Informed Consent in the Prescription Drug Context: The Special Case

Evaluation of the general doctrine of informed consent is the starting point for determining whether, and how, the doctrine might apply to prescription drug therapy. This article demonstrates that, unlike the decision to undergo surgery (the more typical informed consent situation), the process of prescribing drugs contains numerous considerations, many of which are inherent in and unique to prescription drug therapy. The presence of these considerations dictates that courts accord even greater significance to the need for patient participation in prescription drug therapy than that accorded in the more typical consent to surgery situation. Moreover, in light of the many unique considerations involved, courts need to examine their ready deference to physicians\u27 autonomy, which results in total exclusion of patient participation and the abrogation of patients\u27 rights of self-determination and bodily integrity. This article argues that when the physician prescribes drug therapy, the only reasonable guarantee of a patient\u27s right of bodily integrity and self-determination is for courts to apply a subjective, individual-patient standard of disclosure in conjunction with a presumption of proximate cause. Finally, the article proposes a duty/disclosure scheme that alters the objective-patient model of informed consent to accommodate the unique aspects of prescription drug therapy and to give full force and effect to the patient\u27s rights

Li distribution in the ionic conductor Li1+xAlxTi2-x(PO4)3 with 0 ≤ x ≤ 0.6 studied by neutron diffraction

Li1+xAlxTi2-xP3O12 (LATP) is among the most widely investigated solid electrolyte materials for Li ion batteries because of its relatively high ionic conductivity, chemical stability and mechanical strength. Its ionic conductivity is induced by partial substitution of Ti with Al, in combination with the incorporation of additional Li ions into the structure. The electrical conductivity therefore depends strongly on the substitution parameter x. A series of Li1+xAlxTi2-x(PO4)3 powders with 0 ≤ x ≤ 0.6 were prepared by two different syntheses routes, a) solid state reaction and b) a novel sol-gel method leading to high phase purity, densification activity and conductivity. The highest ionic conductivity of 1.0 × 10-3 S cm-1 at 25 °C was obtained for Li1.5Al0.5Ti1.5(PO4)3 with nearly theoretical density. We have studied the distribution of Li ions in this series by neutron diffraction analysis at different temperatures. The refinements revealed that excess Li ions are scattered throughout the crystal structure at temperatures above 600 K, making it difficult to precisely determine Li positions and non-stoichiometry. At low temperatures Li ions may occupy a set of different positions, namely the 6a site identified in our previous study or the 18e and 36f sites discussed in the literature [1-3]. A correlation between the synthesis method and the location of Li ions was observed, which is consistent with the ionic conductivity of these materials. [1] E. Dashjav, F. Tietz, Z. Anorg. Allg. Chem., 2014, 640, 15, 3070 [2] D. Tran Qui, S. Hamdoune, J. L. Soubeyroux, E. Prince, J. Solid State Chem. 1988, 72, 309 [3] M. Catti, A. Comotti, S. di Blas, R. M. Ibberson, J. Mater. Chem., 2004, 14, 83

Exposure to Polyfluoroalkyl Chemicals and Cholesterol, Body Weight, and Insulin Resistance in the General U.S. Population

BACKGROUND. Polyfluoroalkyl chemicals (PFCs) are used commonly in commercial applications and are detected in humans and the environment worldwide. Concern has been raised that they may disrupt lipid and weight regulation. OBJECTIVES. We investigated the relationship between PFC serum concentrations and lipid and weight outcomes in a large publicly available data set. METHODS. We analyzed data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES) for participants 12-80 years of age. Using linear regression to control for covariates, we studied the association between serum concentrations of perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), and perfluorohexane sulfonic acid (PFHxS) and measures of cholesterol, body size, and insulin resistance. RESULTS. We observed a positive association between concentrations of PFOS, PFOA, and PFNA and total and non-high-density cholesterol. We found the opposite for PFHxS. Those in the highest quartile of PFOS exposure had total cholesterol levels 13.4 mg/dL [95% confidence interval (CI), 3.8-23.0] higher than those in the lowest quartile. For PFOA, PFNA, and PFHxS, effect estimates were 9.8 (95% CI, -0.2 to 19.7), 13.9 (95% CI, 1.9-25.9), and -7.0 (95% CI, -13.2 to -0.8), respectively. A similar pattern emerged when exposures were modeled continuously. We saw little evidence of a consistent association with body size or insulin resistance. CONCLUSIONS. This exploratory cross-sectional study is consistent with other epidemiologic studies in finding a positive association between PFOS and PFOA and cholesterol, despite much lower exposures in NHANES. Results for PFNA and PFHxS are novel, emphasizing the need to study PFCs other than PFOS and PFOA.National Institute of Environmental Health Sciences (R21ES013724, T32ES014562

Throat Swabs Are Necessary to Reliably Detect Carriers of Staphylococcus aureus

The anterior nares are the most important screening site of colonization with Staphylococcus aureus. We screened 2966 individuals for S. aureus carriage with swabs of both nares and throat. A total of 37.1% of persons were nasal carriers, and 12.8% were solely throat carriers. Screening of throat swabs significantly increases the sensitivity of detection among carriers by 25.7