The intention to hasten death: a survey of attitudes and practices of surgeons in Australia

Objective: To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request. Design: Anonymous, cross-sectional, mail-out survey between August and November 1999. Participants: 683 out of 992 eligible general surgeons (68.9% response rate). Main outcome measures: Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death. Results: 247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request. Conclusions: More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic

The intention to hasten death: a survey of attitudes and practices of surgeons in Australia

Objective: To determine attitudes among surgeons in Australia to assisted death, and the proportion of surgeons who have intentionally hastened death with or without an explicit request. Design: Anonymous, cross-sectional, mail-out survey between August and November 1999. Participants: 683 out of 992 eligible general surgeons (68.9% response rate). Main outcome measures: Proportion of respondents answering affirmatively to questions about administering excessive doses of medication with an intention to hasten death. Results: 247 respondents (36.2%; 95% CI, 32.6%-39.9%) reported that, for the purpose of relieving a patient's suffering, they have given drugs in doses that they perceived to be greater than those required to relieve symptoms with the intention of hastening death. More than half of these (139 respondents; 20.4% of all respondents; 95% CI, 17.4%-23.6%) reported that they had never received an unambiguous request for a lethal dose of medication. Of all respondents, only 36 (5.3%; 95% CI, 2.9%-6.1%) reported that they had given a bolus lethal injection, or had provided the means to commit suicide, in response to an unambiguous request. Conclusions: More than a third of surgeons surveyed reported giving drugs with an intention to hasten death, often in the absence of an explicit request. However, in many instances, this may involve the use of an infusion of analgesics or sedatives, and such actions may be difficult to distinguish from accepted palliative care, except on the basis of the doctor's self-reported intention. Legal and moral distinctions based solely on a doctor's intention are problematic

The learning experiences of health and social care paraprofessionals on a foundation degree

Foundation degrees have been developed in the UK as a means of meeting the learning needs of paraprofessionals in health and social care and the services within which they work in a cost-effective fashion. Workplace learning is an intrinsic component to these degrees. Taking a socio-cultural perspective, this paper examines how the students' workplaces, life circumstances and sense of career trajectory shaped their learning experience and motivation. A small-scale evaluation study, using semi-structured interviews, focused on the learning experiences of a group of paraprofessionals enrolled in a foundation degree in health and social care. Data revealed fragmented employment patterns, underpinned by consistent vocational drives. While the study resonated with vocation, participants were ambivalent or lacked information about career progression. Workplace conditions, relationships and limited time shaped learning and coping strategies. A strategic and focused approach to student learning is required and includes attention to career pathways, workforce development strategy, the requirements of a range of stakeholders, workplace supervision and support for learning

Stimulating the innovation potential of 'routine' workers through workplace learning

Governments worldwide seek to upgrade the ‘basic skills' of employees deemed to have low literacy and numeracy, in order to enable their greater productivity and participation in workplace practices. A longitudinal investigation of such interventions in the United Kingdom has examined the effects on employees and on organizations of engaging in basic skills programmes offered in and through the workplace. ‘Tracking’ of employees in selected organizational contexts has highlighted ways in which interplay between formal and informal workplace learning can help to create the environments for employees in lower grade jobs to use and expand their skills. This workplace learning is a precondition, a stimulus and an essential ingredient for participation in employee-driven innovation, as workers engage with others to vary, and eventually to change, work practices. © 2010, SAGE Publications. All rights reserved

Environmental DNA captures elasmobranch diversity in a temperate marine ecosystem

Abstract: Many sharks, skates, and rays (elasmobranchs) are highly threatened by the activities of commercial fisheries, and a clear understanding of their distributions, diversity, and abundance can guide protective measures. However, surveying and monitoring elasmobranch species can be highly invasive or resource‐intensive, and utilization of non‐invasive environmental DNA‐based methods may overcome these problems. Here, we studied spatial and seasonal variation in the elasmobranch community of the Western English Channel using environmental DNA (eDNA) collected from surface and bottom waters periodically over an annual cycle (2017–2018). In total we recovered 13 elasmobranch species within eDNA samples, and the number of transformed eDNA reads was positively associated with species (hourly) catch data resolved from 105‐year time series trawl data (1914–2018). These results demonstrate the ability of eDNA to detect and semi‐quantitatively reflect the prevalence of historically dominant and rare elasmobranch species in this region. Notably, eDNA recorded a greater number of species per sampling event than a conventional trawl survey in the same area over the same sampling years (2017–2018). Several threatened species were recovered within the eDNA, including undulate ray, porbeagle shark, and thresher shark. Using eDNA, we found differences in elasmobranch communities among sampling stations and between seasons, but not between sampling depths. Collectively, our results suggest that non‐invasive eDNA‐based methods can be used to study the spatial and seasonal changes in the diversity and abundance of whole elasmobranch communities within temperate shelf habitats. Given the threatened status of many elasmobranchs in human‐impacted marine environments, eDNA analysis is poised to provide key information on their diversity and distributions to inform conservation‐focused monitoring and management

Precise age of Bangiomorpha pubescens dates the origin of eukaryotic photosynthesis

Although the geological record indicates that eukaryotes evolved by 1.9–1.4 Ga, their early evolution is poorly resolved taxonomically and chronologically. The fossil red alga Bangiomorpha pubescens is the only recognized crown-group eukaryote older than ca. 0.8 Ga and marks the earliest known expression of extant forms of multicellularity and eukaryotic photosynthesis. Because it postdates the divergence between the red and green algae and the prior endosymbiotic event that gave rise to the chloroplast, B. pubescens is uniquely important for calibrating eukaryotic evolution. However, molecular clock estimates for the divergence between the red and green algae are highly variable, and some analyses estimate this split to be younger than the widely inferred but poorly constrained first appearance age of 1.2 Ga for B. pubescens. As a result, many molecular clock studies reject this fossil ex post facto. Here we present new Re-Os isotopic ages from sedimentary rocks that stratigraphically bracket the occurrence of B. pubescens in the Bylot Supergroup of Baffin Island and revise its first appearance to 1.047 +0.013/–0.017 Ga. This date is 150 m.y. younger than commonly held interpretations and permits more precise estimates of early eukaryotic evolution. Using cross-calibrated molecular clock analyses with the new fossil age, we calculate that photosynthesis within the Eukarya emerged ca. 1.25 Ga. This date for primary plastid endosymbiosis serves as a benchmark for interpreting the fossil record of early eukaryotes and evaluating their role in the Proterozoic biosphere

Sustainable development and African local government: can electronic training help build capacities?

A recent study carried out by European and African organizations into the potential for electronic distance training (EDT) on sustainability in African local governments concluded that EDT was both 'useful and feasible'. This article reflects on some of the theoretical and practical implications of that study. It focuses on the connection between learning and sustainability and how EDT programmes might be designed and promoted. The paper argues that, while resource issues and poor access to Information and Communication Technologies (ICTs) create considerable constraints and point to the need for policies to improve access, in general the most important factors for successful capacity building relate to the design of learning programmes that take account of the work contexts and skill and capability requirements of those targeted as learners. 'Useful' and 'feasible' depend on (i) how work-based and work-related learning processes are understood and (ii) the conditions to promote learning within African local government. Keywords: Africa; Electronic distance training; Local government; Sustainability; Workplace learnin

Trends in publications regarding evidence-practice gaps: A literature review

<p>Abstract</p> <p>Background</p> <p>Well-designed trials of strategies to improve adherence to clinical practice guidelines are needed to close persistent evidence-practice gaps. We studied how the number of these trials is changing with time, and to what extent physicians are participating in such trials.</p> <p>Methods</p> <p>This is a literature-based study of trends in evidence-practice gap publications over 10 years and participation of clinicians in intervention trials to narrow evidence-practice gaps. We chose nine evidence-based guidelines and identified relevant publications in the PubMed database from January 1998 to December 2007. We coded these publications by study type (intervention versus non-intervention studies). We further subdivided intervention studies into those for clinicians and those for patients. Data were analyzed to determine if observed trends were statistically significant.</p> <p>Results</p> <p>We identified 1,151 publications that discussed evidence-practice gaps in nine topic areas. There were 169 intervention studies that were designed to improve adherence to well-established clinical guidelines, averaging 1.9 studies per year per topic area. Twenty-eight publications (34%; 95% CI: 24% - 45%) reported interventions intended for clinicians or health systems that met Effective Practice and Organization of Care (EPOC) criteria for adequate design. The median consent rate of physicians asked to participate in these well-designed studies was 60% (95% CI, 25% to 69%).</p> <p>Conclusions</p> <p>We evaluated research publications for nine evidence-practice gaps, and identified small numbers of well-designed intervention trials and low rates of physician participation in these trials.</p

Precise age of Bangiomorpha pubescens dates the origin of eukaryotic photosynthesis

Although the geological record indicates that eukaryotes evolved by 1.9–1.4 Ga, their early evolution is poorly resolved taxonomically and chronologically. The fossil red alga Bangiomorpha pubescens is the only recognized crown-group eukaryote older than ca. 0.8 Ga and marks the earliest known expression of extant forms of multicellularity and eukaryotic photosynthesis. Because it postdates the divergence between the red and green algae and the prior endosymbiotic event that gave rise to the chloroplast, B. pubescens is uniquely important for calibrating eukaryotic evolution. However, molecular clock estimates for the divergence between the red and green algae are highly variable, and some analyses estimate this split to be younger than the widely inferred but poorly constrained first appearance age of 1.2 Ga for B. pubescens. As a result, many molecular clock studies reject this fossil ex post facto. Here we present new Re-Os isotopic ages from sedimentary rocks that stratigraphically bracket the occurrence of B. pubescens in the Bylot Supergroup of Baffin Island and revise its first appearance to 1.047 +0.013/–0.017 Ga. This date is 150 m.y. younger than commonly held interpretations and permits more precise estimates of early eukaryotic evolution. Using cross-calibrated molecular clock analyses with the new fossil age, we calculate that photosynthesis within the Eukarya emerged ca. 1.25 Ga. This date for primary plastid endosymbiosis serves as a benchmark for interpreting the fossil record of early eukaryotes and evaluating their role in the Proterozoic biosphere