We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

This article describes the benefits of including institutional leadership in a faculty fellowship program where faculty were tasked with implementing a curricular innovation at their home institution. These benefits included: serving as an ally, advocate, and defender for the faculty fellow; seeing the bigger picture and how the fellowship can be leveraged to benefit the institution in other ways; and assisting to ensure the fellowship project will be ongoing at their institution.

Emergence, the coming-into-being of new entities, new organizations, or new structures out of the interactions of individual agents in networks, is becoming a central concept in today's management literature. We are now evolving from the age of reductionism to the age of emergence, meaning that organizations in the connected society can no longer predict what is going to happen but will find themselves continuously doing things in co-evolution with their environment, things that are not necessarily in line with actions planned (...) in advance. In such a dynamic environment managers must learn to enable emergent processes in real time if an organization is to turn unpredictability to its competitive advantage. The importance of the perspective of emergence is introduced in regard to the growing complexity in society. (shrink)

Uncertainty regarding potential disciplinary action may give physicians pause when considering whether to accept a chronic pain patient or how to treat a patient who may require long-term or high doses of opioids. Surveys have shown that physicians fear potential disciplinary acrion for prescribing controlled substances and that physicians will, in some cases, inadequately prescribe opioids due to fear of regulatory scrutiny. Prescribing opioids for long-term pain management, particularly noncancer pain management, has been controversial; and boards have investigated and, in (...) some cases, disciplined physicians for such prescribing. While in virtually all of these cases the disciplinary actions were successfully appealed, news of the success was not often as well-publicized as news of the disciplinary actions, leaving some physicians confused about their potential liability when prescribing opioids for pain. The confusion has perhaps increased as a result of two relatively recent cases, one where a physician was successfully disciplined by a state medical board for undertreatment of his patients’ pain, and another where the physician was successfully sued for inadequate pain treatment. (shrink)

The problem of inadequate pain management for both terminally ill patients and patients with chronic pain has recently been documented by a number of authors and studies. A 1997 report by the Institute of Medicine, for example, states that “a significant proportion of dying patients and patients with advanced disease experience serious pain, despite the availability of effective pharmacological and other options for relieving most pain.” There are particularly impressive data that pain associated with cancer is not adequately treated.The problem (...) has been attributed to inadequate education of physicians on approaches to pain management and an often misguided belief that prolonged therapy with certain pain medication will lead to addiction; legal obstacles, such as physicians’ fear of criminal prosecution and other disciplinary actions by state licensing boards for overprescribing narcotics; and inadequate insurance coverage as a result of narrow eligibility criteria for hospice care for Medicare beneficiaries, and inadequate reimbursement more generally for pain management and palliative care. (shrink)

During the past several years, numerous studies have been conducted regarding advance directives for health care). Studies have examined how many individuals have executed advance directives, who is more likely to execute such directives, and whether factors such as education, income, race, religiosity, or family status affect the likelihood of having executed an advance directive or one's willingness to do so. Studies have also investigated the effectiveness of different educational strategies aimed at increasing the number of individuals who execute these (...) documents. Finally, a number of researchers have looked at the implementation of advance directives.Although we now have a better understanding of some of these issues, one area that has been virtually ignored is the reliability, validity, and overall user friendliness of the advance directive forms themselves, and, in particular, of the statutory advance directive forms. (shrink)

This article examines ways in which research conducted under the Human Microbiome Project, an effort to establish a “reference catalogue” of the micro-organisms present in the human body and determine how changes in those micro-organisms affect health and disease, raise challenging issues for regulation of human subject research. The article focuses on issues related to subject selection and recruitment, group stigma, and informational risks, and explores whether: (1) the Common Rule or proposed changes to the Rule adequately address these issues (...) and (2) the Common Rule is the most appropriate vehicle to provide regulatory oversight and guidance on these topics. (shrink)

A study of the research on postpartum mother-infant bonding shows that results from poorly constructed research programs were published in major journals and became a part of hospital policy because the bonding concept was politically useful in the struggle between advocates of natural childbirth and managers of the medical model of birth. The concept was also uncritically accepted because it was consistent with a longstanding ideology of motherhood that sees women as the prime architects of their children’s personalities.

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”Genesis 3:16There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their (...) pain.One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men. (shrink)

Explorations in Anthropology and Theology. Frank A. Salamone and Walter Randolph Adams. eds. Lanham, MD: University Press of America. 1997. xii. 279 pp. $57.50 (cloth); $32.50 (paper).

Sagoff critiqued the exclusion of cultivated plants and animals from much of the body of work in ecology. However, there is a history of attempting to incorporate cultivated landscapes in ecology that goes back at least two decades, particularly in urban ecology. The subdiscipline of urban ecology has received relatively little attention in philosophy, although some of its methodologies, such as coupled human-natural systems research, have been critiqued. Here I will attempt to explicitly address the conceptual limitations in ecology for (...) studying cultivated ecosystems and evaluate these limitations in the context of coupled human-natural systems and socioecological research, urban ecosystem services frameworks, and actor-network theory. I argue that the history of cultivated organisms is highly germane to their ecology, necessitating the incorporation of human agency into ecological theory. However, human agency and nonhuman nature exist along a continuum of nature vs. culture. As a result, dualistic approaches to studying the role of human agency in ecosystem processes, such as socioecology and ecosystem services assessments—which explicitly separate humans from nature—have had limited success in cultivated landscapes. More fully integrated frameworks such as actor-network theory may better address ecological research questions in cultivated landscapes. (shrink)

Researchers summoned a Baltimore County woman to an office at the Johns Hopkins School of Public Health last spring to tell her the bad news. They had found a genetic threat lurking in her 7-year-old son's DNA—a mutant gene that almost always triggers a rare form of colon cancer. It was the same illness that led surgeons to remove her colon in 1979. While the boy, Michael, now 8, is still perfectly healthy, without surgery he is almost certain to develop (...) cancer by age 40.This genetic fortune-telling was no parlor trick. It was the product of astonishing advances in recent decades in understanding how genes build and regulate our bodies. And as scientists pinpoint new genes and learn to forecast the onset of more inherited disorders, millions of people are likely to demand their medical prognosis. (shrink)

In June 2013, faculty from the University of Maryland Carey School of Law, along with students from the law school and several health professional schools at the University of Maryland, Baltimore, visited Malawi, in southeast Africa. While there, they met with faculty and students at the University of Malawi Chancellor College to discuss the possibility of establishing an ongoing collaboration between the two universities’ law schools. The starting point for our discussion was the potential establishment of a multi-professional, comparative health (...) law clinic that would focus on serving individuals living with HIV and AIDS. This goal would serve two objectives of the Law & Health Care Program at Maryland: to increase interprofessional education opportunities and to expose law students to more global health law issues. Establishing this clinic would also be consistent with two strategic objectives of the University of Malawi Faculty of Law: to establish links with other law schools providing clinical legal education, and to contribute to Malawi’s efforts to solve HIV/AIDS-related problems. (shrink)

Abstnn Eye movements were monitored while subjects performed parallel and serial sarah tasks. In Experiment la, subjects searched for an “O' among "X"s (parallel condition) and for a 'T" among "L"s (serial condition). In the parallel condition of Eqcriment lb, “q)" was the target and “O"s were distractors; in the serial condition, time..

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing (...) homes. This is somewhat puzzling given that considerable resources have been devoted to bringing public attention to this problem, we have the knowledge and expertise to provide such care, and we have a government-financed benefit that covers this type of care - the Medicare hospice benefit.While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting. (shrink)

In the early days of HIV awareness, prior to universal precautions, as a local health officer, I was supervising an openly gay employee. The county executive asked me the HIV status of the employee and threatened my employment if I did not reveal it. I was reluctant to do so, believing it would be an invasion of the employee’s privacy. I contacted the county attorney who advised me that I could reveal the employee’s HIV status to the county executive but (...) he was not willing to put his guidance in writing. Ultimately, I spoke with the employee’s attorney and was given permission to reveal the employee’s HIV status. The experience, however, left a bad taste in my mouth. I felt the county attorney was acting politically in support of the county executive rather than doing what was legally appropriate. He certainly did not act as an advocate for the local health department! (shrink)

Generating research findings, which make sense in today's society and can be appreciated as such by both the academic and the business worlds, requires reframing not only the core of how research is being developed but also questions the relevance of organizational survival. The Imagineering Methodology developed within the framework of the NHTV University of Applied Sciences provides a complementary perspective on management research and design. This article aims to present the essence and the specifics of how research is evolving (...) today, using the aforementioned methodological stance and showing certain outcomes, already achieved in practice. (shrink)

With growing complexity in society, designers are entering the fields of organizational studies and social change with high levels of responsibility and, sometimes, little background knowledge of theories and recent evolution. Specifically in the fields of strategy, change, and transformation, the turn toward complexity science is gaining acceptance in both academia and practice. This article presents Imagineering as a complexity-inspired design approach to effectuate transformational objectives. It illustrates the method with an application on the city of Antwerp. The author concludes (...) by reflecting on the implications and perspectives of the method for transformational design and for design thinking in management. (shrink)

In this article, the authors explore the impact of a potential future regulatory decision by FDA whether or not to continue its enforcement discretion policy allowing physicians to perform, and stool banks to sell, stool product for fecal microbiota transplantation as a treatment for recurrent Clostridium Difficile infection without an Investigative New Drug application. The paper looks at the Agency's regulatory options in light of the current gut microbiota based products that are in the FDA pipeline for drug approval and (...) the potential impact and repercussions of their approval on FDA action. In laying out FDA's options we consider the implications of market exclusivity and off-label use of newly approved drugs. Ultimately, we explore the potential impact of FDA's decision on patients, research, and innovation. (shrink)

As national and state health care policy -making becomes contentious and complex, there is a need for a forum to debate and explore public concerns and values in health care, give voice to local citizens, to facilitate consensus among various stakeholders, and provide feedback and direction to health care institutions and policy makers. This paper explores the role that regional health care ethics committees can play and provides two contrasting examples of Networks involved in facilitation of public input into and (...) the development of health care policies and adoption of state-wide practices. (shrink)

This monograph consists of five parts: (1) introductory material including a conference overview; (2) papers presented at an international symposium on the topic of ethical issues in disability and rehabilitation as a section of the Annual Conference of the Society for Disability Studies; (3) responses to the symposium, prepared by four of the participants; (4) selected additional papers which offer views from perspectives or cultures not represented at the Denver conference; and (5) an annotated international bibliography. Representatives from 10 countries (...) discussed ethical issues and decision making in disability and rehabilitation. Conference papers include: "Genetic Engineering--The New Eugenics? Evolving Medical Attitudes towards the Quality of Life" (Hugh Gallagher);"Description of the Decision-Making Project" (Daryl Evans); "Treatment and Nontreatment Decisions with Respect to Extremely Premature, Very Low Birthweight Infants (500-750g)" (Ernle Young); "Allocation of Resources and Distributive Justice" (John Mather); "Quality Assurance as an Aid to Ethical Decision Making in Disability Management: Lessons from Recent Ethical Issues Involving Disadvantaged Groups in New Zealand" (Peter Gow); "Disability and Ethical Issues: A Point of View from the Netherlands" (Yolan Koster-Dreese); "Who Shall Live or How Shall They Live? Consumer and Professional Perspectives on Treatment/Non-Treatment Decisions" (Joseph Kaufert and Patricia Kaufert); and "Debates across Social Movements on Reproductive Technologies, Genetic Engineering, and Eugenics" (Theresia Degener). Conference commentaries include: "The Meeting of Disability and Bioethics: A Beginning Rapprochement" (Adrienne Asch); "A Plea for More Dialogue: Commentary on Ethics Conference" (Robert Slater); "Healing Our Wounds" (Martha Lentz Walker); "Theories and Values: Ethics and Contrasting Perspectives on Disability" (Harlan Hahn); and "Current Example of Ethical Dilemma" (Susan Lacetti). Selected additional papers include: "High-tech Medicine Is Basic Care" (Frederick Abrams); "Prevention of Disabilities as a Medical Question" (G. Schioler); "The Ethics of Disability Prevention: A Parent's Point of View" (Mrs. J. Baker); "A Reference Matrix for Issues of Life and Personhood" (Mike Miles); "Nazi Scientists and Ethics of Today" (Isabel Wilkerson); "Ethical and Policy Issues in Rehabilitation Medicine (Hastings Center Report)" (Arthur Caplan et al.); and "Differing Approaches to Prevention of Disability and Treatment of Impaired Infants Creates Controversies Worldwide" (Barbara Duncan). (JDD). (shrink)

The success of fecal microbiota transplantation as a treatment for Clostrioides difficile infection has stirred excitement about the potential for microbiota transplantation as a therapy for a wide range of diseases and conditions. In this article, we discuss vaginal microbiota transplantation as “the next frontier” in microbiota transplantation and identify the medical, regulatory, and ethical challenges related to this nascent field. We further discuss what we anticipate will be the first context for testing VMT in clinical trials, prevention of the (...) recurrence of a condition referred to as bacterial vaginosis. We also compare clinical aspects of VMT with FMT and comment on how VMT may be similar to or different from FMT in ways that may affect research design and regulatory decisions. (shrink)

This study provides an attributional perspective to the ethical leadership literature by examining the role of attributed altruistic motives and perceptions of organizational politics in a moderated mediation model. Path analytic tests from two field studies were used for analyses. The results support our hypotheses that attributed altruistic motives would mediate the relationship between perceived ethical leadership and affective organizational commitment. Moreover, the relationship between perceived ethical leadership and attributed altruistic motives was stronger when perceptions of organizational politics were high (...) but weaker when these perceptions were low. The study concludes with a discussion of future research implications as well as managerial implications. (shrink)

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

IntroductionThis case study describes the process faculty at a large research university undertook to build a stand-alone online academic integrity course for first-year and transfer students. Because academic integrity is decentralized at the institution, building a more systematic program had to come from the bottom-up (faculty developed) rather than from the top down (institutionally mandated).Case descriptionUsing the learning management system, faculty and e-learning designers collaborated to build the course. Incorporating nuanced scenarios for six different types of misconduct (consistent with the (...) University’s Code of Student Rights, Responsibilities & Conduct), a pre- and post-test, and assessments for each scenario, the course provides experience in recognizing and avoiding academic misconduct.Discussion and evaluationAs a stand-alone course, the faculty who created it maintain control over content and are able to analyze student performance across the institution. In the ten months since its launch, the course has been eagerly adopted by faculty (n = 1853 students have completed the course) and post-test scores indicate students are learning from the course.ConclusionsAfter the successful launch of the student course, the next step, already underway, is the launch of learning modules for faculty and teaching assistants. (shrink)

Text of and reflection on the 1981 encounter between Hans-Georg Gadamer and Jacques Derrida, which featured a dialogue between hermeneutics in Germany and post-structuralism in France. <br.

In 2006, the University of Maryland Carey School of Law had the privilege of co-hosting the annual Health Law Professors Conference with the American Society of Law, Medicine & Ethics (ASLME). Coincidentally, as director of the Law & Health Care Program at Maryland, I had the opportunity to announce the winner of the Jay Healey Health Law Teachers’ Award at the conference. The award is given to “professors who have devoted a significant portion of their career to health law teaching (...) and whose selection would honor Jay [Healey’s] legacy through their passion for teaching health law, their mentoring of students and/or other faculty and by their being an inspiration to colleagues and students.”1 Healey, a Professor in the Humanities Department at the University of Connecticut School of Medicine, was the youngest recipient of the Society’s Health Law Teachers’ Award, which he received in 1990. He was passionate about teaching and had the idea to devote a session each year at the annual conference to teaching health law. It was always a plenary session at which he challenged us to be better teachers. Jay died in 1993, at the age of 46, not long after the Health Law Teachers conference that year, which he attended and which also happened to be held in Baltimore at the University of Maryland School of Law. Thereafter, the award was given in his name. (shrink)

Building on the breakthrough text Philosophy and Engineering: An Emerging Agenda, this book offers 30 chapters covering conceptual and substantive developments in the philosophy of engineering, along with a series of critical reflections by engineering practitioners. The volume demonstrates how reflective engineering can contribute to a better understanding of engineering identity and explores how integrating engineering and philosophy could lead to innovation in engineering methods, design and education. The volume is divided into reflections on practice, principles and process, each of (...) which challenges prevalent assumptions and commitments within engineering and philosophy. The volume explores the ontological and epistemological dimensions of engineering and exposes the falsity of the commonly held belief that the field is simply the application of science knowledge to problem solving. Above all, the perspectives collected here demonstrate the value of a constructive dialogue between engineering and philosophy and show how collaboration between the disciplines casts light on longstanding problems from both sides. The chapters in this volume are from a diverse and international body of authors, including philosophers and engineers, and represent a highly select group of papers originally presented in three different conferences. These are the 2008 Workshop on Philosophy and Engineering held at the Royal Academy of Engineering; the 2009 meeting of the Society for Philosophy and Technology at the University of Twente in the Netherlands; and the Forum on Philosophy, Engineering, and Technology, held in Golden, Colorado at the Colorado School of Mines. (shrink)

Over twenty years have passed since JLME published “The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain.” This article revisits the conclusions drawn in that piece and explores what we have learned in the last two decades regarding the experience of men and women who have chronic pain and whether women continue to be treated less aggressively for their pain than men.

The emergence of queer ideas has unsettled other forms of exploring gender and sexuality, in particular feminism. In response, feminists have been significant critics of queer ideas. This book, through the contribution of important US and UK writers, seeks to explore the debates between feminist and queer theorizing in order to seek out interconnections between the two; they identify new directions in thinking about sexuality and gender that may emerge out of and at the interface.

In lieu of an abstract, here is a brief excerpt of the content:Jacques Derrida INTERPRETING SIGNATURES (NIETZSCHE/HEIDEGGER): TWO QUESTIONS T1HE first question concerns die name Nietzsche, die second has to do with the concept of totality. Let us begin widi chapters 2 and 3 of Heidegger's Nietzsche — dealing with "The Eternal Recurrence of the Same" and "The Will to Power as Knowledge," respectively. We will be turning especially to the subsection on chaos ["The Concept of Chaos," I, pp. 562-70] (...) and to "The Alleged Biologism of Nietzsche" ["Nietzsches angeblicher Biologismus"]. In view ofme fact mat the same interpretation is regularly at work throughout, the risks involved in choosing diis strategy are, I hope, quite limited. In each instance, a single system of reading is powerfully concentrated and gadiered together. It is directed at gadiering togedier the unity and the uniqueness of Nietzsche's diinking, which, as a fulfilled unity, is itself in a fair way to being the culmination of occidental metaphysics. Nietzsche would be precisely at the crest, or ridge, atop the peak of diis fulfillment. And thus he would be looking at both sides, down both slopes. What about diis unity — diis doubled unity? What is its connection to the name — or rather, the signature — of Nietzsche? Does Heidegger take any account of this question — which others might call biographical, autobiographical, or autographical — of the singularity of a signature ostensibly the proper name of Nietzsche? To put the matter anodier way, if one can glimpse behind Heidegger's reading of Nietzsche the foundations of a general reading of Western metaphysics, men die question Translated by Diane Michelfelder and Richard E. Palmer. 246 Jacques Derrida247 arises: To what extent does this interpretation of metaphysics in its totality and as a whole contain an interpretive decision about die unity or singularity of thinking? And to what extent does this interpretive decision also presuppose a decision about die "biographical," about the proper name, the autobiographical, and about signature — about the politics of signature? ' Heidegger's position on this subject I will indicate first ofall widi a summarizing and simplifying statement, which one could, I hope, demonstrate is not wrong: there is a unity in Nietzschean thought even if it is not that of a system in the classical sense. This unity is also its uniqueness, its singularity. A thesis explicidy advanced by Heidegger is that every great thinker has only one thought. This uniqueness was neither constituted nor threatened, neither gadiered together nor brought about, through a name or proper name — nor by the life of Nietzsche, either normal or insane. This unique unity is something it draws from the unity of Western metaphysics which is gathered together mere at its crest, which one could also compare to the simple unity of a line created by a fold. The result of all this is that biography, autobiography, the scene or the powers of the proper name, of proper names, signatures, and so on, are again accorded minority status, are again given the inessential place diey have always occupied in the history ofmetaphysics. This points to the necessity and place of a questioning which I can only sketch here. Such would be a simplified version of the question. Now let us read Heidegger a little more closely and seek to confirm the strongest coherence of his interpretation or, beyond its coherence, his deepest thought. As a provisional concession to die classical norms of reading, let us take this book at its beginning, or even before its beginning at the beginning ofthe preface. Naturally, diis preface was, like so many odiers, written later. As we know, the book goes back to a series of lectures given between 1936 and 1940, and to some treatises written between 1940 and 1946. One should take most careful note of these dates if one is to bring this interpretation, as a whole and in detail, into connection with the historicopolitical and institutional field of its presentation. The preface, however, dates from 1961. The intention of the two pages in mis case, as almost always, is to justify the publication of this collection by reference to the essential unity ofits totality: "This publication, rethought (nachgedacht) as a whole (als Ganzes) should provide a glimpse ofthe path ofthought... (shrink)