Beyond Pittsburgh: protocols for controlled non-heart-beating cadaver organ recovery

Much of the ethical debate about controlled non-heart-beating cadaver (NHBC) organ recovery has focused on the University of Pittsburgh Medical Center (UPMC) protocol. Some commentators have voiced serious reservations about the ethical acceptability of that protocol; others have argued that the protocol contains sufficiently stringent ethical safeguards to warrant a limited and carefully monitored trial at UPMC. UPMC is not the only organization pursuing controlled NHBC organ procurement, however. The study of organ procurement organizations described in this article suggests that controlled NHBC organ procurement is a practice that, if not yet widespread, is certainly no longer isolated to a few organizations in which it is carefully monitored. Rather, it is being carried out under a variety of circumstances, many of which are less carefully constrained ethically than at the University of Pittsburgh Medical Center. The next stage of the ethical debate should focus on issues that are arising in a variety of settings as the practice spreads.     

Principles and theory in bioethics.

The following citations were selected from BIOETHICSLINE, the online database prepared at the Kennedy Institute of Ethics for the National Library of Medicine's MEDLARS system. Searching the keywords autonomy, beneficence, casuistry, justice, and virtues, as well as the text word principlism produced more than 400 citations. Only the citations concerned with theory and principle in the practice of bioethics are included here -- e.g., works about justice in resource allocation have been deleted.     

Ecologically relevant stimuli and color memory

Ecologically relevant stimuli were developed as an alternative to Munsell color chips. Colored pictures of familiar objects were used to study color memory. We investigated the typicality of color to particular objects. Contextually typical colors were remembered more accurately than atypical colors were. Moreover, this variable had a stronger effect on memory than focality did. We concluded that memory for ecologically relevant material is more impressed by a color's relation to experience than by its intrinsic properties.     

Resistance and countertransference in child and adolescent psychotherapy

Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.     

Applying the Interactive Systems Framework to the Dissemination and Adoption of National and State Recommendations for Hypertension

The Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention (DHDSP), commissioned an Institute of Medicine (IOM) report to identify the highest priority action areas for CDC, state health departments, and other public health partners in their efforts to reduce and control hypertension. To assess the dissemination and adoption of the IOM report recommendations, DHDSP developed an evaluation based on the Interactive Systems Framework for Dissemination and Implementation (ISF). The evaluation incorporates data collection at critical points across 3 years. In this article, we focus on the ISF systems to describe the role of funded state partners and their relationship with CDC in implementing public health recommendations. We describe baseline results for three data collection activities: (1) key informant interviews, (2) a Web‐based survey, and (3) content analysis of state workplans to determine the degree of alignment with IOM recommendations. For example, currently 30 % of surveyed programs are implementing most (or all) of the recommendations in the IOM report, however 76 % intend to change hypertension program priorities based on the recommendations of the IOM report. Qualitative data suggest that there are several facilitators and barriers in implementing public health policy recommendations. DHDSP will use these baseline results to provide additional technical assistance and support to state health departments in their efforts to implement the IOM report's recommendations. Special Issue: Advances in Bridging Research and Practice Using the Interactive System Framework for Dissemination and Implementation; Guest Editors: Abraham Wandersman, Paul Flaspohler, Catherine A. Lesesne, Richard Puddy; Action Editor: Emilie Phillips Smith