Must the Surgeon Take the Pill? Negligence Duty in the Context of Cognitive Enhancement

Recently, attention has turned to the possibility of enhancing human cognitive abilities via pharmacological interventions. Known as ‘cognitive enhancers’, these drugs can alter human mental capacities, and in some cases can effect significant improvements. One prime example is modafinil, a drug used to treat narcolepsy, which can help combat decreases in wakefulness and cognitive capacity that arise due to fatigue in otherwise healthy individuals. In this paper, we respond to calls in the philosophical and ethical literature that surgeons and other medical professionals should be morally obliged to take cognitively enhancing drugs. We examine whether surgeons who make fatigue‐related errors during patient care might be considered legally obliged to enhance themselves. We focus on liability for a failure to medicate, and conclude that it is highly unlikely that surgeons will be legally obliged to address their fatigue through the use of cognitive enhancing drugs.     

Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions--an overview

Venous stasis predisposes to thrombosis. One hundred and sixty cases of fatal pulmonary thromboembolism were reviewed to determine how many cases had deep venous thromboses associated with venous blood flow reduction caused by external pressure from benign pelvic masses. Three cases were identified, representing 2% of cases overall (3/160): a 44-year-old woman with a large uterine leiomyoma (1048 g); a 74-year-old man with prostatomegaly and bladder distension (containing 1 L of urine); and a 70-year-old man with prostatomegaly and bladder distension (containing 3 L of urine). Although a rare cause of fatal deep venous thrombosis and pulmonary thromboembolism, space-occupying pelvic lesions can lead to extrinsic pressure on adjacent veins reducing blood flow and causing stasis and thrombosis. Individuals with large pelvic masses may, therefore, be at increased risk of pulmonary thromboembolism from deep venous thrombosis, particularly in the presence of concurrent risk factors such as immobility, thrombophilias, malignancy, and significant cardiopulmonary disease.     

Comparing Standard and Selective Degradation DNA Extraction Methods: Results from a Field Experiment with Sexual Assault Kits,

A growing number of U.S. cities have large numbers of untested sexual assault kits (SAKs) in police property facilities. Testing older kits and maintaining current case work will be challenging for forensic laboratories, creating a need for more efficient testing methods. Methods: We evaluated selective degradation methods for DNA extraction using actual case work from a sample of previously unsubmitted SAKs in Detroit, Michigan. We randomly assigned 350 kits to either standard or selective degradation testing methods and then compared DNA testing rates and CODIS entry rates between the two groups. Results and conclusions: Continuation‐ratio modeling showed no significant differences, indicating that the selective degradation method had no decrement in performance relative to customary methods. Follow‐up equivalence tests indicated that CODIS entry rates for the two methods could differ by more than ±5%. Selective degradation methods required less personnel time for testing and scientific review than standard testing.     

An evaluation of the effectiveness of positive behavioural support within a medium secure mental health forensic service

A number of recent influential reports recommend the use of proactive and preventative approaches such as Positive Behavioural Support (PBS) in the management of challenging behaviours. Although evidence supporting the use of PBS is mainly drawn from studies of learning disability and child populations, it is recognised that PBS could have a much wider utility. In this study, PBS was implemented in a medium secure forensic mental health service, a novel context. Impact was evaluated using an adapted version of the Checklist of Challenging Behaviour at baseline and then at 3 monthly intervals for a year. Significant reductions were observed in aggression frequency, management difficulty and severity and other challenging behaviour frequency and management difficulty. Reductions in challenging behaviour were still evident after six months for the full group and twelve months for the sub-group with the exception of other challenging behaviour management difficulty. In contrast, no such significant differences were found for a control group. This study indicated that PBS was an effective intervention in the management of challenging behaviour in this forensic mental health context.     

Early Voting Changes and Voter Turnout: North Carolina in the 2016 General Election

North Carolina offers its residents the opportunity to cast early in-person (EIP) ballots prior to Election Day, a practice known locally as “One-Stop” voting. Following a successful legal challenge to the state’s controversial 2013 Voter Information and Verification Act, North Carolina’s 100 counties were given wide discretion over the hours and locations of EIP voting for the 2016 General Election. This discretion yielded a patchwork of election practices across the state, providing us with a set of natural experiments to study the effect of changes in early voting hours on voter turnout. Drawing on individual-level voting records from the North Carolina State Board of Elections, our research design matches voters on race, party, and geography. We find little evidence that changes to early opportunities in North Carolina had uniform effects on voter turnout. Nonetheless, we do identify areas in the presidential battleground state where voters appear to have reacted to local changes in early voting availability, albeit not always in directions consistent with the existing literature. We suspect that effects of changes to early voting rules are conditional on local conditions, and future research on the effects of election law changes on turnout should explore these conditions in detail.

     

Most Significant Change in conflict settings: staff development through monitoring and evaluation

Capoeira4Refugees is an NGO that uses the Afro-Brazilian art form of Capoeira to promote psychosocial well-being in children affected by conflict and occupation. Capoeira4Refugees introduced the Most Significant Change (MSC) methodology to monitor and evaluate project implementation and impact across two locations in the Middle East. Analysis of interviews conducted with five field staff revealed that in line with, and building on, previous research, MSC became an empowering tool that led to staff development. The potential for MSC to build staff reflexivity, independence, and leadership has implications for other organisations working in conflict areas, particularly in situations of remote management.     

China and the EU: Where next in bilateral trade and investment relations?

Trade and investment relations between China and the European Union (EU) have reached a momentous significance. China is the EU’s No. 1 supplier of goods and its second-largest export market. In turn, the EU is China’s largest trading partner. Not only goods but also services trade has large potential to grow, even as China undergoes a structural transition and the EU’s single market faces headwinds from a surge in state-centric political forces within Europe. Transport and trade-related services are bound to expand significantly as China’s integration into the world economy continues. Moreover, Chinese tourists have been flocking to Europe in ever greater numbers, giving a boost to related business. Foreign direct investment (FDI) is becoming the next engine of the China–EU partnership. While the EU is a long-standing investor in China, Chinese direct investment accounts for <1 % of the EU’s total inbound FDI stock. Investment relations have seen tremendous dynamism in line with Chinese companies’ outward expansion and Chinese M&A deals vis-à-vis the EU have grown rapidly in magnitude, scope and sophistication. Finally, plenty of headroom exists for greater adoption of the use of the Chinese Renminbi (RMB) in Europe, supporting financing of both investment and trade. The Bilateral Investment Treaty (BIT) currently in negotiation between China and the EU as well as growing rather than declining interdependence of trade and investment highlight the future potential for a comprehensive free trade agreement between the EU and China.

     

Hypothermia-related Deaths: A 10-year Retrospective Study of Two Major Metropolitan Cities in the United States*

Hypothermia-related deaths affect vulnerable populations and are preventable. They account for the vast majority of weather-related deaths in the United States. The postmortem diagnosis of hypothermia can be challenging, as there are no pathognomonic signs. The electronic databases of the New York City Office of Chief Medical Examiner and Harris County Institute of Forensic Sciences were searched for all fatalities where the primary cause of death included hypothermia, between January 2009 and July 2019. There were 139 hypothermia deaths in New York City (NYC) with an average annualized rate of 1.7 per million. During this same time, there were 50 hypothermia deaths in Houston with an average annualized rate of 2.4 per million. Males were more likely to die of hypothermia compared to females in both cities. The rate ratio (RR) in NYC was 3.55 (95% CI 2.40, 5.25), while the RR in Houston was 2.83 (95% CI 1.50, 5.32). Age- and sex-specific standardized hypothermia mortality rates were 18.2 (95% CI 15.1, 21.2) per million in NYC and 30.1 (95% CI 21.7, 38.6) per million in Houston. The comparative hypothermia death ratio was 1.66 (95% CI 1.19, 2.30), indicating hypothermia mortality in Houston was 66% higher than in NYC. There was no correlation between zip code poverty rates and hypothermia-related deaths. The most consistent autopsy finding was Wischnewski spots (56.6%), and ethanol was the most common toxicological finding (36.5%). Local agencies can use this data to target these higher-risk populations and offer appropriate interventions to try to prevent these deaths.