ETHICAL AND ORGANISATIONAL CONSIDERATIONS IN SCREENING FOR DEMENTIA

The United Kingdom National Screening Committee (UKNSC) defines screening as “the process of identifying individuals who may be at higher risk of a disease or condition amongst large populations of healthy people”. Building on foundations laid by Wilson and Jungner in the landmark paper in 1968, the UKNSC states that “Once identified, those individuals can consider further tests, and healthcare providers can offer them interventions of benefit. A screening programme needs to offer more benefit than harm, at a reasonable cost to the NHS” (gov.uk 2014). We will consider the ethical issues surrounding some of the UK’s screening programmes and other methods used to assess and communicate patients’ risk of disease. We will discuss the appropriateness of candidate dementia biomarkers in order to inform research into developing such a biomarker or series of biomarkers

ETHICAL AND ORGANISATIONAL CONSIDERATIONS IN SCREENING FOR DEMENTIA

The United Kingdom National Screening Committee (UKNSC) defines screening as “the process of identifying individuals who may be at higher risk of a disease or condition amongst large populations of healthy people”. Building on foundations laid by Wilson and Jungner in the landmark paper in 1968, the UKNSC states that “Once identified, those individuals can consider further tests, and healthcare providers can offer them interventions of benefit. A screening programme needs to offer more benefit than harm, at a reasonable cost to the NHS” (gov.uk 2014). We will consider the ethical issues surrounding some of the UK’s screening programmes and other methods used to assess and communicate patients’ risk of disease. We will discuss the appropriateness of candidate dementia biomarkers in order to inform research into developing such a biomarker or series of biomarkers

The importance of boundary objects in industry-academia collaborations to support evidencing the efficacy of educational technology

The context of a 2.5 year academia-led programme for the educational technology sector in the United Kingdom is used to explore the role of logic models as boundary objects to support the programme objectives. The programme provided educational research training and mentoring to participants from 252 small and medium-sized enterprises to support them with the use of existing and self-generated evidence of the efficacy of their educational technologies. Participants from a deliberate sample of six enterprises were interviewed to elicit their perceptions of the process through which the creation and use of a logic model for their product or service did or did not become a useful tool to support their research and business goals. The results suggest that logic models have vital roles as boundary objects in this context, such as supporting communication, learning, and product development. The study offers a first-case example of how logic models can be used in the design of educational technology, responding to the call for research in this area. A discussion on the challenges associated with the use of the logic model in the context of the project concludes the article

A Primer on Hobby Lobby: For-Profit Corporate Entities\u27 Challenge to the HHS Mandate, Free Exercise Rights, RFRA\u27s Scope, and the Nondelegation Doctrine

Earlier this term, the United States Supreme Court heard oral argument in the consolidated case of Hobby Lobby Stores, Inc. v. Sebelius, the first of a litany of cases in which for-profit business entities are invoking the Religious Freedom Restoration Act ( RFRA ) in support of their claim that the Affordable Care Act’s HHS Mandate violates their freedom of religion. In particular, these plaintiffs argue that the Mandate’s requirement that employer-provided health insurance covers the costs of contraceptives, the morning after pill, and other fertility-related drugs conflicts with their deeply-held religious belief that life begins at conception and is, therefore, unconstitutional. While the Mandate does exempt religious employers from this requirement, it does not excuse all secular, for-profit corporations from complying simply because their officers, founders, or directors may have religious beliefs that conflict with the Mandate’s provisions. Authors Day and Diaz were sitting just feet away from the advocates during the riveting Hobby Lobby oral argument. One question by Justice Kennedy piqued their interest in the nondelegation doctrine and the principle of separation of powers as they apply to the HHS Mandate. In the first academic article authored during the crucial time between oral arguments and the Court’s decision, this paper breaks down the complex legal issues and provides a solid dose of common sense in analyzing what will ultimately be a decision with momentous and far-reaching consequences. First, this Article sets the stage for the Court’s forthcoming decision by providing some background and insight into the parties’ arguments, the history of free exercise jurisprudence, and RFRA, the centerpiece of Hobby Lobby’s claim. The Article poses critical and timely questions, such as whether this decision will reinstate or expand the pre-Smith standard for assessing religious exercise claims and whether Hobby Lobby, as a for-profit commercial business, has standing under RFRA to bring a free exercise claim. Second, this Article deconstructs the complexities of RFRA, providing a step-by-step analysis of its legal framework. It first provides a comprehensive overview of the dense substantial burden inquiry, which asks whether the government has imposed a substantial burden on the plaintiffs’ religious beliefs. Then, it outlines and analyzes the strict scrutiny standard, which RFRA applies. Next, the Article simplifies the complex and less widely-discussed nondelegation doctrine and addresses the dangerous trend spreading countrywide, in which states are enacting their own RFRA laws to exempt religious employers from complying with public accommodation laws. These exemptions essentially condone a new wave of discrimination, which give license to wedding vendors and other businesses to refuse service to same-sex couples or homosexual patrons. Lastly, the Article cautions that, in the wake of Hobby Lobby and the other RFRA cases, where the clash between religion, politics, and the law have met head-on, this Court must be cautious not to set a dangerous precedent and shield for-profit, secular businesses from liability when they fail to comply with public accommodation laws based on their asserted religious beliefs. Not only do we face a crucial crossroad in this Country’s free exercise jurisprudence, we also risk overlooking an impermissible delegation of legislative authority, which, when coupled with deference to administrative decision-making, threatens the constitutional structure and separation of powers. An accretion of administrative agency power -- the headless fourth branch of government -- threatens all of our rights, not just religious freedom

DEPRESSION AND DRY EYE DISEASE: A NEED FOR AN INTERDISCIPLINARY APPROACH?

A recent meta-analysis including data from 22 studies including 2.9 million patients found that anxiety and depression are more prevalent in patients with dry eye disease (DED) than in controls. DED is a common disorder of the tear film which can cause ocular irritation, foreign body sensation and visual disturbance. However there is often a great discrepancy between signs and symptoms of DED, which the symptoms often being more associated with non-ocular disorders such as depression and PTSD than to tear film parameters. In this way it could be considered as more of a psychiatric than ophthalmic complaint. DED and depression feedback on one another in a synergistic manner. Severity of DED is associated with symptoms of anxiety and depression. Treatment of DED could help reduce depression symptoms, but also effective management of depression could help alleviate symptoms of DED. Complicating this however is the evidence that SSRIs can exacerbate DED. This makes the management of these comorbidities more difficult, however there are putative therapeutic targets which may be a source of future treatments for DED-associated depression. In conclusion, it is clear that DED and depression are closely linked and influence one another in ways that drastically affect patients’ lives. Collaboration between psychiatrists and ophthalmologists could be beneficial in the management of those with DED

Impact of patient characteristics on the risk of influenza/ILI-related complications

BACKGROUND: We sought to quantify the impact of patient characteristics on complications and health care costs associated with influenza and influenza-like illness (ILI) in a nonelderly population. METHODS: Patients with medical reimbursement claims for influenza in the 1996–1997 season were identified from the automated database of a large private New England Insurer (NEI). Influenza care during the 21- day follow-up period was characterized according to age, gender, vaccine status, co-morbidities, prior influenza/ILI episodes, treatments, and recent health care costs and related diagnoses. RESULTS: There were 6,241 patients. Approximately 20% had preexisting chronic lung disease. Overall, 23% had health care services for possible complications, among which respiratory diagnoses were the most common (13%). Two percent of the influenza/ILI episodes involved hospitalization, with a median stay of five days. Factors most strongly predictive of hospitalizations and complications were preexisting malignancy (hospitalizations OR = 3.7 and complications OR = 2.4), chronic heart disease (OR = 3.2 and OR = 1.8), diabetes (OR = 2.2 and OR = 1.7) and recent illnesses that would have counted as complications had they occurred during an influenza/ILI episode (hospitalizations OR = 3.2 and complications OR = 1.5). The same factors affected influenza-related costs and total costs of care as dramatically as they affected complication rates. CONCLUSIONS: Influenza/ILI-related costs are driven by the characteristics that predict complications of influenza. Patients with chronic illness and those with recent acute respiratory events are the most likely to experience complications and hospitalizations

Supporting small and medium-sized enterprises in the educational technology sector to become more research-minded: Introduction to a small collection

The EDUCAtional Technology Exchange programme (EDUCATE) at UCL Institute of Education provides the context for this paper, which describes the programme’s vision, objectives and key activities, and sets the context for the collection of articles that follow. This university-led programme was underpinned by Luckin’s (2016) golden triangle of evidence-informed educational technology (edtech) as it sought to support 252 small and medium-sized enterprises to become more research-informed through a six-month research training and mentoring programme. The evaluation of the programme’s design-based research cycles revealed the importance of the careful choice and evolution of its boundary objects. These boundary objects, namely each enterprise’s ‘logic model’ and research proposal, facilitated meaningful conversations between the programme’s research mentors and the enterprises. These boundary objects involved several iterations, during which the language of the two communities became more aligned, helping to bridge the academic knowledge and practices with those of the enterprises

Controlled dehydration of a ruthenium complex-DNA crystal induces reversible DNA kinking

Hydration-dependent DNA deformation has been known since Rosalind Franklin recognised that the relative humidity of the sample had to be maintained to observe a single conformation in DNA fibre diffraction. We now report for the first time the crystal structure, at the atomic level, of a dehydrated form of a DNA duplex and demonstrate the reversible interconversion to the hydrated form at room temperature. This system, containing d(TCGGCGCCGA) in the presence of Λ-[Ru(TAP)2(dppz)]2+ (TAP = 1,4,5,8-tetraazaphenanthrene, dppz = dipyridophenazine), undergoes a partial transition from an A/B hybrid to the A-DNA conformation, at 84-79% relative humidity. This is accompanied by an increase in kink at the central step from 22° to 51°, with a large movement of the terminal bases forming the intercalation site. This transition is reversible on rehydration. Seven datasets, collected from one crystal at room temperature, show the consequences of dehydration at near-atomic resolution. This result highlights that crystals, traditionally thought of as static systems, are still dynamic and therefore can be the subject of further experimentation