AIDS strikes most heavily at those already marginalized by conventional society. With no immediate prospect of vaccination or cure, how can liberty, dignity, and reasoned hope be preserved in the ...shadow of an epidemic? In this humane and graceful book, philosopher Timothy Murphy offers insight into our attempts—popular and academic, American and non-American, scientific and political—to make moral sense of pain.
Murphy addresses the complex moral questions raised by AIDS for health-care workers, politicians, policy makers, and even people with AIDS themselves. He ranges widely, analyzing contrasting visions of the origin and the future of the epidemic, the moral and political functions of obituaries, the uncertain value of celebrity involvement in anti-AIDS education, the functional uses of AIDS in the discourse of presidential campaigns, the exclusionary function of HIV testing for immigrants, the priority given to AIDS on the national health agenda, and the hypnotic publicity given to "innocent" victims.
Murphy's discussions of the many social and political confusions about AIDS are unified by his attempt to articulate the moral assumptions framing our interpretations of the epidemic. By understanding those assumptions, we will be in a better position to resist self-serving and invidious moralizing, reckless political response, and social censure of the sick and the dying.
New molecular, cellular, and immunologic techniques used to study host–pathogen interactions have led to a reexamination of the role of infection in chronic obstructive pulmonary disease (COPD). ...There is now considerable evidence that infection plays a major role in the pathogenesis and clinical course of COPD. A vicious circle of infection and inflammation is thought to lead to exacerbations of the disease.
New molecular, cellular, and immunologic techniques used to study host–pathogen interactions have led to a reexamination of the role of infection in chronic obstructive pulmonary disease (COPD). Considerable evidence suggests that a vicious circle of infection and inflammation leads to exacerbations of the disease.
Historical Perspective
In the 1950s and 1960s, according to a theory known as the British hypothesis, repeated airway infection and hypersecretion of mucus were thought to be the causes of chronic obstructive pulmonary disease (COPD). Subsequently, exposure to tobacco smoke was identified as the predominant cause. Researchers were still unable to relate the frequency of exacerbations — acute increases in the respiratory symptoms of COPD that require medical intervention — and hypersecretion of mucus to the progression of airflow obstruction.
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Instead, the frequency of bacterial isolation from sputum was found to be similar in stable COPD and during exacerbations. On . . .
Infections due to nontypeable Haemophilus influenzae result in enormous global morbidity in two clinical settings: otitis media in children and respiratory tract infections in adults with chronic ...obstructive pulmonary disease (COPD). Recurrent otitis media affects up to 20% of children and results in hearing loss, delays in speech and language development and, in developing countries, chronic suppurative otitis media. Infections in people with COPD result in clinic and emergency room visits, hospital admissions, and respiratory failure. An effective vaccine would prevent morbidity, help control health care costs, and reduce antibiotic use, a major contributor to the global crisis in bacterial antibiotic resistance. The widespread use of the pneumococcal conjugate vaccines is causing a relative increase in H. influenzae otitis media. The partial protection against H. influenzae otitis media induced by the pneumococcal H. influenzae protein D conjugate vaccine represents a proof of principle of the feasibility of a vaccine for nontypeable H. influenzae. An ideal vaccine antigen should be conserved among strains, have abundant epitopes on the bacterial surface, be immunogenic, and induce protective immune responses. Several surface proteins of H. influenzae have been identified as potential vaccine candidates and are in various stages of development. With continued research, progress toward a broadly effective vaccine to prevent infections caused by nontypeable H. influenzae is expected over the next several years.
Abstract
Non-typeable Haemophilus influenzae (NTHi) is the most common bacterial cause of infection of the lower airways in adults with chronic obstructive pulmonary disease (COPD). Infection of the ...COPD airways causes acute exacerbations, resulting in substantial morbidity and mortality. NTHi has evolved multiple mechanisms to establish infection in the hostile environment of the COPD airways, allowing the pathogen to persist in the airways for months to years. Persistent infection of the COPD airways contributes to chronic airway inflammation that increases symptoms and accelerates the progressive loss of pulmonary function, which is a hallmark of the disease. Persistence mechanisms of NTHi include the expression of multiple redundant adhesins that mediate binding to host cellular and extracellular matrix components. NTHi evades host immune recognition and clearance by invading host epithelial cells, forming biofilms, altering gene expression and displaying surface antigenic variation. NTHi also binds host serum factors that confer serum resistance. Here we discuss the burden of COPD and the role of NTHi infections in the course of the disease. We provide an overview of NTHi mechanisms of persistence that allow the pathogen to establish a niche in the hostile COPD airways.
A review of mechanisms of persistence used by non-typeable Haemophilus influenzae to infect the airways of individuals with chronic obstructive pulmonary disease
Moraxella catarrhalis is an exclusively human pathogen and is a common cause of otitis media in infants and children, causing 15%-20% of acute otitis media episodes. M. catarrhalis causes an ...estimated 2–4 million exacerbations of chronic obstructive pulmonary disease in adults annually in the United States. M. catarrhalis resembles commensal Neisseria species in culture and, thus, may be overlooked in samples from the human respiratory tract. The prevalence of colonization of the upper respiratory tract is high in infants and children but decreases substantially in adulthood. Most strains produce β-lactamase and are thus resistant to ampicillin but susceptible to several classes of oral antimicrobial agents. Recent work has elucidated mechanisms of pathogenesis and focused on vaccine development to prevent otitis media in children and respiratory tract infections caused by M. catarrhalis in adults with chronic obstructive pulmonary disease.
...de Beauvoir addressed men’s transcendence and contrasted it with women’s immanence, a status distinction possible because women are mired in expectations that they will marry, produce children and ...remain in the domestic realm; and for her part, Firestone argued that biological reproduction underlies women’s inferiority to men and that ‘The reproduction of the species by one sex for the benefit of both (should) be replaced by…artificial reproduction’1 2 Her concern was to liberate women from expectations of biological reproduction so their productive value in society is not reduced to their reproductive contributions. The protection and nurturing of babies that contribute to the future of children is arguably just as important as it is during gestation. ...the responsibilities of caring for and raising children fall disproportionately on women. The value of a human future is entirely assumed in the analysis, without consideration of whether there are wrongful rationales for particular individuals to have children let alone whether there are wrongful rationales for the continuance of human beings as such.5 Robinson holds that her analysis does not oblige any particular person to want to become pregnant let alone oblige them to become pregnant.
As a matter of ethics and law, adults enjoy wide berth in securing hormonal and surgical interventions to align their bodies with their desired gender appearance. In contrast, the exercise of choice ...by minors is more constrained, because they can be less well situated to grasp the nature and consequences of interventions having life-long effects. Even so, some minors hope for body modifications prior to adulthood. Starting very young, some minors may assert atypical gender identity: those with female-typical bodies assert a male identity and those with male-typical bodies assert a female identity. This assertion of identity is atypical only in a descriptive sense, because it is uncharacteristic, not because it is normatively unacceptable. Not all minors persist in their atypical gender identities, but some do. For those who do, it is desirable to minimize unwanted secondary sex characteristics and to maximize desired secondary sex characteristics. I outline here a theory of respect for decisions by minors in regard to hormonal and surgical interventions that help align their bodies with their gender identity. Of particular ethical interest here are body modifications for fertility preservation since certain interventions in the body can leave people unable to have genetically related children. In general, I will show that the degree of respect owed to minors in regard to body modifications for gender identity expression should be scaled according to their decision-making capacities, in the context of robust practices of informed consent.
Understanding the causes and factors related to readmission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) within a nationwide database including all payers and ages can ...provide valuable input for the development of generalizable readmission reduction strategies.
To determine the rates, causes, and predictors for early (3-, 7-, and 30-d) readmission in patients hospitalized with AECOPD in the United States using the Nationwide Readmission Database after the initiation of the Hospital Readmissions Reduction Program, but before its expansion to COPD.
We conducted an analysis of the Nationwide Readmission Database from 2013 to 2014. Index admissions and readmissions for an AECOPD were defined consistent with Hospital Readmissions Reduction Program guidelines. We investigated the percentage of 30-day readmissions occurring each day after discharge and the most common readmission diagnoses at different time periods after hospitalization. The relationship between predictors (categorized as patient, clinical, and hospital factors) and early readmission were evaluated using a hierarchical two-level logistic model. To examine covariate effects on early-day readmission, predictors for 3-, 7-, and 30-day readmissions were modeled separately.
There were 202,300 30-day readmissions after 1,055,830 index AECOPD admissions, a rate of 19.2%. The highest readmission rates (4.2-5.5%) were within the first 72 hours of discharge, and 58% of readmissions were within the first 15 days. Respiratory-based diseases were the most common reasons for readmission (52.4%), and COPD was the most common diagnosis (28.4%). Readmission diagnoses were similar at different time periods after discharge. Early readmission was associated with patient (Medicaid payer status, lower household income, and higher comorbidity burden) and clinical factors (longer length of stay and discharge to a skilled nursing facility). Predictors did not vary substantially by time of readmission after discharge within the 30-day window.
Thirty-day readmissions after an AECOPD remain a major healthcare burden, and are characterized by a similar spectrum of readmission diagnoses. Predictors associated with readmission include both patient and clinical factors. Development of a COPD-specific risk stratification algorithm based on these factors may be necessary to better predict patients with AECOPD at high risk of early readmission.
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