Communication of genetic information within families: the case for familial comity

Advances in genetic technologies raise a multitude of ethical issues, some of which give rise to novel dilemmas for medical practice. One of the most controversial problems arising in clinical genetics is that of confidentiality and who may disclose genetic health information. This paper considers the question of when it is appropriate for health professionals to disclose clinically significant genetic information without patient consent. Existing ethical principles offer little guidance in relation to this issue. We build on suggestions that genetic information may be viewed as collective or shared information, and we introduce the concept of ‘familial comity’ as a fresh way to consider the issues. Keywords: Genetics, Ethics, clinical, Confidentiality, Family, Genetic privacyThis article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Understanding the organizational barriers of promoting electronic delivery options in the United States healthcare system: an insurer’s perspective

Consumer-driven technologies are rapidly transforming how industries conduct business both internally and externally. From online banking to retail, the broad adoption of smart devices, internet access, and wearables amongst consumers has shifted the way enterprises develop software and conduct information technology (IT) operations. Although successful adoption of consumer-driven technologies is a reality for many industries, the healthcare platform is lagging. The promotion and adoption of online patient engagement is widely perceived to be one of the biggest hurdles faced by healthcare organizations (Carr, 2014). While setting up patient portals and electronic delivery options can be relatively simple, promoting consumer utilization and achieving widespread use of these portals use has posed challenges. The healthcare paradigm has shifted in recent decades from viewing the patient as incidental to the delivery of healthcare to a more patient-centric approach. The previous model of indirectly funding Medicare, Medicaid, or employers has been noted as one of the greatest flaws of the healthcare system by contributing to cost inflation (Carr, 2014). Recent trends have promoted patient-empowered care, but have generally transferred the burden of cost to the individual. The Affordable Care Act (ACA) stimulated this shift by creating insurance exchanges which allow insurers to directly reach consumers; however, these readily-available healthcare options now require higher monthly premium payments from shoppers. This new model proposes that as patients become increasingly financially liable, they become more invested in their healthcare trajectories

Communication of genetic information within families: the case for familial comity

Advances in genetic technologies raise a multitude of ethical issues, some of which give rise to novel dilemmas for medical practice. One of the most controversial problems arising in clinical genetics is that of confidentiality and who may disclose genetic health information. This paper considers the question of when it is appropriate for health professionals to disclose clinically significant genetic information without patient consent. Existing ethical principles offer little guidance in relation to this issue. We build on suggestions that genetic information may be viewed as collective or shared information, and we introduce the concept of ‘familial comity’ as a fresh way to consider the issues. Keywords: Genetics, Ethics, clinical, Confidentiality, Family, Genetic privacyThis article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Isobaric multiplet yrast energies and isospin non-conserving forces

The isovector and isotensor energy differences between yrast states of isobaric multiplets in the lower half of the $pf$ region are quantitatively reproduced in a shell model context. The isospin non-conserving nuclear interactions are found to be at least as important as the Coulomb potential. Their isovector and isotensor channels are dominated by J=2 and J=0 pairing terms, respectively. The results are sensitive to the radii of the states, whose evolution along the yrast band can be accurately followed.Comment: 4 pages, 4 figures. Superseeds second part of nucl-th/010404

Dynamical Interactions and the Black Hole Merger Rate of the Universe

Binary black holes can form efficiently in dense young stellar clusters, such as the progenitors of globular clusters, via a combination of gravitational segregation and cluster evaporation. We use simple analytic arguments supported by detailed N-body simulations to determine how frequently black holes born in a single stellar cluster should form binaries, be ejected from the cluster, and merge through the emission of gravitational radiation. We then convolve this ``transfer function'' relating cluster formation to black hole mergers with (i) the distribution of observed cluster masses and (ii) the star formation history of the universe, assuming that a significant fraction gcl of star formation occurs in clusters and that a significant fraction gcand of clusters undergo this segregation and evaporation process. We predict future ground--based gravitational wave (GW) detectors could observe ~500 (gcl/0.5) (gcand/0.1) double black hole mergers per year, and the presently operating LIGO interferometer would have a chance (50%) at detecting a merger during its first full year of science data. More realistically, advanced LIGO and similar next-generation gravitational wave observatories provide unique opportunities to constrain otherwise inaccessible properties of clusters formed in the early universe.Comment: 4 pages, 2 figures. To appear in PRD Rapid Communication

Cost-Effectiveness of Targeted Reemployment Bonuses

Targeting reemployment bonus offers to unemployment insurance (UI) claimants identified as most likely to exhaust benefits is estimated to reduce benefit payments. We show that targeting bonus offers with profiling models similar to those in state Worker Profiling and Reemployment Services systems can improve cost effectiveness. Since estimated average benefit payments do not steadily decline as the eligibility screen is gradually tightened, we find that narrow targeting is not optimal. The best candidate is a low bonus amount with a long qualification period, targeted to the half of profiled claimants most likely to exhaust their UI benefit entitlement. I

Time Reversal and n-qubit Canonical Decompositions

For n an even number of qubits and v a unitary evolution, a matrix decomposition v=k1 a k2 of the unitary group is explicitly computable and allows for study of the dynamics of the concurrence entanglement monotone. The side factors k1 and k2 of this Concurrence Canonical Decomposition (CCD) are concurrence symmetries, so the dynamics reduce to consideration of the a factor. In this work, we provide an explicit numerical algorithm computing v=k1 a k2 for n odd. Further, in the odd case we lift the monotone to a two-argument function, allowing for a theory of concurrence dynamics in odd qubits. The generalization may also be studied using the CCD, leading again to maximal concurrence capacity for most unitaries. The key technique is to consider the spin-flip as a time reversal symmetry operator in Wigner's axiomatization; the original CCD derivation may be restated entirely in terms of this time reversal. En route, we observe a Kramers' nondegeneracy: the existence of a nondegenerate eigenstate of any time reversal symmetric n-qubit Hamiltonian demands (i) n even and (ii) maximal concurrence of said eigenstate. We provide examples of how to apply this work to study the kinematics and dynamics of entanglement in spin chain Hamiltonians.Comment: 20 pages, 3 figures; v2 (17pp.): major revision, new abstract, introduction, expanded bibliograph

New insight into the transmission dynamics of the crustacean pathogen Hematodinium perezi (Dinoflagellata) using a novel sentinel methodology

Hematodinium perezi causes disease and mortality in several decapod crustaceans along the eastern seaboard and Gulf coast of the USA. The route of transmission of the parasite is unknown, but infections exhibit a sharp seasonal cycle in its primary host, the blue crab Callinectes sapidus, that indicates the possibility of a short transmission period in its life cycle. We developed a sentinel methodology based on the use of naïve, uninfected, early benthic juvenile crabs (instars C1 to C10) to investigate the transmission of H. perezi. Crabs were collected from a non-endemic site, held for a short period for evaluation, and then deployed in a highly endemic site for 14 d. Transmission of the pathogen was successful; 12.7 to 25.7% of the crabs deployed at the endemic site became infected over this period. Infections developed rapidly, with 25% of new infections developing into heavy infections during the deployment. The large number of infections that developed using the sentinel methodology allowed for the first estimates of incidence (the proportion of new infections in a population over time) in this system. Incidence varied from 0.9 to 1.8% of the resident crab population per day and accounts for the high prevalence levels observed in the endemic coastal bays of the Delmarva Peninsula. The development of this sentinel methodology has broad application for studying disease ecology in this system and in other pathogens that infect decapods