Yhteinen verkosto? : Tutkimus nuorten syrjäytymistä ehkäisevistä poikkihallinnollisista ryhmistä

Since the 1990s, European policy strategies have stressed the mutual responsibility and joint action of all societal branches in preventing social problems. Network policy is an integral part of the new governance that generates a new kind of dependency between the state and civil society in formulating and adhering to policy goals. Using empirical group interview data collected in Helsinki, the capital of Finland, this case study explores local multi-agency groups and their efforts to prevent the exclusion of children and young people. These groups consist mainly of professionals from the social office, youth clubs and schools. The study shows that these multi-agency groups serve as forums for professional negotiation where the intervention dilemma of liberal society can be addressed: the question of when it is justified and necessary for an authority or network to intervene in the life of children and their families, and how this is to be done. An element of tension in multi-agency prevention is introduced by the fact that its objectives and means are anchored both in the old tradition of the welfare state and in communitarian rhetoric. Thus multi-agency groups mend deficiencies in wellbeing and normalcy while at the same time try to co-ordinate the creation of the new community, which will hopefully reduce the burden on the public sector. Some of the professionals interviewed were keen to see new and even forceful interventions to guide the youth or to compel parents to assume their responsibilities. In group discussions, this approach often met resistance. The deeper the social problems that the professionals worked with, the more solidarity they showed for the families or the young people in need. Nothing seems to assure professionals and to legitimise their professional position better than advocating the under-privileged against the uncertainties of life and the structural inequalities of society. The groups that grappled with the clear, specific needs of certain children and families were the most capable of co-operation. This requires the approval of different powers and the expertise of distinct professions as well as a forum to negotiate case-specific actions in professional confidentiality. The ideals of primary prevention for everyone and value discussions alone fail to inspire sufficient multiagency co-operation. The ideal of a network seems to give word and shape to those societal goals that are difficult or even impossible to reach, but are nevertheless yearned for: mutual understanding of the good life, close social relationships, mutual trust and active agency for all citizens. Individualisation, the multiplicity of life styles and the possibility to choose have come true in such a way that the very idea of a mutual and binding network can be attained only momentarily and between restricted participants. In conclusion, uniting professional networks that negotiate intervention dilemmas with citizen networks based on changing compassions and feelings of moral superiority seems impossible. Rather, one should encourage openness to scrutiny among tangential or contradicting groups, networks and communities. Key words: network policy, prevention of exclusion, multi-agency groups, young people

Urban growth dilemmas and solutions in China: Looking forward to 2030

China’s urbanization and industrialization are occupying farmland in large amounts, which is strongly driven by land finance regime. This is due to the intensified regional/local competition for manufacturing investment opportunities that push local governments to expropriate farmland at low prices while lease land at high market value to property developers. The additional revenue obtained in this way, termed financial increment in land values, can drive local economic growth, and provide associated infrastructure and other public services. At the same time, however, a floating population of large numbers of inadequately compensated land-lost farmers, although unable to become citizens, have to migrate into the urban areas for work, causing overheated employment and housing markets, with rocketing unaffordable housing prices. This, together with various micro factors relating to the party/state’s promotion/evaluation system play an essential role leading to some serious economic, environment and social consequences, e.g., on migrant welfare, the displacement of peasants and the loss of land resources that requires immediate attention. Our question is: whether such type of urbanization is sustainable? What are the mechanisms behind such a phenomenal urbanization process? From the perspective of institutionalism, this paper aims to investigate the institutional background of the urban growth dilemma and solutions in urban China and to introduce further an inter-regional game theoretical framework to indicate why the present urbanization pattern is unsustainable. Looking forward to 2030, paradigm policy changes are made from the triple consideration of floating population, social security and urban environmental pressures. This involves: (1) changing land increment based finance regime into land stock finance system; (2) the citizenization of migrant workers with affordable housing, and; (3) creating a more enlightened local government officer appraisal system to better take into account societal issues such as welfare and beyond.

A hitchhiker's guide to a crowded syconium: how do fig nematodes find the right ride?

P>1Organisms with low mobility, living within ephemeral environments,need to find vehicles that can disperse them reliably to new environments. The requirement for specificity in this passenger-vehicle relationship is enhanced within a tritrophic interaction when the environment of passenger and vehicle is provided by a third organism. Such relationships pose many interesting questions about specificity within a tritrophic framework. 2. Central to understanding how these tritrophic systems have evolved, is knowing how they function now. Determining the proximal cues and sensory modalities used by passengers to find vehicles and to discriminate between reliable and non-reliable vehicles is, therefore, essential to this investigation. 3. The ancient, co-evolved and highly species-specific nursery pollination mutualism between figs and fig wasps is host to species-specific plant-parasitic nematodes which use fig wasps to travel between figs. Since individual globular fig inflorescences, i.e. syconia, serve as incubators for hundreds of developing pollinating and parasitic wasps, a dispersal-stage nematode within such a chemically,complex and physically crowded environment is faced with the dilemma of choosing the right vehicle for dispersal into a new fig. Such a system therefore affords excellent opportunities to investigate mechanisms that contribute to the evolution of specificity between the passenger and the vehicle. 4. In this study of fig-wasp-nematode tritrophic interactions in Ficus racemosa within which seven wasp species can breed, we demonstrate using two-choice as well as cafeteria assays that plant-parasitic nematodes (Schistonchus racemosa) do not hitch rides randomly on available eclosing wasps within the fig syconium, but are specifically attracted, at close range, i.e. 3 mm distance, to only that vehicle which can quickly, within a few hours, reliably transfer it to another fig. This vehicle is the female pollinating wasp. Male wasps and female parasitic wasps are inappropriate vehicles since the former are wingless and die within the fig, while the latter never enter another fig. Nematodes distinguished between female pollinating wasps and other female parasitic wasps using volatiles and cuticular hydrocarbons. Nematodes could not distinguish between cuticular hydrocarbons of male and female pollinators but used other cues, such as volatiles, at close range, to find female pollinating wasps with which they have probably had a long history of chemical adaptation. 5. This study opens up new questions and hypotheses about the evolution and maintenance of specificity in fig-wasp-nematode tritrophic interactions.

Theorizing the Nature of Reflection

For the past decades reflection has been the buzzword of adult and higher education. Reflection is facilitated in many practices and there is abundant research on the issue. Despite the popularity of the concept, the reasons why bringing about reflection in educational practices is difficult remain unclear. The prevailing theories inform of the process in its ideal form. However, to a great extent, they fail to offer conceptual tools for understanding and working with the actualities of reflection. The aim of the doctoral thesis was to explore the challenges and prerequisites of reflection in order to theorize the nature of reflection. By the term reflection it is here referred to becoming aware of and questioning the assumptions that orient our thinking, feelings and actions. The doctoral thesis consists of five studies that approach these questions from different viewpoints and within different contexts. The methods involve both a philosophical and an empirical approach. This multifaceted approach embodies the aim of both gaining a more thorough grasp of the phenomenon and to develop the methodology of researching reflection. The theory building is based on conceptual analysis and rational reconstruction (see Davia 1998; Habermas 1979; Rorty1984) of Mezirow s (1981; 1991; 2000; 2009) theory of transformative learning. In order to explore the aspects which, based on the analysis, appeared insufficiently considered within Mezirow s theory, Damasio s (1994; 1999; 2003; 2010) theory on emotions and consciousness as well as Clausewitz s (1985) view on friction are used as complementary theories. Empirical analyses are used in dialogue with the theoretical, in order to challenge and refine the emerging theorization. Reflection is examined in three different contexts; regarding university teachers pedagogical growth, involuntarily childless women recovering from a life-event crisis, and soldiers preparing to act in chaotic situations of the battlefield as well as recovering from it. The choice of these contexts is based on Mezirow s notion of disorienting dilemma as a trigger for reflection. This notion indicates that reflection may more naturally emerge in association to life-event crises or other cumulative sets of instances, which bring our worldview and beliefs under question. Nevertheless, reflection is often being promoted in educational contexts in which the trigger conditions may not readily prevail. These contextual issues as well as the differences between the facilitated and non-facilitated contexts have not, however, been considered in detail within the research on reflection (or transformative learning). The doctoral thesis offers a new perspective into reflection which, as a further development on Mezirow s transformative learning theory, theorizes the nature of reflection. The developed theory explicates the prerequisites and challenges to reflection. The theory suggests that the challenges of reflection are fundamentally connected to the way the biological life-support system affects our thinking through emotions. While depicting the mechanisms that function as a counterforce to reflection, the developed theory also opens a perspective for considering possibilities for carrying out reflection, and suggests ways to locate and deal with the assumptions to be reflected on. The basic dynamic of the challenges to reflection was explicated by conceptually bridging the gap between Mezirow s and Damasio s theories, through exploring the connections between the meaning perspective and the biological functions of emotions. The concepts of comfort zone and edge-emotions were formed so as to depict the emotional orientation of our thinking, as part of the explanation of the nature of reflection.

Profitable Customer Management: A Study in Retail Banking

The increasing focus of relationship marketing and customer relationship management (CRM) studies on issues of customer profitability has led to the emergence of an area of research on profitable customer management. Nevertheless, there is a notable lack of empirical research examining the current practices of firms specifically with regard to the profitable management of customer relationships according to the approaches suggested in theory. This thesis fills this research gap by exploring profitable customer management in the retail banking sector. Several topics are covered, including marketing metrics and accountability; challenges in the implementation of profitable customer management approaches in practice; analytic versus heuristic (‘rule of thumb’) decision making; and the modification of costly customer behavior in order to increase customer profitability, customer lifetime value (CLV), and customer equity, i.e. the financial value of the customer base. The thesis critically reviews the concept of customer equity and proposes a Customer Equity Scorecard, providing a starting point for a constructive dialog between marketing and finance concerning the development of appropriate metrics to measure marketing outcomes. Since customer management and measurement issues go hand in hand, profitable customer management is contingent on both marketing management skills and financial measurement skills. A clear gap between marketing theory and practice regarding profitable customer management is also identified. The findings show that key customer management aspects that have been proposed within the literature on profitable customer management for many years, are not being actively applied by the banks included in the research. Instead, several areas of customer management decision making are found to be influenced by heuristics. This dilemma for marketing accountability is addressed by emphasizing that CLV and customer equity, which are aggregate metrics, only provide certain indications regarding the relative value of customers and the approximate value of the customer base (or groups of customers), respectively. The value created by marketing manifests itself in the effect of marketing actions on customer perceptions, behavior, and ultimately the components of CLV, namely revenues, costs, risk, and retention, as well as additional components of customer equity, such as customer acquisition. The thesis also points out that although costs are a crucial component of CLV, they have largely been neglected in prior CRM research. Cost-cutting has often been viewed negatively in customer-focused marketing literature on service quality and customer profitability, but the case studies in this thesis demonstrate that reduced costs do not necessarily have to lead to lower service quality, customer retention, and customer-related revenues. Consequently, this thesis provides an expanded foundation upon which marketers can stake their claim for accountability. By focusing on the range of drivers and all of the components of CLV and customer equity, marketing has the potential to provide specific evidence concerning how various activities have affected the drivers and components of CLV within different groups of customers, and the implications for customer equity on a customer base level.

Protein Kinase C and Anaplastic Lymphoma Kinase Targeted Compounds

The protein kinases (PKs) belong to the largest single family of enzymes, phosphotransferases, which catalyze the phosphorylation of other enzymes and proteins and function primarily in signal transduction. Consequently, PKs regulate cell mechanisms such as growth, differentiation, and proliferation. Dysfunction of these cellular mechanisms may lead to cancer, a major predicament in health care. Even though there is a range of clinically available cancer-fighting drugs, increasing number of cancer cases and setbacks such as drug resistance, constantly keep cancer research active. At the commencement of this study an isophthalic acid derivative had been suggested to bind to the regulatory domain of protein kinase C (PKC). In order to investigate the biological effects and structure-activity relationships (SARs) of this new chemical entity, a library of compounds was synthesized. The best compounds induced apoptosis in human leukemia HL-60 cells and were not cytotoxic in Swiss 3T3 fibroblasts. In addition, the best apoptosis inducers were neither cytotoxic nor mutagenic. Furthermore, results from binding affinity assays of PKC isoforms revealed the pharmacophores of these isophthalic acid derivatives. The best inhibition constants of the tested compounds were measured to 210 nM for PKCα and to 530 nM for PKCδ. Among natural compounds targeting the regulatory domain of PKC, the target of bistramide A has been a matter of debate. It was initially found to activate PKCδ; however, actin was recently reported as the main target. In order to clarify and to further study the biological effects of bistramide A, the total syntheses of the natural compound and two isomers were performed. Biological assays of the compounds revealed accumulation of 4n polyploid cells as the primary mode of action and the compounds showed similar overall antiproliferative activities. However, each compound showed a distinct distribution of antimitotic effect presumably via actin binding, proapoptotic effect presumably via PKCδ, and pro-differentiation effect as evidenced by CD11b expression. Furthermore, it was shown that the antimitotic and proapoptotic effects of bistramide A were not secondary effects of actin binding but independent effects. The third aim in this study was to synthesize a library of a new class of urea-based type II inhibitors targeted at the kinase domain of anaplastic lymphoma kinase (ALK). The best compounds in this library showed IC50 values as low as 390 nM for ALK while the initial low cellular activities were successfully increased even by more than 70 times for NPM-ALK- positive BaF3 cells. More importantly, selective antiproliferative activity on ALK-positive cell lines was achieved; while the best compound affected the BaF3 and SU-DHL-1 cells with IC50 values of 0.5 and 0.8 μM, respectively, they were less toxic to the NPM-ALK-negative human leukemic cells U937 (IC50 = 3.2 μM) and BaF3 parental cells (IC50 = 5.4 μM). Furthermore, SAR studies of the synthesized compounds revealed functional groups and positions of the scaffold, which enhanced the enzymatic and cellular activities.

"Pitää kuitenkin lähentyä sitä vangin roolia, vaikka ite ois toista mieltä" : Diskurssianalyyttinen tutkimus toiseuden rakentumisesta vankilaopetuksessa

The focus of this discourse analytical study was to review the meanings which prison education and its participants are given in the formal educational policy and to find out whether these meanings are agreed by the prison students. The intrestes of this thesis were to examine what kind of social and individual promises are related to the prison education and what kind of subject positions are possible to the prison students. The thesis was also interested in the meanings of education in different contexts. The aim of this study was to examine prison education especially for women. This thesis was based on Michel Foucault s ideas of power and the view of this study was directly critical. The prison education was seen as normalizing governance which tends to prepare its subjects to the normal. In this process of differentiating the normal and the abnormal the subjects of prison education are reconstructed as the others . The three research questions of this thesis were: how and what kind of prison education is reconstructed firstly in the strategy of prison education and secondly in the interviews. Thirdly it was questioned how and what kind of meanings gender receive in the discourse of prison education. The main data was consisted by the Finnish Criminal Sanctions Agency s document The Strategy of the Prison education for years 2008 2012 and the three interviews of women who participated to prison education. The interviews were made for this thesis in Autumn 2010. Two other Finnish Criminal Sanctions Agency s documents Prisoners in education (2007) and Visible women (2008) - the report of the working group on female prisoners were also used as subtext materials. The methods of critical and realistic discourse analysis and rhetorical analysis were applied in the analysis. The results of the thesis support the outlook of prison education as a form of normalizing governance which reconstruct the others position for the prison students. Prison education was seen supportive for personal life control and for integrating to the society. The participants of prison education repeated the official discourses in their accounts which is a signal of internalized governance. The interviewees also used different types of anti-discourses when forming implications of prison education.

Constructing a Community : Myths and Realities of the Open Development Model

The open development model of software production has been characterized as the future model of knowledge production and distributed work. Open development model refers to publicly available source code ensured by an open source license, and the extensive and varied distributed participation of volunteers enabled by the Internet. Contemporary spokesmen of open source communities and academics view open source development as a new form of volunteer work activity characterized by hacker ethic and bazaar governance . The development of the Linux operating system is perhaps the best know example of such an open source project. It started as an effort by a user-developer and grew quickly into a large project with hundreds of user-developer as contributors. However, in hybrids , in which firms participate in open source projects oriented towards end-users, it seems that most users do not write code. The OpenOffice.org project, initiated by Sun Microsystems, in this study represents such a project. In addition, the Finnish public sector ICT decision-making concerning open source use is studied. The purpose is to explore the assumptions, theories and myths related to the open development model by analysing the discursive construction of the OpenOffice.org community: its developers, users and management. The qualitative study aims at shedding light on the dynamics and challenges of community construction and maintenance, and related power relations in hybrid open source, by asking two main research questions: How is the structure and membership constellation of the community, specifically the relation between developers and users linguistically constructed in hybrid open development? What characterizes Internet-mediated virtual communities and how can they be defined? How do they differ from hierarchical forms of knowledge production on one hand and from traditional volunteer communities on the other? The study utilizes sociological, psychological and anthropological concepts of community for understanding the connection between the real and the imaginary in so-called virtual open source communities. Intermediary methodological and analytical concepts are borrowed from discourse and rhetorical theories. A discursive-rhetorical approach is offered as a methodological toolkit for studying texts and writing in Internet communities. The empirical chapters approach the problem of community and its membership from four complementary points of views. The data comprises mailing list discussion, personal interviews, web page writings, email exchanges, field notes and other historical documents. The four viewpoints are: 1) the community as conceived by volunteers 2) the individual contributor s attachment to the project 3) public sector organizations as users of open source 4) the community as articulated by the community manager. I arrive at four conclusions concerning my empirical studies (1-4) and two general conclusions (5-6). 1) Sun Microsystems and OpenOffice.org Groupware volunteers failed in developing necessary and sufficient open code and open dialogue to ensure collaboration thus splitting the Groupware community into volunteers we and the firm them . 2) Instead of separating intrinsic and extrinsic motivations, I find that volunteers unique patterns of motivations are tied to changing objects and personal histories prior and during participation in the OpenOffice.org Lingucomponent project. Rather than seeing volunteers as a unified community, they can be better understood as independent entrepreneurs in search of a collaborative community . The boundaries between work and hobby are blurred and shifting, thus questioning the usefulness of the concept of volunteer . 3) The public sector ICT discourse portrays a dilemma and tension between the freedom to choose, use and develop one s desktop in the spirit of open source on one hand and the striving for better desktop control and maintenance by IT staff and user advocates, on the other. The link between the global OpenOffice.org community and the local end-user practices are weak and mediated by the problematic IT staff-(end)user relationship. 4) Authoring community can be seen as a new hybrid open source community-type of managerial practice. The ambiguous concept of community is a powerful strategic tool for orienting towards multiple real and imaginary audiences as evidenced in the global membership rhetoric. 5) The changing and contradictory discourses of this study show a change in the conceptual system and developer-user relationship of the open development model. This change is characterized as a movement from hacker ethic and bazaar governance to more professionally and strategically regulated community. 6) Community is simultaneously real and imagined, and can be characterized as a runaway community . Discursive-action can be seen as a specific type of online open source engagement. Hierarchies and structures are created through discursive acts. Key words: Open Source Software, open development model, community, motivation, discourse, rhetoric, developer, user, end-user

Effect of dynamical asymmetry on the viscosity of a random copolymer melt

The variation of the viscosity as a function of the sequence distribution in an A-B random copolymer melt is determined. The parameters that characterize the random copolymer are the fraction of A monomers f, the parameter lambda which determines the correlation in the monomer identities along a chain and the Flory chi parameter chi(F) which determines the strength of the enthalpic repulsion between monomers of type A and B. For lambda>0, there is a greater probability of finding like monomers at adjacent positions along the chain, and for lambda<0 unlike monomers are more likely to be adjacent to each other. The traditional Markov model for the random copolymer melt is altered to remove ultraviolet divergences in the equations for the renormalized viscosity, and the phase diagram for the modified model has a binary fluid type transition for lambda>0 and does not exhibit a phase transition for lambda<0. A mode coupling analysis is used to determine the renormalization of the viscosity due to the dependence of the bare viscosity on the local concentration field. Due to the dissipative nature of the coupling. there are nonlinearities both in the transport equation and in the noise correlation. The concentration dependence of the transport coefficient presents additional difficulties in the formulation due to the Ito-Stratonovich dilemma, and there is some ambiguity about the choice of the concentration to be used while calculating the noise correlation. In the Appendix, it is shown using a diagrammatic perturbation analysis that the Ito prescription for the calculation of the transport coefficient, when coupled with a causal discretization scheme, provides a consistent formulation that satisfies stationarity and the fluctuation dissipation theorem. This functional integral formalism is used in the present analysis, and consistency is verified for the present problem as well. The upper critical dimension for this type of renormaliaation is 2, and so there is no divergence in the viscosity in the vicinity of a critical point. The results indicate that there is a systematic dependence of the viscosity on lambda and chi(F). The fluctuations tend to increase the viscosity for lambda<0, and decrease the viscosity for lambda>0, and an increase in chi(F) tends to decrease the viscosity. (C) 1996 American Institute of Physics.

Sustaining cooperation on networks: an analytical study based on evolutionary game theory

We analytically study the role played by the network topology in sustaining cooperation in a society of myopic agents in an evolutionary setting. In our model, each agent plays the Prisoner's Dilemma (PD) game with its neighbors, as specified by a network. Cooperation is the incumbent strategy, whereas defectors are the mutants. Starting with a population of cooperators, some agents are switched to defection. The agents then play the PD game with their neighbors and compute their fitness. After this, an evolutionary rule, or imitation dynamic is used to update the agent strategy. A defector switches back to cooperation if it has a cooperator neighbor with higher fitness. The network is said to sustain cooperation if almost all defectors switch to cooperation. Earlier work on the sustenance of cooperation has largely consisted of simulation studies, and we seek to complement this body of work by providing analytical insight for the same. We find that in order to sustain cooperation, a network should satisfy some properties such as small average diameter, densification, and irregularity. Real-world networks have been empirically shown to exhibit these properties, and are thus candidates for the sustenance of cooperation. We also analyze some specific graphs to determine whether or not they sustain cooperation. In particular, we find that scale-free graphs belonging to a certain family sustain cooperation, whereas Erdos-Renyi random graphs do not. To the best of our knowledge, ours is the first analytical attempt to determine which networks sustain cooperation in a population of myopic agents in an evolutionary setting.

Bi-Modal DRAM Cache: Improving Hit Rate, Hit Latency and Bandwidth

In this paper, we present Bi-Modal Cache - a flexible stacked DRAM cache organization which simultaneously achieves several objectives: (i) improved cache hit ratio, (ii) moving the tag storage overhead to DRAM, (iii) lower cache hit latency than tags-in-SRAM, and (iv) reduction in off-chip bandwidth wastage. The Bi-Modal Cache addresses the miss rate versus off-chip bandwidth dilemma by organizing the data in a bi-modal fashion - blocks with high spatial locality are organized as large blocks and those with little spatial locality as small blocks. By adaptively selecting the right granularity of storage for individual blocks at run-time, the proposed DRAM cache organization is able to make judicious use of the available DRAM cache capacity as well as reduce the off-chip memory bandwidth consumption. The Bi-Modal Cache improves cache hit latency despite moving the metadata to DRAM by means of a small SRAM based Way Locator. Further by leveraging the tremendous internal bandwidth and capacity that stacked DRAM organizations provide, the Bi-Modal Cache enables efficient concurrent accesses to tags and data to reduce hit time. Through detailed simulations, we demonstrate that the Bi-Modal Cache achieves overall performance improvement (in terms of Average Normalized Turnaround Time (ANTT)) of 10.8%, 13.8% and 14.0% in 4-core, 8-core and 16-core workloads respectively.

Aspectos antropológicos de las terapias con células madre

Resumen: Las células madre tienen dos características naturales únicas, que son su capacidad de división celular indefinida, y de regeneración y reparación de tejidos. Esto genera un gran interés en las áreas de investigación y tratamiento de enfermedades que aún no tienen cura y son motivadoras de una importante fuente de esperanza para los pacientes. Surge, entonces, el dilema ético de definir cuáles serán los recursos para obtenerlas, procesarlas y determinar la seguridad y eficacia de su uso en la aplicación clínica. Un enfoque personalista ontológico considerará la protección de todos los participantes en los procesos de investigación: los donantes de células, los participantes de la investigación y los pacientes que serán beneficiarios de estos tratamientos, de manera de proteger a todos los involucrados sin exponer a riesgos a unos para salvar a otros.

Tratamientos proporcionados y desproporcionados en el estado vegetativo persistente

Los pacientes en estado vegetativo permanente representan un dilema ético en términos de atención médica. El problema está instalado en la sociedad desarrollando un importante dilema que implica la justicia, la religión, la economía y la familia. En el presente trabajo se analiza esta problemática de acuerdo con el “principio de lo éticamente adecuado en el uso de los medios de conservación de la vida”, desarrollado por el profesor M. Calipari. Se presentarán varios casos clínicos que serán analizados a través de esta teoría complementada con aspectos médicos y judiciales, según la legislación argentina.

Diagnóstico prenatal : su relación con la prevención de enfermedades fundantes de discapacidad

Resumen: La prevención de enfermedades que fundan discapacidad es un tema central en las políticas de salud pública, y en la vida de las familias, dada la contribución de las mismas en la morbi-mortalidad perinatal. La implementación del diagnóstico prenatal genera, entonces, un dilema controversial. Por un lado, se interpreta que el diagnóstico temprano de la patología favorece el mejor desarrollo y adaptación del niño por nacer y sus familias, porque definen el estatuto moral del feto como inherente, por lo que deben recibir las mismas consideraciones morales que el niño ya nacido. Pero por otro, se asumen como medidas preventivas que disminuyen la prevalencia de enfermedades genéticas, al evitar el nacimiento de niños con estas patologías. El niño por nacer no es considerado como persona y la discapacidad se interpreta como un daño para el niño y su familia, y debe ser evitada. Tres conceptos se involucran en este conflicto: el de persona; el de discapacidad; y el de prevención de enfermedades. El objetivo del trabajo es realizar una reflexión acerca de la interpretación de estos conceptos en las diferentes visiones en bioética, que facilite una profundización de la compresión de los mismos y permita aplicar los avances tecnológicos de manera que respeten la condición humana.

Impacto de la evolución científico-tecnológica en la Bioética neonatal-perinatal

Resumen: Los avances científico-tecnológicos en neonatología en los últimos 40 años han permitido una importante mejoría en la sobrevida de recién nacidos de extremo bajo peso al nacer, sin embargo la mortalidad neonatal aun representa un porcentaje muy grande de la mortalidad infantil. Esto esta principalmente relacionado a las muertes por prematuridad y sus complicaciones, anomalías congénitas y asfixia perinatal. La mayoría de los recién nacidos son tratados favorablemente en sala de partos y son admitidos a la Unidad de Cuidados Intensivos Neonatales (UCIN). La incertidumbre en el pronóstico de los prematuros extremos en el límite de la viabilidad con alto riesgo de morir en la UCIN o presentar alguna discapacidad, presenta un difícil dilema ético. Se deberá considerar cada caso en forma individual y evaluar el riesgo-beneficio entre las conductas a seguir y el “mejor interés para el niño” y los deseos de los padres que guiarán a decisiones éticas. Diferentes guías de cuidado y variaciones en la práctica médica en los límites de la viabilidad fetal se han descripto dentro y entre países. El objetivo es proveer a los padres una comunicación abierta, directa y transparente con suficiente entendimiento de los factores más relevantes en relación a la situación clínica, el pronóstico y las opciones de tratamiento para que ellos puedan tener una significativa participación en la toma de decisiones. Aceptar que en neonatología, hacer todo lo que uno puede hacer puede ser perjudicial, no útil o beneficioso. No todo lo técnicamente posible es éticamente correcto. El dilema afecta tanto al origen de la vida como a la terminación de la vida.