22 research outputs found

    Insights into the Management of Emerging Infections: Regulating Variant Creutzfeldt-Jakob Disease Transfusion Risk in the UK and the US

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    BACKGROUND: Variant Creutzfeldt-Jakob disease (vCJD) is a human prion disease caused by infection with the agent of bovine spongiform encephalopathy. After the recognition of vCJD in the UK in 1996, many nations implemented policies intended to reduce the hypothetical risk of transfusion transmission of vCJD. This was despite the fact that no cases of transfusion transmission had yet been identified. In December 2003, however, the first case of vCJD in a recipient of blood from a vCJD-infected donor was announced. The aim of this study is to ascertain and compare the factors that influenced the motivation for and the design of regulations to prevent transfusion transmission of vCJD in the UK and US prior to the recognition of this case. METHODS AND FINDINGS: A document search was conducted to identify US and UK governmental policy statements and guidance, transcripts (or minutes when transcripts were not available) of scientific advisory committee meetings, research articles, and editorials published in medical and scientific journals on the topic of vCJD and blood transfusion transmission between March 1996 and December 2003. In addition, 40 interviews were conducted with individuals familiar with the decision-making process and/or the science involved. All documents and transcripts were coded and analyzed according to the methods and principles of grounded theory. Data showed that while resulting policies were based on the available science, social and historical factors played a major role in the motivation for and the design of regulations to protect against transfusion transmission of vCJD. First, recent experience with and collective guilt resulting from the transfusion-transmitted epidemics of HIV/AIDS in both countries served as a major, historically specific impetus for such policies. This history was brought to bear both by hemophilia activists and those charged with regulating blood products in the US and UK. Second, local specificities, such as the recall of blood products for possible vCJD contamination in the UK, contributed to a greater sense of urgency and a speedier implementation of regulations in that country. Third, while the results of scientific studies played a prominent role in the construction of regulations in both nations, this role was shaped by existing social and professional networks. In the UK, early focus on a European study implicating B-lymphocytes as the carrier of prion infectivity in blood led to the introduction of a policy that requires universal leukoreduction of blood components. In the US, early focus on an American study highlighting the ability of plasma to serve as a reservoir of prion infectivity led the FDA and its advisory panel to eschew similar measures. CONCLUSIONS: The results of this study yield three important theoretical insights that pertain to the global management of emerging infectious diseases. First, because the perception and management of disease may be shaped by previous experience with disease, especially catastrophic experience, there is always the possibility for over-management of some possible routes of transmission and relative neglect of others. Second, local specificities within a given nation may influence the temporality of decision making, which in turn may influence the choice of disease management policies. Third, a preference for science-based risk management among nations will not necessarily lead to homogeneous policies. This is because the exposure to and interpretation of scientific results depends on the existing social and professional networks within a given nation. Together, these theoretical insights provide a framework for analyzing and anticipating potential conflicts in the international management of emerging infectious diseases. In addition, this study illustrates the utility of qualitative methods in investigating research questions that are difficult to assess through quantitative means

    Entre consumos suntuários e comuns: a posse de objetos exóticos entre alguns habitantes do Porto (séculos XVI – XVII)

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    O estudo da documentação referente aos doadores da Misericórdia do Porto entre os séculos XVI e XVII, através dos objetos exóticos patentes nos respectivos testamentos e inven- tários – estes últimos provenientes de uma área que se estende de Macau ao Brasil –, permite discernir uma panóplia de objetos que mudaram a cultura material dos portuenses em contato com os territórios da expansão portuguesa. Um levantamento sistemático permitiu já rastrear, até o ano de 1699, 257 doadores, dos quais se apresentarão aqui apenas alguns, referentes a benfeitores que, não obstante possuírem bens móveis nesse âmbito, não são dados como tendo estado nos territórios de expansão transoceânica. Argumentar-se-á que essa circulação de objetos não foi exclusiva das elites nobiliárquicas, nem dos grandes centros urbanos, pelo que a sua difusão atingiu maiores proporções do que aquelas que a historiografia tem admitido até agora. A cidade em observação neste estudo – o Porto dos séculos XVI e XVII – estava longe de ser das maiores da Europa nesse período, quer em dimensão territorial, quer em efetivos populacionais, embora se situasse numa região de demografia pujante, que canalizou os seus excedentes desde cedo para a emigração interna e externa – o Entre Douro e Minho. Como teremos ocasião de verificar, fidalgos e nobres possuíam bens exóticos, mas estes encontravam-se também entre mercadores e até artesãos mais desafogados. Por outro lado, nem todos os objetos provenientes dos espaços da expansão transoceânica devem ser conotados com bens de luxo.The study of the sources referring to the donors of the Misericórdia of the city of Porto during the sixteenth and seventeenth centuries has revealed the presence of numerous exotic objects in their last wills and inventories. A survey has traced 257 donors until 1699, some of them having died in an area that extends from Macao to Brazil. Only a small number of cases shall be presented here, pertaining to benefactors who, in spite of owning objects of transoceanic origin, seem to have remained in mainland Portugal. It shall be argued that the circulation of objects has not been exclusive either to the elites of the nobility or to the large urban centres, their diffusion having been on a larger scale than what has been admitted until now. The city under scrutiny in this study – Porto during the sixteenth and seventeenth centuries – was not one of the bigger cities in this period, either in what respects to size or population, although it was located in an area of flourishing demography, that channelled its surplus population early on to internal and external emigration. Fidalgos and noblemen owned exotic goods, but these were to be found among merchants and even well-to-do artisans. On the other hand, not all objects originating from the areas of transoceanic expansion should be considered as luxury goods.info:eu-repo/semantics/publishedVersio

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    Establishing a constitutional 'right of asylum' in early nineteenth-century Britain

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    For several generations before the First World War, the idea that the British constitution contained a ‘right of asylum' for foreign nationals was commonplace. Though this belief had profound consequences for Britain's treatment of political and religious exiles, its relations with foreign states, and the drafting of its extradition and immigration laws, there has been little enquiry into its origins. This article delineates the emergence of the idea of a constitutional ‘right of asylum', locating it in a series of political clashes over the ‘Alien Act' that took place during the decade after the Napoleonic Wars. This legislation, which established controls over foreigners during the French Revolution and the quarter-century of war that followed, was increasingly challenged by the Whig and radical oppositions after Waterloo, both for its specific arbitrary provisions and as a more fundamental violation of the rights of aliens guaranteed by key constitutional documents like Magna Carta and the Habeas Corpus Act. By the mid-1820s these objections cohered into a conviction that asylum itself could be claimed as a right. This conviction and the arguments that spawned it were repeated for many subsequent decades, forming the basis of the widespread Victorian belief in the ‘right of asylum’
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