Littérature scientifique sur le sujet « Callaway county »

The role of psychosocial factors that contribute to the maintenance of health has been conceptualized in terms of a health-sustaining function (or direct-effects hypothesis), as well as a stress-reducing function (or moderating hypothesis). This study is concerned with the stress-reducing function of helplessness on Rheumatoid Arthritis (RA) health outcome. In a sample of 186 adult hospital RA patients of low socioeconomic status, helplessness measured by the Arthritis Helplessness Index (AHI; Nicassio, Wallston, Callahan, Herbert, & Pincus, 1985), was found to moderate the relationship between the following: swollen joint count and depression, number of tender joints and functional ability, tender joint count and pain experience, and tender joint count and perceived disability.

The overthrow of Haile Selassie in Ethiopia in 1974, and the independence of Angola and Mozambique in 1975, as well as Zimbabwe in 1980, seem to have strengthened the case for classifying African régimes on the basis of their ideology.In a collection of mainly country-studies of socialism in sub-Saharan Africa edited by Carl Rosberg and Thomas Callaghy in 1978, various explanations were advanced about why the so-called ‘first wave’ of radicals failed to transform African societies successfully, and a common theme was the major rô played by ideology in differentiating ‘African’ from ‘scientific’ socialist régimes.1 In 1981 David and Marina Ottaway contrasted the ‘African socialism’ of Guinea, Zambia, and Tanzania with the ‘Afrocommunism’ of Angola, Mozambique, and Ethiopia, and contended that ideology was the best indicator of the clear differences that existed in both their institutions and policy choices.2 In 1982 Crawford Young placed African régimes in three ideological categories: ‘Populist socialist’, and ‘African capitalist’.3

British Burma has never beenadequately or even systematically studied as both students of modern Burmese history and British empire historians have given it relatively short shrift. Nonetheless, imperial rule lasted for nearly five generations and helped to produce the nation which now identifies itself as Myanmar. By the end of the nineteenth century, Burma was crucial to the wider South Asian economy, supplying oil, minerals, teak, and, above all, rice to destinations around the Indian Ocean. Yet, it took three Anglo-Burmese Wars to make Burma a part of British India. These conflicts are largely forgotten but they determined not only the fate of the country, but helped to shape its future trajectories. Military conflict proved more durable than colonization as independence brought with it a situation in which the “state has been continuously at war with the population mapped into its territorial claim” (Callahan 13). Nonetheless, the intellectual and cultural history of British Burma is rich and fascinating: colonial authors made the country their subject matter and they left behind a diverse corpus which bore the stamp of Victorian civilization. The experience of writing about Burma – particularly by those writers who identified with Burmese culture – produced some forgotten masterpieces. However, the dominant British understanding of the country arose from military conflict and occupation; this paper focuses on four British war narratives (which followed each of the Anglo-Burmese Wars) because they disclose more than their recounting of these conflicts might suggest. By exploring the works of John James Snodgrass, Henry Gouger, William F. B. Laurie, and Major Edmond Charles Browne, it will be possible to trace the beginnings of the colonizing narrative which helped to shape British rule. These writers experienced the Anglo-Burmese Wars directly and their narratives illustrate that they were “involuntary sightseers” recording not only the details of conflict, but their assessments of Burma and the Burmese.

Counted among the most original and prolific medieval French poets, Thibaut IV, count of Champagne and Brie, King of Navarre, was also called Thibaut the poet entertainer (1201–1253). This great-grandson of Eleanor of Aquitaine and great-grandfather of Marie de Champagne, was celebrated by Dante for the purity of his lyrics and widely admired for his mastery of all genres of the time. Remarkable as well for his interpretations of antique mythology and bestiaries, this grand prince and Crusade hero forged poems devoted to the Virgin, transmuting the lyrical lady into a celestial figura. The generous and capacious volume to hand, prepared by young scholars, one French and two Americans, is completely devoted to the famous poet; it is, since the long-respected 1925 edition by Wallensköld (SATF; just a single scholar), the first really complete one. It offers not only all the poems (love songs, debate poems, pastourelles, Crusade, and religious poems) accompanied by their melody, but also robust notes, concordant variants, and isolated melodies. The modern French translations are complemented by additional comments in the glossary, thus offering the reader a very generous and useful reference tool, the fruit of years of accumulated philological and musicological research.

Abstract Background: Anti-CD19 Chimeric Antigen Receptor (CAR) T cell therapy has emerged as a mainstay in the treatment of patients with relapsed/refractory (r/r) B-cell acute lymphoblastic leukemia (ALL). While trials have shown encouraging survival rates, up to 50% of patients receiving CART eventually relapse. Identification of risk factors for subsequent relapse is crucial, as this could allow tailored surveillance and treatment approaches for high-risk patients, potentially leading to improved morbidity and mortality. Complete remission with incomplete hematologic recovery (CRi) has been associated with decreased remission duration and overall survival in acute leukemias. As count suppression following CAR T cell therapy is frequently seen, this study evaluated CRi as a prognostic marker for worse relapse-free (RFS) and overall survival (OS) after CAR T cell therapy in comparison to complete remission with hematologic recovery (CR). Methods: Patients with r/r ALL who achieved a complete morphologic remission after receiving anti-CD19 CAR T cell treatment with the 4-1BB-containing products CTL019 or humanized CART19 in the context of a clinical trial (NCT01626495, NCT02374333, NCT02228096, NCT02435849, NCT02906371) or commercial product (tisagenlecleucel) at Children's Hospital of Philadelphia from 4/2012-4/2019 were identified. Patients who received prior CAR therapy, and those with Trisomy 21 were excluded. Demographic, disease and treatment characteristics, and outcome data were abstracted from the medical record or clinical trial datasets. CR was defined as achieving a morphologic remission with both an absolute neutrophil count (ANC) ≥1,000/µL and a transfusion-independent platelet count ≥100,000/µL at any time between 27-33 days after CAR T cell infusion, whereas those achieving a morphologic remission without complete hematologic recovery were defined as CRi. RFS and OS were described for each cohort. Exposure-outcome association was assessed via the log-rank test and multivariable Cox proportional hazard regression. Results: Of the 206 patients included in the analysis, 104 (51%) achieved CR, 102 (49%) CRi. Forty patients (39%) met criteria for CRi with both ANC <1000/µL and platelets <100,000/µL, 40 (39%) for isolated thrombocytopenia, and 20 (20%) for neutropenia alone. Median age at leukemia diagnosis was 7 years (range 0.2-24), and at CAR T cell infusion was 12 years (range 1-29), with 48% undergoing a prior allogeneic stem cell transplant (HSCT), 32% with high risk cytogenetics, and 10% with prior blinatumomab treatment, none of which differed between the CR and CRi groups (Table 1). The number of relapses prior to CAR T cell referral was different between the groups (p=0.003), with more CR patients having been referred for primary refractory disease (25% vs 9.8%), and more CRi patients for first relapse (34% vs 18%). More CRi patients had >25% bone marrow blasts (43% vs 19%) at infusion, whereas more CR patients were MRD-negative (50% vs 30%) at infusion (p=0.002). CRi patients were also more likely to have Grade 3/4 CRS (38% vs 6.7%). Median length of follow-up for patients with CR was 39 months (range 7-89), which was not statistically significantly different than for those patients with CRi (41 months, 11-98, p=0.875). There was no difference in RFS when stratified by hematologic recovery (Figure 1, p=0.2165), with RFS at 36 months for CR of 57% (47-69) and CRi of 46% (36-59). OS was significantly lower (Figure 2, p=0.0081) for those with CRi, with 36-month OS for CR of 81% (74-89), and for CRi of 63% (54-73). In multivariable analysis adjusting for sex, prior blinatumomab, relapse number, disease burden at infusion, and maximum CRS grade, CR was not associated with either RFS (HR 0.76 [95%CI 0.50-1.17] p=0.2182) or OS (HR 0.74 [95%CI 0.43-1.29] p=0.2908), in comparison to CRi, Table 2. Discussion: Complete remission with incomplete hematologic recovery, manifesting as neutropenia and/or thrombocytopenia, at the first disease assessment following CAR T cell infusion should not be regarded as a harbinger of relapse and demonstrates that patients with CRi have similar probability of durable remission without further therapy. Anticipatory guidance should be provided to patients, and their families, that CRi is more frequently seen in patients who experience high grade CRS, who have high disease burden at infusion, and who are treated in first relapse. Figure 1 Figure 1. Disclosures Callahan: Novartis: Speakers Bureau. Rheingold: Optinose: Other: Spouse's current employment; Pfizer: Research Funding. Grupp: Novartis, Roche, GSK, Humanigen, CBMG, Eureka, and Janssen/JnJ: Consultancy; Novartis, Adaptimmune, TCR2, Cellectis, Juno, Vertex, Allogene and Cabaletta: Other: Study steering committees or scientific advisory boards; Novartis, Kite, Vertex, and Servier: Research Funding; Jazz Pharmaceuticals: Consultancy, Other: Steering committee, Research Funding. Maude: Wugen: Consultancy; Novartis Pharmaceuticals Corporation: Consultancy, Research Funding.

Differences in PCR strategies and errors, sequencing errors and methods used for extractions affect sequence data and potentially its interpretation. These effects could vary based on the target fragments, which are also influenced by limitations of incomplete databases. In this study, we tested the effects of two different proprietary DNA extraction kits on sediment samples, for the purposes of benthic monitoring of salmon farms. The levels of organic enrichment at farms show a gradient from cage edge to more distant locations. The effects of enrichment on benthic communities can be established with metabarcoding. We collected samples at three salmon farms in Scotland, at varying distances from cage edge. The sediments underneath two of the farms was fine while the sediment under the other was coarse, with a larger mean particle size. We extracted the samples with two different kits, each using a different mass of sediment – Qiagen DNeasy PowerSoil Pro (0.5 g) and Qiagen DNeasy PowerMax (5 g). We then subjected each extract to three independent PCRs targeting 16S (bacterial) and CO1 (eukaryotic) fragments. The PCR products of samples and blanks were sequenced with an Illumina MiSeq instrument on a single run. We denoised the sequenced data using DADA2 and rarefied it before analysis (Callahan et al. 2016). The 16S data was annotated against the seven-level SILVA database (Quast 2012). We collated this data at ‘Family’ level. The CO1 data was filtered to remove Amplicon Sequence Variants (ASVs) present in only one sample and ASVs with a frequency of less than ten reads across all samples. The read count data of family level 16S and ASVs of CO1 were transformed and converted to Bray-Curtis dissimilarity matrices (Bray and Curtis 1957). A permutational multivariate analysis of variance was carried out. We also ordinated these data with non-metric multi-dimensional scaling. 474 bacterial families and 3380 eukaryotic ASVs were included in the analysis. The samples extracted with both kits demonstrated a gradient based on distance from cage edge. This gradient in sampling stations was observed with both the 16S and CO1 markers. Data from both markers and kits showed a greater distinction between cage edge stations and more distant stations in the farms characterised by fine sediment. The two extraction kits showed similar trends but differed in their results. The 16S data showed a separation of samples by extraction kit along the y-axis. PowerMax extractions were associated with higher values on the y-axis (Fig. 1). The multivariate analysis of variance of the 16S data showed that extraction kit contributes to approximately 7% (p<0.001) of variation in data. The CO1 ASV data also showed a grouping of samples of both kits along the x-axis on the basis of distance from the farm (Fig. 1). The CO1 data showed that extraction kits contribute to about 5% (p<0.001) of the variation. The results of the two extraction kits were more similar to each other with the CO1 marker than with 16S. The greater axes values and grouping in the CO1 ordination, indicate that it is able to split farms and distances better than 16S. We show that both extraction kits demonstrated a gradient according to distance from the cage edge. However, there was a systematic difference between the extraction kits. Variability due to kit was greater with the 16S marker despite it including fewer bacterial families than CO1 ASVs. We recommend that the same extraction kit be used to develop protocols for monitoring of fish farms with metabarcoding. Though both kits demonstrate the same major trend, subtle differences may not be distinguished. These variations between the kits could influence the results and interpretation of metabarcoding.

I knew all about places like the Hotel Tremaine…they are flops where you find the cheap ones, the sniffers and the gowed-up runts who shoot you before you can say hello Raymond Chandler, Mandarin's Jade. It is in such a city, of the derelict and the displaced, that film-goers once encountered the private eye. And while we recognise the private eye as naturally urban, the 'hard-boiled' guys of Chandler, David Goodis and their imitators rarely appeal as urbane. Dictionary advice offers a neatly-plotted resolution to such a puzzle, informing us that 'urbane' is dependent on 'urban' in the manner that 'humane' is connected unavoidably to 'human'. As with much of the information scattered across a mystery narrative, such deduction may be too neat. The varying linkages of 'urban' and 'urbane' can be queried in that classic tale of the twentieth-century city, the detective story. In what sense is the detective, as urbane male hero, dependent on the urban world in which he moves? Some years before the emergence of Chandler's Philip Marlowe as the classic 'dick', the private detective inhabited an urban setting and was, in his set of personal attributes, urbane. Sherlock Holmes, the most filmed character in the history of cinema did set out for the moors to entrap the Baskerville hound, but kept coming back to his bolt-hole in central London, right in the heart of the world's great empire. From here he explored London in all its complexity, moving effortlessly between contrasting milieus. He brought with him a mastery of codes and a charm in dealing with especially, female, clients. So proficient was Holmes in reading the city, that he perfected almost any disguise, penetrating in at least one tale, the opium-smokers' flophouses of the East End. In his character, urbane style emerged as a privilege of the educated and wealthy male, a distinguishing mark which somehow seemed to justify all the evasions required in his detection. Holmes's urbanity is thoroughly of London, the huge imperial city. As is that of his law-breaking alter ego, Raffles. E.W. Hornung's character, a gentleman turned thief, who came to the screen in silent films and later under Sam Wood's direction in the 1940 Raffles, with the impeccably urbane David Niven as hero. It is not immediately clear that this urbanity survived displacement from London to Southern California. The first noir era in crime film, claimed Mike Davis, exposed 'the epic dereliction of Downtown's Bunker Hill, which symbolized the rot at the heart of the expanding metropolis' (1992, 41). Davis recognised the class-conscious construction of the 'hard-boiled' detective, in which the tropes of aristocratic style were passed down from Raffles to Philip Marlowe. The detective, a representative of the threatened post-Depression urban middle class, employed stylistic markers to hold himself aloof from the poor, the working class and the marginal. In defending himself from their 'epic dereliction', the private eye depended on traces of the urbane inherited from a cycle of movies, which intervened between the Holmes stories and those of wartime noir, especially the first Saint and Falcon movies with George Sanders as hero. Indeed, that most urbane of all male stars of the 1940s, George Sanders ousted Philip Marlowe from his own mystery in The Falcon takes over [1942], a Chandler adaptation for which director Irving Reis inserted the urbane Falcon [Sanders]. Yet as the Falcon series wore on, crimes had to be set in distant and cosmopolitan locations, as if the city of the 1930s and '40s could not sustain the urbanity of the detective. In the later Falcon movies, the detective resorts to globe-trotting around fashionably exotic locations, as if his urbanity can no longer be demonstrated by imaginative daring but requires the prop of the cosmopolitan backdrop. While the subsequent noir cycle relied on fears of personal entrapment, the detective as urbane, was able to overcome dislocation. The solution of the crime is in effect an exteriorisation of inner order. The detective's languidness and characteristic dress, the male formal attire dissembled slightly for the rain-slicked street, has produced its own markers of the urbane, even if drawn from Casablanca rather than Los Angeles. The stylish detective, through dress, movement, and words, was able to remain aloof from the sufferings of the Hotel Tremaine. As Frank Kutnik pointed out, 'the impact of the American private-eye as a culturally iconized fantasy male derives from his role as a perpetually liminal self who can move freely among the diverse social worlds thrown up by the city, while existing on their margins' (1997, 90). What of the city in which the private eye resolves crime? In the transition from novel to movie, cities are regularly collapsed into a sequence of standard settings: night club, lounge, bar, office and most frequently, interior of the automobile. The city itself in its dissipation and disorder recedes into abstraction. A familiar range of shots and lighting, characteristic of noir, oblique angles, formalist patterning, low-key lights and extreme close-up, displaces the city of the written stories. In this first noir cycle, the detective-hero traverses an emerging urban disorder which, although he finds it despicable and degraded, remains a place in which he is at home. The urbanity of Holmes and the Saint has its terminal reflection in this command of localised and underworld codes and space. The private eye is defending a sense of self and self-worth from the degradation of urban life. Many of the noir films exaggerated this apartness by their use of low-key lighting to create an abstract order, redolent of psychological imbalance but nonetheless masking the jumbled city of the written detective fiction. To observe Jack Nicholson's Jake Gittes in Polanski's Chinatown [1974] is to see simultaneously the dissolving of the urbane self-containment of the detective and the fakery of his city. In Chinatown, Gittes is sleazy and foul mouthed and his attempts at wit fall short. He can't understand the crime narrative into which he has stumbled. Symbolically his nose is slit by a villain [he can't sniff out crime] and the mnemonic Chinatown is a model of the city as beyond knowledge; in which there are bad memories but no grasp of how the future might unfold. Perhaps even more removed from the urban and urbane is Gene Hackman's Harry Moseby, private eye as victim, in Arthur Penn's Night Moves [1975]. Like Jake he fails to rescue the female victim, his wit is rough rather than urbane, he dresses badly and has an unsuave background as professional sportsman . The old public school brigade in which the Saint, Raffles, the Falcon and indeed Chandler himself were all conjoined, had foresworn professional games in defence of the gifted amateur. Moseby drifts from the city to the Florida coast and then out to sea, the detective well and truly out of his depth. The first detectives took from the city an urbaneness parallel to the genteel detection of a country house whodunnit. In the neo-noir, the city is, despite Polanski's too careful reproduction [a simulacrum in itself] essentially uncoded and emptied. There is no milieu into which the detective can insinuate himself. Reservoir Dogs [1992] has characters with no names and is set in vacant industrial storage blocks. The best the characters can do for urbane conversation is to deconstruct Madonna. In Pulp Fiction, [1994] Tarantino's characters from the outset are presented to us as even more unsuave. They eat, crudely, in tinny diners and their understanding of the cosmopolitan is limited to European translations of 'Big Mac'. The urban world in which the languidly suave detective moved with ease and wit has degenerated into predictability. There are no codes to understand, no subject to remain self-contained. The detecting figure has in consequence come to be shaped more by Harry Callahan than by Holmes. No longer a knight errant struggling to maintain morality, Dirty Harry is barely distinguishable from the murderers he guns down. He hates urban diversity and the setting of the first film, in the monumental civic locations and tourism landscapes of San Francisco, ridicules any notion of architectural urbanity. In Dirty Harry [1971] the detective's nemesis is not the killer but the Mayor, who plays with urbanity, but in his foppish dress, over-tidy room and gold-embossed phone is a culpably weak fool. Harry in contrast is deliberately far from urbane. In the final scenes he even leaves the city itself for a Western-style setting of creek and antiquated machinery. With the urbane detective now a rarity on the screen, Los Angeles can be resurrected in urban theory as a crass land of simulacra, of theme parks and drive-in diners. Such hyper-reality would drive Marlowe to cynical disgust and Harry Callahan to wreak bloody revenge on both property developers and cultural theorists. Urbane, even cool, have come down it seems to, at best, 'street smart'. In the process, the urbanity inherited from a turn-of-the century aristocracy and passed down in cruder form to the declining middle class of Marlowe's California, has no significance. The people of the Hotel Tremaine have outlasted the detective. We don't have to see Los Angeles as the prototype of the 21st century city, even though a few geographers continue to insist that this is the case. But in the film story of detection, the urban of the twentieth- century city is a vacuum and urbane style means little. The male detective hero has dropped his guard. As dictionary detectives might have suspected, in these movies, humane is now absent from the human. References Davis, Mike (1992) City of Quartz: excavating the future in Los Angeles. Vintage. Krutnik, Frank (1997) 'Something more than night: tales of the noir city', in David B Clarke, ed., The cinematic city, Routledge. Citation reference for this article MLA Style McConville, Chris. "The private eye as urbane" M/C: A Journal of Media and Culture 5.2 (2002). [your date of access] < http://www.media-culture.org.au/0205/private_eye.php>. Chicago Style McConville, Chris, "The private eye as urbane" M/C: A Journal of Media and Culture 5, no. 2 (2002), < http://www.media-culture.org.au/0205/private_eye.php> ([your date of access]). APA Style McConville, Chris. (2002) The private eye as urbane. M/C: A Journal of Media and Culture 5(2). < http://www.media-culture.org.au/0205/private_eye.php> ([your date of access]).

In the Philippines, many people would think that items made in other countries have better quality and are more desirable.More recently, with numerous goods coming from nearby countries also having built their reputation for similar or even betterquality – for example, those coming from Japan, Taiwan and more lately, China – goods from these countries are now alsopopular. But it remains unusual that we would generally prefer local brands, i.e., those made in the Philippines.When it comes to using scientific evidence as basis for local medical practice, it should be argued that high quality localdata is superior and should be used. After all, it is derived from our countrymen who may have a different disease biology and/or natural history, sociocultural determinants, as well as clinical practices. It is unfortunate, however, that such local data arenot always available. Even if it exists, it is also not easily accessible. In this, and other issues of Acta Medica Philippina, we see some of the efforts being made by our colleagues to look intothis local experience. They offer varied insights into how global diseases are manifested locally: are there differences that weshould be aware of? As far back as 2006, the Philippine Council for Health Research and Development (PCHRD) has already facilitatedthe creation of a National Unified Health Research Agenda (NUHRA) which is reviewed every five years to identifyresearch priorities in the Philippines.1 In its latest iteration, the 2017-2022 NUHRA prioritizes among others, the holisticapproach to health and wellness that aims to produce evidence geared towards the application and recognition of traditional,sociocultural, and alternative approaches to health.2 The study by Sanico and Medina in this issue highlights this objective.It looked into the potential health benefits and risks of an indigenous fermented rice wine called tapuy. Utilizing a modernbiotechnology technique called metagenomic sequencing, the authors found significant presence of probiotic bacteria thatcan be explored for health applications. However, they also detected the presence of harmful bacteria which may indicate theneed for possible standardization of the fermentation practices. The Acquired Immunodeficiency Syndrome (AIDS) has long plagued the global landscape ever since it was first describedin 1981.3 Because cases have not been described previously, AIDS with its increasing numbers, was soon labeled as anepidemic.4,5 In the Philippines, the HIV/AIDS epidemic has been a fairly more recent one.6-9 Sadly, our country is nowidentified as one with the fastest growing HIV epidemic in the Western Pacific.10 Identifying perceptions of the generalcommunity, especially the high risk populations, can go a long way in curtailing the rising numbers.11 The article by Jamesand colleagues looked further into this by evaluating the knowledge, attitudes and practices on prevention and transmission ofHIV/AIDS among college students in Pampanga, Philippines. The participants were found to have a low knowledge of HIV/AIDS, but had a good attitude toward HIV positive individuals. The authors recommended that education on HIV/AIDScould help control the local epidemic. The study by Rogelio and Santiago looked into screening for retinopathy in patients with gestational diabetes mellitus(GDM). Their data did not support screening to be done in this population. A study had previously reported that GDM has aprevalence of 14% in the Philippines making GDM a disease that is worth addressing.12 On a related note, several internationalguidelines define how GDM can be diagnosed.13 The Philippine Obstetrics and Gynecology Society advocates for a one-stepapproach (a single OGTT using a 75-g anhydrous glucose load with fasting blood sugar ≥92 mg/dL, and a 2-hour level of<126 mg/dL). The one-step approach may be more convenient for patients as it also needs a single visit. A recent report fromAustralia, which also follows a one-step screening process, showed at least a 25% overdiagnosis and its consequent need forfurther testing and the patient anxiety that goes with it.14 An earlier US study also showed 50% more women diagnosed withGDM using the one-step approach compared to a two-step one.15 To be fair, the US study, similar to another one done alsoin Australia, showed no significant differences in the pregnancy outcomes between the two approaches.16 Although a localstudy identified numerical differences in pregnancy outcomes (e.g., risk for primary caesarean section, large for gestational ageinfants, etc.) comparing the two criteria, these were not found to be statistically significant.13 Perhaps there is a need to lookinto this matter again using larger cohorts. As the Philippines gears up for Universal Healthcare, the outcomes of screeningfor GDM can become even more important. The article by Arcilla, et al., on validation of foreign instruments to assess disease and treatment outcomes representsanother area where local data is needed.17 Such validation seeks to investigate whether an instrument developed elsewhere willlikewise yield accurate – and comparable – data for which it was intended. The BREAST-Q is a patient-reported outcomeinstrument designed to evaluate outcomes among women undergoing different types of breast surgery.18 The authors foundhigh internal consistency, test-retest reliability, and acceptability. But there was only low to moderate construct validity inthe Filipino cohort. Among other findings, the authors report respondents having difficulty in understanding some languagetranslations, and even negative reactions to some of the questions. The authors recommend further studies with a largernumber of respondents including those who have undergone nipple reconstruction. The initial results also note that it may bebetter to interpret the “sexual well-being” subscale separately because of the influence that culture may play. The study of Manalili, et al. looked into hemoperfusion as an intervention for COVID-19. The authors report a highmortality and a long length of hospital stay. To put this into perspective, the period of study was from April to September 2020,early in the pandemic period when little is relatively known about the disease. Since then, we know more about COVID-19,with vaccination and anti-virals being available that could alter the disease severity. As of December 2021, local experts donot recommend the use of hemoperfusion among patients diagnosed with COVID-19 mostly because of low certainty ofevidence.19 The option to use it in COVID-19 patients with clinical deterioration despite standard medical therapy includingtocilizumab is however still suggested. The study published here would have been more interesting if there was a comparisonof the outcomes with a similar group who did not undergo hemoperfusion. But it certainly illustrates how generating localdata and local experience goes a long way in examining relevant medical practice/s in our Philippine setting. Case reports help to enhance clinical knowledge by describing the profile and management of patients who have anuncommon or rare disease or may have presented atypically.20-22 We have the opportunity in this issue to share four of theserare cases. The report submitted by Terencio, et al. on the combination of COVID-19 and Guillain-Barre syndrome (GBS)allows us better understanding of COVID-19 and its neurologic complications. As we continue to gain more importantinformation on COVID-19, describing the possibility of GBS as a possible consequence can help clinicians anticipate additionaltreatments as in this case. The same is true for the report submitted by Ablaza and Salonga-Quimpo on abdominal dyskinesia(with its more colorful description as “belly dancer dyskinesia”). Then we have the case of SOLAMEN syndrome, reported by Maceda and colleagues. This case is more dramatic in thatit presents with disfigurement of the patient. Its management is more nuanced as it requires a multidisciplinary approachto address all the affected body parts.23,24 Unfortunately, it also has a strong genetic component as well as predilection tomalignancy which would require longer-term care. Another genetic disease, X-linked dystonia parkinsonism, is likewisereported in this issue in the article by Jamora and others. It is a rare movement disorder that is highly prevalent in Panay Islandin the Philippines.25-28 All cases described so far have been linked to Filipino ancestry, suggesting a single genetic founder andgenetic homogeneity. Although extremely rare globally, the prevalence of XDP in the Philippines is 0.31 per 100,000; and inPanay Island, 5.74 per 100,000. Ninety-five percent of affected individuals are males; the average age is 44 years (20–70 years);and the average age at onset is 39 years (12–64 years).27 Cases in patients of Filipino descent have been described in othercountries.29 The report published here is of particular interest as it is the first time the procedure called Unilateral TranscranialMagnetic Resonance-guided Focused Ultrasound Pallidothalamic Tractotomy has been tried for this condition; a conditionwhich leads to significant progressive disability but no definite treatment.27 All of these case reports may well be the first ones in the Philippines and we have it published here in Acta MedicaPhilippina. I am certain there will be many more insightful studies done locally that will be published – and had been published – inthis journal. These are testament to the recognition that even as we are able to think following the highest global standards,we are also able to act (and do studies) locally in ways that are beneficial to our own Philippine community. Joven Jeremius Q. Tanchuco, MD, MHA Department of Biochemistry and Molecular Biology College of Medicine, University of the Philippines Manila REFERENCES1. Philippine National Health Research System. National Unified Health Research Agenda 2017-2022 [Internet]. [cited 2022 Sep 9]. Available from: https://www.healthresearch.ph/index.php/nuhra2. National Unified Health Research Agenda 2017-2022. Philippine National Health Research System [Internet]. [cited 2022 Sep 9].Available from: https://doh.gov.ph/sites/default/files/publications/NUHRA.pdf3. Schmid S. The Discovery of HIV-1. Nature Communications [Internet]. [cited 2022 Sep 9]. Available from: https://www.nature.com/articles/d42859-018-00003-x#:~:text=In%201983%2C%20Luc%20Montagnier’s%20team,AIDS)%2C%20such%20as%20lymphadenopathy.4. Curran JW, Jaffe HW, Centers for Disease Control and Prevention (CDC). AIDS: the early years and CDC’s response. MMWR Suppl.2011 Oct; 60(4):64-9.5. Sencer DJ. The AIDS Epidemic in the United States, 1981-early 1990s. Centers of Disease Control and Prevention [Internet]. [cited2022 Sep 12]. Available from: https://www.cdc.gov/museum/online/story-of-cdc/aids/index.html6. Restar A, Nguyen M, Nguyen K, Adia A, Nazareno J, Yoshioka E, et al. Trends and emerging directions in HIV risk and prevention researchin the Philippines: A systematic review of the literature. PLoS One. 2018 Dec;13(12):e0207663. doi: 10.1371/journal.pone.02076637. Adia AC, Bermudez ANC, Callahan MW, Hernandez LI, Imperial RH, Operario D. “An Evil Lurking Behind You”: Drivers, Experiences,and Consequences of HIV-Related Stigma Among Men Who Have Sex With Men With HIV in Manila, Philippines. AIDS Educ Prev.2018 Aug;30(4):322-334. doi: 10.1521/aeap.2018.30.4.3228. Mateo R Jr, Sarol JN Jr, Poblete R. HIV/AIDS in the Philippines. AIDS Educ Prev. 2004 Jun;16(3 Suppl A):43-52. doi: 10.1521/aeap.16.3.5.43.355199. Farr AC, Wilson DP. An HIV epidemic is ready to emerge in the Philippines. J Int AIDS Soc. 2010 Apr;13:16. doi: 10.1186/1758-2652-13-1610. Cousins S. The fastest growing HIV epidemic in the western Pacific. Lancet HIV. 2018 Aug;5(8):e412-e413. doi: 10.1016/S2352-3018(18)30182-611. de Lind van Wijngaarden JW, Ching AD, Settle E, van Griensven F, Cruz RC, Newman PA. “I am not promiscuous enough!”: Exploringthe low uptake of HIV testing by gay men and other men who have sex with men in Metro Manila, Philippines. 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Photo by 187929822 © Victor Moussa | Dreamstime.com INTRODUCTION The nonconsensual taking of a human organ to use in transplantation medicine violates ethical principles, including autonomy, informed consent, and human rights, as well as criminal laws. When such an organ harvesting is not just nonconsensual, but performed in a way that causes a death or uses the pretense of brain death without meeting the criteria, it also violates the dead donor[1] rule.[2] The dead donor rule is both ethical and legal. It prevents organ retrieval that would predictably cause the death of the organ donor.[3] Retrieval of a vital organ is permissible only after a declaration of death.[4] Forced organ harvesting may breach the dead donor rule as it stands. A reimagined, broader dead donor rule could consider a larger timeframe in the forced organ harvesting context. In doing so, the broad dead donor rule could cover intent, premeditation, aiding and abetting, and due diligence failures. A broad definition of forced organ harvesting is ‘‘the removal of one or more organs from a person by means of coercion, abduction, deception, fraud, or abuse of power. . .’’[5] A more targeted definition is “[t]he killing of a person so that their organs may be removed without their free, voluntary and informed consent and transplanted into another person.”[6] In the global organ harvesting context, forced organ harvesting violates the World Health Organization (WHO) Guiding Principle 3, which says “live organ donors should be acting willingly, free of any undue influence or coercion.”[7] Furthermore, WHO states live donors should be “genetically, legally, or emotionally” attached to the recipient. Guiding Principle 1 applies to deceased donors, covers consent, and permits donation absent any known objections by the deceased.[8] Principle 7 says, “Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures if the cells, tissues or organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor.”[9] There are underground markets in which organ hunters prey on the local poor in countries with low wages and widespread poverty[10] and human trafficking that targets migrants for the purpose of organ harvesting.[11] This paper explores forced harvesting under the backdrop of the dead donor rule, arguing that a human rights violation so egregious requires holding even distant participants in the chain of events accountable. By interfering with resources necessary to carry out bad acts, legislation and corporate and institutional policies can act as powerful deterrents. A broader dead donor rule would highlight the premeditation and intent evidenced well before the act of organ retrieval. I. Background and Evidence In China, there is evidence that people incarcerated for religious beliefs and practices (Falun Gong) and ethnic minorities (Uyghurs) have been subjects of forced organ harvesting. A tribunal (the China Tribunal) found beyond a reasonable doubt that China engaged in forced organ harvesting.[12] Additionally, eight UN Special Rapporteurs found a system of subjecting political prisoners and prisoners of conscience to blood tests and radiological examinations to determine the fitness of their organs.[13] As early as 2006, investigators found evidence of forced organ harvesting from Falun Gong practitioners. [14] Over a million Uyghurs are in custody there, and there is ample evidence of biometric data collection.[15] An Uyghur tribunal found evidence of genocide.[16] “China is the only country in the world to have an industrial-scale organ trafficking practice that harvests organs from executed prisoners of conscience.”[17] Witnesses testified to the removal of organs from live people without ample anesthesia,[18] summonses to the execution grounds for organ removal,[19] methods of causing death for the purpose of organ procurement,[20] removing eyes from prisoners who were alive,[21] and forcing live prisoners into operating rooms.[22] The current extent of executions to harvest organs from prisoners of conscience in China is unknown. The Chinese press has suggested surgeons in China will perform 50,000 organ transplants this year.[23] Doctors Against Forced Organ Harvesting (DAFOR) concluded, “[f]orced organ harvesting from living people has occurred and continues to occur unabated in China.”[24] China continues to advertise in multiple languages to attract transplant tourists.[25] Wait times for organs seem to remain in the weeks.[26] In the United States, it is common to wait three to five years.[27] II. The Nascent System of Voluntary Organ Donation in China In China, throughout the 1990s and early 2000s, the supply of organs for transplant was low, and there was not a national system to register as a donor. A 1984 act permitted death row prisoners to donate organs.[28] In 2005, a Vice Minister acknowledged that 95 percent of all organ transplants used organs from death row prisoners.[29] In 2007 the planning of a voluntary system to harvest organs after cardiac death emerged. According to a Chinese publication, China adopted brain death criteria in 2013.[30] There had been public opposition due partly to cultural unfamiliarity with it.[31] Cultural values about death made it more difficult to adopt a universal brain death definition. Both Buddhist and Confucian beliefs contradicted brain death.[32] Circulatory death was traditionally culturally accepted.[33] The Ministry of Health announced that by 2015 organ harvesting would be purely voluntary and that prisoners would not be the source of organs.[34] There are cultural barriers to voluntary donation partly due to a Confucian belief that bodies return to ancestors intact and other cultural and religious beliefs about respect for the dead.[35] An emphasis on family and community over the individual posed another barrier to the Western approach to organ donation. Public awareness and insufficient healthcare professional knowledge about the process of organ donation are also barriers to voluntary donation.[36] Although the Chinese government claims its current system is voluntary and no longer exploits prisoners,[37] vast evidence contradicts the credibility of the voluntary transplant program in China.[38] III. Dead Donor Rule: A Source of Bioethical Debate It seems tedious to apply this ethical foundation to something as glaring as forced organ harvesting. But the dead donor rule is a widely held recognition that it is not right to kill one person to save another.[39] It acts as a prohibition on killing for the sake of organ retrieval and imposes a technical requirement which influences laws on how death is declared. The dead donor rule prevents organ harvesting that causes death by prohibiting harvesting any organ which the donor agreed to donate only after death prior to an official declaration of death. There is an ongoing ethical debate about the dead donor rule. Many in bioethics and transplant medicine would justify removing organs in specific situations prior to a declaration of death, abandoning the rule.[40] Some use utilitarian arguments to justify causing the death of someone who is unconscious and on life support irreversibly. Journal articles suggest that the discussion has moved to one of timing and organ retrieval.[41] Robert Truog and Franklin Miller are critics of the dead donor rule, arguing that, in practice, it is not strictly obeyed: removing organs while a brain-dead donor is still on mechanical ventilation and has a beating heart and removing organs right after life support is removed and cardio-pulmonary death is declared both might not truly meet the requirement of the dead donor rule, making following the rule “a dubious norm.”[42] Miller and Truog question the concept of brain death, citing evidence of whole body integrated functions that continue indefinitely. They challenge cardio-pulmonary death, asserting that the definition includes as dead, those who could be resuscitated. Their hearts could resume beating with medical intervention. Stopping life support causes death only in those whose lives are sustained by it. Some stipulate that the organ retrieval must not itself cause the death. Some would rejigger the cause of death: Daniel Callahan suggests that the underlying condition causes the death despite removal of life support.[43] But logically, a person could continue life support and be alive, so clearly, removing life support does cause death. Something else would have caused brain death or the circumstance that landed the person on mechanical ventilation. To be more accurate, one could say X caused the irreversible coma and removing life support caused the death itself. Miller and Truog take the position that because withdrawal of life support does cause death, the dead donor rule should be defunct as insincere. To them, retrieving vital organs from a technically alive donor should be permissible under limited conditions. They look to the autonomous choices of the donor or the surrogate (an autonomy-based argument). They appreciate the demand for organs and the ability to save lives, drawing attention to those in need of organs. Live donor organ retrieval arguably presents a slippery slope, especially if a potential donor is close to death, but not so close to label it imminent. They say physicians would not be obligated to follow the orders of a healthy person wishing to have vital organs removed, perhaps to save a close friend or relative. Similarly, Radcliffe-Richards, et al. argue that there is no reason to worry about the slippery slope of people choosing death so they can sell their vital organs, whether for money for their decedents or their creditors.[44] The movement toward permissibility and increased acceptance of medical aid in dying also influence the organ donation arena. The slippery slope toward the end of life has potential to become a realistic concern. Older adults or other people close to death may want to donate a vital organ, like their heart, to a young relative in need. That could greatly influence the timing of a decision to end one’s life. IV. Relating the Dead Donor Rule to Forced Organ Harvesting There is well documented evidence that in China organs have been removed before a declaration of death.[45] But one thing the dead donor rule does not explicitly cover is intent and the period prior to the events leading to death. It tends to apply to a near-death situation and is primarily studied in its relationship to organ donation. It is about death more than it is about life. Robertson and Lavee investigated data on transplantation of vital organs in China and they document cases where the declaration of death was a pretense, insincere, and incorrect. Their aim was to investigate whether the prisoners were in fact dead prior to organ harvesting.[46] (The China Tribunal found that organs have been removed from live prisoners and that organ harvesting has been the cause of death.) They are further concerned with the possible role of doctors as executioners, or at least as complicit in the execution as the organ harvesting so closely follows it. V. A Broader Dead Donor Rule A presumed ethical precursor to the dead donor rule may also be an important ethical extension of the rule: the dead donor rule must also prohibit killing a person who is not otherwise near death for the purpose of post-death organ harvesting. In China, extra-judicial killings of prisoners of conscience are premeditated ― there is ample evidence of blood tests and radiology to ensure organ compatibility and health.[47] To have effective ethical force, the dead donor rule should have an obvious application in preventing intentional killing for an organ retrieval, not just killing by way of organ retrieval. When we picture the dead donor rule, bioethicists tend to envision a person on life support who will either be taken off it and stop breathing or who will be declared brain dead. But the dead donor rule should apply to healthy people subject to persecution at the point when the perpetrator lays the ground for the later killing. At that point, many organizations and people may be complicit or unknowingly contributing to forced organ harvesting. In this iteration of the dead donor rule, complicity in its violations would be widespread. The dead donor rule could address the initial action of ordering a blood or radiology test or collecting any biometric data. Trained physicians and healthcare technicians perform such tests. Under my proposed stretch of the dead donor rule, they too would be complicit in the very early steps that eventually lead to killing a person for their organs. I argue these steps are part of forced organ harvesting and violate the dead donor rule. The donor is very much alive in the months and years preceding the killing. A conspiracy of indifference toward life, religious persecution, ethnic discrimination, a desire to expand organ transplant tourism, and intent to kill can violate this broader dead donor rule. The dead donor rule does not usually apply to the timing of the thought of organ removal, nor the beginning of the chain of events that leads to it. It is usually saved for the very detailed determination of what may count as death so that physicians may remove vital and other organs, with the consent of the donor.[48] But I argue that declaring death at the time of retrieval may not be enough. Contributing to the death, even by actions months or years in advance, matter too. Perhaps being on the deathbed awaiting a certain death must be distinguished from going about one’s business only to wind up a victim of forced organ harvesting. Both may well be declared dead before organ retrieval, but the likeness stops there. The person targeted for future organ retrieval to satisfy a growing transplant tourism business or local demand is unlike the altruistic person on his deathbed. While it may seem like the dead donor rule is merely a bioethics rule, it does inform the law. And it has ethical heft. It may be worth expanding it to the arena of human trafficking for the sake of organ removal and forced organ harvesting.[49] The dead donor rule is really meant to ensure that death was properly declared to protect life, something that must be protected from an earlier point. VI. Complicity: Meaning and Application Human rights due diligence refers to actions that people or institutions must take to ensure they are not contributing to a human rights violation. To advise on how to mitigate risk of involvement or contribution to human rights violations, Global Rights Compliance published an advisory that describes human rights due diligence as “[t]he proactive conduct of a medical institution and transplant-associated entity to identify and manage human rights risks and adverse human rights impacts along their entire value and supply chain.”[50] Many people and organizations enable forced organ harvesting. They may be unwittingly complicit or knowingly aiding and abetting criminal activity. For example, some suppliers of medical equipment and immunosuppressants may inadvertently contribute to human rights abuses in transplantation in China, or in other countries where organs were harvested without consent, under duress, or during human trafficking. According to Global Rights Compliance, “China in the first half of 2021 alone imported ‘a total value of about 24 billion U.S. dollars’ worth of medical technology equipment’, with the United States and Germany among the top import sources.”[51] The companies supplying the equipment may be able to slow or stop the harm by failing to supply necessary equipment and drugs. Internal due diligence policies would help companies analyze their suppliers and purchasers. Corporations, educational institutions, and other entities in the transplantation supply chain, medical education, insurance, or publishing must engage in human rights due diligence. The Global Rights Compliance advisory suggests that journals should not include any ill-gotten research. Laws should regulate corporations and target the supply chain also. All actors in the chain of supply, etc. are leading to the death of the nonconsenting victim. They are doing so while the victim is alive. The Stop Forced Organ Harvesting Act of 2023, pending in the United States, would hold any person or entity that “funds, sponsors, or otherwise facilitates forced organ harvesting or trafficking in persons for purposes of the removal of organs” responsible. The pending legislation states that: It shall be the policy of the United States—(1) to combat international trafficking in persons for purposes of the removal of organs;(2) to promote the establishment of voluntary organ donation systems with effective enforcement mechanisms in bilateral diplomatic meetings and in international health forums;(3) to promote the dignity and security of human life in accordance with the Universal Declaration of Human Rights, adopted on December 10, 1948; and(4) to hold accountable persons implicated, including members of the Chinese Communist Party, in forced organ harvesting and trafficking in persons for purposes of the removal of organs.[52] The Act calls on the President to provide Congress a list of such people or entities and to sanction them by property blocking, and, in the case of non-US citizens, passport and visa denial or revocation. The Act includes a reporting requirement under the Foreign Assistance Act of 1961 that includes an assessment of entities engaged in or supporting forced organ harvesting.[53] The law may have a meaningful impact on forced organ harvesting. Other countries have taken or are in the process of legal approaches as well.[54] Countries should consider legislation to prevent transplant tourism, criminalize complicity, and require human rights due diligence. An expanded dead donor rule supports legal and policy remedies to prevent enabling people to carry out forced organ harvesting. VII. Do Bioethicists Mention Human Rights Abuses and Forced Organ Harvesting Enough? As a field, bioethics literature often focuses on the need for more organs, the pain and suffering of those on organ transplant waitlists, and fairness in allocating organs or deciding who belongs on which waitlist and why. However, some bioethicists have drawn attention to forced organ harvesting in China. Notably, several articles noted the ethical breaches and called on academic journals to turn away articles on transplantation from China as they are based on the unethical practice of executing prisoners of conscience for their organs.[55] The call for such a boycott was originally published in a Lancet article in 2011.[56] There is some acknowledgement that China cares about how other countries perceive it,[57] which could lead to either improvements in human rights or cover-ups of violations. Ill-gotten research has long been in the bioethics purview with significant commentary on abuses in Tuskegee and the Holocaust.[58] Human research subjects are protected by the Declaration of Helsinki, which requires acting in the best interests of research subjects and informed consent among other protections.[59] The Declaration of Helsinki is directed at physicians and requires subjects enroll in medical research voluntarily. The Declaration does not explicitly cover other healthcare professionals, but its requirements are well accepted broadly in health care. CONCLUSION The dead donor rule in its current form really does not cover the life of a non-injured healthy person at an earlier point. If it could be reimagined, we could highlight the link between persecution for being a member of a group like Falun Gong practitioners or Uyghurs as the start of the process that leads to a nonconsensual organ retrieval whether after a proper declaration of death or not. It is obviously not ethically enough to ensure an execution is complete before the organs are harvested. It is abuse of the dead donor rule to have such a circumstance meet its ethical requirement. And obviously killing people for their beliefs or ethnicity (and extra-judicial killings generally) is not an ethically acceptable action for many reasons. The deaths are intentionally orchestrated, but people and companies who may have no knowledge of their role or the role of physicians they train or equipment they sell are enablers. An expanded dead donor rule helps highlight a longer timeframe and expanded scope of complicity. The organ perfusion equipment or pharmaceuticals manufactured in the United States today must not end up enabling forced organ harvesting. With an expanded ethical rule, the “donor is not dead” may become “the donor would not be dead if not for. . .” the host of illegal acts, arrests without cause, forced detention in labor camps, extra-judicial killings, lacking human rights due diligence, and inattention to this important topic. The expanded dead donor rule may also appeal to the bioethics community and justify more attention to laws and policies like the Stop Forced Organ Harvesting Act of 2023. - [1] The word “donor” in this paper describes any person from whom organs are retrieved regardless of compensation, force, or exploitation in keeping with the bioethics literature and the phrase “dead donor rule.” [2] Robertson, M.P., Lavee J. (2022). Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [3] Robertson, J. A. (1999). Delimiting the donor: the dead donor rule. Hastings Center Report, 29(6), 6-14. [4] Retrieval of non-vital organs which the donor consents to donate post-death (whether opt-in, opt-out, presumed, or explicit according to local law) also trigger the dead donor rule. [5] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [6] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [7] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the sixty-third World Health Assembly in May 2010, in Resolution WHA63.22 https://apps.who.int/iris/bitstream/handle/10665/341814/WHO-HTP-EHT-CPR-2010.01-eng.pdf?sequence=1. [8] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [9] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [10] Promchertchoo, Pichayada (Oct. 19, 2019). Kidney for sale: Inside Philippines’ illegal organ trade. https://www.channelnewsasia.com/asia/kidney-for-sale-philippines-illegal-organ-trade-857551; Widodo, W. and Wiwik Utami (2021), The Causes of Indonesian People Selling Covered Kidneys from a Criminology and Economic Perspective: Analysis Based on Rational Choice Theory. European Journal of Political Science Studies, Vol 5, Issue 1. [11] Van Reisen, M., & Mawere, M. (Eds.). (2017). Human trafficking and trauma in the digital era: The ongoing tragedy of the trade in refugees from Eritrea. African Books Collective. [12] The Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China (China Tribunal) (2020). https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [13] UN Office of the High Commissioner, Press Release, China: UN human Rights experts alarmed by ‘organ harvesting’ allegations (UN OTHCHR, 14 June 2021), https://www.ohchr.org/en/press-releases/2021/06/china-un-human-rights-experts-alarmed-organ-harvesting-allegations. [14] David Matas and David Kilgour, Bloody Harvest. The killing of Falun Gong for their organs (Seraphim Editions 2009). [15] How China is crushing the Uyghurs, The Economist, video documentary, July 9, 2019, https://youtu.be/GRBcP5BrffI. [16] Uyghur Tribunal, Judgment (9 December 2021) (Uyghur Tribunal Judgment) para 1, https://uyghurtribunal.com/wp-content/uploads/2022/01/Uyghur-Tribunal-Judgment-9th-Dec-21.pdf. [17] Ali Iqbal and Aliya Khan, Killing prisoners for transplants: Forced organ harvesting in China, The Conversation Published: July 28, 2022. https://theconversation.com/killing-prisoners-for-transplants-forced-organ-harvesting-in-china-161999 [18] Testimony demonstrated surgeries to remove vital organs from live people, killing them, sometimes without ample anesthesia to prevent wakefulness and pain. China Tribunal (2020), p. 416-417. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf; Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [19] Doctors reported being summoned to execution grounds and told to harvest organs amid uncertainty that the prisoner was in fact dead. China Tribunal (2020), p. 52-53. [20]In testimony to the China Tribunal, Dr. Huige Li noted four methods of organ harvesting from live prisoners: incomplete execution by shooting, after lethal injection prior to death, execution by removal of the heart, and after a determination of brain death prior to an intubation (pretense of brain death). China Tribunal (2020), pp. 54-55. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [21] A former military medical student described removing organs from a live prisoner in the late 1990s. He further described his inability to remove the eyes of a live man and his witnessing another doctor forcefully remove the man’s eyes. China Tribunal (2020), p. 330. [22] In 2006, a nurse testified that her ex-husband, a surgeon, removed the eyes of 2,000 Falun Gong practitioners in one hospital between 2001 and 2003. She described the Falun Gong labor-camp prisoners as being forced into operating rooms where they were given a shot to stop their hearts. Other doctors removed other organs. DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf [23] Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [24] DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf; DAFOH’s physicians were nominated for a Nobel Prize for their work to stop forced organ harvesting. Šućur, A., & Gajović, S. (2016). Nobel Peace Prize nomination for Doctors Against Forced Organ Harvesting (DAFOH) - a recognition of upholding ethical practices in medicine. Croatian medical journal, 57(3), 219–222. https://doi.org/10.3325/cmj.2016.57.219 [25] Robertson and Lavee (2022). [26] Stop Organ Harvesting in China, website (organization of the Falun Dafa). https://www.stoporganharvesting.org/short-waiting-times/ [27] National Kidney Foundation, The Kidney Transplant Waitlist – What You Need to Know, https://www.kidney.org/atoz/content/transplant-waitlist [28] Wu, Y., Elliott, R., Li, L., Yang, T., Bai, Y., & Ma, W. (2018). Cadaveric organ donation in China: a crossroads for ethics and sociocultural factors. Medicine, 97(10). [29] Wu, Elliott, et al., (2018). [30] Su, Y. Y., Chen, W. B., Liu, G., Fan, L. L., Zhang, Y., Ye, H., ... & Jiang, M. D. (2018). An investigation and suggestions for the improvement of brain death determination in China. Chinese Medical Journal, 131(24), 2910-2914. [31] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2012). A pilot programme of organ donation after cardiac death in China. The Lancet, 379(9818), 862-865. [32] Yang, Q., & Miller, G. (2015). East–west differences in perception of brain death: Review of history, current understandings, and directions for future research. Journal of bioethical inquiry, 12, 211-225. [33] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2015). Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transplantation, 21(4), 419-422. [34] Huang, Millis, et al. (2015). [35] Wu, X., & Fang, Q. (2013). Financial compensation for deceased organ donation in China. Journal of Medical Ethics, 39(6), 378-379. [36] An, N., Shi, Y., Jiang, Y., & Zhao, L. (2016). Organ donation in China: the major progress and the continuing problem. Journal of biomedical research, 30(2), 81. [37] Shi, B. Y., Liu, Z. J., & Yu, T. (2020). Development of the organ donation and transplantation system in China. Chinese medical journal, 133(07), 760-765. [38] Robertson, M. P., Hinde, R. L., & Lavee, J. (2019). Analysis of official deceased organ donation data casts doubt on the credibility of China’s organ transplant reform. BMC Medical Ethics, 20(1), 1-20. [39] Miller, F.G. and Sade, R. M. (2014). Consequences of the Dead Donor Rule. The Annals of thoracic surgery, 97(4), 1131–1132. https://doi.org/10.1016/j.athoracsur.2014.01.003 [40] For example, Miller and Sade (2014) and Miller and Truog (2008). [41] Omelianchuk, A. How (not) to think of the ‘dead-donor’ rule. Theor Med Bioeth 39, 1–25 (2018). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s11017-018-9432-5 [42] Miller, F.G. and Truog, R.D. (2008), Rethinking the Ethics of Vital Organ Donations. Hastings Center Report. 38: 38-46. [43] Miller and Truog, (2008), p. 40, citing Callahan, D., The Troubled Dream of Life, p. 77. [44] Radcliffe-Richards, J., Daar, A.S., Guttman, R.D., Hoffenberg, R., Kennedy, I., Lock, M., Sells, R.A., Tilney, N. (1998), The Case for Allowing Kidney Sales, The Lancet, Vol 351, p. 279. (Authored by members of the International Forum for Transplant Ethics.) [45] Robertson and Lavee, (2022). [46] Robertson and Lavee, (2022). [47] China Tribunal (2020). [48] Consent varies by local law and may be explicit or presumed and use an opt-in or opt-out system and may or may not require the signoff by a close family member. [49] Bain, Christina, Mari, Joseph. June 26, 2018, Organ Trafficking: The Unseen Form of Human Trafficking, ACAMS Today, https://www.acamstoday.org/organ-trafficking-the-unseen-form-of-human-trafficking/; Stammers, T. (2022), "2: Organ trafficking: a neglected aspect of modern slavery", Modern Slavery and Human Trafficking, Bristol, UK: Policy Press. https://bristoluniversitypressdigital.com/view/book/978144736. [50] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [51] Global Rights Compliance, p. 22. [52] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023). https://www.congress.gov/bill/118th-congress/house-bill/1154. [53] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [54] Global Rights Compliance notes that Belgium, France (passed law on human rights due diligence in the value supply chain), United Kingdom, United States, Canada, Australia, and New Zealand have legal approaches, resolutions, and pending laws. p. 45. [55] For example, Caplan, A.L. (2020), The ethics of the unmentionable Journal of Medical Ethics 2020;46:687-688. [56] Caplan, A.L. , Danovitch, G., Shapiro M., et al. (2011) Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet, 378(9798):1218. doi:10.1016/S0140-6736(11)61536-5 [57] Robertson and Lavee. [58] Smolin, D. M. (2011). The Tuskegee syphilis experiment, social change, and the future of bioethics. Faulkner L. Rev., 3, 229; Gallin, S., & Bedzow, I. (2020). Holocaust as an inflection point in the development of bioethics and research ethics. Handbook of research ethics and scientific integrity, 1071-1090. [59] World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended multiple times, most recently by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/

Thesis (M.S.)--Northwest Missouri State University, 2006.
The full text of the thesis is included in the pdf file. Title from title screen of full text.pdf file (viewed on January 25, 2008) Includes bibliographical references.

Abstract A suggestion from Francis Ford Coppola leads to Maltby and Shire’s first Broadway show, Baby (1983). After considering other collaborators, the songwriters choose Sybille Pearson as their librettist and book writer. The painful decision is made to cut “The Bear, the Tiger, the Hamster and the Mole,” but the song is resurrected later for Closer Than Ever. The show is rewritten considerably during previews, and Maltby discovers that songs can gain dramatic action if important information is withheld until the end—a reminder that good songwriting is actually playwriting. Maltby and Liz Callaway recall Callaway’s unusual audition process which did not include a formal audition. Baby went on to receive seven Tony Award nominations, although it did not ultimately win in any category. Thanks to Baby, Callaway met her husband, Dan Foster, who attended the first preview of the show and continued to court her throughout the run.

This chapter describes how Bob Thomas acknowledged the inevitability of Rolf Benirschke returning at some point to compete for his old job. Although the San Diego Chargers' long-time kicker was indeed on his way back, the team still expressed an interest in negotiating a new deal with Thomas. But in deference to Benirschke, Thomas declined the team's qualifying offer and requested his release. It was time for Thomas to head back to the western suburbs of Chicago and resume his law work with the Callahan firm, while also keeping in shape in the hope that another chance would come. The chapter then recounts how Thomas landed at the New York Giants' training camp facilities at Pace University. It also looks at how Thomas became a circuit court judge.