Enlightenment: Science and Human Rights

The subject of science and human rights sparks off thoughts of how this link has historically and geographically been severed, which has the effect of finding it newsworthy that scientists speak out in favor of human rights. The ancient Greek philosophers were not limited in their subject matters in the same way as we take for granted now: science, society and the self were all deliberated about both empirically and normatively. Moreover, there was no division of labor between thinkers about one or other of these subjects. Pre-Islamic Persian influences also affected debates on science. In the Middle Ages with Christian, Jewish and Islamic scholarly efforts mainly located in religious contexts, still there was no separation between studying science and society

Rights and responsibilities in trafficking for forced labour: Migration regimes, labour law and welfare states

Trafficking in human beings is often associated with women and girls and especially the sex industry. Gradually information is getting through more widely about cases of exploitation in domestic work, agriculture, hospitality and construction, too. In this paper I add to the conventional picture of trafficking in human beings by illustrating that trafficking for labour occurs in a long list of industries by discussing the outcomes of a recent collaborativeresearch project across Europe http://www.esf.org/activities/eurocores/programmes/ecrp/ecrp-i-2005.html).I put forward an argument that vulnerability to labour exploitation is often exacerbated by current complex and restrictive migration regimes, the complexity and restrictive nature of labour laws and the harsh exclusions from welfare provisions in several European states.I suggest that cosmopolitanism is a good starting-point for addressing these issues. Usually cosmopolitanism is associated with duties across borders but in an age of migration the duties of states and their ‘global citizens’ are as much towards their disenfranchised counterpartswithin their countries. This means that creating accessible human rights involves initiatives in countries of origin, transit and destination; these should be supported by cross-border collaboration and social investment. Therefore campaigns of solidarity with trafficked persons and measures to prevent trafficking should be directed both to national provisions and international law. I also sketch some implication of cosmopolitanism for individualduties to combat trafficking and transform the regimes that exacerbate it

Healing from War to End All Wars

The First World War was known as the war to end all wars. After the Second World War, and especially in reference to the Holocaust, the urgent slogan was “Never Again.” Although these hopes to end war and genocide have not yet been fulfilled, they inspired the worldwide moral stance against war and a host of international instruments and bodies contributed to the protection of both civilians and combatants during war

Key Components for Antibiotic Dose Optimization of Sepsis in Neonates and Infants.

Sepsis in neonates and infants remains a major cause of death despite a decline in child mortality and morbidity over the last decades. A key factor in further reducing poor clinical outcomes is the optimal use of antibiotics in sepsis management. Developmental changes such as maturation of organ function and capacity of drug metabolizing enzymes can affect the pharmacokinetic profile and therefore the antibiotic exposure and response in neonates and infants. Optimal antibiotic treatment of sepsis in neonates and young infants is dependent on several key components such as the determination of treatment phase, the administered dose and the resulted drug exposure and microbiological response. During the initial phase of suspected sepsis, the primary focus of empirical treatment is to assure efficacy. Once bacterial infection as the cause of sepsis is confirmed the focus shifts toward a targeted treatment, ensuring an optimal balance between efficacy and safety. Interpretation of antibiotic exposure and microbiological response in neonates and infants is multifaceted. The response or treatment effect can be determined by the microbiological parameters (MIC) together with the characteristics of the pathogen (time- or concentration dependent). The antibiotic response is influenced by the properties of the causative pathogen and the unique characteristics of the vulnerable patient population such as reduced humoral response or reduced skin barrier function. Therapeutic drug monitoring (TDM) of antibiotics may be used to increase effectiveness while maximizing safety and minimizing the toxicity, but requires expertise in different fields and requires collaborations between physicians, lab technicians, and quantitative clinical pharmacologists. Understanding these clinical, pharmacological, and microbiological components and their underlying relationship can provide a scientific basic for proper antibiotic use and reduction of antibiotic resistance in neonates and infants. This highlights the necessity of a close multidisciplinary collaboration between physicians, pharmacists, clinical pharmacologists and microbiologist to assure the optimal utilization of antibiotics in neonates and young infants

Neonatal pain management: still in search for the Holy Grail.

Inadequate pain management but also inappropriate use of analgesics in early infancy has negative effects on neurodevelopmental outcome. As a consequence, neonatal pain management is still in search for the Holy Grail. At best, effective pain management is based on prevention, assessment, and treatment followed by a re-assessment of the pain to determine if additional treatment is still necessary. Unfortunately, epidemiological observations suggest that neonates are undergoing painful procedures very frequently, unveiling the need for effective preventive, non-pharmacological strategies. In addition, assessment is still based on validated, multimodal, but subjective pain assessment tools. Finally, in neonatal intensive care units, there is a shift in clinical practices (e.g., shorter intubation and ventilation), and this necessitates the development and validation of new pharmacological treatment modalities. To illustrate this, a shift in the use of opioids to paracetamol has occurred and short-acting agents (remifentanil, propofol) are more commonly administered to neonates. In addition to these new modalities and as part of a more advanced approach of the developmental pharmacology of analgesics, pharmacogenetics also emerged as a tool for precision medicine in neonates. To assure further improvement of neonatal pain management the integration of pharmacogenetics with the usual covariates like weight, age and/or disease characteristics is needed

Individualized dosing of aminoglycosides in neonates: mission accomplished or work in progress?

We have read with great interest the paper of Sherwin et al. on individualized dosing of amikacin based on a population pharmacokinetic and-dynamic (PKPD) study in 80 neonates [1]. To the very best of our knowledge, this is the first PD study (outcome indicator sepsis) of aminoglycosides in neonates. We fully support the clinical need to evaluate both PK and PD of drugs, including aminoglycosides in neonates. The recent review on aminoglycosides in neonates in this journal hereby illustrates that clinical pharmacologists are aware of and interested in the specific needs and characteristics of this patient population [2]. We are, however, intrigued by the dosing suggestions formulated by the authors: 15 mg/kg at 36-h intervals for neonates with a postmenstrual age (PMA)≤28 weeks, 14 mg/kg at 24-h intervals for neonate

Pharmacologic management of the opioid neonatal abstinence syndrome.

Opioid use in pregnant women has increased over the last decade. Following birth, infants with in utero exposure demonstrate signs and symptoms of withdrawal known as the neonatal abstinence syndrome (NAS). Infants express a spectrum of disease, with most requiring the administration of pharmacologic therapy to ensure proper growth and development. Treatment often involves prolonged hospitalization. There is a general lack of high-quality clinical trial data to guide optimal therapy, and significant heterogeneity in treatment approaches. Emerging trends in the treatment of infants with NAS include the use of sublingual buprenorphine, transition to outpatient therapy, and pharmacogenetic risk stratification