THE FUTURE OF BIOETHICS: THREE DOGMAS AND A CUP OF HEMLOCK

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self‐reflection that I characterize here as a commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction.     

北京试行医药分开改革对医患双方的影响观察

医药分开改革的目的是从制度上消除“以药养医”，从利益机制上规范医疗行为，加强合理用药，减轻患者负担，体现医务人员的劳动价值。对北京试行“医药分开”改革对医患双方产生的影响进行分析，探求公立医院优化管理模式的途径。同时，通过验证改革实施所取得的效果挖掘政策存在的不足，为政策的进一步改进和完善提供有益建议和决策依据。     

“Social Jetlag” in Morning-Type College Students Living On Campus: Implications for Physical and Psychological Well-being

Although on-campus residence allows easier access to campus facilities, existing studies showed mixed results regarding the relationship between college residence and students’ well-being indicators, such as sleep behaviors and mood. There was also a lack of studies investigating the role of chronotype in the relationship between on-campus residence and well-being. In particular, the temporal relationships among these factors were unclear. Hence, this longitudinal study aims to fill in these gaps by first reporting the well-being (measured in terms of mood, sleep, and quality of life) among students living on and off campus across two academic semesters. We explored factors predicting students’ dropout in university residences. Although students living on campus differ in their chronotypes, activities in campus residence (if any) are mostly scheduled in the nighttime. We therefore tested if individual differences in chronotype interact with campus residence in affecting well-being. Our final sample consisted of 215 campus residents and 924 off-campus-living students from 10 different universities or colleges in Hong Kong or Macau. Their mean age was 20.2 years (SD?=?2.3); 6.5% of the participants are female. Participants completed self-reported questionnaires online on their sleep duration, sleep quality, chronotype, mood, and physical and psychological quality of life. Across two academic semesters, we assessed if students living on and off campus differed in our well-being measures after we partialed out the effects of demographic information (including age, sex, family income, and parents’ education) and the well-being measures at baseline (T1). The results showed that, campus residents exhibited longer sleep duration, greater sleep efficiency, better sleep quality, and less feeling of stress than off-campus-living students. From one semester to the next, around 10% of campus residents did not continue to live on campus. Logistic regression showed that a morning type was the strongest factor predicting dropout from campus residence. Chronotype significantly moderated the effects of campus residence on participants’ physical and psychological quality of life. Although morning-type off-campus-living students have better well-being than their evening-type peers living off campus, morning-type campus residents had worse well-being than other campus residents and they were more likely to discontinue living on campus after one semester. Our findings bear practical significance to college management that morning-type campus residents are shown to be experiencing deteriorating well-being. The authorities may need to review and revise the room-allocation policy in campus residence in improving the well-being among campus residents.     

基于信息技术的医院医保闭环式管理

新医改背景下医院面临越来越大的医保拒付风险，借助信息技术推动医保闭环式管理能有效防范医保拒付风险。文章先分析了医院推行医保闭环式管理的必要性，再对医院医保闭环式管理的内涵进行了论述，后以我院基于信息技术的医保闭环式管理进行了案例分析。     

Weight-Based Insulin During and After Intravenous Insulin Infusion Reduces Rates of Rebound Hyperglycemia When Transitioning to Subcutaneous Insulin in the Medical Intensive Care Unit

ObjectiveHyperglycemia often occurs after the transition from intravenous insulin infusion (IVII) to subcutaneous insulin. Weight-based basal insulin initiated earlier in the course of IVII in the medical intensive care unit (MICU), and a weight-based basal-bolus regimen after IVII, can potentially improve post-IVII glycemic control by 48 hours.MethodsThis prospective study included 69 patients in MICU who were on IVII for ≥24 hours. Exclusions were end-stage renal disease, type 1 diabetes mellitus, and the active use of vasopressors. The intervention group received weight-based basal insulin (0.2-0.25 units/kg) with IVII and weight-based bolus insulin after IVII. The control group received current care. The primary end points were glucose levels at specific time intervals up to 48 hours after IVII.ResultsThere were 25 patients in the intervention group and 44 in the control group. The mean age of the patients was 59 ± 15 years, 32 (47%) were men, and 52 (78%) had prior diabetes mellitus. The 2 groups were not different (acute kidney injury/chronic kidney disease, pre-existing diabetes mellitus, illness severity, or nothing by mouth status after IVII), except for the steroid use, which was higher in the control group than in the intervention group (34% vs 12%, respectively). Glucose levels were not lower until 36 to 48 hours after IVII (166.8 ± 39.1 mg/dL vs 220.0 ± 82.9 mg/dL, P < .001). When controlling for body mass index, nutritional status, hemoglobin A1C, and steroid use, glucose level was lower starting at 12 to 24 hours out (166.87 mg/dL vs 207.50 mg/dL, P = .015). The frequency of hypoglycemia was similar between the 2 groups (5.0% vs 7.1%). The study did not reach target enrollment.ConclusionThe addition of weight-based basal insulin during, and basal-bolus insulin immediately after, IVII in MICU results in better glycemic control at 24 hours after IVII with no increased hypoglycemia.     

Multimodal data acquisition at SARS-CoV-2 drive through screening centers: Setup description and experiences in Saarland,Germany

SARS-CoV-2 drive through screening centers (DTSC) have been implemented worldwide as a fast and secure way of mass screening. We use DTSCs as a platform for the acquisition of multimodal datasets that are needed for the development of remote screening methods. Our acquisition setup consists of an array of thermal, infrared and RGB cameras as well as microphones and we apply methods from computer vision and computer audition for the contactless estimation of physiological parameters. We have recorded a multimodal dataset of DTSC participants in Germany for the development of remote screening methods and symptom identification. Acquisition in the early stages of a pandemic and in regions with high infection rates can facilitate and speed up the identification of infection specific symptoms and large-scale data acquisition at DTSC is possible without disturbing the flow of operation.     

Kinetics of the use of cryopreserved autologous stem cell grafts: a GITMO-SIDEM survey

Background aimsHematopoietic stem cell cryopreservation significantly contributed to autologous stem cell transplantation (ASCT). Cryopreserved stem cell units (SCU) are expected to be used soon after harvesting for most purposes, but, in a number of cases, they remain stored for some time, creating an increasing load for SCU depositories. Disposal policies vary widely in each center, and the existing guidelines are insufficient.MethodsWe conducted a survey of seven Gruppo Italiano Trapianto di Midollo Osseo centers to investigate the outcome of SCU harvested from January 2005 to December 2009 for ASCT. The data from 1603 collections were gathered, for a total of 5822 SCU.ResultsIn our cohort, 79% of patients collected >5 × 10⁶ CD34+ cells/kg, and 3.4% collected <2 × 10⁶ CD34+ cells/kg. Up to 21% of all the patients and 42% of those with acute leukemia did not undergo reinfusion, and 37% of the cryopreserved SCU were excess, resulting from patients not reinfusing or partially reinfusing. Less than one-third of the excess SCU was disposed, and the major causes of disposal were death and, in a minority of cases, withdrawal of the indication for ASCT. In our analysis, very few first reinfusions occurred after 2 years, and those after 5 years were exceptional. Through the use of a multivariate analysis, we sought to identify the risk factors for collection non-use, independent of the centers' policies. Non-use of SCU was significantly associated with patients with acute leukemia, collections of <2 × 10⁶ CD34/kg and lower age groups.ConclusionsThese data serve as a valid basis to support rational recommendations for cost-effective storage and disposal of SCU.     

Reasonability and Conscientious Objection in Medicine: A Reply to Marsh and an Elaboration of the Reason‐Giving Requirement

In this paper I defend the Reasonability View: the position that medical professionals seeking a conscientious exemption must state reasons in support of their objection and allow those reasons to be subject to evaluation. Recently, this view has been criticized by Jason Marsh as proposing a standard that is either too difficult to meet or too easy to satisfy. First, I defend the Reasonability View from this proposed dilemma. Then, I develop this view by presenting and explaining some of the central criteria it uses to assess whether a conscientious objection is proper grounds for extending an exemption to a medical practitioner.     

Anatomical Feature Segmentation of Femur Point Cloud Based on Medical Semantics

Feature segmentation is an essential phase for geometric modeling and shape processing in anatomical study of human skeleton and clinical digital treatment of orthopedics. Due to various degrees of freedom of bone surface, the existing segmentation algorithms can hardly meet specific medical need. To address this, a novel segmentation methodology for anatomical features of femur model based on medical semantics is put forward. First, anatomical reference objects (ARO) are created to represent typical characteristics of femur anatomy by 3D point fitting in combination with medical priori knowledge. Then, local point clouds between adjacent anatomies are selected according to the AROs to extract boundary feature point (BFP)s. Finally, the complete model of femur is divided into anatomical regions by executing the enhanced watershed algorithm guided with BFPs. Experimental results show that the proposed method has the advantages of automatic segmentation of femoral head, neck and other complex areas, and the segmentation results have better medical semantics. In addition, the slight modification of segmentation results can be achieved by adjusting a few threshold parameter values, which improves the convenience of modification for ordinary users.