“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

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

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

Assessment of the performance of a turbulence closure model: along the tidally-influenced Kaipara River to the estuary, NZ

The success of many coastal management projects hinges on the ability to predict the dispersal and settling of sediment particles. Hydrodynamic models have enabled the efficient simulation of sediment transport scenarios at large spatial scales and long time scales. However, these models have limited predictive capacity owing to an incomplete understanding of the processes involved. Turbulence has been shown to have a substantial influence on sediment transport by influencing flocculation (i.e. aggregation of particles), hence driving the behaviour of particles (e.g. deposition, erosion, mixing). Turbulence tends to promote aggregation at low shear stresses and cause floc breakups at high shear stresses. However, despite the key role of turbulence in coastal modelling, there is not a unique approach but several methods to describe turbulence, each based on a different combination of assumptions. We present modelling results exploring the performance of one closure scheme implemented in a hydrodynamic and sediment transport model, Delft3D. The assessment of the performance of the model is based on comparisons with measured data collected in the heavily sediment-laden Kaipara river, New Zealand. Data was collected in October 2013 using Lagrangian “flocdrifter” platforms released at multiple locations to capture both hydrodynamic and sediment data. In general the model was found to be able to reproduce the right order of magnitude of dissipation rates. However, turbulence characteristics in some sections of the river, usually in the vicinity of abrupt bends, are relatively poorly reproduced. Future work will aim to use the present model to improve the conceptual understanding of fundamental physical processes, in particular the effect of turbulence on flocculation, and floc formation and breakup in estuarine and riverine systems

The optimal employee journey to retain Gen Z and Millennial young professionals in the Netherlands

Gen Z and Millennials are becoming a bigger part of the workforce in the coming years. Gen Z and Millennials will become 75% of the workforce by 2025 (Buganim, 2023). Gen Z refers to the generation of people born between 1997 and 2012 (Merrian Webster, 2023) and the Millennial generation is considered anyone born between 1981 and 1996 (Dimock, 2019). Millennials and Gen Z make a significant impact on the company culture, with their fluency in technology, together with their willingness to speak up to persuade their employers to have a purpose beyond profit, to prioritise actions such as climate change and creating a more diverse, equal, and inclusive work environment (Deloitte, 2022). When the manager understands the behaviour and needs of these generations in the workplace, it will lead to a higher engagement of employees and a lower turnover. Research shows that Gen Z employees may be struggling with engagement at work. According to a 2022 Gallup Poll, 54% of Gen Z employees are ambivalent or not engaged at work (Fernandez, 2023). A meta-analysis of data from 30 case studies over 15 years found that for employees earning less than €75.000, - annually, the cost of turnover is 20% of the salary. Investing in managing these employees and keeping them satisfied will not only result in a higher productivity and engagement, but also result in less costs replacing the employees (Schroth, 2019). In this report, there is research provided on how to retain young Gen Z and Millennial professionals in companies in the Netherlands. Young professionals are young highly qualified (bachelor degree or higher) employees, who are starters or in the process of taking the second step in their career. These employees are already working in the profession in which they want to advance (Your talent, 2019). The choice for young professionals was made, because they are working in an area they want to stay in, and therefore will be more likely to stay for a longer term within a company. It is profitable for these companies to invest in an optimal employee journey to retain their employees. The Netherlands has been chosen because this country is in a labour crisis. From a period of too little work for many people due to the Corona crisis, the market is now flipping to the other extreme: there is now too much work for too few people. This means that there is a shortage of staff.La Generación Z y los Millennials se convertirán en una parte cada vez más importante de la fuerza laboral en los próximos años. La Generación Z y los Millennials constituirán el 75% de la fuerza laboral en 2025 (Buganim, 2023). Gen Z se refiere a la generación de personas nacidas entre 1997 y 2012 (Merrian Webster, 2023) y se considera generación Millennial a toda aquella nacida entre 1981 y 1996 (Dimock, 2019). Los Millennials y la Generación Z tienen un impacto significativo en la cultura de la empresa, con su fluidez en la tecnología, junto con su voluntad de hablar para persuadir a sus empleadores a tener un propósito más allá de las ganancias, a priorizar acciones como el cambio climático y la creación de una sociedad más diversa y sostenible. ambiente de trabajo igualitario e inclusivo (Deloitte, 2022). Cuando el gerente comprende el comportamiento y las necesidades de estas generaciones en el lugar de trabajo, conducirá a un mayor compromiso de los empleados y una menor rotación. Las investigaciones muestran que los empleados de la Generación Z pueden tener dificultades con el compromiso en el trabajo. Según una encuesta Gallup de 2022, el 54% de los empleados de la Generación Z son ambivalentes o no están comprometidos en el trabajo (Fernández, 2023). Un metaanálisis de datos de 30 estudios de casos a lo largo de 15 años encontró que para los empleados que ganan menos de 75.000 euros al año, el coste de rotación es el 20% del salario. Invertir en gestionar a estos empleados y mantenerlos satisfechos no solo dará como resultado una mayor productividad y compromiso, sino que también generará menos costos de reemplazo de empleados (Schroth, 2019). En este informe, se proporciona una investigación sobre cómo retener a los jóvenes profesionales de la Generación Z y Millennial en empresas de los Países Bajos. Los jóvenes profesionales son empleados jóvenes altamente calificados (licenciatura o superior), que están iniciando o en proceso de dar el segundo paso en su carrera. Estos empleados ya están trabajando en la profesión en la que quieren avanzar (Tu talento, 2019). Se eligió a los jóvenes profesionales porque trabajan en un área en la que quieren permanecer y, por lo tanto, tendrán más probabilidades de permanecer por más tiempo en una empresa. Es rentable para estas empresas invertir en un recorrido óptimo de los empleados para retenerlos. Se ha elegido a los Países Bajos porque este país atraviesa una crisis laboral. De una época de muy poco trabajo para mucha gente debido a la crisis del coronavirus, el mercado ahora está virando al otro extremo: ahora hay demasiado trabajo para muy poca gente. Esto significa que hay escasez de personal.Administración y Dirección de Empresa