Medical ethics questions of COVID-19 vaccination in pregnant and lactating women in East Asia and Oceania.

Abstract: We aimed to investigate some of the medical ethics issues that characterize the COVID-19 vaccination phase in pregnancy and breast-feeding. A literature search was conducted using PubMed, Scopus, Web of Science, focusing mainly on the countries of East Asia and Oceania. Vaccination during pregnancy and breastfeeding appears to help protect babies from COVID-19 by enabling antibodies to pass from mother to baby. However, individual countries of the same continent may adopt conflicting policy positions. Not only that, indications on the type of vaccine sometimes vary, depending on whether a woman is pregnant or breastfeeding. In this review we have taken into considerationp the policy positions on pregnancy and lactation by country and type of Covid-19 vaccine in East Asia and Oceania. Ten out of the 18 countries considered (representing more than two thirds of the population of East Asia and Oceania) provide different vaccine indications for pregnant and breastfeeding women. Can this diversity of recommendations be seen as a form of optimal protection for women in these categories, or does it suggest that some countries have taken a defensive position to avoid compensation claims in the event of complications? Is it ethically correct to leave questions concerning informed consent open? Misin-formation during a health crisis leaves people without protection and with increased vaccine hesitancy, especially for vulnerable populations in hard-to-reach areas of East Asia and Oceania.

Protective Geometry and Reproductive Anatomy as Candidate Determinants of Clutch Size Variation in Pentatomid Bugs.

AbstractMany animals lay their eggs in clusters. Eggs on the periphery of clusters can be at higher risk of mortality. We asked whether the most commonly occurring clutch sizes in pentatomid bugs could result from geometrical arrangements that maximize the proportion of eggs in the cluster's interior. Although the most common clutch sizes do not correspond with geometric optimality, stink bugs do tend to lay clusters of eggs in shapes that protect increasing proportions of their offspring as clutch sizes increase. We also considered whether ovariole number, an aspect of reproductive anatomy that may be a fixed trait across many pentatomids, could explain observed distributions of clutch sizes. The most common clutch sizes across many species correspond with multiples of ovariole number. However, there are species with the same number of ovarioles that lay clutches of widely varying size, among which multiples of ovariole number are not overrepresented. In pentatomid bugs, reproductive anatomy appears to be more important than egg mass geometry in determining clutch size uniformity. In addition, our analysis demonstrates that groups of animals with little variation in ovariole number may nonetheless lay a broad range of clutch shapes and sizes.

Child brides: the age estimation problem in young girls.

The aim of this work is to study a sample of girls from 15 different countries using Third Molar Maturity Index (I3M ), to assess the probability that a girl has reached the legal age of 18 years. The studied sample consisted of 3228 Orthopantomograms of healthy female subjects from 15 different countries. The cut-off value of I3M = 0.08 was tested to discriminate adults (≥18 years) and minors (<18 years). X-ray images were processed by computer-aided drafting program ImageJ. The information on sensitivity and specificity of I3M coming from the 15 countries was pooled together using a bivariate Bayesian modeling approach. Specificity of the I3M test did not change when the country was considered, and its value remains greater than 85% for each studied country. This method is useful to estimate the age of the girls involved in suspected early marriage because of the high probability of correctly identifying a minor with similar results observed among tested populations.

Polyandry and trade-off between fecundity and longevity in female Dichelops furcatus (Hemiptera: Pentatomidae).

A trade-off is a relationship between two life history characteristics principally reproduction and adult longevity that are fundamental in predicting the optimal life history in any given environment. Mating is indispensable for sexual reproduction, but also can impose risks to females. Nevertheless, in the majority of insects, females allow multiple mating. Dichelops furcatus (Hemiptera: Pentatomidae) is a pest of wheat and corn in Argentina and southern Brazil, but little is known about its reproduction (i.e., the characteristics of the process that results in offspring). We analyzed reproductive attributes of D. furcatus, and the effect of single mating vs. multiple matings, evaluating the trade-off between fecundity and adult female longevity. We found that mating is not required for D. furcatus to oviposit, and multiple copulations were costly in terms of reduced longevity. Although multicopulated females lived a shorter period, only the pre- and post-reproductive periods were shortened. Fecundity was not affected but fertility was incremented in multicopulated females. Females copulated only once oviposited most of the eggs in the first half of the reproductive period, while eggs oviposited in the second half were all inviable (did not hatch). Studying demographic attributes of phytophagous insects provides relevant information to better understand the population dynamics of pests.

Age estimation in children by measurement of open apices in teeth with Bayesian calibration approach.

Age estimation from teeth by radiological analysis, in both children and adolescents, has wide applications in several scientific and forensic fields. In 2006, Cameriere et al. proposed a regression method to estimate chronological age in children, according to measurements of open apices of permanent teeth. Although several regression models are used to analyze the relationship between age and dental development, one serious limitation is the unavoidable bias in age estimation when regression models are used. The aim of this paper is to develop a full Bayesian calibration method for age estimation in children according to the sum of open apices, S, of the seven left permanent mandibular teeth. This cross-sectional study included 2630 orthopantomographs (OPGs) from healthy living Italian subjects, aged between 4 and 17 years and with no obvious developmental abnormalities. All radiographs were in digital format and were processed by the ImageJ computer-aided drawing program. The distance between the inner side of the open apex was measured for each tooth. Dental maturity was then evaluated according to the sum of normalized open apices (S). Intra- and inter-observer agreement was satisfactory, according to an intra-class correlation coefficient of S on 50 randomly selected OPGs. Mean absolute errors were 0.72 years (standard deviation 0.60) and 0.73 years (standard deviation 0.61) in boys and girls, respectively. The mean interquartile range (MIQR) of the calibrating distribution was 1.37 years (standard deviation 0.46) and 1.51 years (standard deviation 0.52) in boys and girls, respectively. Estimate bias was ßERR=-0.005 and 0.003 for boys and girls, corresponding to a bias of a few days for all individuals in the sample. Neither of the ßERR values was significantly different from 0 (p>0.682). In conclusion, the Bayesian calibration method overcomes problems of bias in age estimation when regression models are used, and appears to be suitable for assessing both age and age distribution in children according to tooth maturity.

Measurements of developing teeth, and carpals and epiphyses of the ulna and radius for assessing new cut-offs at the age thresholds of 10, 11, 12, 13 and 14 years.

The minimum age of criminal responsibility is the youngest age at which children may be held liable for infringements of penal laws. New cut-offs at the age thresholds of 10, 11, 12, 13 and 14 years were determined by applying three different methods: measurement of open apices in tooth roots (T); the ratio between the total area of carpal bones and epiphyses of the ulna and radius (HW); and the combined method (THW). The sample consisted of 291 Italian children (152 boys, 139 girls), aged between 5 and 15 years. The sensitivity and specificity were established. As regards THW, specificity reached the maximum of 95% in boys aged 10, and the minimum of 87% in boys aged 11. The best score of the Positive Predictive Value (PPV) was obtained in boys at 10 years with the THW method and the worst in girls of 12 with the HW method.

Age estimation in children and young adolescents for forensic purposes using fourth cervical vertebra (C4).

The aim of this study was to evaluate the applicability of using the growth of the body of C4 vertebra for the estimation of age in children and young adolescents. We used the fact that the proportions between the radiologic projections of the posterior and anterior sides of the C4 vertebral body, which forms a trapezoidal shape, differ with age: in younger individuals, the posterior side is higher, whereas in older individuals, the projections of the sides of the vertebral body form a rectangular shape with the two sides equal or with the anterior side slightly higher. Cephalograms of 444 Italian subjects (214 female and 230 male individuals) aged between 5 and 15 years and with no obvious development abnormalities were analyzed. The projections of the anterior side (a) and of the posterior side (b) of each C4 body were measured, and their ratio (Vba), as a value of the C4 body development, was used for age estimation. Distribution of the Vba suggested that it does not change after 13 years in female and 14 years in male subjects. Consequently, we restricted our analysis of the Vba growing model until 14 years in both sexes. We used a Bayesian calibration method to estimate chronological age as function of Vba as a predicting variable. The intra- and inter-observer agreement was satisfactory, using intra-class correlation coefficient of Vba on 30 randomly selected cephalograms. The mean absolute errors were 1.34 years (standard deviation 0.95) and 1.01 years (standard deviation 0.71), and the mean inter-quartile ranges of the calibrating distribution were 2.32 years (standard deviation 0.25) in male and 1.72 years (standard deviation 0.39) in female individuals, respectively. The slopes of the regression of the estimated age error to chronological age were 0.02 in male and 0.06 in female individuals, where both values did not result significantly different from 0 (p > 0.12). In conclusion, although our Bayesian calibration method might not really outperform the classical regression models in the precision of its estimates, it appears to be more robust, to greatly reduce the typical bias inherent in the regression model approach, and to have the ability to incorporate multiple predictors.

Hair analysis in order to evaluate drug abuse in driver's license regranting procedures.

In Italy, driving under the influence of drugs determines the suspension of the offender's driver's license. To regain the license the person must be drug free during an observation period. People whose license has been revoked or suspended can obtain, or re-obtain their driver's license subject to the judgment of a medical commission. The exclusion of illicit drug use is determined by means of toxicological analysis, mainly on urine or hair matrices. We reported the results of several years of experience of the forensic toxicology laboratory of the University of Macerata in the use of hair analysis for the assessment of past exposure to drugs in people suspected of driving under the influence of drugs. From 2004 to 2013, 8612 hair samples, were analyzed for opiates, cocaine and delta-9-tetrahydrocannabinol (Δ(9)-THC) using gas chromatography/mass spectrometry (GC/MS) method. We used a cutoff (SoHT or national guidelines) to determine the positive data, regardless of the hair sample concentrations. 1213 samples resulted positive, 71.7% were positive for cocaine and metabolites, 19.8% for morphine and metabolites, 8.5% for Δ(9)-THC. We also studied the timeframe of the abuse, as well as gender and age distribution of positive subjects. Moreover, we analyzed the possible deterrent effect of the hair analysis on driving under the influence of psychoactive substances.

Effect of Telenomus podisi, Trissolcus urichi, and Trissolcus basalis (Hymenoptera: Platygastridae) age on attack of Piezodorus guildinii (Hemiptera: Pentatomidae) eggs.

Parasitoid's performance is subject to parasitism decisions influenced by host quality and parasitoid's age. We evaluated parasitism, emergence, and the progeny sex ratio proportions of Telenomus podisi (Ashmead), Trissolcus urichi (Crawford), and Trissolcus basalis (Wollaston) (Hymenoptera: Platygastridae) females of different age attacking Piezodorus guildinii (Westwood) (Hemiptera: Pentatomidae), an important soybean pest. Eggs were offered to females of T. podisi 1-10 d old, T. urichi 1, 3, 4, or 6 d old, or T. basalis 1-6 or 8 d old. Average egg parasitism proportions were 0.71 and 0.79 to T. podisi and T. urichi, respectively; and preimaginal survivorship was >97% for both species. Trissolcus basalis females 1, 2, and 3 d old did not parasitize P. guildinii eggs, and high parasitism proportions were recorded from older females, but only 0.5 of females attacked host eggs. A greater proportion of males were produced in the progeny of T. podisi and T. urichi as maternal age increased, but no differences were found in the progeny of T. basalis wasps of different ages. The results from this study indicate that performance of T. podisi and T. urichi would not be affected by the age of the females. However, aging would induce T. basalis females to attack P. guildinii, although it is known that their main host is Nezara viridula (L.) (Hemiptera: Pentatomidae). Under certain circumstances, such as shortage of preferred host availability, high egg load, and short life expectancy, this wasp may include P. guildinii as a host.

Susceptibility of Nezara viridula (L.) (Hemiptera: Pentatomidae) Egg Masses of Different Sizes to Parasitism by Trissolcus basalis (Woll.) (Hymenoptera: Platygastridae) in the Field.

Egg masses of Nezara viridula (L.) are commonly parasitized by Trissolcus basalis (Woll.), and we investigated the role of size of egg masses on parasitization by T. basalis. Sentinel egg masses were exposed to parasitism in the field for 6-7 days, when they were collected for evaluation of parasitoid emergence. We recorded the number of eggs per egg mass, the number of emerged hosts, and the number of empty and parasitized eggs. We calculated the proportion of attacked host egg masses (DE), the proportion of parasitized eggs per attacked egg mass (PE), and total parasitism (PI). The total number of egg masses exposed to parasitism was 330. The minimum, mean, and maximum egg mass sizes were 25, 75.2, and 111, respectively. DE and PE varied widely between different fields, and they were independent of egg mass size. In 14.2% of all parasitized egg masses, we found simultaneous emergence of T. basalis and N. viridula independently of host egg mass size. PE exhibited low variability compared with PI and DE, which were linearly related. PI and DE values from other field studies are consistent with the linear relationship, suggesting that PI is mostly related to the proportion of the DE. This also suggests that total parasitism is independent of egg mass size, of possible differences in plant species, and T. basalis density and strains.

Accuracy of Cameriere's cut-off value for third molar in assessing 18 years of age.

Due to increasingly numerous international migrations, estimating the age of unaccompanied minors is becoming of enormous significance for forensic professionals who are required to deliver expert opinions. The third molar tooth is one of the few anatomical sites available for estimating the age of individuals in late adolescence. This study verifies the accuracy of Cameriere's cut-off value of the third molar index (I3M) in assessing 18 years of age. For this purpose, a sample of orthopantomographs (OPTs) of 397 living subjects aged between 13 and 22 years (192 female and 205 male) was analyzed. Age distribution gradually decreases as I3M increases in both males and females. The results show that the sensitivity of the test was 86.6%, with a 95% confidence interval of (80.8%, 91.1%), and its specificity was 95.7%, with a 95% confidence interval of (92.1%, 98%). The proportion of correctly classified individuals was 91.4%. Estimated post-test probability, p was 95.6%, with a 95% confidence interval of (92%, 98%). Hence, the probability that a subject positive on the test (i.e., I3M<0.08) was 18 years of age or older was 95.6%.

Age estimation by pulp/tooth ratio in lateral and central incisors by peri-apical X-ray.

Since 2004, several papers on the analysis of the apposition of secondary dentine have been published. The aim of this paper was to study a sample of peri-apical X-ray images of upper and lower incisors, both lateral and medial, to examine the application of pulp/tooth area ratio as an indicator of age. A sample of 116 individuals, 62 men and 54 women, aged between 18 and 74 years, was studied. Data were fitted with age as a linear function of the pulp/tooth ratio of incisors. The total variance explained by the regression equation ranged from 51.3% of age, when lower lateral incisors were used as explanatory variable, to 81.6% when upper lateral incisors were used. The accuracy of the corresponding regression model yielded ME = 8.44 and 5.34 years, respectively. These results show that, although incisors are less reliable than canines or lower premolars, they can be used to estimate age-at-death when the latter are absent.

The functional and numerical responses of Trissolcus basalis (Hymenoptera: Platygastridae) parasitizing Nezara viridula (Hemiptera: Pentatomidae) eggs in the field.

Trissolcus basalis has been used as a biological control agent of its main host, Nezara viridula, in many countries. However, estimations of its functional and numerical responses in the field are lacking. We estimated the density of N. viridula eggs, the proportion of parasitized N. viridula eggs, and the number of T. basalis adults/trap in the field. We transformed relative parasitoid density to an absolute density, and estimated the parasitoid's attack rate, a, and the mutual interference parameter, m, in two ways: following Arditi & Akçakaya (1990) and using the Holling-Hassell-Varley model with two iterative techniques. The attack rate estimated by both methods were a=1.097 and a=0.767, respectively. Parameter m varied less between methods: m=0.563 and m=0.586, respectively, and when used to calculate the number of parasitized N. viridula eggs per m2, differences with the observed values were not significant. The numerical response of T. basalis was affected by the sex allocation of their progeny and the proportion of adult parasitoids trapped decreased with field parasitoid population density. Theoretical models show that 0

Negative interaction between twospotted spider mites and aphids mediated by feeding damage and honeydew.

Among the herbivorous arthropods that feed on strawberry, the most important are the two-spotted spider mite (TSSM), Tetranychus urticae Koch, and several species of aphids. Mites and aphids belong to different guilds that coexist in the field and feed on the undersides of strawberry leaflets. However, the occurrence of large numbers of individuals of both species on the same leaflet is rarely recorded. We hypothesize that negative interactions between TSSM and aphids explain the intraplant distribution of these herbivores. We first examined the spatial coincidence of both herbivores in the field. Under experimental conditions, we then analyzed: (i) the rate of increase of TSSM and the aphid Chaetosiphon fragaefolii (Cockerell), growing individually and together; (ii) the effect of honeydew on TSSM preference; and (iii) the effect of previous strawberry leaflet damage by TSSM on C. fragaefolii preference. The proportion of TSSM that coincided with at least one aphid decreased as the percentage of leaflets with TSSM increased. The spatial coincidence index between aphids and TSSM increased together with the percentage of TSSM-infested leaflets. TSSM showed both a lower rate of increase when they shared the same leaflet with C. fragaefolii and lower fecundity on strawberry discs with honeydew. The rate of increase of C. fragaefolii did not change on co-occupied leaves, but the aphid species moved to the other side of leaflets shared with TSSM. Negative interactions resulting in a tendency for species to avoid each other, such as demonstrated herein, can affect distribution and performance of herbivorous arthropods.

Reliability of Schmeling's stages of ossification of medial clavicular epiphyses and its validity to assess 18 years of age in living subjects.

Nowadays, due to the global increase in migration movements, forensic age estimation of living young adults has become an important focus of interest. Minors often have no identification documents providing their correct birth dates. Establishing the age of majority is therefore fundamental in order to determine whether juvenile penal systems or penal systems in force for adults are to be applied. Radiological examination of the clavicles is one of the methods recommended by the Study Group on Forensic Age Diagnostics. In this retrospective study, a sample of chest radiographs of 274 subjects, aged between 12 and 25 years, was studied according to Schmeling's method in order to examine the ossification of both medial clavicular epiphyses. All stage classifications were evaluated by five examiners. Intra- and inter-examiner reliability was analysed by Cohen's K statistic. Intra-examiner agreement was insufficient for two of the experts. Inter-examiner agreement, among the other three operators, was moderate (K = 0.509). Study of reliability highlighted difficulties in interpretation, the need to select qualified personnel and choice of the best radiographic image in order to reduce any anatomic overlaps. Although ossification of the medial clavicular epiphyses is recommended to assess whether an individual has already reached the age of majority or not, these results suggested that it is very difficult to clearly identify the five stages of ossification by using conventional chest radiography.

Radiographic analysis of epiphyseal fusion at knee joint to assess likelihood of having attained 18 years of age.

Radiological analysis of the epiphyses of the knee joint provides new valuable information, which may be used in combination with these well-established techniques in order to maximise the accuracy in the assessment of age of 18 years. A total of 215 antero-posterior radiographs of the knee was reviewed retrospectively in patients aged between 14 and 24 years old (99 boys, 116 girls). Fusion was scored as stage 1, epiphysis not fused; stage 2, epiphysis is fully ossified and epiphyseal scar is visible; and stage 3, epiphysis is fully ossified and epiphyseal scar is not visible. Scores of 0, 1 and 2 were assigned to stages 1, 2 and 3, respectively. Lastly, the score related to epiphyseal fusion at the knee joint was obtained by adding the three scores of the distal femur, proximal tibia and proximal fibula. Age distribution gradually increased with each score, for both genders. The mean age (±standard error) in each score category varied between genders, but the differences were not significant (p > 0.11). Five tests were performed to discriminate between individuals who were or were not at age 18 years or more, according to the receiver operating curve. For boys, the highest value of accuracy was obtained with score 3, with high sensitivity (Se = 93.33 %) and specificity (Sp = 89.29 %). For girls, it was obtained with score 4, with high accuracy (Acc = 85.86 %). These results indicate that radiographic analysis of the knee is a valuable alternative as a non-invasive method of estimation of 18 years of age.

Saliva as a diagnostic matrix for drug abuse.

Scientific interest in saliva as a diagnostic matrix has greatly increased over the last decade. The Triage screening test (Biosite Diagnostics), a rapid immunological test used to detect recreational drugs in the urine, was used to compare two biological matrixes: a non-conventional one, saliva, and a traditional one, urine. Twenty-one drug abusers collected one urine and one saliva specimen, both of which were tested with the Triage kit. Data were validated by gas-chromatography-mass-spectrometry (GC-MS). Results were positive for methadone in 9 saliva and 14 urine specimens, for opiates in 2 and 10, respectively, and for barbiturates in 2 specimens. Saliva specimens were negative for cannabis, THC, benzodiazepines and tricyclic antidepressants, although the GC-MS analysis revealed low concentrations of these drugs in the saliva. The study demonstrates the possibility of using saliva as a diagnostic matrix to test for drug-taking; however, the Triage kit must be improved before being used with saliva.

A case of suicide by ingestion of sodium nitroprusside.

The study reports a case of suicide by ingestion of sodium nitroprusside which resulted in acute cyanide poisoning. Analyses carried out on body fluid yielded the quantitation of total (5.00 mg/L) and free (3.30 mg/L) cyanide in blood and of methemoglobin (blood = 10.5%). At the scene, some solid reddish-brown material was found in a glass, which on toxicological analysis was found to contain sodium nitroprusside; about 9 g of the same substance was identified in stomach contents. The detection and quantification of cyanide and methemoglobin in biological samples from the case indicated that the lethal effect was due to both metabolic products (cyanide and methemoglobin).

Detection and quantitation of morphine in fixed tissues and formalin solutions.

The study reports the results of the detection and quantitation of morphine in tissues fixed in formalin and in the formalin solutions in which the same tissues were fixed. Toxicological analyses were performed on formalin-fixed liver and kidney samples from five cases of opiate poisoning and on the formalin solutions (10% buffered pH 7) in which the samples were preserved. Analyses carried out at the time of autopsy on body fluids and tissues allowed identification of opiate as the cause of death and its quantitation. Tissue samples were preserved in formalin solutions for 12 weeks before analysis. The mean levels of recovery of morphine in fixed tissues were 36.29% in liver, 29.41% in kidney, 74.93% in formalin from liver, and 42.17% in formalin from kidney. Results indicated that this particular toxic substance shows good stability even in biological specimens subjected to chemical fixation.

Planned complex suicide: report of three cases.

Three cases of planned complex suicide in a 3-year period are reported. A 40-year-old man was found dead, in his garage, hanging by his neck, with a gunshot in the head from a pen gun. A 50-year-old man was found dead in the sea with a gunshot to his head. A third man was found in a field hanging by a tree and burned. The investigation of the scenes and the methods used pointed toward a suicidal etiology. The main difference between planned complex suicide and those cases defined in medicolegal literature as combined suicides lies in the complex mechanism used by the victim as a protection against the failure of one of the mechanisms.