1Centre for Medical Genetics Ghent, University Hospital Ghent, Ghent, Belgium.
21] Centre for Medical Genetics Ghent, University Hospital Ghent, Ghent, Belgium  Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
3Master Life Sciences and Medicine, University of Ghent, Ghent, Belgium.
4Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
5Center for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Cystic fibrosis (CF) is a life-limiting autosomal recessive disorder affecting ~1 in 2500-4000 Caucasians. As most CF patients have no family history of the disorder, carrier screening for CF has the potential to prospectively identify couples at risk of conceiving an affected child. At-risk couples may consequently choose to act on the provided information and take steps to avoid the birth of a child with CF. Although carrier screening is widely believed to enhance reproductive autonomy of prospective parents, the practice also raises important ethical questions. A written questionnaire was administered to adult patients and parents of children with CF with the aim to explore participants' attitudes toward CF carrier screening and related reproductive issues. The study population was recruited from a CF patient registry in Belgium and comprised 111 participants (64 parents, 47 patients aged 16 or older). We found that more than 80% of all participants were in favor of preconception carrier screening for CF. However, some were concerned over potential negative consequences of population-wide CF carrier screening. Regarding future reproductive intentions, 43% of the participants indicated a desire to have children. Among these, preimplantation genetic diagnosis was found to be the most preferred reproductive option, closely followed by spontaneous pregnancy and prenatal diagnosis. Although the findings of our study suggest that patients and parents of children with CF support a population-based carrier screening program for CF, they also highlight some issues deserving particular attention when implementing such a program.
"Life as a medical oncologist is hard work, and hospital life can be very unpredictable and stressful. It is very hard to switch off from the job. I think about my patients all the time. Despite the stress, my job is very rewarding. It is a real pleasure to treat patients and try to make a difference in their lives. Patients make me realise how lucky I am in my own life."
1From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Drs Romano and Blessing); and the Department of Pathology, University of Texas Medical Branch, Galveston, Texas (Dr Allen).
"But Brisbane district judge Fleur Kingham refused throw out the case and has ordered medical checks on Bassos. Although the outcome is far from clear, any ruling against the airline could have further ramifications for obese passengers already being turned away by some carriers or required to book extra seats."
"When I was in college–from 1964 to 1968–I saw what real leftists look like, because a lot of people at my college, which was the State University of New York at Binghamton, were radicalized Jews from downstate. They were very avant-garde, doing experimental theater and modern dance, and they knew all about abstract expressionism. Their parents were often Holocaust survivors, so they had a keen sense of history. And they spoke in a very direct and open working-class style. That’s why, in the 1990s, I was saying that the academic leftists were such frauds–sitting around applying Foucault to texts and thinking that was leftism! No it wasn’t! It was a snippy, prim, smug bourgeois armchair leftism. Real ’60s radicals rarely went to grad school and never became big-wheel humanities professors, with their fat salaries and perks. The proof of the vacuity of academic leftism for the past forty years is the complete silence of leftist professors about the rise of the corporate structure of the contemporary university–their total failure to denounce the gross expansion of the administrator class and the obscene rise in tuition costs. The leading academic leftists are such frauds–they’ve played the system and are retiring as millionaires!"
1Kaiser Family Foundation, Menlo Park, California.
2Kaiser Family Foundation, Menlo Park, California2Dr Frist is the former US Senate majority leader.
Medicare and Medicaid are the nation's 2 largest public health insurance programs, serving the elderly, those with disabilities, and mostly lower-income populations. The 2 programs are the focus of often deep partisan disagreement. Medicare and Medicaid payment policies influence the health care system and Medicare and Medicaid spending influences federal and state budgets. Debate about Medicare and Medicaid policy sometimes influences elections.
To review the roles of Medicare and Medicaid in the health system and the challenges the 2 programs face from the perspectives of the general public and beneficiaries, health care professionals and health care institutions, and policy makers.
Analysis of publicly available data and private surveys of the public and beneficiaries.
Together, Medicare and Medicaid serve 111 million beneficiaries and account for $1 trillion in total spending, generating 43% of hospital revenue and representing 39% of national health spending. The median income for Medicare beneficiaries is $23 500 and the median income for Medicaid beneficiaries is $15 000. Future issues confronting both programs include whether they will remain open-ended entitlements, the degree to which the programs may be privatized, the scope of their cost-sharing structures for beneficiaries, and the roles the programs will play in payment and delivery reform.
CONCLUSIONS AND RELEVANCE:
As the number of beneficiaries and the amount of spending for both Medicare and Medicaid increase, these programs will remain a focus of national attention and policy debate. Beneficiaries, health care professionals, health care organizations, and policy makers often have different interests in Medicare and Medicaid, complicating efforts to make changes to these large programs.
Debates about the American "culture wars" have led scholars to develop several theories relating morality to political attitudes and behaviors. However, researchers have not adequately compared these theories, nor have they examined the overall contribution of morality to explaining political variation. This study uses nationally representative data to compare the utility of 19 moral constructs from four research traditions - associated with the work of Hunter, Lakoff, Haidt, and Schwartz - for predicting political orientation (liberalism/conservatism). Results indicate that morality explains a third of the variation in political orientation - more than basic demographic and religious predictors - but that no one theory provides a fully adequate explanation of this phenomenon. Instead, political orientation is best predicted by selected moral constructs that are unique to each of the four traditions, and by two moral constructs that crosscut them. Future work should investigate how these moral constructs can be synthesized to create a more comprehensive theory of morality and politics.
"WASHINGTON (AP) Federal health regulators say they have approved an inflatable medical balloon that helps patients lose weight by filling up space in the stomach.
Unlike invasive weight-loss surgery, which can involve risks like malnutrition following a duodenal switch, involving removal of most of the stomach, the Dual Balloon is inserted through the mouth via an endoscope in a minimally invasive manner. The procedure typically takes less than 30 minutes and is done while a patient is under mild sedation."
1Columbia University Center for Research on Ethical, Legal, and Social Implications of Psychiatric, Neurologic, & Behavioral Genetics, 1051 Riverside Drive New York, NY 10032.
2Institute for Society and Genetics And the Department of Sociology, University of California Los Angeles, Box 957221, 1320 Rolfe Hall, Los Angeles, CA 90095-7221 Telephone: 310-825-1517.
In the space of little more than a decade, ideas of the human genome have shifted significantly, with the emergence of the notion that the genome an individual changes with development, age, disease, environmental inputs, and time. This paper examines the emergence of the genome with a life span, one that experiences drift, instability and mutability, and a host of other temporal changes. We argue that developments in chromatin biology have provided the basis for this genomic embodiment of experience and exposure. We analyze how time has come to matter for the genome through chromatin, providing analysis of examples in which the human life course is being explored as a set of material changes to chromatin. A genome with a lifespan aligns the molecular and the experiential in new ways, shifting ideas of life stages, their interrelation, and the temporality of health and disease.
"A new report from the Gallup-Healthways Well-Being Index® shows the obesity rate in the United States for adults aged 55 and older is the highest since Gallup and Healthways began tracking and measuring well-being in 2008.
According to the report, the incidence of obesity is at an all-time high of 27.7 percent in 2014, up from 27.1 percent in 2013 and significantly above the 25.5 percent recorded in 2008."
1CMH Lahore Medical College and Institute of Dentistry , Lahore Cantt , Pakistan.
2Center for Evaluation, Harvard Medical School , Boston, MA , United States of America.
Background. A good doctor-patient relationship is the centre stone of modern medicine. Patients are getting increasingly aware about exercising their autonomy and thus modern medicine cannot deliver all its advances to the patients if a good doctor-patient relationship is not established. We initiated this study with the aim to assess the leaning of medical students, who are the future physicians, towards either a doctor-centered or a patient-centered care, and to explore the effects of personal attributes on care such as gender, academic year, etc.
Materials & Methods. A cross-sectional study was conducted between July and Sep 2013. CMH Lahore Medical and Dental College Ethical Review Committee approved the study questionnaire. The study population consisted of 1,181 medical students in years 1-5 from two medical colleges. The English version of Patient Practitioner Orientation Scale (PPOS) was used to assess attitudes of medical students towards doctor-patient relationship. PPOS yields a mean score range of 1-6, where 1 signifies tendency towards a doctor centered relationship and 6 signifies patient-centered relationship. The relationship between PPOS scores and individual characteristics like gender, academic year etc. were examined by multiple regression.
Results. A total of 783 students formed the final sample (response rate = 92%). Mean PPOS score of the entire sample was 3.40 (± .49 S.D.). Mean sharing sub-scale score was 3.18 (± 0.62 S.D. Mean caring sub-scale score was 3.63 (± 0.56 S.D.). Characteristics associated with most patient-centered attitudes were advanced academic year, having a clinical rotation, foreign background and studying in a private college. Gender, having doctor parents, relationship and residence status had no bearing on the attitudes (p > 0.05).
Conclusion. Despite ongoing debate and the emphasis on a patient-centered curriculum, our study suggests that the current curriculum and its teachings are not producing the results they are designed to achieve. Students should be adequately exposed to the patients from the beginning of their medical education in clinical settings which are more sympathetic to a patient-centered care.
1Centre for Clinical Ethics, Canada; Hôtel-Dieu Grace Healthcare, Canada; Joint Centre for Bioethics, University of Toronto, Canada; Department of Philosophy, University of Waterloo, Canada firstname.lastname@example.org.
2Centre for Clinical Ethics, Canada; Department of Family and Community Medicine, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada email@example.com.
3University Health Network, Canada; Joint Centre for Bioethics, University of Toronto, Canada.
4Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada.
5Sunnybrook Health Sciences Centre, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada.
6Department of Family and Community Medicine, University of Toronto, Canada.
7Humber River Hospital, Canada; Joint Centre for Bioethics, University of Toronto, Canada.
8Department of Family and Community Medicine, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada.
In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.
We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to be made.
This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.
PARTICIPANTS AND RESEARCH CONTEXT:
We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.
The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.
As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.
We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethicaltreatment of the patients for whom they care.
One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients.
1Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan ; Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan.
2Albany Law School, NY, USA.
3Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
The process of informed consent remains a constant challenge in clinical research. The aim of the present study was to evaluate the understanding of researchers and members of Institutional Review Boards (IRBs) regarding the essential elements of an Informed Consent Form (ICF) as required by internationally recognized regulations. Using eight case studies to illustrate basic ethical elements, the study involved 107 participants, mainly from the Asia Pacific and African regions. The results showed that most of the participants had general knowledge regarding the essential elements required in an ICF. However, the issues of confidentiality of data and payment for study participation proved to be problematic for some participants, accounting for 35% and 28% of all incorrect answers respectively. This suggests that participants' understanding of the underlying concepts of the required ICF elements is limited. Ethical training of researchers and IRB members, particularly in the Asia Pacific and African regions, concerning valid informed consent is still needed.
1a Department of Psychology , Henderson State University , Arkadelphia , Arkansas , USA.
Christian serpent handling sects of Appalachia comprise a community that has long been mischaracterized and marginalized by the larger communities surrounding them. To explore this dynamic, this article traces the emergence of serpent handling in Appalachia and the emergence of anti-serpent-handling state laws, which eventually failed to curb the practice, as local communities gave serpent handling groups support. We present two studies to consider for improving community relations with serpent handling sects. In study 1, we present data relating the incidence of reported serpent-bite deaths with the rise of anti-serpent-handling laws and their eventual abatement, based on increasing acceptance of serpent handlers by the larger community. Study 2 presents interview data on serpent bites and death that provide explanations for these events from the cultural and religious perspective. We conclude that first-hand knowledge about serpent handlers, and other marginalized groups, helps to lessen suspicion and allows them to be seen as not much different, which are tendencies that are important for promoting inter-community harmony.
Guided by a racial microaggression framework and utilizing a mixed-method approach, this study explores multiracial individuals' interpersonal experiences and perceptions of racial identification inquiries-queries directed toward them as others attempt to determine their racial background (e.g., "What are you?").
As part of an online study, multiracial college students (n = 40) were presented with a hypothetical situation in which racial identification inquiries were delivered by a White, racial minority, or racially unspecified communicator. Qualitative analyses identified the categories and thematic codes of participants' open-ended explanations of the personal relevance of these hypothetical situations and proposed endings. Nonparametric tests examined differences in situation, affect, and communication partner ratings based on race of the communicator.
Findings affirmed that racial identification inquiries are commonly reported by diverse multiracial individuals (92.5% of the present sample). Qualitative coding of participants' explanations of personal relevance and proposed endings for the hypothetical situations, as well as ratings of situation, affect, and communication partner, revealed both positive and negative characterizations ascribed to racial identification inquiry experiences. Participants who imagined the queries came from a White communicator allotted less time to continuing the conversation than those in the control condition (communicator race unspecified).
A racial microaggression framework was relevant but not sufficient in reflecting the complex nature of racial identification inquiries for multiracial individuals. The insights into multiracial individuals' perceptions of these stimuli encourage more critical and dynamic thinking about racial categorization systems and interpersonal racial processes for this underrepresented but growing population.
1Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy. Electronic address: firstname.lastname@example.org.
2Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy.
Malignant mesothelioma (MM) is a highly aggressive malignancy with a very dismal prognosis. Current treatment for unresectable MM is largely unsatisfactory; therefore, new therapeutic approaches are eagerly awaited. A better understanding of the complex mechanisms of immune escape operated by neoplastic cells and the ability to unleash an efficient anti-tumor immune response by targeting regulatory immune checkpoint(s) with immunomodulatory monoclonal antibodies (mAbs), is leading to very promising clinical results in different tumor types. Herein, we highlight the clinical impact so far identified for these new immunomodulatory agents in MM patients and discuss their prospective use to design novel clinical trials.
"Sarcopenia is bad news at any age, but at 71 the rate of muscle loss is greatly accelerated, and if you allow it to continue you can become too weak to carry out everyday tasks (lifting, carrying, climbing stairs, etc.) that allow you to live independently. What's more, when the muscles are weak, the odds of falling increase substantially. Why? Your balance is not as good as it once was, and when you lose it, even only slightly and momentarily, you expect your muscles to brace you and compensate. But if they are too weak, down you go.
That's why everyone needs to lift weights, and the older you get the more you need it."
11 Sport Performance Optimization Research Team, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia 2 Canadian Sports Institute - Pacific, Victoria, British Columbia, Canada.
Implementation of gluten-free diets amongst non-celiac athletes has rapidly increased in recent years due to perceived ergogenic and health benefits. The aim of this study was to investigate the effects of a gluten-free diet (GFD) on exercise performance, gastrointestinal (GI) symptoms, perceived well-being, intestinal injury, and inflammatory responses in non-celiac athletes.
Thirteen competitive endurance cyclists (8 males, 5 females) with no positive clinical screening for celiac disease or history of irritable bowel syndrome (mean±SD; age: 32±7 years; weight: 71.1±13.4kg; height 177.0±11.8cm, VO2max 59.1±8.0ml.kgmin) were allocated to a sevendaygluten-containing diet (GCD) or GFD separated by a 10-day washout in a controlled randomized double-blind, cross-over study. Cyclists ate a GFD alongside either gluten-containing or gluten-free food bars (16g wheat gluten per day) while habitual training and nutrition behaviors were controlled. During each diet, cyclists completed the Daily Analysis of Life Demand for Athletes (DALDA) and GI questionnaires (post-exercise and daily). Ondayseven cyclists completed a submaximal steady-state (SS) 45 minute ride at 70% peak power followed by a 15 minute time-trial (TT). Blood samples were taken pre-exercise, post SS and post TT to determine intestinal fatty acid binding protein (IFABP) and inflammatory markers (cytokine responses: IL-1β, IL-6, IL-8, IL-10, IL-15, TNF-α). Mixed effect logistic regression was used to analyze data.
TT performance was not significantly different (p=0.37) between the GCD (245.4±53.4kJ) and GFD (245.0±54.6kJ). GI symptoms during exercise, daily, and DALDA responses were similar for each diet (p>0.11). There were no significant differences in IFABP (p=0.69) or cytokine (P>0.13) responses.
A short-term GFD had no overall effect on performance, GI symptoms, well-being, and a select indicator of intestinal injury or inflammatory markers in non-celiac endurance athletes.
2Neuroscience and Behavior Program and Department of Psychology, Vassar College, Poughkeepsie, NY 12604.
Viruses, parasites, and some bacteria use host organisms to complete their lifecycle. These infectious agents are able to hijack host processes to replicate and transmit to the next host. While we tend to think of infections as just making us sick, they are also capable of changing host behavior. In fact, many infectious agents are able to mediate host behavior in ways that can enhance transmission of the disease. In this course we explore the process of host behavior mediation by infectious agents, combining aspects of multiple fields including neurobiology, animal behavior, infectious disease microbiology, and epidemiology. The goals for this course are: 1) To explore the neurological and behavioral effects of infectious organisms on their hosts, in particular pathogen mediation of host behavior to the benefit of the pathogen, 2) to introduce students to primary literature in a multidisciplinary field, and 3) when applicable, to address cultural/historical/mythological perspectives that might alter societal norms and pressures and influence the impact of the biological processes of behavior modification by infections.
1Senior Resident, Department of Forensic Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh, India .
2Demonstrator, Department of Biochemistry, Government Medical College and Hospital , Sector 32, Chandigarh, India .
3Professor and Head, Department of Forensic Medicine, Post Graduate Institute of Medical Education and Research , Chandigarh, India .
4Associate Professor, Department of Forensic Medicine, Government Medical College , Patiala, Punjab, India .
The use of knock out drugs for perpetuation of crime has significantly increased in recent years. These drug facilitated crimes mainly involve robbery and sexual offences. Most of the drugs employed for these purposes affect the nervous system and bring a state of incapacitation and amnesia. The miscreants exploit these properties of drugs to commit such crimes. The unsuspecting travellers on public transport vehicles and women in discoparties are most vulnerable to such crimes. The unrestricted and unregulated sale of prescription drugs and general ignorance of such incidents is a challenge that needs to be addressed promptly.
"Increasing prosperity in developing countries has been accompanied by a sudden increase in caloric intake.
However their populations' epigenetic makeup, whereby changing environmental factors alter how people's genes are expressed, has not compensated for these dietary changes.
This means their bodies are still designed to cope with undernourishment; so they store fat in a manner that makes them more prone to obesity and its resulting diseases than populations accustomed to several generations of a 'normal' diet."