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Drzayich Antol D, Schwartz R, Caplan A, Casebeer A, Erwin CJ, Shrank WH, Powers BW. Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries With Complex Care Needs. JAMA Health Forum 2022; 3:e223451. [PMID: 36206006 PMCID: PMC9547312 DOI: 10.1001/jamahealthforum.2022.3451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Importance Medicare beneficiaries with co-occurring chronic conditions and complex care needs experience high rates of acute care utilization and poor outcomes. These patterns are well described among traditional Medicare (TM) beneficiaries, but less is known about outcomes among Medicare Advantage (MA) beneficiaries. Compared with TM, MA plans have additional levers to potentially address beneficiary needs, such as network design, care management, supplemental benefits, and value-based contracting. Objective To compare health care utilization for MA and TM beneficiaries with complex care needs. Design, Setting, and Participants This cross-sectional study analyzed beneficiaries enrolled in MA and TM using claims data from a large, national MA insurer and a random 5% sample of TM beneficiaries. Beneficiaries were segmented into the following cohorts: frail elderly, major complex chronic, and minor complex chronic. Regression models estimated the association between MA enrollment and health care utilization in 2018, using inverse probability of treatment weighting to balance the MA and TM cohorts on observable characteristics. The study period was January 1, 2017, through December 31, 2018. All analyses were conducted from December 2020 to August 2022. Exposures Enrollment in MA vs TM. Main Outcomes and Measures Hospital stays (inpatient admissions and observation stays), emergency department (ED) visits, and 30-day readmissions. Results Among a study population of 1 844 326 Medicare beneficiaries (mean [SD] age, 75.6 [7.1] years; 1 021 479 [55.4%] women; 1 524 458 [82.7%] White; 223 377 [12.1%] with Medicare-Medicaid dual eligibility), 1 177 896 (63.9%) were enrolled in MA and 666 430 (36.1%) in TM. Beneficiary distribution across cohorts was as follows: frail elderly, 116 047 with MA (10.0% of the MA sample) and 104 036 with TM (15.6% of the TM sample); major complex chronic, 320 954 (27.2%) and 158 811 (23.8%), respectively; and minor complex chronic, 740 895 (62.9%) and 403 583 (60.6%), respectively. Beneficiaries enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions. The largest relative differences were observed for hospital stays, which ranged from -9.3% (95% CI, -10.9% to -7.7%) for the frail elderly cohort to -11.9% (95% CI, -13.2% to -10.7%) for the major complex chronic cohort. Conclusions and Relevance In this cross-sectional study of Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions than similar beneficiaries enrolled in TM, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries.
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Affiliation(s)
| | | | | | | | | | | | - Brian W. Powers
- Humana Inc, Louisville, Kentucky,Mass General Brigham, Boston, Massachusetts,Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Boudreau E, Schwartz R, Schwartz AL, Navathe AS, Caplan A, Li Y, Blink A, Racsa P, Antol DD, Erwin CJ, Shrank WH, Powers BW. Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries. JAMA Health Forum 2022; 3:e222935. [PMID: 36218933 PMCID: PMC9463603 DOI: 10.1001/jamahealthforum.2022.2935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Question Do rates of low-value care differ between traditional Medicare (TM) and Medicare Advantage (MA), and, if so, what elements of insurance design are associated with the differences? Findings In this cross-sectional study of 2 470 199 Medicare beneficiaries, those enrolled in MA received 9.2% fewer low-value services than those in TM (23.1 vs 25.4 total low-value services per 100 beneficiaries). The MA beneficiaries in health maintenance organizations and those in primary care organizations reimbursed within advanced value-based payment models had the lowest rates of low-value care. Meaning The study results suggest that low-value care is less common in MA than TM, with elements of insurance design present in MA associated with fewer low-value services. Importance Low-value care in the Medicare program is prevalent, costly, potentially harmful, and persistent. Although Medicare Advantage (MA) plans can use managed care strategies not available in traditional Medicare (TM), it is not clear whether this flexibility is associated with lower rates of low-value care. Objectives To compare rates of low-value services between MA and TM beneficiaries and explore how elements of insurance design present in MA are associated with the delivery of low-value care. Design, Setting, and Participants This cross-sectional study analyzed beneficiaries enrolled in MA and TM using claims data from a large, national MA insurer and a random 5% sample of TM beneficiaries. The study period was January 1, 2017, through December 31, 2019. All analyses were conducted from July 2021 to March 2022. Exposures Enrollment in MA vs TM. Main Outcomes and Measures Low-value care was assessed using 26 claims-based measures. Regression models were used to estimate the association between MA enrollment and rates of low-value services while controlling for beneficiary characteristics. Stratified analyses explored whether network design, product design, value-based payment, or utilization management moderated differences in low-value care between MA and TM beneficiaries and among MA beneficiaries. Results Among a study population of 2 470 199 Medicare beneficiaries (mean [SD] age, 75.6 [7.0] years; 1 346 777 [54.5%] female; 229 107 [9.3%] Black and 2 126 353 [86.1%] White individuals), 1 527 763 (61.8%) were enrolled in MA and 942 436 (38.2%) were enrolled in TM. Beneficiaries enrolled in MA received 9.2% (95% CI, 8.5%-9.8%) fewer low-value services in 2019 than TM beneficiaries (23.1 vs 25.4 total low-value services per 100 beneficiaries). Although MA beneficiaries enrolled in health management organization and preferred provider organization products received fewer low-value services than TM beneficiaries, the difference was largest for those enrolled in health management organization products (2.6 fewer [95% CI, 2.4-2.8] vs 2.1 fewer [95% CI, 1.9-2.3] services per 100 beneficiaries, respectively). Across primary care payment arrangements, MA beneficiaries received fewer low-value services than TM beneficiaries, with the largest difference observed for MA beneficiaries whose primary care physicians were reimbursed within 2-sided risk arrangements. Conclusions and Relevance In this cross-sectional study of Medicare beneficiaries, those enrolled in MA had lower rates of low-value care than those enrolled in TM; elements of insurance design present in the MA program and absent in TM were associated with reduction in low-value care.
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Affiliation(s)
| | | | - Aaron L. Schwartz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Amol S. Navathe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Yong Li
- Humana Inc, Louisville, Kentucky
| | | | | | | | | | | | - Brian W. Powers
- Humana Inc, Louisville, Kentucky
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Shaw K, Doudican N, Frazzette N, Caplan A, Femia A, Carucci J. 014 Differential gene expression in lesional skin may signify immune-mediated lung parenchymal damage in dermatomyositis patients. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Bayefsky M, Dorice V, Caplan A, Quinn G. P–353 When Parents and Minor Children Disagree about Fertility Preservation: A Scoping Review and Ethical Analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Periodically, parents and children disagree about whether to pursue fertility preservation (FP). How should medical teams navigate these ethically complex situations?
Summary answer
Several considerations must be weighed, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP.
What is known already
As reproductive technology advances, FP prior to gonadotoxic therapy has become the standard of care. Periodically, parents and children disagree about whether to pursue FP. To date, there is no clear guidance on how to navigate these difficult situations. Prior studies have demonstrated that adolescents undergoing gonadotoxic therapy want their views regarding FP to be taken into account, and also that most children and adolescents are comfortable with parental involvement in decision-making. However, transgender adolescents pursue FP at lower rates than adolescents with cancer, and more research is required to elucidate the unique needs and barriers of transgender youth.
Study design, size, duration
This study involves a scoping review and ethical analysis about parent-child disagreement regarding FP in minors. The review analyzes papers that either demonstrate that parent-child disagreement occurs, describe the preferences of parents or children regarding decision-making around FP, or provide recommendations that can be used to resolve parent-child conflicts. The ethical analysis weighs relevant rights and interests, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy.
Participants/materials, setting, methods
A search string was developed to identify all relevant published manuscripts on the topic of FP in minors, including studies on decision-making, family relations and ethical challenges. The search was run through several databases, abstracts were screened using Covidence, and data were extracted from full texts. Data abstracted from the review and existing literature on general medical decision-making for minors were used to construct an ethical framework for parent-child disagreements regarding FP in minors.
Main results and the role of chance
Published work directly on the topic of parent-child disputes regarding FP is limited, however a number of studies tangentially discuss parent-child disagreements and provide insight into the desires of parents and children regarding decision-making around FP. Studies suggest that adolescents desire to have their views taken into account, and a minority of adolescents believe their wishes alone should be followed. The age of the minor is a crucial factor, and some propose that as adolescents approach adulthood, their autonomy should increase. At the same time, in practice, legal and financial constraints often render parents the ultimate decision-makers. Our ethical analysis weighs competing considerations, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy. It concludes that who prevails should depend on contextual factors, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP. There may also be special considerations for transgender adolescents, some of whom might have deeply personal reasons for pursuing or forgoing FP that are not well-understood by cisgender parents.
Limitations, reasons for caution
The scoping review captured a variety of results, including survey and interview studies, society guidelines, and ethical analyses. As such, we were unable to define a uniform quality metric. However, we aimed to be more rather than less inclusive because of the limited results directly pertaining to parent-child disagreements.
Wider implications of the findings: This study provides a robust review of decision-making for FP in minors and offers an ethical framework for weighing countervailing considerations when parents and children disagree about whether to pursue FP. The conclusions can be used to inform guidance for clinicians presented with this challenging ethical dilemma.
Trial registration number
N/A
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Affiliation(s)
- M Bayefsky
- NYU Langone Health, Obstetrics and Gynecology, New York, USA
| | - V Dorice
- NYU Grossman School of Medicine, Medical Library, New York, USA
| | - A Caplan
- NYU Langone Health, Division of Medical Ethics, New York, USA
| | - G Quinn
- NYU Langone Health- NYU School of Medicine, Obstetrics and Gynecology- Department of Population Health, New York, USA
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5
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Bayefsky M, Dorice V, Caplan A, Quinn G. P-353 When Parents and Minor Children Disagree about Fertility Preservation: A Scoping Review and Ethical Analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab128.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Periodically, parents and children disagree about whether to pursue fertility preservation (FP). How should medical teams navigate these ethically complex situations?
Summary answer
Several considerations must be weighed, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP.
What is known already
As reproductive technology advances, FP prior to gonadotoxic therapy has become the standard of care. Periodically, parents and children disagree about whether to pursue FP. To date, there is no clear guidance on how to navigate these difficult situations. Prior studies have demonstrated that adolescents undergoing gonadotoxic therapy want their views regarding FP to be taken into account, and also that most children and adolescents are comfortable with parental involvement in decision-making. However, transgender adolescents pursue FP at lower rates than adolescents with cancer, and more research is required to elucidate the unique needs and barriers of transgender youth.
Study design, size, duration
This study involves a scoping review and ethical analysis about parent-child disagreement regarding FP in minors. The review analyzes papers that either demonstrate that parent-child disagreement occurs, describe the preferences of parents or children regarding decision-making around FP, or provide recommendations that can be used to resolve parent-child conflicts. The ethical analysis weighs relevant rights and interests, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy.
Participants/materials, setting, methods
A search string was developed to identify all relevant published manuscripts on the topic of FP in minors, including studies on decision-making, family relations and ethical challenges. The search was run through several databases, abstracts were screened using Covidence, and data were extracted from full texts. Data abstracted from the review and existing literature on general medical decision-making for minors were used to construct an ethical framework for parent-child disagreements regarding FP in minors.
Main results and the role of chance
Published work directly on the topic of parent-child disputes regarding FP is limited, however a number of studies tangentially discuss parent-child disagreements and provide insight into the desires of parents and children regarding decision-making around FP. Studies suggest that adolescents desire to have their views taken into account, and a minority of adolescents believe their wishes alone should be followed. The age of the minor is a crucial factor, and some propose that as adolescents approach adulthood, their autonomy should increase. At the same time, in practice, legal and financial constraints often render parents the ultimate decision-makers. Our ethical analysis weighs competing considerations, including the child’s best interest, the right to an open future, the child’s autonomy, and parental autonomy. It concludes that who prevails should depend on contextual factors, including the minor’s age, the burden of the proposed procedure, and whether the minor or parent seeks to decline FP. There may also be special considerations for transgender adolescents, some of whom might have deeply personal reasons for pursuing or forgoing FP that are not well-understood by cisgender parents.
Limitations, reasons for caution
The scoping review captured a variety of results, including survey and interview studies, society guidelines, and ethical analyses. As such, we were unable to define a uniform quality metric. However, we aimed to be more rather than less inclusive because of the limited results directly pertaining to parent-child disagreements.
Wider implications of the findings
This study provides a robust review of decision-making for FP in minors and offers an ethical framework for weighing countervailing considerations when parents and children disagree about whether to pursue FP. The conclusions can be used to inform guidance for clinicians presented with this challenging ethical dilemma.
Trial registration number
N/A
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Affiliation(s)
- M Bayefsky
- NYU Langone Health, Obstetrics and Gynecology, New York, U.S.A
| | - V Dorice
- NYU Grossman School of Medicine, Medical Library, New York, U.S.A
| | - A Caplan
- NYU Langone Health, Division of Medical Ethics, New York, U.S.A
| | - G Quinn
- NYU Langone Health- NYU School of Medicine, Obstetrics and Gynecology- Department of Population Health, New York, U.S.A
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Casebeer AW, Schwartz R, Patel H, Caplan A, Bhattacharya R, Long C, Sharma A, Changamire T, Uribe C, Stemple C, Thomas K, Newsom M, Painter P, Shrank W, Brown CR. Post-SNF outcomes and cost comparison: Medicare Advantage vs traditional Medicare. Am J Manag Care 2021; 27:140-146. [PMID: 33877772 DOI: 10.37765/ajmc.2021.88616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare outcomes and costs following skilled nursing facility (SNF) discharge for patients within a Medicare Advantage (MA) organization vs traditional Medicare (TM). STUDY DESIGN Retrospective analysis of adults with a postacute SNF admission identified from MA claims (MA cohort: n = 56,228) and the Medicare 5% Limited Data Sets (TM cohort: n = 67,859). METHODS Outcomes included hospitalization, proportion of days at home, and total medical costs during the 180 days post SNF discharge, and successful community discharge. Regression models accounted for patient characteristics and health care utilization in the 180 days prior to the proximal hospitalization and characteristics of the proximal hospitalization using backward variable selection and fixed effects for MA enrollment. To control for observable differences between individuals who selected MA vs TM, inverse probability of treatment weighting (IPTW) was conducted. RESULTS The MA cohort was younger than the TM cohort (median age, 77 vs 81 years), more likely to have qualified for Medicare based on disability (29% vs 20%), and less likely to have dual Medicare/Medicaid eligibility (16% vs 23%). After adjustment, MA was associated with 22% decreased odds of hospitalization during the 180 days post SNF discharge, 19% increased odds of successful community discharge, a 4% increase in the proportion of days at home (equating to 6.7 additional days), and a 24% decrease in medical costs post SNF discharge. Results using IPTW were similar. CONCLUSIONS MA was associated with better outcomes and lower costs post SNF discharge, suggesting efficiencies in care for SNF patients with MA. Further research is needed to evaluate specific MA features that may lead to better value.
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7
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Caplan A, Imadojemu S, Werth VP. Importance of recognition and improved treatment for antimelanoma differentiation-associated protein 5-associated dermatomyositis. Br J Dermatol 2017; 177:1168-1169. [PMID: 29192975 DOI: 10.1111/bjd.15944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- A Caplan
- Department of Dermatology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - S Imadojemu
- Departments of Medicine and Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, U.S.A
| | - V P Werth
- Department of Dermatology, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, U.S.A.,Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A
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8
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Lewis A, Weaver J, Caplan A. Portrayal of Brain Death in Film and Television. Am J Transplant 2017; 17:761-769. [PMID: 27642118 DOI: 10.1111/ajt.14016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/11/2016] [Accepted: 08/14/2016] [Indexed: 01/25/2023]
Abstract
We sought to evaluate whether television and cinematic coverage of brain death is educational or misleading. We identified 24 accessible productions that addressed brain death using the archives of the Paley Center for Media (160 000 titles) and the Internet Movie Database (3.7 million titles). Productions were reviewed by two board-certified neurologists. Although 19 characters were pronounced brain dead, no productions demonstrated a complete examination to assess for brain death (6 included an assessment for coma, 9 included an evaluation of at least 1 brainstem reflex, but none included an assessment of every brainstem reflex, and 2 included an apnea test). Subjectively, both authors believed only a small fraction of productions (13% A.L., 13% J.W.) provided the public a complete and accurate understanding of brain death. Organ donation was addressed in 17 productions (71%), but both reviewers felt that the discussions about organ donation were professional in a paucity of productions (9% for A.L., 27% for J.W.). Because television and movies serve as a key source for public education, the quality of productions that feature brain death must be improved.
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Affiliation(s)
- A Lewis
- Division of Neurocritical Care, Departments of Neurology and Neurosurgery, NYU Langone Medical Center, New York, NY
| | - J Weaver
- Department of Neurology, New York Presbyterian-Weill Cornell Medical Center, New York, NY
| | - A Caplan
- Division of Medical Ethics, Department of Population Health, NYU Langone Medical Center, New York, NY
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Abstract
Esophageal atresia (EA) occurs in one out of 2500 to 4500 live births. As the vast majority of infants are now surviving neonatal corrective surgery, the focus has shifted from mortality to morbidity associated with EA. However, little is known about its psychological morbidity. This paper synthesizes research and clinical evidence to highlight the psychological sequelae of EA, including its impact on parents' psychological functioning and its effects on child development from infancy to adulthood. Whether it is discovered at birth or prenatally, EA is a psychologically traumatic event, and parents are at risk for developing traumatic stress reactions following diagnosis. Neonatal surgery and intensive care, risk of complications, associated anomalies, and genetic etiologies multiply risk for parents' acute and post-traumatic stress disorders (PTSD). Parental PTSD has a negative impact on infant and child development through its effects on parenting skills and parent-child interactions. EA children are also at risk for PTSD because of invasive and stressful procedures they undergo during the neonatal period. Consequences of EA can have an important long-term impact on children's psychological and social development. The scant studies pertaining to cognitive functioning suggest that EA does not affect mental development during infancy, but may be associated with deficits as children reach school age. Long-term sequelae are unclear because psychological functioning in adults has not yet been adequately examined. Research and clinical evidence of psychological morbidity associated with EA has implications for clinical practice. Psychological support for parents must begin during the neonatal period and should continue as an integral component of long-term follow up for both children and parents. Support is best provided within the context of a multidisciplinary treatment team that follows patients from birth through childhood and adolescence. Psychological follow up should continue into adulthood, as patients grow up and transition from pediatric to adult health-care settings.
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Affiliation(s)
- A Caplan
- Division of Gastroenterology, Hepatology, and Nutrition, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.
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Abstract
With the use of technologically constructed hypoxic environments (TCHE) in soccer as our case, we propose four check points from which to evaluate new performance-enhancing technologies in sport. These are (I) Is the technology beneficial, (II) Is it safe, (III) Can fairness be assured, and (IV) Is the technology in line with the spirit of or rationale for sport? The use of TCHE is ambiguous. On the one hand, in situations with grave inequalities between teams due to lack of acclimatization of one team, TCHE can be an efficient means to even the playing field and out of concern for athlete welfare and health. On the other hand, if used as a pure performance-enhancing means to enhance the oxygen-carrying capacity of the blood independent of altitude, it belongs to a category of expert-assisted performance enhancement that may challenge athletic autonomy and the responsibility for one's own performance and, hence, the spirit of sport.
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Abstract
Whether the number of organs available for transplant would be positively or negatively affected by providing benefits to families of organ donors has been debated by policymakers, ethicists and the transplant community at large. We designed a telephone survey to measure public opinion regarding the use of benefits in general and of five types in particular: funeral benefits, charitable contributions, travel/lodging expenses, direct payments and medical expenses. Of the 971 adults who completed the survey (response rate = 69%), all were from Pennsylvania households, 45.6% were registered organ donors, and 51.7% were nonwhite. Although 59% of respondents favored the general idea of incentives, support for specific incentives ranged from 53% (direct payment) to 84% (medical expenses). Among those registered as donors, more nonwhites than whites supported funeral benefits (88% vs. 81%; p = 0.038), direct payment (63% vs. 41%; p < 0.001) and medical expenses (92% vs. 84%; p = 0.013). Among those not registered as donors, more nonwhites supported direct payment (64% vs. 46%; p = 0.001). Most respondents believed that benefits would not influence their own behavior concerning donation but would influence the behavior of others. While benefits appear to be favored, their true impact can only be assessed through pilot programs.
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Affiliation(s)
- C L Bryce
- Department of Medicine, University of Pittsburgh, Pennsylvania, USA.
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Wernet P, Fischer J, Caplan A, Zanjani E, Müller H, Knipper A, Kögler G. Isolation of non-hematopoietic stem cells from umbilical cord blood. Biol Blood Marrow Transplant 2004. [DOI: 10.1016/j.bbmt.2004.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices as scaffold materials. One matrix that has been shown to promote healing and regeneration of neotissue in various applications is porcine-derived small intestinal submucosa. It was the objective of this study to investigate small intestinal submucosa for intrasynovial flexor tendon grafting in a canine model. We hypothesized that at 6 weeks small intestinal submucosa grafts would undergo host cell infiltration, neovascularization, and replacement by host neotendon. We also hypothesized that small intestinal submucosa grafts would be incorporated by the host without extensive adhesions to surrounding tissues and therefore maintain normal digit function. An intrasynovial tendon autograft was used as a gold standard. At 6 weeks the intrasynovial tendon autografts remained viable, contained normal numbers of cells along their length, and had minimal peritendinous adhesions. Four of six autografts had normal function as determined by rotation of the distal interphalangeal joint. Also at 6 weeks, the small intestinal submucosa grafts had host cell infiltration, neovascularization, and wavy, oriented tissue. However, ubiquitous adhesions together with impaired function in all cases suggest that small intestinal submucosa grafts in the configuration used are not suitable as full-length intrasynovial grafts in this tendon and animal model.
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Affiliation(s)
- K Derwin
- Department of Biomedical Engineering, The Cleveland Clinic Foundation, Cleveland, OH, USA.
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14
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Magnus D, Caplan A. NAS cloning hearing disappoints participants. Science 2001; 294:1651. [PMID: 11724062 DOI: 10.1126/science.294.5547.1651c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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15
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Caplan A. Rheumatoid pneumoconiosis syndrome. 1965. Med Lav 2001; 92:483-5. [PMID: 11899941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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16
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McGee G, Caplan A. Stem cell research. Hastings Cent Rep 2001; 31:4; author reply 4-5. [PMID: 12974108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Caplan A. Mapping of the human genome. Genewatch 2000; 13:6. [PMID: 12814101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- A Caplan
- Center for Bioethics, University of Pennsylvania, USA
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Abstract
Recent educational efforts in the US medical community have begun to address the critical issue of palliative care for terminally ill patients. However, a newly introduced bill in Congress, the Pain Relief Promotion Act of 1999 (PRPA), could dramatically hinder these efforts if enacted. The act criminally punishes the use of controlled substances to cause-or assist in causing-a patient's death. The primary purposes of PRPA are to override the physician-assisted suicide law currently in effect in Oregon and prohibit other states from enacting similar laws. The act also includes valuable provisions for better research and education in palliative care, but the benefits of those provisions are outweighed by the punitive sections of the act. Under PRPA, the quality of palliative care in the United States could be compromised when physicians, fearing criminal prosecution, err on the side of caution rather than risk their patients' deaths by using highly aggressive pain treatments. Furthermore, PRPA would put Drug Enforcement Administration officials, who have no medical expertise, in the position of regulating medical decisions. The act also would interfere with individual states' long-standing authority over medical practice. Finally, PRPA would discourage physicians from engaging in experimentation and innovation in palliative care, again out of concern for crossing the line between relief of suffering and physician-assisted suicide. Other bills have been introduced that go much further than PRPA to encourage palliative care, without its problematic provisions. Regardless of the controversy surrounding physician-assisted suicide in the United States, the need for quality end-of-life care will be far better served if Congress enacts one of these bills rather than PRPA.
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Affiliation(s)
- D Orentlicher
- Center for Law and Health, Indiana University School of Law-Indianapolis 46202-5194, USA.
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Abstract
Tremendous controversy has surrounded efforts to undertake research on totipotent human stem cells. To date public policy in the United States has attempted to skirt the ethical and social questions raised by this research. Annas et al. argue that research using human embryos as a source of totipotent stem cells can secure broad public support if there is an open and public discussion about the ethical justification for undertaking such research and the assurance of adequate federal regulation and oversight.
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Affiliation(s)
- G J Annas
- Health Law Department, Boston University School of Public Health Boston, Massachusetts 02118, USA
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20
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Affiliation(s)
- A Caplan
- Center for Bioethics, University of Pennsylvania, USA
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21
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Caplan A. The case for using pigs. Bull World Health Organ 1999; 77:67-8. [PMID: 10206761 PMCID: PMC2557583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- A Caplan
- Center for Bioethics, University of Pennsylvania, PA 19104, USA
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22
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Garcia AB, Engler JDA, Claes B, Villarroel R, Van Montagu M, Gerats T, Caplan A. The expression of the salt-responsive gene salT from rice is regulated by hormonal and developmental cues. Planta 1998; 207:172-80. [PMID: 9951720 DOI: 10.1007/s004250050470] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The expression pattern of the salT gene was analyzed in different cell types and organs of rice (Oryza sativa L.) in response to saline and hormonal treatments to obtain detailed information on the physiological cues controlling gene expression. Gel blot analysis of RNA and in-situ hybridization performed on seedlings grown for 10 ds in the presence of 1% NaCl revealed that salT was expressed mainly in the younger tissues of the plant. In contrast, 6-week-old plants exhibited maximal salT mRNA accumulation in sheaths of older leaves. In addition, salT was normally expressed in rapidly dividing suspension-cultured cells, but not in quiescent ones. Altogether, these results may indicate that salT expression in each region of the plant is dependent on the metabolic activity of the cells as well as on whether or not they are stressed. The effects of two growth regulators, abscisic acid (ABA) and gibberellic acid, were investigated in combination with the effects of NaCl. Gibberellic acid had a synergistic effect on the induction of the salT gene when combined with 0.5% NaCl, but did not induce salT on its own. At 10 microM, ABA induced salT both in the absence of NaCl and in its presence. Whereas 1 microM ABA acted additively with NaCl to induce gene expression, 5 microM ABA with NaCl was only as effective as NaCl alone. This may indicate that the two stimuli act independently and possibly through antagonistic signal transduction pathways.
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Affiliation(s)
- A B Garcia
- Departement Genetica, Vlaams Interuniversitair Instituut voor Biotechnologie (VIB), Universiteit Gent, Belgium
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23
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Abstract
Clinical bioethics is big business. There are now
hundreds of people who “do” bioethics in community
and university hospitals, nursing homes, rehabilitation
and home care settings, and some (though quite a few less)
who play the role of clinical ethics consultant to transplant
teams, managed care companies, and genetic testing firms.
Still, there is as much speculation about what clinically
active bioethicists actually do as there was ten years
ago. Various commentators have pondered the need for training
standards, credentials, “certification” exams,
and malpractice insurance for ethicists engaged in clinical
consultation. Much of the discussion seems to accept an
implicit presumption that all clinical ethics consultation
practices look pretty much alike. But is this accurate?
What do clinical ethicists do, how and where do they do
it, and what kind of clinical ethics is useful in the hospital
and in other settings?
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Affiliation(s)
- M D Fox
- University of Rochester, USA
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24
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25
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27
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Caplan A. Physician-assisted suicide is not a good option without decent, universal health care. Minn Med 1997; 80:46. [PMID: 9385813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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28
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Abstract
A mutation in tobacco (Nicotiana tabacum L. cv `Xanthi') called lat (low auxin transport) that changes many morphogenic features throughout the life of the plant has been isolated. Abnormalities were observed in seed development, embryogenesis, cotyledon formation, leaf initiation and development, leaf veination pattern, and flower development. Selfed R2 lat mutant plants set between 60% and 90% fewer seeds than wild-type tobacco, and about 10% of these seeds did not germinate. Non-germinating seeds contained either abnormal embryos or abnormal endosperm tissues. There was no uniformity in the stage at which embryonic development ceased in the aberrant seeds. Seedlings often revealed abnormal and highly varied phenotypes after germination. In some of these cases, cotyledons were heart-shaped, fused, cup-shaped, or cylindrical. Leaf morphology ranged from normal to cup-shaped, and some leaves occasionally produced shoots from the leaf midvein. Flowers ranged from normal to compound with occasional fused floral parts or split petals. Stamens were sometimes petal-like. This unusual assortment of phenotypic changes suggested that the mutation might affect a basic component of plant metabolism. We found that polar transport of indole-3-acetic acid (IAA) was reduced to about 9-19% of the wild-type level in the inflorescence axis of selfed R2 lat mutants. In addition, supplementation of 1-naphthaleneacetic acid (NAA) to sterile media suppressed some of the abnormalities of the lat mutation so long as the plants grew there. Similarities in the phenotype of embryos, cotyledon and leaf shapes, translocation of labeled IAA, and response to applied NAA indicate that the lat locus of tobacco may be analogous to the pin locus of Arabidopsis, or produce a protein that functions in the same auxin-transport pathway.
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Affiliation(s)
- M Naderi
- Department of Plant, Soil and Entomological Sciences, Division of Plant Pathology, University of Idaho, Moscow, ID 83844-2339, USA, , , , , , US
| | - A Caplan
- Department of Microbiology, Molecular Biology, and Biochemistry, University of Idaho, Moscow, ID 83844, USA, , , , , , US
| | - P H Berger
- Department of Plant, Soil and Entomological Sciences, Division of Plant Pathology, University of Idaho, Moscow, ID 83844-2339, USA, , , , , , US
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29
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Baker R, Caplan A, Emanuel LL, Latham SR. Crisis, ethics, and the American Medical Association 1847 and 1997. JAMA 1997; 278:163-4. [PMID: 9214535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Kerr SM, Caplan A, Polin G, Smugar S, O'Neill K, Urowitz S. Postmortem sperm procurement. J Urol 1997; 157:2154-8. [PMID: 9146605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We determined the prevalence of requests for postmortem sperm procurement and the degree to which procurement is performed by those working in the field of infertility. MATERIALS AND METHODS Structured telephone interviews were conducted with personnel at 273 assisted reproductive facilities in the United States and Canada. The number of facilities reporting requests and the number of facilities reporting that they performed the procedure were determined. RESULTS The prevalence of requests for postmortem sperm procurement was much greater than initially anticipated. A total of 82 requests was reported at 40 facilities in 22 different states between 1980 and 1995. More than half of the reported requests (43) were made between 1994 and 1995. Of the 82 requests 25 were honored at 14 facilities in 11 different states. No requests or procedures were reported from Canada. CONCLUSIONS Medical advances in postmortem sperm procurement, cryopreservation and in vitro fertilization permit retrieval of sperm after death for various purposes, including posthumous fatherhood. There are no explicit ethical guidelines, legislation or relevant case law, and fertility specialists must confront these issues before proceeding in a field fraught with moral and policy uncertainties.
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Affiliation(s)
- S M Kerr
- University of Pennsylvania Center for Bioethics, Philadelphia, USA
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Chen Z, Iyer S, Caplan A, Klessig DF, Fan B. Differential Accumulation of Salicylic Acid and Salicylic Acid-Sensitive Catalase in Different Rice Tissues. Plant Physiol 1997; 114:193-201. [PMID: 12223699 PMCID: PMC158294 DOI: 10.1104/pp.114.1.193] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We previously proposed that salicylic acid (SA)-sensitive catalases serve as biological targets of SA in plant defense responses. To further examine the role of SA-sensitive catalases, we have analyzed the relationship between SA levels and SA sensitivity of catalases in different rice (Oryza sativa) tissues. We show here that, whereas rice shoots contain extremely high levels of free SA, as previously reported (I. Raskin, H. Skubatz, W. Tang, B.J.D. Meeuse [1990] Ann Bot 66: 369-373; P. Silverman, M. Seskar, D. Kanter, P. Schweizer, J.-P. Metraux, I. Raskin [1995] Plant Physiol 108: 633-639), rice roots and cell-suspension cultures have very low SA levels. Catalases from different rice tissues also exhibit differences in sensitivity to SA. Catalase from rice shoots is insensitive to SA, but roots and cell-suspension cultures contain SA-sensitive catalase. The difference in SA sensitivity of catalases from these different tissues correlates with the tissue-specific expression of two catalase genes, CatA and CatB, which encode highly distinctive catalase proteins. CatA, which encodes a catalase with relatively low sequence homology to the tobacco SA-sensitive catalases, is expressed at high levels exclusively in the shoots. On the other hand, in roots and cell-suspension cultures, with northern analysis we detected expression of only the CatB gene, which encodes a catalase with higher sequence homology to tobacco catalases. The role of catalases in mediating some of the SA-induced responses is discussed in light of these results and the recently defined mechanisms of catalase inhibition by SA.
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Affiliation(s)
- Z. Chen
- Department of Microbiology, Molecular Biology and Biochemistry, University of Idaho, Moscow, Idaho 83844-3052 (Z.C., S.I., A.C., B.F.)
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Affiliation(s)
- S Baum
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia
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33
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Snyder L, Caplan A. Die hard: end-of-life care in America. Pa Med 1996; 99:10-1. [PMID: 8755781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- L Snyder
- University of Pennsylvania Center for Bioethics, Philadelphia, USA
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Affiliation(s)
- G J Annas
- Boston University School of Medicine and Public Health, MA 02118, USA
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Haber C, Jones WR, Soglia J, Surve MA, McGlynn M, Caplan A, Reineck JR, Krstanovic C. Conductivity detection in capillary electrophoresis--a powerful tool in ion analysis. J Capillary Electrophor 1996; 3:1-11. [PMID: 9384759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Conductivity detection in CE has recently become available in a commercial CE instrument. The new conductivity cell is based on an end-capillary concept. The conductivity sensor and the detection end of the fused-silica capillary are permanently encapsulated in two individually modified coupling connectors (ConTip, ConCap [both from Orion Research, Boston, MA, U.S.A.]). This open-architecture cell permits interchangeability of sensors and capillaries, while maintaining a precisely defined detection volume between those two components when inserted into the detector cell block. The detector's performance is evaluated for sensitivity, linearity, and reproducibility using low-mobility electrolytes. Electropherograms comprising a variety of ionic class separations including inorganic and organic anions, organic surfactants, alkali metals, alkaline earths, transition metals, and organic amines are shown along with separations of actual samples.
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Affiliation(s)
- C Haber
- Orion Research, a Subsidiary of Thermedics, Inc., a Thermo Electron Company, Boston, MA, USA
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36
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Caplan A. Bioethics: from adolescence to mid-life crisis. Hosp Ethics 1995; 11:4-5. [PMID: 10184453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- A Caplan
- Center for Bioethics, University of Pennsylvania, Philadelphia, USA
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Caplan A. An improved future? Sci Am 1995; 273:142-3. [PMID: 7652533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Caplan
- University of Pennsylvania Medical Center, USA
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38
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Caplan A. Minn. hospital bets home care will cut outpatient surgery LOS. Healthc Syst Strategy Rep 1995; 12:11. [PMID: 10152369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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39
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Caplan A. Training hospital R.N.s in home care streamlines processes, ups income. Healthc Syst Strategy Rep 1995; 12:11-2. [PMID: 10152417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Caplan A. ER-coordinated home care can save hospitals expensive inpatient costs. Healthc Syst Strategy Rep 1995; 12:7. [PMID: 10152404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Van den Broeck D, Van der Straeten D, Van Montagu M, Caplan A. A group of chromosomal proteins is specifically released by spermine and loses DNA-binding activity upon phosphorylation. Plant Physiol 1994; 106:559-66. [PMID: 7991684 PMCID: PMC159561 DOI: 10.1104/pp.106.2.559] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biologically relevant concentrations as low as 500 microM spermine led to the specific release of chromatin-associated proteins from nuclei of rice (Oryza sativa) seedlings. Using a southwestern technique, it was shown that several of these proteins bind DNA. This affinity was lost upon in organello phosphorylation by an endogenous kinase. The effect of spermine was very specific. Spermidine was far less effective and putrescine was essentially ineffective in releasing these proteins. The most abundant spermine-released protein was shown to be homologous to the maize HMG1 protein. Our results suggest that spermine induces the release of spermine-released proteins by changing DNA conformation. Binding of these proteins might be sensitive to long-range changes in chromosome structure caused by torsional stress.
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Van Breusegem F, Dekeyser R, Gielen J, Van Montagu M, Caplan A. Characterization of a S-adenosylmethionine synthetase gene in rice. Plant Physiol 1994; 105:1463-4. [PMID: 7972513 PMCID: PMC159491 DOI: 10.1104/pp.105.4.1463] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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Caplan A. Think today's ethical issues are tough? Just wait. Interview by Anita J. Slomski. Med Econ 1994; 71:38-9, 43-4, 48 passim. [PMID: 10133495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Caplan A. In health care reform, think of patient comfort, too. Minn Med 1993; 76:10-1. [PMID: 7690877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Caplan
- Center for Biomedical Ethics, University of Minnesota
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46
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Mudge GH, Goldstein S, Addonizio LJ, Caplan A, Mancini D, Levine TB, Ritsch ME, Stevenson LW. 24th Bethesda conference: Cardiac transplantation. Task Force 3: Recipient guidelines/prioritization. J Am Coll Cardiol 1993; 22:21-31. [PMID: 8509544 DOI: 10.1016/0735-1097(93)90812-f] [Citation(s) in RCA: 184] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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47
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Israel EJ, Simister N, Freiberg E, Caplan A, Walker WA. Immunoglobulin G binding sites on the human foetal intestine: a possible mechanism for the passive transfer of immunity from mother to infant. Immunology 1993; 79:77-81. [PMID: 8509144 PMCID: PMC1422058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
In humans, the prenatal transfer of IgG from mother to foetus is facilitated by a receptor for IgG on the placenta. However, amniotic fluid contains IgG of maternal origin, and transfer of swallowed IgG into the circulation from the foetal intestine represents another potential pathway of passive immunization. In this study we assayed for a foetal intestinal IgG receptor to support the hypothesis of this alternate pathway of antibody transfer. Microvillous membrane (MVM) from small bowel of aborted foetuses (18 weeks gestation) were probed with [125I]IgG to detect specific IgG binding sites. Binding was pH dependent and was maximal at pH 6. Competitive inhibition of the binding of [125I]IgG was noted with the addition of increasing amounts of unlabelled IgG. Scatchard analysis showed one binding site with a dissociation constant of 1.58 x 10(-7), similar to that of the IgG receptor described on the suckling rat intestine. The binding of labelled IgG to the human MVM receptor was Fc mediated. These observations provide evidence for an Fc receptor on the human foetal intestine.
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Affiliation(s)
- E J Israel
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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48
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Caplan A. Must I be my brother's keeper? Ethical issues in the use of living donors as sources of liver and other solid organs. Transplant Proc 1993; 25:1997-2000. [PMID: 8470256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Caplan
- Center for Biomedical Ethics, University of Minnesota, Minneapolis 55455
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49
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Caplan A. Biomedical ethics captures center stage. Minn Med 1992; 75:7-9. [PMID: 1470089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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50
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Affiliation(s)
- S H Miles
- Hennepin County Medical Center, University of Minnesota, Minneapolis 55415
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