Time to ACT-UP: Update on precautionary allergen labelling (PAL).

Background: Precautionary Allergen ("may contain") Labelling (PAL) is used by industry to communicate potential risk to food-allergic individuals posed by unintended allergen presence (UAP). In 2014, the World Allergy Organization (WAO) highlighted that PAL use was increasing, but often applied inconsistently and without regulation - which reduces its usefulness to consumers with food allergy and those purchasing food for them. WAO proposed the need for a regulated, international framework to underpin application of PAL. In 2019, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) of the United Nations convened an expert consultation to address the issue of PAL, the outputs of which are now being considered by the Codex Committee on Food Labelling (CCFL). Objectives: To summarise the latest data to inform the application of PAL in a more systematic way, for implementation into global food standards. Methods: A non-systematic review of issues surrounding precautionary labelling and food allergens in pre-packaged products. Results: Approximately, 100 countries around the world have legislation on the declaration of allergenic ingredients. Just a few have legislation on UAP. Given the risks that UAP entails, non-regulated PAL creates inconvenience in real life due to its unequal, difficult interpretation by patients. The attempts made so far to rationalize PAL present lights and shadows. Conclusions: At a time when CCFL is considering the results of the FAO/WHO Expert Consultation 2020-2023, we summarise the prospects to develop an effective and homogeneous legislation at a global level, and the areas of uncertainty that might hinder international agreement on a regulated framework for PAL of food allergens.

AI Governance: A Challenge for Public Health.

Unlabelled: The rapid evolution of artificial intelligence (AI) is structuralizing social, political, and economic determinants of health into the invisible algorithms that shape all facets of modern life. Nevertheless, AI holds immense potential as a public health tool, enabling beneficial objectives such as precision public health and medicine. Developing an AI governance framework that can maximize the benefits and minimize the risks of AI is a significant challenge. The benefits of public health engagement in AI governance could be extensive. Here, we describe how several public health concepts can enhance AI governance. Specifically, we explain how (1) harm reduction can provide a framework for navigating the governance debate between traditional regulation and "soft law" approaches; (2) a public health understanding of social determinants of health is crucial to optimally weigh the potential risks and benefits of AI; (3) public health ethics provides a toolset for guiding governance decisions where individual interests intersect with collective interests; and (4) a One Health approach can improve AI governance effectiveness while advancing public health outcomes. Public health theories, perspectives, and innovations could substantially enrich and improve AI governance, creating a more equitable and socially beneficial path for AI development.

[Inspection of deceased : Issuing a death certificate]. / Prähospitale Leichenschau : Durchführung und das Ausstellen der Todesbescheinigung.

The obligatory post-mortem examination and the issuing of a death certificate are among the more unpopular medical tasks. Nevertheless, the legislature has entrusted the medical profession with a socially important task that should be carried out carefully. The examining physician decides whether the death remains a private matter or whether an official death investigation should first shed light on the circumstances of the death. The post-mortem examination system is the only instrument for the systematic detection of homicide offences. The prerequisite for issuing a death certificate is a carefully conducted external post-mortem examination, which must be carried out in full at least when certifying a natural or unexplained cause of death. In addition, the medical information on the death certificate serves epidemiological and health policy purposes and contains important information on infection control.

Enhancing Professional Awareness of Informed Consent : Safeguarding the Rights of Patients and Practitioners.

Informed consent is a crucial communication process between doctors and patients for obtaining patients' approval before initiating medical treatment. It is derived from the legal principles of medical contracts and requires doctors to explain the treatment process to patients. Surgeons should be aware of informed consent not only to avoid unnecessary litigation risks but also to provide patients with the right to self-determination. The aim of the study is to help surgeons in Korea understand the legal doctrine on informed consent for practical application. This article reviews the legal doctrine of IC according to 4W1H-why, who, what, when, and how-with judicial cases to communicate effectively with patients in clinical settings. Regardless of seniority or rank, doctors may provide competent patients with information to protect their rights to self-determination. Informed consent should be advanced for patients to consider, discuss with significant others, and determine whether or not to undergo medical treatment. At that stage, patients need to be informed of the necessity, risks, and so on. The most common method of informed consent is an oral explanation utilizing certain forms for documentation. However, the informed consent of patients can be exempted on certain occasions. Optimal informed consent, when implemented, leads to patient-centered care, which significantly improves patient satisfaction and outcomes. Ultimately, it not only protects doctors from litigation risks but also upholds patients' autonomy.

The Pluralities of Property.

In Property Rights: A Re-Examination, James Penner returns to and develops a project that he has been engaged in for nearly three decades: to replace the influential 'bundle of rights' picture of property, which he regards as irredeemably flawed, with an alternative account-one that regards property as a unified entitlement. In this review article, I expound and analyse the central features of Penner's theory. I defend the view that, in its original iteration, Penner's account was trebly monistic: it regarded property as a single entitlement justified by a single human interest and protected by a single duty of non-interference. I go on to critically examine one of Penner's central ideas-that to understand property it is necessary to understand its justification. Along the way, I trace how Penner's account has evolved and explain how certain alterations have put some problems to bed while generating others.

The topic of not initiating resuscitation from the perspective of Czech law not only in the context of palliative care.

In the age of advanced modern medicine, prolonging the lives of patients is becoming easier and easier. Science is even going so far that some authors are beginning to see the need to advocate for the patient's right to die. The authors of the recommended resuscitation procedures themselves state that prolonging the inevitable dying process should be considered a harm (dysthanasia). The issue of not initiating urgent resuscitation is part of not only clinical practice, but also the study of physicians and other health professionals. The various criteria, indications, and contraindications for this action are repeatedly discussed in the course of study and practice, but rarely does this discussion go into significant detail. The teaching is limited to their enumeration or description of some of the more clearly understood ones, which are, for example, certain signs of death and their presence. The terminal stage of an incurable chronic disease is only marginally mentioned as a contraindication to urgent resuscitation, perhaps due to its ethical and legal overlap. The article includes an analysis of the sources of regulation of this issue, focusing mainly on legal and professional sources and their relationship. It also describes the actual process of decision making about the initiation of palliative care, decision making about end-of-life care, including the issue of not initiating urgent resuscitation.

A inclusão (tácita) do município à competência legislativa para proteção e defesa da saúde: análise sob o binômio urgência e popularização / The (tacit) inclusion of the municipality in the legislative competence for the protection and defense of health: analysis under the binomial urgency and popularization / La inclusión (tácita) del municipio en la competencia legislativa para la protección y defensa de la salud: análisis bajo el binomio urgencia y divulgación

Objetivo: o presente estudo analisa a descentralização federalista materializada por decisões do Supremo Tribunal Federal proferidas durante a pandemia do vírus Sars-CoV-2. Com isso, objetiva-se considerar a possibilidade da inclusão tácita do município à competência concorrente legislativa na área da saúde, a partir dos elementos de popularização e urgência. Metodologia: o estudo pautou-se em pesquisa bibliográfica ­ doutrina jurídica e sanitária ­ e legislativa, além da pesquisa ex post facto, com a análise das causas e dos efeitos da Ação Direta de Inconstitucionalidade 6.341, da Arguição de Descumprimento de Preceito Fundamental 672 e da Ação Cível Originária 3.451, todas fundamentadas no federalismo cooperativo. Resultados: o reconhecimento do dever do município em legislar em defesa da saúde, especialmente na inércia dos demais entes e limitado apenas por agências reguladoras, e a existência do embate protelatório entre incompetência legislativa, urgência e popularização do sistema de saúde. Conclusão: concluiu-se pela inclusão tácita do município à competência legislativa na área da saúde pelas decisões do STF.

Objective: this study analyzes the federalist decentralization materialized by decisions of the Brazilian Supreme Federal Court rendered during the SARS-CoV-2 virus pandemic. In this context, the aim is to consider the possibility of tacitly including municipalities within the concurrent legislative competence in the area of health, based on the elements of popularization and urgency. Methods: the study is based on bibliographic research ­ legal and public health doctrine ­ and legislative research, as well as ex post facto research, analyzing the causes and effects of Direct Action of Unconstitutionality 6.341, Allegation of Violation of Fundamental Precept 672, and Original Civil Action 3.451, all grounded in cooperative federalism. Results: as a result, the recognition of the municipality's duty to legislate in defense of health, especially in the inertia of other entities and limited only by regulatory agencies, and the existence of a delaying clash between legislative incompetence, urgency and popularization of the health system. Conclusion: it was concluded that the municipality was tacitly included in the legislative competence in the area of health by the decisions of the STF.

Objetivo: el presente estudio analiza la descentralización federalista materializada por decisiones del Supremo Tribunal Federal pronunciadas durante la pandemia del virus Sars-CoV-2. Con esto, se busca considerar la posibilidad de la inclusión tácita del municipio en la competencia legislativa concurrente en el área de la salud, a partir de los elementos de popularización y urgencia. Metodología: el estudio se basó en investigación bibliográfica ­ doctrina jurídica y sanitaria ­ y legislativa, además de la investigación ex post facto, con el análisis de las causas y efectos de la Acción Directa de Inconstitucionalidad 6.341, la Alegación de Incumplimiento de Precepto Fundamental 672 y la Acción Civil Originaria 3.451, todas fundamentadas en el federalismo cooperativo. Resultados: en consecuencia, el reconocimiento del deber del municipio de legislar en defensa de la salud, especialmente en la inercia de otras entidades y limitada solo por las agencias reguladoras, y la existencia del choque dilatorio entre la incompetencia legislativa, urgencia y popularización del sistema de salud. Conclusíon: se concluye que el municipio está tácitamente incluido en la competencia legislativa en materia de salud por las decisiones del STF.

Self-induced extreme intoxication akin to automatism: A psycholegal tug of war.

Self-induced extreme intoxication akin to automatism (SIEA) is a complicated and controversial legal concept resistant to jurisdictional consensus. In the United States, SIEA has, at times, been considered under the concept of "settled insanity.". In the United Kingdom, the defense may be allowed for specific intent crimes, though the defendant's awareness of the foreseeability of risk is addressed at trial. In Canada, recent jurisprudence has led to legal and practice landscape changes related to self-induced extreme intoxication. Here, we provide an overview of automatism and an update on the Canadian perspective with a review of the facts and an analysis of the Supreme Court of Canada's landmark decision in R v. Brown, where the court permitted the SIEA defense to be utilized for general intent crimes and acquitted Matthew Winston Brown, a 26-year-old male with no history of mental illness, with respect to two counts of "break and enter" and one count of "aggravated assault." We review the social and legislative response to the changing case law as well as related implications for expert testimony, which may be provided by forensic mental health professionals. Given the judicial and legal implications of the recent changes for both perpetrators and victims of violent crime and given the dynamic international landscape on extreme intoxication in criminal law, the review is thought to be of interest to a broad category of stakeholders including policymakers and those working in forensic psychiatry and law.

Even laypeople use legalese.

Whereas principles of communicative efficiency and legal doctrine dictate that laws be comprehensible to the common world, empirical evidence suggests legal documents are largely incomprehensible to lawyers and laypeople alike. Here, a corpus analysis (n = 59) million words) first replicated and extended prior work revealing laws to contain strikingly higher rates of complex syntactic structures relative to six baseline genres of English. Next, two preregistered text generation experiments (n = 286) tested two leading hypotheses regarding how these complex structures enter into legal documents in the first place. In line with the magic spell hypothesis, we found people tasked with writing official laws wrote in a more convoluted manner than when tasked with writing unofficial legal texts of equivalent conceptual complexity. Contrary to the copy-and-edit hypothesis, we did not find evidence that people editing a legal document wrote in a more convoluted manner than when writing the same document from scratch. From a cognitive perspective, these results suggest law to be a rare exception to the general tendency in human language toward communicative efficiency. In particular, these findings indicate law's complexity to be derived from its performativity, whereby low-frequency structures may be inserted to signal law's authoritative, world-state-altering nature, at the cost of increased processing demands on readers. From a law and policy perspective, these results suggest that the tension between the ubiquity and impenetrability of the law is not an inherent one, and that laws can be simplified without a loss or distortion of communicative content.

Trigeminal nerve injuries following dental procedures: A retrospective analysis of malpractice claims from 2016 to 2023 in South Korea.

BACKGROUND: Dental malpractice claims, which pertain to legal actions against dentists accused of clinical negligence that caused harm to patients, have increased in the past ten years in South Korea. The claims are caused by complications, particularly trigeminal nerve injuries, resulting from various dental procedures. Medicolegal issues related to trigeminal nerve injury have not been previously described in South Korea. Therefore, in this study, we aimed to identify the general, dental, and judicial characteristics of closed dental malpractice claims. METHODS: This study was designed as a descriptive study. We collected the data of 51 closed claims related to trigeminal nerve injury resulting from dental procedures such as dental implant emplacement, tooth extraction, and local anesthesia. The claims were decided by courts in South Korea between 2016 and 2023. The general, dental, and judicial characteristics of the claims were analyzed retrospectively. RESULTS: The average claim resolution period was 4.2 (range: 1.47-8.39) years post-adverse events that occurred more frequently in dental clinics (68.6 %) than in dental (25.5 %) or general hospitals (5.9 %). Inferior alveolar (66.7 %) and lingual (17.6 %) nerves were injured following dental procedures. The duty to inform was breached in 68.6 % of claims. The dental procedure performed (P < 0.001) and the injured nerve (P < 0.001) were associated with the violation of the duty to care. CONCLUSION: To improve the quality of dental care services, the analysis of the adverse events using various resources including judgments should be strongly addressed.

A Qualitative Analysis of a Primary Care Medical-Legal Partnership: Impact, Barriers, and Facilitators.

BACKGROUND: Certain health-related risk factors require legal interventions. Medical-legal partnerships (MLPs) are collaborations between clinics and lawyers that address these health-harming legal needs (HHLNs) and have been shown to improve health and reduce utilization. OBJECTIVE: The objective of this study is to explore the impact, barriers, and facilitators of MLP implementation in primary care clinics. METHODS: A qualitative design using a semistructured interview assessed the perceived impact, barriers, and facilitators of an MLP, among clinicians, clinic and MLP staff, and clinic patients. Open AI software (otter.ai) was used to transcribe interviews, and NVivo was used to code the data. Braun & Clarke's framework was used to identify themes and subthemes. RESULTS: Sixteen (n = 16) participants were included in this study. Most respondents were women (81%) and white (56%). Four respondents were clinic staff, and 4 were MLP staff while 8 were clinic patients. Several primary themes emerged including: Patients experienced legal issues that were pernicious, pervasive, and complex; through trusting relationships, the MLP was able to improve health and resolve legal issues, for some; mistrust, communication gaps, and inconsistent staffing limited the impact of the MLP; and, the MLP identified coordination and communication strategies to enhance trust and amplify its impact. CONCLUSION: HHLNs can have a significant, negative impact on the physical and mental health of patients. Respondents perceived that MLPs improved health and resolved these needs, for some. Despite perceived successes, integration between the clinical and legal organizations was elusive.

The criterion of human dignity in the Quran.

In the Holy Quran, a strong emphasis has been placed on the dignity of human beings. There are two verses in the Quran that discuss the differences between humans and other creatures. In this article, we have tried to interpret these two verses using free selection of virtues and goodness as the criterion for human dignity that was obtained in our previous research. In the verse of trust, unlike other creatures, man accepts a trust that informs us about his cruelty and ignorance. However, if we consider this trust as freedom of choice, it can also imply injustice and ignorance alongside justice and wisdom for humans. In the verse of succession, angels tell God that human as vicegerent on earth leads to corruption and bloodshed. God does not deny this, but reminds the angels of the existence of pure ones. If we consider freely choosing goodness the differentiating factor between humans and other creatures the angels accurately refer to the possibility of creating corruption and bloodshed. However, they did not see the value of voluntary goodness compared to their own compulsory goodness. Therefore, by considering freely choosing goodness as the criterion for human dignity, these two verses can be easily interpreted.

Impact of a new state law and electronic health record prompt on naloxone prescribing in an academic medical center.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To evaluate the impact of a best-practice advisory (BPA) and South Carolina legislation on naloxone prescribing patterns. The primary objective was to assess the change in naloxone prescription rates following BPA implementation. The secondary objective was to analyze the performance of the BPA. METHODS: Naloxone prescriptions generated before (July 28, 2020, through July 27, 2021) and after (July 28, 2021, through July 28, 2022) BPA implementation were analyzed via retrospective chart review. Lists of patients at risk for opioid overdose and patients for whom the BPA fired were generated for March 2022. The BPA's effectiveness was evaluated based on the proportion of at-risk patients missed by the alert, the frequency with which the BPA resulted in a naloxone prescription, and the reasons for not prescribing naloxone when the BPA fired. RESULTS: Following BPA implementation, there was a significant increase in the average monthly naloxone prescribing rate from 66.1 to 625.5 prescriptions per month. Overall, 2,086 patients were considered at risk for opioid overdose and 1,101 had a BPA alert during March 2022, with 32.7% of BPA alerts resulting in naloxone prescribing. The most common reasons selected for not prescribing naloxone were "patient refusal" and "criteria not met." Only 354 patients (17.1%) at risk for opioid overdose also had a BPA alert. CONCLUSION: State legislation and implementation of the BPA significantly increased naloxone prescribing rates. However, a significant proportion of patients identified as being at risk did not have a BPA alert and most BPA alerts did not result in naloxone prescribing, suggesting a need for improvement of the BPA.

Therapeutic and non-therapeutic practices in the child justice system in Kenya: A therapeutic jurisprudence perspective.

Child justice systems are specialized jurisdictions set up for the purpose of providing justice related services to children. In an effort to resolve many of the systemic injustices expereinced by justice involved children, Kenya recently legislated the Children Act 2022. This new law is viewed as a paradigm shift from previous children acts as it incorporates constitutional provisions, UN conventions, minimum rules and other international protocols that Kenya is a state party to. The Act seeks to transform the child justice system into a jurisdiction which is more amenable to prioritising the mental wellbeing of children. The current study sought to examine the practices applied by state child justice agencies and whether these were therapeutic or non- therapeutic. This would clarify areas where the Act may need to be amended or reviewed to further its own goals. The findings revealed that the most non-therapeutic procedures centred on the courtroom such as the formal court environment and children facing perpetrators in court as well as limited access to mental health services. Therapeutic practices included ensuring children access treatment, use of child friendly interviewing techniques and testifying in camera. These may guide justice actors as to how they apply the Children Act 2022 within their own contexts whilst developing rules and standards that embody the principles of therapeutic jurisprudence.

"The reasons you believe ": An exploratory study of text driven evidence gathering and prediction from first responder records justifying state authorised intervention for mental health episodes.

Objective First responders' mandatory reports of mental health episodes requiring emergency hospital care contain rich information about patients and their needs. In Queensland (Australia) much of the information contained in Emergency Examination Authorities (EEAs) remains unused. We propose and demonstrate a methodology to extract and translate vital information embedded in reports like EEAs and to use it to investigate the extreme propensity of incidence of serious mental health episodes. Methods The proposed method integrates clinical, demographic, spatial and free text information into a single data collection. The data is subjected to exploratory analysis for spatial pattern recognition leading to an observational epidemiology model for the association of maximum spatial recurrence of EEA episodes. Results Sentiment analysis revealed that among EEA presentations hospital and health service (HHS) region #4 had the lowest proportion of positive sentiments (18 %) compared to 33 % for HHS region #1 pointing to spatial differentiation of sentiments immanent in mandated free text which required more detailed analysis. At the postcode geographical level, we found that variation in maximum spatial recurrence of EEAs was significantly positively associated with spatial range of sentiments (0.29, p < 0.001) and the postcode-referenced sex ratio (0.45, p = 0.01). The volatility of sentiments significantly correlated with extremes of recurrence of EEA episodes. The predicted (probabilistic) incidence rate when mapped reflected this correlation. Conclusions The paper demonstrates the efficacy of integrating, machine extracted, human sentiments (as potential surrogates) with conventional exposure variables for evidence-based methods for mental health spatial epidemiology. Such insights from informatics-driven epidemiological observations may inform the strategic allocation of health system resources to address the highest levels of need and to improve the standard of care for mental patients while also enhancing their safe and humane treatment and management.

The power of compassion: a judicial reflection on wellbeing and the court.

This article explores the stress, vicarious trauma, and burnout experienced by judicial officers and their need for protective skills. Compassion is one skill that can be incredibly beneficial. Compassion involves recognising a person's suffering, and 'turning towards' the sufferer. This has been said to be 'neurologically rejuvenating'. In contrast, empathy alone can lead to distress and generate burnout. There are three pillars of compassionate practice: (1) procedural fairness; (2) judicial engagement; and (3) other therapeutic jurisprudence approaches and court programs. The authors, both experienced judicial officers, have experienced how compassionate practice can inspire offenders to achieve rehabilitation goals. These practices can also be implemented in traditional court lists by judicial officers acknowledging the possibility of suffering of court users and empowering them by judicial engagement and granting them agency. A compassionate approach to justice can improve judicial effectiveness, health, and the fostering of a healthy work environment.

[Palliative care and legislation]. / Soins palliatifs et législation.

PALLIATIVE CARE AND LEGISLATION. Defined by the circular of August 26, 1986, palliative care is provided to people at the end of life, helping to relieve their suffering. Since the law of June 9, 1999, access to palliative care has been a right of all patients. With a view to alleviating suffering, human resources are mobilized to support the sick person. While human relationships play a central role, technology is also called. Caregivers have a responsibility to provide palliative care, as they are bound by professional ethics. Doctors and nurses have a duty to accompany the dying person to his final moments, ensuring the quality of a life that is coming to an end through appropriate care and measures. They are liable for any breach.

SOINS PALLIATIFS ET LÉGISLATION. Définis par la circulaire du 26 août 1986, les soins palliatifs sont dispensés à des personnes en fin de vie et contribuent au soulagement des souffrances. Depuis la loi du 9 juin 1999, l'accès aux soins palliatifs est un droit des personnes malades. Dans une optique de conjuration de la souffrance, des moyens humains sont mobilisés à travers l'accompagnement de la personne malade. Si les relations humaines occupent une place centrale, la technique est également sollicitée. Les soignants ont une responsabilité dans la délivrance des soins palliatifs, puisque la déontologie les y oblige. Le médecin et l'infirmier ont notamment le devoir d'accompagner le mourant jusqu'à ses derniers moments en assurant, par des soins et mesures appropriés, la qualité d'une vie qui prend fin. Leur responsabilité est engagée en cas de manquement.

A rare skin reaction in an elderly woman after exposure to prophylaxis for rabies: A case report.

Introduction: Rabies is a zoonosis caused by viruses of the family Rhabdoviridae. Prophylaxis with the rabies vaccine and immunoglobulins, depending on the severity of the case, is recommended. After vaccination, mild, moderate, or severe adverse events (AE) are described. Although rare, severe skin reactions may occur, increasing the risk of anaphylaxis. Case report: An 84-year-old woman was attacked by a stray unknown cat, leaving her with bites and scratches in the neck region and multiple injuries. The case was classified as severe. About 3 h after the first dose of the rabies vaccine, disseminated purplish spots appeared on her lower limbs, worsening significantly after the second dose, requiring hospitalization for the application of the third dose under observation, dermatology evaluation, and collection of skin tissue for biopsy. She was discharged 24 h after the third vaccination, and the purple spots cleared gradually. The biopsy suggested an adverse reaction to the vaccine components. Immunohistochemistry of the rabies virus antigen in dermal nerve fillets was negative. The seroconversion post rabies vaccine showed IgG antibody values below the reference levels. Conclusion: Vaccination against rabies is extremely important; however, AEs may occur. Our patient developed an important AE and required hospitalization. After complete vaccination, the serum was not converted. A similar case was not previously described, and the case report is important for the creation of jurisprudence on rabies vaccination in elderly patients in Brazil.