Transplant Candidates and Substance Use: Adopting Rational Health Policy for Resource Allocation

Organ transplant candidates are often denied life saving organs on account of their medical marijuana drug use. Individuals who smoke medicinal marijuana are typically classified as substance abusers, and ultimately deemed ineligible for transplantation, despite their receipt of the drug under a physician\u27s supervision and prescription. However, patients who smoke cigarettes or engage in excessive alcohol consumption are routinely considered for placement on the national organ transplant waiting list. Transplant facilities have the freedom to regulate patient selection criteria with minimal oversight. As a result, the current organ allocation system in the United States is rife with inconsistencies and results in disparities in allocation decisions. This Article reviews the history and underlying rationale of organ allocation in the United States and the National Organ Transplant Act. It then examines ill-founded policies regarding transplant candidates who present issues of substance abuse compared with substance use, and the resulting disparities in waiting-list criteria. In response, a model rule for a national set of patient selection guidelines is provided. Definitions of terms, distinctions regarding proper patient classification, and protocols for a second chance policy to be used in the event of a relapse among wait-listed patients are addressed. Finally, stipulations that require designated abstention periods as well as random drug screenings in relation to subsequent relisting are also included. This policy distinguishes between candidates who present issues of substance use versus substance abuse. The use of such a model allocation policy will promote equity and scientific bases in the organ allocation process

New taxa of Neotropical Geophilomorpha (Chilopoda)

A new family (Macronicophilidae) is establishedflor Macronicophilus Silvestri, 1909, currently placed in Geophilidae. Seven new species of Neotropical Geophilomorpha are described: Ityphilus saucius n.sp. and I. sensibilis n.sp. (Ballophilidae), Hyphydrophilus projectus n.sp. and Ribautia onycophaena n.sp. (Geophilidae), Macronicophilus abbreviatus n.sp., M. unguiseta n.sp. and M. venezolanus n.sp. (Macronicophilidae). The hitherto unknown male of Schendylops marchantariae (PEREIRA, MINELLI & BARBIERI, 1995) is described and two species (Pectiniunguis geayi (BRÖLEMANN & RIBAUT, 1911) and ltyphilus calinus CHAMBERLIN, 1957 are redescribed from the type and new material. A key to the species of Macronicophilus is provided

Robotic versus laparoscopic approach in colonic resections for cancer and Benign diseases. Systematic review and meta-analysis

Objectives The aim of this systematic review and meta-Analysis is to compare robotic colectomy (RC) with laparoscopic colectomy (LC) in terms of intraoperative and postoperative outcomes. Materials and Methods A systematic literature search was performed to retrieve comparative studies of robotic and laparoscopic colectomy. The databases searched were PubMed, Embase and the Cochrane Central Register of Controlled Trials from January 2000 to October 2014. The Odds ratio, Risk difference and Mean difference were used as the summary statistics. Results A total of 12 studies, which included a total of 4,148 patients who had undergone robotic or laparoscopic colectomy, were included and analyzed. RC demonstrated a longer operative time (MD 41.52, P<0.00001) and higher cost (MD 2.42, P<0.00001) than did LC. The time to first flatus passage (MD-0.51, P = 0.003) and the length of hospital stay (MD-0.68, P = 0.01) were significantly shorter after RC. Additionally, the intraoperative blood loss (MD-16.82, P<0.00001) was significantly less in RC. There was also a significantly lower incidence of overall postoperative complications (OR 0.74, P = 0.02) and wound infections (RD-0.02, P = 0.03) after RC. No differences in the postoperative ileus, in the anastomotic leak, or in the conversion to open surgery rate and in the number of harvested lymph nodes outcomes were found between the approaches. Conclusions The present meta-Analysis, mainly based on observational studies, suggests that RC is more time-consuming and expensive than laparoscopy but that it results in faster recovery of bowel function, a shorter hospital stay, less blood loss and lower rates of both overall postoperative complications and wound infections. Copyright: © 2015 Trastulli et al.OBJECTIVES: The aim of this systematic review and meta-analysis is to compare robotic colectomy (RC) with laparoscopic colectomy (LC) in terms of intraoperative and postoperative outcomes. MATERIALS AND METHODS: A systematic literature search was performed to retrieve comparative studies of robotic and laparoscopic colectomy. The databases searched were PubMed, Embase and the Cochrane Central Register of Controlled Trials from January 2000 to October 2014. The Odds ratio, Risk difference and Mean difference were used as the summary statistics. RESULTS: A total of 12 studies, which included a total of 4,148 patients who had undergone robotic or laparoscopic colectomy, were included and analyzed. RC demonstrated a longer operative time (MD 41.52, P<0.00001) and higher cost (MD 2.42, P<0.00001) than did LC. The time to first flatus passage (MD -0.51, P = 0.003) and the length of hospital stay (MD -0.68, P = 0.01) were significantly shorter after RC. Additionally, the intraoperative blood loss (MD -16.82, P<0.00001) was significantly less in RC. There was also a significantly lower incidence of overall postoperative complications (OR 0.74, P = 0.02) and wound infections (RD -0.02, P = 0.03) after RC. No differences in the postoperative ileus, in the anastomotic leak, or in the conversion to open surgery rate and in the number of harvested lymph nodes outcomes were found between the approaches. CONCLUSIONS: The present meta-analysis, mainly based on observational studies, suggests that RC is more time-consuming and expensive than laparoscopy but that it results in faster recovery of bowel function, a shorter hospital stay, less blood loss and lower rates of both overall postoperative complications and wound infections

A basic protocol for the acoustic characterization of small and medium-sized classrooms

To promote a fast and effective characterization of the sound environment in small and medium-sized classrooms, a basic measurement protocol, based on a minimum number of parameters and positions, is provided. Measurements were taken in 29 occupied classrooms belonging to 13 primary schools in Turin, Italy, that differ in location and typology. The background noise level was acquired during silent and group activities, and the reverberation time, speech clarity, useful-to-detrimental ratio and speech level, were acquired along the main axis of each classroom and in one or two offset positions. To reduce the number of measured parameters that can be used to fully characterize classroom acoustics, data were divided into two groups on the basis of a cutoff value of maximum occupied reverberation time in the case of moderate and severe requirements. Given the strong correlation among the quantities, thresholds were identified for the other acoustical parameters, and their accuracy and precision were tested to assess their ability to classify the acoustic quality as compliant or non-compliant. Results suggest that more convenient parameters, like clarity in the central position of the classroom, can be used instead of reverberation time to classify classroom acoustics

Liberal parentalism

What normative constraints should bind parents (or policy makers) if they intervene in the choices of children (or constituencies) whose preferences evolve over time? For a sophisticated child who anticipates correctly his preference change, we prove that generically there exist parental interventions that are Pareto improving over the backward induction path that the child will follow on his own. If, in contrast, the child misperceives his future preferences, Pareto improving interventions might not exist, and even nudges might be painfully sobering. The parent may then choose to minimize the maximal disappointment along time that her benevolent intervention would cause

The insect antenna: segmentation, patterning and positional homology

The basic mechanism by which the antennal flagellum is subdivided into flagellomeres is probably the same in all insects, irrespective of whether the process occurs in the embryo, in the eye/antenna imaginal disc, or through a series of post-embryonic increments punctuated by moults. The ultimate origin of (all?) flagellomeres is the first antennomere following the pedicel, from which split off in apical direction new primary flagellomeres, each of which is eventually the source of secondary flagellomeres, according to specific spatial and temporal patterns subject to heterochrony. Only a detailed knowledge of the underlying segmentation processes could provide the ultimate background for determining positional homology between flagellomeres of two antennae with different number of antennomeres. The antennae of the Heteroptera are likely re-segmented, as their second antennomere seems to include a flagellar component. The larval antennae of the holometabolans are temporal serial homologues of those of the adult, but their segmental composition is problematic. Significant progress will be done by understanding what differentiates antennomeres that divide, either embryonically or post-embryonically, from those that do not; and by discovering whether the spatial and temporal pattern of division along the flagellum depends on local cues, or on signals travelling along the whole proximo-distal axis of the appendage

Egg quality traits of laying hens reared in organic and conventional systems.

This study aims to compare the physico-chemical properties of eggs (weight, eggshell breakingstrength, Haugh index, yolk colour, lipid, cholesterol, protein, ash and dry matter) laid either by hens reared accordingto the organic method or by caged hens kept in conventional system. More than 1,400 eggs have been analysedat the beginning, in the middle and at the end of the laying cycle in organic and conventional farms. The eggobtained from the organic system were lighter (64.4 vs 66.2 g) being yolk, albumen and eggshell weights statisticallylower in comparison with those produced in conventional system. The yolk/albumen ratio resulted lower inthe organic eggs (0.38 vs 0.39). The percentage of eggshell was not affected by the hen rearing system while theeggshell strength resulted higher in the eggs produced in the conventional system (3.265 vs 3.135 kg). The organicyolks were paler than the conventional ones. Organic eggs showed significantly higher contents of protein (17.1%vs 16.7%) and cholesterol (1.26% vs 1.21%)