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101.
Thogmartin JR Wilson CI Palma NA Ignacio SS Shuman MJ Flannagan LM 《Journal of forensic sciences》2011,56(5):1352-1360
This study presents a series of 16 carriers of hemoglobin S (HbS) who died during various circumstances. Many of the cases were associated with mild to moderate exertion. The onset and/or duration of symptoms varied from a few minutes to several hours with many displaying a prolonged lucid interval with stable vital signs. Despite seeking medical treatment, sickle cell trait-related micro-occlusive crisis was never considered in the differential diagnosis. Several cases were associated with sudden death. In those deaths which were delayed, high anion gap and uncompensated metabolic acidosis were typical and were not heat related. Also characteristic were large increases in creatine kinase, alanine aminotransferase, and aspartate aminotransferase along with myoglobinemia. Although the antemortem diagnosis of rhabdomyolysis was made, the underlying cause was never deduced by the clinicians. The sickling found at autopsy is not always a postmortem artifact, and in the right circumstances can be diagnostic. 相似文献
102.
Nancy M. Baum Sarah E. Gollust Susan D. Goold Peter D. Jacobson 《The Journal of law, medicine & ethics》2007,35(4):657-667
Ethical challenges in public health can have a significant impact on the health of communities if they impede efficiencies and best practices. Competing needs for resources and a plurality of values can challenge public health policymakers and practitioners to make fair and effective decisions for their communities. In this paper, the authors offer an analytic framework designed to assist policymakers and practitioners in managing the ethical tensions they face in daily practice. Their framework is built upon the following set of six considerations: determining population-level utility of the proposed action; demonstrating evidence of need and effectiveness of actions; establishing fairness of goals and proposed implementation strategies; ensuring accountability; and, assessing expected efficiencies and costs associated with the proposed action. Together, these considerations create a structured guide to assist decision-makers in identifying potential ethical challenges and in assessing the moral considerations that underlie public health practice - and possibly even, if the conditions are met, reduce the creation of ethical tension. Although the authors'empirical experiences provide the basis for the framework advanced here, their approach remains to be tested and evaluated by public health practitioners. 相似文献
103.
Susan L Smith 《The Journal of law, medicine & ethics》2008,36(3):517-521
This essay examines the risks of racialized science as revealed in the American mustard gas experiments of World War II. In a climate of contested beliefs over the existence and meanings of racial differences, medical researchers examined the bodies of Japanese American, African American, and Puerto Rican soldiers for evidence of how they differed from whites. 相似文献
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Claire E.V. French Cynthia G. Jensen Susan K. Vintiner Douglas A. Elliot Susan R. McGlashan 《Forensic Science International Supplement Series》2008,178(1):1-6
There are a number of forensic cases in which the identification of the epithelial cell type from which DNA originated would provide important probative evidence. This study aimed to develop a technique using histological staining of fixed cells to distinguish between skin, buccal and vaginal epithelium. First, 11 different stains were screened on formalin-fixed, wax-embedded cells from five women. Samples were analysed qualitatively by examining staining patterns (colour) and morphology (absence or presence of nuclei). Three of the staining methods – Dane's, Csaba's and Ayoub-Shklar – were successful in distinguishing skin epithelial cells from buccal and vaginal. Second, cells were smeared directly onto slides, fixed with one of five fixatives and stained with one of the three stains mentioned above. Methanol fixation, coupled with the Dane's staining method, specific to keratin, was the only technique that distinguished between all three cell types. Skin cells stained magenta, red and orange and lacked nuclei; buccal cells stained predominantly orange–pink with red nuclei; while vaginal cells stained bright orange with orange nuclei and a blue extracellular hue. This staining pattern in vaginal cells was consistent in samples collected from 50 women aged between 18 and 67. Identification of cell type from unlabelled micrographs by 10 trained observers showed a mean success rate of 95%. The results of this study demonstrate that histological staining may provide forensic scientists with a technique for distinguishing between skin, buccal and vaginal epithelial cells and thus would enable more conclusive analyses when investigating sexual assault cases. 相似文献
107.
Managing incidental findings in human subjects research: analysis and recommendations. 总被引:8,自引:8,他引:0
Susan M Wolf Frances P Lawrenz Charles A Nelson Jeffrey P Kahn Mildred K Cho Ellen Wright Clayton Joel G Fletcher Michael K Georgieff Dale Hammerschmidt Kathy Hudson Judy Illes Vivek Kapur Moira A Keane Barbara A Koenig Bonnie S Leroy Elizabeth G McFarland Jordan Paradise Lisa S Parker Sharon F Terry Brian Van Ness Benjamin S Wilfond 《The Journal of law, medicine & ethics》2008,36(2):219-48, 211
No consensus yet exists on how to handle incidental findings (IFs) in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are findings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. 相似文献
108.
In an effort to take positive steps toward coping with problems for families and children created by high levels of separation and divorce, ever increasing civil caseloads and the exposure of children to interparental conflict, court‐affiliated educational programs have emerged in the United States for parents separating from their spouse or partner or going through a divorce. This article will provide an overview of the creation of such programs and their development, which includes a discussion regarding the numerous states currently mandating parents to attend. It will summarize some of the research which has been conducted as to the efficacy of the programs and will provide the results of our nationwide research for each state's parent education status. There is a discussion of domestic violence issues and sensitivities in the context of parent education programs and possible future directions for mandatory parent education. 相似文献
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