Nursing culpability: a proposal for change in nursing regulation

Nurses make mistakes. They work in a complex environment which can sometimes be a contributory factor to a mistake being made. At present, Nurses' Boards in Australia have no mandate to investigate the circumstances in which a mistake is made. Their jurisdiction is limited to investigation of the individual nurse. This article sets out the argument for change in nursing legislation to allow for a broadening of the role of Nurses' Boards. It argues that an extension of their jurisdiction explicitly to allow them to investigate inadequacies in the health system would be a constructive development.     

Ensuring the safe and effective FDA regulation of fecal microbiota transplantation

Scientists, policymakers, and medical professionals alike have become increasingly worried about the rise of antibiotic resistance, and the growing number of infections due to bacteria like Clostridium difficile, which cause a significant number of deaths and are imposing increasing costs on our health care system. However, in the last few years, fecal microbiota transplantation (FMT), the transplantation of stool from a healthy donor into the bowel of a patient, has emerged as a startlingly effective means to treat recurrent C. difficile infections. At present, the FDA is proposing to regulate FMT as a biologic drug. However, this proposed classification is both underregulatory and overregulatory. The FDA''s primary goal is to ensure that patients have access to safe, effective treatments—and as such they should regulate some aspects of FMT more stringently than they propose to, and others less so. This essay will examine the nature of the regulatory challenges the FDA will face in deciding to regulate FMT as a biologic drug, and will then evaluate available policy alternatives for the FDA to pursue, ultimately concluding that the FDA ought to consider adopting a hybrid regulatory model as it has done in the case of cord blood.     

A test for carrion fly full siblings: a tool for detecting postmortem relocation of a corpse

We propose a genetic test for full sibship for a pair of carrion flies that could reveal the postmortem relocation of a corpse. A carrion fly larva is sometimes left behind when a corpse is moved. The discovery of full sibling larvae of approximately the same developmental stage at two locations would strongly suggest that a corpse was moved between those two sites. Distributions of pairwise comparisons of relatedness (R) coefficients were generated using amplified fragment length polymorphism profiles for nine samples of laboratory-generated full siblings as well as for a reference sample of nonfull sibling Phormia regina (Diptera: Calliphoridae). The mean relative R coefficient, a pairwise measure of the proportion of shared alleles, was 0.479 (±0.289 SD) for full siblings, close to the theoretical expectation of 0.5. A likelihood ratio (LR) test was based on observed distributions of R. R >0.55 corresponded to an LR >1000 favoring full sibship for that pair of individuals.     

Creating a ‘what works’ translational tool for police: a researcher-city government partnership

ABSTRACT

In recent years, a number of translational tools have been developed in policing to make the growing research evidence base more accessible and useful for practitioners and policymakers. Here we focus on the creation of the ‘What works in policing?’ website, which resulted from a collaboration between a government agency in Seattle, Washington and researchers at George Mason University and Arizona State University. We describe the site in detail and its similarities to and differences from existing translation tools, as well as the rationale for a local government’s involvement in translational work. In particular we focus on efforts to link the site with the work of the Seattle Police Department through a case study approach. We review indicators that suggest the site is being well-utilized and close with thoughts on the future of translational work in policing and efforts to ensure translational tools are useful to practitioners.     

Stereolithography: a potential new tool in forensic medicine

Stereolithography is a computer-mediated method that can be used to quickly create anatomically correct three-dimensional epoxy and acrylic resin models from various types of medical data. Multiple imaging modalities can be exploited, including computed tomography and magnetic resonance imaging. The technology was first developed and used in 1986 to overcome limitations in previous computer-aided manufacturing/milling techniques. Stereolithography is presently used to accurately reproduce both the external and internal anatomy of body structures. Current medical uses of stereolithography include preoperative planning of orthopedic and maxillofacial surgeries, the fabrication of custom prosthetic devices; and the assessment of the degree of bony and soft-tissue injury caused by trauma. We propose that there is a useful, as yet untapped, potential for this technology in forensic medicine.     

Atherosclerosis: a medicolegal tool in exhumed decomposed bodies

An exhumed body of 40-year-old Hindu man was brought for repostmortem after 10 days of death with history of allegation of assault by mob. The body was in the advanced stage of decomposition with adipocere formation over chest, thigh, and arms. In the present case, atherosclerosis was present in the coronaries and aorta sufficiently enough to deduce the cause of death and to substantiate the first autopsy findings even in highly decomposed exhumed body.     

Community participation in the certificate-of-need process: a look at ten-taxpayer groups in Massachusetts

Certificate-of-need statutes give designated state agencies veto power over investment in health care facilities. Some states have sought to temper the arbitrary character of this power by expanding the opportunities for community input into the certificate-of-need process. Massachusetts, for example, has enacted a statute that allows groups of ten taxpayers to petition for a public hearing on any certificate-of-need application. Some observers question whether the benefits of taxpayer-group participation are substantial enough to compensate for the delays and abuses that the statute allegedly invites. To help resolve this question, this Comment examines historical data on Massachusetts taxpayer groups and on their activities and assesses the significance of their composition and tactics to the certificate-of-need process. Although flaws exist in the Massachusetts ten-taxpayer mechanism, in this writer's view it has succeeded partially in making the certificate-of-need process responsive to community opinion. Many groups lack the skills and qualities needed to make constructive use of the ten-taxpayer mechanism. Nevertheless, it serves a valuable purpose by creating a public forum for and by encouraging public participation in the certificate-of-need process, especially by those who might otherwise try to circumvent that process through use of special legislation, of private pressure, or of other similar means.     

Hair analysis: a worthless tool for therapeutic compliance monitoring

Hair analysis has been presented by some authors as a possible tool of investigation for estimating patients' compliance to long-term therapies. This paper summarises the different publications that have been devoted to this topic and highlights the available statistical data presented to support this proposition. Qualitative results of such determinations may be of some interest but due to the enormous interindividual variations of quantitative data, the idea of using hair analysis to ascertain whether a patient has taken his treatment exactly as prescribed, clearly appears to be inapplicable.     

Morphine perfused rabbits: a tool for experiments in forensic entomotoxicology

In order to establish an animal model for entomotoxicological studies, the kinetics of morphine elimination from blood after a single intravenous injection of morphine and the concentration of morphine in tissues following a continuous perfusion were studied. The aim of these experiments was to obtain controlled morphine tissue concentrations similar to those encountered in fatal human heroin overdoses. These tissues can be used as a food source for developing fly larvae in entomotoxicological studies. In the single injection experiment, seven rabbits were administered 1 or 2 mg/kg body weight of morphine chlorhydrate via the main ear artery. Blood samples of 200 microL were removed regularly via a catheter. Morphine concentration was determined using RIA techniques. Morphine was found to be first rapidly distributed and then slowly eliminated, following a two-exponential equation. Elimination of morphine from blood can be described as a two-compartment model. Constants of the equation were determined using the Kaleidagraph program. Using those constants, the main pharmacokinetics parameters were calculated. Results of these parameters showed the following: clearance from 13.3 to 16.2 L.h.1, half-life of the distribution phase from 0.6 to 0.9 min, and half-life of the elimination phase from 21 to 26 min. These results were used to calculate the rate of perfusion of morphine for rabbits to obtain desired, controlled, and constant concentrations of morphine in tissues. In the second experiment, three rabbits received a perfusion of morphine intravascularly at a rate of 2 mg/kg/h for a period of 3 h. These rabbits were sacrificed and analyses performed on several abdominal and thoracic organs. Results showed that the concentrations of morphine differed according to the organ analyzed, but were reproducible for organs between animals. These concentrations were similar to those normally encountered in cases of human death due to heroin overdoses.     

The attack on national regulation: why we need a global framework for domestic regulation

The first 150 words of the full text of this article appear below. Key points

• In regulating cross-border capital markets transactions,regulators are employing either an exemptive approach, or aunilateral or mutual recognition approach. The exemptive approachallows market participants wherever located to transact businessin the host countries without complying with local requirements.The recognition approach is limited to a particular market,but is more expansive in terms of access to host country investors.In regulating cross-border transactions, the SEC has traditionallyrelied on the exemptive approach, and has restricted participationto only the largest, most sophisticated US investors. Recently,it has moved to a mutual recognition approach with its agreementwith Australia, which allows a broader range of US investorsto conduct cross-border transactions with Australian exchangesand broker–dealers relying almost entirely on the adequacyof the Australian regulatory system. However, both its exemptiveapproach and mutual recognition approach deal only with secondarymarket transactions, not participation in offerings.
• While. . . [Full Text of this Article]