Racism and Health Care in America: Legal Responses to Racial Disparities in the Allocation of Kidneys

African Americans have long been subjected to racism within the health care sector of the United States. During earlier eras of American history, including the pre-Civil War, Reconstruction and Jim Crow time periods, blatant racism in the health care sector was prevalent. Following the Civil Rights Movement of the 1960s, more overt forms of racism dissipated. Now, at the dawn of the twenty-first century, racism within the health care industry manifests itself in more subtle forms. A modern day example of the abominable and often governmentally sanctioned health care that African Americans receive is racial discrimination in the allocation of transplantable kidneys. Despite having a greater incidence of kidney failure than European Americans, African Americans are less likely to be the recipients of transplantable kidneys and spend considerably longer periods of time on kidney allocation waiting lists than European Americans. This Note proposes and analyzes various responses to disparities in kidney allocation on the basis of race including public education, organ donation publicity campaigns, presumed consent to donation laws, the creation of criteria for placement on an United Network for Organ Sharing kidney allocation waiting list, alteration of kidney allocation guidelines, and litigation under both the Equal Protection Clause of the United States Constitution and Title VI of the Civil Rights of 1964

Upper Limits on the Continuum Emission from Geminga at 74 and 326 MHz

We report a search for radio continuum emission from the gamma-ray pulsar Geminga. We have used the VLA to image the location of the optical counterpart of Geminga at 74 and 326 MHz. We detect no radio counterpart. We derive upper limits to the pulse-averaged flux density of Geminga, taking diffractive scintillation into account. We find that diffractive scintillation is probably quenched at 74 MHz and does not influence our upper limit, S < 56 mJy (2\sigma), but that a 95% confidence level at 326 MHz is S < 5 mJy. Owing to uncertainties on the other low-frequency detections and the possibility of intrinsic variability or extrinsic variability (refractive interstellar scintillation) or both, our non-detections are nominally consistent with these previous detections.Comment: 8 pages, LaTeX2e with AASTeX 4.0, 3 figures; to be published in Ap

Effects of Cell Morphology and Attachment to a Surface on the Hydrodynamic Performance of Unicellular Choanoflagellates

Choanoflagellates, eukaryotes that are important predators on bacteria in aquatic ecosystems, are closely related to animals and are used as a model system to study the evolution of animals from protozoan ancestors. The choanoflagellate Salpingoeca rosetta has a complex life cycle with different morphotypes, some unicellular and some multicellular. Here we use computational fluid dynamics to study the hydrodynamics of swimming and feeding by different unicellular stages of S. rosetta: a swimming cell with a collar of prey-capturing microvilli surrounding a single flagellum, a thecate cell attached to a surface and a dispersal-stage cell with a slender body, long flagellum and short collar. We show that a longer flagellum increases swimming speed, longer microvilli reduce speed and cell shape only affects speed when the collar is very short. The flux of prey-carrying water into the collar capture zone is greater for swimming than sessile cells, but this advantage decreases with collar size. Stalk length has little effect on flux for sessile cells. We show that ignoring the collar, as earlier models have done, overestimates flux and greatly overestimates the benefit to feeding performance of swimming versus being attached, and of a longer stalk for attached cells

A Computer Aided Detection system for mammographic images implemented on a GRID infrastructure

The use of an automatic system for the analysis of mammographic images has proven to be very useful to radiologists in the investigation of breast cancer, especially in the framework of mammographic-screening programs. A breast neoplasia is often marked by the presence of microcalcification clusters and massive lesions in the mammogram: hence the need for tools able to recognize such lesions at an early stage. In the framework of the GPCALMA (GRID Platform for Computer Assisted Library for MAmmography) project, the co-working of italian physicists and radiologists built a large distributed database of digitized mammographic images (about 5500 images corresponding to 1650 patients) and developed a CAD (Computer Aided Detection) system, able to make an automatic search of massive lesions and microcalcification clusters. The CAD is implemented in the GPCALMA integrated station, which can be used also for digitization, as archive and to perform statistical analyses. Some GPCALMA integrated stations have already been implemented and are currently on clinical trial in some italian hospitals. The emerging GRID technology can been used to connect the GPCALMA integrated stations operating in different medical centers. The GRID approach will support an effective tele- and co-working between radiologists, cancer specialists and epidemiology experts by allowing remote image analysis and interactive online diagnosis.Comment: 5 pages, 5 figures, to appear in the Proceedings of the 13th IEEE-NPSS Real Time Conference 2003, Montreal, Canada, May 18-23 200

Emerging Infectious Diseases: a 10-Year Perspective from the National Institute of Allergy and Infectious Diseases

Advances in infectious disease research over the past 10 years have allowed breakthroughs in th

Towards a New System for the Assessment of the Quality in Care Pathways: An Overview of Systematic Reviews

Clinical or care pathways are developed by a multidisciplinary team of healthcare practitioners, based on clinical evidence, and standardized processes. The evaluation of their framework/content quality is unclear. The aim of this study was to describe which tools and domains are able to critically evaluate the quality of clinical/care pathways. An overview of systematic reviews was conducted, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Science Citation Index, PsychInfo, CINAHL, and Cochrane Library, from 2015 to 2020, and with snowballing methods. The quality of the reviews was assessed with Assessment the Methodology of Systematic Review (AMSTAR-2) and categorized with The Leuven Clinical Pathway Compass for the definition of the five domains: processes, service, clinical, team, and financial. We found nine reviews. Three achieved a high level of quality with AMSTAR-2. The areas classified according to The Leuven Clinical Pathway Compass were: 9.7% team multidisciplinary involvement, 13.2% clinical (morbidity/mortality), 44.3% process (continuity-clinical integration, transitional), 5.6% financial (length of stay), and 27.0% service (patient-/family-centered care). Overall, none of the 300 instruments retrieved could be considered a gold standard mainly because they did not cover all the critical pathway domains outlined by Leuven and Health Technology Assessment. This overview shows important insights for the definition of a multiprinciple framework of core domains for assessing the quality of pathways. The core domains should consider general critical aspects common to all pathways, but it is necessary to define specific domains for specific diseases, fast pathways, and adapting the tool to the cultural and organizational characteristics of the health system of each country