Killing Two Birds with One Stone: Mandatory Therapy and the Prevention of Sex Crime in France.

This paper considers the development of new clinical and medical practices in the early 2000s in France, after the adoption of legal reforms aiming at the prevention of sexual infractions and the protection of minors. The paper explains how the reform led to the creation of a new form of punishment for sexual offenders, l'obligation de soin (therapeutic obligation), which can be described as long-term mandatory therapeutic monitoring. This paper offers an analysis of the implementation of this measure from the standpoint of the specialized mental health care unit which were entrusted the mission of caring for the new group of convicted patients, i.e., patients sentenced to undergo mandatory therapy, after this legal reform. In the new regime these mandatory therapies created, clinicians are tasked to combine their conventional mission of care for the patient in the present, with the judicial mandate of detecting and preventing the patient's relapse qua recidivism in the future. Mobilizing ethnographic examples that evidence the way clinical care comes to encompass a penal mandate of long-term surveillance of convicted patients, I argue that the dual injunction of procuring care while preventing relapse-recidivism constrains the psychodynamic forms of clinical intervention deployed by French clinicians, realigns both psychiatric and clinical interventions along penal lines, and revives interest in some of the diagnostic categories and aims of criminal psychiatry which were important for the development of psychiatry in France.

Revisiting the effects of state anesthesia policy interventions: A comprehensive look at certified registered nurse anesthetist service provision in U.S. hospitals from 2010 to 2021.

AIMS: Rural hospitals in the United States often rely on nonphysician providers such as advanced practice nurses to care for their patients. One important role that is served by advanced practice nurses is that of anesthesia provider (certified registered nurse anesthetist or CRNA). In 2001, Centers for Medicare & Medicaid Services (CMS) passed an opt-out law affording state governors the right to loosen physician supervision requirements on CRNAs in their respective states, thus potentially improving access in targeted areas. Since then, 24 states have adopted these opt-out provisions. We aim to understand the extent to which the CMS opt-out law has resulted in increased CRNA service provision in hospitals, especially in rural areas. DESIGN: The study used a longitudinal design. We compiled 2010-2021 American Hospital Association data, which includes 4,464 unique U.S. hospitals observed an average of 8 times annually (35,863 total hospital-year observations). METHODS: We model CRNA services provision at the hospital level using longitudinal mixed effects generalized linear models that incorporate state, county, and hospital control variables. RESULTS: Using descriptive statistics and mixed effects generalized linear models, we discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals. Notably, opt-out provisions do not improve access in rural counties. However, in supplemental analysis, we discover some of the conditions under which the likelihood of CRNA service provision is influenced. CONCLUSIONS: Hospitals often utilize CRNAs to staff their hospitals. However, many hospitals use both CRNAs and physician anesthesiologists; this can be a potential source of contention and confusion, given the lack of uniformity in the scope of practice policies. We offer some suggestions with regard to the effects of state interventions into the field, and how they might impact this dispute. Lastly, policymakers should consider additional measures to address rural access limitations, as the opt-out policy does not seem to be working as intended.

Are Wild Prey Sufficient for the Top Predators in the Lowland Protected Areas of Nepal?

A balanced equilibrium between carnivores and their prey is crucial for maintaining ecosystem sustainability. In this study, we applied the predator-prey power law equation to assess the balance between the biomass densities of carnivores and their wild prey within Nepal's lowland protected areas during 2013, 2018, and 2022. The estimated value of the power law exponent k for predator-prey biomass was 0.71 (95% CI = 0.39-1.05), indicating an approximate threefold increase in predator biomass density for every fivefold increase in prey biomass density. Consequently, this creates a systematically bottom-heavy predator-prey biomass pyramid. This finding, consistent with the k = 3/4 trophic biomass scaling across ecosystems, suggests that predator biomass is proportionally sustained by prey biomass, indicating a balance between top predators and their wild prey in Nepal's lowland protected areas. We further demonstrated it is possible to retain the overall power law exponent while jointly measuring intraguild competition between two predators with canonical correlation analysis. This understanding opens avenues for future research directed toward unraveling the factors that drive these consistent growth patterns in ecological communities.

Insight into the enhancement and mechanism of saltiness perception by salty peptides from bovine bone.

Food-derived salty peptides have been considered promising substitutes for sodium salt. In this work, three novel salty dipeptides Asp-Pro (DP), Asp-Arg (DR), and Arg-Glu (RE) were identified from bovine bone hydrolysates. The salt reduction rates were 76.85 %, 77.28 %, and 73.72 % by the three peptides (2 mg/mL) in a NaCl concentration of 0.203 g/100 mL, respectively. According to Stevens' law, a non-linear relationship between saltiness intensity and concentration was quantified, showing a slower increase in the sensory intensity perception compared with the changes in physical concentration (ß < 1). In molecular detail, electrostatic energy and van der Waals energy were the main energetic contributions to forming stable complexes. The binding of salty peptides to TMC4 was driven by hydrogen bonding and salt bridge, and the main binding sites were Glu319, Ala579, and Thr581. These results could provide new insight into the salt-enhancing property and interaction mechanism of salty peptides as novel sodium substitutes.

Phenotypes of Velopharyngeal Tube Law in Obstructive Sleep Apnea.

OBJECTIVE: The biomechanics of upper airway collapse in obstructive sleep apnea (OSA) remains poorly understood. The goal of this study is to compare the area-pressure relationship (tube law) of the velopharynx at peak inspiration and peak expiration. STUDY DESIGN: Cross-sectional. SETTING: Academic tertiary medical center. METHODS: The velopharyngeal tube law was quantified in a convenience sample of 20 OSA patients via step reductions in nasal mask pressure during drug induced sleep endoscopy (DISE). The velopharyngeal airspace cross-sectional area was estimated from endoscopy while luminal pressure was recorded with a catheter. The tube law was quantified for nasal mask pressures from 14 to 0 cmH2O at peak inspiration and at peak expiration in all patients. The tube law was also quantified during the breathing cycle at a constant nasal mask pressure of 4 cmH2O in 3 patients representing different phenotypes. RESULTS: Velopharyngeal compliance (the slope of the tube law) was not statistically different in the peak inspiration versus peak expiration tube laws. Three phenotypes were observed, namely inspiratory collapse (phenotype 1), expiratory collapse (phenotype 2 = palatal prolapse), and a mostly stable airway during inspiration and expiration that collapsed as CPAP was reduced (phenotype 3). CONCLUSION: Velopharyngeal compliance is not significantly different at peak inspiration and peak expiration, which suggests that muscle tone is low when luminal pressure is above the closing pressure. Additional studies are needed to investigate how different phenotypes of velopharyngeal collapse may affect therapeutic outcomes.

Palliative care-based arguments against assisted dying.

Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end-of-life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims.

Personal responsibility for health in Bulgarian public health law and social legislation.

BACKGROUND: In the last decades all health systems have experienced a lack of resources. Against this background, the idea of ​​applying personal responsibility of the patient as a criterion for allocation of resources (PRCAR) is gaining increasing attention. Bulgarian healthcare reform has been marked by the implementation of many new strategies, that grounded our scientific interest towards investigating PRCAR in Bulgarian public health law and social legislation. METHODS: Through a search of national legal databases 7 documents were selected and subjected to content analysis. RESULTS: Prospective responsibility was found in two and retrospective responsibility - in three documents, two of which imposed explicit penalties on the patient. Two documents did not distinguish between the types of patient responsibility. PRCAR was found to be controversial through the prism of the social justice principle. The discussion was conducted through the perspectives of evidence translation of research to law, particularities of social cohesion in Bulgaria, and the interpretation of principles of public health ethics. CONCLUSION: Although PRCAR was traceable in Bulgarian legislation, no supporting arguments for its introduction were deduced. The applicability of PRCAR should be further studied and wider public debate should be initiated.

Study on major legal issues and solutions in pandemic treaty negotiations.

In December 2021, WHO's 194 member states began reaching a consensus to start the process of drafting and negotiating a pandemic treaty under the WHO Act. Although there is already a PHEIC system to deal with sudden public health events such as pandemics, the system is not sufficient to deal with global pandemic events. The draft WHO Pandemic Agreement reflects the negotiating process until 24 May 2024. The negotiating team is faced with legal issues such as the treatment of the relationship between the pandemic treaty and the International Health Regulations, the determination of the contracting model, the attribution of the pandemic definition power and the construction of the dispute settlement mechanism. Through a study of the articles of the current draft and a comparative analysis with other treaties, this paper discusses the need to distinguish the functions of the pandemic treaty and the International Health Regulations (IHR), adopt a soft and hard contracting model, establish an open and transparent pandemic determination mechanism, reform the institutional functions of WHO, and establish an effective dispute settlement mechanism in order to solve the above problems. Ultimately, fairness and justice in international public health governance will be achieved.

PCLOS based fractional-order sliding mode stochastic path following control for underactuated marine vehicles with multiple disturbances and constraints.

This paper investigates the stochastic path following control of underactuated marine vehicles (UMVs) subject to multiple disturbances and constraints. Firstly, the complex marine environment in which UMVs navigate typically contains stochastic components, thus the multiple disturbances are categorized as slow-varying deterministic disturbances and stochastic disturbances. Secondly, a position-constrained line-of-sight (PCLOS) based fractional-order sliding mode stochastic (FSMS) control strategy is established to achieve path following control of UMVs. A PCLOS guidance law based on universal barrier Lyapunov function is proposed to ensure that the position errors remain within the constraint ranges, which is versatile for systems with symmetric constraints or without constraints. An FSMS controller based on fractional-order theory and sliding mode control is designed to improve the dynamic response speed of the system and effectively attenuate chattering phenomenon. A stochastic disturbance observer is developed to estimate the slow-varying deterministic disturbances in the stochastic system, and auxiliary dynamic compensators are used to mitigate the impact of input constraints. Lastly, theoretical analysis indicates that the closed-loop system is stable and the position constraint requirements are satisfied. Comparative simulations illustrate the effectiveness of the proposed control strategy.

Soret and dufour impacts on radiative power-law fluid flow via continuously stretchable surface with varying viscosity and thermal conductivity.

The intricate dynamics of mixed convective thermic and species transport in a power-law flowing fluid through a continuously stretched surface are investigated. The uniqueness of this study lies in the consideration of fluid variable thermic conductivity and viscosity, which introduces a higher degree of realism into the analysis. The transformation of similarity is used to transform the fundamental governing equations, and after that, the set of equations is processed numerically utilizing a non-similarity local approach. Furthermore, the effects of Soret and Dufour represent the cross-diffusion phenomena, accounting for the energy exchange with the surroundings. These factors collectively influence the stretching surface's gradient velocity, affecting the thermal and species concentration rates. The findings offer a comprehensive understanding of these complex interactions, paving the way for optimizing thermic and species transport processes in various industrial applications. This study, therefore, holds significant potential for enhancing efficiency and performance in relevant industrial sectors. The main terms are the combinations of Dufour and Soret numbers that significantly impact the flow rate profile and mass transfer field. The coupled study of the nonlinear velocity, energy distribution and chemical mixture variance made the study more impactful in practicality. Skin friction variation shows limited impact with variations in the Soret number. The enhanced thermal gradient results in improved non-similarity parameters, yet it demonstrates a decrease with an increase in variable thermal diffusivity. There is a decrease in the temperature gradient as the buoyancy term reduces, while an increase is observed with changes in the Prandtl number. Similarly, the Nusselt number experiences a comparable impact due to changes in the Soret number.

Calculation method and evolution rule of the strain energy density of sandstone under true triaxial compression.

Deep rock masses are typically in complex stress states, and research on the evolution of their strain energy density is of highly important for understanding their failure characteristics. In this work, a true triaxial stress‒balanced unloading test is designed to analyze the ud and ue evolution of sandstone under true triaxial compression conditions. The study results indicate that as σ1 increases, the elastic strain decreases in the σ2 and σ3 directions, whereas the residual strain progressively increases, and the magnitude of decrease in elastic strain exceeds the magnitude of increase in residual strain. Throughout the loading process of σ1, ue progressively decreases in the σ2 and σ3 directions, whereas ud gradually increases, and the magnitude of decrease in ue surpasses the magnitude of increase in ud. The ud and ue of sandstone under different stress levels were calculated via true triaxial stress‒balanced unloading tests, and the evolution of ud and ue in the three principal stress directions and the overall strain energy density of sandstone followed a linear energy storage law. On the basis of this law and the true triaxial stress‒balanced unloading test, a new method for calculating the true triaxial ud and ue was proposed. A study on the σ1 unloading stress path revealed that the σ1 unloading stress path significantly affects the storage and dissipation of the strain energy density in the three principal stress directions of sandstone. On the basis of the research results, the criteria for determining rockbursts were discussed.

Exploring the regulatory framework of psychedelics in the US & Europe.

Psychedelic drug therapy has gained prominence for its potential in treating various mental health conditions, including depression, post-traumatic stress disorder (PTSD), and anxiety. Psychedelic treatment differs from conventional psychiatric approaches in mode of action, legal status, and treatment approach. This work delves into the therapeutic potential, mechanisms, and regulatory approvals of key psychedelic substances like psilocybin, 3,4-Methyl enedioxy methamphetamine (MDMA), mescaline, ketamine, and Lysergic acid diethylamide (LSD). It also provides an overview of legal aspects, and regulations surrounding psychedelics in the US & Europe, emphasizing their Schedule I classification due to potential misuse. The United States Food & Drug Administration (USFDA) closely monitors psychedelics, employing expedited pathways for evaluation. Further, recent guidance from the FDA on considerations for clinical Investigations supports the safe development of psychedelics for human welfare. European Medicines Agency (EMA) regulators focus on atypical psychedelics, addressing challenges in safety and efficacy. Marketed products, such as Spravato nasal spray, face limited distribution due to safety concerns. The call for careful regulation and legislation is essential for harnessing psychedelics' potential for therapeutic benefits and human welfare.

A Children's Rights Framework for Genomic Medicine: Newborn Screening as a Use Case.

The year 2023 marked the 60th anniversary of screening newborns in the United States for diseases that benefit from early identification and intervention. All around the world, the goal of NBS is to facilitate timely diagnosis and management to improve individual health outcomes in all newborns regardless of their place of birth, economic circumstances, ability to pay for treatment, and access to healthcare. Advances in technology to screen and treat disease have led to a rapid increase in the number of screened conditions, and innovations in genomics are expected to exponentially expand this number further. A system where all newborns are screened, coupled with rapid technological innovation, provides a unique opportunity to improve pediatric health outcomes and advance children's rights, including the unique rights of sick and disabled children. This is especially timely as we approach the 100th anniversary of the 1924 Geneva Declaration of the Rights of the Child, which includes children's right to healthcare, and the 1989 United Nations Convention on the Rights of the Child that expanded upon this aspect and affirmed each child's right to the highest attainable standard of health. In this manuscript, we provide background on the evolving recognition of the rights of children and the foundational rights to healthcare and non-discrimination, provide two examples that highlight issues to access and equity in newborn screening that may limit a child's right to healthcare and best possible outcomes, detail ways the current approach to newborn screening advances the rights of the child, and finally, propose that the incorporation of genomics into newborn screening presents a useful case study to recognize and uphold the rights of every child.

When is directed deceased donation justified? Practical, ethical, and legal issues.

This paper explores whether directed deceased organ donation should be permitted, and if so under which conditions. While organ donation and allocation systems must be fair and transparent, might it be "one thought too many" to prevent directed donation within families? We proceed by providing a description of the medical and legal context, followed by identification of the main ethical issues involved in directed donation, and then explore these through a series of hypothetical cases similar to those encountered in practice. Ultimately, we set certain conditions under which directed deceased donation may be ethically acceptable. We restrict our discussion to the allocation of organs to recipients already on the waiting list.

HIV: California's 2018 criminalization reform and testing among those reporting risk behavior.

HIV criminalization laws may discourage HIV testing. We tested whether California's 2018 HIV criminalization law reform increased the likelihood of past-year HIV testing compared to Nevada, which did not reform its HIV criminalization law. We fitted two difference-in-differences logistic regression models: one for all respondents reporting behaviors that increase the chances of getting or transmitting HIV, and one for male respondents reporting these behaviors. All analyses accounted for the complex survey design of BRFSS. HIV criminalization reform was significantly associated with an increased likelihood of past-year HIV testing. After reform, the predicted marginal probability of past-year HIV testing increased by six percentage points. By comparison, probabilities of a past-year HIV test decreased in Nevada. HIV criminalization law reform may increase the likelihood of getting tested by individuals who engage in behaviors that increase the chances of getting or transmitting HIV.

Research on enhancing the efficiency of food safety sampling inspections in China based on Pareto's law.

BACKGROUND: Food safety is pivotal for public welfare and directly impacts consumer health. Food safety sampling inspections (FSSIs) are essential in detecting unqualified food products and non-compliant manufacturers, which form an integral part of government regulatory frameworks. However, given the constraints on budgetary resources, improving the efficiency of food safety sampling inspections (EFSSIs) remains a considerable challenge in China's food quality and safety supervision. This study aims to apply Pareto's law, starting from the examination of food sample testing items and major hazard types, to theoretically analyze methods for improving the EFSSIs. Following the theoretical analysis, the research employs provincial food sampling data from China in 2022 to empirically validate the proposed improvement strategies. RESULTS: The research findings indicate that applying Pareto's law significantly reduces the number of items that should be tested for each food subcategory, effectively lowering testing costs for each batch of food samples. Theoretically, employing Pareto's law in sampling inspections can increase the EFSSIs to 2.78 times the current observed level. Furthermore, empirical validation using food sampling data confirms that EFSSIs can be improved to 2.12 times the existing level, consistent with theoretical predictions. CONCLUSION: Implementing Pareto's law in FSSIs facilitates the detection of more unqualified food products and non-compliant manufacturers without additional financial burden, significantly enhancing the EFSSIs. This approach provides an innovative strategy for government to bolster their food safety management efforts. © 2024 Society of Chemical Industry.

Shorting the metaphorical circuit: vascular partitioning and stomatal patchiness can create apparent unsaturation and CO2 gradient inversion in the Ohmic analogy for leaf gas exchange.

Analyses of leaf gas exchange rely on an Ohmic analogy that arrays single stomatal, internal air space, and mesophyll conductances in series. Such models underlie inferences of mesophyll conductance and the relative humidity of leaf airspaces, reported to fall as low as 80%. An unresolved question is whether such series models are biased with respect to real leaves, whose internal air spaces are chambered at various scales by vasculature. To test whether unsaturation could emerge from modeling artifacts, we compared series model estimates with true parameter values for a chambered leaf with varying distributions and magnitudes of leaf surface conductance ('patchiness'). Distributions of surface conductance can create large biases in gas exchange calculations. Both apparent unsaturation and internal CO2 gradient inversion can be produced by the evolution of broader distributions of stomatal apertures consistent with a decrease in surface conductance, as might occur under increasing vapor pressure deficit. In gas exchange experiments, the behaviors of derived quantities defined by simple series models are highly sensitive to the true partitioning of flux and stomatal apertures across leaf surfaces. New methods are needed to disentangle model artifacts from real biological responses.

Considerations on expanding criminal offender DNA databases with Y-STR profiles.

Although national criminal offender DNA databases (NCODDs) including autosomal short tandem repeats (STRs) have been a successful tool to identify criminals for decades in many countries, yet there are many criminal cases they cannot solve. In cases with mixed male-female samples, particularly sexual assault, expanding NCODDs with Y-chromosomal STR (Y-STR) profiles allows database matching in the absence of autosomal STR profiles. Although Y-STR matches are not individual-specific, this can be largely overcome with rapidly mutating Y-STRs (RM Y-STR) allowing separation of paternally related men. Expanding NCODDs with Y-STR profiles is also beneficial for law enforcement in cases without known suspects via familial searching. Expanding NCODDs with Y-STR profiles may raise concerns about genetic privacy and fundamental human rights. A legal analysis of the European Convention on Human Rights revealed that when primarily for reidentifying convicted sex offenders, it would be in line with the case law of the European Court of Human Rights, while a generalized approach primarily for familial searching and involving all types of offenders may not. This paper aims to stimulate a debate among various stakeholders regarding the benefits and risks of expanding NCODDs with Y-STR profiles that in some countries has already been practically implemented.

The influence of the psychosocial stress on oral health status in the conditions of being in Ukraine during the prolonged state of martial law.

OBJECTIVE: Aim: To study the presence of clinical and biochemical correlations between psycho-emotional stress, level of cortisol and periodontal oral health status of the patients in Ukraine during prolonged martial law. PATIENTS AND METHODS: Materials and Methods: The comprehensive clinical and laboratory study covered 49 persons, including 20 patients with Gingivitis (40.8%) and 29 with Periodontitis (59.2%). Biochemical blood test was performed to determine the level of "stress hormone" - cortisol. Patients filled out the questionnaire by the method of V. Zung (low mood-subdepression scale) to determine psycho-emotional state in the conditions of prolonged martial law in Ukraine. RESULTS: Results: The research results showed that in the conditions of martial law in Ukraine, "stabilization" and "improvement" of the process of patients with Gingivitis was established in 50%, with Periodontitis - only in 41.4% of patients. In 54% of patients, a significant deterioration of clinical indices was established, compared to the indicators before the war. In patients with Periodontitis, РВІ index was 1.33 (0.62-1.43) score, which was not statistically significantly different from the initial level (p>0.05). Biochemical blood tests revealed an increased level of the hormone cortisol in 18% of patients. According to the method by V. Zung scale of mental states, the majority of patients (87%) showed low mood and emotional instability within the medium level (range 2 and 3). Correlation was identified, according to the Spearman coefficient (R=0.39, р<0.05), between scale assessments by V.Zung and the blood level of cortisol. CONCLUSION: Conclusions: Psycho-emotional stress is one of the leading pathogenetic factors in the deterioration of oral health status and the development of periodontal diseases, especially in people in Ukraine during prolonged martial law. Indicators of method by V. Zung scale of mental states and the level of cortisol are optimal markers of the need to correct the psycho-emotional state. For patients with increased levels of stress and fear, it is necessary to create special treatment-prevention schemes, taking into account greater attention to motivation to maintain the health of the oral cavity, as well as more frequent hygiene procedures.

'Hard AI Crime': The Deterrence Turn.

Machines powered by artificial intelligence (AI) are increasingly taking over tasks previously performed by humans alone. In accomplishing such tasks, they may intentionally commit 'AI crimes', ie engage in behaviour which would be considered a crime if it were accomplished by humans. For instance, an advanced AI trading agent may-despite its designer's best efforts-autonomously manipulate markets while lacking the properties for being held criminally responsible. In such cases (hard AI crimes) a criminal responsibility gap emerges since no agent (human or artificial) can be legitimately punished for this outcome. We aim to shift the 'hard AI crime' discussion from blame to deterrence and design an 'AI deterrence paradigm', separate from criminal law and inspired by the economic theory of crime. The homo economicus has come to life as a machina economica, which, even if cannot be meaningfully blamed, can nevertheless be effectively deterred since it internalises criminal sanctions as costs.