Rethinking the Three Rs: Growing Momentum Toward a New Gold Standard in Australian Research.

Recent years have seen increasing recognition of the scientific, economic and ethical benefits of the use of non-animal models in advancing preclinical research, giving reason to rethink the application and framework of the Three Rs. However, to benefit from the economic advantages of shifting to such alternative methods, and to realise Australia's drug development potential, legislative reform is essential. Such reform should be responsive to international regulations that encourage the use of animal-free methods, and be coupled with a corresponding re-evaluation of current Three Rs frameworks and principles. If these supportive changes, and the recommendations from the 2023 Australian Commonwealth Scientific and Industrial Research Organisation (CSIRO) Futures Non-animal models report, are implemented concurrently - with government support paramount- then a new gold standard for scientific research in Australia could be created in which the use of non-animal models and animal-free methods is the default.

How Has High School Learned from the Global Pandemic?

The study focuses on the consequences of the pandemic for the further development of higher education. The purpose of the article is to summarize the main consequences of the pandemic, which have become the result of scientific analysis and the object of many scientific studies. These are the degree of students' satisfaction with online learning, technological readiness of universities, the impact of new learning conditions on the psychological and emotional sphere, the problem of cheating at examinations, the problem of quality of education. Analysis of studies shows that in the academic environment there are different estimates of the pandemic period, sometimes they are of opposite nature. In spite of possibilities of online education universities tend to return to the full-time form of education. The study emphasizes that there are long-term consequences of the pandemic that are on the periphery of researchers' attention. These are the legal and economic consequences for universities, as the online form of learning has acquired a different legal status. In addition, the introduction of online learning is inevitably associated with additional hardware and software costs. Another important consequence is the impact of the pandemic on academic culture. Under the pandemic, students were isolated from the traditional academic environment, which affected the transformation of social rituals and academic ethics. Academic Values. Since there has been no complete return to previous conditions and the threat of a global pandemic exists, the new experience is integrated into the existing system of academic values and serves as a trigger for change in the long term.

Do compulsory mental health patients have a right to receive a second opinion on their treatment under Australian mental health legislation?

We reviewed Australian mental health legislation to determine what obligations it places on psychiatrists to facilitate second opinions for compulsory patients who request them. Only four jurisdictions-Australian Capital Territory, Queensland, Victoria, and Western Australia-have legislated for 'patient-initiated' second opinions. Within these four regimes, there is variation in important aspects of the second opinion process, and there is a general absence of direction given to the second opinion providers. Based on research showing the variability of second opinion provision under New Zealand mental health legislation, we argue that this absence is likely to result in significant variation in the quality and depth of second opinions provided in Australia. We argue that New South Wales, the Northern Territory, South Australia, and Tasmania should consider formal provision for patient-initiated second opinions in their mental health legislation. We believe that such legislation ought to be aware of the barriers patients may face in accessing second opinions, and avoid exacerbating these barriers as Queensland's legislation appears to. Also, we argue that research on current practice in Australia should be conducted to better understand the effects of legislation on second opinions, and to help determine what amounts to best practice.

Mental Health Agency Officials' Perceived Priorities for Youth Mental Health and Factors That Influence Priorities.

OBJECTIVE: This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities. METHODS: Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities. RESULTS: Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities. CONCLUSIONS: These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems.

Dating Violence Among Chinese College Students: Unaided Victims and Legal Lacunae.

This research draws on literature review and case analyses revealed that the main reasons for Chinese dating violence's high prevalence are the long-term influence of patriarchy and gender culture and low recognition and awareness of the issue among students. Current Anti-domestic Violence Act does not apply to dating violence rendering victims devoid of preventive skills or relief recourse critiqued. Research exploring the lack of education on intimate partner violence in colleges has made students oblivious to the risks. Finally, the review provides detailed recommendations on expanding the practical scope of the Anti-domestic Violence Act to include dating violence and provide judges with clarification on the relevant elements of a dating relationship and cooperation of the legal system and education system in preventing dating violence.

The impact of recreational cannabis legalization on ED visit rates for acute cannabis intoxication.

BACKGROUND: In December 2018 the Michigan Regulation and Taxation of Marihuana Act legalized the recreational use of cannabis in Michigan. There are now high potency forms of cannabis readily available in the state, which could result in increased emergency department (ED) visit rates due to intoxication in adults and children. Although cannabis related visits account for a small percentage of all adult and pediatric ED visits, they impose a significant burden on the health care system's resources. This study aimed to assess the impact of the legalization of recreational marijuana on the rate of ED visits for acute cannabis intoxication. METHODS AND DESIGN: We utilized the legalization of marijuana in the state of Michigan to conduct a natural experiment utilizing a retrospective observational cohort design of ED visits for acute intoxication before and after legalization. The study was conducted at a health system composed of eight hospitals in southeast Michigan, including both academic and community hospitals serving a diverse patient population. We estimated monthly cannabis-related ED visits based on cannabis-related ICD-10 discharge codes and total ED visits using electronic health record data from 2016 to 2022. A negative-binomial (NB) regression model was used to estimate the immediate and cumulative changes in cannabis-related ED visit rate after legalization. RESULTS: There were a total of 2177 ED visits from 2066 patients for cannabis intoxication in our study cohort. Of the 2177 visits, 671 were before and 1506 were after legalization. In the univariate analysis, recreational cannabis legalization was associated with an increase in the average cannabis-related ED visit rate (Rate Ratio [RR]:1.70, 95% CI: (1.49, 1.94), p-value <0.001). In the multivariate analysis adjusting for age, results remain significant (RR 1.47, 95% CI (1.29, 1.70), p-value <0.001). The increased visit rate occurred in the first month after legalization; however, the slope of the increasing rate of ED visits were similar before and after cannabis legalization (RR, 1.28, 95% CI (1.07, 1.54), p-value <0.001). CONCLUSIONS: The legalization of recreational cannabis in Michigan was associated with an immediate increase in ED visit rates for acute cannabis intoxications across all ages, especially among middle-aged adults, in the context of an stably increasing ED visit rate.

Level of Adoption of Hygiene Practices in Small-Scale Dairy Plants in Serbia.

The main aim of this study was to analyze hygiene practices in small-scale dairy plants (SSDPs) in Serbia. A total of 60 plants were included in the research. A survey questionnaire used for SSDPs was designed to obtain the main information about hygiene practices they perform, as well as the data about the SSDPs, their production portfolio, and improvement plans. For the purpose of this study, a good hygiene practice score (GHPS) was calculated showing that the average score is 75%, spanning from 71.4% to 80.3% depending on the type of dairy plant. This study showed that the biggest challenges for small-scale dairy plants are associated with adequate labeling and external analysis of their dairy products, followed by record keeping and use of appropriate food contact materials. As expected, registered and approved SSDPs had higher GHPS scores and more information on their labels than those still in the approval or registration process. This study confirms the need for supporting this type of dairy producer to improve two main pillars of their business-the infrastructure for where they produce dairy products and awareness/knowledge of food safety legislative requirements. At the same time, approved processors are significantly underutilizing their processing capacity, which implies the need for both policy change consideration and educational initiatives. The policy changes should aim to align regulations with small-scale dairy processing realities.

[Disciplinary responsibility of medical workers in medical organizations].

Bringing to disciplinary responsibility of medical workers in the context of reforming the system of personnel training for the medical field, the introduction of digital technologies into the daily activities of a doctor, acquires pronounced specific features. The purpose of the study is to review the current labor legislation regulating labor discipline and identify the grounds for bringing medical workers to disciplinary responsibility in medical organizations.

Attitude of Jordanians towards a new enactment for an opt-out organ donation system: a cross-sectional study.

BACKGROUND: Organ donation entails saving or transforming lives through the provision of organs, either from living donors or deceased individuals. In Jordan, low donation rates are attributed to religious misconceptions, limited education and insufficient awareness of the burden on patients with organ failure. OBJECTIVES: To investigate the attitudes of the Jordanian population towards the practicality and effectiveness of introducing an opt-out organ donation system through legislative measures, with the aim of increasing donation rates. DESIGN: This cross-sectional study used a designed self-administered questionnaire. Data were subsequently analysed using IBM SPSS software. SETTING: The study encompassed all 12 cities located in Jordan. PARTICIPANTS: Data were collected from 1146 Jordanian participants, excluding individuals under the age of 18. RESULTS: Approximately 36.6% reported organ or blood donation while 18.9% participated in awareness campaigns. Many (75.7%) perceived insufficient awareness about the importance of organ donation, and 67.1% noted a scarcity of online donor registration platforms. Only 12.0% of participants discussed organ donation with healthcare providers. As anticipated, only 9.0% were registered donors while 67.7% expressed acceptance of organ donation, with 55.3% willing to enrol in donor programmes. Religion influenced 54.2% of organ donation decisions. There are associations between agreement for a new enactment and prior organ or blood donation or discussions with healthcare providers. However, religion affected willingness to donate organs. Most importantly, refusal to be a donor after death was associated with religion, occupation and awareness levels. CONCLUSION: Despite the population's understanding and support for the concept of organ donation, the willingness towards donating their own organs is limited. To boost organ donation rates and acceptance of the new enactment, we recommend conducting educational campaigns, improving online registration platforms, enhancing healthcare provider engagement, collaborating with religious communities and advocating for supportive policies.

Recent State Legislative Attempts to Restructure Public Health Authority: The Good, The Bad, and The Way Forward.

The COVID-19 pandemic spurred legal and policy attacks against foundational public health authorities. Act for Public Health - a partnership of public health law organizations - has tracked legislative activity since January 2021. This article describes that activity, highlighting 2023 bills primarily related to vaccine requirements and policy innovations undertaken in the wake of the pandemic. Finally, we preview a legal framework for more equitable and effective public health authority.

Legislation strengthening Maternal and Perinatal Death Surveillance and Response systems.

Historically, countries have primarily relied on policy rather than legislation to implement Maternal and Perinatal Death Surveillance and Response systems (MPDSR). However, evidence shows significant disparities in how MPDSR is implemented among different countries. In this article, we argue for the importance of establishing MPDSR systems mandated by law and aligned with the country's constitutional provisions, regional and international human rights obligations, and public health commitments. We highlight how a "no blame" approach can be regulated to provide a balance between confidentiality of the system and access to justice and remedies.

From virtually extinct to superabundant in 35 years: establishment, population growth and shifts in management focus of the Swedish wild boar (Sus scrofa) population.

BACKGROUND: The wild boar (Sus scrofa) was extinct in Sweden when a few animals established in the 1970s. Over the past 35 years, the species has made a substantial comeback. In this paper, we analyse wild boar population growth using three indices of population size. We also map the legislative decisions and research prompted by the expanding population. We discuss to what extent, in the eyes of the state, the view of wild boar and the management focus has shifted over time, from a perceived pest (eradication) to scarce (conservation), overabundant (reduction/control) or somewhere in between (sustainable management). RESULTS: Wild boar harvest started in the early 1990s with a few hundred animals annually and peaked at 161,000 in 2020/2021. The distribution now comprises most of southern Sweden. Analyses of harvest and traffic accidents involving wild boar showed that the population grew exponentially until 2010/2011, after which the increase levelled off. Thus, logistic growth models showed the best fit for the full study period. We recorded 38 legislative decisions or commissions to government agencies regarding wild boar. The first decision in 1981 was to eradicate the free-ranging population. In 1987 however, the parliament decided that wild boar is native to Sweden and should be allowed in restricted extent. Later decisions mainly concerned hunting regulations and hunting methods as direct means to increase harvest and regulate the population. Another topic, increasing in importance over time, was to facilitate the use of wild boar meat to indirectly stimulate harvest. A local outbreak of African swine fever in 2023 necessitated a stamping out strategy in the affected area. We found 44 scientific papers regarding the present free-ranging population. Topics include movements and feeding patterns, hunting, reproduction, and population development. CONCLUSIONS: The state historically regarded wild boar as a pest to be eradicated. This changed with the decision that wild boar should be allowed in restricted extent, suggesting a conservation approach. In response to population growth, the focus shifted to means facilitating sustainable management and, lately, reducing growth. The story of wild boar in Sweden illustrates attempts to mitigate conflicts and balance interests in wildlife management.

Anthropogenic land uses lead to changes in limnological variables in Neotropical streams.

Streams are vulnerable to anthropogenic impacts, such as changes in land use, which reflect on water quality and can be evaluated by abiotic variables. In this context, the aims were to compare the abiotic values recorded in streams of different land use categories with the limits established by National legislation, and to analyze changes in abiotic variables in response to different land use impacts. Thus, 17 streams located in southern Brazil were sampled and grouped into urban, rural, and protected areas (PA) categories. The results showed the major impacts in urban streams. However, some variables in rural streams and PA also exceeded local legislation limits. Conductivity, total dissolved solids, salinity, ammoniacal nitrogen and coliforms were significantly higher in the urban streams. Contrary to expectations, the highest levels of manganese were found in PA streams. The relationship between abiotic variables and land uses suggests possible contamination by sewage in urban streams and by pesticides in rural streams. The abiotic similarity between rural and PA streams indicates that the conservation of these water bodies is ineffective. We suggest the monitoring of these environments and measures to mitigate the impacts to seek the restoration of ecosystem services and the well-being of human populations.

Atmospheric bulk depositions: state-of-the-art and European legislative framework with focus on Italy.

The determination of total atmospheric deposition (bulk) is an essential tool to assess the state of environmental contamination and the consequent exposure of the population to persistent organic pollutants (POPs) through the intake of contaminated food. Over the past 20 years, international authorities and the European Union through various pieces of legislation have emphasised the importance of conducting monitoring and studies on depositions to better understand their impact on the environment and human health without setting reference values. Despite the absence of such values, several European countries, through national laws, have adopted limit values and/or guideline values for the deposition fluxes of some organic (dioxins, furans, polychlorinated biphenyls and polycyclic aromatic hydrocarbons) and inorganic persistent pollutants (metals). The aim of this review is both to summarise the present European legislation on depositions both to discuss the different legislations adopted by the various member states. Furthermore, a focus of this paper will be dedicated to the Italian legislation, where there is currently no specific guideline values for POPs in atmospheric deposition. In any case, some national authorities in Italy, such as the National Institute of Health (ISS) and the Regional Environmental Protection Agencies (ARPA), have conducted numerous monitoring activities on depositions, providing the scientific community and policymakers with numerous data on which to establish national reference values.

Access to Psychotherapy Notes: Review of Legal Standards for Mental Health Clinicians.

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence.

Survey on ART and IUI: legislation, regulation, funding, and registries in European countries-an update.

STUDY QUESTION: How are ART and IUI regulated, funded, and registered in European countries, and how has the situation changed since 2018? SUMMARY ANSWER: Of the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding varies across and sometimes within countries (and is lacking or minimal in four countries), and national registries are in place in 33 countries; only a small number of changes were identified, most of them in the direction of improving accessibility, through increased public financial support and/or opening access to additional subgroups. WHAT IS KNOWN ALREADY: The annual reports of the European IVF-Monitoring Consortium (EIM) clearly show the existence of different approaches across Europe regarding accessibility to and efficacy of ART and IUI treatments. In a previous survey, some coherent information was gathered about how those techniques were regulated, funded, and registered in European countries, showing that diversity is the paradigm in this medical field. STUDY DESIGN, SIZE, DURATION: A survey was designed using the SurveyMonkey tool consisting of 90 questions covering several domains (legal, funding, and registry) and considering specific details on the situation of third-party donations. New questions widened the scope of the previous survey. Answers refer to the situation of countries on 31 December 2022. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: All members of the EIM were invited to participate. The received answers were checked and initial responders were asked to address unclear answers and to provide any additional information considered relevant. Tables resulting from the consolidated data were then sent to members of the Committee of National Representatives of ESHRE, requesting a second check. Conflicting information was clarified by direct contact. MAIN RESULTS AND THE ROLE OF CHANCE: Information was received from 43 out of the 45 European countries where ART and IUI are performed. There were 39 countries with specific legislation on ART, and artificial insemination was considered an ART technique in 33 of them. Accessibility is limited to infertile couples only in 8 of the 43 countries. In 5 countries, ART and IUI are permitted also for treatments of single women and all same sex couples, while a total of 33 offer treatment to single women and 19 offer treatment to female couples. Use of donated sperm is allowed in all except 2 countries, oocyte donation is allowed in 38, simultaneous donation of sperm and oocyte is allowed in 32, and embryo donation is allowed in 29 countries. Preimplantation genetic testing (PGT)-M/SR (for monogenetic disorders, structural rearrangements) is not allowed in 3 countries and PGT-A (for aneuploidy) is not allowed in 10; surrogacy is accepted in 15 countries. Except for marital/sexual situation, female age is the most frequently reported limiting criterion for legal access to ART: minimal age is usually set at 18 years and the maximum ranges from 42 to 54 with some countries not using numeric definition. Male maximum age is set in very few countries. Where third-party donors are permitted, age is frequently a limiting criterion (male maximum age ranging from 35 to 50; female maximum age from 30 to 37). Other legal restrictions in third-party donation are the number of children born from the same donor (or, in some countries, the number of families with children from the same donor) and, in 12 countries, there is a maximum number of oocyte donations. How countries deal with the anonymity is diverse: strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), a mixed system (anonymous and non-anonymous donations), and strict non-anonymity. Inquiring about donors' genetic screening showed that most countries have enforced either mandatory or scientific recommendations that exclude the most prevalent genetic diseases, although, again, diversity is evident. Reimbursement/compensation systems exist in more than 30 European countries, with around 10 describing clearly defined maximum amounts considered acceptable. Public funding systems are extremely variable. One country provides no financial assistance to ART/IUI patients and three offer only minimal support. Limits to the provision of funding are defined in the others i.e. age (female maximum age is the most used), existence of previous children, BMI, maximum number of treatments publicly supported, and techniques not entitled for funding. In a few countries reimbursement is linked to a clinical policy. The definitions of the type of expenses covered within an IVF/ICSI cycle, up to which limit, and the proportion of out-of-pocket costs for patients are also extremely dissimilar. National registries of ART are in place in 33 out of the 43 countries contributing to the survey and a registry of donors exists in 19 of them. When comparing with the results of the previous survey, the main changes are: (i) an extension of the beneficiaries of ART techniques (and IUI), evident in nine countries; (ii) public financial support exists now in Albania and Armenia; (iii) in Luxembourg, the only ART centre expanded its on-site activities; (iv) donor-conceived children are entitled to know the donor identity in six countries more than in 2018; and (v) four more countries have set a maximum number of oocyte donations. LIMITATIONS, REASONS FOR CAUTION: Although the responses were provided by well-informed and committed individuals and submitted to double checking, no formal validation by official bodies was in place. Therefore, possible inaccuracies cannot be excluded. The results presented are a cross-section in time, and ART and IUI frameworks within European countries undergo continuous modification. Finally, some domains of ART activity were deliberately left out of the scope of this survey. WIDER IMPLICATIONS OF THE FINDINGS: Our results offer a detailed updated view of the ART and IUI situation in European countries. It provides extensive answers to many relevant questions related to ART usage at the national level and could be used by institutions and policymakers at both national and European levels. STUDY FUNDING/COMPETING INTEREST(S): The study has no external funding, and all costs were covered by ESHRE. There were no competing interests.

Linking implementation science and policy: Process and tools for congressionally mandated implementation, evaluation, and reporting.

OBJECTIVE: To describe a process model for assisting partners in addressing requirements of legislation and review policy analysis, planning, and evaluation design processes and tools. Throughout its 25-year history, the United States Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) program has been a forerunner in partnering with organizational leaders to improve health care. The Foundations of Evidence-based Policymaking Act of 2018 provided new opportunities for QUERI and other implementation scientists to support federal agency leaders in implementing, evaluating, and reporting on congressionally mandated programs. Although implementation scientists have the skills to support partnered implementation and evaluation, these skills must be adapted for congressionally mandated projects as many scientists have limited experience in policy analysis and the intersection of data informing organizational policy, programs, and practices (i.e., evidence-based policy). DATA SOURCES AND STUDY SETTING: During the conduct of four congressionally mandated projects, our national VA QUERI team developed processes and tools to achieve the goals and aims of our VHA partners and to ensure our collective work and reporting met legislative requirements. STUDY DESIGN: Our process model, program planning, and analysis tools were informed by an iterative process of refining and adapting the tools over a period of six years, spanning the years 2017 to 2023. PRINCIPAL FINDINGS: Work to support our partners was conducted across three phases: preparation and planning, conducting implementation and evaluation, and developing the congressionally mandated report. The processes and tools we developed within the context of mutually respectful and honest partnerships have been critical to our QUERI center's success in this area. CONCLUSIONS: Lessons we learned may help other scientists partnering in VA or other federal agencies to plan, conduct, and report on congressionally mandated projects.

The association between county ordinances allowing off-road vehicles on public roads and crash rates.

BACKGROUND: Legislative bodies across the country have increasingly allowed off-road vehicles (ORVs) including all-terrain vehicles (ATVs) and utility task vehicles (UTVs) on public roads, an environment for which they are not designed. In 2004, Iowa gave individual counties the discretion to pass ordinances allowing ORVs on public roadways. The objective of this study was to evaluate the relationship between the passage of ORV ordinances and ORV crash rates, especially on public roads. METHODS: An Iowa ORV roadway ordinance database and an Iowa ORV crash database (2002-2018) for all 99 counties were compiled. Crashes for which county location could not be determined were excluded. Utilizing a zero-inflated Poisson model, correcting for background crash frequency trends and population, investigators compared the relative rates of crashes after ordinance passage to time points before ordinance implementation and to counties without such ordinances. Sub-analyses, including that focused on more recent years (2008-2018), were also performed. RESULTS: Forty-five county ORV roadway ordinances went into effect between 2011 and 2018 and 2,347 crashes (69%) met inclusion criteria. Adjusted for year, there was a 58% greater ORV crash rate in counties after passing an ORV roadway ordinance (incidence rate ratio (IRR) 1.58, 95% CI 1.32-1.90). Roadway crashes (n = 834) increased 48% after ordinance passage (IRR 1.48, 95% CI 1.14-1.94). This roadway crash association remained statistically significant when analysis was limited to the years 2008-2018 (IRR 1.39, CI 1.06-1.83, n = 544); to ATV crashes only (IRR 1.70, CI 1.20-2.40, n = 683); and to ATV crashes excluding counties with UTV-only ordinances (IRR 1.74, CI 1.40-2.15, n = 2,011). CONCLUSIONS: ORV roadway and total crashes increased significantly after implementation of county ordinances allowing ORVs on public roadways and when compared to counties without such ordinances. It is likely that these increased crashes have resulted in more injuries and possibly deaths. Results from this study may help inform policymakers as they consider legislation regarding ORV usage on public roads.

A Novel Scoring System and Correlative Analysis of the Strength and Effectiveness of Nationwide High School Cardiopulmonary Resuscitation Mandates: Insights from a High School CPR Study.

BACKGROUND: Numerous states have introduced cardiopulmonary resuscitation (CPR) training mandates for high school students and staff to prevent sudden cardiac death (SCD). However, the content and implementation of these mandates vary substantially. Furthermore, a comprehensive and objective assessment of these mandates and their impact is lacking. OBJECTIVE: To conduct a thorough evaluation of CPR training mandates across the United States. METHODS: We developed a novel scoring system based on proposed CPR standards, training and certification requirements, and legislative action to assess current mandates. This was used to rate the CPR mandates across all 50 states and the District of Columbia. Mandate scores were then compared to available real-world registry data as a surrogate for efficacy from 2018 to 2021. RESULTS: State CPR mandate scores ranged from 0 to 47, with a higher score indicating more robust mandates. The median and mean scores were 24 [IQR 19.5-27] and 21.52±8.61, respectively, with 35 being the highest score. Intra-observer variability was 0.986 (95% CI 0.944-1.028; p<0.001). The year of implementation did not influence the strength of the score (R2=-0.173; 95% CI -0.447-0.131, p=0.262), Correlation between SCD rate (R2=-0.76; 95% CI -0.492-0.367, p=0.742), bystander-initiated CPR (R2= -0.006; 95% CI -0.437-0.427, p=0.978), automatic external defibrillator use (R2= -0.125; 95% CI -0.528-0.324, p=0.590), or cardiovascular death rate (R2=-0.13; 95% CI -0.379-0.21, p=0.355) failed to reach statistical significance. CONCLUSION: Modest scoring consistency highlights the need for robust, standardized CPR requirements to potentially mitigate SCD. This study lays the groundwork for evidence-informed policy development in this area.

Hungarian legislation regarding implementing a forensic DNA elimination database.

The inception of forensic DNA elimination database represents a pivotal advancement in forensic science, aiming to streamline the process of distinguishing between DNA found at crime scenes and that of individuals involved in the investigation process, such as law enforcement personnel and forensic lab staff. In subsequent phases, once familiarity with the database is achieved by its administrators and other stakeholders, and they have accrued sufficient experience, the possibility of expanding the database to encompass first responders-including firefighters, paramedics, emergency medical technicians, and other emergency services personnel-can be contemplated. Key challenges in managing these databases encompass the grounds for collecting samples, ensuring the integrity of both samples and profiles, along with the duration of retention, access to the database, and the protocols to follow when a match is found in the database. This paper outlines the conceptual and detailed legislative framework in Hungary, where the forensic DNA elimination database was introduced in 2022.