Between a rock and a hard place: ethical dilemmas of local community facilitators doing participatory research projects

Participatory research is supposed to involve participants in a collective definition of goals, and the co-production and sharing of research outputs. However, when articulated through an extended period of time involving a range of local, national and international actors, the practicalities of participatory research means that certain groups and individuals become responsible for taking leading roles, with subsequent ethical dilemmas. In the ‘Community-owned solutions for future environmental challenges in the Guiana Shield, South America’ (COBRA) project, the participatory research process involves a group of five Indigenous researchers – “the local team” – in charge of carrying out the research on the ground e.g. defining procedures, carrying out community engagement and supporting the communities in analyzing and disseminating the material. This local team is, in turn, supported by researchers from a national NGO and foreign academics. Considerable responsibility has been given to the local team for achieving project outcomes, and freedom in defining project tasks and activities. This paper analyses the multiple ethical dilemmas arising out of this situation, particularly the role of the local team as intermediaries between the wider community and project partners. We highlight the existence of significant mismatches between research expectations, and the ethical processes in operation at community level which are usually established on long-term, tacit and reciprocal relationships. We discuss how local community researchers are challenged with balancing the tensions between these two ethical polarities, while at the same time producing participatory research outcomes that are acceptable by everyone involved

Reproducible, Ultra High-Throughput Formation of Multicellular Organization from Single Cell Suspension-Derived Human Embryonic Stem Cell Aggregates

Background: Human embryonic stem cells (hESC) should enable novel insights into early human development and provide a renewable source of cells for regenerative medicine. However, because the three-dimensional hESC aggregates [embryoid bodies (hEB)] typically employed to reveal hESC developmental potential are heterogeneous and exhibit disorganized differentiation, progress in hESC technology development has been hindered. Methodology/Principal Findings: Using a centrifugal forced-aggregation strategy in combination with a novel centrifugalextraction approach as a foundation, we demonstrated that hESC input composition and inductive environment could be manipulated to form large numbers of well-defined aggregates exhibiting multi-lineage differentiation and substantially improved self-organization from single-cell suspensions. These aggregates exhibited coordinated bi-domain structures including contiguous regions of extraembryonic endoderm- and epiblast-like tissue. A silicon wafer-based microfabrication technology was used to generate surfaces that permit the production of hundreds to thousands of hEB per cm 2. Conclusions/Significance: The mechanisms of early human embryogenesis are poorly understood. We report an ultra high throughput (UHTP) approach for generating spatially and temporally synchronised hEB. Aggregates generated in this manner exhibited aspects of peri-implantation tissue-level morphogenesis. These results should advance fundamental studies into early human developmental processes, enable high-throughput screening strategies to identify conditions tha

Exploration et modèle d’analyse de ratios de coûts de médicaments par indicateurs de volumes d’activités en établissement de santé

Résumé Les coûts des médicaments utilisés en établissement de santé augmentent plus rapidement que la plupart des autres postes de dépenses du réseau de la santé. Les systèmes d’information utilisés pour recueillir les coûts de médicaments en établissements de santé sont peu interfacés, souvent limités et développés d’abord dans une perspective clinique plutôt qu’économique.Nous décrivons une démarche visant à intégrer des données provenant du système de gestion du dossierpatient par les archives, du système de gestion des approvisionnements et du système de gestion du dossier pharmacologique afin d’en tirer des applications pratiques. Nous explorons le profil des coûts de médicaments pour ces clientèles en identifiant des ratios susceptibles de mieux nous renseigner sur les coûts et de faciliter la planification et les comparaisons. Il existe peu de données publiées sur les coûts de médicaments en établissements de santé. De plus, il n’existe pas d’unités de mesure largement étudiées pour favoriser des comparaisons internes et externes valables. Le modèle proposé permet d’intégrer des données de différents systèmes d’information et de favoriser la recherche de ratios utiles à la planification et aux comparaisons. Ainsi, une meilleure connaissance de ces données peut contribuer à planifier des ressources matérielles et humaines, de même qu’une hiérarchisation plus structurée des soins pharmaceutiques. Abstract The costs of medication used in health care institutions are growing more rapidly than those of most other expenditures in the health care system. Information systems used to capture medication costs in health institutions were developed from a clinical, rather than an economic, perspective. As a result, their capacity is often limited and their data poorly coordinated.The present article discusses a procedure for integrating data from systems that manage supplies, medication and the archival storage of patient records for the purpose of offering certain practical applications. We explore the medication cost profile for these clienteles while identifying the ratios most likely to inform us about costs and therefore facilitate planning and comparisons. Few studies have been published on the costs of medication in health care institutions. What’s more, an extensive study of measuring units to encourage valid internal and external comparisons has never been done. The proposed model makes it possible to integrate data from various information systems and to encourage the search for ratios that can be used in planning and making comparisons. We believe that a better knowledge of these data may aid in the planning of material and human resources and lead to a more structured hierarchical organization of drug services.

Deux générations, deux sensibilités = Two Generations, Two Sensibilities

Six texts document sculptural, photographic, and performance works presented at the Canadian Embassy in Tokyo by four Québec artists. Biographical notes. 2 bibl. ref

Neighborhood Social Inequalities in Road Traffic Injuries: The Influence of Traffic Volume and Road Design

Objectives. We examined the extent to which differential traffic volume and road geometry can explain social inequalities in pedestrian, cyclist, and motor vehicle occupant injuries across wealthy and poor urban areas. Methods. We performed a multilevel observational study of all road users injured over 5 years (n = 19 568) at intersections (n = 17 498) in a large urban area (Island of Montreal, Canada). We considered intersection-level (traffic estimates, major roads, number of legs) and area-level (population density, commuting travel modes, household income) characteristics in multilevel Poisson regressions that nested intersections in 506 census tracts. Results. There were significantly more injured pedestrians, cyclists, and motor vehicle occupants at intersections in the poorest than in the richest areas. Controlling for traffic volume, intersection geometry, and pedestrian and cyclist volumes greatly attenuated the event rate ratios between intersections in the poorest and richest areas for injured pedestrians (−70%), cyclists (−44%), and motor vehicle occupants (−44%). Conclusions. Roadway environment can explain a substantial portion of the excess rate of road traffic injuries in the poorest urban areas

Fin de vie et mort

Ce numéro explore les enjeux liés à la prise en charge de proches atteints de maladies graves et du décès d’un membre de la famille sur les relations familiales. Les contributions dans ce numéro abordent les répercussions psychologiques, la gestion des soins, les maladies pédiatriques, les maladies dégénératives, les enjeux législatifs, les familles transnationales et le suicide dans des contextes différents (Europe et Amérique du Nord)