Anna J Dare,1 Anthony RJ Phillips,1–3 Michael Chu,1 Anthony JR Hickey,2 Adam SJR Bartlett1–31Department of Surgery, 2Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; 3New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New ZealandBackground: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation, and little is known about local practices in this area. The aim of this (...) survey was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand in the evaluation and use of steatotic donor livers in LT.Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ in January 2010.Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with "severe" steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver, using hematoxylin and eosin staining for fat assessment. There was wide variation in the upper limit of steatosis considered to be acceptable for LT. A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction.Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.Keywords: liver transplantation, steatosis, fatty liver, organ donors. (shrink)

Most models of patient-physician communication take decision-making as a central concept. However, we found that often the treatment course of metastatic cancer patients is not easy to describe in straightforward terms used in decision-making models but is instead frequently more erratic. Our aim was to analyse these processes as trajectories. We used a longitudinal case study of 13 patients with metastatic colorectal and pancreatic cancer for whom palliative chemotherapy was a treatment option, and analysed 65 semi-structured interviews. We analysed three (...) characteristics of the treatment course that contributed to the ‘erraticness’ of the course: (1) The treatment (with or without chemotherapy) contained many options; (2) these options were not stable entities to be decided upon, but changed identity over the course of treatment, and (3) contrary to the closure (option X means no option Y, Z, etc.) a decision implies, the treatment course was a continuous process in which options instead remained open. When the treatment course is characterised by these many and changeable options that do not result in closure, the shared decision-making model should take these into account. More attention needs to be paid to the erratic character of the process in which the doctor has to provide continuous information that is related to the changing situation of the patient; also, flexibility in dealing with protocols is warranted, as is vigilance about the overall direction of the process. (shrink)

This empirical study concerns the authorship credit decision-making processes and outcomes that occur among coauthors in cases of multiauthored publications. The 2002 American Psychological Association (APA) Ethics Code offers standards for determining authorship order; however, little is known about how these decisions are made in actual practice. Results from a survey of 109 randomly selected authors indicated that most authors were satisfied with the decision-making process and outcome with few disagreements. Participants reported cases of both undeserved authorship being given and (...) omission of deserving contributors' names as coauthors. Some factors associated with authorship decisions included "sense of loyalty or obligation," "publish or perish pressures," and "power differentials." Authors who used APA standards were significantly more satisfied with both the process and outcome of authorship credit decisions. (shrink)

This paper reports a study of planning processes in the five-disc Tower of London (TOL) task in 20 younger and 20 older adult participants. A concurrent direct ''think-aloud'' method was used to obtain data on planning processes prior to moving discs in the TOL. A check was made of the effects of verbalising by comparing performance data from the experimental groups with data from control groups who did not verbalise during planning or moving. Verbalising slowed down planning and moving but (...) did not appear to distort the participants' approaches to the task. Older and younger participants did not differ in average moves taken to solve the tasks. However, older participants' planning was less complete and more error-prone than that of younger participants. The planning processes were characterised as showing a means-ends ''goal selection'' strategy. In this strategy participants (1) identify a single active goal disc at the start, (2) select moves and move sequences to enable the placing of the current goal disc in its target position, and (3) continue in this way until all discs are in their target positions. Age differences were found in the planning stage, during which there was no stimulus support and hence a substantial working memory load. During the move phase there was stimulus support and hence little loading of working memory. Age differences in moves required were not found in the move phase. As older participants tend to have depleted working memory capacity the present results suggest that working memory is heavily loaded in TOL planning but less so in the move phase of TOL. (shrink)

The debate over corporate moral responsibility has become a fixture in business ethics research and teaching. Only rarely, however, does the sizable literature on that question consider whether the debate has important practical implications. This article examines that question from a corporate control perspective. After assuming corporate moral responsibility’s existence for purposes of argument, the article concludes that such responsibility makes a difference in cases where it is present but personal responsibility is absent. Then the article tries to identify the (...) forces that diminish personal responsibility when corporate responsibility exists. The most important such forces, it concludes, spring from the socialization processes people undergo when they enter groups. One example is the well-known phenomenon of groupthink, which can exculpate individuals by rendering them justifiably ignorant of foreseeable risks of harm. (shrink)

The book examines the emerging approach of using qualitative methods, such as interviews and field observations, in the philosophy of science. Qualitative methods are gaining popularity among philosophers of science as more and more scholars are resorting to empirical work in their study of scientific practices. At the same time, the results produced through empirical work are quite different from those gained through the kind of introspective conceptual analysis more typical of philosophy. This volume explores the benefits and challenges of (...) an empirical philosophy of science and addresses questions such as: What do philosophers gain from empirical work? How can empirical research help to develop philosophical concepts? How do we integrate philosophical frameworks and empirical research? What constraints do we accept when choosing an empirical approach? What constraints does a pronounced theoretical focus impose on empirical work? Nine experts discuss their thoughts and empirical results in the chapters of this book with the aim of providing readers with an answer to these questions. (shrink)

Combat deployments put health care providers in ethically compromising and morally challenging situations. A sample of recently deployed nurses and physicians provided narratives that were analyzed to better appreciate individual perceptions of moral dilemmas that arise in combat. Specific questions to be answered by this inquiry are: 1) How do combat deployed nurses and physicians make sense of morally injurious traumatic exposures? and 2) What are the possible psychosocial consequences of these and other deployment stressors? This narrative inquiry involves analysis (...) of ten deployed military nurses’ and physicians’ aversive or traumatic experiences. Burke’s dramatist pentad is used for structural narrative analysis of stories that confirm and illuminate the impact of war zone events such as betrayal, disproportionate violence, incidents involving civilians, and within-rank violence on military health care provider narrators. Results indicate cognitive dissonance and psychosocial sequelae related to moral and psychological stressors faced by military medical personnel. Discussion addresses where healing efforts should be focused. (shrink)

Today, an increased impact of information and communication technologies in the society at large has lead teachers to engage in professional development activities related to the use of ICT. Even though this development has been prominent for more than two decades, its long term effects seem complex to determine. This paper is based on interviews with twelve Swedish teachers who participated in a national program for promoting school development and use of ICT in 2000-2001. The program was aligned with the (...) pedagogical approaches set out in the national Swedish curriculum, such as a shift from teaching to learning and giving pupils more responsibility, introducing interdisciplinary approaches to teaching in teams, and a problem based pupils-oriented pedagogy. The analysis of the interviews show that teachers still feel a high degree of appreciation for the program, and that they share a relative agreement of the importance of the program for their teaching with ICT in the last decade. The general intentions of the program to be more concerned with school development and pedagogy rather than technology and ICT seem also to be present today as a long term effect. (shrink)

Standards for farm animal welfare are variously managed at a national level by government-led regulatory control, by consumer-led welfare economics and co-regulated control in a partnership between industry and government. In the latter case the control of research to support animal welfare standards by the relevant industry body may lead to a conflict of interest on the part of researchers, who are dependent on industry for continued research funding. We examine this dilemma by reviewing two case studies of research published (...) under an Australian co-regulated control system. Evidence of unsupported conclusions that are favourable to industry is provided, suggesting that researchers do experience a conflict of interest that may influence the integrity of the research. Alternative models for the management of research are discussed, including the establishment of an independent research management body for animal welfare because of its public good status and the use of public money derived from taxation, with representation from government, industry, consumers, and advocacy groups. (shrink)