Ethics of the fiduciary relationship between patient and physician: the case of informed consent.

This paper serves two purposes: first, the proposition of an ethical fiduciary theory that substantiates the often-cited assertion that the patient-physician relationship is fiduciary in nature; and second, the application of this theory to the case of informed consent. Patients' decision-making preferences vary significantly. While some seek fully autonomous decision-making, others prefer to delegate parts of their decision. Therefore, we propose an ethical fiduciary theory that allows physician and patient to jointly determine the physician's role on a spectrum from fiduciary as advisor to fiduciary as agent. Drawing on legal concepts of the fiduciary relationship and on phenomenological accounts of obligation by Lévinas and Løgstrup, our theory relies on the key attributes of trust, vulnerability and otherness. Finally, practical implications of this theory for the informed consent process are developed: we propose a preassessment of patients' risk and value profiles as well as a restructuring of the oral consent interview and the written consent materials.

A microbial expression system for high-level production of scFv HIV-neutralizing antibody fragments in Escherichia coli.

Monoclonal antibodies (mABs) are of great biopharmaceutical importance for the diagnosis and treatment of diseases. However, their production in mammalian expression hosts usually requires extensive production times and is expensive. Escherichia coli has become a new platform for production of functional small antibody fragment variants. In this study, we have used a rhamnose-inducible expression system that allows precise control of protein expression levels. The system was first evaluated for the cytoplasmic production of super folder green fluorescence protein (sfGFP) in various production platforms and then for the periplasmic production of the anti-HIV single-chain variable antibody fragment (scFv) of PGT135. Anti-HIV broadly neutralizing antibodies, like PGT135, have potential for clinical use to prevent HIV transmission, to promote immune responses and to eradicate infected cells. Different concentrations of L-rhamnose resulted in the controlled production of both sfGFP and scFv PGT135 antibody. In addition, by optimizing the culture conditions, the amount of scFv PGT135 antibody that was expressed soluble or as inclusions bodies could be modulated. The proteins were produced in batch bioreactors, with yields of 4.9 g/L for sfGFP and 0.8 g/L for scFv. The functionality of the purified antibodies was demonstrated by their ability to neutralize a panel of different HIV variants in vitro. We expect that this expression system will prove very useful for the development of a more cost-effective production process for proteins and antibody fragments in microbial cells.

An Efficient Algorithm for the Piecewise Affine-Linear Mumford-Shah Model Based on a Taylor Jet Splitting.

We propose an algorithm to efficiently compute approximate solutions of the piecewise affine Mumford-Shah model. The algorithm is based on a novel reformulation of the underlying optimization problem in terms of Taylor jets. A splitting approach leads to linewise segmented jet estimation problems for which we propose an exact and efficient solver. The proposed method has the combined advantages of prior algorithms: it directly yields a partition, it does not need an initialization procedure, and it is highly parallelizable. The experiments show that the algorithm has lower computation times and that the solutions often have lower functional values than the state-of-the-art.

Integration of ecosystem services into the carbon footprint of milk of South German dairy farms.

Allocation of greenhouse gas emissions (GHG) in Life Cycle Assessments (LCA) is challenging especially when multi-functionality of dairy farms, which do not only produce milk but also meat is considered. Moreover, some farms fulfill a wide range of additional services for society such as management of renewable natural resources as well as preservation of biodiversity and cultural landscapes. Due to the increasing degradation of ecosystems many industrialized as well as developing countries designed payment systems for environmental services. This study examines different allocation methods of GHG for a comparatively large convenience sample of 113 dairy farms located in grassland-based areas of southern Germany. Results are carbon footprints of 1.99 kg CO2eq/kg of fat and protein corrected milk (FPCM) on average if "no allocation" for coupled products is performed. "Physical allocation" results in 1.53 kg CO2eq/kg FPCM and "conventional economic allocation" in 1.66 kg CO2eq/kg FPCM on average if emissions are apportioned between milk and meat. Economic allocation which includes ecosystem services for society based on the farm net income as a new aspect in this study results in a carbon footprint of 1.5 kg CO2eq/kg FPCM on average. System expansion that puts greater emphasis on coupled beef production accounts for a carbon footprint of 0.68 kg CO2eq/kg FPCM on average. Intense milk production systems with higher milk yields show better results based on "no allocation", "physical allocation" and "conventional economic allocation". By contrast, economic allocation, which takes into account ecosystem services favors extensive systems, especially in less favored areas. This shows that carbon footprints of dairy farms should not be examined one-dimensionally based on the amount of milk and meat that is produced on the farm. Rather, a broader perspective is necessary that takes into account the multi-functionality of dairy farms especially in countries where a wide range of ecosystem services is provided.

The effect of feed demand on greenhouse gas emissions and farm profitability for organic and conventional dairy farms.

The reduction of product-related greenhouse gas (GHG) emissions in milk production appears to be necessary. The reduction of emissions on an individual farm might be highly accepted by farm owners if it were accompanied by an increase in profitability. Using life cycle assessments to determine the product carbon footprints (PCF) and farm-level evaluations to record profitability, we explored opportunities for optimization based on analysis of 81 organic and conventional pasture-based dairy farms in southern Germany. The objective of the present study was to detect common determining factors for low PCF and high management incomes (MI) to achieve GHG reductions at the lowest possible operational cost. In our sample, organic farms, which performed economically better than conventional farms, produced PCF that were significantly higher than those produced by conventional farms [1.61 ± 0.29 vs. 1.45 ± 0.28 kg of CO2 equivalents (CO2eq) per kg of milk; means ± SD)]. A multiple linear regression analysis of the sample demonstrated that low feed demand per kilogram of milk, high grassland yield, and low forage area requirements per cow are the main factors that decrease PCF. These factors are also useful for improving a farm's profitability in principle. For organic farms, a reduction of feed demand of 100 g/kg of milk resulted in a PCF reduction of 105 g of CO2eq/kg of milk and an increase in MI of approximately 2.1 euro cents (c)/kg of milk. For conventional farms, a decrease of feed demand of 100 g/kg of milk corresponded to a reduction in PCF of 117 g of CO2eq/kg of milk and an increase in MI of approximately 3.1 c/kg of milk. Accordingly, farmers could achieve higher profits while reducing GHG emissions. Improved education and training of farmers and consultants regarding GHG mitigation and farm profitability appear to be the best methods of improving efficiency under traditional and organic farming practices.