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Facial transplantation is emerging as a therapeutic option for self-inflicted gunshot wounds. The self-inflicted nature of this injury raises questions about the appropriate role of self-harm in determining patient eligibility. Potential candidates for facial transplantation undergo extensive psychosocial screening. The presence of a self-inflicted gunshot wound warrants special attention to ensure that a patient is prepared to undergo a demanding procedure that poses significant risk, as well as stringent lifelong management. Herein, we explore the ethics of considering mechanism of injury in the patient selection process, referring to the precedent set forth in solid organ transplantation. We also consider the available evidence regarding outcomes of individuals transplanted for self-inflicted mechanisms of injury in both solid organ and facial transplantation. We conclude that while the presence of a self-inflicted gunshot wound is significant in the overall evaluation of the candidate, it does not on its own warrant exclusion from consideration for a facial transplantation.
This document serves as an update and companion piece to the 2005 Society for Healthcare Epidemiology of America (SHEA) Position Paper entitled “Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages.” In large part, the discussion about the rationale for influenza vaccination of healthcare personnel (HCP), the strategies designed to improve influenza vaccination rates in this population, and the recommendations made in the 2005 paper still stand. This position paper notes new evidence released since publication of the 2005 paper and strengthens SHEA's position on the importance of influenza vaccination of HCP. This document does not discuss vaccine allocation during times of vaccine shortage, because the 2005 SHEA Position Paper still serves as the Society's official statement on that issue.
We show how the expansion of classical Galactic Hii regions can trigger massive-star formation via the collect & collapse process. We give examples of this process at work. We suggest that it also works in a turbulent medium.
Various physical processes are believed to trigger star formation on the borders of Galactic HII regions. Among these, the collect & collapse process is particularly attractive as it allows the formation of massive objects (single stars or clusters). In order to identify specific cases of this way of triggering star formation we are carrying out a multi-wavelength study of Galactic HII regions that exhibit signposts of massive-star formation at their borders. Hereby, we present two typical examples of such sources and discuss the results in the framework of the collect and collapse process, which seems to be at work as the major triggering agent in these two cases.
The moral status of the human embryo is particularly controversial in the United States, where one debate has centered on embryos created in excess at in vitro fertilization (IVF) clinics. Little has been known about the disposal of these embryos.
We mailed anonymous, self-administered questionnaires to directors of 341 American IVF clinics.
217 of 341 clinics (64 percent) responded. Nearly all (97 percent) were willing to create and cryopreserve extra embryos. Fewer, but still a majority (59 percent), were explicitly willing to avoid creating extras. When embryos did remain in excess, clinics offered various options: continual cryopreservation for a charge (96 percent) or for no charge (4 percent), donation for reproductive use by other couples (76 percent), disposal prior to (60 percent) or following (54 percent) cryopreservation, and donation for research (60 percent) or embryologist training (19 percent). Qualifications varied widely among those personnel responsible for securing couples' consent for disposal and for conducting disposal itself. Some clinics performed a religious or quasi-religious disposal ceremony. Some clinics required a couple's participation in disposal; some allowed but did not require it; some others discouraged or disallowed it.
The disposal of human embryos created in excess at American IVF clinics varies in ways suggesting both moral sensitivity and ethical divergence.
Background. We carried out a large randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behaviour therapy (MACT) versus treatment as usual (TAU) for deliberate self-harm.
Method. Patients presenting with recurrent deliberate self-harm in five centres were randomized to either MACT or (TAU) and followed up over 1 year. MACT patients received a booklet based on cognitive behaviour therapy (CBT) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study. Ratings of parasuicide risk, anxiety, depression, social functioning and global function, positive and negative thinking, and quality of life were measured at baseline and after 6 and 12 months.
Results. Four hundred and eighty patients were randomized. Sixty per cent of the MACT group had both the booklet and CBT sessions. There were seven suicides, five in the TAU group. The main outcome measure, the proportion of those repeating deliberate self-harm in the 12 months of the study, showed no significant difference between those treated with MACT (39%) and treatment as usual (46%) (OR 0·78, 95% CI 0·53 to 1·14, P=0·20).
Conclusion. Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition, but the findings taken in conjunctin with the economic evaluation (Byford et al. 2003) indicate superiority of MACT over TAU in terms of cost and effectiveness combined.
In 1992, the Joint Commission on the Accreditation of
Healthcare Organizations (JCAHO) passed a mandate that all its
approved hospitals put in place a means for addressing ethical
concerns.Although the particular process the hospital uses to
address such concerns—ethics consultant, ethics forum,
ethics committee—may vary, the hospital or healthcare ethics
committee (HEC) is used most often. In a companion study to
that reported here, we found that in 1998 over 90% of U.S.
hospitals had ethics committees, compared to just 1% in 1983,
and that many have some and a few have sweeping clinical powers
Glenn McGee argues that the time is now for debating the
morality of patenting human genes. In one sense he is surely
right. While thousands of patents have been issued or are
pending on many gene sequences, public policy with respect
to ownership of the human genome is still far from settled.
So a debate about the ethics of patenting genes is, if nothing
else, timely. In another sense however, Professor McGee is wrong.
Two experiments were conducted with the purpose of investigating possible age effects on the abilities of older and younger adults to use contextual information to resolve ambiguous pronouns. In both experiments, subjects were presented with pairs of sentences (a leading sentence followed by a pronominal sentence) and were required to indicate the referent of the ambiguous pronoun. In both experiments, the older adults responded more slowly and were less accurate than the younger adults. However, both groups of subjects were equally influenced by the contextual information available, which was located in the leading sentence to aid in the resolution of the pronouns. Older adults did not demonstrate a specific impairment in the ability to use contextual information to resolve ambiguous pronouns. Nevertheless, agerelated difficulties in resolving pronouns may emerge, possibly as a function of an underspecified discourse model.
The Large Magellanic Cloud (LMC) HII region N159A is shown to be a group of ionized regions, some of which overlap, rather than a single HII region. There are at least 11 stars earlier than B2 in this region
The avian eggshell is one of the most rapidly mineralizing biological systems known. By understandi'ng the key components and steps in this process, we hope to provide relevant information for fabrication of ceramic composites. The calcification of the eggshell occurs in three main steps: 1) fabrication of an organic matrix, 2) nucleation of an inorganic phase on the organic matrix, and 3) space-filling growth of the calcite phase. The different layers of an eggshell can be separately isolated and studied. Three approaches have been used in our study of the eggshell: 1) characterization of the organization and chemical composition of the shell, 2) selective removal or blocking of particular components to improve the remineralization of demineralized shells, and 3) addition of new components to produce composite ceramics of different kinds. In this preliminary communication, the organization of the shell matrix and membranes and their association with the crystal phase, the immunohistochemical occurrence and distribution of types I and X collagen, and of different proteoglycans are reviewed. Also the preliminary findings of the remineralization of the intact or modified eggshell are presented. These experiments allow us to identify the essential steps in forming a natural composite ceramic.
Ninety-two women and their first-born children took part in a longitudinal survey of maternal mental health. When the children were four years old, their mothers were interviewed by means of the Behavioural Screening Questionnaire, and the children's problems were rated by a psychiatrist, who was unaware of the mothers' psychiatric histories or of assessments of their current health. As expected, mothers who were concurrently depressed reported significantly more behavioural difficulties in their children. Marital disharmony during pregnancy and a history of paternal psychiatric problems were also associated with later childhood behavioural difficulties. Children who scored below average on the McCarthy scales of cognitive abilities were also reported by their mothers to have more behavioural problems, but the children's behavioural difficulties at four showed no clear links with postnatal depression.