Public Health and Personal Choice: The Ethics of Vaccine Mandates and Parental Refusal in the United States

In January 2019 The World Health Organization (WHO) released its list Ten threats to global health in 2019. For the first time ever, vaccine hesitancy, “the reluctance or refusal to vaccinate despite the availability of vaccine services” is officially on the list.1 Although great progress has been made in reducing or eradicating various diseases such as polio, measles, and whooping cough (pertussis), the number of parents refusing vaccination for their children is growing rapidly in what is now often referred to as the “anti-vaccination movement” ( or “anti-vax movement”). This is causing a threat to public health as the lowered proportion of vaccine uptake within communities is triggering a reversal of the progress made by vaccination thus far through a weakening herd immunity, putting everyone at a greater risk of contracting and spreading infectious diseases.2 According to the Center for Disease Control and Prevention (CDC), so far in 2019 the United States has already faced three outbreaks of the measles, a disease previously considered eliminated in the United States, in New York City, New York state, and Washington state.3 Each outbreak was found in areas with particularly low vaccination rates.4https://thekeep.eiu.edu/lib_awards_2019_docs/1006/thumbnail.jp

Public Health and Personal Choice: The Ethics of Vaccine Mandates and Parental Refusal in the United States

In January 2019 The World Health Organization (WHO) released its list Ten threats to global health in 2019. For the first time ever, vaccine hesitancy, “the reluctance or refusal to vaccinate despite the availability of vaccine services” is officially on the list.1 Although great progress has been made in reducing or eradicating various diseases such as polio, measles, and whooping cough (pertussis), the number of parents refusing vaccination for their children is growing rapidly in what is now often referred to as the “anti-vaccination movement” ( or “anti-vax movement”). This is causing a threat to public health as the lowered proportion of vaccine uptake within communities is triggering a reversal of the progress made by vaccination thus far through a weakening herd immunity, putting everyone at a greater risk of contracting and spreading infectious diseases.2 According to the Center for Disease Control and Prevention (CDC), so far in 2019 the United States has already faced three outbreaks of the measles, a disease previously considered eliminated in the United States, in New York City, New York state, and Washington state.3 Each outbreak was found in areas with particularly low vaccination rates.4https://thekeep.eiu.edu/lib_awards_2019_docs/1006/thumbnail.jp

Architecture and Agency For Equity In Areas Beyond National Jurisdiction

The United Nations (UN) Sustainable Development Goals (SDGs) and the UN Decade of Ocean Science for Sustainable Development (Ocean Decade) bring increased attention to various aspects of ocean governance, including equity. One of the Ocean Decade\u27s identified challenges is to develop a sustainable and equitable ocean economy, but questions arise about how to conceptualize the multiple dimensions of equity in an ocean context. These questions become more complex as activities move away from coastal ecosystems and communities into off-shore Areas Beyond National Jurisdiction (ABNJ), where ocean resources are recognized simultaneously as unowned/open access and as common heritage. In this paper, we mobilize the Earth System Governance analytics of ‘architecture’ and ‘agency’, to reflect on the possibilities for equity in ABNJ. Motivated by the general attention to equity in UN initiatives like the SDGs and the Ocean Decade, we describe current UN architecture for ocean governance, including principles that might support equity. Existing UN architecture focuses on distributional equity among nation states, with less attention to recognitional or procedural equity. State actors have most agency, while non-state actors can exercise some via broad UN declarations and through mechanisms like ‘major groups.’ We use on-going negotiations in the International Seabed Authority on rules for mineral exploitation and in the Intergovernmental Conference on an international legally binding instrument under UNCLOS on the conservation and sustainable use of marine biological diversity of Areas Beyond National Jurisdiction to illustrate how existing architecture shapes possibilities for equity in ABNJ. As new governance possibilities are imagined, attending to existing architecture and agency can help avoid further entrenching existing power imbalances and unwittingly reproducing or exacerbating inequities

La importancia del turismo sostenible en la reversión de la tendencia de la desaceleración económica y la población declive de las comunidades rurales

Across the world there is an ever increasing trend of human migration from rural areas and in particular small settlements to urban centres. Migration to urban centres is most prevalent in the young adult age groups, which affects traditional industries such as agriculture and associated services, and thus threatens the sustainability of rural settlements. In some rural towns, a decline in population and agriculture has led to their social and economic deterioration. This paper presents small settlements, two in Italy and two in Australia, which have leveraged locality very effectively to develop a thriving tourist industry. The study provides a comparison and evaluation of data on visitor numbers and tourism expenditure in these regions demonstrating success and growth trends. It is shown how various industries other than tourism often in conjunction with unique characteristics or assets of an area create a major draw card for tourists. Thus providing significant economic, social and environmental benefits to these areas. Key Words: rural tourism, population trends, sustainable tourism, resilient communities,A nivel mundial existe una tendencia cada vez mayor de desplazamiento de personas en zonas rurales, particularmente en pequeños sentamientos, a los centros urbanos. Este desplazamiento es más común en grupos de edad jóvenes, afectando industrias tradicionales como la agricultura y sus servicios asociados, amenazando por ende la sostenibilidad de asentamientos rurales. En algunos pueblos de zonas rurales, la disminución de población y reducción de la agricultura ha conducido a su deterioro social y económico. Este artículo presenta el caso de pequeños asentamientos, dos en Italia y dos en Australia en los cuales se ha eficazmente fortalecido la localidad para desarrollar una próspera industria del turismo. Este artículo provee una comparación y evaluación de los registros del número de visitantes y el aporte del turismo en estas regiones, demostrando su éxito y tendencias de crecimiento. También se presenta como a menudo otras industrias, aparte del turismo en conjunto con características únicas o activos de una zona, crean un atractivo importante para los turistas. De este modo se están proporcionando beneficios económicos, sociales y ambientales significativos a estas áreas

Late gadolinium enhancement is common in patients with hypertrophic cardiomyopathy and no clinical risk factors for sudden cardiac death: A single center experience

Background: Cardiac magnetic resonance (CMR) is used in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM) and can detect myocardial replacement fibrosis (anindependent predictor of adverse cardiac outcomes) using late gadolinium enhancement (LGE).Methods: We retrospectively analysed CMR studies carried out over a 2 year period identifying those which were diagnostic of HCM. 117 cases were analysed. Mean age of subjects was 53 years and 78 (67%) were male. Mean ejection fraction (EF) was 68.3% with a mean left ventricular (LV) mass index of 89.4 g/m2. Hypertrophy was predominantly asymmetric in 94 (80%).Results: All subjects received gadolinium and 80 (68%) had evidence of LGE. LVEF was lower (67 vs. 71%; p = 0.015) and LV mass index higher (94 vs. 81 g/m2; p = 0.007) in the LGE group. The proportion of patients with at least 1 clinical risk factor for sudden cardiac death (SCD) was similar in groups with and without LGE (48% vs. 32%; p = 0.160). In this study, a significant proportion (62%) of patients without clinical risk factors for SCD were found to have LGE on CMR. These patients would not currently be considered for therapy with an implantable cardiac defibrillator.Conclusions: 1. Patients with HCM are at increased risk of SCD, but identifying patients who may benefit from implantable defibrillators is difficult. 2. LGE is associated with adverse cardiovascular outcomes in HCM, but is present in a large proportion of patients. 3. Many patients without clinical risk factors for SCD have LGE and would not currently be considered for an implantable cardiac device

Interactive Effects of Climate Change with Nutrients, Mercury, and Freshwater Acidification on Key Taxa in the North Atlantic Landscape Conservation Cooperative Region

The North Atlantic Landscape Conservation Cooperative LCC (NA LCC) is a public-private partnership that provides information to support conservation decisions that may be affected by global climate change (GCC) and other threats. The NA LCC region extends from southeast Virginia to the Canadian Maritime Provinces. Within this region, the US National Climate Assessment documented increases in air temperature, total precipitation, frequency of heavy precipitation events, and rising sea level, and predicted more drastic changes. Here, we synthesize literature on the effects of GCC interacting with selected contaminant, nutrient, and environmental processes to adversely affect natural resources within this region. Using a case study approach, we focused on 3 stressors with sufficient NA LCC region-specific information for an informed discussion. We describe GCC interactions with a contaminant (Hg) and 2 complex environmental phenomena-freshwater acidification and eutrophication. We also prepared taxa case studies on GCC- and GCC-contaminant/nutrient/process effects on amphibians and freshwater mussels. Several avian species of high conservation concern have blood Hg concentrations that have been associated with reduced nesting success. Freshwater acidification has adversely affected terrestrial and aquatic ecosystems in the Adirondacks and other areas of the region that are slowly recovering due to decreased emissions of N and sulfur oxides. Eutrophication in many estuaries within the region is projected to increase from greater storm runoff and less denitrification in riparian wetlands. Estuarine hypoxia may be exacerbated by increased stratification. Elevated water temperature favors algal species that produce harmful algal blooms (HABs). In several of the region\u27s estuaries, HABs have been associated with bird die-offs. In the NA LCC region, amphibian populations appear to be declining. Some species may be adversely affected by GCC through higher temperatures and more frequent droughts. GCC may affect freshwater mussel populations via altered stream temperatures and increased sediment loading during heavy storms. Freshwater mussels are sensitive to un-ionized ammonia that more toxic at higher temperatures. We recommend studying the interactive effects of GCC on generation and bioavailability of methylmercury and how GCC-driven shifts in bird species distributions will affect avian exposure to methylmercury. Research is needed on how decreases in acid deposition concurrent with GCC will alter the structure and function of sensitive watersheds and surface waters. Studies are needed to determine how GCC will affect HABs and avian disease, and how more severe and extensive hypoxia will affect fish and shellfish populations. Regarding amphibians, we suggest research on 1) thermal tolerance and moisture requirements of species of concern, 2) effects of multiple stressors (temperature, desiccation, contaminants, nutrients), and 3) approaches to mitigate impacts of increased temperature and seasonal drought. We recommend studies to assess which mussel species and populations are vulnerable and which are resilient to rising stream temperatures, hydrological shifts, and ionic pollutants, all of which are influenced by GCC

Interactive Effects of Climate Change with Nutrients, Mercury, and Freshwater Acidification on Key Taxa in the North Atlantic Landscape Conservation Cooperative Region

The North Atlantic Landscape Conservation Cooperative LCC (NA LCC) is a public–private partnership that provides information to support conservation decisions that may be affected by global climate change (GCC) and other threats. The NA LCC region extends from southeast Virginia to the Canadian Maritime Provinces. Within this region, the US National Climate Assessment documented increases in air temperature, total precipitation, frequency of heavy precipitation events, and rising sea level, and predicted more drastic changes. Here, we synthesize literature on the effects of GCC interacting with selected contaminant, nutrient, and environmental processes to adversely affect natural resources within this region. Using a case study approach, we focused on 3 stressors with sufficient NA LCC regionspecific information for an informed discussion. We describe GCC interactions with a contaminant (Hg) and 2 complex environmental phenomena—freshwater acidification and eutrophication. We also prepared taxa case studies on GCCand GCC-contaminant/nutrient/process effects on amphibians and freshwater mussels. Several avian species of high conservation concern have blood Hg concentrations that have been associated with reduced nesting success. Freshwater acidification has adversely affected terrestrial and aquatic ecosystems in the Adirondacks and other areas of the region that are slowly recovering due to decreased emissions of N and sulfur oxides. Eutrophication in many estuaries within the region is projected to increase from greater storm runoff and less denitrification in riparian wetlands. Estuarine hypoxia may be exacerbated by increased stratification. Elevated water temperature favors algal species that produce harmful algal blooms (HABs). In several of the region\u27s estuaries, HABs have been associated with bird die-offs. In the NA LCC region, amphibian populations appear to be declining. Some species may be adversely affected by GCC through higher temperatures and more frequent droughts. GCC may affect freshwater mussel populations via altered stream temperatures and increased sediment loading during heavy storms. Freshwater mussels are sensitive to un-ionized ammonia that more toxic at higher temperatures. We recommend studying the interactive effects of GCC on generation and bioavailability of methylmercury and how GCC-driven shifts in bird species distributions will affect avian exposure to methylmercury. Research is needed on how decreases in acid deposition concurrent with GCC will alter the structure and function of sensitive watersheds and surface waters. Studies are needed to determine how GCC will affect HABs and avian disease, and how more severe and extensive hypoxia will affect fish and shellfish populations. Regarding amphibians, we suggest research on 1) thermal tolerance and moisture requirements of species of concern, 2) effects of multiple stressors (temperature, desiccation, contaminants, nutrients), and 3) approaches to mitigate impacts of increased temperature and seasonal drought. We recommend studies to assess which mussel species and populations are vulnerable and which are resilient to rising stream temperatures, hydrological shifts, and ionic pollutants, all of which are influenced by GCC

Toxicity and patient-reported outcomes of a phase 2 randomized trial of prostate and pelvic lymph node versus prostate only radiotherapy in advanced localised prostate cancer (PIVOTAL)

Purpose To establish the toxicity profile of high-dose pelvic lymph node intensity-modulated radiation therapy (IMRT) and to assess whether it is safely deliverable at multiple centers. Methods and Materials In this phase 2 noncomparative multicenter trial, 124 patients with locally advanced, high-risk prostate cancer were randomized between prostate-only IMRT (PO) (74 Gy/37 fractions) and prostate and pelvic lymph node IMRT (P&P; 74 Gy/37 fractions to prostate, 60 Gy/37 fractions to pelvis). The primary endpoint was acute lower gastrointestinal (GI) Radiation Therapy Oncology Group (RTOG) toxicity at week 18, aiming to exclude a grade 2 or greater (G2+) toxicity-free rate of 80% in the P&P group. Key secondary endpoints included patient-reported outcomes and late toxicity. Results One hundred twenty-four participants were randomized (62 PO, 62 P&P) from May 2011 to March 2013. Median follow-up was 37.6 months (interquartile range [IQR], 35.4-38.9 months). Participants had a median age of 69 years (IQR, 64-74 years) and median diagnostic prostate-specific androgen level of 21.6 ng/mL (IQR, 11.8-35.1 ng/mL). At week 18, G2+ lower GI toxicity-free rates were 59 of 61 (96.7%; 90% confidence interval [CI], 90.0-99.4) for the PO group and 59 of 62 (95.2%; 90% CI, 88.0-98.7) for the P&P group. Patients in both groups reported similarly low Inflammatory Bowel Disease Questionnaire symptoms and Vaizey incontinence scores. The largest difference occurred at week 6 with 4 of 61 (7%) and 16 of 61 (26%) PO and P&P patients, respectively, experiencing G2+ toxicity. At 2 years, the cumulative proportion of RTOG G2+ GI toxicity was 16.9% (95% CI, 8.9%-30.9%) for the PO group and 24.0% (95% CI, 8.4%-57.9%) for the P&P group; in addition, RTOG G2+ bladder toxicity was 5.1% (95% CI, 1.7%-14.9%) for the PO group and 5.6% (95% CI, 1.8%-16.7%) for the P&P group. Conclusions PIVOTAL demonstrated that high-dose pelvic lymph node IMRT can be delivered at multiple centers with a modest side effect profile. Although safety data from the present study are encouraging, the impact of P&P IMRT on disease control remains to be established

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy