Women Who Continue Hormone Replacement Therapy Despite Findings from the Women\u27s Health Initiative

Since the results of the Women\u27s Health Initiative (WHI) study were published in 2002, millions of women and their healthcare practitioners have had to re-examine decisions about the use of hormone replacement therapy. This level one descriptive study explored the characteristics of menopausal women who could not tolerate estrogen withdrawal and continued taking hormone replacement therapy despite findings of risk published in the Women\u27s Health Initiative. The sample included the medical records of 1,195 patients in a single-physician OB-GYN practice in northeast Florida. All records of women with a birth date in 1954 or prior and a visit to the practice for gynecological care between July 2002 and March 1, 2004 were reviewed to collect data about demographics, past medical history, and hormone replacement therapy (HRT) use. A significant portion of women (77.2%) had discontinued HRT. Of the women remaining on HRT, 54.7% changed either the dose or type of hormones taken. Only 59.5% of these women remained on the same estrogen dose both before and after the WHI results were published in 2002. Interestingly, there were 29 women (4%) who initiated HR T use after July 2002. The women who remained on HR T after WHI were more likely to be younger, Caucasian (72. 7% ), non-smokers (82.3% ), and taking medication for other conditions (68.5%). The older the woman, the less likely she was to have continued HRT. Younger women were more likely to have changed HRT drug and/or dose post-WHI

Surrogates and Artificial Intelligence: Why AI Trumps Family

The increasing accuracy of algorithms to predict values and preferences raises the possibility that artificial intelligence technology will be able to serve as a surrogate decision-maker for incapacitated patients. Following Camillo Lamanna and Lauren Byrne, we call this technology the autonomy algorithm (AA). Such an algorithm would mine medical research, health records, and social media data to predict patient treatment preferences. The possibility of developing the AA raises the ethical question of whether the AA or a relative ought to serve as surrogate decision-maker in cases where the patient has not issued a medical power of attorney. We argue that in such cases, and against the standard practice of vesting familial surrogates with decision making authority, the AA should have sole decision-making authority. This is because the AA will likely be better at predicting what treatment option the patient would have chosen. It would also be better at avoiding bias and, therefore, choosing in a more patient-centered manner. Furthermore, we argue that these considerations override any moral weight of the patient\u27s special relationship with their relatives

Multiemployer Pension Plans Respond to the Financial Crisis

Multiemployer pension plans cover union-represented participants who work for two or more employers. Plan assets and liabilities are pooled, so the risks and rewards are experienced by the group as a whole. Union and employer representatives collaborate in setting plan policy, defining benefits, and overseeing investments and operations; each side has an equal say. This chapter describes how, spurred by the Pension Protection Act’s new requirements and flexibility, multiemployer plans are adapting to the crisis with a mix of benefit reductions and employer contribution increases aimed at stabilizing their finances, rather than phasing out their defined benefit programs – at least for no

The Common Rule’s “Reasonable Person” Standard for Informed Consent

Laura Odwazny and Benjamin Berkman have raised several challenges regarding the new reasonable person standard in the revised Common Rule, which states that informed consent requires potential research subjects be provided with information a reasonable person would want to know to make an informed decision on whether to participate in a study. Our aim is to offer a response to the challenges Odwazny and Berkman raise, which include the need for a reasonable person standard that can be applied consistently across institutional review boards and that does not stigmatize marginal groups. In response, we argue that the standard ought to be based in an ordinary rather than ideal person conception of reasonable person and that the standard ought to employ what we call a liberal constraint: the reasonability standard must be malleable enough such that a wide variety of individuals with different, unique value systems would endorse it. We conclude by suggesting some of the likely consequences our view would have, if adopted

On expressive punishment and holisitic desert

Expressive theories of punishment incorporate both deontological and consequentialist components. The deontological element claims that punishment expresses the value of both victim and wrongdoer. The consequentialist element claims that punishment restores the victim’s and wrongdoer’s worth. In contemporary literature, however, it is unclear which component is given priority and therefore expressive theories appear ambiguous at best and inconsistent at worst. My thesis argues that expressive theories are cleared up and made consistent through employing a holistic notion of punitive desert. Holism is the view that accurate desert judgments must reference an actually obtaining just distribution of punishment. In my view, the expressive function is feasible only when desert is understood holistically and in this sense expressive theories are committed to giving priority to the deontological component

The impact of ADHD on quality of life and peer relations in college students

This study examines the relationship of ADHD with quality of life (QoL) and peer relations in college students. Specifically, this study analyzes how ADHD impacts QoL and peer relations and how other variables can impact these relationships. The current study was conducted through an online survey on Qualtrics which included demographic questions as well as validated measures on ADHD, QoL, and peer relations. It was found that ADHD had a significant negative correlation with QoL and a significant positive correlation with peer relations. When controlling for confounders, the relationship between ADHD and QoL remained consistent while the relationship between ADHD and peer relations increased. Through a stepwise multiple linear regression analysis, it was found that ADHD score, comorbidity, peer relations, and gender were significant predictors of QoL. Additionally, it was found that QoL and ADHD scores were significant predictors of peer relations. The findings of this study can shed light on how universities support students with ADHD and how ADHD treatment should address QoL and peer relations.Keywords: ADHD, Quality of Life, Peer Relations, College Student

Detecting Cancer Gene Networks Characterized by Recurrent Genomic Alterations in a Population

High resolution, system-wide characterizations have demonstrated the capacity to identify genomic regions that undergo genomic aberrations. Such research efforts often aim at associating these regions with disease etiology and outcome. Identifying the corresponding biologic processes that are responsible for disease and its outcome remains challenging. Using novel analytic methods that utilize the structure of biologic networks, we are able to identify the specific networks that are highly significantly, nonrandomly altered by regions of copy number amplification observed in a systems-wide analysis. We demonstrate this method in breast cancer, where the state of a subset of the pathways identified through these regions is shown to be highly associated with disease survival and recurrence

Wavelet Analysis in Virtual Colonoscopy

The computed tomographic colonography (CTC) computer aided detection (CAD) program is a new method in development to detect colon polyps in virtual colonoscopy. While high sensitivity is consistently achieved, additional features are desired to increase specificity. In this paper, a wavelet analysis was applied to CTCCAD outputs in an attempt to filter out false positive detections. 52 CTCCAD detection images were obtained using a screen capture application. 26 of these images were real polyps, confirmed by optical colonoscopy and 26 were false positive detections. A discrete wavelet transform of each image was computed with the MATLAB wavelet toolbox using the Haar wavelet at levels 1-5 in the horizontal, vertical and diagonal directions. From the resulting wavelet coefficients at levels 1-3 for all directions, a 72 feature vector was obtained for each image, consisting of descriptive statistics such as mean, variance, skew, and kurtosis at each level and orientation, as well as error statistics based on a linear predictor of neighboring wavelet coefficients. The vectors for each of the 52 images were then run through a support vector machine (SVM) classifier using ten-fold cross-validation training to determine its efficiency in distinguishing polyps from false positives. The SVM results showed 100% sensitivity and 51% specificity in correctly identifying the status of detections. If this technique were added to the filtering process of the CTCCAD polyp detection scheme, the number of false positive results could be reduced significantly

Metagenomic analysis of the saliva microbiome with merlin

In recent years, metagenomics has demonstrated to play an essential role on the study of the microorganisms that live in microbial communities, particularly those who inhabit the human body. Several bioinformatics tools and pipelines have been developed for the analysis of these data, but they usually only address one topic: to identify the taxonomic composition or to address the metabolic functional profile. This work aimed to implement a computational framework able to answer the two questions simultaneously. Merlin, a previously released software aiming at the reconstruction of genome-scale metabolic models for single organisms, was extended to deal with metagenomics data. It has an user-friendly and intuitive interface, being suitable for those with limited bioinformatics skills. The performance of the tool was evaluated with samples from the Human Microbiome Project, particularly from saliva. Overall, the results show the same patterns reported before: while the pathways needed for microbial life remain relatively stable, the community composition varies extensively among individuals