Does withdrawing life-sustaining treatment cause death or allow the patient to die?

The paper discusses the view of Franklin Miller and Robert Truog that withdrawing life-sustaining treatment causes death and so is a form of killing. I reject that view. I argue that even if we think there is no morally relevant difference between allowing a patient to die and killing her (itself a controversial view), it does not follow that allowing to die is a form of killing. I then argue that withdrawing life-sustaining treatment is properly classified as allowing the patient to die rather than as killing her. Once this is accepted, the law cannot be criticised for inconsistency by holding, as it does, that it is lawful to withdraw life-sustaining treatment but unlawful to give patients a lethal injection.

Safety management in repair, maintenance, minor alteration, and addition works : knowledge management perspective

Safety of repair, maintenance, alteration, and addition (RMAA) works have long been neglected because RMAAworks are often minute and only last for a short period of time. With rising importance of the RMAA sector in many developed societies, safety of RMAA works has begun to draw attention. Many RMAA contracting companies are small- and medium-sized enterprises (SMEs) that do not have comprehensive safety management systems. Existing safety legislation and regulations for new construction sites are not fully applicable to RMAAworks. Instead of relying on explicit and well-established safety systems, tacit safety knowledge plays an extremely important role in RMAA projects. To improve safety of RMAAworks, safety knowledge should be better managed. However, safety knowledge is difficult to capture in RMAA works. This study aims to examine safety management practices of RMAA contracting companies to see how safety knowledge of RMAA projects is managed. Findings show that RMAA contracting companies undertaking large-scale RMAA projects have more initiatives of safety management. Safety management of small-scale RMAA works relies heavily on the motivation of site supervisors and self-regulation of workers. Better tacit knowledge management improves safety performance. To enhance safety capability of RMAA contracting companies, a knowledge sharing culture should be cultivated. The government should provide assistance to SMEs to implement proper safety management practices in small-sized projects. Potentials of applying computer software technology in RMAA projects to capture, store, and retrieve safety information should be explored. Employees should be motivated to share safety knowledge by giving proper recognition to those who are willing to share.

More than simple living : a cultural perspective on sustainable living

This paper provides a cultural perspective to the sustainability research within HCI. I draw on the results from an ethnographic field study of sustainable household practices of ten women belonging to the so-called middle class in India. Focusing on their reuse practices, I provide examples of domestic artefacts that are creatively and resourcefully reused from worn-out artefacts. My initial findings show that the rationale behind creating such artefacts is not limited to the practicality and usefulness, but how cultural and religious beliefs are incorporated into such practices.

Designing for Awareness: An Experience-focused HCI Perspective

Within Human-Computer Interaction (HCI) and Computer Supported Cooperative Work (CSCW) research, the notion of technologically-mediated awareness is often used for allowing relevant people to maintain a mental model of activities, behaviors and status information about each other so that they can organize and coordinate work or other joint activities. The initial conceptions of awareness focused largely on improving productivity and efficiency within work environments. With new social, cultural and commercial needs and the emergence of novel computing technologies, the focus of technologically-mediated awareness has extended from work environments to people’s everyday interactions. Hence, the scope of awareness has extended from conveying work related activities to people’s emotions, love, social status and other broad range of aspects. This trend of conceptualizing HCI design is termed as experience-focused HCI. In my PhD dissertation, designing for awareness, I have reported on how we, as HCI researchers, can design awareness systems from experience-focused HCI perspective that follow the trend of conveying awareness beyond the task-based, instrumental and productive needs. Within the overall aim to design for awareness, my research advocates ethnomethodologically-informed approaches for conceptualizing and designing for awareness. In this sense, awareness is not a predefined phenomenon but something that is situated and particular to a given environment. I have used this approach in two design cases of developing interactive systems that support awareness beyond task-based aspects in work environments. In both the cases, I have followed a complete design cycle: collecting an in-situ understanding of an environment, developing implications for a new technology, implementing a prototype technology to studying the use of the technology in its natural settings.

A comparison of patient matched meibum and tear lipidomes

Purpose. To quantify the molecular lipid composition of patient-matched tear and meibum samples and compare tear and meibum lipid molecular profiles. Methods. Lipids were extracted from tears and meibum by bi-phasic methods using 10:3 tertbutyl methyl ether:methanol, washed with aqueous ammonium acetate, and analyzed by chipbased nanoelectrospray ionization tandem mass spectrometry. Targeted precursor ion and neutral loss scans identified individual molecular lipids and quantification was obtained by comparison to internal standards in each lipid class. Results. Two hundred and thirty-six lipid species were identified and quantified from nine lipid classes comprised of cholesterol esters, wax esters, (O-acyl)-x-hydroxy fatty acids, triacylglycerols, phosphatidylcholine, lysophosphatidylcholine, phosphatidylethanolamine, sphingomyelin, and phosphatidylserine. With the exception of phospholipids, lipid molecular profiles were strikingly similar between tears and meibum. Conclusions. Comparisons between tears and meibum indicate that meibum is likely to supply the majority of lipids in the tear film lipid layer. However, the observed higher mole ratio of phospholipid in tears shows that analysis of meibum alone does not provide a complete understanding of the tear film lipid composition.

Geometric sensitivity of patient-specific finite element models of the spine to variability in user-selected anatomical landmarks

Software to create individualised finite element (FE) models of the osseoligamentous spine using pre-operative computed tomography (CT) data-sets for spinal surgery patients has recently been developed. This study presents a geometric sensitivity analysis of this software to assess the effect of intra-observer variability in user-selected anatomical landmarks. User-selected landmarks on the osseous anatomy were defined from CT data-sets for three scoliosis patients and these landmarks were used to reconstruct patient-specific anatomy of the spine and ribcage using parametric descriptions. The intra-observer errors in landmark co-ordinates for these anatomical landmarks were calculated. FE models of the spine and ribcage were created using the reconstructed anatomy for each patient and these models were analysed for a loadcase simulating clinical flexibility assessment. The intra-observer error in the anatomical measurements was low in comparison to the initial dimensions, with the exception of the angular measurements for disc wedge and zygapophyseal joint (z-joint) orientation and disc height. This variability suggested that CT resolution may influence such angular measurements, particularly for small anatomical features, such as the z-joints, and may also affect disc height. The results of the FE analysis showed low variation in the model predictions for spinal curvature with the mean intra-observer variability substantially less than the accepted error in clinical measurement. These findings demonstrate that intra-observer variability in landmark point selection has minimal effect on the subsequent FE predictions for a clinical loadcase.

Bone regeneration based on tissue engineering conceptions – a 21st century perspective

The role of Bone Tissue Engineering in the field of Regenerative Medicine has been the topic of substantial research over the past two decades. Technological advances have improved orthopaedic implants and surgical techniques for bone reconstruction. However, improvements in surgical techniques to reconstruct bone have been limited by the paucity of autologous materials available and donor site morbidity. Recent advances in the development of biomaterials have provided attractive alternatives to bone grafting expanding the surgical options for restoring the form and function of injured bone. Specifically, novel bioactive (second generation) biomaterials have been developed that are characterised by controlled action and reaction to the host tissue environment, whilst exhibiting controlled chemical breakdown and resorption with an ultimate replacement by regenerating tissue. Future generations of biomaterials (third generation) are designed to be not only osteo- conductive but also osteoinductive, i.e. to stimulate regeneration of host tissues by combining tissue engineer- ing and in situ tissue regeneration methods with a focus on novel applications. These techniques will lead to novel possibilities for tissue regeneration and repair. At present, tissue engineered constructs that may find future use as bone grafts for complex skeletal defects, whether from post-traumatic, degenerative, neoplastic or congenital/developmental “origin” require osseous reconstruction to ensure structural and functional integrity. Engineering functional bone using combinations of cells, scaffolds and bioactive factors is a promising strategy and a particular feature for future development in the area of hybrid materials which are able to exhibit suitable biomimetic and mechanical properties. This review will discuss the state of the art in this field and what we can expect from future generations of bone regeneration concepts.

Venous leg ulcer recurrence : deciphering long term patient adherence to preventive treatments and activities

To better understand long term adherence to self-care activities to prevent the recurrence of venous leg ulcers, participants (n=80) were recruited to a prospective longitudinal study after experiencing healing of a venous leg ulcer. Data on demographics, health, psychosocial measures and adherence to prevention strategies (compression therapy, leg elevation and lower leg exercise) were collected every three months for one year after healing. Multivariable regression modelling was used to identify the factors that were independently associated with adherence. Over the year, a significant decline in adherence to all three strategies was observed, predominantly between 6–12 months after healing (p<0.01). Several factors were associated with adherence to more than one preventive activity. Regular follow-up care and a history of multiple previous ulcers were related to improved adherence (p<0.05), while scoring at higher risk for depression and restricted mobility were related to decreasing adherence over time (p<0.05). Patients with osteoarthritis had significantly reduced adherence to compression hosiery (p=0.026). These results provide information to assist care providers plan strategies for prevention of recurrent venous leg ulcers; and suggest a need for regular follow-up care which addresses both the physical and mental health of this population.

Gender inequities in health research : an Australian perspective

This chapter presents the current challenges facing legislators, regulators, researchers, and ethics committees in determining how and when to include women appropriately in research, and ensure that sex analysis of research results is routinely performed. It offers five issues that require attention to address these challenges: that national regulatory statements could provide researchers with definitions of the terms ‘sex’ , ‘gender’, and ‘gender equity’ in research; that sex and gender analysis should be built into health research protocols; the lack of internationally comparable data regarding the rates of inclusion of men and women presents a major hurdle for analysing the efficacy of different regulatory strategies; the accessibility of data would be facilitated by a requirement for publication of the results of health research to include descriptions of sex analysis performed on research data; and that institutional review boards, research ethics committees, and researchers themselves require better education about the scientific and ethical importance of including of women in clinical research.

Optimising employee engagement with internal communication : a social exchange perspective

Drawing on principles of social exchange this thesis employs mediated regression to investigate the relationship between internal communication and employee engagement in the Australian workforce. Findings suggest organisations and supervisors should focus internal communication efforts toward building greater perceptions of support and stronger identification among employees in order to foster optimal engagement. This research contributes to public relations and management scholarship through understanding how perceived support and identification act as mediating mechanisms in the relationship between internal communication and employee engagement at the organisational and supervisory level.

Designing intelligent litigation support tools : The IKBALS perspective

In the legal domain, it is rare to find solutions to problems by simply applying algorithms or invoking deductive rules in some knowledge‐based program. Instead, expert practitioners often supplement domain‐specific knowledge with field experience. This type of expertise is often applied in the form of an analogy. This research proposes to combine both reasoning with precedents and reasoning with statutes and regulations in a way that will enhance the statutory interpretation task. This is being attempted through the integration of database and expert system technologies. Case‐based reasoning is being used to model legal precedents while rule‐based reasoning modules are being used to model the legislation and other types of causal knowledge. It is hoped to generalise these findings and to develop a formal methodology for integrating case‐based databases with rule‐based expert systems in the legal domain.

What is a good project manager? An Aristotelian perspective

The purpose of this paper is to take a critical look at the question “what is a competent project manager?” and bring some fresh added-value insights. This leads us to analyze the definitions, and assessment approaches of project manager competence. Three major standards as prescribed by PMI, IPMA, and GAPPS are considered for review from an attribute-based and performance-based approach and from a deontological and consequentialist ethics perspectives. Two fundamental tensions are identified: an ethical tension between the standards and the related competence assessment frameworks and a tension between attribute and performance-based approaches. Aristotelian ethical and practical philosophy is brought in to reconcile these differences. Considering ethics of character that rises beyond the normative deontological and consequentialist perspectives is suggested. Taking the mediating role of praxis and phrónêsis between theory and practice into consideration is advocated to resolve the tension between performance and attribute-based approaches to competence assessment.

Learning and development opportunities as a tool for the retention of volunteers : a motivation perspective

The growing reliance on volunteers in Australia has heightened the need for non-profit organisations to retain these valuable resources. However, the current literature on volunteer retention is limited. One potential way volunteers can be retained is by providing learning and development opportunities (LDOs). This study investigates the relationship between volunteer perceptions of LDOs, their motivations for volunteering, and retention. Analyses revealed significant main effects for LDOs and volunteer motivations on retention and several interactive effects demonstrating that LDOs can have differential effects on retention depending on the reasons for volunteering.

Organizational factors impacting on patient satisfaction : a cross sectional examination of service climate and linkages to nurses' effort and performance

Background Patient satisfaction is influenced by the setting in which patients are treated and the employees providing care. However, to date, limited research has explained how health care organizations or nurses influence patient satisfaction. Objectives The purpose of this study was to test the model that service climate would increase the effort and performance of nursing groups and, in turn, increase patient satisfaction. Method This study incorporated data from 156 nurses, 28 supervisors, and 171 patients. A cross-sectional design was utilized to examine the relationship between service climate, nurse effort, nurse performance and patient satisfaction. Structural equation modeling was conducted to test the proposed relationships. Results Service climate was associated with the effort that nurses directed towards technical care and extra-role behaviors. In turn, the effort that nurses exerted predicted their performance, as rated by their supervisors. Finally, task performance was a significant predictor of patient satisfaction. Conclusions This study suggests that both hospital management and nurses play a role in promoting patient satisfaction. By focusing on creating a climate for service, health care managers can improve nursing performance and patient satisfaction with care.

Developing transactive memory systems : theoretical contributions from a social identity perspective

Transactive memory system (TMS) theory explains how expertise is recognized and coordinated in teams. Extending current TMS research from a group information-processing perspective, our article presents a theoretical model that considers TMS development from a social identity perspective. We discuss how two features of communication (quantity and quality) important to TMS development are linked to TMS through the group identification mechanism of a shared common team identity. Informed by social identity theory, we also differentiate between intragroup and intergroup contexts and outline how, in multidisciplinary teams, professional identification and perceived equality of status among professional subgroups have a role to play in TMS development. We provide a theoretical discussion of future research directions aimed at testing and extending our model.