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It took nearly two thousand years for society to recognize the Hippocratic insistence that “the doctor knows best”1 was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.2
This paper examines and critiques the ethical issues in postmortem sperm retrieval and the use of postmortem sperm to create new life. The article was occasioned by the recent request of the parents of a West Point cadet who died in a skiing accident at the Academy to retrieve and use his sperm to honor his memory and perpetuate the family name. The request occasioned national media attention. A trial court judge in New York in a two-page order authorized both the retrieval and use of the postmortem sperm.
Trapping experiments have been performed at the Idaho National Laboratory to assess the performance of AgX sorbent media in capturing volatile iodine during the oxidation of irradiated oxide fuel. The demonstration of iodine release and capture from the used fuel has been accomplished with laboratory-scale equipment in a hot cell environment. Iodine loadings as high as 6 ug/g media have been achieved via chemical adsorption with filter efficiencies in excess of 90%. In addition to iodine, significant quantities of tritium have also been collected on the AgX filter media. Filter media loaded with radioactive iodine has been sequestered in a tin matrix by hot isostatic pressing at 200°C. The placement and encapsulation of the sorbent media was examined by neutron radiography, thus confirming the sequestration of radioactive iodine.
To describe and investigate the cause of an outbreak of 10 cases of nosocomial invasive infection with Aspergillus flavus in a hematologic oncology patient care unit.
A retrospective cohort study.
The hematologic oncology unit of a comprehensive cancer center.
Ninety-one patients admitted to the hematologic oncology service between January 1 and December 31,1992, for 4 or more consecutive days were included in the study.
Ten (18%) of 55 patients admitted from July to December 1992 were diagnosed as having invasive aspergillosis compared with 0 (0%) of 36 patients admitted from January to June 1992 to the same patient care units. Patient characteristics, mortality rate, autopsy rate, and admitting location did not change significantly during the course of the year to result in a sudden increase in the number of aspergillosis cases. The source of the outbreak was the high counts of Aspergillus conidia determined from air sampling in the non–bone marrow transplant wing during the outbreak. After high-efficiency particulate air (HEPA) filters were installed as an infection control measure, there were only two additional cases of nosocomial aspergillosis in the 2 years following the outbreak.
This outbreak occurred among hematologic oncology patients with prolonged granulocytopenia housed in an environment with neither HEPA filters nor laminar air flow units. Our data demonstrate that in the setting of an outbreak of aspergillosis, HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination with Aspergillus conidia.
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