Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism

Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data

Ethics and/or aesthetics? reflections on cosmetic surgery for adolescents

Cosmetic surgery entails various ethical issues, even more so in cases involving adolescent patients. Cosmetic surgeons need to take into account how modern societies consider physical appearance an essential component of everyday life, as well as the vulnerability of youths and adolescents. For that reason, it is imperative to thoroughly assess the psychological and emotional states, in addition to the motivations, of minor patients. That goal can be achieved through the use of the DAS-59, (the Derriford Appearance Scale)1 , an effective and dependable tool devised to evaluate the psychological difficulties and distress experienced by people living with problems of appearance. Prior to undergoing cosmetic surgery procedures, adolescents should be required to go through adequate counseling, over multiple sessions and extended to their family members as well, on account of the complex issues inherent in evaluating the risk-benefit ratio and a prospective patient's decision-making capability. A concerted effort on the part of surgeons, psychiatrists or psychologists is key in determining the real motivations behind a minor's decision to opt for cosmetic surgery in the first place. Possible psychiatric conditions may in fact prevent a minor from making a free, informed decision. From an ethical standpoint, cosmetic surgery procedures should be geared to serve the best interest of the minor patient, who may experience distress over his or her body image, from a health and psychological balance perspective and improve his or her social, affective and working life. Besides, cosmetic surgery should not be overly invasive compared to its potential benefits. Those procedures aimed at achieving ″ideal beauty″ are not desirable and ought to be banned. By virtue of such criteria, the authors have set out to evaluate the ethical admissibility of some aesthetic treatments. Thus, doctors should not consent to any request coming from their patients, but rather, intervene only in presence of an objective physical flaw or deformity, e.g. protruding ears, which have a potential to negatively affect social life and interactions

The reform of the Italian legislation on childhood immunization

Upon the proposal of the Italian government, Law n. 191/2017 has been enacted, meant to considerably raise the number of mandatory vaccinations, while leaving several others merely "recommended" (non-mandatory). Such a reform has proven necessary in light of the latest epidemiologic data reflecting a steady decrease in the rates of immunization coverage in most Italian regions over the past few years, including mandatory vaccinations. Court rulings that held vaccinations may have caused autism, or even a child's death, have probably contributed to decrease in coverage. Early interventions to mandate immunization had been put in place at the regional level, yet the Italian Government and Parliament have opted for a national piece of legislation devised to make mandatory vaccinations a requirement to gain access to the preschool system or day care services. The authors elaborate on the reform's contents and shed a light on the medical, ethical and legal elements underpinning the mandate to immunize children. As a matter of fact, possible risks arising from vaccinations are rare, and largely offset by the benefits to both the children and society at large. On the heels of the reform in question, the doctor-patient relationship is still at the forefront. In fact, citizens need to understand the value and usefulness of non-mandatory, recommended vaccines as well. Therefore, it appears necessary to improve the quality of vaccination counseling practices in childcare, but such activities need to take place within the framework of a broader strategy, centered on the fostering of a culture of prevention, backed by scientific research to the fullest extent possible

The importance of disclosing the conflict of interest (CoI) in the era of open access publishing

In pharmacological and biomedical sciences, most of the principle donators are progressively demanding open access as a condition in economical support, something which has already become common in various other areas1. The expression “open access” has been used since 2002: first in the Budapest Open Access Initiative (February 2002), then in the Bethesda Statement on Open Access Publishing (June 2003) and finally in the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (October 2003). Open access was initially intended for scholarly journal manuscripts in order to provide an unrestricted online access to them. However, even though this term first appeared in the 2000s, free on-line access to journal manuscripts had started at least 10 years previousl

The static evolution of the new Italian code of medical ethics

Eight years since the last revision, in May 2014 the Italian code of medical ethics has been updated. Here, the Authors examine the reform in the light of the increasing difficulties of the medical profession arising from the severity of the Italian law Courts. The most significant aspects of this new code are firstly, the patient's freedom of self-determination and secondly, risk prevention through the disclosure of errors and adverse events. However, in both areas the reform seems to be less effective if we compare the ethical codes of France, the United Kingdom and the United States. In particular, the non-taking into consideration of the said code quality standards and scientific evidence which should guide doctors in their clinical practice is to say the least questionable. Since these are the most significant changes in the new code, it seems inevitable to conclude that the 2014 edition is essentially in line with previous versions. Now more than ever it is necessary that medical ethics acknowledges that medicine, society and medical jurisprudence have changed and doctors must be given new rules in order to protect both patients' rights and dignity of the profession. The physician's right to refuse to perform treatment at odds with his own clinical beliefs cannot be the only mean to safeguard the dignity of the profession. A clear boundary must also be established between medicine and professionalism as well as the criteria in determining the scientific evidences that physicians must follow. This has not been done in the Italian code of ethics, despite all the controversy caused by the Stamina case

Production cost model of the multi-jet-fusion technology

© IMechE 2019. The paper presents a model of the production costs of the multi-jet-fusion technology that is based on a model of production costs of the selective laser sintering technology. The model is developed using the methodology of analysis of the event-driven process chain, which consists of modeling, batch assembly, setup, building, removal, and blasting activities. Production costs of each of the activities are separated to direct (labor, material, and energy) costs and indirect (equipment, overheads, and other indirect) costs. The developed model represents a basis for the development of algorithms and software tools for the calculation of the production costs of the multi-jet-fusion technology, since it defines all the necessary inputs and calculation procedures that enable the calculation of the total costs of a batch of products. Besides, the paper presents a procedure for the estimation of production costs that are attributed to a single product or product type.The authors wish to acknowledge the support of European Commission through the project “Advanced design rules for optimal dynamic properties of additive manufacturing products – A_MADAM”, which has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 734455

Maternal cultural orientation and speech sound production in Spanish/English dual Language preschoolers

Empirical work has shown that maternal education is related to children’s language outcomes, especially in the societal language, among Spanish-English bilingual children growing up in the U.S. However, no study thus far has assessed the links between maternal cultural orientation and children’s speech sound production. This paper explores whether mothers’ orientation to American (acculturation) and Mexican culture (enculturation) and overall linear acculturation are related to children’s accuracy of production of consonants, of different sound classes, and of phonemes shared and unshared between languages in both English and Spanish at age 4;6 (4 years and 6 months). The results reveal a link between maternal acculturation and children’s segmental accuracy in English, but no relation was found between mothers’ enculturation and children’s speech sound production in Spanish. We interpreted the results in English as suggesting that more American-oriented mothers may have been using more English with their children, boosting their English production abilities and promoting English speech sound development. At the same time, we speculate that the results in Spanish were possibly due to the high and homogeneous levels of Mexican orientation among mothers, to language input differences attributable to distinct cultural practices, or to the status of Spanish as a minority language