The admission of Asian patients to intensive therapy units and its implications for kidney donation: a preliminary report from Coventry, UK

OBJECTIVE

To determine the relative admission rates of Asian and non-Asian patients to intensive therapy units (ITUs) in Coventry and to explore the implications of these rates for the transplantation of organs to Asian people.

DESIGN

Examination of 1991 census data and a retrospective review of ITU admissions books. Data were collected on ethnic background, presenting diagnosis, and clinical outcome for each admission.

SETTING

The three ITUs in Coventry.

PATIENTS

All admissions to the ITUs from 1990-93 inclusive.

RESULTS

Asian patients were admitted to ITUs disproportionately to their numbers in the Coventry population. Members of the Asian community were less than half as likely to be admitted to an ITU (p < 0.001) and more likely to die while there (p = 0.007) than members of the non-Asian population in Coventry. The proportions of patients referred to the transplant unit and the rates of subsequent donation do not seem to differ significantly for Asian and non-Asian patients (p = 0.26 in both cases).

CONCLUSIONS

There are clear implications for the availability of cadaveric kidney transplantation to Asian patients, given that few kidneys from non-Asian donors are histocompatible with Asian recipients. Indeed, in Asians, promotion of living related donation may be more effective in countering the organ shortfall than efforts to increase consent to cadaveric transplantation. However, it may be valuable to investigate any patterns of morbidity or social or cultural factors that might explain the initial low admissions rates to ITUs for Asian patients.

Attitudes and beliefs within the Sikh community regarding organ donation: a pilot study

The current shortage of organs for transplantation is a matter of considerable concern in the United Kingdom (U.K.). Whilst issues of histocompatibility create particular problems in this respect for the Asian population in the U.K., it is sometimes suggested that there is also a resistance to the idea of organ transplantation among this community. To explore this issue, a small-scale interview study was conducted in Coventry among members of the Sikh community. A judgemental sample of 22 individuals, from different strata of the local Sikh community, were interviewed either in one-to-one interviews or in a focus group. These interviews had two broad aims: to determine the prevailing attitudes towards organ transplantation, and to gauge the impact and acceptability of the current Department of Health campaign literature. It was found that, whilst there were a number of misgivings to do with notions of mutilation and reincarnation, and anxieties as to technical or clinical aspects of the transplantation process, the prevailing view was supportive of transplantation, and organ donation was seen as a highly appropriate means of exhibiting the altruistic tradition within Sikhism. Such barriers that exist to the idea of transplantation seem to have more to do with knowledge and understanding than with cultural or religious factors. Concerning the campaign literature, informants identified a number of shortcomings, and indicated ways in which the impact of the leaflets and posters might be enhanced. Although the generalizability of these findings is limited, and despite possible threats to the validity of the data collected, this study has produced findings with significant implications for future policy in this area.

Optimizing conditions for the growth of Lactobacillus casei YIT 9018 in tryptone-yeast extract-glucose medium by using response surface methodology

This study was undertaken to find optimum conditions of tryptone, yeast extract, glucose, Tween 80, and incubation temperature for the growth of Lactobacillus casei YIT 9018 and to assess the effects of these factors by use of response surface methodology. A central composite design was used as an experimental design for allocation of treatment combinations. A second-order polynomial regression model, which was used at first for analysis of the experiment, had a significant lack of fit. Therefore, cubic and quartic terms were incorporated into the regression model through variable selection procedures. Effects involving incubation temperature, yeast extract, glucose, and tryptone were significant, whereas the only significant effect involving Tween 80 was the interaction effect between temperature and Tween 80. It turned out that growth of L. casei YIT 9018 was most strongly affected by the incubation temperature. Estimated optimum conditions of the factors for growth of L. casei YIT 9018 are as follows: tryptone, 3.04%; yeast extract, 0.892%; glucose, 1.58%; Tween 80, 0%; incubation temperature, 35 degrees C.

Moral rights and the ethics of nursing

This paper explores the nature of rights, and their implications for the ethics of nursing. A right is seen as an entitlement which is justified on moral and/or legal grounds, and which may take the form of a right of action or a right of recipience, or both; in either case, correlative duties are generally imposed on others. Some of the conflicts which can occur among two or more conflicting rights are examined through three hypothetical scenarios, and approaches to their resolution are suggested. The question of whether nurses, as nurses, possess rights is then considered, and it is suggested that they do not. In conclusion, it is argued that, if rights are to be a helpful concept, they must be carefully defined and analysed, and their relationship to one another, and to duties, must be clarified.

Use of denaturing gradient electrophoresis to determine the distributions of polymorphisms in entire genes in natural populations

We show here that the method of genomic denaturing gradient electrophoresis (gDGGE) can be used to examine any gene that has been previously cloned and sequenced, and to detect and approximately localize within the gene the majority of its polymorphisms. By using pooled-DNA gDGGE, many different samples can be scanned on a single gel. Further, the patterns on the gels and results from sequencing of some of the alleles shows that a variety of different kinds of polymorphism, ranging from single base changes to more substantial allelic differences, can be distinguished. The extramacrochaetae (emc) gene of Drosophila melanogaster exhibits no polymorphism in its ORF that can be detected by this method, although a rearrangement polymorphism was detected in the 3' downstream region of the gene. The suppressor-of-hairless (Su(H)) gene of D. melanogaster, however, exhibits a variety of polymorphisms in its ORF. Some are small deletions or insertions in a glutamine-rich part of the gene product that would not have been detectable by ordinary screening methods. Many of the polymorphisms detected in this preliminary survey are likely to have an impact on the function of the Su(H) gene product.

Molecular mechanisms of resistance to heat and oxidative damage

Spore heat resistance can be predicted within reasonable limits from knowledge of optimal growth temperature of the sporeformer, the temperature of sporulation, water content of the spore protoplast, cortex size, total mineralization and specific mineralization. The molecular mechanisms by which dehydration and mineralization act to stabilize spores against heat damage are unknown. A major need for further progress is to identify the principal targets for lethal damage. In this review the hypothesis was explored that heat killing may be related to oxidative killing. The proposed common denominator for the two is the formation of radicals able to react with, and irreversibly damage, spore polymers such as proteins or DNA.

Sports medicine: some ethical issues

The ethical aspects of sports medicine have hitherto received little scrutiny, in contrast to its legal implications, which have recently been subject to much greater discussion. However, the differences that are apparent between sports medicine and 'mainstream' areas of clinical practice can shed new light on a number of the central issues within health-care ethics. By means of hypothetical case studies, this paper seeks to examine some of these issues within a sports medicine context. Specific attention will be paid to the concepts of autonomy and paternalism, issues to do with truthfulness, and the question of conflicting professional loyalties. It is suggested that the ethics of sports medicine warrant further and more detailed examination.

Measurement validity in physical therapy research

This article considers the role of measurement validity within physical therapy research. The concept of measurement validity is identified as a component of internal validity, and it is differentiated from the notion of reliability; these concepts are related to systematic and random sources of error, respectively. Using examples from physical therapy and rehabilitation, four main types of validity are reviewed: face validity, criterion-related validity, content validity, and construct validity. The differing implications of these types of validity for quantitative and qualitative research are discussed. Three principal areas of concern are then addressed, based on a critical discussion of selected examples from the literature. First, it is argued that validity is often poorly distinguished from the allied concept of reliability and that purported claims for validity often only demonstrate reliability. Second, it is claimed that validity is too often neglected in favor of reliability, and specific examples relating to gait analysis are put forward to support this argument. Third, some of the methodological difficulties that may occur when attempts are made to demonstrate validity are considered. The article concludes with a plea for a closer focus on the issue of measurement validity within physical therapy research.

Preferential accumulation of n-3 fatty acids in the brain of chicks from eggs enriched with n-3 fatty acids

Docosahexaenoic acid (DHA) is the major polyunsaturated fatty acid in the phospholipids of brain tissue. The extent to which maternal dietary n-3 fatty acid may influence the n-3 fatty acid composition of phosphatidylethanolamine (PE) and phosphatidylcholine (PC) fractions of brain and liver tissue of progeny was investigated. Hens were fed diets containing n-9, n-3, or n-6 fatty acids. The brain tissue of the chicks from eggs enriched with n-3 fatty acids contained higher DHA, resulting in an increased C22:6 n-3:C20:4 n-6 ratio compared with chicks from eggs enriched with n-9 or n-6 fatty acids. Incorporation of C22:5 n-3, and C22:6 n-3 was mainly in the PE fraction as compared with the PC fraction of the chick brain. For chicks hatched from eggs enriched with n-9, n-3, and n-6 fatty acids, the total n-3 fatty acids in the brain PE fraction were 29.3, 41.3, and 21.9% compared with 6.7, 8.8, and 4.0% in the brain PC fraction. In contrast, the n-3 fatty acids increased evenly in phospholipid PC and PE fractions. Total amounts of PE in the brain lipids of chicks from eggs enriched with n-3 and n-6 fatty acids were 40.8 and 41.9% compared with 33.1% for chicks from eggs enriched with n-9 fatty acids. Analyses of the remaining yolk sac revealed a preferential absorption of DHA from the egg PE fraction by the developing chick.

AIDS, nursing and occupational risk: an ethical analysis

This paper examines the notion of risk assessment in relation to nursing patients with HIV infection or AIDS. Risk assessment consists in examining three features of a given hazard; its magnitude, its probability, and its acceptability. In relation to the last of these, an 'acceptability threshold' can be identified. If contact with HIV-infected patients is perceived to pass this threshold, nurses may seek to abrogate the usual 'duty to treat'. Rather than endeavour to pinpoint this threshold, the paper explores some of the factors which may either raise or lower it, and their ethical implications. In particular, the consequences of setting a high threshold, and thereby limiting or avoiding contact with patients infected with HIV, are examined. In this debate, the burden of proof is seen as resting firmly on nurses themselves, not on the patients at risk of being deprived of care.

Modulation of plasma and tissue cholesterol and fatty acid composition by feeding flax and canola seeds and oils to rats

Intact full-fat oil seeds might be more resistant to oxidation than extracted and refined oils and might therefore be used as sources of dietary fat. The present study was conducted to examine and compare the influence of feeding full-fat flax and canola seeds and oils on the plasma and tissue lipids of the rat. Male weanling Sprague Dawley rats (n = 4) were housed individually in metabolic cages and fed isoenergetic and isonitrogenous diets containing full-fat flax (FFF), flax meal + flax oil (FO), full-fat canola (FFC), canola meal + canola oil (CO), and soybean meal + animal tallow (AT). After 6 wk of feeding, plasma cholesterol levels were significantly (P < 0.05) reduced in rats fed flax diets (FF and FO) but not in those fed canola diets (FFC and CO). Liver cholesterol levels were not affected by dietary treatment. The highest levels of α-linolenic acid (LNA) and eicosapentaenoic acid (EPA) were recorded in the plasma, liver, heart and epididymal fat of rats fed the flax-containing diets. Intermediate levels of LNA and EPA in plasma and tissues were found in rats fed canola-containing diets. Rats fed flax diets had less arachidonic acid (AA) in plasma, liver, and heart tissues than those fed control and canola diets, indicating inhibition of AA synthesis by high dietary LNA provided by full-fat flax seed and flax oil. These results demonstrated that full-fat flax and canola seeds could be used as sources of dietary LNA to modify plasma and tissue lipids. Key words: Flax seed, canola seed, cholesterol, fatty acid, rat

Nursing research: is there an obligation on subjects to participate?

Studies of the ethics of medical and nursing research have focused principally on the more practical issues to do with the research process, such as informed consent and protection of subjects from harm. A more fundamental question, which is often overlooked, is whether individuals are under any sort of obligation to participate as subjects in nursing research in the first place. The conclusions which nurses reach on this issue will help establish the overall moral climate in which nursing research is conducted. In this paper, three models of such an obligation are explored; one based on a notion of payment, one centred in the social contract, and one which seeks to establish an unconditional obligation. Each of these is seen to be flawed in various respects. The delicate and potentially conflicting relationship between obligation and consent is then briefly examined. In conclusion, it is argued that the notion of a 'moral claim' on participation in research is an ethically more acceptable approach than any strict sense of obligation.

An ethical analysis of physical therapists' duty to treat persons who have AIDS: homosexual patients as a test case

A possible abrogation of the health professional's usual duty to treat sometimes is suggested in regard to patients with acquired immunodeficiency syndrome (AIDS). The issue first arose and continues to be discussed in regard to those patients who have contracted AIDS through homosexual encounters, though there are now additional populations of patients with AIDS to whom the issue is being directed as well. We examine three lines of reasoning that may be advanced to support this view: the argument from morality, the argument from responsibility, and the argument from the alleged danger to others. We show logical and ethical shortcomings in each view and suggest how the physical therapist's duty to treat all patients who have AIDS can be realized in a safe and supportive environment.

Effects of two feeding systems, two protein levels, and different dietary energy sources and levels on performance of squabbing pigeons

Two experiments were conducted to study the effects on the performance of squabbing pigeons of two feeding systems based on two protein levels, two fat sources, and varying fat and energy levels. The first experiment was carried out with birds housed in pens and fed pelleted feeds of different CP levels (16 and 22%), with or without whole yellow corn. In the second experiment, birds were housed in pair cages. Two fat types (sunflower oil and animal tallow) were tested at three levels (0, 3, and 6%) to give three energy levels (2,650, 2,900, and 3,150 kcal ME/kg of diet) in isonitrogenous diets (15% CP). In the first experiment, the 16% CP diet with corn adversely affected squab livability and growth without affecting egg production traits or adult body weight. The 22% CP diet with or without corn and the 16% CP diet without corn gave similar responses for both the adult birds and their squabs. Daily intakes per pair of birds fed these three diets varied between 106 and 126 g for feed, 17.4 and 23.4 g for CP, and 340 and 398 kcal ME. In the second experiment, birds fed the diet with no supplemental fat did not produce squabs, whereas fat-supplemented diets resulted in production of at least six squabs. The source of fat did not significantly affect squab production. Feed intake decreased with increase in dietary energy level, resulting in similar consumption levels of energy for birds on all the diets. Average energy intake was about 235 kcal ME per pair per day for pigeons not producing squabs. Energy intake did not appear to correlate with squab production.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of feeding egg yolk powder on the plasma and tissue cholesterol levels in rats

Two isonitrogenous diets, one containing 18.7% egg yolk powder (YP) and the other balanced with casein, lard, and cholesterol (CN), were fed to male Sprague-Dawley rats for 4 wk. Rats fed the YP diet had levels of plasma total cholesterol and high density lipoprotein cholesterol similar to those fed CN. Free and total cholesterol contents of liver, but not heart tissue, were significantly lower in YP-fed than in CN-fed rats.

Vibratory massage and short-term recovery from muscular fatigue

Percussive vibratory massage has long been purported to offset the negative effects of muscular exercise. The purpose of this experiment was to determine the effect of this type of massage on recovery from repeated submaximal contractions. Twelve male subjects performed repeated, static contractions of the quadriceps at 70% maximal voluntary contraction (MVC), with periodic MVCs performed after every fourth one. This pattern continued until the subject could no longer produce the required 70% (Tlim). The entire procedure was repeated three times with rest periods between each series. The rate of fatigue (ROF) was calculated from a regression line fit to the decline of the periodic MVCs. We studied the ROF during static exercise alone, as well as during static exercise following cycling for 30 min at 75% VO2max. In the control conditions, the subjects rested for 5 min between each of the three series of contractions. In the experimental conditions the subjects received 4 min of percussive vibratory massage and 1 min of rest. The results showed that there was no significant difference in ROF in either static or following dynamic exercise between the control and vibrated conditions. Although ROF was the same in all experimental conditions. Tlim occurred sooner following dynamic exercise because the initial MVC was significantly lower than static (p less than .008). We have therefore concluded that short-term recovery from intense muscular activity is not augmented by percussive vibratory massage.

Barley and full-fat canola seed in layer diets

Combinations of barley and full-fat canola seed (FFCS) were evaluated in two experiments with pullets. In Experiment 1, diets containing 40% barley plus FFCS or canola meal (CM) were compared with wheat-soybean and barley-soybean control diets. In Experiment 2, various steam-pelleted barley-FFCS mixtures (80:20 70:30, 60:40, 50:50) were used at the 40% dietary level in pullet diets. Diets within each experiment were isocaloric and isonitrogenous. Egg production was depressed when hens were fed unpelleted barley-FFCS diets, whereas hens fed pelleted barley-FFCS diets produced at a rate equivalent to those fed the control diet. Feed consumption, feed conversion, and egg weight were not influenced by dietary treatment. Yolk color index was significantly increased in eggs from hens fed diets containing increasing amounts of FFCS. In Experiment 2, contents of linoleic acid, linolenic acid, and docosahexaenoic acid in the yolk increased in a linear manner with increasing content of FFCS in the diets.

Barley and full-fat canola seed in broiler diets

Barley and full-fat canola seed (FFCS), with or without an added enzyme mixture, were evaluated in experiments with broiler chicks. In Experiment 1, test diets contained barley, wheat, and soybean meal and were supplemented or unsupplemented with raw FFCS (10%) or canola meal (6%). The control was a wheat-soybean meal diet. Diets were fed to male and female broiler chicks for 7 wk. The diet supplemented with raw FFCS produced significantly (P less than .05) lower weight gains than the other diets. There were elevated levels (P less than .05) of linoleic and linolenic acids (18:2 omega 6; 18:3 omega 3) in tissue lipids of chicks fed raw FFCS. In Experiment 2, broiler chicks were fed diets containing a steam-pelleted barley-FFCS mixture (80:20), included at a 50% level, along with supplemental barley. Total barley level in the experimental diets was 50%. 45%, and 40%. A barley-soybean meal diet was used as a control. All diets were fed with and without an enzyme supplement. Chicks fed the barley-FFCS diets were similar to those fed the control diet in respect to production parameters and carcass characteristics. Supplementation of diets with the enzyme mixture resulted in significantly larger body weight gains and lower feed:gain ratios. In Experiment 3, enzyme supplementation increased (P less than .01) the ME of the steam-pelleted barley-FFCS mixtures and the mixed feed containing barley-FFCS. Data from Experiment 4 indicated that there were no significant differences in availability among amino acids from barley, FFCS, or pelleted barley-FFCS mixture diets.

The health visitor's visit

A study was undertaken to see how closely 100 clients' views of the purpose of the health visitor's home visit were in accord with the professionals' views. It was found that overall clients' views of the purposes of the health visitor's visit were in general agreement with the professionals' view. However the satisfaction with the visit felt by professionals and client did not depend on the closeness of agreement of their views on the reasons for the visit.