Incidental findings in pediatric research

The approach to incidental research findings in children emerges by considering the child-parent relationship and balancing divergent interests and preferences. Incidental findings with clear and proximate clinical importance should be disclosed to both. We recommend that particularly sensitive or private information (e.g., pregnancy or drug use) should be disclosed to the adolescent first, while particularly serious information (e.g., cancer) should first be disclosed to the parent. These approaches allow the researcher to form an alliance with one party prior to engaging the other. However, unlike clinical settings, where there may be presumptive expectations of confidentiality about sharing information within the family, in most research settings it is reasonable to plan to disclose such information to both parties. It is important to communicate this plan during the informed consent process separately to adolescents to avoid enrolling adolescents when sensitive incidental findings such as pregnancy and drug use may be detected. The approach to incidental findings without clear and proximate benefit is challenging. Researchers should plan more limited disclosure of such incidental findings for pediatric participants than for adult participants.     

The legal ethics of pediatric research

Since the mid- to late 1990s, the scientific and medical research community has sought to increase its access to healthy children for research protocols that involve harm or a risk of harm. This move reverses longstanding policy within that community generally to exclude healthy children from such protocols on the grounds that the research as to them is non-therapeutic, that they are particularly vulnerable to research-related abuses, and that they are unable themselves to give informed consent to their participation. The research community's new posture has been supported by prominent pediatric bioethicists who have argued that unless healthy children are included as research subjects in harmful or risky research, the pediatric population will continue to suffer relative to the adult population in the extent to which it benefits from modern advances in science and medicine. In their view, it is possible for the research community to self-administer a rule that strikes a balance between protecting healthy children from research-related abuses and allowing their inclusion in cutting-edge pediatric research. In this scheme, parental consent is central to the research community's claims about child protection. This Article explores the flaws inherent in this ethics of pediatric research. Specifically, it challenges the view from ethics that the law permits parents to consent to their children's inclusion in harmful or risky research to the extent that related invasions would meet legal maltreatment standards. More broadly, it challenges the movement to increase access to healthy children for harmful and risky research on the ground that it risks two important regressions: First, in its willingness to risk harm to individual children in the interests of the group, it threatens the progress the law has made in its development of the concept of the child as an individual worthy of respect in his or her own right, a concept that imagines parents as fiduciaries and that includes strong protections against invasions of bodily integrity. Second, in its failure to assure that the burdens of non-therapeutic research are not placed disproportionately on children of lower socioeconomic and minority status, it violates the antidiscrimination principle, which has only begun to make good on its promise of equal treatment for all children. Ultimately, this Article argues that harmonization of the rules governing pediatric research with the law of child protection and parents' consent authority is the best way to assure that children are protected in the research setting in these respects and to the same extent they are otherwise in the society.     

Rethinking Injunctions in Tort Law

This article considers the way in which injunctions have generallybeen made more freely available in tort in connection with theprotection of property and property-like interests. It arguesthat this prioritization of property can be viewed as underminingthe generally accepted hierarchy of protected interests. Itthen argues that if negligence law were seen as a tort thatembraces not just careless, but also deliberate and recklessconduct, it could be used as a basis for granting injunctionsin a number of important circumstances that would help to restorethe right to bodily integrity to its rightful place at the topof the hierarchy of protected interests in tort law.     

Rethinking Regional Disparity in China

Income disparities in China decreased both across provinces and across three transprovincial areas from 1978 through 1984. After 1984 there was an increase in disparity across the three areas, but there was no change across provinces. The faster growth of the coastal area can be attributed to the growth of the previously relatively poorer areas of the eastern seaboard. But this was not realised at the cost of growth in other areas; instead it contributed to overall national economic growth. International trade and foreign direct investment are the main driving forces behind the changes in regional disparity. The reasons for the concentration of trade and foreign investment in the coastal area are its inherent comparative advantage in terms of lower labour costs, better infrastructure facilities, close relations with overseas Chinese, favourable geographic location, as well as national industrial policies that protect the domestic market from foreign investment. The central government's preferential policies towards the coastal area were a necessary, but not sufficient, condition for such a concentration of foreign trade and investment.     

Fatal non-accidental pediatric cranial fracture risk and three-layered cranial architecture development

This study examines the influence of three-layered cranial architecture development upon blunt force trauma (BFT) cranial outcomes associated with pediatric non-accidental injury (NAI). Macroscopic and microscopic metric and morphological comparisons of subadult crania ranging from perinatal to 17 years of age chronicle the ontogenetic development and spatial and temporal variability in the emergence of a mature cranial architecture. Cranial vault thickness increases with subadult age, accelerating in the first 2 years of life due to rapid brain growth during this period. Three-layer differentiation of the cranial tables and diploë initiates by 3–6 months but is not consistently observed until 18 months to 2 years; diploë formation is not well developed until after age 4 and does not manifest a mature appearance until after age 8. These results allow topographic documentation of cortical and diploic development and temporal and spatial variability across the growing cranium. The lateral cranial vault is identified as expressing delayed development and reduced expression of the three-layer architecture, a pattern that continues into adulthood. Comparison of fracture locations from known BFT pediatric cases with identified cranial fracture high-risk impact regions shows a concordance and suggests the presence of a higher fracture risk associated with non-accidental BFT in the lateral vault region in subadults below the age of 2. The absence or lesser development of a three-layered architecture in subadults leaves their cranial bones, particularly in the lateral vault, thin and vulnerable to the effects of BFT.     

Rethinking Regime Politics

Many recent studies of “regime politics” argue that judicial review is ultimately used to promote the interests of the dominant governing regime. I explore this claim by evaluating whether the invalidation of federal laws by the US Supreme Court fits the empirical expectations of the regime politics approach. I find that the Court frequently invalidates statutes when (1) the ideology of the Court diverges from that of the sitting elected branches (suggesting that the Court does not fear sanctions or nonimplementation), and (2) the ideology of the sitting elected branches converges with that of the elected branches that enacted the statute (suggesting that the Court is defying the sitting elected branches). My findings suggest that the Court does not primarily use judicial review to promote the interests of the dominant governing regime.