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X. Asam, M.A., M.D., M.P.H.

Professor, University of Miami Leonard M. Miller School of Medicine

However, because of events such as noted above, modern scientists in other fields almost never claim that their knowledge is totally comprehensive. The existence of non-science factors uniquely allows and encourages such views in evolutionary mechanics science. Some traditional biologists dismiss adaptive theories for this reason and some biology textbooks heavily promote this idea. However, the traditional view of the effect of aging on fitness is overly simplified. In the following sections we shall see how characteristics of actual animals greatly increase the impact of aging on animal populations. In the wild, animals die mainly of predator attack, warfare, inability to obtain food, disease, and environmental conditions. Aging causes weakness, reduced agility and mobility, increased susceptibility to disease, increased susceptibility to adverse environmental conditions, deterioration of senses, and reduced reproductive effectiveness. It is therefore clear that, in wild populations, well prior to the occurrence of "programmed death", aging causes greatly increased probability of death from the causes listed above. Aging does not have to , directly, by itself, cause death in order to result in death and thus have an impact on evolution. If a lion is chasing 100 wildebeest in the Serengeti which one is going to be caught? Therefore, we can think of genetically programmed aging as causing programmed weakness, programmed increased susceptibility to disease, programmed reduced mobility, programmed reduced sexual vigor, etc. The effect of aging in actual wild animals on fitness and thereby natural selection is therefore not insignificant. Studies on large wild animals such as those of Anne Loison[27] of the Norwegian Institute for Nature Research (See Resources) confirm that death rates increase with age beginning at rather young ages. Another aspect of the performance deterioration caused by aging in most animals is that it generally gradually increases. Those familiar with different breeds of dogs know how different members of the same species can be from each other as a result of selective breeding. We now know that evolution of two different species from a single parent species (speciation) occurs when genetic differences between two breeds significantly interfere with the various complex processes involved in meiosis (such as matching and swapping of genetic instructions between parent chromosomes) and other aspects of sexual reproduction. Once speciation occurs, it is reasonable to believe that evolution of the descendent species proceeds more rapidly because interbreeding becomes difficult or impossible. Species is a very important concept to understanding evolution and to understanding the interaction of various organisms present at any particular point in time. However, how does the concept of "species" relate to the time-sequential flow of evolution? It is wholly irrelevant if "mouse" of today could or could not interbreed with "mouse" of 1000 years ago. Assuming mice are under evolutionary pressure, then "mouse" of this year is presumably a minutely different species from "mouse" of last year. Is "species" even an applicable concept when considering the time-sequential flow of evolution? Group Selection and Evolutionary Immediacy All of the evolution theories we will be discussing agree that the design of an organism (or any complex system) is a forest of compromises or tradeoffs. Whether a design change would be incorporated by the evolution process depends on the existence of net benefit. A major functional difference in evolution theories is the extent to which a future, long-term benefit can offset an immediate, short-term cost during the evolution process. Since workers and warriors were sterile, they could not have evolved by means of strict Darwinian natural selection. Apparently, the workers and warriors evolved by virtue of the collective fates of their colonies. Depending on the beneficial characteristics of the workers and warriors, the colony would survive or not survive thus selecting the beneficial characteristics of the workers or warriors.

By participating in this, a Soldier is contributing to the enslavement of women and girls from all over the world. Army, 2nd Infantry Division Preventive Medicine Officer, 2004 Reverse Stings the most commonly used tactic to address demand for commercial sex is most usually referred to as the reverse sting. These police special operations feature one or more women officers serving as a decoy (or decoys), posing as a prostitute to await being approached by those attempting to purchase sex. The term "reverse sting" is an artifact of the historic gender inequity in the enforcement of prostitution. Until relatively recently, the vast majority of all police attention devoted to prostitution was focused on arresting providers of commercial sex. The most common police tactic to combat commercial sex was operations using plainclothes male officers use to elicit offers of commercial sex from prostituted persons. To distinguish those operations from the more traditional stings, the term "reverse stings" devolved into common usage, and implies that those operations that are something other than the typical or default tactic. The term is somewhat controversial particularly for advocates of approaches in which the majority of police attention is focused on buyers rather than sellers sex. It has been proposed by many that the movement to eradicate sexual exploitation should promote the use of the term sting to apply to operations aimed at johns, and not to arrests providers of commercial sex at all. Since the Campaign and this report will address broad audiences and the term reverse sting is still the most common usage, we will continue to use that. As the National Campaign works on messaging, one of the considerations regarding use of language may be whether to work on changing the terminology used to describe police decoy operations. Chapter 7: An Overview of Tactics Used to Combat Demand 7-9 Street-Level Reverse Stings In our observations of reverse stings, and in descriptions gathered from interviews with police and reviews of the literature (Jetmore, 2008; Newman, 2007; Nolan, 2001; Scott, 1999; Spruill, 2009), we found the following to be typical. In addition to the female officer or officers, there are usually several additional undercover police in supporting roles. The operations often consist of one or two male plainclothes officers on foot, posing as pedestrians, at least one unmarked car carrying plainclothes officers, and at least one police patrol car with officers that may be in uniform. There are usually other officers who support the operations by processing arrestees and their vehicles. In some cases, police use a van serving as a mobile booking or screening station, and in other instances processing occurs in nearby police stations or substations. In the latter circumstance, the operations require more on-site officers so that there is less "down time" between arrests. While there is no good data source that would allow a firm average to be calculated, from our observations and literature we believe that at least five police officers are required for reverse stings using one female decoy. An unmarked police van serving as a mobile screening or booking station is usually parked nearby, but out of sight of the street operation. The decoy officer is often dropped off with a tape recorder, hidden mic, and cell phone (for safety, in case she is abducted). Some police departments videotape the reverse stings surreptitiously from one of the unmarked police cars. When potential "clients" speak with the decoy, the supporting officers track her carefully until she makes a pre-arranged signal indicating a "good case," which is when the man has made an offer of money in exchange for sex and has committed an "act in furtherance" of that offer. Any overt behavior that can be construed reasonably to move toward consummating the act of prostitution implied by the verbal exchange completes the legal requirements for making an arrest. When the signal for a "good case" is given, the officers on foot and in unmarked cars converge and make the arrest. At this point, the decoy officer enters the police car as quickly as possible and leaves the scene, while the man is arrested and driven to a point where he will be processed. Arrestees who are on foot are driven to the van or police station in a patrol car. It they have identification and no outstanding warrants, they are usually issued a citation and allowed to leave. In the time it takes the officers to process the arrestee, the decoy officer usually remains in an unmarked car writing notes for her report and (if applicable) checking to ensure that the quality of the tape of the transaction was acceptable. She stays out of sight of the arrestee and away from the location where the arrest was made, until it is time to reset the operation. When reverse stings use multiple decoys, it is possible to keep the street operations going continuously: if one or two of the decoys have made a good case and the men are being processed, there can still be one or more decoys active, provided that there are enough support officers for a safe operation.

If not, are there other organizations that provide accurate information as well as social support? The third principle of professionalism, to promote social justice, reminds doctors that their role responsibilities extend to broader populations. In addition to the questions above, then, doctors might also ask themselves: Am I considering the unmet needs of women from disadvantaged communities? Addressing these questions reveals that in this case there is a strong link between evidence-based care and promoting the welfare of individual women. Yet it is crucial for women to be informed about advocacy groups that can empower them and promote their health. The challenge for physicians is to balance both of these obligations to best serve the goals of medical care. Thus, while it may be fine to bring brochures to the medical staff room, we would recommend against distributing brochures in the patient waiting room. Sanders should inform individual patients about the organization and its pros and cons as part of educating them both about the need for discernment regarding mammography and about the health value of social support. Wang does not know of another comparable source of social support, we think that, despite his misgivings, he too should inform women about this organization as one source of possible social support even as he shares his concerns with them. Wang might also support the development of more evidence-based advocacy groups (through speaking or writing about the science, for example). Still, practicing evidence-based medicine is one of the most powerful ways to serve individual patients, so professionalism will most often coincide with favoring scientific practice. The ethical issue is to see that science-as it constitutes the "evidence base"-is a means to the end of helping real people. Good clinical practice integrates clinical research, professional experience, and knowledge of the individual patient. Cancer screening in the United States, 2009: a review of current American Cancer Society guidelines and issues in cancer screening. Evidence-based medicine, heterogeneity of treatment effects, and the trouble with averages. A psychiatrist with a doctorate in philosophy, she is the author of From Detached Concern to Empathy: Humanizing Medical Practice (paperback 2011, Oxford University Press). It is, after all, a desirable outcome for any curriculum in evidence-based medicine to produce graduates who not only understand the medical literature, but who can appraise, discuss, and apply what they read in a sound, thoughtful, and efficient manner [1]. When critical appraisal skills remain underdeveloped, students tend to resort to other, less useful approaches. One of these might be called convenient appraisal, in which the reader merely accepts, at face value, what the literature claims. Another, equally concerning, approach might be called cynical appraisal, in which the reader simply rejects the bulk of the literature, perhaps citing the potential for bias in all research studies. Instruction in critical appraisal skills is sometimes deferred in favor of teaching students what they read rather than demonstrating how to read it. Below are three practical methods for reversing this trend-that is, for actively teaching critical appraisal skills in an evidence-based medicine curriculum. It is hard to imagine a student who believes that basing the practice of medicine on evidence is unimportant. There are certainly many, however, who question whether incorporating the skills of evidence-based medicine into clinical decision making is practicable and who doubt that they can ever become proficient in these skills. Indeed, understanding of evidence-based medicine concepts among medical learners tends to be lower than desired [2]. Yet, the fact is that many principles of evidence-based medicine-including some of the most complex-mirror the way that many clinicians already think about medicine. For instance, the likelihood that a treatment will benefit a patient often depends on the characteristics of the patients in whom it is used. This parallels the evidence-based medicine concepts of "effect modification" or its practice of differentiating between effectiveness and efficacy. Likewise, individual patients and their experiences are, unsurprisingly, not all the same. This nonuniformity can be linked to discussions in evidence-based medicine about diagnostic validity and precision or about variation and central tendency. For instance, how might a particular diagnostic result be interpreted in a population at high risk for disease compared to a population at lower risk?