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Medical privacy

Medical privacy, or health privacy, is the practice of maintaining the security and confidentiality of patient records. It involves both the conversational discretion of health care providers and the security of medical records. The terms can also refer to the physical privacy of patients from other patients and providers while in a medical facility, and to modesty in medical settings. Modern concerns include the degree of disclosure to insurance companies, employers, and other third parties. The advent of electronic medical records (EMR) and patient care management systems (PCMS) have raised new concerns about privacy, balanced with efforts to reduce duplication of services and medical errors.

Most developed countries including Australia, Canada, Turkey, the United Kingdom, the United States, New Zealand, and the Netherlands have enacted laws protecting people's medical health privacy. However, many of these health-securing privacy laws have proven less effective in practice than in theory. In 1996, the United States passed the Health Insurance Portability and Accountability Act (HIPAA) which aimed to increase privacy precautions within medical institutions.

History
The history of medical privacy traces back to the Hippocratic Oath, which mandates the secrecy of information obtained while helping a patient.

Before the technological boom, medical institutions relied on the paper medium to file individual medical data. Nowadays, more and more information is stored within electronic databases. Research indicates that storing information on paper is safer because it is more difficult to physically steal, whereas digital records are vulnerable to hacker access.

In the early 1990s, to address healthcare privacy issues, researchers explored using credit cards and smart cards to enable secure access to medical information, aiming to mitigate fears of data theft. The "smart" card allowed the storage and processing of information to be stored in a singular microchip, yet people were fearful of having so much information stored in a single spot that could easily be accessed. This "smart" card included an individual's social security number as an important piece of identification that can lead to identity theft if databases are breached. Additionally, there was the fear that people would target these medical cards because they have information that can be of value to many different third parties, including employers, pharmaceutical companies, drug marketers, and insurance reviewers.

In response to the lack of medical privacy, there was a movement to create better medical privacy protection, but nothing has been officially passed. The Medical Information Bureau was thus created to prevent insurance fraud, yet it has since become a significant source of medical information for over 750 life insurance companies; thus, it is very dangerous as it is a target of privacy breaches. Although the electronic filing system of medical information has increased efficiency and administration costs have been reduced, there are negative aspects to consider. The electronic filing system allows for individual information to be more susceptible to outsiders; even though their information is stored on a singular card. Therefore, the medical card serves as a false sense of security as it does not protect their information completely.

Patient care management systems (PCMS)
With the technological boom, there has been an expansion of the record filing system and many hospitals have therefore adopted new PCMS. PCMS store large amounts of medical records, and hold the personal data of many individuals. These have become critical to the efficiency of storing medical information because of the high volumes of paperwork, the ability to quickly share information between medical institutions, and the increased mandatory reporting to the government. PCMS have ultimately increased the productivity of data record utilization and have created a large dependence on technology within the medical field.

It has also led to social and ethical issues because basic human rights are considered to be violated by the PCMS, since hospitals and health information services are now more likely to share information with third-party companies. Thus, there needs to be a reformation to specify which hospital personnel have the access to medical records. This has led to the discussion of privacy rights and created safeguards that will help data keepers understand situations where it is ethical to share an individual's medical information, provide ways for individuals to gain access to their own records, and determine who has ownership of those records. Additionally, it is used to ensure that a person's identity is kept confidential for research or statistical purposes and to understand the process to make individuals aware that their health information is being used. Thus, a balance between privacy and confidentiality must be kept in order to limit the amount of information disclosed and protect patients' rights by safeguarding sensitive information from third parties.

Electronic Medical Records (EMR)
Electronic medical records are a more efficient way of storing medical information, yet there are many negative aspects of this type of filing system as well. Hospitals are willing to adopt this type of filing system only if they are able to ensure that the private information of their patients is sufficiently protected.

Researchers have found that U.S. state legislation and regulation of medical privacy laws reduce the number of hospitals that adopt EMR by more than 24%. This is due to decreasing positive network externalities that are created by additional state protections. With increases in restrictions against the diffusion of medical information, hospitals have neglected to adopt the new EMRs because privacy laws restrict health information exchanges. With decreasing numbers of medical institutions adopting the EMR filing system, the U.S. government's plan of a national health network has not been fully recognized. The national network will ultimately cost US$156 billion in investments, yet in order for this to happen, the U.S. government needs to place a higher emphasis on protecting individual privacy. Many politicians and business leaders find that EMRs allow for more efficiency in both time and money, yet they neglect to address the decreasing privacy protections, demonstrating the significant trade-off between EMRs and individual privacy.

Privacy and Electronic Health Records (EHR)
The three goals of information security, including electronic information security, are confidentiality, integrity, and availability. Organizations are attempting to meet these goals, referred to as the C.I.A. Triad, which is the "practice of defending information from unauthorized access, use, disclosure, disruption, modification, inspection, recording or destruction."

In a 2004 editorial in the Washington Post, U.S. Senators Bill Frist and Hillary Clinton supported this observation, stating "[patients] need...information, including access to their own health records... At the same time, we must ensure the privacy of the systems, or they will undermine the trust they are designed to create". A 2005 report by the California Health Care Foundation found that "67 percent of national respondents felt 'somewhat' or 'very concerned' about the privacy of their personal medical records".

The importance of privacy in electronic health records became prominent with the passage of the American Recovery and Reinvestment Act (ARRA) in 2009. One of the provisions (known as the Health Information Technology for Economic and Clinical Health [HITECH] Act) of the ARRA mandated incentives to clinicians for the implementation of electronic health records by 2015.Privacy advocates in the United States have raised concerns about unauthorized access to personal data as more medical practices switch from paper to electronic medical records. The Office of the National Coordinator for Health Information Technology (ONC) explained that some of the safety measures that EHR systems can utilize are passwords and pin numbers that control access to such systems, encryption of information, and an audit trail to keep track of the changes made to records.

Providing patient access to EHRs is strictly mandated by HIPAA's Privacy Rule. One study found that each year there are an estimated 25 million compelled authorizations for the release of personal health records. . Researchers, however, have found new security threats open up as a result. Some of these security and privacy threats include hackers, viruses, worms, and the unintended consequences of the speed at which patients are expected to have their records disclosed while frequently containing sensitive terms that carry the risk of accidental disclosure.

These privacy threats are made more prominent by the emergence of "cloud computing", which is the use of shared computer processing power. Health care organizations are increasingly using cloud computing as a way to handle large amounts of data. This type of data storage, however, is susceptible to natural disasters, cybercrime and technological terrorism, and hardware failure. Health information breaches accounted for the 39 percent of all breaches in 2015. IT Security costs and implementations are needed to protect health institutions against security and data breaches.

Health screening cases
Although privacy issues with the health screening is a great concern among individuals and organizations, there has been little focus on the amount of work being done within the law to maintain the privacy expectation that people desire. Many of these issues lie within the abstractness of the term "privacy" as there are many different interpretations of the term, especially in the context of the law. Prior to 1994, there had been no cases regarding screening practices and the implications towards an individual's medical privacy, unless it was regarding HIV and drug testing. Within Glover v Eastern Nebraska Community Office of Retardation, an employee sued her employer against violating her 4th amendment rights because of unnecessary HIV testing. The court ruled in favor of the employer and argued that it was unreasonable search to have it tested. However, this was only one of the few precedents that people have to use. With more precedents, the relationships between employees and employers will be better defined. Yet with more requirements, testing among patients will lead to additional standards for meeting health care standards. Screening has become a large indicator for diagnostic tools, yet there are concerns with the information that can be gained and subsequently shared with other people other than the patient and healthcare provider

Third party issues
One of the main dangers to an individual's privacy are private corporations because of the profits they can receive from selling seemingly private information. Privacy merchants are made up of two groups - one that tries to collect people's personal information while the other focuses on using client's information to market company products. Subsequently, privacy merchants purchase information from other companies, such as health insurance companies, if there is not sufficient information from their own research. Privacy merchants target health insurance companies because, nowadays, they collect huge amounts of personal information and keep them in large databases. They often require patients to provide more information that is needed for purposes other than that of doctors and other medical workers.

Additionally, people's information can be linked to other information outside of the medical field. For example, many employers use insurance information and medical records as an indicator of work ability and ethic. The selling of privacy information can also lead employers to make much money; however, this happens to many people without their consent or knowledge.

Within the United States, in order to define clear privacy laws regarding medical privacy, Title 17 thoroughly explains the ownership of one's data and adjusted the law so that people have more control over their own property. The Privacy Act of 1974 offers more restrictions regarding what corporations can access outside of an individual's consent.

States have created additional supplements to medical privacy laws. With HIPAA, many individuals were pleased to see the federal government take action in protecting the medical information of individuals. Yet when people looked into it, there was proof that the government was still protecting the rights of corporations. Many rules were seen as more of suggestions and the punishment for compromising the privacy of its patients were minimal. Even if release of medical information requires consent, blank authorizations can be allowed and will not ask for individuals for additional consent later on.

Although there is a large group of people who oppose the selling of individual's medical information, there are groups such as the Health Benefits Coalition, the Healthcare Leadership Council, and the Health Insurance Association of America that are against the new reforms for data protection as it can ruin their work and profits. Previous controversies, such as Google's "Project Nightingale" in 2019 have demonstrated potential holes in regulations of patient data and medical information. Project Nightingale, a joint effort between Google and the healthcare network Ascension, saw to the selling of millions of patients' identifiable medical information without their consent. Though Google claimed that their process was legal in obtaining the information, there was concern between researchers on this claim.

Efforts to protect health information
With the lack of help from the Department of Health and Human Services there is a conflict of interest that has been made clear. Some wish to place individual betterment as more important, while others focus more on external benefits from outside sources. The issues that occur when there are problems between the two groups are also not adequately solved which leads to controversial laws and effects. Individual interests take precedence over the benefits of society as a whole and are often viewed as selfish and for the gain of capital value. If the government does not make any more future changes to the current legislation, countless organizations and people will have access to individual medical information.

In 1999, the Gramm-Leach-Billey Act (GLBA) addressed the insurance privacy debate regarding medical privacy. Yet, there were many issues with the implementation. One issue was that there were inconsistent regulation requirements within the different states due to preexisting laws. Secondly, it was difficult to combine the pre-existing laws with the new framework. And thirdly, in order for the federal government to implement these new rules, they needed state legislature to pass it.

GLBA aimed to regulate financial institutions so that corporations could not affect people's insurance. Because of the difficulty of the implementation of the GLBA, state legislatures are able to interpret the laws themselves and create initiatives to protect the medical privacy. When states are creating their own independent legislature, they create standards that understand the impact of the legislation. If they stray from the standard laws, they must be valid and fair. The new legislation must protect the rights of businesses and allow them to continue to function despite federally regulated competition. Patients gain benefits from these new services and standards through the flow of information that is considerate with medical privacy expectations.

These regulations should focus more on the consumer versus the benefits and political exploitation. Many times, regulations are for the personal gain of the corporation, therefore, state legislatures be wary of this and try to prevent it to the best of their abilities. Medical privacy is not a new issue within the insurance industry, yet the problems regarding exploitation continue to reoccur; there is more focus on taking advantage of the business environment for personal gain.

In 2001, President George W. Bush passed additional regulations to HIPAA in order to better protect the privacy of individual medical information. These new regulations were supposed to safeguard health information privacy by creating extensive solutions for the privacy of patients. The new regulation goals included being notified once an individual's information is inspected, amend any medical records, and request communication opportunities to discuss information disclosure.

However, there are exceptions to when the disclosure of PHI can be inspected. This includes specific conditions among law enforcement, judicial and administrative proceedings, parents, significant others, public health, health research, and commercial marketing. These aspects of lack of privacy have caused an alarming number of gaps within privacy measures.

Ultimately, there is still an issue on how to ensure privacy securities; in response, the government has created new regulations that makes trade offs between an individual's privacy and public benefit. These new regulations, however, still cover individually identifiable health information - any data that contains information unique to an individual. However, non-identifiable data is not covered as the government claims it will cause minimal damage to a person's privacy. It also covers all health care organizations and covers businesses as well.

Additionally, under new HIPAA additions, the state legislation is more protective than national laws because it created more obligations for organizations to follow. Ultimately, the new rules called for expansive requirements that created better safety measures for individuals. Yet, there are still ways that businesses and healthcare organizations can be exempt from disclosure rules for all individuals. Thus, the HHS needs to find more ways to balance personal and public trade offs within medical laws. This creates a need for extra government intervention to enforce legislation and new standards to decrease the number of threats against an individual's privacy of health data.

The COVID-19 pandemic led to a global effort to use technologies, like contact tracing, to reduce the spread of the disease. Contact tracing involves notifying people that they have been in contact with an individual who has tested positive for the virus. This led to the general public being concerned about the privacy risks of this technology. In response, in April 2020 Apple and Google created a contact tracing API.

Physician-patient relationships
Patients want to be able to share medical information with their physicians, yet they worry about potential privacy breaches that can occur when they release financial and confidential medical information. In order to ensure better protection, the government has created frameworks for keeping information confidential - this includes being transparent about procedures, disclosure and protection of information, and monitoring of these new rules to ensure that people's information.

Effects of Technological Advances
Recently physicians and patients have started to use email as an additional communication tool for treatment and medical interactions. This way of communication is not "new", but its effects on doctor patient relationships has created new questions regarding legal, moral, and financial problems.

The American Medical Informatics Association has characterized medical emails as way to communicate "medical advice, treatment, and information exchanged professionally"; yet, the "spontaneity, permanence, and information power characterizing" role is significant because of its unknown affects. However, the use of emails allows for increased access, immediate aid, and increased interactions between patients and doctors. There are many benefits and negative aspects of using emails; doctors feel a new sense of negative responsibility to respond to emails outside of the office, but also find benefits with facilitating rapid responses to patient's questions.

Additionally, the use of email between physicians and their patients will continue to grow because of the increasing use of the Internet. With the Internet, patients are able to ask for medical advice and treatment, yet issues regarding confidentiality and legal issues come up. Ultimately, emails between a physician and patient are supposed to be used as a supplement for face to face interactions, not for casual messages. If used properly, physicians could use emails as a way to supplement interactions and provide more medical aid to those who need it immediately.

Traditional beliefs on doctor-patient relationship
Although many people believe that the technological changes are the reason for fear of sharing medical privacy, there is a theory that states that institutional ideals between doctors and their patients have created the fear of sharing medical privacy information. Although levels of confidentiality are changing, individuals often feel the need to share more information with their doctors in order to get diagnosed correctly. Because of this, people are concerned with how much information their physicians have. This information could be transferred to other third-party companies. However, there is a call for smaller emphasis on sharing and confidentiality in order to rid patients from their fears of information breaching. There is a common belief that the confidentiality of one's information also only protects the doctors and not the patients, therefore there is a negative stigma towards revealing too much information. Thus it causes patients to not share vital information relevant to their illnesses.

Australia – eHealth
On July 1, 2012, the Australian Government launched the Personally Controlled Electronic Health Record (PCEHR) (eHealth) system. The full implementation incorporates an electronic summary prepared by nominated healthcare providers along with consumer-provided notes. Further, the summary includes information on the individual's allergies, adverse reactions, medications, immunizations, diagnoses, and treatments. The consumer notes operate as a personal medical diary that only the individual can view and edit. The opt-in system gives people the option to choose whether to register for the eHealth record or not.

As of January 2016, the Commonwealth Department of Health changed the name PCEHR to My Health Record.

Privacy – governance
The Personally Controlled Electronic Health Records Act 2012 and Privacy Act 1988 governs how eHealth record information is managed and protected. The PCEHR System Operator abides by the Information Privacy Principles in the Privacy Act 1988 (Commonwealth) as well as any applicable State or Territory privacy laws. A Privacy Statement sets out the application of the collection of personal information by the System Operator. The statement includes an explanation of the types of personal information collected, what the information is used for, and how the information is stored. The statement covers measures in place to protect personal information from misuse, loss, unauthorized access, modification, and disclosure.

Privacy – security measures
Security measures include audit trails so that patients can see who has accessed their medical records along with the time the records were accessed. Other measures include the use of encryption as well as secure logins and passwords. Patient records are identified using an Individual Health Identifier (IHI), assigned by Medicare, the IHI service provider.

Privacy – issues
A 2012 nationwide survey in Australia assessed privacy concerns on patients' health care decisions, which could impact patient care. Results listed that 49.1% of Australian patients stated they have withheld or would withhold information from their health care provider based on privacy concerns.

 * How does consent impact privacy?

One concern is that personal control of the eHealth record via consent does not guarantee the protection of privacy. It is argued that a narrow definition, 'permission' or 'agreement', does not provide protection for privacy and is not well represented in Australian legislation. The PCEHR allows clinicians to assume consent by consumer participation in the system; however, the needs of the consumer may not be met. Critics argue that the broader definition of 'informed consent' is required, as it encompasses the provision of relevant information by the healthcare practitioner, and understanding of that information by the patient.

 * Is it legitimate to use personal information for public purposes?

Data from the PCEHR is to be predominantly used in patient healthcare, but other uses are possible, for policy, research, audit and public health purposes. The concern is that in the case of research, what is allowed goes beyond existing privacy legislation.

 * What are 'illegitimate' uses of health information?

The involvement of pharmaceutical companies is viewed as potentially problematic. If they are perceived by the public to be more concerned with profit than public health, public acceptance of their use of PCEHRs could be challenged. Also perceived as problematic, is the potential for parties other than health care practitioners, such as insurance companies, employers, police or the government, to use information in a way which could result in discrimination or disadvantage.

Information 'leakage' is seen as having the potential to discourage both patient and clinician from participating in the system. Critics argue the PCEHR initiative can only work, if a safe, effective continuum of care within a trusting patient/clinician relationship is established. If patients lose trust in the confidentiality of their eHealth information, they may withhold sensitive information from their health care providers. Clinicians may be reluctant to participate in a system where they are uncertain about the completeness of the information.
 * What are the potential implications of unwanted disclosure of patient information?

 * Are there sufficient safeguards for the protection of patient information?

Security experts have questioned the registration process, where those registering only have to provide a Medicare card number, and names and birth dates of family members to verify their identity. Concerns have also been raised by some stakeholders, about the inherent complexities of the limited access features. They warn that access to PCEHR record content, may involve transfer of information to a local system, where PCEHR access controls would no longer apply.

Canada
The privacy of patient information is protected at both the federal level and provincial level in Canada. The health information legislation established the rules that must be followed for the collection, use, disclosure and protection of health information by healthcare workers known as "custodians". These custodians have been defined to include almost all healthcare professionals (including all physicians, nurses, chiropractors, operators of ambulances and operators of nursing homes). In addition to the regulatory bodies of specific healthcare workers, the provincial privacy commissions are central to the protection of patient information.

Turkey
The privacy of patient information is guaranteed by articles 78 and 100 of legal code 5510.

On the other hand, the Social Security Institution (SGK), which regulates and administers state-sponsored social security / insurance benefits, sells patient information after allegedly anonymizing the data, confirmed on October 25, 2014.

United Kingdom
The National Health Service is increasingly using electronic health records, but until recently, the records held by individual NHS organisations, such as General Practitioners, NHS Trusts, dentists and pharmacies, were not linked. Each organization was responsible for the protection of patient data it collected. The care. data programme, which proposed to extract anonymised data from GP surgeries into a central database, aroused considerable opposition.

In 2003, the NHS made moves to create a centralized electronic registry of medical records. The system is protected by the UK's Government Gateway, which was built by Microsoft. This program is known as the Electronic Records Development and the Implementation Programme (ERDIP). The NHS National Program for IT was criticized for its lack of security and lack of patient privacy. It was one of the projects that caused the Information Commissioner to warn about the danger of the country "sleepwalking" into a surveillance society. Pressure groups opposed to ID cards also campaigned against the centralized registry.

Newspapers feature stories about lost computers and memory sticks but a more common and longstanding problem is about staff accessing records that they have no right to see. It has always been possible for staff to look at paper records, and in most cases, there is no track of record. Therefore, electronic records make it possible to keep track of who has accessed which records. NHS Wales has created the National Intelligent Integrated Audit System which provides "a range of automatically generated reports, designed to meet the needs of our local health boards and trusts, instantly identifying any potential issues when access has not been legitimate". Maxwell Stanley Consulting will use a system called Patient Data Protect (powered by VigilancePro) which can spot patterns – such as whether someone is accessing data about their relatives or colleagues.

United States
Since 1974, numerous federal laws have been passed in the United States to specify the privacy rights and protections of patients, physicians, and other covered entities to medical data. Many states have passed its own laws to try and better protect the medical privacy of their citizens.

An important national law regarding medical privacy is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), yet there are many controversies regarding the protection rights of the law.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The most comprehensive law passed is the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which was later revised after the Final Omnibus Rule in 2013. HIPAA provides a federal minimum standard for medical privacy, sets standards for uses and disclosures of protected health information (PHI), and provides civil and criminal penalties for violations.

Prior to HIPAA, only certain groups of people were protected under medical laws such as individuals with HIV or those who received Medicare aid. HIPAA provides protection of health information and supplements additional state and federal laws; yet it should be understood that the law's goal is to balance public health benefits, safety, and research while protecting the medical information of individuals. Yet many times, privacy is compromised for the benefits of the research and public health.

According to HIPAA, the covered entities that must follow the law's set mandates are health plans, health care clearinghouses, and health care providers that electronically transmit PHI. Business associates of these covered entities are also subject to HIPAA's rules and regulations.

In 2008, Congress passed the Genetic Information Nondiscrimination Act of 2008 (GINA), which aimed to prohibit genetic discrimination for individuals seeking health insurance and employment. The law also included a provision which mandated that genetic information held by employers be maintained in a separate file and prohibited disclosure of genetic information except in limited circumstances.

In 2013, after GINA was passed, the HIPAA Omnibus Rule amended HIPAA regulations to include genetic information in the definition of Protected Health Information (PHI). This rule also expanded HIPAA by broadening the definition of business associates to include any entity that sends or accesses PHI such as health IT vendors.

Controversies
The Health Insurance Portability and Accountability Act (HIPAA) is critiqued for not providing strong medical privacy protections as it only provides regulations that disclose certain information.

The government authorizes the access of an individual's health information for "treatment, payment, and health care options without patient consent". Additionally, HIPAA rules are very broad and do not protect an individual from unknown privacy threats. Additionally, a patient would not be able to identify the reason for breach due to inconsistent requirements. Because of limited confidentiality, HIPAA facilitates the sharing of medical information as there is little limitation from different organizations. Information can easily be exchanged between medical institutions and other non-medical institutions because of the little regulation of HIPAA - some effects include job loss due to credit score sharing or loss of insurance.

Additionally, doctors are not required to keep patients information confidential because in many cases patient consent is now optional. Patients are often unaware of the lack of privacy they have as medical processes and forms do not explicitly state the extent of how protected they are. Physicians believe that overall, HIPAA will cause unethical and non-professional mandates that can affect a person's privacy and therefore, they in response have to provide warnings about their privacy concerns. Because physicians are not able to ensure a person's privacy, there is a higher chance that patients will be less likely to get treatment and share what their medical concerns are. Individuals have asked for better consent requirements by asking if physicians can warn them prior to the sharing of any personal information. Patients want to be able to share medical information with their physicians, yet they worry about potential breaches that can release financial information and other confidential information and with that fear, they are wary of who may have access.

In order to ensure better protection, the government has created frameworks for keeping information confidential - some of which include being transparent about procedures, disclosure and protection of information, and monitoring of these new rules to ensure that people's information is not affected by breaches. Although there are many frameworks to ensure the protection of basic medical data, many organizations do not have these provisions in check. HIPAA gives a false hope to patients and physicians as they are unable to protect their own information. Patients have little rights regarding their medical privacy rights and physicians cannot guarantee those.

Hurricane Katrina
HIPAA does not protect the information of individuals as the government is able to publish certain information when they find it necessary. The government is exempted from privacy rules regarding national security. HIPAA additionally allows the authorization of protected health information (PHI) in order to aid in threats to public health and safety as long as it follows the good faith requirement - the idea that disclosing of information is necessary to the benefit of the public. The Model State Emergency Powers Act (MSEHPA) gives the government the power to "suspend regulations, seize property, quarantine individuals and enforce vaccinations" and requires that healthcare providers give information regarding potential health emergencies".

In regards to Hurricane Katrina, many people in Louisiana relied on Medicaid and their PHI was subsequently affected. People's medical privacy rights were soon waived in order for patient's to get the treatment they needed. Yet, many patients were unaware that their rights had been waived. In order to prevent the sharing of personal information in future natural disasters, a website was created in order to protect people's medical data. Ultimately, Katrina showed that the government was unprepared to face a national health scare.

Medical data outside of HIPAA
Many patients mistakenly believe that HIPAA protects all health information. HIPAA does not usually cover fitness trackers, social media sites and other health data created by the patient. Health information can be disclosed by patients in emails, blogs, chat groups, or social media sites including those dedicated to specific illnesses, "liking" web pages about diseases, completing online health and symptom checkers, and donating to health causes. In addition, credit card payments for physician visit co-pays, purchase of over the counter (OTC) medications, home testing products, tobacco products, and visits to alternative practitioners are also not covered by HIPAA.

A 2015 study reported over 165,000 health apps available to consumers. Disease treatment and management account for nearly a quarter of consumer apps. Two-thirds of the apps target fitness and wellness, and ten percent of these apps can collect data from a device or sensor. Since the Food and Drug Administration (FDA) only regulates medical devices and most of these applications are not medical devices, they do not require FDA approval. The data from most apps are outside HIPAA regulations because they do not share data with healthcare providers. "Patients may mistakenly assume that mobile apps are under the scope of HIPAA since the same data, such as heart rate, may be collected by an application that is accessible to their physician and covered by HIPAA, or on a mobile app that is not accessible to the physician and not covered by HIPAA.

Changes
In 2000, there was a new surge to add new regulations to HIPAA. It included the following goals: to protect individual medical information by providing secure access and control of their own information, improving healthcare quality by creating a more trust between consumers and their healthcare providers and third party organizations, and improve the efficiency of the medical system through new rules and regulations put forth by the local governments, individuals, and organizations.

The implementation of these new goals was complicated by the change in administrations (Clinton to Bush), so it was difficult for the changes to be successfully implemented. HIPAA, in theory, should apply to all insurance companies, services, and organizations, yet there are exceptions to who actually qualifies under these categories.

Yet, within each category, there are specific restrictions that are different in every category. There are no universal laws that can be easily applied that are easy for organizations can follow. Thus, many states have neglected to implement these new policies. Additionally, there are new patient rights that call for better protection and disclosure of health information. However, like the new rules regarding insurance companies, the enforcement of the legislation is limited and not effective as they are too broad and complex. Therefore, it is difficult for many organizations to ensure the privacy of these people. Enforcing these new requirements also causes companies to spend many resources that they are not willing to use and enforce, which ultimately leads to further problems regarding the invasion of an individual's medical privacy.

Oregon-specific laws
The Oregon Genetic Privacy Act (GPA) states that "an individual's genetic information is the property of the individual". The idea of an individual's DNA being compared to property occurred when research caused an individual's privacy to be threatened. Many individuals believed that their genetic information was "more sensitive, personal, and potentially damaging than other types of medical information." Thus, people started calling for more protections. People started to question how their DNA would be able to stay anonymous within research studies and argued that the identity of an individual could be exposed if the research was later shared. As a result, there was a call for individuals to treat their DNA as property and protect it through property rights. Therefore, individuals can control the disclosure of their information without extra questioning and research. Many people believed that comparing one's DNA to property was inappropriate, yet individuals argued that property and privacy are interconnected because they both want to protect the right to control one's body.

Many research and pharmaceutical companies showed opposition because they were worried about conflicts that might arise regarding privacy issues within their work. Individuals, on the other hand, continued to support the act because they wanted protection over their own DNA. As a result, lawmakers created a compromise that included a property clause, that would give individuals protection rights, but also included provisions that would allow research to be done without much consent, limiting the benefits of the provisions. Afterwards, a committee was created to study the effects of the act and how it affected the way it was analyzed and stored. They found that the act benefited many individuals who did not want their privacy being shared with others and therefore the law was officially implemented in 2001.

Connecticut-specific laws
In order to solve HIPAA issues within Connecticut, state legislatures tried to create better provisions to protect the people living within the state. One of the issues that Connecticut tried to solve were issues with consent. Within the consent clause, health plans and health care clearinghouses do not need to receive consent from individuals because of a general provider consent form with gives healthcare providers permission to disclose all medical information. The patient thus does not get notification when their information is being shared afterwards.

Connecticut, like many other states, tried to protect individual's information from disclosure of information through additional clauses that would protect them from businesses initiatives. In order to do so, Connecticut legislature passed the Connecticut Insurance Information and Privacy Protect Act, which provides additional protections of individual medical information. If third parties neglect to follow this law, they will be fined, may face jail time, and may have their licenses suspended. Yet, even in these additional provisions, there were many holes within this legislation that allowed for businesses agreements to be denied and subsequently, information was compromised. Connecticut is still working to shift its divergent purposes to creating more stringent requirements that create better protections through clear provisions of certain policies.

California-specific laws
In California, the Confidentiality of Medical Information Act (CMIA), provides more stringent protections than the federal statutes. HIPAA expressly provides that more stringent state laws like CMIA, will override HIPAA's requirements and penalties. More specifically, CMIA prohibits providers, contractors and health care service plans from disclosing PHI without prior authorization.

These medical privacy laws also set a higher standard for health IT vendors or vendors of an individual's personal health record (PHR) by applying such statutes to vendors, even if they are not business associates of a covered entity. CMIA also outlines penalties for violating the law. These penalties range from liability to the patient (compensatory damages, punitive damages, attorneys' fees, costs of litigation) to civil and even criminal liability.

Likewise, California's Insurance Information and Privacy Protection Act (IIPPA) protects against unauthorized disclosure of PHI by prohibiting unapproved information sharing for information collected from insurance applications and claims resolution.

New Zealand
In New Zealand, the Health Information Privacy Code (1994) sets specific rules for agencies in the health sector to better ensure the protection of individual privacy. The code addresses the health information collected, used, held and disclosed by health agencies. For the health sector, the code takes the place of the information privacy principles.

Netherlands
The introduction of a nationwide system for the exchange of medical information and access to electronic patient records led to much discussion in the Netherlands.

Privacy for research participants
In the course of having or being part of a medical practice, doctors may obtain information that they wish to share with the medical or research community. If this information is shared or published, the privacy of the patients must be respected. Likewise, participants in medical research that are outside the realm of direct patient care have a right to privacy as well.

Future research
While medical privacy remains an important right, it is also crucial to balance privacy with innovation. By limiting patient data in response to privacy violations, it potentially hinders data-driven innovation in medicine. In addition, keeping data secret for a competitive advantage also poses multiple concerns, potentially slowing advances in medical testing (e.g. Myriad Genetics).

title: Medical privacy


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Plethodon

Plethodon is a genus of salamanders in the family Plethodontidae. They are commonly known as woodland salamanders. All members of the genus are endemic to North America (Canada and the United States). They have no aquatic larval stage. In some species, such as the red-backed salamander (Plethodon cinereus). Young hatch in the adult form. Members of Plethodon primarily eat small invertebrates. The earliest known fossils of this genus are from the Hemphillian of Tennessee in the United States.

Taxonomy
Plethodon is part of the family Plethodontidae (lungless salamanders) and the subfamily Plethodontinae. The genus Plethodon can be divided into two subgenera: the nominal subgenus Plethodon, which includes up to 49 eastern species (the bulk of diversity in the genus), and the subgenus Hightonia, which includes 9 species native to the western part of North America.

The eastern Plethodon subgenus can be further categorized into at least three major species groups which genetic analyses confirm to be clades:

 * The Plethodon cinereus group, which contains the ubiquitous red-backed salamander and 9 other small, slender species (P. electromorphus, P. hoffmani, P. hubrichti, P. nettingi, P. richmondi, P. serratus, P. shenandoah, P. sherando, and P. virginia).
 * The Plethodon wehrlei group  is a species complex centered on Wehrle's salamander and at least 4 of its close relatives (P. dixi, P. jacksoni, P. pauleyi, P. punctatus). Some of these species were only formally distinguished from P. wehrlei as recently as 2019.
 * The Plethodon welleri group includes Weller's salamander and the three species of zigzag salamander (P. angusticlavius, P. dorsalis, P. ventralis). Many studies have argued that the wehrlei and welleri groups should be conceived of as one larger clade, the Plethodon wehrlei-welleri group.
 * The Plethodon glutinosus group is the largest species group within Plethodon, with around 30 species and several subordinate species complexes. Many species within this group (including the nominal species) are commonly known as "slimy salamanders", characterized by a large size, robust build and black-and-white coloration. Not all members of the Plethodon glutinosus group are labelled as slimy salamanders, and species delimitation among slimy salamanders and their close relatives is a subject of continued debate.  For example, some studies interpret Plethodon grobmani and Plethodon mississippi to be junior synonyms of Plethodon glutinosus, based on a lack of genetic or anatomical distinctiveness.
 * One difficult-to-classify species is Webster's salamander, which may lie among the wehrlei-welleri group    or the glutinosus group, or outside both groups, depending on the study.

List of species
As of 2024 there are up to 58 species in the genus Plethodon. Most are native to eastern and central North America, with the Appalachian Mountains having the highest diversity. Seven species live along the West Coast, one (P. idahoensis) in the Rocky Mountains of Idaho, and one (P. neomexicanus) in the Jemez Mountains of New Mexico.

All 58 Plethodon species listed in alphabetical order of specific name:

Nota bene: A binomial authority in parentheses indicates that the species was originally described in a genus other than Plethodon.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Plethodon


text:
User talk:Msvaughn

I am the webmaster for his official site and have permission to use his material.
 * Unfortunately we need to see some proof that this is your material. A notice on the website that it is licensed under the GFDL or is in the Public Domain should be sufficient. --snoyes 19:18, 28 Nov 2003 (UTC)

title: User talk:Msvaughn


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Red-backed salamander

The red-backed salamander (Plethodon cinereus) is a small, hardy woodland salamander species in the family Plethodontidae. It is also known as the redback salamander, eastern red-backed salamander, or the northern red-backed salamander to distinguish it from the southern red-backed salamander (Plethodon serratus). The species inhabits wooded slopes in eastern North America, west to Missouri, south to North Carolina, and north from southern Quebec and the Maritime provinces in Canada to Minnesota. It is one of 56 species in the genus Plethodon. Red-backed salamanders are notable for their color polymorphism and primarily display two color morph varieties ("red-backed" and "lead-backed"), which differ in physiology and anti-predator behavior.

Description and ecology
The red-backed salamander is a small terrestrial salamander, 5.7 - 10.0 cm in total length (including tail), which usually lives in forested areas under rocks, logs, bark, and other debris. It is one of the most numerous salamanders throughout its range.

As with all amphibians, the red-backed salamander has permeable skin. They also lack lungs, a condition which is an ancestral trait of the Plethodontidae. Red-backed salamanders are thus entirely reliant on cutaneous respiration for gas exchange. Permeable skin is susceptible to desiccation and must be kept moist in order to facilitate cutaneous respiration; as a result much of the ecology and behavior of the red-backed salamander is restricted by climatic and microclimatic variables, particularly dryness and temperature.

The skin of red-backed salamanders was found to contain Lysobacter gummosus, an epibiotic bacterium that produces the chemical 2,4-diacetylphloroglucinol and inhibits the growth of certain pathogenic fungi.

Polymorphism
Plethodon cinereus exhibits color polymorphism, the common ones being the red-striped morph and the lead-phase. The "red-backed" or "red-stripe" variety has a red dorsal stripe that tapers towards the tail, and the darker variety, known as the "lead-backed" (or simply "lead") phase, lacks most or all of the red pigmentation. The red-backed phase is not always red, but may actually be various other colors (e.g., yellow-backed, orange-backed, white-backed, or a rare erythristic morph in which the body is completely red). Both morphs have speckled black and white bellies. Additional color anomalies of this species also exist, including iridistic, albino, leucistic, amelanistic, and melanistic anomalies. These color morphs are rarer than the red-backed, lead-backed, and erythristic morphs, but still have been reported with consistency among varying populations of this species.

How color polymorphism arose in this species
Color polymorphism is thought to be an adaptive strategy in a heterogeneous environment, so the maintenance of polymorphism is derived from behavioral and physiological choices. The color polymorphism of The red-striped morph Plethodon cinereus and the lead-phase Plethodon cinereus show different anti-predator responses in behavior, and predator attacks differently based on the color form. Compared to red-striped morph P. cinereus which prefers an "all trunk raised" posture and tends to stay still, the lead-phase P. cinereus is significantly more mobile. Moreover, lead-phase P. cinereus has the ability to automatically cut off the tail, indicating that the two forms also differ in the frequency of being attacked.

As an evidence that polymorphism is to adapt the environment, P. cinereus color morph frequencies are correlated with climatic variables, suggesting habitat temperature and more broadly climate to be potential sources of selective pressure on P. cinereus polymorphism. The red-backed form is found with greater frequency in colder regions at more northerly latitudes and easterly longitudes throughout its range, whereas the opposite is true of the lead-backed form. Additionally, lead-backed morphs withdraw from surface activity earlier in the autumn than red-backed morphs, presumably to avoid cooling temperatures. Standard metabolic rate has also been found to differ between the morphs at certain temperatures, with significantly lower metabolic rates being displayed by the lead-backed form at 15 °C; in the same study, lead-backed individuals were also more active on the ground surface at this temperature. These findings suggest that the lead-backed color variant is less tolerant of cool temperatures than the red-backed color variant, and that the two color forms differ physiologically and behaviorally at certain temperatures.

An alternate explanation for the uneven geographic distribution of the red-backed and lead-backed P. cinereus color morphs involves phenotypic plasticity responding to developmental temperature. Although the genetic origins of the P. cinereus polymorphic condition are not fully understood, initial studies indicate that color morph dominance is likely subject to epistasis, and that multiple loci may interact to determine an individual's morph condition. However, more recent research indicates that a plastic response to thermal conditions during development also contributes to color morph determination; in one study, P. cinereus eggs incubated at a higher temperature hatched a greater proportion of lead-backed morphs than eggs incubated at a lower temperature. Temperature-dependent color morph determination may therefore also potentially influence the spatial distribution of P. cinereus color morphs.

Diet
Red-backed salamanders are mostly insectivorous, but prey on a wide assortment of other small invertebrates including isopods, millipedes, centipedes, pseudoscorpions, harvestmen, spiders, and gastropods.

The two primary P. cinereus color morphs also differ in diet. The prevalence of certain prey taxa and the overall diversity and quality of prey items have been observed to differ seasonally between the two morphs in the spring and autumn when surface activity is greatest. The diets of striped and unstriped P. cinereus differ the most in the spring and fall seasons. The striped salamanders have a red-colored dorsal band that runs from the head/neck to their tail, and the unstriped ones lack this red stripe and are instead totally black. These salamanders are at the surface the most during these seasons. Contrasting diets during the fall and spring are due to differences in two types of prey consumed during this time. In the fall, the striped salamanders eat more entomobryomorph Collembola, the largest species of elongated springtails, as opposed to in the spring when they eat more oribatid mites.

Some studies have suggested that the unstriped morph has adapted to be better suited for drier and warmer conditions explaining the differences in diets. Unstriped morphs are less aggressive and less likely to hold territories because they are more well suited to find a territory that these striped salamanders are less adapted to withstand. The unstriped salamanders can forage in drier leaf litter, so they do not need to protect their territory to the extent that striped morphs do. The less pressure the unstriped salamander feels to hold territory does change what type of access of prey it has access to compared to the striped salamander during the drier months. Striped salamanders defend territories underneath objects such as rocks and logs when the conditions are dry. During these dry conditions, arthropods are forced to hide in these same moist areas that the striped salamanders claim as their territory since some arthropods will desiccate in dry periods. These arthropods then become the (red-backed) striped salamander's prey while the unstriped salamanders miss this opportunity. This allows striped salamanders to feed on springtails, mites, ants, and other small invertebrates.

There are some disputes on which morph has the more diverse diet. In one study, the autumn diet of red-backed morphs was more diverse and of higher quality, and found to be dominated by mites, springtails, and ants, whereas the most important prey for lead-backed morphs were ants, mites, and isopods. A later study notes that this was because the earlier study only compared diets during the fall season, while the later study compared their diets throughout all of the seasons. The later study concludes that the unstriped morph has a broader diet and encounters prey the striped morph does not. They link this back to unstriped salamanders being able to roam more freely between drier territories during this time.

Distribution
Distribution of P. cinereus are in close contact with the soil on the forest floor. As deciduous forests mature, acid deposition can accelerate the acidification of soils. Acidic conditions can limit the distribution of amphibians and the numbers of sibling species, while the pH value of soil has a strong effect on the density and distribution of P. cinereus. When choosing between acidic and neutral soils, P. cinereus prefers to occupy more neutral soils. P. cinereus is rarely found in soils with a pH value of 3.7, and relatively more to be found in soils with a pH value of about 3.8 or higher. Juvenile P. cinereus have never been found in soils with a pH value lower than 3.7. Similar conclusions have also been supported in the laboratory. P. cinereus prefers to occupy substrates near neutral pH. A pH value between 2.5 and 3 results in acute mortality, while a pH value between 3 and 4 results in chronic mortality. Low pH will reduce their growth and respiration. Slowed growth and delayed metamorphosis make juvenile P. cinereus more vulnerable to predators and has serious consequences for population survival.

Several other factors, such as moisture and temperature, can affect the population density or dispersion of Botrytis as well. During prolonged dry periods, individuals move down into the soil, while during short dry periods they retreat under logs or rocks. They will avoid very warm areas, and when the temperature drops to 4–5 Celsius degrees, they will retreat to the ground as well. The optimum temperature is 10 to 15 Celsius degrees. Moreover, intraspecific and interspecific competition also affected the distribution of P. cinerea. Individuals confine themselves to moist microhabitats (beneath rocks, woody debris, etc. as well as beneath the soil) for long periods of time in order to maintain hydration when surface conditions are inhospitably dry or hot, and are only active on the surface to travel, forage, or reproduce for short periods. The duration of surface activity is directly limited by the rate of cutaneous water loss to the environment, which is influenced by environmental variables such as altitude, forest canopy cover, and the amount of recent precipitation.

Spatial distributions of the salamander Plethodon cinereus is observed to be seasonal. In spring, Plethodon cinereus are more likely to exist in groups of around 2 to 7 individuals under some object covers such as rocks and wood, than in the other seasons, while the density on the forest floor stays constant. This is because that spatial dispute starts in spring. A study in Blackrock Mountain, Virginia indicates that the mean number of salamanders in each quadrant of 100*100 m varies from 1.6 to 3 in spring compared to 0.8 to 1.8 in summer. A significant increase in the spatial distribution of P. cinereus from spring to summer is thought to be due to intraspecific interference competition. The cover objects on the ground can be a good choice of moisture refuge for P. cinereus during the rainy season. The failure of P. cinereus to forage underground causes them to restrict down to areas under and around the cover objects. Aggression and territoriality under resource, food and shelter limitation are the reasons for the observed spacing.

Moreover, the two morphologies have different standard metabolic rates, while lead-phase P. cinereus favor warm habitats or microclimates. So the strong argument is that the geographic distribution of color form is caused by the selection of physiological traits.

Behavior
Antipredator behavior of P. cinereus was found to differ between the two color phases; the lead-backed phase has a tendency to run away from predators, whereas the red-backed phase often stays immobile and possibly exhibits aposematic coloration. Stress levels of each color phase were estimated by determining the ratio of neutrophil to lymphocyte cells in the blood, and the results suggest stress levels are higher in the lead-backed phase than in the red-backed phase. This may be a consequence of a higher predation risk experienced in the wild by the lead-backed phase, and may also mean lead-phase salamanders could be more vulnerable in captivity settings.

Home range and territoriality
Plethodon cinereus, like many plethodon species, exhibit homing behavior, with homing of females to their nests, as well as non-attending females and males to a home range. This allows for essential contact between a female and her eggs in order to ensure their survival, as well as for non-attending females and males to explore beyond the home range when under predation pressures, or searching for food or cover, and return to their home range if a more favorable microhabitat is not found.

Male Plethodon cinereus actively defends its territory from intrusion by other males and is less aggressive towards invading females and juveniles. Plethodon cinereus usually directs aggressive behavior towards conspecific as well as heterospecific, as long as it is thought to be a potential competitor. Plethodon cinereus positively interacts not only with conspecifics, but also with other potential competitors such as centipedes.

It is necessary to have a visual display in order to elicit the threat posture of P. cinereus, and there will be no obvious aggressive behavior toward conspecifics and heterospecifics if only chemical cues exist. However, P. cinereus will increase time spent in aggressive postures when paired with centipedes but did not show increased aggression when paired with conspecifics. The specific test method was to expose male P. cinereus to four substrate chemical cue treatments separately: control, self, conspecific, or centipede (Scolopocryptops sexspinosus) to determine its behavior in the presence or absence of conspecifics and heterospecific cues reaction.

Their residence status affects the attack level as well. Even if in different residency statuses, they do attack centipedes.

Defense mechanisms against pathogens
Plethodon cinereus coexists with some bacteria. These bacteria help salamanders defend against fungal pathogens. For example, Batrachochytrium dendrobatidis, a fungal pathogen that causes a disease called chytridiomycosis, has led to a rapid decline in amphibian populations worldwide. Around one-third of amphibians are endangered because of the disease, but some species persist from the infection, and some even clear the pathogen. As evidence, the skin of P. cinereus harbors bacterial microsymbionts such as Janthinobacterium lividum, whose metabolites can inhibit the growth of pathogens. This finding suggests an idea for providing long-term protection to individual amphibians who are infected with chytridiomycosis. It also provides a research pathway for future drug development that uses novel antifungal compounds for the treatment of human pathogens.

Reproduction and biomass
Males and females of P. cinereus typically establish separate feeding and/or mating territories underneath rocks and logs. However, some red-backed salamanders are thought to engage in social monogamy, and may maintain co-defended territories throughout their active periods. Breeding occurs in June and July. Females produce from four to 17 eggs in a year. The eggs hatch in 6 to 8 weeks. Not much is known about the dispersal of neonates, although neonates and juveniles are thought to be philopatric.

As in many Plethodon species, female red-backed salamanders have the ability to store sperm as spermatophore, and have been evidenced in doing so up to eight months prior to the oviposition period in June and July. Sperm or spermatophores are not retained following the oviposition period.

Mimicry
Lead-backed individuals are absent in northeastern United States and southeastern Canada. Instead, another phase called erythristic is observed and exclusive in these areas. This phase shows macro- and microgeographic variation in frequency. Regardless of the wide geographic variation, the highest frequency is always under 25%. This phase of P. cinereus mimic Notophthalmus viridescens to protect themselves. Birds selectively avoid to predate all-red or erythristic color P. cinereus because they think that red color is a signal of noxiousness and toxicity. Even if people trained the birds to enhance the avoidance by increasing exposure to red efts (juvenile Notophthalmus viridescens), the frequencies of erythrism is never above 25%.

Interactions with humans
Roads have various negative effects on animal populations. For example, a major source of direct mortality for many species is accidental collisions with moving vehicles. Due to the slow movement of amphibians, it is estimated that the mortality rate of these animals on roads is as high as 10% of the total population each year. From a genetic point of view, roads also reduce gene flow and thus divide animal populations, causing drift and loss of genetic diversity. Eventually, populations separated by roads may become more and more distinct from each other, thus losing the original population. Amongst different sizes of roads, it is known that the interstate highway leads to increased genetic differentiation of Plethodon cinereus by microsatellite examination. Genetic distances between regions on either side of an interstate highway were significantly larger than those between equally spaced quadrants on the same side of the highway. However, plots on smaller roads were not genetically different compared to that in the case of interstate highways. Narrow paved roads reduce the movement of redback salamanders by approximately 25–75% but do not eliminate the dynamic of the population. And the detection of genetic differences across the interstate means that the spread on this road is reduced by well over 25–75%. So there is little gene flow across very large roads, and the P. cinereus population diverges from each other. The indirect effect of smaller roads on genetic population structure is also not a big issue for terrestrial salamanders and is not a direct effect of mortality and habitat change.

The observed rate of dispersion in P. cinereus is far less than in most of the animals previously studied. Because P. cinereus have very high population densities, this should reduce the effects of genetic drift in isolated populations. From a conservation standpoint, red-backed salamanders are an important research organism because of their behavioral and physiological similarities to many threatened and endangered salamanders.

Moreover, salamanders are largely affected by forest management practices thus impacting the food web dynamics and nutrient cycling of the ecosystem they are residing in. In order to conserve the species, proper forest management practice is essential. For instance, even-aged timber harvesting practices are documented which show significantly low abundance and species richness of amphibian creatures in the area. SCE, so-called structural complexity enhancement, aims to promote the vertical development of differentiated canopies and make the horizontal density variable which then can help to rearrange the basal area, snag and log density. It turns out that SCE brings positive effects to the abundance of the Plethodon cincereus population.

title: Red-backed salamander


text:
International Communist League

International Communist League may refer to:

 * Internationalist Communist League (Brazil), predecessor of the Communist League
 * International Communist League (Fourth Internationalist), also known as the Spartacist League
 * International Communist League (Mexico), which joined the Workers' Revolutionary Party in 1976
 * Internationalist Communist League (Portugal)
 * International Communist League (Vietnam), active from 1944 until about 1946
 * International-Communist League, a short-lived alliance of British groups in the mid-1970s
 * Left Opposition, led by Trotsky from 1933 until 1936
 * Pathfinder tendency, sometimes referred to as the International Communist League
 * International Communist League (Maoist), the international of the Shining Path and other Maoist parties

title: International Communist League


text:
Talk:Aylesbury

Complete Outdoors?
Is it just me, or is this an advert for a commercial organisation on Wikipedia?

If anyone else thinks it should be removed or altered, note your comments here.--82.32.105.240 18:36, 24 October 2006 (UTC)

 * It was blatant advertising; I have removed it. -- Roleplayer 22:47, 24 October 2006 (UTC)

Page name
This page belongs at Aylesbury and should be moved back, as the Aylesbury in England is the main use of the term. There has already been an extensive discussion about this subject at Talk:Exeter. G-Man 19:20, 28 Nov 2003 (UTC)

 * Naming conventions (city names) says that in general, there are no special naming conventions for cities and Wikipedia talk:Naming conventions (city names) indicates that the "priority" issue is not a policy but still under discussion. I think that equal disambiguation is a vastly superior approach, but if you wish to revert my changes I won't muck around. Penfold 20:17, Nov 28, 2003 (UTC)

I think the general rule is (as I understand it) that if one place or use of a term is the most well known or most linked to, it should have the name space to itself and provide a link to a disambiguation page for other uses, at the top or bottom of the article.

So for instance London in England is the most well known London in the world, and so has the 'London' name all to itself, but has a link to a disambiguation page for other Londons. The same is true for Boston in America even though there is a place called Boston in England.

Of course nothing is set in stone, its a case of judging each case by it's merits. But in this case seem as all the links go to the Aylesbury in England and it s the most well known Aylesbury in the world, it really belongs in it's own namespace G-Man 20:43, 28 Nov 2003 (UTC)

 * As far as I can tell, the point of Naming conventions (city names) is that there aren't any rules as yet. In addition, I think assigning priority as in the examples of London and Boston is not the way to build an encyclopedia free from anglo-centrism or americo-centrism (if that's the word). And where there are multiple uses of a name, I think the default should be to show all the available options. But as I said, I'm not prepared to get into a fight over it. Penfold 21:04, Nov 28, 2003 (UTC)

What matters is how articles link to it. There were 40 articles linking to the Buckinghamshire one, and a couple linking to the Canadian one. Likewise Paris should be about the french capital. I hardly think you can call that anglocentric. Morwen 21:10, 28 Nov 2003 (UTC)

 * No, that would be Euro-centric, which is equally undesirable. You surely can't be arguing that significance or priority should be determined by number of Wikipedia links? Given that Wikipedia is a) incomplete, and b) rather skewed in terms of the topics present, the number of links seems to be a measure of merit without any merit whatsoever. I'd take your point if I'd left broken Wiki links all over the shop, but I didn't. Penfold 12:59, Nov 29, 2003 (UTC)

If you're interested Penfold we had a big argument about this subject a few months ago about Exeter. Between User:Mintguy and User:BRG, over whether Exeter should be a disambiguation page or about the Exeter in England, and it was eventually decided that it should be the Exeter in England. So I am merely going by the precedent set there.

If you want to see the details of the argument try looking at User talk:Mintguy and User talk:BRG. G-Man 21:27, 28 Nov 2003 (UTC)

 * Thanks for the link, although I'm still having difficulty reconciling what Naming conventions (city names) says versus comments tucked away on talk pages. But the Exeter discussion was a terrible argument. Aylesbury is no Paris or London, or even Exeter or Durham. It was also argued that 'most users will want to look at Exeter'. I've always found that attempting to second-guess users is a very poor strategy, and I fail to see how the 'principle of least surprise' is an appropriate guide for the content of an encyclopedia. However, I see that the reversion has been made, so this all academic I suppose. I won't muck around with that but I'm happy to keep on whining here. Penfold 12:59, Nov 29, 2003 (UTC)

Anne Boleyn
"The infamous Anne Boleyn:" only an Irish Catholic would say that. The Papacy had many reasons to declare her marriage null and void and the Protestant monarch a bastard. Infamous indeed. Wetman 23:15, 20 May 2004 (UTC)

 * I thought she was generally unpopular as a person anyway. She was certainly unpopular as far as the English general public were concerned at the time. -- Graham  :) | Talk 23:25, 20 May 2004 (UTC)

Depending on how you were taught English history, Anne Boleyn could certainly be considered infamous- Irish Catholic or otherwise. At my school we covered the Tudor period in a lot of detail and the name of Henry VIII's wife who was mentioned the most by far was Anne Boleyn.

Racial riot
"racial riot"? When? If not substantiated this should be removed. —Preceding unsigned comment added by 79.64.13.107 (talk) 21:31, 28 November 2007 (UTC)

 * Duly removed. -- Roleplayer (talk) 23:54, 28 November 2007 (UTC)

Commuter belt??
IMHO Aylesbury is not part of the London commuter belt.. it isn't even easily accessible by London. High Wycombe is probably the furthest out the commuter belt goes. I have removed comment.. thoughts anyone? Dvmedis (talk) 13:00, 16 March 2009 (UTC)

 * London is an hour by train, and if you can drive to Amersham it's even faster from there. The density of traffic on the London-bound roads at peak times would suggest that Aylesbury does indeed have a large number of commuters, although obviously not to the same extent as those towns nearer the capital.  Demographic figures show little difference between the daytime population and resident population of Aylesbury, suggesting a low percentage of commuters, however that doesn't take into account the number of people who commute to Aylesbury from outlying areas.  Lower down the same table of figures it shows that 38% of the population have an income over £40k a year, and it is highly unlikely that 38% of jobs in Aylesbury have £40k+ salaries.  This is a good indicator that a good chunk of the working population of Aylesbury commute, however firm figures that demonstrate this do not exist. --  role player 19:20, 16 March 2009 (UTC)

 * I also support  role player. There are daily peaktime non stopping trains direct from Aylesbury to London and vice versa scheduled at 54 mins. This in my book defines they are commuter trains and that there are sufficient regular daily travellers to meet the definition of Aylesbury being part of a London commuter beltTmol42 (talk) 23:49, 26 March 2009 (UTC)

Industry
The industry section is rather dated. Can someone with reliable info update it? The Blue Leanie might be worth a mention, and am I right in thinking CBS have a factory there? —Preceding unsigned comment added by 217.43.81.99 (talk) 21:00, 25 April 2009 (UTC)

Answer, yes, its changed name a few times - but Sony used to make vinyl records there. Now it just packs music CD-ROMs.

Most industry has left the town, shortage of manual workers and affordable housing. So all the light engineering has gone - in fact one factory is now an electronic seminar / conference centre.

The main central light industrial area has been flattened; but remains un-built due to the recession. (We are in the last building standing and that should be going in 4 years. —Preceding unsigned comment added by Chrisjw37 (talk • contribs) 08:26, 21 May 2009 (UTC)

Also - Antiference, Industrial Alloys, Rivets, Elmtube, New Holland, Electropower Gears, Redifusion, Hazell Watson & Viney, Negretti,....all gone!

Hospitals and Prisons (famous)
''MAJOR omissions from the pages of Aylesbury. I'm just going to highlight them for future addition:''

Royal Buckinghamshire Hospital Designed and approved by Florence Nightingale, the central staircase is listed. The Hospital is designated: RBH

It was the main hospital for Aylesbury It had the 1st Casualty unit

This was then moved to Tindell Hospital (now mental health and as old as RBH) and then to Stoke Mandeville hospital In the 1980-to 2000 it was the maternity and special care baby unit for the area, moving to its own building Stoke Mandeville.

The former NHS Hospital has been bought and re-furbished by Dr Clark as a spinal and re-hab hospital

Stoke Mandeville Hospital, actually its in Aylesbury.

Built by the Canadian red cross post WWII for re-hab Dr Ludwig Guttman came from Heidelberg university and started the whole science of treating spinal injuries. His famous technique was to shout at the airmen and tell them they would never manage - they re-buffed the german by taking up sports and surviving their industry. (i worked with his medical colleagues, 1st hand from Senior consultant, same origins)

It is now the site of the Ludwig Guttmann para-Olympic stadium, world famous and the creator of para-Olympic games. Famous enough for Wiki or what?

HM Prisons Aylesbury is also infamous for hosting 3 prisons. 1) The young offenders high security prison - the highest category prisoners in the country under 25's. 2) Grendon Underwood, the only UK prison with psychiatric therapy and help. Regular prisons have NONE. The next stage up is the Rampton or Broadway for criminally insane prisoners. 3) the 3rd is Springhill, an open prison

There you go chaps -  DISCUSS.

CjW (talk) 08:49, 21 May 2009 (UTC)chrisjw37

 * Of those you mention above, the following have their own articles:
 * Royal Buckinghamshire Hospital
 * Stoke Mandeville Hospital
 * Tindal Centre
 * Aylesbury (HM Prison)
 * While it is probably true that more of a mention could be made of these institutions in the main article, the kind of detail you are suggesting should go in the individual articles rather than in the Aylesbury article. Grendon and Springhill prisons are not in Aylesbury.  They are, as the name of the former suggests, in Grendon Underwood. --  role player 09:30, 21 May 2009 (UTC)

Facts about Aylesbury
hey could sum1 give me sum more facts plz? — Preceding unsigned comment added by 94.2.182.187 (talk) 18:40, 20 September 2012 (UTC)

Town's role in extreme Islam?
Why is there no mention of the fact that this small town was the residence of a notorious suicide bomber who killed 26 people on a packed tube train or the former residence of the world's most wanted female terrorist (although she is at least mentioned in the list of notable people)? Is someone trying to cover up the bad points about this town?-- XANIA - ЗAНИAWikipedia talk | talk 18:59, 20 October 2014 (UTC)
 * Please don't attribute a conspiracy theory to WP edirors. If you have something constructive to contribute to improving the article then go ahead and do so rather than making stupid comments here. Your choice of heading for this section was also unfortunate and reduces the credibility of your suggestion by attributing the terrorism to the town of Aylesbury!Tmol42 (talk) 20:44, 20 October 2014 (UTC)

Pronunciation
It's /'eylzbri/. 95.73.2.20 (talk) 21:01, 25 December 2014 (UTC), Josh

External links modified
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Nice David Bowie tribute there now. — Preceding unsigned comment added by 217.39.69.128 (talk) 20:37, 19 August 2018 (UTC)

I believe this may be a factual error
The article states:

"Aylesbury was declared the new county town of Buckinghamshire in 1529 by King Henry VIII"

I don't believe it became the county town until 1725 - this as stated in the Wikipedia article relating to Buckingham:

"Buckingham was the county town of Buckinghamshire from the 10th century, when it was made the capital of the newly formed shire of Buckingham,[2] until Aylesbury took over this role early in the 18th century.[3]"

I just noticed the discrepancy - it would be good to get a definitive answer. — Preceding unsigned comment added by 80.88.195.234 (talk) 13:16, 12 September 2019 (UTC)

Whole Aylesbury article in need of updating
The whole Wikipedia page for the town is 5-12+ years out of date with a lot of now incorrect information, especially regarding the not happening link to th Varsity line and the highly controversial work on HS2. Given the town is now very much a London commuter place with many new houses supporting it, that likewise needs updating with correct information. 185.104.136.51 (talk) 19:52, 21 April 2022 (UTC)

title: Talk:Aylesbury


text:
User talk:Nickpelling

William Romaine Newbold and John Matthews Manly
Develop the pages as you wish. I come to the Voynich Manuscript and those associated with it from the historical angle. Jackiespeel (talk) 22:36, 19 March 2013 (UTC)

Voynich Manuscript and Alphabetum Kaldeorum
Could there be a link between the two at least as conceptual ideas? (The authors of the VM being familiar with 'fancy cipher scripts' just develop one of their own.) Jackiespeel (talk) 12:55, 17 October 2013 (UTC)

Dandy
Hi there; odd question. Ages ago you were given the thankless task of converting Dandy to the Commodore C64 with only a few weeks to spare. The chaps at C64Endings have been long flummoxed by the game's ending - it has a riddle that the player is supposed to work out, but the riddle makes no sense and the game appears to have never had a proper ending on any format. Do you recall if there was one? -Ashley Pomeroy (talk) 14:23, 7 September 2014 (UTC)

 * Can you tell me what the riddle is? I don't recall putting a riddle in Dandy, but I should have a reasonably good chance of working it out. :-) Nickpelling (talk) 19:02, 9 February 2015 (UTC)

Merge discussion for False writing system
You have listed the reasons for your proposed merge of this article with Asemic writing on Talk:False writing system. When you propose a merge of article X into article Y, you should list your rationale on the talk page of Y. Therefore, next time you should list your reasons for the proposed merge between two articles on the talk page of the article you want an article to merge with. Anyway, I endorse this merger. Tseung Kwan O Let's talk 01:39, 11 July 2016 (UTC)

Books WikiProject
Hi ,

I saw your work on articles related to writing and wanted to say hello, as I work in the topic area too. If you haven't already, you might want to the WikiProject Books talk page, which is a noticeboard for Wikipedia's book coverage. It's a great place to ask questions, collaborate, discuss style/structure precedent, and stay informed about content related to books. Take a look for yourself!

And if you're looking for other juicy places to edit, consider adopting a cleanup category or participating in one of our current formal discussions.

Feel free to say hi on my talk page and let me know if these links were helpful (or at least interesting). Hope to see you around! czar 00:43, 12 February 2018 (UTC)

Speedy deletion nomination of User:Nickpelling/Voynich manuscript theories

A tag has been placed on User:Nickpelling/Voynich manuscript theories requesting that it be speedily deleted from Wikipedia. This has been done under section U5 of the criteria for speedy deletion, because the page appears to consist of writings, information, discussions, and/or activities not closely related to Wikipedia's goals. Please note that Wikipedia is not a free web hosting service. Under the criteria for speedy deletion, such pages may be deleted at any time.

If you think this page should not be deleted for this reason, you may contest the nomination by visiting the page and clicking the button labelled "Contest this speedy deletion". This will give you the opportunity to explain why you believe the page should not be deleted. However, be aware that once a page is tagged for speedy deletion, it may be deleted without delay. Please do not remove the speedy deletion tag from the page yourself, but do not hesitate to add information in line with Wikipedia's policies and guidelines. If the page is deleted, and you wish to retrieve the deleted material for future reference or improvement, then please contact the, or if you have already done so, you can place a request here. MrLinkinPark333 (talk) 18:57, 25 January 2022 (UTC)

title: User talk:Nickpelling


text:
Craig Thomas

Craig Thomas may refer to:

 * Craig L. Thomas (1933–2007), American politician who represented Wyoming in the United States Senate from 1995 to 2007
 * Craig Thomas (author) (1942–2011), Welsh writer of techno-thrillers, whose best-known novel, Firefox (1977), became a successful film
 * Craig Thomas (screenwriter), American writer-producer who is the co-creator of the CBS sitcom How I Met Your Mother

title: Craig Thomas


text:
Talk:International Spartacist Tendency

I think they are actually trotskyist (albeit mad ones), and that saying stalinist in this sense is meant as POV rather than fact - as North Korea isn't stalinist but its own variety. (which name I forget). Anyway - I'm now _convinced_ you're in Workers' Liberty ;) Secretlondon 19:22, Nov 28, 2003 (UTC)

 * Fair point, if you can think of that more appropriate word, change it - I'm not sure what it is. Oh, and, um, good guess... Warofdreams 19:46, 28 Nov 2003 (UTC)

title: Talk:International Spartacist Tendency


text:
Roll On, Columbia, Roll On

"Roll On, Columbia, Roll On" is an American folk song written in 1941 by American folk singer Woody Guthrie, who popularized the song through his own recording of it. The song glamorized the harnessing of the Columbia River in the Pacific Northwest. The 11 hydroelectric dams built on the American stretch of the Columbia helped farms and industry, but their construction also permanently altered the character of the river.

The song became famous as an anthem about American public works projects arising out of the New Deal in the Great Depression. In 1987, it was adopted as the official folk song of the State of Washington.

History
"Roll On, Columbia, Roll On" was part of the Columbia River Ballads, a set of twenty-six songs written by Guthrie as part of a commission by the Bonneville Power Administration (BPA), the federal agency created to sell and distribute power from the river's federal hydroelectric facilities (primarily Bonneville Dam and Grand Coulee Dam). At the time, the agency was facing a controversy because several counties in Washington and Oregon had begun construction of their own dams on the Columbia, outside of the federal jurisdiction. On the recommendation of Alan Lomax, the BPA hired Guthrie to write a set of propaganda songs about the federal projects to gain support for federal regulation of hydroelectricity.

As part of the effort, Guthrie, who was from Oklahoma and knew little about the Pacific Northwest, was driven all around Washington and Oregon to gain inspiration from the sites of the Columbia and its tributaries. Guthrie was glad he was able to tour and get a feel for the area, commenting that "these Pacific Northwest songs and ballads have all got these personal feelings for me because I was there on these very spots and very grounds before."

Of the Columbia River Ballads "Roll on, Columbia", which he set to a modified version of Huddie Ledbetter's "Goodnight, Irene", was by far the most popular. Because of the song's message and popularity, it was established as the official folk song of Washington in 1987.

Historical and geographical content
The chorus of "Roll On, Columbia, Roll On" declares that the Columbia River is "turning the darkness to dawn". This refers to the electricity generated by the New Deal hydropower projects that brought electricity to homes in rural areas.

The first verse describes the path of the Columbia River from the Canadian Northwest to the Pacific Ocean. The second verse lists a number of the Columbia's tributaries: the Yakima, the Snake, the Klickitat, the Sandy, the Willamette, and the Hood.

In some later versions, after the first two verses, a verse was inserted describing how Thomas Jefferson had sent Lewis and Clark to explore this region. Lewis and Clark had reached the mouth of the Columbia in 1805. However, this verse did not appear in Guthrie's original recording of the song.

The next four verses describe the late 19th century American Indian Wars that took place in the Columbia basin after white settlers followed the Oregon Trail westward and were met with resistance from the Native Americans. The first three of these four verses describe a battle with a congress of the northwestern tribes in the area surrounding Cascade Locks on the Washington bank of the Columbia. If the Indians had taken the blockhouse at this location, they would have continued on into Oregon and to the Willamette Valley. However, they were stopped when Philip Henry Sheridan sailed across from Fort Vancouver with soldiers. The fourth of these verses refers to additional Indian wars that occurred "year after year", citing battles fought near Cascades Rapids, in The Dalles, and on Memaloose Isle.

The final three verses describe the construction of two Columbia River dams: Bonneville Dam and Grand Coulee Dam. Bonneville Dam had locks built into it so ships could navigate past it, alleviating worries that a dam would prevent the shipment of goods and passengers along the length of the river. Guthrie's lyrics describe Grand Coulee Dam as "the mightiest thing ever built by a man"; when it was built it was the largest concrete dam in the world, and as of 2021 it is still the largest electric power-producing facility in the United States and one of the largest concrete structures in the world.

Cultural references
The Emerald City Supporters, a fan group of the Major League Soccer team Seattle Sounders FC, sing the chorus of "Roll On, Columbia" during home matches at the 12th minute, in honor of the team's first goal in MLS, scored by Colombian forward Fredy Montero in their inaugural match against New York Red Bulls on March 19, 2009.

The Columbians Drum and Bugle Corps have the audience yell the phrase, "Roll On," during a moment of musical silence on the field to energize the members.

title: Roll On, Columbia, Roll On