Bioethics Symposium: The ethical food movement: What does it mean for the role of science and scientists in current debates about animal agriculture?

Contemporary animal agriculture is increasingly criticized on ethical grounds. Consequently, current policy and legislative discussions have become highly controversial as decision makers attempt to reconcile concerns about the impacts of animal production on animal welfare, the environment, and on the efficacy of antibiotics required to ensure human health with demands for abundant, affordable, safe food. Clearly, the broad implications for US animal agriculture of what appears to be a burgeoning movement relative to ethical food production must be understood by animal agriculture stakeholders. The potential effects of such developments on animal agricultural practices, corporate marketing strategies, and public perceptions of the ethics of animal production must also be clarified. To that end, it is essential to acknowledge that people's beliefs about which food production practices are appropriate are tied to diverse, latent value systems. Thus, relying solely on scientific information as a means to resolve current debates about animal agriculture is unlikely to be effective. The problem is compounded when scientific information is used inappropriately or strategically to advance a political agenda. Examples of the interface between science and ethics in regards to addressing currently contentious aspects of food animal production (animal welfare, antimicrobial use, and impacts of animal production practices on the environment) are reviewed. The roles of scientists and science in public debates about animal agricultural practices are also examined. It is suggested that scientists have a duty to contribute to the development of sound policy by providing clear and objectively presented information, by clarifying misinterpretations of science, and by recognizing the differences between presenting data vs. promoting their own value judgments in regard to how and which data should be used to establish policy. Finally, the role of the media in shaping public opinions on key issues pertaining to animal agriculture is also discussed.

Assessing options for the development of surface water flood warning in England and Wales.

This paper explores the technical options for warning of surface water flooding in England and Wales and presents the results of an Environment Agency funded project. Following the extensive surface water flooding experienced in summer 2007 a rainfall threshold-based Extreme Rainfall Alert (ERA) was piloted by the Met Office and Environment Agency providing initial steps towards the establishment of a warning for some types of surface water flooding. The findings of this paper are based primarily on feedback on technical options from a range of professionals involved in flood forecasting and warning and flood risk management, about the current alerts and about the potential options for developing a more targeted surface water flood warning service. Providing surface water flooding warnings presents a set of technical, forecasting and warning challenges related to the rapid onset of flooding, the localised nature of the flooding, and the linking of rainfall and flood forecasts to flood likelihood and impact on the ground. Some examples of rainfall alerting and surface water flood warning services from other countries are evaluated, as well as a small number of recently implemented local services in England and Wales. Various potential options for implementation of a service are then explored and assessed. The paper concludes that development of a surface water flood warning service for England and Wales is feasible and is likely to be useful to emergency responders and operational agencies, although developing such a service for the pluvial components of this type of flooding is likely to be feasible sooner than for other components of surface water flooding such as that caused by sewers. A targeted surface water flood warning service could be developed for professional emergency responders in the first instance rather than for the public for whom such a service without further operational testing and piloting would be premature.

A psychosocial risk assessment model (PRAM) for use with pregnant and postpartum women in primary care settings.

Recognition of high rates of mental health morbidity and mortality that affect women during the perinatal period has prompted the development of psychosocial risk assessment programs. Designed to identify women, at risk, during routine health checks and delivered by primary care health service providers, these fit within a primary prevention and early intervention strategic approach to the reduction of perinatal mental illness and reflect an integrated approach to perinatal health services delivery. This paper describes the development and use of the psychosocial risk assessment model (PRAM) at the Royal Hospital for Women in Sydney, Australia. Data is presented on 2,142 women who attended the Antenatal Midwives Clinic between 2002 and 2005. The PRAM guides primary care staff to quickly identify women experiencing emotional distress and/or psychosocial problems during pregnancy or postnatal checks. Measures used in pregnancy are the symptom-based Edinburgh Depression Scale and the psychosocial risk-based Antenatal Risk Questionnaire. In postnatal setting the Postnatal Risk Questionnaire is used. Scores can be used to compute a Psychosocial Risk Index (PRI) to guide individualized care planning, define needs for referral and classify groups for clinical and research purposes. Based on the PRI, among 2,142 women assessed in pregnancy 70.6% were classified as low/no risk (no interventions indicated currently), 24.1% as medium risk (in need of monitoring), and 5.3% as high risk (complex). The PRAM offers a conceptual framework, methods and measures for brief psychosocial assessment with clinical and research applications. Postpartum follow up studies of women assessed during pregnancy have commenced. Randomized controlled trials and cross-cultural studies are now indicated to strengthen the evidence base for the model.

Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders.

OBJECTIVE: This paper presents evidence of new developments in the detection and treatment of perinatal mood and anxiety disorders that have relevance for clinicians. METHOD: An electronic search was conducted in MEDLINE, CINAHL, PsychINFO and The Cochrane Library Database for the interval 1995-2005 for papers published in English. RESULTS: New developments were identified as follows: i) Broadening frames of reference within perinatal mental health. ii) Impact of disorders upon offspring. iii) Identifying women at risk of mental health problems. iv) Prevention and early intervention strategies. v) Treatments. CONCLUSION: Perinatal mental health is a rapidly expanding field that impacts upon the health and wellbeing of all members of families with infants and young children. An evidence base for best practice is slowly emerging but considerable work is still needed in relation to the identification of women at risk, standardisation of diagnostic procedures, reduction of adverse outcomes for women and infants, prevention, early intervention, and treatment of clinical disorders.

The effect of electrothermal cautery-assisted resection of diminutive colonic polyps on histopathologic diagnosis.

We examined diminutive colonic polyps to identify relationships between thermal electrocoagulation or resection trauma cytologic artifacts, type of thermal electrocoagulation, polyp size, and the interobserver variation among 3 pathologists. The 3 pathologists independently evaluated 119 colonic polyps 5 mm or less in maximum dimension for diagnosis and degree of thermal electrocoagulation or resection trauma cytologic artifacts. The maximum dimension of the polyps and type of thermal electrocoagulation were recorded. The average percentage of polyps in which a definitive diagnosis could not be made because of cytologic artifacts was 16.5% (range, 11.8%-19.3%). Decreasing polyp size was associated linearly with the inability to make a definitive diagnosis owing to cytologic artifacts. Polyps smaller than 2 mm significantly more often could not be definitively diagnosed by at least 1 pathologist owing to cytologic artifacts, including some polyps that were excised without thermal electrocautery. Interobserver variation increased with decreasing polyp dimension. Two millimeters seems to represent a cut point, below which the likelihood that a definitive diagnosis can be made can be increased if thermal electrocoagulation is used. This small size seems to make them especially susceptible to cytologically injurious forces.

Leveraging HIPAA to support consumer empowerment.

The consumer empowerment movement needs to provide consumers with more access and control of their healthcare records. The premise of this article is that there is a fundamental market shift towards consumer empowerment--and technology is the driving force. We contend the results will satisfy the intent of the HIPAA mandate. Two restrictions impede the market from moving toward real consumer empowerment. First, managing one's own health history record is difficult because the complete record is segmented in disparate systems that are difficult to integrate. This is because unique identifiers and consistent coding are nonexistent. Second, security and control of patient identifiable health information is still evolving. There is no consensus among providers for Internet security, as we can see by all the legislative privacy bills trying to address the issue. HIPAA is both a legislative mandate and an enabler of the next healthcare paradigm. Providers must comply with the HIPAA mandates for electronic data interchange (EDI) code sets, administrative simplification, and privacy and confidentiality protocols. By recognizing HIPAA as part of a consumer-driven movement, organizations can incorporate empowerment strategies into a planning process that creates consumer options in healthcare and leverages HIPAA compliance to benefit both providers and consumers. This article suggests methods for meeting HIPAA compliance through innovative consumer empowerment methods.

Seeds of discontent: expert opinion, mass media messages, and the public image of agricultural biotechnology.

Survey data are presented on opinions about agricultural biotechnology and its applications held by agricultural science faculty at highly ranked programs in the United States with and without personal involvement in biotechnology-oriented research. Respondents believed biotech holds much promise, but policy positions vary. These results underscore the relationship between opinion and stakeholder interests in this research, even among scientific experts. Media accounts are often seen as causes, rather than artifacts, of the existence of public controversy; European and now U.S. opposition to food biotechnology is often explained away in terms of such a relationship. The authors argue that where even experts are divided, public opposition cannot reasonably be attributed to poor public understanding or sensationalistic media accounts. Ethical implications for communicating science are explored.

Is it necessary to catheterise the bladder before laparoscopy?

Fifty patients had residual urine measured by catheterisation immediately before laparoscopic cholecystectomy. The median amount of urine in the bladder was 100 ml (range 5-500 ml). This urine volume does not distend the bladder enough to risk inadvertant perforation during insertion of a subumbilical port. Urinary bladder catheterisation is unnecessary before laparoscopy especially if the bladder is impalpable.

Emotional health of Indonesian adoptees living in Australian families.

OBJECTIVE: To compare the prevalence of emotional and behavioural problems in adolescent adoptees from Indonesia living in South Australian families with that of adolescents living in the community and those referred to mental health clinics in South Australia. METHOD: Thirty-four Indonesian adoptees completed the Youth Self-Report and their adoptive mothers completed the Child Behaviour Checklist. The results on these instruments were compared with the scores of a community sample and a mental health clinic population. RESULTS: There was a striking similarity between scores on the Youth Self-Report and the Child Behaviour Checklist instruments for the adoption and community groups. Both these groups had significantly fewer problems than adolescents referred to mental health clinics. CONCLUSIONS: These results indicate that the outcome in terms of emotional and behavioural health for intercountry adoptions between Indonesia and Australia is favourable.

Ileoproctostomy is preferred over ileoanal pull-through in patients with indeterminate colitis.

A 15-year retrospective review was undertaken to evaluate the operative outcomes of patients with indeterminate colitis who were referred for rectal-sparing operations. Review of 95 consecutive patients operated for ulcerative colitis (UC) or indeterminate colitis (IC) revealed characteristics of IC in 13 patients. In the group as a whole, there were 45 females and 50 males; the average age was 33. A total of 64 patients had ileoanal pull-through (IAA). Analysis revealed that four of these patients had IC revealed by findings before operation in three patients and following the first stage of operation in one patient. Three of these four patients have subsequently required permanent ileostomy. Six patients who underwent IAA have subsequently demonstrated signs and symptoms of Crohn's disease (CD). All six have subsequently required ileostomy. Overall 10 patients with CD underwent IAA, and nine have required permanent ileostomy. Fourteen patients had ileorectal anastomosis (IRA) for UC or IC. IRA was performed for patients with IC in nine cases, and five patients with UC elected this operative option. Indications for IRA in patients with UC included obesity, 2; mental retardation, 1; advanced age, 1; and patient preference, 1. Of the patients with IC who underwent IRA, two have subsequently shown signs and symptoms of Crohn's disease. Overall, 14 of 14 patients who had IRA still have functioning IRA. None has required ileostomy. The poor results in patients with UC or IC subsequently shown to have CD have caused us to change our operative approach in patients with any question in the diagnosis of UC.(ABSTRACT TRUNCATED AT 250 WORDS)

A cyclic breathing pattern in patients with poor left ventricular function and compensated heart failure: a mild form of Cheyne-Stokes respiration?

OBJECTIVES: This study was designed to evaluate the breathing patterns of patients with poor left ventricular systolic function and compensated heart failure. BACKGROUND: Cheyne-Stokes respiration is often found in patients with severe decompensated heart failure. Breathing patterns of patients with clinically moderate congestive heart failure have not been well described. METHODS: Tidal volume, oxygen consumption, carbon dioxide production, respiratory rate, minute ventilation and partial pressure of end-tidal oxygen and of end-tidal carbon dioxide were measured in 36 consecutive patients with an ejection fraction < 40% and compensated congestive heart failure. Measurements were made with a computerized expiratory gas analyzer. RESULTS: Nine of the 36 patients demonstrated a cyclic breathing pattern, with a cycle length of 130 +/- 82 s. At the peak of the cycle, minute ventilation was 16.7 +/- 2.9 liters/min, tidal volume was 582 +/- 130 ml, end-tidal carbon dioxide was 25 +/- 2.7 mm Hg and end-tidal oxygen was 121 +/- 4.9 mm Hg. At the nadir of the cycle, minute ventilation was 9.5 +/- 2.1 liters/min, tidal volume was 372 +/- 120 ml, end-tidal carbon dioxide was 35 mm Hg +/- 2.1 and end-tidal oxygen was 101 +/- 3.9 mm Hg. Respiratory rate was 27 +/- 5.9 breaths/min at peak and 24 +/- 5.1 breaths/min at nadir (p = NS). Patients with a cyclic respiratory pattern had a significantly lower ejection fraction (15 +/- 5%) compared with patients without cyclic respirations (26 +/- 8%; p < 0.001). There was no difference in the origin of heart failure, clinical status or exercise performance between these two groups. CONCLUSIONS: A cyclic respiratory pattern occurs commonly in patients with mild to moderate heart failure. It is related to poor left ventricular systolic function and not related to clinical status or etiology of heart failure. The cyclic respiratory pattern found commonly in patients with compensated heart failure and very poor ventricular function (ejection fraction < 25%) consists of a variation in tidal volume only. Respiratory rate is relatively constant and true apnea does not occur.