The Robert A. Cooke Memorial Lecture. Medicine and government: self-regulation or government control.
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Women asylum seekers and refugees face persistent barriers to maternity care (antenatal, intrapartum and postnatal care) across high-income countries, yet the upstream governance shaping access remains under-examined. Although legally distinct, both groups share protection-seeking experiences and are addressed jointly in governance documents. This study examined and synthesised how international (macro), European regional (meso), and United Kingdom (UK, micro) governance documents frame and operationalise maternity service access. Sixty-four documents were analysed using the READ framework. Inductive analysis of macro and meso documents identified six access dimensions: universal coverage; cultural and linguistic adaptation; rights-based approaches; multi-agency collaboration; data, monitoring and accountability; and quality of care. These dimensions structured assessment of UK governance, with jurisdictions rated strong, moderate or weak. Alignment was fragmented: Wales, Scotland and Northern Ireland exempted asylum seekers from charging, whereas England retained charging provisions. Multi-agency collaboration was consistently articulated, yet none of the 35 UK government documents focused on maternity access for this population, and none required outcome monitoring disaggregated by asylum or refugee status. UK governance appears coordinated in form but fragmented in substance. UK-wide minimum standards and routine recording of these data, with safeguards against immigration-related use, could strengthen coherence and accountability and improve visibility of inequities.
The hypothesis that hyperkinetic children are stimulus-governed was tested. In a sample of 39 nonmedicated hyperkinetic boys 26 were found to be stimulus-governed. In a control sample of 20 nonmedicated boys 6 were found to be stimulus-governed. An association was found between the hyperkinetic syndrome and stimulus-governance. The hypothesis is raised that response to methylphenidate is related to stimulus-governance. Several issues raised by the research are discussed.
Public sector spending and private sector spending for health and medical services have tended to parallel one another over the past four decades. Although total expenditures have grown dramatically, the relationship between the two sectors has not. Government gradually increased its support and provision of health care between 1929 and 1940. Between 1940 and 1966 government spending for health care remained at a plateau. The federal government's major participation since 1966 has been through its role as a transfer agent for the Medicare trust fund, acting as an intermediary, rather than through the expenditure of general revenues for health and medical care services. Rising costs and increased demand for medical services will probably force a larger financial role upon government.
This paper presents points brought out in a panel discussion held at the 12th Hawaiian International Conference on System Sciences, January 1979. The session was attended by approximately two dozen interested parties from various segments of the academic, government, and health care communities. The broad categories covered include the specific problems of government regulations and their impact on specific clinical information systems installed at The University of Texas Health Science Center at Dallas, opportunities in a regulated environment, problems in a regulated environment, vendor-related issues in the marketing and manufacture of computer-based information systems, rational approaches to government control, and specific issues related to medical computer science.
A common feature of much scientific information reflected in government regulation is its passage directly from the laboratory into government decision without benefit of review and interpretation. This pattern can be attributed to a variety of factors. One is the incentives that lead government agencies to act quickly and conservatively in the name of protection of human health. Another is the relatively lengthy process of traditional review and interpretation via professional meetings and scientific publication. Yet, the case appears very strong for preserving, if foreshortening, the stages of peer review of otherwise unmatured data used in regulation. Several schemes of this sort have been tried in the past few years-some with apparent success. These are discussed alongside the proposal for a science court-a quasi-judicial vehicle for rendering judgements about scientific findings.
BACKGROUND: Institutional research teams and core facilities routinely manage pre-publication omics datasets that span heterogeneous file types, nested project structures, and multiple downstream uses. Public repositories mainly support post-publication dissemination, while workflow systems and enterprise data platforms do not directly provide a lightweight governance and delivery layer for internal research assets. RESULTS: We present MetaServe, an open-source governance and delivery layer for pre-publication research assets in institutional multi-omics settings. MetaServe registers and delivers heterogeneous assets, including sequencing files, processed matrices, imaging data, analysis-ready objects, tabular files, and documents, without requiring repository-grade standardization. Its metadata-aware design combines file-type recognition, partial automatic extraction for selected formats, manually supplied project and biological annotations, and indexed faceted retrieval. MetaServe supports authenticated web download, viewer-oriented handoff for compatible services such as cellxgene, and path-manifest export for downstream workflows under shared-storage assumptions. The current implementation combines role-based controls, explicit file-level sharing, path-constrained delivery, and operational traceability to support controlled institutional access. MetaServe has been deployed at the Chinese Institutes for Medical Research (CIMR) as part of an institutional multi-omics data-management system. CONCLUSIONS: MetaServe provides a practical layer between institutional storage and downstream analytical platforms for pre-publication research data. Its contribution is the integration of lightweight metadata-aware registration, permission-aware retrieval, and controlled delivery for heterogeneous institutional omics assets. Rather than replacing workflow engines, public repositories, or enterprise-scale research data platforms, MetaServe offers a deployable governance layer for core facilities and collaborative teams that need structured discovery and traceable delivery before public deposition or manuscript release.
This presentation traces the history of the Federal government's support of research and development related to the therapeutic modalities dialysis and renal transplantation. A description is presented of the Federal government's role in introduction of these new treatment methods into medical practice and of the gradual assumption by the government of responsibility for funding of the cost of dialysis and transplantation in the United States. Current issues and problems related to the federally subsidized End-State Renal Disease Program are discussed. The concept of "technology assessment" is introduced followed by discussion of the vital role it must play in any future federal development and support of new medical treatment technologies which must be paid for with public moneys because of their high cost.
There are broad requirements for translation of scientific knowledge in nutrition to public policy through the legislative process. First, it requires an ability to take highly objective, highly specific, scientifically derived facts--the stuff of scientific knowledge--and translate them into legislation based on highly subjective, quite general, broadly perceived values. Another requirement is to keep the level of uncertainty to tolerable levels during consideration of a legislative proposal. Finally, the governmental action proposed must conform to the perception held at that particular time of the role of government in carrying out the law. Three examples of the use of government to protect and promote the health of the public through nutrition are given. They illustrate very well the trials and tribulations of the untidy process of translating scientific knowledge in nutrition to public policy. Governmental action to improve the health of the general public through dietary means has been much a part of this country's policies. The augmentation of purchasing power of the poor, the distribution of surplus commodities to the indigent, the provision of meals to school children and the elderly, etc., are examples of govermental action. There will be further use of government to protect and promote the health of the public through nutrition. A basic requirement is further understanding of the relationship between nutrients and health through good scientific work.
Administrative and legal requirements and, in particular, federal and state government health care assistance and social services program regulations all combine to add complexity to the management and operation of ambulatory and inpatient health programs. This paper describes how constantly changing government regulations and differences in interpretations and definitiions have been expensive, time-consuming and sometimes detrimental to health care delivery for two large management and clinical computer-based information systems.
Two genes governing ribosomal protein methylation have been located on the map of Escherichia coli by conjugation and transduction crosses between wild-type and prm (protein methylation) mutants. The Prm phenotype of recombinants was determined by an in vitro assay of methylgroups incorporation into protein. Gene prmA, governing methylation of protein L11 is situated at minute 71 on the map and is cotransduced with aroE (30%) and with rpsL (5%). Gene prmB, governing methylation of protein L3 is at minute 50, very close to aroC (98.5% co-transduction). A cold-sensitive phenotype was found associated with mutation prmB and was used to score a large number of recombinants in a three factor cross. The results of this cross suggest the order aroC -prmB - purF. The striking symmetrical clustering of aro, prm and rim (ribosome maturation) genes is discussed.
Antigen-stimulated Ly1:Qa1+ cells induce a nonimmune set of T-acceptor cells (surface phenotype Ly123+Qa1+) to participate in the generation of specific suppressive activity. The experiments reported here were designed to test the possibility that the interaction between T-inducer and T-acceptor cells might be governed by genes linked to the Ig locus. We find that inducer:acceptor interactions occur only if the inducer and acceptor T-cell sets are obtained from donor that are identical at the Ig locus and are independent of the Ig locus expressed on the B cells used for assay of T-helper activity. In addition, experiments using inducer and acceptor T cells from the congenic recombinant BAB. 14 strain show that T-T interactions are not governed by Ig-CH genes, per se. These data indicate that T-inducer: T-acceptor interactions are governed by Ig-linked genes that may control expression of VH-like structures on T cells, or control expression of as yet unidentified cell-surface molecules.