Hormesis and toxic torts

2008 ◽  
Vol 27 (2) ◽  
pp. 97-107
Author(s):  
Gary E Marchant

Policy implementation of hormesis has to date focused on regulatory applications. Toxic-tort litigation may provide an alternative policy venue for real-world applications of hormesis. Businesses and government entities, who are sued by individuals claiming to have been injured by exposure to very low levels of toxic substances may defend those cases by deploying hormesis to argue that such exposures were unlikely to be harmful. The threshold issue in using hormesis in toxic-tort defense is whether such evidence will be admissible under applicable standards for scientific evidence, which will likely turn on whether hormesis is deemed to be `generally accepted' in the relevant scientific community. Given the relatively novel status of hormesis, its admissibility will likely be a close call, but is likely to be held admissible in favorable circumstances. If admissible, hormesis is likely to receive a fairer and more even-handed consideration than in regulatory decisions, where regulatory agencies are bound by policy-based default assumptions that limit their receptivity to new concepts such as hormesis. The perception of hormesis by juries will likely be the critical factor for determining the utility of hormesis in toxic-tort litigation, and this perception is likely to be affected by the presentation and circumstances in the individual case.

2011 ◽  
Vol 31 (S 01) ◽  
pp. S34-S37
Author(s):  
J. Holzschuh ◽  
K.-H. Beck

SummaryIn contrast to children with haemophilia the scientific evidence of prophylaxis treatment in adults is not yet proven. Existing studies are of observational character and mostly retrospectively designed. Therefore, opinion leaders in this field postulate prospectively designed, randomized, controlled and multicentric studies to set up urgently needed guidelines. Evidence according to the Canadian task force ranking is assessed as level III with a re- commendation grade C by the authors.The recognition of benefits of health care providers in accordance with the German Federal Joint Committee generally demands a Grade- Ia to Ib evidence. As long as the actual evidence of prophylaxis in adult haemophiliacs does not meet the postulated criteria of the German Federal Joint Committee, prophylactic replacement therapy of the individual case has to be well documented and reasonably explained.


2021 ◽  
Vol 11 (3) ◽  
pp. 177
Author(s):  
Giovanni Badiali ◽  
Ottavia Lunari ◽  
Mirko Bevini ◽  
Barbara Bortolani ◽  
Laura Cercenelli ◽  
...  

Current scientific evidence on how orthognathic surgery affects the airways morphology remains contradictory. The aim of this study is to investigate the existence and extension of a neutral-impact interval of bony segments displacement on the upper airways morphology. Its upper boundary would behave as a skeletal displacement threshold differentiating minor and major jaw repositioning, with impact on the planning of the individual case. Pre- and post-operative cone beam computed tomographies (CBCTs) of 45 patients who underwent maxillo-mandibular advancement or maxillary advancement/mandibular setback were analysed by means of a semi-automated three-dimensional (3D) method; 3D models of skull and airways were produced, the latter divided into the three pharyngeal subregions. The correlation between skeletal displacement, stacked surface area and volume was investigated. The displacement threshold was identified by setting three ∆Area percentage variations. No significant difference in area and volume emerged from the comparison of the two surgical procedures with bone repositioning below the threshold (approximated to +5 mm). A threshold ranging from +4.8 to +7 mm was identified, varying in relation to the three ∆Area percentages considered. The ∆Area increased linearly above the threshold, while showing no consistency in the interval ranging from −5 mm to +5 mm.


2018 ◽  
Vol 277 (2) ◽  
pp. 75
Author(s):  
Gabriel Ducatti Lino Machado

<p>The fundamental right to health services in Brazil</p><p> </p><p>O ramo público do sistema de saúde brasileiro é marcado por uma tensão entre um auspicioso direito fundamental à saúde, que até mesmo garantiria a qualquer pessoa o acesso gratuito a serviços de assistência terapêutica, e uma política que se esforça para restringir os serviços disponíveis. Se, por força dos arts. 6º e 196 CF, existe um direito fundamental a serviços de saúde (serviços de assistência terapêutica), então a quais serviços? Essa é a questão central que aqui se analisa, de uma perspectiva jurídico-dogmática. Em outras palavras: objeto de investigação é a dimensão material do direito fundamental a serviços de saúde. Para a definição de seus limites, ressaltam como determinantes os conceitos de saúde e de doença em sentido amplo; a segurança e eficácia do serviço, servindo a exigência de evidência científica verificada em processo próprio de aprovação como regra geral, mas se admitindo uma regra de exceção que responda às peculiaridades do caso concreto; e a eficácia marginal ou relevante do serviço. Finalmente, se Legislativo e Executivo têm pouco espaço para determinar os serviços disponíveis, eles têm uma ampla margem de discricionariedade para a organização do sistema de saúde.</p><p> </p><p>The public branch of the Brazilian health system is characterised by a tension between an auspicious fundamental right to health, which should even guarantee to anyone gratuitous access to the therapeutic assistance services, and a politics which strives to restrict the available services. If, by virtue of Articles 6 and 196 of the Brazilian Constitution, there is a fundamental right to health services (therapeutic assistance services), then to which services? This is the central question to be analysed here, from the perspective of legal dogmatics. In other words: object of inquiry is the material dimension of the fundamental right to health services. Determinant for the definition of its limits are the concepts of health and illness in a broader sense; the safety and effectiveness of the service, whereby the requirement of scientific evidence verified in a particular process of approval should serve as a general rule, supplemented by an exception rule which takes account of the peculiarities of the individual case; and the marginal or relevant effectiveness of the service. Finally, if Legislative and Executive do not have much freedom to determine the available services, they have a wide margin of discretion in the organization of the health system.</p>


2016 ◽  
Vol 21 (6) ◽  
pp. 3-4
Author(s):  
J. Mark Melhorn ◽  
LuAnn Haley ◽  
Charles N. Brooks

Abstract Repetitive illness sometimes is wrongly called repetitive injury or cumulative trauma, but the latter are misnomers because the employee cannot identify a specific injury as a cause of the symptoms. In workers’ compensation, such gradual illness claims may be compensable if the condition arises during the course of employment, which requires that it be caused by occupational duties, exposures, or equipment used on the employer's premises. Expert impairment evaluators face three requirements: they must know the best scientific evidence currently available regarding causation of the condition(s) in question, ie, generic causation; the facts of the individual case, ie, specific causation; and the legal threshold in the applicable jurisdiction for acceptance of a condition as work related. The AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, is an excellent resource and provides the physician a blueprint for the assessment of causation in occupational injury and illness claims. The book adopts the methodology developed by the National Institute for Occupational Safety and Health and the American College of Occupational and Environmental Medicine. When asked to render opinions regarding causation, a physician is wise to consider this methodology in determining the work relatedness of the condition. Medical opinions based on an accepted methodology and the best scientific evidence will result in better patient outcomes.


2017 ◽  
Vol 22 (1) ◽  
pp. 11-16
Author(s):  
Joel Weddington ◽  
Charles N. Brooks ◽  
Mark Melhorn ◽  
Christopher R. Brigham

Abstract In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.


Author(s):  
Яна Валерьевна Самиулина

В настоящей статье предпринята попытка исследовать отдельные проблемные аспекты института потерпевшего в российском уголовном процессе. В этих целях подвергнуты анализу правовые нормы, регламентирующие его процессуальный статус. Раскрываются отдельные пробелы уголовно-процессуального законодательства в сфере защиты законных прав и интересов потерпевшего. Автор акцентирует внимание на том, что совершенствование уголовно-процессуального законодательства в части расширения правомочий потерпевшего по отстаиванию своих нарушенных преступлением прав следует продолжить. На основании проведенного исследования действующего законодательства в части регламентации прав потерпевшего от преступления предлагается расширить перечень получаемых им копий постановлений, указанных в п. 13 ч. 2 ст. 42 УПК РФ. Автор предлагает включить в перечень указанной законодательной нормы право получения потерпевшим копии постановления об избрании конкретного вида меры пресечения, избранного в отношении подозреваемого (обвиняемого). Для создания действенного механизма защиты интересов потерпевших от преступления юридических лиц предлагаем ч. 9 ст. 42 УПК РФ изложить в следующей редакции: «в случае признания потерпевшим юридического лица его процессуальное право в уголовном процессе осуществляет представляющий его профессиональный адвокат». This article attempts to investigate certain problematic aspects of the institution of the victim in the Russian criminal process. For this purpose, analyzed the individual norms governing his procedural status. Separate gaps of the criminal procedure legislation in the sphere of protection of the legal rights and interests of the victim are disclosed. The author emphasizes that the improvement of the criminal procedure legislation in terms of the extension of the victim’s authority to defend his rights violated by the crime should be continued. On the basis of the study of the current legislation regarding the regulation of the rights of the victim of a crime, it is proposed to expand the list of decisions received by him, referred to in paragraph 13, part 2 of article 42 Code of Criminal Procedure. The author proposes to include in the list of the indicated legislative norm the right to receive the victim a copy of the decision on the selection of a specific type of preventive measure, selected in relation to the suspect (accused). To create an effective mechanism for protecting the interests of legal entities victims of a crime, we offer part 9 of art. 42 of the Code of Criminal Procedure of the Russian Federation shall be reworded as follows: «if a legal entity is recognized as a victim, his procedural right in criminal proceedings is exercised by the professional lawyer representing him».


Author(s):  
Jacob Busch ◽  
Emilie Kirstine Madsen ◽  
Antoinette Mary Fage-Butler ◽  
Marianne Kjær ◽  
Loni Ledderer

Summary Nudging has been discussed in the context of public health, and ethical issues raised by nudging in public health contexts have been highlighted. In this article, we first identify types of nudging approaches and techniques that have been used in screening programmes, and ethical issues that have been associated with nudging: paternalism, limited autonomy and manipulation. We then identify nudging techniques used in a pamphlet developed for the Danish National Screening Program for Colorectal Cancer. These include framing, default nudge, use of hassle bias, authority nudge and priming. The pamphlet and the very offering of a screening programme can in themselves be considered nudges. Whether nudging strategies are ethically problematic depend on whether they are categorized as educative- or non-educative nudges. Educative nudges seek to affect people’s choice making by engaging their reflective capabilities. Non-educative nudges work by circumventing people’s reflective capabilities. Information materials are, on the face of it, meant to engage citizens’ reflective capacities. Recipients are likely to receive information materials with this expectation, and thus not expect to be affected in other ways. Non-educative nudges may therefore be particularly problematic in the context of information on screening, also as participating in screening does not always benefit the individual.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 978.1-978
Author(s):  
D. Krijbolder ◽  
M. Verstappen ◽  
F. Wouters ◽  
L. R. Lard ◽  
P. D. De Buck ◽  
...  

Background:Magnetic resonance imaging (MRI) of small joints sensitively detects inflammation. MRI-detected subclinical inflammation, and tenosynovitis in particular, has been shown predictive for RA development in patients with arthralgia. These scientific data are mostly acquired on 1.0T-1.5T MRI scanners. However, 3.0T MRI is nowadays increasingly used in practice. Evidence on the comparability of these field strengths is scarce and it has never been studied in arthralgia where subclinical inflammation is subtle. Moreover, comparisons never included tenosynovitis, which is, of all imaging features, the strongest predictor for progression to RA.Objectives:To determine if there is a difference between 1.5T and 3.0T MRI in detecting subclinical inflammation in arthralgia patients.Methods:2968 locations (joints, bones or tendon sheaths) in hands and forefeet of 28 arthralgia patients were imaged on both 1.5T and 3.0T MRI. Two independent readers scored for erosions, osteitis, synovitis (according to RAMRIS) and tenosynovitis (as described by Haavaardsholm et al.). Scores were also summed as total inflammation (osteitis, synovitis and tenosynovitis) and total RAMRIS (erosions, osteitis, synovitis and tenosynovitis) scores. Interreader reliability (comparing both readers) and field strength agreement (comparing 1.5T and 3.0T) was assessed with interclass correlation coefficients (ICCs). Next, field strength agreement was assessed after dichotomization into presence or absence of inflammation. Analyses were performed on patient- and location-level.Results:ICCs between readers were excellent (>0.90). Comparing 1.5 and 3.0T revealed excellent ICCs of 0.90 (95% confidence interval 0.78-0.95) for the total inflammation score and 0.90 (0.78-0.95) for the total RAMRIS score. ICCs for individual inflammation features were: tenosynovitis: 0.87 (0.74-0.94), synovitis 0.65 (0.24-0.84) and osteitis 0.96 (0.91-0.98). The field strength agreement on dichotomized scores was 83% for the total inflammation score and 89% for the total RAMRIS score. Of the individual features, agreement for tenosynovitis was the highest (89%). Analyses on location- level showed similar results.Conclusion:Agreement of subclinical inflammation scores on 1.5T and 3.0T were good to excellent, in particular for tenosynovitis. This suggests that scientific evidence on predictive power of MRI in arthralgia patients, obtained on 1.5T, can be generalized to 3.0T when this field strength would be used for diagnostic purposes in daily practice.Disclosure of Interests:None declared


2011 ◽  
Vol 12 (5) ◽  
pp. 1261-1278 ◽  
Author(s):  
Milan Kuhli ◽  
Klaus Günther

Without presenting a full definition, it can be said that the notion of judicial lawmaking implies the idea that courts create normative expectations beyond the individual case. That is, our question is whether courts' normative declarations have an effect which is abstract and general. Our purpose here is to ask about judicial lawmaking in this sense with respect to international criminal courts and tribunals. In particular, we will focus on the International Criminal Tribunal for the Former Yugoslavia (ICTY). No other international criminal court or tribunal has issued so many judgments as the ICTY, so it seems a particularly useful focus for examining the creation of normative expectations.


1990 ◽  
Vol 29 (4) ◽  
pp. 435-436 ◽  
Author(s):  
J. R. Crawford ◽  
K. M. Allan ◽  
R. H. B. Cochrane ◽  
D. M. Parker

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