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Additional Issues (additional + issues)
Selected AbstractsThe 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] Perioperative care of a patient with Beare,Stevenson syndromePEDIATRIC ANESTHESIA, Issue 12 2005SARA UPMEYER DO Summary Beare,Stevenson syndrome is a craniofacial syndrome consisting of a specific pattern of craniosynostosis resulting in a cloverleaf skull deformity and hydrocephalus, down-slanting palpebral fissures, proptosis, hypertelorism, strabismus, dysmorphic ears, choanal atresia, cleft palate, cutis gyratum, acanthosis nigricans, and abnormal genitalia. Its primary cause has been identified as a single amino acid substitution in fibroblast growth factor receptor 2. Of primary importance to the anesthesiologist are issues related to airway management resulting from midface hypoplasia, choanal atresia, and airway abnormalities (tracheal stenosis). Additional issues affecting airway management include associated cervical spine and foramen magnum abnormalities. The authors present their experience caring for a patient with Beare,Stevenson syndrome and discuss the anesthesia care of these patients. [source] Extrinsic cohesive modelling of dynamic fracture and microbranching instability in brittle materialsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 8 2007Zhengyu (Jenny) Zhang Abstract Dynamic crack microbranching processes in brittle materials are investigated by means of a computational fracture mechanics approach using the finite element method with special interface elements and a topological data structure representation. Experiments indicate presence of a limiting crack speed for dynamic crack in brittle materials as well as increasing fracture resistance with crack speed. These phenomena are numerically investigated by means of a cohesive zone model (CZM) to characterize the fracture process. A critical evaluation of intrinsic versus extrinsic CZMs is briefly presented, which highlights the necessity of adopting an extrinsic approach in the current analysis. A novel topology-based data structure is employed to enable fast and robust manipulation of evolving mesh information when extrinsic cohesive elements are inserted adaptively. Compared to intrinsic CZMs, which include an initial hardening segment in the traction,separation curve, extrinsic CZMs involve additional issues both in implementing the procedure and in interpreting simulation results. These include time discontinuity in stress history, fracture pattern dependence on time step control, and numerical energy balance. These issues are investigated in detail through a ,quasi-steady-state' crack propagation problem in polymethylmethacrylate. The simulation results compare reasonably well with experimental observations both globally and locally, and demonstrate certain advantageous features of the extrinsic CZM with respect to the intrinsic CZM. Copyright © 2007 John Wiley & Sons, Ltd. [source] On the appropriate modeling of process plant water systemsAICHE JOURNAL, Issue 3 2010Débora C. Faria Abstract The definition of the water/wastewater allocation problem is discussed as it was originally defined by Takama et al.1 how this concept was modified, and sometimes simplified, through time, as well as additional issues that is believed are still not properly addressed. A few attempts are reviewed where parts are pointed out, and the addition of water pretreatment units are discussed, and further investigation in to the impact that proper modeling has on predictions of freshwater consumption, total annual cost and zero discharge cycles. © 2009 American Institute of Chemical Engineers AIChE J, 2010 [source] Targeted delivery of proteins by nanosized carriersJOURNAL OF POLYMER SCIENCE (IN TWO SECTIONS), Issue 1 2008Roberto Solaro Abstract Proteic drug administration poses some additional issues as compared with conventional drugs because of protein high molecular weight and short half-life in plasma. It is well known that protein delivery canbe significantly improved by using targeted nanocarriers. Among the diverse investigated systems, this overview focuses onliposomes and nanoparticles. Indeed, because of their subcellular size, nanocarriers can cross the fenestration of the vascular epithelium and penetrate tissues. Moreover, nanosystems can be confined at the location of choice by conjugation to molecules that strongly bind the target cells. In spite of the significant progress made in the design and engineering of liposomes and nanoparticles tailored to the targeted delivery of proteins, these nanocarriers seldom succeed in delivering proteins directly inside the cell cytosol. Accordingly, some attention is also paid to virosomes and fusion proteins. These systems have a few advantages over conventional nanocarriers, particularly the ability to cross the cell membrane. They also share the main drawback of being highly immunogenic. © 2007 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 46: 1,11, 2008 [source] Adult nephrotic syndrome: Non-specific strategies for treatment (Review Article)NEPHROLOGY, Issue 1 2008JOHN A CHARLESWORTH SUMMARY: Irrespective of aetiology, the nephrotic syndrome presents a range of potentially serious complications. These include thrombo-embolism, infection and hyperlipidaemia. Despite the prevalence of the nephrotic state among renal patients, there has been little prospective analysis of the therapeutic approach to these potentially life-threatening events even though their pathogenesis has been examined in some detail. Most of these complications are more prevalent once the albumin concentration falls below 20 g/L and it is recognized that restoration of serum albumin significantly diminishes their frequency. However, this may be difficult to achieve, especially in adults. The problems of thrombo-embolism and infection are of immediate concern but, in persistent cases, the additional issues of hyperlipidaemia and loss of bone density also require consideration for therapy. Thus, in addition to specific attempts to reduce proteinuria, it is recommended that high-risk nephrotic patients receive anticoagulation, pneumococcal vaccination and lipid lowering therapy. Strategies for the preservation of bone density should also be considered, particularly in patients who receive high-dose corticosteroids. Among a range of non-specific treatments for proteinuria, angiotensin-converting enzyme inhibitors appear best in terms of efficacy and safety. Prospective trials are required to clarify the longitudinal impact of these generic strategies on the protection of the persistently nephrotic patient. [source] Bioengineered tissues: the science, the technology, and the industryORTHODONTICS & CRANIOFACIAL RESEARCH, Issue 3 2005T Ahsan Structured Abstract Authors ,, Ahsan T, Nerem RM Objective ,, The bioengineering of tissues and organs, sometimes called tissue engineering and at other times regenerative medicine, is emerging as a science, as a technology, and as an industry. The goal is the repair, replacement, and/or the regeneration of tissues and organs. The objective of this paper is to identify and discuss the major issues that have become apparent. Results ,, One of the critical issues is that of cell source, i.e. what will be the source of the cells to be employed? Another critical issue is the development of approaches for the fabrication of substitute tissues/organs and/or vehicles for the delivery of biological active molecules for use in the repair/regeneration of tissues. A third critical issue, one very much related to cell source, is that of immune acceptance. In addition, there are technological hurdles; there are additional issues such as the scale-up of manufacturing processes and the preservation of living-cell products for off-the-shelf availability. Although the initial products have been superficially applied skin substitutes, as this fledgling industry continues to evolve, it is beginning to focus on a wider range of more invasive and complicated products. From a public health perspective, the real opportunity may be in addressing chronic diseases, as well as the transplantation crisis (i.e. the tremendous disparity between patient need for vital organs and donor availability) and, equally important is the challenge of neural repair. Conclusion ,, These are the grand challenges, and the scientific community, business/private sector, and federal government must mobilize itself together in this emerging area to translate the benchtop science to the patient bedside. [source] Audit Issues Related to GASB Statement No. 34PUBLIC BUDGETING AND FINANCE, Issue 3 2001John H. Engstrom This paper discusses a variety of audit issues related to the implementation of GASB Statement No. 34. Ten specific audit issues are addressed. Each issue is defined and discussed, and the relevant professional literature is reviewed. The results of interviews of four experienced auditors of governments are presented with respect to these issues. These auditors identified several additional issues related to the implementation of Statement No. 34. The focus is on gaining insight from the concerns of auditor professionals to assist academics by identifying topics that warrant future research. [source] Codex final definition of dietary fibre: issues of implementationQUALITY ASSURANCE & SAFETY OF CROPS & FOOD, Issue 4 2009Joanne R. Lupton Abstract Introduction At its 30th session in South Africa in November 2008, the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU) agreed on a definition of dietary fibre. Although many aspects of what can be called "dietary fibre" were resolved, the application of this definition raises additional issues in need of resolution. Objectives The goal of this paper is to discuss the major areas at issue in implementing the new Codex definition of dietary fibre: (1) the footnote that individual countries can decide whether they accept oligosaccharides with a degree of polymerization (DP) from 3 to 9 (included) as being fibre; and 2) guidance on which physiological effects are beneficial. Less critical but still important is the issue of animal sources of fibre not requiring proof of a beneficial physiological effect; and the effect of processing on fibre. Results and conclusion Unless all countries accept (or do not accept) that carbohydrate polymers with 3,9 monomeric units are dietary fibre, there will be two, rather than one definition. Again, if each country has its own criteria as to the physiological benefits of fibre and how to verify those benefits there will be as many "definitions" of fibre as there are effects accepted by all the member states. Given the importance to consumers, food companies, researchers, and regulatory agencies in having one definition, it is incumbent on all of us in the field to work toward that end. [source] Cognitive Development, Culture, and Conversation: Comments on Harris and Koenig's "Truth in Testimony: How Children Learn about Science and Religion"CHILD DEVELOPMENT, Issue 3 2006Maureen A. Callanan Harris and Koenig make a compelling case for the importance of adult "testimony" and its influence on children's developing conceptions of topics in science and religion. This commentary considers how their analysis relates to constructivist and sociocultural theories and discusses several ways in which Harris and Koenig's arguments help to debunk some prevalent assumptions about research on the social context of cognitive development. Finally, a number of additional issues are raised for debate and discussion, and some critiques and suggestions for future research are discussed. The issues discussed by Harris and Koenig are crucial if we are to take seriously the importance of culture in cognitive development. [source] | ||||||||||