Faculty Bibliography

There are competing ethical concerns when it comes to designing any clinical research study. Clinical trials of possible treatments for Ebola virus are no exception. If anything, the competing ethical concerns are exacerbated in trying to find answers to a deadly, rapidly spreading, infectious disease. The primary goal of current research is to identify experimental therapies that can cure Ebola or cure it with reasonable probability in infected individuals. Pursuit of that goal must be methodologically sound, practical and consistent with prevailing norms governing human subjects research. Some maintain that only randomized controlled trials (RCTs) with a placebo or standard-of-care arm can meet these conditions. We maintain that there are alternative trial designs that can do so as well and that sometimes these are preferable to RCTs.

Wilderness and other protected areas provide myriad benefits to Utahns, including clear air and water, places to recreate and spiritual value. [...]it's determined which of the lands under BLM management are indeed wilderness, a transfer of the magnitude being considered in this report is nothing short of a Faustian bargain

OBJECTIVE:Fertility preservation (FP) is a widespread practice in paediatric oncology when gonadotoxic medications such as cyclophosphamide (CPO) are used. FP practice outside of oncology has not been studied, although nephrologists regularly use CPO. This is the first study to explore FP practice by paediatric nephrologists when CPO is used. DESIGN/METHODS:Survey study. Descriptive statistics and chi-squared analyses were employed to analyse the data. PARTICIPANTS/METHODS:US paediatric nephrologists were sent a survey via email. The survey queried participants about FP practice behaviours, FP attitudes and barriers to practice. MAIN OUTCOME MEASURES/METHODS:Of 579 nephrologists invited, 32% responded to the survey. RESULTS:CPO was dosed in mg/kg by 23% of physicians, g/m(2) by 40% and both by 37%. About 80% agreed that pubertal females should be offered a fertility referral, while 58% report that they actually refer. Factors negatively associated with referral include lack of training, lack of referral network and adherence to gonadotoxic dose limits. Results were similar for male patients. CONCLUSION/CONCLUSIONS:The survey showed that FP practice in the United States is widespread among nephrologists. Lack of referral networks is a notable barrier for nephrologists. Perceived adherence to dose limits may be problematic given the variable dosing regimens utilised. This is due to the risk of unintended overdose in large adolescents dosed in mg/kg whose cumulative dose exceeds gonadotoxic limits in g/m(2) . This paper has implications for nephrology care providers and other specialists who utilise CPO, generalists who care for these patients and oncologists with extant FP referral networks.

[...]because of the 'terrible choice' Medicare rules impose, hospice is not doing end-of-life care as much as brink-of-death care."