Heart and lung transplant recipients require care provided by clinicians from multiple different specialties, each contributing unique expertise and perspective. The period the patient spends in the intensive care unit is one of the most critical times in the perioperative trajectory. Various organizational models of intensive care exist, including those led by intensivists, surgeons, transplant cardiologists, and pulmonologists. Coordinating timely efficient intensive care is an essential and logistically difficult goal. The present work product of the American Society of Transplantation\'s Thoracic and Critical Care Community of Practice, Critical Care Task Force outlines operational guidelines and principles that may be applied in different organizational models to optimize the delivery of intensive care for the cardiothoracic organ recipient.

Leadership is a widespread phenomena in social organisms and it is recognised to facilitate coordination between individuals. While the role of leadership in group foraging or swarm movement is well understood, it is not clear if leaders would also benefit more complex forms of coordination. In particular, a number of organisms coordinate by consensus decision-making, where individuals explicitly communicate their opinions until they converge toward a common decision. Taking inspiration from physical sciences, we extend a consensus formation model to integrate leaders, which we define by three traits: persuasiveness, talkativeness, and stubbornness. We use numerical simulations to investigate the effect of the number of leaders and their characteristics on the time a group spends to reach consensus, and the bias in the final decision. We show that having a minority of influential individuals (leaders) and a majority of influenceable individuals (followers) reduces the time to reach consensus, but biases the decision towards the preferences of the leaders. This effect emerges solely from the differences in individuals\' personality traits, with the most determinant trait being the talkativeness of the individuals. Overall, we provide a comprehensive investigation of the effects of leaders and their traits on consensus decision-making.

Coordination and consensus in collective behavior have attracted a lot of research interest. Although previous studies have investigated the role of compromisers in group consensus, they provide little insight into why compromisers would allow such social arrangements to persist. In this study, the potential relationship between group movements and conflict management in Tibetan macaques in Anhui province, China, was investigated using hierarchical cluster analyses. Some members with higher social centrality or social rank often formed a front-runner cluster during group movements. They had higher leadership success than individuals outside the front-runner cluster. Other members with lower social centrality or social rank often followed the group movements initiated by the front-runner cluster, and thus formed the compromiser cluster. Compromisers\' proximity relations with front-runners increased with their following scores to front-runners. Compromisers had fewer events of being attacked when they followed group movements initiated by the front-runners. The compromising process made compromisers lose the choice of direction preference, but it could increase their individual safeties. This trade-off suggests that compromisers play a role of decision-maker in coordination and consensus scenarios among social animals.

For group-living animals to remain cohesive they must agree on where to travel. Theoretical models predict shared group decisions should be favoured, and a number of empirical examples support this. However, the behavioural mechanisms that underpin shared decision-making are not fully understood. Groups may achieve consensus of direction by active communication of individual preferences (i.e. voting), or by responding to each other\'s orientation and movement (i.e. copying). For example, African buffalo (Syncerus caffer) are reported to use body orientation to vote and indicate their preferred direction to achieve a consensus on travel direction, while golden shiners (Notemigonus crysoleucas) achieve consensus of direction by responding to the movement cues of their neighbours. Here, we present a conceptual model (supported by agent-based simulations) that allows us to distinguish patterns of motion that represent voting or copying. We test our model predictions using high-resolution GPS and magnetometer data collected from a herd of free-ranging goats (Capra aegagrus hircus) in the Namib Desert, Namibia. We find that decisions concerning travel direction were more consistent with individuals copying one another\'s motion and find no evidence to support the use of voting with body orientation. Our findings highlight the role of simple behavioural rules for collective decision-making by animal groups.

The collection and classification of data into meaningful categories is a key step in the process of knowledge making. In the life sciences, the design of data discovery and integration tools has relied on the premise that a formal classificatory system for expressing a body of data should be grounded in consensus definitions for classifications. On this approach, exemplified by the realist program of the Open Biomedical Ontologies Foundry, progress is maximized by grounding the representation and aggregation of data on settled knowledge. We argue that historical practices in systematic biology provide an important and overlooked alternative approach to classifying and disseminating data, based on a principle of coordinative rather than definitional consensus. Systematists have developed a robust system for referring to taxonomic entities that can deliver high quality data discovery and integration without invoking consensus about reality or \"settled\" science.

Whether individual behavior in social settings correlates with behavior when individuals are alone is a fundamental question in collective behavior. However, evidence for whether behavior correlates across asocial and social settings is mixed, and no study has linked observed trends with underlying mechanisms. Consistent differences between individuals in boldness, which describes willingness to accept reward over risk, are likely to be under strong selection pressure. By testing three-spined sticklebacks (Gasterosteus aculeatus) in a risky foraging task alone and repeatedly in shoals, we demonstrate that the expression of boldness in groups is context-specific. Whereas personality is repeatable in a low-risk behavior (leaving a refuge), the collectively made consensus decision to then cross the arena outweighs leadership by bolder individuals, explaining the suppression of personality in this context. However, despite this social coordination, bolder individuals were still more likely to feed. Habituation and satiation over repeated trials degrade the effect of personality on leaving the refuge and also whether crossing the arena is a collective decision. The suppression of personality in groups suggests that individual risk-taking tendency may rarely represent actual risk in social settings, with implications for the evolution and ecology of personality variation.

Shortages of essential drugs, including critical chemotherapy drugs, have become commonplace. Drug shortages cost significant time and financial resources, lead to adverse patient outcomes, delay clinical trials, and pose significant ethical challenges. Pediatric oncology is particularly susceptible to drug shortages, presenting an opportunity to examine these ethical issues and provide recommendations for preventing and alleviating shortages. We convened the Working Group on Chemotherapy Drug Shortages in Pediatric Oncology (WG) and developed consensus on the core ethical values and practical actions necessary for a coordinated response to the problem of shortages by institutions, agencies, and other stakeholders. The interdisciplinary and multiinstitutional WG included practicing pediatric hematologist-oncologists, nurses, hospital pharmacists, bioethicists, experts in emergency management and public policy, legal scholars, patient/family advocates, and leaders of relevant professional societies and organizations. The WG endorsed 2 core ethical values: maximizing the potential benefits of effective drugs and ensuring equitable access. From these, we developed 6 recommendations: (1) supporting national polices to prevent shortages, (2) optimizing use of drug supplies, (3) giving equal priority to evidence-based uses of drugs whether they occur within or outside clinical trials, (4) developing an improved clearinghouse for sharing drug shortage information, (5) exploring the sharing of drug supplies among institutions, and (6) developing proactive stakeholder engagement strategies to facilitate prevention and management of shortages. Each recommendation includes an ethical rationale, action items, and barriers that must be overcome. Implemented together, they provide a blueprint for effective and ethical management of drug shortages in pediatric oncology and beyond.

Despite widespread public awareness in Kenya about the HIV/AIDS epidemic, most policy makers in government and other sectors as of 1994 chose not to adopt and implement HIV/AIDS prevention and control policies. Since then, however, the HIV/AIDS policy situation has changed in many ways. Officials now hope to see practical policies adopted and implemented. The government is preparing a national HIV/AIDS policy and has sought input from a broad range of technical, legal, ethical, and policy opinion makers. With support from the AIDS Control and Prevention (AIDSCAP) Project, MAP International facilitated policy-oriented discussions among church leaders, while the Kenya AIDS Nongovernmental Organizations Consortium solicited the experiences and views of local constituents during a series of district and provincial policy workshops. These and other efforts to shape HIV/AIDS policy include improvements in the policy climate in Kenya, better mechanisms for strengthening HIV/AIDS prevention and care, and some specific changes in policy. Policy development, the policy climate, improved mechanisms, and policy change are discussed.

This paper presents elements of the growing governmental and organizational consensus that population issues are at the heard of sustainable development. An integrated approach to population and resources is urgently needed. This approach would comprehensively consider population dynamics and not simply fertility. Radical change in approach, policy, and decision making processes are needed to effect such an approach, as are a better understanding of relevant science, strengthened political commitment, and additional financial support. Governments and organizations also agree that population targets should be consistent with national development goals and that the role and status of women are at the center of population and environment strategies. Overall, a participatory approach and national capacity building are the two major ingredients of efficient population/environment activities.

The UN International Conference on Population and Development (ICPD) in Cairo through September 5-13, 1994, will be remembered for having achieved the global consensus among 180 countries that population is a serious issue which merits attention at the highest levels of government, that population should be considered in the broader context of development, and that improving the status of women is integral not only to addressing issues of population growth but also to sustaining global development efforts. World governments and international organizations agreed to triple levels of current world spending upon population programs to $17 billion by the year 2000 for activities in the developing world and the former Soviet Union, with two-thirds of the funds coming from the recipient countries themselves and the rest from external sources. International agreement was even reached to view family planning as a component of more comprehensive reproductive health care and that the notion of sexual health is a critical aspect of reproductive health. Finally, thanks to Vatican stonewalling, this ICPD represents the first time that the reality of abortion was discussed at length and in depth at any international governmental meeting; the Vatican insisted that debate on abortion continue over three days and nights.