Neurobiol Aging. 2014 Jul 15. pii: S0197-4580(14)00474-6. doi: 10.1016/j.neurobiolaging.2014.07.005. [Epub ahead of print]

Pattern of brain atrophy rates in autopsy-confirmed dementia with Lewy bodies.

Nedelska Z1, Ferman TJ2, Boeve BF3, Przybelski SA4, Lesnick TG4, Murray ME5, Gunter JL6, Senjem ML6, Vemuri P6, Smith GE7, Geda YE8, Graff-Radford J3,Knopman DS3, Petersen RC3, Parisi JE9, Dickson DW10, Jack CR Jr6, Kantarci K11.

Author information

• 1Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurology, 2nd Faculty of Medicine and Motol University Hospital, Charles University in Prague, Prague, the Czech Republic; International Clinical Research Center, St. Anne's University Hospital Brno, Brno, the Czech Republic.
• 2Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA.
• 3Department of Neurology, Mayo Clinic, Rochester, MN, USA.
• 4Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
• 5Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA.
• 6Department of Radiology, Mayo Clinic, Rochester, MN, USA.
• 7Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
• 8Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA; Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
• 9Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA.
• 10Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA; Neuropathology Laboratory, Mayo Clinic, Jacksonville, FL, USA.
• 11Department of Radiology, Mayo Clinic, Rochester, MN, USA. Electronic address: kantarci.kejal@mayo.edu.

Abstract

Dementia with Lewy bodies (DLB) is characterized by preserved whole brain and medial temporal lobe volumes compared with Alzheimer's disease dementia (AD) on magnetic resonance imaging. However, frequently coexistent AD-type pathology may influence the pattern of regional brain atrophy rates in DLB patients. We investigated the pattern and magnitude of the atrophy rates from 2 serial MRIs in autopsy-confirmed DLB patients (n = 20) and mixed DLB/AD patients (n = 22), compared with AD (n = 30) and elderly nondemented control subjects (n = 15), followed antemortem. DLB patients without significant AD-type pathology were characterized by lower global and regional rates of atrophy, similar to control subjects. The mixed DLB/AD patients displayed greater atrophy rates in the whole brain, temporoparietal cortices, hippocampus and amygdala, and ventricle expansion, similar to AD patients. In the DLB and DLB/AD patients, the atrophy rates correlated with Braak neurofibrillary tangle stage, cognitive decline, and progression of motor symptoms. Global and regional atrophy rates are associated with AD-type pathology in DLB, and these rates can be used as biomarkers of AD progression in patients with LB pathology.

World Health Popul. 2014;15(2):4-13.

End-of-Life Decisions - Some International Comparisons.

Costello MM1, West DJ2, Ramirez B3.

Author information

• 1Consultant, Moses Taylor Foundation, and Adjunct Professor, The University of Scranton, Scranton, Pennsylvania, USA.
• 2Professor and Chairman, Department of Health Administration & Human Resources, The University of Scranton, Pennsylvania, USA.
• 3Assistant Professor, Health Services Administration Program, Department of Health Management & Informatics, College of Health & Public Affairs, University of Central Florida, Florida, USA.

Abstract

Healthcare professionals often confront difficult issues in end-of-life care. Caregivers who question futile care and treatment can find themselves at odds with patients, family members and surrogates who stress patient autonomy. Many developed nations recognize hospital ethics committees as appropriate venues for discussion of end-of-life care, and palliative care initiatives in many hospitals play important roles in patient care at the end of life. As health systems worldwide confront diminishing resources and endless questioning on expenditures, the concept of medical futility has taken on increasing prominence. Medical professionals know intuitively that certain interventions near the end of life can neither extend life nor improve the quality of life remaining. In addition to medical futility, concerns about international economic pressures and enhanced recognition of patient autonomy lead to questions as to the appropriateness of withdrawing life-sustaining treatment, assisted suicide and euthanasia. While some appellate courts seem willing to entertain questions on the legal rights of patients to access certain end-of-life measures, legislative bodies appear reluctant to legalize assisted suicide and euthanasia.

"It is of ultimate concern for the nursing discipline to highlight self-realization connected to the positive view of freedom understood as an exercise-concept."

Nurs Ethics. 2014 Aug 20. pii: 0969733014543967. [Epub ahead of print]

The nursing discipline and self-realization.

Kristoffersen M1, Friberg F2.

Author information

• 1University of Stavanger, Norway margareth.kristoffersen@uis.no.
• 2University of Stavanger, Norway.

Abstract

BACKGROUND:

It is obvious from literature within the nursing discipline that nursing is related to moral or moral-philosophical related ideas which are other-oriented. The socio-cultural process of change in modern society implies that more self-oriented ideas have been found to be significant.

AIM:

The overall aim of this article is to highlight self-oriented moral or moral-philosophical related ideas as an important part of the nursing discipline. This is achieved by (a) exploring self-realization as a significant self-oriented moral or moral-philosophical related idea based on a philosophical anthropological perspective, (b) demonstrating how moral or moral-philosophical related ideas are expressed by nurses, (c) discussing the relevance of self-realization for the nursing discipline, and (d) pointing out possible consequences for the future development of the discipline of nursing.

RESEARCH DESIGN:

This theoretical study draws empirical examples from interviews.

PARTICIPANTS AND RESEARCH CONTEXT:

Data consisted of interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions.

ETHICAL CONSIDERATIONS:

The empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the study participants.

FINDINGS:

Findings are presented in two themes: (a) other-oriented ideas and (b) self-oriented ideas. More concretely, the findings show that nurses hope to make life as good as possible for the patient and they have a wish to improve themselves as human beings, to become better persons.

DISCUSSION:

The relevance of self-realization for the nursing discipline is discussed along two lines, first, by connecting nurses' self-understanding to a horizon of identity and second, by considering what self-realization could offer.

CONCLUSION:

It is of ultimate concern for the nursing discipline to highlight self-realization connected to the positive view of freedom understood as an exercise-concept. Further identifying and articulating the contribution of self-realization to nurses and nursing practice is of particular importance.

Suicide tourism

J Med Ethics. 2014 Aug 20. pii: medethics-2014-102091. doi: 10.1136/medethics-2014-102091. [Epub ahead of print]

Suicide tourism: a pilot study on the Swiss phenomenon.

Gauthier S1, Mausbach J2, Reisch T3, Bartsch C1.

Author information

• 1Institute of Legal Medicine, University of Zurich, Zurich, Switzerland.
• 2Centre for Medicine-Ethics-Swiss Law, Institute of Jurisprudence, University of Zurich, Zurich, Switzerland.
• 3Psychiatric Clinic, Centre for Psychiatry, Münsingen, Switzerland.

Abstract

While assisted suicide (AS) is strictly restricted in many countries, it is not clearly regulated by law in Switzerland. This imbalance leads to an influx of people-'suicide tourists'-coming to Switzerland, mainly to the Canton of Zurich, for the sole purpose of committing suicide. Political debate regarding 'suicide tourism' is taking place in many countries. Swiss medicolegal experts are confronted with these cases almost daily, which prompted our scientific investigation of the phenomenon. The present study has three aims: (1) to determine selected details about AS in the study group (age, gender and country of residence of the suicide tourists, the organisation involved, the ingested substance leading to death and any diseases that were the main reason for AS); (2) to find out the countries from which suicide tourists come and to review existing laws in the top three in order to test the hypothesis that suicide tourism leads to the amendment of existing regulations in foreign countries; and (3) to compare our results with those of earlier studies in Zurich. We did a retrospective data analysis of the Zurich Institute of Legal Medicine database on AS of non-Swiss residents in the last 5 years (2008-2012), and internet research for current legislation and political debate in the three foreign countries most concerned. We analysed 611 cases from 31 countries all over the world. Non-terminal conditions such as neurological and rheumatic diseases are increasing among suicide tourists. The unique phenomenon of suicide tourism in Switzerland may indeed result in the amendment or supplementary guidelines to existing regulations in foreign countries.

Chest. 2014 Aug 21. doi: 10.1378/chest.14-0742. [Epub ahead of print]

Ethical Considerations: Care of the Critically Ill and Injured During Pandemics and Disasters: CHEST Consensus Statement.

Daugherty Biddison L, Berkowitz KA, Courtney B, De Jong MJ, Devereaux AV, Kissoon N, Roxland B, Sprung CL, Dichter JR, Christian MD, Powell T.

Abstract

ABSTRACT:

Background:Mass critical care (MCC) entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may therefore jeopardize disciplined, ethical decision-making. Planning for disasters and pandemics should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This manuscript provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this chapter are important for all of those involved in any disaster or pandemic with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials. Methodology:We adapted the American College of Chest Physician's (ACCP) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process. Results:We report the suggestions which focus on five essential domains: triage and allocation; ethical concerns of patients and families, ethical responsibilities to providers; conduct of research; and international concerns. Conclusions:Ethics issues permeate virtually all aspects of disaster and pandemic response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation; ethical concerns of patients and families, ethical responsibilities to providers; conduct of research; and international concerns. Our suggestions reflect the consensus of the Task Force. We recognize, however, that some suggestions, including those related to end-of-life care, may be controversial. We highlight the need for additional research and dialogue in articulating values to guide healthcare decisions during disasters.

BACKGROUND:

Mass critical care (MCC) entails time-sensitive decisions and changes in the standard of care that it is possible to deliver. These circumstances increase provider uncertainty as well as patients' vulnerability and may therefore jeopardize disciplined, ethical decision-making. Planning for disasters and pandemics should incorporate ethics guidance to support providers who may otherwise make ad hoc patient care decisions that overstep ethical boundaries. This manuscript provides consensus-developed suggestions about ethical challenges in caring for the critically ill or injured during pandemics or disasters. The suggestions in this chapter are important for all of those involved in any disaster or pandemic with multiple critically ill or injured patients including front line clinicians, hospital administrators, and public health or government officials.

METHODOLOGY:

We adapted the American College of Chest Physician's (ACCP) Guidelines Oversight Committee's methodology to develop suggestions. Twenty-four key questions were developed, and literature searches were conducted to identify evidence for suggestions. The detailed literature reviews produced 144 articles. Based on their expertise within this domain, panel members also supplemented the literature search with governmental publications, interdisciplinary workgroup consensus documents, and other information not retrieved through PubMed. The literature in this field is not suitable upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions utilizing a modified Delphi process.

RESULTS:

We report the suggestions which focus on five essential domains: triage and allocation; ethical concerns of patients and families, ethical responsibilities to providers; conduct of research; and international concerns.

CONCLUSIONS:

Ethics issues permeate virtually all aspects of disaster and pandemic response. We have addressed some of the most pressing issues, focusing on five essential domains: triage and allocation; ethical concerns of patients and families, ethical responsibilities to providers; conduct of research; and international concerns. Our suggestions reflect the consensus of the Task Force. We recognize, however, that some suggestions, including those related to end-of-life care, may be controversial. We highlight the need for additional research and dialogue in articulating values to guide healthcare decisions during disasters.

New world order in anatomic pathology: “Optical Biopsy” for Real-Time Evaluation of Lung Tumors

Manu Jain, Navneet Narula, Amit Aggarwal, Brendon Stiles, Maria M. Shevchuk, Joshua Sterling, Bekheit Salamoon, Vishal Chandel, Watt W. Webb, Nasser K. Altorki, and Sushmita Mukherjee (2014) Multiphoton Microscopy: A Potential “Optical Biopsy” Tool for Real-Time Evaluation of Lung Tumors Without the Need for Exogenous Contrast Agents. Archives of Pathology & Laboratory Medicine: August 2014, Vol. 138, No. 8, pp. 1037-1047.

ORIGINAL ARTICLES

Multiphoton Microscopy: A Potential “Optical Biopsy” Tool for Real-Time Evaluation of Lung Tumors Without the Need for Exogenous Contrast Agents

Manu Jain, MD; Navneet Narula, MD; Amit Aggarwal, PhD; Brendon Stiles, MD; Maria M. Shevchuk, MD; Joshua Sterling, BS;Bekheit Salamoon, MBBS; Vishal Chandel, MBBS; Watt W. Webb, ScD; Nasser K. Altorki, MD; Sushmita Mukherjee, PhD, MS

From the Departments of Urology (Dr Jain), Pathology and Laboratory Medicine (Drs Narula and Shevchuk), Biochemistry (Drs Aggarwal and Mukherjee, Mr Sterling, and Mr Salamoon), Thoracic Surgery (Drs Stiles and Altorki), and Surgery (Mr Chandel), Weill Cornell Medical College, New York, New York; and the School of Applied and Engineering Physics, Cornell University, Ithaca, New York (Dr Webb). Dr Aggarwal is now with the Department of Science, Borough of Manhattan Community College, New York.

Context.—Multiphoton microscopy (MPM) is an emerging, nonlinear, optical-biopsy technique, which can generate subcellular-resolution images from unprocessed and unstained tissue in real time.

Objective.—To assess the potential of MPM for lung tumor diagnosis.

Design.—Fresh sections from tumor and adjacent nonneoplastic lung were imaged with MPM and then compared with corresponding hematoxylin-eosin slides.

Results.—Alveoli, bronchi, blood vessels, pleura, smokers' macrophages, and lymphocytes were readily identified with MPM in nonneoplastic tissue. Atypical adenomatous hyperplasia (a preinvasive lesion) was identified in tissue adjacent to the tumor in one case. Of the 25 tumor specimens used for blinded pathologic diagnosis, 23 were diagnosable with MPM. Of these 23 cases, all but one adenocarcinoma (15 of 16; 94%) was correctly diagnosed on MPM, along with their histologic patterns. For squamous cell carcinoma, 4 of 7 specimens (57%) were correctly diagnosed. For the remaining 3 squamous cell carcinoma specimens, the solid pattern was correctly diagnosed in 2 additional cases (29%), but it was not possible to distinguish the squamous cell carcinoma from adenocarcinoma. The other squamous cell carcinoma specimen (1 of 7; 14%) was misdiagnosed as adenocarcinoma because of pseudogland formation. Invasive adenocarcinomas with acinar and solid pattern showed statistically significant increases in collagen. Interobserver agreement for collagen quantification (among 3 observers) was 80%.

Conclusions.—Our pilot study provides a proof of principle that MPM can differentiate neoplastic from nonneoplastic lung tissue and identify tumor subtypes. If confirmed in a future, larger study, we foresee real-time intraoperative applications of MPM, using miniaturized instruments for directing lung biopsies, assessing their adequacy for subsequent histopathologic analysis or banking, and evaluating surgical margins in limited lung resections.

From Duke: Informed consent for biobanking

Genet Med. 2014 Aug 21. doi: 10.1038/gim.2014.102. [Epub ahead of print]

Informed consent for biobanking: consensus-based guidelines for adequate comprehension.

Beskow LM1, Dombeck CB2, Thompson CP2, Watson-Ormond JK2, Weinfurt KP3.

Author information

• 11] Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA [2] Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
• 2Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
• 31] Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA [2] Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.

Abstract

Purpose:Federal regulations and best practice guidelines identify categories of information that should be communicated to prospective biobank participants during the informed consent process. However, uncertainty remains about which of this information participants must understand to provide valid consent.

Methods:We conducted a Delphi process to define "adequate comprehension" in the context of biobanking consent. The process involved an iterative series of three online surveys of a diverse panel of 51 experts, including genome scientists, biobank managers, ethicsand policy experts, and community and participant representatives. We sought consensus (>70% agreement) concerning what specific details participants should know about 16 biobank consent topics.

Results:Consensus was achieved for 15 of the 16 consent topics. The exception was the comprehension needed regarding the Genetic Information Nondiscrimination Act.

Conclusion:Our Delphi process was successful in identifying a concise set of key points that prospective participants must grasp to provide valid consent for biobanking. Specifying the level of knowledge sufficient for individuals to make an informed choice provides a basis for improving consent forms and processes, as well as an absolute metric for assessing the effectiveness of other interventions to improve comprehension.

Clinics (Sao Paulo). 2014 Aug;69(8):509-514.

Treatment priorities in oncology: do we want to live longer or better?

Marta GN1, Del Nero LG1, Marta GN2, Mangabeira A3, Critchi G3, Kovács MJ4, Silva JL2, Saad ED3.

Author information

• 1Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
• 2Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
• 3Dendrix Research, São Paulo, SP, Brazil.
• 4Psychology Institute, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

Abstract

OBJECTIVES:

Despite the progress achieved in the fight against cancer over the past several years, assessing the needs, goals and preferences of patients with cancer is of the utmost importance for the delivery of health care. We sought to assess priorities regarding quantity versus quality of life among Brazilian patients, comparing them with individuals without cancer.

METHODS:

Using a questionnaire presenting four hypothetical cancer cases, we interviewed cancer patients, oncology health-care professionals and laypersons, most of whom had administrative functions in our hospital.

RESULTS:

A total of 214 individuals participated: 101 patients, 44 health-care professionals and 69 laypersons. The mean ages in the three groups were 56, 34 and 31 years old, respectively (p<0.001). The patients had gastrointestinal (25%), breast (22%), hematologic (10%), lung (8%) or other tumors (36%) and the tumor-node- metastasis (TNM) stage was I, II, III or IV in 22%, 13%, 34% and 31% of cases, respectively. Treatment priorities differed significantly among the three groups (p = 0.005), with survival time being a higher priority for patients than for the other two groups and with opposite trends regarding quality of life. In multivariate analysis, the age and sex distributions were not associated with the choice to maximize quality of life. In this limited sample of cancer patients, there were no associations between treatment priorities and disease stages.

CONCLUSIONS:

Both survival time and quality of life appeared to be important to cancer patients, oncology health-care professionals and laypersons, but survival time seemed to have higher priority for people diagnosed with cancer than for healthy people. Additionally, survival seemed to be more important than quality of life for all three groups assessed.

J Pers Soc Psychol. 2014 Aug 18. [Epub ahead of print]

Moral Character in the Workplace.

Cohen TR, Panter AT, Turan N, Morse L, Kim Y.

Abstract

Using two 3-month diary studies and a large cross-sectional survey, we identified distinguishing features of adults with low versus high levels of moral character. Adults with high levels of moral character tend to: consider the needs and interests of others and how their actions affect other people (e.g., they have high levels of Honesty-Humility, empathic concern, guilt proneness); regulate their behavior effectively, specifically with reference to behaviors that have positive short-term consequences but negative long-term consequences (e.g., they have high levels of Conscientiousness, self-control, consideration of future consequences); and value being moral (e.g., they have high levels of moral identity-internalization). Cognitive moral development, Emotionality, and social value orientation were found to be relatively undiagnostic of moral character. Studies 1 and 2 revealed that employees with low moral character committed harmful work behaviors more frequently and helpful work behaviors less frequently than did employees with high moral character, according to their own admissions and coworkers' observations. Study 3 revealed that adults with low moral character committed more delinquent behavior and had more lenient attitudes toward unethical negotiation tactics than did adults with high moral character. By showing that individual differences have consistent, meaningful effects on employees' behaviors, after controlling for demographic variables (e.g., gender, age, income) and basic attributes of the work setting (e.g., enforcement of an ethics code), our results contest situationist perspectives that deemphasize the importance of personality. Moral people can be identified by self-reports in surveys, and these self-reports predict consequential behaviors months after the initial assessment. 

J Med Ethics. 2014 Aug 18. pii: medethics-2014-102383. doi: 10.1136/medethics-2014-102383. [Epub ahead of print]

Refugees, humanitarian aid and the right to decline vaccinations.

Caplan AL, Curry DR.

Author information

• Population Health, Medical Ethics, New York University School of Medicine, New York, New York, USA.

Abstract

Recent instances of governments and others refusing humanitarian assistance to refugees and IDPs (internally-displaced persons) unless they agreed to polio immunization for their children raise difficult ethical challenges. The authors argue that states have the right and a responsibility to require such vaccinations in instances where the serious vaccine-preventable disease(s) at issue threaten others, including local populations, humanitarian workers, and others in camps or support settings.

How big is the myelinating orchestra?

Front Cell Neurosci. 2014 Jul 28;8:201. doi: 10.3389/fncel.2014.00201. eCollection 2014.

How big is the myelinating orchestra? Cellular diversity within the oligodendrocyte lineage: facts and hypotheses.

Tomassy GS1, Fossati V2.

Author information

• 1Department of Stem Cell and Regenerative Biology, Harvard University Cambridge, MA, USA.
• 2The New York Stem Cell Foundation New York, NY, USA.

Abstract

Since monumental studies from scientists like His, Ramón y Cajal, Lorente de Nó and many others have put down roots for modern neuroscience, the scientific community has spent a considerable amount of time, and money, investigating any possible aspect of the evolution, development and function of neurons. Today, the complexity and diversity of myriads of neuronal populations, and their progenitors, is still focus of extensive studies in hundreds of laboratories around the world. However, our prevalent neuron-centric perspective has dampened the efforts in understanding glial cells, even though their active participation in the brain physiology and pathophysiology has been increasingly recognized over the years. Among all glial cells of the central nervous system (CNS), oligodendrocytes (OLs) are a particularly specialized type of cells that provide fundamental support to neuronal activity by producing the myelin sheath. Despite their functional relevance, the developmental mechanisms regulating the generation of OLs are still poorly understood. In particular, it is still not known whether these cells share the same degree of heterogeneity of their neuronal companions and whether multiple subtypes exist within the lineage. Here, we will review and discuss current knowledge about OL development and function in the brain and spinal cord. We will try to address some specific questions: do multiple OL subtypes exist in the CNS? What is the evidence for their existence and those against them? What are the functional features that define an oligodendrocyte? We will end our journey by reviewing recent advances in human pluripotent stem cell differentiation towards OLs. This exciting field is still at its earliest days, but it is quickly evolving with improved protocols to generate functional OLs from different spatial origins. As stem cells constitute now an unprecedented source of human OLs, we believe that they will become an increasingly valuable tool for deciphering the complexity of human OL identity.

How Intersections of Race and Gender Shape Black Professional Men's Experiences With Tokenization

Cultur Divers Ethnic Minor Psychol. 2014 Aug 11. [Epub ahead of print]

When Visibility Hurts and Helps: How Intersections of Race and Gender Shape Black Professional Men's Experiences With Tokenization.

Wingfield AH, Wingfield JH.

Abstract

Research shows groups who experience minority status encounter tokenization. Most studies applying token theory to minority groups at work focus on either gendered or racialized processes of tokenization. We offer a different approach by using an intersectional lens to examine how both race and gender work together to shape ways Black professional men experience tokenization when employed in predominantly White male-dominated workplaces. Based on interviews with 42 Black men employed as doctors, lawyers, bankers, or engineers, we conclude that although Black professional men encounter some of the typical negative aspects of tokenization, intersections of race and gender create other important facets that render their token experience somewhat unique and different from their White male, White female, and Black female counterparts. 

From U Michigan: A paradigm shift in the treatment of extreme prematurity: the artificial placenta

Curr Opin Pediatr. 2014 Jun;26(3):370-6. doi: 10.1097/MOP.0000000000000083.

A paradigm shift in the treatment of extreme prematurity: the artificial placenta.

Davis RP1, Bryner B, Mychaliska GB.

Author information

• 1aSection of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Health System bSection of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Abstract

PURPOSE OF REVIEW:

Extremely low gestational age newborns (ELGANs), born at less than 28 weeks' estimated gestational age, suffer the greatest consequences of prematurity. There have been significant advances in their care over the last several decades, but the prospects for major advances within traditional treatment modalities appear limited. An artificial placenta using extracorporeal life support (ECLS) has been investigated in the laboratory as a new advance in the treatment of ELGANs. We review the concept of an artificial placenta, the purported benefits, and the most recent research efforts in this area.

RECENT FINDINGS:

For 50 years, researchers have attempted to develop an artificial placenta based on ECLS. Traditional artificial placentastrategies have been based on arteriovenous ECLS using the umbilical vessels with moderate success. Recently, the use of venovenous ECLS and miniaturization of ECLS components have shown potential for creating a next-generation artificial placenta.

SUMMARY:

ELGANs suffer the greatest morbidity and mortality of prematurity, and are poised to benefit from a paradigm shift in the treatment. Although challenges remain, the artificial placenta is feasible. An artificial placenta would not only protect ELGANs from the complications of mechanical ventilation, but also support their development until a stage of greater maturity, preparing them for a life free of the sequelae of prematurity.

Soc Sci Med. 2014 Jul 30. pii: S0277-9536(14)00498-5. doi: 10.1016/j.socscimed.2014.07.058. [Epub ahead of print]

Uncovering zoonoses awareness in an emerging disease 'hotspot'

Paige SB1, Malavé C2, Mbabazi E3, Mayer J4, Goldberg TL2.

Author information

• 1University of Wisconsin-Madison, USA. Electronic address: spaige1@gmail.com.
• 2University of Wisconsin-Madison, USA.
• 3Makerere University Biological Field Station, Uganda.
• 4University of Washington, USA.

Abstract

Emerging infectious diseases from animals pose significant and increasing threats to human health; places of risk are simultaneously viewed as conservation and emerging disease 'hotspots'. The One World/One Health paradigm is an 'assemblage' discipline. Extensive research from the natural and social sciences, as well as public health have contributed to designing surveillance and response policy within the One World/One Health framework. However, little research has been undertaken that considers the lives of those who experience risk in hotspots on a daily basis. As a result, policymakers and practitioners are unable to fully comprehend the social and ecological processes that catalyze cross-species pathogen exchange. This study examined local populations' comprehension of zoonotic disease. From October 2008-May 2009 we collected data from people living on the periphery of Kibale National Park, in western Uganda. We administered a survey to 72 individuals and conducted semi-structured, in-depth interviews with 14 individuals. Results from the survey showed respondents had statistically significant awareness that transmission of diseases from animals was possible compared to those who did not think such transmission was possible (x2 = 30.68, df = 1, p < 0.05). However, individual characteristics such as gender, occupation, location, and age were not significantly predictive of awareness. Both quantitative and qualitative data show local people are aware of zoonoses and provided biomedically accurate examples of possible infections and corresponding animal sources (e.g., worm infection from pigs and Ebola from primates). Qualitative data also revealed expectations about the role of the State in managing the prevention of zoonoses from wildlife. As a result of this research, we recommend meaningful discourse with people living at the frontlines of animal contact in emerging disease and conservation hotspots in order to develop informed and relevant zoonoses prevention practices that take into account local knowledge and perceptions.

BMC Med Ethics. 2014 Aug 15;15(1):63. [Epub ahead of print]

Joint issues - conflicts of interest, the ASR hip and suggestions for managing surgical conflicts of interest.

Johnson J, Rogers W.

Abstract

BACKGROUND:

Financial and nonfinancial conflicts of interest in medicine and surgery are troubling because they have the capacity to skew decision making in ways that might be detrimental to patient care and well-being. The recent case of the Articular Surface Replacement (ASR) hip provides a vivid illustration of the harmful effects of conflicts of interest in surgery.

DISCUSSION:

We identify financial and nonfinancial conflicts of interest experienced by surgeons, hospitals and regulators in the ASR case. These conflicts may have impacted surgical advice, decision-making and evidence gathering with respect to the ASR prosthesis, and contributed to the significant harms experienced by patients in whom the hip was implanted. Drawing on this case we explore shortcomings in the standard responses to conflicts of interest - disclosure and recusal. We argue disclosure is necessary but by no means sufficient to address conflicts of interest. Using the concept of recusal we develop remedies including second opinions and third party consent which may be effective in mitigating conflicts, but their implementation introduces new challenges.

SUMMARY:

Deployment of the ASR hip is a case of surgical innovation gone wrong. As we show, there were multiple conflicts of interest involved in the introduction of the ASR hip into practice and subsequent attempts to gloss over the mounting body of evidence about its lack of safety and effectiveness. Conflicts of interest in surgery are often not well managed. We suggest strategies in this paper which can minimise the conflicts of interest associated with surgical innovation.

From the Cleveland Clinic: Gynecologic care for transgender youth

Curr Opin Obstet Gynecol. 2014 Aug 13. [Epub ahead of print]

Gynecologic care for transgender youth.

Unger CA.

Author information

• Department of Obstetrics & Gynecology, Division of Female Pelvic Medicine & Reconstructive Surgery, Cleveland Clinic Foundation, Women's Health Institute, Cleveland, Ohio, USA.

Abstract

PURPOSE OF THE REVIEW:

To provide an overview of the care of the adolescent transgender patient with regard to the guidelines and recommendations that currently exist, and to review the role of the clinician caring for transgender youth.

RECENT FINDINGS:

The World Professional Association for Transgender Health and the Endocrine Society continue to provide comprehensive guidelines for the care of adolescent transgender patients. The decision to perform surgery on a patient who is a minor remains a complex one, and a case-by-case approach should be taken with important ethical principles in mind. Cross-sex steroid use places transgender adolescents at risk for metabolic disorders, and careful surveillance is necessary. In addition, transgender teens are at high risk for depression, anxiety and suicidality and have been shown to engage in more high-risk behaviors compared with their nontransgender heterosexual counterparts.

SUMMARY:

Clinicians who care for adolescents can play an important role in the counseling, screening, health maintenance and support of their patients through the transition process.