Here we show that extracting a single food resource can exert www.selleckchem.com/products/MG132.html a series of distinct, potentially competing, selective forces during resource acquisition. This study illustrates how animals combine behaviors and morphological specializations to competently overcome distinct mechanical challenges,

emphasizing the need for holistic approaches in understanding feeding adaptations. “
“Competition for prey is thought to be important in structuring snake assemblages. However, due in part to the secretive behavior and low detectability of many snake species, this generalization is based on a limited number of studies, most of which focus on a single study site. We examined differences in diet composition, trophic niche overlap, site occupancy and detectability of five sympatric aquatic snake species between two different habitat

types in the Southeastern US, replicated at the landscape scale: permanent wetlands with fishes (n = 13) and isolated, often ephemeral wetlands without fishes (n = 10). We collected >3700 prey items from snakes and compared diet composition among snake species to examine niche breadth and overlap, correcting for relative availability of prey captured independently in the same wetlands. We evaluated evidence for competitive exclusion by estimating the probability of co-occupancy for pairs of snake species in each habitat type using occupancy modeling. In wetlands with fishes, niche overlap was low, suggesting resource partitioning. Conversely, in wetlands without fishes, niche overlap was high, with most species feeding on larval or paedomorphic ambystomatid salamanders, but competitive exclusion did not occur. We SB203580 suggest that high co-occupancy of aquatic snakes in wetlands without fishes despite the apparent lack of resource partitioning is due to a combination MCE公司 of seasonally high abundance of high quality amphibian prey, unique aspects of predator physiology and stochastic abiotic processes that prevent these systems from reaching equilibrium.

Our results demonstrate that snake diets can be highly context (e.g. habitat)-specific. Studies should consider other factors in addition to competition for prey when attempting to understand snake population and community dynamics. “
“Herbivores live in a landscape of fear and must incorporate danger in their foraging decisions, balancing their need of food and safety using a variety of cues to assess the risk of predation. These cues can either be direct (i.e. signalling the possible presence of a predator) or indirect (i.e. linked to the likelihood of encountering a predator). How then do herbivores negotiate these multiple cues in the landscape? And which type of cues do foraging herbivores use to assess variation in predation risk? We examined these questions by investigating the foraging responses of a free-ranging marsupial herbivore, the common brushtail possum Trichosurus vulpecula to perceived predation risk. We found that indirect habitat-related cues of predation (i.e.

22 1.22 Age-standardized gender 2.05 1.09 Females 12 (38.7%) 5 (29.4%) Males 19 (61.3%) 12 (70.6%) Male/female 1.58/1 2.4/1 Medianage at diagnosis, yr (range)     Females 47.5 (21–64) 20 (18–29) Males 36 (14–73) 25.5 (11–49) total 38 (14–73) 25 (11–49) Smoking status     Non-smoker 27 (87.1%) 15 (88.2%) Ex-smoker 3 (9.7%) 0 Current smoker 1 (3.2%) 2 (11.8%) Education JNK inhibitor screening library     Primary or below 5 0 Secondary and apprentice 16 9 Tertiary (university or college) 10 8 Urban/Rural 0.72/1 1.42/1 Appendectomy 0 0 Positive family history 0 0 Empirical anti-tuberculosis treatment

0 1 Presenting Author: ZHU ZHENHUA Additional Authors: ZENG ZHIRONG, PENG XIABIAO, PENG LIN, HAO YUANTAO, QIAN JIAMING, NG SIEW CHIEN, CHEN MINHU, HU PINJIN Corresponding Author: CHEN MINHU, HU PINJIN Affiliations: sun yat-sen university; Zhongshan people’s hospital; Zhongshan hospital of traditional Chinese medicine; Peking Union Medical College Hospital; The Chinese University of Hong Kong Objective: To identify the potential risk factors in Inflammatory bowel disease. Methods: A total of 27 patients diagnosed with Crohn’s disease (CD) and 53 with ulcerative colitis (UC) in Zhongshan, Guangdong (2011–2012) were matched 1:2 on age and gender to 160 orthopaedic

controls. Participants received a questionnaire with 87 questions concerning this website environmental factors prior to IBD/orthopaedic admission. Logistic regression analysis was performed to select statistically significant risk factors. Results: (1)Univariate analysis showed that 5 variants were statistieally correlated with CD, including educational status, sibling number, appendectomy, living area and hygienic condition, while 5 variants with UC, including

smoking, sibling number, chicken pox, physical exercise and living area. (2)one variant was identified by multivariate analysis, including educational status (OR = 0.211, 95% CI = 0.070–0.635, p = 0.006), while 4 variants with UC, including chicken pox (OR = 0.108, 95%CI = 0.038–0.419, p = 0.001), living area (OR = 0.564, 95%CI = 0.351–0.907, p = 0.018), smoking (OR = 0.153, 95%CI = 0.040–0.585, p = 0.006), sibling number (OR = 0.344, 95%CI = 0.146–0.814, 上海皓元 p = 0.015). Conclusion: Low degree education is risk factor in CD, appendectomy might be risk factor in CD; while smoking, Rural residence, chicken pox, more sibling are the protective factors for UC. Key Word(s): 1. IBD; 2. Ulcerative colitis; 3. Crohn’s disease; 4. Risk factor; Presenting Author: SHOMRON BEN-HORIN Additional Authors: BELLA UNGAR, YEHUDA CHOWERS, MIRI YAVZORI, ORIT PICARD, ELLA FUDIM, RAMI ELIAKIM Corresponding Author: SHOMRON BEN-HORIN Affiliations: Sheba Medical Center; Rambam Health Care Campus Objective: Despite ample research on the prevalence of antibodies to infliximab (ATI), their incidence during therapy is poorly defined. This knowledge gap may hamper the understanding of the clinical impact of anti-TNFs immunogenicity. We aimed to characterize the temporal evolution of ATI.

Neuschwander-Tetri – Advisory Committees or Review Panels: Boehring-er-Ingelheim Wnt activation Stephen H. Caldwell – Advisory Committees or Review Panels: Vital Therapy; Consulting: Wellstat diagnostics; Grant/Research Support: Genfit, Gilead Sciences Kris V. Kowdley – Advisory Committees or Review Panels: AbbVie, Gilead, Merck, Novartis, Trio

Health, Boeringer Ingelheim, Ikaria, Janssen; Grant/Research Support: AbbVie, Beckman, Boeringer Ingelheim, BMS, Gilead Sciences, Ikaria, Janssen, Merck, Mochida, Vertex Mary E. Rinella – Advisory Committees or Review Panels: Gilead The following people have nothing to disclose: Zurabi Lominadze, Michael Charl-ton Background: We already reported that incretin based medicine, such as GLP-1 analogues or DPP-4 inhibitors, leading to improve not only glycaemic control but

also liver inflammation in non-alcoholic fatty liver disease (NAFLD) patients with type 2 diabetes mellitus (T2DM). However, the features and differences between GLP-1 analogues and DPP-4 inhibitors are not well known. Aims: The aim of this study is to elucidate the features and differences of each incretin based medicine in NAFLD PF-02341066 nmr patients with T2DM compared to conventional treatments such as diet therapy, exercise therapy, and other pharmacological treatments including pioglitazone. Methods: We retrospectively enrolled consecutive 209 Japanese NAFLD patients with T2DM and divided these patients into three groups (GLP-1 group, DPP-4 group, and controls). We compared the base line characteristics and the changes of laboratory data and body weight among the three groups 上海皓元医药股份有限公司 at the end of follow-up. We also assessed the significant factors which contributed to rapid normalization of serum ALT level using multivariate Cox proportional hazard models. Results: There

were 41 patients treated with incretin based medicine (GLP-1 group), 88 patients treated with DPP-4 inhibitors (DPP-4 group), and 80 patients treated with conventional therapies (controls). At the end of follow-up, serum ALT level, fast blood glucose level, and HbA1c level significantly improved among the three groups. Although the body weight significantly decreased in incretin based medicine group (83.3 kg to 78.9 kg, P < 0.01), the body weight did not change in other two groups. The cumulative normalization rates of serum ALT level significantly differed among the three groups (P < 0.01); 20.9%, and 64.5% at 1 year, and 2 years in GLP-1 group, 31.7%, and 46.8% in DPP-4 group, and 23.4%, and 30.5% in the controls, respectively. Multivariate analysis indicated that administration of GLP-1 analogues (OR 0.61, P = 0.04), and age (per 1 year, OR 1.03, P = 0.

36 The diagnostic criteria include some combination of fever, abdominal pain, neutropenia, and bowel wall thickening.36,37 This syndrome may be seen, not only in leukemia, but also in aplastic anemia, cyclic neutropenia, and multiple myeloma, where the common denominator is neutropenia. Although initially described in children, it is increasingly being reported in adults. The incidence is rising probably due to the increased intensity of chemotherapy.38 The pooled incidence rate is 5.6% for

patients with acute leukemias treated with myelosuppressive chemotherapy.36 It occurs in 2.6%39 with acute leukemia and 11.6% or 32.5% of patients during chemotherapy.35,37 It is found in 9.9% to 46% of children with leukemia at autopsy.40,41 NE is the most common source of fever in AML after mucositis, PF-6463922 purchase pneumonia, and central venous catheter infections.42 It usually occurs during the onset or relapse of the leukemia rather Rapamycin price than during remission.41 Vincristine is implicated as it causes megacolon probably due to autonomic ganglia damage43 and may contribute

to cecal necrosis and perforation especially in the presence of corticosteroids.44 Cytosine arabinoside (Ara-C) causes mucosal alterations with surface glandular epithelial atypia and necrosis as well as delayed regeneration, leading to intestinal cytopenia.45 In those treated with the combination of idarubicin and Ara-c, 15% develop NE.46 The combination of 6-thioguanine and Ara-c may result in extensive

necrosis of small and large bowel.47 However, other factors besides chemotherapy are operative since NE can occur before chemotherapy,48 and the chemotherapy regimen does not differ between those who do and do not develop intestinal complications.49 The cecum may be prone to NE since its vascular and lymphatic systems are less abundant than those seen in the ileum and appendix. Vascular perfusion decreases with distension, and the cecum is more distensible than the remainder of the colon. Its large diameter results in greater wall tension at any given pressure than occurs in a smaller diameter organ according to LaPlace’s law.50 Colonic stasis is aggravated medchemexpress by decreased motility in these inactive, seriously-ill patients. The distension and impaired vascular perfusion lead to mucosal breaches in the wall permitting the entry of organisms, usually Gram-negative bacilli, which grow profusely in the absence of neutrophils. Ischemic necrosis follows, leading to perforation and/or peritonitis. One pathogenic event is shock involving large areas of the GI tract without leukemic infiltrates resulting in telangiectasias of submucosal vessels and submucosal edema leading to mucosal necrosis.51 Another process is necrosis of leukemic or lymphomatous infiltrates secondary to chemotherapy occurring at sites with the most abundant lymphoid tissue such as the terminal ileum and appendix.

36 The diagnostic criteria include some combination of fever, abdominal pain, neutropenia, and bowel wall thickening.36,37 This syndrome may be seen, not only in leukemia, but also in aplastic anemia, cyclic neutropenia, and multiple myeloma, where the common denominator is neutropenia. Although initially described in children, it is increasingly being reported in adults. The incidence is rising probably due to the increased intensity of chemotherapy.38 The pooled incidence rate is 5.6% for

patients with acute leukemias treated with myelosuppressive chemotherapy.36 It occurs in 2.6%39 with acute leukemia and 11.6% or 32.5% of patients during chemotherapy.35,37 It is found in 9.9% to 46% of children with leukemia at autopsy.40,41 NE is the most common source of fever in AML after mucositis, selleck chemical pneumonia, and central venous catheter infections.42 It usually occurs during the onset or relapse of the leukemia rather AZD6738 than during remission.41 Vincristine is implicated as it causes megacolon probably due to autonomic ganglia damage43 and may contribute

to cecal necrosis and perforation especially in the presence of corticosteroids.44 Cytosine arabinoside (Ara-C) causes mucosal alterations with surface glandular epithelial atypia and necrosis as well as delayed regeneration, leading to intestinal cytopenia.45 In those treated with the combination of idarubicin and Ara-c, 15% develop NE.46 The combination of 6-thioguanine and Ara-c may result in extensive

necrosis of small and large bowel.47 However, other factors besides chemotherapy are operative since NE can occur before chemotherapy,48 and the chemotherapy regimen does not differ between those who do and do not develop intestinal complications.49 The cecum may be prone to NE since its vascular and lymphatic systems are less abundant than those seen in the ileum and appendix. Vascular perfusion decreases with distension, and the cecum is more distensible than the remainder of the colon. Its large diameter results in greater wall tension at any given pressure than occurs in a smaller diameter organ according to LaPlace’s law.50 Colonic stasis is aggravated 上海皓元 by decreased motility in these inactive, seriously-ill patients. The distension and impaired vascular perfusion lead to mucosal breaches in the wall permitting the entry of organisms, usually Gram-negative bacilli, which grow profusely in the absence of neutrophils. Ischemic necrosis follows, leading to perforation and/or peritonitis. One pathogenic event is shock involving large areas of the GI tract without leukemic infiltrates resulting in telangiectasias of submucosal vessels and submucosal edema leading to mucosal necrosis.51 Another process is necrosis of leukemic or lymphomatous infiltrates secondary to chemotherapy occurring at sites with the most abundant lymphoid tissue such as the terminal ileum and appendix.

Results: Baseline demographics and clinical characteristics of the mothers and the infants were comparable. The incidence of undetectable HBV DNA levels was significantly higher in infants born to tel-bivudine-treated mothers than in the controls (P=8.433×1 0-1 8). The serum anti-HBs positive rate in infants delivered from telbivudine-treated

mothers over 3 months was significantly higher than in the controls (P<0.001). As for the serum HBsAg positive rate in infants over 6 months, the difference was strikingly significant between the two groups (P<0.001). Telbivudine-treated mothers displayed a marked decline in HBV DNA levels from the beginning to the end of the treatment. Twenty-five (20%) of 125 telbivudine-treated mothers had undetectable HBV DNA, as compared to 0% in the controls. No severe adverse events or complications were observed in telbivudine-treated Carfilzomib ic50 mothers or infants. The rate of spontaneous delivery in untreated mothers

and in telbivudine-treated mothers was similar (48.5% vs. 41.1%, P=0.1 70). Conclusion: Telbivudine was effective and well-tolerated in HBeAg-positive pregnant women and their infants, and it was associated with significant reduction of vertical transmission of HBV. [Key words] Hepatitis B virus, Telbivudine, Mother-to-child transmission, Prevention Disclosures: The AZD4547 research buy following people have nothing to disclose: Quanxin Wu, Xiaowen Sun, Meimin Pan, Shun Tan, Yi Zeng, Li Li, Guohong Deng, Hongfei Huang, Zehui Yan, Dengming He, Yuming Wang, JunNan Li Background and Aims: GS-9620 is an orally available specific agonist of TLR-7,

a highly conserved innate immune receptor. GS-9620 has demonstrated a rapid and sustained reduction in viral load and surface antigen levels in animal models of viral hepatitis (woodchuck [Stephan Menne et al, J Hepatol 201 1; 54: S441] and chimpanzees [Robert E. Lanford et al, Gastroenterology 201 3; 144(7): 1508-1517]). In healthy volunteers and in patients with chronic hepatitis C, low doses (0.3 mg-4 mg) of GS-9620 demonstrated ISG15 and CCL8 mRNA induction without systemic IFNα 上海皓元 related adverse events. We assessed the safety, tolerability and pharmacodynamics (PD) of GS-9620 in patients with chronic hepatitis B (CHB). Methods: A dose escalation (0.3 mg, 1 mg, 2 mg, 4 mg) placebo controlled study of a single dose or 2 doses one week apart, one in treatment naïve CHB patients and one in virologically suppressed CHB patients, is ongoing. Serum levels of IFNα and IP1 0 are being assessed by Cyraplex assay, and whole blood mRNA expression of ISG15 and CCL8 genes are being determined by qRT-PCR. Results: Patients demographics are summarized in the table. GS-9620 was well tolerated in both single (SAD) and multiple (MAD) dose cohorts, in both CHB patient populations. None of the patients experienced treatment related grade 2-4 AEs or hematologic reductions.

32 Cheung et al. have found that the growth factor, granulin-epithelin precursor (GEP), regulated chemoresistance in liver cancer cells through modulation of the expression of the ABCB5 drug transporter. Specifically, chemoresistant HCC cells that expressed GEP had increased levels of ABCB5, whereas suppression of ABCB5 sensitized Maraviroc molecular weight the cells to doxorubicin treatment and apoptosis. Most interestingly, HCC cells that expressed GEP and ABCB5 were also found to co-express the liver CSC markers, CD133 and EpCAM. Conversely, blocking ABCB5 reduced the expression of CD133 and EpCAM. The expression

levels of GEP and ABCB5 were increased in liver cancer cells, as compared with non-tumor liver tissue from patients with cirrhosis or hepatitis, or normal liver tissue. ABCB5 expression was also associated with a higher recurrence rate in patients with HCC who had undergone curative partial hepatectomy.33 The maintenance of CSCs involves regulatory pathways that are known to be involved

in stem cell maintenance and self-renewal and pluripotency, which include Bmi-1, Wnt/β-catenin, transforming growth factor-β (TGF-β), Notch and Sonic hedgehog. Thus, new therapeutic strategies targeting signaling pathways that are involved in the self-renewal of CSCs and which also block differentiated cancer cells have been suggested. In HCC, Everolimus mw the disruption of a number of these pathways has also been implicated in liver CSCs. Bmi-1 belongs to a family of polycomb group (PcG) proteins that are highly conserved throughout evolution and 上海皓元医药股份有限公司 are known to be vital transcriptional repressors, contributing to epigenetic chromatin modifications during stem cell self-renewal programs and tumor development. The forced expression of Bmi-1 was shown to promote the self-renewal

of hepatic stem/progenitor cells and contribute to malignant transformation,34 and the aberrant upregulation of Bmi-1 was found to play a particularly important role in liver CSCs identified by CD133+ and CD90+ expression.14,15,22,23 Chiba et al. performed a more detailed study on the critical role of Bmi-1 in the maintenance of CSCs with the SP phenotype in HCC cell lines. The knockdown of Bmi-1 completely abolished the self-renewal and tumorigenic potential of SP cells.35 Results from the same study indicated that Bmi-1 expression was also tightly correlated with the CSC phenotype represented by CD133+ HCC cells because altering Bmi-1 expression resulted in a similar change in the maintenance of a CD133 subpopulation in liver cancer cells.35 The Wnt/β-catenin signaling pathway plays a critical role in the proliferation, self-renewal and differentiation of stem cells in many tissue types. Disruption of WNT signaling results from both genetic and epigenetic changes and is associated with a wide range of cancer types, especially colon cancer and liver cancer.

32 Cheung et al. have found that the growth factor, granulin-epithelin precursor (GEP), regulated chemoresistance in liver cancer cells through modulation of the expression of the ABCB5 drug transporter. Specifically, chemoresistant HCC cells that expressed GEP had increased levels of ABCB5, whereas suppression of ABCB5 sensitized Opaganib order the cells to doxorubicin treatment and apoptosis. Most interestingly, HCC cells that expressed GEP and ABCB5 were also found to co-express the liver CSC markers, CD133 and EpCAM. Conversely, blocking ABCB5 reduced the expression of CD133 and EpCAM. The expression

levels of GEP and ABCB5 were increased in liver cancer cells, as compared with non-tumor liver tissue from patients with cirrhosis or hepatitis, or normal liver tissue. ABCB5 expression was also associated with a higher recurrence rate in patients with HCC who had undergone curative partial hepatectomy.33 The maintenance of CSCs involves regulatory pathways that are known to be involved

in stem cell maintenance and self-renewal and pluripotency, which include Bmi-1, Wnt/β-catenin, transforming growth factor-β (TGF-β), Notch and Sonic hedgehog. Thus, new therapeutic strategies targeting signaling pathways that are involved in the self-renewal of CSCs and which also block differentiated cancer cells have been suggested. In HCC, Napabucasin the disruption of a number of these pathways has also been implicated in liver CSCs. Bmi-1 belongs to a family of polycomb group (PcG) proteins that are highly conserved throughout evolution and 上海皓元 are known to be vital transcriptional repressors, contributing to epigenetic chromatin modifications during stem cell self-renewal programs and tumor development. The forced expression of Bmi-1 was shown to promote the self-renewal

of hepatic stem/progenitor cells and contribute to malignant transformation,34 and the aberrant upregulation of Bmi-1 was found to play a particularly important role in liver CSCs identified by CD133+ and CD90+ expression.14,15,22,23 Chiba et al. performed a more detailed study on the critical role of Bmi-1 in the maintenance of CSCs with the SP phenotype in HCC cell lines. The knockdown of Bmi-1 completely abolished the self-renewal and tumorigenic potential of SP cells.35 Results from the same study indicated that Bmi-1 expression was also tightly correlated with the CSC phenotype represented by CD133+ HCC cells because altering Bmi-1 expression resulted in a similar change in the maintenance of a CD133 subpopulation in liver cancer cells.35 The Wnt/β-catenin signaling pathway plays a critical role in the proliferation, self-renewal and differentiation of stem cells in many tissue types. Disruption of WNT signaling results from both genetic and epigenetic changes and is associated with a wide range of cancer types, especially colon cancer and liver cancer.

On average, a health care provider can reasonably initiate therapy on only three patients each week before exceeding their work capacity. Because we anticipate at least 500 requests for evaluation for HCV therapy within the first few weeks of DAA availability, current staffing will be unable to meet the demands of all patients with HCV who are expected to request treatment. Resource scarcity will be a prominent issue once DAA therapy becomes available. Historically, enthusiasm over

a scientific breakthrough has caused the medical community Talazoparib ic50 to lose sight of the importance of prediction and resolution of problems of scarcity.9 In 1922, Frederick Banting and Charles Best discovered how to produce and use insulin to treat diabetes mellitus. Word of this life-saving medication traveled quickly, creating a deluge of requests for insulin that could not possibly be fulfilled due to limitations of production capacity.10 Unprepared to handle this dilemma, Dr. Banting created a somewhat arbitrary and subjective plan where Banting himself decided whom to treat first, which resulted in friends and politically well-connected individuals unfairly receiving priority over others.9 Twenty years later, penicillin was discovered, and efforts were made to avoid the injustices seen with insulin allocation. From 1942 to 1944, the Committee on Chemotherapeutic and Other Agents was responsible for rationing

penicillin to civilians.11 Although efforts were made to prioritize clinical need over political and social worth, penicillin allocation became subject to intense scrutiny due to a double standard in rationing Doxorubicin mw for civilian and military personnel. Penicillin was carefully allocated to civilians based on severity of disease; however, it was liberally given to military personnel to treat gonorrhea, a less serious illness, because it was highly effective and allowed soldiers to quickly return to their duties.9 In 1960, Belding Scribner developed a shunt that allowed patients with chronic kidney disease 上海皓元 to safely undergo dialysis.12

Given the paucity of dialysis machines compared to the number of patients with chronic kidney disease, physicians were once again forced to allocate scarce, life-saving technology. A nine-member committee consisting of two physicians and seven lay persons was formed in 1961 to determine who would receive dialysis services. Because most patients with chronic kidney disease had similar medical needs for dialysis, the committee made decisions in part based on a patient’s “social worth.”9 Not surprisingly, this criterion was widely criticized and eventually led to approval of legislation in 1972 to allow federal funding for hemodialysis to all Americans with chronic kidney disease. In 2011, nearly a century after the discovery of insulin, we continue to struggle with issues of resource scarcity.

On average, a health care provider can reasonably initiate therapy on only three patients each week before exceeding their work capacity. Because we anticipate at least 500 requests for evaluation for HCV therapy within the first few weeks of DAA availability, current staffing will be unable to meet the demands of all patients with HCV who are expected to request treatment. Resource scarcity will be a prominent issue once DAA therapy becomes available. Historically, enthusiasm over

a scientific breakthrough has caused the medical community DAPT mouse to lose sight of the importance of prediction and resolution of problems of scarcity.9 In 1922, Frederick Banting and Charles Best discovered how to produce and use insulin to treat diabetes mellitus. Word of this life-saving medication traveled quickly, creating a deluge of requests for insulin that could not possibly be fulfilled due to limitations of production capacity.10 Unprepared to handle this dilemma, Dr. Banting created a somewhat arbitrary and subjective plan where Banting himself decided whom to treat first, which resulted in friends and politically well-connected individuals unfairly receiving priority over others.9 Twenty years later, penicillin was discovered, and efforts were made to avoid the injustices seen with insulin allocation. From 1942 to 1944, the Committee on Chemotherapeutic and Other Agents was responsible for rationing

penicillin to civilians.11 Although efforts were made to prioritize clinical need over political and social worth, penicillin allocation became subject to intense scrutiny due to a double standard in rationing Selleck AZD1208 for civilian and military personnel. Penicillin was carefully allocated to civilians based on severity of disease; however, it was liberally given to military personnel to treat gonorrhea, a less serious illness, because it was highly effective and allowed soldiers to quickly return to their duties.9 In 1960, Belding Scribner developed a shunt that allowed patients with chronic kidney disease MCE to safely undergo dialysis.12

Given the paucity of dialysis machines compared to the number of patients with chronic kidney disease, physicians were once again forced to allocate scarce, life-saving technology. A nine-member committee consisting of two physicians and seven lay persons was formed in 1961 to determine who would receive dialysis services. Because most patients with chronic kidney disease had similar medical needs for dialysis, the committee made decisions in part based on a patient’s “social worth.”9 Not surprisingly, this criterion was widely criticized and eventually led to approval of legislation in 1972 to allow federal funding for hemodialysis to all Americans with chronic kidney disease. In 2011, nearly a century after the discovery of insulin, we continue to struggle with issues of resource scarcity.