The Normative Approach of the Catholic Tradition in the Ethical and Religious Directives for Resolving Ethical Dilemmas Regarding Medical Technology

The dissertation engages the Catholic Tradition enunciated in the Ethical and Religious Directives for Catholic Health Care Services to provide a normative approach for resolving ethical dilemmas regarding pivotal breakthroughs in medical technology. This normative ethical approach has two components: a normative framework for Catholic health care ethics that adopts practical ethical principles as enunciated in the Ethical and Religious Directives (Chapter 2) and secular decision-making models in organizational and clinical ethics that are consistent with the Catholic Tradition (Chapter 3). At the end of the theoretical analysis in these chapters, the conclusion to Chapter 3 explains how this normative approach reflects the Catholic Tradition on Natural Law. This normative approach is then applied to significant ethical dilemmas regarding a variety of pivotal issues that deal with medical technology: reproductive technologies (Chapter 4), regenerative technologies (Chapter 5), and end-of-life technologies (Chapter 6). The conclusion of each of these practical chapters applies the Natural law approach of the Catholic Tradition to offer an ethical critique of each topic based on the Ethical and Religious Directives

ACCLPP

The U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) convened a teleconference meeting of the Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) Laboratory Workgroup (LWG). The proceedings were held on July 25, 2013 from 2:00 P.M. to 4:30 P.M. EST.The purpose of the teleconference meeting was for ACCLPP to review, discuss and formally vote on LWG\u2019s draft report, Guidelines for Measuring Lead in Blood Using Point of Care Instruments.200

An Enhanced Model for Parental Decision Making for Pediatric Care

Pediatric medicine, the branch of medicine dedicated to taking care of children, is a relatively new medical specialty, developing in the mid-19th century. Pediatrics emerged as society began to believe that children were different from adults and in need of specialized care. Soon after the development of specialty medicine for children it became evident that many challenging ethical issues were present with children that did not exist, or at least not to the same extent with adults. In some cases, issues are similar, however they become much more complex or challenging when applied to children. The field of pediatrics is constantly changing and developing, with tremendous advancements within the fields of genetics, neuroscience, and clinical research. Developments in these fields have led to the emergence of many new diagnostic and therapeutic interventions for children, but with these new technologies come enhanced ethical issues and challenging decisions. Currently within pediatric medicine, decision-making processes are primarily guided by the models of adult surrogate decision making, in particular substituted judgment and best interests models. The substituted judgment model focuses on executing the wishes of the patient, while best interests asks the surrogate to select the course of action that will most benefit the patient overall. These models are ethically contested within adult medicine, the field in which they originated, and are even more problematic when applied to children, specifically mature minors with varying developmental levels. In pediatrics, the best interests standard is the typical model advocated for because children, as children, cannot legally make their own decisions, however that does not mean they should be automatically excluded from decision making processes or assumed to lack decision making capacity. These issues become larger when dealing with mature minors due to issues of agency, consent and assent, stewardship, and the vulnerable status of the child. Children are not only viewed as vulnerable by society, but many times parents as well. Many parents feel it is their obligation and duty to not only take care of their children but also advocate for and protect them. Additionally, because they are so emotionally invested and connected to the child, it is difficult to comprehend situations where the child is at risk or they are told something they never imagined or thought about, such as that their child is very sick and in need of advanced medical care. There are heightened emotions present due to the parent-child relationship. Despite parents wanting to protect their children, in most medical instances they are unable to do so, leaving parents vulnerable and full of emotion. Making decisions for another is very challenging in all instances throughout medicine, complicated even more so when the person for whom decisions are being made is a relative and a person that one strives to protect and take care of on a day to day basis. Additionally in pediatrics many decisions have higher stakes and longer impacts, due to the age, status, and development of the child. Parents are in very challenging positions when making decisions for their children in light of the tremendous amounts of uncertainty that accompany new and emerging technologies, including obstacles that make determining the child\u27s best interests and inevitably make a decision challenging. The addition of complicated medical information from presented by the new technologies within the fields of genetics, neuroscience, and clinical research, combined with the and heightened emotions only complicates this process, necessitating an enhanced decision making model. As in areas of adult medicine, decisions are challenging and difficult to work through, complicated more by the lacking of explicit goals of pediatric medicine and an overarching framework to use to structure all decision making processes, which exists in adult medicine. The current decision-making models do not accommodate the fact that within pediatrics there is a long term relationship and partnership that must be created and nurtured by all those involved; decisions are therefore not isolated decisions but components of a continuum. Additionally, they do not ensure that parents receive support and guidance, identify the level of involvement of an older child, or facilitate and assist with decisions when parents and physicians disagree. Along with some of the objective elements of medicine, pediatric decision making has many subjective components, and emerging technologies create even more. On the basis of these considerations, it is argued that there is a need for an enhanced decision making model developed out of the field of pediatrics, centered around the goals of pediatric medicine. Current models need to be reconsidered in order to outline a model that enables parents to make the optimal decision for their child in light of the possibilities of emerging technologies. This dissertation will look at the question Why should an enhanced model for parental decision making be advocated for within pediatric care, and how can such a model be developed and applied? In Chapter 2 the history and development of the field of pediatrics will be looked at, followed by an analysis of the current decision making models of adult medicine in Chapter 3, demonstrating that they do not apply well to mature minors and are not sufficient for pediatric medicine. In Chapter 4 the changing field of pediatric medicine will be explained, the new technologies will be introduced, and the ethical issues that the current models of decision making do not accommodate will be presented. In Chapter 5, an enhanced model of shared decision making related to the goals of pediatric medicine will be developed followed by an analysis of the roles of parties involved and how they should work together to achieve the best results for the child who is the patient. In chapter 6 the enhanced decision making model will be applied to areas of genetic screening, neuroscience, and clinical research to show how it will better facilitate decisions within these areas and address the concerns that the new technologies and developments create throughout present-day pediatrics. Pediatric medicine is in great need of an enhanced parental decision-making model that addresses the goals of pediatric medicine to ensure that the best decisions are made in the face of new technologies and the continuous advancement of care for children

Malaria Parasitic Detection using a New Deep Boosted and Ensemble Learning Framework

Malaria is a potentially fatal plasmodium parasite injected by female anopheles mosquitoes that infect red blood cells and millions worldwide yearly. However, specialists' manual screening in clinical practice is laborious and prone to error. Therefore, a novel Deep Boosted and Ensemble Learning (DBEL) framework, comprising the stacking of new Boosted-BR-STM convolutional neural networks (CNN) and the ensemble ML classifiers, is developed to screen malaria parasite images. The proposed Boosted-BR-STM is based on a new dilated-convolutional block-based split transform merge (STM) and feature-map Squeezing-Boosting (SB) ideas. Moreover, the new STM block uses regional and boundary operations to learn the malaria parasite's homogeneity, heterogeneity, and boundary with patterns. Furthermore, the diverse boosted channels are attained by employing Transfer Learning-based new feature-map SB in STM blocks at the abstract, medium, and conclusion levels to learn minute intensity and texture variation of the parasitic pattern. The proposed DBEL framework implicates the stacking of prominent and diverse boosted channels and provides the generated discriminative features of the developed Boosted-BR-STM to the ensemble of ML classifiers. The proposed framework improves the discrimination ability and generalization of ensemble learning. Moreover, the deep feature spaces of the developed Boosted-BR-STM and customized CNNs are fed into ML classifiers for comparative analysis. The proposed DBEL framework outperforms the existing techniques on the NIH malaria dataset that are enhanced using discrete wavelet transform to enrich feature space. The proposed DBEL framework achieved Accuracy (98.50%), Sensitivity (0.9920), F-score (0.9850), and AUC (0.997), which suggest it to be utilized for malaria parasite screening.Comment: 26 pages, 10 figures, 9 Table

Decision fusion in healthcare and medicine : a narrative review

Objective: To provide an overview of the decision fusion (DF) technique and describe the applications of the technique in healthcare and medicine at prevention, diagnosis, treatment and administrative levels. Background: The rapid development of technology over the past 20 years has led to an explosion in data growth in various industries, like healthcare. Big data analysis within the healthcare systems is essential for arriving to a value-based decision over a period of time. Diversity and uncertainty in big data analytics have made it impossible to analyze data by using conventional data mining techniques and thus alternative solutions are required. DF is a form of data fusion techniques that could increase the accuracy of diagnosis and facilitate interpretation, summarization and sharing of information. Methods: We conducted a review of articles published between January 1980 and December 2020 from various databases such as Google Scholar, IEEE, PubMed, Science Direct, Scopus and web of science using the keywords decision fusion (DF), information fusion, healthcare, medicine and big data. A total of 141 articles were included in this narrative review. Conclusions: Given the importance of big data analysis in reducing costs and improving the quality of healthcare; along with the potential role of DF in big data analysis, it is recommended to know the full potential of this technique including the advantages, challenges and applications of the technique before its use. Future studies should focus on describing the methodology and types of data used for its applications within the healthcare sector

Key Components for an Ethics Consultation Curriculum

Due to a lack of formal credentials for clinical ethics consultants, the professionalization of clinical ethics as a normative discipline in contemporary American health care is diminished amongst other health care professionals. While medical specialties, organizational leadership positions, and other miscellaneous health care occupations possess governing bodies that posit credentials that justify these roles, clinical ethics consultants lack a standard of competence. While this gap has been temporarily reconciled by individual employer criteria, a national standard that attempts to educate and demonstrate a clinical ethicist’s abilities does not exist. Still, various attempts have been made to establish a certification program for clinical ethicists. These programs contain central concepts in ethics consultation and are effective in demonstrating the impact of a clinical ethicist’s knowledge. However, the educational facets entailed in proposed certification programs that clinical ethicist ought to be familiar with do not include information surrounding the nature of clinical ethics and the role a clinical ethicist must embody in order to perform his job effectively. The central supposition of this dissertation is that additional work needs to be completed around clinical ethics education and certification. While no formal certification or educational standard exists for clinical ethicists, this dissertation proposes key components for an ethics consultation curriculum. The key components in this dissertation emphasize the nature and value of virtue in clinical ethics and the role virtue plays in orchestrating an effective certification program for ethicists. This dissertation aims to do the following: (i) Clarify and demonstrate the problems associated with a lack of formal certification standard for ethicists; (ii) Define and examine the nature of clinical ethics and the role philosophy plays in this line of work; (iii) Explain and demonstrate the effectiveness of teaching virtues as key components for a formalized ethics consultation curriculum; and (iv) Illustrate how key components for an ethics consultation curriculum manifest in an educational venue for clinical ethicists. This dissertation seeks to contribute a novel approach to educating and certifying clinical ethicists in the United States. By combining knowledge points associated with moral philosophy and medicine with general skill objectives for ethics consultants, this dissertation aids in developing analytic moral reasoning skills for clinical ethicists which in turn fosters the overall education and professional development of clinical ethics consultants

Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup

The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles, extracted data, summarized findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 51 articles met the inclusion criteria. Only case reports, case series, and pharmacokinetic studies were identified, yielding a very low quality of evidence. Clinical data from 31 patients and toxicokinetic grading from 46 patients were abstracted. The workgroup concluded that phenytoin is moderately dialyzable (level of evidence = C) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available (graded 1D). In summary, phenytoin appears to be amenable to extracorporeal removal. However, because of the low incidence of irreversible tissue injury or death related to phenytoin poisoning and the relatively limited effect of ECTR on phenytoin removal, the workgroup proposed the use of ECTR only in very select patients with severe phenytoin poisoning

University of South Alabama College of Medicine Annual Report for 2016-2017

This Annual Report of the College of Medicine catalogues accomplishments of our faculty, students, residents, fellows and staff in teaching, research, scholarly and community service during the 2016-2017 academic year.https://jagworks.southalabama.edu/com_report/1001/thumbnail.jp

University of South Alabama College of Medicine Annual Report for 2015-2016

This Annual Report of the College of Medicine catalogues recent accomplishments of our faculty, students, residents, fellows and staff in teaching, research, patient care, scholarly and community service activities during the 2015-16 academic year.https://jagworks.southalabama.edu/com_report/1000/thumbnail.jp