specificity for Sm and ssDNA.
Review : Decreased tumour necrosis factor-beta production in TNFB*2 homozygote: an important predisposing factor of lupus nephritis in Koreans
Authors: Lee Sang-Heon , Park Sung-Hwan , Min Jun-Ki , Kim Sung-Il , Yoo Wan-Hee , Hong Yeon-Sik , Park Jae-Ho , Cho Chul-Soo , Kim Tai-Gyu , Han Hoon , Kim Ho-Youn
Published: November 2007

Low TNF production and its association with TNF gene restriction fragment length polymorphism (RFLP) was demonstrated in (NZW/NZB) F1 mice. However, little is known about the significance of TNF production in association with TNF gene polymorphism in human SLE. This study was designed to evaluate the role of TNF production of peripheral blood mononuclear cells (PBMC) and its association with TNFB gene polymorphism in SLE, particularly lupus nephritis. TNFB gene polymorphism was defined by PCR- NcoI RFLP. TNF productions of phytohemagglutinin (PHA)- stimulated PBMC and T cells were examined by bioassay using L929 cell line and ELISA. The PBMC stimulated by PHA from patients with SLE ( n = 60) tended to secrete less amounts of TNF by bioassay (1032±184pg/ml vs 1524±224pg/ml, P=0.094), and TNF-β by ELISA ( P = 0.0082) than that from normal controls ( n = 38). The low TNF-α producer was more frequent in nephritis than non-nephritis (34.4% vs 7.1% respectively, P<0.01). TNF-β also revealed similar results (53.1% vs 21.4%, P<0.05). In SLE, mean production of TNF-β was decreased in TNFB*2 homozygote ( n=18) than that in TNFB*1 homozygote ( n = 9) (1126.3±145 pg/ml) vs 642 ± 118.4 pg/ml, respectively, P = 0.021), whereas TNF-α production showed little difference between the two groups (710.1 ± 56.4 vs 542.4 ± 71.1 pg/ml, respectively, P = 0.149). Our results demonstrate that decreased TNF production of PBMC, which was significantly associated with TNFB*2 homozygosity, could be an important predisposing factor of lupus nephritis in Koreans.
Fatal amoebic colitis in a patient with SLE: a case report and review of the literature
Authors: Tai ES , Fong KY
Published: November 2007

Colitis in systemic lupus erythematosus (SLE) poses a diagnostic challenge as clinical, radiological and laboratory findings are often non-specific. Fulminant amoebic colitis is a rare cause of death in SLE. Early diagnosis coupled with timely surgery can reduce the mortality. The demonstration of haematophagous trophozoites in the stool is diagnostic but insensitive. Early endoscopy with adequate specimen collection is an important part of the diagnosis. Serology is both sensitive and specific but can take up to 2-4 weeks for seroconversion making it less useful in a disease that takes a rapid downhill course if treated inappropriately. We report a fatal case of colitis in a patient with SLE due to invasive amoebiasis which was complicated by Salmonella bacteraemia, disseminated intravascular coagulation, acute oliguric renal failure and adult respiratory syndrome. We also reviewed the literature on the clinical features and diagnosis of fulminant amoebic colitis. Amoebic colitis, although rare, should be considered in the differential diagnosis of lupus patients with colitis.
Anti-Intercellular Adhesion Molecule-1 (ICAM-1) antibody treatment prevents central and peripheral nervous system disease in autoimmune-prone mice
Authors: Brey RL , Amato AA , Kagan-Hallet K. , Rhine CB , Stallworth CL
Published: November 2007

Abnormal neurological functioning similar to that seen in systemic lupus erythematosus (SLE) patients is detectable in an SLE-prone murine strain (MRL/1pr) by 8-10 weeks and is severe by 18 weeks of age. The purpose of this study was to evaluate the effectiveness of murine anti- intercellular adhesion molecule-1 (ICAM-1) in suppressing neurological disease in MRL/1pr mice. Beginning at 6 weeks of age, five MRL/1pr mice received 5 weekly intraperitoneal injections of anti-ICAM-1-containing culture supernatant in phosphate-buffered saline (PBS) whereas four animals were treated with non-anti-ICAM-1 containing supernatant in PBS. A decline in neurological functioning began in control mice by 10 weeks, but anti-ICAM-1 treated mice remained normal throughout the study. All control mice had vasculitic skin lesions by 14 weeks of age whereas none of the anti-ICAM-1 treated mice ever developed skin lesions. Nerve conduction studies performed on all mice prior to sacrifice showed sciatic compound motor action potentials of anti-ICAM-1 treated mice that were of higher amplitude and shorter latency than those of controls. Inflammation in the sciatic nerve was more common in control mice. Brain histology revealed a similar degree of choroid plexus inflammation in both groups. Our study demonstrated that anti- ICAM-1 was effective in suppressing neurological abnormalities in MRL/1pr mice and may potentially be useful therapy in human SLE.
Elevated anticardiolipin antibodies in autoimmune haemolytic anaemia irrespective of underlying systemic lupus erythematosus
Authors: Lang B. , Straub RH , Weber S. , Röther E. , Fleck M. , Peter H-H.
Published: November 2007

In patients with systemic lupus erythematosus (SLE) and concomitant Coombs positive autoimmune haemolytic anaemia (AIHA) anticardiolipin antibodies (aCL) are found more frequently and at higher titres than in SLE patients without AIHA. In order to assess if aCL elevation is primarily associated with the underlying SLE, or with AIHA itself, we examined AIHA patients with and without underlying SLE for the presence of aCL.

aCL (IgG and IgM) were determined by ELISA in 74 SLE patients without AIHA, 22 SLE patients with AIHA, 50 patients with idiopathic AIHA (warm-reactive autoantibodies), 52 patients with idiopathic AIHA (cold-reactive autoantibodies) and 50 healthy controls.

The mean IgG and IgM aCL titres in SLE patients without AIHA (IgG 37.0 U/ml, IgM 8.9 U/ml) were significantly elevated compared with the values in healthy controls (IgG 9.1 U/ml, IgM 3.2 U/ ml; P < 0.005). The mean aCL levels in SLE patients with AIHA (IgG 53.2 U/ml, IgM 28.2 U/ml) were higher than in SLE patients without AIHA ( P = 0.09 for IgG, P < 0.005 for IgM). Interestingly, the mean aCL levels of patients with idiopathic AIHA (warm-reactive autoantibody type: IgG 29.2 U/ml, IgM 19.3 U/ml; cold-reactive autoantibody type: IgG 27.4 U/ml, IgM 18.9 U/ ml) were also significantly elevated compared with healthy controls P < 0.001).

As aCL are elevated not only in SLE (with and without concomitant AIHA) but also in idiopathic AIHA it can be speculated that aCL are involved in the pathomechanism of autoantibody-induced erythrocyte destruction per se irrespective of an underlying SLE.
Serological characteristics of systemic lupus erythematosus from a hospital-based rheumatology clinic in Kuwait
Authors: Al-Mekaimi Adla , Malaviya AN , Serebour F. , Umamaheswaran I. , Kumar R. , Al-Saeid K. , Sharma PN
Published: November 2007

Thirty-one consecutive patients with SLE were screened for antinuclear antibody (ANA), anti-DNA antibodies, extractable nuclear antigen antibodies (anti-ENAs) including anti-Sm, anti-RNP, anti- SSA (anti-Ro), anti-SSB; (anti-La), anti-Sc1-70, rheumatoid factor (RF), C-reactive protein (CRP), C3 and C4 levels, anti-cardiolipin antibodies (aCL), biologically false positive serological test for syphilis (BF-STS) using VDRL test and Coombs' test. The age of the patients ranged from 11 to 52 year with a median of 29 year; female to male ratio of 5 : 1. There were 21 Kuwaitis, four Egyptians, three from the Indian subcontinent, two Filipinos and one Syrian. Main clinical categories of SLE were: mild cutaneous SLE in 12 (38.7%), clinical antiphospholipid syndrome (APS) secondary to SLE in 8 (25.8%), haematological manifestations of SLE in 5 (16.1%), renal lupus in four (12.9%), neuropsychiatric in three (9.7%), others (6.4%). Clinical features overlapped in several patients. ANA was positive in 96.8% (mean value 891.61 units/ml), anti-DNA in 35.5% (mean value 56.4 units) that was lower than expected and could be due to selection bias as the patients were from a rheumatology clinic, anti-ENA in 42%, anti-Sm 13% that was lower than other non-Caucasian populations, anti-RNP 13%, anti-SS-A in 35.5%, anti-SS-B in 19.4%, Sc1-70 in 13%, CRP in 71% (moderate 58%, very high 13%); C3 mean 1.52 mg/ml (3.2% low levels), C4 mean 0.35 mg/ml (32% low levels), anticardiolipin mean GPL 35.35 units (high 58%), mean MPL 10.61 units (high 26%), BF-STS in 6%, Coombs' test in 6%, RF positive in 36%. The only significant positive clinical associations observed were those of renal involvement with anti-DNA antibodies ( P = 0.042), and clinical antiphospholipid antibody syndrome with aCL antibodies ( P = < 0.05).
Adverse pregnancy outcome in the antiphospholipid syndrome: focus for future research
Authors: Lakasing L. , Poston L.
Published: November 2007

Pregnant patients with antiphospholipid syndrome (APS) may suffer from recurrent pregnancy loss, pre-eclampsia, intrauterine growth restriction and placental abruption. These conditions inevitably result in a high incidence of premature delivery with all the neonatal complications that follow. The mechanism underlying these adverse pregnancy outcomes has not yet been established. This may be primarily a maternal disease process with secondary placental maldevelopment and/or malfunction. Alternatively, there may be primary placental damage mediated directly or indirectly by antiphospholipid antibodies. The safe and successful treatment of pregnant women with APS lies in the understanding of the aetiology of this condition and the mechanism by which complications in pregnancy may arise. In this article we highlight areas in which research may be targeted such that our understanding of the pathogenesis of adverse pregnancy outcome may be enhanced.
Detection of restricted junctional diversity of peripheral T cells in SLE patients by spectratyping
Authors: Kolowos W. , Herrmann M. , Ponner BB , Voll R. , Kern P. , Frank C. , Kalden JR
Published: November 2007

Analysis of somatic mutations revealed that anti-double-stranded DNA (dsDNA) autoantibodies from patients with systemic lupus erythematosus (SLE) share features of a T cell dependent, antigen driven immune response. Therefore we analysed the length diversity of the complementarity determining region 3 (CDR3) of T cell receptor (TCR) by high resolution gel electrophoresis of 16 Vβ family specific RT PCR products (spectratyping). To enable statistical analysis we developed a quantitative scoring method for the histograms. We investigated 16 Vβ gene families in peripheral T cells of SLE patients (n = 9) with active (n = 5) and inactive (n = 4) disease as well as normal healthy blood donors (NHD; n = 9). Analysis of TCR Vβ spectratypes (active SLE, n = 59; inactive SLE, n = 51 and NHD n = 97) revealed statistically significant differences of CDR3 length distribution between SLE patients and NHD (P < 0.0001 (active SLE/NHD) and P = 0.0034 (inactive SLE/NHD). These results suggest that spectratyping is able to detect clonal activation of peripheral T cells which correlates to disease activity in SLE patients. We conclude that peripheral T cells from SLE patients display features of a secondary antigen driven immune response.
Lack of NK cells in lupus patients with renal involvement
Authors: Erkeller-Yuksel FM , Lydyard PM , Isenberg DA
Published: November 2007

We have previously shown that patients with SLE have significantly lower percentages and absolute numbers of NK(CD3-/CD16+56) cells in their peripheral blood compared with normals.1 Patients with active disease had very low levels of NK cells and the reduction was also associated with patients who had renal involvement. We have now performed a serial study immunophenotyping 11 patients with SLE and renal involvement using dual colour immuno flourescence and flow cytometry. Patients were tested every three months on an average of three occasions. As a control, nine SLE patients without renal involvement were immunophenotyped for similar intervals; 11 normal controls were also tested.

Major lymphocyte subsets (T, B and NK) remained very stable during serial bleeds. However, the NK cell populations were decreased significantly in patients with renal involvement both as percentages (5±6 vs 9±5, P<0.0001) and absolute counts (75±108 vs 109±52, P<0.001) in comparison to non-renal patients. Analysis of disease activity using BILAG score showed an inverse correlation between renal system activity and percentage and absolute number of NK cells (P<0.002 and 0.01, respectively).

In this study we have also analysed a CD8 T cell subset which we have not studied before. We have found a significantly increased percentage of CD38+ CD8+ T cells(activated CD8 subset) in patients with SLE in comparison to normal controls. We did not find any association with the CD38 + CD8 + T cells and disease activity as measured by BILAG or renal involvement.

NK cells are important factors in immunity against virus infections and tumour cells. CD38 +CD8+T cells are increased in viral infections. We speculate that the lack of NK cells in SLE patients might have an association with increased CD38 expression.
Professional Codes: an Exercise in Tokenism?
Authors: Tadd Vic
Published: November 2007

The paper questions the effectiveness of the United Kingdom Central Council's (UKCC's) Code of Professional Conduct upon the moral climate of nursing. It challenges the claim that the empowerment of nurses is significantly enhanced by the Code or that it necessarily makes them more accountable for their practice. The position is taken that the Code, in the absence of an effective support network for whistle-blowers, places an unreasonable burden upon nurses in its exhortations to report unprofessional conduct. The paper acknowledges the need to retain the Code, but with more modest claims being made concerning its empowering qualities. It is argued that unless more attention is focused on ways to support potential whistle-blowers, the Code will come to be seen as an irrelevance.

Cet article met en question l'effet du Code du UKCC sur le climat moral des soins infirmiers. Il conteste l'affirmation que les infirmiers/ères sont considérablement plus fort à cause du Code ou qu'il les rend plus responsables dans leur pratique. La position est prise que le Code, en l'absence d'un réseau efficace de soutien pour les 'Whistleblowers' (personnes qui dévoilent un système), met un fardeau excessif sur les infirmiers/ères dans ses exhortations de signaler une conduite contraire au Code professionnel. Cet article reconnâit la nécessité de retenir le Code, mais avec des demandes plus modestes concernant ses pouvoirs de rendre fort. Il est soutenu que si non plus d'attention est concentré sur les moyens de soutenir les 'Whistlebowers', le Code va devenir hors de propos.

Dieser Artikel bezweifelt die Wirksamkeit des Kodex des UKCC über das moralische Klima der Krankenpflege. Er stellt die Behauptung in Frage, dass der Kodex das Pflegepersonal bedeutend ermächtigt, oder dass er es mehr verantwortlich macht für seine Praxis. Die Position ist hier, dass der Kodex, in der Abwesenheit von effektiver Unterstützung für 'Whistleblowers' (d.h. Leute, die ein System verpfeifen), zu viel vom Pflegepersonal verlangt, in seiner Ermahnung, berufswidrige Praxis zu melden. Dieser Artikel anerkennt die Notwendigkeit, den Kodex zu behalten, aber mit kleineren Ansprüchen für seine ermächtigenden Qualitäten. Wenn nicht mehr Aufmerksamkeit gelegt wird, auf welche Weise die 'Whistleblowers' unterstützt werden können, dann wird der Kodex als eine Nebensächlichkeit verurteilt.
Knowledge for Ethical Care
Authors: Bergum Vangie
Published: November 2007

Knowledge needed for ethical care must be constructed in the relationship between professional and patient who strive together to understand what meaning the disease factors have within the experience of the individual patient. Three kinds of knowledge are described. The first two, descriptive knowledge and abstract knowledge, are part of the more comprehensive and complex inherent knowledge. The reality of human experience and meaning is profoundly more complex than the scientific approach of fragmentation for purposes of dissection and diagnosis. In order to develop descriptive, abstract and inherent knowledge as outlined here, three moves need to be made: the move from dominance to collaboration, the move from abstraction to context, and the move from beneficence to nurturance.
Confidentiality and Personal Integrity
Authors: Edgar Andrew
Published: November 2007

This paper uses the social theory of Erving Goffman in order to argue that confidentiality should be understood in relation to the mundane social skills by which individuals present and respect specific self-images of themselves and others during social interaction. The breaching of confidentiality is analysed in terms of one person's capacity to embarrass another, and so to expose that person as incompetent. Respecting confidentiality may at once serve to protect the vulnerable from an unjust society, and yet also protect the guilty from just accusation. Ethical reasoning about confidentiality must therefore recognize the dangers of prejudice and violence inherent in decisions to breach or to respect confidentiality. Case studies are used to illustrate the efficacy of this account, culminating with analyses of three examples from the UKCC document Confidentiality.
Confidentiality and Nursing Practice: Ethics and Law
Authors: Ngwena Charles , Chadwick Ruth
Published: November 2007

This paper examines the ethical and legal duties of confidentiality owed by the nurse, with special reference to obligation to the employer. The main focus is on exploring the parameters of that duty and determining circumstances in which it might be ethically and legally justifiable to disclose confidential information. It is submitted that the obli gation to preserve the confidence of the patient or employer is relative rather than abso lute. In exceptional cases, disclosure is permissible in order to prevent harm to others or to promote a greater public good. A number of suggestions for reform are also made, with a view to reinforcing nurses' ethical and legal rights to exercise discretion to dis close confidential information in appropriate cases in order to protect themselves from victimization by employers.

Cet article passe à l'examen les devoirs éthiques et légales de la confidence que les infirmiers/ères doivent obligatoirement à leur employeur. Le point de mire est l'exploration des donnés de cette obligation, et la détermination des circonstances dans lesquelles il est légitime, éthiquement et légalement, d'exposer de l'information confidentielle. Il est suggéré que l'obligation de préserver la confiance du malade ou de l'employeur est relative plutôt qu'absolu. Dans des cas exceptionels pourtant, la révélation d'information est permisible pour prévenir le mal des autres ou pour promouvoir un plus grand bien public. Quelques suggestions pour réformes sont proposées en vue du renforcement des droits éthiques et légales des infirmiers/ères d'exercer la discretion en ce qui concerne la révélation d'information dans des cas bien choisis, et de les protéger des représailles de l'employeur.

Dieser Artikel prüft die ethischen und legalen Pflichten des Vertrauens, die das Pflegepersonal dem Arbeitsgeber schuldet. Das Zentrum des Arguments ist eine Untersuchung dieser Pflichten, und eine Festsetzung der Umstände, in welchen es ethisch und rechtlich möglich ist, Information bekannt zu machen. Es ist anerkennt, dass die Pflicht des Vertrauens des Patienten oder des Arbeitsgebers zu behalten, eher relativ als absolut ist. In aussergewöhnlichen Fällen jedoch ist die Bekanntgabe von Information erlaubt, um das Böse zu verhindern und das Gute aller zu fördern. Eine Anzahl von Vorschlägen für Reformen sind gemacht, mit der Absicht, die ethischen und legalen Rechte des Pflegepersonals, in gegebenen Fällen Information bekannt zu machen, zu verstärken, und es von ungerechter Behandlung eines Arbeitsgebers zu schützen.
Participant Observation and Informed Consent: Relationships and Tactical Decision-Making in Nursing Research
Authors: Merrell Joy , Williams Anne
Published: November 2007

This paper draws on research undertaken by the authors in community well woman clinics and hospital settings. Discussion focuses on issues around informed consent and participant observation.

The authors are concerned to highlight the complexity of decision-making where researchers hold dual or multiple agendas, which are sometimes in conflict. Further situational factors which affect decision-making in research settings are explored. In particular, the complexity of gaining informed consent throughout the research process is addressed.

The intention is not to point to definitive resolutions to the problems posed, but rather to prompt debate about the often taken for granted meaning of 'informed' consent in relationship to participant observation.

Cet article est basé sur les recherches que les auteurs avaient entrepris dans des polycliniques de santé de femmes et des hôpitaux. La discussion est concentré sur les thèmes du consentement informé et l'observation participante.

Les auteurs sont inquiets de montrer la complexité du processus de se décider quant les chercheurs ont un rôle double ou multiple qui peut être en conflit. D'autres éléments qui influencent la prise de décisions dans des cadres de recherche sont aussi étudiés. En particulier, la compléxité de l'acquisition du consentement informé est adressée.

L'intention n'est pas d'amener à une résolution définitive du problème posé, mais plutôt d'inviter á une discussion sur le sens (trop souvent pris pour réalité) du consentment 'informé' quant il s'agit de l'observation participante.

Dieser Artikel stützt auf Forschungen, die die Autoren in Frauengesundheits-Kliniken und Spitälern unternommen hatten. Die Diskussion ist hier über die Themen Informierte Zustimmung und Mitteilende Beobachtung.

Die Autoren befassen sich mit der Vielschichtigkeit der Entscheidungskräfte wenn die Forscher doppelte oder mehrfache Rollen haben, die manchmal im Konflikt sein können. Andere Faktoren, die die Entscheidungsmöglichkeit beeinflussen, sind auch untersucht. Besonders wird hier die Komplexität des erhalten von informierter Zustimmungung während des Forschungsprozesses angesprochen.

Die Absicht ist nicht, eine definitive Lösung des Problems zu finden, sondern eher zu einer Debatte einzuladen über die zu oft als selbstverständlich betrachtete Bedeutung der 'informierten' Zustimmung auf der Ebene der mitteilenden Beobachtung.
Medical and Nursing Ethics: Never the Twain?
Authors: Gallagher Ann
Published: November 2007

Since the publication of Carol Gilligan's In a different voice in 1982, there has been much discussion about masculine and feminine approaches to ethics. It has been suggested that an ethics of care, or a feminine ethics, is more appropriate for nursing practice, which contrasts with the 'traditional, masculine' ethics of medicine. It has been suggested that Nel Noddings' version of an 'ethics of care' (or feminine ethics) is an appropriate model for nursing ethics. The 'four principles' approach has become a popular model for medical or health care ethics.

It will be suggested in this article that, whilst Noddings presents an interesting analysis of caring and the caring relationship, this has limitations. Rather than acting as an alternative to the 'four principles' approach, the latter is necessary to provide a framework to structure thinking and decision-making in health care. Further, it will be suggested that ethical separatism (that is, one ethics for nurses and one for doctors) in health care is not a progressive step for nurses or doctors.

Three recommendations are made: that we promote a health care ethics that incorporates what is valuable in a 'traditional, masculine ethics', the why (four principles approach) and an 'ethics of care', the 'how' (aspects of Noddings' work and that of Urban Walker); that we encourage nurses and doctors to participate in the 'shared learning' and discussion of ethics; and that our ethical language and concerns are common to all, not split into unhelpful dichotomies.
Patients' Rights in Hospital: an Empirical Investigation in Finland
Authors: Leino-Kilpi Helena , Kurittu Kristiina
Published: November 2007

The purpose of this study was to examine patients' rights in Finnish hospitals from the patients' own points of view. In 1993, a new Act on the status and right of patients in health care came into force. In this Act patients' rights are divided into three categories: the right to good health care, the right to be informed, and the right to self-determination and participation. These same categories of rights were used in this empirical investigation during 1993, in which a questionnaire was answered by 204 patients in two Finnish hospitals. The results indicate that Finnish hospital patients do not know enough about their rights. Information seems to be one of the most problematic areas for hospital patients. The study will be repeated in five years' time.
Nursing Home Staff Attitudes To Ethical Conflicts With Respect To Patient Autonomy and Paternalism
Authors: Mattiasson Anne-Cathrine , Andersson Lars
Published: November 2007

Six case studies on nursing home staff attitudes to patient autonomy have been analysed. The case studies are based on six polarities within autonomy, as developed by Collopy. In total, 189 professional caregivers, comprising the staff of 13 nursing homes in the county of Stockholm, Sweden, responded to questions based on the case studies. Results show that the attitudes within each professional category had a high level of internal correspondence. Nurses consistently supported patient preferences to the highest degree, followed by assistant nurses and auxiliary staff. Nurses' aides ranked lowest in supporting patient preferences. In only one of the cases were background variables of significance.
Ethical Issues in Qualitative Nursing Research
Authors: Holloway Immy , Wheeler Stephanie
Published: November 2007

This article is concerned with ethical issues that have to be considered when under taking qualitative research. Some of the issues - such as informed consent, the dignity and privacy of the research subjects, voluntary participation and protection from harm - are the same as in other types of research and have their basis in moral and ethical principles. Qualitative research, however, generates specific ethical problems because of the close relationship that researchers form with participants.

Qualitative research with patients is especially difficult because of their vulnerability and lack of power in the clinical situation. Therefore the potential conflict between the dual role of the nurse - the professional and the research roles - has to be solved. Researchers also learn how to cope with the tension of subjective and objective elements of the research. Nurses who attempt qualitative research have to consider a variety of complex ethical issues, which are addressed in this paper.
Enhancing Ethical Thinking: the Role of a National Nurses' Association
Authors: Panchaud Catherine
Published: November 2007

In democratic Switzerland, each of its 26 cantons (states) has its own government and its own laws. Thus there are 26 ministries of health and as many different laws regulating medical and health care practice. The Swiss Nurses' Association likewise has 13 regional chapters and a central organization that works on the national level.

Medicine is private and practically all of the Swiss population is privately insured. High technology has led to high specialization with, among other results, a reduced number of premature deaths, longer life span but also rising costs of health. Health professionals are also becoming much more aware of ethical issues such as cost versus quality, high technology versus compassionate care, etc.

A multilingual (four national languages) and multicultural country, Switzerland's health care system relies heavily on foreign nurses, many of whom come from neighbouring France and Germany but also from England, Yugoslavia, Canada and other countries.

Regulation of nursing practice is still poor. Nursing or nurses are hardly mentioned in the state laws and, when mentioned, are often put in a dependent relation to the physician.

Basic nurse training is regulated nationally by cantonal delegations to the Swiss Red Cross. Although there is a good postbasic training scheme, nurses are still striving for access to the university. Meanwhile, they go abroad to acquire degrees. Research in nursing is being developed mainly by the efforts of individuals and the Swiss Nurses' Association.
Consent and the Social Context
Authors: Alderson Priscilla
Published: November 2007

A series of eight multidisciplinary conferences on consent to health care and research was held in London during the period 1992 to 1995. The aim was to present a rich and varied account of consent from the perspectives of academics (especially social scientists), practitioners, and people affected by personal experience. This report summarizes some of the main contributions.
The Attitudes of Nurses and Third and Fourth Year Nursing Students who Deal With Ethical Issues
Authors: Tabak Nili , Reches Rachel
Published: November 2007

Ethical attitudes towards pregnant women were examined by using a questionnaire among 50 nurses, 50 midwives and 100 nursing students (third and fourth years). The main findings show that nurses and students differ in: (1) their knowledge of the Code of Ethics; (2) their protection of patients' rights with regard to secrecy and privacy; and (3) their reporting of mistakes. These findings highlight the need for more serious study of ethics among senior professional nurses.
The Immorality of Pre Registration Nurse Education: a Personal Perspective
Authors: Wainwright Paul
Published: November 2007

Since the introduction of the new nursing curriculum in the United Kingdom, nurse edu cation has undergone a series of fundamental changes, including the introduction of stu dent status, closer links (and in many cases full integration) with higher education, and, for the majority of preregistration courses, the award of a higher education diploma. It is this author's opinion that, given the duration, nature and location of such courses, the award of a diploma amounts to a grave injustice and is representative of a situation that is immoral and corrupt. This opinion is presented from the perspective of educational awards as goods or rewards to be distributed fairly, in recognition of the efforts and abil ities of students.
Client Age, Gender, Behaviour: Effects On Quality of Predicted Self-Reactions and Colleague Reactions
Authors: Greipp Mary Elizabeth
Published: November 2007

This comparative study shows biases relative to client age, gender and behaviour demon strated by 268 female nurse subjects. A repeated measures design was utilized. All three main effects were significant (p < 0.001) for how respondents predicted that they would react to various clients and also how they predicted that their colleagues would react. Most two-way and three-way interaction effects were significant. Subjects demonstrated more favourable reactions to nice, young, male clients and least favourable reactions to not nice, old, male clients.

Study subjects predicted more favourable self-reactions to simulated clients than for their colleagues. What should be important to every professional as a result of this study is the need to be aware of self-biases, which may cause errors in decision-making and nursing care interventions and lead to ethical violations with clients.
Ethics in the Intensive Care Unit: a Need for Research
Authors: Kendrick Kevin , Cubbin Bev
Published: November 2007

Intensive care units are challenging and technologically advanced environments. Dealing with situations that have an ethical dimension is an intrinsic part of working in such a milieu. When a moral dilemma emerges, it can cause anxiety and unease for all staff involved with it. Theoretical and abstract papers reveal that having to confront situations of ethical difficulty is a contributory factor to levels of poor morale and burnout among critical care staff. Despite this, there is a surprising dearth of published nursing research in the UK that investigates how staff deal with ethical issues in intensive care units.

The purpose of this paper is to explore and discuss the development of a research framework designed to explore how staff deal with moral dilemmas in a British inten sive care unit.
The Role of Virtue Ethics in Psychiatric Nursing
Authors: Lützén Kim , da Silva António Barbosa
Published: November 2007

The main purpose of this article is to discuss the place of the ethics of virtues and char acter in nursing and health care in general, and in psychiatric nursing in particular. To attain this goal, the relationship between the ethics of duty (i.e. rule based ethics) and the ethics of virtue and character will be clarified in order to defend our main hypothe sis that these two types of ethics should complement each other, since both are necessary but neither by itself is sufficient for nursing. This means that any applied ethics, as in nursing, should consider the importance of the agent's moral character. To support our arguments, we shall use cases from the empirical reality of psychiatric and mental health care.
Caring and Justice: A Study of two Approaches to Health Care Ethics
Authors: Rickard Maurice , Kuhse Helga , Singer Peter
Published: November 2007

This article presents an empirical study of approaches to ethical decision-making among nurses and doctors. It takes as its starting point the distinction between the perspectives of care and of justice in ethical thinking, and the view that nurses' thinking will be aligned with the former and doctors' with the latter. It goes on to argue that the differences in these approaches are best understood in terms of the distinction between partialist and impartialist modes of moral thinking. The study seeks to determine the distribution of these modes of thinking between nurses and doctors, and finds that there are no signif icant differences between them. A 'two-level' philosophical view of the nature of moral thinking is appealed to in order to explain the study findings.
Ethical Dilemmas Experienced By Hospital and Community Nurses: an Israeli Survey
Authors: Wagner Nurit , Ronen Ilana
Published: November 2007

The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas.

In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas.

A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.
Dehydration Among Terminally Ill Patients: an Integrated Ethical and Practical Approach for Caregivers
Authors: De Ridder Dolf , Gastmans Chris
Published: November 2007

The purpose of this paper is to examine the possibilities and limitations of an ethical and practical approach to terminal dehydration. We have argued that dehydration among terminally ill patients offers an important key to a better understanding of the dying process, and that the caregivers' reactions can lead to a deepening of holistic palliative care.

This article makes clear that the moral question of terminal dehydration can only be treated by an interdisciplinary approach. Therefore, before studying the question of the most humane course possible, we must first understand the meaning of dehydration and its repercussions for the dying patient.

Inspired by an attitude of respect for a good dying process, we have suggested that it is possible to put forward as a general guideline that medical therapy should be progressively reduced when it has been determined that a patient has reached the terminal stage, or is in an irreversible deteriorating process. We describe the critical somatic, social, psychological, moral and spiritual points, which make up an ethical approach to terminal dehydration (TD). In the total care of the irreversibly terminally ill patient, tolerating TD can be an expression of an authentic and caring involvement in the dying patient's welfare.
Predicting Indian Business Cycles
Authors: Dua Pami , Banerji Anirvan
Published: November 2007

This paper evaluates the real-time performance of the Delhi School of Economics-Economic Cycle Research Institute (DSE-ECRI) Indian Leading Index for exports for predicting cyclical swings in Indian exports growth. The index comprises the 36-country real effective exchange rate and leading indices of India's 17 major trading partners. Leading indices of India's major trading partners were developed at the Economic Cycle Research Institute and forecast the onset and end of recessions in overall economic activity in these economies. The results show that the real-time performance of the leading index of Indian exports has been creditable in the last seven years since its construction in 2001. In conjunction with the DSE-ECRI Indian Leading Index, designed to monitor the domestic economy, the exports leading index forms a sound foundation for a pioneering effort to monitor Indian economic cycles.
Performance Measurement in Social Sectors
Authors: Sen Tapas K.
Published: November 2007

Large public sectors in countries like India need to be efficient; one of the tools to achieve this end is performance measurement. Performance indicators have been in use in the private corporate sector for a long time, and the idea of its adoption in the public sector is also not new. By now, there are several instances of practical application in the public sector, with varying degrees of success. This paper, after briefly discussing the rationale and practical issues relating to use of performance indicators in general and for social sector interventions in particular, illustrates its possible use by the state governments in India with the case of two departments of the Government of Chhattisgarh—health and school education. It discusses the administrative setup of the selected departments and desirable revamp of the setup along with the budgetary system, and discusses the preconditions of useful application of performance indicators. The paper then lists out some output and outcome indicators that can be used to begin with in the two departments of the state government. Possibilities for future refinements with better availability of data than now available are also indicated.
Livin' on the Edge: Imaging Dendritic Spine Turnover in the Peri-Infarct Zone during Ischemic Stroke and Recovery
Authors: Brown Craig E. , Murphy Timothy H.
Published: November 2007

The spontaneous recovery of sensory, motor, and cognitive functions after stroke is thought to be mediated primarily through the reorganization and rewiring of surviving brain circuits. Given that dendritic spine turnover underlies rewiring during normal development and plasticity, this process is likely to play a key role in mediating functional changes that occur during and after stroke. Recently, a new approach has been taken using two-photon microscopy to monitor, in real time, the temporal and spatial progression of dendritic plasticity in the living animal, both while it is experiencing the initial ischemic episode as well as during long-term recovery from stroke damage. Here, we highlight recent evidence showing that stroke can trigger extensive changes in the relatively hardwired adult brain. For example, when dendrites are challenged by acute ischemia, they can disintegrate within minutes of ischemia and rapidly reassemble during reperfusion. Over longer time scales, dendrites in the surviving peri-infarct zone show heightened levels of spine turnover for many weeks after stroke, thereby raising the possibility that future stroke therapies may be able to facilitate or optimize dendritic rewiring to improve functional recovery. NEUROSCIENTIST 14(2):139—146, 2008. DOI: 10.1177/1073858407309854
Vibration Control Strategies for Proof-mass Actuators
Authors: Huyanan Satienpong , Sims Neil D.
Published: November 2007

Proof-mass actuators have been considered for a broad range of structural vibration control problems, from seismic protection for tall buildings to the improvement of metal machining productivity by stabilizing the self-excited vibrations known as chatter. This broad range of potential applications means that a variety of controllers have been proposed, without drawing direct comparisons with other controller designs that have been considered for different applications. This article takes three controllers that are potentially suitable for the machining chatter problem: Direct velocity feedback, tuned-mass-damper control (or vibration absorber control), and active-tuned-mass-damper control (or active vibration absorber control). These control strategies are restated within the more general framework of Virtual Passive Control. Their performance is first compared using root locus techniques, with a model based on experimental data, including the low frequency dynamics of the proof-mass. The frequency response of the test structure is then illustrated under open and closed-loop conditions. The application of the control strategies to avoid machine-tool chatter vibrations is then discussed, without going into detail on the underlying physical mechanisms of chatter. It is concluded that virtual passive absorber control is more straightforward to implement than virtual skyhook damping, and may be better suited to the problem of machining chatter.
A/r/tography as an Ethics of Embodiment
Authors: La Jevic Lisa , Springgay Stephanie
Published: November 2007

A/r/tography is an arts-based research methodology that inquires into educational phenomenon through artistic and aesthetic means. A/r/tographical research engages in pedagogical inquiry where the distinctions between researcher and researched become complicated, responsive, and undone. A/r/tography, the authors argue, develops the relationship between embodiment and ethics as a being-with. In this manner, ethics does not refer to the rationalist acquisition of knowledge or moral codes that advocate particular bodily behaviors but instead suggests that participating in a network of relations lends itself to gestures of non-violence. This article extends previous writings on a/r/tographical inquiry through a particular examination of the use of visual journals in a preservice teacher education course. Through the intertextuality of image and word, visual journals enable teachers and students to make meaning and inquire creatively into educational issues in a space that respects self and other.