Professionally responsible counseling when a fetal anomaly is diagnosed by ultrasound

© The Author(s). 2020. Ethics plays an essential role in the clinical management of pregnancies complicated by fetal anomalies diagnosed by ultrasound. Utilizing the prima facie ethical principles of beneficence and respect for autonomy, this paper first explicates the ethical concept of the fetus as a patient. This ethical concept provides the basis for a comprehensive approach to counseling pregnant women about the management of pregnancies complicated by fetal anomalies. Practical, ethically justified guidance is given for counseling about decisions both before and after viabilities

Teaching Professional Formation in Response to the COVID-19 Pandemic.

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, the authors provide an account of the process of teaching professional formation that medical educators and academic leaders should implement. Medical educators and academic leaders should embrace the opportunity that the COVID-19 pandemic presents for teaching professional formation. Learners should acquire the conceptual vocabulary of professional formation. Learners should recognize that risk of infection from patients is unavoidable. Learners should become aware of established ethical standards for professional responsibility during epidemics from the history of medicine. Learners should master understandable fear. Medical educators and academic leaders should ensure that didactic teaching of professional formation continues when it becomes justified to end learners\u27 participation in the processes of patient care; topics should include the professionally responsible management of scarce medical resources. The COVID-19 pandemic will not be the last major infectious disease that puts learners at risk. Professional ethics in medicine provides powerful conceptual tools that can be used as an ethical framework to guide medical educators to teach learners, who will bear leadership responsibilities in responses to future pandemics, professional formation

ETHICAL DIMENSIONS OF THE FETUS AS A PATIENT

Objective: To describe the ethical concept of the fetus as a patient and identify its implications for the deliberative practice of perinatal medicine.Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence.Results: In the deliberative practice of perinatal medicine guided by the ethical concept of the fetus as a patient, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient.Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

Investigating Performance of Bonded Concrete Overlays

A bonded concrete overlay (BCO) is a concrete pavement rehabilitation method used to extend the life of an existing concrete pavement. The BCO should bond fully with the existing concrete, leading to a thicker composite pavement section, a much stiffer pavement, and a considerable decrease in pavement stresses. For one project, cost estimates for a BCO were half as much as for full-depth replacement of a pavement. In some cases BCOs have delaminated shortly after construction. This paper proposes a framework for identifying the causes of early age delamination in BCOs. The early age behavior of newly constructed BCOs is examined. The factors affecting the long-term performance of the BCO are the quality of the surface preparation, the materials used in the BCO, and the curing of the BCO. Weather monitoring during BCO construction is recommended. Methods of detecting and mapping delaminations are discussed. Several BCO delamination case studies are analyzed using this framework. The model is useful not only for investigating BCO performance but also for understanding and preparing BCO construction specifications

Investigating Performance of Bonded Concrete Overlays

A bonded concrete overlay (BCO) is a concrete pavement rehabilitation method used to extend the life of an existing concrete pavement. The BCO should bond fully with the existing concrete, leading to a thicker composite pavement section, a much stiffer pavement, and a considerable decrease in pavement stresses. For one project, cost estimates for a BCO were half as much as for full-depth replacement of a pavement. In some cases BCOs have delaminated shortly after construction. This paper proposes a framework for identifying the causes of early age delamination in BCOs. The early age behavior of newly constructed BCOs is examined. The factors affecting the long-term performance of the BCO are the quality of the surface preparation, the materials used in the BCO, and the curing of the BCO. Weather monitoring during BCO construction is recommended. Methods of detecting and mapping delaminations are discussed. Several BCO delamination case studies are analyzed using this framework. The model is useful not only for investigating BCO performance but also for understanding and preparing BCO construction specifications

Kepler-413b: a slightly misaligned, Neptune-size transiting circumbinary planet

We report the discovery of a transiting, Rp = 4.347+/-0.099REarth, circumbinary planet (CBP) orbiting the Kepler K+M Eclipsing Binary (EB) system KIC 12351927 (Kepler-413) every ~66 days on an eccentric orbit with ap = 0.355+/-0.002AU, ep = 0.118+/-0.002. The two stars, with MA = 0.820+/-0.015MSun, RA = 0.776+/-0.009RSun and MB = 0.542+/-0.008MSun, RB = 0.484+/-0.024RSun respectively revolve around each other every 10.11615+/-0.00001 days on a nearly circular (eEB = 0.037+/-0.002) orbit. The orbital plane of the EB is slightly inclined to the line of sight (iEB = 87.33+/-0.06 degrees) while that of the planet is inclined by ~2.5 degrees to the binary plane at the reference epoch. Orbital precession with a period of ~11 years causes the inclination of the latter to the sky plane to continuously change. As a result, the planet often fails to transit the primary star at inferior conjunction, causing stretches of hundreds of days with no transits (corresponding to multiple planetary orbital periods). We predict that the next transit will not occur until 2020. The orbital configuration of the system places the planet slightly closer to its host stars than the inner edge of the extended habitable zone. Additionally, the orbital configuration of the system is such that the CBP may experience Cassini-States dynamics under the influence of the EB, in which the planet's obliquity precesses with a rate comparable to its orbital precession. Depending on the angular precession frequency of the CBP, it could potentially undergo obliquity fluctuations of dozens of degrees (and complex seasonal cycles) on precession timescales.Comment: 48 pages, 13 figure

Mitigation of Double-crested Cormorant Impacts on Lake Ontario: From Planning and Practice to Product Delivery

The New York State Department of Environmental Conservation initiated a Double-crested Cormorant (Phalacrocorax auritus) control program in the eastern basin of Lake Ontario to mitigate cormorant impacts in 1999. Key objectives included improving the quality of Smallmouth Bass (Micropterus dolomieu) and other fisheries, restoring the structure and function of the warmwater fish community and reducing cormorant impacts to nesting habitats of other colonial waterbird species. In eight years of intensive control, cormorant numbers declined, with a corresponding reduction in estimated fish consumption. Diversity and numbers of co-occurring waterbirds either increased or have not been shown to be negatively impacted by management. Woody vegetation favorable to Black-crowned Night-Herons (Nycticorax nycticorax) has been maintained. A ca. 2.5-fold increase in the abundance of Smallmouth Bass abundance in assessment nets over the last seven years is a sign of improved recruitment to the fishery. Since the target population level of 4,500 to 6,000 cormorants has essentially been achieved, the eastern Lake Ontario cormorant program is expected to shift in 2007 from a population reduction focus towards a less intensive program intended to prevent population resurgence

Mitigation of Double-crested Cormorant Impacts on Lake Ontario: From Planning and Practice to Product Delivery

The New York State Department of Environmental Conservation initiated a Double-crested Cormorant (Phalacrocorax auritus) control program in the eastern basin of Lake Ontario to mitigate cormorant impacts in 1999. Key objectives included improving the quality of Smallmouth Bass (Micropterus dolomieu) and other fisheries, restoring the structure and function of the warmwater fish community and reducing cormorant impacts to nesting habitats of other colonial waterbird species. In eight years of intensive control, cormorant numbers declined, with a corresponding reduction in estimated fish consumption. Diversity and numbers of co-occurring waterbirds either increased or have not been shown to be negatively impacted by management. Woody vegetation favorable to Black-crowned Night-Herons (Nycticorax nycticorax) has been maintained. A ca. 2.5-fold increase in the abundance of Smallmouth Bass abundance in assessment nets over the last seven years is a sign of improved recruitment to the fishery. Since the target population level of 4,500 to 6,000 cormorants has essentially been achieved, the eastern Lake Ontario cormorant program is expected to shift in 2007 from a population reduction focus towards a less intensive program intended to prevent population resurgence

Diet-Quality Scores and the Risk of Type 2 Diabetes in Men

Objective: To 1) compare associations of diet-quality scores, which were inversely associated with cardiovascular disease, with incident type 2 diabetes and 2) test for differences in absolute-risk reduction across various strata. Research Design and Methods: Men from the Health Professionals Follow-Up Study, who were initially free of type 2 diabetes, cardiovascular disease, or cancer (n = 41,615), were followed for $\leq 20$ years. The Healthy Eating Index (HEI) 2005, the alternative HEI (aHEI) the Recommended Food Score, the alternative Mediterranean Diet (aMED) Score, and the Dietary Approaches to Stop Hypertension (DASH) Score were calculated from food-frequency questionnaires. Cox proportional hazard models with time-varying covariates were used to assess risk by quintiles and continuous intervals. Results: There were 2,795 incident cases of type 2 diabetes. After multivariate adjustment, the aHEI, aMED, and DASH scores were significantly associated with reduced risk. A 1-SD increase was associated with 9–13% reduced risk (P < 0.01), and the DASH score was associated with lower risk independent of other scores. These scores were associated with lower absolute risk among those who were overweight or obese compared with normal weight (P for interaction < 0.01). Conclusions: Several diet-quality scores were associated with a lower risk of type 2 diabetes and reflect a common dietary pattern characterized by high intakes of plant-based foods such as whole grains; moderate alcohol; and low intakes of red and processed meat, sodium, sugar-sweetened beverages, and trans fat. High-quality diets may yield the greatest reduction in diabetes cases when followed by those with a high BMI