End-of-life decision making in Europe and Australia - A physician survey

Background: The frequencies with which physicians make different medical end-of-life decisions (ELDs) may differ between countries, but comparison between countries has been difficult owing to the use of dissimilar research methods. Methods: A written questionnaire was sent to a random sample of physicians from 9 specialties in 6 European countries and Australia to investigate possible differences in the frequencies of physicians' willingness to perform ELDs and to identify predicting factors. Response rates ranged from 39% to 68% (N= 10 139). Using hypothetical cases, physicians were asked whether they would ( probably) make each of 4 ELDs. Results: In all the countries, 75% to 99% of physicians would withhold chemotherapy or intensify symptom treatment at the request of a patient with terminal cancer. In most cases, more than half of all physicians would also be willing to deeply sedate such a patient until death. However, there was generally less willingness to administer drugs with the explicit intention of hastening death at the request of the patient. The most important predictor of ELDs was a request from a patient with decisional capacity (odds ratio, 2.1-140.0). Shorter patient life expectancy and uncontrollable pain were weaker predictors but were more stable across countries and across the various ELDs (odds ratios, 1.1-2.4 and 0.9-2.4, respectively). Conclusion: Cultural and legal factors seem to influence the frequencies of different ELDs and the strength of their determinants across countries, but they do not change the essence of decision making.

The use of proteomics for the assessment of clinical samples in research

Proteomics, the analysis of expressed proteins, has been an important developing area of research for the past two decades [Anderson, NG, Anderson, NL. Twenty years of two-dimensional electrophoresis: past, present and future. Electrophoresis 1996;17:443-53]. Advances in technology have led to a rapid increase in applications to a wide range of samples; from initial experiments using cell lines, more complex tissues and biological fluids are now being assessed to establish changes in protein expression. A primary aim of clinical proteomics is the identification of biomarkers for diagnosis and therapeutic intervention of disease, by comparing the proteomic profiles of control and disease, and differing physiological states. This expansion into clinical samples has not been without difficulties owing to the complexity and dynamic range in plasma and human tissues including tissue biopsies. The most widely used techniques for analysis of clinical samples are surface-enhanced laser desorption/ionisation mass spectrometry (SELDI-MS) and 2-dimensional gel electrophoresis (2-DE) coupled to matrix-assisted laser desorption ionisation [Person, MD, Monks, TJ, Lau, SS. An integrated approach to identifying chemically induced posttranslational modifications using comparative MALDI-MS and targeted HPLC-ESI-MS/MS. Chem. Res. Toxicol. 2003;16:598-608]-mass spectroscopy (MALDI-MS). This review aims to summarise the findings of studies that have used proteomic research methods to analyse samples from clinical studies and to assess the impact that proteomic techniques have had in assessing clinical samples. © 2004 The Canadian Society of Clinical Chemists. All rights reserved.

What purpose does the MPharm research project serve?

In 2004, the Royal Pharmaceutical Society of Great Britain (RPSGB) funded research on teaching, learning and assessment within the UK undergraduate pharmacy degree (MPharm), including the compulsory final year project. Documentary analysis showed that all schools met the project requirement, although there were wide variations in the relative contribution of the project to the final year mark and the degree classification. Interviews with staff revealed that organisation of research projects was complex and time consuming and exacerbated by increasing student numbers and the impact of research ethics. 61% of students, surveyed via a self-completion questionnaire (response rate 50.6%) perceived the research project to be very or fairly important. Whilst 47% considered that they had enough choice of topic and 37% said that their training in research methods provided a good foundation for their project, this suggests scope for improvement. In the UK, there are legislative changes impending which may provide an opportunity to review the future purpose and feasibility of a "significant" final year project within the MPharm.

Doing business research:a guide to theory and practice

For anyone involved in developing a research project, this textbook provides an integrated, accessible and humorous account that explains why research methods are the way they are and how they do what they do. Unrivalled in its nature Doing Business Research addresses the research project as a whole and provides: - essential detail of philosophical and theoretical matters that are crucial to conceptualising the nature of methodology - a pragmatic guide to why things are important and how they are important - a huge range of things to consider that the reader can use to develop their research project further - a resource book, providing extensive suggested reading to help the researcher do their research.

Pre-conception care : current practice and methods of provision

This thesis examines the present provisions for pre-conception care and the views of the providers of services. Pre-conception care is seen by some clinicians and health educators as a means of making any necessary changes in life style, corrections to imbalances in the nutritional status of the prospective mother (and father) and the assessment of any medical problems, thus maximizing the likelihood of the normal development of the baby. Pre-conception care may be described as a service to bridge the gap between the family planning clinic and the first ante-natal booking appointment. There were three separate foci for the empirical research - the Foresight organisation (a charity which has pioneered pre-conception care in Britain); the pre-conception care clinic at the West London Hospital, Hammersmith; and the West Midlands Regional Health Authority. The six main sources of data were: twenty five clinicians operating Foresight pre-conception clinics, couples attending pre-conception clinics, committee members of the Foresight organisation, staff of the West London Hospital pre-conception clinic, Hammersmith, District Health Education Officers working in the West Midlands Regional Health Authority and the members of the Ante-Natal Care Action Group, a sub-group of the Regional Health Advisory Group on Health Promotion and Preventive Medicine. A range of research methods were adopted. These were as follows: questionnaires and report forms used in co-operation with the Foresight clinicians, interviews, participant observation discussions and informal meetings and, finally, literature and official documentation. The research findings illustrated that pre-conception care services provided at the predominantly private Foresight clinics were of a rather `ad hoc' nature. The type of provision varied considerably and clearly reflected the views held by its providers. The protocol which had been developed to assist in the standardization of results was not followed by the clinicians. The pre-conception service provided at the West London Hospital shared some similarities in its approach with the Foresight provision; a major difference was that it did not advocate the use of routine hair trace metal analysis. Interviews with District Health Education Officers and with members of the Ante Natal Care Action Group revealed a tentative and cautious approach to pre-conception care generally and to the Foresight approach in particular. The thesis concludes with a consideration of the future of pre-conception care and the prospects for the establishment of a comprehensive pre-conception care service.

Metaphor in translation:possibilities for process research

This paper explores potential benefits of closer interaction between metaphor studies and translation process research. It presents some developments within Translation Studies which make use of conceptual metaphor theory and illustrates some process research methods for investigating metaphors. The paper considers a number of methodological recommendations and argues that of greatest importance is the need to take full account of insights from metaphor studies and associated disciplines. Another important potential innovation is the use of a multilingual approach in respect of both product- and process-oriented studies in order to increase both the amount and generality of data available for analysis. Thirdly, it is important to extend and complement the current ST-oriented approach. The paper concludes by suggesting some options for triangulating data gathered through a combination of methods.

Knowledge and innovation as value drivers in professional services firms: an empirical research in Central and Eastern Europe

The purpose of this study was to investigate empirically the role of knowledge and innovation within Central and Eastern Europe’s changing economy. We applied qualitative research methods, and focused only on professional services firms within the region. The connection between knowledge and innovation as well as knowledge and competitiveness was analyzed by top managers and senior industry experts. Our findings revealed that knowledge might be a real value driver for professional services firms. These companies can significantly contribute to the development of modern economies through the dissemination of their internal best practices in knowledge management. We found three factors that might influence the effectiveness of knowledge management. These three factors are the involvement of international knowledge networks, the investments in human capital, and focus on critical resources. These issues proved to be essential to maximize the potential of knowledge and to leverage this into increased business performance.

Flanerie: A post -reflexive mode of urban research inquiry

Urban ethnographic studies in social science usually proceed from within a pre-figured research framework that guides field activity and filters what is considered see-worthy and study-worthy to those phenomena which are in some way necessary for the fulfillment of specific research agendas. Reliance on formalized ethnographic research methods to explore the city, and the reflex to intellectualize that which is observed by using them, frequently leads to the neglect of much of what comprises the ethnographic richness of city-life through an overly-contemplative intellectuocentrism. ^ Flânerie, an avocational, proto-sociological ethnographic mode of urban exploration and observation originating in early-nineteenth-century Paris, is representative of an alternate approach to exploration and study of the city—one less subject to a compressed horizon of ethnographic experience. It affords insight into a broad range of phenomena taking place in interstitial urban space and time which often escape the instrumentally overly-determined gaze of professionalist research inquiry. ^ The present work addressed the fact that the concept of flânerie , though occasionally invoked in discussions of methodology in urban sociology and cultural studies, had not been subjected to a systematic attempt to relate it to the research methods of these disciplines. Though as a typological figure the flâneur is thought to have disappeared long ago, practices represented by the concept continue to be engaged in by persons inside and outside of academia who approach city life and social science with a perspective somewhat transcending the reified dichotomies of private-professional and art-and-science. This study transferred aspects of the experience of the city embodied in the flâneur to the realm of ethnographic urban studies and the building of grounded social theory, finding flânerie to be crucial to the development of a refined knowledge of urban life, and an important means by which previously overlooked social phenomena and silenced avenues of research inquiry might be exposed. ^ The conclusions reached found a “flâneuristic” approach to the city as being beneficial to research practice and the vitalization of urban ethnographic inquiry, by affording opportunities for exposure to, and immersion within, an expanded range of quotidian social phenomena that have frequently escaped the academicist gaze. ^

The Caribbean Court of Justice: An investigation of the impact of elites on its creation and present structure as it relates to original jurisdiction

The primary focus of this dissertation is to determine the degree to which political, economic, and socio-cultural elites in Jamaica and Trinidad & Tobago influenced the development of the Caribbean Court of Justice's (CCJ) original jurisdiction. As members of the Caribbean Community (CARICOM), both states replaced their protectionist model with open regionalism at the end of the 1980s. Open regionalism was adopted to make CARICOM member states internationally competitive. Open regionalism was also expected to create a stable regional trade environment. To ensure a stable economic environment, a regional court with original jurisdiction was proposed. A six member Preparatory Committee on the Caribbean Court of Justice (PREPCOM), on which Jamaica and Trinidad & Tobago sat, was formed to draft the Agreement Establishing the Caribbean Court of Justice that would govern how the Court would interpret the Revised Treaty of Chaguaramas (RTC) and enforce judgments. ^ Through the use of qualitative research methods, namely elite interviews, document data, and text analysis, and a focus on three levels of analysis, that is, the international, regional, and domestic, three major conclusions are drawn. First, changes in the international economic environment caused Jamaica and Trinidad & Tobago to support the establishment of a regional court. Second, Jamaica had far greater influence on the final structure of the CCJ than Trinidad & Tobago. Third, it was found that in both states the political elite had the greatest influence on the development and structure of the CCJ. The economic elite followed by the socio-cultural elite were found to have a lesser impact. These findings are significant because they account for the impact of elites and elite behavior on institutions in a much-neglected category of states: the developing world.^

An Examination of Current Approaches to Integrative Indigenous and Western Knowledge System Implementation in Water Research and Management: A Case Study Encompassing the Colonized Geographies of Canada, Australia, New Zealand, and the United States

The commodification of natural resources and the pursuit of continuous growth has resulted in environmental degradation, depletion, and disparity in access to these life-sustaining resources, including water. Utility-based objectification and exploitation of water in some societies has brought us to the brink of crisis through an apathetic disregard for present and future generations. The ongoing depletion and degradation of the world’s water sources, coupled with a reliance on Western knowledge and the continued omission of Indigenous knowledge to manage our relationship with water has unduly burdened many, but particularly so for Indigenous communities. The goal of my thesis research is to call attention to and advance the value and validity of using both Indigenous and Western knowledge systems (also known as Two-Eyed Seeing) in water research and management to better care for water. To achieve this goal, I used a combined systematic and realist review method to identify and synthesize the peer-reviewed, integrative water literature, followed by semi-structured interviews with first authors of the exemplars from the included literature to identify the challenges and insights that researchers have experienced in conducting integrative water research. Findings suggest that these authors recognize that many previous attempts to integrate Indigenous knowledges have been tokenistic rather than meaningful, and that new methods for knowledge implementation are needed. Community-based participatory research methods, and the associated tenets of balancing power, fostering trust, and community ownership over the research process, emerged as a pathway towards the meaningful implementation of Indigenous and Western knowledge systems. Data also indicate that engagement and collaborative governance structures developed from a position of mutual respect are integral to the realization of a given project. The recommendations generated from these findings offer support for future Indigenous-led research and partnerships through the identification and examination of approaches that facilitate the meaningful implementation of Indigenous and Western knowledge systems in water research and management. Asking Western science questions and seeking Indigenous science solutions does not appear to be working; instead, the co-design of research projects and asking questions directed at the problem rather than the solution better lends itself to the strengths of Indigenous science.