Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Returning to the text of his phrase-making Rede lecture Sir Charles Snow, surely an experienced explorer of the corridors of power, confesses to the awe of the sorcerer’s apprentice at the flood of comment, hostile and appreciative, near and far in origin, which his unpretentiously original thoughts upon the current rift in cultural communication conjured from the practitioners of literature and science, who broadly divide higher education in England today and whom he addressed at Cambridge in May 1959. The widespread (...) spontaneity of reaction has led him to conclude that his analysis touched a nerve, ‘something which people, all over the world, suspect is relevant to present actions’. His original lecture refused to relate itself to the political waging of ‘the cold war’ as ‘the prime absolute of our age’ and it castigated modernist literature for its neglect of the currently scientific stage of the industrial revolution, which is producing a new egalitarian society in our own time. Now he restates his major theme: the pressing need for a new education to promote common understanding between these two dominant cultures, so that the expanding social force of applied science be directed with the minimum danger and the maximum good for humanity. He does not minimise the danger of leaving a mystic status to the initiates of science. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)

The focus of this study was to analyze the content, distribution, and comparative genome relationships of 996 chromosome bin-mapped expressed sequence tags accounting for 2266 restriction fragments on the homoeologous group 3 chromosomes of hexaploid wheat. Of these loci, 634, 884, and 748 were mapped on chromosomes 3A, 3B, and 3D, respectively. The individual chromosome bin maps revealed bins with a high density of mapped ESTs in the distal region and bins of low density in the proximal region of the (...) chromosome arms, with the exception of 3DS and 3DL. These distributions were more localized on the higher-resolution group 3 consensus map with intermediate regions of high-mapped-EST density on both chromosome arms. Gene ontology classification of mapped ESTs was not significantly different for homoeologous group 3 chromosomes compared to the other groups. A combined analysis of the individual bin maps using 537 of the mapped ESTs revealed rearrangements between the group 3 chromosomes. Approximately 232 of the consensus mapped ESTs matched sequences on rice chromosome 1 and revealed large- and small-scale differences in gene order. Of the group 3 mapped EST unigenes ∼21 and 32% matched the Arabidopsis coding regions and proteins, respectively, but no chromosome-level gene order conservation was detected. (shrink)

Earp, Lewis, and Hart make a comprehensive and compelling argument for ending the “war on drugs,” highlighting the importance of both ending the criminalization of people who use drugs, and...

Since the Collected Papers of C S Peirce have been published at Harvard, the constructive originality of this major American philosopher is being unravelled from the disjointed threads of his mainly logical papers. The elusive roots of his metaphysic lie in his insistence upon the empirical origin and pragmatic application in purposive action of the content of ideas and also in the attempt to deduce their supreme categories in strict logical system. Professor Thompson’s penetrating study of 1953 claims to expound (...) the essential propaedeutic to the determination of Peirce’s place in the history of thought and clearly shows that ‘quite apart from the question of influence, Peirce’s meaning at many points is most easily elucidated by comparison with Kant’. (shrink)

In 1931 Father D’Arcy, then also a don at Oxford, published the first comprehensive exposition and critical evaluation in England of John Henry Newman’s sole philosophical work, the Essay on Assent—if one excepts the contemporary set of censorious articles published by his pedantic confrère, Father Thomas Harper, in The Month and later edited for private circulation. Father D’Arcy’s philosophic humanism and lifelong interest in the apologetics of belief make him a particularly sympathetic commentator and his work has done much to (...) illuminate both the problem of belief and his illustrious predecessor. It is pleasant to welcome his urbane wisdom back to print in a new edition, whose Introduction concisely notes the current modest evaluation of certitude in science and whose revision includes a trenchant chapter on the shallowness of contemporary logical positivism and analysis. This latter has become more puzzled than sceptical about a certitude, which springs neither from direct observation nor from formal logic, and yet is commonly accepted in history and geography concerning matters of fact which are now either past or absent, and so apparently is beyond decisive rational verification. Nevertheless no one in practice reasonably denies the contingent existence of Mr. Krushchev or of China, even though he has never visited either. Religious belief is thus no more paradoxical than secular daily belief, whose certitude equally demands explanation and justification. (shrink)