Ethical Allocation of Preexposure HIV Prophylaxis

Civil society-led movements transformed global AIDS action from deep skepticism about extending anti-retroviral (ARV) treatment in low and middle-income countries to an historic scaling up of treatment towards universal access. The AIDS movement, however, is at an inflection point due to the interplay of key health and economic determinants—the global financial downturn, tight foreign aid budgets, and intense resource competition. Policy makers will now have to consider implementation of a new intervention—pre-exposure prophylaxis (PrEP), which could mean a diversion of ARVs from treatment to prevention. The principle underlying PrEP is that ARVs could prevent HIV infection among people who are HIV-negative and at high risk. Unlike existing prevention strategies such as voluntary counseling and testing (VCT), condoms, and male circumcision, PrEP is a continuous biomedical intervention. Although it will take several years to fully establish the clinical efficacy of PrEP in varying populations, the encouraging early results from CAPRISA, iPrEx, and CDC 4323 have accelerated global dialogue on its proof of deliverability. The studies encompass diverse populations, including injecting drug users (IDUs), MSM, serodiscordant heterosexual couples, and sex workers. These studies will be completed at different times, raising the question: if a trial demonstrates effectiveness for a given study group, should PrEP be used for others? The ethical issues raised by PrEP are difficult, but not insurmountable. Examining comparative cost-effectiveness, good governance, overcoming access barriers, and ensuring quality improvement would help ensure ethical allocation under circumstances of scarcity

Quasi-Chemical Theory and Implicit Solvent Models for Simulations

A statistical thermodynamic development is given of a new implicit solvent model that avoids the traditional system size limitations of computer simulation of macromolecular solutions with periodic boundary conditions. This implicit solvent model is based upon the quasi-chemical approach, distinct from the common integral equation trunk of the theory of liquid solutions. The physical content of this theory is the hypothesis that a small set of solvent molecules are decisive for these solvation problems. A detailed derivation of the quasi-chemical theory escorts the development of this proposal. The numerical application of the quasi-chemical treatment to Li$^+$ ion hydration in liquid water is used to motivate and exemplify the quasi-chemical theory. Those results underscore the fact that the quasi-chemical approach refines the path for utilization of ion-water cluster results for the statistical thermodynamics of solutions.Comment: 30 pages, contribution to Santa Fe Workshop on Treatment of Electrostatic Interactions in Computer Simulation of Condensed Medi

The O’Neill Institute for National and Global Health Law: Discovering Innovative Solutions for the Most Pressing Health Problems Facing the Nation and the World

The connection between health and an individual’s ability to function in society, as well as the importance of health to a society’s economic, political, and social wellbeing necessitates finding innovative solutions to the world’s most pressing health problems. The O’Neill Institute for National and Global Health Law at Georgetown University seeks to demonstrate the role that academia can play in addressing complex national and global health problems in a comprehensive, evidence-based, intellectually-rigorous, and nonpartisan manner. The O’Neill Institute currently has three research programs: global health law, national health law, and the center for disease prevention and outcomes. Projects within these programs examine a broad range of health law and policy issues, such as global health governance, global tobacco control, health worker migration, emergency preparedness, national and Chinese health reform, HIV and AIDS issues, food safety, and personalized medicine. These projects merge the scholarly capacity within the institute with the resources of its partners, which include the World Health Organization, World Bank, the Bill & Melinda Gates Foundation, the U.S. Centers for Disease Control and Prevention, and the Campaign for Tobacco Free Kids. Additionally, the faculty and fellows of the O’Neill Institute regularly produce high-level scholarship and engage in teaching offering multi-disciplinary course offerings and innovative graduate degree programs. URL: http://www.law.georgetown.edu/oneillinstitute/documents/2010-03-09_oneill-solutions.pdf; http://mjlst.umn.edu/uploads/Pf/V1/PfV1QhiCT6lUOsv1AqDTCA/111_gostin.pdf

Child Abuse Reporting: Rethinking Child Protection

The general public has been bewildered by the magnitude of sex abuse cases and the widespread failure by pillars of the community to notify appropriate authorities. The crime of sexually abusing children is punishable in all jurisdictions and this article examines the duty to report suspected cases by individuals in positions of trust over young people, such as in the church or university sports. The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child maltreatment as an act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, sexual abuse, or exploitation, and establishes minimum federal standards. Each state has its own definitions of maltreatment and every state identifies persons who are required to report child abuse. As such, state law is highly variable in defining who has a mandatory duty to report, and clergy and other individuals in close supervision of children (e.g., athletic coaches, scout leaders, volunteers in religious programs, and university officials) may necessarily hold such duty. The article outlines why there are strong moral reasons the law should require all adults in close supervision of children to report any individual who they have good reason to believe has abused a child and moreover outlines how to ensure prompt reporting of abuse, while still ensuring that respected individuals are not falsely accused

Trends in sun exposure awareness and protection practices in Malta : 1999-2004

Rising skin cancer incidence rates have led to sun awareness campaigns in Malta since the early 1990s. The aim of this study is to assess the impact of these campaigns by analysing trends in sun exposure-related knowledge and behaviour amongst the Maltese people. A total of 559 Maltese pedestrians aged 16-50 years were interviewed in 1999. The same questionnaire was used to interview 304 pedestrians in 2004. More people admitted spending leisure time outdoors during peak sunshine hours in 2004 than in 1999 (85.9% vs 62.4%, p<0.001). There was a drop in people regularly wearing a hat during outdoor leisure activities from 32.4% to 18.4% (p<0.001), and from 37.5% to 9.3% (p<0.001) during outdoor work activities. Rates of regular sunscreen use remained constant at about 50% using it for outdoor leisure activities, but dropped from 25.0% to 9.3% for outdoor work (p=0.02). In 2004, 96.1% of participants having children aged less than 12 years stated that they regularly used sunscreen on their children (87.0% in 1999, p=0.01), while 66.2% said that their children regularly wore a hat (78.4% in 1999, p=0.05). More people were regarding a suntan as unhealthy in 2004 than in 1999 (62.8% versus 37.0%, p<0.001). The mass media remained the most important source of health information.peer-reviewe

Autopsy

An autopsy is a standardized biomedical procedure during which trained medical pathologists examine the exterior of the body, dissect the corpse, view the vital organs for any obvious abnormality and weigh them, and collect specimens of tissues and fluids for further analysis. The procedure takes 2-4 hours and ends with the body being prepared either for storage until it can be released, or to go to the undertaker for embalming and burial or cremation. After additional laboratory work on the tissues and fluid specimens to detect the presence of drugs and/or coexisting medical conditions, the pathologist forms an opinion on the cause of death. As important as autopsies are in the abstract for law and medicine, they will continue to carry important cultural and emotional meanings as humans face the deaths of relatives and friends