Stephen Hanson | Tulane University (original) (raw)
Papers by Stephen Hanson
Journal of Respiratory Infections, 2020
Introduction: The period, from exposure to a potential pathogen to the manifestation of symptoms ... more Introduction: The period, from exposure to a potential pathogen to the manifestation of symptoms i.e. incubation period, is time the virus spends replicating in the host. An estimation of this period and subsequent quarantine of the host can limit potential spread, particularly in asymptomatic carriers. Effective contact tracing, length of self-quarantine, repeat testing and understanding of disease transmission are all contingent on a true estimation of this incubation period. Methods: Articles in English from December 1st , on Google scholar, PubMed, Research gate along with bulletins from WHO and the CDC were queried for the keywords, "SARS-CoV-2", "COVID-19", "median incubation period", "mean incubation period", "symptom onset", "quarantine" and "exposure interval'' and reviewed independently by two authors to establish consensus. Travel to Wuhan, or in absence of travel, the earliest possible exposure, were used to calculate mean or median incubation period. Correspondingly, we reviewed the advised lengths of quarantine period. Results: Five studies with a combined sample size of 505 patients were reviewed for mean/ median incubation period. Four studies recommended periods for self-quarantine, ranging from 2-14 days. Linton et al. recommended the shortest estimate of the median incubation period at 4.3 days (95% CI 4.5-5.6), whereas the longest was by Backer et al. at 6.4 days (95% CI 4.5-5.8). Similarly, the shortest estimation of mean incubation period was by Liu et al. (n=16) at 4.8 days (95% CI 2.2-7.4) days while the longest at 5.5 days (95% CI 4.5-5.8) was by Lauer et al. (n=181). Although the range for quarantine in these four studies was 12.5 to 14 days, all four recommended 14 days as the optimum for self-quarantine. Conclusion: A precise estimate of incubation period is instrumental in outlining an effective quarantine measure. Calculation of the incubation period using mathematical models has established an accurate measure, albeit with uncertainty increasing towards the tail of each distribution. Based on a thorough review of these studies a quarantine period of 14 days can be recommended allowing 97.5% of the infected people to show symptoms. These symptomatic patients would be further evaluated based on their respective state health guidelines so that they may be effectively isolated and treated.
Journal of Respiratory Infections, 2020
Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized w... more Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized with community-acquired pneumonia (CAP). The objective of this study was to define the clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 CAP in the city of Louisville, KY. Methods: This was a retrospective observational study of 700 patients with SARS-CoV-2 infection hospitalized to eight of the adult hospitals in the city of Louisville. Patients with 1) a positive RT-PCR for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate at chest imaging were defined as having SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. For each patient more than 500 variables were abstracted from electronic medical records and recorded using Research Electronic Data Capture software. Data was analyzed by descriptive and inferential statistics using R version 3.4.0. Results: SARS-CoV...
Journal of Respiratory Infections, 2021
Journal of Respiratory Infections, 2021
Journal of health care law and policy, 2021
Journal of the Philosophy of Sport, 2018
Team physicians have a complicated job that involves potentially conflicting obligations to multi... more Team physicians have a complicated job that involves potentially conflicting obligations to multiple entities. Though responsible for the medical care of the athletes as individuals, they also have obligations to the team that employs them which can include returning athletes to play who are at heightened risk of re-injury. The fact that the athletes and owners have some overlapping interests (e.g. players playing well and winning games) only complicates this issue. Further, there are strong financial incentives to do what is necessary to obtain and keep a position as a team physician. This article examines dual loyalty and conflict of interest in sports medicine, and argues that there is not now a widely accepted or adequate solution to either. Moving toward a solution will require fairly serious changes in the role of the team physician.
Nature Precedings, 2008
Within the realm of medical care, Self-Identified Race and Ethnicity (SIRE) categories are promot... more Within the realm of medical care, Self-Identified Race and Ethnicity (SIRE) categories are promoted as an inexpensive tool to identify underlying genotypic diversity. Scientific opinion is divided about the adequacy of SIRE to serve this function. If genetic diversity can guide medical decisions, it is important to know the effectiveness of genetic screening via SIRE. Proper development of self-reported measures such as SIRE requires sensitivity and specificity studies. These types of formal evaluation are largely absent for SIRE. To begin this formal process, we estimate the sensitivity of SIRE in screening for variant Single Nucleotide Polymorphism (SNP). Our results indicate that the current use of SIRE is inadequate to screen for selected biotransformation related SNP in the N-Acetyl Transferase pathway. The widespread usage of SIRE to screen for genotypic diversity could promote erroneous assignment of patients to disease risk or therapeutic categories.
Reichel's Care of the Elderly
Philosophical Studies in Contemporary Culture, 2009
Standard interpretations of the relevance of natural facts through natural law theory tend to fai... more Standard interpretations of the relevance of natural facts through natural law theory tend to fail once one considers the full implications of evolutionary theory. This chapter argues that natural facts about human beings can still have moral meaning in this context. After a brief discussion of natural law, it is shown that the moral acquaintanceships between human beings (and possibly
American family physician, Jan 15, 2004
The Hastings Center report
Clinical Aspects of Aging
Philosophy and Medicine, 2009
ABSTRACT The preceding chapters have discussed three different attempts to determine and justify ... more ABSTRACT The preceding chapters have discussed three different attempts to determine and justify actions to be taken to resolve potentially morally problematic cases. Recall from Chapter 1 that the definition of “resolving” difficult cases is presenting and defending a particular action as the right one to take in a potentially morally difficult circumstance, and justifying that decision as correct to others in a way that those others can (or should be able to) recognize as a valid justification. Note that this does not require that each person actually agree that each other person’s justification is adequate to justify the action to themselves, but each person must be able to recognize the justification as a valid form of justification, one which could possibly serve as a justification for the decision for another person with a different moral understanding. A reasonable justification, then, is a justification that is at least a well-formed justification, grounded in moral claims, which one recognizes as a valid form of moral justification.
Philosophy and Medicine, 2009
ABSTRACT As explored in Chapter 2, the minimal requirements of content-free secular morality are ... more ABSTRACT As explored in Chapter 2, the minimal requirements of content-free secular morality are too minimal to serve as any kind of useful tool for justifiably solving moral conflicts in a pluralistic society. Tom Beauchamp and James Childress try a different approach to address the same problem. They argue that what they understand as the “common morality ,” held by all morally serious persons, already contains certain basic norms, which can be loosely codified as principles of morality. These principles, appropriately made specific and in interaction with each other, can be used to respond to and resolve moral conflicts.
Philosophy and Medicine, 2009
In seeking a means of addressing problems in modern secular society in such a way that has moral ... more In seeking a means of addressing problems in modern secular society in such a way that has moral authority for all parties to a given issue, one might search first for a means to eliminate the grounds of conflict. If a theory can appeal to a source of moral authority which all persons must recognize, and that theory can resolve moral conflicts, then such a theory would provide rationally justified means of resolving morally problematic cases. It is a premise of this work that a thick set of moral claims cannot be so justified to all, but it might be possible to justify and defend a minimal set of claims so that at least some reasonable conclusions can be made and justified to all potential parties to a moral conflict. Such a “thin theory” would be a means to derive solutions to moral conflicts with secular moral authority.
Philosophy and Medicine, 2009
Moral disagreement is to be expected in modern, pluralistic societies. Rational and reasonable pe... more Moral disagreement is to be expected in modern, pluralistic societies. Rational and reasonable persons can and do disagree about the appropriate solutions to various moral problems. Though each party to a moral disagreement may derive moral answers to moral problems in a morally justifiable fashion, different persons will not necessarily arrive at similar moral conclusions. This results from the combination of the under-determination of morality by reason and the related fact of rational moral pluralism . So, when persons who disagree encounter one another in a situation in which they must determine the right thing to do, they may not agree upon the appropriate solution, even when all parties actually desire to reach a solution.
Philosophy and Medicine, 2010
To an analytic philosopher, reading some of Richard Zaner’s writings can be strangely challenging... more To an analytic philosopher, reading some of Richard Zaner’s writings can be strangely challenging. Such frustrations can lead to a belief that there is a strong divide between Zaner’s case-focused approach to bioethics and certain theoretical approaches, such as Engelhardt’s principle of permission or specified principlism. This apparent divide might lead one to think that practitioners of the two types
Philosophy and Medicine, 2009
ABSTRACT The medieval practice of casuistry , the practice of case-based reasoning by analogy to ... more ABSTRACT The medieval practice of casuistry , the practice of case-based reasoning by analogy to similar cases, has been revived as another means of addressing moral conflicts in medical cases.
HEC Forum, 2011
The development of a code of ethics for a profession can be an indicator of the coherence and sta... more The development of a code of ethics for a profession can be an indicator of the coherence and stability of a discipline as a unique and singular entity. Since "bioethics", as a discipline, is not one profession but many, practiced by persons with not one but many varying responsibilities and training, it has been argued that no code of ethics is possible for the discipline(s) of bioethics. I argue that a code of ethics is possible for bioethics by looking at the nature of the various disciplines and noting necessary overlap between them, and deriving the ethics from the nature of the discipline(s) themselves. I show how this can be done by arguing that strict rules about funding and conflict of interest are necessary for bioethicists.
Philosophy and Medicine, 2009
Journal of Respiratory Infections, 2020
Introduction: The period, from exposure to a potential pathogen to the manifestation of symptoms ... more Introduction: The period, from exposure to a potential pathogen to the manifestation of symptoms i.e. incubation period, is time the virus spends replicating in the host. An estimation of this period and subsequent quarantine of the host can limit potential spread, particularly in asymptomatic carriers. Effective contact tracing, length of self-quarantine, repeat testing and understanding of disease transmission are all contingent on a true estimation of this incubation period. Methods: Articles in English from December 1st , on Google scholar, PubMed, Research gate along with bulletins from WHO and the CDC were queried for the keywords, "SARS-CoV-2", "COVID-19", "median incubation period", "mean incubation period", "symptom onset", "quarantine" and "exposure interval'' and reviewed independently by two authors to establish consensus. Travel to Wuhan, or in absence of travel, the earliest possible exposure, were used to calculate mean or median incubation period. Correspondingly, we reviewed the advised lengths of quarantine period. Results: Five studies with a combined sample size of 505 patients were reviewed for mean/ median incubation period. Four studies recommended periods for self-quarantine, ranging from 2-14 days. Linton et al. recommended the shortest estimate of the median incubation period at 4.3 days (95% CI 4.5-5.6), whereas the longest was by Backer et al. at 6.4 days (95% CI 4.5-5.8). Similarly, the shortest estimation of mean incubation period was by Liu et al. (n=16) at 4.8 days (95% CI 2.2-7.4) days while the longest at 5.5 days (95% CI 4.5-5.8) was by Lauer et al. (n=181). Although the range for quarantine in these four studies was 12.5 to 14 days, all four recommended 14 days as the optimum for self-quarantine. Conclusion: A precise estimate of incubation period is instrumental in outlining an effective quarantine measure. Calculation of the incubation period using mathematical models has established an accurate measure, albeit with uncertainty increasing towards the tail of each distribution. Based on a thorough review of these studies a quarantine period of 14 days can be recommended allowing 97.5% of the infected people to show symptoms. These symptomatic patients would be further evaluated based on their respective state health guidelines so that they may be effectively isolated and treated.
Journal of Respiratory Infections, 2020
Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized w... more Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized with community-acquired pneumonia (CAP). The objective of this study was to define the clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 CAP in the city of Louisville, KY. Methods: This was a retrospective observational study of 700 patients with SARS-CoV-2 infection hospitalized to eight of the adult hospitals in the city of Louisville. Patients with 1) a positive RT-PCR for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate at chest imaging were defined as having SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. For each patient more than 500 variables were abstracted from electronic medical records and recorded using Research Electronic Data Capture software. Data was analyzed by descriptive and inferential statistics using R version 3.4.0. Results: SARS-CoV...
Journal of Respiratory Infections, 2021
Journal of Respiratory Infections, 2021
Journal of health care law and policy, 2021
Journal of the Philosophy of Sport, 2018
Team physicians have a complicated job that involves potentially conflicting obligations to multi... more Team physicians have a complicated job that involves potentially conflicting obligations to multiple entities. Though responsible for the medical care of the athletes as individuals, they also have obligations to the team that employs them which can include returning athletes to play who are at heightened risk of re-injury. The fact that the athletes and owners have some overlapping interests (e.g. players playing well and winning games) only complicates this issue. Further, there are strong financial incentives to do what is necessary to obtain and keep a position as a team physician. This article examines dual loyalty and conflict of interest in sports medicine, and argues that there is not now a widely accepted or adequate solution to either. Moving toward a solution will require fairly serious changes in the role of the team physician.
Nature Precedings, 2008
Within the realm of medical care, Self-Identified Race and Ethnicity (SIRE) categories are promot... more Within the realm of medical care, Self-Identified Race and Ethnicity (SIRE) categories are promoted as an inexpensive tool to identify underlying genotypic diversity. Scientific opinion is divided about the adequacy of SIRE to serve this function. If genetic diversity can guide medical decisions, it is important to know the effectiveness of genetic screening via SIRE. Proper development of self-reported measures such as SIRE requires sensitivity and specificity studies. These types of formal evaluation are largely absent for SIRE. To begin this formal process, we estimate the sensitivity of SIRE in screening for variant Single Nucleotide Polymorphism (SNP). Our results indicate that the current use of SIRE is inadequate to screen for selected biotransformation related SNP in the N-Acetyl Transferase pathway. The widespread usage of SIRE to screen for genotypic diversity could promote erroneous assignment of patients to disease risk or therapeutic categories.
Reichel's Care of the Elderly
Philosophical Studies in Contemporary Culture, 2009
Standard interpretations of the relevance of natural facts through natural law theory tend to fai... more Standard interpretations of the relevance of natural facts through natural law theory tend to fail once one considers the full implications of evolutionary theory. This chapter argues that natural facts about human beings can still have moral meaning in this context. After a brief discussion of natural law, it is shown that the moral acquaintanceships between human beings (and possibly
American family physician, Jan 15, 2004
The Hastings Center report
Clinical Aspects of Aging
Philosophy and Medicine, 2009
ABSTRACT The preceding chapters have discussed three different attempts to determine and justify ... more ABSTRACT The preceding chapters have discussed three different attempts to determine and justify actions to be taken to resolve potentially morally problematic cases. Recall from Chapter 1 that the definition of “resolving” difficult cases is presenting and defending a particular action as the right one to take in a potentially morally difficult circumstance, and justifying that decision as correct to others in a way that those others can (or should be able to) recognize as a valid justification. Note that this does not require that each person actually agree that each other person’s justification is adequate to justify the action to themselves, but each person must be able to recognize the justification as a valid form of justification, one which could possibly serve as a justification for the decision for another person with a different moral understanding. A reasonable justification, then, is a justification that is at least a well-formed justification, grounded in moral claims, which one recognizes as a valid form of moral justification.
Philosophy and Medicine, 2009
ABSTRACT As explored in Chapter 2, the minimal requirements of content-free secular morality are ... more ABSTRACT As explored in Chapter 2, the minimal requirements of content-free secular morality are too minimal to serve as any kind of useful tool for justifiably solving moral conflicts in a pluralistic society. Tom Beauchamp and James Childress try a different approach to address the same problem. They argue that what they understand as the “common morality ,” held by all morally serious persons, already contains certain basic norms, which can be loosely codified as principles of morality. These principles, appropriately made specific and in interaction with each other, can be used to respond to and resolve moral conflicts.
Philosophy and Medicine, 2009
In seeking a means of addressing problems in modern secular society in such a way that has moral ... more In seeking a means of addressing problems in modern secular society in such a way that has moral authority for all parties to a given issue, one might search first for a means to eliminate the grounds of conflict. If a theory can appeal to a source of moral authority which all persons must recognize, and that theory can resolve moral conflicts, then such a theory would provide rationally justified means of resolving morally problematic cases. It is a premise of this work that a thick set of moral claims cannot be so justified to all, but it might be possible to justify and defend a minimal set of claims so that at least some reasonable conclusions can be made and justified to all potential parties to a moral conflict. Such a “thin theory” would be a means to derive solutions to moral conflicts with secular moral authority.
Philosophy and Medicine, 2009
Moral disagreement is to be expected in modern, pluralistic societies. Rational and reasonable pe... more Moral disagreement is to be expected in modern, pluralistic societies. Rational and reasonable persons can and do disagree about the appropriate solutions to various moral problems. Though each party to a moral disagreement may derive moral answers to moral problems in a morally justifiable fashion, different persons will not necessarily arrive at similar moral conclusions. This results from the combination of the under-determination of morality by reason and the related fact of rational moral pluralism . So, when persons who disagree encounter one another in a situation in which they must determine the right thing to do, they may not agree upon the appropriate solution, even when all parties actually desire to reach a solution.
Philosophy and Medicine, 2010
To an analytic philosopher, reading some of Richard Zaner’s writings can be strangely challenging... more To an analytic philosopher, reading some of Richard Zaner’s writings can be strangely challenging. Such frustrations can lead to a belief that there is a strong divide between Zaner’s case-focused approach to bioethics and certain theoretical approaches, such as Engelhardt’s principle of permission or specified principlism. This apparent divide might lead one to think that practitioners of the two types
Philosophy and Medicine, 2009
ABSTRACT The medieval practice of casuistry , the practice of case-based reasoning by analogy to ... more ABSTRACT The medieval practice of casuistry , the practice of case-based reasoning by analogy to similar cases, has been revived as another means of addressing moral conflicts in medical cases.
HEC Forum, 2011
The development of a code of ethics for a profession can be an indicator of the coherence and sta... more The development of a code of ethics for a profession can be an indicator of the coherence and stability of a discipline as a unique and singular entity. Since "bioethics", as a discipline, is not one profession but many, practiced by persons with not one but many varying responsibilities and training, it has been argued that no code of ethics is possible for the discipline(s) of bioethics. I argue that a code of ethics is possible for bioethics by looking at the nature of the various disciplines and noting necessary overlap between them, and deriving the ethics from the nature of the discipline(s) themselves. I show how this can be done by arguing that strict rules about funding and conflict of interest are necessary for bioethicists.
Philosophy and Medicine, 2009