Requests by patients for providers of specific demographic backgrounds pose an ongoing challenge for hospitals, policymakers, and ethicists. These requests may stem from a wide variety of motivations; some may be consistent with broader societal values, although many others may reflect prejudices inconsistent with justice, equity, and decency. This paper proposes a taxonomy designed to assist healthcare institutions in addressing such cases in a consistent and equitable manner. The paper then reviews a range of ethical and logistical challenges raised by such requests and proposed guidance to consider when reviewing and responding to them.

Decades of research show that (i) social value orientation (SVO) is related to important behavioral outcomes such as cooperation and charitable giving, and (ii) individuals differ in terms of SVO. A prominent scale to measure SVO is the social value orientation slider measure (SVOSM). The central premise is that SVOSM captures a stable trait. But it is unknown how reliable the SVOSM is over repeated measurements more than one week apart. To fill this knowledge gap, we followed a sample of N = 495 over 6 months with monthly SVO measurements. We find that continuous SVO scores are similarly distributed (Anderson-Darling k-sample p = 0.57) and highly correlated (r ≥ 0.66) across waves. The intra-class correlation coefficient of 0.78 attests to a high test-retest reliability. Using multilevel modeling and multiple visualizations, we furthermore find that one’s prior SVO score is highly indicative of SVO in future waves, suggesting that the slider measure consistently captures one’s SVO. Our analyses validate the slider measure as a reliable SVO scale.

Interrupted time-series graphs are often judged by eye. Such a graph might show, for example, patient symptom severity (y) on each of several days (x) before and after a treatment was implemented (interruption). Such graphs might be prone to systematic misjudgment because of serial dependence, where random error at each timepoint persists into later timepoints. An earlier study (Matyas & Greenwood, 1990) showed evidence of systematic misjudgment, but that study has often been discounted due to methodological concerns. We address these concerns and others in two experiments. In both experiments, serial dependence increased mistaken judgments that the interrupting event led to a change in the outcome, though the pattern of results was less extreme than in previous work. Receiver operating characteristics suggested that serial dependence both decreased discriminability and increased the bias to decide that the interrupting event led to a change. This serial dependence effect appeared despite financial incentives for accuracy, despite feedback training, and even in participants who had graduate training relevant to the task. Serial dependence could cause random error to be misattributed to real change, thereby leading to judgments that interventions are effective even when they are not.

Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skills” approach. This essay proposes an alternative model that relies upon categorization and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient’s autonomy and ensure that her underlying wishes are met.

The Trump presidency generated concern about democratic backsliding and renewed interest in measuring the national democratic performance of the United States. However, the US has a decentralized form of federalism that administers democratic institutions at the state level. Using 51 indicators of electoral democracy from 2000 to 2018, I develop a measure of subnational democratic performance, the State Democracy Index. I then test theories of democratic expansion and backsliding based in party competition, polarization, demographic change, and the group interests of national party coalitions. Difference-in-differences results suggest a minimal role for all factors except Republican control of state government, which dramatically reduces states’ democratic performance during this period. This result calls into question theories focused on changes within states. The racial, geographic, and economic incentives of groups in national party coalitions may instead determine the health of democracy in the states.

The purpose of this investigation was to expand upon the limited existing research examining the test–retest reliability, cross-sectional validity and longitudinal validity of a sample of bioelectrical impedance analysis (BIA) devices as compared with a laboratory four-compartment (4C) model. Seventy-three healthy participants aged 19–50 years were assessed by each of fifteen BIA devices, with resulting body fat percentage estimates compared with a 4C model utilising air displacement plethysmography, dual-energy X-ray absorptiometry and bioimpedance spectroscopy. A subset of thirty-seven participants returned for a second visit 12–16 weeks later and were included in an analysis of longitudinal validity. The sample of devices included fourteen consumer-grade and one research-grade model in a variety of configurations: hand-to-hand, foot-to-foot and bilateral hand-to-foot (octapolar). BIA devices demonstrated high reliability, with precision error ranging from 0·0 to 0·49 %. Cross-sectional validity varied, with constant error relative to the 4C model ranging from −3·5 (sd 4·1) % to 11·7 (sd 4·7) %, standard error of the estimate values of 3·1–7·5 % and Lin’s concordance correlation coefficients (CCC) of 0·48–0·94. For longitudinal validity, constant error ranged from −0·4 (sd 2·1) % to 1·3 (sd 2·7) %, with standard error of the estimate values of 1·7–2·6 % and Lin’s CCC of 0·37–0·78. While performance varied widely across the sample investigated, select models of BIA devices (particularly octapolar and select foot-to-foot devices) may hold potential utility for the tracking of body composition over time, particularly in contexts in which the purchase or use of a research-grade device is infeasible.

The advent of modern, high-speed electron detectors has made the collection of multidimensional hyperspectral transmission electron microscopy datasets, such as 4D-STEM, a routine. However, many microscopists find such experiments daunting since analysis, collection, long-term storage, and networking of such datasets remain challenging. Some common issues are their large and unwieldy size that often are several gigabytes, non-standardized data analysis routines, and a lack of clarity about the computing and network resources needed to utilize the electron microscope. The existing computing and networking bottlenecks introduce significant penalties in each step of these experiments, and thus, real-time analysis-driven automated experimentation for multidimensional TEM is challenging. One solution is to integrate microscopy with edge computing, where moderately powerful computational hardware performs the preliminary analysis before handing off the heavier computation to high-performance computing (HPC) systems. Here we trace the roots of computation in modern electron microscopy, demonstrate deep learning experiments running on an edge system, and discuss the networking requirements for tying together microscopes, edge computers, and HPC systems.

We conducted a scientific survey of paediatric practitioners who manage heart failure with dilated cardiomyopathy in children. The survey covered management from diagnosis to treatment to monitoring, totalling 63 questions. There were 54 respondents from 40 institutions and 3 countries. There were diverse selections of management options by the respondents in general, but also unanimity in some management options. Variation in practice is likely due to the relative paucity of scientific data in this field and lack of strong evidence-based recommendations from guidelines, which presents an opportunity for future research and quality improvement efforts as the evidence base continues to grow.

This essay advocates for the wholesale reevaluation of the process used by American medical schools for selecting physicians, examining fundamental questions such as the purpose of physicians and the nature of meritocracy. It raises questions about the size of medical school classes, the specific academic requirements, and the inadequacy of current efforts to increase diversity. Ultimately, the essay argues for consideration of a range of reforms that will focus on the community-empowering aspects of medical admissions decisions.

The Society of Thoracic Surgeons Congenital Heart Surgery Database and the Vermont Oxford Network Expanded Database are both large, international, well-established quality and outcomes databases with high penetration in their respective fields of congenital heart surgery and neonatology. Previous studies have shown the value of combining large databases for research purposes. Our aim was to examine the feasibility and value of combining these databases on a local level.

We included patients from both databases, cared for at our centre and born from 2015–2020, who had cardiac surgery as neonates or during the birth hospitalisation. We examined the number of patients from each database and overlap between the two. We compared cardiac diagnoses, surgeries performed, pre-operative factors, mortality, and length of stay between databases.

Of the 255 patients meeting criteria, 209 (81.9%) had records in both databases. The most common diagnoses in both were hypoplastic left heart syndrome, coarctation, and transposition of the great arteries. Surgical data were incompletely recorded in Vermont Oxford. Gestational age, birth weight, multiple gestation, mortality, and length of stay did not differ significantly between the databases, while the percentage of patients with an extracardiac malformation or genetic syndrome recorded was higher in the Society for Thoracic Surgeons group.

Larger-scale matching and comparison studies using these databases are feasible and desirable; for some variables, a record with data from both databases may be more complete. Specific attention should be given to inclusion criteria, reconciling different schema of diagnoses, and formulating questions relying on each database’s relative strengths.