Structured transverse orbital angular momentum probed by a levitated optomechanical sensor.

The momentum carried by structured light fields exhibits a rich array of surprising features. In this work, we generate transverse orbital angular momentum (TOAM) in the interference field of two parallel and counter-propagating linearly-polarised focused beams, synthesising an array of identical handedness vortices carrying intrinsic TOAM. We explore this structured light field using an optomechanical sensor, consisting of an optically levitated silicon nanorod, whose rotation is a probe of the optical angular momentum, which generates an exceptionally large torque.

Bystander Ethics and Good Samaritanism: A Paradox for Learning Health Organizations.

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: "Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.

Insurance Coverage Policies for Pharmacogenomic and Multi-Gene Testing for Cancer.

Insurance coverage policies are a major determinant of patient access to genomic tests. The objective of this study was to examine differences in coverage policies for guideline-recommended pharmacogenomic tests that inform cancer treatment. We analyzed coverage policies from eight Medicare contractors and 10 private payers for 23 biomarkers (e.

Rationing Care through Collaboration and Shared Values.

Although "rationing" continues to be a dirty word for the public in health policy discourse, Nir Eyal and colleagues handle the concept exactly right in their article in this issue of the Hastings Center Report. They correctly characterize rationing as an ethical requirement, not a moral abomination. They identify the key health policy question as how rationing can best be done, not whether it should be done at all.

Professional Ethics for Digital Age Psychiatry: Boundaries, Privacy, and Communication.

Purpose Of Review: Internet and social media use continue to expand rapidly. Many patients and psychiatrists are bringing digital technologies into the treatment process, but relatively little attention has been paid to the ethical challenges in doing this. This review presents ethical guidelines for psychiatry in the digital age.

Ethical practice in Telehealth and Telemedicine.

This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code.

Using Moral Distress for Organizational Improvement.

Moral distress is a major problem for nurses, other clinicians, and the health system itself. But if properly understood and responded to, it is also a promising guide for healthcare improvement. When individuals experience moral distress or burnout, their reports must be seen as crucial data requiring careful attention to the individuals and to the organization.

Seeking Legitimacy for DSM-5: The Bereavement Exception as an Example of Failed Process.

In 2013 the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Even before publication, DSM-5 received a torrent of criticism, most prominently over removal of the "bereavement exclusion" for the diagnosis of major depression. We argue that while the APA can claim legitimate authority for deciding scientific questions, it does not have legitimacy for resolving what is ultimately a question of ethics and public policy.

\How Can Clinical Ethics Committees Take on Organizational Ethics? Some Practical Suggestions.

Although leaders in the field of ethics have for many years pointed to the crucial role that organizations play in shaping healthcare ethics, organizational ethics remains a relatively undeveloped area of ethics activity. Clinical ethics committees are an important source of potential expertise, but new skills will be required. Clinical ethics committees seeking to extend their purview to organizational issues will have to respond to three challenges-how to gain sanction and support for addressing controversial and sensitive issues, how to develop an acceptable process, and how to make a difference on the ground.

Medication Refusal in Schizophrenia: Preventive and Reactive Ethical Considerations.

Clinicians treating patients with recurrent psychosis should encourage contingency planning with patients and families for how to respond to potential recurrences. Whether or not patients create a formal psychiatric advance directive, patients, families, and clinicians will be better prepared to deal with emergencies if they include "scenario planning" as part of ongoing clinical care. In the case under discussion this was not done, resulting in an ethical conundrum as to whether it was ethically justifiable to override the proxy decision maker's refusal of medication.

A framework of ethics for telepsychiatry practice.

Psychiatrists who provide telepsychiatric services must uphold the standards of ethics and professionalism expected in in-person interactions. Psychiatrists' fundamental ethical responsibilities do not change when they take up a new form of practice. But as in other areas of medicine, the introduction of a new technology - here, Internet use and videoconferencing - raises new ethical challenges, requiring a fresh look at clinical practice and social issues such as equitable access.

Detoxifying the concept of rationing.

Andrew Hantel's proposal for dealing with cancer drug shortages exemplifies the kind of clinician-led discussion of rationing the U.S. political process requires.

Values conflicts in professional-community collaborations.

GAP/I and INP+ represent markedly divergent cultures and therefore highlight the opportunities and strains associated with professional-community collaborations. I believe, however, that the factors that emerge from studying GAP/I-INP+ are not idiosyncratic and are relevant for other professional-community dyads. Every such partnership is likely to require some form of bridging mechanism to serve the same purposes as Mr Varghese's role did.

No place like the hospital.

The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company.

Consumer awareness and strategies among families with high-deductible health plans.

Objective: High-deductible health plans (HDHPs) are a new and controversial approach to increasing the share of health care costs paid by patients. Our study had the following aims: (1) to describe the experiences of families with HDHPs who had incurred high out-of-pocket costs and (2) to identify areas where clinicians could support more effective health care decisions by such families.

Methods: We conducted four focus groups with adults whose families had HDHPs in a New England-based health plan and had experienced high or unexpected out-of-pocket health care costs during the past 12 months.

Cluster randomized trials to study the comparative effectiveness of therapeutics: stakeholders' concerns and recommendations.

Purpose: To describe the concerns raised by health plan members, providers and purchasers related to studying the comparative effectiveness of therapeutics using cluster randomized trials (CRTs) within health plans. An additional goal was to develop recommendations for increasing acceptability.

Methods: Eighty-four qualitative in-depth telephone interviews were conducted; 50 with health plan members, 21 with providers, and 13 with purchasers.

Best practices in policy and access (coding and reimbursement) for weight loss surgery.

To update evidence-based best practice guidelines for coding and reimbursement and establish policy and access standards for weight loss surgery (WLS). Systematic search of English-language literature on WLS and health-care policy, access, insurance reimbursement, coding, private payers, public policy, and mandated benefits published between April 2004 and May 2007 in MEDLINE, EMBASE, and the Cochrane Library. Use of key words to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models.

Comparing drug effectiveness at health plans: the ethics of cluster randomized trials.

"Cluster randomized trials," in which groups of patients are randomly assigned to different therapeutic interventions, provide a powerful way of evaluating drugs. CRTs have not been widely used, in good part because of concerns about whether patients must give informed consent to participate in them. A better understanding of how CRTs fit into clinical practice resolves the concerns.