Medical regulation of cognitive enhancement devices: some concerns

The authors present a cogent and detailed case for altering the Medical Devices Directive to allow regulation of cognitive enhancement devices (CEDs). Protection against significant risk of harm, especially for the vulnerable, and promotion of benefit through informed use of CEDs are all good features of the proposal. However, the pre-market approval process has limitations, which we explore. We raise the possibility of ‘risk compensation’ in response to the introduction of safety measures, which could alter its effectiveness. The proposal alludes to use of ‘formally trained practitioners,’ which provide a further tier of regulation for CEDs within the proposal. We consider some positive and negative implications of this aspect of the proposal that might warrant further consideration.     

超声引导下针刀联合神经触激治疗腰椎间盘突出症临床观察

目的 探讨超声引导下针刀联合神经触激治疗腰椎间盘突出症（lumbar disc herniation,LDH）的临床价值。方法 将60例LDH患者分为试验组与对照组,每组30例,对照组采用超声引导下针刀治疗,试验组采用超声引导下针刀联合神经触激治疗,每周1次,连续4周。采用疼痛视觉模拟评分法（visual analogue score,VAS）评价患者疼痛程度,采用日本骨科协会（Japanese Orthopaedic Association,JOA）评分标准评价患者腰椎功能,采用直腿抬高试验角度观察患者下肢活动度,比较两组疗效并进行统计分析。结果 与治疗前比较,治疗后两组患者VAS评分显著降低,JOA评分、直腿抬高角度显著升高,差异均有统计学意义（P＜0.05）;且试验组VAS评分、JOA评分、直腿抬高角度改善程度均显著优于对照组（P＜0.05）。试验组综合疗效优于对照组（P＜0.05）。结论 超声引导下针刀联合神经触激疗法能够更加精准有效地缓解LDH的临床症状,疗效优于超声引导下针刀松解术。     

治理河流污染的制度激励悖论分析

为了治理日益加剧的河流污染,从中央到地方都相应出台了各种激励措施,但是这些措施并未起到显著效果,却形成了制度激励悖论。排污企业与地方政府在经历了新政策出台初的短暂扰动后,恢复原有均衡。要打破这一均衡,必须改变博弈各方的收益结构、可选策略集以及信息结构等,才有望建立符合科学发展观的最优均衡。     

论公安教育培训中教官的素质培养

随着公安教育改革的不断发展,教官队伍的培养和管理已成为影响公安教育发展的一个重要因素,文章通过对教官的基本特征、素质结构等问题的探讨,提出培养教官必须从个体的需要出发,运用激励机制调动一线民警和公安院校教师的积极性。     

大学生道德需要激发途径初探

道德需要是指人基于道德良知、道德价值的吸引以及对社会道德规范的强烈认同等而产生的成为一个有道德的人的热切渴望。它是道德学习、道德修养与道德行为的动机。激发道德需要既是德育凸现生命力的手段,又是德育所要达到的最高境界。大学生道德需要的激发途径有:(一)改善认知法。(二)角色期待法。(三)榜样示范法。(四)爱心感召法。(五)灵魂启迪法。(六)情感感染法。(七)体验感悟法。     

限制与激励：我国民事公诉程序改革中的两个维度

出于在国家干预与私法自治 ,强化检察职能与防止权力滥用等不同价值取向之间寻求平衡 ,激励与限制是我国民事公诉程序改革中的两个维度。应限定检察机关提起民事公诉案件的条件和范围 ,设置一定的前置程序 ,并赋予公民、社会团体公益诉讼权 ,但同时又应当通过废除法院受理案件的“原告适格”要件 ,建立民事公诉的惩罚性赔偿制度 ,改革诉讼成本制度 ,委托专家诉讼来励检察机关提起民事公诉。     

Buttressing regulation of cognitive enhancement devices with principles of harm reduction

Maslen and colleagues offer an excellent model for regulating cognitive enhancement devices (CEDs), and we largely endorse their approach of extending medical device policy to include CEDs. Maslen et al. argue that since the risks and benefits of CEDs can be identified, consumers are best placed to evaluate the impact of these effects on their own wellbeing: ‘experts are to assess what the risks are, the consumer how much they matter’. In principle, we agree: consumers should be allowed to decide what risks are worth taking, but the situation is somewhat more complicated, for the evidence that consumers are in a strong position to evaluate the many risks associated with CED use is lacking. Indeed, a glance at online forums on CEDs suggests that undue risks are already being taken. Importantly, given the ease with which devices can be built using easily obtainable parts, overly tough regulation will not effectively curtail use, but rather push it underground. For these reasons, we suggest that any regulatory framework be buttressed by principles of harm reduction, providing real-world users with expert-backed recommendations for safe use. We argue for the development of tools that facilitate this dialogue, while recognizing the challenges in so doing.     

When benefitting a patient increases the risk for harm for third persons — The case of treating pedophilic Parkinsonian patients with deep brain stimulation

This paper investigates the question whether it is ethically justified to treat Parkinsonian patients with known or suspected pedophilia with deep brain stimulation — given increasing evidence that this treatment might cause impulse control disorders, disinhibition, and hypersexuality. This specific question is not as exotic as it looks at a first glance. First, the same issue is raised for all other types of sexual orientation or behavior which imply a high risk for harming other persons, e.g. sexual sadism. Second, there are also several (psychotropic) drugs as well as legal and illegal leisure drugs which bear severe risks for other persons. We show that Beauchamp and Childress' biomedical ethics fails to derive a veto against medical interventions which produce risks for third persons by making the patients dangerous to others. Therefore, our case discussion reveals a blind spot of the ethics of principles. Although the first intuition might be to forbid the application of deep brain stimulation to pedophilic patients, we argue against such a simple way out, since in some patients the reduction of dopaminergic drugs allowed by deep brain stimulation of the nucleus subthalamicus improves impulsive control disorders, including hypersexuality. Therefore, we propose a strategy consisting of three steps: (1) risk assessment, (2) shared decision-making, and (3) risk management and safeguards.     

Cardiac Inhibitory Reflex as a Cause/Mechanism of Death

The role of cardiac inhibitory reflex as a potential cause of death is still a matter of debate. This study reports two cases of death under unusual circumstances. Case 1 corresponds to a man found hanging where the role of ligature compression of the carotid sinus became relevant as a possible explanation of death. In Case 2, the participation of a vasovagal syncope was clearly triggered by the laryngoscopic procedure. It is proposed that cardiac inhibitory reflex should be taken into account in those cases of unexpected death, which fulfills the following three criteria: (i) The investigation of the circumstances of the death is consistent with a hypothesis of cardiac arrest. (ii) A typical triggering peripheral stimulus is present. (iii) The performance of a complete autopsy cannot rule out the participation of a cardiac inhibitory reflex in the cause of death.