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

Measuring gender equality in education: Lessons from 43 countries

Through the 2015 Sustainable Development Goals (SDG), governments committed to achieving universal secondary school completion, including eliminating gender disparities, by 2030. The period from 1997 to 2014 saw considerable progress in closing gender gaps in school enrollment and attainment in many, but not all, low- and middle-income countries. However, as this research brief explains, claims that gender parity in primary education now exists are premature, especially in the poorest countries and new gender gaps, or gender-related challenges, may emerge as attainment increases. Moreover, the extremely low levels of secondary school enrollment—and even moreso completion—demonstrate that the SDG target of universal secondary school completion is likely more aspirational than realistic without dramatic increases in investments in education in these settings. The report concludes that improvements in the overall quality of education systems have proven even more elusive than improvements in attainment and gender parity, to the detriment of both boys and girls

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

Hormonal contraceptives and the acquisition of sexually transmitted infections: an updated systematic review.

BACKGROUND:Evidence suggests that some forms of hormonal contraception (HC) increase women's risk of non-HIV sexually transmitted infections (STIs), yet evidence has not been reviewed since 2008. We conducted an updated systematic review to incorporate studies published between January 2009 and June 2017 to examine the relationship between HCs and incident and/or recurrent STIs. METHODS:We searched PubMed and EMBASE to identify prospective studies comparing risk of Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), herpes simplex virus type 2 (HSV-2), Treponema pallidum, or Trichomonas vaginalis, between women using HC vs. non-hormonal methods or no methods. We summarize results by type of STI and HC and study quality using an adapted Newcastle-Ottawa Quality Assessment Scale. RESULTS:Thirty articles met the inclusion criteria. Depo-medroxyprogesterone acetate (DMPA) reduces the risk of trichomoniasis (consistent evidence) and may increase the risk of HSV-2 (strong effect, few studies); inconclusive evidence exists for HPV, chlamydia, gonorrhea and syphilis. Data on oral contraceptive pills (OCPs; generally not differentiated whether combined or progestin-only pills) suggest use is associated with a reduced risk of trichomoniasis with inconclusive findings for HSV-2, HPV, chlamydia, gonorrhea, and syphilis. Very few studies included norethisterone enanthate (Net-En) injectable, implants or the levonorgestrel IUD. CONCLUSIONS:DMPA and OCPs reduce the risk of trichomoniasis and DMPA may increase the risk of HSV-2. However, the potential for confounding cannot be ruled out. Future studies should specify the type of injectable or OCP used to increase understanding of biological pathways; more research is needed on implants and hormonal IUDs

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