National audit of anaesthesia for major abdominal surgery

A postal survey was conducted of all hospitals in Australia known to have a department of anaesthesia and an intensive care or high dependency unit. Each hospital was asked to report the anaesthetic and postoperative analgesic techniques used for the last ten cases of four common major surgical procedures-aorto-femoral bypass, repair of an abdominal aortic aneurysm, hemicolectomy and anterior resection of the rectum. Half of 76 hospitals sent a survey form completed and returned it. Responding hospitals were larger on average, than non-responding ones, but otherwise typical of them in terms of university affiliation and metropolitan versus rural location. For each of the procedures studied the proportion of cases in which epidural block was used intra- or postoperatively varied from 0% to 100%. Depending on the procedure, between 65% and 85% of hospitals used epidural block sometimes, with between 10% and 90% of patients in these hospitals being managed with this technique. There is wide variation in the use of epidural block, intra- and postoperatively, in Australia, variation that is unlikely to be explained by systematic differences between institutions in the patients seen or their suitability for one or other technique. This pattern of practice mirrors the lack of agreement about the proper place for epidural techniques evident in the recent literature. There is a widespread belief among clinicians that this is a question of great importance. Accordingly, we believe that anaesthetists and surgeons share an ethical responsibility to enter suitable patients in an appropriately designed randomized controlled trial in order to resolve this question.

The role of legal coercion in the treatment of offenders with alcohol and heroin problems

This article discusses the ethical justification for and reviews the American evidence on the effectiveness of; treatment for alcohol and heroin dependence that is provided under legal coercion to offenders whose alcohol and drug dependence has contributed to the commission of the offence with which they have been charged or convicted. The article focuses on legally coerced treatment for drink-driving offenders and heroin-dependent property offenders. it outlines the various arguments that have been made for providing such treatment under legal coercion, namely. the over-representation of alcohol and drug dependent persons in prison populations; the contributory causal role of alcohol and other drug problems in the offences that lead to their imprisonment; the high rates of relapse to drug use and criminal involvement after incarceration; the desirability of keeping injecting heroin users out of prisons as a way of reducing the transmission of infectious diseases such as HIV and hepatitis; and the putatively greater cost-effectiveness of treatment compared with incarceration. The ethical objections to legally coerced drug treatment are briefly discussed before the evidence on the effectiveness of legally coerced treatment for alcohol and other drug dependence is reviewed. The evidence, which is primarily from the USA, gives qualified support for some forms of legally coerced drug treatment provided that these programs are well resourced, carefully implemented, and their performance is monitored to ensure that they provide a humane and effective alternative to imprisonment. Expectations about what these programs can achieve also need to be realistic.

Goal setting among adolescents: A comparison of delinquent, at risk, and not-at-risk youth

A series of studies was conducted to compare group differences in the goal orientations of delinquent, at-risk, and not-at-risk adolescents. An Importance of Goals Scale was developed by examining the item responses of 230 high school students and validated by administering the revised scale to 80 delinquent, 90 at-risk, and 90 not-at-risk adolescents. Results identified differences in the importance attributed to different goals by the 3 groups. Delinquent and at-risk adolescents attached significantly more importance to goals associated with developing a social image (e.g., delinquency, freedom-autonomy), whereas not-at-risk adolescents were more concerned with goals associated with an academic image (e.g., educational, interpersonal). Results are discussed in terms of their implications for school achievement, peer relations, and future life paths.

The recent Australian debate about the prohibition on cannabis use

This paper outlines the ethical arguments used in the Australian debate about whether or not to relax the prohibition on cannabis use by adults. Over the past two decades a rising prevalence of cannabis use in the Australian population has led to proposals for the decriminalization of the personal use of cannabis. Three states and territories have removed criminal penalties for personal use while criminal penalties are rarefy imposed in the remaining states. Libertarian arguments for legalization of cannabis use have attracted a great deal of media interest but very little public and political support. Other arguments in favour of decriminalization have attracted more support. One has been the utilitarian argument that prohibition has failed to deter cannabis use and the social costs of its continuation outweigh any benefits that it produces. Another has been the argument from hypocrisy that cannabis is less harmful than alcohol and so, on the grounds of consistency, if alcohol is legally available then so should cannabis. To date public opinion has not favoured legalization, although support for the decriminalization of personal cannabis use has increased. In the long term, the outcome of the debate may depend more upon trends in cannabis use and social attitudes among young adults than upon the persuasiveness of the arguments for a relaxation of the prohibition of cannabis.

The distribution of naloxone to heroin users

Overdose deaths are a manor contributor to excess mortality among heroin users. It has been proposed that opioid overdose morbidity and mortality could be reduced substantially by distributing the opioid antagonist naloxone to heroin users. The ethical issues raised by this proposal are evaluated from a utilitarian perspective. The potential advantages of naloxone distribution include the increased chance of comatose opioid users being quickly resuscitated by others present at the time of an overdose, naloxone's safety and its lack of abuse potential. The main problems raised by the proposal are: the medico-legal complications of medical practitioners prescribing a drug that is most likely to be administered to and by people other than the one for whom it is prescribed; the economic costs of distributing naloxone sufficiently widely to have an impact on overdose morbidity and mortality; and the potentially greater cost-effectiveness of simpler educational interventions. Given the possible benefits of naloxone distribution, it may be worthwhile considering a controlled trial of naloxone distribution to high-risk heroin users.

Relations between coal petrology and gas content in the Upper Newlands Seam, central Queensland, Australia

The Upper Newlands Seam in the northern Bowen Basin, Queensland, Australia consists of six benches (A-F) that have different petrographic assemblages. Benches C and E contain relatively abundant inertodetrinite and mineral matter, as well as anomalously high reflectance values; these characteristics support a largely allochthonous, detrital origin for the C and E benches. Fractures and cleats in the seam show a consistent orientation of northeast- southwest for face cleats, and a wide range of orientations for fractures. Cleat systems are well developed in bright bands, with poor continuity in the dull coal. Both maceral content and cleat character are suggested to influence gas drainage in the Upper Newlands Seam. A pronounced positive correlation between vitrinite abundance and gas desorption data suggests more efficient drainage from benches with abundant vitrinite. Conversely, inertinite-rich benches are suggested to have less efficient drainage, and possibly retain gas within pore spaces, which could increase the outburst potential of the coal. (C) 2001 Elsevier Science BN. All rights reserved.

Communicating trustworthiness and building trust in interorganizational virtual organizations

We propose a theory of trust in interorganizational virtual organizations that focuses on how trustworthiness can be communicated and trust built in this environment. The theory highlights three issues that must be dealt with if the potential obstacles to the development of trust in the virtual context are to be overcome. These are communication of trustworthiness facilitated by reliable Information and Communication Technology (ICT), establishment of a common business understanding, and strong business ethics. We propose four specific propositions relating to these issues, and suggest topics to be explored in future research. (C) 2001 Elsevier Science Inc. All rights reserved.

Fitting mixtures of Kent distributions to aid in joint set identification

When examining a rock mass, joint sets and their orientations can play a significant role with regard to how the rock mass will behave. To identify joint sets present in the rock mass, the orientation of individual fracture planer can be measured on exposed rock faces and the resulting data can be examined for heterogeneity. In this article, the expectation-maximization algorithm is used to lit mixtures of Kent component distributions to the fracture data to aid in the identification of joint sets. An additional uniform component is also included in the model to accommodate the noise present in the data.

Peacebuilding in East Timor

This essay analyses some of the political, economic and social challenges of East Timer's transition to independence. It scrutinizes the ethical dimensions of building peace in a territory devastated by the combined effect of Indonesia's colonial occupation and the violent militia attacks of September 1999. The most difficult task ahead does not lie in the physical rebuilding of the territory-gargantuan as it may be-but in the more intricate and long-term rehabilitation of a traumatized society. The latter involves competing Timorese factions as well as a range of international actors, including the United Nations Transitional Authority, foreign governments, business institutions and various multilateral and bilateral donors. each having their own organizational leitmotifs and policy priorities. If not managed carefully, the reconstruction process could further exacerbate existing societal tensions and complicate the starch for peace and reconciliation. The essay identifies a number of crucial components necessary to counter such risks, including the need to promote popular participation in the rebuilding process. Without the legitimacy created by strong community involvement and grassroots participation in decision making, the task of national reconstruction may well become overwhelmed by conflict.

An Ethics Core Curriculum for Australasian Medical Schools

Teaching ethics incorporates teaching of knowledge as well as skills and attitudes. Each of these requires different teaching and assessment methods. A core curriculum of ethics knowledge must address both the foundations of ethics and specific ethical topics. Ethical skills teaching focuses on the development of ethical awareness, moral reasoning, communication and collaborative action skills. Attitudes that are important for medical students to develop include honesty, integrity and trustworthiness, empathy and compassion, respect, and responsibility, as well as critical self-appraisal and commitment to lifelong education.

Curriculum development for professional ethics in Australian human service university programmes

Australian academics and practitioners in the human services are particularly susceptible to social, political and economic influences in respect of their relevance, viability and operations. In fact, it can be argued that the impact of these influences has placed human service practitioners and academics in a perpetual state of vulnerability. Australian universities have been challenged to make their programmes more relevant and viable to the community at large, and practitioners face increasing workloads with limited resources based on restricted fiscal allocation, and the changing relationship between government and service providers. Drawing on interview data from twenty-one (n = 21) practitioners, this article highlights their identified problems regarding the notion of professionalism in the human services with a particular focus on ethical dilemmas in human service practice. Gleaning these details will be a basis for recommending necessary professionalethics curricula content in human services programmes offered in Australian universities. Moreover, while the research data is Australian based, the authors contend that the universal theories and principles underpinning human service practice justify the significance and value of the data as an important source for international consideration in curriculum development of human service academic programmes.