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.
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).
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.
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.
Breast re-irradiation (reRT) after breast-conserving surgery (BCS) using external beam radiation is an increasingly used salvage approach for women presenting with recurrent or new primary breast ...cancer. However, radiation technique, dose and fractionation as well as eligibility criteria differ between studies. There is also limited data on efficacy and safety of external beam hypofractionation and accelerated partial-breast irradiation (APBI) regimens. This paper reviews existing retrospective and prospective data for breast reRT after BCS, APBI reRT outcomes and delivery at our institution and the need for a randomized controlled trial using shorter courses of radiation to better define patient selection for different reRT fractionation regimens.
Accelerated partial breast irradiation (APBI) is increasingly used to treat select patients with early stage breast cancer. However, radiation technique, dose and fractionation as well as eligibility ...criteria differ between studies. This has led to controversy surrounding appropriate patients for APBI and an assessment of the toxicity and cosmetic outcomes of APBI as compared to whole breast irradiation (WBI). This paper reviews existing data for APBI, APBI delivery at our institution, and ongoing research to better define patient selection, treatment delivery, dosimetric considerations and toxicity outcomes.
•M. haemolytica serotype (S) 1 vaccine cross-protected lambs against S2 infection.•The vaccine provided 49.1% overall cross-protection in vaccinated lambs.•Elevated post-vaccination antibody titres ...to cellular and LKT antigens of S1 and S2.
Ovine pneumonia is an economic important disease worldwide for the sheep industry. Multiple serotypes (S) of Mannheimia haemolytica are involved in the disease and S2 and S1 are the most frequent isolates associated with lung lesions in sheep. Vaccines based on some M. haemolytica S2 strains have been shown to have poor immunogenicity. The objective of this study was to determine the cross-protection effect of an S1 strain based vaccine, Bovilis MH, in sheep against an experimental challenge with an S2 strain. Lambs (n=12) in the vaccine group were injected subcutaneously with 1ml of the Bovilis MH vaccine, and revaccinated 4 weeks later, while the control group (n=12) received 1ml of saline at each occasion. Two weeks after revaccination, all lambs were challenged intratracheally with parainfluenza virus 3, and with an M. haemolytica S2 strain at day 7 post-viral challenge. The proportion of animals having pyrexia in the first 2 days post-bacterial challenge was significantly less in the vaccine group compared to the control group (P<0.05). The animals in the vaccine group had significantly lower dyspnoea scores and lung/bodyweight ratio than those in the control group (P<0.05). The vaccine provided 49.1% overall protection. Prior to the challenge, the vaccinated animals had significantly higher titres of antibodies to S1 and S2 whole cell antigens and to leukotoxins produced by S1 and S2 strains compared to the control animals (P<0.05). The S1 strain vaccine provided considerable cross-protection against the S2 strain challenge.
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