Solo doctors and ethical isolation

This paper uses the case of solo doctors to explore whether working in relative isolation from one's peers may be detrimental to ethical decision-making. Drawing upon the relevance of communication and interaction for ethical decision-making in the ethical theories of Habermas, Mead and Gadamer, it is argued that doctors benefit from ethical discussion with their peers and that solo practice may make this more difficult. The paper identifies a paucity of empirical research related to solo practice and ethics but draws upon more general medical ethics research and a study that identified ethical isolation among community pharmacists to support the theoretical claims made. The paper concludes by using the literary analogy of Soderberg's Doctor Glas to illustrate the issues raised and how ethical decision-making in relative isolation may be problematical

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

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

Target value design: using collaboration and a lean approach to reduce construction cost

Target Costing is an effective management technique that has been used in manufacturing for decades to achieve cost predictability during new products development. Adoption of this technique promises benefits for the construction industry as it struggles to raise the number of successful outcomes and certainty of project delivery in terms of cost, quality and time. Target Value Design is a management approach that takes the best features of Target Costing and adapts them to the peculiarities of construction. In this paper the concept of Target Value Design is introduced based on the results of action research carried out on 12 construction projects in the USA. It has been shown that systemic application of Target Value Design leads to significant improvement of project performance – the final cost of projects was on average 15% less than market cost. The construction industry already has approaches that have similarities with elements of the Target Value Design process or uses the same terminology, e.g. Partnering and Target Cost Contracts, Cost planning, etc. Following an exploration of the similarities and differences Target Value Design is positioned as a form of Target Costing for construction that offers a more reliable route to successful projects outcomes

Development of simultaneous electroencephalography and near-infrared optical topography for applications to neurovascular coupling and neonatal seizures

This thesis describes the development and preliminary application of methods for performing simultaneous electroencephalography (EEG) and near-infrared (NIR) imaging of the brain. The simultaneous application of EEG and NIR imaging has many benefits because of the complementary nature of the two modalities, and has significant potential in the study of the relationship between neuronal activity and cerebral haemodynamics. This work goes beyond previous experiments which have combined EEG and limited-channel near-infrared spectroscopy by designing and implementing an arrangement which allows dense near-infrared optical topography and EEG to be performed over the same cortical area, with as simple an application method as possible. These application methods are described in detail, as is their extensive testing using novel dual-modality phantoms and an in-vivo EEG-NIR imaging experiment in a healthy adult. These methods are subsequently applied to the study of neonates in the clinical environment. An intricate EEG-NIR imaging experiment is designed and implemented in an investigation of functional activation in the healthy neonatal visual cortex. This series of experiments also acts as a further test of the suitability of our EEG-NIR imaging methods for clinical application. The results of these experiments are presented. The EEG-NIR imaging arrangement is then applied to four neurologically damaged infants in the neonatal intensive care unit, each of whom had been diagnosed with seizures. The results of these studies are presented, and a potentially significant haemodynamic feature, which is not present in agematched controls, is identified. The importance and physiological implications of our findings are discussed, as is the suitability of a combined EEG and NIR imaging approach to the study and monitoring of neonatal brain injury

Human papillomavirus vaccination acceptance and hesitancy in South Africa: Research and policy agenda

Cervical cancer is responsible for one-quarter of a million deaths per year  worldwide. In South Africa (SA), cervical cancer is the leading cause of  cancer deaths among women aged 15 - 44 years. Human papillomavirus  (HPV) vaccines provide a safe and highly effective means to reduce the burden of cervical cancer. The World Health Organization initiated a plan for the elimination of cervical cancer; the programme’s success relies on the introduction and high uptake of HPV vaccines globally. SA introduced a school-based HPV vaccination programme in 2014, but uptake is not as high as expected. Suboptimal HPV vaccination coverage may result from various factors, including vaccine hesitancy. Vaccine-hesitant parents may delay or refuse HPV vaccination for their daughters. Tailored interventions are needed to address this. However, knowledge regarding vaccine  hesitancy and policies to address this hesitancy in SA are currently limited. While SA has taken commendable steps in cervical cancer prevention by implementing and financing the HPV vaccination programme, it is  imperative that there are clear policies in place to help strengthen the programme. These policies need to clarify areas of uncertainty that may lead to mistrust, and pre-empt factors that will cause hesitancy. Equally important is that local research should be conducted to better understand HPV vaccination hesitancy and other determinants of uptake to further inform and shape national policies

The construction of a bedrock geology model for the UK: UK3D_v2015

This report is available for download on the BGS UK3D web page to allow the reader to better understand the context and development of UK3D, a national network, or ‘fence diagram model’, of bedrock geology cross-sections. It also explains the development of the metadata underpinning the model and therefore supports use and understanding of UK3D. The pre-existing BGS GB3D model provided the only nationally consistent representation of the bedrock geology of Great Britain to depths of at least 1 km. The latest version of this model was released in 2014 as the GB3D_v2014 and accompanying report (Mathers et al. 2014b). However, the existing GB3D_v2014 model lacked equivalent scale presentation of a fence diagram model for Northern Ireland. It was recognised that in order to provide comparable geological information across the United Kingdom it was necessary to upgrade the model to a UK3D fence diagram model incorporating Northern Ireland, with rigorous peer review performed to enable an enhanced dataset. The objective of this study was therefore to further develop the GB3D model, outlined by Mathers et al. (2014a and b), into a UK3D model by the incorporation of 36 deep boreholes and a framework of 15 cross-sections for Northern Ireland. The appropriate applications for the revised model are for geoscience communication and education to illustrate the national and regional bedrock geology of the United Kingdom to a depth of at least 1 km with an intended resolution of use in the 1:250 000 to 1:1 million scale range. Limitations inherent in the model preclude such applications as detailed geological assessments, resource-reserve estimation and exploration, and any representation or use outside the intended resolution range. The new model produced by this study UK3D_v2015 supersedes the earlier 2014 version for England and Wales, for which areas of the fence diagrams remain the same. The Scottish portion of the model remains unchanged from the earlier 2012 version. The new dataset is a wholly owned BGS product and as with its forerunners it is freely available from the BGS website http://bgs.ac.uk as downloads in a variety of formats