Giant Eustachian valve and left ventricular systolic dysfunction in a patient with non-dilated amyloid cardiomyopathy.

Amyloid cardiomyopathy is characterized by non-dilated thick-walled left ventricular, thickening of interventricular septum and right ventricular free wall, biatrial enlargement associated with granular 'sparkling' appearance of the myocardium. Typically, decreased left ventricular compliance results in abnormal diastolic functions but left ventricular systolic functions are preserved until late in the course of the illness when left ventricle starts to dilate culminating into dilated cardiomyopathy. We present a 77-year-old patient who had typical echocardiographic features of amyloid heart disease, a giant Eustachian valve resembling cor triatriatum dexter and left ventricular systolic dysfunction without associated left ventricular dilatation.

Stakeholder perspectives on radiation protection.

Standards for permissible exposure to radiation and the way they are established must incorporate a set of principles that uphold both health and democracy. When the science is uncertain, the burden of proof that risk is not being imposed should be on the source of the risk, not on the possibly affected public or workforce. Scientific processes must be transparent to the public, must address all relevant risk issues and endpoints (and not only cancer), and must be inclusive of the actual experience and opinion of the people who are exposed to radiation risks. Scientists are too often dismissive of public experience and interests, as for instance with worker illnesses or fallout, even though input from the public and workers has frequently proven to be valuable in the development of radiation protection principles. Incorporating the concerns, views, and experiences of workers and the public in a respectful way while maintaining a high standard of scientific work must be an essential part of the standard-setting process. Further, the clearly enunciated International Commission on Radiological Protection principle that the imposition of risk must be accompanied by a clear benefit needs to be a far more explicit part of standard-setting processes, which must also ensure that all known risks are disclosed and that suspected risks, such as possible synergisms between some radionuclides and hormone-disrupting chemicals, are carefully considered. Finally, given the long-lived nature of risks from many radionuclides and the large uncertainties about future physical, social, economic, and other conditions, the issue of how the interests of future generations can be included in standard setting is a difficult but vital matter.

Attitudes of people with disabilities toward physician-assisted suicide legislation: broadening the dialogue.

This article presents the methods, findings, and implications of a participatory action research project that attempted to shed additional light on the debate over death with dignity (DWD) or physician-assisted suicide (PAS) legislation. In-depth, qualitative interviews with forty-five physically disabled residents of the San Francisco Bay Area, conducted by others with disabilities, revealed a wide breadth of opinions about and attitudes toward such legislation. For close to half of the participants, the desire for autonomy in making end-of-life decisions was a primary concern, yet fear that PAS legislation could violate this autonomy in various ways was a deep concern as well. Also reported were widespread accounts of disability-based discrimination and frequent expressions of fear about openly discussing positions that diverge from the official, publicly held opinions of disability leaders who oppose such legislation. The findings support those of a recent Harris poll demonstrating considerable diversity of opinion about PAS legislation among people with disabilities. The findings further suggest the need for additional research on the apparent disjunction between the diversity of attitudes held by those interviewed and the more unified position taken by many disability activists. Use of the study findings to promote greater dialogue within the community and to better position people with disabilities to take their place at the policy table also is discussed. In addition, the findings are seen as reinforcing the need for the public health community to become more engaged in this central ethical debate.

Ethical dilemmas in participatory action research: a case study from the disability community.

Participatory action research (PAR) is a collaborative approach to inquiry for education and social change that is gaining increasing prominence in health education. This case study explores the use of PAR by and with a community of people with disabilities in addressing a polarizing issue in that community: death with dignity or physician-assisted suicide legislation. Following a brief review of the debate within the community about this issue and the goals, methods, and findings of this project, the authors examine four key ethical challenges. These are dilemmas in issue selection when the community is deeply divided over a problem area, inclusion and exclusion in study team makeup and sample selection, insider/outsider issues, and how best to use findings in ways that can unite and strengthen the community. The implications of these issues for health educators and others engaged in community-based PAR efforts are presented.