A community-university run conference as a catalyst for addressing health disparities in an urban community.

The African American population of Buffalo, New York experiences striking race-based health disparities due to adverse social determinants of health. A team of community leaders and university faculty determined that a community dialogue was needed to focus research and advocacy on the root causes of these disparities. In response, we organized the annual Igniting Hope conference series that has become the premier conference on health disparities in the region. The series, now supported by an R13 conference grant from NCATS, has been held four times (2018-2021) and has attracted community members, community leaders, university faculty, and trainees. The agenda includes talks by national leaders and breakout/working groups that led to a new state law that has reduced disproportionate traffic-ticketing and drivers' license suspensions in Black neighborhoods; mitigation of the disproportionate COVID-19 fatalities in Black communities; and the launching of a university-supported institute. We describe the key elements of success for a conference series designed by a community-university partnership to catalyze initiatives that are having an impact on social determinants of health in Buffalo.

First Come, First Served in the Intensive Care Unit: Always?

Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions-if any-may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of "first come, first served" in ICU admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes.

A Moraxella catarrhalis vaccine to protect against otitis media and exacerbations of COPD: An update on current progress and challenges.

Moraxella catarrhalis is a major cause of morbidity and mortality worldwide, especially causing otitis media in young children and exacerbations of chronic obstructive pulmonary disease in adults. This pathogen uses several virulence mechanisms to colonize and survive in its host, including adherence and invasion of host cells, formation of polymicrobial biofilms with other bacterial pathogens, and production of ß-lactamase. Given the global impact of otitis media and COPD, an effective vaccine to prevent M. catarrhalis infection would have a huge impact on the quality of life in both patient populations by preventing disease, thus reducing morbidity and health care costs. A number of promising vaccine antigens have been identified for M. catarrhalis. The development of improved animal models of M. catarrhalis disease and identification of a correlate of protection are needed to accelerate vaccine development. This review will discuss the current state of M. catarrhalis vaccine development, and the challenges that must be addressed to succeed.

Prescription Opioid Dependence in Western New York: Using Data Analytics to Find an Answer to the Opioid Epidemic.

Opioid dependence and overdose is on the rise. One indicator is the increasing trends of prescription buprenorphine use among patient on chronic pain medication. In addition to the New York State Department of Health's prescription drug monitoring programs and training programs for providers and first responders to detect and treat a narcotic overdose, further examination of the population may provide important information for multidisciplinary interventions to address this epidemic. This paper uses an observational database with a Natural Language Processing (NLP) based Not Only Structured Query Language architecture to examine Electronic Health Record (EHR) data at a regional level to study the trends of prescription opioid dependence. We aim to help prioritize interventions in vulnerable population subgroups. This study provides a report of the demographic patterns of opioid dependent patients in Western New York using High Throughput Phenotyping NLP of EHR data.

Against withdrawing government and insurance subsidies for ARTs from fertile people, with special reference to lesbian and gay individuals.

One way to help ensure the future of human life on the planet is to reduce the total number of people alive as a hedge against dangers to the environment. One commentator has proposed withdrawing government and insurance subsidies from all fertile people to help reduce the number of births. Any proposal of this kind does not, however, offer a solution commensurate with current problems of resource use and carbon emissions. Closing off fertility medicine to some people-or even to all-would have only negligible effects on environmental protection. Moreover, the proposal to withdraw financial subsidies from fertile individuals would have prejudicial effects on lesbian and gay people, who must always reach beyond their same-sex relationships for help in having children. It is, moreover, entirely unclear why some people turning to fertility medicine for help in having children should have to pay their own way even though they contribute to the pool of money available for government and insurance subsidies. Entitlements based on an alleged moral difference between the 'fertile' and the 'infertile' cannot support such a conclusion.

Assisted Gestation and Transgender Women.

Developments in uterus transplant put assisted gestation within meaningful range of clinical success for women with uterine infertility who want to gestate children. Should this kind of transplantation prove routine and effective for those women, would there be any morally significant reason why men or transgender women should not be eligible for the same opportunity for gestation? Getting to the point of safe and effective uterus transplantation for those parties would require a focused line of research, over and above the study of uterus transplantation for non-transgender women. Some commentators object to the idea that the state has any duty to sponsor research of this kind. They would limit all publicly-funded fertility research to sex-typical ways of having children, which they construe as the basis of reproductive rights. This objection has no force against privately-funded research, of course, and in any case not all social expenditures are responses to 'rights' properly speaking. Another possible objection raised against gestation by transgender women is that it could alter the social meaning of sexed bodies. This line of argument fails, however, to substantiate a meaningful objection to gestation by transgender women because social meanings of sexed bodies do not remain constant and because the change in this case would not elicit social effects significant enough to justify closing off gestation to transgender women as a class.

Parents' choices in banking boys' testicular tissue.

Researchers are working to derive sperm from banked testicular tissue taken from pre-pubertal boys who face therapies or injuries that destroy sperm production. Success in deriving sperm from this tissue will help to preserve the option for these boys to have genetically related children later in life. For the twin moral reasons of preserving access and equity in regard to having such children, clinicians and researchers are justified in offering the option to the parents of all affected boys. However, some parents may wish to decline the option to bank tissue from their boys because the technique may seem too unfamiliar or unusual, but over time people may become more comfortable with the technique as they have done with other novel assisted reproductive treatments (ARTs). Other parents may wish to decline the option because of moral or religious reasons. A prominent natural law theory holds, for example, that the ARTs that would be involved in using sperm derived from banked tissue to produce a child are morally objectionable. Some parents might not want to bank tissue in order to shield their son from using ARTs they see as objectionable. Clinicians and researchers should respect parents who wish to decline banking tissue, but parents should ordinarily embrace choices that protect the possible interests their sons may have as adult men, including the wish to have genetically related children.

Ethics and the prohibition of donor gametes in fertility medicine.

Some countries and societies ban the use of donor gametes in IVF and other assisted reproductive treatments. Supporters of these bans maintain that third-party gametes damage marriage, pose dangers to children and families, put donors at risk, and endanger society at large, but these views are open to moral dispute. In particular, secular moral philosophy does not require couples to rely on their own gametes only to have children. Families can thrive even if children vary in their genetic relationships with parents and siblings. The use of donor gametes merits close attention in matters of safety and oversight, but there is no effect that is so damaging to children, donors or society that justifies closing off their use altogether. Moreover, bans on donor gametes can sometimes be evaded through reproductive tourism, which raises questions of justice for those unable to afford that option. According to one method of measuring moral progress - a method that relies on principles of humaneness and humanity - providing access to donor gametes makes important contributions to happiness and equality. These arguments suggest that the bans against donor gametes in fertility medicine should be reconsidered.

Informed consent, capitation, and conflicts of interest in clinical trials: views from the field.

BACKGROUND: The beliefs of research team members about informed consent practices are not well studied, especially in regard to financial aspects of research such as capitation fees. Sponsors of research offer capitation fees for the enrollment of subjects, and although this money is intended to cover the costs of the research it can sometimes be used in other ways. There is no clear consensus about whether this financial aspect of trials should be part of the informed consent process or whether it represents a potential conflict of interest. METHODS: We presented several hypothetical cases to members of the American College of Surgeons Oncology Group (ACOSOG) at a semi-annual meeting. ACOSOG is a federally funded clinical trials group evaluating surgical and adjuvant methods of cancer treatment. The meeting included surgeons, nurses, case managers, and others involved in clinical surgical trials. RESULTS: We found that most respondents believed that it would be a violation of the protocol to enroll a subject who showed lack of recall about the study. Most respondents also favored disclosure of capitation fees, especially if those fees went into discretionary accounts, but there was some disagreement about the benefit of that disclosure to potential participants. CONCLUSIONS: This study shows the need for greater work in ensuring that research team members share common understandings about informed consent. It also shows that most of these research team participants are prepared to make more disclosure about financial aspects of research than current standards in fact require.

Moraxella catarrhalis in chronic obstructive pulmonary disease: burden of disease and immune response.

RATIONALE: Moraxella catarrhalis is frequently present in the sputum of adults with chronic obstructive pulmonary disease (COPD). Little is known about the role of M. catarrhalis in this common disease. OBJECTIVE: To elucidate the burden of disease, the dynamics of carriage, and immune responses to M. catarrhalis in COPD. METHODS: Prospective cohort study of 104 adults with COPD in an outpatient clinic at the Buffalo Veterans Affairs Medical Center. MEASUREMENTS: Clinical information, sputum cultures, molecular typing of isolates, and immunoassays to measure antibodies to M. catarrhalis. MAIN RESULTS: Over 81 months, 104 patients made 3,009 clinic visits, 560 during exacerbations. Molecular typing identified 120 episodes of acquisition and clearance of M. catarrhalis in 50 patients; 57 (47.5%) of the acquisitions were associated with clinical exacerbations. No instances of simultaneous acquisition of a new strain of another pathogen were observed. The duration of carriage of M. catarrhalis was shorter with exacerbations compared with asymptomatic colonization (median, 31.0 vs. 40.4 days; p = 0.01). Reacquisition of the same strain was rare. The intensity of the serum IgG response was greater after exacerbations than asymptomatic colonization (p = 0.009). Asymptomatic colonization was associated with a greater frequency of a sputum IgA response than exacerbation (p = 0.009). CONCLUSIONS: M. catarrhalis likely causes approximately 10% of exacerbations of COPD, accounting for approximately 2 to 4 million episodes annually. The organism is cleared efficiently after a short duration of carriage. Patients develop strain-specific protection after clearance of M. catarrhalis from the respiratory tract.