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Ethical Concerns (ethical + concern)
Selected AbstractsEthical Concerns in International Business: Are Some Issues More Important than Others?BUSINESS AND SOCIETY REVIEW, Issue 2 2002Turgut Guvenli First page of article [source] Training and performance improvement professionals' perspectives on ethical challenges during evaluationPERFORMANCE IMPROVEMENT QUARTERLY, Issue 1 2010Seung Youn (Yonnie) Chyung EdD Ethical concerns are rising in the business world. With this in mind, training and performance improvement practitioners, especially during evaluation projects, should be aware of principles and codes of ethics, and their behaviors and decisions should reflect the standards recognized by members of the professional society. A study was conducted with 108 training and performance improvement practitioners to reveal the reasoning behind their judgments of ethically challenging evaluation situations and to understand their rationales through the lens of existing guiding principles. Participants read three scenarios and judged the ethicality of the evaluator's actions in each scenario. Results revealed that participants who were aware of both the International Society for Performance Improvement's Code of Ethics and American Evaluation Association's Guiding Principles for Evaluators were stricter in their judgments about the ethicality of one scenario than those who were not. This article discusses implications of the results and higher education's role in reinforcing an ethical culture and ethical practice by employees. [source] Ethical issues related to epilepsy care in the developing worldEPILEPSIA, Issue 5 2009Chong-Tin Tan Summary There are three major issues of ethical concern related to epilepsy care in the developing world. First, is it ethical for a developing country to channel its limited resources from direct epilepsy care to research? The main considerations in addressing this question are the particular research questions to be addressed and whether such research will bring direct benefits to the local community. Second, in a country with limited resources, when does ignoring the high treatment gap become an ethical issue? This question is of particular concern when the community has enough resources to afford treatment for its poor, yet is not providing such care because of gross wastage and misallocation of the national resources. Third, do countries with plentiful resources have an ethical responsibility to help relieve the high epilepsy treatment gap of poor countries? Indeed, we believe that reasonable health care is a basic human right, and that human rights transcend national boundaries. Although health care is usually the responsibility of the nation-state, many modern states in the developing world are arbitrary creations of colonization. There is often a long process from the establishment of a political-legal state to a mature functional nation. During the long process of nation building, help from neighboring countries is often required. [source] Ethical issues faced by field primatologists: asking the relevant questionsAMERICAN JOURNAL OF PRIMATOLOGY, Issue 9 2010Linda Marie Fedigan Abstract Field primatologists face unusual ethical issues. We study animals rather than people and receive research approval from animal care rather than ethics committees. However, animal care evaluation forms are developed from concerns about laboratory animal research and are based on the "Three R's" for humane treatment of captive experimental subjects (replacement, reduction and refinement), which are only debatably relevant to field research. Scientists who study wild, free-ranging primates in host countries experience many ethical dilemmas seldom dealt with in animal care forms. This paper reviews the ethical issues many field primatologists say they face and how these might be better addressed by animal care forms. The ethical issues arising for field researchers are divided into three categories: "Presence, Protocols and People" and for each the most frequent issues are described. The most commonly mentioned ethical concern arising from our presence in the field is the possibility of disease transmission. Although most primate field studies employ only observational protocols, the practice of habituating our study animals to close human presence is an ethical concern for many since it can lessen the animals' fear of all humans, thereby facilitating undesirable behaviors (e.g., crop-raiding) and rendering them vulnerable to harm. Field primatologists who work in host countries must observe national laws and local traditions. As conservationists, primatologists must often negotiate between the resource needs and cultural practices of local people and the interests of the nonhuman primates. Many say they face more ethical dilemmas arising from human interactions than from research on the animals per se. This review concludes with suggestions for relevant questions to ask on animal care forms, and actions that field primatologists can take to better inform animal care committees about the common ethical issues we experience as well as how to develop guidelines for addressing them. Am. J. Primatol. 72:754,771, 2010. © 2010 Wiley-Liss, Inc. [source] The genes encoding bovine SP-A, SP-D, MBL-A, conglutinin, CL-43 and CL-46 form a distinct collectin locus on Bos taurus chromosome 28 (BTA28) at position q.1.8,1.9ANIMAL GENETICS, Issue 4 2004M. Gjerstorff Summary Collectins are a group of C-type lectins involved in the innate immune system, where they mediate and modulate clearance of pathogens. The health status of cattle is of major economical and ethical concern; therefore, the study of bovine collectins is of importance. The collectins conglutinin, CL-43 and CL-46 are only present in Bovidae and the characterization of their genes indicates that they are structural descendants of another collectin, lung surfactant protein D (SP-D). In this study, we assembled BAC clones into a contig spanning 330,1150 kb, which includes the bovine genes encoding the collectins SP-A (SFTPA), SP-D (SFTPD), mannan-binding lectin A (MBL1), CL-43 (COLEC9), CL-46 (COLEC13) and conglutinin (COLEC8). In the same contig, we also identified a gene that potentially encodes a novel conglutinin-like collectin (COLEC14). The arrangement of STFPA, SFTPD and MBL1 is homologous to the organization found in humans and mice, whereas the Bovidae-specific collectin genes, COLEC8, COLEC9 and COLEC13, extend from SFTPD. Proximal to the collectin locus at BTA28q1.8,1.9, and included in the contig, we found the microsatellite IDVGA8, which may be a valuable marker for tracking polymorphisms in the linked collectin genes. [source] THE ETHICS OF INTERCOUNTRY ADOPTION: WHY IT MATTERS TO HEALTHCARE PROVIDERS AND BIOETHICISTSBIOETHICS, Issue 7 2010SARAH JONES ABSTRACT The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion. [source] Corporate Governance and Business Ethics: insights from the strategic planning experience*CORPORATE GOVERNANCE, Issue 6 2005Ingrid Bonn In this paper we develop an integrated approach towards corporate governance and business ethics. Our central argument is that organisations can learn from the development of strategic planning in the 1970s and 1980s. We identify three weaknesses , a bureaucratic and formalised approach, lack of implementation and lack of integration throughout the organisation , which were prevalent in strategic planning in the past and which are potentially just as problematic for an integrated corporate governance approach to business ethics. We suggest ways these weaknesses might be avoided and provide questions for boards of directors to consider when integrating ethical concerns into their organisations' corporate governance structures. [source] ETHICAL PROBLEMS IN CONDUCTING RESEARCH IN ACUTE EPIDEMICS: THE PFIZER MENINGITIS STUDY IN NIGERIA AS AN ILLUSTRATIONDEVELOPING WORLD BIOETHICS, Issue 1 2010EMMANUEL R. EZEOME ABSTRACT The ethics of conducting research in epidemic situations have yet to account fully for differences in the proportion and acuteness of epidemics, among other factors. While epidemics most often arise from infectious diseases, not all infectious diseases are of epidemic proportions, and not all epidemics occur acutely. These and other variations constrain the generalization of ethical decision-making and impose ethical demands on the individual researcher in a way not previously highlighted. This paper discusses a number of such constraints and impositions. It applies the ethical principles enunciated by Emmanuel et al.1 to the controversial Pfizer study in Nigeria in order to highlight the particular ethical concerns of acute epidemic research, and suggest ways of meeting such challenges. The paper recommends that research during epidemics should be partly evaluated on its own merits in order to determine its ethical appropriateness to the specific situation. Snap decisions to conduct research during acute epidemics should be resisted. Community engagement, public notification and good information management are needed to promote the ethics of conducting research during acute epidemics. Individual consent is most at risk of being compromised, and every effort should be made to ensure that it is maintained and valid. Use of data safety management boards should be routine. Acute epidemics also present opportunities to enhance the social value of research and maximize its benefits to communities. Ethical research is possible in acute epidemics, if the potential challenges are thought of ahead of time and appropriate precautions taken. [source] Adult bone marrow,derived stem cells for organ regeneration and repairDEVELOPMENTAL DYNAMICS, Issue 12 2007Florian Tögel Abstract Stem cells have been recognized as a potential tool for the development of innovative therapeutic strategies. There are in general two types of stem cells, embryonic and adult stem cells. While embryonic stem cell therapy has been riddled with problems of allogeneic rejection and ethical concerns, adult stem cells have long been used in the treatment of hematological malignancies. With the recognition of additional, potentially therapeutic characteristics, bone marrow,derived stem cells have become a tool in regenerative medicine. The bone marrow is an ideal source of stem cells because it is easily accessible and harbors two types of stem cells. Hematopoietic stem cells give rise to all blood cell types and have been shown to exhibit plasticity, while multipotent marrow stromal cells are the source of osteocytes, chondrocytes, and fat cells and have been shown to support and generate a large number of different cell types. This review describes the general characteristics of these stem cell populations and their current and potential future applications in regenerative medicine. Developmental Dynamics 236:3321,3331, 2007. © 2007 Wiley-Liss, Inc. [source] Sequential methods and group sequential designs for comparative clinical trialsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 5 2003Véronique Sébille Abstract Comparative clinical trials are performed to assess whether a new treatment has superior efficacy than a placebo or a standard treatment (one-sided formulation) or whether two active treatments have different efficacies (two-sided formulation) in a given population. The reference approach is the single-stage design and the statistical test is performed after inclusion and evaluation of a predetermined sample size. In practice, the single-stage design is sometimes difficult to implement because of ethical concerns and/or economic reasons. Thus, specific early termination procedures have been developed to allow repeated statistical analyses to be performed on accumulating data and stop the trial as soon as the information is sufficient to conclude. Two main different approaches can be used. The first one is derived from strictly sequential methods and includes the sequential probability ratio test and the triangular test. The second one is derived from group sequential designs and includes Peto, Pocock, and O'Brien and Fleming methods, , and , spending functions, and one-parameter boundaries. We review all these methods and describe the bases on which they rely as well as their statistical properties. We also compare these methods and comment on their advantages and drawbacks. We present software packages which are available for the planning, monitoring and analysis of comparative clinical trials with these methods and discuss the practical problems encountered when using them. The latest versions of all these methods can offer substantial sample size reductions when compared with the single-stage design not only in the case of clear efficacy but also in the case of complete lack of efficacy of the new treatment. The software packages make their use quite simple. However, it has to be stressed that using these methods requires efficient logistics with real-time data monitoring and, apart from survival studies or long-term clinical trials with censored endpoints, is most appropriate when the endpoint is obtained quickly when compared with the recruitment rate. [source] Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic reviewINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2007L. Robinson Abstract Background Wandering occurs in 15,60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. Objective To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. Design A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. Results (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. Conclusions In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials. Copyright © 2006 John Wiley & Sons, Ltd. [source] Porcine induced pluripotent stem cells may bridge the gap between mouse and human iPSIUBMB LIFE, Issue 4 2010Miguel A. Esteban Abstract Recently, three independent laboratories reported the generation of induced pluripotent stem cells (iPSCs) from pig (Sus scrofa). This finding sums to the growing list of species (mouse, human, monkey, and rat, in this order) for which successful reprogramming using exogenous factors has been achieved, and multiple others are possibly forthcoming. But apart from demonstrating the universality of the network identified by Shinya Yamanaka, what makes the porcine model so special? On one side, pigs are an agricultural commodity and have an easy and affordable maintenance compared with nonhuman primates that normally need to be imported. On the other side, resemblance (for example, size of organs) of porcine and human physiology is striking and because pigs are a regular source of food the ethical concerns that still remain in monkeys are not applicable. Besides, the prolonged lifespan of pigs compared with other domestic species can allow exhaustive follow up of side effects after transplantation. Porcine iPSCs may thus fill the gap between the mouse model, which due to its ease is preferred for mechanistic studies, and the first clinical trials using iPSCs in humans. However, although these studies are relevant and have created significant interest they face analogous problems that we discuss herein together with potential new directions. © 2010 IUBMB IUBMB Life, 62(4): 277,282, 2010 [source] The ethics of research using electronic mail discussion groupsJOURNAL OF ADVANCED NURSING, Issue 5 2005Debbie Kralik PhD RN Aim., The aim of this paper is to identify and discuss the ethical considerations that have confronted and challenged the research team when researchers facilitate conversations using private electronic mail discussion lists. Background., The use of electronic mail group conversations, as a collaborative data generation method, remains underdeveloped in nursing. Ethical challenges associated with this approach to data generation have only begun to be considered. As receipt of ethics approval for a study titled; ,Describing transition with people who live with chronic illness' we have been challenged by many ethical dilemmas, hence we believe it is timely to share the issues that have confronted the research team. These discussions are essential so we can understand the possibilities for research interaction, communication, and collaboration made possible by advanced information technologies. Discussion., Our experiences in this study have increased our awareness for ongoing ethical discussions about privacy, confidentiality, consent, accountability and openness underpinning research with human participants when generating data using an electronic mail discussion group. We describe how we work at upholding these ethical principles focusing on informed consent, participant confidentiality and privacy, the participants as threats to themselves and one another, public,private confusion, employees with access, hackers and threats from the researchers. Conclusion., A variety of complex issues arise during cyberspace research that can make the application of traditional ethical standards troublesome. Communication in cyberspace alters the temporal, spatial and sensory components of human interaction, thereby challenging traditional ethical definitions and calling to question some basic assumptions about identity and ones right to keep aspects of it confidential. Nurse researchers are bound by human research ethics protocols; however, the nature of research by electronic mail generates moral issues as well as ethical concerns. Vigilance by researchers is required to ensure that data are viewed within the scope of the enabling ethics approval. [source] Mesenchymal stem cells in tissue engineeringJOURNAL OF CHEMICAL TECHNOLOGY & BIOTECHNOLOGY, Issue 4 2008Pankaj Godara Abstract Mesenchymal stem cells (MSC) offer great promise in therapies aimed at repairing, replacing or regenerating damaged or diseased tissues and organs. This potential is due to their capacity for self-renewal, ability to differentiate down a range of lineages, and potential in autologous therapies, free from major ethical concerns. This review examines the issues around the use of MSC in tissue engineering (TE) applications. Key issues facing widespread MSC therapeutic use include both the scarcity in adult tissues and the current lack of a simple unambiguous identifying marker. These major challenges facing the isolation, characterization and expansion of MSC to therapeutically significant numbers currently limit their usefulness as ,off the shelf' therapies. Balanced against this, recent evidence suggests that MSC have a much wider tissue distribution and greater plasticity than originally envisaged. Although therapeutic applications of MSC initially focused on mesenchymal lineages such as cartilage and bone, this is now broadening to include organs such as the heart and skin. Ultimately, the clinical utility of such MSC-based therapies will depend on their performance and cost. Copyright © 2008 Society of Chemical Industry [source] Ethical challenges in mental health services to children and familiesJOURNAL OF CLINICAL PSYCHOLOGY, Issue 5 2008Gerald P. KoocherArticle first published online: 2 APR 200 Abstract Mental health practitioners working with children and families must attend to several ethical concerns that do not typically come into play with adult clients. The challenges for practitioners usually involve attention to four subsets of concerns that all begin with the letter c: competence, consent, confidentiality, and competing interests. Using the 4-C model, this article focuses on ethical aspects of practitioner competence, consent and assent, confidentiality, and the incongruence of interests that occurs when different people organize and set goals for psychological services. After explicating these issues, I provide recommendations for addressing them in the course of clinical practice. © 2008 Wiley Periodicals, Inc. J Clin Psychol:In Session 64 : 1,12, 2008. [source] Coercive treatment for drug misuse: a dialogical junctureJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 5 2004Christine Horrocks Abstract This article adopts a ,dialogical' relational perspective to explore the recently introduced initiative of coercive treatment for drug misuse in the UK. Conversational interviews were undertaken with 11 people who had been sentenced to the Drug Treatment and Testing Order. Receiving treatment for drug misuse is often storied within a motivational account that is expectant of a ,readiness to change'; such assumptions seem theoretically problematic when change is legally imposed. Therefore, moral and ethical concerns surround the introduction of this initiative, however the interview data illustrates the potential that participation might offer for the creation of ,counterstories' where a more moral self can be enacted. Our analysis suggests that this counterstory is co-constructed thus being an outcome of both self and other. Furthermore such stories appear fragile; constantly under assault from detrimental authoritative discourses that are not only part of wider social understandings around drug misuse but also permeate the policy and practice of coercive treatment. Copyright © 2004 John Wiley & Sons, Ltd. [source] Consumer response to tobacco smoke in service settingsJOURNAL OF CONSUMER BEHAVIOUR, Issue 4 2010Frederic B. Kraft Establishing smoking policies which accommodate customers' smoking preferences is a major problem for restaurants, bars, hotels, and other firms in the service industry. This study is based on the premise that tobacco smoke can be considered a component of both the physical and ambient retail service environment. Because of legal and ethical concerns, the presence or absence of environmental tobacco smoke (ETS) in two types of eating facilities (bar and fine dining restaurant) was operationalized by the presentation to respondents of photographs which pictured customers in a setting where smoking was either present or absent. The success of this method of manipulation of the treatment variable was assessed with a thought listing procedure. Thought listing responses indicate that both treatments (type of facility and smoking policy) were adequately conveyed by the photographs. Results indicate that cognitive, emotional, and behavioral responses were all negatively affected by the presence of tobacco smoke. The conclusion is that managers who permit smoking in their facilities risk losing non-smoking patrons while smokers are little affected by either the presence or absence of smoke. The major contributions of this study include both the exploration of tobacco smoke as part of the retail service environment for eating establishments and the use of thought listings as a manipulation check for variables which were manipulated through use of photographs depicting the treatment conditions. Copyright © 2010 John Wiley & Sons, Ltd. [source] Overcoming the barriers experienced in conducting a medication trial in adults with aggressive challenging behaviour and intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2010P. Oliver-Africano Abstract Background Aggressive challenging behaviour in people with intellectual disability (ID) is frequently treated with antipsychotic drugs, despite a limited evidence base. Method A multi-centre randomised controlled trial was undertaken to investigate the efficacy, adverse effects and costs of two commonly prescribed antipsychotic drugs (risperidone and haloperidol) and placebo. Results The trial faced significant problems in recruitment. The intent was to recruit 120 patients over 2 years in three centres and to use a validated aggression scale (Modified Overt Aggression Scale) score as the primary outcome. Despite doubling the period of recruitment, only 86 patients were ultimately recruited. Conclusions Variation in beliefs over the efficacy of drug treatment, difficulties within multidisciplinary teams and perceived ethical concerns over medication trials in this population all contributed to poor recruitment. Where appropriate to the research question cluster randomised trials represent an ethically and logistically feasible alternative to individually randomised trials. [source] New frontiers of assisted reproductive technology (Chien Tien Hsu Memorial Lecture 2007)JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009P. C. Ho Abstract Many significant advances have been made in assisted reproductive technology since the birth of the first baby conceived with in vitro fertilization and embryo transfer. The development of recombinant gonadotropins and gonadotropin releasing hormone antagonists helps to simplify the ovarian stimulation. Excessive ovarian stimulation should be avoided because of the risks of ovarian hyperstimulation syndrome and reduction in endometrial receptivity. Maturation of oocytes in vitro has been developed in some centers. It is still uncertain whether techniques such as assisted hatching, blastocyst transfer and pre-implantation aneuploidy screening can improve the live birth rates in assisted reproduction. The introduction of pre-implantation genetic diagnosis for selection of human lymphocyte antigens (HLA) compatible embryos for treatment of siblings has raised ethical concerns. There is a higher risk of obstetric complications and congenital abnormalities even in singleton pregnancies achieved with assisted reproduction. Because of the risks of multiple pregnancies, elective single embryo transfer is increasingly used in good-prognosis patients. With a good freezing program, the cumulative pregnancy rate (including the pregnancies from subsequent replacement of frozen-thawed embryos) is not adversely affected. Improvement in cryopreservation techniques has made it possible to cryopreserve slices of ovarian tissue or oocytes, thus helping women who have to receive sterilizing forms of anti-cancer treatment to preserve their fertility. It is important that the development of the new techniques should be based on good scientific evidence. Ethical, legal and social implications should also be considered before the introduction of new techniques. [source] Laboratory Models Available to Study Alcohol-Induced Organ Damage and Immune Variations: Choosing the Appropriate ModelALCOHOLISM, Issue 9 2010Nympha B. D'Souza El-Guindy The morbidity and mortality resulting from alcohol-related diseases globally impose a substantive cost to society. To minimize the financial burden on society and improve the quality of life for individuals suffering from the ill effects of alcohol abuse, substantial research in the alcohol field is focused on understanding the mechanisms by which alcohol-related diseases develop and progress. Since ethical concerns and inherent difficulties limit the amount of alcohol abuse research that can be performed in humans, most studies are performed in laboratory animals. This article summarizes the various laboratory models of alcohol abuse that are currently available and are used to study the mechanisms by which alcohol abuse induces organ damage and immune defects. The strengths and weaknesses of each of the models are discussed. Integrated into the review are the presentations that were made in the symposium "Methods of Ethanol Application in Alcohol Model,How Long is Long Enough" at the joint 2008 Research Society on Alcoholism (RSA) and International Society for Biomedical Research on Alcoholism (ISBRA) meeting, Washington, DC, emphasizing the importance not only of selecting the most appropriate laboratory alcohol model to address the specific goals of a project but also of ensuring that the findings can be extrapolated to alcohol-induced diseases in humans. [source] Explorations of a trust approach for nursing ethicsNURSING INQUIRY, Issue 1 2001Elizabeth Peter Explorations of a trust approach for nursing ethics Trust has long been acknowledged as central to nurse,patient relationships. It, however, has not been fully explored nor-matively. That is, trust must be examined from a perspective that encompasses not only reliability and competence, but also good will within nursing relationships. In this paper, we explore how a trust approach, based on Annette Baier's work on trust in feminist ethics, could help inform future developments in nursing ethics. We discuss the limitations of other approaches such as those based on contracts, paternalism, and care. By drawing out central features of Baier's theory, we demonstrate how it can help overcome the problems of these previous models. In doing so, we emphasise the importance of combining the ethics of care and justice, acknowledging vulnerability and the potential for evil in nursing relationships, and politically situating the ethical concerns of nursing. [source] On the relationship between population differentiation and sampling effort: is more always better?OIKOS, Issue 8 2009Mats Björklund Given the relative ease by which genotypic data now can be obtained, studies of population differentiation can attain high statistical power provided the number of individuals and loci scored are sufficiently high. This has led to a misunderstanding of the concept of power, and studies with a low number of individuals and loci are dismissed despite highly significant results. This raises statistical, biological and ethical concerns, which we discuss in this note. We suggest that authors should routinely report the number of additional non-significant loci as a measure of the robustness of the results. [source] The risks and benefits of long-term use of hydroxyurea in sickle cell anemia: A 17.5 year follow-up,,§¶,,,,,§§AMERICAN JOURNAL OF HEMATOLOGY, Issue 6 2010Martin H. Steinberg A randomized, controlled clinical trial established the efficacy and safety of short-term use of hydroxyurea in adult sickle cell anemia. To examine the risks and benefits of long-term hydroxyurea usage, patients in this trial were followed for 17.5 years during which they could start or stop hydroxyurea. The purpose of this follow-up was to search for adverse outcomes and estimate mortality. For each outcome and for mortality, exact 95% confidence intervals were calculated, or tests were conducted at , = 0.05 level (P -value <0.05 for statistical significance). Although the death rate in the overall study cohort was high (43.1%; 4.4 per 100 person-years), mortality was reduced in individuals with long-term exposure to hydroxyurea. Survival curves demonstrated a significant reduction in deaths with long-term exposure. Twenty-four percent of deaths were due to pulmonary complications; 87.1% occurred in patients who never took hydroxyurea or took it for <5 years. Stroke, organ dysfunction, infection, and malignancy were similar in all groups. Our results, while no longer the product of a randomized study because of the ethical concerns of withholding an efficacious treatment, suggest that long-term use of hydroxyurea is safe and might decrease mortality. Am. J. Hematol. 2010. © 2010 Wiley-Liss, Inc. [source] The Treating Physician as Expert Witness: Ethical and Pragmatic ConsiderationsPAIN MEDICINE, Issue 5 2006Ben A. Rich JD ABSTRACT Objective., The objective of this analysis is to apprise pain physicians of the ethical concerns and practical considerations that arise when a treating physician is called upon to testify as an expert witness in a legal proceeding involving his or her own patient. The provision of expert testimony in medico-legal proceedings has come under heightened scrutiny in recent years. When a physician testifies as an expert witness, such testimony is considered to be the practice of medicine, and hence subject to the same ethical and professional obligations as patient care. Increasingly, medical professional organizations have promulgated guidelines for such activities, and even implemented oversight mechanisms to review complaints concerning expert testimony by their members. Additional issues are raised when the expert witness is also the treating physician for the patient who is a party to the legal proceeding in which the expert testimony is offered. Conclusions., While it is not categorically unethical or inadvisable for a physician to testify as an expert witness in a medico-legal proceeding involving his or her own patient, such activity raises special issues and concerns. Prospective expert witnesses in such situations should be cognizant of these issues and insure that they have been adequately addressed before and during the testimony. [source] Beyond a code of ethics: phenomenological ethics for everyday practicePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2010Bruce Greenfield Abstract Physical therapy, like all health-care professions, governs itself through a code of ethics that defines its obligations of professional behaviours. The code of ethics provides professions with a consistent and common moral language and principled guidelines for ethical actions. Yet, and as argued in this paper, professional codes of ethics have limits applied to ethical decision-making in the presence of ethical dilemmas. Part of the limitations of the codes of ethics is that there is no particular hierarchy of principles that govern in all situations. Instead, the exigencies of clinical practice, the particularities of individual patient's illness experiences and the transformative nature of chronic illnesses and disabilities often obscure the ethical concerns and issues embedded in concrete situations. Consistent with models of expert practice, and with contemporary models of patient-centred care, we advocate and describe in this paper a type of interpretative and narrative approach to moral practice and ethical decision-making based on phenomenology. The tools of phenomenology that are well defined in research are applied and examined in a case that illustrates their use in uncovering the values and ethical concerns of a patient. Based on the deconstruction of this case on a phenomenologist approach, we illustrate how such approaches for ethical understanding can help assist clinicians and educators in applying principles within the context and needs of each patient. Copyright © 2010 John Wiley & Sons, Ltd. [source] Living Donor Kidney Donation in the United States: Quo Vadis?AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010G. Danovitch Editorial comment on the ethical concerns raised by Woodle, et al regarding a policy of preferentially allocating kidneys from non-directed living donors to facilitate paired-exchange and chain transplantation. See article by Woodle et al on page 1460. [source] Ethical Considerations for Participation of Nondirected Living Donors in Kidney Exchange ProgramsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010E. S. Woodle Kidneys from nondirected donors (NDDs) have historically been allocated directly to the deceased donor wait list (DDWL). Recently, however, NDDs have participated in kidney exchange (KE) procedures, including KE ,chains', which have received considerable media attention. This increasing application of KE chains with NDD participation has occurred with limited ethical analysis and without ethical guidelines. This article aims to provide a rigorous ethical evaluation of NDDs and chain KEs. NDDs and bridge donors (BDs) (i.e. living donors who link KE procedures within KE chains) raise several ethical concerns including coercion, privacy, confidentiality, exploitation and commercialization. In addition, although NDD participation in KE procedures may increase transplant numbers, it may also reduce NDD kidney allocation to the DDWL, and disadvantage vulnerable populations, particularly O blood group candidates. Open KE chains (also termed ,never-ending' chains) result in a permanent diversion of NDD kidneys from the DDWL. The concept of limited KE chains is discussed as an ethically preferable means for protecting NDDs and BDs from coercion and minimizing ,backing out', whereas ,honor systems' are rejected because they are coercive and override autonomy. Recent occurrences of BDs backing out argue for adoption of ethically based protective measures for NDD participation in KE. [source] Perceived Challenges to Obtaining Informed Consent for a Time-sensitive Emergency Department Study of Pediatric Status Epilepticus: Results of Two Focus GroupsACADEMIC EMERGENCY MEDICINE, Issue 8 2009James M. Chamberlain MD Abstract Objectives:, The objective was to describe the perspective of research personnel on issues of informed consent in a time-sensitive clinical study under emergency circumstances. Methods:, The authors convened concurrent focus groups of research staff and investigators involved in a pharmacokinetic study of lorazepam for status epilepticus (SE). Moderators led discussion with open-ended questions on selected issues of parental consent, communication and understanding, patient assent, and comparison to other types of studies. Focus group transcripts were analyzed to identify themes and subthemes from the discussions. Results:, Most themes and subthemes were identified in both research staff and investigator focus groups. Focus group discussion points were categorized into three main themes: barriers to and enablers of informed consent, barriers to and enablers of actual enrollment, and overall ethical concerns about the research. Many of the issues identified were unique to emergency research. Conclusions:, From the perspectives of research staff and investigators enrolling patients in a time-sensitive emergency department study, the authors identified several areas of concern that should be addressed when planning future emergency studies. [source] Conducting fieldwork with Tarieng communities in southern Laos: Negotiating discursive spaces between neoliberal dogmas and Lao socialist ideologyASIA PACIFIC VIEWPOINT, Issue 2 2010Steeve Daviau Abstract Based on research with ethnic minorities in Laos aimed at understanding how they cope with and negotiate political and economic ,double domination', this article examines the experiences of prolonged fieldwork in a remote Tarieng area in the Annam Range, southern Laos. After briefly reviewing Lao ethnographical policy and practice regarding ethnic minorities, I introduce the Tarieng people. I detail how I initially gained access to these local communities via long-term engagement with a range of development project initiatives. Then, after eight years of conducting such fieldwork in a Tarieng area ,below the radar of the state', I managed to obtain official authorisations to continue research as a graduate student. In this new position, I accessed the field via different negotiations with central, provincial and local official bureaucracies. After detailing this process, back in the field I reveal my strategies to create a discursive space that has allowed me to access dissident Tarieng voices and agency. Finally, I highlight four central elements that have continued to shape my field research: language proficiency, working with research assistants, awareness of political relations and cultural sensitivity, and ethical concerns. These have emerged while the possibilities and constraints of political engagement with the Tarieng people are explored. [source] EPIDEMIOLOGY AND SOCIAL JUSTICE IN LIGHT OF SOCIAL DETERMINANTS OF HEALTH RESEARCHBIOETHICS, Issue 2 2009SRIDHAR VENKATAPURAM ABSTRACT The present article identifies how social determinants of health raise two categories of philosophical problems that also fall within the smaller domain of ethics; one set pertains to the philosophy of epidemiology, and the second set pertains to the philosophy of health and social justice. After reviewing these two categories of ethical concerns, the limited conclusion made is that identifying and responding to social determinants of health requires inter-disciplinary reasoning across epidemiology and philosophy. For the reasoning used in epidemiology to be sound, for its scope and (moral) purpose as a science to be clarified as well as for social justice theory to be relevant and coherent, epidemiology and philosophy need to forge a meaningful exchange of ideas that happens in both directions. [source] | |||||||||||||||||||||||||