Ethical issues in funding orphan drug research and development

This essay outlines the moral dilemma of funding orphan drug research and development. To date, ethical aspects of priority setting for research funding have not been an issue of discussion in the bioethics debate. Conflicting moral obligations of beneficence and distributive justice appear to demand very different levels of funding for orphan drug research. The two types of orphan disease, rare diseases and tropical diseases, however, present very different ethical challenges to questions about allocation of research funds. The dilemma is analysed considering utilitarian and rights based theories of justice and moral obligations of non-abandonment and a professional obligation to advance medical science. The limitations of standard economic evaluation tools and other priority setting tools used to inform health policy decision makers on research funding decisions are outlined.C A Gericke, A Riesberg, R Buss

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations

BACKGROUND: Quantification of medical interventions administered during prolonged field care (PFC) is necessary to inform training and planning. MATERIALS AND METHODS: Retrospective cohort study of Department of Defense Trauma Registry casualties with maximum Abbreviated Injury Scale (MAIS) score of 2 or greater and prehospital records during combat operations 2007 to 2015; US military nonsurvivors were linked to Armed Forces Medical Examiner System data. Medical interventions administered to survivors of 4 hours to 72 hours of PFC and nonsurvivors who died prehospital were compared by frequency-matching on mechanism (explosive, firearm, other), injury type (penetrating, blunt) and injured body regions with MAIS score of 3 or greater. Covariates for adjustment included age, sex, military Service, shock, Glasgow Coma Scale, transport team, MAIS and Injury Severity Score (ISS). Sensitivity analysis focused on US military subgroup with AIS/ISS assigned to nonsurvivors after autopsy. RESULTS: The total inception cohort included 16,202 casualties (5,269 US military, 10,809 non-US military), 64% Afghanistan, 36% Iraq. Of US military, 734 deaths occurred within 30 days, nearly 90% occurred within 4 hours of injury. There were 3,222 casualties (1,111 US military, 2,111 non-US military) documented for prehospital care and died prehospital (691) or survived 4 hours to 72 hours of PFC (2,531). Twenty-five percent (815/3,222) received advanced airway, 18% (583) ventilatory support, 9% (281) tourniquet. Twenty-three percent (725) received blood transfusions within 24 hours. Of the matched cohort (1,233 survivors, 490 nonsurvivors), differences were observed in care (survivors received more warming, intravenous fluids, sedation, mechanical ventilation, narcotics, antibiotics; nonsurvivors received more intubations, tourniquets, intraosseous fluids, cardiopulmonary resuscitation). Sensitivity analysis focused on US military (732 survivors, 379 nonsurvivors) showed no significant differences in prehospital interventions. Without autopsy information, the ISS of nonsurvivors significantly underestimated injury severity. CONCLUSION: Tourniquets, blood transfusion, airway, and ventilatory support are frequently required interventions for the seriously injured. Prolonged field care should direct resources, technology, and training to field technology for sustained resuscitation, airway, and breathing support in the austere environment. LEVEL OF EVIDENCE: Prognostic, Level III

Is There a Particular RC Attachment Preference in Turkish? Negotiating the Effects of Semantic Factors

WOS:000520798900001PubMed: 32189183The goal of this study is to investigate whether or not Turkish has a particular preference in ambiguity resolution of relative clause attachment when two possible NPs are available as in "Someone shot [NP1 the servant] of [NP2 the actress] [RC who was on the balcony]& x2ee;. The relevant literature has showed that RC attachment preferences-whether NP1 or NP2-vary across languages, which results in contradictory evidence if some universal processing principle is assumed. Turkish differs typologically from English and other European languages in the construction of RC using complex "genitive-possessor" construction. In order to make a valid cross-linguistic comparison it is therefore of particular importance to carefully control potential extraneous factors which might obstruct true attachment preferences-if they exist. The present study, which controls various confounding factors, reveals that both syntactic and non-syntactic factors should be taken into consideration when constructing the stimulus sentences for testing attachment ambiguity resolution. Specifically, we propose that the semantic relations (e.g. part-whole relations) between the noun phrases of the genitive-possessive construction and the semantic associations with the proximal as well as with the distal predicate play a key role in the attachment preferences of monolingual Turkish native speakers in this type of ambiguous sentences. When these extraneous factors were controlled, no preference was observed.TUBITAK (The Scientific and Technological Research Council of Turkey)Turkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)We wish to acknowledge TUBITAK (The Scientific and Technological Research Council of Turkey) for the doctoral scholarship granted to the first author, and to thank two anonymous academics who reviewed and commented on the Turkish stimulus material