735 research outputs found
The Fairness of a Fair Trial: Not Guilty Pleas and the Right to Effective Assistance of Counsel
The pervasiveness of plea bargaining in our modern justice system has led too many courts to conclude that the Sixth Amendment right to effective assistance of counsel applies to not guilty pleas. This Note argues that, although the United States Supreme Court has never directly addressed this issue, its decisions inform a Sixth Amendment analysis and indicate that the right to effective assistance of counsel is limited to providing the defendant a fair trial. The Court has suggested that a critical stage at which this right attaches must, in contrast to a not guilty plea, affect the fairness of a defendant’s trial. It has further indicated that a defendant who receives a fair trial after pleading not guilty cannot establish the constitutional prejudice required to demonstrate ineffective assistance. Finally, the past seventy years of Supreme Court Sixth Amendment jurisprudence supports the conclusion that the gravamen of an ineffective assistance of counsel claim is an assertion that the defendant was denied a fair trial
The Mgeni Estuary pre- and post Inanda Dam Estuarine dynamics.
Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2009.The funnel-shaped Mgeni Estuary, at the mouth of the fourth largest river along the KwaZulu- Natal coast, discharges into the Indian Ocean in the northern suburbs of Durban. This system is under considerable anthropogenic stress associated with modern development and industrialisation, both adjacent to the estuary and in the catchment area. The construction of Inanda Dam in 1989, immediately upstream of the estuary, is considered to have had an irreversible impact on the system and the estuary and is addressed in this study. A thorough analysis of available maps, aerial photographs and oblique images from 1860 to 2006, provided a record of the changes in the estuary morphology. The Pre-Inanda Dam period is characterised by the repeated re-establishment of a large central bar after major floods as evident prior to the 1987 flood. The post 1989 Inanda-Dam period, however, is characterised by the deposition of a series of side-attached bars and the development of extensive mudflats. Sediment distribution results show a definite decrease in grain size compared to the predominant gravel fraction in 1986 towards an estuary dominated by medium to fine sand-sized sediment. A reduction in sediment grain size is also complemented by an increase in carbonate concentration throughout the estuary. This indicates an increase in marine incursion with decreased fluvial flow suggesting a shift from a river dominated estuary to a marine dominated system since the completion of Inanda Dam. Linked to the finer grained sediment is a higher increased organic and heavy metal concentration. An analysis of the enrichment factor for 9 metals shows that the Mgeni Estuary is significantly contaminated, especially at the head of the estuary. This situation is exacerbated by decreased fluvial flow rates, an increase in the frequency of mouth closures and the reduction in flooding events effectively preventing the removal of contaminants out of the estuary
Gastrointestinal Mucormycosis in a Renal Transplant Patient
The clinical course and management of a rare case of gastrointestinal mucormycosis occurring in a renal transplant patient are presented. The diagnosis was made on pathological examination of surgically resected tissue from the colon, spleen and stomach. The patient did not survive the infection. To the best of our knowledge, this is the 11th reported case of gastrointestinal mucormycosis in a solid organ transplant patient. The pathophysiology, incidence and prognosis of this disease are discussed
A global analysis of the use of immunoglobulin, shortages in supply, and mitigating measures:A survey of hospital providers (a BEST Collaborative study)
Background:Immunoglobulin (IG) therapy is widely used to treat primary and secondary immune deficiencies and as immunomodulatory agent for various disorders. There is great concern that shortages of IG may rise, potentially affecting medical treatment options. Study Design and Methods: An international survey was developed to study how intravenous immunoglobulins (IVIGs) are used and managed within hospitals in case of shortages. Study data were collected and managed using REDCap electronic data capture tools hosted by the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. The survey was directed to hospital pharmacists and blood bank transfusion professionals and disseminated through members of the BEST Collaborative network. Results: Survey respondents from institutions in the USA, Canada, Europe, Japan, and Australia (n = 13) confirmed that the primary specialties utilizing IG are neurology, hematology, and immunology. More than 60% of respondents reported IG supply shortages, but mitigation strategies were not well developed. Discussion: As IG is the leading driver in plasma demand, more studies are needed to understand current and future demand for IG from the clinical perspective. Necessity lies in establishing clinical guidance to address shortages.</p
Different doses of prophylactic platelet transfusion for preventing bleeding in patients with haematological disorders after chemotherapy or stem cell transplantation
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether different doses of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect their efficacy and safety in preventing bleeding in patients with haematological disorders after chemotherapy with or without stem cell transplantation
A global analysis of the use of immunoglobulin, shortages in supply, and mitigating measures:A survey of hospital providers (a BEST Collaborative study)
Background:Immunoglobulin (IG) therapy is widely used to treat primary and secondary immune deficiencies and as immunomodulatory agent for various disorders. There is great concern that shortages of IG may rise, potentially affecting medical treatment options. Study Design and Methods: An international survey was developed to study how intravenous immunoglobulins (IVIGs) are used and managed within hospitals in case of shortages. Study data were collected and managed using REDCap electronic data capture tools hosted by the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. The survey was directed to hospital pharmacists and blood bank transfusion professionals and disseminated through members of the BEST Collaborative network. Results: Survey respondents from institutions in the USA, Canada, Europe, Japan, and Australia (n = 13) confirmed that the primary specialties utilizing IG are neurology, hematology, and immunology. More than 60% of respondents reported IG supply shortages, but mitigation strategies were not well developed. Discussion: As IG is the leading driver in plasma demand, more studies are needed to understand current and future demand for IG from the clinical perspective. Necessity lies in establishing clinical guidance to address shortages.</p
A systematic review and meta-analysis of the utility of EUS for preoperative staging for gastric cancer
Background Accurate preoperative staging is important in determining the appropriate treatment of gastric cancer. Recently, endoscopic ultrasound (EUS) has been introduced as a staging modality. However, reported test characteristics for EUS in gastric cancer vary. Our purpose in this study was to identify, synthesize, and evaluate findings from all articles on the performance of EUS in the preoperative staging of gastric cancer.Methods Electronic literature searches were conducted using Medline, Embase, and the Cochrane Central Register of Controlled Trials from 1 January 1998 to 1 December 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. Meta-analysis for the performance of EUS was analyzed by calculating agreement (Kappa statistic), and pooled estimates of accuracy, sensitivity, and specificity for all EUS examinations, using histopathology as the reference standard. Subgroup analyses were also performed.Results Twenty-two articles met our inclusion criteria and were included in the review. EUS pooled accuracy for T staging was 75% with a moderate Kappa (0.52). EUS was most accurate for T3 disease, followed by T4, T1, and T2. EUS pooled accuracy for N staging was 64%, sensitivity was 74%, and specificity was 80%. There was significant heterogeneity between the included studies. Subgroup analyses found that annual EUS volume was not associated with EUS T and N staging accuracy (P = 0.836, 0.99, respectively).Conclusion EUS is a moderately accurate technique that seems to describe advanced T stage (T3 and T4) better than N or less advanced T stage. Stratifying by EUS annual volume did not affect EUS performance in staging gastric cancer.Canadian Cancer SocietyMinistry of Health and Long Term CareCIHRHanna Family Chair in Surgical OncologySunnybrook Hlth Sci Ctr, Sunnybrook Res Inst, Toronto, ON M4N 3M5, CanadaSunnybrook Hlth Sci Ctr, Div Surg Oncol, Toronto, ON M4N 3M5, CanadaOdette Canc Ctr, Toronto, ON M4N 3M5, CanadaInst Clin Evaluat Sci, Toronto, ON, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilSunnybrook Hlth Sci Ctr, Div Gastroenterol, Dept Med, Toronto, ON M4N 3M5, CanadaUniversidade Federal de São Paulo, Dept Surg, São Paulo, BrazilCanadian Cancer Society: 019325Web of Scienc
Restrictive versus liberal red blood cell transfusion strategies for patients with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine the efficacy and safety of restrictive versus liberal transfusion strategies for patients with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without HSCT
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