Public Health Principlism

Public health ethics has grown out of the medical ethics movement and has remained in individualistic biomedical models. However, as public health is a different enterprise than medicine dealing with communities rather than individuals. The author develops public health principlism based on the idea of common citizenship in the community. When the four principles of public health ethics—solidarity, efficacy, integrity, and dignity—are in balance, a state of justice exists. The goal is to have programs that are the least destructive to communities and the least restrictive to people. These principles provide guidance in ethical reasoning when analyzing programs and interventions such as mandatory helmet laws, water fluoridation, and smallpox vaccination to improve the aggregate health of a community

Is Bioethics A Profession?

The development of an occupation into a profession is an historical process that concerns power, jurisdiction, social contracts, and economic interests. Sociological theories of professionalization view these developments through perspectives of superior work, pay for performance, historical processes, jurisdictional disputes, struggles of social and economic power, and virtues. This essay explores these theories and examines the field of bioethics through each of these lenses looking at such issues amateur versus professional, education, professional organizations, specialized knowledge, code of ethics, jurisdiction, work sites, work focus, research, socialization, professional autonomy, licensure, legislation, and prestige. Bioethics is seen as falling in the middle of Goode’s “profession continuum.” While bioethics has adopted some of the necessary characteristics of a profession, having those elements is not a sufficient condition to being a profession. In the end, professionalization is undesirable for the field

Aboriginal Rules: The Black History of Australian Football

This paper is interested in the significance of Australian football to the Aboriginal and Torres Strait Islander people of Australia. In particular, this paper is interested in the cultural power of football and how it has foregrounded the struggle and highlighted the contribution that Indigenous people have made to the national football code of Australia. This paper also discusses key moments in Indigenous football history in Australia. It questions further that a greater understanding of this contribution needs to be more fully explored from a national perspective in order to appreciate Indigenous peoples' contribution to the sport not just in elite competitions but also at a community and grass roots level

Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals

OBJECTIVE: In a multicenter cohort of neonates recovering from cardiac surgery, we sought to describe the epidemiology of extubation failure and its variability across centers, identify risk factors, and determine its impact on outcomes. METHODS: We analyzed prospectively collected clinical registry data on all neonates undergoing cardiac surgery in the Pediatric Cardiac Critical Care Consortium database from October 2013 to July 2015. Extubation failure was defined as reintubation less than 72 hours after the first planned extubation. Risk factors were identified using multivariable logistic regression with generalized estimating equations to account for within-center correlation. RESULTS: The cohort included 899 neonates from 14 Pediatric Cardiac Critical Care Consortium centers; 14% were premature, 20% had genetic abnormalities, 18% had major extracardiac anomalies, and 74% underwent surgery with cardiopulmonary bypass. Extubation failure occurred in 103 neonates (11%), within 24 hours in 61%. Unadjusted rates of extubation failure ranged from 5% to 22% across centers; this variability was unchanged after adjusting for procedural complexity and airway anomaly. After multivariable analysis, only airway anomaly was identified as an independent risk factor for extubation failure (odds ratio, 3.1; 95% confidence interval, 1.4-6.7; P = .01). Neonates who failed extubation had a greater median postoperative length of stay (33 vs 23 days, P < .001) and in-hospital mortality (8% vs 2%, P = .002). CONCLUSIONS: This multicenter study showed that 11% of neonates recovering from cardiac surgery fail initial postoperative extubation. Only congenital airway anomaly was independently associated with extubation failure. We observed a 4-fold variation in extubation failure rates across hospitals, suggesting a role for collaborative quality improvement to optimize outcomes

BEHAVIOR OF SANDHILL CRANES HARNESSED WITH DIFFERENT SATELLITE TRANSMITTERS

The effectiveness of various attachment methods and designs of platform transmitting terminals (PIT\u27s) was tested on captive sandhill cranes (Grus canadensis) at the Patuxent Wildlife Research Center, Laurel, Maryland, during 1989-91. Combinations of attachment and transmitter designs included neoprene cord harness with batteries separate from the transmitter (2 harness designs), Teflon ribbon harness with batteries incorporated into the transmitter package (4 transmitter models), and a package attached directly to the bird with epoxy glue only. Physical effects seen on cranes wearing PTT\u27s ranged from skin lacerations (caused by rubbing of harness material) to no observed effects (other than feather wear). The most successful harness material and design utilized a Teflon ribbon harness with the 4 ribbon ends from the transmitter forming a neck loop and a body loop joined at the sternum. Time spent by sandhill cranes performing most activities did not change after transmitter attachment using this harness method

Impact of Experimental Human Pneumococcal Carriage on Nasopharyngeal Bacterial Densities in Healthy Adults

Colonization of the nasopharynx by Streptococcus pneumoniae is a necessary precursor to pneumococcal diseases that result in morbidity and mortality worldwide. The nasopharynx is also host to other bacterial species, including the common pathogens Staphylococcus aureus, Haemophilus influenzae, and Moraxella catarrhalis. To better understand how these bacteria change in relation to pneumococcal colonization, we used species-specific quantitative PCR to examine bacterial densities in 52 subjects 7 days before, and 2, 7, and 14 days after controlled inoculation of healthy human adults with S. pneumoniae serotype 6B. Overall, 33 (63%) of subjects carried S. pneumoniae post-inoculation. The baseline presence and density of S. aureus, H. influenzae, and M. catarrhalis were not statistically associated with likelihood of successful pneumococcal colonization at this study’s sample size, although a lower rate of pneumococcal colonization in the presence of S. aureus (7/14) was seen compared to that in the presence of H. influenzae (12/16). Among subjects colonized with pneumococci, the number also carrying either H. influenzae or S. aureus fell during the study and at 14 days post-inoculation, the proportion carrying S. aureus was significantly lower among those who were colonized with S. pneumoniae (p = 0.008) compared to non-colonized subjects. These data on bacterial associations are the first to be reported surrounding experimental human pneumococcal colonization and show that co-colonizing effects are likely subtle rather than absolute