bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex pheromone production and perception in the mating disruption‐resistant strain of the smaller tea leafroller moth, Adoxophyes honmai
Authors: Tabata J. , Noguchi H. , Kainoh Y. , Mochizuki F. , Sugie H.
Published: January 2007

Mating disruption is an environmentally safe plant protection strategy that uses a synthetic copy of an insect pheromone to interfere with sexual communication and hence reproduction. To date, a number of pest moths have been controlled with applications of formulated pheromones as mating disruptants. Recently, however, the first example of resistance to mating disruption was documented in one of the major tea pests in Japan, the smaller tea leafroller moth, Adoxophyes honmai Yasuda (Lepidoptera: Tortricidae). To avoid other such cases, it is important to elucidate the mechanism(s) by which the disruptant lost its effectiveness. To this end, we imposed further selection by rearing field‐collected resistant insects with a synthetic pheromone in the laboratory. After more than 70 generations of selection, a strain with quite strong resistance was established, males of which could find and copulate with their mates even in the presence of 1 mg l−1 of disruptant. Although the mating ability of this strain was greatly increased, the composition and blend ratio of the sex pheromone produced and emitted by females were not obviously changed in comparison with those of females sensitive to mating disruption. However, male response to the pheromone blend was markedly broadened after selection so that resistant males could locate a synthetic pheromone source even when it lacked a pheromone component that is normally necessary for attraction. Males capable of locking onto off‐ratio pheromone blends may be better able to find calling females in pheromone‐treated environments than narrowly tuned males because of greater capability of overcoming sensory imbalance.
Healing of surgically created circumferential gap around non‐submerged‐type implants in dogs: a histomorphometric study
Authors: Jung Ui‐Won , Kim Chang‐Sung , Choi Seong‐Ho , Cho Kyoo‐Sung , Inoue Takashi , Kim Chong‐Kwan
Published: January 2007

Objectives: This study was conducted to evaluate the healing of surgically created circumferential gaps around non‐submerged‐type implants according to varying size and healing periods in dogs.

Material and methods: In four mongrel dogs, all mandible premolars were extracted and after an 8‐week healing period, non‐submerged‐type implants were placed. Circumferential coronal defects around the implants were performed surgically with a customized tapered step drill. Groups were divided according to the width of the coronal gaps: 1, 1.5, or 2 mm. First the right side of the mandible was prepared, and after 8 weeks, the left side was prepared. The dogs were sacrificed following an 8‐week healing period. Specimens were analyzed histologically and histomorphometrically.

Results: As the size of the coronal gap increased, the unfilled area tended to be greater. In terms of bone‐to‐implant contact and bone density, both the 1 and 1.5 mm groups showed a larger percentage of coronal defect than the apical side, while the 2 mm group showed contrary results in the 8‐week groups. The general histologic features in the 16‐week groups were similar to the findings of 8‐week groups but were more matured, with a higher percentage of lamellar bone. A certain amount of bone filling and osseointegration was observed in the defects of all the groups.

Conclusion: It can be concluded that the remaining defect, small enough to be clinically neglected, irrespective of gap size within 2 mm, does not need any kind of regenerating procedures.
Soft and hard tissue assessment of immediate implant placement: a case series
Authors: Juodzbalys Gintaras , Wang Hom‐Lay
Published: January 2007

Objectives: The aim of this prospective study was to evaluate clinically and radiographically the success and esthetic result of immediate implant placement at the time of extraction.

Material and methods: Twelve patients with 14 titanium screw‐shaped implants (13–16 mm length and 4.3 or 5 mm diameters) were placed in the extraction sockets. Defects after implant placement were recorded, and then filled up with deproteinized bovine bone mineral, bioabsorbable collagen membrane, and absorbable pins. The defect was again re‐evaluated at second‐stage surgery. Clinical and radiographic parameters of the peri‐implant conditions were assessed at the moment of prosthesis placement and at 1‐year follow‐up.

Results: The cumulative implant survival and success rate was 100% after a 1‐year observation period. Analysis of the esthetic result showed that the mean pink esthetic score (PES) was 11.1 (SD 1.35) at 1‐year follow‐up. At 1 year, 64.3% papillae had a score of 2 and the remaining 35.7% score 3 according to the Jemt (1997) papillary index. Optimal value of width of the keratinized mucosa was recorded in 13 (92.9%) implant cases in both periods of follow‐up. At 1‐year follow‐up, the linear distance between implant‐shoulder to the bone peaks remains stable with a mean of 2.62±0.2 mm at the mesial and 2.9±0.58 mm at the distal aspect.

Conclusion: Careful evaluation of potential extraction sites before immediate implant installation promotes optimal implant esthetics.
Immediate implant placement with transmucosal healing in areas of aesthetic priority: A multicentre randomized‐controlled clinical trial I. Surgical outcomes
Authors: Lang Niklaus P. , Tonetti Maurizio S. , Suvan Jean E. , Pierre Bernard Jean , Botticelli Daniele , Fourmousis Ioannis , Hallund Marlene , Jung Ronald , Laurell Lars , Salvi Giovanni E. , Shafer David , Weber Hans‐Peter ,   on Behalf of European Research Group on Periodontology (ERGOPerio)
Published: January 2007

Objectives: To compare the clinical outcomes of standard, cylindrical, screw‐shaped to novel tapered, transmucosal (Straumann Dental®) implants immediately placed into extraction sockets.

Material and methods: In this randomized‐controlled clinical trial, outcomes were evaluated over a 3‐year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient‐centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post‐surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was ≥1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss® and BioGide®). The flaps were then sutured. During non‐submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post‐operatively.

Results: The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient‐centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel‐tapered implant was evident.

Conclusions: This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short‐term outcomes after immediate implant placement into the extraction socket.
Looking for the keys to diurnality downstream from the circadian clock: role of melatonin in a dual‐phasing rodent, Octodon degus
Authors: Vivanco P. , Ortiz V. , Rol M. A. , Madrid J. A.
Published: January 2007

Abstract:  Melatonin is an essential component for circadian system function, whose daily plasma secretory rhythm is driven by the suprachiasmatic nucleus (SCN), contributing to the communication of temporal messages from the central circadian clock to all cells. Melatonin secretion peaks in the dark, regardless of whether animals are diurnal or nocturnal. To date, the precise mechanisms that explain how the circadian system is configured as nocturnal or diurnal remain unknown. The present study examines mid‐day and midnight melatonin plasma levels and the influence of exogenous melatonin on the circadian system phasing of Octodon degus, a diurnal rodent, which exhibits nocturnal and diurnal chronotypes when free access to a wheel is provided. Plasma levels of melatonin were determined by RIA in blood samples taken from the jugular vein at mid‐light (ML) and mid‐dark (MD). Melatonin (0.5 mg/kg b.wt.) was orally administered in their drinking water for 30 days, 2 hr before the onset of darkness. The results showed that plasma melatonin levels and their qualitative effects, hypothermia and improved synchronization with no modification in the 24‐hr wheel running activity (WR), were similar in both nocturnal and diurnal degus. Furthermore, melatonin can be used to improve the impaired circadian rhythmicity observed in aged animals, with no rebound effect after ceasing the treatment. It is concluded that plasma melatonin levels and the differential responses to melatonin do not seem to be responsible for nocturnal and diurnal chronotypes, and thus other mechanisms upstream, within, or downstream from the SCN should be investigated.
Increased vascular permeability and nitric oxide production in response to hypoxia in the pineal gland
Authors: Kaur C. , Sivakumar V. , Lu J. , Ling E. A.
Published: January 2007

Abstract:  This study examined the factors that may be involved in altering the function of pineal gland in hypoxic conditions. Adult Wistar rats were subjected to hypoxia and the pineal gland was examined for the mRNA and protein expression of hypoxia‐inducible factor‐1α (HIF‐1α), vascular endothelial growth factor (VEGF), endothelial, neuronal and inducible nitric oxide synthase (eNOS, nNOS, iNOS) at 3 hr–14 days after hypoxic exposure by real time reverse transcription‐polymerase chain reaction, Western blotting and immunohistochemistry. Upregulated mRNA and protein expression of HIF‐1α, VEGF, eNOS, nNOS and iNOS was observed in response to hypoxia. VEGF concentrations as determined by enzyme immunoassay and nitric oxide (NO) production measured by colorimetric assay were significantly higher after hypoxic exposure when compared with the controls. Melatonin content of the pineal gland, as determined by ELISA, was significantly reduced after the hypoxic exposure. Dilated blood vessels expressing eNOS were observed in hypoxic rats. Cells immunoreactive for VEGF were identified as the astrocytes whereas those immunoreactive for iNOS were pinealocytes and macrophages. Our findings indicate that excess production of VEGF and NO in pineal gland in response to hypoxia may be involved in increased vascular permeability as evidenced by an enhanced leakage of rhodamine isothiocyanate (RhIC). The increased vascular permeability may allow free access of serum‐derived substances in the pineal gland that may affect the secretory function of the pinealocytes. Administration of exogenous melatonin may be beneficial as it reduced VEGF concentration and NO production significantly in hypoxic rats, and leakage of RhIC was concomitantly reduced.
Mature Minors Should Have the Right to Refuse Life-Sustaining Medical Treatment
Authors: Derish Melinda T. , Heuvel Kathleen Vanden
Published: January 2007

Imagine that you are a teenager and have cancer. You undergo a year of chemotherapy and after a brief return to normal life, you have a relapse. Your physician says that chemotherapy and radiation therapy could be tried, but a bone marrow transplant (BMT) is your only chance of a real cure. He tells you and your parents that you could die as a result of complications from the transplant, but without it you would only be expected to live one year. You and your family discuss the alternatives and decide to have the transplant. You ask what will happen if the BMT fails, but both your physician and your family tell you that right now you must fight to get better and not think negative thoughts. You do not ask any more questions.
Patient Confidentiality and the Surrogate's Right to Know
Authors: Jansen Lynn A. , Ross Lainie Friedman
Published: January 2007

Physicians treating newly incapacitated patients often must navigate surrogate decision-makers through a difficult course of treatment decisions. Such a process can be complex. Physicians must not only explain the medical facts and prognosis to the surrogate, but also attempt to ensure that the surrogate arrives at decisions that are consistent with the patient's own values and wishes. Where these values and wishes are unknown, physicians must help surrogates make decisions that reflect the patient's best interests.
Taking Names: The Ethics of Indirect Recruitment in Research on Sexual Networks
Authors: Margolis Lewis H.
Published: January 2007

Evaluating the risks and anticipated benefits of medical, behavioral and, social research is a central function of institutional review boards (IRBs). The calculation that IRBs undertake ultimately determines whether a particular research project involving human participants is permitted to proceed. In medical research the physical harms and even the anticipated benefits of a new procedure or drug are often apparent and quantifiable. In contrast, for social/behavioral research that may involve probing the most intimate feelings, thoughts, and actions of participants, the weighing of risks and anticipated benefits, the calculation of possible harms and the acceptability of that harm require a more intense level of scrutiny.

Even the early step of identifying and recruiting participants for a research endeavor may potentially cause harm, making participant selection a focus of IRB analysis.
Research Bioethics in the Ugandan Context II: Procedural and Substantive Reform
Authors: Loue Sana , Okello David
Published: January 2007

In July 1997, the voting representatives at the National Consensus Conference (NCC) on Bioethics in Health Research voted unanimously to adopt the proposed Guidelines for the Conduct of Health Research Involving Human Subjects in Uganda (Guidelines). This vote represented the culmination of a three-year journey towards the development of a coherent and cohesive framework for the ethical review of health research involving human subjects in Uganda.

Attendees at the NCC included both voting representatives and non-voting participants. Voting representatives had been designated by the institutional entity with which they were affiliated to represent that entity at the NCC and to voice the concerns and opinions of the entity and its constituents.
Administrative Developments: Celera Genomics to Complete DNA Map
Authors: Doran Jennifer
Published: January 2007

On April 6, 2000, Dr. J. Craig Venter of Celera Genomics told a Congressional committee that his company finished its analysis of the human DNA and would have a completed map of the human genome by early summer, 2000. Scientists expect the completed human genome to revolutionize drug therapies through the creation of treatments tailored to specific genetic makeups. In order to create a map of the human genome, three billion letters of DNA that encode eighty thousand genes must be identified and ordered. In March, 2000, Celera released a successful sequence of the fruit fly genome, and it employed the same methods in creating the human genome.
Administrative Developments: Civil Cause of Action under RICO Requires Tortious Act—Beck v. Prupis
Authors: Hussong Sharon
Published: January 2007

The U.S. Supreme Court held 7-2 that an individual harmed by an overt act that is not tortious under the Racketeer Influenced and Corrupt Organizations Act (RICO) does not have a civil cause of action under RICO. Therefore, an individual terminated from his job in furtherance of a racketeering conspiracy does not have a civil cause of action, since such termination is not an “independently wrongful” act under RICO.

The plaintiff, Robert Beck, was the president, CEO, director, and shareholder of Southeastern Insurance Group (SIG). The defendants, including Ronald Prupis, were senior officers and directors of SIG. In 1998, the plaintiff discovered that the defendants were engaged in racketeering. The racketeering activities included refusing to qualify contractors for SIG surety bonds unless they paid fees to SIG; diverting corporate funds for their personal use; and providing regulators, shareholders, and creditors with false financial statements.
Fraud and Abuse: United States ex rel Merena v. SmithKline Beecham Corp.; United States ex rel Spear v. SmithKline Beecham Clinical Lab.; United States ex rel Grossenbacher v. SmithKline Beecham Clinical Lab.
Authors: Behm Allyson
Published: January 2007

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act (FCA), their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730(e)(4) Relator Merena filed a quitam suit against his employer, SmithKline Beecham (SKB), claiming, among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit.
Fraud and Abuse: OIG Advisory Opinion No. 00-3
Authors: Gabriel Kathleen
Published: January 2007

The Office of the Inspector General issued an advisory opinion in April announcing that an arrangement to provide various services free of charge to patients with terminal illnesses who have a prognosis of one year or less to live (the “Program”) does not constitute grounds for sanctions under either the anti-kickback statute, section 1128(b) of the Social Security Act, or under section 1128A(a)(5) of the Act, which prohibits offering of inducements to beneficiaries to influence their selection of a provider for Medicare or Medicaid covered services.

The Hospice Foundation of Martin & St. Lucie, Inc., is a Florida nonprofit organization that acts as the supporting foundation for the Hospice of Martin & St. Lucie, Inc., a nonprofit organization that provides various end-of-life services.
Criminal Law/Medical Malpractice: Court Strikes Down Murder Conviction of Physician Where Inappropriate Care Led to Patient's Death
Authors: Bell Alessia T.
Published: January 2007

On March 29,2000, in U.S. v. Wood, the U.S. Court of Appeals for the Tenth Circuit held that a physician cannot be convicted of murder simply for adopting, in an emergency setting, a risky course of treatment intended to prolong life that, when carried out, effectively hastened death. Finding the government's evidence flawed, based on several evidentiary errors and an erroneous denial of a motion for judgment of acquittal on murder charges, the court reversed the conviction of involuntary manslaughter and ordered a new trial.

Virgil Dykes, an 86-year-old man, was suffering from severe abdominal pain when he arrived at the Veterans Administration hospital in Muskogee, Oklahoma, on February 5, 1994.
Product Liability: Florida Jury Finds that Cigarettes Caused Smoker's Disease
Authors: Morton Matthew
Published: January 2007

On April 7,2000 a Florida jury ordered the tobacco industry to pay $12.7 million in compensatory damages to three former smokers who were chosen to represent hundreds of thousands of Florida residents in an unprecedented class action lawsuit. The decision not only marks the first time that a jury has found on behalf of smokers in a class action lawsuit, it also sets the stage for a huge punitive damage award against the industry. The awards followed a finding by the same jury last July that the cigarette manufacturers have “acted with reckless disregard” and “engaged in extreme and outrageous conduct” while conspiring to mislead the public about the health risks of smoking. These previous findings make it likely that there will be punitive damages levied against the tobacco companies when the jury reconvenes in May.
Reproductive Health: Massachusetts Court Holds Contracts Forcing Parenthood Violate Public Policy
Authors: Gardiner Avery W.
Published: January 2007

On March 31, 2000, the Massachusetts Supreme Judicial court ruled that a contract awarding custody of frozen pre-embryos to the wife upon divorce was unenforceable because it violates public policy. This is the first reported case to address a contract between the clinic and the parties where the contract would have awarded the pre-embryos to one of the gamete providers. The decision in A.Z. v. B.Z. 431 Mass. 150 (2000) differs from decisions in the two other courts of last resort deciding related cases where enforcement of contracts was supported. This case represents an important development in the legal doctrines associated with frozen pre-embryos as it explicitly differs from the other courts’ decisions in addressing pre-embryos at the same developmental stage.
Hands On/Hands Off: Why Health Care Professionals Depend on Families but Keep Them at Arm's Length
Authors: Levine Carol , Zuckerman Connie
Published: January 2007

In the theater the fictional Dr. Kelekian’s relief that he does not have to talk to family members about his patient’s cancer treatment draws uneasy laughter from the audience. Doctors, patients, and family members alike recognize the situation, even if hearing it so baldly expressed discomfits them.

Why do physicians and other health care professionals, including lawyers and bioethicists, so often view families as “trouble”? And why do families so often see medical professionals as uncaring and uncommunicative? Presumably everyone wants the same goal—recovery or the best possible outcome for the patient. And yet trouble clearly exists. We do not see the problem as one of “dysfunctional families” or “callous doctors,” although there are undoubtedly many of each.
Relieving Pain and Foreseeing Death: A Paradox About Accountability and Blame
Authors: Nuccetelli Susana , Seay Gary
Published: January 2007

In a familiar moral dilemma faced by physicians who care for the dying, some patients who are within days or hours of death may experience suffering in a degree that cannot be relieved by ordinary levels of analgesia. In such cases, it may sometimes be possible to honor a competent patient's request for pain relief only by giving an injection of narcotics in a dosage so large that the patient's death is thereby hastened. Doctors rightly worry that taking an action likely to result in a patient's death may violate the Hippocratic injunction against the direct killing of anyone in their care.
Are Ethics Committee Members Competent to Consult?
Authors: Hoffmann Diane , Tarzian Anita , O'Neil J. Anne
Published: January 2007

A significant amount of discussion in the bioethics community has been devoted to the question of whether individuals performing ethics consultations in healthcare institutions have any special expertise. In addition, articles in the lay press have questioned the “added value” that bioethicists bring to ethical dilemmas. Those at the forefront of the bioethics community have argued repeatedly that those doing ethics consults cannot simply be well-intentioned individuals, that some training in bioethics, group process, and facilitation is necessary to competently execute a consult. As one bioethicist commented:

if you approach any endeavor as an amateur activity, you will get, in the end, an amateurish version of the activity. Without a sufficient commitment of personnel, time, support, and financial resources, a healthcare organization will get the ‘ethics’ program … it set out to create: an inept, unskilled, inefficient, and highly risky ‘program’ in healthcare ethics and bioethics.
Involving Study Populations in the Review of Genetic Research
Authors: Sharp Richard R. , Foster Morris W.
Published: January 2007

Research on human genetic variation can present collective risks to all members of a socially identifiable group. Research that associates race or ethnicity with a genetic disposition to disease, for example, presents risks of group discrimination and stigmatization. To better protect against these risks, some have proposed supplemental community-based reviews of research on genetic differences between populations. The assumption behind these appeals is that involving members of study populations in the review process can help to identify and minimize collective risks that otherwise could go unnoticed. In contrast to this position, critics have argued that supplemental community-based reviews are unnecessary, impractical, and morally problematic. This paper is our attempt to advance this debate by distinguishing the various goals of community review and the forms that it can take.
Autonomy and Connectedness: A Re-evaluation of Georgetown and its Progeny
Authors: Scott Rosamund
Published: January 2007

In the late twentieth century the United States experienced a wave of cases concerning compelled obstetric interventions, cases which attracted much legal and philosophical interest. Behind and alongside them, however, lies a little known strand of authorities which concerns a parent wishing to refuse life-sustaining treatment and a hospital seeking to prevent this on the basis of the State's interest in protecting innocent third parties, usually the patient's dependent minor children. This issue appears to be unique to the United States. Although the leading case in point was influential in cases concerning compelled obstetric intervention, it has received little examination in its own right. This is a shame, since it spawned an intriguing line of cases worthy of reflection today.
Recent Developments in Health Law
Authors: Lee Susan
Published: January 2007

In December 1998, two groups of scientists announced that they had successfully isolated and cultured human pluripotent stem cells. This news was greeted with both tremendous enthusiasm and concern. Because these cells can develop into most types of cells or tissues in the human body, they hold great promise for scientific research and medical advances. For example, stem cells can potentially be used to:

Generate cells and tissues for transplantation and therapy for conditions such as Parkinson’s disease, spinal cord injury, stroke, burns, heart disease, diabetes, and arthritis;

Improve scientists’ understanding of the complex events that occur during normal human development, as well as the abnormal events which cause conditions such as birth defects and cancer; and

Substantially change the development and testing of drugs. New medications could be tested initially on stem cells, and only drugs which were safe and effective on the cells would be tested further on laboratory animals and humans.
Legal Implications of Discrimination in Medical Practice
Authors: Berniker Jessamyn S.
Published: January 2007

Recent medical studies have indicated that medical professionals discriminate in their treatment practices on the basis of race and gender. Among the many concerns stemming from this realization are questions about the possibility of legal actions and the availability of individual compensation for the denial of equal care. By meeting legal evidentiary standards, the recent statistical data pointing to discriminatory trends have created the potential for legal recourse through Title VI of the Civil Rights Act which prohibits recipients of federal funding from treating people differently on the basis of race or national origin.
Wrongful Death: Oklahoma Supreme Court Replaces Viability Standard with “Live Birth” Standard
Authors: Marouf Fatma
Published: January 2007

On December 7,1999, a divided Oklahoma Supreme Court held inNealis v. Bairdthat a claim may be brought under Oklahoma's wrongful death statute on behalf of a nonviable fetus born alive. The decision represents a departure from the traditional notion that “viability”—the ability of a fetus to sustain life outside the womb with or without medical assistance—is the standard for wrongful death recovery. In replacing the “viability” standard with a “live birth” standard, the majority maintained that live birth is the “unassailable point at which legal rights must be said to attach to the human person. “ By holding a nonviable fetus a legal “person” for the purpose of a wrongful death claim, the court's decision emphasizes the limited application of the United States Supreme Court's holding inRoe v. Wadethat a fetus is not a person for the purposes of the Fourteenth Amendment.
AIDS: Mississippi Supreme Court Adopts New Standard for Fear of Exposure to AIDS
Authors: Lan Iris
Published: January 2007

On November 4,1999, in South Central Regional Medical Center v. Pickering, 1999 WL 1000703 (1999), the Mississippi Supreme Court created a new legal standard that allows patients to recover damages for fear of exposure to AIDS even though they cannot prove actual exposure. By adopting this standard, the Mississippi Supreme Court joined the minority of jurisdictions seeking to encourage providers to use reasonable care when handling instruments capable of transmitting disease.

Plaintiff Jimmie Pickering is a female diabetic, who was receiving treatment at South Central Regional Medical Center (South Central) between September 30 and October 5, 1987 to regulate her blood sugar levels. Pickering used the hospital's Autoclix machine, which required that Pickering use lancets to prick her finger to draw blood.
Organ Transplantation: New Regulations to Alter Distribution of Organs
Authors: Geyser Daniel Luke
Published: January 2007

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999, which instituted a 90-day comment period for the amended Organ Procurement and Transplantation Network (“OPTN”) Final Rule (“Final Rule”), a comprehensive set of guidelines that would affect how organs are allocated throughout the country. Barring further legislative action, the Final Rule, which has been over five years in the making, will be effective on March 16,2000.

The Final Rule, issued by the Department of Health and Human Services (‘‘DHHS”) pursuant to the National Organ Transplant Act, was originally publishedApril 2, 1998. It provided a number of substantive changes to the process through which organs are allocated by the United Network for Organ Sharing (UNOS), a private, non-profit organization charged with administering the national organ transplantation network.
Internet Pharmacies: Regulation of a Growing Industry
Authors: Oliver Amy J.
Published: January 2007

Industry analysts estimate that Internet pharmacies will generate $1.4 billion in prescription drug sales by 2001 and over $15 billion by 2004. The recent rush by traditional brick and mortar pharmacies either to partner with existing Internet pharmacies or to create their own web counterparts illustrates the increasing importance of business on the Internet. Last summer, retail pharmacy giant CVS acquired the Internet pharmacy soma.com and changed its name to reflect the new ownership. Early this year, in another key industry move, Walgreen's launched an upgraded, full-service Internet pharmacy in order to compete more successfully in the pharmacy industry.
Risking Ethical Insolvency: A Survey of Trends in Criminal DNA Databanking
Authors: Kimmelman Jonathan
Published: January 2007

Over ten years have elapsed since Virginia passed the nation's first criminal DNA banking law, which authorized law enforcement authorities to collect DNA samples from certain categories of offenders for the purposes of performing profile analysis. Within nine years, Rhode Island became the fiftieth state to enact a similar statute. The passage of a decade since the first enactment provides a convenient opportunity to assess the strengths and weaknesses of ethical safeguards under present law as well as predict the likely direction of future developments.

DNA forensics are merely the latest in a long line of biologically based identifying law enforcement technologies that include fingerprints and serotyping. Nevertheless, DNA has properties that make it significantly different than its predecessors with respect to the ethical and social concerns it raises.
Expert Testimony by Persons Trained in Ethical Reasoning: The Case of Andrew Sawatzky
Authors: Baylis Françoise
Published: January 2007

In February 1999, I received a call from a lawyer at Hill Abra Dewar stating that she had instructions to retain my services as an expert witness in the case of Sawatzky v. Riverview Health Centre. She was representing the Manitoba League of Persons with Disabilities which had intervenor status.

In Canada the admission of expert testimony depends upon the application of four criteria outlined in R. v. Mohan by Justice Sopinka. These criteria are: (a) relevance; (b) necessity in assisting the trier of fact, (c) the absence of any exclusionary rule; and (d) a properly qualified expert. The lawyer believed that I could provide the court with relevant, reliable ethics testimony about surrogate decision-making and about medical futility-information that likely would be outside the experience and knowledge of the trier of fact.
Rebuttal: Expert Ethics Testimony
Authors: Baylis Françoise
Published: January 2007

According to Giles Scofield, ethicists can provide expert testimony in descriptive ethics and metaethics, but not normative ethics. Lawrence Schneiderman appears to disagree with this view, and presumably believes that it is appropriate for an expert witness in ethics to provide ethics testimony in all three areas. I draw this conclusion from several claims made in his commentary which aim to show that we would be contending experts if both invited to testify on a case involving claims about futile medical treatment. This disagreement aside, taken together both commentaries suggest that my testimony in the case of Andrew Sawatzky is wanting.

In the response that follows I do not engage in a debate about the content of my testimony.
Genetic Privacy Laws and Patients' Fear of Discrimination by Health Insurers: The View from Genetic Counselors
Authors: Hall Mark A. , Rich Stephen S.
Published: January 2007

Since 1991, over half the states have enacted laws that restrict or prohibit insurers’ use of genetic information in pricing, issuing, or structuring health insurance. Wisconsin was the first state to do so, in 1991, followed by Ohio in 1993, California and Colorado in 1994, and then several more states a year in each of the next five years. Similar legislation has been pending in Congress for several years. Also, a 1996 federal law known as the Health Insurance Portability and Accountability Act (HIPAA) prohibits group health insurers from applying “preexisting condition” exclusions to genetic conditions that are indicated solely by genetic tests and not by any actual symptoms.
A Survey of Physician Training Programs in Risk Management and Communication Skills for Malpractice Prevention
Authors: Lefevre Frank V. , Waters Teresa M. , Budetti Peter P.
Published: January 2007

Malpractice lawsuits serve as a great source of pain, consternation and loss for physicians and patients alike, usually leaving all parties involved in the process with a sense of betrayal. A significant number of physicians will be sued at least once in their career, especially if they practice in some of the more vulnerable specialties. In addition, there is some evidence that the threat of malpractice lawsuits changes the practice style of many physicians, leading to the practice of “defensive medicine” and raises the total cost of health care. Clearly, the prevention of medical malpractice is an issue that deserves considerable attention from physicians and from those who train them.

Empirical evidence suggests that medical negligence may play a relatively minor role in malpractice lawsuits. As demonstrated by Localio, et al., one in thirty-five cases of negligence or incompetence actually results in a lawsuit.
Lessons to Be Learned from Harvard Pilgrim HMO's Fiscal Roller Coaster Ride
Authors: Miller Frances H. , Miller Walter W.
Published: January 2007

The recent high-profile financial difficulties of Harvard Pilgrim Health Care, the largest HMO in Massachusetts and consistently rated as one of the top ten HMOs in the nation, shed light on many problems common to health insurers throughout the country. This article explores those difficulties in the context of the short but complicated history of Harvard Pilgrim, and its regulatory and competitive environments. The state legislation which made a receivership proceeding possible for Harvard Pilgrim offered some protection for subscribers, but failed to provide the means for achieving a long term solution. The statute merely presented a method for staving off immediate collapse by temporarily protecting the plan from dissolution, and forcing the plan's contracting providers to continue delivering care even if owed money by the plan. The article concludes by drawing lessons for understanding and ideally avoiding similar managed care nearfatalities in the future.
Risks, Benefits, and Conflicts of Interest in Human Research: Ethical Evolution in the Changing World of Science
Authors: Koski Greg
Published: January 2007

A generation ago, we adopted a national system for the protection of human subjects in research. Today, that system is facing new challenges. Many argue that the system has failed to evolve in concert with dramatic changes in the research environment. Accordingly, efforts are underway to reform the existing process to make it both more efficient and more effective. At the same time, many are also reexamining the system in more fundamental ways — going well beyond considerations of policies and compliance and raising questions that go to the very foundations of what constitutes an ethical conduct of human research.

Experimentation involving human subjects is a necessary step in the process of translating scientific discovery and technological advancement into procedures and products that offer the prospect of better lives for all of us. It helps us to better understand why we do the things we do and believe what we believe.
Defining and Describing Benefit Appropriately in Clinical Trials
Authors: King Nancy M. P.
Published: January 2007

Institutional review boards (IRBs) and investigators are used to talking about risks of harm. Both low risks of great harm and high risks of small harm must be disclosed to prospective subjects and should be explained and categorized in ways that help potential subjects to understand and weigh them appropriately. Everyone on an IRB has probably spent time at meetings arguing over whether a three-page bulleted list of risk description is helpful or overkill for prospective subjects. Yet only a small fraction of all the time and attention lavished on risk disclosure has been devoted to discussing whether and when potential benefit to subjects can reasonably be claimed and, if so, how it should be described in the consent form and process.

Traditionally, IRBs and regulators have worked to ensure that clear lines can be drawn between research that, by definition, carries no potential for direct benefit — because it uses healthy volunteers or because it is not foreseeably focused on the development of treatments — and research that does have the development of effective treatments as its goal.
The Ethics of Clinical Trials: A Child's View
Authors: Rosato Jennifer
Published: January 2007

Until a few years ago, the prevailing view was that children should not be participants in clinical research trials because children were incapable of consenting to such nontherapeutic interventions and are particularly vulnerable to abuse. That view has undergone a significant shift in the last few years, particularly in the context of trials to test the safety and effectiveness of drugs. A number of events facilitated this change, including the widespread off-label distribution of drugs to children and developments in the AIDS epidemic. These social forces have shifted the core ethical question fromwhetherchildren should be research subjects towhenchildren should be research subjects.

The presumption in favor of including children as research subjects for drug trials has manifested itself primarily through two different reforms: a 1997 federal statute and a set of regulations promulgated by the Food and Drug Administration (FDA) that recently became effective. Together they reflect the view that children deserve the same access to safe and effective therapies as adults.
The Girl Who Cried Pain: A Bias against Women in the Treatment of Pain
Authors: Hoffmann Diane E. , Tarzian Anita J.
Published: January 2007

To the woman, God said, “I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you.”

Genesis 3:16

There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for their pain.

One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, “it's real”; and women are better able to tolerate pain or have better coping skills than men.
Pain Management and Provider Liability: No More Excuses
Authors: Furrow Barry R.
Published: January 2007

Pain is undertreated in the American health-care system at all levels: physician offices, hospitals, long-term care facilities. The result is needless suffering for patients, complications that cause further injury or death, and added costs in treatment overall. The health-care system's failure to respond to patient pain needs corrective action. Excuses for such shortcomings are simply not acceptable any longer.

Physicians have long been accused of poor pain management for their patient. The term “opiophobia” has been coined to describe this remarkable clinical aversion to the proper use of opioids to control pain. If the professional mandate of the health-care professional is to relieve suffering, then physicians are falling far short of their obligations by accepting myths about the use of opioids in the face of evidence to the contrary.
Race, Ethnicity, and Pain Treatment: Striving to Understand the Causes and Solutions to the Disparities in Pain Treatment
Authors: Bonham Vence L.
Published: January 2007

would like for them to know that I am in pain or this part of my body hurts or the other part hurts — that I am not lying about it. To examine me and to cut down on the pain….And help me out.

Patient with Sickle Cell Disease, Focus Group Participant

Pain in the United States is widely recognized to be undertreated; however, the capacity to treat pain has never been greater. The causes of this undertreatment are varied. As we focus on pain and why it is too often ineffectively treated, we also discover that this undertreatment afflicts some more than others. What divides the some from the others isn't limited to one factor, but one particularly disturbing factor is race and ethnicity. Racial and ethnic minority populations are at higher risk for oligoanalgesia, or the ineffective treatment of pain. Only through further study of the differences in pain treatment based on race and ethnicity can we develop strategies to reduce the disparities in care.
From Confrontation to Collaboration: Collegial Accountability and the Expanding Role of Pharmacists in the Management of Chronic Pain
Authors: Brushwood David B.
Published: January 2007

Federal and state laws create a tightly controlled system for distribution of those drugs that have recognized value in therapy, but also have the potential for abuse. The challenges pharmacists face in keeping controlled substances within the closed system are many and complex. Drug abusers and drug dealers have at times seen pharmacists as easy marks for access to abusable drugs. Unfortunately, pharmacists often find themselves in a game with criminals, who use both sophisticated and dangerous methods of inducing pharmacists to divert controlled substances. The effects of this problem on the health-care system have been judicially noted:

The frequency of these crimes has terrorized the community of dispensing pharmacists. Some pharmacists have ceased to carry drugs that are highly desired on the black market, although this interferes with their patients’ ability to obtain necessary medicine. This has a serious potential to impede the delivery of health care in many communities around the nation.
Currents in Contemporary Ethics
Authors: Stone T. Howard
Published: January 2007

In what is clearly an important development related to research integrity and the protection of human research subjects, the U.S. government has instituted two new training requirements as a condition of receiving federal financial support. First, the National Institutes of Health (NIH) is requiring, as a condition of funding, that key research personnel involved in human subject research complete education “in the protection of human subjects.” Evidence that key personnel have completed this training must be provided in NIH grant applications or contract proposals.

The NIH education policy will eventually be superseded by a more broadly applicable instructional policy for the “responsible conduct of research,” which will be promulgated by the Department of Health and Human Service's Office of Research Integrity and the Public Health Service (PHS). The instructional policy will apply to all persons engaged in any research or research training with PHS support. Presently, the only version of the policy is in draft form.
Jonathan Mann's Legacy to the 21st Century: The Human Rights Imperative for Public Health
Authors: Marks Stephen P.
Published: January 2007

Professor Gostin is a leading authority on health law, whose writing and teaching are among the most authoritative in the United States, as exemplified by his recent work, Public Health Law: Power, Duty, Restraint. Gostin's article in this issue of the Journal of Law, Medicine & Ethics pays homage to Jonathan Mann (1947-1998) by expressing the debt he feels toward this extraordinary doctor and public health official with whom he had collaborated on several projects.

As many will remember, Mann held high-level positions at the Centers for Disease Control and worked on AIDS research in Central Africa before setting up the World Health Organization's Global Programme on AIDS, which he ran from 1986 to 1990. Thanks to his profound commitment and consummate communication skills, he achieved the unprecedented feat of raising the budget within two years to almost $100 million from the initial set-up of “himself, a secretary, and one typewriter,” as described by Daniel Tarantola.