Ethical Allocation of Preexposure HIV Prophylaxis

Civil society-led movements transformed global AIDS action from deep skepticism about extending anti-retroviral (ARV) treatment in low and middle-income countries to an historic scaling up of treatment towards universal access. The AIDS movement, however, is at an inflection point due to the interplay of key health and economic determinants—the global financial downturn, tight foreign aid budgets, and intense resource competition. Policy makers will now have to consider implementation of a new intervention—pre-exposure prophylaxis (PrEP), which could mean a diversion of ARVs from treatment to prevention. The principle underlying PrEP is that ARVs could prevent HIV infection among people who are HIV-negative and at high risk. Unlike existing prevention strategies such as voluntary counseling and testing (VCT), condoms, and male circumcision, PrEP is a continuous biomedical intervention. Although it will take several years to fully establish the clinical efficacy of PrEP in varying populations, the encouraging early results from CAPRISA, iPrEx, and CDC 4323 have accelerated global dialogue on its proof of deliverability. The studies encompass diverse populations, including injecting drug users (IDUs), MSM, serodiscordant heterosexual couples, and sex workers. These studies will be completed at different times, raising the question: if a trial demonstrates effectiveness for a given study group, should PrEP be used for others? The ethical issues raised by PrEP are difficult, but not insurmountable. Examining comparative cost-effectiveness, good governance, overcoming access barriers, and ensuring quality improvement would help ensure ethical allocation under circumstances of scarcity

Legal socialization effects on democratization

As is the case with all our joint publications, this article represents a genuine research collaboration between the authors, with equal contributions. Therefore, neither is first or second author. This article uses data from a collaborative project that grew out of the Law and Society Associations Working Group on Orientations toward Law and Normative Ordering‘. Ellen S. Cohn, lames L. Gibson, Susan O. White, Joseph Sanders, Joan McCord, and Felice Levine were responsible for the development and implementation of the research design. Funding for the project was provided by the (US) National Science Foundation (SE 13237 and SIR 11403). Our European collaborators include Chantal Kourilsky-Augeven (France), Grazyna Skapska, Iwona Jakubowska-Branicka, and Maria Barucka-Arctowa (Poland), Andras Sajo (Hungary), Rosemary Barberet (Spain), and Stefka Naoumova (Bulgaria). Pam Moore, Kris Guffey, Marika Litras, Julie Nadeau, John Kraft, and Kimberly Smirles provided valuable research assistance

A study of the portability of an Ada system in the software engineering laboratory (SEL)

A particular porting effort is discussed, and various statistics on analyzing the portability of Ada and the total staff months (overall and by phase) required to accomplish the rehost, are given. This effort is compared to past experiments on the rehosting of FORTRAN systems. The discussion includes an analysis of the types of errors encountered during the rehosting, the changes required to rehost the system, experiences with the Alsys IBM Ada compiler, the impediments encountered, and the lessons learned during this study

Altruism Spillovers: Are Behaviors in Context-Free Experiments Predictive of Altruism Toward a Naturally Occurring Public Good?

This paper addresses the external validity of experiments investigating the characteristics of altruism in the voluntary provision of public goods. We conduct two related experiments that allow us to examine whether individuals who act more altruistically in the context-free environment are also more likely to act altruistically toward a naturally-occurring public good. We find that laboratory behavior can be predictive of contributions toward naturally-occurring goods, but not in a uniform way. In fact, parametric measures of altruism do a poor job of predicting which subjects are most likely to contribute to a naturally-occurring public good.

The O’Neill Institute for National and Global Health Law: Discovering Innovative Solutions for the Most Pressing Health Problems Facing the Nation and the World

The connection between health and an individual’s ability to function in society, as well as the importance of health to a society’s economic, political, and social wellbeing necessitates finding innovative solutions to the world’s most pressing health problems. The O’Neill Institute for National and Global Health Law at Georgetown University seeks to demonstrate the role that academia can play in addressing complex national and global health problems in a comprehensive, evidence-based, intellectually-rigorous, and nonpartisan manner. The O’Neill Institute currently has three research programs: global health law, national health law, and the center for disease prevention and outcomes. Projects within these programs examine a broad range of health law and policy issues, such as global health governance, global tobacco control, health worker migration, emergency preparedness, national and Chinese health reform, HIV and AIDS issues, food safety, and personalized medicine. These projects merge the scholarly capacity within the institute with the resources of its partners, which include the World Health Organization, World Bank, the Bill & Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention, and the Campaign for Tobacco Free Kids. Additionally, the faculty and fellows of the O’Neill Institute regularly produce high-level scholarship and engage in teaching offering multi-disciplinary course offerings and innovative graduate degree programs. URL: http://www.law.georgetown.edu/oneillinstitute/documents/2010-03-09_oneill-solutions.pdf; http://mjlst.umn.edu/uploads/Pf/V1/PfV1QhiCT6lUOsv1AqDTCA/111_gostin.pdf

Child Abuse Reporting: Rethinking Child Protection

The general public has been bewildered by the magnitude of sex abuse cases and the widespread failure by pillars of the community to notify appropriate authorities. The crime of sexually abusing children is punishable in all jurisdictions and this article examines the duty to report suspected cases by individuals in positions of trust over young people, such as in the church or university sports. The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child maltreatment as an act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, sexual abuse, or exploitation, and establishes minimum federal standards. Each state has its own definitions of maltreatment and every state identifies persons who are required to report child abuse. As such, state law is highly variable in defining who has a mandatory duty to report, and clergy and other individuals in close supervision of children (e.g., athletic coaches, scout leaders, volunteers in religious programs, and university officials) may necessarily hold such duty. The article outlines why there are strong moral reasons the law should require all adults in close supervision of children to report any individual who they have good reason to believe has abused a child and moreover outlines how to ensure prompt reporting of abuse, while still ensuring that respected individuals are not falsely accused

Implications of the Ticket to Work and Self-Sufficiency Program for Young Adults

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act (P.L. 106-170) into law establishing in section 101(a) the Ticket to Work and Self-Sufficiency Program (Ticket to Work Program) as well as several other provisions to support the movement of beneficiaries with disabilities who receive Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) into employment. The Ticket to Work Program was established to expand the universe of providers available to beneficiaries with disabilities as they are afforded the opportunity to choose from whom they access their needed employment services and supports. The Ticket to Work Program also increased provider incentives to serve these individuals. The Social Security Administration (SSA) administers this new program with the support of Maximus, Inc, the entity contracted with by the SSA to serve as the program manager. The SSA is currently contracting with agencies to serve as Employment Networks (EN). These ENs perform an array of duties under the law, including providing employment services, vocational rehabilitation (VR) services, and other support services to assist individuals with disabilities to obtain and maintain employment. Under this program, the SSA is directed to provide to beneficiaries with disabilities who meet certain eligibility criteria a Ticket they may use to obtain employment services, VR services and/or other support services from an EN of their choice. “A Ticket under the Ticket to Work and Self-Sufficiency Program is a document that provides evidence of SSA’s agreement to pay an EN or a State VR agency for providing employment services, VR services and/or other support services to a Ticket recipient who requests such services.” (SSA 2001, p. 12) The Ticket to Work Program will be phased in nationally over a three-year period beginning in January, 2002, with beneficiaries in 13 states: Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont and Wisconsin. The remaining states will be included by January, 2004

Developing a Medical Staff Plan to Proactively Address Physician Shortages

No abstract available

Family, Time, and Meaning toward the End of Life in Japan

In contrast to media images of lonely deaths, stereotypes of the Japanese calm acceptance of dying, and the “naturalness” of dependency in old age or illness, this paper explores the complex ways in which changing perceptions of time refocus people towards the question of how to live. Time both narrows to the level of medication schedules and bodily functions, and expands to more immediate engagement with others in the past and future. The idea of a moral timeline of such changes builds upon recent work in the anthropology of morality by recognizing shifting ideas and actions people take to retain agency through suffering. People near the end of life in Japan commonly employ cultural idioms of effort, reciprocity, and gratitude to express their continual striving to be moral persons in a social world. Ultimately, such efforts determine not only how they see themselves and are seen by others through their final days, but whether theirs will be judged to be a “good death,” and thus the nature of the person’s continued social existence in spirit and memories after death. The moral timeline expressed by many of the people I met reflected intensified concern with becoming a burden and with reciprocity as the end of life came close. For many, that deepened their sense of engagement, sometimes transforming their relationships with others who would survive them or who had preceded them in death. The ethnographic data in this article come from a participant-observation study of adults of all ages with life-threatening illnesses, and from an interview study of frail elderly and their family caregivers in the early 21st century in urban and rural settings

Doing Science: Data Enactments in Mathematics Education and Qualitative Research

Leading mathematics education scholars have called for different theoretical possibilities (Stinson & Walshaw, 2017) and broader considerations of what “counts” (D. B. Martin, Gholson, & Leonard, 2010) in mathematics education research. This study—situated at the intersections of statistics education, mathematics education, and qualitative inquiry—responds to these calls through an intellectual exploration of Karen Barad’s (2007) readings of Niels Bohr’s philosophy–physics and her questions of what it might look like to do science while valuing both objectivity and posthumanist accounts of reality. The study considers how taking up data with different theories and methods in mathematics education research produces different knowledges and the ways this rethinking opens up different possibilities for school mathematics. To bring clarity to the theoretical exploration, mathematics teaching and learning at the classroom level was examined. Two middle school mathematics teachers who taught a 10-week mathematics enrichment course Mathematics and Current Events were observed and interviewed. During the course, teachers and students researched provocative topics in the media and considered the ways in which mathematics interacts with how they understand the world. The course focused on the statistics that are presented by the media and the ways that citizens might use mathematics to make meanings of important problems. Observation and interview data were mapped to aspects of statistical literacy (e.g., Wild & Pfannkuch,1999) informing practice in middle grades classrooms and bringing questions forward for consideration about how critical dispositions of statistical thinking might be developed in middle grades mathematics classrooms. The theoretical exploration of the diffraction (Barad, 2007; Haraway, 1992) of interpretivist and poststructuralist readings of the data illustrates that different theories and broader considerations in mathematics education research can open up important new spaces in the field of mathematics education research. Shifts in what is legitimized in the field of mathematics education research makes cracks in hardened places in the field that can provoke new questions and, in turn, new methods. In the end, different theories and ways of knowing allow diverse ways of doing science and broader views on what gets counted in knowledge production