RESUMEN
Bioelectronic medicine (BEM) offers exciting opportunities to treat diseases such as movement disorders and refractory inflammatory disease. The many variations of BEM allow for noninvasive aspects of treatment that might eliminate or reduce the need for pharmaceuticals; therefore, the term "electroceuticals" may be suitable. BEM has been effective for movement disorders and improvement of prosthetic devices. Based on this implication, there is an allowance to impact many focus areas that include but are not limited to autoimmune disease, sensory motor conditions, and neurological conditions. There are a wide array of ethical issues that relate to BEM, which include informed consent, research ethics, innovation, academic-industry relationships, intellectual property, and the conundrum that needs to be addressed when altering the brain such as the issues of autonomy and free beneficence and social justice. The major goal is to heighten awareness of ethical issues and facilitate a proactive ethical approach regarding BEM research.
Asunto(s)
Biotecnología/ética , Electrónica Médica/ética , Ética en Investigación , Beneficencia , Terapia por Estimulación Eléctrica , Humanos , Cultura Organizacional , Justicia Social/éticaRESUMEN
Endothelin-1 (ET-1) is a pain mediator, elevated in skin after injury, which potentiates noxious thermal and mechanical stimuli (hyperalgesia) through the activation of ET(A) (and, perhaps, ET(B)) receptors on pain fibers. Part of the mechanism underlying this effect has recently been shown to involve potentiation of neuronal TRPV1 by PKCÉ. However, the early steps of this pathway, which are recapitulated in HEK 293 cells co-expressing TRPV1 and ET(A) receptors, remain unexplored. To clarify these steps, we investigated the pharmacological profile and signaling properties of native endothelin receptors in immortalized cell lines including HEK 293 and ND7 model sensory neurons. Previously we showed that in ND7/104, a dorsal root ganglia-derived cell line, ET-1 elicits a rise in intracellular calcium ([Ca(2+)](in)) which is blocked by BQ-123, an ET(A) receptor antagonist, but not by BQ-788, an ET(B) receptor antagonist, suggesting that ET(A) receptors mediate this effect. Here we extend these findings to HEK 293T cells. Examination of the expression of ET(A) and ET(B) receptors by RT-PCR and [(125)I]-ET-1 binding experiments confirms the slight predominance of ET(A) receptor binding sites and messenger RNA in both ND7/104 and HEK 293T cells. In addition, selective agonists of the ET(B) receptor (sarafotoxin 6c, BQ-3020 or IRL-1620) do not induce a transient increase in [Ca(2+)](in). Furthermore, reduction of ET(B) mRNA levels by siRNA does not abrogate calcium mobilization by ET-1 in HEK 293T cells, corroborating the lack of an ET(B) receptor role in this response. However, in HEK 293 cells with low endogenous ET(A) mRNA levels, ET-1 does not induce a transient increase in [Ca(2+)](in). Observation of the [Ca(2+)](in) elevation in ND7/104 and HEK 293T cells in the absence of extracellular calcium suggests that ET-1 elicits a release of calcium from intracellular stores, and pretreatment of the cells with pertussis toxin or a selective inhibitor of phospholipase C (PLC) point to a mechanism involving Gαq/11 coupling. These results are consistent with the hypothesis that a certain threshold of ET(A) receptor expression is necessary to drive a transient [Ca(2+)](in) increase in these cells and that this process involves release of calcium from intracellular stores following Gαq/11 activation.
Asunto(s)
Calcio/metabolismo , Citoplasma/metabolismo , Endotelina-1/metabolismo , Subunidades alfa de la Proteína de Unión al GTP Gq-G11/metabolismo , Receptor de Endotelina A/metabolismo , Fosfolipasas de Tipo C/metabolismo , Animales , Línea Celular , Regulación de la Expresión Génica , Células HEK293 , Humanos , Riñón/citología , Ratones , Ratas , Receptor de Endotelina A/genética , Receptor de Endotelina B/genética , Receptor de Endotelina B/metabolismo , Células Receptoras Sensoriales/metabolismoRESUMEN
For at least 50 years informed consent in medicine has focused on the principle of autonomy. Recently, attention has been given to informed consent being a shared decision. A primary mandate to do what is in the best interest of the patient still remains. The shared view looks to expand beyond the dyadic image of doctor and patient, to acknowledge the essential contribution to be made to informed consent from the cultural, religious, and personal values. This paper explores some of the cultural aspects of Islam that should influence informed consent.
RESUMEN
Relationships between physicians and industry including pharmaceutical companies and device manufacturers are being closely scrutinized by the public and the media. These companies can contribute beneficially to patient outcomes by supporting research that improves eye care. However, ethical issues may arise that affect practicing ophthalmologists, researchers, academic faculty, and ophthalmologic organizations. These topics were discussed at a symposium sponsored by the American Ophthalmological Society in May 2008. After this meeting, the council of the society developed this perspective to clarify some of the issues at the interface of industry and ophthalmology. The perspective is intended to provide some guidance to physicians, researchers, and professional societies and to enhance further dialogue.
Asunto(s)
Conflicto de Intereses , Industria Farmacéutica/ética , Ética Médica , Guías como Asunto , Sector de Atención de Salud/ética , Oftalmología/ética , Centros Médicos Académicos/ética , Investigación Biomédica/ética , Conducta Cooperativa , Humanos , Relaciones InterinstitucionalesRESUMEN
BACKGROUND: Few studies have explored influences on mental health of migrants moving between non-Western countries. METHODS: Focus group discussions were used to explore the experiences of Ethiopian female domestic migrants to Middle Eastern countries, comparing those who developed severe mental illness with those remaining mentally well. DISCUSSION: Prominent self-identified threats to mental health included exploitative treatment, enforced cultural isolation, undermining of cultural identity and disappointment in not achieving expectations. Participants countered these risks by affirming their cultural identity and establishing socio-cultural supports. CONCLUSIONS: Mental health of migrant domestic workers may be jeopardized by stressors, leading to experience of social defeat.
Asunto(s)
Países en Desarrollo , Trastornos Mentales/etnología , Trastornos Mentales/psicología , Pobreza/psicología , Identificación Social , Migrantes/psicología , Adulto , Mujeres Maltratadas/psicología , Etiopía/etnología , Femenino , Grupos Focales , Hospitales Psiquiátricos , Humanos , Satisfacción en el Trabajo , Acontecimientos que Cambian la Vida , Trastornos Mentales/diagnóstico , Medio Oriente , Servicio de Psiquiatría en Hospital , Factores de Riesgo , Acoso Sexual/etnología , Acoso Sexual/psicología , Tolerancia al Trabajo Programado/psicología , Carga de Trabajo/psicología , Adulto JovenAsunto(s)
Competencia Clínica , Procedimientos Quirúrgicos Oftalmológicos/educación , Oftalmología/normas , Optometría/educación , Curriculum , Oftalmopatías/diagnóstico , Oftalmopatías/cirugía , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Oftalmología/tendencias , Control de Calidad , Medición de RiesgoAsunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Ética Médica , Oftalmopatías/tratamiento farmacológico , Inhibidores de la Angiogénesis/economía , Anticuerpos Monoclonales/economía , Anticuerpos Monoclonales Humanizados , Bevacizumab , Costos de los Medicamentos , Economía Farmacéutica , Empatía , Oftalmopatías/economía , Humanos , Ranibizumab , Medición de Riesgo , Factor A de Crecimiento Endotelial VascularRESUMEN
PURPOSE: To demonstrate the effect of ethics education on a resident's ability to answer questions that relate to moral dilemmas and on the clinical evaluations of residents by faculty. METHODS: The curriculum for the ethics education that was used for this study was designed by the author and consisted of 10 lectures of 1.5 hours each. Five residencies were included in the project. One residency received one lecture, two residencies received three lectures, and two residencies received 10 lectures. To evaluate the moral skills of the residents at the beginning of the course and at the end, the residents were given the Defining Issues Test (DIT-2) developed by James Rest, which involves answering standardized questions about four moral dilemmas. Faculty evaluations were completed before and after the ethics lectures were given. At the beginning of the ethics course, each resident was given a social survey that was designed to assess participation in community, religious, political, and societal activities as well as attitudes about these activities. All residents were also asked demographic information, including their age, gender, and year of residency. RESULTS: The results of the DIT-2 taken before and after the ethics lectures were compared. No correlations were found in faculty evaluations of clinical performance of the residents before and after the course (P = .052). Associations between DIT-2 scores and questions on community and religion in the social survey were noted. CONCLUSION: The finding that the effect of an ethics course on residents' ability to answer moral dilemmas did not achieve statistical significance should be accepted with the understanding that this was a first attempt at standardization of many variables, especially the format of the curriculum and materials used. The use of faculty evaluations to assess clinical performance needs to be standardized, and the faculty members need additional training to ensure validity of the results. The social survey was also the first attempt to assess an association between a resident's response to moral dilemmas, attending evaluations, and residents' opinions that relate to community, society, politics, and religion.