'We're completely back to normal, but I'd say it's a new normal': a qualitative exploration of adaptive functioning in rural families following a parental cancer diagnosis.

PURPOSE: The purpose of this study was to explore rural families' functioning following a parental cancer diagnosis. METHOD: Ten families in which a parent of dependent children had received a cancer diagnosis were purposively sampled using two questionnaires based upon the Resiliency Model of Family Adjustment and Adaptation (RMFAA): the Family Crisis Oriented Personal Evaluation Scales (F-COPES) and the Family Attachment Changeability Index 8 (FACI8). The total participant number was 34, which comprised the involvement of 17 parents and 17 children. The use of questionnaires ensured representation from both high and low functioning families. Qualitative data were gathered via semi-structured family interviews, and thematic analysis was used. RESULTS: Families identified three key challenges that are not accounted for by the RMFAA and may be unique to the rural cancer patient experience: frequent travel, increased work/financial demands and family separation. Families also described a number of protective factors that enabled them to cope with the demands of the cancer diagnosis, some of which were specific to rural families, while others may apply to Australian families more broadly. Many of these protective factors aligned with the RMFAA framework. CONCLUSION: The findings suggest that rural families' ability and willingness to access external resources, including informal community support and formal support services, are influenced by the strength of their internal protective factors. This result has practical implications for the development of interventions that accommodate the specific supportive care needs of rural families affected by cancer.

In defence of moral imperialism: four equal and universal prima facie principles.

Raanan Gillon is a noted defender of the four principles approach to healthcare ethics. His general position has always been that these principles are to be considered to be both universal and prima facie in nature. In recent work, however, he has made two claims that seem to present difficulties for this view. His first claim is that one of these four principles, respect for autonomy, has a special position in relation to the others: he holds that it is first among equals. We argue that this claim makes little sense if the principles are to retain their prima facie nature. His second claim is that cultural variation can play an independent normative role in the construction of our moral judgments. This, he argues, enables us to occupy a middle ground between what he sees as the twin pitfalls of moral relativism and (what he calls) moral imperialism. We argue that there is no such middle ground, and while Gillon ultimately seems committed to relativism, it is some form of moral imperialism (in the form of moral objectivism) that will provide the only satisfactory construal of the four principles as prima facie universal moral principles.

What is the role of the research ethics committee? Paternalism, inducements, and harm in research ethics.

In a recent paper Edwards, Kirchin, and Huxtable have argued that research ethics committees (RECs) are often wrongfully paternalistic in their approach to medical research. They argue that it should be left to competent potential research subjects to make judgments about the acceptability of harms and benefits relating to research, and that this is not a legitimate role for any REC. They allow an exception to their overall antipaternalism, however, in that they think RECs should have the power to prohibit the use of financial inducements to recruit research subjects into trials. In this paper it is argued that these claims are unjustified and implausible. A sketch is provided of an alternative model of the role of the REC as an expert body making judgments about the acceptability of research proposals through a consensual weighing of different moral considerations.

Passive euthanasia.

The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of euthanasia and the (supposed) permissibility of what is often called passive euthanasia. Secondly, the claim that passive euthanasia (so-called) cannot really be euthanasia because it does not cause death. And finally, a consequence based argument which appeals to the (alleged) bad consequences of accepting the category of passive euthanasia.We conclude that although healthcare professionals' nervousness about the concept of passive euthanasia is understandable, there is really no reason to abandon the category provided that it is properly and narrowly understand and provided that "euthanasia reasons" for withdrawing or withholding life-prolonging treatment are carefully distinguished from other reasons.

Inhibition of trypanothione reductase by substrate analogues.

Trypanothione reductase (TR) catalyzes the NAPDH-dependent reduction of the spermidine-glutathione conjugate trypanothione, an antioxidant found in Trypanosomatid parasites. TR plays an essential role in the parasite's defense against oxidative stress and has emerged as a prime target for drug development. Here we report the synthesis of several trypanothione analogues and their inhibitory effects on T. cruzi TR. All are competitive inhibitors with K(i) values ranging from 30 to 91 microM.

Clathrin plays a novel role in the regulation of cell polarity, pseudopod formation, uropod stability and motility in Dictyostelium.

Although the traditional role of clathrin has been in vesicle trafficking and the internalization of receptors, a novel role in cytokinesis was recently revealed in an analysis of a clathrin-minus Dictyostelium mutant (chc(-)). chc(-) cells grown in suspension were demonstrated to be defective in assembling myosin II into a normal contractile ring. To test whether this defect reflected a more general one of cytoskeletal dysfunction, chc(-) cells were analyzed for cell polarity, pseudopod formation, uropod stability, cell locomotion, chemotaxis, cytoskeletal organization and vesicle movement. chc(-) cells crawled, chemotaxed, localized F-actin in pseudopods, organized their microtubule cytoskeleton in a relatively normal fashion and exhibited normal vesicle dynamics. Although chc(-) cells extended pseudopods from the anterior half of the cell with the same frequency as normal chc(+) cells, they extended pseudopods at twice the normal frequency from the posterior half of the cell. The uropods of chc(-) cells also exhibited spatial instability. These defects resulted in an increase in roundness, a reduction in polarity, a reduction in velocity, a dramatic increase in turning, a high frequency of 180 degrees direction reversals and a decrease in the efficiency of chemotaxis. All defects were reversed in a rescued strain. These results are the first to suggest a novel role for clathrin in cell polarity, pseudopod formation, uropod stability and locomotion. It is hypothesized that clathrin functions to suppress pseudopod formation and to stabilize the uropod in the posterior half of a crawling cell, two behavioral characteristics that are essential for the maintenance of cellular polarity, efficient locomotion and efficient chemotaxis.

Bodily integrity and the sale of human organs.

Existing arguments against paid organ donation are examined and found to be unconvincing. It is argued that the real reason why organ sale is generally thought to be wrong is that (a) bodily integrity is highly valued and (b) the removal of healthy organs constitutes a violation of this integrity. Both sale and (free) donation involve a violation of bodily integrity. In the case of the latter, though, the disvalue of the violation is typically outweighed by the presence of other goods: chiefly, the extreme altruism involved in the giving. There is usually no such outweighing feature in the case of the former. Given this, the idea that we value bodily integrity can help to account for the perceived moral difference between sale and free donation.

Drug utilization review: dipyridamole plus aspirin antiplatelet therapy.

To assess whether dipyridamole was being used appropriately in providing antiplatelet therapy at the San Diego VAMC, a drug utilization review was conducted. Concomitant aspirin therapy was required for dipyridamole to be considered effective in the disease states reviewed. Seventy-three patients on antiplatelet therapy were evaluated, using dosing criteria established through a literature review. Our data indicated tht based on the criteria, only 11% of patients received dipyridamole in appropriate doses; it was underdosed in 89% of patients, and in 19% of patients, it was used when not indicated. In addition, 19% of patients did not receive concomitant aspirin therapy. Results suggest hat dipyridamole is not used optimally in providing antiplatelet therapy to patients in this institution.

Evaluation of appropriateness and interpretation of serum theophylline assays.

A drug utilization review of serum theophylline assays was undertaken to: (1) evaluate the prescribers' usage and interpretation of serum theophylline levels (STLs), and (2) calculate the cost of inappropriate assays. Criteria for appropriate use and interpretation were defined by an audit committee and approved by the chief medical resident. STLs were evaluated on medicine patients for a one-month period. Results of 102 levels ordered showed that 47 percent were inappropriate. The reasons cited most often for inappropriateness were: (1) previously-known STLs with no reason to expect a change in subsequent levels (26 percent); and (2) STLs drawn prior to steady state (12 percent). None of the levels evaluated had a request entered for the sampling time to be recorded. STLs were interpreted with the same degree of accuracy regardless of whether they were ordered appropriately. Results from this study suggest significant cost savings can be realized if physicians' ordering habits are corrected.