Professional ethics at the bottom line

Recently, there has been much written about professional ethics in health care, but the literature has tended to focus on the ethical care and treatment of patients and protection of their privacy and confidential information. This article focuses on the ethical behavior of health care professionals and how they treat each other in the workplace. Examples of unethical behavior are described ranging from subtle favoritism by managers and bullying to crossing the legal line. Two specific cases demonstrate serious situations where it was necessary for colleagues to "blow the whistle" even at the risk of their own careers.     

Attenuation of mitochondrial respiration by sevoflurane in isolated cardiac mitochondria is mediated in part by reactive oxygen species

BACKGROUND: Anesthetic preconditioning protects against cardiac ischemia/reperfusion injury. Increases in reduced nicotinamide adenine dinucleotide and reactive oxygen species during sevoflurane exposure suggest attenuated mitochondrial electron transport as a trigger of anesthetic preconditioning. The authors investigated the effects of sevoflurane on respiration in isolated cardiac mitochondria. METHODS: Mitochondria were isolated from fresh guinea pig hearts, and mitochondrial oxygen consumption was measured in the presence of complex I (pyruvate) or complex II (succinate) substrates. The mitochondria were exposed to 0, 0.13, 0.39, 1.3, or 3.9 mM sevoflurane. State 3 respiration was determined after adenosine diphosphate addition. The reactive oxygen species scavengers manganese(III) tetrakis (4-benzoic acid) porphyrin chloride and N-tert-Butyl-a-(2-sulfophenyl)nitrone sodium (10 microM each), or the K(ATP) channel blockers glibenclamide (2 microM) or 5-hydroxydecanoate (300 microM), were given alone or before 1.3 mM sevoflurane. RESULTS: Sevoflurane attenuated respiration for both complex I and complex II substrates, depending on the dose. Glibenclamide and 5-hydroxydecanoate had no effect on this attenuation. Both scavengers, however, abolished the sevoflurane-induced attenuation for complex I substrates, but not for complex II substrates. CONCLUSION: The findings suggest that sevoflurane-induced attenuation of complex I is mediated by reactive oxygen species, whereas attenuation of other respiratory complexes is mediated by a different mechanism. The opening of mitochondrial K(ATP) channels by sevoflurane does not seem to be involved in this effect. Thus, reactive oxygen species formation may not only result from attenuated electron transport by sevoflurane, but it may also contribute to complex I attenuation, possibly leading to a positive feedback and amplification of sevoflurane-induced reactive oxygen species formation in triggering anesthetic preconditioning.     

Evidence-Based Teaching Practice: Implications for Behavioral Health

Educational practices and strategies have changed very little over the years, and even emerging advances in technology have become the prisoners of traditional academic norms. Thus, while there is increasing emphasis on evaluating and aligning caregiving processes with the strongest evidence of effectiveness, there is little demonstration or role-modeling of this same expectation in either the formal or continuing educational processes of behavioral healthcare providers. This "disconnect" is a significant problem in the field. This paper addresses the urgent need to inform the education and training of the behavioral health workforce with current theories regarding the teaching-learning process and evidence about the effectiveness of various teaching strategies. The relevant theories and available bodies of evidence are described, and the implications for workforce education and training are identified.     

Macrofilaricides and onchocerciasis control, mathematical modelling of the prospects for elimination

Background

In most endemic parts of the world, onchocerciasis (river blindness) control relies, or will soon rely, exclusively on mass treatment with the microfilaricide ivermectin. Worldwide eradication of the parasite by means of this drug is unlikely. Macrofilaricidal drugs are currently being developed for human use.

Methods

We used ONCHOSIM, a microsimulation mathematical model of the dynamics of onchocerciasis transmission, to explore the potentials of a hypothetical macrofilaricidal drug for the elimination of onchocerciasis under different epidemiological conditions, as characterized by previous intervention strategies, vectorial capacity and levels of coverage.

Results

With a high vector biting rate and poor coverage, a very effective macrofilaricide would appear to have a substantially higher potential for achieving elimination of the parasite than does ivermectin.

Conclusions

Macrofilaricides have a substantially higher potential for achieving onchocerciasis elimination than ivermectin, but high coverage levels are still key. When these drugs become available, onchocerciasis elimination strategies should be reconsidered. In view of the impact of control efforts preceding the introduction of macrofilaricides on the success of elimination, it is important to sustain current control efforts.     

Lead-produced changes in the relative rate of open field activity of laboratory rats

Four groups of rats, continuously exposed to one of two lead acetate solutions, ad lib water or a limited amount of water, were tested for three daily 5 min periods on the open field. The effects of treatment on activity, relative to animals drinking ad lib water, depended upon the concentration of the lead acetate solution. Animals exposed to a 10^?4 M lead acetate solution showed increased overall activity while animals exposed to a 10^?2 M lead acetate solution showed changes in the relative rate of activity. Activity was not affected by limiting the amount of water consumed. These findings illustrate the importance of recording activity in a manner which allows assessment of changes in activity as well as absolute level.