Perceptions de néphrologues transplanteurs et référents face à la quantification du risque immunologique global en transplantation rénale

Problématique : La pénurie d’organes qui sévit actuellement en transplantation rénale incite les chercheurs et les équipes de transplantation à trouver de nouveaux moyens afin d’en améliorer l’efficacité. Le Groupe de recherche transdisciplinaire sur les prédicteurs du risque immunologique du FRSQ travaille actuellement à mettre en place de nouveaux outils facilitant la quantification du risque immunologique global (RIG) de rejet de chaque receveur en attente d’une transplantation rénale. Le calcul du RIG s’effectuerait en fonction de facteurs scientifiques et quantifiables, soit le biologique, l’immunologique, le clinique et le psychosocial. La détermination précise du RIG pourrait faciliter la personnalisation du traitement immunosuppresseur, mais risquerait aussi d’entraîner des changements à l’actuelle méthode de sélection des patients en vue d’une transplantation. Cette sélection se baserait alors sur des critères quantifiables et scientifiques. L’utilisation de cette méthode de sélection possède plusieurs avantages, dont celui d’améliorer l’efficacité de la transplantation et de personnaliser la thérapie immunosuppressive. Malgré tout, cette approche soulève plusieurs questionnements éthiques à explorer chez les différents intervenants œuvrant en transplantation rénale quant à sa bonne utilisation. Buts de l’étude : Cette recherche vise à étudier les perceptions de néphrologues transplanteurs et référents de la province de Québec face à l’utilisation d’une méthode de sélection des patients basée sur des critères scientifiques et quantifiables issus de la médecine personnalisée. Les résultats pourront contribuer à déterminer la bonne utilisation de cette méthode et à étudier le lien de plus en plus fort entre science et médecine. Méthodes : Des entretiens semi-dirigés combinant l’emploi de courtes vignettes cliniques ont été effectués auprès de 22 néphrologues québécois (transplanteurs et référents) entre juin 2007 à juillet 2008. Le contenu des entretiens fut analysé qualitativement selon la méthode d’analyse de Miles et Huberman. Résultats : Les résultats démontrent une acceptation généralisée de cette approche. La connaissance du RIG pour chaque patient peut améliorer le traitement et la prise en charge post-greffe. Son efficacité serait supérieure à la méthode actuelle. Par contre, la possible exclusion de patients pose un important problème éthique. Cette nouvelle approche doit toutefois être validée scientifiquement et accorder une place au jugement clinique. Conclusions : La médecine personnalisée en transplantation devrait viser le meilleur intérêt du patient. Malgré l’utilisation de données scientifiques et quantifiables dans le calcul du RIG, le jugement clinique doit demeurer en place afin d’aider le médecin à prendre une décision fondée sur les données médicales, son expertise et sa connaissance du patient. Une réflexion éthique approfondie s’avère nécessaire quant à l’exclusion possible de patients et à la résolution de la tension entre l’équité et l’efficacité en transplantation rénale.

Teaching of medical ethics: Implications for an integrated curriculum

This paper reports on an investigation into the teaching of medical ethics and related areas in the medical undergraduate course at the University of Queensland. The project was designed in the context of a major curriculum change to replace the current 6 year course by an integrated, problem-based, 4 year graduate medical course, which began in 1997. A survey of clinical students, observations of clinical teaching sessions, and interviews with clinical teachers were conducted. Data obtained have contributed to curriculum development and will provide a baseline for comparison and evaluation of the graduate course in this field. A view of integrated ethics teaching is advanced in the light of the data obtained.

Ethics and creative accounting: Some empirical evidence on accounting for intangibles in Spain

Recent research shows that financial reports are losing relevance. Mainly thisis due to the growing strategic importance of intangible assets in theperformance of a company. A possible solution is to modify accounting standardsso that statements include more self-generated intangible assets, taking intoaccount with their inherent risk and difficulty of valuation. We surveyed loanofficers who were asked to assess the credit-worthiness of a hypotheticalcompany. The only information given was a simplified version of financialstatements. Half the group got statements where research and development costshad been capitalized. The other half got statements in which these costs hadbeen treated as an expense. The findings show that capitalization wassignificantly more likely to attract a positive response to a loan request. Thepaper raises the question of whether accounting for intangibles might providemanagers with one more creative accounting technique and, in consequence, itsethical implications.

Educating integrated catalysts: transforming business schools toward ethics and sustainability

Joining the sharpening critique of conventional University-based business school education, we argue that educating integrated catalysts is necessary to meet current sustainability challenges. The key feature of moving toward the integration required at the individual level is focusing on developing students' capacity for moral and cognitive maturity. Practically, this makes the practice of genuine dialogue focal as core interpersonal method for educating management students. In supporting such education, business schools must however first transform themselves. Acting as transformative social enterprises, they can demonstrate being a part in critically questioning and improving the impact and relevance of management on the flourishing of wider society and the practice of an ethically oriented economy. We offer practical suggestions and implications for future business education reform.

Il ruolo della Narrative in Medical Ethics, Medical Practice e Medical Education. Elementi di ricerca

La mia tesi di dottorato ha ad oggetto lo studio e l’analisi del ruolo della Narrative all’interno di tre ambiti, quali Medical Ethics, Clinical Practice e Medical Education. La tesi è strutturata in 4 capitoli: i primi tre vanno a comporre la parte teorica mentre nel quarto capitolo viene riportata una ricerca sul campo da me svolta negli Stati Uniti. Nel primo capitolo, analizzo il ruolo della narrative all’interno della Medical Ethics specificando che cosa si intenda con etica narrativa, quali sono le motivazione alla base del suo sviluppo e chi sono i suoi principali esponenti. In questo capitolo, inoltre, esamino i problemi che l’etica narrativa solleva suggerendo un nuovo modo in cui essa si integra alla riflessione bioetica. Il secondo capitolo è dedicato al contributo della narrative nella Medical Practice investigando sia le modalità attraverso le quali il paziente può avvalersi della narrazione per analizzare la sua esperienza di malattia sia la cosiddetta Medicina Narrativa. Il terzo capitolo è dedicato all'analisi delle Medical Humanities, ossia di quelle discipline che all’interno della Medical Education si stanno rivelando strumenti efficaci per una formazione più equilibrata e completa dei professionisti della salute. Il quarto capitolo, invece, è dedicato alla descrizione di una ricerca svolta presso l’University of California – Irvine . Durante questa esperienza ho frequentato i corsi del Program in Medical Humanities and Arts diretto dalla Prof.ssa J. Shapiro, (programma in vigore da 13 anni e implementato allo scopo di migliorare alcune competenze nei futuri medici quali: l'empatia, l’altruismo, la compassione e la predisposizione alla cura verso i pazienti, oltre che per affinare le comunicazione clinica e la capacità di osservazione) e intervistato gli studenti che hanno preso parte a queste lezioni.

State of the art of integrated therapy approaches in the treatment of schizophrenia: empirical evidence and clinical relevance

Objective: Integrated behavior therapy approaches are defined by the combination of behavioral and or cognitive interventions targeting neurocognition combined with other goal-oriented treatment targets such as social cognition, social skills, or educational issues. The Integrated Psychological Therapy Program (IPT) represents one of the very first behavior therapy approaches combining interventions of neurocognition, social cognition, and social competence. This comprehensive group-based bottom-up and top-down approach consists of five subprograms, each with incremental steps. IPT has been successfully implemented in several countries in Europe, America, Australia and in Asia. IPT worked as a model for some other approaches designed in the USA. IPT was undergone two further developments: based on the social competence part of IPT, the three specific therapy programs focusing residential, occupational or recreational topics were developed. Recently, the cognitive part of INT was rigorously expanded into the Integrated Neurocognitive Therapy (INT) designed exclusively for outpatient treatment: INT includes interventions targeting all neurocognitive and social cognitive domains defined by the NIMH-MATRICS initiative. These group and partially PC-based exercises are structured into four therapy modules, each starting with exercises on neurocognitive domains followed by social cognitive targets. Efficacy: The evidence of integrated therapy approaches and its advantage compared to of one-track interventions was becoming a discussion tool in therapy research as well as in mental health systems. Results of meta-analyses support superiority of integrated approaches compared to one-track interventions in more distal outcome areas such as social functioning. These results are in line with the large body of 37 independent IPT studies in 12 countries. Moreover, IPT research indicates the maintenance of therapy effects after the end of therapy and some evidence generalization effects. Additionally, the international randomized multi-center study on INT with 169 outpatients strongly supports the successful therapy of integrated therapy in proximal and distal outcome such as significant effects in cognition, functioning and negative symptoms. Clinical implication: therapy research as well as expert’s clinical experience recommends integrated therapy approaches such as IPT to be successful agents within multimodal psychiatric treatment concepts. Finally, integrated group therapy based on cognitive remediation seems to motivate and stimulate schizophrenia inpatients and outpatients to more successful and independent life also demanded by the recovery movement.

Integrated strategic supply chain positioning for SME's:an empirical study

Purpose – The purpose of this paper is to report on an investigation into the selection and evaluation of a suitable strategic positioning methodology for SMEs in Singapore. Design/methodology/approach – The research methodology is based on critical review of the literature to identify the potentially most suitable strategic positioning methodology, evaluation and testing of the methodology within the context of SME's in Singapore, and analysis to determine the strengths and weaknesses of the methodology and opportunities for further research. Findings – This paper illustrates a leading integrated strategic positioning decision making process, which has been found to be potentially suitable for SMEs in Singapore, and the process is then applied and evaluated in two industrial case studies. Results in the form of strengths, weaknesses and opportunities are evaluated and discussed in detail, and further research to improve the process has been identified. Practical implications – A practical and integrated strategic supply chain positioning methodology for SMEs to define their own competitive space, among other companies in the manufacturing supply chain, so as to maximize business competitiveness. Originality/value – This paper contributes to the knowledge of the strategic positioning decision process as well as identifies further research to adapt the process for SMEs in Singapore.

An integrated psychology virtual research ethics committee

Research and professional ethics are an integral part of every Psychology degree, as this is seen as a key graduate learning outcome for students leaving to become clinicians working with clients and patients. The development of these skills is embedded in teaching, but they culminate in the final year of a degree when final year students must gain formal ethical approval for their final research project. Decision as to the ethical appropriateness of research are made by a Departmental Research Ethics Committee, which considers all research project proposals submitted by staff and students within the department. One of the challenges of this practice is the scale of work involved for committee members (Doyle & Buckley, 2014) who are all faculty members, and the tracking of applications and decisions, alongside the quality assurance required to ensure that all applications are treated fairly and equally. The time involved in performing this work is often underestimated by Universities, and the variety and complexity of decisions requires extensive discussion and negotiation. Traditionally, these decisions are reached by committee discussions, however this presents logistical difficulties as it requires meetings with quorate attendance. The University of Westminster launched a virtual tool in 2014 to facilitate the management of the Research Ethics Committee, to help track the progress of applications and to allow discussions to occur and be managed virtually. The Department of Psychology adopted the tools in September 2014 to deal with all ethics applications. Here we report on how this virtual committee has affected the role and practices of a working committee that deals with over 300 applications per year, and how an online ethics procedure has facilitated an integrated developmental approach to ethical education.

The interaction of economic and pedagogical ideals in the context of workplace learning in Germany: a framework for empirical research – inspired by business ethics

As an effect of marketisation, the importance of workplace learning in Germany has increased. The article follows up on the long-standing discourse around the question of how economic and pedagogical ideals interact in this context. In order to develop a theoretical framework for empirical research, three major positions of the discipline of business ethics are introduced. Business ethics in more abstract ways deals with the very same question, namely how do ideas such as profit orientation interact with other norms and values? The new perspectives show that the discourse has been hitherto based on a specific understanding of economy. In order to derive an empirical answer to the research question, the question is re-formulated as follows: Which values are inherent in the decisions taken? Consequently, it suggests using the concept of ‘rationalities of justification’ for empirical research. The article shows how this concept can be applied by conducting a test run. (DIPF/Orig.)

An Integrated Framework To Improve The Concept Of Resource Specialisation.

Resource specialisation, although a fundamental component of ecological theory, is employed in disparate ways. Most definitions derive from simple counts of resource species. We build on recent advances in ecophylogenetics and null model analysis to propose a concept of specialisation that comprises affinities among resources as well as their co-occurrence with consumers. In the distance-based specialisation index (DSI), specialisation is measured as relatedness (phylogenetic or otherwise) of resources, scaled by the null expectation of random use of locally available resources. Thus, specialists use significantly clustered sets of resources, whereas generalists use over-dispersed resources. Intermediate species are classed as indiscriminate consumers. The effectiveness of this approach was assessed with differentially restricted null models, applied to a data set of 168 herbivorous insect species and their hosts. Incorporation of plant relatedness and relative abundance greatly improved specialisation measures compared to taxon counts or simpler null models, which overestimate the fraction of specialists, a problem compounded by insufficient sampling effort. This framework disambiguates the concept of specialisation with an explicit measure applicable to any mode of affinity among resource classes, and is also linked to ecological and evolutionary processes. This will enable a more rigorous deployment of ecological specialisation in empirical and theoretical studies.

DERIVING METALLICITIES FROM THE INTEGRATED SPECTRA OF EXTRAGALACTIC GLOBULAR CLUSTERS USING THE NEAR-INFRARED CALCIUM TRIPLET

The Ca II triplet (CaT) feature in the near-infrared has been employed as a metallicity indicator for individual stars as well as integrated light of Galactic globular clusters (GCs) and galaxies with varying degrees of success, and sometimes puzzling results. Using the DEIMOS multi-object spectrograph on Keck we obtain a sample of 144 integrated light spectra of GCs around the brightest group galaxy NGC 1407 to test whether the CaT index can be used as ametallicity indicator for extragalactic GCs. Different sets of single stellar population models make different predictions for the behavior of the CaT as a function of metallicity. In this work, the metallicities of the GCs around NGC 1407 are obtained from CaT index values using an empirical conversion. The measured CaT/metallicity distributions show unexpected features, the most remarkable being that the brightest red and blue GCs have similar CaT values despite their large difference in mean color. Suggested explanations for this behavior in the NGC 1407 GC system are (1) the CaT may be affected by a population of hot blue stars, (2) the CaT may saturate earlier than predicted by the models, and/or (3) color may not trace metallicity linearly. Until these possibilities are understood, the use of the CaT as a metallicity indicator for the integrated spectra of extragalactic GCs will remain problematic.

The impact of life stage and societal culture on subordinate influence ethics: A study of Brazil, China, Germany, and the US

In this paper, we investigate the effects of societal values and life stage on subordinate influence ethics. Based on the evolving crossvergence theory of macro-level predictors of values evolution, we demonstrate the applicability of crossvergence theory in the micro-level context. Furthermore, our study provides the first empirical multi-level analysis of influence ethics utilizing a multi pie-country sample. Thus, we illustrate how the breath of crossvergence can be expanded to provide a multi-level theoretical foundation of values and behavior evolution across cultures. Specifically, we integrate micro-level life stage theory and macro-level societal culture theory to concurrently assess the contributions of each theory in explaining subordinate influence ethics across the diverse societies of Brazil. China, Germany and the U.S. Consistent with previous research, we found significant societal differences in influence ethics. However, we also found that life stage theory played a significant role in understanding influence ethics. Thus, our findings expand the crossvergence perspective on societal change, indicating that key micro-level predictors (e.g., life stage) should be included in cross-cultural research. (C) 2009 Elsevier Inc. All rights reserved.

Investigating the gap between citizens` sustainability attitudes and food purchasing behaviour: empirical evidence from Brazilian pork consumers

Consumers worldwide are increasingly concerned with sustainable production and consumption. Recently, a comprehensive study ranked 17 countries in regard to their environmentally friendly behaviour among consumers. Brazil was one of the top countries in the list. Yet, several studies highlight significant differences between consumers` intentions to consume ethically, and their actual purchase behaviour: the so-called `Attitude-Behaviour Gap`. In developing countries, few studies have been conducted on this issue. The objective of this study is therefore to investigate the gap between citizens` sustainability-related attitudes and food purchasing behaviour using empirical data from Brazil. To this end, Brazilian citizens` attitudes towards pig production systems were mapped through conjoint analysis and their coexistence with relevant pork product-related purchasing behaviour of consumers was investigated through cluster analysis. The conjoint experiment was carried Out with empirical data collected from 475 respondents surveyed in the South and Center-West regions of Brazil. The results of the conjoint analysis were used for a subsequent cluster analysis in order to identify clusters of Brazilian citizens with diversified attitudes towards pig production systems, using socio-demographics, attitudes towards sustainability-related themes that are expected to influence the way they evaluate pig production systems, and consumption frequency of various pork products as clusters` background information. Three clusters were identified as `indifferent`, `environmental conscious` and `sustainability-oriented` citizens. Although attitudes towards environment and nature had indeed an influence on citizens` specific attitudes towards pig farming at the cluster level, the relationship between `citizenship` and consumption behaviour was found to be weak. This finding is similar to previous research conducted with European consumers: what people (in their role of citizens) think about pig production systems does not appear to significantly influence their pork consumption choices. Improvements in the integrated management of this chain would better meet consumers` sustainability-related expectations towards pig production systems.

The effects of adolescent cannabis use: How should the empirical evidence inform drug policy for young people? : Meeting abstract

Ethics as a subject is now consistently taught in medical schools within Australia. The theoretical Ethical models used, and the associated clinical discussions, vary between schools. Registrars have further theoretical Ethics teaching within Psychiatry Fellowship Training, and ongoing clinical work that is likely to provide exposure to complex and frequent Ethical dilemmas. As Psychiatry Trainees approach subspecialty training in Child and Adolescent Psychiatry they therefore have a rich experience of both theoretical Ethics teaching and clinical exposure to Ethical issues. In this symposium, the difficulties Child and Adolescent Psychiatry Trainees may have in the integration of multiple theoretical Ethical models are discussed. It is suggested that these difficulties make Ethics Teaching for Child and Adolescent Psychiatry Trainees particularly challenging. This is important given the complex Ethical issues often present when working with Children and their Families. The three main Ethical models of Deontology, Virtue Ethics and Consequentialism are described and their usefulness for the Child and Adolescent Psychiatrist examined. Limitations of these models, and “Four Principles” approaches (such as that of Beauchamp and Childress), for Child and Adolescent Psychiatry, are also considered. Clinical cases are included for discussion. Finally, the ways in which these models may be used to enhance Child and Adolescent Psychiatry Training, and subsequent clinical practice as a Child and Adolescent Psychiatrist, are discussed. The integration of different theoretical Ethical models is considered, with implications identified for clinical practice.

Willingness of Sri Lankan farmers to pay for a scheme to conserve elephants: An empirical analysis

This paper explores the feasibility of adopting an integrated economic approach to raise farmers’ tolerance of the presence of elephants on their farming lands. Responses to this approach were sought from a sample of farmers in the areas affected by human elephant conflict in the northwestern province of Sri Lanka. Results from a contingent valuation survey of their willingness to pay for a scheme to conserve elephants are also reported. Two separate logit regression analyses were undertaken to examine the factors that influence the farmers’ responses for the payment principle question and their opinions on the integrated economic approach. Although found that the majority of the respondents expressed their willingness to pay for the proposed scheme and supported for the implementation of the integrated approach, we have insufficient data yet to determine if their support and financial contribution would be sufficient to set up this programme and also to predict its economic viability. Nevertheless, the overall finding of this study provides an improved economic assessment of the farmers’ attitudes towards the wild elephant in Sri Lanka. At the same time the study shows that, contrary to commonly held assumptions, farmers in this developing country, do support wildlife conservation.