Evaluation of the Addition of Angiotensin II in Patients With Shock After Cardiac Surgery at a Veterans Affairs Medical Center.

BACKGROUND: Vasoplegic shock occurs in up to 37% of cardiac surgery patients. We investigated the use of angiotensin II for treating vasoplegic shock in these patients. OBJECTIVES: We assessed clinical outcomes and mortality in patients undergoing cardiac surgery at our center between March 1, 2018 and October 31, 2020 who developed vasoplegic shock, comparing those who received angiotensin II with those who did not. METHODS: This was a retrospective chart review. Response to angiotensin II was defined as increase in or maintenance of mean arterial pressure (MAP) and decrease in background vasopressor dosage. RESULTS: Angiotensin II was administered to 7 patients (postoperatively in 4 patients [57.1%]) with vasoplegic shock and baseline norepinephrine equivalent (NEE) of 0.49 ± 0.08 µg/kg/min; 12 patients with vasoplegic shock did not receive angiotensin II. Within 3 hours of angiotensin II administration, NEE decreased by 38.0 ± 33.1%. Angiotensin patients were more likely to newly require renal replacement therapy (66.7% vs 9.1%, P = 0.03) and had a longer, although not statistically significant, postoperative stay (23.1 vs 14.0 days, P = 0.16). Despite higher NEE requirements at baseline (0.49 vs 0.30, P = 0.03) and over the next 48 hours in the angiotensin group, no between-group differences in 7-day mortality (14.3% vs 0.0%, P = 0.37) or 30-day mortality (28.6% vs 8.3%, P = 0.52) were noted. CONCLUSION AND RELEVANCE: In patients who developed vasoplegic shock after cardiac surgery, angiotensin II administration allowed immediate dosage reductions of other vasopressors while maintaining MAP. Despite its small sample size, this study adds to the paucity of data in these patients and highlights future research needs.

The Survival Imperative : Commentary on "Whither the University? Universities of Technology and the Problem of Institutional Purpose".

Humans are powerful and clever, and also more ignorant than they know. As a result, they too often fail to acknowledge or even recognize their limitations, and are more arrogant than humble regarding their capabilities. Education that explicitly recognizes and addresses the context of science and technology, their inherent values and ethical implications and concerns, and their problematic as well as beneficial impacts can potentially rescue the human species from itself.

Real-world treatment patterns and associated progression-free survival in relapsed/refractory multiple myeloma among US community oncology practices.

BACKGROUND: Evidence supporting optimal treatment sequencing in relapsed/refractory multiple myeloma (RRMM) patients requiring multiple therapy lines is lacking. METHODS: Using retrospective chart data, this study describes real-world RRMM treatment patterns and related progression-free survival (PFS) in US community oncology clinics. RESULTS: Bortezomib ± a non-immunomodulatory drug (IMiD), lenalidomide ± a non-proteasome inhibitor (PI), bortezomib + an IMiD were the most commonly used regimens in early lines of therapy. Median PFS was similar in 1(st) (11.1 months) and 2(nd) line (10.5) and decreased in lines 3 through 5 (3(rd): 7.9; 4(th): 7.2, 5(th): 5.4). Longest PFS (12.5 months) in first line was with bortezomib + ImiD; longest PFS in second line was with lenalidomide ± a non-PI was (13.2 months). CONCLUSIONS: Re-treatment with bortezomib was common; novel agents were reserved for later therapy lines. Overall, the observed PFS associated with real-world treatment sequences were shorter than those reported in clinical trials.

Socially responsible science is more than "good science".

The role of scientist carries an array of responsibilities. The most obvious is accurate and reliable research that can be depended upon by fellow researchers. Scientists also have a responsibility to oppose misuse or abuse in the application of research findings, and to attend to both the limitations and the foreseeable impacts of their work. In addition, as members of society, scientists have a responsibility to participate in discussions and decisions regarding the appropriate use of science in addressing societal issues and concerns, and to bring their specialized knowledge and expertise to activities and discussions that promote the education of students and fellow citizens, thereby enhancing and facilitating informed decision making and democracy.

Editors' overview perspectives on teaching social responsibility to students in science and engineering.

Global society is facing formidable current and future problems that threaten the prospects for justice and peace, sustainability, and the well-being of humanity both now and in the future. Many of these problems are related to science and technology and to how they function in the world. If the social responsibility of scientists and engineers implies a duty to safeguard or promote a peaceful, just and sustainable world society, then science and engineering education should empower students to fulfil this responsibility. The contributions to this special issue present European examples of teaching social responsibility to students in science and engineering, and provide examples and discussion of how this teaching can be promoted, and of obstacles that are encountered. Speaking generally, education aimed at preparing future scientists and engineers for social responsibility is presently very limited and seemingly insufficient in view of the enormous ethical and social problems that are associated with current science and technology. Although many social, political and professional organisations have expressed the need for the provision of teaching for social responsibility, important and persistent barriers stand in the way of its sustained development. What is needed are both bottom-up teaching initiatives from individuals or groups of academic teachers, and top-down support to secure appropriate embedding in the university. Often the latter is lacking or inadequate. Educational policies at the national or international level, such as the Bologna agreements in Europe, can be an opportunity for introducing teaching for social responsibility. However, frequently no or only limited positive effect of such policies can be discerned. Existing accreditation and evaluation mechanisms do not guarantee appropriate attention to teaching for social responsibility, because, in their current form, they provide no guarantee that the curricula pay sufficient attention to teaching goals that are desirable for society as a whole.

Editors' overview: Neuroethics: many voices and many stories.

Advances in neuroscience continue to enhance understanding of the brain and provide new tools to take advantage of that understanding. These changes are poised to profoundly alter society. Given that the impact will be felt not only by neuroscientists, but by diverse members of society, it is imperative that conversations engage all stakeholders. Doing so will allow for the sharing of diverse views and perspectives to understand and frame the science, better educate and prepare the public for new developments, and provide a shared approach to identifying and resolving ethical challenges. These were the goals of Neuroethics Week, staged in 2007 by the Center for Ethics in Science and Technology in San Diego, and are the basis for the contributions to this special issue of Science and Engineering Ethics.

Potential for bias in the context of neuroethics. Commentary on "Neuroscience, neuropolitics and neuroethics: the complex case of crime, deception and fMRI".

Neuroscience research, like all science, is vulnerable to the influence of extraneous values in the practice of research, whether in research design or the selection, analysis and interpretation of data. This is particularly problematic for research into the biological mechanisms that underlie behavior, and especially the neurobiological underpinnings of moral development and ethical reasoning, decision-making and behavior, and the other elements of what is often called the neuroscience of ethics. The problem arises because neuroscientists, like most everyone, bring to their work assumptions, preconceptions and values and other sources of potentially inappropriate bias of which they may be unaware. It is important that the training of neuroscientists, and research practice itself, include open and in-depth discussion and examination of the assumptions that underlie research. Further, policy makers, journalists, and the general public, that is, the consumers of neuroscience research findings (and by extension, neurotechnologies) should be made aware of the limitations as well as the strengths of the science, the evolving nature of scientific understanding, and the often invisible values inherent in science.

Responsible research: what is expected? Commentary on: "Statistical power, the Belmont Report, and the ethics of clinical trials".

"Responsible research" and "good science" are concepts with various meanings depending on one's perspective and assumptions. Fellow researchers, research participants, policy makers and the general public also have differing expectations of the benefits of research ranging from accurate and reliable data that extend the body of knowledge, to solutions to societal concerns. Unless these differing constituencies articulate their differing views they may fail to communicate and undermine the value of research to society.

Editors' overview: topics in the responsible management of research data.

Responsible data management is a multifaceted topic involving standards within the research community regarding research design and the sharing of data as well as the collection, selection, analysis and interpretation of data. Transparency in the manipulation of images is increasingly important in order to avoid misrepresentation of research findings, and research oversight is also critical in helping to assure the integrity of the research process. Intellectual property issues both unite and divide academe and industry in their approaches to data management. Central to the realization and promulgation of responsible data management is clear and careful communication of standards and expectations within the research community to trainees as well as among colleagues. These topics are examined and explored in depth in a special issue of Science and Engineering Ethics on responsible data management.

Neuroethics: a modern context for ethics in neuroscience.

Neuroethics, a recently modernized field at the intersection of bioethics and neuroscience, is founded on centuries of discussion of the ethical issues associated with mind and behavior. Broadly defined, neuroethics is concerned with ethical, legal and social policy implications of neuroscience, and with aspects of neuroscience research itself. Advances in neuroscience increasingly challenge long-held views of the self and the individual's relationship to society. Neuroscience also has led to innovations in clinical medicine that have not only therapeutic but also non-therapeutic dimensions that extend well beyond previously charted boundaries. The exponential increase in cross-disciplinary research, the commercialization of cognitive neuroscience, the impetus for training in ethics, and the increased attention being paid to public understanding of science all illuminate the important role of neuroethics in neuroscience.