Ethical decision-making, passivity and pharmacy

Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals' ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making. Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group. Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis. Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists' failure to report healthcare professionals' bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty. Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients' welfare, and concerns emerge about improving pharmacists' ethical training and promoting ethical awareness and responsibility

A new prescription for empirical ethics research in pharmacy: a critical review of the literature

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy - one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline

Low carbon housing: lessons from Elm Tree Mews

This report sets out the findings from a low carbon housing trial at Elm Tree Mews, York, and discusses the technical and policy issues that arise from it. The Government has set an ambitious target for all new housing to be zero carbon by 2016. With the application of good insulation, improved efficiencies and renewable energy, this is theoretically possible. However, there is growing concern that, in practice, even existing carbon standards are not being achieved and that this performance gap has the potential to undermine zero carbon housing policy. The report seeks to address these concerns through the detailed evaluation of a low carbon development at Elm Tree Mews. The report: * evaluates the energy/carbon performance of the dwellings prior to occupation and in use; * analyses the procurement, design and construction processes that give rise to the performance achieved; * explores the resident experience; * draws out lessons for the development of zero carbon housing and the implications for government policy; and * proposes a programme for change, designed to close the performance gap

Evidence for heat losses via party wall cavities in masonry construction

This paper presents empirical evidence and analysis that supports the existence of a significant heat loss mechanism resulting from air movement through cavities in party walls in masonry construction. A range of heat loss experiments were undertaken as part of the Stamford Brook housing field trial in Altrincham in the United Kingdom. Co-heating tests showed a large discrepancy between the predicted and measured whole house heat loss coefficients. Analysis of the co-heating results, along with internal temperature data, thermal imaging and a theoretical analysis indicated that the most likely explanation for the discrepancy was bypassing of the thermal insulation via the uninsulated party wall cavities. The data show that such a bypass mechanism is potentially the largest single contributor to heat loss in terraced dwellings built to the 2006 revision of the Building Regulations. A comparable convective heat bypass associated with masonry party walls was identified in the late 1970s during the course of the Twin Rivers Project in the United States, albeit in a somewhat different construction from that used at Stamford Brook. A similar effect was also reported in the United Kingdom in the mid 1990s. However, it appears that no action was taken at that time either to confirm the results, to develop any technical solutions, or to amend standards for calculating heat losses from buildings. Current conventions for heat loss calculations in the United Kingdom do not take account of heat losses associated with party walls and it is suggested by the authors that such conventions may need to be updated to take account of the effect described in this paper. In the final part of the paper, the authors propose straightforward solutions to prevent bypassing of roof insulation via party walls by for example filling the cavity of the party wall with mineral fibre insulation, or by inserting a cavity closer across the cavity in the plane of the roof insulation.Practical application: The heat bypass mechanism described in this paper is believed by the authors to contribute to a significant proportion of heat loss from buildings in the UK constructed with clear cavities such as those found in separating walls between cavity masonry dwellings. It is proposed that relatively simple design changes could be undertaken to eliminate such heat loss pathways from new buildings. In addition, simple and cost effective measures are envisaged that could be used to minimise or eliminate the bypass from existing buildings. Such an approach could give rise to a significant reduction in carbon emissions from UK housing

Airtightness of buildings — towards higher performance: Final Report — Domestic Sector Airtightness

This report constitutes milestone D11 — Final Report — Domestic Sector Airtightness of the Communities and Local Government/ODPM Project reference CI 61/6/16 (BD2429) Airtightness of Buildings — Towards Higher Performance (Borland and Bell, 2003). This report presents the overall conclusions and key messages obtained from the project through design assessments, construction observations, discussions with developers and pressurisation test results. It also summarises discussion on the airtight performance of current UK housing, the implementation and impact of current and future legislation, and identifies potential areas for future work

Names of fungal species with the same epithet applied to different morphs: how to treat them

The abolition of the separate naming of different morphs of the same fungal species in 2011 will inevitably result in many name changes in some genera. The working practices commended here are intended to minimize one category of these changes, that which can arise as a consequence of an author using the epithet of an asexual morph when describing the sexual morph of the same species. We consider that name proposed for the sexual morph in such cases should be treated as a formal error for a new combination and not as a new species, and so be corrected. This is interpreted as applying even where the author indicated that a new species was being described and designated a type. We argue that those formalities were a result of the requirements of the rules then in force, as the author recognized that a morph of a named species was being described, and not a new hitherto unnamed species was being reported - but was barred from making a new combination so used the same epithet for the new morph name instead. Where a type with the sexual morph was designated for the sexual morph, under this interpretation that no longer has nomenclatural status, the type being that of the basionym. The material for the sexual morph indicated as a type, would be available for designation as an epitype, though a modern sequenced sample with both sexual and asexual morphs would be more informative as an epitype in many cases. A proposal to regularize the working practice commended here, and also the converse situation where the sexual morph typified name is the earlier, will be made to the 2017 Shenzhen Congress

Evaluating the impact of an enhanced energy performance standard on load-bearing masonry domestic construction: Understanding the gap between designed and real performance: lessons from Stamford Brook.

This report is aimed at those with interests in the procurement, design and construction of new dwellings both now and in the coming years as the Government’s increasingly stringent targets for low and zero carbon housing approach. It conveys the results of a research project, carried out between 2001 and 2008, that was designed to evaluate the extent to which low carbon housing standards can be achieved in the context of a large commercial housing development. The research was led by Leeds Metropolitan University in collaboration with University College London and was based on the Stamford Brook development in Altrincham, Cheshire. The project partners were the National Trust, Redrow and Taylor Wimpey and some 60 percent of the planned 700 dwelling development has been completed up to June 2008. As the UK house building industry and its suppliers grapple with the challenges of achieving zero carbon housing by 2016, the lessons arising from this project are timely and of considerable value. Stamford Brook has demonstrated that designing masonry dwellings to achieve an enhanced energy standard is feasible and that a number of innovative approaches, particularly in the area of airtightness, can be successful. The dwellings, as built, exceed the Building Regulations requirements in force at the time but tests on the completed dwellings and longer term monitoring of performance has shown that, overall, energy consumption and carbon emissions, under standard occupancy, are around 20 to 25 percent higher than design predictions. In the case of heat loss, the discrepancy can be much higher. The report contains much evidence of considerable potential but points out that realising the design potential requires a fundamental reappraisal of processes within the industry from design and construction to the relationship with its supply chain and the development of the workforce. The researchers conclude that, even when builders try hard, current mainstream technical and organisational practices together with industry cultures present barriers to consistent delivery of low and zero carbon performance. They suggest that the underlying reasons for this are deeply embedded at all levels of the house building industry. They point out also that without fundamental change in processes and cultures, technological innovations, whether they be based on traditional construction or modern methods are unlikely to reach their full potential. The report sets out a series of wide ranging implications for new housing in the UK, which are given in Chapter 14 and concludes by firmly declaring that cooperation between government, developers, supply chains, educators and researchers will be crucial to improvement. The recommendations in this report are already being put into practice by the researchers at Leeds Metropolitan University and University College London in their teaching and in further research projects. The implications of the work have been discussed across the industry at a series of workshops undertaken in 2008 as part of the LowCarb4Real project (see http://www.leedsmet.ac.uk/as/cebe/projects/lowcarb4real/index.htm). In addition, the learning is having an impact on the work of the developers (Redrow and Taylor Wimpey) who, with remarkable foresight and enthusiasm, hosted the project. This report seeks to make the findings more widely available and is offered for consideration by everyone who has a part to play in making low and zero carbon housing a reality

The relationship between airtightness and ventilation in new UK dwellings

The ATTMA airtightness testing competent persons scheme collects pressure test data and metadata from the majority of new build dwellings in the UK. This article uses the dataset to investigate the importance of the ventilation strategy in airtightness design and construction. Design and measured airtightness were tested for association with declared ventilation strategy. It was found that ventilation strategy makes a statistically significant difference to airtightness, however this difference is too small to be practically relevant. Properties with mechanical ventilation and heat recovery (MVHR) were shown to have a mean designed air permeability only 0.46 m3/m2h lower than naturally ventilated dwellings. 73% of homes with MVHR have design airtightness greater than or equal to 5 m3/m2h and 17% of naturally ventilated dwellings have design airtightness less than 5 m3/m2h. We discuss how current design is not maximising the CO2, cost and air quality benefit of each ventilation strategy. A new approach to regulatory compliance is proposed which explicitly links the designed airtightness and chosen ventilation system. It is suggested that compliance could then be achieved using a set of airtightness ranges linked to appropriate ventilation strategies. This could be expected to result in reduced energy consumption and carbon emissions for new build homes compared to the current approach, and would also potentially lead to better outcomes for occupants in terms of indoor air quality

Celoporthe dispersa gen. et sp. nov. from native Myrtales in South Africa

In a survey for Cryphonectria and Chrysoporthe species on Myrtales in South Africa, a fungus resembling the stem canker pathogen Chrysoporthe austroafricana was collected from native Syzygium cordatum near Tzaneen (Limpopo Province), Heteropyxis canescens near Lydenburg (Mpumalanga Province) and exotic Tibouchina granulosa in Durban (KwaZulu-Natal Province). The fungus was associated with dying branches and stems on S. cordatum, H. canescens and T. granulosa. However, morphological differences were detected between the unknown fungus from these three hosts and known species of Chrysoporthe. The aim of this study was to characterise the fungus using DNA sequence comparisons and morphological features. Pathogenicity tests were also conducted to assess its virulence on Eucalyptus (ZG 14 clones), H. natalensis and T. granulosa. Plants of H. canescens were not available for inoculation. Results showed distinct morphological differences between the unknown fungus and Chrysoporthe spp. Phylogenetic analysis showed that isolates reside in a clade separate from Chrysoporthe and other related genera. Celoporthe dispersa gen. et sp. nov. is, therefore, described to accommodate this fungus. Pathogenicity tests showed that C. dispersa is not pathogenic to H. natalensis, but that it is a potential pathogen of Eucalyptus and Tibouchina spp