Journal articles on the topic 'Surrogate'
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1
Nixon, Joseph, and Olinda Timms. "Il dibattito legale ed etico sul divieto di commercio della maternità surrogata in India / The legal and moral debate leading to the ban of commercial surrogacy in India." Medicina e Morale 66, no. 4 (October 11, 2017): 513–31. http://dx.doi.org/10.4081/mem.2017.504.
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Le tecniche di riproduzione assistita (ART) offrono la possibilità di una maternità surrogata alle coppie sterili o senza figli. Alla fine degli anni ‘80, specialisti qualificati in India hanno approfittato della disponibilità di madri surrogate e dell’assenza di regole per creare un mercato di maternità surrogata per i clienti sia indiani sia esteri. Il Ministero della Salute è intervenuto con le linee guida solo dopo forti proteste di gruppi di donne e cittadini, facendo seguito alle storie su ostelli surrogati, bambini abbandonati e sfruttamento. Nel frattempo, le cliniche dell’infertilità si sono moltiplicate, offrendo gameti di donatori, fecondazione in vitro e maternità surrogata ad un costo molto inferiore rispetto ai paesi occidentali. Dai primi anni del 2000, l’India è divenuta la destinazione più popolare per la pratica della maternità surrogata. In risposta alle proteste e consapevole del divieto di accordi di maternità surrogata negli altri paesi, il Governo indiano ha emanato le linee guida ART che erano via via restrittive; ma tali disposizioni non sono state in grado di arginare il business ormai florido. Infine, nel 2016, il governo ha proposto un disegno di legge per porre fine alla maternità surrogata commerciale. Il regolamento Bill 2016 considera esclusivamente gli accordi di maternità surrogata, non considerando tutti gli altri aspetti della riproduzione assistita e delle cliniche coinvolte. La legislazione è stata rivolta principalmente alle questioni sociali e agli elementi di sfruttamento della maternità surrogata commerciale, più che al processo tecnico. Se approvata, tale legge vieterà efficacemente maternità surrogata commerciale in India. ---------- Assisted Reproductive Technologies (ART) offer the possibility of unrelated surrogacy arrangements to infertile couples and childless human relationships. In the late 80s, qualified specialists in India took advantage of the availability of willing surrogates and the absence of regulations, to create a market in commercial surrogacy for clients from within the country and abroad. The Ministry of Health stepped in with guidelines only after strong protests from women’s groups and citizens, following media stories of surrogate hostels, abandoned children and exploitation. Meanwhile, ‘infertility’ clinics mushroomed, offering donor gametes, in-vitro fertilization and surrogacy services at a fraction of the cost in western countries. By early 2000s, India had emerged as the most popular destination for commercial surrogacy arrangements. In response to protests from doctors, citizens and human rights groups, and mindful of the ban on commercial surrogacy arrangements in most developed countries, the Government issued ART guidelines that were progressively restrictive; but these did not have the teeth to rein in the lucrative business that commercial surrogacy had transformed into. Finally, in 2016, the Government proposed a Bill that would bring an end to commercial surrogacy. The Surrogacy (Regulation) Bill 2016 addressed surrogacy arrangements exclusively, taking it out of proposed ART Bill that was aimed at comprehensively regulating all other aspects of assisted reproduction and the clinics involved. The legislation was directed mainly at the social issues and exploitative elements specific to commercial surrogacy arrangements, rather than the technical process. If passed, the Surrogacy Bill will effectively ban commercial surrogacy in India.
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Gupta, Anu, and Sheela Prasad. "‘Outsourced pregnancy’: Surrogate narratives from Hyderabad." Contributions to Indian Sociology 53, no. 2 (May 23, 2019): 299–327. http://dx.doi.org/10.1177/0069966719836883.
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Surrogacy has always been contested and much debated in India since its legalisation in 2002, and the recent Surrogacy (Regulation) Bill, 2016, has led to a renewed engagement with it. The advent of assisted reproductive technologies (ART) provided an opportunity for the medical establishment, market and infertile couples to come together in a mutually beneficial arrangement, which is made possible by a surrogate. ART, while medicalising the reproductive capacity of women, also calls for a redefining of the concepts of ‘motherhood’, family and reproductive choice. This article primarily documents the experiences of surrogates through their narratives about the continuous struggle with themselves, their families and the medical establishment. In this matrix of unequal power relations that surrogacy epitomises, the surrogate has a precarious voice. The article argues that while surrogacy extracts a physiological and emotional price that the surrogates pay, it is empowering in a limited way. It offers women economic opportunities of a scale otherwise denied to them, enabling them to fight a life of poverty.
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C, Suganya, and Vijayakumar M. "Surrogacy: A Bio-economical Exploitation of Proletariats in Amulya Malladi’s A House for Happy Mothers." World Journal of English Language 12, no. 8 (October 7, 2022): 127. http://dx.doi.org/10.5430/wjel.v12n8p127.
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Infertility remains a threat to global health issues thus the remedy is global with the medical advancements in technology that enable infertile couples to have babies through surrogacy. Surrogacy is a legal practice of hiring a woman’s womb for bearing a child to infertile parents where the intended parents claim full parental rights and the surrogate mothers get the monetary compensation in commercial gestational surrogacy. Surrogates are proletariats from third-world countries struggling to meet day-to-day ends, whilst intended parents are from first-world countries. The existence of poverty and poor economy avail abundant surrogates in third world countries like India attracts infertile couples to flock to these countries thus surrogacy clinics and agents practice exploitative surrogacy (baby) business. This article unveils the exploitation of poor surrogate women and their bodies, with reference to Amulya Malladi’s A House for Happy Mothers (2016). Further, this study attempts to evaluate surrogacy with the theoretical framework of Marxist Theory of Alienation or Estrangement which condemns the poor surrogates as reproductive machines (lobourers) and commercial surrogacy as commodification of wombs.
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Borah, Meghna, Arup Kumar Hazarika, and Unmilan Kalita. "Right to be a Surrogate: Biological, Constitutional and Economic Perspectives." Space and Culture, India 8, no. 1 (June 29, 2020): 78–90. http://dx.doi.org/10.20896/saci.v8i1.699.
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For the survival of all forms of life, procreation is essential. However, natural procreation is not always scientifically possible. As such, the practice of surrogacy and the use of Assisted Reproductive Techniques have become more widely recognised and accepted in societies all over the world. However, various complex and controversial issues are bounded in such practices. The Surrogacy (Regulation) Bill, 2019 introduced by Government of India makes an attempt to eradicate some of those issues associated with surrogacy.
Nevertheless, the legislation seems to be in derogation to the Constitution of India and universal human rights. This study is designed to substantiate in detail the right to be a surrogate in light of the constitutional mandate along with an evaluation of the eligibility criteria to be a surrogate and its consequences with regard to the existing legal framework. Besides, the economic perspective of exploitation of surrogates via banning of commercial surrogacy has been briefly discussed. The discussion under this study is expected to put forward an essential perspective to the right to be a surrogate in relation to a woman’s right to life and personal liberty. Further, prohibiting commercial surrogacy may push practicing surrogates towards other economically unrewarding, poorly regulated and potentially hazardous forms of employment or even make them subject to human trafficking. Therefore, recognition of the right to be a surrogate vis-à-vis the Surrogacy (Regulation) Bill, 2019, would help in avoiding blatant miscarriage of universal justice while upholding the supremacy of the Constitution of India.
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Huber, Sarah, Sharvari Karandikar, and Lindsay Gezinski. "Exploring Indian Surrogates’ Perceptions of the Ban on International Surrogacy." Affilia 33, no. 1 (October 3, 2017): 69–84. http://dx.doi.org/10.1177/0886109917729667.
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This study examined surrogate women’s perceptions on the Indian ban on international surrogacy. In-depth interviews were conducted with 25 surrogate women at a fertility clinic in Gujarat, India. Three themes emerged: (1) perceptions of the ban; (2) impact of the ban on surrogates, international couples, and fertility clinics; and (3) long-term economic results of surrogacy. Women stated that international surrogacy should not be banned, because it provides substantial economic benefits. They also noted that the ban affects childless couples and clinics by cutting off a source of income. This research provides recommendations for social work action.
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Madden, Laurence V., and Pierce A. Paul. "Is Disease Intensity a Good Surrogate for Yield Loss or Toxin Contamination? A Case Study with Fusarium Head Blight of Wheat." Phytopathology® 110, no. 10 (October 2020): 1632–46. http://dx.doi.org/10.1094/phyto-11-19-0427-r.
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Sometimes plant pathologists assess disease intensity when they are primarily interested in other response variables, such as yield loss or toxin concentration in harvested products. In these situations, disease intensity potentially could be considered a surrogate of yield or toxin. A surrogate is a variable which can be used instead of the variable of interest in the evaluation of experimental treatments or in making predictions. Surrogates can be measured earlier, more conveniently, or more cheaply than the variable of primary interest, but the reliability or validity of the surrogate must be shown. We demonstrate ways of quantifying two facets of surrogacy by using a protocol originally developed by Buyse and colleagues for medical research. Coefficient-of-determination type statistics can be used to conveniently assess the strength of surrogacy on a unitless scale. As a case study, we evaluated whether field severity of Fusarium head blight (i.e., FHB index) can be used as a surrogate for yield loss and deoxynivalenol (DON) toxin concentration in harvested wheat grain. Bivariate mixed models and corresponding approximations were fitted to data from 82 uniform fungicide trials conducted from 2008 to 2013. Individual-level surrogacy—for predicting the variable of interest (yield or DON) from the surrogate (index) in plots with the same treatment—was very low. Trial-level surrogacy—for predicting the effect of treatment (e.g., mean difference) for the variable of interest based on the effect of the treatment on the surrogate (index)—was moderate for yield, and only low for DON. Challenges in using disease severity as a surrogate for yield and toxin are discussed.
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KNEEBONE, Ezra, Kiri BEILBY, and Karin HAMMARBERG. "Surrogates’ and Intended Parents’ Experiences of Surrogacy: A Systematic Review." Fertility & Reproduction 04, no. 03n04 (September 2022): 191. http://dx.doi.org/10.1142/s2661318222741029.
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Background: Surrogacy arrangements can be conducted domestically, where the surrogate and intended parents live in the same country, or internationally, where the intended parents engage a surrogate in a foreign destination. Understanding the experiences of people participating in surrogacy arrangements can inform policy to protect the best interests of all parties. Aim: To review the evidence relating to surrogates’ and intended parents’ experiences of surrogacy arrangements. Method: Studies of surrogates’ and intended parents’ experiences of a surrogacy arrangement, published since 2005 in English language peer reviewed journals were identified by searching Embase, Medline, PsycInfo and Scopus. Data relating to each participant group were synthesised separately using thematic analysis. Methodological quality of the studies was assessed using the QualSyst scoring system. Results: 67 articles were included in the synthesis. The mean QualSyst score was 0.78/1. Four themes relating to surrogates’ (exercising agency, making sense of their maternal identity, forming a relationship with the intended parents’, and accessing information and support) and intended parents’ experiences (navigating the law, rationalising the financial transaction, forming a relationship with the surrogate, and accessing information and support) were identified. Intended parents faced legal barriers when seeking domestic arrangements and difficulties when obtaining legal parenthood and citizenship for their child after an international arrangement. Having a close relationship between participants contributed to a positive experience for both parties. Conversely, a distant relationship, whether emotionally or geographically, negatively impacted participants’ experiences. Conclusion: Legal barriers in the home country lead some to seek international surrogacy which limits opportunities for intended parents and surrogates to form a close relationship and poses legal challenges when they return home. Removing the legal barriers to domestic surrogacy would allow more arrangements to be conducted where participants have a better prospect of forming close relationships and can avoid the challenges inherent in international arrangements.
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Mohnke, Margaux, Ursula Christmann, Yannick Roos, and Chris Thomale. "Do metaphors make opinions?" Metaphor and the Social World 12, no. 1 (January 20, 2022): 92–114. http://dx.doi.org/10.1075/msw.20028.moh.
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Abstract Introduction: A frame makes specific information about a topic more salient. Metaphors can be used as frames to influence people’s opinions on controversial political topics as well as on health-related topics. This study aims to determine the influence of metaphorical frames on the opinion towards surrogacy and examines whether specific aspects of surrogacy are more prone to the influence than others. Method: 236 participants were assigned to one of three groups with different metaphorical frames for surrogacy and thereafter completed the Attitude Towards Surrogacy Questionnaire. To investigate if participants’ opinions on surrogacy were influenced by the frame used for surrogacy, three ANOVAS were conducted. Result: The main effect of the ANOVAS revealed that opinion towards payment of the surrogate mothers, but not the attitude towards surrogacy in general, was influenced by the metaphorical frame used for surrogacy. Discussion: The results support the idea that a metaphorical frame can evoke reactance regarding the payment of surrogate mothers. Participants might resist the frame of the metaphorical term for surrogacy as an unemotional business act, by favouring less monetary compensation of the surrogate mother, when the metaphorical frame implies that surrogates only help intended parents for the monetary compensation.
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VanderWeele, Tyler J. "Surrogate Measures and Consistent Surrogates." Biometrics 69, no. 3 (September 2013): 561–65. http://dx.doi.org/10.1111/biom.12071.
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Ciani, Oriana, Sarah Davis, Paul Tappenden, Ruth Garside, Ken Stein, Anna Cantrell, Everardo D. Saad, Marc Buyse, and Rod S. Taylor. "VALIDATION OF SURROGATE ENDPOINTS IN ADVANCED SOLID TUMORS: SYSTEMATIC REVIEW OF STATISTICAL METHODS, RESULTS, AND IMPLICATIONS FOR POLICY MAKERS." International Journal of Technology Assessment in Health Care 30, no. 3 (July 2014): 312–24. http://dx.doi.org/10.1017/s0266462314000300.
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Objectives: Licensing of, and coverage decisions on, new therapies should rely on evidence from patient-relevant endpoints such as overall survival (OS). Nevertheless, evidence from surrogate endpoints may also be useful, as it may not only expedite the regulatory approval of new therapies but also inform coverage decisions. It is, therefore, essential that candidate surrogate endpoints be properly validated. However, there is no consensus on statistical methods for such validation and on how the evidence thus derived should be applied by policy makers.Methods: We review current statistical approaches to surrogate-endpoint validation based on meta-analysis in various advanced-tumor settings. We assessed the suitability of two surrogates (progression-free survival [PFS] and time-to-progression [TTP]) using three current validation frameworks: Elston and Taylor's framework, the German Institute of Quality and Efficiency in Health Care's (IQWiG) framework and the Biomarker-Surrogacy Evaluation Schema (BSES3).Results: A wide variety of statistical methods have been used to assess surrogacy. The strength of the association between the two surrogates and OS was generally low. The level of evidence (observation-level versus treatment-level) available varied considerably by cancer type, by evaluation tools and was not always consistent even within one specific cancer type.Conclusions: Not in all solid tumors the treatment-level association between PFS or TTP and OS has been investigated. According to IQWiG's framework, only PFS achieved acceptable evidence of surrogacy in metastatic colorectal and ovarian cancer treated with cytotoxic agents. Our study emphasizes the challenges of surrogate-endpoint validation and the importance of building consensus on the development of evaluation frameworks.
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Subedi, Madhusudan. "Contractual Transaction: How Renting a Uterus Makes the Human Body a Commodity in Nepal." Dhaulagiri Journal of Sociology and Anthropology 9 (December 7, 2015): 1–25. http://dx.doi.org/10.3126/dsaj.v9i0.14020.
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The issue of surrogate motherhood has started public debates in Nepal. With surrogacy a child becomes the object of a legal transaction, while the surrogate mother is used, in effect as an incubator, and the hospital declares commissioned parents’ name of a newborn child. The poor women in low-income countries have been used as means to compensate for the reproductive deficiencies of high-income infertile parents. Do purchasing cheaper services, receiving surrogates easier, and having the possibility of gender selection, all in the poor countries, support ‘surrogacy tourism’ or is it a kind of exploitative relationship? Until today, Nepal’s laws do not have any specific provision to deal with surrogacy and, therefore, it is urgent to address the challenges with commercial surrogacy and establish a precise legal policy.
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Ziff, Elizabeth. "“Honey, I Want to Be a Surrogate”: How Military Spouses Negotiate and Navigate Surrogacy With Their Service Member Husbands." Journal of Family Issues 40, no. 18 (July 18, 2019): 2774–800. http://dx.doi.org/10.1177/0192513x19862843.
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This article examines how military spouses negotiate the decision to become a surrogate with their service member husband and how the two navigate surrogacy together. It is speculated that military spouses are ideal candidates for surrogacy due to their particular status as a military spouse; however, military spouses face structural constraints in their everyday lives which in turn would prove challenging to their desire to become a surrogate. Based on in-depth interviews with 33 military spouses who had been surrogates, this article examines how military spouses discuss, negotiate, and experience surrogacy with their spouses all the while navigating the structural demands of the military and the contractual demands of surrogacy. Findings highlight egalitarian decision making between the spouses, and a mostly collaborative approach to the surrogacy process. Ultimately, this work illuminates how surrogacy is experienced by the women who participate in the practice and provides insight as to how military marriages function.
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Mirocha, Łukasz. "„Macierzyństwo zastępcze” w aktualnym orzecznictwie Europejskiego Trybunału Praw Człowieka." Prawo w Działaniu 34 (2018): 164–88. http://dx.doi.org/10.32041/pwd.3404.
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Surrogate motherhood, known also as surrogacy, is a kind of civil law contract according to which one party – surrogate mother is obliged to bear a pregnancy and after giving a birth transfer all rights concerning a child to commissioning party. There are two basic types of surrogacy, of which gestational surrogacy has recently become more popular. By concluding gestational surrogacy agreement commissioning party oblige itself to provide an embryo no matter of its source, while surrogate mother is bonded only to bear pregnancy. The second type of surrogacy agreement, often called traditional, encompasses also surrogates obligation to provide an egg, due to this fact, as the egg donor, surrogate mother becomes also a genetic mother. Surrogacy is connected to a variety of serious legal problems among others: deciding whether this kind of contract should be legal or banned and resolving an issue of a legal status of a new born child, by answering the question who is its legal parent. The paper comments a number of recent judgements given by European Court of Human Rights in the field of surrogacy. All the cases concerned question of international surrogacy, so the particular problems that were adjudicated regard the problem of recognising a foreign act of birth (Menneson v. France), giving permission to a child arrival to the intended parents country (D. and others v. Belgium) or factual separation of the child and the intended parents (Paradiso and Campanelli v. Italy). Applicants in the aforementioned cases claimed that states actions regarding surrogacy were opposite to the article 8 of European Convention on Human Rights, especially the right to respect private and family life. European Court of Human Rights has not been settling a dispute in which intended parents refused to take care of the child, what could be a real test to Strasbourg`s view on the commented problem.
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Spalding, Rachael, JoNell Strough, and Barry Edelstein. "What Would People Think? Social Norms, Willingness to Serve as a Surrogate, and End-of-Life Treatment Decisions." Innovation in Aging 4, Supplement_1 (December 1, 2020): 421. http://dx.doi.org/10.1093/geroni/igaa057.1359.
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Abstract Population aging has increased the prevalence of surrogate decision making in healthcare settings. However, little is known about factors contributing to the decision to become a surrogate and the surrogate medical decision-making process in general. We investigated how intrapersonal and social-contextual factors predicted two components of the surrogate decision-making process: individuals’ willingness to serve as a surrogate and their tendency to select various end-of-life treatments, including mechanical ventilation and palliative care options. An online sample (N=172) of adults made hypothetical surrogate decisions about end-of-life treatments on behalf of an imagined individual of their choice, such as a parent or spouse. Using self-report measures, we investigated key correlates of willingness to serve as surrogate (e.g., decision-making confidence, willingness to collaborate with healthcare providers), and choice of end-of-life treatments. Viewing service as a surrogate as a more typical practice in healthcare was associated with greater willingness to serve. Greater decision-making confidence, greater willingness to collaborate with patients’ physicians, and viewing intensive, life-sustaining end-of-life treatments (e.g., mechanical ventilation) as more widely accepted were associated with choosing more intensive end-of-life treatments. The current study’s consideration of both intrapersonal and social-contextual factors advances knowledge of two key aspects of surrogate decision making—the initial decision to serve as surrogate, and the surrogate’s selection of various end-of-life treatment interventions. Providers can use information about the role of these factors to engage with surrogates in a manner that better facilitates their decision making.
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Scher, Howard I., Glenn Heller, Arturo Molina, Gerhardt Attard, Daniel C. Danila, Xiaoyu Jia, Weimin Peng, et al. "Circulating Tumor Cell Biomarker Panel As an Individual-Level Surrogate for Survival in Metastatic Castration-Resistant Prostate Cancer." Journal of Clinical Oncology 33, no. 12 (April 20, 2015): 1348–55. http://dx.doi.org/10.1200/jco.2014.55.3487.
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Purpose Trials in castration-resistant prostate cancer (CRPC) need new clinical end points that are valid surrogates for survival. We evaluated circulating tumor cell (CTC) enumeration as a surrogate outcome measure. Patients and Methods Examining CTCs alone and in combination with other biomarkers as a surrogate for overall survival was a secondary objective of COU-AA-301, a multinational, randomized, double-blind phase III trial of abiraterone acetate plus prednisone versus prednisone alone in patients with metastatic CRPC previously treated with docetaxel. The biomarkers were measured at baseline and 4, 8, and 12 weeks, with 12 weeks being the primary measure of interest. The Prentice criteria were applied to test candidate biomarkers as surrogates for overall survival at the individual-patient level. Results A biomarker panel using CTC count and lactate dehydrogenase (LDH) level was shown to satisfy the four Prentice criteria for individual-level surrogacy. Twelve-week surrogate biomarker data were available for 711 patients. The abiraterone acetate plus prednisone and prednisone-alone groups demonstrated a significant survival difference (P = .034); surrogate distribution at 12 weeks differed by treatment (P < .001); the discriminatory power of the surrogate to predict mortality was high (weighted c-index, 0.81); and adding the surrogate to the model eliminated the treatment effect on survival. Overall, 2-year survival of patients with CTCs < 5 (low risk) versus patients with CTCs ≥ 5 cells/7.5 mL of blood and LDH > 250 U/L (high risk) at 12 weeks was 46% and 2%, respectively. Conclusion A biomarker panel containing CTC number and LDH level was shown to be a surrogate for survival at the individual-patient level in this trial of abiraterone acetate plus prednisone versus prednisone alone for patients with metastatic CRPC. Additional trials are ongoing to validate the findings.
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Kleinpeter, Christine Hagan, and Melinda M. Hohman. "Surrogate Motherhood: Personality Traits and Satisfaction with Service Providers." Psychological Reports 87, no. 3 (December 2000): 957–70. http://dx.doi.org/10.2466/pr0.2000.87.3.957.
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This study explored the personality traits of 15 women who served as surrogate mothers in a California-based surrogacy program. Their satisfaction with their service providers, i.e., the program director, psychologist, and medical doctor, were explored. All had given birth to one or more children, and five had been a surrogate more than once. 13 used in vitro fertilization, with only two choosing artificial insemination. 15 subjects were given the NEO–R Personality Inventory, a global measure of normal personality traits. Analysis indicated that surrogates overall were very pleased with their experiences, and they differed from the general population on nine personality traits.
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Majumdar, Anindita. "Conceptualizing Surrogacy as Work-Labour." Journal of South Asian Development 13, no. 2 (June 18, 2018): 210–27. http://dx.doi.org/10.1177/0973174118778481.
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Using ethnographic findings, this article reflects on Indian women engaged in commercial surrogacy for foreign and Indian couples and expands on the existing ideas of paid and unpaid employment by conceptualizing transnational commercial surrogacy in India. The latter is undertaken through a mapping of the meanings surrogates and intended couples make of their participation in the transnational commercial surrogacy arrangement. Here, ideas about motherhood, domesticity and contractual labour come together to create an understanding of the unique role of surrogates in the arrangement. While emerging research has aimed to conceptualize the surrogate’s contribution through differing theoretical understandings of work and labour, my ethnographic findings suggest that surrogacy and its linkages with paid work are more complex than conveyed by its researched connections with care work and/or sex work. Invoking established theorizing of sexualized care work and reproductive choice, I point to the need for a deeper engagement with the idea of work-labour itself. Within this wider conceptualization are social categories that mediate between commerce and intimacy—including that of the paid domestic worker. By using frames used to study paid domestic work in India and South Asia, I portray surrogacy and the commercial surrogate through notions of domesticity, family and intimacy paying particular attention to its linkages with paid work.
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Royce, Trevor Joseph, Ming-Hui Chen, Jing Wu, Marian Loffredo, Andrew A. Renshaw, Philip W. Kantoff, and Anthony Victor D'Amico. "A comparison of surrogate endpoints for all cause mortality in men with localized unfavorable-risk prostate cancer." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 21. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.21.
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21 Background: Several surrogates for prostate cancer-specific mortality exist, but whether these are surrogates for all cause mortality (ACM), and how their performance compares, is unknown. We investigated the relative efficacy of 4 candidate surrogates for ACM using the proportion of treatment effect (PTE) metric. Methods: Two-hundred and six men with localized unfavorable-risk prostate cancer were randomized to radiation therapy (RT) or RT and 6 months of androgen-deprivation therapy (ADT) from 1995 to 2001 and followed for a median of 16.62 years. Among the 159 men with no or minimal comorbidity, a significant reduction in the risk of death was observed in those randomized to RT and ADT versus RT alone; these 159 men formed the study cohort. In order to assess whether the candidate surrogated satisfied Prentice’s criteria for surrogacy, Cox regression analyses were performed to assess the risk of death for each of the candidate surrogates and treatment before and after adjusting for prostate-specific antigen (PSA), age at randomization, T category, and Gleason score. Results: PSA nadir > 0.5 ng/mL, PSA doubling time < 9 months and interval to PSA failure < 30 months met Prentice’s criteria for surrogacy (P = 0.01, 0.003, and 0.03 for the surrogate covariate in the multivariable model, respectively) for ACM, while PSA failure did not (P = 0.10). For the three surrogates, the PTE values were 103.86%, 43.09%, and 41.26%, respectively. Conclusions: A PSA nadir value of > 0.5 ng/mL following RT and ADT identified men prior to PSA failure who were at high-risk for death and therefore could be used to select men for entry, at the time of PSA nadir and before PSA failure, onto randomized trials evaluating the impact on survival of salvage ADT with or without agents shown to prolong survival in men with castrate-resistant metastatic prostate cancer. By enriching study cohorts with men who have achieved a surrogate endpoint for ACM, one can enhance the likelihood that the study will be able to observe whether survival is prolonged when novel treatment is added to ADT, as compared to ADT alone, in an abbreviated time period. Clinical Trial Number: NCT00116220
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Asirvatham, Packiaraj. "Can coercion be justified when it benefits the poor? The case of commercial surrogacy industry in India." Bangladesh Journal of Bioethics 8, no. 3 (February 14, 2018): 9–17. http://dx.doi.org/10.3329/bioethics.v8i3.35574.
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Commercial surrogacy in India is a booming industry however the raising number of poor illiterate women's participation as commercial surrogate poses serious question of coercion, on the other hand it economically empowers them. In this context, this article analyses the crucial question, can coercion be justified when it benefits the poor by investigating commercial surrogates’ life stories and looking into the various types of coercion discreetly operates. It concludes with few recommendations which can help in empowering poor commercial surrogates who involved in commercial surrogacy industry in India.
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THIEL, MARCO, M. CARMEN ROMANO, UDO SCHWARZ, JÜRGEN KURTHS, and JENS TIMMER. "SURROGATE-BASED HYPOTHESIS TEST WITHOUT SURROGATES." International Journal of Bifurcation and Chaos 14, no. 06 (June 2004): 2107–14. http://dx.doi.org/10.1142/s0218127404010527.
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Fourier surrogate data are artificially generated time series, that — based on a resampling scheme — share the linear properties with an observed time series. In this paper we study a statistical surrogate hypothesis test to detect deviations from a linear Gaussian process with respect to asymmetry in time (Q-statistic). We apply this test to a Fourier representable function and obtain a representation of the asymmetry in time of the sample data, a characteristic for nonlinear processes, and the significance in terms of the Fourier coefficients. The main outcome is that we calculate the expected value of the mean and the standard deviation of the asymmetries of the surrogate data analytically and hence, no surrogates have to be generated. To illustrate the results we apply our method to the saw tooth function, the Lorenz system and to measured X-ray data of Cygnus X-1.
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Hernandez-Villafuerte, Karla, Alastair Fischer, and Nicholas Latimer. "CHALLENGES AND METHODOLOGIES IN USING PROGRESSION FREE SURVIVAL AS A SURROGATE FOR OVERALL SURVIVAL IN ONCOLOGY." International Journal of Technology Assessment in Health Care 34, no. 3 (2018): 300–316. http://dx.doi.org/10.1017/s0266462318000338.
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Objectives:A primary outcome in oncology trials is overall survival (OS). However, to estimate OS accurately requires a sufficient number of patients to have died, which may take a long time. If an alternative end point is sufficiently highly correlated with OS, it can be used as a surrogate. Progression-free survival (PFS) is the surrogate most often used in oncology, but does not always satisfy the correlation conditions for surrogacy. We analyze the methodologies used when extrapolating from PFS to OS.Methods:Davis et al. previously reviewed the use of surrogate end points in oncology, using papers published between 2001 and 2011. We extend this, reviewing papers published between 2012 and 2016. We also examine the reporting of statistical methods to assess the strength of surrogacy.Results:The findings from 2012 to 2016 do not differ substantially from those of 2001 to 2011: the same factors are shown to affect the relationship between PFS and OS. The proportion of papers reporting individual patient data (IPD), strongly recommended for full assessment of surrogacy, remains low: 33 percent. A wide range of methods has been used to determine the appropriateness of surrogates. While usually adhering to reporting standards, the standard of scholarship appears sometimes to be questionable and the reporting of results often haphazard.Conclusions:Standards of analysis and reporting PFS to OS surrogate studies should be improved by increasing the rigor of statistical reporting and by agreeing to a minimum set of reporting guidelines. Moreover, the use of IPD to assess surrogacy should increase.
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Ciani, Oriana, Bogdan Grigore, Hedwig Blommestein, Saskia de Groot, Meilin Möllenkamp, Stefan Rabbe, Rita Daubner-Bendes, and Rod S. Taylor. "Validity of Surrogate Endpoints and Their Impact on Coverage Recommendations: A Retrospective Analysis across International Health Technology Assessment Agencies." Medical Decision Making 41, no. 4 (March 10, 2021): 439–52. http://dx.doi.org/10.1177/0272989x21994553.
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Background Surrogate endpoints (i.e., intermediate endpoints intended to predict for patient-centered outcomes) are increasingly common. However, little is known about how surrogate evidence is handled in the context of health technology assessment (HTA). Objectives 1) To map methodologies for the validation of surrogate endpoints and 2) to determine their impact on acceptability of surrogates and coverage decisions made by HTA agencies. Methods We sought HTA reports where evaluation relied on a surrogate from 8 HTA agencies. We extracted data on the methods applied for surrogate validation. We assessed the level of agreement between agencies and fitted mixed-effects logistic regression models to test the impact of validation approaches on the agency’s acceptability of the surrogate endpoint and their coverage recommendation. Results Of the 124 included reports, 61 (49%) discussed the level of evidence to support the relationship between the surrogate and the patient-centered endpoint, 27 (22%) reported a correlation coefficient/association measure, and 40 (32%) quantified the expected effect on the patient-centered outcome. Overall, the surrogate endpoint was deemed acceptable in 49 (40%) reports ( k-coefficient 0.10, P = 0.004). Any consideration of the level of evidence was associated with accepting the surrogate endpoint as valid (odds ratio [OR], 4.60; 95% confidence interval [CI], 1.60–13.18, P = 0.005). However, we did not find strong evidence of an association between accepting the surrogate endpoint and agency coverage recommendation (OR, 0.71; 95% CI, 0.23–2.20; P = 0.55). Conclusions Handling of surrogate endpoint evidence in reports varied greatly across HTA agencies, with inconsistent consideration of the level of evidence and statistical validation. Our findings call for careful reconsideration of the issue of surrogacy and the need for harmonization of practices across international HTA agencies.
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Ambarwati, Mega Dewi, and Ghina Azmita Kamila. "THE EVALUATION OF SURROGACY’S LEGAL SYSTEM IN INDONESIA AS COMPARISON TO INDIA’S LEGISLATION." Diponegoro Law Review 4, no. 2 (October 1, 2019): 167. http://dx.doi.org/10.14710/dilrev.4.2.2019.167-180.
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Nowadays, in marriage life, spouse often dealing with big problem as like infertility which make them unable to have offspring. However, due to infertility, the spouse has obtained some efforts to solve their problems. One way to solve the problem is by obtaining surrogacy with the help of surrogate mother. Nevertheless, in Indonesia, especially, surrogacy as well as surrogate mother is still considered to be taboo things and no legal system which regulate the surrogacy and/or surrogate mother. Yet other countries have allowed or legalize the surrogacy practice as well as surrogate mother. Hence, this study aimed to reveal a comparison of legal system on surrogate mother and surrogacy law in Indonesia and India. This study used comparative legal research methodology through the functional method since Indonesia has the same function over the purpose of law establishment on the surrogate mother in India. The result reveals that it needs a legal system on surrogacy and surrogate mother as the legal certainty for any individual especially spouse who could not have offspring along with some reasons such as minimalize prostitution and unregistered marriage, prevent dispute, and to develop scientific field.
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Saja, A. M. Aslam, Melissa Teo, Ashantha Goonetilleke, A. M. Ziyath, and Jagath Gunatilake. "Selection of surrogates to assess social resilience in disaster management using multi-criteria decision analysis." International Journal of Disaster Resilience in the Built Environment 11, no. 4 (February 26, 2020): 453–80. http://dx.doi.org/10.1108/ijdrbe-07-2019-0045.
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Purpose The purpose of this paper is to present a framework for evaluation and ranking of potential surrogates to select the optimum surrogates and test it for five selected social resilience indicators in a disaster context. Innovative resilience assessment approaches are required to capture key facets of resilience indicators to deepen the understanding of social resilience. Surrogates can adequately represent the target indicator that is difficult to measure, as surrogates are defined as key facets of a target indicator. Design/methodology/approach To optimize the selection of surrogates, five key evaluation criteria were used. Disaster management experts completed an online survey questionnaire and evaluated three potential surrogate options. Surrogates were then ranked using PROMETHEE, a multi-experts multi-criteria group decision analysis technique. Findings A framework was devised to evaluate and rank potential surrogates to assess social resilience in a disaster context. The findings revealed that the first ranked surrogate can be the most critical facet of a resilience indicator of measure. In most instances, highly experienced cohort of practitioners and policy makers have aligned their preferences of surrogates with the overall ranking of surrogates obtained in this study. Research limitations/implications The surrogate approach can also be tested in different disaster and geographic contexts. The resilience indicators used in this study to explore surrogates are largely applicable in all contexts. However, the preference of surrogates may also vary in different contexts. Practical implications Once the surrogate is selected through an evaluation process proposed in this paper, the resilience status can be updated regularly with the help of the selected surrogate. The first ranked surrogate for each of the social resilience indicator can be applied, since the findings revealed that the first ranked surrogate can be the most critical facet in the context of the social resilience indicator being measured. Social implications The framework and the selection of optimal surrogates will assist to overcome the conceptual and methodical challenges of social resilience assessment. The applicability of selected surrogates by practitioners and policymakers in disaster management will play a vital role in resilience investment decision-making at the community level. Originality/value The surrogate approach has been used in the fields of ecology and clinical medicine to overcome the challenges in measuring difficult to measure indicators. The use of surrogates in this study to measure social resilience indicators in a disaster context is innovative, which was not yet explored in resilience measurement in disaster management. Graphical abstract
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Hu, Zhen, Saideep Nannapaneni, and Sankaran Mahadevan. "Efficient Kriging surrogate modeling approach for system reliability analysis." Artificial Intelligence for Engineering Design, Analysis and Manufacturing 31, no. 2 (May 2017): 143–60. http://dx.doi.org/10.1017/s089006041700004x.
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AbstractCurrent limit state surrogate modeling methods for system reliability analysis usually build surrogate models for failure modes individually or build composite limit states. In practical engineering applications, multiple system responses may be obtained from a single setting of inputs. In such cases, building surrogate models individually will ignore the correlation between different system responses and building composite limit states may be computationally expensive because the nonlinearity of composite limit state is usually higher than individual limit states. This paper proposes a new efficient Kriging surrogate modeling approach for system reliability analysis by constructing composite Kriging surrogates through selection of Kriging surrogates constructed individually and Kriging surrogates built based on singular value decomposition. The resulting composite surrogate model will combine the advantages of both types of Kriging surrogate models and thus reduce the number of required training points. A new stopping criterion and a new surrogate model refinement strategy are proposed to further improve the efficiency of this approach. The surrogate models are refined adaptively with high accuracy near the active failure boundary until the proposed new stopping criterion is satisfied. Three numerical examples including a series, a parallel, and a combined system are used to demonstrate the effectiveness of the proposed method.
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Schupp, Donald A., Adam C. Burdsall, Rendahandi G. Silva, John Lee Heckman, E. Radha Krishnan, Jeffrey G. Szabo, and Matthew Magnuson. "Persistence of surrogates for high consequence viral and bacterial pathogens in a pilot-scale activated sludge treatment system." PLOS ONE 17, no. 10 (October 7, 2022): e0275482. http://dx.doi.org/10.1371/journal.pone.0275482.
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The persistence of high consequence public health pathogens in a wastewater treatment system can significantly impact worker safety, as well as the public and downstream water bodies, particularly if the system is forced to shut down the treatment processes. This study utilizes organism viability to compare the persistence of three pathogen surrogates in wastewater using a pilot-scale activated sludge treatment (AST) system, operated to mimic treatment processes of large-scale plants. Bacillus globigii spores, surrogate for Bacillus anthracis, persisted in the AST system for at least a 50-day observation period leading to a possible steady condition far beyond the solid retention time for sludge particles. MS2 bacteriophage, surrogate for Poliovirus and other non-enveloped enteric viruses, was observed for up to 35 days after introduction, which largely and expectedly correlated to the measured solid retention time. Phi-6 bacteriophage, a surrogate for Ebola virus and other enveloped viruses, was detected for no more than 4 days after introduction, even though the AST system was operated to provide three times slower solids removal than for the other surrogates. This suggests Phi-6 is subject to inactivation under AST conditions rather than physical removal. These results may suggest similar persistence for the surrogated pathogens, leading to appropriate consequence management actions.
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Van Scoy, Lauren J., Michael J. Green, Theresa Smith, Erika VanDyke, Andrew J. Foy, Laurie Badzek, and Benjamin H. Levi. "Conceptualization of Surrogate Decision-making Among Spokespersons for Chronically Ill Patients." JAMA Network Open 5, no. 12 (December 8, 2022): e2245608. http://dx.doi.org/10.1001/jamanetworkopen.2022.45608.
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ImportanceThe value of advance care planning (ACP) has been the subject of recent debate because of mixed findings. This may be, in part, because trials presume that researchers and patient spokespersons share the same understanding of the role of a surrogate decision-maker. We explored how patient surrogates conceptualized and defined surrogate decision-making vs patient advocacy. Understanding how surrogates perceive their role in decision-making is important to avoid misinterpreting the effectiveness of ACP interventions.ObjectiveTo understand how patient spokespersons distinguish surrogate decision-making from patient advocacy.Design, Setting, and ParticipantsThis qualitative thematic analysis of a subsample of participants from a randomized clinical trial at a tertiary medical center was conducted from September 27, 2012, to June 30, 2021. Participants (n = 36) were the designated spokespersons of adult patients with severe illness who had made a surrogate decision on behalf of the patient since the last follow-up. Analysis was performed from March 21, 2021, to February 7, 2022.Main Outcomes and MeasuresSemistructured interviews examined how patient spokespersons conceptualize differences between surrogate decision-making and advocacy.ResultsThe study included 36 patient spokespersons (32 women [88.9%]; mean [SD] age, 62.1 [11.8] years) and found substantial variability in how the spokespersons conceptualized what it means to make a surrogate decision for another. A total of 10 spokespersons (27.8%) did not distinguish surrogate decision-making from advocacy. There were 5 definitions for both surrogate decision-making and advocacy. The 3 most common definitions of surrogate decision-making were (1) acting as the final decision-maker (18 [50.0%]), (2) doing what is best for the patient (8 [22.2%]), and (3) making decisions on behalf of patients so that their wishes are respected (6 [16.7%]). The 3 most common definitions of advocacy were (1) doing what is best for the patient (8 [22.2%]), (2) respecting patients’ wishes (6 [16.7%]), and (3) providing support to the patient (6 [16.7%]). The most common pairing of definitions by an individual spokesperson involved defining surrogate decision-making as being the final decision-maker, and defining advocacy as acting in the best interest of the patient (6 [16.7%]).Conclusions and RelevanceThis qualitative study found that many spokespersons perceive their roles as surrogate decision-makers differently than clinicians and researchers likely do, often conflating surrogacy with advocacy. These findings may help explain why researchers have found that ACP does not consistently improve traditional outcomes. If spokespersons do not distinguish surrogate decision-making from advocacy, then what is being reported by spokespersons and measured by clinicians and researchers may not accurately reflect the true association of ACP with outcomes.
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Kim, Hyejin, Janet A. Deatrick, and Connie M. Ulrich. "Ethical frameworks for surrogates’ end-of-life planning experiences." Nursing Ethics 24, no. 1 (August 3, 2016): 46–69. http://dx.doi.org/10.1177/0969733016638145.
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Background: Despite the growing body of knowledge about surrogate decision making, we know very little about the use of ethical frameworks (including ethical theories, principles, and concepts) to understand surrogates’ day-to-day experiences in end-of-life care planning for incapacitated adults. Objectives and Methods: This qualitative systematic review was conducted to identify the types of ethical frameworks used to address surrogates’ experiences in end-of-life care planning for incapacitated adults as well as the most common themes or patterns found in surrogate decision-making research. Findings: Seven research papers explicitly identified ethical theories, principles, or concepts, such as autonomy, substituted judgment, and best interest standards as guidelines for the research. Surrogate decision making themes included the responsibilities and goals of being a surrogate, factors influencing surrogates’ decision making, outcomes for surrogates, and an overarching theme of “wanting to do the right thing” for their loved one and/or themselves. Discussion: Understanding the complexity of surrogates’ experiences of end-of-life care planning is beyond the scope of conventional ethical frameworks. Conclusion: Ethical frameworks that address individuality and contextual variations related to decision making may more appropriately guide surrogate decision-making research that explores surrogates’ end-of-life care planning experiences.
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Armstrong, A. J., M. A. Eisenberger, E. S. Garrett-Mayer, Y. Ou Yang, M. A. Carducci, R. de Wit, and I. Tannock. "Analysis of prostate-specific antigen decline as a surrogate for overall survival in metastatic hormone-refractory prostate cancer (HRPC)." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 5009. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.5009.
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5009 Background: A 30% PSA decline following initiation of cytotoxic chemotherapy has been identified as a potential surrogate for overall survival in metastatic HRPC. We sought to examine whether various levels of PSA decline were surrogates for overall survival in TAX327, a randomized trial of q3w docetaxel and prednisone (DP), q1w DP, and q3w mitoxantrone and prednisone (MP). Methods: In this trial of 1006 men with HRPC, 943 men had sufficient data on 3-month post-treatment PSA decline for analysis, and 646 had sufficient data for analysis for a change in PSA kinetics with therapy. Surrogacy was examined for a range of PSA decline from 0% to 90% and PSA normalization, and for post-treatment changes in PSA kinetics. We investigated the Prentice Criteria for surrogacy using Cox proportional hazards models and calculated the proportion of treatment effect explained (PTE) by each surrogate marker. Results: In this analysis, a 30% or greater PSA decline with therapy was identified as the optimal cutoff that correlated with overall survival, based on the highest PTE point estimate (0.66, 95% CI 0.23–1.0), with 1.0 being a perfect surrogate. A 30% decline in PSA in the first 3 months after treatment occurred in 65% of subjects receiving q3w DP, 67% q1w DP, and 44% q3w MP, despite the significant survival benefits seen only with q3w DP. A 30% PSA decline was associated with a hazard ratio (HR) of 0.43 (95% CI 0.36–0.51) for overall survival after adjusting for treatment effect, while treatment effect itself lost significance, indicating surrogacy. Additionally, PSA normalization, changes in PSA kinetics, and pain response were significant prognostic variables, yet were only modest surrogates for the survival benefit seen with q3w DP therapy. Conclusions: In this trial of two schedules of DP as compared to MP for HRPC, a PSA decline of 30% in the first three months following initiation of cytotoxic chemotherapy was found to have the highest degree of surrogacy for overall survival, thus confirming data from the SWOG 9916 trial. However, given that the confidence interval for the estimate of this surrogate effect is wide, overall survival should remain the preferred endpoint for phase III trials of cytotoxic agents in HRPC. No significant financial relationships to disclose.
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Toledano, Sarah Jane, and Kristin Zeiler. "Hosting the others’ child? Relational work and embodied responsibility in altruistic surrogate motherhood." Feminist Theory 18, no. 2 (April 4, 2017): 159–75. http://dx.doi.org/10.1177/1464700117700048.
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Studies on surrogate motherhood have mostly explored paid arrangements through the lens of a contract model, as clinical work or as a maternal identity-building project. Turning to the under-examined case of unpaid, so-called altruistic surrogate motherhood and based on an analysis of interviews with women who had been unpaid surrogate mothers in a full gestational surrogacy with a friend or relative in Canada, the United States or Australia, this article explores altruistic surrogate motherhood as relational work. It argues that this form of surrogate motherhood within close interpersonal relations can be conceptualised through the relational work involved in hosting a child for the intended parents. The article explores how relational work in this context implies an embodied, asymmetrical and far-reaching sense of responsibility that surrogate mothers describe as characteristic of their surrogacy experience. In this way, the article sheds light on feminist concerns about surrogacy as an embodied and objectifying work of women while at the same time illuminating how surrogate mothers respond to the intended parents in light of their pre-surrogacy relationship, how meanings are negotiated by them and how relationships are managed during the pregnancy.
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Parks, Jennifer A., and Timothy F. Murphy. "So not mothers: responsibility for surrogate orphans." Journal of Medical Ethics 44, no. 8 (April 12, 2018): 551–54. http://dx.doi.org/10.1136/medethics-2017-104331.
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The law ordinarily recognises the woman who gives birth as the mother of a child, but in certain jurisdictions, it will recognise the commissioning couple as the legal parents of a child born to a commercial surrogate. Some commissioning parents have, however, effectively abandoned the children they commission, and in such cases, commercial surrogates may find themselves facing unexpected maternal responsibility for children they had fully intended to give up. Any assumption that commercial surrogates ought to assume maternal responsibility for abandoned children runs contrary to the moral suppositions that typically govern contract surrogacy, in particular, assumptions that gestational carriers are not ‘mothers’ in any morally significant sense. In general, commercial gestational surrogates are almost entirely conceptualised as ‘vessels’. In a moral sense, it is deeply inconsistent to expect commercial surrogates to assume maternal responsibility simply because commissioning parents abandon children for one reason or another. We identify several instances of child abandonment and discuss their implications with regard to the moral conceptualisation of commercial gestational surrogates. We conclude that if gestational surrogates are to remain conceptualised as mere vessels, they should not be expected to assume responsibility for children abandoned by commissioning parents, not even the limited responsibility of giving them up for adoption or surrendering them to the state.
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MEEKER, MARY ANN, and MARY ANN JEZEWSKI. "Family decision making at end of life." Palliative and Supportive Care 3, no. 2 (June 2005): 131–42. http://dx.doi.org/10.1017/s1478951505050212.
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Objective: To enhance understanding of the phenomenon of family surrogate decision-making at the end of life (EOL) by means of a systematic review and synthesis of published research reports that address this phenomenon.Methods: Garrard's (1999) methods for conducting a systematic review of the literature were followed. Fifty-one studies focusing on family decision-making experiences, needs, and processes when assisting a dying family member were selected following electronic database searches and ancestry searches.Results: In studies using hypothetical scenarios to compare patients' choices and surrogates' predictions of those choices, surrogates demonstrated low to moderate predictive accuracy. Increased accuracy occurred in more extreme scenarios, under conditions of forced choice, and when the surrogate was specifically directed to use substituted judgment. In qualitative explorations of their perspectives, family members voiced their desire to be involved and to accept the moral responsibility attendant to being a surrogate. Quality of communication available with providers significantly influenced family satisfaction with decision-making and EOL care. Group or consensual decision-making involving multiple family members was preferred over individual surrogate decision-making. Surrogates experienced long-term physical and psychological outcomes from being decision-makers.Significance of results: Functioning as a surrogate decision-maker typically places great moral, emotional, and cognitive demands on the family surrogate. Clinicians can provide improved care to both patients and families with better understanding of surrogates' needs and experiences.
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Snyder, Scott, and Halima Amjad. "Surrogate prediction of quality-of-life and desire for treatment: a guess of a guess." International Psychogeriatrics 29, no. 7 (May 5, 2017): 1059–60. http://dx.doi.org/10.1017/s1041610217000771.
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In conditions, such as dementia, stroke, or critical illness, clinicians often rely on substituted judgment through a surrogate to assist in medical decision making. Surrogates may face tough decisions regarding whether to pursue or forego surgery, tube feeding, and cardiopulmonary resuscitation. Surrogates often have little confidence in their decision (Majesko et al., 2012), though substituted judgment relies on the surrogate to determine the decision that the patient would have made. Prior studies suggest that surrogates predict patient preferences with only 68% accuracy (Shalowitz et al., 2006). This month's study by Bravo and colleagues (Bravo et al., 2017) explores differences in quality-of-life assessments between patients and surrogates as a potential explanation for surrogate inaccuracy.
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Foo, Aaron SC, Tze Wee Lee, and Chai Rick Soh. "Discrepancies in End-of-life Decisions Between Elderly Patients and Their Named Surrogates." Annals of the Academy of Medicine, Singapore 41, no. 4 (April 15, 2012): 141–53. http://dx.doi.org/10.47102/annals-acadmedsg.v41n4p141.
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Introduction: This study aims to determine the attitudes of Asian elderly patients towards invasive life support measures, the degree of patient-surrogate concordance in end-of-life decision making, the extent to which patients desire autonomy over end-of-life medical decisions, the reasons behind patients’ and surrogates’ decisions, and the main factors influencing patients’ and surrogates’ decision-making processes. We hypothesize that there is significant patient-surrogate discordance in end-of-life decision making in our community. Materials and Methods: The patient and surrogate were presented with a hypothetical scenario in which the patient experienced gradual functional decline in the community before being admitted for life-threatening pneumonia. It was explained that the outcome was likely to be poor even with intensive care and each patient-surrogate pair was subsequently interviewed separately on their opinions of extraordinary life support using a standardised questionnaire. Both parties were blinded to each other’s replies. Results: In total, 30 patients and their surrogate decision-makers were interviewed. Twenty-eight (93.3%) patients and 20 (66.7%) surrogates rejected intensive care. Patient-surrogate concurrence was found in 20 pairs (66.7%). Twenty-four (80.0%) patients desired autonomy over their decision. The patients’ and surrogates’ top reasons for rejecting intensive treatment were treatment-related discomfort, poor prognosis and financial cost. Surrogates’ top reasons for selecting intensive treatment were the hope of recovery, the need to complete final tasks and the sanctity of life. Conclusion: The majority of patients desire autonomy over critical care issues. Relying on the surrogates’ decisions to initiate treatment may result in treatment against patients’ wishes in up to one-third of critically ill elderly patients. Key words: Advanced medical directive, Intensive care
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Jadva, V. "Surrogacy: the experiences of surrogate mothers." Human Reproduction 18, no. 10 (October 1, 2003): 2196–204. http://dx.doi.org/10.1093/humrep/deg397.
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Rios, Ricardo Araújo, Michael Small, and Rodrigo Fernandes de Mello. "Testing for Linear and Nonlinear Gaussian Processes in Nonstationary Time Series." International Journal of Bifurcation and Chaos 25, no. 01 (January 2015): 1550013. http://dx.doi.org/10.1142/s0218127415500133.
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Surrogate data methods have been widely applied to produce synthetic data, while maintaining the same statistical properties as the original. By using such methods, one can analyze certain properties of time series. In this context, Theiler's surrogate data methods are the most commonly considered approaches. These are based on the Fourier transform, limiting them to be applied only on stationary time series. Consequently, time series including nonstationary behavior, such as trend, produces spurious high frequencies with Theiler's methods, resulting in inconsistent surrogates. To solve this problem, we present two new methods that combine time series decomposition techniques and surrogate data methods. These new methods initially decompose time series into a set of monocomponents and the trend. Afterwards, traditional surrogate methods are applied on those individual monocomponents and a set of surrogates is obtained. Finally, all individual surrogates plus the trend signal are combined in order to create a single surrogate series. Using this method, one can investigate linear and nonlinear Gaussian processes in time series, irrespective of the presence of nonstationary behavior.
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Pearl, Judea. "Discussion on “Surrogate Measures and Consistent Surrogates”." Biometrics 69, no. 3 (September 2013): 573–77. http://dx.doi.org/10.1111/biom.12073.
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Joffe, Marshall M. "Discussion on “Surrogate Measures and Consistent Surrogates”." Biometrics 69, no. 3 (September 2013): 569–73. http://dx.doi.org/10.1111/biom.12074.
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Elliott, Michael R., Anna Conlon, and Yun Li. "Discussion on “Surrogate Measures and Consistent Surrogates”." Biometrics 69, no. 3 (September 2013): 565–69. http://dx.doi.org/10.1111/biom.12075.
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Joseph, Rachel A., Alexandria M. Rafanello, Cassidy J. Morris, and Kerry F. Fleming. "Surrogacy: Pathway to Parenthood." Neonatal Network 37, no. 1 (January 2018): 19–23. http://dx.doi.org/10.1891/0730-0832.37.1.19.
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Assistive reproductive technology has progressed significantly over the past few decades. In spite of the advances, people may still resort to a surrogate for bearing and birthing a baby. Surrogacy, though an altruistic act, has been commercialized in the past few years, leading to emergence of several ethico-legal concerns. Nurses care for the surrogates, the infants, and the intended parents through their journey with sensitivity, advocacy, compassion, and confidentiality. This article intends to explore the implications of surrogacy to individuals, families, nations, and health care.
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Muharam, Yuswan, Danny Leonardi, and Alisya P. Ramadhania. "Simulation of the Oxidation and Combustion of Mixed Diesel-Biodiesel Fuel." MATEC Web of Conferences 156 (2018): 03008. http://dx.doi.org/10.1051/matecconf/201815603008.
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A comparative simulation-based research has been set up to obtain valid kinetic models of the oxidation and combustion of biodiesel surrogate and diesel surrogate, as well as mixed diesel-biodiesel surrogates which is used to predict their ignition delay times (IDT). The research consists of the development of the detailed kinetic models of the oxidation and combustion of biodiesel surrogate and diesel surrogate, the validation of the two models with the corresponding experimental IDT data, the merging and the validation of the two models for mixed diesel-biodiesel surrogates. The biodiesel surrogate kinetic model was validated with the experimental IDT data of methyl 9-decenoate at 20 atm and three equivalence ratios. The diesel surrogate kinetic model was validated with the experimental IDT data of n-hexadecane at the pressure ranging from 2 atm to 5 atm and the equivalence ratio of 1.0. The diesel-biodiesel surrogate kinetic model was validated with the experimental IDT data of real diesel-biodiesel fuels for four compositions and at 1.18 atm. The validation results of all models show that the models and the experiments are in good agreement.
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Armstrong, Andrew J., Elizabeth Garrett-Mayer, Yi-Chun Ou Yang, Michael A. Carducci, Ian Tannock, Ronald de Wit, and Mario Eisenberger. "Prostate-Specific Antigen and Pain Surrogacy Analysis in Metastatic Hormone-Refractory Prostate Cancer." Journal of Clinical Oncology 25, no. 25 (September 1, 2007): 3965–70. http://dx.doi.org/10.1200/jco.2007.11.4769.
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Purpose It is currently unclear if early prostate-specific antigen (PSA) or pain improvements are adequate surrogates for overall survival in men with metastatic hormone-refractory prostate cancer (HRPC). Here we examined various degrees of PSA decline and pain response as surrogates for the survival benefit observed in the TAX327 trial. Patients and Methods In the TAX327 trial, 1,006 men with HRPC were randomly assigned to receive docetaxel in two schedules, or mitoxantrone, each with prednisone: 989 men provided data on 3-month PSA decline. Surrogacy was examined for post-treatment changes in PSA and pain response using Cox proportional hazards models to calculate the proportion of treatment effect (PTE) explained by each potential surrogate. Results A ≥ 30% PSA decline within 3 months of treatment initiation provides the highest degree of surrogacy, with a PTE of 0.66 (95% CI, 0.23 to 1.0), and was associated with a hazard ratio (HR) of 0.50 (95% CI, 0.43 to 0.58) for overall survival after adjusting for treatment effect. Introduction of a ≥ 30% PSA decline is predictive of survival regardless of treatment arm. Other changes in PSA or PSA kinetics, PSA normalization, and pain responses were highly prognostic but weaker surrogates for survival. Conclusion In the TAX327 trial, a PSA decline of ≥ 30% within 3 months of chemotherapy initiation had the highest degree of surrogacy for overall survival, confirming data from the Southwest Oncology Group 9916 trial. However, given the wide CIs around the estimate of this moderate surrogate effect, overall survival should remain the preferred end point for phase III trials of cytotoxic agents in HRPC.
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Gola, Swati. "One step forward or one step back? Autonomy, agency and surrogates in the Indian Surrogacy (Regulation) Bill 2019." International Journal of Law in Context 17, no. 1 (February 16, 2021): 58–74. http://dx.doi.org/10.1017/s174455232100001x.
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AbstractThe Indian government has recently introduced legislation to regulate ‘altruistic’ surrogacy while banning ‘commercial’ surrogacy amidst the criticism that India has become the ‘baby factory’. In the past decade, academic discourse has raised socioethical and legal issues that surfaced in the unrestricted transnational commercial-surrogacy industry. Most of the literature and ethnographic studies centred on the issues of informed consent, autonomy, decision-making and exploitation. With the proposed legislation, the Indian government has shown its will to regulate surrogacy, including the medical intermediaries as well as the contract between the intending parents and the surrogate mother-to-be. The present paper addresses the legal and socioethical context in which India introduced the Surrogacy (Regulation) Bill 2019. It examines the extent to which the proposed law responds to the legal challenges and socioethical concerns that surfaced in the course of unregulated transnational commercial-surrogacy arrangements in India. It argues that, even though the proposed legislation addresses and responds to some of the legal and ethical concerns such as informed consent and legal parentage, it stops short of ensuring the welfare and well-being of the surrogate. Second, the legal certainty of parentage and the child's rights comes at the cost of the physical and psychological well-being of the surrogate. Finally, it argues that, by presupposing the surrogate as an autonomous agent and yet imposing the requirement of marriage, the Bill overlooks the sociocultural realities of patriarchal hierarchies entrenched in Indian society – that, in its conception of ‘family’, the focus on the ‘traditional’ family not only presents a narrow view of the heteronormative family and perpetuates the patriarchal notions of gender roles, but also fails to take into consideration maternal pluralism in surrogacy arrangements, undermines the modern family and, above all, discriminates against the single person's and lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities’ right to found a family. Since many countries that served as centres for international commercial-surrogacy arrangement (such as Cambodia, Thailand and Nepal) have recently started to take steps to prohibit or limit transnational surrogacy arrangements, the analysis of Indian law in the present paper will provide a useful context within which these countries can effectively regulate surrogacy while safeguarding the surrogate's rights and interests.
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Alpers, Ann, and Bernard Lo. "Avoiding Family Feuds: Responding to Surrogate Demands for Life-Sustaining Interventions." Journal of Law, Medicine & Ethics 27, no. 1 (1999): 74–80. http://dx.doi.org/10.1111/j.1748-720x.1999.tb01438.x.
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The laws and ethical guidelines governing decision making for incompetent patients evolved from controversies in which family members refused life-sustaining interventions. These cases led to a consensus that advance directives to limit interventions should be respected and that a surrogate designated by the patient or specified by statute could refuse interventions, even when other relatives disagreed. Surrogate decision-making statutes and ethical principles about respect for delegated autonomy promote an active role for family members or other surrogates in medical decisions for incompetent patients. Inviting surrogates to participate actively in medical decisions recognizes the importance of the patient's personal community and assures that decisions will reflect the patient's own preferences and values.The standard approach to decisions for incompetent adults gives advance directives priority over a surrogate's substituted judgment, which in turn has priority over assessments of the patient's best interest. A patient may express advance directives by appointing a proxy, stating specific preferences, or articulating general values. We use case examples to illustrate the limitations of all three types of advance directives.
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Suprun, Yana Ivanovna, and Anastasiya Maksimovna Kozlova. "Practical and theoretical problems of legal regulation of surrogacy." Политика и Общество, no. 1 (January 2021): 1–12. http://dx.doi.org/10.7256/2454-0684.2021.1.35608.
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The subject of this research is the legal norms applied to the surrogacy program as an independent institution that requires a separate place in the system. The object of this research is the social relations arising in the sphere of surrogacy procedures for future parents, as well as protection of the rights of a child born from artificial insemination. Special attention is given to such aspects as the surrogacy contract, registration of a child born to a surrogate mother, court opinion on the refusal to register a child born to a surrogate mother, and right of a single father to register a child born to a surrogate mother. The novelty of this article lies the analysis and examination of case law dedicated to the practical and theoretical problems of using surrogacy. The definitions are provided to the concepts of surrogacy and surrogate mother. Recommendations are made on the amendments to family and civil legislation by introducing norms that would regulate and determine the legal nature of surrogacy contract, norms on the child’s registration by the genetic parents who are not legally marries, as well as norms that to regulate the rights and responsibility, legal status of the father of a child born to a surrogate mother.
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Ye, Pengcheng, and Guang Pan. "Selecting the Best Quantity and Variety of Surrogates for an Ensemble Model." Mathematics 8, no. 10 (October 7, 2020): 1721. http://dx.doi.org/10.3390/math8101721.
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Surrogate modeling techniques are widely used to replace the computationally expensive black-box functions in engineering. As a combination of individual surrogate models, an ensemble of surrogates is preferred due to its strong robustness. However, how to select the best quantity and variety of surrogates for an ensemble has always been a challenging task. In this work, five popular surrogate modeling techniques including polynomial response surface (PRS), radial basis functions (RBF), kriging (KRG), Gaussian process (GP) and linear shepard (SHEP) are considered as the basic surrogate models, resulting in twenty-six ensemble models by using a previously presented weights selection method. The best ensemble model is expected to be found by comparative studies on prediction accuracy and robustness. By testing eight mathematical problems and two engineering examples, we found that: (1) in general, using as many accurate surrogates as possible to construct ensemble models will improve the prediction performance and (2) ensemble models can be used as an insurance rather than offering significant improvements. Moreover, the ensemble of three surrogates PRS, RBF and KRG is preferred based on the prediction performance. The results provide engineering practitioners with guidance on the superior choice of the quantity and variety of surrogates for an ensemble.
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Frey, Renato, Stefan M. Herzog, and Ralph Hertwig. "Deciding on behalf of others: a population survey on procedural preferences for surrogate decision-making." BMJ Open 8, no. 7 (July 2018): e022289. http://dx.doi.org/10.1136/bmjopen-2018-022289.
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ObjectivesTo assess people’s procedural preferences for making medical surrogate decisions, from the perspectives of both a potential surrogate and an incapacitated patient.DesignComputer-assisted telephone interviews. Respondents were randomly assigned either the role of an incapacitated patient or that of a potential surrogate for an incapacitated family member. They were asked to rate six approaches to making a surrogate decision: patient-designated surrogate, discussion among family members, majority vote of family members’ individual judgements, legally assigned surrogate, population-based treatment indicator and delegating the decision to a physician.SettingGermany and German-speaking and French-speaking parts of Switzerland.Participants2010 respondents were quota sampled from a panel (representative for the German and German-speaking and French-speaking Swiss populations, respectively, in terms of age, sex and regions).Main outcome measuresEndorsement of each approach (rated on a scale from 1 to 10). Degree to which preferences overlap between the perspective of potential surrogates and potential patients.ResultsRespondents’ endorsement of the six different approaches varied markedly (from Mdn=9.3 to Mdn=2.6). Yet the preferences of respondents taking the perspective of incapacitated patients corresponded closely with those of respondents taking the perspective of a potential surrogate (absolute differences ranging from 0.1 to 1.3). The preferred approaches were a patient-designated surrogate (Mdn=9.3) and all family members making a collective decision by means of group discussion (Mdn=9.3). The two least-preferred approaches were relying on a statistical prediction rule (Mdn=3.0) and delegating the decision to a physician (Mdn=2.6).ConclusionsAlthough respondents taking the perspective of an incapacitated patient preferred a patient-designated surrogate, few people have designated such a surrogate in practice. Policy-makers may thus consider implementing active choice, that is, identifying institutional settings in which many people can be reached (eg, when obtaining a driver’s licence) and requesting them to complete advance directives and to designate a specific surrogate. Moreover, potential patients and surrogates alike highly valued shared surrogate decisions among family members. Policy-makers may consider acknowledging this possibility explicitly in future legislation, and caregivers and physicians may consider promoting shared surrogate decisions in practice.
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Feldman, Eric A. "Baby M Turns 30: The Law and Policy of Surrogate Motherhood." American Journal of Law & Medicine 44, no. 1 (March 2018): 7–22. http://dx.doi.org/10.1177/0098858818763811.
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This article marks the 30th anniversary of the Supreme Court of New Jersey's Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature.First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can be taken to minimize the potential exploitation of women who are willing to rent their wombs for income? Third, what criteria should govern the eligibility to serve as a surrogate mother and an intended parent? Fourth, what principle(s) should serve as the basis for determining the parentage of children born through surrogacy? Fifth, is regulatory uniformity in the surrogacy realm desirable? Is it achievable?The article concludes that courts and legislatures should accept the validity of surrogacy contracts, determine parentage according to intent, and identify transparent criteria for the eligibility of both surrogates and intended parents.
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Sinclair, Ryan G., Joan B. Rose, Syed A. Hashsham, Charles P. Gerba, and Charles N. Haas. "Criteria for Selection of Surrogates Used To Study the Fate and Control of Pathogens in the Environment." Applied and Environmental Microbiology 78, no. 6 (January 13, 2012): 1969–77. http://dx.doi.org/10.1128/aem.06582-11.
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ABSTRACTThis article defines the term surrogate as an organism, particle, or substance used to study the fate of a pathogen in a specific environment. Pathogenic organisms, nonpathogenic organisms, and innocuous particles have been used as surrogates for a variety of purposes, including studies on survival and transport as well as for method development and as “indicators” of certain conditions. This article develops a qualitative surrogate attribute prioritization process and allows investigators to select a surrogate by systematically detailing the experimental process and prioritizing attributes. The results are described through the use of case studies of various laboratories that have used this process. This article also discusses the history of surrogate and microbial indicator use and outlines the method by which surrogates can be used when conducting a quantitative microbial risk assessment. The ultimate goal of selecting a sufficiently representative surrogate is to improve public health through a health-based risk assessment framework. Under- or overestimating the resistance, inactivation, or movement may negatively impact risk assessments that, in turn, will impact health assessments and estimated safety levels. Reducing uncertainty in a risk assessment is one of the objectives of using surrogates and the ultimate motive for any experiment investigating potential exposure of a pathogen.
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Malmquist, Anna, and Sonja Höjerström. "Constructions of surrogates, egg donors, and mothers: Swedish gay fathers’ narratives." Feminism & Psychology 30, no. 4 (May 14, 2020): 508–28. http://dx.doi.org/10.1177/0959353520922415.
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The study explored in detail how Swedish gay fathers (through surrogacy) talked about the surrogate mother and the egg donor. Thirteen semi-structured interviews with 22 gay fathers were conducted and analysed using critical discursive analysis. The surrogates were primarily constructed as a close family member, but occasionally in terms of their instrumental function. They were often described as active and independent, but occasionally as vulnerable or exploited. The egg donors were in some interviews constructed as close family members, while others talked about them as distant acquaintances. Further, donors were constructed either as a significant individual (for the fathers), or as an instrumental provider of the oocyte. While some participants constructed the surrogate and/or donor as their child’s mother(s), others were more reluctant or ambivalent about the mother construct. In conclusion, the participants engaged in rhetorical work that shed a positive light on surrogacy, and their own decisions were depicted as solid, ethical and genuine. The participants’ positive framing can be understood as the production of a counter discourse, in relation to an ongoing debate in Sweden, in which surrogacy is constructed as exploitation, dehumanization and prostitution.