The CRPD and mental health law reform in Scotland.

Scotland's mental health and capacity legislation and its implementation is underpinned by European Convention on Human Rights (ECHR) informed principles, and such legislation and its implementation has remained largely ECHR compliant. It is designed to protect individuals' autonomy from inappropriate and disproportionate nonconsensual intrusions but its scope is largely limited to this. However, since the legislation was enacted at the start of the twenty first century the UK subsequently ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) which requires the law and related practice to focus on giving effect to all the rights of persons with mental disabilities (people living with psychosocial, cognitive and intellectual disabilities) on an equal basis with others and to actively support such equality in rights enjoyment. The Terms of Reference of the independent Scottish Mental Health Law Review (2019-2022) included considering and making recommendations to align Scotland's mental health and capacity legislation with the CRPD. After engaging widely with stakeholders its recommendations sought to strengthen the voice of persons who use services and of those who care for them, reduce the need for non-consensual measures and secure rights to the help and support necessary to live a good life. In order to achieve this, it recommended, amongst other things, a refocusing on mental health and capacity law together with a Human Rights Enablement, Supported Decision Making and Autonomous Decision Making framework.

Investigating the regional ecological environment stability and its feedback effect on interference using a novel vegetation resilience assessment model.

Vegetation resilience is critical for understanding the dynamic feedback effect of regional ecological environment stability against interferences. Thus, based on quantify the interferences of climate dryness and vegetation water deficit affecting vegetation growth function, incorporate mechanical Hooke's law to develop a vegetation resilience assessment model by quantitatively expressing vegetation growth function maintenance ability, to reveal the ecological environment stability and its feedback effect on interferences in the study area. The essential discoveries of the study are as follows: (1) with the increase of precipitation and the improvement of afforestation on soil erosion, the interferences intensity of climate dryness and vegetation water deficit in the ecological environment decreased by 5.88 % and 4.92 % respectively, the regional vegetation growth function loss was improved, especially in the southern region; (2) the decrease of vegetation growth function loss promoted the vegetation resilience level fluctuated from class II to class IV, with the average annual vegetation resilience increased by 7.02 %, reflecting that the regional ecological environment stability increased from difficult to rapid recovery after disturbance, and the benefit was especially noticeable in the eastern and southern forested areas; (3) the contribution rates of climate dryness and vegetation water deficit to the variation of vegetation resilience caused by vegetation restoration were -1.38 % and 4.73 %, respectively, and the prominent positive feedback effect of increasing vegetation resilience with decreasing vegetation water deficit degree in forest restoration area, indicating that the vegetation water deficit greatly impacts ecological environment stability in the study area, and forest restoration constantly improves regional ecological environment stability more than grassland restoration. This research has crucial guiding implications for supporting the sustainable development of regional ecological environments.

Navigating equity in global access to genome therapy expanding access to potentially transformative therapies and benefiting those in need requires global policy changes.

In December 2023, the US Food and Drug Administration and the UK Medicines and Healthcare Products Regulatory Agency granted the first regulatory approval for genome therapy for sickle cell disease. This approval brings hope to those suffering from this debilitating genetic disease. However, several barriers may hinder global patient access, including high treatment costs, obtaining informed consent for minors, inadequate public health infrastructure, and insufficient regulatory oversight. These barriers reflect the structural inequalities inherent in global health governance, where patient access often depends on social and institutional arrangements. This article addresses concerns around informed consent, treatment costs, and patient access, and proposes corresponding policy reforms. We argue that these discussions should be framed within a broader global context that considers social and institutional structures, global research priorities, and a commitment to health equity.

Prescribing Justice: A Close Examination of Physicians Acting As Expert Witnesses in Saudi Arabia.

INTRODUCTION: An expert witness is a person who provides testimony on issues that the court finds to be outside the scope of their expertise and experience. Any physician who has performed an independent medical evaluation or written medical records can and should expect to be requested as an expert witness. Medical malpractice, workers' compensation, and personal injury are the most prominent areas where medical expert witnesses participate and provide opinions and testimony. To our knowledge, this is the first study to be conducted in Saudi Arabia on physicians acting as expert witnesses. METHODS: This observational descriptive cross-sectional study conducted in Saudi Arabia from November 2022 to July 2023 aimed to assess physicians' experiences, education, training, willingness, self-competency, attitude, and perception as expert witnesses. The study population consisted of physicians working in Saudi Arabia, with at least a specialist level of professional expertise. Participants completed a self-administered online survey, utilizing a researcher-designed questionnaire. RESULTS: In total, 417 participants, with males comprising 51.3% of the sample, responded to the survey. More than half of the physicians (58.3%) had never produced a medical report for the court. Among those who had, the majority had done so one to twice. Similarly, the majority had never testified in court (77.5%), with only a small percentage having done so once or twice. Approximately 80% of participants had no prior education or training as expert witnesses, but among those who did, courses and workshops were the most common forms of education or training. Most participants expressed interest in learning or training for this role (69.1%) and were willing to provide medical reports or court testimony (73.9%). However, half of the participants did not feel competent in writing a medical report for the court, and more than half lacked confidence in giving testimony. CONCLUSION: The findings highlight the need for increased engagement, education, and training among physicians, particularly early and mid-career professionals, to enhance their confidence and competence as expert witnesses and ensure ethical practices in the medicolegal domain in Saudi Arabia.

Laws governing access to sexual health services and information: contents, protections, and restrictions.

Access to sexual health services and information is critical to achieving the highest attainable standard of sexual health, and enabling legal environments are key to advancing progress in this area. In determining overall alignment with human rights standards to respect, protect, and fulfil sexual health-related rights without discrimination, there are many aspects of laws, including their specificity and content, which impact which sexual health services and information are availed, which are restricted, and for whom. To understand the nature of existing legal provisions surrounding access to sexual health services and information, we analysed the content of 40 laws in English, French, and Spanish from 18 countries for the specific sexual health services and information to which access is ensured or prohibited, and the non-discrimination provisions within these laws. Overall, there was wide variation across countries in the types of laws covering these services and the types and number of services and information ensured. Some countries covered different services through multiple laws, and most of the laws dedicated specifically to sexual health addressed only a narrow aspect of sexual health and covered a small range of services. The protected characteristics in non-discrimination provisions and the specificity of these provisions with regard to sexual health services also varied. Findings may inform national legal and policy dialogues around sexual health to identify opportunities for positive change, as well as to guide further investigation to understand the relationship between such legal provisions, the implementation of these laws within countries, and relevant sexual health outcomes.

Access to sexual health services and information is important to being able to have good sexual health. Laws are relevant because what they include and how specific they are affects what types of sexual health services people can access, what types of services are illegal, and whether or not all people can access services equally. We reviewed 40 laws in English, French, and Spanish from 18 countries to understand how many and which sexual health services and information countries ensure in their laws, which sexual health services are illegal, and which people are protected from discrimination in accessing these services. We found that countries use many different types of laws to ensure access to sexual health services or information, and most countries do not cover the same types or number of sexual health services. There are also differences in which people are specifically protected from discrimination in the laws we reviewed. These findings are important because they may help countries identify ways that access to sexual health services and information could be improved so as to improve people's sexual health. They may also guide future research.

Multi-Strategy Boosted Fick's Law Algorithm for Engineering Optimization Problems and Parameter Estimation.

To address the shortcomings of the recently proposed Fick's Law Algorithm, which is prone to local convergence and poor convergence efficiency, we propose a multi-strategy improved Fick's Law Algorithm (FLAS). The method combines multiple effective strategies, including differential mutation strategy, Gaussian local mutation strategy, interweaving-based comprehensive learning strategy, and seagull update strategy. First, the differential variation strategy is added in the search phase to increase the randomness and expand the search degree of space. Second, by introducing the Gaussian local variation, the search diversity is increased, and the exploration capability and convergence efficiency are further improved. Further, a comprehensive learning strategy that simultaneously updates multiple individual parameters is introduced to improve search diversity and shorten the running time. Finally, the stability of the update is improved by adding a global search mechanism to balance the distribution of molecules on both sides during seagull updates. To test the competitiveness of the algorithms, the exploration and exploitation capability of the proposed FLAS is validated on 23 benchmark functions, and CEC2020 tests. FLAS is compared with other algorithms in seven engineering optimizations such as a reducer, three-bar truss, gear transmission system, piston rod optimization, gas transmission compressor, pressure vessel, and stepped cone pulley. The experimental results verify that FLAS can effectively optimize conventional engineering optimization problems. Finally, the engineering applicability of the FLAS algorithm is further highlighted by analyzing the results of parameter estimation for the solar PV model.

Recent Developments in the Regulation of Heritable Human Genome Editing.

In 2018, the Chinese scientist He Jiankui presented his research at the Second International Summit on Human Genome Editing in Hong Kong. While it was intended that he facilitate a workshop, he was instead called on to present his research in heritable human genome editing, where he made the announcement that he had taken great strides in advancement of his research, to the extent that he had gene-edited human embryos and that this had resulted in the live births of two children. While his research ethic and methodology was interrogated, he insisted that two children, twin girls, had been born healthy and that there was another pregnancy (at the time) where birth of a third gene edited child would be imminent. This announcement generated a ripple effect in the scientific community and exposed the gaps in regulation and absence of law relating to the technology. This resulted in a flurry of activity and conversation around regulation of the technology, which scientists stated was not ready for human trials. This article reviews the Third Summit which was held in London in March 2023 and comments on the latest developments in the regulation of heritable human genome editing.

Replacing Animal Testing with Stem Cell-Organoids : Advantages and Limitations.

Various groups including animal protection organizations, medical organizations, research centers, and even federal agencies such as the U.S. Food and Drug Administration, are working to minimize animal use in scientific experiments. This movement primarily stems from animal welfare and ethical concerns. However, recent advances in technology and new studies in medicine have contributed to an increase in animal experiments throughout the years. With the rapid increase in animal testing, concerns arise including ethical issues, high cost, complex procedures, and potential inaccuracies.Alternative solutions have recently been investigated to address the problems of animal testing. Some of these technologies are related to stem cell technologies, such as organ-on-a-chip, organoids, and induced pluripotent stem cell models. The aim of the review is to focus on stem cell related methodologies, such as organoids, that can serve as an alternative to animal testing and discuss its advantages and limitations, alongside regulatory considerations.Although stem cell related methodologies has shortcomings, it has potential to replace animal testing. Achieving this requires further research on stem cells, with potential societal and technological benefits.

Study on the kinetics of formation process of emulsion of heavy oil and its functional group components.

Enhanced oil recovery (EOR) by in situ formation of oil-in-water emulsion in heavy oil cold production technology has received growing interest from the petroleum industry. We present an experimental study of emulsification of model oils prepared by heavy oil and its functional group compositions dissolved into toluene brought into contact with a surfactant solution. The effects of functional group composition, emulsifier concentration, temperature, pH and stirring speed on the emulsification rate of heavy oil was investigated. A second-order kinetic model characterizing the temporal variation of conductivity during the emulsification has been established. The results show that acidic and amphoteric fractions exhibit higher interfacial activity, larger emulsification rate constant and faster emulsification rate. With the increase of emulsifier concentration, the emulsification rate constant increase to the maximum value at a concentration of 0.05 mol/L before decreasing. Temperature increase benefits the emulsification rate and the activation energy of the emulsification process is 40.28 kJ/mol. Higher pH and stirring speed indicate faster emulsification rate. The heterogeneity of emulsions limits the accuracy of dynamic characterization of the emulsification process and the determination method of emulsification rate has always been controversial. The conductivity method we proposed can effectively evaluates the emulsification kinetics. This paper provides theoretical guidance for an in-depth understanding of the mechanism and application of cold recovery technology for heavy oil.

Trial by YouTube: effects of expert psychiatric witness testimony on viewers' opinions of Amber Heard and Johnny Depp.

AIMS AND METHOD: We aimed to assess whether viewing expert witness evidence regarding the mental health of Johnny Depp and Amber Heard in the 2022 court case in the USA would affect viewers' attitudes towards the mental health of the two protagonists and towards mental illness in general. After viewing excerpts of the cross-examination evidence, 38 trial-naive undergraduate students completed the Prejudice towards People with a Mental Illness (PPMI) scale. RESULTS: Following viewing, participants held more stigmatising views of the protagonists than they held about mental disorders in general. CLINICAL IMPLICATIONS: It is plausible that mass media trial coverage further stigmatises mental illness.

Understanding nonuse of mandatory e-scooter helmets.

OBJECTIVES: Head injuries resulting from e-scooter use have led to calls for helmet use to be promoted or mandatory. Helmet use is mandatory for e-scooters in Australia but observational studies have reported significant levels of nonuse, particularly by riders of shared e-scooters. The aim of this study is to understand whether nonuse in the mandatory context is a consistent behavior for an individual or is situationally-influenced, and what are the factors associated with nonuse. METHODS: An online survey was completed between 2022 and 2023 by 360 adult e-scooter riders in Canberra, Australia. Riders were asked whether they had worn a helmet on their last ride and how often they had not worn a helmet when riding in the last 30 days. The survey also asked about rider characteristics (demographics, frequency of e-scooter and bicycle use, perceived risk of e-scooter use, e-scooter ownership, and risky behaviors while riding), trip duration and perceptions of the helmet requirement (knowledge of and support for the law). RESULTS: Respondents were mostly male, young, highly educated, and full-time workers. Of the 29.1% of riders who reported riding without a helmet in the last 30 days, 24.4% had worn a helmet at least once during that period and 4.8% had consistently not worn a helmet. Younger age, shared e-scooter use and more frequent riding frequency (shared e-scooters only) were associated with helmet nonuse in the bivariate analyses but not in the logistic regression. Logistic regression showed that the independent predictors of helmet nonuse were the number of risky riding behaviors, lack of knowledge, and lack of support for the law. CONCLUSIONS: Most nonuse of helmets in a mandatory context seems to be situational, rather than consistent. Many of the factors associated with nonuse of helmets for e-scooters are similar to those reported for bicycles. Nonuse of helmets appears to be one of a number of risky behaviors performed by riders, rather than being primarily an outcome that is specific to factors associated with helmets (e.g., concerns about hygiene, discomfort or availability).

Two Types of Survival Curves of Different Lines of Progeric Mice.

For most of their lifespan, the probability of death for many animal species increases with age. Gompertz law states that this increase is exponential. In this work, we have compared previously published data on the survival kinetics of different lines of progeric mice. Visual analysis showed that in six lines of these rapidly aging mutants, the probability of death did not strictly depend on age. In contrast, ten lines of progeric mice have survival curves similar to those of the control animals, that is, in agreement with Gompertz law, similar to the shape of an exponential curve upside down. Interestingly, these ten mutations cause completely different cell malfunctions. We speculate that what these mutations have in common is a reduction in the lifespan of cells and/or an acceleration of the transition to the state of cell senescence. Thus, our analysis, similar to the conclusions of many previously published works, indicates that the aging of an organism is a consequence of the aging of individual cells.

Review article: Patients who leave before care is completed: What does the legal duty to warn mean for emergency department clinicians?

Patients leave ED for a variety of reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet entered a treatment space. There is also a positive duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed. The form of that warning may vary based on what is known about the patient's condition and the associated risks at the time. Specific documentation of warnings given is essential.

Designing gradient coils with the shape derivative and the closed B-spline curves.

This study proposes a versatile and efficient optimisation method for discrete coils that induce a magnetic field by their steady currents. The prime target is gradient coils for MRI (Magnetic Resonance Imaging). The derivative (gradient) of the z-component the magnetic field, which is calculated by the Biot-Savart's law, with respect to the z-coordinate in the Cartesian xyz coordinate system is considered as the objective function. Then, the derivative of the objective function with respect to a change of coils in shape is formulated according to the concept of shape optimisation. The resulting shape derivative (as well as the Biot-Savart's law) is smoothly discretised with the closed B-spline curves. In this case, the control points (CPs) of the curves are naturally selected as the design variables. As a consequence, the shape derivative is discretised to the sensitivities of the objective function with respect to the CPs. Those sensitivities are available to solve the present shape-optimisation problem with a certain gradient-based nonlinear-programming solver. The numerical examples exhibit the mathematical reliability, computational efficiency, and engineering applicability of the proposed methodology based on the shape derivative/sensitivities and the closed B-spline curves.

A generic approach to infer community-level fitness of microbial genes.

The gene content in a metagenomic pool defines the function potential of a microbial community. Natural selection, operating on the level of genomes or genes, shapes the evolution of community functions by enriching some genes while depriving the others. Despite the importance of microbiomes in the environment and health, a general metric to evaluate the community-wide fitness of microbial genes remains lacking. In this work, we adapt the classic neutral model of species and use it to predict how the abundances of different genes will be shaped by selection, regardless of at which level the selection acts. We establish a simple metric that quantitatively infers the average survival capability of each gene in a microbiome. We then experimentally validate the predictions using synthetic communities of barcoded Escherichia coli strains undergoing neutral assembly and competition. We further show that this approach can be applied to publicly available metagenomic datasets to gain insights into the environment-function interplay of natural microbiomes.

Solidarity as a Political Determinant of Health: Insights from EU Competition Policy.

CONTEXT: The connection between law and political determinants of health is not well-understood, but nevertheless it is suggested that the two are inseparable, and that this represents an "upstream" level with scope for influencing other determinants of health (particularly social). Solidarity underpins European healthcare systems and given its clear link with redistribution, can be seen as a means to address health inequities. As such, solidarity may be seen as a political determinant of health in the specific context of EU competition policy. METHODS: A range of EU case law, Treaty provisions, and Commission publications relating to EU competition policy are analysed. FINDINGS: Solidarity is typically juxtaposed as antithetical to competition, thus underpins exceptions to the applicability of the prohibitions on anticompetitive agreements, abuse of dominance, and state aid. Case law indicates a further dynamic between definitions of solidarity at EU and national levels. CONCLUSIONS: This analysis leads to two groups of considerations when framing solidarity as a political determinant of health in the EU competition policy context: firstly, the predominance of solidarity suggests it may shape competition reforms, and secondly the EU-Member State dynamic which indicates less EU-level reach into national competition reforms in healthcare than may be expected.

Recreational cannabis legalization and immigration enforcement: a state-level analysis of arrests and deportations in the United States, 2009-2020.

BACKGROUND: Recreational cannabis laws (RCL) in the United States (US) can have important implications for people who are non-citizens, including those with and without formal documentation, and those who are refugees or seeking asylum. For these groups, committing a cannabis-related infraction, even a misdemeanor, can constitute grounds for status ineligibility, including arrest and deportation under federal immigration policy-regardless of state law. Despite interconnections between immigration and drug policy, the potential impacts of increasing state cannabis legalization on immigration enforcement are unexplored. METHODS: In this repeated cross-sectional analysis, we tested the association between state-level RCL adoption and monthly, state-level prevalence of immigration arrests and deportations related to cannabis possession. Data were from the Transactional Records Access Clearinghouse. Immigration arrest information was available from Oct-2014 to May-2018 and immigration deportation information were available from Jan-2009 to Jun-2020 for. To test associations with RCLs, we fit Poisson fixed effects models that controlled for pre-existing differences between states, secular trends, and potential sociodemographic, sociopolitical, and setting-related confounders. Sensitivity analyses explored potential violations to assumptions and sensitivity to modeling specifications. RESULTS: Over the observation period, there were 7,739 immigration arrests and 48,015 deportations referencing cannabis possession. By 2020, 12 stated adopted recreational legalization and on average immigration enforcement was lower among RCL compared to non-RCL states. In primary adjusted models, we found no meaningful changes in arrest prevalence, either immediately following RCL adoption (Prevalence Ratio [PR]: 0.84; [95% Confidence Interval [CI]: 0.57, 1.11]), or 1-year after the law was effective (PR: 0.88 [CI: 0.56, 1.20]). For the deportation outcome, however, RCL adoption was associated with a moderate relative decrease in deportation prevalence in RCL versus non-RCL states (PR: 0.68 [CI: 0.56, 0.80]; PR 1-year lag: 0.68 [CI: 0.54, 0.82]). Additional analyses were mostly consistent by suggested some sensitivities to modeling specification. CONCLUSIONS: Our findings suggest that decreasing penalties for cannabis possession through state RCLs may reduce some aspects of immigration enforcement related to cannabis possession. Greater attention to the immigration-related consequences of current drug control policies is warranted, particularly as more states weigh the public health benefits and drawbacks of legalizing cannabis.

Impacts of attacks to female health care workers in three territories of Colombia.

BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.