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.