Elizabeth Garrett, USC provost, named Cornell's 13th president
The Cornell University Board of Trustees today approved the appointment of Elizabeth Garrett, provost and senior vice president for academic affairs at the University of Southern California, as Cornell’s next president. Garrett will assume the presidency July 1, 2015.
1Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, NSW, Australia. firstname.lastname@example.org.
2Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, NSW, Australia.
The current outbreak of Ebola virus disease in West Africa is the worst so far. The unprecedented extent of mortality and morbidity in this outbreak has followed more from imposition of neoliberal economic policies on the countries affected than from the biological virulence of Ebola virus. The lack of vaccines and medications for Ebola virus disease is evidence that markets cannot reliably supply treatments for epidemic diseases. We attribute the current difficulties in containment chiefly to the erosion or non-development of the health and medical infrastructure needed to respond effectively, as a direct result of market-privileging policies imposed in the interests of wealthy nations. These events and responses hold lessons for public health priorities in Australia.
1School of Population Health, The University of Queensland, Herston, QLD, Australia; email@example.com.
2Nuffield Centre for International Health & Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
3School of Population Health, The University of Queensland, Herston, QLD, Australia.
4Integrated Health Services, Islamabad, Pakistan.
The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development.
Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation.
The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries' governments nor the donors had the experience of development collaboration in this context.The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differingpolitics and governance context.
The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships.
The progress of lesbian, gay, bisexual, transsexual, and queer rights entails the erosion of prejudice, and erosion is a slow process. Much press accrues to the dramatic advancement of gay marriage, but that progress reflects decades of committed activism that antedate the sea change. Social science, physical science, politics, philosophy, religion, and innumerable other fields have bearing on the emergence of healthy LGBTQ identities. The field of bioethics is implicated both in revolutionizing attitudes and in determining how best to utilize such ameliorated positions. For decades, the debate around homosexuality has centered on whether it is a choice or an inherent quality. A growing segment of the population believes that gay people are "made that way" and therefore do not deserve to be treated with the prejudice they might warrant if they had simply elected what others resisted. In effect, they are like disabled people, who can't help the challenges they face, and unlike murderers, who could choose not to kill. Anti-gay arguments tend to hinge on a view of gayness as a behavior; the liberatory ones, on gayness as an identity. A behavior can be avoided; an identity is integral and therefore warrants acceptance-or even celebration. People have a right to their identities, even if they have the capacity to act out other, different identities. Bioethics is the field in which this distinction between gay acts and a gay self may be argued most directly.
1Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
2Morehouse University School of Medicine, Atlanta, GA, USA.
This paper briefly reviews the social science on "neighborhood effects" as an independent force in shaping poor outcomes, specifically mental illness and criminal behavior, before discussing the implications of that research for understanding the relationship between neighborhoods, race and class. Neighborhood effects research has proliferated in recent years with extensive attention again being focused on the social context of family and individual development and life course. Moreover, recent work has suggested the need to consider the developmental effects of neighborhoods that persist across life-span. This paper will focus specifically on mental illness and criminal behavior as outcomes for understanding neighborhood effects, but will also consider what the structural causes of individual behavior and functioning mean for clinical assessment, especially forensic assessment.
1a Animal Welfare Science Centre , University of Melbourne , Parkville , Victoria 3010 , Australia.
Abstract Animal welfare is a state within the animal and a scientific perspective provides methodologies for evidence-based assessment of an animal's welfare. A simplistic definition of animal welfare might be how the animal feels now". Affective experiences including emotions, are subjective states so cannot be measured directly in animals, but there are informative indirect physiological and behavioural indices that can be cautiously used to interpret such experiences. This review enunciates several key science-based frameworks for understanding animal welfare. The biological functioning and affective state frameworks were initially seen as competing, but a recent more unified approach is that biological functioning is taken to include affective experiences and affective experiences are recognised as products of biological functioning, and knowledge of the dynamic interactions between the two is considered to be fundamental to managing and improving animal welfare. The value of these two frameworks in understanding the welfare of group-housed sows is reviewed. The majority of studies of the welfare of group-housed sows have employed the biological functioning framework to infer compromised sow welfare, on the basis that suboptimal biological functioning accompanies negative affective states such as sow hunger, pain, fear, helplessness, frustration and anger. Group housing facilitates social living, but group housing of gestating sows raises different welfare considerations to stall housing, such as high levels of aggression, injuries and stress, at least for several days after mixing, as well as subordinate sows being underfed due to competition at feeding. This paper highlights the challenges and potential opportunities for the continued improvement in sow management through well-focused research and multidisciplinary assessment of animal welfare. In future the management of sentient animals will require the promotion of positive affective experiences in animals and this is likely to be a major focus for animal welfare science activity in the early twenty-first century.
1Adjunct Professor of Practice-Bioethics in the Department of Communication, and faculty at the Center for Bioethics, Health, and Society at Wake Forest University.
The recent explosion of publicity about the dangers of concussion in contact sports - particularly in football - represents the unraveling of a disinformation campaign by the NFL amid growing public and professional concern about the game's long-term risks of harm. The persistence of controversy and denial reflects a cultural view of football players as serving the needs of the team, a resulting evidentiary skepticism, and resistance to rule changes as excessive or unenforceable. This article considers the cultural context of informed decision making by parents of youth football players and suggests that policy changes designed to lower (although they cannot eliminate) risks of brain injury have the potential to change both the culture of football and the way the benefits and harms of the game are regarded for its players, without loss of its essential excitement and appeal.
1J.D. candidate (2016) at Yale Law School in New Haven, CT.
Although the Federal Common Rule requires that informed consent documents include all material information, it does not specify the content of materials used to recruit human subjects. In particular, there is no federal regulation relating to how payment for research participation is to be advertised. Rather, the FDA has issued guidance, advising researchers not to emphasize payment information. In order to determine how IRBs have interpreted this guidance, we coded the policies of the top 100 institutions by receipt of NIH funding, in order to determine whether they require, permit, or forbid researchers to disclose the amount of compensation in their recruitment materials. We found that the vast majority of institutions implicitly or explicitly permit such disclosures; however, there are a significant number of IRBs at each extreme, some discouraging or forbidding with others encouraging or mandating such disclosures. Such heterogeneity in local regulations suggests that IRB discretion may be imposing costs on human subjects and the scientific enterprise that outweigh the benefits. We suggest that this heterogeneity should be resolved towards a national consensus on permissibility.
Drug Prevention and Health Branch, United Nations Office On Drugs and Crime (UNODC), Vienna.
The services for drug-dependence treatment and care, particularly in low-income countries, should not be fragmented and uncoordinated. A basic package of interventions should be provided in the same place and managed by the same team, with a one-stop shop approach. The services for substance use disorders should be appealing, accessible, voluntary-based, and science-based. They should also, like efforts to fight other diseases, be included in the community and the public health systems; that is, those who are affected by drug use and those who serve them should not face discrimination. The first-line assistance and the second-line essential elements of the comprehensive package will be described. The work of the United Nations Office on Drugs and Crime (UNODC) and World Health Organization (WHO) to promote science-based and voluntary-based ethicaltreatment in Asia will be illustrated.
Ann T. Moriarty, Ritu Nayar, Terry Arnold, Lisa Gearries, Andrew Renshaw, Nicole Thomas, and Rhona Souers (2014) The Tahoe Study: Bias in the Interpretation of Papanicolaou Test Results When Human Papillomavirus Status Is Known. Archives of Pathology & Laboratory Medicine: September 2014, Vol. 138, No. 9, pp. 1182-1185.
Ann T.Moriarty, MD;RituNayar, MD;TerryArnold, CT(ASCP);LisaGearries, CT(ASCP);AndrewRenshaw, MD;NicoleThomas,MPH, CT(ASCP);RhonaSouers, MS
From Esoteric Testing, AmeriPath Indiana (Dr Moriarty), and Cytology, Mid America Clinical Laboratories (Mr Arnold and Ms Gearries), Indianapolis; the Department of Cytopathology, Northwestern University Medical Center, Chicago (Dr Nayar), and Surveys Department, College of American Pathologists (Ms Thomas), and Biostatistics Department, College of American Pathologists (Ms Souers), Northfield, Illinois; and the Department of Pathology, Baptist Memorial Hospital, Miami, Florida (Dr Renshaw).
Context.—Knowledge of human papillomavirus (HPV) status is expected to bias the morphologic evaluation of Papanicolaou (Pap) test results.
Objective.—To characterize Pap test result interpretive bias when the HPV status is known at the microscopic evaluation.
Design.—Forty HPV-positive liquid-based Pap test results initially interpreted as negative for squamous intraepithelial lesion or malignancy were selected from a quality assurance program, separated into 2 groups of 20 slides each, and circulated in 2 groups to 22 members of the College of American Pathologists Cytopathology Committee. Each member reviewed each case and indicated whether the result was negative for squamous intraepithelial lesion or malignancy or was an epithelial cell abnormality (ECA). The participants assessed the severity of ECAs using the Bethesda System. The participants were not informed of the HPV status in the initial review round. Each group of 20 slides was then distributed to the opposite group (to avoid slide recall), and the participants were informed that all slides were from patients who were high-risk HPV positive. Differences in the responses between groups were analyzed by χ2 test and Cochran-Mantel-Haenszel test at the .05 significance level.
Results.—Without knowledge of the HPV status, slides were more often categorized as negative for squamous intraepithelial lesion or malignancy and less likely identified as an ECA (P < .001). There was an increase across all categories of ECAs in the biased responses compared with the unbiased responses (P = .002).
Conclusions.—Knowledge of positive HPV status biases morphologic Pap test result interpretation. If the HPV status is positive, observers are more likely to report a Pap test result as abnormal across all categories of ECAs.
Up to a third of residents might be living with Sarcopenia, a health condition linked with an increased risk of falls and functional dependence, in care homes in the UK.
A report into Sarcopenia shows it may currently affect one in 20 adults and a third of residents. The National Sarcopenia Initiative has been launched to educate and offer positive recommendations for those living with the condition, which affects the strength and function of muscles in sufferers.
1Department of Obstetrics & Gynecology, Sahlgrenska Academy, University of Gothenburg, Women's Clinic, Carlanderska Hospital, Gothenburg.
The only untreatable subgroup of female infertility is absolute uterine factor infertility (AUFI), which is due to congenital or surgical absence of a uterus or presence of a nonfunctional uterus. The solitary option for a woman with AUFI to become a biological mother today is through a gestational surrogate mother, a procedure that is prohibited in Sweden and large parts of the world. Uterus transplantation (UTx) is a potential future treatment of AUFI. After extensive animal research, also involving non-human primates, a small number of human UTx cases have recently been performed. Here, we summarize the primate UTx experiments that have paved the way for the human UTx cases, which are described and analyzed in more detail. We also estimate how many women of fertile age are affected by AUFI and describe the causes. The ethics around UTx is complex and is also addressed.
1Department of Health Policy, George Washington University School of Public Health and Health Services, Washington, District of Columbia (Drs Regenstein and Andres).
Reducing hospital readmissions is a key approach to curbing health care costs and improving quality and patient experience in the United States. Despite the proliferation of strategies and tools to reduce readmissions in the general population and among Medicare beneficiaries, few resources exist to inform initiatives to reduce readmissions among Medicaid beneficiaries. Patients covered by Medicaid also experience readmissions and are likely to experience distinct challenges related to socioeconomic status. This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. Our search yielded 254 unique results, of which 37 satisfied all review criteria. Much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population. Risk factors such as medication noncompliance, postdischarge care environments, and substance abuse comorbidities increase the risk of readmission among Medicaid patients.
1Division of Management, Policy, and Community Health (Dr DelliFraine) and Fleming Center for Healthcare Management (Ms Wang and Dr Langabeer II), University of Texas School of Public Health, Houston; Department of Health Administration and Policy, The Pennsylvania State University, University Park (Dr McCaughey); and Health Services Administration Program, Department of Political Science, Auburn University, Auburn, Alabama (Dr Erwin).
Popular quality improvement tools such as Six Sigma (SS) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether this quality improvement tool is being used correctly and improves health care quality. The authors conducted a comprehensive literature review to assess the correct use and implementation of SS and the empirical evidence demonstrating the relationship between SS and improved quality of care in health care organizations. The authors identified 310 articles on SS published in the last 15 years. However, only 55 were empirical peer-reviewed articles, 16 of which reported the correct use of SS. Only 7 of these articles included statistical analyses to test for significant changes in quality of care, and only 16 calculated defects per million opportunities or sigma level. This review demonstrates that there are significant gaps in the Six Sigma health care quality improvement literature and very weak evidence that Six Sigma is being used correctly to improve health care quality.
1The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex. Electronic address: firstname.lastname@example.org.
2The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex.
An elderly gentleman, from Scandinavia, Mr K. R. Plunk, with a soon-to-be lethal disease, has come to see you because you are the world's expert in complex aneurysm surgery and his is a case for the books. He has multiple comorbidities; the most concerning is his cardiopulmonary functioning. You have only operated on a few patients who are at this level of risk. He has been told repeatedly you are his only hope, which is literally true. A cure would pair one of the "biggest operations" with one of the frailest patients. You have been on an invincible roll and have decided to give it a shot, if he agrees. What is the most ethical informed consent in this case?
In November 2000, the Occupational Safety and Health Administration (OSHA) issued an ergonomics standard to prevent debilitating work-related musculoskeletal disorders (WMSDs). It was rescinded by Congress within four months. We explore how this story unfolded over two decades of collaboration and conflict. Part I provides an overview of the historical context of the struggle for a standard, followed by interviews with key players from labor, academia and government. They provide a snapshot of the standard; discuss the prevalence of WMSDs in the context of changing work organization; give insight into the role of unions and of scientific debate within the context of rulemaking; and uncover the basis for the groundbreaking OSHA citations that laid the foundation for a standard. Part II interviews further explore the anti-regulatory political landscape of the 1990s that led to repeal of the standard, discuss the impact of the struggle beyond the standard, and describe creative approaches for the future.
New Solut. 2014 Jan 1;24(3):391-408. doi: 10.2190/NS.24.3.j.
1UCLA Labor Occupational Safety & Health Program (UCLA-LOSH).
2University of California, Los Angeles.
3Civil Rights Project at UCLA.
4Urban and Regional Planning from UCLA.
The OSHA ergonomics standard issued in 2000 was repealed within four months through a Congressional resolution that limits future ergonomics rulemaking. This section continues the conversation initiated in Part I, documenting a legacy of struggle for an ergonomics standard through the voices of eight labor, academic, and government key informants. Part I summarized important components of the standard; described the convergence of labor activism, research, and government action that laid the foundation for a standard; and highlighted the debates that characterized the rulemaking process. Part II explores the anti-regulatory political landscape of the 1990s, as well as the key opponents, power dynamics, and legal maneuvers that led to repeal of the standard. This section also describes the impact of the ergonomics struggle beyond the standard itself and ends with a discussion of creative state-level policy initiatives and coalition approaches to prevent work-related musculoskeletal disorders (WMSDs) in today's sociopolitical context.
1Department of Pharmacy, University of Rochester Medical Center, New York.
2Division of Infectious Diseases, Wayne State University School of Medicine and Detroit Medical Center, Michigan.
3Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
4Global Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha.
To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.
From the Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Harvard University, Boston, Massachusetts.
Context.— The analysis of molecular biomarkers in lung adenocarcinoma (ACA) is now a central component of pathologic diagnosis and oncologic care. The identification of an EGFR mutation or ALK rearrangement in advanced-stage lung ACA will dictate a change in first-line treatment from standard chemotherapy to targeted inhibition of these oncogenic alterations. Viable approaches to therapeutic targeting of KRAS-mutated ACA are now under investigation, raising the possibility that this too will become an important predictive marker in this tumor type. The recognized array of less common oncogenic alterations in lung ACA, including in the ROS1, RET, BRAF, and ERBB2 genes, is growing rapidly. The therapeutic implications of these findings are, in many cases, still under investigation.
Objective.— To focus on the major molecular biomarkers in lung ACA, recommended testing strategies, the implications for targeted therapies, and the mechanisms that drive development of resistance.
Data Sources.— Our current understanding of predictive and prognostic markers in lung ACA is derived from a decade of technical advances, clinical trials, and epidemiologic studies. Many of the newest discoveries have emerged from application of high-throughput next-generation sequencing and gene expression analyses in clinically and pathologically defined cohorts of human lung tumors.
Conclusions.— Best practices require a solid understanding of relevant biomarkers for diagnosis and treatment of patients with lung ACA.
When a speaker presents an opinion, an important factor in audiences' reactions is whether the speaker seems to be basing his or her decision on ethical (as opposed to more pragmatic) concerns. We argue that, despite a consequentialist philosophical tradition that views utilitarian consequences as the basis for moral reasoning, lay perceivers think that speakers using arguments based on consequences do not construe the issue as a moral one. Five experiments show that, for both political views (including real State of the Union quotations) and organizational policies, consequentialist views are seen to express less moralization than deontological views, and even sometimes than views presented with no explicit justification. We also demonstrate that perceived moralization in turn affects speakers' perceived commitment to the issue and authenticity. These findings shed light on lay conceptions of morality and have practical implications for people considering how to express moral opinions publicly.
1Dipartimento di Scienze Politiche, Scienze della Comunicazione & Ingegneria dell'Informazione, Università degli Studi di Sassari, 07100 Sassari, Italy.
We explore at a world level the awareness of nanotechnology expressed through the most popular online social media: Facebook. We aimed at identifying future trends, the most interested countries and the public perception of ethics, funding and economic issues. We found that graphene and carbon nanotubes are the most followed nanomaterials. Our poll showed that the continents with the most interest are Asia and Africa. A total of 43% would like to have a world commission regulating nanomedicine. In addition, 43% would give priority to theranostics. Over 90% believe that nanomedicine has an economic impact. Finally, we observed that the continents of living and origin of poll contributors correlated with ethic and funding opinions. This study highlights the potential of online social media to influence scientific communities, grant committees and nanotechnology companies, spreading nanotechnology awareness in emerging countries and among new generations.