Establishing the need and identifying goals for a curriculum in medical business ethics: A survey of students and residents at two medical centers in Missouri

BACKGROUND: In recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encourage self-regulation and impose rules to limit physician relationships with for-profit entities. Nevertheless, no published curricula exist in the area of MBE. This study aimed to establish a baseline level of knowledge and the educational goals medical students and residents prioritize in the area of MBE. METHODS: 732 medical students and 380 residents at two academic medical centers in the state of Missouri, USA, completed a brief survey indicating their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about. RESULTS: Medical students and residents had little awareness of recent and major reports on MBE topics, and had minimal knowledge of basic MBE facts. Residents scored statistically better than medical students in both of these areas. Medical students and residents were in close agreement regarding the goals of an MBE curriculum. Both groups showed significant interest in learning more about MBE topics with an emphasis on background topics such as “the business aspects of medicine” and “health care delivery systems”. CONCLUSIONS: The content of major reports by professional associations and expert bodies has not trickled down to medical students and residents, yet both groups are interested in learning more about MBE topics. Our survey suggests potentially beneficial ways to frame and embed MBE topics into the larger framework of medical education

Curricular priorities for business ethics in medical practice and research: Recommendations from Delphi consensus panels

BACKGROUND: No published curricula in the area of medical business ethics exist. This is surprising given that physicians wrestle daily with business decisions and that professional associations, the Institute of Medicine, Health and Human Services, Congress, and industry have issued related guidelines over the past 5 years. To fill this gap, the authors aimed (1) to identify the full range of medical business ethics topics that experts consider important to teach, and (2) to establish curricular priorities through expert consensus. METHODS: In spring 2012, the authors conducted an online Delphi survey with two heterogeneous panels of experts recruited in the United States. One panel focused on business ethics in medical practice (n = 14), and 1 focused on business ethics in medical research (n = 12). RESULTS: Panel 1 generated an initial list of 14 major topics related to business ethics in medical practice, and subsequently rated 6 topics as very important or essential to teach. Panel 2 generated an initial list of 10 major topics related to business ethics in medical research, and subsequently rated 5 as very important or essential. In both domains, the panel strongly recommended addressing problems that conflicts of interest can cause, legal guidelines, and the goals or ideals of the profession. CONCLUSIONS: The Bander Center for Medical Business Ethics at Saint Louis University will use the results of the Delphi panel to develop online curricular resources for each of the highest rated topics. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1472-6920-14-235) contains supplementary material, which is available to authorized users

General Framework for the Behaviour of Continuously Observed Open Quantum Systems

We develop the general quantum stochastic approach to the description of quantum measurements continuous in time. The framework, that we introduce, encompasses the various particular models for continuous-time measurements condsidered previously in the physical and the mathematical literature.Comment: 30 pages, no figure

Drag Force in a Charged N=4 SYM Plasma

Following recent developments, we employ the AdS/CFT correspondence to determine the drag force exerted on an external quark that moves through an N=4 super-Yang-Mills plasma with a non-zero R-charge density (or, equivalently, a non-zero chemical potential). We find that the drag force is larger than in the case where the plasma is neutral, but the dependence on the charge is non-monotonic.Comment: 16 pages, 1 eps figure; v2: references added, typos fixed; v3: more general ansatz, new nontrivial solution obtained, nonmonotonicity of the drag force made explicit in new figure, version to appear in JHE

A Randomized Placebo-Controlled Phase 3 Trial of an Antisense Oligonucleotide, Drisapersen, in Duchenne Muscular Dystrophy

This 48-week, randomized, placebo-controlled phase 3 study (DMD114044; NCT01254019) evaluated efficacy and safety of subcutaneous drisapersen 6 mg/kg/week in 186 ambulant boys aged ≥5 years, with Duchenne muscular dystrophy (DMD) resulting from an exon 51 skipping amenable mutation. Drisapersen was generally well tolerated, with injection-site reactions and renal events as most commonly reported adverse events. A nonsignificant treatment difference (P = 0.415) in the change from baseline in six-minute walk distance (6MWD; primary efficacy endpoint) of 10.3 meters in favor of drisapersen was observed at week 48. Key secondary efficacy endpoints (North Star Ambulatory Assessment, 4-stair climb ascent velocity, and 10-meter walk/run velocity) gave consistent findings. Lack of statistical significance was thought to be largely due to greater data variability and subgroup heterogeneity. The increased standard deviation alone, due to less stringent inclusion/exclusion criteria, reduced the statistical power from pre-specified 90% to actual 53%. Therefore, a post-hoc analysis was performed in 80 subjects with a baseline 6MWD 300-400 meters and ability to rise from floor. A statistically significant improvement in 6MWD of 35.4 meters (P = 0.039) in favor of drisapersen was observed in this subpopulation. Results suggest that drisapersen could have benefit in a less impaired population of DMD subjects

HPV infection and immunochemical detection of cell-cycle markers in verrucous carcinoma of the penis

Penile verrucous carcinoma is a rare disease and little is known of its aetiology or pathogenesis. In this study we examined cell-cycle proteins expression and correlation with human papillomavirus infection in a series of 15 pure penile verrucous carcinomas from a single centre. Of 148 penile tumours, 15 (10%) were diagnosed as pure verrucous carcinomas. The expression of the cell-cycle-associated proteins p53, p21, RB, p16INK4A and Ki67 were examined by immunohistochemistry. Human papillomavirus infection was determined by polymerase chain reaction to identify a wide range of virus types. The expression of p16INK4A and Ki67 was significantly lower in verrucous carcinoma than in usual type squamous cell carcinoma, whereas the expression of p53, p21 and RB was not significantly different. p53 showed basal expression in contrast to usual type squamous cell carcinoma. Human papillomavirus infection was present in only 3 out of 13 verrucous carcinomas. Unique low-risk, high-risk and mixed viral infections were observed in each of the three cases. In conclusion, lower levels of p16INK4A and Ki67 expressions differentiate penile verrucous carcinoma from usual type squamous cell carcinoma. The low Ki67 index reflects the slow-growing nature of verrucous tumours. The low level of p16INK4A expression and human papillomavirus detection suggests that penile verrucous carcinoma pathogenesis is unrelated to human papillomavirus infection and the oncogenes and tumour suppressor genes classically altered by virus infection.Peer reviewedFinal Accepted Versio

The TEMPO Survey I: Predicting Yields of the Transiting Exosatellites, Moons, and Planets from a 30-day Survey of Orion with the Nancy Grace Roman Space Telescope

We present design considerations for the Transiting Exosatellites, Moons, and Planets in Orion (TEMPO) Survey with the Nancy Grace Roman Space Telescope. This proposed 30-day survey is designed to detect a population of transiting extrasolar satellites, moons, and planets in the Orion Nebula Cluster (ONC). The young (1-3 Myr), densely-populated ONC harbors about a thousand bright brown dwarfs (BDs) and free-floating planetary-mass objects (FFPs). TEMPO offers sufficient photometric precision to monitor FFPs with ${\rm M}\geq1{\rm M}_{\rm J}$ for transiting satellites. The survey is also capable of detecting FFPs down to sub-Saturn masses via direct imaging, although follow-up confirmation will be challenging. TEMPO yield estimates include 14 (3-22) exomoons/satellites transiting FFPs and 54 (8-100) satellites transiting BDs. Of this population, approximately $50\%$ of companions would be "super-Titans" (Titan to Earth mass). Yield estimates also include approximately $150$ exoplanets transiting young Orion stars, of which $>50\%$ will orbit mid-to-late M dwarfs and approximately ten will be proto-habitable zone, terrestrial ($0.1{\rm M}_{\oplus} - 5{\rm M}_{\oplus}$) exoplanets. TEMPO would provide the first census demographics of small exosatellites orbiting FFPs and BDs, while simultaneously offering insights into exoplanet evolution at the earliest stages. This detected exosatellite population is likely to be markedly different from the current census of exoplanets with similar masses (e.g., Earth-mass exosatellites that still possess H/He envelopes). Although our yield estimates are highly uncertain, as there are no known exoplanets or exomoons analogous to these satellites, the TEMPO survey would test the prevailing theories of exosatellite formation and evolution, which limit the certainty surrounding detection yields.Comment: Submitted to PAS

Dobrava-Belgrade Hantavirus from Germany Shows Receptor Usage and Innate Immunity Induction Consistent with the Pathogenicity of the Virus in Humans

BACKGROUND: Dobrava-Belgrade virus (DOBV) is a European hantavirus causing hemorrhagic fever with renal syndrome (HFRS) in humans with fatality rates of up to 12%. DOBV-associated clinical cases typically occur also in the northern part of Germany where the virus is carried by the striped field mouse (Apodemus agrarius). However, the causative agent responsible for human illness has not been previously isolated. METHODOLOGY/PRINCIPAL FINDINGS: Here we report on characterization of a novel cell culture isolate from Germany obtained from a lung tissue of "spillover" infected yellow necked mouse (A. flavicollis) trapped near the city of Greifswald. Phylogenetic analyses demonstrated close clustering of the new strain, designated Greifswald/Aa (GRW/Aa) with the nucleotide sequence obtained from a northern German HFRS patient. The virus was effectively blocked by specific antibodies directed against β3 integrins and Decay Accelerating Factor (DAF) indicating that the virus uses same receptors as the highly pathogenic Hantaan virus (HTNV). In addition, activation of selected innate immunity markers as interferon β and λ and antiviral protein MxA after viral infection of A549 cells was investigated and showed that the virus modulates the first-line antiviral response in a similar way as HTNV. CONCLUSIONS/SIGNIFICANCE: In summary, our study reveals novel data on DOBV receptor usage and innate immunity induction in relationship to virus pathogenicity and underlines the potency of German DOBV strains to act as human pathogen