An Exploration of the Protective Effects of Investigators’ Ethical Awareness upon Subjects of Drug Clinical Trials in China

Up till now, China has not enacted any legal mechanisms governing certification or supervision for ethics committees. This article analyses deficiencies in the protection of subjects in clinical drug trials under China’s current laws and regulations; it emphasizes that investigators, as practitioners who have direct contact with subjects, play significant roles in protecting and safeguarding subjects’ rights and interests. The paper compares the status quo in China in this area to that of other countries and discusses ways China might enhance the protection of rights and interests of trial subjects, such as enhancing the ethical awareness of investigators through training, improving laws and regulations, and strengthening the communication between investigators and ethics committees.     

Restricted treatments, inducements, and research participation

In this paper, I support the claim that placing certain restrictions on public access to possible new treatments is morally problematic under some exceptional circumstances. Very ill patients may find that all available standard treatments are unacceptable, either because they are ineffective or have serious adverse effects, and these patients may understandably be desperate to try something new even if this means stepping into the unknown. Faced with certain death, it is rational to want to try something new and to chance a dire outcome. Restricting possible new treatments to research trials may put these treatments scientifically, geographically or economically out of reach of these patients. For those who can get access, research restrictions could weaken, though not necessarily eliminate, the value of consent participants of such trials are able to give. Some participants may therefore be exploited for scientific purposes in the name of public interest. There are nonetheless compelling reasons for keeping some restrictive regulation in this area.     

Child murder by mothers: patterns and prevention

The tragedy of maternal filicide, or child murder by mothers, has occurred throughout history and throughout the world. This review of the research literature sought to identify common predictors in the general population as well as in correctional and psychiatric samples. Further research is needed to improve identification of children and mothers at risk. Infanticide laws are discussed. Suggestions for prevention are made based on the current literature and the authors'' experiences.     

新形势下加强医疗服务质量监管的路径选择

卫生服务质量包括公共卫生服务质量和医疗服务质量。其中,医疗服务质量直接关系到患者的生命与健康,是卫生服务的核心工作。目前,医疗服务市场”信息不对称”,因此,如何有效的监管医疗机构的服务质量成为政府的重要职责之一。本文在明确医疗服务质量监管内涵的基础上,结合我国监管现状,指出我国医疗服务领域所存在的监管主体单一、监管力量薄弱、监管法规有待完善、监管过程缺乏常态化、监管结果未能及时公开等方面的不足,并针对上述不足之处,提出四点政策建议：一是以政府为核心,培育多元监管主体;二是以信息化建设为平台,创新监管手段;三是以法规建设为重点,完善监管体系;四是加强监管结果的运用。     

Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin

BackgroundBuruli ulcer may induce severe disabilities impacting on a person''s well-being and quality of life. Information about long-term disabilities and participation restrictions is scanty. The objective of this study was to gain insight into participation restrictions among former Buruli ulcer patients in Ghana and Benin.MethodsIn this cross-sectional study, former Buruli ulcer patients were interviewed using the Participation Scale, the Buruli Ulcer Functional Limitation Score to measure functional limitations, and the Explanatory Model Interview Catalogue to measure perceived stigma. Healthy community controls were also interviewed using the Participation Scale. Trained native interviewers conducted the interviews. Former Buruli ulcer patients were eligible for inclusion if they had been treated between 2005 and 2011, had ended treatment at least 3 months before the interview, and were at least 15 years of age.ResultsIn total, 143 former Buruli ulcer patients and 106 community controls from Ghana and Benin were included in the study. Participation restrictions were experienced by 67 former patients (median score, 30, IQR; 23;43) while 76 participated in social life without problems (median score 5, IQR; 2;9). Most restrictions encountered related to employment. Linear regression showed being female, perceived stigma, functional limitations, and larger lesions (category II) as predictors of more participation restrictions.ConclusionPersisting participation restrictions were experienced by former BU patients in Ghana and Benin. Most important predictors of participation restrictions were being female, perceived stigma, functional limitations and larger lesions.     

Death Following Inhalation of Mercury Vapor at Home.

Confusion exists among physicians over the legal requirements and appropriate prescribing of narcotics to addicted or habitual users of narcotics. The result has often been either (1) the deprivation of appropriate treatment for patients who desire detoxification or adequate pain relief, or (2) illegal prescribing by physicians. Because most narcotics are potent and dangerous substances, certain legal restrictions are necessary to protect the general public. State-approved programs have been established to prescribe methadone and propoxyphene napsylate for addiction treatment. Current laws and regulations in California permit every practicing physician to provide effective and safe treatment for addiction and pain relief.     

Control of Babesia equi parasitemia

Infection of horses with the hemoprotozoan Babesia equi has been reported in southern Florida, US Virgin Islands, part of Asia, Russia, India, the Middle East, Europe, Africa, Australia, South America, Central America, Mexico, Philippine Islands and some Caribbean islands. The restrictions placed on the international movement of infected horses has refocused attention on potential methods to control or eliminate infection. Don Knowles here discusses the primary chemotherapeutic compounds that have been used; the current knowledge concerning immune responses that potentially contribute to control of the parasite, and the development of infection of severe combined immuno-deficient foals as a model to dissect potential mechanisms of immunological control.     

Healthier Fundraising in U. S. Elementary Schools: Associations between Policies at the State,District, and School Levels

Objectives

We examined whether state laws and district policies pertaining to nutritional restrictions on school fundraisers were associated with school policies as reported by administrators in a nationally-representative sample of United States public elementary schools.

Methods

We gathered data on school-level fundraising policies via a mail-back survey during the 2009–10 and 2010–11 school years. Surveys were received from 1,278 public elementary schools (response rate = 60.9%). Data were also gathered on corresponding school district policies and state laws. After removing cases with missing data, the sample size for analysis was 1,215 schools.

Results

After controlling for school characteristics, school policies were consistently associated with state laws and district policies, both those pertaining to fundraising generally, as well as specific restrictions on the sale of candy and soda in fundraisers (all Odds Ratios >2.0 and Ps<.05). However, even where district policies and state laws required fundraising restrictions, school policies were not uniformly present; school policies were also in place at only 55.8% of these schools, but were more common at schools in the West (77.1%) and at majority-Latino schools (71.4%), indicating uneven school-level implementation of district policy and state law.

Conclusions

District policies and state laws were associated with a higher prevalence of elementary school-level fundraising policies, but many schools that were subject to district policies and state laws did not have school-level restrictions in place, suggesting the need for further attention to factors hindering policy implementation in schools.     

HIV/AIDS among Inmates of and Releasees from US Correctional Facilities, 2006: Declining Share of Epidemic but Persistent Public Health Opportunity

Because certain groups at high risk for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) come together in correctional facilities, seroprevalence was high early in the epidemic. The share of the HIV/AIDS epidemic borne by inmates of and persons released from jails and prisons in the United States (US) in 1997 was estimated in a previous paper. While the number of inmates and releasees has risen, their HIV seroprevalence rates have fallen. We sought to determine if the share of HIV/AIDS borne by inmates and releasees in the US decreased between 1997 and 2006. We created a new model of population flow in and out of correctional facilities to estimate the number of persons released in 1997 and 2006. In 1997, approximately one in five of all HIV-infected Americans was among the 7.3 million who left a correctional facility that year. Nine years later, only one in seven (14%) of infected Americans was among the 9.1 million leaving, a 29.3% decline in the share. For black and Hispanic males, two demographic groups with heightened incarceration rates, recently released inmates comprise roughly one in five of those groups'' total HIV-infected persons, a figure similar to the proportion borne by the correctional population as a whole in 1997. Decreasing HIV seroprevalence among those admitted to jails and prisons, prolonged survival and aging of the US population with HIV/AIDS beyond the crime-prone years, and success with discharge planning programs targeting HIV-infected prisoners could explain the declining concentration of the epidemic among correctional populations. Meanwhile, the number of persons with HIV/AIDS leaving correctional facilities remains virtually identical. Jails and prisons continue to be potent targets for public health interventions. The fluid nature of incarcerated populations ensures that effective interventions will be felt not only in correctional facilities but also in communities to which releasees return.     

My father's life.

Medicine has many unsung heroes, and among them are physicians who spend their careers providing medical care in remote areas. In this article, Ronald Porth remembers the life of his father, Dr. Frank Porth, who for more than 30 years provided medical care on native reserves and in rural parts of the Prairies.     

The evolutionary origin of a second radiation of annual Castilleja (Orobanchaceae) species in South America: The role of long distance dispersal and allopolyploidy

Considerable attention has been directed toward understanding the wide gaps in range that are common among many groups of closely related organisms. By placing their biology and geography in a phylogenetic context, we may gain a broader knowledge of the series of historical events that have led to present species distributions. In addition to the North American annuals, a second radiation of annual Castilleja species is in Andean Peru and central Chile. Phylogenetic analyses of chloroplast and nuclear DNA regions revealed a complex history for the origin and diversification of annual Castilleja species in South America. In addition to at least three independent long-distance dispersal events from North America, allopolyploidy has played a significant role in this disjunct radiation. Only C. attenuata occurs in both California and South America, and these results support its recent arrival to central Chile. Two Peruvian species are inferred to be allopolyploids; hybridization between annual lineages derived from independent long-distance dispersal events from North America gave rise to C. profunda, and hybridization between South American annual and perennial species gave rise to C. cerroana. The relative importance these events are discussed with reference to the observed morphological, ecological, and distributional patterns.     

Neural control of quadrupedal and bipedal stance: implications for the evolution of erect posture

The transition among hominids from quadrupedalism to bipedalism resulted in modifications in their musculoskeletal morphology. It is unclear, however, whether changes in the circuitry of the CNS were also necessary in order to accommodate the unique balance requirements of two-limb support. This study addresses the issue of modifications in control strategies by investigating the rapid, automatic postural responses of feline and human subjects to sudden disturbances of balance in the anteroposterior (AP) direction while they stand quadrupedally and bipedally on movable platforms. Postural responses are characterized in terms of segmental adjustments, generated AP shear forces, and electromyographic activity. Feline and human subjects correct posture similarly when standing quadrupedally. Furthermore, both species correct stance primarily with their hindlimbs and use their forelimbs as supportive struts. In contrast, both species use completely different correctional strategies when standing bipedally. Morphological restrictions, however, prevent cats from adopting the pillar-like plantigrade posture of human beings. Thus, the correctional strategies of bipedal cats are distinct from those of bipedal human subjects. It is concluded that 1) automatic postural response patterns of quadrupedal Felis and bipedal Homo reflect the different biomechanical characteristics of the initial postures rather than species differences in CNS circuitry controlling stance; 2) hindlimb-dominated posture control is probably a common and relatively ancient pattern; and 3) reorganization of hominid CNS circuitry was probably unnecessary because hindlimb control was already a feature of the system.     

Drying and warming immediately after birth may reduce piglet mortality in loose-housed sows

The aim of the present experiment was to investigate the effects of placing newborn piglets under the heat lamp or both drying and placing them under the heat lamp on piglet mortality. Sixty-seven healthy (Landrace × Yorkshire) sows were divided equally into three different experimental groups: a control group where the farrowings occurred without supervision from the farmer (C; n = 23 litters), another group where the piglets were placed under the heat lamp in the creep area immediately after birth (HL; n = 22 litters) and a third group where the piglets were dried with straw and paper towels followed by placing them under the heat lamp in the creep area immediately after birth (DHL; n = 22 litters). The sows were individually loose-housed in farrowing pens during farrowing and lactation. The piglets were not closed inside the creep area, but were free to move around in the pen. The routines in the experimental groups required the stock person to attend the farrowings from the onset of birth of the first piglet until the last piglet was born. All the dead piglets were weighed and subjected to a post mortem examination at the farm to ascertain the causes of death. Postnatal mortality (% of live born) was significantly lower in the HL and DHL groups than in the control group (P < 0.0001). This was significant concerning all causes of mortality. Compared to the control group, crushing occurred in significantly fewer litters when the piglets were both dried and placed under the heat lamp (P < 0.05). In the DHL treatment, crushing of one or more piglets by the sow occurred in only 13.6% of the litters, whereas this was increased to 34.8% in the HL and to 47.9% in the control group, respectively. All causes of death, except the proportion of stillborn piglets, increased significantly with increasing litter size. Because of the relatively large potential that these rather simple routines may have to improve piglet survival, different types of management or human interference around the time of farrowing should be compared on a larger scale, both experimentally and on commercial farms.     

Why treat doctors like pushers?

Harsher laws and enforcement procedures are making Canadian physicians more vulnerable to conviction as drug traffickers. The authors question this development on the grounds that it extends a drug prohibition policy that has failed in the past and has incurred intolerable social costs. To help envision an alternative, the authors discuss conflicting claims about the British tradition of permitting doctors to prescribe narcotics to addicts. They conclude that, with some restrictions, allowing Canadian doctors to prescribe narcotics according to their judgements of patient needs would be more efficacious than increasing the penalties they face for violating nonmedical norms.     

Abortion Rights along the Irish-English Border and the Liminality of Women’s Experiences

My research in European abortion laws and restrictions focuses on the migration of thousands of Irish women who travel to England each year to access safe and legal abortion services. This article is an investigation of the Irish-English border as a symbol for reproductive freedom and the new value systems in which Irish women participate when they cross its boundary. I provide a brief history of abortion law in the Republic of Ireland and Northern Ireland and emphasize a specific case in which border crossing was severely restricted for a young rape victim desiring an abortion. Additionally, my research examines women’s experiences of liminality as they cross the Irish-English border and the complex, conflicting emotions that they may feel as they travel abroad. In particular, I address a recent pro-choice initiative by a Dutch organization called Women on Waves, which sent a ship converted into a reproductive clinic to Dublin to provide services to Irish women. The ship, which has since sailed to Poland and Portugal to offer further assistance to women in countries with bans on abortion, complicates the notion of crossing concrete national lines as it moves throughout international waters.     

Delinquency in women

From observation of some 1,000 women who were committed to a California correctional institution because of felonious offense it was concluded that:1. Delinquency results from certain identifiable factors, particularly basic defects in early family relationships, various aberrant psychological states including many forms of mental illness; physical illness or injuries, particularly those producing brain damage and resulting in abnormal psychological conditions; general environmental factors, and specific environmental factors.2. Certain personality-types and certain life-environmental situations appear to be associated with certain patterns of offenses.3. Correction and rehabilitation may be achieved to a greater degree as correctional institution treatment programs are increasingly implemented with psychiatric personnel, and as increased guidance and support are made available through parole divisions.     

Pasture clearing from invasive woody plants in the Pantanal: a tool for sustainable management or environmental destruction?

With a total area of 160,000 km², the Pantanal is one of the largest wetlands in South America and certainly the most famous. It is essential for the maintenance of biodiversity and is highly ranked in national and international protection plans. The ecology of the Pantanal is influenced by the annual inundation, frequent fires during the dry period, and multiple human activities. To maintain traditional low density cattle ranching, which is the economic basis for the Pantanal’s human population, the spread of woody vegetation into former pasture areas requires pasture clearing. Legal restrictions, however, have led to the confusion of pasture clearing with the illegal deforestation that has accompanied Brazil’s rapid economic development, thus creating serious conflicts between the Pantanal’s ranchers and the governmental environmental agency. This dichotomy of interests, i.e., the need to maintain habitat and species diversity while guaranteeing the livelihoods of the ranchers but warding off deforestation, can only be resolved through modern management plans that reconcile the requirements of environmental protection with the economic needs of the ranchers, who are the owners of most of the Pantanal. The key to any such plan’s successful implementation is to consider the Pantanal not as a pristine wetland, but as a valuable cultural landscape. Over the last two and a half centuries, the vegetation in large parts of the Pantanal has been altered due to the presence of cattle ranches. This has maintained its habitat diversity and multiple services to humans and to the environment, including the enhancement of species diversity. This management practice corresponds to modern approaches in other parts of the world, where low density animal grazing, sometimes in combination with mechanical removal of woody vegetation are considered powerful management tools for the maintenance of valuable cultural landscapes.     

Declining growth rate of West Nile virus in North America

To determine the demographic history of West Nile virus (WNV) in North America, we employed a coalescent method to envelope coding region data sets for the NY99 and WN02 genotypes. Although the observed genetic diversities in both genotypes were of approximately the same age, the mean rate of epidemiological growth of the WN02 population was approximately three times that of the NY99 population, a finding compatible with the recent dominance of the former genotype. However, there has also been a marked decrease in the recent growth rate of WN02, suggesting that WNV has reached its peak prevalence in North America.     

Cause of the “power-on reset” phenomenon other than electric magnetic interference in a patient with a pacemaker

A 67-year old male with a dual-chamber pacemaker visited for a regular check-up. An unfamiliar message emerged on the display just after placing the programmer wand. We could recognize that the pacemaker had already been in the safe back-up mode of DDI, and the programmer prompted a re-initialization request. We are so surprised because there was no indication of device malfunction the day before in daily monitoring and a 12-lead electrocardiogram revealed normally working in the DDD mode just before checking the device. The pacemaker was immediately re-programmed to the former setting. This phenomenon has not recurred for 12 months.     

DELINQUENCY IN WOMEN

From observation of some 1,000 women who were committed to a California correctional institution because of felonious offense it was concluded that:1. Delinquency results from certain identifiable factors, particularly basic defects in early family relationships, various aberrant psychological states including many forms of mental illness; physical illness or injuries, particularly those producing brain damage and resulting in abnormal psychological conditions; general environmental factors, and specific environmental factors.2. Certain personality-types and certain life-environmental situations appear to be associated with certain patterns of offenses.3. Correction and rehabilitation may be achieved to a greater degree as correctional institution treatment programs are increasingly implemented with psychiatric personnel, and as increased guidance and support are made available through parole divisions.