Ethics and Rationing Access to Dialysis in Resource‐Limited Settings: The Consequences of Refusing a Renal Transplant in the South African State Sector

Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state‐funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making (pressurising a patient to undergo renal transplantation) is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical ‘lenses’. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing.     

Spatial distribution,size structure,and prey of Craspedacusta sowerbyi Lankester in a shallow New Zealand lake

Solar ultraviolet radiation both degrades and alters the quality of natural organic matter as well as organic pollutants in surface waters. Still, it is only recently that this indirect influence of photochemical processes on aquatic organisms (e.g. bacteria) has received attention. We experimentally studied the photochemical degradation of three PAHs; anthracene, phenanthrene and naphthalene, in water. Anthracene and phenanthrene were rapidly photodegraded (half-lives of 1 and 20.4 hours, respectively), while the photochemical half-life of naphthalene exceeded 100 hours. Hence photodegradation is most likely a less important removal mechanism for the latter compound. The influence of humic substance additions (0–25 mg C l^–1) on degradation rates was also assessed, and while photodegradation of anthracene was not affected by these additions, phenanthrene photodegradation slowed down considerably at the higher humic substance concentrations. These differential responses of anthracene and phenanthrene can at least partially be explained by differences in the spectral absorbance of the two compounds. In contrast, ionic strength did not have any appreciable effect on the estimated photodegradation rates of either compound. The influence of PAHs on growth of aquatic bacteria was assessed in dilution cultures with and without exposure to PAHs and simulated solar UV radiation. Separately, neither PAHs nor simulated solar UV radiation had any effect on bacterial growth. However, when combined, a marked inhibition of bacterial growth could be observed in water obtained from a clearwater lake. This could be due to the formation of toxic photodegradation products such as quinones (detected in our incubations) or other reactive species that affect bacteria negatively. Hence, in addition to influencing the fate and persistence of PAHs in aquatic systems, solar radiation and natural organic matter and regulate the toxicity of these compounds to indigenous micro-organisms.     

Multiple host barriers restrict poliovirus trafficking in mice

RNA viruses such as poliovirus have high mutation rates, and a diverse viral population is likely required for full virulence. We previously identified limitations on poliovirus spread after peripheral injection of mice expressing the human poliovirus receptor (PVR), and we hypothesized that the host interferon response may contribute to the viral bottlenecks. Here, we examined poliovirus population bottlenecks in PVR mice and in PVR mice that lack the interferon alpha/beta receptor (PVR-IFNAR-/-), an important component of innate immunity. To monitor population dynamics, we developed a pool of ten marked polioviruses discriminated by a novel hybridization-based assay. Following intramuscular or intraperitoneal injection of the ten-virus pool, a major bottleneck was observed during transit to the brain in PVR mice, but was absent in PVR-IFNAR-/- mice, suggesting that the interferon response was a determinant of the peripheral site-to-brain bottleneck. Since poliovirus infects humans by the fecal-oral route, we tested whether bottlenecks exist after oral inoculation of PVR-IFNAR-/- mice. Despite the lack of a bottleneck following peripheral injection of PVR-IFNAR-/- mice, we identified major bottlenecks in orally inoculated animals, suggesting physical barriers may contribute to the oral bottlenecks. Interestingly, two of the three major bottlenecks we identified were partially overcome by pre-treating mice with dextran sulfate sodium, which damages the colonic epithelium. Overall, we found that viral trafficking from the gut to other body sites, including the CNS, is a very dynamic, stochastic process. We propose that multiple host barriers and the resulting limited poliovirus population diversity may help explain the rare occurrence of viral CNS invasion and paralytic poliomyelitis. These natural host barriers are likely to play a role in limiting the spread of many microbes.     

The influence of DNA sequence on terbium (III) fluorescence enhancement by DNA

The synthetic DNA duplexes, poly(dA-dC):poly(dG-dT), poly(dG):poly(dC), poly(dG-dC):poly(dG-dC), and poly(dG-m5dC):poly(dG-m5dC), were analyzed as double- and single-strand polymers for the ability to enhance terbium fluorescence. Using conditions which limited the enhancement of Tb3+ fluorescence to that from DNA-guanosines, our results showed that (a) guanosines in single-strand DNA enhanced terbium fluorescence equally well irrespective of the primary sequence surrounding them, and (b) guanosines in either left- (Z-form) or right- (B-form) handed double helixes failed to enhance terbium fluorescence.     

Investigations into the etiology of neural tube defects

Neural tube defects (NTDs) are serious malformations affecting approximately 1 per 1000 births, yet the mechanisms by which they arise are unknown. There have been consistent efforts in many fields of research to elucidate the etiology of this multifactorial condition. While no single gene has been identified as a major independent risk factor for NTDs, candidate genes have been proposed that may modify the effects of maternal and/or embryonic exposures. Folate supplementation effectively reduces the occurrence of NTDs and, consequently, has focused much research on metabolism of folate-related pathways during pregnancy and development. Further understanding of normal development and how teratogens can perturb these orchestrated processes also remains at the fore of modern scientific endeavors. The composite of these factors remains fragmented; the aim of this review is to provide the reader with a summary of sentinel and current works in the body of literature addressing NTD disease etiology.     

The effects of changes in consequences on hens' performance in delayed-matching-to-sample tasks

A delayed-matching-to-sample (DMTS) task was used to investigate remembering with domestic hens. In Conditions 1 and 3 of Experiment 1, six hens responded under a mixed-delay procedure with delays of 0.25, 2, and 8 s. In Condition 2, the reinforcer for correct responding was delayed for 6 s after each correct matching response on 2-s delay trials. In Condition 1, discrimination performance decreased monotonically over the three delays. With the delay to the reinforcer, the decreases were non-monotonic as a result of the considerable drop in the accuracy of discrimination on the 2-s delay trials. Performance at the 2-s delay did not recover completely in Condition 3. In Conditions 1 and 3 of Experiment 2, five hens responded under a mixed-delay procedure with delays of 0, 4, and 16 s. In Condition 2 no reinforcers were provided for correct responding on 0- and 16-s delay trials. When reinforcers were available on all trials discrimination performance decreased monotonically with delay. There were non-monotonic changes in discrimination with delay when there was extinction at two delays resulting mainly from a large drop in discrimination performance at 0 s. In addition, response latencies increased markedly at the two delays associated with extinction. Performance recovered completely in Condition 3. The data support the ideas that remembering involves a temporal discrimination that the effects of delaying reinforcement and removing reinforcement may differ, and that the measurement of response latencies may be a useful tool in DMTS procedures.