Strange bedfellows: The ethics and politics of medical futility in Texas

Background: Futile medical treatments are interventions that are not associated with a benefit to the patient. The definition and concept of medical futility are controversial. The Texas Advance Directives Act (TADA) was passed in 1999 to address medically inappropriate interventions by allowing providers to withdraw inappropriate interventions against a surrogate decision maker's wishes following a review, attempt to transfer the patient, and 10-day waiting period. The original legislation was a negotiated compromise by players across the political spectrum. However, in recent years there has been increasing controversy regarding TADA and attempts to alter its applicability in Texas. ^ Purpose: The purpose of this project was to apply Paul Sabatier's advocacy coalition framework (ACF) to gain understanding into the historical, ethical, and political basis of the initial compromise, and determine the sources of conflict that have led to increased opposition to TADA. ^ Methods: Using the ACF model, key actors within the medical futility policy debate in Texas were aggregated into coalitions based on shared beliefs. A narrative summary based analysis identified the core elements of the policy subsystem, as well as the constraints and resources of the subsystem actors. Externalities that promoted adjustments to coalition beliefs and tactics used by coalition participants were analyzed. Data sources included review of the published literature regarding medical futility, as well as analysis of published newspaper accounts and editorials regarding the medical futility issue in Texas, legislative testimony, and review of weblogs and online commentaries dealing with the issue. ^ Results: Primary coalition participants in developing compromise legislation in 1999 were the Providers and Vitalists, with Autonomists gaining a prominent role starting in 2006. Internal factors associated with the breakdown of consensus included changes to the makeup of the governing coalition and changes in individual case information available to the Vitalist coalition. Externalities related to the intertwining of the Sun Hudson case and the Terri Schiavo case generated negative publicity for the TADA from progressive and conservative viewpoints. Dissemination of information in various venues regarding contentious cases was associated with more polarization of viewpoints, and realignment of coalition alliances. ^ Conclusions: The ACF provided an outline for the initial compromise over the creation of the Texas Advance Directives Act as well as the eventual loss of consensus. The debate between the Provider, Vitalist, and Autonomist coalitions has been affected by internal policy evolution, changes in the governing coalition, and important externalities. The debate over medical futility in Texas has had much broader implications in the dispute over Health Care Reform.^

Issues Affecting the Movement of Rural Labour in Myanmar: Rakhine Case Study

This paper presents issues affecting the movement of rural labour in Myanmar, by examining the background, purpose and earned income of labourers migrating to fishing villages in southern Rakhine. A broad range of socioeconomic classes, from poor to rich, farmers to fishermen, is migrating from broader areas to specific labour-intensive fishing subsectors, such as anchovy fishing. These labourers are a mixed group of people whose motives lie either in supplementing their household income or accumulating capital for further expansion of their economic activities. The concentration of migrating labourers with different objectives in this particular unstable, unskilled employment opportunity suggests an insufficiently developed domestic labour market in rural Myanmar. There is a pressing need to create stable labour-intensive industries to meet this demand.

Cyber-networks, physical coalitions and missing links : imagining and realizing dissent in Malaysia 1998-2008

From September 1998 to March 2008, dissident cyber-networks in Malaysia developed connections with physical coalitions that contributed to the Opposition’s historic gains in the 12th General Election of March 2008. To succeed in entrenching a ‘two-coalition system’, however, the component parties of the Opposition coalition (Pakatan Rakyat) must establish its ‘missing links’, namely, extensive and deep organizational networks in society that would permit the coalition to move from imagining and realizing dissent to institutionalizing it meaningfully.

Diffusion of photovoltaic in Germany: policy vs. consumers

In some countries photovoltaic (PV) technology has already achieved a stage of development at which it can compete with conventional electricity sources. Germany provides a good illustration of this where PV market has reached a mature stage. As a manifest of this, the German government has recently reduced subsidies for households and industry by decreasing the feed in tariff for PV. This development raises fundamental questions: could the PV industry survive? Will consumers be motivated to continue to adopt PV when feed-in tariff diminish? The point of departure for the relevant literature on diffusion of PV has been on the effect of subsidies but little attention has paid to consumer motives when the policy support is scaled down. This paper introduces an in-depth analysis on understanding the consumer motives for adopting photovoltaic applications. Anchored in an extensive exploratory case study on PV consumers and PV system providers, this study aims to provide an encompassing explanation of diffusion of PV by revealing the link between consumer motives and the impact of policy.

Cis-, trans-, transcriptional regulation of the Arabidopsis thaliana gene AtTrxo1 and its response upon germination and to salt

Plants contain several genes encoding thioredoxins (Trxs), small proteins involved in redox regulation of many enzymes in different cell compartments. Among them, mitochondrial Trxo has been described to have a response in plants grown under salinity but there is scarce information about its functional role in abiotic stress or its gene regulation. In this work, the transcriptional regulation of the mitochondrial AtTrxo1 gene has been studied for the first time, by identifying functionally relevant cis- elements in its promoter: two conserved motives were found as positive and one as negative regulators. Using them as baits for the screening of an arrayed yeast library containing Arabidopsis Transcription Factors (TF) ORFs, two TFs were selected that are now being validated at the molecular level. We have also studied the response of T-DNA insertion mutant plants for AtTrxo1 to salt stress. The K.O. AtTrxo1 mutants presented several phenotypic changes including the time required to reach 50% germination under salinity, without affecting the final germination percentage.

Transcription factors of the bzip factors of the BZIP family affecting arabidopsis thaliana germination sensu stricto

During seed germination, the endosperm cell walls (CWs) suffer an important weakening process mainly driven by hydrolytic enzymes, such are endo-?- mannanases (MAN; EC. 3.2.1.78) that catalyze the cleavage of ?1?4 bonds in the mannan-polymers. In Arabidopsis thaliana seeds, endo-?-mannanase activity increases during seed imbibition, decreasing after radicle emergence1. AtMAN7 is the most highly expressed MAN gene in seeds upon germination and their transcripts are restricted to the micropylar endosperm and to the radicle tip just before radicle emergence. Mutants with a T-DNA insertion in this gene (K.O. MAN7) have a slower germination rate than the wild type (t50=34 h versus t50=25 h). To gain insight into the transcriptional regulation of the AtMAN7 gene, a bioinformatic search for conserved non-coding cis-elements (phylogenetic shadowing) within the Brassicaceae orthologous MAN7 gene promoters has been done and these conserved motives have been used as baits to look for their interacting transcription factors (TFs), using as a prey an arrayed yeast library of circa 1,200 TFs from A. thaliana. The basic leucine zipper AtbZIP44, but not its closely related ortholog AtbZIP11, has been thus identified and its regulatory function upon AtMAN7 during seed germination validated by different molecular and physiological techniques, such are RT-qPCR analyses, mRNA Fluorescence in situ Hybridization (FISH) experiments, and by the establishment of the germination kinetics of both over-expression (oex) lines and TDNA insertion mutants in AtbZIP44. The transcriptional combinatorial network through which AtbZIP44 regulates AtMAN7 gene expression during seed germination has been further explored through protein-protein interactions between AtbZIP44 and other bZIP members. In such a way, AtbZIP9 has been identified by yeast two-hybrid experiments and its physiological implication in the control of AtMAN7 expression similarly established.

Diffusion of photovoltaic in Germany: roles of policy, system suppliers and adopters

In some countries photovoltaic (PV) technology is at a stage of development at which it can compete with conventional electricity sources. A case in point is Germany where PV market has reached a mature stage. As a manifest of this, the German government has recently reduced the feed-in-tariff, which had been the strongest driver of PV diffusion. This development raises a fundamental question: Why would potential adopters be motivated to adopt PV when feed-in tariff diminishes? The point of departure for the literature on diffusion of PV has been on the effect of subsidies but little attention has paid to adopter motives when the policy support is scaled down. This paper presents an in-depth analysis of the adopter motives for photovoltaic applications. Anchored in an extensive exploratory case study we provide an encompassing explanation of roles of policy, adopters and system suppliers on diffusion of PV.

Motivators for adoption of photovoltaic systems at grid parity: A case study from Southern Germany

In some countries, photovoltaic (PV) technology is at a stage of development at which it can compete with conventional electricity sources in terms of electricity generation costs, i.e., grid parity. A case in point is Germany, where the PV market has reached a mature stage, the policy support has scaled down and the diffusion rate of PV systems has declined. This development raises a fundamental question: what are the motives to adopt PV systems at grid parity? The point of departure for the relevant literature has been on the impact of policy support, adopters and, recently, local solar companies. However, less attention has been paid to the motivators for adoption at grid parity. This paper presents an in-depth analysis of the diffusion of PV systems, explaining the impact of policy measures, adopters and system suppliers. Anchored in an extensive and exploratory case study in Germany, we provide a context-specific explanation to the motivations to adopt PV systems at grid parity.

Organizational determinants of substantive sustainability reporting practices: the role of company-level fit

As sustainability reporting (SR) practices have being increasingly adopted by corporations over the last twenty years, most of the existing literature on SR has stressed the role of external determinants (such as institutional and stakeholder pressures) in explaining this uptake. However, given that recent evidence points to a broader range of motives and uses (both external and internal) of SR, we contend that its role within company-level activities deserves greater academic attention. In order to address this research gap, this paper seeks to provide a more detailed examination of the organizational characteristics acting as drivers and/or barriers of SR integration within corporate sustainability practices at the company-level. More specifically, we suggest that substantive SR implementation can be predicted by assessing the level of fit between the organization and the SR framework being adopted. Building on this hypothesis, our theoretical model defines three forms of fit (technical, cultural and political) and identifies organizational characteristics associated to each of these fits. Finally, implications for academic research, businesses and policy-makers are derived.

Symbolic vs substantive sustainability reporting: examining the role of company-level characteristics

As sustainability reporting (SR) practices have being increasingly adopted by corporations over the last twenty years, most of the existing literature on SR has stressed the role of external determinants (such as institutional and stakeholder pressures) in explaining this uptake. However, given that recent evidence points to a broader range of motives and uses (both external and internal) of SR, we contend that its role within company-level activities deserves greater academic attention. In order to address this research gap, this paper seeks to provide a more integrated perspective of both institutional and efficiency explanations of SR dynamics, as well as to highlight the role of company-level characteristics in explaining its contribution to sustainability management practices. More specifically, we suggest that substantive SR implementation can be predicted by assessing the level of fit between the organization and the SR framework being adopted. Building on this idea, our theoretical model defines three forms of fit (technical, cultural and political) and identifies organizational characteristics associated to each of these fits. Finally, implications for academic research, businesses and policy-makers are derived.

Sea lions, sacrifice, and ritual : The symbolism of Moche Island imagery

The Mochica, or Moche (c. 100-800 AD) culture, flourished along the northern Peruvian coast. The Moche did not have a formal written language; as such, contemporary scholars base their analysis on Moche iconography and archaeological burial remains. Especially renown for their ceramic artistry, Moche vessels exhibit a wide range of subject matter, including animal and enigmatic figural representations that evoke terrestrial, marine and possibly, spiritual realms. While research has focused on political organization and the interrelationship between sacrifice and warfare, many marine themes have not been fully explored in the discourse. An exploration of sea lion imagery and sacrifice themes suggests that the marine mammals were ritually hunted. A careful iconographic analysis of island scenes demonstrates ritual and gender affiliations held by the Moche about sea lions. In a multi-disciplinary approach, scientific, archaeological and ethnographic resources substantiate this claim.

Internalization of quality management in service organizations

Purpose – The purpose of this paper is to analyze the internalization of quality management (QM) on the basis of quality certifiable standards – also referred to as meta-standards – in service organizations. More specifically, the paper analyzes the case of the internalization of a quality standard in the Spanish hotel industry. Design/methodology/approach – The paper examines the relationships between the measures of internalization, benefit, QM tools and motivation, using partial least squares in the framework of the structural equation modeling technique. Findings – The results show that the hotels that have internalized the standard to a greater extent are more likely to be driven by internal motivation, develop more QM tools and achieve greater benefits than the hotels with a lower degree of internalization. Originality/value – As previous studies have examined these issues in relation to the internalization of ISO standards, the present study adds to this important stream of research and contributes by advancing the understanding of these issues through the case of a specific standard for the hotel industry.