The First Thousand Days of Life.

The first thousand days of life, composing the 270 days of pregnancy and the first two years (730 days) of life, is at once a critical and vulnerable time for human development. It is a time in which the human person is to a large extent "embodied," becoming the integrated mind-brain-body-spirit that defines every human being. This embodiment is set in motion at fertilization and continues with the unfolding development of the embryo. By six weeks in utero, the brain is forming via ongoing neurogenesis, neuronal migration, synaptogenesis, and myelination. By the age of two the brain will be 80 percent of its adult size. As the brain develops, it connects to other developing body systems including the immune, endocrine, metabolic, gastrointestinal, cardiovascular and musculoskeletal systems. In this process of interconnection, a human being is shaped by both internal and external environments, both at the stage of the fetus and the stage of the infant. Human well-being and flourishing depends upon making these first thousand days as safe, secure, and healthy as possible. Physician practices, local health policy, and global health advocacy should focus on optimizing the first thousand days. This should include pre-conception care, pregnancy, safe birth, infant nutrition and fostering secure emotional and relational attachments.

Compassionate Conservation Clashes With Conservation Biology: Should Empathy, Compassion, and Deontological Moral Principles Drive Conservation Practice?

"Compassionate Conservation" is an emerging movement within conservation science that is gaining attention through its promotion of "ethical" conservation practices that place empathy and compassion and the moral principles of "first, do no harm" and "individuals matter" at the forefront of conservation practice. We have articulated elsewhere how Compassionate Conservation, if adopted, could be more harmful for native biodiversity than any other conservation action implemented thus far, while also causing more net harm to individuals than it aims to stop. Here, we examine whether empathy, compassion and inflexible adherence to moral principles form a solid basis upon which to meet the goals of conservation biology as specified by pioneers in the discipline. Specifically, we examine a large empirical literature demonstrating that empathy is subject to significant biases and that inflexible adherence to moral rules can result in a "do nothing" approach. In light of this literature, we argue that our emotional systems have not evolved to provide a reliable basis for making decisions as to how best to ensure the long-term persistence of our planet. Consequently, in its most radical form, the Compassionate Conservation philosophy should not be enshrined as a legalized guiding principle for conservation action.

Deconstructing compassionate conservation.

Compassionate conservation focuses on 4 tenets: first, do no harm; individuals matter; inclusivity of individual animals; and peaceful coexistence between humans and animals. Recently, compassionate conservation has been promoted as an alternative to conventional conservation philosophy. We believe examples presented by compassionate conservationists are deliberately or arbitrarily chosen to focus on mammals; inherently not compassionate; and offer ineffective conservation solutions. Compassionate conservation arbitrarily focuses on charismatic species, notably large predators and megaherbivores. The philosophy is not compassionate when it leaves invasive predators in the environment to cause harm to vastly more individuals of native species or uses the fear of harm by apex predators to terrorize mesopredators. Hindering the control of exotic species (megafauna, predators) in situ will not improve the conservation condition of the majority of biodiversity. The positions taken by so-called compassionate conservationists on particular species and on conservation actions could be extended to hinder other forms of conservation, including translocations, conservation fencing, and fertility control. Animal welfare is incredibly important to conservation, but ironically compassionate conservation does not offer the best welfare outcomes to animals and is often ineffective in achieving conservation goals. Consequently, compassionate conservation may threaten public and governmental support for conservation because of the limited understanding of conservation problems by the general public.

Deconstrucción de la Conservación Compasiva Resumen La conservación compasiva se enfoca en cuatro principios: no causar daño; los individuos importan; la integración de los animales individualmente; y la coexistencia pacífica entre los humanos u los animales. Recientemente, la conservación compasiva ha sido promovida como una alternativa a la filosofía convencional de la conservación. Creemos que los ejemplos presentados por los conservacionistas compasivos han sido elegidos arbitraria o deliberadamente por estar enfocados en los mamíferos; por ser inherentes y no compasivos; y por ofrecer soluciones de conservación poco efectivas. La conservación compasiva se enfoca arbitrariamente en las especies carismáticas, principalmente los grandes depredadores y los megaherbívoros. La filosofía no es compasiva cuando deja que los depredadores invasores dentro del ambiente causen daño a un vasto número de individuos nativos o usa el miedo al daño por superdepredadores para aterrorizar a los mesodepredadores. El entorpecimiento del control de especies exóticas (megafauna, depredadores) in situ no mejorará las condiciones de conservación de la mayoría de la biodiversidad, incluso si los conservacionistas compasivos no dañan a los individuos exóticos. Las posiciones que toman los llamados conservacionistas compasivos sobre especies particulares y sobre las acciones de conservación podrían extenderse para entorpecer otros tipos de conservación, incluyendo las reubicaciones, el encercado para la conservación y el control de la fertilidad. El bienestar animal es increíblemente importante para la conservación e irónicamente, la conservación compasiva no ofrece los mejores resultados de bienestar para los animales y comúnmente es poco efectiva en el logro de los objetivos de conservación. Como consecuencia, la conservación compasiva puede poner en peligro el apoyo público y del gobierno que tiene la conservación debido al entendimiento poco limitado que tiene el público general sobre los problemas de conservación.

Validation and Testing of Fast Healthcare Interoperability Resources Standards Compliance: Data Analysis.

BACKGROUND: There is wide recognition that the lack of health data interoperability has significant impacts. Traditionally, health data standards are complex and test-driven methods played important roles in achieving interoperability. The Health Level Seven International (HL7) standard Fast Healthcare Interoperability Resources (FHIR) may be a technical solution that aligns with policy, but systems need to be validated and tested. OBJECTIVE: Our objective is to explore the question of whether or not the regular use of validation and testing tools improves server compliance with the HL7 FHIR specification. METHODS: We used two independent validation and testing tools, Crucible and Touchstone, and analyzed the usage and result data to determine their impact on server compliance with the HL7 FHIR specification. RESULTS: The use of validation and testing tools such as Crucible and Touchstone are strongly correlated with increased compliance and "practice makes perfect." Frequent and thorough testing has clear implications for health data interoperability. Additional data analysis reveals trends over time with respect to vendors, use cases, and FHIR versions. CONCLUSIONS: Validation and testing tools can aid in the transition to an interoperable health care infrastructure. Developers that use testing and validation tools tend to produce more compliant FHIR implementations. When it comes to health data interoperability, "practice makes perfect."

Safe Passages: Pro-Life Response to the Tragedy of Maternal Deaths.

Maternal mortality in Africa remains unacceptably high. The prevailing response to reducing maternal mortality has emphasized "reproductive health" and has failed to clearly focus on those causes responsible for 90 percent of maternal deaths. In contrast, the "Safe Passages" model directs training and resources toward interventions that save the lives of mothers and babies. Within the Safe Passages model, a "premise" and an "equation" offer an ethical and strategic framework for maternal health-care development which respects human life and dignity and prioritizes those interventions most likely to reduce maternal and newborn deaths. The Safe Passages "equation" emphasizes the key components of respect for persons, safe birth, and fertility literacy. Successful training and development programs should work to insure participants and organizations are inspired, educated, equipped, and evaluated.

Long-term protective effects of hypothermia on reperfusion injury post-testicular torsion.

OBJECTIVE: As many as two-thirds of salvaged testes post-torsion will atrophy within 2 years. Subsequent testicular damage is due at least in part to an ischaemia/reperfusion injury. Thus we analysed the long-term protective effects of subjecting the ischaemic testis to hypothermia in an attempt to prevent or attenuate subsequent testicular damage. MATERIAL AND METHODS: Forty male Sprague-Dawley rats (mean age 97 days; mean weight 408 g) were randomized to one of two groups. The left testis was removed as a control and the right testis was subjected to torsion through 720 degrees in a clockwise direction and maintained in this position for 3 h. Half of the models were subjected to hypothermia by submerging the testis in a cooling bath, which was kept at a constant temperature of 2-4 degrees C for the final hour prior to detorsion. Testes were retrieved at 1 and 12 weeks and examined by a single blinded pathologist using the following histological criteria: mean seminiferous tubular diameter, mean tubular wall thickness (MTWT) and Johnsen's score. RESULTS: Histological examination revealed significant injury after 1 week of reperfusion in both groups. However, after 12 weeks of reperfusion there was a marked benefit seen in the testes subjected to hypothermia. MTWT (p=0.007) and Johnsen's score (p=0.05) were significantly better in the cooled testes after 12 weeks of reperfusion. CONCLUSION: Hypothermia reduces the degree of long-term testicular damage post-torsion and, if applied in clinical practice, may improve long-term salvage rates.

Cutaneous squamous carcinoma leading to acute abdomen after renal transplantation.

Skin carcinoma is the commonest malignant complication of renal transplantation. We report the first case of a renal transplant recipient who presented with ileal obstruction as a consequence of squamous cell carcinoma metastases to the small intestine. This complication highlights the unusual presentation of malignancies associated with prolonged exposure to immunosuppression and the need for extra vigilance in such cases.