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Little is known about which nursing interventions used in adolescent psychiatric inpatient treatment demonstrate improvements in outcome in the 'real world' setting, despite an increase in external outcomes reporting requirements.This paper examines nursing and other multidisciplinary interventions commonly used at the Youth Inpatient Unit, Christchurch, New Zealand, in relation to improvements in outcomes as measured by the Health of the Nation Outcome Scales for Children and Adolescents, utilizing data gathered prospectively as part of an ongoing quality assurance and outcomes project. We found the majority of interventions investigated were utilized equally across diagnostic groups, although stress management and problem-solving education was used more for patients with mixed affective disorders. Further, the results contribute to growing evidence toward the value of providing medication and problem-solving education to this population. Mental health nurses working with children and adolescents should be supported to utilize and develop their unique skill set to offer targeted interventions and to examine their practice to identify the most valuable interventions for their patients within this developmental context. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

False hope is costly for individuals, their loved ones, and society. Scholars have defined false hope as one that involves an epistemically unjustified belief. In this paper, I argue that this account of false hope is incomplete and that false hope should be conceptualized in terms of the way in which the agent attends to or focuses on a highly desired but unlikely outcome. I explain how this account better captures the distinctiveness of false hope., Competing Interests: Declarations Ethics approval I confirm that this submission material has not been published previously elsewhere, including any self-publication website like Medium, Academia, or LinkedIn. Conflict of interest There are no conflicts of interest to declare., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Can it be ethical to conduct xenotransplant research on a human brain-dead decedent (HB-DD) whose organs could otherwise be given to persons in need? The ethical consensus is that it is better to save existing persons via organ donation than to devote a HB-DD to research that will not directly benefit anyone. I argue otherwise. Given how rapidly xenotransplant research is progressing, and its clinical promise in the next couple of years or decades, I argue that it can be ethical to conduct xenotransplant research on a HB-DD whose organs could otherwise be given to individuals in need., (© 2024 John Wiley & Sons Ltd.)

Due to the current organ shortage waitlist, alternatives to allotransplantation are necessary. Xenotransplantation is currently being pursued as one such alternative in adults in need of kidney or heart transplantation. Cardiac xenotransplantation of genetically modified pig hearts has been conducted twice in adults under the United States Food and Drug Administration (FDA) expanded access criteria. Because of the shortage of transplantable hearts for children as well as the lack of mechanical circulatory support in this population, pediatric researchers are exploring FDA expanded access in high-risk neonates and infants who lack alternative options for survival. The adult cardiac xenotransplantation experience with expanded access can provide lessons and highlight nuances for researchers preparing pediatric application. This includes aspects of informed consent, biosurveillance, and protection of bystanders from potential xenozoonoses., (© 2024 The Author(s). Pediatric Transplantation published by Wiley Periodicals LLC.)

Competing Interests: Declaration of competing interest The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Daniel J. Hurst is a paid consultant with a xenotransplant research group at New York University. Christopher Bobier and Daniel Rodger declare no conflict of interest.

For children with complex congenital heart problems, cardiac allotransplantation is sometimes the best therapeutic option. However, availability of hearts for pediatric patients is limited, resulting in a long and growing waitlist, and a high mortality rate while waiting. Cardiac xenotransplantation has been proposed as one therapeutic alternative for neonates and infants, either in lieu of allotransplantation or as a bridge until an allograft becomes available. Scientific and clinical developments in xenotransplantation appear likely to permit cardiac xenotransplantation clinical trials in adults in the coming years. The ethical issues around xenotransplantation of the heart and other organs and tissues have recently been examined, but to date, only limited literature is available on the ethical issues that are attendant with pediatric heart xenotransplantation. Here, we summarize the ethical issues, focusing on (1) whether cardiac xenotransplantation should proceed in adults or children first, (2) pediatric recipient selection for initial xenotransplantation trials, (3) special problems regarding informed consent in this context, and (4) related psychosocial and public perception considerations. We conclude with specific recommendations regarding ethically informed design of pediatric heart xenotransplantation trials., Competing Interests: D.J.H. and L.P. are members and paid consultants to a working group on xenotransplantation ethics at New York University. D.J.H. is a member of the International Xenotransplantation Association (IXA) Ethics Committee. R.N.P. is the chair of the IXA Ethics Committee and has received research funding and material support from multiple companies involved in xenotransplantation. D.K.C.C. is a consultant to eGenesis Bio, Cambridge, MA, but the opinions expressed in the article are those of the author’s and do not necessarily reflect those of eGenesis. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of a first-in-human (FIH) clinical trial is to gather information about how the drug or device affects and interacts with the human body: its safety, side effects, and (potential) dosage. As such, the primary goal of a FIH trial is not participant benefit but to gain knowledge of drug or device efficacy, i.e., baseline human safety knowledge. Some FIH clinical trials carry significant foreseeable risk to participants with little to no foreseeable participant benefit. Participation in such trials would be a bad deal for participants, and the research is considered justifiable because of the promise of significant potential social benefit. I argue that there is an ethical tension inherent in risky FIH research and that researchers should fairly compensate risky FIH trial participants. This does not make the risk-benefit outcome more favorable for participants; rather, it amounts to a collective reckoning with the ethical tension inherent in the research., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

According to many scholars, kidney xenotransplantation promises to mitigate the organ supply shortage. This claim has a certain obviousness to it: by flooding the market with a new source of kidneys, xenotransplantation promises to be a panacea. Our goal is to challenge this claim. We argue that xenotransplantation may increase rather than decrease demand for kidneys, may reduce kidney allotransplants, and may be inaccessible or otherwise unused. By offering the challenge, we hope to show deeper reflection is needed on how xenotransplantation will affect the dearth of available organs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Preclinical xenotransplantation research using genetically engineered pigs has begun to show some promising results and could one day offer a scalable means of addressing organ shortage. While it is a fundamental tenet of ethical human subject research that participants have a right to withdraw from research once enrolled, several scholars have argued that the right to withdraw from xenotransplant research should be suspended because of the public health risks posed by xenozoonotic transmission. Here, we present a comprehensive critical evaluation of the claim that xenotransplant recipients should be required to waive their right to withdraw from lifelong biosurveillance. We conclude that if xenotransplantation requires participants to waive their right to withdraw, then clinical trials may not be justifiable, given the ethical and legal obstacles involved with doing so. Consequently, if clinical trials are permitted with a right to withdraw, then they may pose a significant public health risk., (© 2024 John Wiley & Sons Ltd.)

What would it look like for researchers to take non-human animal rights seriously? Recent discussions foster the impression that scientific practice needs to be reformed to make animal research ethical: just as there is ethically rigorous human research, so there can be ethically rigorous animal research. We argue that practically little existing animal research would be ethical and that ethical animal research is not scalable. Since animal research is integral to the existing scientific paradigm, taking animal rights seriously requires a radical, wholesale reimagining of science. Trial registration: ClinicalTrials.gov identifier: NCT05340426.

Killing animals has been a ubiquitous human behaviour throughout history, yet it is becoming increasingly controversial and criticised in some parts of contemporary human society. Here we review 10 primary reasons why humans kill animals, discuss the necessity (or not) of these forms of killing, and describe the global ecological context for human killing of animals. Humans historically and currently kill animals either directly or indirectly for the following reasons: (1) wild harvest or food acquisition, (2) human health and safety, (3) agriculture and aquaculture, (4) urbanisation and industrialisation, (5) invasive, overabundant or nuisance wildlife control, (6) threatened species conservation, (7) recreation, sport or entertainment, (8) mercy or compassion, (9) cultural and religious practice, and (10) research, education and testing. While the necessity of some forms of animal killing is debatable and further depends on individual values, we emphasise that several of these forms of animal killing are a necessary component of our inescapable involvement in a single, functioning, finite, global food web. We conclude that humans (and all other animals) cannot live in a way that does not require animal killing either directly or indirectly, but humans can modify some of these killing behaviours in ways that improve the welfare of animals while they are alive, or to reduce animal suffering whenever they must be killed. We encourage a constructive dialogue that (1) accepts and permits human participation in one enormous global food web dependent on animal killing and (2) focuses on animal welfare and environmental sustainability. Doing so will improve the lives of both wild and domestic animals to a greater extent than efforts to avoid, prohibit or vilify human animal-killing behaviour., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Xenotransplant patient selection recommendations restrict clinical trial participation to seriously ill patients for whom alternative therapies are unavailable or who will likely die while waiting for an allotransplant. Despite a scholarly consensus that this is advisable, we propose to examine this restriction. We offer three lines of criticism: (1) The risk-benefit calculation may well be unfavorable for seriously ill patients and society; (2) the guidelines conflict with criteria for equitable patient selection; and (3) the selection of seriously ill patients may compromise informed consent. We conclude by highlighting how the current guidance reveals a tension between the societal values of justice and beneficence.

In response to criticism of the impairment argument for the immorality of abortion, Bruce Blackshaw and Perry Hendricks appeal to Don Marquis's future-like-ours (FLO) account of the wrongness of killing to explain why knowingly causing fetal impairments is wrong. I argue that wedding the success of the impairment argument to FLO undermines all claims that the impairment argument for the immorality of abortion is novel. Moreover, I argue that relying on FLO when there are alternative explanations for the wrongness of causing FAS begs the question. I conclude, therefore, that the impairment argument remains unsuccessful., (© 2023. Journal of Bioethical Inquiry Pty Ltd.)

It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The role of ethics is becoming an increasingly important feature of biodiversity conservation dialogue and practice. Compassionate conservationists argue for a prohibition of, or at least a strong presumption against, the adoption of conservation policies that intentionally harm animals. They assert that to be compassionate is to care about animals and that it is antithetical to caring for animals to intentionally harm them. Compassionate conservationists thus criticize many existing conservation practices and policies. Two things together challenge the philosophical foundation of compassionate conservation. First, compassionate conservationists ground their theory in virtue ethics, yet virtue ethics permits exceptions to moral rules, so there cannot be an in-principle prohibition on adopting intentional harm-inducing policies and practices. But not all compassionate conservationists advocate for a prohibition on intentionally harming animals, only a strong presumption against it. This leads to the second point: compassion can motivate a person to adopt a harm-inducing conservation policy or practice when doing so is the best available option in a situation in which animals will be harmed no matter what policy or practice is adopted. Combining these insights with the empirical observation that conservationists regularly find themselves in tragic situations, we arrive at the conclusion that conservationists may regularly advocate for harm-inducing policies and practices from a position of compassion. Article Impact Statement: Compassionate conservationists should accept that the virtuously compassionate person may adopt harm-causing conservation policies., (© 2021 Society for Conservation Biology.)

Objective: The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit., Method: A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation., Results: The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful., Conclusions: A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.

Objectives: The aim of this paper was to determine if patients undergoing treatment at an older adolescent inpatient unit receive psychoeducation according to the unit philosophy of providing timely and pertinent information regarding illness/diagnosis, medication, diet, outpatient follow-up, and alcohol/ drug use., Methods: Data were gathered prospectively as part of a quality assurance initiative at the Christchurch Youth Inpatient Unit. Patients were interviewed by a registered nurse using a structured audit tool., Results: Participants reported receiving adequate information on medication and illness, and most received information on outpatient follow-up and alcohol and drug use. However, the majority reported a lack of information/ advice about diet. Patients' reported awareness of relapse prevention and the relationship of alcohol and other drugs use to medication and treatment was lower than expected., Conclusions: The audit highlighted areas of discrepancy between information staff believed they had delivered and information youth perceived as received. Psychiatric staff working with young people need be aware of the timing, language and mode of delivery of psychoeducation to enable their patients to 'take in' the information provided.

Problem: Little has been written on the value of composing narrative letters to adolescent psychiatric inpatients as rated by those who receive them., Methods: Survey of youth, family members, and professionals given copies of a narrative discharge letter written as an alternative to a copy of an initial discharge letter written to the referrer., Findings: Narrative letters conceptualized and validated youth experience, progress, and future directions in a language easily understood by the youth and family members, enabling reflection and empowerment., Conclusion: Narrative letter writing is a valuable therapeutic tool to facilitate reflective, empowering partnerships among professionals, youth, and family members.

Armodafinil, the (R)-enantiomer of modafinil, is a medication used to treat the excessive sleepiness associated with narcolepsy, obstructive sleep apnea/hypopnea syndrome, and shift work sleep disorder. We report here the chemical development of armodafinil and the investigations that led to a commercial route to prepare this pure enantiomer. Three synthetic approaches were used to provide the chiral sulfoxide. Resolution via preferential crystallization was used for phase I clinical trials and was subsequently replaced by chiral chromatography, enabling us to pursue a rapid filing and registration of the API. Finally, the commercial route was developed and employed asymmetric oxidation catalyzed by a titanium(IV) isopropoxide and diethyl tartrate system. The advantages of choosing a chromatographic development pathway to expedite registration while concurrently developing an economical chiral synthesis route is discussed in the context of armodafinil development., ((c) 2008 Wiley-Liss, Inc.)

Objective: To determine the level of compliance with official guidelines for prescribing mood stabilizers among adolescents in Christchurch, New Zealand., Methods: A retrospective audit of clinical files of patients aged 13-19 years attending inpatient and outpatient services in the Child, Adolescent and Family Service in the Canterbury District catchment area was carried out against set criteria derived from the Ministry of Health Guidelines regarding the use of mood stabilizers (lithium and sodium valproate). A guideline compliance index was also created to measure overall compliance., Results: Over a period of 3 years beginning from January 2000, we identified 68 episodes of initiation among 58 adolescents. Of those, 91.2% were for indications set in the guidelines. More than half appeared to have been given no information about the medication, and only 61.8% had documented consent. Two-thirds had a full laboratory work-up before initiation. More than one-third had no evidence of communication with general practitioners about being initiated on a mood stabilizer. Overall, only 13.2% were 100% compliant and only 50% were 80% compliant., Conclusion: In general, mood stabilizers were prescribed as indicated, but adherence to the guidelines beyond that appears to fall short of standards set by the guidelines.

Objective: The aim of this study is to identify factors associated with readmission to adolescent psychiatric inpatient care, in the context of a relapsing major mental illness., Method: Data were obtained from 71 patients admitted to an adolescent psychiatric inpatient unit over a 2-year period. Patients who were rehospitalized within 12 months of discharge were compared with patients who had only one admission during the study period with respect to diagnosis, age of first admission, history of child sexual abuse (CSA) and the events precipitating admission., Results: Medication non-adherence and a history of CSA were positively and independently associated with relapse readmission, while a trend emerged among readmitted patients toward younger age at first psychiatric hospitalization. A negative association was found between readmission and the experience of personal loss. Readmission was not related to DSM-IV axis I or axis II diagnosis, including substance abuse., Conclusions: The association, in an adolescent sample, of medication non-adherence and relapse readmission is consistent with findings from numerous adult studies, as is the trend toward younger age of first admission. The relationship of a history of CSA to readmission has attracted little previous research and the finding of a positive association suggests that further investigation of a history of CSA in this context is warranted. The implications of these findings and suggestions for further research are discussed.

Objective: To determine the length of stay in hospital for youth with acute psychiatric illness, and the treatment outcome., Methods: Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) psychiatric diagnosis, clinical outcome and the length of stay were systematically gathered for admissions over an 18 month period at the Christchurch Youth Inpatient Unit (YIU). Clinical outcome data were collected at admission, 3 weeks after admission and at discharge, using the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). The length of stay was determined retrospectively. Discharge was decided on clinical grounds., Results: During the 18 months of the investigation, 72 subjects were admitted for the treatment of acute mental illness. The most common diagnostic category was mood disorder (n=39, 54%), followed by anxiety or adjustment disorder (n=18, 25%), and major psychosis (n=15, 21%). The mean length of admission for the whole population was 27.3 days, 23.7 days for mood disorders, 18.9 days for anxiety disorders and 46.9 days for the major psychosis diagnostic groups. According to HoNOSCA clinician ratings, the major portion of the improvement occurred during the first 3 weeks of admission., Conclusions: For the majority of youth with acute psychiatric illness, a relatively short stay in hospital is feasible, because most health gains tend to occur early during an admission.

Objective: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder., Method: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected., Results: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD., Conclusions: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.

The axial chromatic aberration of the eye was determined as in previous studies by finding the lens required to eliminate or minimize blur of the fixation target when it is illuminated by a series of monochromatic sources. Objective measurement of the refraction of the eyes during this procedure showed that accommodation remained constant throughout. Hence, the conclusion that the accommodative state does not in this case respond automatically to changes in the vergence of light falling in the retinal plane. It is suggested that some other stimulus, perhaps perceived distance, predominates. Further, the least amount of plus lens required to blur a near target was about the same for white and red but much less for blue. This substantiates an earlier finding that the eye accommodates for near only sufficiently to place the blue end of the chromatic interval on the retina.