Can old age be given a public meaning?

Anti-ageism has done much to eliminate bias and stereotyping, but it has given us no positive vision of what old age might be. A shared interpretation of the physical and social realities of the elderly can enhance the lives of aging people and provide the foundations for public policy.

Must the old and young compete for health care resources?

The number of older persons in our society is increasing as the number of younger persons decreases. Expenditures on the young are decreasing and those on the elderly are increasing. Questions relating to the decisions that may be made in the process of allocation of resources for these competing groups are examined in detail. The goal of meeting all individual needs may well require setting "reasonable" limits and fashioning a broader societal perspective.

[Current trends in biomedical ethics in the United States of America]

In the United States, contemporary biomedical ethics began to develop in the 1960s, together with the advent of major advances in basic research and clinical application and the establishment of health care entitlement programs. Problems of a moral nature promptly arose in the fields of biology and medicine that have generated ongoing debate. Today, the five topics of greatest importance are the rights and autonomy of the patient, the meaning of the "sanctity of life" as opposed to the "quality of life," interventions in nature, the allocation of resources, and the function of the public in decision-making about health. Ethics committees have been set up in 60% of hospitals to examine the most difficult problems and provide pertinent advice. Another trend that may be very significant in the future is a politicization of bioethical questions and a division into factions that will introduce political rhetoric into the field of medicine.

Analysis of event synchronization in a parallel programming tool

Understanding synchronization is important for a parallel programming tool that uses dependence analysis as the basis for advising programmers on the correctness of parallel constructs. This paper discusses static analysis methods that can be applied to parallel programs with event variable synchronization. The objective is to be able to predict potential data races in a parallel program. The focus is on how dependencies and synchronization statements inside loops can be used to analyze complete programs with parallel loop and parallel case style parallelism.

Quantitative immunofluorescence assay for cyclobutyldithymidine dimers in individual mammalian cells

An indirect immunofluorescence procedure was developed for the measurement of cyclobutyl dithymidine dimers in DNA of individual Syrian hamster embryo cells using a specific monoclonal antibody. A fluorescein-labeled secondary antibody and a fluorochrome which binds to DNA were used to measure the photoproduct and total DNA in the same nucleus. Fluorescence intensity was quantitated with a computer-assisted microfluorometric system which was calibrated with a uranyl oxide impregnated glass slide. Similar dose-response curves, i.e. normalized fluorescence intensity plotted as a function of dose of germicidal irradiation, were obtained with two different cell types. Normalized fluorescence intensity per nucleus was related to thymidine dimer content with a competitive enzyme-linked immunosorbent assay using DNA isolated from cells given doses of germicidal irradiation identical to those used in the immunofluorescence assay. Thymidine dimer levels produced by 10 J/m2 of germicidal irradiation (approximately 8 x 10(5)/nucleus) and which allow for 15-30% cell survival can readily be detected. The specific monoclonal antibody was labeled with tritium and used in the immunofluorescence assay to relate the number of antibodies bound to the number of thymidine dimers per cell. The data revealed that approximately 45% of the thymidine dimers in cells exposed to 100 J/m2 of germicidal irradiation and essentially all the T mean value of T in cells receiving 20 J/m2, were being detected in the indirect immunofluorescence assay. This technique can provide a sensitive means for measuring various types of DNA damage in individual cells given that the appropriate probes are available. It can be especially useful for monitoring occupationally or environmentally exposed populations where usually only small samples of cells or tissues are available.

New transurethral system for interstitial radiation of prostate cancer

Direct endoscopic implantation of radioactive materials for carcinoma of the prostate without an open operation was accomplished by the use of modified existing transurethral instrumentation and techniques. The closed approach seems applicable particularly to the geriatric population, which is afflicted more commonly but is frequently not treated because of concurrent diseases or because the patient had transurethral resection of the prostate as a diagnostic procedure. Eleven patients were implanted using the transurethral route. Implantations were accomplished successfully with extremely low morbidity. Along with more conventional dosimetry studies, computer tomography was used to assess the placement of seeds. The direct visualization of the method suggests a potential for greater precision of seed placement as illustrated by computer tomography. In addition, this new instrumentation and method offers a low-risk procedure for carcinoma of the prostate that can be performed on an outpatient basis for selected patients.

Meeting needs and rationing care

I think it is fair to say that there have been two overriding needs of the health care system in the United States for the past couple of decades. One of them is to provide an adequate minimal level of care for all, especially for the underinsured and for those who could be faced by catastrophic health care costs. That need points to an expansion of health care expenditures and to the creation of new programs and strategies. The second need is that of finding a permanent and effective way of controlling the constant escalation of health care costs, and of the proportion of health care costs in our overall economy. That need points to restraint and limitations, not constant expansion.

We are left, then, with two apparently contradiaory needs, each pointing to a major problem, but each standing, it would seem, directly in the path of the other.

Abortion: the new debate

The course of the debate on abortion following the 1973 Supreme Court decision legalizing abortion has been marked by a variety of medical and scientific developments. Many of these new developments have important legal, psychologic, social, moral, and political implications. The cumulative impact of all these developments may pose a significant challenge to the social and legal foundations of Roe v. Wade.

Hard choices: who lives, how, and who decides? The ethics of making national policy

Technological advances in medicine and biomedical research have been both exhilarating and depressing. They have heralded prolonged life and with it a moral dilemma regarding the quality of that life. These moral issues are relatively trouble-free on the individual level; however, they become extremely problematic when a policy must be developed which will affect the lives of thousands or millions of people. The persistent problem which is likely to haunt us for decades is the question of allocation of our health care resources--should these health care resources be rationed, and if so, by whom.

How technology is reframing the abortion debate

Since the 1973 Supreme Court decision legalizing abortion, medical and scientific developments have focused greater public and professional attention on the status of the fetus. Their cumulative effect may influence legal, social, and moral thought and set the stage for a change in public opinion and a challenge to legalized abortion. There is as yet no inexorable convergence of medical data and legal opinion that would undermine the rational of Roe v. Wade. But the prochoice movement must find room for an open airing of the moral questions if abortion is to remain what it should be--a legally acceptable act.

The care of the terminally ill: morality and economics

Are current expenditures on dying patients disproportionate, unreasonable, or unjust? Although a review of empirical data reveals that care for the terminally ill is very costly, it is not appropriate to conclude that such expenditures represent a morally troubling misallocation of societal resources. Moreover, though efforts to reduce the costs of caring for the dying are not unreasonable, they must be undertaken with great caution. At present, such efforts should concentrate on three basic goals: development of better criteria for admission to intensive- and critical-care units; promotion of patient and family autonomy with regard to decisions to stop or refuse certain kinds of treatment; and promotion of alternative forms of institutional care, such as hospice care. The most difficult moral problems will arise when patients and their physicians seek access to therapies judged only marginally useful. There may be conflict between administrators with broad institutional responsibilities and clinicians committed to particular patients.

Endometriosis of the ureter can present as renal failure: a case report and review of endometriosis affecting the ureters

Of the female subjects with pelvic endometriosis 1.2 per cent are found to have involvement of the genitourinary tract. Ureteral obstruction secondary to endometriosis is uncommon and usually is unilateral. We report a case of renal failure with hypertension due to bilateral ureteral obstruction from pelvic endometriosis. Ureteral endometriosis and its treatment are discussed. In premenopausal women presenting with bilateral obstruction of the distal ureters endometriosis should be part of the differential diagnosis.