Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? ...One compelling framework is Anita Silvers and Leslie Francis' mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient's will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination.
This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder (ASD). ...However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis (ABA), which is widely taken to be far-and-away the best "treatment" for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but often exacerbate them. Warnings of the perils of ABA are not original to us-autism advocates have been ringing this bell for some years. However, their pleas have been largely unheeded, and ABA continues to be offered to and quite frequently pushed upon parents as the appropriate treatment for autistic children. Our contribution is to argue that, from a bioethical perspective, autism advocates are fully justified in their concerns-the rights of autistic children and their parents are being regularly infringed upon. Specifically, we will argue that employing ABA violates the principles of justice and nonmaleficence and, most critically, infringes on the autonomy of children and (when pushed aggressively) of parents as well.
Abstract Multiwavelength photometry of brown dwarfs and planetary-mass objects provides insight into their atmospheres and cloud layers. We present near-simultaneous J - and K s -band multiwavelength ...observations of the highly variable T2.5 planetary-mass object, SIMP J013656.5+093347. We reanalyze observations acquired over a single night in 2015 using a recently developed data reduction pipeline. For the first time, we detect a phase shift between J - and K s -band light curves, which we measure to be 39 .° 9 − 1.1 + 3.6 . Previously, phase shifts between near-infrared and mid-infrared observations of this object were detected and attributed to probing different depths of the atmosphere, and thus different cloud layers. Using the Sonora Bobcat models, we expand on this idea to show that at least two different patchy cloud layers must be present to explain the measured phase shift. Our results are generally consistent with recent atmospheric retrievals of this object and other similar L/T transition objects.
Previable and periviable preterm prelabor rupture of membranes are challenging obstetric complications to manage, given the substantial risk of maternal morbidity and mortality with no guarantee of ...fetal benefit. The following are Society for Maternal-Fetal Medicine recommendations for the management of previable and periviable preterm prelabor rupture of membranes prior to the period when a trial of neonatal resuscitation and intensive care would be considered appropriate by the healthcare team and desired by the patient: (1) we recommend that pregnant patients with previable and periviable preterm prelabor rupture of membranes receive individualized counseling about the maternal and fetal risks and benefits of both abortion care and expectant management to guide an informed decision. All patients with previable and periviable preterm prelabor rupture of membranes should be offered abortion care. Expectant management can also be offered in the absence of contraindications (GRADE 1C); (2) we recommend antibiotics for pregnant individuals who choose expectant management after preterm prelabor rupture of membranes at ≥ 24 0/7 weeks of gestation (GRADE 1B); (3) antibiotics can be considered after preterm prelabor rupture of membranes at 20 0/7 to 23 6/7 weeks of gestation (GRADE 2C); (4) administration of antenatal corticosteroids and magnesium are not recommended until the time when a trial of neonatal resuscitation and intensive care would be considered appropriate by the healthcare team and desired by the patient (GRADE 1B); (5) serial amnioinfusions and amniopatch are considered investigational and should be used only in a clinical trial setting; they are not recommended for routine care of previable and periviable preterm prelabor rupture of membranes (GRADE 1B); (6) cerclage management after preterm prelabor rupture of membranes is similar to cerclage management after preterm prelabor rupture of membranes at later gestational ages; it is reasonable to either remove the cerclage or leave it in situ after discussing the risks and benefits and incorporating shared decision-making (GRADE 2C); (7) in subsequent pregnancies after a history of previable or periviable preterm prelabor rupture of membranes, we recommend following guidelines for management of pregnant persons with a prior spontaneous preterm birth (GRADE 1C).
Tennessee’s new restrictive abortion law poses harms to pregnant patients and conflicts with ethical commitments that any medical professional participating in the care of pregnant patients should be ...able to endorse.
Abstract
We describe the Perkins INfrared Exosatellite Survey (PINES), a near-infrared photometric search for short-period transiting planets and moons around a sample of 393 spectroscopically ...confirmed L- and T-type dwarfs. PINES is performed with Boston University’s 1.8 m Perkins Telescope Observatory, located on Anderson Mesa, Arizona. We discuss the observational strategy of the survey, which was designed to optimize the number of expected transit detections, and describe custom automated observing procedures for performing PINES observations. We detail the steps of the
PINES Analysis Toolkit
(
PAT
), software that is used to create light curves from PINES images. We assess the impact of second-order extinction due to changing precipitable water vapor on our observations and find that the magnitude of this effect is minimized in Mauna Kea Observatories
J
band. We demonstrate the validity of
PAT
through the recovery of a transit of WASP-2 b and known variable brown dwarfs, and use it to identify a new variable L/T transition object: the T2 dwarf WISE J045746.08-020719.2. We report on the measured photometric precision of the survey and use it to estimate our transit-detection sensitivity. We find that for our median brightness targets, assuming contributions from white noise only, we are sensitive to the detection of 2.5
R
⊕
planets and larger. PINES will test whether the increase in sub-Neptune-sized planet occurrence with decreasing host mass continues into the L- and T-dwarf regime.
Abstract
We describe a new transit-detection algorithm designed to detect single-transit events in discontinuous Perkins INfrared Exosatellite Survey (PINES) observations of L and T dwarfs. We use ...this algorithm to search for transits in 131 PINES light curves and identify two transit candidates: 2MASS J18212815+1414010 (2MASS J1821+1414) and 2MASS J08350622+1953050 (2MASS J0835+1953). We disfavor 2MASS J1821+1414 as a genuine transit candidate due to the known variability properties of the source. We cannot rule out the planetary nature of 2MASS J0835+1953's candidate event and perform follow-up observations in an attempt to recover a second transit. A repeat event has yet to be observed, but these observations suggest that target variability is an unlikely cause of the candidate transit. We perform a Markov Chain Monte Carlo simulation of the light curve and estimate a planet radius ranging from
4.2
−
1.6
+
3.5
R
⊕
to
5.8
−
2.1
+
4.8
R
⊕
, depending on the host’s age. Finally, we perform an injection and recovery simulation on our light-curve sample. We inject planets into our data using measured M-dwarf planet occurrence rates and attempt to recover them using our transit-search algorithm. Our detection rates suggest that, assuming M-dwarf planet occurrence rates, we should have roughly a 1% chance of detecting a candidate that could cause the transit depth we observe for 2MASS J0835+1953. If 2MASS J0835+1953 b is confirmed, it would suggest an enhancement in the occurrence of short-period planets around L and T dwarfs in comparison to M dwarfs, which would challenge predictions from planet formation models.
ABSTRACT
Autism research frequently seeks to evaluate interventions or inform their development. Unfortunately, researchers often assume that autism intervention should reduce autistic traits, ...effectively setting as a goal of treatment that autistic people attempt to “pass” as nonautistic. A growing body of evidence highlights serious potential harms from passing demands. We discuss why it is important for institutional review boards (IRBs) to scrutinize autism research for clinical passing demands, and we document the existence of such demands in outcome measures commonly employed in autism research. We propose an ethical framework for IRBs and others to make use of in evaluating the ethical appropriateness of particular treatment goals in autism intervention or intervention‐adjacent research, emphasizing that treatment goals should be in pursuit of a beneficial nonpassing purpose and be the least burdensome means of accomplishing such a purpose. We also highlight potential promising practices for IRBs, investigators, and other stakeholders seeking to address these issues in autism research.
An accurate description of metal nanoparticle (NP)–support interactions is required for designing and optimizing NP catalytic systems because NP–support interactions may significantly impact NP ...stability and properties, such as catalytic activity. The ability to calculate NP interactions with amorphous supports, which are commonly used in industrial practice, is hampered because of a general lack of accurate atomically detailed model structures of amorphous surfaces. We have systematically studied relaxation processes of Pt13 NPs on amorphous silica using recently developed realistic model amorphous silica surfaces. We have modeled the NP relaxation process in multiple steps: hard-sphere interactions were first used to generate initial placement of NPs on amorphous surfaces, then Pt–silica bonds were allowed to form, and finally both the NP and substrate were relaxed with density functional theory calculations. We find that the amorphous silica surface significantly impacts the morphology and electronic structure of the Pt clusters. Both NP energetics and charge transfer from NP to the support depend linearly on the number of Pt–silica bonds. Moreover, we find that the number of Pt–silica bonds is determined by the silica silanol number, which is a function of the silica pretreatment temperature. We predict that catalyst stability and electronic charge can be tuned via the pretreatment temperature of the support materials. The extent of support effects suggests that experiments aiming to measure the intrinsic catalytic properties of very small NPs on amorphous supports will fail because the measurable catalytic properties will depend critically on metal–support interactions. The magnitude of support effects highlights the need for explicitly including amorphous supports in atomistic studies.
OBJECTIVES
The impact of occupational therapy (OT) and physical therapy (PT) on functional outcomes in older adults with cancer is unknown.
DESIGN
Two‐arm single‐institution randomized controlled ...trial of outpatient OT/PT.
SETTING
Comprehensive cancer center with two off‐site OT/PT clinics.
PARTICIPANTS
We recruited adults 65 years and older with a recent diagnosis or recurrence of cancer within 5 years, with at least one functional limitation as identified by a geriatric assessment. Participants were randomized to OT/PT or usual care.
INTERVENTION
Rehabilitation consisted of individualized OT and PT that addressed functional activities and strength/endurance needs.
MEASUREMENTS
Primary outcome was functional status as measured by the Nottingham Extended Activities of Daily Living scale. Secondary outcomes were Patient‐Reported Outcomes Measurement Information System‐Global Mental Health (GMH) and Global Physical Health (GPH), ability to participate in Social Roles (SR), physical function, and activity expectations and self‐efficacy (Possibilities for Activity Scale PActS).
RESULTS
Among those recruited (N = 63), only 45 patients (71%) were evaluable due to loss of follow‐up and/or nonreceipt of intervention. The median age was 74 years; 53% were female, and 91% were white. Overall, 30% patients had hematologic malignancies, 30% breast cancer, and 16% colorectal cancers. A total of 65% were in active treatment; 49% had stage 3 or 4 disease. At follow‐up, both OT/PT (P = .02) and usual care (P = .03) groups experienced a decline in functional status. PActS scores between groups (P = .04) was significantly improved in the intervention group. GMH and SR met criteria for minimally important clinical difference favoring the intervention, but not statistical significance. Several barriers were noted in the implementation of the intervention program: recruitment, concerns about cost, distance, scheduling, and limited treatment provided.
CONCLUSION
OT/PT may positively influence activity expectations and self‐efficacy. Future research needs to address significant barriers to implementation to increase use of OT/PT services and access to quality care. J Am Geriatr Soc 67:953–960, 2019.
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