Respect for autonomy in the healthcare context: observations from a qualitative study of young adults with cerebral palsy.

BACKGROUND: Respect for patient autonomy is a cornerstone of contemporary medical ethics and clinical practice. In its different shapes and forms (e.g. being informed, being engaged in discussions and decisions about medical care and being supported in developing healthcare preferences and choices), patient autonomy has been fostered by both paediatric and adult professional societies. The transition from paediatric to adult care creates a complex situation where autonomy for medical decisions shifts to the developing adolescent. More specific challenges to respect for autonomy may be experienced by young adults with cerebral palsy in the transition period where, for example, language and motor impairments may affect communication skills and this may be conflated with cognitive disability. AIM: To characterize perspectives towards autonomy in the healthcare context for young adults with cerebral palsy. METHOD: We carried out semi-structured interviews with 14 young adults (aged 18-25) with cerebral palsy. The audiotaped interviews were transcribed verbatim and analysed using a conventional thematic qualitative content analysis. RESULTS: Participants displayed a range of attitudes towards autonomy, suggesting that the value of autonomy is considered in light of competing values and of context. Testimonials from participants demonstrated that both contextual (e.g. ill-adapted health care, lack of specialized public transport) and relational (e.g. attitudes towards parental involvement in decision making) factors negatively or positively impact autonomy. CONCLUSION: We observed that there were four key elements interwoven in participants' characterization of autonomy: the coupling of decisional and physical autonomy, the influences of family and society on autonomy, the influence of healthcare professionals on autonomy and the need for preparation for autonomy.

Determination of equilibrium free energy from nonequilibrium work measurements.

The fluctuation-dissipation theorem (FDT) of Brownian dynamics (BD) is applied to extract the equilibrium free-energy profile from the nonequilibrium, irreversible work measured in single-molecule pulling experiments. Two sets of in silico experiments are performed to explore the free-energy landscape of deca-alanine peptide as a function of its end-to-end distance and to determine the free-energy profile of water permeation through the channels of aquaglyceroporin GlpF. With a small number of pulling paths sampled, the BD-FDT is shown to produce accurate estimates of the free-energy profiles for both systems.

Characterization of a mosaic minisatellite locus in the mitochondrial DNA of Norway spruce [Picea abies (L.) Karst.].

A mosaic minisatellite region has been identified in the mitochondrial genome of Norway spruce (Picea abies). The array was composed of three tandem repeats PaTR1 (32 bp), PaTR2a (26 bp) and PaTR2b (26 bp). PaTR2a and PaTR2b differed by one base substitution. The analysis of 92 trees covering the whole natural distribution area of the species allowed detection of 11 length variants ranging from 131 bp to 447 bp. This high intra-specific polymorphism relies on variation in the number of the tandem repeats. Population genetic parameters estimated among 14 populations suggested high population differentiation (Gst=0.749). The phylogenetic analysis of the 11 sequenced length variants has been performed using a parsimony approach. The topology of the tree showed a good association of groups with geographical origin and a low level of size homoplasy. The phylogenetic reconstruction also suggests that this minisatellite locus has mainly evolved by an increase in the repeat copy number.

Evolutionary adaptation of a mammalian species to an environment severely depleted of iodide.

Lack of dietary iodine is associated with thyroid insufficiency and its dire consequences including cretinism, yet territories severely deficient in iodine are home to many species of wild animals. The premise of our work is that an adaptation must be in place in order to allow these animals to thrive. We collected phyllotine rodents of the genus Auliscomys from the Altiplanic region of North Chile, an area historically associated with goitre and other manifestations of iodine deficiency disorders. The iodide concentration in the stream water in this locality, at <1 micro g l(-1) would undoubtedly result in widespread thyroidal insufficiency in humans and domestic livestock. The animals we collected, identified as Auliscomys boliviensis, showed no evidence of thyroidal insufficiency. There was no enlargement of the thyroid glands; the serum concentrations of thyroid hormone (measured as T4) and thyroid-stimulating hormone were comparable to laboratory rats. Serum iodide concentration was about 40% of that measured in laboratory rats. We conclude that these animals have established a specialised adaptive mechanism, most probably at the level of the Na(+)/I(-) symporter, that acts to enhance the uptake of dietary iodide into the gut and again from the serum into the follicular cells of the thyroid gland.

A new diprenyl coumarin and alkaloids from the bark of Zanthoxylum dimorphophyllum (Rutaceae).

The alkaloids chelerythrine, norchelerythrine, oxyavicine, canthine-6-one, 4,5-dihydrocanthin-6-one, and gamma-fagarine were isolated from Zanthoxylum dimorphophyllum bark, together with two coumarins, scoparone and dimoxylin. This latter is a novel compound whose structure was elucidated on the basis of its spectral data.

Ecological integrated model of children of war: individual and social psychology.

The psychological trauma associated with war is a topic that has occupied the attention of mental health researchers and practitioners for some time. Most of their attention, though, has focused on the traumatic stress of soldiers, and little attention has been paid to the problems and traumatization of civilians caught in war zones, especially the children. In this paper, the limited research on children of war is reviewed, and themes are extracted. Children suffer from both acute and chronic traumatic stress. The key to determining the amount of suffering has to do with the dynamic interaction among five processes within an ecological framework: the child's psychobiological makeup, the disruption of the family unit, the breakdown of community, and the ameliorating effects of culture. The intensity, suddenness and duration of the war-like experience itself constitute an additional component to this ecological model. In the final section, psychotherapeutic guidelines to help children cope with symptoms associated with war are presented for current and future caregivers. The prevention of war should be the primary task of all.