Resident-generated versus instructor-generated cases in ethics and professionalism training

BACKGROUND: The emphasis on ethics and professionalism in medical education continues to increase. Indeed, in the United States the ACGME will require residency programs to include professionalism training in all curricula by 2007. Most courses focus on cases generated by the course instructors rather than on cases generated by the trainees. To date, however, there has been no assessment of the utility of these two case discussion formats. In order to determine the utility of instructor-generated cases (IGCs) versus resident-generated cases (RGCs) in ethics and professionalism training, the author developed an innovative course that included both case formats. The IGCs were landmark cases and cases from the experience of the course instructors, while the RGCs were selected by the residents themselves. Residents were then surveyed to assess the strengths and weaknesses of each format. RESULTS: Of twenty-two second and third year residents, fourteen completed surveys (response rate 64%). Residents were nearly evenly split in preferring RGCs (38%), IGCs (31%), or not preferring one to the other (31%). 29% stated that they learn more from the RGCs, 21% stated that they learn more from the IGCs, and 50% stated that they did not find a difference in their learning based on format. In general, residents surveyed prefer a mix of formats. Residents tended to find the RGCs more relevant and interesting, and felt the IGCs were necessary to ensure adequate breadth of cases and concepts. CONCLUSION: Based on our relatively small sample at a single institution, we believe that educators should consider incorporating both instructor-generated and resident-generated cases in their ethics and professionalism curricula, and should evaluate the utility of such a model at their own institution. Further work is needed to illuminate other potential improvements in ethics and professionalism education

Neonatal Euthanasia and the Groningen Protocol

Neonatal euthanasia has been legal in the Netherlands since 2005. Data indicate that neonatal euthanasia is practiced sub rosa by some clinicians in other countries as well; however, the true extent of neonatal euthanasia practice remains unknown. In this chapter, we review end-of-life options to describe the ethical background in the adult setting and how these translate into the neonatal setting. Further, the ethical arguments in favor and opposed to allowing euthanasia of infants, and those in favor and opposed to the use of paralytics in neonatal euthanasia, are presented

Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance.

INTRODUCTION: 2018 World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-resistant (Hr) tuberculosis recommend a four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx), with or without H ([H]RZE-Lfx). This is used once Hr is known, such that patients complete 6 months of Lfx (≥6[H]RZE-6Lfx). This cohort study assessed the impact of fluoroquinolones (Fq) on treatment effectiveness, accounting for Hr mutations and degree of phenotypic resistance. METHODS: This was a retrospective cohort study of 626 Hr tuberculosis patients notified in London, 2009-2013. Regimens were described and logistic regression undertaken of the association between regimen and negative regimen-specific outcomes (broadly, death due to tuberculosis, treatment failure or disease recurrence). RESULTS: Of 594 individuals with regimen information, 330 (55.6%) were treated with (H)RfZE (Rf=rifamycins) and 211 (35.5%) with (H)RfZE-Fq. The median overall treatment period was 11.9 months and median Z duration 2.1 months. In a univariable logistic regression model comparing (H)RfZE with and without Fqs, there was no difference in the odds of a negative regimen-specific outcome (baseline (H)RfZE, cluster-specific odds ratio 1.05 (95% CI 0.60-1.82), p=0.87; cluster NHS trust). Results varied minimally in a multivariable model. This odds ratio dropped (0.57, 95% CI 0.14-2.28) when Hr genotype was included, but this analysis lacked power (p=0.42). CONCLUSIONS: In a high-income setting, we found a 12-month (H)RfZE regimen with a short Z duration to be similarly effective for Hr tuberculosis with or without a Fq. This regimen may result in fewer adverse events than the WHO recommendations

Global Study of Electron-Quark Contact Interactions

We perform a global fit of data relevant to $eeqq$ contact interactions, including deep inelastic scattering at high $Q^2$ from ZEUS and H1, atomic physics parity violation in Cesium from JILA, polarized $e^-$ on nuclei scattering experiments at SLAC, Mainz and Bates, Drell-Yan production at the Tevatron, the total hadronic cross section $\sigma_{had}$ at LEP, and neutrino-nucleon scattering from CCFR. With only the new HERA data, the presence of contact interactions improves the fit compared to the Standard Model. When other data sets are included, the size of the contact contributions is reduced and the overall fit represents no real improvement over the Standard Model.Comment: 26 pages (now single-spaced), Revtex, 2 eps figures, uses epsf.sty. Some clarifications, minor corrections, 2 new references, also 3 new tables which present 95% CL bounds on the contact interaction scales Lambd

Connecting Hospitalized Patients with Their Families: Case Series and Commentary

The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital—principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction

Effect of Cyclosporine and Rifampin on the Pharmacokinetics of Macitentan, a Tissue-Targeting Dual Endothelin Receptor Antagonist

Macitentan is a dual endothelin receptor antagonist under phase 3 investigation in pulmonary arterial hypertension. We investigated the effect of cyclosporine (Cs) and rifampin on the pharmacokinetics of macitentan and its metabolites ACT-132577 and ACT-373898 in healthy male subjects. In addition, in vitro studies were performed to investigate interactions between macitentan and its active metabolite ACT-132577 with human organic anion-transporting polypeptides (OATPs). The clinical study (AC-055-111) was conducted as a two-part, one-sequence, crossover study. Ten subjects in each part received multiple-dose macitentan followed by multiple-dose co-administration of Cs (part A) or rifampin (part B). In the presence of Cs, steady-state area under the plasma concentration–time profiles during a dose interval (AUCτ) for macitentan and ACT-373898 increased 10% and 7%, respectively, and decreased 3% for ACT-132577. Steady-state AUCτ of macitentan and ACT-373898 in the presence of rifampin decreased 79% and 64%, respectively. For ACT-132577, no relevant difference in AUCτ between the two treatments was observed. Macitentan co-administered with Cs or rifampin was well tolerated. The complementary in vitro studies demonstrated no marked differences in uptake rates of macitentan and ACT-132577 between the wild-type and OATP over-expressing cells over the concentration range tested. Concomitant treatment with Cs did not have any clinically relevant effect on the exposure to macitentan or its metabolites, at steady-state. Concomitant treatment with rifampin reduced significantly the exposure to macitentan and its metabolite ACT-373898 at steady-state but did not affect the exposure to the active metabolite ACT-132577 to a clinically relevant extent

The effect of asymmetries on stock index return value-at-risk estimates

It is widely accepted that equity return volatility increases more following negative shocks rather than positive shocks. However, much of value-at-risk (VaR) analysis relies on the assumption that returns are normally distributed (a symmetric distribution). This article considers the effect of asymmetries on the evaluation and accuracy of VaR by comparing estimates based on various models

Characterization of ARF-BP1/HUWE1 Interactions with CTCF, MYC, ARF and p53 in MYC-Driven B Cell Neoplasms

Transcriptional activation of MYC is a hallmark of many B cell lineage neoplasms. MYC provides a constitutive proliferative signal but can also initiate ARF-dependent activation of p53 and apoptosis. The E3 ubiquitin ligase, ARF-BP1, encoded by HUWE1, modulates the activity of both the MYC and the ARF-p53 signaling pathways, prompting us to determine if it is involved in the pathogenesis of MYC-driven B cell lymphomas. ARF-BP1 was expressed at high levels in cell lines from lymphomas with either wild type or mutated p53 but not in ARF-deficient cells. Downregulation of ARF-BP1 resulted in elevated steady state levels of p53, growth arrest and apoptosis. Co-immunoprecipitation studies identified a multiprotein complex comprised of ARF-BP1, ARF, p53, MYC and the multifunctional DNA-binding factor, CTCF, which is involved in the transcriptional regulation of MYC, p53 and ARF. ARF-BP1 bound and ubiquitylated CTCF leading to its proteasomal degradation. ARF-BP1 and CTCF thus appear to be key cofactors linking the MYC proliferative and p53-ARF apoptotic pathways. In addition, ARF-BP1 could be a therapeutic target for MYC-driven B lineage neoplasms, even if p53 is inactive, with inhibition reducing the transcriptional activity of MYC for its target genes and stabilizing the apoptosis-promoting activities of p53

Physics of leptoquarks in precision experiments and at particle colliders

We present a comprehensive review of physics effects generated by leptoquarks (LQs), i.e., hypothetical particles that can turn quarks into leptons and vice versa, of either scalar or vector nature. These considerations include discussion of possible completions of the Standard Model that contain LQ fields. The main focus of the review is on those LQ scenarios that are not problematic with regard to proton stability. We accordingly concentrate on the phenomenology of light leptoquarks that is relevant for precision experiments and particle colliders. Important constraints on LQ interactions with matter are derived from precision low-energy observables such as electric dipole moments, (g-2) of charged leptons, atomic parity violation, neutral meson mixing, Kaon, B, and D meson decays, etc. We provide a general analysis of indirect constraints on the strength of LQ interactions with the quarks and leptons to make statements that are as model independent as possible. We address complementary constraints that originate from electroweak precision measurements, top, and Higgs physics. The Higgs physics analysis we present covers not only the most recent but also expected results from the Large Hadron Collider (LHC). We finally discuss direct LQ searches. Current experimental situation is summarized and self-consistency of assumptions that go into existing accelerator-based searches is discussed. A progress in making next-to-leading order predictions for both pair and single LQ productions at colliders is also outlined.Comment: 136 pages, 22 figures, typographical errors fixed, the Physics Reports versio