Patient-Centred Care: Qualitative Findings on Health Professionals’ Understanding of Ethics in Acute Medicine

In recent years the literature on bioethics has begun to pose the sociological challenge of how to explore organisational processes that facilitate a systemic response to ethical concerns. The present discussion seeks to make a contribution to this important new direction in ethical research by presenting findings from an Australian pilot study. The research was initiated by the Clinical Ethics Committee of Redland Hospital at Bayside Health Service District in Queensland, Australia, and explores health professionals’ understanding of the nature of ethics and their experience with ethical decision-making within an acute medical ward. This study focuses on the actual experience, understanding and attitudes of clinical professionals in a general medical ward. In particular, the discussion explores the specific findings from the study concerned with how a multi-disciplinary team of health professionals define and operationalise the notion of ethics in an acute ward hospital setting. The key issue reported is that health professionals are not only able to clearly articulate notions of ethics, but that the notions expressed by a multi-disciplinary diversity of participants share a common definitional concept of ethics as patient-centred care. The central finding is that all professional groups indicated that there is a guiding principle to address their ethical sense of the ‘good’ or the ‘ought’ and that is to act in a way that furthered the interests of patients and their families. The findings affirm the importance of a sociological perspective as a productive new direction in bioethical research.     

Guidelines for Community-based Ethics Review of Children’s Science Fair Projects

Low-level community based ethics committees staffed by teachers, parents and community representatives can readily review children’s science fair projects subject to the revision of two core assumptions currently governing children’s Science Fairs. The first part of the paper recasts the New Zealand Royal Society guidelines from its primary emphasis on risk to a new assumption, without benefit there can be no risk. Equally, this revision gives more prominence to the participant information sheet, allowing it to act as a quasi application form which provides ethical transparency between student researchers, participants and a community based ethics committee. A second core assumption, more accurately labeled a cult of originality, produces a random, open-ended array of student topics taking ethics review beyond the confidence level of most community based ethics review committees. This paper reins in Science Fair coordinators recommending they make community level ethics review more manageable by providing a list of preapproved topics for those students wanting to conduct research involving human participants. These revised assumptions create a workable division of labour. Teachers’ preapproved topics involving human participants are more likely to be low risk, permitting community level ethics review to focus primarily on two aspects of the minimization of harm: first, for all participants, especially those with diminished autonomy, and second, for the child researchers themselves, as some participants may be unknown to the student. These revised assumptions make science and ethics more accessible to public education thus demonstrating how Science Fairs can lead students and the community into better understanding the role and function that ethics has in all scientific research human participants. Martin Tolich chaired New Zealand’s National Health Ethics committee, the multi-region ethics committee.     

Structural and Narrative Reconstruction of Rural Residents’ Representations of ‘Nature’, ‘Wildlife’, and ‘Landscape’

The objective of this paper is the structural and narrative reconstruction of representations of ‘nature’, ‘wildlife’ and ‘landscape’, held by rural residents of the Dadia Forest Reserve. Data collection involved in-depth interviews. Employing a social representations’ approach, we recovered representational elements that are expected in the case of rural belief systems, such as negative dispositions towards wolves and foxes, as well as elements of an urban adherence, such as nature’s independence. Representational elements refer to visual aspects of the countryside, which seem compatible with the figurative nucleus of the rural idyll. Concerning ‘wildlife’, residents focused on vultures, which comprise the main tourist attraction of the reserve. Scientific knowledge adds to the complexity of the narrative schema, which corresponds to the representation of ‘wildlife’. Interviewees perceived the rural landscape as an interface between the natural and the human-conditioned environment. Our study shows that interviewees make no reference to environmental conservation or quality of life issues, as it could be expected according to relatively wide definitions of the term ‘environmentalism’. Environmental messages reinforced by ecotourism development seem to be recalled primarily in terms of their compatibility with the perceived economic benefit of local people. Despite ecotourism development, representational elements that diverge from a tourist version of ‘nature’, ‘wildlife’ and ‘landscape’ were not pronounced within rural belief-systems. Further interventions within the study area are needed, in order to address a variety of topics under the environmental conservation discourse and raise the environmental awareness of rural residents.     

An extensionist environmental ethic

Environmental ethics consists of a set of competing theories about whether human actions and attitudes to nature are morally right or wrong. Ecocentrists are holists whose theory locates the primary site of value in biological communities or ecosystems and who tend to regard actions interfering with the progress of an ecosystem toward its mature equilibrium state as prima facie wrong. I suggest that this form of ecocentrism may be built on a questionable scientific foundation, organismic ecology, and that a better scientific foundation for environmental ethics may be found in individualistic neo-Darwinian population biology. However, the latter approach probably requires a corresponding shift away from ethical holism and toward approaches locating value primarily in individuals. I call such environmental ethicists extensionists and briefly outline an extensionist environmental ethic.     

Genomes were forged by massive bombardments with retroelements and retrosequences

Retroposition is an efficient route to move coding regions around the genome ‘in search’ of novel regulatory elements and to shotgun regulatory elements into the genome ‘in search’ of new target genes. The templates for such retrogenes are mRNAs, and for regulatory retronuons (nuon=any definable nucleic acid sequence) usually small non-mRNAs. An example in support of the ‘master gene’ model for SINEs (short interspersed repetive elements) is provided with neuronal BC1 RNA. Furthermore, an alternative explanation of LINE (long interspersed repetive elements) involvement in the generation of SINEs is given. I will also argue that the status of transposable elements with respect to the host resembles more symbiosis than parasitiasis and that host defense is often lenient as if even to ‘tolerate or support’ retronuons. Finally the paradox of evolution's lack of foresight and the future exaptive use of retronuons is being dealt with by referring to W.F. Doolittle's ‘Hierarchical Approaches to Genome Evolution’. This revised version was published online in July 2006 with corrections to the Cover Date.     

Pharmacogenetics: the bioethical problem of DNA investment banking

Concern about the ethics of clinical drug trials research on patients and healthy volunteers has been the subject of significant ethical analysis and policy development--protocols are reviewed by Research Ethics Committees and subjects are protected by informed consent procedures. More recently attention has begun to be focused on DNA banking for clinical and pharmacogenetics research. It is, however, surprising how little attention has been paid to the commercial nature of such research, or the unique issues that present when subjects are asked to consent to the storage of biological samples. Our contention is that in the context of pharmacogenetic add-on studies to clinical drug trials, the doctrine of informed consent fails to cover the broader range of social and ethical issues. Applying a sociological perspective, we foreground issues of patient/subject participation or 'work', the ambiguity of research subject altruism, and the divided loyalties facing many physicians conducting clinical research. By demonstrating the complexity of patient and physician involvement in clinical drug trials, we argue for more comprehensive ethical review and oversight that moves beyond reliance on informed consent to incorporate understandings of the social, political and cultural elements that underpin the diversity of ethical issues arising in the research context.     

Publication: an ethical imperative.

Publication of medical research is both a monitor of the researcher''s ethics and an audit of the local or regional ethics committee that approved it. Selectivity of publication or of the intention to publish lessens this audit. Opinions differ about what is ethically allowable in clinical and benchtop medical research. Ethical permission and ethical monitoring of medical research are subject to a hierarchy of pyramidal controls, starting in hospital and ending with the local, institutional, or regional ethics committee. Currently, such committees function with widely varying degrees of efficiency and quality of output, and with differing viewpoints on many ethical issues. Without an a priori insistence by institutional ethics committees that there be an intention to publish all medical research involving human subjects, ethics committees cannot routinely be subject to the scrutiny or audit which they themselves demand of researchers.     

Measuring male-female relationships during the mating season in wild Japanese macaques (Macaca fuscata yakui)

Heterosexual relationships during one mating season were examined in a wild troop of Japanese macaques (Macaca fuscata yakui) on Yakushima Island, Japan. Validation tests of putative mate choice behaviors demonstrated that female initiation and maintenance of proximity, female lookback at the male, and sexual presents to the male, were associated with increased mating. Male grooming the female was also associated with increased mating. Ten dyadic social behaviors were subject to principal components analysis to empirically define behavioral dimensions of male-female relationships. The analysis yielded four relationship dimensions: ‘Mutual Choice and Male Coercion,’ ‘Female Choice’ (two types), and ‘Mutual Choice’ Dyads tended to be characterized by more than one dimension. The results suggested that females sought matings with multiple males of various dominance ranks. Female relationships with high ranking males contained elements of male coercion and mate guarding, however, because these males attempted to inhibit females from mating with lower ranking males. The correlation between each relationship dimension and mating success depended, in part, on the dominance rank of males. Relationships involving high ranking males, which were most likely to contain elements of male coercion and mate guarding, were associated with mating success. Relationships involving low ranking males, which usually lacked such coercive elements. were less strongly correlated with mating success. These results, obtained from a wild troop, are compared to those previously obtained in captive and provisioned groups of Japanese macaques.     

Life Cycle Impact assessment of land use based on the hemeroby concept

The impact category ‘land use’ describes in the Life Cycle Assessment (LCA) methodology the environmental impacts of occupying, reshaping and managing land for human purposes. Land use can either be the long-term use of land (e.g. for arable farming) or changing the type of land use (e.g. from natural to urban area). The impact category ‘land use’ comprises those environmental consequences, which impact the environment due to the land use itself, for instance through the reduction of landscape elements, the planting of monocultures or artificial vegetation, or the sealing of surfaces. Important environmental consequences of land use are the decreasing availability of habitats and the decreasing diversity of wildlife species. The assessment of the environmental impacts of land use within LCA studies is the objective of this paper. Land use leads to a degradation of the naturalness of the area utilised. In this respect the naturalness of any area can be defined as the sum of land actually not influenced by humans and the remaining naturalness of land under use. To determine the remaining naturalness of land under use, this study suggests applying the Hemeroby concept. “Hemeroby is a measure for the human influence on ecosystems” (Kowarik 1999). The Hemeroby level of an area describes the intensity of land use and can therefore be used to characterise different types of land use. Characterization factors are proposed, which allow calculating the degradation of the naturalness of an area due to a specific type of land use. Since the resource ‘nature/naturalness’ is on a larger geographical scale by far not homogeneous, the assessment of land use needs to be regionalised. Therefore, the impact category ‘land use’ has been subdivided into the impact sub-categories ‘land use in European biogeographic regions’. Following the general LCA framework, normalization values for the impact sub-categories are calculated in order to facilitate the evaluation of the characterization results with regard to their share in a reference value. Weighting factors, which enable an aggregation of the results of the different land use sub-categories and make them comparable to other impact categories (e.g. climate change or acidification) are suggested based on the assumption that the current land use pattern in the European biogeographic regions is acceptable.     

Discourses,Power Negotiations and Indigenous Political Organization in Forest Partnerships: The Case of Selva de Matavén,Colombia

While much research on forest partnerships hitherto has been focused mainly on the drivers behind their formation, the kind of actors and deals involved, and the factors that promote or hinder their success, much less attention has been paid to the dynamic relationships and processes inherent in these partnerships. Based on the study of a partnership process in an indigenous reservation in Colombian Amazonia covering a variety of projects, this paper seeks to fill part of this lacuna by analyzing the partnership as a dynamic ‘discursive battlefield,’ in which objectives and actions are being constantly negotiated. Actors in the Matavén partnership strategically incorporate discursive elements in order to pursue their own interests while also endorsing those that ensure the continuation of collaboration. We conclude that discourses are embedded in partnership micro-politics. On the one hand, discursive shifts occur as a reflection of power balances at given moments. On the other hand, discourses constitute indispensable resources with the potential to both enhance individual actor’s negotiating power and to create opportunities for compromise. Within an ongoing discursive tension between ‘conservation’ and ‘indigenous autonomy,’ flexible notions such as ‘territorial ordering’ prove to be successful in allowing space for manoeuvre and granting conceptual coherence to shifts occurring ‘on the ground.’     

Control of plant development: Signals from without—Signals from within

The powerful technology for transferring functional foreign genes into plants can only express its potential to the extent that our knowledge about signals and signal transmission in plants improves. In higher plants gene expression is regulated by ‘signals from within’ and ‘signals from without’ (e.g., light). Since light-mediated changes provide the basis for much of plant development, photocontrol of gene expression will mainly be considered. The recently discovered ‘plastidic factor’ will serve as the prototype of an intracellular ‘signal from within’. Particular emphasis will be laid on rapid interorgan signal transmission since these novel observations suggest a revision of the presently held concepts about the means of communication within a plant. It will be concluded in the end that the prevailing views about the nature of plants underestimate the degree of sophistication actually exhibited by higher plants.     

Investing in biodiversity: an economic perspective on global priority setting

Biodiversity investment priorities are a major concern for funding agencies and parties to the Convention on Biodiversity. We present a cost-effectiveness index designed to rank global biodiversity investments addressing weaknesses identified in several existing procedures. First, we explicitly address the issue of cost. Biodiversity conservation can be expensive -- ensuring that money is efficiently spent is important if conserving maximum biodiversity is an objective. Second, a high degree of threat to biodiversity is commonly accepted as constituting the principal reason for intervention and a basis for prioritization. The possibility that a high degree of threat might constitute a reason for non-intervention is rarely considered. The index presented in this study seeks to address these shortcomings by incorporating biodiversity ‘cost’, as measured by investment, and biodiversity ‘benefit’, as measured by a representative biodiversity indicator, species, richness. These elements form the basis of the cost -- benefit ratio needed for cost-effectiveness analysis. Investment in biodiversity is affected by issues of vulnerability (threat) and viability (success). A successful investment intervention will, however, depend on the probability or likelihood of success and the degree of threat prevalent in a particular country. These are integrated into the index as probabilities which will influence the amount of biodiversity ‘saved’ by an intervention. We apply the index using data for the Asia – Pacific region, to provide a cost-effective priority investment index (CEPII) ranking by country. Acute data limitations at the global level particularly in applying complementarity, necessitate caution in the interpretation of the index which, like other methods, requires some subjective choice of success and threat surrogates. The index continues the task of combining scientific and socioeconomic criteria relevant to global priorities. This revised version was published online in November 2006 with corrections to the Cover Date.     

Microbiology and the species problem

This paper examines the species problem in microbiology and its implications for the species problem more generally. Given the different meanings of ‘species’ in microbiology, the use of ‘species’ in biology is more multifarious and problematic than commonly recognized. So much so, that recent work in microbial systematics casts doubt on the existence of a prokaryote species category in nature. It also casts doubt on the existence of a general species category for all of life (one that includes both prokaryotes and eukaryotes). Prokaryote biology also undermines recent attempts to save the species category, such as the suggestion that species are metapopulation lineages and the idea that ‘species’ is a family resemblance concept.     

Increasing population and declining biological resources in the context of global change and globalization

In the context of over-consumption of natural resources in the name of development and rapid industrialization by a small section of the human population that is rapidly growing, the world is currently faced with a variety of environmental uncertainties. ‘Global change’ covering a whole variety of ecological issues, and ‘globalization’ in an economic sense, are two major phenomena that are responsible for these uncertainties. There is increasing evidence to suggest that the developing countries more than the developed, particularly the marginalized traditional (those living close to nature and natural resources) societies would be the worst sufferers. In order to cope with this problem in a situation where the traditional societies have to cope with rapidly depleting biodiversity on which they are dependant for their livelihood, there is an urgent need to explore additional pathways for sustainable management of natural resources and societal development. Such pathways should be based on a landscape management strategy, that takes into consideration the rich traditional ecological knowledge (TEK) that these societies have. This is critical because TEK is the connecting link between conservation and sustainable development. This paper explores the possibilities in this direction through a balanced approach to development, that links the ‘traditional’ with the ‘modern’, in a location-specific way.     

An Evolutionary Scenario For The Origin Of Pentaradial Echinoderms—Implications From The Hydraulic Principles Of Form Determination

The early evolutionary history of echinoderms was reconstructed on the basis of structural-functional considerations and application of the quasi-engineering approach of ‘Konstruktions-Morphologie’. According to the presented evolutionary scenario, a bilaterally symmetrical ancestor, such as an enteropneust-like organism, became gradually modified into a pentaradial echinoderm by passing through an intermediate pterobranch-like stage. The arms of a pentaradial echinoderm are identified as hydraulic outgrowths from the central coelomic cavity of the bilateral ancestor which developed due to a shortening of the body in length but widening in the diameter. The resulting pentaradial symmetry is a consequence of mechanical laws that dictate minimal contact surface areas among hydraulic pneumatic entities. These developed in the coelomic cavity (metacoel) in the bilaterally symmetrical ancestor, when from the already U-shaped mesentery with the intestinal tract two additional U-shaped bows developed directly or subsequently. During the subsequent development tensile chords of the mesentery ‘sewed’ the gut with the body wall first in three and secondly in five ‘seams’. During the direct development five ‘seams’ between tensile chords and body wall developed straightly. These internal tensile chords subdivide the body coelom into five hydraulic subsystems (‘pneus’), which eventually arrange in a pentaradial pattern. The body could then enlarge only between the tensile chords, which means that five hydraulic bulges developed. These bulges initially supported the tentacles and finally each of them enclosed the tentacle until only the feather-like appendages of the tentacles projected over the surface. The tentacles with their feathers were transformedinto the ambulacral system, and the bulges become the arms. These morphological transformations were accompanied and partly determined by specific histological modifications, such as the development of mutable connective tissues and skeletal elements that fused to ossicles and provided shape stabilization in form of a calcareous skeleton in the body wall. The organism resulted was an ancestral echinoderm (‘Ur-Echinoderm’) with an enlarged metacoel, stabilized by hydraulic pressure working againsta capsule of mutable connective tissue, skeletal elements and longitudinal muscles. In regard to these reconstructions, the body structure of echinoderms can be understood as a hydraulic skeletal capsule.     

Use of low-budget monitoring of macroalgae to implement the European Water Framework Directive

Benthic macroalgal communities constitute one of the ecological quality elements needed to implement the Water Framework Directive (2000/60/EC), the legislation targetted at sustainable management of the European aquatic environment. As the Directive foresees the establishment of Ecological Status Class boundaries and Reference Conditions in coastal waters, a study was conducted on the Attica coast of Greece to identify the best method to use macroalgal community data for evaluating ecological quality and at the same time keep the program within a low budget. Six seasonal quantitative and qualitative samples were taken from the upper infralittoral macroalgal communities on the Attica coast of Greece on six occasions between summer 1998 and spring 2002; these sites, which reflect a gradient of anthropogenic perturbation, were used on each occasion. A list of 60 macroalgal taxa was prepared, the cover value of each taxon was measured and the structure of the vegetation was described. The use of four different indices (Shannon-Weaver index, Pielou evenness, Multi-Dimensional Scaling plot of Bray-Curtis similarity, Ecological Evaluation index-EEI) were compared. The multidimensional scaling of Bray-Curtis similarity and the EEI were better at indicating the perturbation pattern of the study area. However, only the EEI succeeded in distinguishing four quality classes (‘low’ to ‘high’). By using EEI, a spatial scale-weighted evaluation of ecological quality was also performed. This revised version was published online in August 2006 with corrections to the Cover Date.     

Ecology: modern hero or post-modern villain? From scientific trees to phenomenological wood

This paper sets out to launch a challenge to the usual modernist view of the relationship between ecology and ethics. Two post-modern interpretations of this relationship are considered. The first deep interpretation holds that ecology reveals that nature has intrinsic value. The second interpretation derives from the work of Michel Foucault. The aim of his critique is to reveal how certain values are taken for granted by the acceptance of certain scientific models, and how the acceptance of those models as true makes it impossible to articulate alternative values. I end by suggesting, contra Foucault, that phenomenological enquiry could serve to articulate alternative and perhaps more eco-friendly values.     

Autopoiesis and Interpretive Semiosis

Translation has long been viewed as ‘code-switching’ either within or between languages. Hence, most translation discussions center on its linguistic and cultural aspects. However, the fundamental mechanism of ‘translation as interpretative semiosis’ has yet to be studied with appropriate rigor. Susan Petrilli (2008) has identified ‘iconicity’ as the key that enables translative semiosis. Nevertheless, as her model is restricted to a discussion of literary translation activity in verbal sign systems, a fundamental mechanism to explain translation as interpretative semiosis is still needed. By analyzing the interactions between the source sign (the translated) and the target sign (the translatant) in the translating process, it can be discerned that Humberto Maturana’s notion of autopoiesis may provide some crucial insights into translative semiosis. By identifying the autopoietic nature of translation, that is, the interlocked structural coupling between the Translated and Translatant, translation is no longer the ‘one-to-one-correspondence’ between sign systems, but rather a recursive process of interpretation—an interpretive semiosis. Moreover, it is by this autopoietic, self-productive mechanism of translation that I would suggest translation becomes a recursive generation of new inter-connections between semiotics systems.     

Characterization,Ecological Status and Type-specific Reference Conditions of Surface Water Bodies in Wallonia (Belgium) using Biocenotic Metrics based on Benthic Invertebrate Communities

The river types in Wallonia (Belgium) were defined according to the system B of the European Water Framework Directive (WFD) taking into account obligatory and optional factors synthesized in three criteria: ‘size’, ‘slope’ and ‘natural region’. Under the hypothesis that benthic invertebrate assemblages would be specialized according to river type, a set of 627 faunal samples originating from an 11-year sampling period was tested to characterize river types with faunal assemblages. A multivariate approach led to gather 23 river types into seven groups exhibiting similar faunal assemblages. Using biocenotic metrics based on benthic invertebrate assemblages (e.g., the French standard IBGN), type-specific reference conditions and ecological status class limits were defined for each ‘natural’ river type group. Ecological potential was defined for heavily modified and for artificial (i.e., man-made canals) types. An ‘ecological status’ evaluation strategy was therefore developed and applied in the southern – and more natural – part of Wallonia, where many reference sites were available. In the northern part of Wallonia (i.e., the ‘Loess region’) where no high quality site was available, the expert judgement took a larger part in the definition of the reference conditions and of the ecological status class limits, in addition to the calculations. Two independent distribution gradients of taxa assemblages resulted from multivariate ordination: a first ‘saprobity axis’, as the taxa-sensitivity to organic contamination was increasing from ‘very resistant’ taxa (mainly located in the ‘Loess region’) to ‘sensitive’ and ‘very sensitive’ taxa (from the river types belonging to the Condroz, the Famenne, the Arden and the Jurassic regions) and a second axis characterizing the Meuse-specific faunal assemblage, gathering exotic species and typical limnophilous taxa of large heavily modified rivers. The ecological status monitoring management system developed in this study – i.e., the definition of faunal river type groups, related reference conditions and ecological status class limits – represents a proposal to be integrated in the ecological status assessment of biological elements for the implementation of the WFD and was tested in Wallonia. For the period 2000–2002 involving 349 different sites, the element ‘benthic invertebrate fauna’ was in that way classified ‘high status’ for 31.5% of sites, ‘good status’ for 31.5% and below ‘good status’ for 37% of sites. The best ecological status (i.e., 100% ‘high’ and ‘good’ status) was found in river type ‘Arden’s xenotrophic brooks with strong slope’ and in river types 8large rivers with medium slope’. The worst status was found in river types ‘Loess brooks and rivers with medium slope’.