Epithelial and stromal co-evolution and complicity in pancreatic cancer.

Pancreatic ductal adenocarcinomas are distinguished by their robust desmoplasia, or fibroinflammatory response. Dominated by non-malignant cells, the mutated epithelium must therefore combat, cooperate with or co-opt the surrounding cells and signalling processes in its microenvironment. It is proposed that an invasive pancreatic ductal adenocarcinoma represents the coordinated evolution of malignant and non-malignant cells and mechanisms that subvert and repurpose normal tissue composition, architecture and physiology to foster tumorigenesis. The complex kinetics and stepwise development of pancreatic cancer suggests that it is governed by a discrete set of organizing rules and principles, and repeated attempts to target specific components within the microenvironment reveal self-regulating mechanisms of resistance. The histopathological and genetic progression models of the transforming ductal epithelium must therefore be considered together with a programme of stromal progression to create a comprehensive picture of pancreatic cancer evolution. Understanding the underlying organizational logic of the tumour to anticipate and pre-empt the almost inevitable compensatory mechanisms will be essential to eradicate the disease.

Percepções de mulheres companheiras de homens presos acerca da conjugalidade / Perceptions on conjugality of female partners of imprisoned men / Percepciones de mujeres parejas de hombres encarcelados acerca de la conyugalidad

Este estudo objetivou compreender a experiência de mulheres companheiras de homens privados de liberdade acerca da conjugalidade. Para tanto, realizou-se uma pesquisa qualitativa, em que participaram 12 mulheres companheiras de homens presos. Como instrumentos, utilizou-se um questionário de dados sociodemográficos e uma entrevista semiestruturada, a qual foi analisada por meio da Análise Temática. Os resultados encontrados demonstraram que as mulheres lançavam mão de diferentes estratégias para se manterem próximas de seus companheiros, engajando-se no tratamento penal deles, o que repercutiu em uma percepção de incremento da coesão conjugal. O compromisso assumido com seus relacionamentos mostrou-se relacionado, além do amor sentido pelos parceiros, a um desejo de manutenção do casamento e da família nuclear, além de evidenciar experiências de ciúme por parte dos homens. Dificuldades na comunicação, conflitos relacionados à insatisfação com o contexto prisional, além da falta de privacidade na intimidade e sexualidade do casal foram referidos pelas participantes.(AU)

This study aimed to understand the experience of conjugality of female partners of imprisoned men. Therefore, 12 female partners of imprisoned men participated in a qualitative study. The participants answered to a sociodemographic questionnaire and a semi-structured interview, which was analyzed via Thematic Analysis. The results showed that women used different strategies to stay close to their partners, engaging in their criminal treatment, which reflected in a perception of increased marital cohesion. The commitment to the relationship was related to the love felt towards the partners, the desire to maintain the marriage and the nuclear family, in addition to the experience of men's jealousy. Moreover, it was identified difficulties in communication, conflicts related to dissatisfaction with prison context, and lack of privacy related to couple's intimacy and sexuality.(AU)

Este estudio tuvo como objetivo comprender la experiencia de las mujeres parejas de hombres encarcelados sobre la conyugalidad. Para ello, se realizó una investigación cualitativa, en la cual participaron doce mujeres parejas de hombres encarcelados. El instrumento utilizado fue un cuestionario de datos sociodemográficos y una entrevista semiestructurada, la cual se aplicó el análisis temático. Los resultados encontrados demostraron que las mujeres usaban diferentes estrategias para mantenerse cerca de sus parejas, comprometiéndose en el tratamiento delictivo de ellos, lo que repercutió en una percepción de mayor cohesión marital. El compromiso asumido con sus relaciones se mostró relacionado, además del amor a los cónyuges, a un deseo de mantenimiento del matrimonio y del núcleo familiar, y reveló experiencias de celos por parte de los hombres. Las dificultades en la comunicación, los conflictos relacionados a la insatisfacción con el contexto carcelario, y la ausencia de privacidad en la intimidad y sexualidad de la pareja fueron mencionadas por las participantes.(AU)

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Associação entre os cinco grandes fatores da personalidade e a intenção de corrupção / The Relationship Between the Big Five Personality Factors and the Intention of Corruption

Resumo A comportamento corrupto deve ser investigado a partir de diferentes níveis de análise. A nível intraindividual, a personalidade é uma variável relevante para sua compreensão. Objetivo. Na presente pesquisa, buscou-se analisar a influência dos traços de personalidade na intenção de comportamento corrupto a partir do modelo dos cinco grandes fatores da personalidade. Método. Participaram da pesquisa 286 indivíduos com idades entre 18 e 76 anos. Para coleta, foram utilizadas a Escala Reduzida dos cinco grandes fatores da personalidade, a Medida de Intenção de Corrupção e um questionário sociodemográfico. Resultados. Se encontraram correlações positivas entre a intenção de corrupção com as dimensões amabilidade, conscienciosidade e abertura à experiência. Porém, por meio de uma regressão linear múltipla, apenas a conscienciosidade teve efeito significativo. Implicações são discutidas.

Abstract Corruption must be investigated from different levels of analysis. At the intra-individual level, personality is a relevant variable for its understanding. Objective. In the present research, we sought to analyze the influence of personality traits on the intention of corrupt behavior based on the Big Five model of personality. Method. This study included 286 individuals between the ages of 18 and 76. A Reduced Scale of the Big Five personality factors, and a Corruption Intention Measurement scale, along general sociodemographic data were part of the data collection process. Results. Data showed positive correlations between corruption intention and the dimensions of agreeableness, conscientiousness, and openness. However, using multiple linear regression, only conscientiousness had a significant effect. Implications are discussed.

Deep pharma: psychiatry, anthropology, and pharmaceutical detox.

Psychiatric medication, or psychotropics, are increasingly prescribed for people of all ages by both psychiatry and primary care doctors for a multitude of mental health and/or behavioral disorders, creating a sharp rise in polypharmacy (i.e., multiple medications). This paper explores the clinical reality of modern psychotropy at the level of the prescribing doctor and clinical exchanges with patients. Part I, Geographies of High Prescribing, documents the types of factors (pharmaceutical-promotional, historical, cultural, etc.) that can shape specific psychotropic landscapes. Ethnographic attention is focused on high prescribing in Japan in the 1990s and more recently in the Upper Peninsula of Michigan, in the US. These examples help to identify factors that have converged over time to produce specific kinds of branded psychotropic profiles in specific locales. Part II, Pharmaceutical Detox, explores a new kind of clinical work being carried out by pharmaceutically conscious doctors, which reduces the number of medications being prescribed to patients while re-diagnosing their mental illnesses. A high-prescribing psychiatrist in southeast Wisconsin is highlighted to illustrate a kind of med-checking taking place at the level of individual patients. These various examples and cases call for a renewed emphasis by anthropology to critically examine the "total efficacies" of modern pharmaceuticals and to continue to disaggregate mental illness categories in the Boasian tradition. This type of detox will require a holistic approach, incorporating emergent fields such as neuroanthropology and other kinds of creative collaborations.

Research and complicity: the case of Julius Hallervorden.

The charge of complicity has been raised in debates over the ethics of fetal tissue transplantation and embryonic stem cell research. However, the applicability of the concept of complicity to these types of research is neither clear nor uncontroversial. This article discusses the historical case of Julius Hallervorden, a distinguished German neuropathologist who conducted research on brains of mentally handicapped patients killed in the context of the Nazi 'euthanasia' programme. It is argued that this case constitutes a paradigm of complicity in research that is useful in assessing complicity in contemporary research ethics.

When negative rights become positive entitlements: complicity, conscience, and caregiving.

Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals "against medical advice" are typically allowed to do so. But what happens when they require clinicians' assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients' requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical framework wherein clinicians can honor patients' wishes without necessarily sacrificing their own moral position.

Conciencia moral: ampliando su aplicación en salud: aspectos teóricos y prácticos de los juicios de conciencia en Chile / Consciência moral: ampliando sua aplicação em saúde: aspectos teóricos e práticos dos juízos de consciência no país / Moral conscience: widening its application in health: theoretical and practical issues of moral judgment in Chile

La conciencia se entiende habitualmente como un aspecto individual y subjetivo del ser humano; sin embargo, recientemente se ha destacado su carácter racional y sujeto a criterios externos de evaluación. La aplicación de los juicios de la conciencia moral es transversal a todos los campos de la atención en salud, incluso en la relación cotidiana con los pacientes. La objeción de conciencia de los profesionales de la salud ha sido criticada porque podría faltar a la responsabilidad profesional; no obstante, seguir la conciencia recta es una obligación moral para todos, independiente del rol que se cumpla en un determinado momento. Impedir hacerlo es lesionar la autonomía e integridad moral de quien busca actuar en conciencia.

Generally, conscience is understood as an individual and subjective character of human being; nevertheless, recently its rational character has been highlighted and subjected to external evaluation criteria. The application of moral conscience judgments is transversal to all health care fields, even in daily relations with patients. Health care professionals conscience objection has been criticized because it could neglect professional responsibility; nevertheless, to follow an honest conscience is a moral duty for all, independently of role fulfilled in a certain moment. To prevent to do it means to damage autonomy and moral integrity of who seeks to act in conscience.

A consciência é entendida habitualmente como um aspecto individual e subjetivo do ser humano; entretanto, recentemente se tem destacado seu caráter racional e sujeito a critérios externos de avaliação. A aplicação dos juízos da consciência moral é transversal a todos os campos da atenção em saúde, inclusive na relação cotidiana com os pacientes. A objeção de consciência dos profissionais de saúde tem sido criticada porque esta poderia faltar com a responsabilidade profissional; não obstante, seguir a consciência reta é uma obrigação moral para todos, independente do papel que se cumpra num determinado momento. Impedir fazê-lo é lesar a autonomia e a integridade moral de quem busca atuar com consciência.

Open doorway to truth: legacy of the Minnesota tobacco trial.

More than a decade has passed since the conclusion of the Minnesota tobacco trial and the signing of the Master Settlement Agreement (MSA) by 46 US State Attorneys General and the US tobacco industry. The Minnesota settlement exposed the tobacco industry's long history of deceptive marketing, advertising, and research and ultimately forced the industry to change its business practices. The provisions for public document disclosure that were included in the Minnesota settlement and the MSA have resulted in the release of approximately 70 million pages of documents and nearly 20,000 other media materials. No comparable dynamic, voluminous, and contemporaneous document archive exists. Only a few single events in the history of public health have had as dramatic an effect on tobacco control as the public release of the tobacco industry's previously secret internal documents. This review highlights the genesis of the release of these documents, the history of the document depositories created by the Minnesota settlement, the scientific and policy output based on the documents, and the use of the documents in furthering global public health strategies.

Stem cell research in a Catholic institution: yes or no?

Catholic teaching has no moral difficulties with research on stem cells derived from adult stem cells or fetal cord blood. The ethical problem comes with embryonic stem cells since their genesis involves the destruction of a human embryo. However, there seems to be significant promise of health benefits from such research. Although Catholic teaching does not permit any destruction of human embryos, the question remains whether researchers in a Catholic institution, or any researchers opposed to destruction of human embryos, could participate in research on cultured embryonic stem cells, or whether a Catholic institution could use any therapy that ultimately results from such research. This position paper examines how such research could be conducted legitimately in a Catholic institution by using an ethical analysis involving a narrative context, the nature of the moral act, and the principle of material cooperation, along with references to significant ethical assessments. It also offers tentative guidelines that could be used by a Catholic institution in implementing such research.

Playing hide-and-seek with the tobacco industry.

Despite many peer-reviewed works that draw on tobacco industry documents that have now been made public, questions remain about how complete a picture has emerged. We present a conceptual framework that identifies and evaluates tobacco industry efforts to conceal information. Widespread document destruction like that in recent litigation in Australia is just one of more than a dozen tobacco industry efforts to prevent access, or at least timely access, to documents. Industry efforts range from small, locally employed initiatives to company-wide tactics. Some efforts, such as using "oral only" procedures, scrambling telephone lines, or involving lawyers in scientific projects, are preemptive. Others seek to deal with already existing documents by invoking bogus claims of legal privilege, stipulating "read then destroy" for memos, and rewriting problematic memos. That evidence of concealment has, in fact, been found in tobacco company archives attests to the futility of attempting to control the flow of millions of pieces of paper among tens of thousands of employees. However, researchers have yet to reveal the full story: We know of the industry's failures in concealing information, but not its successes. The industry's objective is not destruction of information per se, but prevention of public disclosure of that information. Exposing the tobacco industry's many approaches to concealment provides greater insight into companies' intentions and potential means for stripping away that concealment.

Stem cells: public policy and ethics.

Debate on the regulation of human stem cells needs to bring together scientific, ethical and policy considerations if it is to be adequately informed. Scientific issues of importance include the relevance of the environment in appreciating the extent of stem cell plasticity, and the relative potential of embryonic and adult stem cells to produce other cell types. An awareness that blastocysts (early embryos) and stem cells in the laboratory are pluripotential and not totipotential has implications for ethical and policy debate. The regulations on stem cell research are reviewed, showing that four positions have emerged. Position A corresponds to the prohibition of all embryo research, position B confines the use of embryonic stem cells to those currently in existence and therefore extracted prior to some specified date, position C allows for the use and ongoing isolation of embryonic stem cells from surplus in vitro fertilization embryos, and position D approves of the creation of human embryos specifically for research. Position B which has been adopted by the United States, Germany, and Australia (with subtle differences between them) and which is regarded as a compromise position, is critiqued. This is principally on the basis that, in spite of claims made about it, the ongoing destruction of human embryos will continue. This is because these countries allow in vitro fertilization programs, inherent within which is embryo destruction. It is argued that position C would be a more consistent ethical position for these countries. The possibility of moving to position D is also raised.