2,275 research outputs found

    The Quiet Period in a Noisy World: Rethinking Securities Regulation and Corporate Free Speech

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    Women as moral pioneers? Experiences of first trimester antenatal screening

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    Copyright @ 2005 Elsevier Ltd.The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as ‘moral pioneers’. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as ‘moral pioneers’ in increasingly complex settings.ESRC/MRC Innovative Health Technologies Programme for funding the project (grant no: L218252042). CW acknowledges the support of The Wellcome Trust Biomedical Ethics Programme in funding her postdoctoral fellowship, which enabled her to work on this project

    Detection of bondline delaminations in multilayer structures with lossy components

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    The detection of bondline delaminations in multilayer structures using ultrasonic reflection techniques is a generic problem in adhesively bonded composite structures such as the Space Shuttles's Solid Rocket Motors (SRM). Standard pulse echo ultrasonic techniques do not perform well for a composite resonator composed of a resonant layer combined with attenuating layers. Excessive ringing in the resonant layer tends to mask internal echoes emanating from the attenuating layers. The SRM is made up of a resonant steel layer backed by layers of adhesive, rubber, liner and fuel, which are ultrasonically attenuating. The structure's response is modeled as a lossy ultrasonic transmission line. The model predicts that the acoustic response of the system is sensitive to delaminations at the interior bondlines in a few narrow frequency bands. These predictions are verified by measurements on a fabricated system. Successful imaging of internal delaminations is sensitive to proper selection of the interrogating frequency. Images of fabricated bondline delaminations are presented based on these studies

    Prospective randomized study evaluating an absorbable cyanoacrylate for use in vascular reconstructions

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    BackgroundAn easy-to-use vascular sealant with good safety and efficacy is needed to prevent anastomotic bleeding in vascular surgery. This study evaluated the safety and efficacy of cyanoacrylate surgical sealant in establishing hemostasis of expanded polytetrafluoroethylene to arterial vascular anastomoses in arteriovenous (AV) grafts and femoral bypass grafts.MethodsThis multicenter, randomized, controlled, open-label study was conducted in a hospital setting at 12 sites: 10 in the United States and 2 in Europe. A total of 151 patients undergoing femoral bypass procedures or AV shunt procedures for hemodialysis access using expanded polytetrafluoroethylene grafts were randomized 2:1 to receive cyanoacrylate surgical sealant or the control (oxidized cellulose) between April 26, 2004, and January 18, 2005. Randomization was stratified by clinical site and type of procedure. After the anastomosis, cyanoacrylate surgical sealant or the control was applied to all anastomosis sites for patients undergoing femoral bypass procedures and to only the arterial anastomosis sites for patients undergoing AV shunt procedures. The primary end point was the elapsed time from clamp release to hemostasis. Secondary end points were the proportion of patients achieving hemostasis at t = 0 (immediate), 1, 5, or 10 minutes after clamp release, use of additional adjunctive measures to achieve hemostasis, and occurrence of adverse events.ResultsBaseline demographics and clinical characteristics showed that the two treatment groups were similar at baseline. The mean time from clamp release to hemostasis was 119.3 seconds with cyanoacrylate surgical sealant vs 403.8 seconds with the control (P < .001). Immediate hemostasis was achieved in 54.5% of patients receiving cyanoacrylate surgical sealant and in 10% of those receiving the control. The proportion of patients requiring additional adjunctive measures was lower with cyanoacrylate surgical sealant, and the occurrence of adverse events was similar in both groups.ConclusionsThis study demonstrates that cyanoacrylate surgical sealant is effective at reducing the time to hemostasis and achieving immediate hemostasis in AV shunt and femoral bypass procedures and that it is safe for internal use. Cyanoacrylate surgical sealant is an easy-to-use vascular sealant with good safety and efficacy that significantly decreases anastomotic bleeding in vascular surgery

    Mesoamerican Reef Spawning Aggregations Help Maintain Fish Population: A Review of Connectivity Research and Priorities for Science Management

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    The life history of most marine organisms includes an obligate period of pelagic larval dispersal. Migration to spawning areas and pelagic dispersal is often well beyond the home range of these organisms. Designing marine protected areas to include a broad range of taxa and their various dispersal patterns is an important and daunting challenge. This paper addresses the issue of connectivity for one set of species in a limited geographic area. We focus on transient spawning reef fish within the Mesoamerican Reef and their connectivity. We divide our scientific review into four sections as follows: (1) ecological characterization of transient multi-species reef fish spawning aggregations, (2) oceanographic and biophysical modeling approaches for understanding connectivity, and (3) validation of models with observations. We conclude that the science behind connectivity is advancing rapidly on many fronts, but there are still large gaps, and it is still largely impossible for managers to apply the results of these studies in specific cases. We further recognize that human and political connectivity may be as important for management as the science behind it. Managers, scientists, fishermen, and politicians can and should embrace connectivity as an important factor in regional fisheries and marine biodiversity management. The collaborative design and implementation of networks of marine reserves that include multi-species spawning aggregation sites, critical nursery habitat, and their connectivity, are likely to provide an important contribution to reversing the decline in fisheries throughout the Gulf of Mexico and Caribbean Region

    Concealment, communication and stigma: The perspectives of HIV-positive immigrant Black African men and their partners living in the United Kingdom

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    This study explored the perspectives of Black men, originally from East Africa, living in the United Kingdom and their families on what it means to live with diagnosed HIV. This article reports on concealment of HIV-positive status as a strategy adopted by the affected participants to manage the flow of information about their HIV-positive status. Analysis of the data, collected using in-depth interviews involving 23 participants, found widespread selective concealment of HIV-positive status. However, a few respondents had ‘come out’ publicly about their condition. HIV prevention initiatives should recognise concealment as a vital strategy in managing communication about one’s HIV-positive status
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