bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL ETHICS AND NURSING: “YES” TO CARING, BUT “NO” TO A FEMALE ETHICS OF CARE
Authors: KUHSE HELGA 
Published: October 2007

AbstractAccording to a contemporary school of thought there is a specific female approach to ethics which is based not on abstract “male” ethical principles or rules, but on “care”. Nurses have taken a keen interest in these female approaches to ethics. Drawing on the views expounded by Carol Gilligan and Nel Noddings, nurses claim that a female “ethics of care” better captures their moral experiences than a traditional male “ethics of justice”. This paper argues that “care” is best understood in a dispositional sense, that is, as sensitivity and responsiveness to the particularities of a situation and the needs of “concrete” others. While “care”, in this sense, is necessary for ethics, it is not sufficient. Ethics needs “justice” as well as “care”. If women and nurses excessively devalue principles and norms, they will be left without the theoretical tools to condemn some actions or practices, and to defend others. They will, like generations of nurses before them, be condemned to silence.
PRIVATIZATION AND JUST HEALTHCARE
Authors: BUCHANAN ALLEN 
Published: October 2007

AbstractWhen advocates of insurance‐privatization consider whether private insurance‐dominated systems achieve justice at all, they tend to rely on an incomplete set of criteria for a just healthcare system. They also mistakenly assume that it is enough to show that justice is in principle achievable within a private insurance‐dominated system. This essay offers a more complete set of criteria for a just healthcare system. It then argues that the motivational assumptions needed to make insurance‐privatization at all plausible (on grounds of choice, efficiency, and quality of care) are inconsistent with the motivational assumptions needed to show that in practice a private insurance‐dominated system will achieve justice. A private insurance‐dominated system can be expected to satisfy the criteria for just healthcare only if (a) there is extensive and effective regulation to constrain the normal competitive behavior of private insurers or if (b) generous public funds are provided to fill the gaps in access left by the private insurance market. Yet the assumptions about the motivations and abilities of the public, regulators, and public officials needed to satisfy conditions (a) or (b) contradict the privatization advocate's explanations of how privatization will maximize efficiency, choice, and quality of care
EXPLOITATION IN THE USE OF HUMAN SUBJECTS FOR MEDICAL EXPERIMENTATION: A RE‐EXAMINATION OF BASIC ISSUES
Authors: CASTRO LEONARDO D. DE 
Published: October 2007

AbstractRelatively subtle forms of exploitation of human subjects may arise from the inefficiency or incompetence of a researcher, from the existence of a power imbalance between principal and subject, or from the uneven distribution of research risks among various segments of the population. A powerful and knowledgeable person (or institution) may perpetrate the exploitation of an unempowered and ignorant individual even without intending to. There is an ethical burden on the former to protect the interests of the vulnerable. Excessive or insufficient compensation may be exploitative. However, genuine economic imperatives motivating needy volunteers have to be considered. These forms of exploitation should be appreciated in the context of social and cultural factors suggesting that the relationship between researcher and subject cannot properly be appraised as a contractual undertaking. While compliance with pertinent codes and regulations minimises the exploitative potential, they cannot be enforced in a way that does not recognise a society's peculiar characteristics. The experience with some Filipino cultural traits illustrates this point.
PHYSICIAN ASSISTED SUICIDE: NEW DEVELOPMENTS IN THE NETHERLANDS
Authors: GEVERS SJEF 
Published: October 2007

AbstractUntil recently, physician assisted suicide was dealt with on the same basis as active voluntary euthanasia in the Netherlands. Over the last years, several cases relating to assistance in suicide of mental patients did raise specific issues, not addressed so far in the debate on euthanasia. One of these cases resulted in a Supreme Court decision. The paper summarizes this decision and comments on it from a legal point of view.
REFELCTIONS ON THE STATE OF CURRENT DEBATE OVER PHYSICIAN‐ASSISTED SUICIDE AND EUTHANASIA
Authors: WINKLER EARL 
Published: October 2007

AbstractThis paper is part of a larger project. My overall aim is to argue that the evolution of familiar forms of termination of life sustaining treatment, constituting so called passive euthanasia,1 has severaly undercut the logic of every form of reasoning that has traditionally been used to oppose active euthanasia and assistance in suicide. Basically, there are two such forms of traditional opposition, each represented in a range of different versions. There is the inevitable argument concerning social utilities — that permitting euthanasia and assisted suicide will have bad social consequences. But more fundamentally, the idea persists that killing is intrinsically worse than letting‐die in some sense that justifies the current practice of prohibiting the first while allowing the latter. In this paper, I first consider this latter claim. My ultimate strategy, as I have said, is to show that the nature of certain things we have all come to approve regarding termination of treatment makes it next to impossible to convincingly explain, in either of these ways, what is wrong with certain forms of assistance in suicide and euthanasia. In the second part of this paper I take another step in this direction by discussing, in a preliminary way, a special case of the argument from social risks.
ASSISTING SUICIDE IN MICHIGAN
Authors: ELLIN JOSEPH 
Published: October 2007

ABSTRACTPerhaps no American state has seen more legal activity on assisting suicide than Michigan, but despite legislation, a study Commission, several legal cases and a state Supreme Court ruling, the state seems much further from a humane resolution of the question than when the activities of Dr. Jack Kevorkian began in June of 1990. This note summarizes major legal events over a twelve‐month period (ending May, 95), which included jury acquittal of Dr. Kevorkian, the inconclusive report of the Michigan Commission on Death and Dying, the failure of the state legislature to enact legislation to replace the expired absolute but temporary prohibition, and the decision of the Michigan Supreme Court in Mich v. Kevorkian declaring assisting suicide a common law felony and ruling that in certain circumstances a person assisting suicide can be prosecuted for murder. The Commission's model decriminalization proposal and the bills subsequently introduced in the legislature (all of which to varying degrees surrounded assisting suicide with restrictions and safeguards), as well as the decision of the Supreme Court, are discussed. Certain puzzling features of the latter, especially with regard to the kind of causation that can turn helping another commit suicide into murder, are noted.
DISCLOSING MISATTRIBUTED PATERNITY
Authors: ROSS LAINIE FRIEDMAN 
Published: October 2007

ABSTRACTIn 1994, the Committee on Assessing Genetic Risks of the Institute of Medicine published their recommendations regarding the ethical issues raised by advances in genetics. One of the Committee's recommendation was to inform women when test results revealed misattributed paternity, but not to disclose this information to the women's partners. The Committee's reason for withholding such information was that “'genetic testing should not be used in ways that disrupt families”. In this paper, I argue that the Committee's conclusion in favour of nondisclosure to the male partner is unethical. I argue that both parties ought to be informed.
‘BIOETHICS’IS SUBORDINATE TO MORALITY IN JAPAN
Authors: TANIDA NORITOSHI 
Published: October 2007

ABSTRACTDisputes over brain death and euthanasia are used to illuminate the question whether there really is a Japanese way of thinking in bioethics. In Japanese thought, a person does not exist as an individual but as a member of the family, community or society. I describe these features of Japanese society as‘mutual dependency’. In this society, an act is‘good’and‘right’when it is commonly done, and it is‘bad’and‘wrong’when nobody else does it. Thus, outsiders to this ring of mutual dependency encounter ostracism. One feature of this society is a lack of open discussion which leads to the existence of multiple standards. This Japanese morality even prevails over written laws. In Japan, there is a public stance that euthanasia does not exist. On the other hand, there are certain decisions which have permitted euthanasia. Similarly, organ transplants were performed from brain dead donors, while that procedure was not accepted officially by the medical profession. In this situation, there is a danger that human rights will be neglected. So far bioethical approaches have not helped to work out these problems. This may be because Japanese think that bioethics is subordinate to morality. The current dispute over brain death involves a struggle for the establishment of a rational society in Japan. Overcoming mutual dependency and ostracism is essential to resolve this struggle and to lead Japan into a society of mutual respect where all individuals, families and communities are esteemed.
Product Market Integration and Heterogeneity—Rent Sharing and Pricing to Market
Authors: Andersen Torben M. , Sørensen Allan 
Published: October 2007

AbstractInternational product market integration makes market penetration easier and therefore creates both export opportunities and import threats. This changes the competitive position of firms and is associated with changes in trade, production, and specialization structures. The gains and losses in this process are unlikely to be equally shared due to heterogeneity across firms/sectors. In a Ricardian trade model with heterogeneity across firms, we find “pricing to market”—effects not only for exports, but also for pricing in the domestic market even for nontradables. Rents to be shared in wage bargaining differ across tradables and nontradables. It is shown that lower trade frictions affect the scope for “pricing to market” and cause wages to become more closely driven by (relative) productivity. Labor market prospects tend not to improve for low wage jobs, and not to deteriorate for high wage jobs.
On Chamberlinian‐Ricardian Trade Patterns
Authors: Kikuchi Toru , Shimomura Koji , Zeng Dao‐Zhi 
Published: October 2007

AbstractThis study provides a simple, many‐industry model of trade which emphasizes the interaction between cross‐country technical heterogeneity (i.e., a Ricardian aspect) and monopolistic competition among producers of differentiated products (i.e., a Chamberlinian aspect) as determinants of trade patterns. It is shown that the emergence of intra‐industry trade is crucially dependent on the shape of the technology index schedule, which is obtained as a step‐function.
Capital Imports and Tariffs
Authors: Oda Masao 
Published: October 2007

AbstractThis paper develops a three‐sector, three‐factor specific factor model with a tariff and presents conditions under which capital imports and tariffs can be welfare enhancing in a developing country. The impact on welfare depends on the tariff revenue effect and the repatriation effect. A capital import is welfare enhancing if it reduces the domestic output of imports. A tariff is welfare enhancing only if it reduces the return to foreign capital.
Import Protection Bias
Authors: Pecorino Paul 
Published: October 2007

Abstract Rodrik (1995) notes that trade regimes tend to be biased towards import protection, while the standard political economy models either yield no prediction on the bias of the trade regime or predict, counterfactually, a bias towards the export sector. This constitutes an important shortcoming in the political economy of trade literature. In this paper, the Grossman and Helpman (1994) “Protection for Sale” model is extended by adding government expenditure. This expenditure may be financed via a combination of tariff revenue and a distorting wage tax. In addition to the government expenditure, export subsidies need to be financed either via tariff revenue or a distorting wage tax. With this addition, plausible values of the model's parameters yield import protection bias.
Multilevel Models for Longitudinal Data
Authors: Steele Fiona 
Published: October 2007

SummaryRepeated measures and repeated events data have a hierarchical structure which can be analysed by using multilevel models. A growth curve model is an example of a multilevel random-coefficients model, whereas a discrete time event history model for recurrent events can be fitted as a multilevel logistic regression model. The paper describes extensions to the basic growth curve model to handle auto-correlated residuals, multiple-indicator latent variables and correlated growth processes, and event history models for correlated event processes. The multilevel approach to the analysis of repeated measures data is contrasted with structural equation modelling. The methods are illustrated in analyses of children’s growth, changes in social and political attitudes, and the interrelationship between partnership transitions and childbearing.
Alleviating Linear Ecological Bias and Optimal Design with Subsample Data
Authors: Glynn Adam N. , Wakefield Jon , Handcock Mark S. , Richardson Thomas S. 
Published: October 2007

SummaryWe illustrate that combining ecological data with subsample data in situations in which a linear model is appropriate provides two main benefits. First, by including the individual level subsample data, the biases that are associated with linear ecological inference can be eliminated. Second, available ecological data can be used to design optimal subsampling schemes that maximize information about parameters. We present an application of this methodology to the classic problem of estimating the effect of a college degree on wages, showing that small, optimally chosen subsamples can be combined with ecological data to generate precise estimates relative to a simple random subsample.
Cumulative Sum Schemes for Surgical Performance Monitoring
Authors: Chang Tee-Chin 
Published: October 2007

SummaryThe standard cumulative sum (CUSUM), risk-adjusted CUSUM and Shiryayev–Roberts schemes for monitoring surgical performance are compared. We find that both CUSUM schemes are comparable in run length performance except when there is a high heterogeneity of surgical risks, in which case the risk-adjusted CUSUM scheme is more sensitive in detecting a shift in surgical performance. The Shiryayev–Roberts scheme is found to be less sensitive compared with the CUSUM schemes in detecting a deterioration in surgical performance. Using the Markov chain method, the exact average run length of a standard CUSUM scheme can be computed whereas the average run length of a risk-adjusted CUSUM scheme is approximated. For a risk-adjusted CUSUM scheme, the accuracy of the average run length depends on the fineness of the discretization of CUSUM values, which relies on the chart limit, shift to be detected optimally and in-control surgical risk distribution. A sensitivity analysis shows that the risk-adjusted CUSUM and Shiryayev–Roberts schemes still perform moderately well in detecting a deterioration and an improvement in surgical performances respectively even though there is a misspecification of the in-control surgical risk distribution. In general, the run length performance of the Shiryayev–Roberts scheme is comparatively less sensitive to a misspecification of the in-control surgical risk distribution.
Botulinum toxin type‐A for the treatment of inverse psoriasis
Authors: Zanchi M , Favot F , Bizzarini M , Piai M , Donini M , Sedona P 
Published: October 2007

AbstractObjective  To evaluate the efficacy of botulinum toxin type‐A (BoNTA) for the treatment of inverse psoriasis.Background  The use of BoNTA in inverse psoriasis would be a novel approach compared with conventional treatments and may act at the neuroglandular junction level to reduce local sweating with its consequent skin maceration and secondary infection and at the extra‐junction level to inhibit the liberation of neuropeptides and other pro‐algogenic substances responsible for inflammation, hyperkeratosis and pain transmission.Patients  Fifteen patients with a confirmed diagnosis of inverse psoriasis were enrolled into the study. The psoriasis was located in several areas: armpits (7 patients), submammary sulcus (6 patients), intergluteal folds (7 patients), inguinal folds (5 patients) and umbilicus (1 patient).Methods  BoNTA treatment comprised individual injections 2.8 cm apart of 2.4 U BoNTA, with a total dosage between 50 and 100 U per patient depending on the extent and severity of the psoriasis. Patient assessments were done pre‐treatment and at 2, 4 and 12 weeks post‐treatment. The erythematous area was defined using objective photographic evidence, and subjective patient assessment of pain and itch was assessed using a 10‐point visual analogue scale scale.Results  Subjective symptomatology improved in all patients and erythema extension, intensity and infiltration improved in 13 of 15 patients (87%). Treatment was well tolerated with no reported adverse events.Conclusions  BoNTA therapy resulted in improvements in subjective patient symptomatology and objective reductions in erythema and maceration in the treated areas according to photographic evidence. Further large‐scale methodologically rigorous studies are required to investigate the safety and efficacy of BoNTA in this indication.
The Validity of a Personality Disorder Diagnosis for People with an Intellectual Disability
Authors: Moreland Jessica , Hendy Steve , Brown Freddy 
Published: October 2007

Background  It has long been appreciated that people with intellectual disabilities experience mental health problems. Studies into the prevalence of personality disorder in the population of people with an intellectual disability indicate significant variations, which have no clear explanation.Method  Work on personality disorder and personality is reviewed.Results  This article will outline some of the reasons for the variations in the reported prevalence figures including the impact of diagnostic overshadowing, problems inherent within the diagnostic classification systems and instruments that have a significant impact upon the reliability of a diagnosis. It will also argue that there are some fundamental issues relating to the validity of the construct of personality disorder and its application to the population of people with intellectual disabilities. The article notes that the model of personality, which in itself is not without critics, is derived from research on the general population and has not been integrated with personality research conducted within the population of people with an intellectual disability.Conclusion  It is suggested that the current diagnostic systems need to be reviewed in the context of an existing evidence base from within the field of intellectual disabilities. There are grounds to be cautious with the current diagnostic process and to question its clinical utility. Furthermore, diagnosis may only serve as an intermediate step and as part of a more detailed nomothetic approach.
Effect of Service Structure and Organization on Staff Care Practices in Small Community Homes for People with Intellectual Disabilities
Authors: Mansell Jim , Beadle‐Brown Julie , Whelton Beckie , Beckett Celia , Hutchinson Aislinn 
Published: October 2007

Background  An important question in community living is what factors influence the extent to which staff provide ‘active support’.Methods  Engagement, care practices and a range of staff and organizational characteristics were studied in 72 residential homes serving 359 adults with intellectual disabilities. Managers in 36 settings were trained in person‐centred active support (PCAS). A group comparison design and multivariate analysis was used to investigate the relationship between variables.Results  The PCAS group showed more active support, assistance, other contact from staff and engagement in meaningful activity but no difference in choice‐making or assessment of participation in activities of daily living. The PCAS group had more staff with a professional qualification, were more likely to think that challenging behaviour was caused by lack of stimulation, had attitudes more in line with a policy of community care, rated most care tasks as less difficult, and were more organized to deliver active support. The comparison group were more likely to think that challenging behaviour was learned negative behaviour, showed more teamwork and were more satisfied. Multivariate analysis identified a range of staff and organizational variables associated with engagement and active support.Conclusions  The results suggest that some variables which have not hitherto been studied in relation with active support are associated with it. Professional qualification, knowledge and experience appear to be important as do some staff attitudes, clear management guidance, more frequent supervision and team meetings, training and support for staff to help residents engage in meaningful activity.
Abdominal massage for the treatment of idiopathic constipation in children with profound learning disabilities: a single case study design
Authors: Moss Lucy , Smith Melanie , Wharton Sarah , Hames Annette 
Published: October 2007

Accessible summary

This report describes how abdominal massage was provided to five children, to see if it would help with their constipation.
Children and adults with learning disabilities often have long‐term constipation that is treated with laxatives.
The abdominal massage was not effective for all the children.
However the parents enjoyed doing the massage and all thought that it was a helpful and enjoyable experience for them and their children.

SummaryChronic constipation is a common problem in people with learning disabilities. Treatment often involves dietary changes or long‐term laxative use. The aim of this study was to examine the effectiveness of abdominal massage. The participants were five children with profound learning disabilities and additional physical difficulties. Their long‐standing idiopathic constipation was managed by laxatives. Intervention lasted up to 35 weeks, during which participants received 20 min of massage at least twice daily. Parents were asked to maintain stable use of laxatives during the intervention phase, although some chose to withdraw laxatives during abdominal massage intervention. Abdominal massage appeared to result in stools of a more ‘normal’ consistency in some cases. However, no significant differences were found in stool frequency. Parents reported that abdominal massage was a positive experience. In addition, they believed that massage was an effective treatment for constipation. As a result, laxative use was reduced in some cases, apparently with no ill‐effects. These subjective beliefs were not, however, generally borne out by the objective results.