Interveners or Interferers: Intervention in Decisions to Withhold and Withdraw Life-Sustaining Medical Treatment

This article considers intervention in proceedings about withholding and withdrawing life-sustaining medical treatment. Since the early 1990s, there have been a number of important decisions, both in Australia and overseas, about whether life-sustaining treatment should be withheld or withdrawn from an adult who no longer has capacity to make the decision for himself or herself. In almost all of these decisions, intervention by a non-party to the matter has been an issue. This article explores the rules of intervention in applications to appear as a party and as amicus curiae, and considers those rules in the context of decisions to withhold and withdraw life-sustaining medical treatment. The relevant cases are examined as are the advantages and disadvantages of intervention in these circumstances. The article concludes by suggesting a model for intervention that strikes the appropriate balance between ensuring all relevant issues are placed before the court while still respecting the intensely private nature of a decision to withhold or withdraw a life-sustaining measure in any given case

Challenging the Health Impacts of Incarceration: The Role for Community Health Workers

With 2.1 million Americans behind bars, the United States incarcerates more people per capita than any other country in the world. This article examines the ways mass incarceration contributes to poor health, particularly within poor communities and communities of color, which already bear a disproportionate burden of ill-health and disease. We explore the multiple health impacts of incarceration and the ways current criminal justice policies contribute to health disparities. We discuss the role of Community Health Workers in mitigating the effects of incarceration by fostering social support, linking formerly incarcerated individuals with existing community services and acting as agents for social change

Into the Andes: multiple independent colonizations drive montane diversity in the Neotropical clearwing butterflies Godyridina.

Understanding why species richness peaks along the Andes is a fundamental question in the study of Neotropical biodiversity. Several biogeographic and diversification scenarios have been proposed in the literature, but there is confusion about the processes underlying each scenario, and assessing their relative contribution is not straightforward. Here, we propose to refine these scenarios into a framework which evaluates four evolutionary mechanisms: higher speciation rate in the Andes, lower extinction rates in the Andes, older colonization times and higher colonization rates of the Andes from adjacent areas. We apply this framework to a species-rich subtribe of Neotropical butterflies whose diversity peaks in the Andes, the Godyridina (Nymphalidae: Ithomiini). We generated a time-calibrated phylogeny of the Godyridina and fitted time-dependent diversification models. Using trait-dependent diversification models and ancestral state reconstruction methods we then compared different biogeographic scenarios. We found strong evidence that the rates of colonization into the Andes were higher than the other way round. Those colonizations and the subsequent local diversification at equal rates in the Andes and in non-Andean regions mechanically increased the species richness of Andean regions compared to that of non-Andean regions ('species-attractor' hypothesis). We also found support for increasing speciation rates associated with Andean lineages. Our work highlights the importance of the Andean slopes in repeatedly attracting non-Andean lineages, most likely as a result of the diversity of habitats and/or host plants. Applying this analytical framework to other clades will bring important insights into the evolutionary mechanisms underlying the most species-rich biodiversity hotspot on the planet

From KIDSCREEN-10 to CHU9D: creating a unique mapping algorithm for application in economic evaluation

Background: The KIDSCREEN-10 index and the Child Health Utility 9D (CHU9D) are two recently developed generic instruments for the measurement of health-related quality of life in children and adolescents. Whilst the CHU9D is a preference based instrument developed specifically for application in cost-utility analyses, the KIDSCREEN-10 is not currently suitable for application in this context. This paper provides an algorithm for mapping the KIDSCREEN-10 index onto the CHU9D utility scores. Methods: A sample of 590 Australian adolescents (aged 11–17) completed both the KIDSCREEN-10 and the CHU9D. Several econometric models were estimated, including ordinary least squares estimator, censored least absolute deviations estimator, robust MM-estimator and generalised linear model, using a range of explanatory variables with KIDSCREEN-10 items scores as key predictors. The predictive performance of each model was judged using mean absolute error (MAE) and root mean squared error (RMSE). Results: The MM-estimator with stepwise-selected KIDSCREEN-10 items scores as explanatory variables had the best predictive accuracy using MAE, whilst the equivalent ordinary least squares model had the best predictive accuracy using RMSE. Conclusions: The preferred mapping algorithm (i.e. the MM-estimate with stepwise selected KIDSCREEN-10 item scores as the predictors) can be used to predict CHU9D utility from KIDSCREEN-10 index with a high degree of accuracy. The algorithm may be usefully applied within cost-utility analyses to generate cost per quality adjusted life year estimates where KIDSCREEN-10 data only are available

The Schiavo Decision: Emotional, But Legally Controversial?

Although the decision to withdraw artificial nutrition and hydration from Terri Schiavo attracted an enormous amount of international publicity, from a legal perspective the decision was unsurprising. This article explores this view by comparing the law that governs the withholding or withdrawal of life-sustaining medical treatment in Florida where the Schiavo decision was made, and the equivalent law in Queensland. It concludes that although the legislation is expressed in different terms, the same decision would be reached if a case similar to Terri Schiavo's arose in Queensland. Indeed, it is suggested that this conclusion is also likely to be reached in other common law jurisdictions

Interveners or interferers: Intervention in decisions to withhold and withdraw life-sustaining medical treatment

This article considers intervention in proceedings about withholding and withdrawing life-sustaining medical treatment. Since the early 1990s, there have been a number of important decisions, both in Australia and overseas, about whether life-sustaining treatment should be withheld or withdrawn from an adult who no longer has capacity to make the decision for himself or herself. In almost all of these decisions, intervention by a non-party to the matter has been an issue. This article explores the rules of intervention in applications to appear as a party and as amicus curiae, and considers those rules in the context of decisions to withhold and withdraw life-sustaining medical treatment. The relevant cases are examined as are the advantages and disadvantages of intervention in these circumstances. The article concludes by suggesting a model for intervention that strikes the appropriate balance between ensuring all relevant issues are placed before the court while still respecting the intensely private nature of a decision to withhold or withdraw a life-sustaining measure in any given case

Diversification of clearwing butterflies with the rise of the Andes

Abstract Aim Despite the greatest butterfly diversity on Earth occurring in the Neotropical Andes and Amazonia, there is still keen debate about the origins of this exceptional biota. A densely sampled calibrated phylogeny for a widespread butterfly subtribe, Oleriina (Nymphalidae: Ithomiini) was used to estimate the origin, colonization history and diversification of this species‐rich group. Location Neotropics. Methods: Ancestral elevation and biogeographical ranges were reconstructed using data generated from detailed range maps and applying the dispersal‐extinction‐cladogenesis model using stratified palaeogeographical time slice matrices. The pattern of diversification through time was examined by comparing constant and variable rate models. We also tested the hypothesis that a change in elevation is associated with speciation. Results: The Oleriina likely originated in the Andes in the Early to Middle Miocene and rapidly diversified to include four genera all of which also originated in the Andes. These clades, together with four species groups, experienced varying spatial and temporal patterns of diversification. An overall early burst and decreasing diversification rate is identified, and this pattern is reflected for most subclades. Main conclusions Changes in the palaeogeological landscape, particularly the prolonged uplift of the Andes, had a profound impact on the diversification of the subtribe. The Oleriina mostly remained within the Andes and vicariant speciation resulted in some instances. Dynamic dispersal occurred with the disappearance of geological barriers such as the Acre System and the subtribe exploited newly available habitats. Our results confirm the role of the Andean uplift in the evolution of Neotropical biodiversity

Contrasting patterns of Andean diversification among three diverse clades of Neotropical clearwing butterflies

Abstract The Neotropical region is the most biodiverse on Earth, in a large part due to the highly diverse tropical Andean biota. The Andes are a potentially important driver of diversification within the mountains and for neighboring regions. We compared the role of the Andes in diversification among three subtribes of Ithomiini butterflies endemic to the Neotropics, Dircennina, Oleriina, and Godyridina. The diversification patterns of Godyridina have been studied previously. Here, we generate the first time‐calibrated phylogeny for the largest ithomiine subtribe, Dircennina, and we reanalyze a published phylogeny of Oleriina to test different biogeographic scenarios involving the Andes within an identical framework. We found common diversification patterns across the three subtribes, as well as major differences. In Dircennina and Oleriina, our results reveal a congruent pattern of diversification related to the Andes with an Andean origin, which contrasts with the Amazonian origin and multiple Andean colonizations of Godyridina. In each of the three subtribes, a clade diversified in the Northern Andes at a faster rate. Diversification within Amazonia occurred in Oleriina and Godyridina, while virtually no speciation occurred in Dircennina in this region. Dircennina was therefore characterized by higher diversification rates within the Andes compared to non‐Andean regions, while in Oleriina and Godyridina, we found no difference between these regions. Our results and discussion highlight the importance of comparative approaches in biogeographic studies