Conant v. Walters: A Misapplication of Free Speech Rights in the Doctor-Patient Relationship

In Conant v. Walters, the United States Court of Appeals for the Ninth Circuit addressed the application of the First Amendment\u27s right of free speech to a federal policy that prohibited the recommendation of medical marijuana by physicians. This class action suit, brought by physicians and severely ill patients, successfully enjoined the federal government from enforcing its policy revoking the federal prescriptive licenses of physicians who recommend or approve of marijuana use by patients suffering from certain severe illnesses. The federal government\u27s policy, issued in 1996 through a statement of Barry McCaffrey, director of the Office of National Drug Control Policy (ONDCP), responded directly to recent legislation in California decriminalizing the use of marijuana under certain medically-approved circumstances. The California legislation also protected physicians from prosecution under state law for recommending marijuana use. Entering an injunction against the federal policy, the United States District Court held that, although the federal government had the right to regulate the distribution and use of marijuana, it could not interfere with First Amendment interests by precluding doctors and patients from discussing marijuana as a treatment for medical conditions. On appeal, the majority affirmed on the basis of the First Amendment implications of the government policy. The concurring opinion, however, expressed another reason for enjoining the government from enforcing its policy, specifically the Commandeering Doctrine, which prohibits the federal government from requiring that states address a particular problem or enforce a federal regulatory program. The Supreme Court denied certiorari on October 14, 2003. This Note explores federal laws that pertain to marijuana use, as well as California\u27s policies on medical marijuana and physician recommendations, considering the implications of both the First Amendment and the Commerce Clause in the resolution of this case

Investing When It Counts: Reviewing the Evidence and Charting a Course of Research and Action for Very Young Adolescents

Since 2006, there has been a burgeoning interest in the very young adolescent population and an ever-expanding array of programs aimed at addressing their social, health, and development needs. This report builds on the momentum generated from recent research and program efforts, and from the greater data available in the past decade. The report is intended to be helpful to anyone who plans, manages, implements, monitors, evaluates, or funds research or programs that involve young adolescent girls and boys. The report outlines several key areas that would benefit from more experimentation and new research. Central to this is the creation of community platforms/meeting places—places for skill building and safe engagement, especially for girls whose social space is already confined and in many cases shrinking

Insights and evidence gaps in girl-centered programming: A systematic review

Increased attention to the needs of adolescent girls has led to a growing number of programs in low- and middle-income countries. Questions remain, however, about what aspects of program design are most effective. This hinders efforts to effectively allocate resources, scale up programs, and replicate results across settings. This review looks at how the number of program components, involvement of supporting actors who influence the lives of girls, supplemental “booster” activities, intervention exposure level, and community saturation level influenced outcomes for girls. While findings suggest the importance of multicomponent programs and longer program exposure, each area requires further rigorous research to determine whether and under what circumstances they amplify impact

Sequential Extraction of Copper and Zinc from Two Californian Soils

In order to understand how to remediate soils contaminated with heavy metals, it is important to first understand their sorption mechanisms. The objective of this study was to evaluate the bioavailability of elevated levels of soil copper (Cu) and zinc (Zn) via sequential extraction. Elevated levels of Cu and Zn were added separately and concurrently to a Mollisol and an Entisol from the central coast of California. The exchangeable amount of Cu and Zn was then extracted from the sorbed amount via 0.1 M NaNO3. The residual fraction was then extracted with 0.1 M sodium citrate (NaC6O7H7) to determine if citrate removed any additional metals. Higher amounts of Cu (\u3e 80 %) was sorbed than Zn (\u3e64 %) for both soils. Cu was shown to inhibit Zn sorption to the Entisol, but not in the Mollisol, when the metals were added concurrently. Zn was more exchangeable in the Mollisol but less exchangeable than Cu in the Entisol. Citrate extracted significantly more Cu and Zn from the Mollisol than the Entisol. Both metals had a low bioavailability. Exchangeable and extractable Cu and Zn were 12-16 % and 3 – 6 % of the originally sorbed amount for the Mollisol and the Entisol. Citrate was able to desorb non-exchangeable Cu and Zn from both a Mollisol and an Entisol, thus, was an important extractant used in assessing the bioavailability of these metals

Validating indicators of the quality of maternal health care: Final report, Mexico

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report of obstetric and immediate postnatal maternal and newborn care received was compared against a “gold standard” of observations by a trained third-party observer during labor and delivery. This report presents results of the Mexico study

Assessing Plasmodium falciparum transmission in mosquito-feeding assays using quantitative PCR.

BACKGROUND: Evaluating the efficacy of transmission-blocking interventions relies on mosquito-feeding assays, with transmission typically assessed by microscopic identification of oocysts in mosquito midguts; however, microscopy has limited throughput, sensitivity and specificity. Where low prevalence and intensity mosquito infections occur, as observed during controlled human malaria infection studies or natural transmission, a reliable method for detection and quantification of low-level midgut infection is required. Here, a semi-automated, Taqman quantitative PCR (qPCR) assay sufficiently sensitive to detect a single-oocyst midgut infection is described. RESULTS: Extraction of genomic DNA from Anopheles stephensi midguts using a semi-automated extraction process was shown to have equivalent extraction efficiency to manual DNA extraction. An 18S Plasmodium falciparum qPCR assay was adapted for quantitative detection of P. falciparum midgut oocyst infection using synthetic DNA standards. The assay was validated for sensitivity and specificity, and the limit of detection was 0.7 genomes/µL (95% CI 0.4-1.6 genomes/µL). All microscopy-confirmed oocyst infected midgut samples were detected by qPCR, including all single-oocyst positive midguts. The genome number per oocyst was assessed 8-9 days after feeding assay using both qPCR and droplet digital PCR and was 3722 (IQR: 2951-5453) and 3490 (IQR: 2720-4182), respectively. CONCLUSIONS: This semi-automated qPCR method enables accurate detection of low-level P. falciparum oocyst infections in mosquito midguts, and may improve the sensitivity, specificity and throughput of assays used to evaluate candidate transmission-blocking interventions

Assessment of High-Sensitivity C-Reactive Protein Levels as Diagnostic Discriminator of Maturity-Onset Diabetes of the Young Due to HNF1A Mutations

OBJECTIVE: Despite the clinical importance of an accurate diagnosis in individuals with monogenic forms of diabetes, restricted access to genetic testing leaves many patients with undiagnosed diabetes. Recently, common variation near the HNF1 homeobox A (HNF1A) gene was shown to influence C-reactive protein levels in healthy adults. We hypothesized that serum levels of high-sensitivity C-reactive protein (hs-CRP) could represent a clinically useful biomarker for the identification of HNF1A mutations causing maturity-onset diabetes of the young (MODY). RESEARCH DESIGN AND METHODS: Serum hs-CRP was measured in subjects with HNF1A-MODY (n = 31), autoimmune diabetes (n = 316), type 2 diabetes (n = 240), and glucokinase (GCK) MODY (n = 24) and in nondiabetic individuals (n = 198). The discriminative accuracy of hs-CRP was evaluated through receiver operating characteristic (ROC) curve analysis, and performance was compared with standard diagnostic criteria. Our primary analyses excluded approximately 11% of subjects in whom the single available hs-CRP measurement was >10 mg/l. RESULTS: Geometric mean (SD range) hs-CRP levels were significantly lower (