Using an Ethical Model to Manage Patient-Soldier Confidentiality When Medical Treatment for Post Traumatic Stress Disorder is Refused

This paper reviews the ethical tensions and the dual loyalty conflict between following military orders and professional codes of conduct. All competent patients have a right to refuse medical treatment. However, maintaining confidentiality is not an absolute right. In the military, a doctor may have a dual loyalty conflict between obeying military orders and following professional codes of practice. This can become exacerbated when a doctor in a military environment does not consider all the parties’ interests. This paper suggests that dual loyalty conflict in military healthcare practice in this environment is best managed via a discretionary ethic-role. This then allows independent clinical judgment while at the same time minimizing ethical dilemmas, harm, and conflict to a third party such as a military commander

Organizational learning and emotion: constructing collective meaning in support of strategic themes

Missing in the organizational learning literature is an integrative framework that reflects the emotional as well as the cognitive dynamics involved. Here, we take a step in this direction by focusing in depth over time (five years) on a selected organization which manufactures electronic equipment for the office industry. Drawing on personal construct theory, we define organizational learning as the collective re-construal of meaning in the direction of strategically significant themes. We suggest that emotions arise as members reflect on progress or lack of progress in achieving organizational learning. Our evidence suggests that invalidation – where organizational learning fails to correspond with expectations – gives rise to anxiety and frustration, while validation – where organizational learning is aligned with or exceeds expectations – evokes comfort or excitement. Our work aims to capture the key emotions involved as organizational learning proceeds

Poro-mechanical analysis of a biomimetic scaffold for osteochondral defects

Osteochondral defects are focal areas of damage involving articular cartilage and sub-chondral bone. Tissue engineering scaffolds are used to improve the organism regeneration ability for this kind of injury, serving as biocompatible structures for cell viability and differentiation. Since biomechanical cues such as substrate stiffness, loading conditions and fluid permeation are fundamental for successful tissue repair, understanding how these features vary in the scaffold is of primary importance. Here we present a mathematical model based on porous media mechanics for the analysis of a tissue engineering scaffold. We consider a three-layered scaffold mimicking a complete osteochondral tissue and vary the mechanical properties of the intermediate layer over a physiological range. Our results show that the interstitial fluid pressure and the vertical component of the solid effective stress depend significantly on the stiffness and permeability of the intermediate layer under mechanical loading. By properly tuning these material properties, regimes of slow or fast temporal variations of mechanical stress can be obtained in the scaffold layer of interest

The impact of biogenic, anthropogenic, and biomass burning volatile organic compound emissions on regional and seasonal variations in secondary organic aerosol

The global secondary organic aerosol (SOA) budget is highly uncertain, with global annual SOA production rates, estimated from global models, ranging over an order of magnitude and simulated SOA concentrations underestimated compared to observations. In this study, we use a global composition-climate model (UKCA) with interactive chemistry and aerosol microphysics to provide an in-depth analysis of the impact of each VOC source on the global SOA budget and its seasonality. We further quantify the role of each source on SOA spatial distributions, and evaluate simulated seasonal SOA concentrations against a comprehensive set of observations. The annual global SOA production rates from monoterpene, isoprene, biomass burning, and anthropogenic precursor sources is 19.9, 19.6, 9.5, and 24.6Tg (SOA) a⁻¹, respectively. When all sources are included, the SOA production rate from all sources is 73.6Tg (SOA) a⁻¹, which lies within the range of estimates from previous modelling studies. SOA production rates and SOA burdens from biogenic and biomass burning SOA sources peak during Northern Hemisphere (NH) summer. In contrast, the anthropogenic SOA production rate is fairly constant all year round. However, the global anthropogenic SOA burden does have a seasonal cycle which is lowest during NH summer, which is probably due to enhanced wet removal. Inclusion of the new SOA sources also accelerates the ageing by condensation of primary organic aerosol (POA), making it more hydrophilic, leading to a reduction in the POA lifetime. With monoterpene as the only source of SOA, simulated SOA and total organic aerosol (OA) concentrations are underestimated by the model when compared to surface and aircraft measurements. Model agreement with observations improves with all new sources added, primarily due to the inclusion of the anthropogenic source of SOA, although a negative bias remains. A further sensitivity simulation was performed with an increased anthropogenic SOA reaction yield, corresponding to an annual global SOA production rate of 70.0Tg (SOA) a⁻¹. Whilst simulated SOA concentrations improved relative to observations, they were still underestimated in urban environments and overestimated further downwind and in remote environments. In contrast, the inclusion of SOA from isoprene and biomass burning did not improve model–observations biases substantially except at one out of two tropical locations. However, these findings may reflect the very limited availability of observations to evaluate the model, which are primarily located in the NH mid-latitudes where anthropogenic emissions are high. Our results highlight that, within the current uncertainty limits in SOA sources and reaction yields, over the NH mid-latitudes, a large anthropogenic SOA source results in good agreement with observations. However, more observations are needed to establish the importance of biomass burning and biogenic sources of SOA in model agreement with observations

The Structure and Entrainment Characteristics of Partially Confined Gravity Currents

Seafloor channels are the main conduit for turbidity currents transporting sediment to the deep ocean, and they can extend for thousands of kilometers along the ocean floor. Although it is common for channel‐traversing turbidity currents to spill onto levees and other out‐of‐channel areas, the associated flow development and channel‐current interaction remain poorly understood; much of our knowledge of turbidity current dynamics comes from studies of fully confined scenarios. Here we investigate the role that partial lateral confinement may play in affecting turbidity current dynamics. We report on laboratory experiments of partially confined, dilute saline flows of variable flux rate traversing fixed, straight channels with cross‐sectional profiles representative of morphologies found in the field. Complementary numerical experiments, validated against high‐resolution laboratory velocity data, extend the scope of the analysis. The experiments show that partial confinement exerts a first‐order control on flow structure. Overbank and downstream discharges rapidly adjust over short length scales, providing a mechanism via which currents of varying sizes can be tuned by a channel and conform to a given channel geometry. Across a wide range of flow magnitudes and states of flow equilibration to the channel, a high‐velocity core remains confined within the channel with a constant ratio of velocity maximum height to channel depth. Ongoing overbank flow prevents any flow thickening due to ambient entrainment, allowing stable downstream flow evolution. Despite dynamical differences, the entrainment rates of partially confined and fully confined flows remain comparable for a given Richardson number

Criteria for the use of omics-based predictors in clinical trials.

The US National Cancer Institute (NCI), in collaboration with scientists representing multiple areas of expertise relevant to 'omics'-based test development, has developed a checklist of criteria that can be used to determine the readiness of omics-based tests for guiding patient care in clinical trials. The checklist criteria cover issues relating to specimens, assays, mathematical modelling, clinical trial design, and ethical, legal and regulatory aspects. Funding bodies and journals are encouraged to consider the checklist, which they may find useful for assessing study quality and evidence strength. The checklist will be used to evaluate proposals for NCI-sponsored clinical trials in which omics tests will be used to guide therapy

OSCE best practice guidelines—applicability for nursing simulations

Background: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. Methods: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.Results: Few changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. Discussion: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. Conclusions: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role