“Do No Harm or Injustice to Them”: Indicting and Convicting Physicians for Controlled Substance Distribution in the Age of the Opioid Crisis

In response to the devastating impact of the opioid crisis, the Department of Justice has in recent years launched an aggressive crackdown on what it characterizes as “fraudulent prescribers” of controlled substances. Against this backdrop, physicians, prosecutors, and defense attorneys face a number of issues. First, there is a lingering circuit court split on the issue of whether indictments against physicians and other medical professionals for illegal controlled substance distribution must allege that the physician acted “outside the usual course of professional practice and without a legitimate medical purpose.” I argue that acting without a legitimate medical purpose is an element of narcotics distribution that must be alleged in indictments for both constitutional and policy reasons. Next, there is ambiguity as to what type of conduct is considered to have no legitimate medical purpose, and the line between poor medical practice and criminal conduct is ill-defined. I argue that the statutory scheme for prosecuting physicians is vague and ineffective at providing guidance to doctors, juries, judges, and attorneys. Finally, there is the broader question of whether physicians should be the target of limited prosecutorial funds, or whether the government should instead focus on the pharmaceutical companies whose actions lie at the heart of the opioid crisis. This comment explores the legal options for holding drug companies accountable for their role in the crisis, and argues that these options are more effective than prosecutions of individual physicians

Bicultural Immersion as a Strategy to Promote A Healthy Professional Role Transition for New Graduate Registered Nurses

The transition to professional practice for newly graduated nurses (NGN) finds them struggling to balance the ‘ideals’ taught in their undergraduate education with the ‘realities’ of the contemporary workplace. Failure to successfully navigate this struggle is playing out in alarming statistics related to NGN attrition, with 33-61% NGNs changing their place of employment or leaving the nursing profession within the first two years, 45.5% expressing uncertainty about their decision to remain in practice, and 25% claiming they would actively discourage someone from going into nursing. The intent of this study was to explore how NGNs experience the cultures of education and the workplace and how the relationship between NGNs and senior nursing staff influences the experience of transition. Duchscher’s Professional Role Transition Risk Assessment Instrument was used to determine correlations between mentoring support and the NGNs experience of transition shock. Preliminary findings indicate that a mentor’s knowledge of the transition experience is imperative to the provision of adequate support. Further to this, the process of guiding the NGN through the transition experience is significantly facilitated when meetings are structured and framed by the Stages of Transition theory variables. Further findings indicate a potential shift in the approaches of NGNs to work, with casualization offering them control over the pace and intensity of their transition. It would appear that previous experience on the ward to which the NGN is hired positively influences their experience and night and day shifts need to be intentionally balanced to provide both stability and growth

Disparities in Water and Sewer Services in North Carolina: An Analysis of the Decision-Making Process

however, failed systems are often underreported. Conclusions. Understanding the health costs and benefits of water and sewer extension and integrating these findings into the local decision-making process may help address disparities in access to municipal services.Objectives. We examined the factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks. Methods. Using a multisite case study design, we conducted in-depth, semistructured interviews with 25 key informants from 3 unincorporated communities in Hoke, New Hanover, and Transylvania counties, North Carolina, July through September 2013. Interviewees included elected officials, health officials, utility providers, and community members. We coded the interviews in ATLAS.ti to identify common themes. Results. Financing for water and sewer service emerged as the predominant factor that influenced decisions to extend these services. Improved health emerged as a minor factor, suggesting that local officials may not place a high emphasis on the health benefits of extending public water and sewer services. Awareness of failed septic systems in communities can prompt city officials to extend sewer service to these area

The protective and immunomodulatory properties of Bordetella pertussis adenylate cyclase toxin

Bordetella pertussis is the causative agent of the disease whooping cough in man, and although there is an effective whole-cell vaccine (WCV), recent efforts have focused on the development of the acellular vaccines (ACVs) to avoid the problems of reactogenicity associated with WCVs. The cell-invasive toxin, adenylate cyclase toxin (CyaA), is an important virulence factor of B. pertussis and, when used as a vaccine, is able to protect mice against intranasal challenge with B. pertussis. The project was designed to investigate the mouse immune responses to two forms of the toxin, an enzymically-active, acylated form (CyaA) and an enzymically-inactive, acylated form (CyaA*). These were expressed as recombinant forms in E. coli, purified and their enzymic, haemolytic and cytotoxic properties characterised. The adenylate cyclase (AC) and cytotoxic activities of CyaA* were low compared to CyaA, but the haemolytic activities of the two toxins were similar. This indicated that the toxic activity of CyaA is dependent on AC enzymic activity, but that haemolytic activity is independent of AC activity. Mouse responses to intraperitoneal immunisation with CyaA or CyaA* were examined, initially when each toxin was administered alone and later when administered in combination with protective antigens commonly used in ACV preparations (pertussis toxin (PT), filamentous haemagglutinin (FHA), and pertactin (P.69)). Both forms of the toxin when administered alone produced a strong serum IgG response which was boosted by a second vaccination. Anti-PT, -FHA and -P.69 IgG levels, in response to immunisation with PT, FHA and P.69 mixture in the presence of CyaA* were all raised compared to mice immunised with just the antigen mixture alone when measured at five weeks post-immunisation, however only anti-P.69 levels were raised by coadministration with CyaA. When detoxified PT (dPT) was co-administered alone with CyaA*, the anti-PTd levels decreased but if FHA or P.69 were also included in the antigen mixture, the anti-PTd levels increased in comparison to mice immunised with PTd alone. When either FHA or P.69 antigen was co-administered with CyaA*, both anti-FHA and anti-P.69 levels respectively were raised in comparison to those immunised with FHA or P.69 alone, again when measured at five weeks postimmunisation. Other work had shown that induction of cell-mediated immunity (CMI) was necessary for effective clearance of B. pertussis in the mouse. In this study, nitric oxide production by peritoneal macrophages was measured as a marker of macrophage activation. Macrophages collected from mice vaccinated with PT, FHA and P.69 together with CyaA or CyaA* responded more to stimulation with B. pertussis heat- killed cells or CyaA* than those taken from mice immunised with just the antigen mixture alone. Increased protection following aerosol challenge with B. pertussis was also observed when mice received a vaccination of CyaA* co-administered with PT, FHA and P.69 mixture. Taken together these results indicate that CyaA is a candidate antigen for inclusion in acellular vaccines, even in the detoxified CyaA* form. As well as being a protective antigen in its own right, it may also afford improved CMI responses than the current ACV formulations

Adopting AI: How Familiarity Breeds Both Trust and Contempt

Despite pronouncements about the inevitable diffusion of artificial intelligence and autonomous technologies, in practice it is human behavior, not technology in a vacuum, that dictates how technology seeps into -- and changes -- societies. In order to better understand how human preferences shape technological adoption and the spread of AI-enabled autonomous technologies, we look at representative adult samples of US public opinion in 2018 and 2020 on the use of four types of autonomous technologies: vehicles, surgery, weapons, and cyber defense. By focusing on these four diverse uses of AI-enabled autonomy that span transportation, medicine, and national security, we exploit the inherent variation between these AI-enabled autonomous use cases. We find that those with familiarity and expertise with AI and similar technologies were more likely to support all of the autonomous applications we tested (except weapons) than those with a limited understanding of the technology. Individuals that had already delegated the act of driving by using ride-share apps were also more positive about autonomous vehicles. However, familiarity cut both ways; individuals are also less likely to support AI-enabled technologies when applied directly to their life, especially if technology automates tasks they are already familiar with operating. Finally, opposition to AI-enabled military applications has slightly increased over time

Current research priorities for UK occupational physicians and occupational health researchers: a modified Delphi study

Objectives: Studies identifying national occupational health (OH) research priorities have been conducted in several countries to establish where OH research should be focused and where funding should be targeted. However, the UK findings are now over 20 years old, and OH practice is continuously evolving. The aim of this study was to identify current research priorities for UK occupational physicians (OPs) and occupational health researchers (OHRs). Methods: Current research priorities in OH were identified using a modified Delphi technique. This was conducted in two rounds to achieve consensus. Research priorities were rated, and then ranked using questionnaires developed from expert panel discussions, key research topics identified from the medical literature and participant feedback. Overall and intergroup comparisons were completed for the ranking scores. Results Consensus among OPs and OHRs was high with almost all (9/10) primary domains rated as ‘very important’ or ‘absolutely necessary’ by more than 54% of respondents. The research priority areas ranked highest were jointly economic evaluation/cost effectiveness studies and disability management followed by occupational disease/injury/illness. Occupational health policy was ranked lowest after sickness absence management and health promotion. The secondary domain analysis identified priority emphasis on mental health and psychosocial hazards within the workplace and the need to further develop evidence-based guidance for clinical OH practice. Conclusions: We identified the current research priorities for UK OPs and OHRs. The findings will inform future national OH research strategy and support research that addresses important knowledge gaps within OH and other interdisciplinary specialties