In Sickness and in Health: Analyzing the Ethical Limits of the Marriage between Health Care and the Market in the United States

This dissertation aims to determine what should be the appropriate base ethical limits of health care markets in the United States. I argue that because we do not value health care goods and services as commodities, treating them as commodities available for market sale can only be ethical when health care markets accord with at least the principles of honesty, respect for autonomy, and increased access to essential health care goods and services. I begin by establishing the theoretical foundation of my argument by expositing three theories of commodification and ethical markets that critically examine the relationship of goods to the market. Each theory shows how commodification often fails to account for the non-market value(s) we attribute to many goods. I then apply these theories to health care goods and services to show how they are not properly valued merely as commodities, and to lay the foundation of my argument regarding the ethical limits of health care markets. I then argue why honesty, respect for autonomy, and increased access to essential health care goods and services should be considered the base ethical limits of health care markets by examining how each ideally applies to both health care and the market. Lastly, I apply my argument to two health care markets: the pharmaceutical industry and a possible legal organ market. For the former, I show how many of the practices of the pharmaceutical industry violate what I argue should be the base ethical limits of health care markets. For the latter, I show the extent to which a legal organ market in the United States could or would violate these limits

Is There a Moral Obligation for Health Care Organizations to Develop Robust Advance Care Planning Programs?

Advance care planning (ACP) has become an integral part of patient care because of its ability to help guide treatment decision making for individuals in need of medical care but who have lost the ability to communicate—temporarily or permanently—due to illness or injury. Not all persons have the same treatment threshold; some persons value their lives above all else and will accept a high level of physical debility regardless of personal discomfort to stay alive. Others value their individual personal comfort over the length of their lives and will refuse otherwise life-sustaining treatment if they believe the treatment will cause them to sacrifice their comfort. The purpose of ACP is to help mentally capable adults express their individual goals, values, and treatment preferences prior to becoming unable to communicate so that medical providers and loved ones can make treatment decisions that best align with those adults’ wishes. When persons in need of medical care have not done ACP, medical providers and loved ones are left to guess what treatment decisions to make and may experience guilt or moral distress if they believe they have made the “wrong” choice. Not all ACP, however, is capable of bringing clarity to the treatment decision-making process. Simply asking persons to complete advance directives typically fails as a helpful treatment guide. ACP that occurs as part of a conversational process in which persons have the opportunity to reflect, understand, and make informed choices about their treatment preferences has a better chance of being useful in treatment decision making. This paper explores the ethical and legal foundations of ACP, demonstrates how robust ACP is superior to basic ACP, and argues that health care organizations have a moral obligation to develop robust ACP programs

The Impact of Schedule Pressure on Software Development: A Behavioral Perspective

Timely software development has been a major issue in both information systems research and software industry. While researchers and practitioners seek better techniques to estimate and manage software schedules, it is important to understand the impact of management pressure on software development projects. This paper investigates the impact of schedule pressure on the performance in software projects. Data analysis indicates that a U-shaped function exists between time pressure and cycle time. A similar relationship is found between time pressure and development effort. Meanwhile, time pressure does not significantly affect software quality. The findings of this study will help software project managers develop effective deadline and budget setting policies

Kinetic Predictions Concerning the Long-Term Stability of TKX-50 and Other Common Explosives Using the NETZSCH Kinetics Neo Software

Explosives are used in both military and civilian applications all over the world. Sufficient longevity and good thermal stability are therefore essential for safe handling and safe storage of energetic materials. In this work, five well-known compounds, TKX-50, RDX, HMX, CL-20 and PETN, were investigated by means of different kinetic models, in order to make predictions about their long-term stability. For this purpose, the compounds were synthesized according to literature-known procedures and thermogravimetric (TG) measurements were performed. The TG plots were analyzed using the Ozawa-Flynn-Wall, Friedman and ASTM E698 kinetic models with the NETZSCH Kinetics Neo software and the activation energy and isothermal long-term stability were determined. Moreover, various climatic predictions of different countries were made

Assessment of sources and fate of nitrate in shallow groundwater of an agricultural area by using a multi-tracer approach

AbstractNitrate isotopic values are often used as a tool to understand sources of contamination in order to effectively manage groundwater quality. However, recent literature describes that biogeochemical reactions may modify these values. Therefore, data interpretation is difficult and often vague. We provide a discussion on this topic and complement the study using halides as comparative tracers assessing an aquifer underneath a sub-humid to humid region in NE Mexico. Hydrogeological information and stable water isotopes indicate that active groundwater recharge occurs in the 8000km2 study area under present-day climatic and hydrologic conditions. Nitrate isotopes and halide ratios indicate a diverse mix of nitrate sources and transformations. Nitrate sources include organic waste and wastewater, synthetic fertilizers and soil processes. Animal manure and sewage from septic tanks were the causes of groundwater nitrate pollution within orchards and vegetable agriculture. Dairy activities within a radius of 1000m from a sampling point significantly contributed to nitrate pollution. Leachates from septic tanks caused nitrate pollution in residential areas. Soil nitrogen and animal waste were the sources of nitrate in groundwater under shrubland and grassland. Partial denitrification processes helped to attenuate nitrate concentration underneath agricultural lands and grassland, especially during summer months

Use and Environmental Occurrence of Antibiotics in Freestall Dairy Farms with Manured Forage Fields

Environmental releases of antibiotics from concentrated animal feeding operations (CAFOs) are of increasing regulatory concern. This study investigates the use and occurrence of antibiotics in dairy CAFOs and their potential transport into first-encountered groundwater. On two dairies we conducted four seasonal sampling campaigns, each across 13 animal production and waste management systems and associated environmental pathways: application to animals, excretion to surfaces, manure collection systems, soils, and shallow groundwater. Concentrations of antibiotics were determined using on line solid phase extraction (OLSPE) and liquid chromatography-tandem mass spectrometry (LC/MS/MS) with electrospray ionization (ESI) for water samples, and accelerated solvent extraction (ASE) LC/MS/MS with ESI for solid samples. A variety of antibiotics were applied at both farms leading to antibiotics excretion of several hundred grams per farm per day. Sulfonamides, tetracyclines, and their epimers/isomers, and lincomycin were most frequently detected. Yet, despite decades of use, antibiotic occurrence appeared constrained to within farm boundaries. The most frequent antibiotic detections were associated with lagoons, hospital pens, and calf hutches. When detected below ground, tetracyclines were mainly found in soils, whereas sulfonamides were found in shallow groundwater reflecting key differences in their physicochemical properties. In manure lagoons, 10 compounds were detected including tetracyclines and trimethoprim. Of these 10, sulfadimethoxine, sulfamethazine, and lincomycin were found in shallow groundwater directly downgradient from the lagoons. Antibiotics were sporadically detected in field surface samples on fields with manure applications, but not in underlying sandy soils. Sulfadimethoxine and sulfamethazine were detected in shallow groundwater near field flood irrigation gates, but at highly attenuated levels

2-Hydrazonyl-Propandihydrazide - A Versatile Precursor for High-Energy Materials

In this work, 2-hydrazonyl-propandihydrazide (2), a new precursor for energetic materials based on diethyl 2,2-diazidomalonate (1) was investigated. Therefore, its versatility was shown by various secondary reactions, including formation of energetic salts (3-5), the synthesis of a nitrogen-rich bistriazole (10) and a highly instable diazido derivative (6). In addition, a Curtius degradation could be observed in detail. When possible, the compounds were analyzed by low temperature X-ray diffraction. All measurable compounds were analyzed by H-1 and C-13 NMR spectroscopy, elemental analysis, differential thermal analysis (DTA) and regarding their sensitivity towards impact and friction according to BAM standard techniques. All promising compounds were evaluated regarding their energetic behavior using the EXPLO5 code (V6.05) and compared to RDX and CL-20. In addition, compound 2 was investigated towards its aquatic toxicity, using the bioluminescent bacteria vibrio fischeri