Beyond the Movie Screen: An Antarctic Adventure

Movies depicting science-related issues often capture the attention of today's youth. As an instructional tool, movies can take us beyond the drama and action and thrilling scenes. In this article we share our experiences of using the movie Eight Below as a centerpiece for developing high school students’ understanding of basic chemistry concepts. In addition to the science concepts developed using the context of the movie, we engaged students in thinking about the ethical dilemmas embedded in the movie.     

Decision-Making Therapy in HIV/AIDS: The African Experience

The challenge of providing relevant and sophisticated counseling interventions to people with HIV/AIDS in Africa has greatly intensified. The task has shifted from what it was deemed to entail at the first decade of the disease. Then, it was understood to involve the process of bringing healing to the emotional situation of the client demoralized by the news of infection. In addition, at that time, the emphasis was on information and education as the most commanding weapon for preventing the spread of the AIDS pandemic. But professional experiences in the second decade of the disease has clearly shown that as we work for prevention we must also develop strategies for responding to the needs and problems of people already in contact with the disease, requiring that they be started on antiviral therapy. The present article is intended to highlight and discuss the critical issues that attend and challenge the decision-making therapy of people with HIV disease in Africa.     

Iron withholding: A defense against viral infections

A variety of laboratory and clinical investigations during the past 15 years have observed that one of the dangers of excessive iron is its ability to favor animal viral infections. The metal is essential for host cell synthesis of virions and can also impair defense cell function and increase oxidative stress. In both animal models and humans, viral infections cause upregulation of the iron withholding defense system. Factors that suppress the system enhance viral progression; factors that strengthen the system augment host defense. Procedures designed to reinforce the system are being developed and tested; some of these may become useful adjuncts in prevention and management of viral diseases.     

Environmental Assessment of End-of-Life Treatment Options for a GSM 900 Antenna Rack (12 pp paper version/18 pp online version)

Goal, Scope and Background Telephony as well as remote data transfer is increasingly performed via mobile phone networks. However, the environmental consequences, in particular of the End-of-Life (EOL) treatment, of such network infrastructures have been investigated insufficiently to date. In the present report the environmental implications of the EOL treatment of a single GSM 900 antenna rack have been analysed. Methods Based on comprehensive inventories of a GSM 900 antenna station rack and currently applied EOL treatment, the environmental impacts related to the EOL treatment of the rack are investigated. Six different EOL treatment scenarios are developed to find an environmentally safe treatment alternative. System expansion, i.e. inclusion of the production phase, is applied to all scenarios in order to consider different amounts of regained materials. Results and Discussion The production of primary rack materials, especially that of palladium (accounts for almost 40% of the ecotoxicity impact category), to substitute lost materials dominates the overall environmental impact. Releases of heavy metals from landfilled rack components / materials and of by-products to the environment greatly influence the overall impacts on human health and ecosystem quality. The final disposal of rack components contributes to about 70% of the non-carcinogenic effects. Landfilled dust from steel production contributes to nearly 11% of this impact category. Conclusion The results suggest that all precious metals containing electronic scrap should be treated in specially equipped metal recovery plants. A complete rack disassembly before processing in high-standard metal recovery plants is not necessary. An elaborated pre-treatment and fractionation of the scrap prior to precious material recovery does not lower the environmental impacts and is not mandatory and would only become environmentally interesting if high recovery of heavy metals is achieved. To avoid the formation and release of volatile and toxic heavy metal, incineration of electronic scrap as of by-products prior to landfilling should be avoided. To reduce the overall environmental load, a standardisation of the sizes of rack components, facilitating their re-use, is recommended.     

Benefits of teaching medical students how to communicate with patients having serious illness: comparison of two approaches to experiential, skill-based, and self-reflective learning

Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-Life Care Assignment. These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum. The two learning programs share a number of educational approaches driven by the learning objectives, the students' development, and clinical realities. Common educational features include: experiential learning, the Biopsychosocial Model, patient-centered communication, integration into clinical clerkships, structured skill-based learning, self-reflection, and self-care. These shared features - as well as some differences - are explored in this paper in order to illustrate key issues in designing and implementing medical student education in these areas.     

End-of-life care issues in advanced dementia

Appropriate management of advanced dementia requires it to be recognised as a terminal condition that needs palliative care. Interventions during this stage should be carefully chosen to ensure the improvement or maintenance of the quality of life of the person with dementia. Advanced care planning is an important aspect of dementia care. Carers and relatives should be educated and encouraged to actively participate in discussions related to artificial nutrition, cardiopulmonary resuscitation (CPR) and other medical interventions.     

DOES PROFESSIONAL AUTONOMY PROTECT MEDICAL FUTILITY JUDGMENTS?

Despite substantial controversy, the use of futility judgments in medicine is quite common, and has been backed by the implementation of hospital policies and professional guidelines on medical futility. The controversy arises when health care professionals (HCPs) consider a treatment futile which patients or families believe to be worthwhile: should HCPs be free to refuse treatments in such a case, or be required to provide them? Most physicians seem convinced that professional autonomy protects them from being forced to provide treatments they judge medically futile, given the lack of patient benefit as well as the waste of medical resources involved. The argument from professional autonomy has been presented in a number of articles, but it has not been subjected to much critical scrutiny. In this paper I distinguish three versions of the argument: 1) that each physician should be free to exercise his or her own medical judgment; 2) that the medical profession as a whole may provide futility standards to govern the practice of its members; and 3) that the moral integrity of each physician serves as a limit to treatment demands. I maintain that none of these versions succeeds in overcoming the standard objection that futility determinations involve value judgments best left to the patients, their designated surrogates, or their families. Nor do resource considerations change this fact, since they should not influence the properly patient‐centered judgment about futility.     

Withholding and withdrawing treatment for cost‐effectiveness reasons: Are they ethically on par?

In healthcare priority settings, early access to treatment before reimbursement decisions gives rise to problems of whether negative decisions for cost‐effectiveness reasons should result in withdrawing treatment, already accessed by patients. Among professionals there seems to be a strong attitude to distinguish between withdrawing and withholding treatment, viewing the former as ethically worse. In this article the distinction between withdrawing and withholding treatment for reasons of cost effectiveness is explored by analysing the doing/allowing distinction, different theories of justice, consequentialist and virtue perspectives. The authors do not find any strong reasons for an intrinsic difference, but do find some reasons for a consequentialist difference, given present attitudes. However, overall, such a difference does not, all things considered, provide a convincing reason against withdrawal, given the greater consequentialist gain of using cost‐effective treatment. As a result, patients should be properly informed when given early access to treatment, that such treatment can be later withdrawn following a negative reimbursement decision.     

Bioethics andCara Sui

Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics.     

2013 年全球新药研发报告——第二部分（Ⅴ）

近年来很多人都悲观地预测医药产业行将消亡,但至今尚未应验,事实上患者活得很好。药品监管者制定的新法规已受到产业的热捧,包括美国食品药品管理局（FDA） 的“突破性疗法”、“合格感染性疾病产品（qualified infectious disease product,QIDP）”认定以及如今在很多国家都已深入人心的孤儿药法规。医药公司往往很务实,及时果断摈弃开发计划中表现欠佳的项目,这样虽对计划进行了瘦身,却提高了项目质量。2013 年医药企业仍趋于继续通过并购以巩固在产业中的地位,提升效率。综述2013 年医药产业林林总总的发展趋势。     

2013 年全球新药研发报告——第二部分（Ⅵ）

近年来很多人都悲观地预测医药产业行将消亡,但至今尚未应验,事实上患者活得很好。药品监管者制定的新法规已受到产业的热捧,包括美国食品药品管理局（FDA） 的“突破性疗法”、“合格感染性疾病产品（qualified infectious disease product,QIDP）” 认定以及如今在很多国家都已深入人心的孤儿药法规。医药公司往往很务实,及时果断摈弃开发计划中表现欠佳的项目,这样虽对计划进行了瘦身,却提高了项目质量。2013 年医药企业仍趋于继续通过并购以巩固在产业中的地位,提升效率。综述2013 年医药产业林林总总的发展趋势。     

What really is the nature of suffering? Three problems with Eric Cassell’s concept of distress

Eric Cassell famously defined suffering as a person’s severe distress at a threat to their personal integrity. This article draws attention to some problems with the concept of distress in this theory. In particular, I argue that Cassell’s theory turns on distress but does not define it, which, in light of the complexity of distress, problematizes suffering in three ways: first, suffering becomes too equivocal to apply in at least some cases that Cassell nevertheless identifies as suffering; second, Cassell’s account does not explain what sort of experience suffering is, resulting in theoretical and practical difficulties in distinguishing it from other medical conditions; third, there is good reason to believe that, in medical contexts, ‘distress’ just means ‘suffering’ or some cognate concept not yet distinguished from it, rendering Cassell’s theory circular. I consider a rebuttal to my objections and reply, concluding that Cassell’s theory of suffering needs a definition of distress to settle what the nature of suffering really is.     

干细胞研究伦理

干细胞具有＂分化＂和＂脱分化＂的特点和潜能,干细胞研究有着良好的医学前景,许多人类严重疾病的治疗有了新的希望。伴随着干细胞研究的开展和深入,出现了诸多伦理问题的争论。拟就干细胞研究的希望和现实、伦理争论的主要观点及干细胞研究伦理准则的构建,作一简要介绍,并就加强干细胞管理提出建议。