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)

We achieve several results. First, we develop a variant of the theory of absolute Galois groups in the context of many sorted structures. Second, we provide a method for coding absolute Galois groups of structures, so they can be interpreted in some monster model with an additional predicate. Third, we prove the “Weak Independence Theorem” for pseudo-algebraically closed (PAC) substructures of an ambient structure with no finite cover property (nfcp) and the property [Formula: see text]. Fourth, we describe Kim-dividing in (...) these PAC substructures and show several results related to the SOPnhierarchy. Fifth, we characterize the algebraic closure in PAC structures. (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)

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute (...) a consult. As one bioethicist commented:if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics. (shrink)

We generalize a well-known theorem binding the elementary equivalence relation on the level of PAC fields and the isomorphism type of their absolute Galois groups. Our results concern two cases: saturated PAC structures and nonsaturated PAC structures.

We study model theory of actions of finite groups on substructures of a stable structure. We give an abstract description of existentially closed actions as above in terms of invariants and PAC structures. We show that if the corresponding PAC property is first order, then the theory of such actions has a model companion. Then, we analyze some particular theories of interest (mostly various theories of fields of positive characteristic) and show that in all the cases considered the PAC property (...) is first order. (shrink)

We introduce a family of local ranks $D_Q$ depending on a finite set Q of pairs of the form $(\varphi (x,y),q(y)),$ where $\varphi (x,y)$ is a formula and $q(y)$ is a global type. We prove that in any NSOP $_1$ theory these ranks satisfy some desirable properties; in particular, $D_Q(x=x)<\omega $ for any finite tuple of variables x and any Q, if $q\supseteq p$ is a Kim-forking extension of types, then $D_Q(q) (...) Kim-non-forking extension, then $D_Q(q)=D_Q(p)$ for every Q that involves only invariant types whose Morley powers are -stationary. We give natural examples of families of invariant types satisfying this property in some NSOP $_1$ theories.We also answer a question of Granger about equivalence of dividing and dividing finitely in the theory $T_\infty $ of vector spaces with a generic bilinear form. We conclude that forking equals dividing in $T_\infty $, strengthening an earlier observation that $T_\infty $ satisfies the existence axiom for forking independence.Finally, we slightly modify our definitions and go beyond NSOP $_1$ to find out that our local ranks are bounded by the well-known ranks: the inp-rank (burden), and hence, in particular, by the dp-rank. Therefore, our local ranks are finite provided that the dp-rank is finite, for example, if T is dp-minimal. Hence, our notion of rank identifies a non-trivial class of theories containing all NSOP $_1$ and NTP $_2$ theories. (shrink)

We study algebraic and model-theoretic properties of existentially closed fields with an action of a fixed finite group. Such fields turn out to be pseudo-algebraically closed in a rather strong sense. We place this work in a more general context of the model theory of fields with a group scheme action.

We study model theory of fields with actions of a fixed finite group scheme. We prove the existence and simplicity of a model companion of the theory of such actions, which generalizes our previous results about truncated iterative Hasse–Schmidt derivations [13] and about Galois actions [14]. As an application of our methods, we obtain a new model complete theory of actions of a finite group on fields of finite imperfection degree.

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)

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)

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)

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)

Die 1990 gegründete Reihe, die auf eine Anregung von Mazzino Montinari zurückgeht, publiziert Quellenmaterialien zu Nietzsches Leben, seinem Umkreis und seiner Wirkung. Die Supplementa stellen somit eine Ergänzung zu den Kritischen Ausgaben von Nietzsches Werken (KGW) und Briefen (KGB) dar.

The proposed changes to the Common Rule, described in the recent Advanced Notice of Proposed Rulemaking, come more than 20 years after the U.S. Department of Health and Human Services adopted the Rule in 1991. Since that time, human subjects research has changed in significant ways. Not only has the volume of clinical research grown dramatically, this research is now regularly conducted at multiple collaborative sites that are often outside of the United States. Research takes place not only in academic (...) medical centers, but also at outpatient clinics, community hospitals, and other nontraditional venues. In addition, technological advances, such as sophisticated computer software programs, the Internet, social media, new research methods, and mobile applications have exponentially increased the volume of data available and the possibilities for accessing, analyzing, and sharing that data. (shrink)

Let G be a finite group. We explore the model-theoretic properties of the class of differential fields of characteristic zero in m commuting derivations equipped with a G-action by differential fie...

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.

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)

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)

Wie kann man einen historischen Blick auf das eigene Fach werfen? Diese Frage ist nicht einfach zu beantworten – will man einerseits nicht in einer Nabelschau und Hagiographie enden, andererseits aber auch keinen umfassenden Entwurf einer zukünftigen Historiographie vorlegen. Die hier in loser Folge publizierten Interviews mit bekannten Protagonist:innen der Berliner Wissenschaftsgeschichte von ca. 1970–1990 in West und Ost rücken die Geschichte des Faches deshalb in einem bestimmten Milieu in den Fokus und versuchen, die Historiographie jenseits einer Institutionen- oder Theoriegeschichte (...) voranzutreiben. Welche Motivationen oder Probleme bewegten einzelne Wissenschaftler:innen, sich der Geschichte ihres Faches zu widmen oder sich etwa aus der Soziologie oder Philosophie in die Wissenschaftsgeschichte zu bewegen? Welche Ausbildungspraktiken existierten in diesem heterogenen, zwischen den Disziplinen angesiedelten Feld, welche Anregungen bezog man aus welchen Kontexten? Wie war Lehre strukturiert und welche Netzwerke bildeten sich mit der Zeit? Kurz: Mit welchem Interesse kam man zur Wissenschaftsgeschichte und was wurde daraus? Die Auswahl der Interviewees erfolgt ohne Anspruch auf Vollständigkeit oder Proporz; der Fragenkatalog der Interviews richtet sich individuell nach den Biographien und dem Werk und entfaltet sich oft spontan im Gespräch. Die Interviews wurden digital aufgezeichnet, transkribiert, der Schriftsprache angepasst, gegebenenfalls gekürzt, annotiert und von den Interviewees authentifiziert. Wir beabsichtigen mit dieser Serie von Interviews zunächst die Dokumentation rezenter Geschichte durch eine Oral History, die subjektive Wahrnehmungen und persönliche Erlebnisse einschließt. Auf diese Weise werden Segmente einer größtenteils ungeschriebenen Geschichte anhand von Biographien erfahrbar und damit auch einer weiteren kritischen Bearbeitung und Integration in ein Gesamtbild zugänglich. Da uns im Zuge der jeweiligen Vorbereitung und Durchführung, Transkription und Abstimmung der Interviews daran gelegen war, aus Sicht der Akteur:innen wichtige Sammelbände und Aufsätze, Monographien oder auch „graue Literatur“ zu erfassen, wird nebenbei eine kommentierte Bibliographie zur Geschichte der Wissenschaftsgeschichte entstehen. Unsere Hoffnung besteht darin, mittels dieser Sammlung mit Berlin einen fruchtbaren Raum und mit den siebziger und achtziger Jahren eine produktive Zeit des Faches jenseits von Reminiszenz oder Nostalgie zu erkunden – nicht zuletzt auch, um den Blick für gegenwärtige Herausforderungen des Faches zu schärfen. (shrink)

We discuss the role of weakly normal formulas in the theory of thorn forking, as part of a commentary on the paper [5]. We also give a counterexample to Corollary 4.2 from that paper, and in the process discuss “theories with selectors.”.

The model companion of the theory of fields with valuation and automorphism exists. A counterexample shows that the theory of models of ACFA equipped with valuation is not this model companion.

Abstract307 S., geb., zahlreiche Abb., € 44,00. ISBN 978-3-86583-808-7.

In this paper I provide a description of the role of body-part terms in expressions of emotion and other semantic extensions in MalakMalak, a non-Pama-Nyungan language of the Daly River area. Body-based expressions denote events, emotions, personality traits, significant places and people and are used to refer to times and number. Particularly central in the language aremen‘stomach’,pundu‘head’ andtjewurr‘ear’ associated respectively with basic emotions, states of mind and reason. The figurative extensions of these body parts are discussed systematically, and compared with (...) what is known for other languages of the Daly River region. The article also explores the grammatical make up of body-based emotional collocations, and in particular the role of noun incorporation. In MalakMalak, noun incorporation is a central part of forming predicates with body parts, but uncommon in any other semantic domain of the language and only lexemes denoting basic emotions may also incorporate closed-class adjectives. (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)

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)

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 1-2, Page 200-201, June 2022.

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)