Open Access Kent State (OAKS)

After reading Dr. Alpert's commentary, we suspect art inspires life but not consistently with historical fact. Duty to serve, a hallmark of professional medicine, is not always exhibited during pandemics. The perception is that physicians provided care to others without personal regard in pandemics. Yet, Camus's physician did not view himself as heroic. Rieux stated “there is no question of heroism in all this. It's a matter of common decency” and it was about “giving people a chance,” trying to alleviate suffering (p. 278).

Since the mid-1980s, medical historians have accepted the Zuger-Miles hypothesis, arguing there was no “strong or constant” tradition of physicians rendering care in epidemics because of a sense of professional responsibility. Most physicians treated patients who sought help often at great cost and personal risk. Other physicians fled in time of plague. During yellow fever and cholera outbreaks, physicians refused to visit patients who were acutely ill. Overtreatment with dangerous and ineffective therapies was worse than abandonment. Some physicians acted on the basis of monetary or contractual agreements. Other physicians became itinerant: “frequently bills were set up upon their doors and written, ‘here is a doctor to be let’ . . . several of those physicians were fain for a while to sit still and look about them, or . . . remove their dwellings, and set up in a new place and among new acquaintance” (p. 361).

Modern debate over physician duty occurred during the century-old Spanish influenza pandemic wherein more than 600 US civilian physicians died. Recent concerns about duty have occurred during the HIV, SARS, Ebola, and current COVID19 outbreak. Hundreds of health care workers in West Africa died during the Ebola outbreak, and numerous health care workers have succumbed during the current pandemic.

Even with social and organizational changes in modern medicine, with conflicting duties and roles for physicians in complex economic and contractual settings, the Zuger-Miles hypothesis is confirmed. We were heartened by selfless efforts of house staff in the current pandemic, placing patient care and duty above personal and family obligations. We witnessed fear of contagion among providers—translated into refusal to provide care but also translated into significant morbidity and mortality for providers. Colleagues reported feeling sidelined; physicians wanted to do more. We heard concerns regarding institutional exploitation: the duty to do more. Physician duty and obligations toward patients should not be exploited, placing physicians at risk and in circumstances considered morally, psychologically, or physically unacceptable. Our observations confirm that duty during pandemics is not a heroic, dichotomous, individual choice but rather a complex, nuanced decision, influenced by conflicting, competing, and overlapping goals, moral obligations, and institutional and contractual concerns.

Camus's Plague reminds physicians that dead rats are everywhere—epidemics, wars, and natural disasters—creating refugees, illness, and untold human suffering. Despite social, political, and scientific progress, these threats persist and repeat. Camus's physician protagonist compiles his chronicle so that he can “bear witness in favor of those plague-stricken people; so that some memorial of the injustice and outrage done them might endure; and to state quite simply what we learn in a time of pestilence” (p. 278). Camus's protagonist continues to remind physicians of the duty to care for patients and of pandemic lessons from history.

With the first reports on coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the scientific community working in the field of type III IFNs (IFN-λ) realized that this class of IFNs could play an important role in this and other emerging viral infections. In this Viewpoint, we present our opinion on the benefits and potential limitations of using IFN-λ to prevent, limit, and treat these dangerous viral infections.

As we enter the second quarter of the COVID-19 pandemic, with testing for severe acute respiratory syndrome coronavirus 2 (SARS–CoV-2) increasingly available (though still limited and/or slow in some areas), we are faced with new questions and challenges regarding this novel virus. When to test? Whom to test? What to test? How often to test? And, what to do with test results? Since SARS–CoV-2 is a new virus, there is little evidence to fall back on for test utilization and diagnostic stewardship (1). Several points need to be considered to begin answering of these questions; specifically, what types of tests are available and under which circumstances are they useful? This understanding can help guide the use of testing at the local, regional, state, and national levels and inform those assessing the supply chain to ensure that needed testing is and continues to be available. Here, we explain the types of tests available and how they might be useful in the face of a rapidly changing and never-before-experienced situation. There are two broad categories of SARS–CoV-2 tests: those that detect the virus itself and those that detect the host’s response to the virus. Each will be considered separately.

We must recognize that we are dealing with (i) a new virus, (ii) an unprecedented pandemic in modern times, and (iii) uncharted territory. With this in mind, in the absence of either proven effective therapy or a vaccine, diagnostic testing, which we have, becomes an especially important tool, informing patient management and potentially helping to save lives by limiting the spread of SARS–CoV-2. What is the most appropriate test, and for whom and when?

Hypothetically, if the entire world’s population could be tested all at once, with a test providing 100% specificity and sensitivity (unrealistic, obviously), we might be able to identify all infected individuals and sort people into those who at that moment in time were asymptomatic, minimally/moderately symptomatic, and severely symptomatic. The asymptomatic and minimally/moderately symptomatic could be quarantined to avoid the spread of the virus, with the severely symptomatic managed and isolated in health care settings. Contract tracing could be carried out to find those at risk of being in the incubation period by virtue of their exposure. Alternatively, testing for a host response, if, again, the test were hypothetically 100% sensitive and specific, could identify those previously exposed to the virus and (if we knew this to be true, which we do not) label those who are immune to the virus, who could be tapped to work in settings where potentially infected individuals (e.g., sick patients in hospitals) might otherwise pose a risk. Unfortunately, these hypothetical scenarios are not reality. However, with this ideal situation as a guide, what we do have available as tests today should be carefully considered in terms of how they can be leveraged to move the current crisis closer to the ideal situation, especially in the absence of therapeutics or vaccines.

Although the virus can be cultured, this is dangerous and not routinely done in clinical laboratories. While detection of viral antigens is theoretically possible, this approach has not, to date, been a primary one, but one that those participating in the summit considered to deserve further research.

Accreditation criteria by the Council on Education for Public Health (CEPH) state that prior to graduation, Masters of Public Health (MPH) students must demonstrate the application of knowledge and skills through a practice experience, commonly called the "Practicum." The purpose of this research was to review those MPH Practicum requirements. Practicum guidelines from US-based schools of public health that were accredited as of October 2011 were reviewed. Data on each Practicum's level of coordination, timing, and credit and contact hours as well as information about written agreements, preceptors, and how the Practicum was graded were collected. Seventy-four Practicums in 46 accredited schools of public health were reviewed. The majority (85 %) of accredited schools controlled the Practicum at the school-level. Among the Practicums reviewed, most did not require completion of any credit hours or the MPH core courses (57 and 74 %, respectively) prior to starting the Practicum; 82 % required written agreements; 60 % had stated criteria for the approval of preceptors; and 76 % required students to submit a product for grading at the conclusion of the Practicum. The results of this research demonstrate that the majority of accredited schools of public health designed Practicum requirements that reflect some of the criteria established by CEPH; however, issues related to timing, credit and contact hours, and preceptor qualifications vary considerably. We propose that a national dialogue begin among public health faculty and administrators to address these and other findings to standardize the Practicum experience for MPH students.

Parents of infants in the neonatal intensive care unit (NICU) experience one of the most stressful events of their lives. At times, they are unable to participate fully, if at all, in the care of their infant. Parents in the NICU have a need to participate in the care of their infant to attain the parental role. Parental reading to infants in the NICU is an intervention that can connect the parent and infant and offers a way for parents to participate in caregiving. This intervention may have many benefits and may positively affect the parent-infant relationship.

The modal number of lumbar vertebrae in modern humans is five. It varies between three and four in extant African apes (mean=3.5). Because both chimpanzees (Pan troglodytes) and gorillas (Gorilla gorilla) possess the same distributions of thoracic, lumbar, and sacral vertebrae, it has been assumed from parsimony that the last common ancestor (LCA) of African apes and humans possessed a similarly short lower back. This “short-backed LCA” scenario has recently been viewed favorably in an analysis of the intra- and interspecific variation in axial formulas observed among African apes and humans (Pilbeam, 2004. J Exp Zool 302B:241–267). However, the number of bonobo (Pan paniscus) specimens in that study was small (N=17). Here we reconsider vertebral type and number in the LCA in light of an expanded P. paniscus sample as well as evidence provided by the human fossil record. The precaudal (pre-coccygeal) axial column of bonobos differs from those of chimpanzees and gorillas in displaying one additional vertebra as well as significantly different combinations of sacral, lumbar, and thoracic vertebrae. These findings, along with the six-segmented lumbar column of early Australopithecus and earlyHomo, suggest that the LCA possessed a long axial column and long lumbar spine and that reduction in the lumbar column occurred independently in humans and in each ape clade, and continued after separation of the two species of Pan as well. Such an explanation is strongly congruent with additional details of lumbar column reduction and lower back stabilization in African apes. J. Exp. Zool. (Mol. Dev. Evol.) 314B:123–134, 2010. © 2009 Wiley-Liss, Inc. [This article was published online on 17 August 2009. An error was subsequently identified and the article was corrected on 8 September 2009.]

Considers three problems that result when research is presented to the Institutional Review Board (IRB) after the work has been completed. Frequency of researchers' failure to obtain IRB review; Qualification for the IRB approval; Regulatory context for ex post facto review.

The Ardipithecus ramidus hand and wrist exhibit none of the derived mechanisms that restrict motion in extant great apes and are reminiscent of those of Miocene apes, such as Proconsul. The capitate head is more palmar than in all other known hominoids, permitting extreme midcarpal dorsiflexion. Ar. ramidus and all later hominids lack the carpometacarpal articular and ligamentous specializations of extant apes. Manual proportions are unlike those of any extant ape. Metacarpals 2 through 5 are relatively short, lacking any morphological traits associable with knuckle-walking. Humeral and ulnar characters are primitive and like those of later hominids. The Ar. ramidus forelimb complex implies palmigrady during bridging and careful climbing and exhibits none of the adaptations to vertical climbing, forelimb suspension, and knuckle-walking that are seen in extant African apes.

Laboratory studies of choice and decision making among real monetary rewards typically use smaller real rewards than those common in real life. When laboratory rewards are large, they are almost always hypothetical. In applying laboratory results meaningfully to real-life situations, it is important to know the extent to which choices among hypothetical rewards correspond to choices among real rewards and whether variation of the magnitude of hypothetical rewards affects behavior in meaningful ways. The present study compared real and hypothetical monetary rewards in two experiments. In Experiment 1, participants played a temporal discounting game that incorporates the logic of a repeated prisoner's-dilemma (PD) game versus tit-for-tat; choice of one alternative ("defection" in PD terminology) resulted in a small-immediate reward; choice of the other alternative ("cooperation" in PD terminology) resulted in a larger reward delayed until the following trial. The larger-delayed reward was greater for half of the groups than for the other half. Rewards also differed in type across groups: multiples of real nickels, hypothetical nickels, or hypothetical hundred-dollar bills. All groups significantly increased choice of the larger delayed reward over the 40 trials of the experiment. Over the last 10 trials, cooperation was significantly higher when the difference between larger and smaller hypothetical rewards was greater. Reward type (real or hypothetical) made no significant difference in cooperation on most measures. In Experiment 2, real and hypothetical rewards were compared in social discounting--the decrease in value to the giver of a reward as social distance increases to the receiver of the reward. Social discount rates were well described by a hyperbolic function. Discounting rates for real and hypothetical rewards did not significantly differ. These results add to the evidence that results of experiments with hypothetical rewards validly apply in everyday life.