Metabolic scaling: consensus or controversy?
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BACKGROUND: The relationship between body mass (M) and standard metabolic rate (B) among living organisms remains controversial, though it is widely accepted that in many cases B is approximately proportional to the three-quarters power of M. RESULTS: The biological significance of the straight-line plots obtained over wide ranges of species when B is plotted against log M remains a matter of debate. In this article we review the values ascribed to the gradients of such graphs (typically 0.75, according to the majority view), and we assess various attempts to explain the allometric power-law phenomenon, placing emphasis on the most recent publications. CONCLUSION: Although many of the models that have been advanced have significant attractions, none can be accepted without serious reservations, and the possibility that no one model can fit all cases has to be more seriously entertained. (+info)
The rules of the game: interprofessional collaboration on the intensive care unit team.
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BACKGROUND: The intensive care unit (ICU) is a nexus for interspecialty and interdisciplinary tensions because of its pivotal role in the care of the hospital's most critically ill patients and in the management of critical care resources. In an environment charged with temporal, financial and professional tensions, learning how to get results collaboratively is a critical aspect of professional competence. This study explored how team members in the ICU interact to achieve daily clinical goals, delineate professional boundaries and negotiate complex systems issues. METHODS: Seven 1-hour focus groups were conducted with ICU team members in two hospitals. Participants consisted of four nursing groups (n = 27), two resident groups (n = 6) and one intensivist group (n = 4). Interviews were audio-recorded, anonymized and transcribed. With the use of a standard qualitative approach, transcripts were analyzed iteratively for recurrent themes by four researchers. RESULTS: Team members articulated their perceptions of the mechanisms by which team collaboration was achieved or undermined in a complex and high-pressure context. Two mechanisms were recurrently described: the perception of 'ownership' and the process of 'trade'. Analysis of these mechanisms reveals how power is commodified, possessed and exchanged as team members negotiate their daily needs and goals with one another. CONCLUSION: Our data provide a non-idealized depiction of how health care professionals function on a team so as to meet both individual and collective goals. We contend that the concept of 'team' must move beyond the rhetoric of 'cooperation' and towards a more authentic depiction of the skills and strategies required to function in the competitive setting of the interprofessional health care team. (+info)
Aaron O. Wells, MD and the Medical Committee for Human Rights: reflections on a life of conscience.
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The southern civil rights movement compelled Dr. Aaron Wells and other doctors to find ways to use their skills in support of that movement. Through the Medical Committee for Human Rights (MCHR), healthcare workers provided a medical presence for civil rights protesters in the south during the 1960s. Formed at a time when racial segregation in professional medical associations, hospitals, and medical education was common, the MCHR also highlighted race-based inequities in American medicine. Dr. Wells, a man who lives a life of activism, was the first national president of the MCHR. During the summer of 2002, nearly 40 years after the founding of MCHR, Wells was interviewed about his experiences. Those reminiscences are the basis of this article. (+info)
Conflicts between employee preferences and ergonomic recommendations in shift scheduling: regulation based on consent is not sufficient.
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OBJECTIVE: Contribution to the discussion of the role of participation/consent of employees in working hours regulation. METHODS: Exploratory analysis of conflicts between preferences of employees and ergonomic recommendations in shift scheduling by analysing a large number of participative shift scheduling projects. RESULTS: The analysis showed that very often the pursuit of higher income played the major role in the decision making process of employees and employees preferred working hours in conflict with health and safety principles. CONCLUSIONS: First, the consent of employees or the works council alone does not ensure ergonomically sound schedules. Besides consent, risk assessment procedures seem to be a promising but difficult approach. Secondly, more research is necessary to check the applicability of recommendations under various settings, to support the risk assessment processes and to improve regulatory approaches to working hours. (+info)
The physician and prison hunger strikes: reflecting on the experience in Turkey.
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The medical ethics of a physician's relationship with a prisoner who is participating in a collective hunger strike has become a major public, professional, and governmental concern in The Republic of Turkey. This article examines the Turkish experience and debate about physician ethics during prison hunger strikes. It is hoped that this analysis will be of use to those formulating policy in similar situations. (+info)
Resuscitation of the preterm infant against parental wishes.
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Over the past 40 years, the norms on who is to make treatment decisions for newborns, and on what standards, have been significantly altered and revised. Today the standard for treatment of newborns is the "best interest" of the child. A recent ruling of the Texas Supreme Court authorizing a doctor to resuscitate a potentially viable very premature newborn over the parents' objection is a challenge to that standard. (+info)
Political coalitions for mutual advantage: the case of the Tobacco Institute's Labor Management Committee.
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In 1984, the tobacco workers' union and the Tobacco Institute, which represents US tobacco companies, formed a labor management committee (LMC). The institute relied on LMC unions to resist smoke-free worksite rules. In a review of the internal tobacco industry documents now publicly available, we found that the LMC succeeded for 2 primary reasons. First, the LMC furthered members' interests, allowing them to overcome institutional barriers to policy success. Second, the LMC used an "institutions, ideas, and interests" strategy to encourage non-LMC unions to oppose smoke-free worksite rules. While public health advocates missed an opportunity to partner with unions on the issue of smoke-free worksites during the era studied, they can use a similar strategy to form coalitions with unions. (+info)
Top 10 health care ethics challenges facing the public: views of Toronto bioethicists.
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BACKGROUND: There are numerous ethical challenges that can impact patients and families in the health care setting. This paper reports on the results of a study conducted with a panel of clinical bioethicists in Toronto, Ontario, Canada, the purpose of which was to identify the top ethical challenges facing patients and their families in health care. A modified Delphi study was conducted with twelve clinical bioethicist members of the Clinical Ethics Group of the University of Toronto Joint Centre for Bioethics. The panel was asked the question, what do you think are the top ten ethical challenges that Canadians may face in health care? The panel was asked to rank the top ten ethical challenges throughout the Delphi process and consensus was reached after three rounds. DISCUSSION: The top challenge ranked by the group was disagreement between patients/families and health care professionals about treatment decisions. The second highest ranked challenge was waiting lists. The third ranked challenge was access to needed resources for the aged, chronically ill, and mentally ill. SUMMARY: Although many of the challenges listed by the panel have received significant public attention, there has been very little attention paid to the top ranked challenge. We propose several steps that can be taken to help address this key challenge. (+info)