State laws addressing teen dating violence in US high schools: A difference-in-differences study

OBJECTIVE

Teen dating violence (TDV) is prevalent with lifelong adverse consequences, and strategies to reduce its burden are needed. Many U.S. states have enacted laws to address TDV in schools, but few studies have examined their effectiveness. This study aimed to assess whether state TDV laws were associated with changes in physical TDV victimization among high school students.

METHODS

We used repeated cross-sectional data of high school students from the Youth Risk Behavior Survey across 41 states from 1999 to 2019. Using a difference-in-differences approach with an event study design, we compared changes in past-year physical TDV in states that enacted TDV laws (n = 21) compared to states with no required laws (n = 20). Analyses accounted for clustering at the state-level and state and year-fixed effects. We conducted sensitivity analyses to assess the robustness of our findings.

RESULTS

In our sample of 1,240,211 students, the prevalence of past-year physical TDV was 9.2% across all state-years. In 1999, the prevalence of TDV at the state-level ranged from 7.5 to 13.0%; in 2019, the prevalence ranged from 3.7 to 10.5%. There was no significant association between TDV laws and past-year physical TDV. Six or more waves after enactment, we observed a non-significant 1.7% percentage point reduction in TDV in states with TDV laws (95% CI: -3.6 to 0.3 percentage points; p = 0.10).

CONCLUSIONS

We found no significant association between enactment of TDV laws and physical TDV among high school students. Further research is needed to understand how TDV laws are implemented and components of TDV laws that may influence effectiveness.

Legislative Differences Governing Exotic Animal Practice

Laws regulating exotic animal ownership vary throughout the world. While some differences regarding the legal status and use of exotic companion animals are associated with cultural differences and public perception, some differences may result in different outcome, which could be of interest for other parts of the world. This article provides a general overview of relevant laws pertaining to exotic companion animals in certain developed countries.

State cannabis laws and cannabis positivity among fatally injured drivers

BACKGROUND

As of November 8, 2023, 24 states and the District of Columbia have legalized cannabis for both recreational and medical use (RMCL-states), 14 states have legalized cannabis for medical use only (MCL-states) and 12 states have no comprehensive cannabis legislation (NoCL-states). As more states legalize cannabis for recreational use, it is critical to understand the impact of such policies on driving safety.

METHODS

Using the 2019 and 2020 Fatality Analysis Reporting System data, we performed multivariable logistic regression modeling to explore the association between state level legalization status and cannabis positivity using toxicological testing data for 14,079 fatally injured drivers. We performed a sensitivity analysis by including multiply imputed toxicological testing data for the 14,876 eligible drivers with missing toxicological testing data.

RESULTS

Overall, 4702 (33.4%) of the 14,079 fatally injured drivers tested positive for cannabis use. The prevalence of cannabis positivity was 30.7% in NoCL-states, 32.8% in MCL-states, and 38.2% in RMCL-states (p < 0.001). Compared to drivers fatally injured in NoCL-states, the adjusted odds ratios of testing positive for cannabis were 1.09 (95% confidence interval: 0.99, 1.19) for those fatally injured in MCL-states and 1.54 (95% confidence interval: 1.34, 1.77) for those fatally injured in RMCL-states. Sensitivity analysis yielded similar results.

CONCLUSIONS

Over one-third of fatally injured drivers tested positive for cannabis use. Drivers fatally injured in states with laws permitting recreational use of cannabis were significantly more likely to test positive for cannabis use than those in states without such laws. State medical cannabis laws had little impact on the odds of cannabis positivity among fatally injured drivers.

State Level Policies on First Responder Mental Health in the U.S.: A Scoping Review

A growing body of evidence demonstrates potential adverse mental health outcomes associated with exposure to occupational trauma among first responders. In response, policymakers nationwide are eager to work on these issues as evidenced by the number of states covering or considering laws for mental health conditions for first responders. Yet, little information exists to facilitate understanding of the impact of mental health-related policies in the United States on this important population. This study aims to identify and synthesize relevant state-level policies and related research on first responder mental health in the United States. Using a scoping review framework, authors searched the empirical and policy literature. State level policies were identified and grouped into two categories: (1) Workers' Compensation-related policies and (2) non-Workers' Compensation (WC) related policies. While benefits levels and other specifics vary greatly by state, 28 states cover certain first responder mental health claims under WC statutes. In addition, at the time of this study, 28 states have policies governing first responder mental health outside of WC. Policies include requiring mental health assessments, provisions for counseling and critical incident management, requiring education and training, providing funding to localities for program development, bolstering peer support initiatives and confidentiality measures, and establishing statewide offices of responder wellness, among others. Authors found a dearth of outcomes research on the impact of state level policies on first responder mental health. Consequently, more research is needed to learn about the direct impact of legislation and establish best practice guidelines for implementing state policy on first responder mental health. By conducting systematic evaluations, researchers can lay the foundation for an evidence-based approach to develop more integrated systems that effectively deliver and finance mental health care for first responders who experience work-related trauma. Such evaluations are crucial for building an understanding of the impact of policies and facilitating improvements in the support provided to first responders in managing mental health challenges arising from their work.

Compulsory treatment in Portuguese-speaking countries: An analysis and comparison of the legal framework

BACKGROUND

Compulsory treatment involves the hospital admission of individuals with mental disorders in appropriate facilities through judicial decisions. However, limited information is available regarding the similarities and differences in compulsory treatment legislation in Portuguese-speaking countries.

AIMS

To analyse the commonalities and differences in compulsory treatment legislation in Portuguese-speaking countries, where Portuguese is the primary official language, including Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Mozambique, Portugal, and São Tomé and Príncipe.

METHODS

A comparative analysis of the specific legislation on compulsory treatment in Portuguese-speaking countries was conducted. National development plans were analysed in countries lacking legislation. A purposive sampling of mental health professionals was contacted to gather information on the countries under study.

RESULTS

Among the eight Portuguese-speaking countries examined, specific legislation regarding compulsory treatment was found only in Brazil, Cape Verde, and Portugal. These countries, with the lowest poverty rates, exhibited a notable degree of homogeneity in the criteria supporting compulsory treatment, ensuring the protection of individual rights. In contrast, in Angola, East Timor, Guinea-Bissau, Mozambique, and São Tomé and Príncipe, compulsory treatment primarily relies on mental health development plans, resulting in significant variations in the presented criteria.

CONCLUSIONS

The significant disparities in compulsory treatment policies among Portuguese-speaking countries, with only Brazil, Cape Verde, and Portugal having specific legislation, underscore the need for a collective effort to establish more consistent procedures and safeguard individual rights.

Modelling cybersecurity regulations for automated vehicles

Technological advancements in Connected and Automated Vehicles (CAVs), particularly the integration of diverse stakeholder groups (communication service providers, road operators, automakers, repairers, CAV consumers, and the general public) and the pursuit of new economic opportunities, have resulted in the emergence of new technical, legal, and social challenges. The most pressing challenge is deterring criminal behaviour in both the physical and cyber realms through the adoption of CAV cybersecurity protocols and regulations. However, the literature lacks a systematic decision tool to analyze the impact of the potential cybersecurity regulations for dynamically interacting stakeholders, and to identify the leverage points to minimise the cyber-risks. To address this knowledge gap, this study uses systems theory to develop a dynamic modelling tool to analyze the indirect consequences of potential CAVs cybersecurity regulations in the medium to long term. It is hypothesized that CAVs Cybersecurity Regulatory Framework (CRF) is the property of the entire ITS stakeholders. The CRF is modelled using the System Dynamic based Stock-and-Flow-Model (SFM) technique. The SFM is founded on five critical pillars: the Cybersecurity Policy Stack, the Hacker's Capability, Logfiles, CAV Adopters, and intelligence-assisted traffic police. It is found that decision-makers should focus on three major leverage points: establishing a CRF grounded on automakers' innovation; sharing risks in eliminating negative externalities associated with underinvestment and knowledge asymmetries in cybersecurity; and capitalising on massive CAV-generated data in CAV operations. The formal integration of intelligence analysts and computer crime investigators to strengthen traffic police capabilities is pivotal. Recommendations for automakers include data-profiteering in CAV design, production, sales, marketing, safety enhancements and enabling consumer data transparency.Furthermore, CAVs-CRF necessitate a balanced approach to the trade-off between: i) data accessibility constraints on CAV automakers and ITS service providers; ii) regulator command and control thresholds; iii) automakers' business investment protection; and iv) consumers' data privacy guard.

Trends of cannabis use and related harms before and after legalization for recreational purpose in a developing country in Asia

BACKGROUND

Thailand was the first country in Asia to legalize the use and purchase of cannabis leaves in February 2021 and the whole plant in June 2022 after the 2019 allowance for medical purposes. The study explored trends in cannabis use in Thailand before and after the recreational cannabis allowance was imposed.

METHODS

Cannabis and other variables of substance use, cannabis use disorder, and attitude towards cannabis of the Thai population aged 18 to 65 years in 2019 (n = 5,002), 2020 (n = 5,389) and 2021 (n = 5,669) were obtained from annual surveys conducted in the last two months of each year by the Centre for Addiction Studies. The surveys were repeat cross-sectional surveys of the general population of Thailand. Repeated variables from at least two annual surveys were included for analysis using the Chi-square test and the t-test.

RESULTS

The prevalence of cannabis use in the past year had increased from 2.2% in 2019 to 2.5% and 4.2% in 2020 and 2021 respectively, while those of methamphetamine, alcohol, and tobacco use had decreased. Trends in past-year drinking/eating cannabis products had increased, especially among the middle age group (40-49 years) from 2.1% (95% confidence interval (CI): 1.3, 3.1) in 2019 and 1.1% (95% CI: 0.6, 1.9) in 2020 to 3.8% (95% CI: 2.8, 5.0) in 2021. The younger population aged 18-19 had an increase in cannabis smoking from 0.9% (95% CI: 0.1, 3.3) in 2019 to 2.0% (95% CI: 0.5, 5.1) and 2.2% (95% CI: 0.7, 5.1) in 2020 and 2021 respectively. Symptoms of cannabis use disorder among cannabis users increased from 2019 to 2020 and then reversed afterwards in 2021. Thais had greater health knowledge about the benefits and harms of cannabis and had attitudes toward more harm of cannabis in 2021; however, 35.6% or a third of the sample in 2021 truly believed that cannabis was a cure for cancer, and 23.2% or one-fourth were uncertain or did not believe that cannabis was addictive.

CONCLUSIONS

Although most of the substances had a lower prevalence of use during the COVID-19 pandemic in Thailand, cannabis had a higher use after legalization. Thai youth had a growing trend to smoke cannabis.

Corporal punishment bans and adolescent suicide rates: An international ecological study

BACKGROUND

Exposure to corporal punishment during childhood is associated with suicidal behaviors during adolescence. To date, the protective effects of national policies governing the use of corporal punishment have rarely been studied for adolescent suicide outcomes.

OBJECTIVE

To investigate contemporaneous and lagged associations between national legislation banning corporal punishment and adolescent suicide rates.

PARTICIPANTS AND SETTING

We used population-level administrative and mortality data from 97 countries spanning the years 1950 to 2017.

METHODS

Negative binomial models were used to investigate the relationship between the existence of official corporal punishment bans in countries and national adolescent suicide mortality rates and the potential time lag between the enactment of such bans and reductions in adolescent suicide rates.

RESULTS

National policies that permitted corporal punishment in all settings (homes, schools, daycares, and alternative care) were associated with a higher relative risk (RR) for suicide in females aged 15-19 (RR = 2.07, p = .03), as were policies allowing corporal punishment in schools specifically (RR = 2.01, p = .02). Partial bans of corporal punishment and bans of school corporal punishment showed lagged effects on suicide rates which peaked after 12 years for females aged 15-19 and after 13 years for males aged 15-19.

CONCLUSIONS

Study findings add to a body of evidence that suggests that official policies banning corporal punishment may promote adolescent health and well-being. The benefits of such policies in terms of reduced risk for adolescent suicide appear to peak approximately 12 to 13 years after enactment of the legislation.

The metaphysical underdetermination of time-reversal invariance

In this paper I argue that the concept of time-reversal invariance in physics suffers from metaphysical underdetermination, that is, that the concept may be understood differently depending on one's metaphysics about time, laws, and a theory's basic properties. This metaphysical under-determinacy also affects subsidiary debates in philosophy of physics that rely on the concept of time-reversal invariance, paradigmatically the problem of the arrow of time. I bring up three cases that, I believe, fairly illustrate my point. I conclude, on the one hand, that any formal representation of time reversal should be explicit about the metaphysical assumptions of the concept that it intends to represent; on the other, that philosophical arguments that rely on time reversal to argue against a direction of time require additional premises.

Biology as involving laws and inconceivable without them

There is an old attempt to divide the sciences into sciences of laws and the historical sciences. More recently, John Beatty has drawn the distinction so that biology is a historical science and urged that there are no genuinely biological laws. This paper shows that there are indeed biological laws, specifically statistical ones, notably in evolutionary theory. Moreover, all or almost all other areas of biology involve laws as well. Even history involves laws. Finally, the paper shows that this pervasiveness of laws is compatible with the most basic commitments of those who, like Beatty, would claim that biology is only historical.

Stakeholder views of current laws surrounding alcohol at UK football matches: Is it a case of using a "sledgehammer to crack a nut"?

BACKGROUND

In 2021, a fan-led review of football governance in England recommended that legislation surrounding alcohol and football be reviewed to determine whether it is still fit for purpose, the first such review since the mid-1980s. Restricting football fans' alcohol consumption has been debated in the UK for over 40 years. However, more research is needed into the current attitudes of fans and influential stakeholders on this matter.

METHODS

Focus groups with football supporters (n=79) and semi-structured interviews (n=15) with key organisational stakeholders were conducted between November 2019 and February 2021. Focus groups included fans who regularly attended matches and supported various teams from professional leagues in Scotland and England, casual fans who usually watched games at home or in bars, and fans who followed the Scotland and England national teams. Stakeholders were selected to represent organisations likely to be instrumental in any regulatory change, such as the UK and Scottish Governments, Police, football supporters' groups and safety organisations.

RESULTS

The current law does not allow for alcohol to be consumed within view of the pitch. Participants from England suggested this could be changed. While in Scotland, where the legislation only allows alcohol to be sold in hospitality, most participants were in favour of allowing the general sale of alcohol at football stadia via a pilot scheme. The reasons for these changes included: reducing unhealthy drinking behaviours; minimising the health and safety risk of fans arriving at the stadium just before kick-off; and a potential increase in much needed revenue for clubs.

CONCLUSION

Our data suggests an evidence-based review of current laws regarding alcohol and football may be appropriate. However, any discussion regarding changes to the law regarding alcohol at football stadia, including potential pilot schemes, should be evaluated and monitored in terms of both financial impact and the impact on public health and safety.

The role of state breastfeeding laws and programs on exclusive breastfeeding practice among mothers in the special supplemental nutrition program for Women, Infants, and Children (WIC)

Background

It is unclear if state laws supporting breastfeeding are associated with exclusive breastfeeding (EBF) practice among low-income mothers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The main objectives of our study were to assess the relationship between such laws and EBF among WIC-participating mothers and to assess whether this association varied by employment status. We also assessed how mother’s exposure to WIC breastfeeding consultation was associated with EBF.

Methods

A cross-sectional study was conducted across seven WIC program locations (i.e., Georgia, Massachusetts, Nevada, Pennsylvania, Wisconsin, Wyoming, Chickasaw Nation) between July–August 2020. Data were collected using convenient sampling from each program location and surveys were administered electronically or on paper to WIC-participating mothers. We restricted our analysis to data from 1161 WIC-participating mothers with infants aged zero to five months old. Multivariable mixed models were used to estimate the relationship between our exposures of interest (i.e., number of laws supporting breastfeeding, employment-related breastfeeding laws, WIC breastfeeding consultation) and EBF, while controlling for potential confounders and accounting for clustering by program location. Effect modification by employment status was assessed on the additive and multiplicative scales.

Results

Among WIC-participating mothers living in program locations with no employment-related breastfeeding laws, EBF was 26% less prevalent for employed mothers compared to unemployed mothers (adjusted prevalence ratios [aPR]: 0.74, 95% CI: 0.67,0.83). Among all mothers, a one-unit increase in laws supporting breastfeeding was not associated with EBF (aPR: 0.88, 95% CI: 0.71,1.10). However, among employed mothers, living in areas with more employment-related laws was associated with a higher prevalence of EBF (aPR: 1.43, 95% CI: 0.83, 2.44). Infants whose mothers received a WIC breastfeeding consultation had 33% higher prevalence of being exclusively breastfed compared to infants whose mothers did not receive a WIC breastfeeding consultation (aPR: 1.33, 95% CI: 1.05,1.70).

Conclusions

Infants whose WIC-participating mothers were employed, were less likely to be exclusively breastfed, but our effect modification analyses showed that laws supporting breastfeeding at the workplace may promote EBF among employed women. EBF was more prevalent among mothers who received a WIC breastfeeding consultation compared to those who did not receive such a consultation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00490-9.

Perceived social norm and behavior quickly adjusted to legal changes during the COVID-19 pandemic

Exploring the joint dynamics of laws and social norms helps understand when social norms are sticky or adaptive. Using the example of the social and physical distancing measures introduced to contain the COVID-19 pandemic in 2020, we studied whether introducing, and then lifting, distancing regulations led individuals to quickly change their habits, not only by modifying the monetary incentives of rule violators but also by shifting the individuals' perception of the appropriateness of social encounters. We conducted an online incentivized experiment in France, where we elicited the same participants' perceived norm and social distancing behavior every week for three months. We find that both norm perception and behavior shifted as soon as the government introduced or removed social distancing measures. This effect was fast acting and long lasting, a result that highlights the importance of the expressive power of the law for norm formation and behavior.

"This Could Mean Death for My Child": Parent Perspectives on Laws Banning Gender-Affirming Care for Transgender Adolescents

OBJECTIVES

Numerous U.S. state legislatures have proposed bills to ban gender-affirming medical interventions for minors. Parents and caregivers play a critical role in advocating for and supporting their transgender and gender-diverse youth (TGDY). We aimed to understand parent and caregiver perspectives about this potential legislation and perceived effects on their TGDY's mental health.

METHODS

We developed and launched a social-media based, anonymous online survey in February 2020 to assess parent and caregiver perspectives on proposed laws to ban gender-affirming medical interventions for minors. Participants were asked to respond to two open-ended questions about these laws; responses were coded to identify key themes.

RESULTS

We analyzed responses from 273 participants from 43 states. Most identified as white (86.4%) female (90.0%) mothers (93.8%), and 83.6% of their TGDY had received gender-affirming medical interventions before age 18 years. The most salient theme, which appeared in the majority of responses, described parent and caregiver fears that these laws would lead to worsening mental health and suicide for their TGDY. Additional themes included a fear that their TGDY would face increased discrimination, lose access to gender-affirming medical interventions, and lose autonomy over medical decision-making due to government overreach.

CONCLUSIONS

In this convenience sample, parents and caregivers overwhelmingly expressed fear that the proposed legislation will lead to worsening mental health and increased suicidal ideation for their TGDY. They implored lawmakers to hear their stories and to leave critical decisions about gender-affirming medical interventions to families and their medical providers.

Comparing medical cannabis use in 5 US states: a retrospective database study

Background

US states have been adopting their own medical cannabis laws since 1996. There is substantial variability in the medical cannabis programs between states, and these differences have not been thoroughly investigated in the literature. The objective of the study was to compare medical cannabis patient characteristics across five states to identify differences potentially caused by differing policies surrounding condition eligibility.

Methods

We conducted secondary analyses following a retrospective study of a registry database with data from 33 medical cannabis evaluation clinics in the US, owned and operated by CB2 Insights. This study narrowed the dataset to include patients from five states with the largest samples: Massachusetts (n = 27,892), Colorado (n = 16,434), Maine (n = 4591), Connecticut (n = 2643), and Maryland (n = 2403) to conduct an in-depth study of the characteristics of patients accessing medical cannabis in these states, including analysis of variance to compare average ages and number of conditions and chi-squared tests to compare proportions of patient characteristics between states.

Results

Average ages varied between the states, with the youngest average in Connecticut (42.2) and the oldest in Massachusetts (47.0). Males represented approximately 60% of the patients with data on gender in each state. The majority of patients in each state had cannabis experience prior to seeking medical certification. Primary medical conditions varied for each state, with chronic pain, anxiety, and back and neck problems topping the list in varying orders for Massachusetts, Maine, and Maryland. Colorado had 78.7% of patients report chronic pain as their primary condition, and 70.4% of patients in Connecticut reported post-traumatic stress disorder as their primary medical condition.

Conclusion

This study demonstrated the significant impact that policy has on patients’ access to medical cannabis in Massachusetts, Colorado, Maine, Connecticut, and Maryland utilizing real-world data. It highlights how qualifications differ between the five states and brings into question the routes through which patients in states with stricter regulations surrounding eligible conditions choose to seek treatment with cannabis. These patients may turn to alternative treatments, or to the illicit or recreational cannabis markets, where permitted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42238-021-00075-z.

Community-level factors and incidence of gun violence in the United States, 2014-2017

RATIONALE AND OBJECTIVE

In the United States, gun violence claims thousands of lives each year and is a pressing public health issue. To gain a better understanding of this phenomenon, this study spatially analyzed county- and state-level predictors of yearly gun violence rates and gun-related casualty rates.

METHODS

This study modeled hypothesized predictors of gun violence incidence and casualties across four years. Data sources included the Gun Violence Archive (gun violence data in the United States for 2014-2017), the U.S. Census Bureau (socioeconomic, demographic, geologic features), ICPSR (crime reports), the U.S. Geologic Survey (elevation data), and U.S. gun laws and ownership. Random forest analyses identified relevant additional interaction terms to include.

RESULTS

The extent to which counties are urban was the most robust predictor of both gun violence incident and casualty rates. Similarly, places characterized by greater income disparity were also more likely to experience higher gun violence rates, especially when high income was paired with high poverty.

CONCLUSIONS

Community- and state-level features are markedly associated with gun violence. Gun violence is higher in counties with both high median incomes and higher levels of poverty; poverty did not seem related to gun violence rates in counties with relatively low median incomes. Some of these findings may well be due to racial segregation and concentrated disadvantage, due to institutional racism, police-community relations, and related factors.

Trends in child marriage and new evidence on the selective impact of changes in age-at-marriage laws on early marriage

This study adopts a cohort perspective to explore trends in child marriage – defined as the proportion of girls who entered first union before the age of 18 – and the effectiveness of policy changes aimed at curbing child marriage by increasing the minimum legal age of marriage. We adopt a cross-national perspective comparing six low- and middle-income countries (LMICs) that introduced changes in the minimum age at marriage over the past two decades. These countries belong to three broad regions: Sub-Saharan Africa (Benin, Mauritania), Central Asia (Tajikistan, Kazakhstan), and South Asia (Nepal, Bhutan). We combine individual-level data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys with longitudinal information on policy changes from the PROSPERED (Policy-Relevant Observational Studies for Population Health Equity and Responsible Development) project. We adopt data visualization techniques and a regression discontinuity design to obtain estimates of the effect of changes in age-at-marriage laws on early marriage. Our results suggest that changes in minimum-age-at-marriage laws were not effective in curbing early marriage in Benin, Mauritania, Kazakhstan, and Bhutan, where child marriage showed little evidence of decline across cohorts. Significant reductions in early marriage following law implementations were observed in Tajikistan and Nepal, yet their effectiveness depended on the model specification and window adopted, thus making them hardly effective as policies to shape girls' later life trajectories. Our findings align with existing evidence from other countries suggesting that changes in age-at-marriage laws rarely achieve the desired outcome. In order for changes in laws to be effective, better laws must be accompanied by better enforcement and monitoring to delay marriage and protect the rights of women and girls. Alternative policies need to be devised to ensure that girls’ later-life outcomes, including their participation in higher education and society, are ensured, encouraged, and protected.

•

Changes in age-at-marriage laws have only a limited impact on delaying marriage age.

•

In Benin, Mauritania, Kazakhstan and Bhutan, laws did not curb early marriage.

•

In Tajikistan and Nepal results depend on model specification.

•

Better enforcement must accompany the implementation of the age-at-marriage laws.

A scoping review of genetics and genomics research ethics policies and guidelines for Africa

BACKGROUND

Genetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to inform and stimulate local policy development and revision on the continent.

METHODS

To identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion.

RESULTS

Documents that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as "guidelines," and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of "respect" appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits.

CONCLUSIONS

Enforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders.

Kant, causation and laws of nature

In the Second Analogy, Kant argues that every event has a cause. It remains disputed what this conclusion amounts to. Does Kant argue only for the Weak Causal Principle that every event has some cause, or for the Strong Causal Principle that every event is produced according to a universal causal law? Existing interpretations have assumed that, by Kant's lights, there is a substantive difference between the two. I argue that this is false. Kant holds that the concept of cause contains the notion of lawful connection, so it is analytic that causes operate according to universal laws. He is explicit about this commitment, not least in his derivation of the Categorical Imperative in Groundwork III. Consequently, Kant's move from causal rules to universal laws is much simpler than previously assumed. Given his commitments, establishing the Strong Causal Principle requires no more argument than establishing the Weak Causal Principle.

Legal liability facing COVID-19 in dentistry: Between malpractice and preventive recommendations

The dental profession is considered at high potential risk of exposure and transmission of SARS-Cov-2. Thus, dentists should implement special safety measures in order to prevent any possible contamination during dental sessions and should be aware of the legal implications of their act in order to avoid malpractice leading them to be a causative agent of transmission of this virus. This paper aimed to provide a global review on COVID-19 preventive recommendations at dental clinics and discussed the legal values of such procedures, the dentist criminal and civil liability arising from transmitting this virus to a patient, the obligation of care under COVID-19 and the possible solution to this dilemma. The review concluded that dentists should follow all modern scientific procedures which are in their interest and in the interest of patients to maintain their safety and advised dentists to document all steps taken during the period of COVID-19 outbreak, because any undocumented action is considered not to have taken place, and they shall be bound by the burden of proof.

Nationalizing Public Health Emergency Legal Responses

The fight for public health primacy in U.S. emergency preparedness and response to COVID-19 centers on which level of government - federal or state - should "call the shots" to quell national emergencies?

Nurse prescribing of medicines in 13 European countries

BACKGROUND

Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing.

METHODS

Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses.

RESULTS

In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses' specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight.

CONCLUSIONS

The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.

Dynamic and stochastic systems as a framework for metaphysics and the philosophy of science

Scientists often think of the world (or some part of it) as a dynamical system, a stochastic process, or a generalization of such a system. Prominent examples of systems are (i) the system of planets orbiting the sun or any other classical mechanical system, (ii) a hydrogen atom or any other quantum-mechanical system, and (iii) the earth's atmosphere or any other statistical mechanical system. We introduce a general and unified framework for describing such systems and show how it can be used to examine some familiar philosophical questions, including the following: how can we define nomological possibility, necessity, determinism, and indeterminism; what are symmetries and laws; what regularities must a system display to make scientific inference possible; how might principles of parsimony such as Occam's Razor help when we make such inferences; what is the role of space and time in a system; and might they be emergent features? Our framework is intended to serve as a toolbox for the formal analysis of systems that is applicable in several areas of philosophy.

Unhelmeted Motorcycle Riders Have Increased Injury Burden: A Need to Revisit Universal Helmet Laws

BACKGROUND

The aim of this study was to compare hospital outcomes for patients in a motorcycle collision with and without helmet use. The study was conducted as a retrospective analysis of the National Trauma Data Bank's 2013 data set, which included reported data from 100 hospitals across the United States.

METHODS

Inclusion criterion for this study is a motorcycle crash involving a driver or passenger. The total number of patients in motorcycle crashes as reported by the National Trauma Data Bank in 2013 was 10,345. Helmet use, hospital stay, ICU and ventilation days, mortality, Glasgow Coma Score, Injury Severity Score, patient payer mix, and complication data were obtained.

RESULTS

Patients were divided into two groups: those wearing a helmet (n = 6250) and those without (n = 4095). Patients not wearing a helmet had an increased risk of admission to the ICU (OR = 1.36, P < 0.001, CI 1.25-1.48), requiring ventilation support (OR = 1.55, P < 0.001, CI 1.39-1.72), presenting with a Glasgow Coma Score of eight or below (OR = 2.15, P < 0.001), and in-patient mortality (OR = 2.00, P < 0.001, CI 1.58-2.54). Unhelmeted patients were more likely to have government insurance or be uninsured than those patients wearing a helmet (P < 0.001).

CONCLUSIONS

It is not well understood why many states are repealing or have repealed universal helmet laws. Lack of helmet use increases the severity of injury in traumatized patients leading to a substantial financial impact on health care costs. Our analysis suggests the need to revisit the issue regarding laws that require protective headwear while riding motorcycles because of the individual and societal impact.

LEVEL OF EVIDENCE

III.

State Firearm Laws and Interstate Transfer of Guns in the USA, 2006-2016

In a cross-sectional, panel study, we examined the relationship between state firearm laws and the extent of interstate transfer of guns, as measured by the percentage of crime guns recovered in a state and traced to an in-state source (as opposed to guns recovered in a state and traced to an out-of-state source). We used 2006-2016 data on state firearm laws obtained from a search of selected state statutes and 2006-2016 crime gun trace data from the Bureau of Alcohol, Tobacco, Firearms, and Explosives. We examined the relationship between state firearm laws and interstate transfer of guns using annual data from all 50 states during the period 2006-2016 and employing a two-way fixed effects model. The primary outcome variable was the percentage of crime guns recovered in a state that could be traced to an original point of purchase within that state as opposed to another state. The main exposure variables were eight specific state firearm laws pertaining to dealer licensing, sales restrictions, background checks, registration, prohibitors for firearm purchase, and straw purchase of guns. Four laws were independently associated with a significantly lower percentage of in-state guns: a waiting period for handgun purchase, permits required for firearm purchase, prohibition of firearm possession by people convicted of a violent misdemeanor, and a requirement for relinquishment of firearms when a person becomes disqualified from owning them. States with a higher number of gun laws had a lower percentage of traced guns to in-state dealers, with each increase of one in the total number of laws associated with a decrease of 1.6 percentage points in the proportion of recovered guns that were traced to an in-state as opposed to an out-of-state source. Based on an examination of the movement patterns of guns across states, the overall observed pattern of gun flow was out of states with weak gun laws and into states with strong gun laws. These findings indicate that certain state firearm laws are associated with a lower percentage of recovered crime guns being traced to an in-state source, suggesting reduced access to guns in states with those laws.

Self-medication of mood and anxiety disorders with marijuana: Higher in states with medical marijuana laws

BACKGROUND

Self-medication with drugs or alcohol is commonly reported among adults with mood or anxiety disorders, and increases the risk of developing substance use disorders. Medical marijuana laws (MML) may be associated with greater acceptance of the therapeutic value of marijuana, leading individuals to self-medicate.

METHODS

The study utilized data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Participants were sampled from households in the general population and included adults with a mood or anxiety disorder in the past 12 months (n = 7418), and the subset of those who used marijuana and no other drug (n = 314). Weighted logistic regression models predicted the prevalence of self-medication with drugs in U.S. states with and without MML, adjusting for individual and state-level covariates. As a negative control, analyses were repeated for self-medication with alcohol.

RESULTS

Overall, self-medication with drugs was 3.73 percentage points higher (95% confidence interval [CI]: 0.93-6.53) among those living in MML states (p = 0.01). For the subpopulation that only used marijuana, self-medication with drugs was 21.22 percentage points higher (95% CI: 3.91-38.53) among those living in MML states (p = 0.02). In contrast, self-medication with alcohol had nearly identical prevalence in MML and non-MML states, overall and for drinkers.

CONCLUSIONS

Among adults with mood or anxiety disorders, living in a medical marijuana law state is associated with self-medication with marijuana. While additional research is needed to determine the reasons for this association, clinical screening for self-medication with marijuana may be particularly important in states with medical marijuana laws.

Child abuse and neglect experts' determination of when a child being left home alone constitutes child neglect

Background

Only 14 states have laws or guidelines regarding the minimum age a child may be left home alone. These ages range from 6 to 14 years. Our objective was to identify factors that influence child neglect determination by experts with regards to parents leaving children home alone.

Methods

American Academy of Pediatrics Section on Child Abuse and Neglect members (N = 523) were surveyed from July–August, 2015. Respondents were asked whether scenarios involving a child of varying age knowingly left home alone for 4 h were neglect in the presence or absence of injury to the child and the legality of the situation. Comparisons were performed using the chi-square test.

Results

One hundred ninety-three members responded (36.9%). In the scenario where there were no relevant laws and the child was uninjured, nearly 100% of the child experts determined this as being child neglect when the child was 6 years old. For 8, 10, 12, and 14 year olds, this was 88, 48, 4, and 1%, respectively. However, a significantly higher percentage of experts considered it child neglect for most ages when there was a law making the scenario illegal as compared when there was no law, and when the child was injured versus when they were not. The only demographic variable that showed a difference in child neglect determination was that females were more likely to consider higher aged children as having been neglected when there were no laws but the child was injured. The vast majority of experts (85%) stated that leaving a child home alone for 4 h should be illegal if the child is < 9 years old, and nearly one-half (44%) said it should be illegal for children < 11 years old.

Conclusions

A number of factors affect how experts view children being left home alone as potential child neglect. Our data suggests that such cases may be evaluated differently due to variations in state laws, even though the risk to the child is the same. These results call for child safety law reform to provide greater uniformity in the evaluation of potential child neglect cases and better protect the safety of children.

Recent advances of medical foods in China: The opportunities and challenges under standardization

Malnutrition with high incidence in hospitalized patients in China has brought a significant burden of disease. Although many clinical studies have demonstrated the importance of nutritional for patients with malnutrition, the application of medical foods in China is still restricted. For the classification, limits, production and registration of medical foods, the Chinese government newly enacted a series of regulations. In this review, comparing the policy, researches, and product variety of medical foods in China with other countries, although the current status of the development of medical foods in China is still far behind that of developed countries, some of regulations are stricter than those of many other countries or organizations. The medical foods in China are divided into four categories, the nutrients and environmental contaminants are limited to ensure the safety. As a prospect, the development of medical foods in China is expected to get out of the predicament of lack of emphasis, shortage of supply, backward of local processing technology and the imperfect management system. After all, in view of the huge population and the increasing demand of nutrition in China, there must be a very good prospect for the future development of the medical foods industry in China.

Comparison of older and younger novice driver crash rates: Informing the need for extended Graduated Driver Licensing restrictions

BACKGROUND

Few previous studies have directly compared crash rates of older and younger novice drivers. To inform discussion about whether Graduated Driver Licensing (GDL) policies that are applied in the US for younger novice drivers should be applied to older novice drivers, we conducted a longitudinal study to examine overall, nighttime, and multiple passenger crash rates over the initial four years of licensure differ for novice drivers licensed at different ages.

METHODS

Using data from the New Jersey Traffic Safety Outcomes (NJ-TSO) data warehouse, we selected all NJ drivers who obtained their initial intermediate driver's license from 2006 through 2014 and had at least one month of follow-up from the date of licensure to study end or death (n=1,034,835). Novice drivers were grouped based on age at licensure: age 17; 18-20; 21-24; and 25 or older. We estimated monthly rates for overall crashes (per 10,000 licensed drivers) as well as: late night crashes (11:01 p.m.-4:59 a.m.); early night crashes (9:00 p.m.-11:00 p.m.); and multiple passenger crashes (two or more passengers). Average monthly rates were calculated for specific relevant time periods and Poisson regression models were used to compare rates: (1) between novice driver groups with the same time since licensure; (2) over the first 48 months of licensure within each novice driver group; and (3) between same-aged 21-year-old drivers with varying lengths of licensure.

RESULTS

Although initial (three months post-licensure) overall crash rates of novice NJ drivers age 21 and older were higher than rates of same-aged experienced drivers, they were substantially lower than initial rates for 17- to 20-year-old novice drivers, who are licensed under GDL policies. Moreover, older novice drivers experience much less steep crash reductions over the first year of licensure than younger novice drivers. Nighttime crash rates among the 21- to 24-year old and aged 25 and older novice driver groups were stable over the first year of licensure. For novice drivers under age 21, early night crash rates declined rapidly over the course of licensure, while changes in late night crashes were much smaller. First-year multiple passenger crash rates were highest for drivers licensed at age 18-20, and novice driver groups experienced varying amounts of reduction in multiple passenger crashes over time.

CONCLUSIONS

Study findings support NJ's current GDL policies for 17- to 20-year-old novice drivers and the potential for added benefits from beginning the nighttime restriction at 9:00 p.m. Conversely, there was a lack of compelling evidence for additional policies for drivers licensed at age 21-24 and no evidence to indicate a need for additional GDL policies for NJ novices aged 25 years and older.

Change over time in parents' beliefs about and reported use of corporal punishment in eight countries with and without legal bans

Stopping violence against children is prioritized in goal 16 of the Sustainable Development Goals adopted by the United Nations General Assembly in 2015. All forms of child corporal punishment have been outlawed in 50 countries as of October 2016. Using data from 56,371 caregivers in eight countries that participated in UNICEF's Multiple Indicator Cluster Survey, we examined change from Time 1 (2005-6) to Time 2 (2008-13) in national rates of corporal punishment of 2- to 14-year-old children and in caregivers' beliefs regarding the necessity of using corporal punishment. One of the participating countries outlawed corporal punishment prior to Time 1 (Ukraine), one outlawed corporal punishment between Times 1 and 2 (Togo), two outlawed corporal punishment after Time 2 (Albania and Macedonia), and four have not outlawed corporal punishment as of 2016 (Central African Republic, Kazakhstan, Montenegro, and Sierra Leone). Rates of reported use of corporal punishment and belief in its necessity decreased over time in three countries; rates of reported use of severe corporal punishment decreased in four countries. Continuing use of corporal punishment and belief in the necessity of its use in some countries despite legal bans suggest that campaigns to promote awareness of legal bans and to educate parents regarding alternate forms of discipline are worthy of international attention and effort along with legal bans themselves.

"The Theory was Beautiful Indeed": Rise, Fall and Circulation of Maximizing Methods in Population Genetics (1930-1980)

Describing the theoretical population geneticists of the 1960s, Joseph Felsenstein reminisced: "our central obsession was finding out what function evolution would try to maximize. Population geneticists used to think, following Sewall Wright, that mean relative fitness, W, would be maximized by natural selection" (Felsenstein 2000). The present paper describes the genesis, diffusion and fall of this "obsession", by giving a biography of the mean fitness function in population genetics. This modeling method devised by Sewall Wright in the 1930s found its heyday in the late 1950s and early 1960s, in the wake of Motoo Kimura's and Richard Lewontin's works. It seemed a reliable guide in the mathematical study of deterministic effects (the study of natural selection in populations of infinite size, with no drift), leading to powerful generalizations presenting law-like properties. Progress in population genetics theory, it then seemed, would come from the application of this method to the study of systems with several genes. This ambition came to a halt in the context of the influential objections made by the Australian mathematician Patrick Moran in 1963. These objections triggered a controversy between mathematically- and biologically-inclined geneticists, with affected both the formal standards and the aims of population genetics as a science. Over the course of the 1960s, the mean fitness method withered with the ambition of developing the deterministic theory. The mathematical theory became increasingly complex. Kimura re-focused his modeling work on the theory of random processes; as a result of his computer simulations, Lewontin became the staunchest critic of maximizing principles in evolutionary biology. The mean fitness method then migrated to other research areas, being refashioned and used in evolutionary quantitative genetics and behavioral ecology.

Review on the Implementation of the Islamic Republic of Iran about Tobacco Control, Based on MPOWER, in the Framework Convention on Tobacco Control by the World Health Organization

BACKGROUND

Smoking is the largest preventable cause of death in the world, killing nearly 6 million people annually. This article is an investigation of measures implemented laws in the Iran to study the proposed strategy of control and reduce tobacco use based on the monitor, protect, offer, warn, enforce and raise (MPOWER) policy.

METHODS

All laws approved by the Parliament along with the instructions on tobacco control prepared by the Ministry of Health and Medical Education, Ministry of Industry, Mine and Trade were collected and studied. Moreover, practical steps of Ministry of Health and other organizations were examined in this regard.

FINDINGS

Iranian Parliament after the adoption of the Framework Convention on Tobacco Control (FCTC) acts to create a comprehensive and systematic program for tobacco control legislation as a first step towards comprehensive national tobacco control and combat. In this law and its implementing guidelines and based on the strategy of MPOWER, specific implement is done to monitor tobacco use and prevention policies, protect people from tobacco smoke, offer help to quit tobacco use, warn about the dangers of tobacco, enforce bans on tobacco advertising, promotion and sponsorship and raise taxes on tobacco. However, the full objectives of the legislation have not achieved yet.

CONCLUSION

According to Iran's membership in the FCTC and executive producer of tobacco control laws and regulations, necessary infrastructure is ready for a serious fight with tobacco use. In Iran, in comparison with developed countries, there is a huge gap between ratified laws and performing of laws.

The legal status of suicide: A global review

Copies were obtained of the criminal codes from 192 countries and states; in 25 suicide is currently illegal, and an additional 20 countries follow Islamic or Sharia law where suicide attempters may be punished with jail sentences. The vast majority of countries have laws making it illegal to abet, aid or encourage suicide, but the nature and punishment of the actions that are illegal varies. Laws in places with Civil, Common Law, Islamic Law and Traditional Law systems are compared. Great variances in application were noted, sometimes within countries. It is impossible to estimate the number of persons currently in jail for having attempted suicide, but jail sentences are still given to suicide attempters. Some countries do not prosecute suicide attempters despite the laws, while others consistently jail suicide attempters. In countries where suicide attempts have been decriminalized, attempters may still face prosecution when another person is injured or dies as a result of their suicide attempt or where the attempter is a member of the military. We discuss the roots of laws making suicide, aiding, and encouraging suicide illegal and examine prospects for future changes. The recent Supreme Court Decision in Canada, invalidating the law making it illegal to assist in the suicide of physically ill people who are suffering (abeit with restrictive conditions) illustrates current trends towards "liberalization" of assisted suicide.

[How is the implementation of the new legal framework for health care affecting HIV-infected immigrants in an irregular situation in Spain?]

INTRODUCTION

The entry into force of Royal Decree (RD) 16/2012 in Spain in September 2012 led to the exclusion of the group of irregular immigrants from the National Healthcare System. With this work, GESIDA attempts to measure the impact of the entry into force of the RD in relation to its application by the Autonomous Communities (CCAA), and how it has affected the health care of irregular immigrants infected with HIV.

METHODS

Information was requested from the 17 CCAA of the existence of measures to ensure the care and treatment of people with HIV infection that were left unprotected because of the implementation of the RD. Likewise, a survey was conducted on health professionals and NGOs involved in the care of these people, to find out how it has affected the implementation of the RD to their daily healthcare work and the availability of information on regulations to implement it.

RESULTS

The response of the CCAA was variable, hardly contributing, in some cases, to mitigate the negative effect of the RD. To this is added a complex bureaucracy to access the benefits offered by some regions, often inaccessible to the most vulnerable subjects. Lack of information for health-care professionals and NGOs involved in the care of immigrants, hinders access of this population to health care and the establishment of control measures for diseases with an impact on the public health.

CONCLUSIONS

The RD 16/2012 has had a negative impact on daily healthcare working, generating the appearance of deep inequities throughout the country.

The use of palliative sedation: A comparison of attitudes of French-speaking physicians from Quebec and Switzerland

OBJECTIVE

Previous literature has suggested that laws and regulations may impact the use of palliative sedation. Our present study compares the attitudes of French-speaking physicians practicing in the Quebec and Swiss environments, where different laws are in place regarding physician-assisted suicide.

METHOD

Data were drawn from two prior studies, one by Blondeau and colleagues and another by Beauverd and coworkers, employing the same two-by-two experimental design with length of prognosis and type of suffering as independent variables. Both the effect of these variables and the effect of their interaction on Swiss and Quebec physicians' attitudes toward sedation were compared. The written comments of respondents were submitted to a qualitative content analysis and summarized in a comparative perspective.

RESULTS

The analysis of variance showed that only the type of suffering had an effect on physicians' attitudes toward sedation. The results of the Wilcoxon test indicated that the attitudes of physicians from Quebec and Switzerland tended to be different for two vignettes: long-term prognosis with existential suffering (p = 0.0577) and short-term prognosis with physical suffering (p = 0.0914). In both cases, the Swiss physicians were less prone to palliative sedation.

SIGNIFICANCE OF RESULTS

The attitudes of physicians from Quebec and Switzerland toward palliative sedation, particularly regarding prognosis and type of suffering, seem similar. However, the results suggest that physicians from Quebec could be slightly more open to palliative sedation, even though most were not in favor of this practice as an answer to end-of-life existential suffering.

Access to safe abortion: progress and challenges since the 1994 International Conference on Population and Development (ICPD)

BACKGROUND

The 1994 International Conference on Population and Development (ICPD) viewed access to safe abortion as imperative for public health.

PROGRESS SINCE ICPD

Globally, the number of induced abortions (safe and unsafe) per 1000 women aged 15-44 years declined from 35 in 1995 to 28 in 2008. The number of deaths due to unsafe abortion declined from 69,000 in 1990 to 47,000 in 2008, as safe and effective methods of abortion, including manual vacuum aspiration and medical abortion, became more widely available. During the same period, there was a slight increase in the number of countries where abortion is permitted on request, and 70 countries made grounds for abortion more liberal.

CHALLENGES

Since ICPD, the decline in unsafe abortion was slower than that in safe abortion, and unsafe-abortion-related mortality continued to be a problem. Nearly all unsafe abortions and mortality occur in developing countries.

RECOMMENDATIONS

While more must be done to ensure universal access to safe, acceptable and affordable contraception to reduce the need for abortion, this need will always exist. Information on grounds for safe abortion should be made widely available for women to access services to which they are legally entitled to. As recommended by ICPD, quality postabortion care including contraception counseling and provision should be available to all women, regardless of the legal grounds for abortion. The paper provides the evidence on unsafe abortion, a reproductive health issue that is entirely preventable but has been largely neglected or tarnished by emotional and contentious debates.

Computer-aided detection of breast cancer on mammograms: a swarm intelligence optimized wavelet neural network approach

Breast cancer is the second leading cause of cancer death in women. Accurate early detection can effectively reduce the mortality rate caused by breast cancer. Masses and microcalcification clusters are an important early signs of breast cancer. However, it is often difficult to distinguish abnormalities from normal breast tissues because of their subtle appearance and ambiguous margins. Computer aided diagnosis (CAD) helps the radiologist in detecting the abnormalities in an efficient way. This paper investigates a new classification approach for detection of breast abnormalities in digital mammograms using Particle Swarm Optimized Wavelet Neural Network (PSOWNN). The proposed abnormality detection algorithm is based on extracting Laws Texture Energy Measures from the mammograms and classifying the suspicious regions by applying a pattern classifier. The method is applied to real clinical database of 216 mammograms collected from mammogram screening centers. The detection performance of the CAD system is analyzed using Receiver Operating Characteristic (ROC) curve. This curve indicates the trade-offs between sensitivity and specificity that is available from a diagnostic system, and thus describes the inherent discrimination capacity of the proposed system. The result shows that the area under the ROC curve of the proposed algorithm is 0.96853 with a sensitivity 94.167% of and specificity of 92.105%.

A comparative study of laws and procedures pertaining to the medical records retention in selected countries

INTRODUCTION

The health record serves several purposes and must be retained to meet those purposes. These varied purposes influence how long health records must be kept, or their retention period.

AIM

Present study aimed to recognize laws and procedures pertaining to retention of health records in selected countries and provide a proposed guideline for Iran.

METHODS

This was an applied and descriptive-comparative research on laws and procedures pertaining to retention of medical records in USA, United Kingdom, Australia and Iran that performed in 2011. The data were collected via library sources, websites, and consultation with specialists in and out of the country. The validity of the data was confirmed by experts. Finally, the recommendations were provided for medical record retention in Iran.

RESULTS

The study revealed that, there are complete and transparent record retention schedules in selected counties so that retention situation for adults, minors, emergency, outpatients and deaths records is clearly recommended. But in Iran, either there aren't specific laws and procedures for medical record or they are unspecified.

CONCLUSION

The lack of a complete, transparent and update medical record retention schedule in Iran, lead to confusion for hospitals. Some of hospitals maintain medical records more than of determined retention period and some of them destruct them before expiring of essential retention period. In order to optimize the situation of health records retention in Iran, it is necessary to review, correction and correction and completion of medical records retention schedule on the provided recommendations for kinds of medical record.

Laws of biology: why so few?

Finding fundamental organizing principles is the current intellectual front end of systems biology. From a hydrogen atom to the whole cell level, organisms manage massively parallel and massively interactive processes over several orders of magnitude of size. To manage this scale of informational complexity it is natural to expect organizing principles that determine higher order behavior. Currently, there are only hints of such organizing principles but no absolute evidences. Here, we present an approach as old as Mendel that could help uncover fundamental organizing principles in biology. Our approach essentially consists of identifying constants at various levels and weaving them into a hierarchical chassis. As we identify and organize constants, from pair-wise interactions to networks, our understanding of the fundamental principles in biology will improve, leading to a theory in biology.

Occupational health and safety and the functions of law: a system's analysis

The article suggests a model that can account for the systemic nature of the law's functions with regard to occupational health and safety. The model presents four functions for law's intervention: to establish standards, to ensure the welfare of those injured on the job, to provide incentives for employers and employees to reduce the level of injuries, and to ensure the efficient administration of public expenditures. The model requires observing law's intertwining functions in context and assessing the output according to a weighted index. The article applies this framework for a critical description of the Israeli system. While injury rates in Israel are 'normal', compared to other industrialized countries, the findings suggest some deficiencies in the functions of law including: inadequate adaptation of the standardization process to the challenges of the 'new workplace', incomplete incentives for adopting a high level of care and for compliance with standards, a relative failure of effort to induce a managerial culture that cooperates with workers on issues of health and safety, and a general fragmentation of the system.