By D. Brant. State University of New York College at Brockport. 2018.
To identify and consider the ethical generic 30 mg paroxetine visa, legal and social implications of transactions involving human bodies and bodily material in medical treatment and research generic 30 mg paroxetine otc. A wide range of forms of human bodily material may be provided by one person for the treatment of others, or for research that aims to improve medical treatment in future. Bodily material can only be derived from the body of a person hence the ethical challenges with which this report is concerned and yet what can be done with that material, once separated from the body, appears to be ever-expanding. Such developments bring their own ethical challenges: for example, they highlight the crucial role played by transactions and intermediaries in the sphere of donation. While many donors may see themselves as donating in a very immediate way to another person in need, in practice many complicated networks are required to connect the sources and recipients of donated bodily material. Diverse intermediaries (specialist nurses, transport services, technical and ancillary staff to name just a few) are involved in processing the material to facilitate its use by the end-recipient. Thus, while we note that potential donors are often encouraged to come forward by agencies focussing on the needs of a single symbolic recipient, any consideration of policy surrounding donation must take into account the complex transactions and multiple intermediaries involved in the process. The range of materials described in this report makes explicit the very different circumstances under which people can donate. Throughout this report, we aim to pinpoint what is specific to the ethical issues that arise in particular cases and what may lie in common with others. Since the publication of the Councils report Human Tissue: ethical and legal issues in 1995, the regulatory frameworks governing the donation, storage and use of human bodily material have changed and multiplied, leading to a very different regulatory environment from fifteen years ago. Nevertheless, the detailed aspects of regulation vary significantly both in terms of the form of bodily material, and the purposes for which it has been donated. Bodily material thus circulates within a global market-place: while almost all countries prohibit donors from deriving financial gain from the donation of their bodily material (gametes being a common exception), money does change hands in connection with the many medical and technical services required to handle and process that material, whether for treatment or research purposes. This may take the form of the reimbursement of direct financial expenses incurred in donating bodily material (such as train fares and lost earnings); or compensation for non-financial losses (such as inconvenience, discomfort and time). There is a continual need to recruit new blood donors in order to maintain an adequate supply of blood; three people die every day while waiting for an organ transplant; many fertility clinics are not able to meet requests for treatment involving donor eggs or sperm; and research organisations cite difficulties in accessing bodily material as a key factor limiting research progress. Shortages of supply may affect particular subgroups of the population more than others, because of the need to match material according to immunological criteria or age. The relationship between supply and demand for human bodily material is, moreover, a complex one. Public expectations of what medical science can achieve may serve to put further upward pressure on demand. Discussions around how best to increase supply of bodily material often focus on questions of donor motivation: how individuals may best be encouraged to donate different forms of bodily material. Considerable effort is put into coordinated advertising campaigns to recruit blood and organ donors, and proposals to incentivise potential donors through benefits in money or in kind regularly emerge in academic circles. However, individual motivation and choice is only one part of the picture: the central role of organisations, organisational procedure and intermediary professionals in facilitating donation is becoming better understood, as is the importance of trust in these systems. Examples of such organisational factors include the significant changes to the management of organ donation services made in recent years, with the aim of ensuring that whenever a person dies in circumstances where organ donation is a possibility, this possibility may be raised with their family. The issue of consent of whether, for example, organs might routinely be taken after death unless the deceased had explicitly objected in advance, or whether people might be required to log their consent or objection to organ donation during their lifetime continues to be a subject of fierce debate. Two unifying factors governing the bodily materials considered in this report are that they all come from persons, and that their intended use is to benefit others rather than the person who is the source of the material. These two aspects of the donation or volunteering of bodily material have generated a number of (sometimes competing) ethical concerns. The concerns 3 H u m a n b o d i e s : d o n a t i o n f o r m e d i c i n e a n d r e s e a r c h focus on such issues as: control and ownership of the human body; the adequacy of consent procedures to protect the donor; and the wider (common) goods arising from donation. Ethical values often invoked in response to such concerns include: altruism; autonomy; dignity; justice; maximising health and welfare; reciprocity; and solidarity. This potential for conflicts in usage does not mean that these values are made redundant; but rather that the way they are being used in particular circumstances needs to be made explicit and, where necessary, justified. For example, the traditional emphasis on the importance of the gift has been criticised both because it may fail to prompt sufficient donors to meet demand, and because it may at times be used as a cover for coercive or exploitative relationships. However, it is clear that for many the notion of the gift elicits the sense of a supremely social act in its orientation towards others. It also plays an important role in drawing attention to the person (the gift-giver) whose body is at issue. No-one would deny that it epitomises the opposite of theft and seizure by force, and in so doing it points to the desirability of material properly given rather than improperly taken. We suggest that donation is a multi-layered process with each layer having its own public and private meanings. It may therefore be more helpful to think of public and private as being complementary and overlapping rather than in opposition (see Box 4. Throughout this report, the Council has sought to be clear as to how these very different meanings and associations are being applied in different circumstances. Finally, we touch on the psychological aspects of how individuals arrive at moral judgments: these may often be based on rapid intuitions, which may then be followed by slower moral reasoning, in which intuited values may be made explicit.
AbbVie can expand more high-need countries such as China and the geographic scope of licences agreed for for- Indonesia: combination ombitasvir/paritaprevir/ mulations of ritonavir (Kaletra ) in its licens- ritonavir (Technivie ) and dasabuvir/ombitas- ing activities buy paroxetine 30 mg on-line. Rest of world Japan Europe North America *AbbVie Inc became an independent company on 1 January 2013 cheap paroxetine 10mg mastercard. The company has gained fve market AbbVie s R&D projects have progressed along Communicable Multiple categories approvals since 2014: including, in Q4 2014, the pipeline. It has several features intended to development, plus atrasentan for diabetic nephropathy. Commitment to R&D partnerships, but no Drops two places due to a lack of improvement policy. AbbVie discloses a list of trade associa- compounds for screening and technical exper- all areas of measurement. It is not transparent tions from around the world in which one of its tise to outside partners. However, it does not regarding its access targets, the performance of employees is a board member. Nevertheless, it report an ofcial policy of ensuring access-ori- its access activities and its stakeholder engage- does not publish its policy positions on topics ented measures are systematically included in its ment selection process. Takes strategic approaches to access but these Takes measures to ensure ethical clinical trial do not align with business strategy. However, AbbVie has not specifed how marketing or corruption anywhere in the world High transparency around clinical trials. AbbVie these components are connected, nor how they during the period of analysis. Has a centralised performance management AbbVie has strong procedures for holding all AbbVie manages requests for data in-house. AbbVie has assigned board- employees and business partners accountable Rejections based on scientifc merit are for- level responsibility for access issues and has for their behaviour. It does not disclose specifc access-related to and including termination of employment. The company has an Has stakeholder engagement strategy, but auditing system, but does not provide details Drops 8 places due to relatively poor pric- is not transparent. AbbVie has a stakeholder about its processes and whether these include ing and registration performance. However, AbbVie does ers when it comes to rapidly registering new not publish details of the stakeholder groups it Drops two places but maintains strong perfor- products in high-burden countries, or to adapt- engages with, nor its process for selecting who mance. AbbVie s drop in rank is explained by the ing its brochures and packaging to facilitate the to engage with. However, pliance system, but its transparency around its only 20% of its products have equitable pric- marketing and lobbying activities is limited. The company Together, they cover 50% of all corresponding ited marketing code and its sales staf are incen- has processes for goal-setting and monitoring priority countries. For its inter-country equitable tivised using sales targets only, which may not and for evaluating progress toward its relevant pricing strategies, AbbVie considers either dis- be sufcient to curb unethical behaviour. It contributes to meeting ease burden or prevalence, as well as the state company is not a signatory of the United Nations the London Declaration targets by 2020, includ- of public fnancing systems. This makes it the newest pharma- ceutical company to engage in non-exclusive vol- Rises four places. With four donation programmes, AbbVie does not have disease-specifc registra- Abbvie has the second largest number of struc- tion targets and does not publish products reg- Does not publish its policy positions on trade tured donation programmes. As a result, it is positions regarding the Doha Declaration on the Expands product donation activity. AbbVie launched a new donation programme, its products based on the need for access. Its ter a few of its recently launched products in all new programme aims to improve the survival corresponding priority countries (disease-spe- No change in rank. AbbVie performs above rates of premature babies in Honduras, India, cifc sub-sets of countries with a particular need average when it comes to strengthening phar- Jamaica, and Paraguay. However, most macovigilance systems and disclosed one of of these products were frst marketed 15 20 the strongest commitments to reporting sus- Clear commitment to product donations. Its performance in AbbVie has made a public commitment to sup- products launched since 2014 in only a few pri- other areas, however, is comparatively weak. AbbVie has glob- AbbVie also commits to adhering to a strict ally consistent guidelines for issuing drug recalls Among the leaders in strengthening pharma- Global Product Donations Policy, which aligns in all countries relevant to the Index where its covigilance systems. AbbVie has not recalled safety data with authorities upon request and a product for a relevant disease in a country in updates safety labels in countries in scope.
Executive Summary: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition): Antithrombotic and Thrombolytic Therapy cheap paroxetine 40 mg online. Results: Pooled results: numerator denominator proportion ---------------------------------------------------- 1 cheap 30mg paroxetine,947 8,569 22. Thomas Tufts Jennifer Lavigne Fallon Michael O Shea - Baycare Health Neil Minkoff - Harvard Pilgrim Health Care Paul Mendis- Neighborhood Health Plan Bob Jordan - Neighborhood Health Plan Bob Sorrenti Unicare Constance Williams Unicare Laura Syron - Neighborhood Health Plan Susan Tiffany Unicare Constance Hwang Resolution Health Darren Schulte - Resolution Health Earl Steinberg Resolution Health David Gregg Mercer Russ Robinson - Mercer 46 Measure Developer/Steward Updates and Ongoing Maintenance Year the measure was first released: 2006 Month and Year of most recent revision: October 2008 What is the frequency for review/update of this measure? Citations for Evidence: N/A Data/sample: Analytic Method: Testing Results: 28 Risk Adjustment Testing Summarize the testing used to determine the need (or no need) for risk adjustment and the statistical performance of the risk adjustment method. Results: numerator denominator proportion ---------------------------------------------------- 131 272 48. Among them, diseases of infectious origin are commonest, notably diarrhoea and dysentery. Other diseases related to the gastrointestinal tract include among others; intestinal helminthiasis, gastrointestinal ulcers, and malignancies. Many research studies ranging from laboratory experiment to field surveys had been carried out on gastrointestinal diseases in the country. The present bibliography was compiled to describe the findings of research studies which were carried out during 1960 to 2010. The compiled abstracts are arranged according to the year of publication for each decade and research findings were summarized for each decade. This collection was published to provide pertinent information on the status of diseases and disorders of gastrointestinal tract research in Myanmar to the scientists, health care personnel, administrators and decision- makers. The compilers simply wish that it will of benefit to those who want to learn about gastrointestinal problems in the context of Myanmar people. The authors greatly appreciate the help provided by librarians of the various libraries and the staff of the Central Biomedical Library, Department of Medical Research (Lower Myanmar). Epidemics of cholera were rampant in the Kingdom of Myanmar th since the 18 century and global pandemics of cholera invaded the Kingdom of th Myanmar and also British Burma from time to time, the 6 pandemic reaching Myanmar in 1901. They were a threat to the health of the colonial army, the administrators, their families and the European community which followed the British flag into Myanmar, as well as to the proper conduct of administration and trade. By the time Myanmar Kingdom was annexed to the British Empire in 1886, the cholera vibrio had already been discovered by Koch in 1883 and the water borne nature of the disease was known. The classic studies of Snow in London in 1855 and others in India had shown that it is possible to prevent cholera by providing clean water. After Independence in 1948, the Myanmar health authorities continued to focus attention on and study different aspects of cholera, according to need and opportunity. Diarrhoea (non-choleric or non-specified diarrhoea) became gradually recognized as a highly prevalent and important cause of mortality and morbidity in Myanmar, especially in children including neonates and was listed among the top priority diseases in successive National Health Plans. Although people in the community and general practitioners would have always been aware of its pervasiveness and health impact, it was only from around the 1960 s that the focus of attention of the health authorities shifted from cholera to diarrhoea and it became the subject of intense scientific study in scope and depth, from the medical as well as socio-economic aspects, throughout the later decades. Intestinal helminthic infections are easily recognized and known to be highly prevalent in children in Myanmar and like diarrhoea, they have been the subject of intense scientific study from about the 1950 s onwards. Dysentery is also easily recognized, very common and has been scientifically studied to some extent and depth from about the 1950 s onwards. The exception was Peptic ulcer, where the new concept 1 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar regarding etiology (Helicobacter pylori infection) gave the stimulus and theme for a series of in-depth studies. Epidemiological methods were at first elementary and descriptive but soon progressed to analytical epidemiological methods to find causal relationships, like between intestinal helminthiasis and nutrition, diarrhoea and climate. Epidemiological modeling methods were used to predict and confirm the results of public health interventions such as mass chemotherapy on intestinal helminthiasis. Special techniques were used to investigate the action of microbial toxins - such as invasiveness, adherence and intestinal secretory response. Novel methods were introduced to investigate food iron absorption:- such as radioactive labeling of rice grown by hydroponic culture, double radio-labeled iron tracers to measure rice iron absorption and quantification of intestinal mucosal iron content. Radio-active tracers were used to investigate biochemical activity in intestinal mucosal cells such as effect of cholera toxin on amino-acid uptake by the gut. Anatomical methods - for study of gross and microscopic gut structure for academic purposes were those routinely available in college anatomy departments. Pathological methods ranged from routine histological methods to hitherto unused approaches like dissecting microscopy of intestinal villi obtained by Crosby intestinal capsule; and special histological stains to detect and measure intestinal mucosal cell contents like lactase enzyme. Aung Than Batu 3 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar 4 Bibliography of Research Findings on Gastrointestinal Diseases in Myanmar Introduction This bibliography was compiled with the aim to accumulate all available data on diseases and disorders of gastrointestinal tract research studies carried out in Myanmar. An extensive literature review was carried out to collect all published data on diseases and disorders of gastrointestinal tract research in country. In collection, literature written in English with research findings on human gastrointestinal diseases, and conducted by a research team which included at least one Myanmar investigator was compiled. Abstracts published in international and local conference/ seminars/ symposium/ were also compiled. All publications on diseases and disorders of the gastrointestinal tract recorded by biographies as mentioned in Who s Who in Medicine in Burma (1972) and Who s Who in Health and Medicine in Myanmar (2003) were included. The search was further extended to all medical subjects and to related science theses such as Zoology.
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