Digital Commons Network^™

Standards For Health Care Decision-Making: Legal And Practical Considerations, A. Kimberley Dayton

Faculty Scholarship

This Article explores the guardian’s role in making, or assisting the ward to make, health care decisions, and provides an overview of existing standards and tools that offer guidance in this area. Part II outlines briefly the legal decisions and statutory developments assuring patient autonomy in medical treatment, and shows how these legal texts apply to and structure the guardian’s role as health care decision-maker. Part III examines the range of legal and practical approaches to such matters as decision-making standards, determining the ward’s likely treatment preferences, and resolving conflicts between guardians and health care agents appointed by the ward. …

Drinking Water And Exclusion: A Case Study From California’S Central Valley, Camille Pannu

Faculty Scholarship

The American West is notorious for its water wars, and California’s complex water allocation and governance challenges serve as a bellwether for contemporary water governance across western states. Policy makers and environmental advocates typically represent California’s water woes as a regulatory problem — a failure to balance the needs of growing urban populations with ecological preservation and agricultural irrigation. These debates, however, often elide the issue of water deprivation, and they do not adequately address the concerns of an important constituency: low-income, rural communities.

This Comment argues that a focus on regulation misses a fundamental feature of water inequality: the …

The Cumulative Impact Of Unemployment On Risks Of Acute Myocardial Infarction, Guangya Liu, Matthew E. Dupree, Linda K. George, Eric D. Peterson

Faculty Scholarship

Background: Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI).

Methods: We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N=13 451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, …

The Assault On Bad Food: Tobacco-Style Litigation As An Element Of The Comprehensive Scheme To Fight Obesity, Jada Fehn

Faculty Scholarship

This article provides a summary of the obesity epidemic - the economic costs and importantly, some causes. The need for a comprehensive scheme will be explained by examining the shortfalls of current regulatory mechanisms. Next, this article will explain the three waves of tobacco litigation, the strategy involved in each, and why the third wave left an impact. Then, the current status of food litigation will be explained. Next, applying the tobacco model to big food, this article will make it clear that discovery is crucial in several respects. Lastly, an explicit call to action and a battle plan will …

Direct-To-Consumer Genetic Testing: Learning From The Past And Looking Toward The Future, Stephanie Bair

Faculty Scholarship

A decade after the complete sequencing of the human genome, we have seen a proliferation of genetic testing services marketed directly to the consumer and purporting to use genetic information to generate individualized health information. These tests have been subject to only minimal regulation, despite the fact that scientists and policymakers have serious concerns about both the clinical effectiveness of the tests and the safety of releasing certain types of health information to the public without the supervision of a health care professional. Proponents of minimal regulation argue that the tests allow for patient autonomy and privacy of genetic information, …

Resource Restraints: Rethinking Disclosure Of Individual Genomic Findings, Michael Ulrich

Faculty Scholarship

While there has been a seemingly endless debate over whether individual results should be disclosed in genomic research, the role that resources should play in determining a researcher's duty has been left unanswered. This commentary fills this void by fully examining how resource limitations constrain a researcher's duty to disclose. This paper is the first to anchor an obligation in the duty to rescue alone, and as a result, the first to find not only an ethical floor of what must be returned, but also a ceiling of the amount of resources that may be utilized to fulfill this duty. …

R2p= Mdgs: Implementing The Responsibility To Protect Through The Millennium Development Goals, Jennifer Moore

Faculty Scholarship

This essay is a peaceful call to arms based on the understanding that an essential way to fight the most egregious and widespread human rights abuses is through a broad-spectrum approach to human security grounded in the Millennium Development Goals and a new, non-military, understanding of humanitarian intervention. The responsibility to protect, often cited as a justification for military force to stop genocide, crimes against humanity, and other widespread human rights abuses, is better seen as a commitment by all nations to strengthen their own social welfare and human rights systems, and for those nations with more resources to assist …

Where You Stand Depends On Where You Sit: Immigrant Incorporation In Federal Workplace Agencies, Ming Hsu Chen

Faculty Scholarship

This Article integrates social science theory about immigrant incorporation and administrative agencies with empirical data about immigrant-serving federal workplace agencies to illuminate the role of bureaucracies in the construction of rights. More specifically, it contends that immigrants' rights can be protected when workplace agencies incorporate immigrants into labor law enforcement in accordance with the agencies' professional ethos and organizational mandates. Building on Miles' Law that "where you stand depends on where you sit," this Article argues that agencies exercise discretion in the face of contested law and in contravention to a political climate hostile to undocumented immigrants for the purpose …

Choosing Between Tax And Nontax Delivery Mechanisms For Health Insurance Subsidies, Lawrence Zelenak

Faculty Scholarship

No abstract provided.

Export Pioneers In Latin America, Charles F. Sabel, Eduardo Fernández-Arias, Ricardo Hausmann, Andrés Rodriguez-Clare, Ernesto Stein

Faculty Scholarship

Export Pioneers in Latin America analyzes a series of case studies of successful new export activities throughout the region to learn how pioneers jump-start a virtuous process leading to economic transformation. The cases of blueberries in Argentina, avocados in Mexico, and aircraft in Brazil illustrate how an initially successful export activity did not stop with the discovery of a single viable product, but rather continued to evolve. The book explores the conjecture that costly burdens to entrepreneurial self-discovery (due to the deterrent effects of imitation by competitors) have held back potential exporters in post-reform Latin America. It also considers the …

Beyond The Private Attorney General: Equality Directives In American Law, Olatunde C.A. Johnson

Faculty Scholarship

American civil rights regulation is generally understood as relying on private enforcement in courts rather than imposing positive duties on state actors to further equity goals. This Article argues that this dominant conception of American civil rights regulation is incomplete. American civil rights regulation also contains a set of "equality directives," whose emergence and reach in recent years have gone unrecognized in the commentary. These federal-level equality directives use administrative tools of conditioned spending, policymaking, and oversight powerfully to promote substantive inclusion with regard to race, ethnicity, language, and disability. These directives move beyond the constraints of the standard private …

Structural Analysis Of Proinsulin Hexamer Assembly By Hydroxyl Radical Footprinting And Computational Modeling, Janna G. Kiselar, Manish Datt, Mark R. Chance, Michael A. Weiss

Faculty Scholarship

Mutations in the insulin gene can impair proinsulin folding and cause diabetes mellitus. Although crystal structures of insulin dimers and hexamers are well established, proinsulin is refractory to crystallization. Although an NMR structure of an engineered proinsulin monomer has been reported, structures of the wild-type monomer and hexamer remain undetermined. We have utilized hydroxyl radical footprinting and molecular modeling to characterize these structures. Differences between the footprints of insulin and proinsulin, defining a "shadow" of the connecting (C) domain, were employed to refine the model. Our results demonstrate that in its monomeric form, (i) proinsulin contains a native-like insulin moiety …

Proteomic Signatures Of Human Oral Epithelial Cells In Hiv-Infected Subjects, Elizabeth Yohannes, Santosh K. Ghosh, Bin Jiang, Thomas S. Mccormick, Aaron Weinberg, Edward Hill, Faddy Faddoul, Mark R. Chance

Faculty Scholarship

The oral epithelium, the most abundant structural tissue lining the oral mucosa, is an important line of defense against infectious microorganisms. HIV infected subjects on highly active antiretroviral therapy (HAART) are susceptible to comorbid viral, bacterial and fungal infections in the oral cavity. To provide an assessment of the molecular alterations of oral epithelia potentially associated with susceptibility to comorbid infections in such subjects, we performed various proteomic studies on over twenty HIV infected and healthy subjects. In a discovery phase two Dimensional Difference Gel Electrophoresis (2-D DIGE) analyses of human oral gingival epithelial cell (HOEC) lysates were carried out; …

Enumeration Of Cd4+ T-Cells Using A Portable Microchip Count Platform In Tanzanian Hiv-Infected Patients, Umut A. Gurkan

Faculty Scholarship

Background: CD4+ T-lymphocyte count (CD4 count) is a standard method used to monitor HIV-infected patients during anti-retroviral therapy (ART). The World Health Organization (WHO) has pointed out or recommended that a handheld, point-of-care, reliable, and affordable CD4 count platform is urgently needed in resource-scarce settings. Methods: HIV-infected patient blood samples were tested at the point-of-care using a portable and label-free microchip CD4 count platform that we have developed. A total of 130 HIV-infected patient samples were collected that included 16 de-identified left over blood samples from Brigham and Women’s Hospital (BWH), and 114 left over samples from Muhimbili University of …

Frontiers Of Oncology: Biobanking Resources For The 21St Century, Jill Barnholtz-Sloan, Mark R. Chance

Faculty Scholarship

No abstract provided.

Opening The Industry Playbook: Myths And Truths In The Debate Over Bpa Regulation, Thomas Mcgarity, Rena I. Steinzor, Matthew Shudtz, Lena Pons

Faculty Scholarship

For the last two decades, scientists have amassed evidence that bisphenol A (BPA) poses a threat to human health.  Although scientists have targeted BPA as a public health concern, plastics industry lobbyists have attempted to thwart the efforts of federal, state, and local authorities to reduce exposure to BPA.  This paper reviews the major arguments advanced by the plastics industry and debunks them as “myths” that public health officials must reject.  The five topics covered include:  the myth of scientific consensus on safety; the myth that only studies complying with “Good Laboratory Practices” guidelines are adequate for making regulatory decisions; …

Alternative Strategies For Managing Pharmaceutical And Personal Care Products In Water Resources, Gabriel Eckstein, George William Sherk

Faculty Scholarship

In recent decades, concern has grown over the presence of pharmaceutical and personal care products (PPCPs) in water. This concern stems from the possibility that the presence of PPCPs in water supplies may pose a threat to both human and environmental health. Such threats may be both direct (e.g., exposure to endocrine disrupting compounds) and indirect (e.g., emergence of antibiotic resistant bacteria). The water treatment and wastewater treatment community has been especially concerned over PPCPs because of PPCPs ubiquitous nature and their ability to persist or only partially degrade in water and during wastewater treatment. Studies done over the past …

Living Bacterial Sacrificial Porogens To Engineer Decellularized Porous Scaffolds, Umut A. Gurkan

Faculty Scholarship

Decellularization and cellularization of organs have emerged as disruptive methods in tissue engineering and regenerative medicine. Porous hydrogel scaffolds have widespread applications in tissue engineering, regenerative medicine and drug discovery as viable tissue mimics. However, the existing hydrogel fabrication techniques suffer from limited control over pore interconnectivity, density and size, which leads to inefficient nutrient and oxygen transport to cells embedded in the scaffolds. Here, we demonstrated an innovative approach to develop a new platform for tissue engineered constructs using live bacteria as sacrificial porogens. E.coli were patterned and cultured in an interconnected three-dimensional (3D) hydrogel network. The growing bacteria …

Women And Children Last — The Predictable Effects Of Proposed Federal Funding Cuts, George J. Annas, Wendy K. Mariner

Faculty Scholarship

"Women and children last” might as well be the refrain of the current U.S. Congress's new health care budget cutters. We have seen similar efforts before. In the mid-1990s, managed care organizations tried to save money by limiting hospitalization benefits for new mothers and their infants to 24 hours after a vaginal delivery and 48 hours after a cesarean section. As with current Congressional proposals, financial savings were seen as more important than the health of women and children. Because only women get pregnant and give birth, restricting access to reproductive health care is discriminatory on its face and undermines …

Johnson-Sea-Link Submersibles Tools For Research And Discovery: Summary Of Users, Publications, Documentaries And Testimonials., John K. Reed, Tamara M. Frank

Faculty Scholarship

This document was compiled by various scientists and users of the Johnson-Sea-Link (JSL) submersibles. This document is not inclusive but presents some highlights of major discoveries, publications, and grants made possible by use of Harbor Branch Oceanographic Institution's (HBOI) research submersibles. The Johnson-Sea-Link submersibles were the cornerstone of Harbor Branch when Edwin Link invented and built the submersibles at HBOI (Harbor Branch Foundation) nearly 40 years ago. The Johnson-Sea-Link submersibles have resulted in international acclaim for Harbor Branch from recent research discoveries to Discovery Channel documentaries. The ocean going and deep-water capabilities of HBOI have been a core strength of …

Schiavo Revisited? The Struggle For Autonomy At The End Of Life In Italy, Kathy L. Cerminara

Faculty Scholarship

Kathy Cerminara, Schiavo Revisited? The Struggle for Autonomy at the End of Life in Italy, 12 Marquette University Elder's Advisor 295 (2011). Politically strident debates surrounding end-of-life decisionmaking have surfaced once again, this time across the Atlantic in Italy. Eluana Englaro died early this year after a prolonged court fight, causing the international press to compare her case to that of Theresa Marie Schiavo, who passed away in 2005 in Florida after nearly sparking constitutional crises on both state and federal levels. In many respects, the facts of Ms. Englaro’s case are similar to Schiavo, but a close analysis …

The Fifth Freedom: The Constitutional Duty To Provide Public Education, Areto Imoukhuede

Faculty Scholarship

“The fifth freedom is freedom from ignorance. It means that every[one], everywhere, should be free to develop his [or her] talents to their full potential – unhampered by arbitrary barriers of race or birth or income.” Lyndon B. Johnson This article argues that education is a fundamental human right that the U.S. Supreme Court has failed to recognize because of the Court’s bias towards negative, rather than positive rights. Viewed from the limited perspective of rights as liberties, the concern with declaring a fundamental right to education is that education legislation would be strictly scrutinized, thus causing the undesired result …

Unshackling Addiction: A Public Health Approach To Drug Use During Pregnancy, Seema Mohapatra

Faculty Scholarship

No abstract provided.

Voluntarily Stopping Eating And Drinking: A Legal Treatment Option At The End Of Life, Thaddeus Mason Pope

Faculty Scholarship

Despite the growing sophistication of palliative medicine, many individuals continue to suffer at the end of life. It is well settled that patients, suffering or not, have the right to refuse life-sustaining medical treatment (such as dialysis or a ventilator) through contemporaneous instructions, through an advance directive, or through a substitute decision maker. But many ill patients, including a large and growing population with advanced dementia who are not dependent upon life-sustaining medical treatment, do not have this option. They have the same rights, but there is simply no life-sustaining medical treatment to refuse.

Nevertheless, these patients have another right, …

Intergenerational Ties In Context: Grandparents Caring For Grandchildren In China, Guangya Liu, Feinian Chen, Christine A. Mair

Faculty Scholarship

Guided by theories and empirical research on intergenerational relationships, we examine the phenomenon of grandparents caring for grandchildren in contemporary China. Using a longitudinal dataset (China Health and Nutrition Survey), the authors document a high level of structural and functional solidarity in grandparent-grandchildren relationships. Intergenerational solidarity is indicated by a high rate of coresidence between grandchildren and grandparents, a sizable number of skipped-generation households (no parent present), extensive childcare involvement by non-coresidential grandparents, and a large amount of care provided by coresidential grandparents. Multivariate analysis further suggests that grandparents’ childcare load is adaptive to familial needs, as reflected by the …

Feminism, Power, And Sex Work In The Context Of Hiv/Aids: Consequences For Women's Health, Aziza Ahmed

Faculty Scholarship

This paper examines the involvement of feminists in approaches to sex work in the context of HIV/AIDS. The paper focuses on two moments where feminist disagreement produced results in favor of an "anti-trafficking" approach to addressing the vulnerability of sex workers in the context of HIV. The first is the UNAIDS Guidance Note on Sex Work and the second is the "anti-prostitution pledge" found in the Presidents Emergency Plan for AIDS Relief. This article also examines the anti-sex work position articulated by abolitionist feminists and demonstrates the unintended consequences of the abolitionist position on women's health. By examining the actual …

The Human Right To Health And Hiv/Aids: South Africa And South-South Cooperation To Reframe Global Intellectual Property Principles And Promote Access To Essential Medicines, Erika George

Faculty Scholarship

The HIV/AIDS pandemic has had a devastating and disproportionate impact in countries of the Global South. The experience of an individual infected with HIV in Africa is very different than that of an individual infected with HIV in America. Life expectancy varies sharply. The ability or inability to access medicines essential for treatment accounts for much of the variance. This article examines how the rhetoric of human rights used in the context of South Africa's AIDS crisis resonated across the Global South, resulted in a powerful social movement for access to medicines, and contributed to important changes in international intellectual …

Hiv And Women: Incongruent Policies, Criminal Consequences, Aziza Ahmed

Faculty Scholarship

UN Women must take an aggressive role in the standardization of laws and policies at the global and national level where their incongruence has negative and often criminal consequences for the health and lives of women and girls. This article focuses in on three such examples: opt-out testing for HIV, criminalization of vertical transmission, and the new World Health Organization guidelines on breastfeeding.

The Freedom Of Health, Abigail Moncrieff

Faculty Scholarship

What would have happened if the Patient Protection and Affordable Care Act (PPACA) really had authorized government “death panels” that would decide whether an elderly patient could get treatment? Leaving aside commerce clause and other constraints particular to Congress, would that kind of direct healthcare rationing be a constitutional exercise of governmental power in the United States? I think not. I argue here that an emergent substantive due process constraint would invalidate such an exercise; direct rationing of that kind would violate a constitutional “freedom of health” that is nascent in Supreme Court jurisprudence. Based on that logic, I argue …

The Potential Of Shared Decision Making To Reduce Health Disparities, Jaime S. King, Mark H. Eckman, Benjamin W. Moulton

Faculty Scholarship

No abstract provided.