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This chapter presents reflections on next-generation ethical issues by four deans at the University of Southern California: Public Policy, Medicine, Business, and Engineering. Each of the deans was asked to reflect on some of the important ethical issues that they believe we face today or that we will face in the near future. Their responses follow.
A significant gap exists between people awaiting an organ transplant and organ donors. The purpose of this study was to determine what percent of successful donors come from the emergency department (ED), whether there are any missed donors, and to identify factors associated with successful and missed donation.
This systematic review used electronic searches of EMBASE, MEDLINE, and CINAHL according to PRISMA guidelines on July 7, 2017. We included primary literature in adults describing successful and missed organ donation. Two authors independently screened articles, and discrepancies were resolved through consensus. Quality was assessed using the STROBE checklist.
This systematic review identified 1,058 articles, and 25 articles were included. For neurologic determination of death, ED patients comprised 4%–50% of successful donors and 3.6%–8.9% of successful donors for donation after circulatory determination of death. ED death reviews revealed up to 84% of missed neurologic determination of death, and 46.2% of missed circulatory determination of death donors who died in the ED are missed due to a failure to refer for consideration of organ donation. Clinical heterogeneity precluded pooling of the data to conduct a meta-analysis.
The ED is a source of actual and missed donors. Potential donors are often missed due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. ED healthcare professionals should be aware of organ donation referral protocols at their institution to ensure that no organ donors are missed.
England has recently started a new paediatric influenza vaccine programme using a live-attenuated influenza vaccine (LAIV). There is uncertainty over how well the vaccine protects against more severe end-points. A test-negative case–control study was used to estimate vaccine effectiveness (VE) in vaccine-eligible children aged 2–16 years of age in preventing laboratory-confirmed influenza hospitalisation in England in the 2015–2016 season using a national sentinel laboratory surveillance system. Logistic regression was used to estimate the VE with adjustment for sex, risk-group, age group, region, ethnicity, deprivation and month of sample collection. A total of 977 individuals were included in the study (348 cases and 629 controls). The overall adjusted VE for all study ages and vaccine types was 33.4% (95% confidence interval (CI) 2.3–54.6) after adjusting for age group, sex, index of multiple deprivation, ethnicity, region, sample month and risk group. Risk group was shown to be an important confounder. The adjusted VE for all influenza types for the live-attenuated vaccine was 41.9% (95% CI 7.3–63.6) and 28.8% (95% CI −31.1 to 61.3) for the inactivated vaccine. The study provides evidence of the effectiveness of influenza vaccination in preventing hospitalisation due to laboratory-confirmed influenza in children in 2015–2016 and continues to support the rollout of the LAIV childhood programme.
The kidnapping by the local chief, O'Connor Faly, of Henry VIII's governor, Lord Delvin, in 1528 plunged the Dublin administration into crisis. Delvin was the most obvious – but not entirely surprising – casualty of an ingenious but flawed experiment by the king, aimed at bolstering as governor a reliable border baron by harnessing to his governorship the manraed of the traditional ruling magnate, so saving the cost to the king of a border garrison. Delvin's weak administration underlined the low priority accorded to Irish affairs at Henry VIII's court; but even after its predictable collapse, the king disclaimed responsibility. Against advice at court and in Ireland, the king then insisted on reappointing a previously unsuccessful governor, thus simply compounding the difficulties faced by the Dublin administration.
Flexible piezoelectric generators (PEGs) present a unique opportunity for renewable and sustainable energy harvesting. Here, we present a low-temperature and low-energy deposition method using solvent evaporation-assisted three-dimensional printing to deposit electroactive poly(vinylidene fluoride) (PVDF)-trifluoroethylene (TrFE) up to 19 structured layers. Visible-wavelength transmittance was above 92%, while ATR-FTIR spectroscopy showed little change in the electroactive phase fraction between layer depositions. Electroactivity from the fabricated PVDF-TrFE PEGs showed that a single structured layer gave the greatest output at 289.3 mV peak-to-peak voltage. This was proposed to be due to shear-induced polarization affording the alignment of the fluoropolymer dipoles without an electric field or high temperature.
This study used a combination of microlevel observation data and longitudinal questionnaire data to study the relationship between differential reactivity and differential susceptibility, guided by three questions: (a) Does a subset of children exist that is both more likely to respond with increasingly negative emotions to increasingly negative emotions of mothers and with increasingly positive emotions to increasingly positive emotions of mothers (“emotional reactivity”)? (b) Is emotional reactivity associated with temperament markers and rearing environment? (c) Are children who show high emotional reactivity “for better and for worse” also more susceptible to parenting predicting child behavior across a year? A total of 144 Dutch children (45.3% girls) aged four to six participated. Latent profile analyses revealed a group of average reactive children (87%) and a group that was emotionally reactive “for better and for worse” (13%). Highly reactive children scored higher on surgency and received lower levels of negative parenting. Finally, associations of negative and positive parenting with externalizing and prosocial behavior were similar (and nonsignificant) for highly reactive children and average reactive children. The findings suggest that children who are emotionally reactive “for better and for worse” within parent-child interactions are not necessarily more susceptible to parenting on a developmental time scale.
Significant increases in excess all-cause mortality, particularly in the elderly, were observed during the winter of 2014/15 in England. With influenza A(H3N2) the dominant circulating influenza A subtype, this paper determines the contribution of influenza to this excess controlling for weather. A standardised multivariable Poisson regression model was employed with weekly all-cause deaths the dependent variable for the period 2008–2015. Adjusting for extreme temperature, a total of 26 542 (95% CI 25 301–27 804) deaths in 65+ and 1942 (95% CI 1834–2052) in 15–64-year-olds were associated with influenza from week 40, 2014 to week 20, 2015. This is compatible with the circulation of influenza A(H3N2). It is the largest estimated number of influenza-related deaths in England since prior to 2008/09. The findings highlight the potential health impact of influenza and the important role of the annual influenza vaccination programme that is required to protect the population including the elderly, who are vulnerable to a severe outcome.
Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.
The aim of the survey is to sample a relatively large, randomly chosen volume of the Universe in order to study the large-scale distribution of galaxies using the two-point correlation function, the peculiar velocities between galaxy pairs and to provide an estimate of the galaxian luminosity function that is unaffected by density inhomogeneities and Virgo infall.
A global array of 20 radio observatories was used to measure the three-dimensional position and velocity of the two meteorological balloons that were injected into the equatorial region of the Venus atmosphere by the VEGA spacecraft.
In autumn 2014, enterovirus D68 (EV-D68) cases presenting with severe respiratory or neurological disease were described in countries worldwide. To describe the epidemiology and virological characteristics of EV-D68 in England, we collected clinical information on laboratory-confirmed EV-D68 cases detected in secondary care (hospitals), between September 2014 and January 2015. In primary care (general practitioners), respiratory swabs collected (September 2013–January 2015) from patients presenting with influenza-like illness were tested for EV-D68. In secondary care 55 EV-D68 cases were detected. Among those, 45 cases had clinical information available and 89% (40/45) presented with severe respiratory symptoms. Detection of EV-D68 among patients in primary care increased from 0.4% (4/1074; 95% CI 0.1–1.0) (September 2013–January 2014) to 0.8% (11/1359; 95% CI 0.4–1.5) (September 2014–January 2015). Characterization of EV-D68 strains circulating in England since 2012 and up to winter 2014/2015 indicated that those strains were genetically similar to those detected in 2014 in USA. We recommend reinforcing enterovirus surveillance through screening respiratory samples of suspected cases.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.
For the past ten years Metalysis have produced tantalum, titanium and titanium alloy powders for high performance applications using their solid state salt electrolysis process. This low energy and environmentally friendly process is now being used to manufacture the next generation of High Entropy Alloys (HEAs).
In most cases the manufacture of HEAs involves high temperatures which put all of the alloying elements into the liquid phase. This can lead to numerous problems and restrict the number of HEAs which can be made, particularly the alloys where one needs to combine low melting point elements with refractory elements and also where there are significant liquid density differences between the constituents causing melt segregation.
The aim is to present the preliminary work carried out by Metalysis and to show how the solid state diffusion process based on molten salt electrolysis lends itself to the industrial scale manufacture of the next generation of HEAs. This study will focus on the HEAs whose constituent alloying elements have large differences in both their melting points and liquid densities, for example, chromium, niobium, tantalum, titanium and aluminum.
The ability of the Utah energy-balance and snowmelt model (UEB) to simulate decline in snow water equivalent (SWE) at an extreme location was assessed. Field data were collected at Paternoster Valley, Signy Island, South Orkney Islands (60°43′S) during the austral summer of 1996–97. This is the first application of UEB in a maritime Antarctic site. UEB is a physically based snow melt model using a lumped snow-pack representation with primary state variables SWE and snow pack-energy content (U). Meteorological inputs are air temperature, wind speed, humidity, precipitation and total incoming solar and longwave radiation. The Paternoster Valley catchment was subdivided into eight non-contiguous terrain classes for sampling and modelling using a geographical information system (GIS). Simulations of SWE in each of these classes were compared พ with field observations. It is shown that initial U and snow-surface thermal conductance (Ks) affect model simulations. Good approximations of SWE depletion are obtained using measured incoming solar radiation to drive the model but there are shortcomings in the characterization of long wave radiation and sensible-heat fluxes.
Human parainfluenza virus (HPIV) infections are one of the commonest causes of upper and lower respiratory tract infections. In order to determine if there have been any recent changes in HPIV epidemiology in England and Wales, laboratory surveillance data between 1998 and 2013 were analysed. The UK national laboratory surveillance database, LabBase, and the newly established laboratory-based virological surveillance system, the Respiratory DataMart System (RDMS), were used. Descriptive analysis was performed to examine the distribution of cases by year, age, sex and serotype, and to examine the overall temporal trend using the χ2 test. A random-effects model was also employed to model the number of cases. Sixty-eight per cent of all HPIV detections were due to HPIV type 3 (HPIV-3). HPIV-3 infections were detected all year round but peaked annually between March and June. HPIV-1 and HPIV-2 circulated at lower levels accounting for 20% and 8%, respectively, peaking during the last quarter of the year with a biennial cycle. HPIV-4 was detected in smaller numbers, accounting for only 4% and also mainly observed in the last quarter of the year. However, in recent years, HPIV-4 detection has been reported much more commonly with an increase from 0% in 1998 to 3·7% in 2013. Although an overall higher proportion of HPIV infection was reported in infants (43·0%), a long-term decreasing trend in proportion in infants was observed. An increase was also observed in older age groups. Continuous surveillance will be important in tracking any future changes.