bluuebunny/crossref_metadata_2025 huggingface dataset:
Synthesis and Microwave Dielectric Properties of Re3Ga5O12 (Re: Nd, Sm, Eu, Dy, Yb, and Y) Ceramics
Authors: Kim Jae Chul , Kim Min‐Han , Lim Jong‐Bong , Nahm Sahn , Paik Jong‐Hoo , Kim Jong‐Hee
Published: January 2007

Re3Ga5O12 (Re: Nd, Sm, Eu, Dy, Yb, and Y) garnet ceramics were synthesized and their microwave dielectric properties were investigated for advanced substrate materials in microwave integrated circuits. The Re3Ga5O12 ceramics sintered at 1350°–1500°C had a high‐quality factor (Q×f) ranging from 40 000 to 192 173 GHz and a low‐dielectric constant (ɛr) of between 11.5 and 12.5. They also exhibited a relatively stable temperature coefficient of resonant frequency (τf) in the range of −33.7 to −12.4 ppm/°C. In particular, the Sm3Ga5O12 ceramics sintered at 1450°C exhibited good microwave dielectric properties of ɛr=12.4, Q×f=192 173 GHz, and τf=−19.2 ppm/°C.
Twin‐Structured Yttria‐Stabilized t′ Zirconia Coatings Deposited by Plasma Spray Physical Vapor Deposition: Microstructure and Mechanical Properties
Authors: Li Jianqiang , Huang Heji , Ma Tian , Eguchi Keisuke , Yoshida Toyonobu
Published: January 2007

In this work, we report a twin‐structured yttria‐stabilized t′ zirconia (YSZ) coating which was fabricated through an advanced plasma spray physical vapor deposition process with a high‐power hybrid plasma spraying system. The as‐deposited YSZ structure, entirely different from those deposited by conventional atmospheric plasma spraying and electron beam physical vapor deposition, is characterized by coarse grains of over 5 μm size which compose the entire coating, differently sized t′‐ZrO2 twins which fill the coarse grains, and micron‐scaled lenticular t′ colonies in which twins on the submicrometer scale arrange alternatively. The indentation tests show that both the nanohardness and microhardness of the peculiar coating are markedly higher than those of the ordinary YSZ coatings, even comparable with those of the sintered YSZ polycrystal bulks.
Strong Green and Red Upconversion Emission in Er3+‐Doped Na1/2Bi1/2TiO3 Ceramics
Authors: Chen Shi , Wu Mengjia , An Liqiong , Li Yongxiang , Wang Shiwei
Published: January 2007

Upconversion emission properties of Na1/2Bi1/2TiO3:Er3+ ceramics prepared by the solid‐state reaction method were analyzed as a function of Er3+ concentration and incident pump power. Strong green (550 nm) and red (670 nm) emission bands were observed with 980 nm excitation at room temperature. Experimental results showed that the emission bands can be tuned by changing Er3+ concentration. Upconversion processes in these samples result from not only a two‐photon excited‐state absorption process but also a nonradiative energy transfer and cross‐relaxation process.
Influence of trap type, trap colour, and trapping location on the capture of the pine moth, Thaumetopoea pityocampa
Authors: Athanassiou Christos G. , Kavallieratos Nickolas G. , Gakis Stergios F. , Kyrtsa Lavrentia A. , Mazomenos Basilios E. , Gravanis Fotios T.
Published: January 2007

Studies were conducted to evaluate the effect of type, location, and colour of traps baited with 1 mg of the sex pheromone (Z)‐13‐hexadecen‐11‐ynyl acetate in polyethylene vials on the capture of the pine processionary moth, Thaumetopoea pityocampa (Denis & Schiffermüller) (Lepidoptera: Thaumetopoeidae), males. The experiments were carried out during two flight seasons in 2002 and 2003 at a low elevation Mediterranean pine forest on the hill of Goritsa (Magnesia, Thessaly, Central Greece). The hill is covered by approximately 120 ha of pines, among which Pinus brutia Ten. (Pinaceae) is predominant with Pinus halepensis Mill. (Pinaceae) as second most common species. Among the commercially available trap types used, the Delta and Pherocon II captured significantly more males than the Funnel trap. Furthermore, pine density had a significant effect on trap type and trap colour catches. Delta traps caught significantly more adults than the other two trap types in the low density pine stand, while in the medium and high‐density pine stands no significant differences were noted between Delta and Pherocon II traps. In addition, trap colour performance varied according to pine density; white‐ and yellow‐coloured traps caught significantly more males than the other two trap colours in the high‐density stand. The first adults were captured in traps during May, and traps continued to capture adults in low numbers (< two individuals per trap) until mid‐June. A period of 3–4 weeks of no trap captures followed until mid‐July, when captures restarted, at low numbers. The peak of T. pityocampa flight was observed during late August–September.
Corneal endothelial cell density reduction: a complication of retinal photocoagulation with an indirect ophthalmoscopy contact lens
Authors: Murata Hiroshi , Kato Satoshi , Fukushima Harumi , Tsutsumi Atsuko , Numaga Jiro , Amano Shiro
Published: January 2007

Purpose:  To investigate the influence of retinal photocoagulation with an indirect ophthalmoscopy contact lens on corneal endothelial cells.

Methods:  Seventeen eyes of 17 patients were evaluated, and corneal endothelial cells were measured twice: just before retinal photocoagulation using an indirect ophthalmoscopy contact lens and 33.2 ± 10.2 days after surgery.

Results:  A statistically significant reduction was found in corneal endothelial cell numbers before versus after surgery (P = 0.0003).

Conclusion:  Our results show corneal endothelial cells to be decreased by retinal photocoagulation with an indirect ophthalmoscopy contact lens. When a patient with a low corneal endothelial cell density receives retinal photocoagulation using an indirect contact lens, it is important to be aware of the potential for further loss.
Patient‐centred outcomes comparing transmucosal implant placement with an open approach in the maxilla: a prospective, non‐randomized pilot study
Authors: Nkenke Emeka , Eitner Stefan , Radespiel‐Tröger Martin , Vairaktaris Eleftherios , Neukam Friedrich Wilhelm , Fenner Matthias
Published: January 2007

Abstract: It was the aim of the study to assess differences in patient morbidity between transmucosal implant placement and implant installation after elevation of mucoperiosteal flaps. In five of the patients, implants were placed in the maxilla transmucosally using a CAD/CAM surgical template [test group (TG)]. In the remaining five patients, the implants were installed after the elevation of mucoperiosteal flaps [control group (CG)]. Directly after surgery, at days 1 and 7 after surgery the patients rated pain and discomfort on a visual analogue scale (0=minimal pain and discomfort, 100=maximal pain and discomfort). Optical three‐dimensional images were assessed preoperatively and at days 1 and 7 after surgery to determine the visible soft tissue swelling of the upper lip and cheeks. Directly postoperatively, the mean pairwise difference between both groups in view of pain and discomfort ratings (control minus test) was 45.6 (SD, 20.7). At days 1 and 7, the mean differences were 51.6 (SD, 21.8) and 19 (SD, 8), respectively. The overall test of the area under curve (AUC) against the null hypothesis ‘AUC of pairwise differences of pain score over study time equals null’ yielded a significant difference (P=0.01). The mean pairwise difference between both groups in view of soft tissue volume increase was 6.1 (SD, 2) cm3 at day 1 after surgery and 4.6 (SD, 1.2) cm3 at day 7. The overall test of the AUC against the null hypothesis ‘AUC of pairwise differences of oedema measurements over study time equals null’ yielded a significant difference (P=0.002). Within the limitations of this pilot study, it could be shown that transmucosal implant placement reduces patient morbidity significantly compared with an open approach.
Squamous cell apocrine hidradenoma
Authors: Angulo Jorge , Jaqueti Gerardo , Kutzner Heinz , Requena Luis
Published: January 2007

Apocrine hidradenoma is a benign adnexal neoplasm with apocrine differentiation. The neoplasm is composed of four different types of epithelial cells, including pale or clear cells, polygonal cells, mucinous cells and squamous cells, with variable proportions of them from case to case. In most examples of this neoplasm, clear or the polygonal cells are predominant, whereas the other types of neoplastic cells are less abundant. We report two cases of apocrine hidradenoma mostly composed of squamous cells. Histopathologic examination showed that the neoplasms were composed of both solid and cystic areas. The solid aggregations of neoplastic cells were composed of a peripheral layer of basaloid polygonal cells, whereas squamous cells forming the bulk of the aggregations. These squamous cells showed large eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli. In one case, small foci of mucinous cells could also be seen in some aggregations of neoplastic cells, mostly around ductal structures. In both the cases, some of the tubular structures lined by epithelial cells showed evidence of decapitation secretion in their luminal border. The neoplastic stroma consisted of sclerotic collagen bundles when compared with adjacent normal dermis, and artefactual clefts separated the neoplasms from the surrounding tissue. The rare cases described in this report are exceptional because most of the neoplastic cells showed squamous appearance and for that reason we think that squamous cell apocrine hidradenoma is the most appropriate name for these neoplasms.
Langerhans cell hyperplasia in scabies: a mimic of Langerhans cell histiocytosis
Authors: Bhattacharjee Pradip , Glusac Earl J.
Published: January 2007

Aim:  In the absence of mites, the histologic diagnosis of human scabies can be difficult. Scabies can mimic a variety of inflammatory and lymphoproliferative disorders. It is under‐recognized that scabies can also mimic Langerhans cell histiocytosis.

Methods:  Sixteen examples of scabies were reviewed histologically and immunohistochemically (CD1a, CD3, CD20, CD30 and S100).

Results:  Immunohistochemical labeling showed florid CD1a and S100 positivity in most cases, indicative of Langerhans cell hyperplasia. Scattered CD30+ lymphocytes were also typically present, within a dense infiltrate, primarily composed of T lymphocytes and eosinophils.

Conclusion:  Because of the prominent CD1a+/S100+ component, scabies can mimic Langerhans cell histiocytosis. This finding should be considered in conjunction with scattered CD30+ cells and clinical features to avoid misdiagnosis.
True intranuclear inclusions in a melanocytic nevus: report of a case and review of the literature
Authors: Murphy Michael J. , Murphy Lauren , Fang Min , Cartun Richard , Jurzyk Ronald , Grant‐Kels Jane M.
Published: January 2007

Melanocytic tumors commonly show intranuclear pseudo‐inclusions or cytoplasmic invaginations within the nuclei of melanocytes. However, true intranuclear inclusions have rarely been described in melanocytic nevus cells. Herein, we describe the histologic, immunohistochemical and ultrastructural features of an additional case of an intradermal melanocytic nevus with true intranuclear inclusions.
Primary cutaneous meningioma of the scalp: a case report and review of literature
Authors: Hussein Mahmoud R. , Abdelwahed Ahmed Rezk
Published: January 2007

Meningiomas of the skin are rare tumors that can pose considerable diagnostic challenges to the pathologist. This study presents a case of primary cutaneous meningioma in a newly born baby girl that presents with a subcutaneous nodule on the left posterior occipital scalp. A Magnetic Resonance Imaging examination failed to detect any communication between the tumor site and the meninges. The mass was excised and intra ‐operatively, there was no evidence of connection between the tumor and the underlying tissues. Microscopically, the tumor was composed of banal looking, mitotically inactive spindle‐shaped cells with a whorled configuration. Some cells were concentrically arranged around blood vessels. Immunohistochemical studies were positive for epithelial membrane antigen and vimentin. Immunostains for cytokeratin, S‐100 protein, vascular (CD34 and CD31) and muscle markers (Desmin and smooth muscle actin) were negative. The diagnosis of cutaneous meningioma was established. A review of literature was presented.
A Deliberative Model of Corporate Medical Management
Authors: Meaney Mark E.
Published: January 2007

Managed care is evolving in ways that pose unique ethical challenges to those interested in the intersection of clinical and organizational ethics. For example, Disease Management (DM) is a form of managed care that has emerged in response to chronic illness. DM is a healthcare management tool that coordinates resources across an entire health care delivery system and throughout the life cycle of chronic disease. Health Maintenance Organizations have reduced some costs in the delivery of acute care, but real cost savings will result only with greater efficiencies in the delivery of costly chronic care. DM is a systematic, population-based approach that identifies persons at risk of chronic ailment, intervenes with specific programs of care, measures clinical and other outcomes, and provides continuous quality improvement. Characterized as a movement to patient-driven services, DM involves a complex web of provider relations.
The Global Forum for Bioethics in Research: Report of a Meeting, November 1999
Authors: Hofman Karen
Published: January 2007

The first meeting of the Global Forum for Bioethics in Research was initiated by the Fogarty International Centre of the National Institutes of Health (NIH) and sponsored by the World Health Organisation (WHO), the Pan American Health Organisation (PAHO) and the NIH. Held in Bethesda on November 7-10,1999, the intent was to bring together individuals involved in medical research in low- and middle-income nations to share views with each other and with organisations that support clinical research. Approximately 120 persons from 34 countries participated, including individuals from developing countries, pharmaceutical organisations, and communities where medical research is under way.

The participants addressed the partnerships required between research sponsors and investigators involved in clinical trials in developing countries and the long-term needs for international multicentred training programs.
Historical Analogies, Slippery Slopes, and the Question of Euthanasia
Authors: Wright Walter
Published: January 2007

The German Nazi regime has become a standard model for unspeakable things that one should reject. Contemporary people will characterize political opponents, benighted policies, and other undesirable things as “fascist” or “Nazi.” In ethics, and medical ethics in particular, this analogy arises regularly. Therefore, it is not surprising that German people are particularly sensitive about their history. For example, the German high court regularly refers to the Nazi era in its reluctance to accept lethal social activities. This sensitivity surfaced again in 1988, when influential applied ethicist Peter Singer accepted a German invitation to speak to a Symposium on “Bioengineering, Ethics, and Mental Disability.” Singer had also agreed to deliver a separate lecture on the topic “Do severely disabled newborn infants have a right to life?”
Recent Developments in Health Law
Authors: Willgoos Christine
Published: January 2007

The Office of Inspector General (OIG), Department of Health and Human Services, has issued a proposed rule under section 5201 of the Omnibus Consolidated and Emergency Supplemental Appropriations Act for Fiscal Year 1999 (OCESAA) that would provide a safe harbor from civil sanctions under section 1128A(a)(5) of the Social Security Act for independent dialysis facilities that pay premiums for Supplementary Medical Insurance (Medicare Part B) or Medicare Supplemental Health Insurance Policies (Medigap) for financially needy Medicare beneficiaries with end-stage renal disease (ESRD).

End-stage renal disease is a chronic disease that requires regular dialysis treatments and monitoring of laboratory values, diet and medication. ESRD patients suffer from irreversible renal failure, often accompanied by diabetes, anemia, hypertension and congestive heart failure.
Malpractice and Negligence: Estate of Taylor v. Muncie Medical Investors, L.P.
Authors: Roberti Stefanie
Published: January 2007

The Court of Appeals of Indiana upheld the trial court's judgment and refused to create a new tort for “wrongful prolongation of life” because existing law offers a remedy to those who do not wish to be kept alive through artificial measures. Specifically, the court affirmed the trial court's dismissal in favor of Muncie Medical Investors, LP, the operator of Woodlands Nursing Home (“Woodlands”) since the plaintiffs could have sought relief under I.C. § 16-36-1-8 which provides for court resolution of disputes regarding an individual's treatment at the end of life.

In 1992, Rebecca Taylor suffered a stroke that left her paralyzed on her left side and confined to a wheelchair. Taylor executed a living will in late 1993 directing that if she was suffering from a terminal illness with “no reasonable possibility of recovery,’’ then no “extraordinary means” to prolong her life should be used.
Physician Value Neutrality: A Critique
Authors: Beckwith Francis J. , Peppin John F.
Published: January 2007

Although the notion of physician value neutrality (PVN) in medicine may be traced back to the writings of Sir William Osler, it is relatively new to medicine and medical ethics. We argue in this paper that how physician value neutrality (PVN) has been cashed out is often obscure and its defense not persuasive. In addition, we argue that the social/political implementation of neutrality, Political Liberalism (PL), fails, and thus, PVN's case is weakened, for PVN's justification relies largely on the reasoning undergirding PL. For these reasons, we conclude that PVN has no philosophical or ethical warrant and thus should be abandoned. We suggest that the physician present to her patients some type of statement or creed that would give them an idea of where she stands on important axiological issues and how these stands are cashed out clinically.
ERISA and RICO: New Tools for HMO Litigators
Authors: Moore Elaine T.
Published: January 2007

As the shield preempting state suits under the Employee Retirement Income Security Act (ERISA) has been successfully pierced (see California Div. Of Labor Standards Enforcement v. Dillingham Constr. N.A. Inc., 519 U.S. 316 (1997) and Duke v. U.S. Healthcare, Inc., 57 F.3d 350 (3rd Cir. 1995)), plaintiff attorneys have begun to use the ERISA statute itself to further litigation against managed care organizations. The court in Shea v. Esensten, 107 F.3d 625 (8th Cir. 1997), held in a landmark decision that an HMO's failure to disclose financial incentives that discourage a treating physician from providing essential health care referrals for conditions covered under the plan benefit structure is a breach of ERISA's fiduciary duties.
Disability & ADA: Disparate Insurance Coverage for Physical and Psychological Disabilities Does Not Violate ADA
Authors: Akers Nicklas A.
Published: January 2007

In Kimber v. Thiokol Corp., 196 F.3d 1092 (10th Cit. 1999), the U.S. Court of Appeals for the Tenth Circuit upheld a U.S. District Court's grant of summary judgment against an employee's claim that an employeroperated disability insurance plan, which offered different levels of compensation for disabilities due to mental and physical conditions, violated Title I of the Americans with Disabilities Act (ADA). The Court of Appeals found that (1) the Thiokol plan administrator's interpretations of the plan were not arbitrary and capricious, and that (2) the plan's different treatment of disabilities caused by physical and mental conditions did not violate the ADA.
Paths to Reducing Medical Injury: Professional Liability and Discipline vs. Patient Safety — And the Need for a Third Way
Authors: Bovbjerg Randall R. , Miller Robert H. , Shapiro David W.
Published: January 2007

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine (IOM) for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care.
Critical Biological Agents: Disease Reporting as a Tool for Determining Bioterrorism Preparedness
Authors: Horton Heather H. , Misrahi James J. , Matthews Gene W. , Kocher Paula L.
Published: January 2007

Before September 11, 2001, a mass-casualty terrorist attack on American soil was generally considered a remote possibility. Similarly, before October 4, 2001—the first confirmed case of anthrax caused by intentional release — widespread bioterrorism seemed implausible. Among the arguments that such a biological artack was unlikely included: the lack of a historical precedent; the technological and organizational challenges to acquiring and weaponizing a biological agent; and the almost universal moral opprobrium that would certainly accompany the use by terrorists of such a weapon. In the wake of September 11th and October 4th, however, many are reconsidering the likelihood of a large-scale bioterrorist attack against civilians.

The Centers for Disease Control and Prevention (CDC) defines bioterrorism as the intentional release of viruses, bacteria, or toxins for the purpose of harming or killing civilian. One measurement of the public health system's level of bioterrorism preparedness is the quality and distribution of laws mandating the reporting of diseases caused by certain biological agents.
The Complex Relationship of Genetics, Groups, and Health: What it Means for Public Health
Authors: Clayton Ellen Wright
Published: January 2007

Genetics offers real opportunities for public health actors. Increased understanding of genetics will illuminate some of the factors that affect disease and, in many cases, will lead to more effective treatments. The recognition that phenylketonuria was caused by a metabolic defect that led to the accumulation of toxic levels of phenylalanine, an elevation that could largely be averted by adopting a low-phenylalanine diet, is an early example. Some cases of what was thought to be Sudden Infant Death Syndrome, a diagnosis used when no etiology is known, now appear to have been caused by metabolic defects in fatty acid oxidation and sodium channel defects. One of the tasks that has already been undertaken by the public health sector is to ensure that genomic information is incorporated into clinical care when the robusmess of findings and their clinical utility have been well defined.
Obtaining Informed Consent for Research: A Model for Use with Participants Who Are Mentally Ill
Authors: Poythress Norman G.
Published: January 2007

An issue of ongoing concern to clinical investigators, medical ethicists, and institutional review board (IRB) members is the problem of obtaining informed consent in research that involves people with mental illness as research participants. Although the presence of a mental disorder per se does not render a person incapable of giving informed consent, some individuals afflicted with significant cognitive impairment, formal thought disorder, substantial anxiety or depression, or a variety of other symptoms may be impaired in their capacity to comprehend consent disclosures and therefore to exercise consent to research participation in a competent manner.

The stakes surrounding this informed consent issue are significant. On the one hand, the inclusion in research of participants who are not capable of giving informed consent may result in their exposure to unwarranted risks and significant harm. These concerns may be exacerbated in certain clinical trials in which patients are required to discontinue their medications during “washout periods” at the onset of a study, or are randomly assigned to a placebo treatment and remain off medication for (potentially) extended periods.
AIDS and Antiretroviral Drugs in South Africa: Public Health, Politics, and Individual Suffering: A Review of Brian Tilley's It's My Life
Authors: Noah Barbara A.
Published: January 2007

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme poverty in the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment.
The Invisible Vulnerable: The Economically and Educationally Disadvantaged Subjects of Clinical Research
Authors: Stone T. Howard
Published: January 2007

U.S. Department of Health and Human Services (HHS) federal regulations pertaining to the protection of human subjects at Title 45 of the Code of Federal Regulations, Part 46, Subpart A (“the Common Rule”), refer to the need for special precautions when persons characterized as vulnerable are used as human research subjects. Under the Common Rule, persons considered “vulnerablae” are those who are likely to be susceptible to coercive or undue influence; the term “vulnerable” includes “children, prisoners, pregnant women, mentally disabled persons,” or those who are “economically or educationally disadvantaged.” The need for special precautions with some of these vulnerable persons in the context of research has long been addressed by both mandatory additional protections found in Subparts B through D of 45 C.F.R. pt. 46 (that arenot, coincidentally, part of the Common Rule) and additional detailed guidance documents provided by HHS or its components to investigators and their respective institutions.
Managed Care: Health Providers' Bill of Rights Now Law in California
Authors: Lee Bryan
Published: January 2007

On September 25, 2002, California Governor Gray Davis approved the Health Care Providers’ Bill of Rights (A.B. 2907). The legislation, which went into effect January 1, 2003, outlaws several practices by insurers that physicians complained represented an imbalance of power. Insurers are now unable to compel doctors to take more patients than they feel they can handle, and managed care companies cannot unilaterally change the terms of their contracts with doctors without notice. Governor Davis praised the legislation, stating, “in order to provide patients with world-class care, we must ensure that our doctors have world-class rights.”

California has one of the highest levels of health maintenance organization (HMO) penetration in the nation, at 52 percent. Seventy-eight percent of HMO patients are enrolled in five HMOs. As a result of these practice conditions, doctors reportedly often felt pressured to comply when HMOs “ordered [them] to take on additional patients,” “changed contracts without warning,” and were “lax in payments.”
Public Health: Smoking Ban Exceeds Board of Health's Authority
Authors: Lockner Sam
Published: January 2007

InD.A.B.E., Inc., v. Toledo-Lucas County Board of Health,the Supreme Court of Ohio held that the Ohio Revised Code does not grant a local board of health the power to proscribe smoking in all public places as defined by the Lucas County Regional Health District Clean Indoor Air Regulation.

On May 24, 2001, the Board of Health of the Lucas County Regional Health District adopted the regulation in question, prohibiting smoking in all public areas in Lucas County, which were defined as “every enclosed, indoor area to which members of the general public are invited or in which members of the general public are normally permitted.” In addition, the regulation prohibited smoking within twenty feet of any entrance or open window of these public areas and in all vehicles of public transportation.
Complementary and Alternative Medicine: Foundations, Ethics, and Law
Authors: Sade Robert M.
Published: January 2007

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine (CAM). Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 billion a year. The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention.
Too Many Twins, Triplets, Quadruplets, and So on: A Call for New Priorities
Authors: Strong Carson
Published: January 2007

Assisted reproductive technology has enabled thousands of infertile couples to experience the joys of parenthood. At various times, however, significant problems have come to light concerning the providing of infertility treatment in the United States. An early problem was misleading advertising by some infertility programs, particularly in regard to pregnancy success rates. This unacceptable activity suggested the need for more oversight of assisted reproductive technology and prompted the passage of a federal law requiring the reporting of success rates in a standardized format. Another problem, one that was especially disturbing, was the transfer of preembryos to infertile women at the University of California, Irvine, without the consent of the progenitor couples. Disclosure of these events added fuel to the debate over whether assisted reproductive technology should be subject to greater governmental regulation.
End-of-Life Care: Forensic Medicine v. Palliative Medicine
Authors: Pestaner Joseph P.
Published: January 2007

The increasing life expectancy of terminally-ill people has raised many public policy concerns about end-of-life care. Due to increased longevity and the lack of cures for illnesses like cancer and heart disease, palliative care, particularly pain management, has become an important mode OF medical therapy. Palliative care providers feel that “[h]ealth care professionals have a moral duty to provide adequate palliative care and pain relief, even if such care shortens the patient’s life.” Practitioners of forensic medicine grapple with determining when to classify the death of a person formerly receiving palliative care as a non-natural death. Such classification may be paramount in the enforcement of new statutes that aim at preventing assisted suicide or monitoring the quality of health care, but it potentially places forensic medicine and palliative medicine in adversarial roles.
The Use of Medical Records in Research: What Do Patients Want?
Authors: Kass Nancy E. , Natowicz Marvin R. , Hull Sara Chandros , Faden Ruth R. , Plantinga Laura , Gostin Lawrence O. , Slutsman Julia
Published: January 2007

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies.
Drug Labeling: FDA Requires New Label for Antibiotics to Prevent Overuse
Authors: Tiwary Devesh
Published: January 2007

In February, the Food and Drug Administration announced a rule imposing new manufacturer labeling requirements for antibiotics. The aim of the new standards is to educate physicians and patients about the dangers of improper antibiotic use. Overprescription of antibiotics, as well as patient failure to comply with treatment regimens, has led to the development of drug-resistant bacteria. “Antibacterial resistance is a serious and growing public health problem in the United States and worldwide,” FDA Commissioner Mark McClellan said in a press release accompanying the rule. “Without effective antibiotic drugs, common infections, that were once easily treated, can create a serious health threat to children and adults alike.”

The FDA regulates foods, drugs, and cosmetics introduced into interstate commerce for safety and effectiveness. Currently, the agency requires drug labels to provide “adequate directions for use,” including indications, quantity of dose, frequency, duration, route, and preparation.
Health Policy and the WTO
Authors: Bloche M. Gregg , Jungman Elizabeth R.
Published: January 2007

Critics of international trade agreements often cast them as threats to human health, and they can point to some sobering warnings from world history. Infectious diseases have swept across political boundaries, carried by traders, colonists, and other agents of globalization. Transnational epidemics have laid economies low, undermining political stability. The spread of viruses and bacteria to peoples previously unexposed and therefore lacking immunity has decimated populations and changed the political course of continents. Trade, exploration, and warfare have repeatedly produced encounters between peoples at different levels of agricultural and technological development. Often, the results have been devastating for the disadvantaged group — economic marginalization, loss of sovereignty and culture, and collapse of public health. Yet the rise of civilization — plant and animal domestication, division of labor, technology, and resulting prosperity — was powered in large part by movement of products and knowledge along routes of trade and migration.
Conflict and Compromise over Tradeoffs in Universal Health Insurance Plans
Authors: Pauly Mark V.
Published: January 2007

Despite a consensus across the political spectrum that the problem of the chronically uninsured is in dire need of solution, little progress has heen made. Public spending goes to topping up coverage for the elderly, already heavily subsidized under Medicare, or helping people temporarily without insurance because of international trade dislocations, so that it is clear that something is lacking in the case for significantly reducing the number of uninsured persons. In this paper I suggest that there have been two missing ingredients: a strategy for breaking the political deadlock around this issue, and information about the benefits of coverage sufficient to persuade kindly but skeptical taxpayers that they should be willing to pay to help solve this problem.

This article begins with a discussion of these two problems. It then outlines a strategy based on income-related or conditioned refundable tax credits for private and public insurance, coupled with a plan to assemble persuasive information that may move things forward.
Health of the People: The Highest Law?
Authors: Gostin Lawrence O.
Published: January 2007

From my perspective, as a White House official watching the budgetary process, and subsequently as head first of a health care financing agency and then of a public health agency, I was continually amazed to watch as billions of dollars were allocated to financing medical care with little discussion, whereas endless arguments ensued over a few millions for community prevention programs. The sums that were the basis for prolonged, and often futile, budget fights in public health were treated as rounding errors in the Medicare budget.

William Roper (1994)
Making Risk-Benefit Assessments of Medical Research Protocols
Authors: Rajczi Alex
Published: January 2007

Most medical experiments are reviewed by groups known as Institutional Review Boards (IRBs); according to every standard account of medical research ethics, an IRB should not approve an experiment unless it has an acceptable combination of risks and benefits. This requirement is often stated in different terms. Some codes say that an experiments benefits to individuals and society must outweigh its risks. Others say that the experiment must have a favorable risk-benefit ratio. The Code of Federal Regulations says that risks must be reasonable in relation to the expected benefits.

However, even though everyone agrees that an experiment must have an acceptable combination of risks and benefits, almost nothing has been said about what it would mean to weigh risks against benefits, compute risk-benefit ratios, or figure out if an experiments risks are reasonable.
Currents in Contemporary Ethics
Authors: Caulfield Timothy , Lemmens Trudo , Kinsella Douglas , McDonald Michael
Published: January 2007

An increasing number of community physicians are involved in clinical research.Indeed, 60 of industry-funded research is now spent on community based trials. This surge in community based clinical trials has increased the number of clinical trials applications submitted to the drug regulatory agencies by pharmaceutical sponsors. Many have argued that the commercial interests connected to the conduct and outcome of these trials also increases the potential for conflicts of interest for participating physicians. The context in which these trials take place increases the potential for a host of practices that infringe on ethical, legal and clinical obligations of physicians For example, financial recruitment incentives may lead to violations of the inclusion criteria and the consent process. It may result in inappropriate recruitment of patient participants and a blurring of the ethically significant distinctions between treatment and research. In some cases, it may be hard to distinguish research from the marketing of new products and attempts to influencing prescribing patterns.
Imwinkelried's Argument for Normative Ethical Testimony
Authors: Barnes David W.
Published: January 2007

Professor Imwinkelried has boldly attempted to justify the admissibility of normative ethical expertise in the face of a legal evidentiary rule requiring a scientific basis for expert testimony. Because ethical testimony is inherently unscientific, Professor Imwinkelried prudently focuses his analysis on circumstances where evidentiary requirements are less strict; those involving the legislative rather than adjudicative function of courts and those in which substantive law overrides normally rigorous evidentiary requirements. While both proposals may have merit and are thoughtful and creative, Professor Imwinkelried ultimately fails to provide sufficient doctrinal support or persuasive rationale for his arguments.

Professor Imwinkelrieds argument for the admissibility of “expert” normative ethical testimony has two parts. The major proposition is that, when courts are engaged in legislative functions, they should be permitted to consider all sources of information. The assumption that apparently underlies this proposition is that nothing limits courts’ exercise of legislative powers.
Dying in America — An Examination of Policies that Deter Adequate End-of-life Care in Nursing Homes
Authors: Hoffmann Diane E. , Tarzian Anita J.
Published: January 2007

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing homes. This is somewhat puzzling given that (1) considerable resources have been devoted to bringing public attention to this problem, (2) we have the knowledge and expertise to provide such care, and (3) we have a government-financed benefit that covers this type of care - the Medicare hospice benefit (MHB).

While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting.
Forensic Science
Authors: Giannelli Paul C.
Published: January 2007

The United States Supreme Court has long recognized the value of scientific evidence - especially when compared to other types of evidence such as eyewitness identifications, confessions, and informant testimony. For example, inEscobedo v. Illinois,the Court observed: “We have learned the lesson of history, ancient and modern, that a system of criminal law enforcement which comes to depend on the ‘confession’ will, in the long run, be less reliable and more subject to abuses than a system which depends on extrinsic evidence independently secured through skillful investigation.” Similarly, inDavis v. Mississippi,the Court commented:

Detention for fingerprinting may constitute a much less serious intrusion upon personal security than other types of police searches and detentions. Fingerprinting involves none of the probing into an individual's private life and thoughts that marks an interrogation or search. Nor can fingerprint detention be employed repeatedly to harass any individual, since the police need only one set of each person's prints. Furthermore, fingerprinting is an inherently more reliable and effective crime-solving tool than eyewitness identifications or confessions and is not subject to such abuses as the improper line-up and the “third degree.”
A Normative Justification for Distinguishing the Ethics of Clinical Research from the Ethics of Medical Care
Authors: Litton Paul , Miller Franklin G.
Published: January 2007

In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.

Some commentators and ethics documents claim that physicians, whether acting as care givers or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”
Clinical Guidelines and Policies: Can they Improve Emergency Department Pain Management?
Authors: Ducharme James
Published: January 2007

The prevalence of pain in patients presenting to Emergency Departments (ED) has been well documented by both Cordell and Johnston. Equally well documented has been the apparent failure to adequately control that pain. In 1990 Selbst found that patients with long bone fractures received little analgesia in the ED, and Ngai, et al., showed that the under-treatment of pain continued after discharge. In a prospective study, Ducharme and Barber found that up to one third of patients presented with severe pain and were often unrelieved at discharge. Even though specific patient subgroups appear to be at greater risk, all patients are potential victims of oligoanalgesia - the under-treatment of pain. Despite an ever increasing volume of research about pain in emergency medicine, dissemination of relevant information with widespread change in practice patterns has not been witnessed. Recent studies continue to affirm that pain management in the ED is suboptimal.
Structural and functional determinants of human muscle power
Authors: Sargeant Anthony J.
Published: January 2007

Measurements of human power need to be interpreted in relation to the movement frequency, since that will determine the velocity of contraction of the active muscle and hence the power available according to the power–velocity relationship. Techniques are described which enable movement frequency to be kept constant during human exercise under different conditions. Combined with microdissection and analysis of muscle fibre fragments from needle biopsies obtained pre‐ and postexercise we have been able ‘to take the muscle apart’, having measured the power output, including the effect of fatigue, under conditions of constant movement frequency. We have shown that fatigue may be the consequence of a metabolic challenge to a relatively small population of fast fatigue‐sensitive fibres, as indicated by [ATP] depletion to ∼30% of resting values in those fibres expressing myosin heavy chain isoform IIX after just 10 s of maximal dynamic exercise. Since these same fibres will have a high maximal velocity of contraction, they also make a disproportionate contribution to power output in relation to their number, especially at faster movement rates. The microdissection technique can also be used to measure phosphocreatine concentration ([PCr]), which is an exquisitely sensitive indicator of muscle fibre activity; thus, in just seven brief maximal contractions [PCr] is depleted to levels < 50% of rest in all muscle fibre types. The technique has been applied to study exercise at different intensities, and to compare recruitment in lengthening, shortening and isometric contractions, thus yielding new information on patterns of recruitment, energy turnover and efficiency.