Assessing Swarming of Aerobic Bacteria from Human Fecal Matter.

Swarming - swift movement across a surface via flagella propulsion - is a unique property of many bacteria. The role of swarming, particularly among bacterial populations of the human gut microbiome, is not yet fully understood; although, it is becoming an area of increased scientific and clinical inquiry. To further characterize bacterial swarming in human health, an effective assay for swarming that utilizes complex material, such as fecal matter, is necessary. Until now, the vast majority of swarming assays have only been able to accommodate bacteria grown in culture, most often Pseudomonas. These assays tend to use a standard lysogenic broth (LB) agar medium; however, the reagents involved have not been tailored to the inoculation of complex material. In this paper, we offer a specialized protocol for eliciting the swarming of bacteria from frozen human fecal samples. We describe the simple, yet reproducible steps required to perform the assay, identifying an ideal volume of 7.5 µl for inoculation of material, as well as an ideal agar concentration of 0.4%. This protocol typically allows researchers to identify swarming within 24 h after incubation in a standard incubator.

Physician unionisation in the USA: ethical and empirical considerations and the free-rider problem.

While American physicians have traditionally practised as non-unionised professionals, there has been increasing debate in recent years over whether physicians in training (known also as interns, residents or house staff) are justified in unionising and using collective action. This paper examines specific ethical criteria that would permit union action, including a desire to ameliorate patient care as well as the goal of improving the conditions of working physicians. We posit that traditional rebuttals to physician unionisation often lean on an infinite conception of a doctor's energies and obligations, one that promotes burnout and serves to advance the financial motives of hospital management and administration. Furthermore, this paper explores the empirical justifications for collective action, which include substantial reductions in medical error. Finally, we address the free-rider problem posed by non-union physicians who might benefit from working improvements garnered through union action. We conclude that in order to maintain a notion of justice as fairness, resident physicians who benefit from union deliberations are impelled to acquire union membership or make a commensurate donation and that the healthcare organisations for which they work ought to share in the responsibility to improve patient care.

Medical error in the care of the unrepresented: disclosure and apology for a vulnerable patient population.

Defined as patients who 'lack decision-making capacity and a surrogate decision-maker', the unrepresented (sometimes referred to as the 'unbefriended', 'isolated patients' and/or 'patients without surrogates') present a major quandary to clinicians and ethicists, especially in handling errors made in their care. A novel concern presented in the care of the unrepresented is how to address an error when there is seemingly no one to whom it can be disclosed. Given that the number of unrepresented Americans is expected to rise in the coming decades, and some fraction of them will experience a medical error, creating protocols that answer this troubling question is of the utmost importance. This paper attempts to begin that conversation, first arguing that the precarious position of unrepresented patients, particularly in regards to errors made in their care, demands their recognition as a vulnerable patient population. Next, it asserts that the ethical obligation to disclose error still exists for the unrepresented because the moral status of error does not change with the presence or absence of surrogate decision-makers. Finally, this paper concludes that in outwardly acknowledging wrongdoing, a clinician or team leader can alleviate significant moral distress, satisfy the standards of a genuine apology, and validate the inherent and equivalent moral worth of the unrepresented patient.