The neurosciences not only challenge assumptions about the mind’s place in the natural world but also urge us to reconsider its role in the normative world. Based on mind-brain dualism, the law ...affords only one-sided protection: it systematically protects bodies and brains, but only fragmentarily minds and mental states. The fundamental question, in what ways people may legitimately change mental states of others, is largely unexplored in legal thinking. With novel technologies to both intervene into minds and detect mental activity, the law should, we suggest, introduce stand alone protection for the inner sphere of persons. We shall address some metaphysical questions concerning physical and mental harm and demonstrate gaps in current doctrines, especially in regard to manipulative interferences with decision-making processes. We then outline some reasons for the law to recognize a human right to mental liberty and propose elements of a novel criminal offence proscribing severe interventions into other minds.
This paper uses an ecological perspective to explore the risk factors associated with bullying behaviors among a representative sample of adolescents aged 11-14 graphic removed Data derived from the ...Health Behavior in School Children: WHO Cross-National Survey were used to model the relationship between bullying and media effects, peer and family support systems, self-efficacy, and school environment. Overall, the results of this study suggest that bullying increases among children who watch television frequently, lack teacher support, have themselves been bullied, attend schools with unfavorable environments, have emotional support from their peers, and have teachers and parents who do not place high expectations on their school performance. In addition, we found an inverse relationship between being Asian or African American, feeling left out of school activities and bullying. Our results lend support to the contention that bullying arises out of deficits in social climate, but that social support systems mediate bullying behavior irrespective of the student's racial/ethnic characteristics, parental income levels or media influences. Because the number of friends and the ability to talk to these friends increases the likelihood of bullying, we suggest that bullying is not simply an individual response to a particular environment but is a peer-group behavior. We conclude that limiting television viewing hours, improving student's abilities to access family support systems and improving school atmospheres are potentially useful interventions to limit bullying behavior.
Dans le cadre de l’examen psychiatrique des dommages d’une victime, la recherche d’un lien d’imputabilité entre un événement, un syndrome post-traumatique et des symptômes d’addiction est ...particulièrement difficile. Nous tentons de clarifier les problèmes liés au raisonnement médico-légal en psychiatrie.
Nous effectuons une revue de la littérature sur deux points. Le premier concerne les notions d’imputabilité, de causalité médicale et de causalité juridique. Le deuxième porte sur les liens entre des conduites addictives et des symptômes traumatiques. Via PubMed et Ascodocpsy, avec les mots clefs suivants : « Substance use disorder in patient with post-traumatic stress disorder ». Dans le champ psychodynamique avec la notion de « traumatophilie ».
1/Le raisonnement juridique rentre dans une démarche rétrospective et recherche l’attribution sociale d’une responsabilité pénale, civile ou administrative. Il est en contradiction avec le raisonnement médical qui vise un projet de soins tourné vers l’action, l’avenir et une possible guérison. 2/Les critères d’imputabilité sont issus d’une médecine d’organe et sont marqués par un modèle lésionnel d’organe. Ils ne sont pas pertinents pour la psychiatrie. 3/Les liens entre le traumatisme et l’addiction sont complexes car il existe une influence réciproque entre l’addiction et l’état de stress post-traumatique : la persistance de l’un favorise la rechute ou l’aggravation de l’autre. Sur un plan statistique, les études montrent une association franche entre des troubles addictifs et des troubles psycho-traumatiques. Les patients qui présentent une comorbidité ESPT/addiction ont par rapport à un ESPT isolé, une évolution plus péjorative surtout si cette comorbidité est associée à des antécédents d’abus durant l’enfance, des maltraitances, une pathologie antérieure, la prise de cocaïne et d’opiacés, un faible soutien par les proches. Quatre modèles psychopathologiques font références : le modèle de risque élevé de trauma, le modèle de vulnérabilité partagée, le modèle de susceptibilité, le modèle de l’automédication. Sur un plan psychodynamique, l’addiction peut se modéliser comme une tentative d’anesthésie psychique, de contrôle et de liaison des angoisses traumatiques.
Pour clarifier le raisonnement médico-légal en psychiatrie portant sur l’imputabilité d’un événement sur des symptômes psycho-traumatiques et des symptômes addictifs, nous proposons d’assumer les spécificités de la maladie mentale. Les maladies mentales sont des maladies fonctionnelles. Il faut donc chercher des modalités de liaison, et non de lésion, entre différents facteurs psychiques. L’addiction est à envisager systématiquement comme un facteur comorbide d’un syndrome psychotraumatique. Entre une addiction et un ESPT : la persistance de l’un favorise la rechute ou l’aggravation de l’autre. Le lien d’imputabilité nous apparaît intéressant à explorer selon les hypothèses développées dans les modèles de comorbidité somatoformes ou bipolaires. Nous proposons plusieurs questions-types qui peuvent aider à la poursuite d’un raisonnement clinique autour de l’imputabilité des troubles.
In the context of the psychiatric examination of the damage of a victim, the research for a link of imputability between an event, a post-traumatic syndrome and symptoms of addiction is specially difficult. We attempt to clarify issues related to forensic thinking in psychiatry.
We carry out a review of the literature on two points: The first one concerns the notions of imputability, medical causality and legal causality. The second one concerns the links between addictive behaviors and traumatic symptoms. Via PubMed and Ascodocpsy, with the following keywords: “Substance use disorder in patient with post-traumatic stress disorder”. In the psychodynamic field with the notion of “traumatophilia”.
1/The legal reasoning is part of a retrospective approach and seeks the social assignment of criminal, civil or administrative responsibility. It contradicts the medical reasoning which aims for a care project focused on action, the future and a possible cure. 2/Imputability criteria come from organ medicine and are marked by an organ lesion model. They are irrelevant to psychiatry. 3/The links between trauma and addiction are complex because there is a reciprocal influence between addiction and post-traumatic stress disorder: the persistence of one promotes the relapse or worsening of the other one. On a statistical level, the studies show a clear link between addictive disorders and psycho-traumatic disorders. Patients with PTSD/addiction comorbidity have, compared to isolated PTSD, a more pejorative evolution, especially if PTSD/addiction is associated with a history of childhood abuse, mistreatment, previous pathology, cocaine use and drug abuse opiates, low support by relatives. Four psychopathological models are referred to PTSD/addiction: the high risk of trauma model, the shared vulnerability model, the susceptibility model, the self-medication model. On a psychodynamic level, addiction can be modeled as an attempt at psychic anesthesia, control and binding of traumatic anxieties. On the neurobiological level, the reference models are based on the hypothalamic-pituitary and noradrenergic system, the opioid systems, NMDA and GABA.
To clarify the medico-legal reasoning in psychiatry relating to the imputability of an event on psycho-traumatic symptoms and addictive symptoms, we propose to assume the specificities of mental illness. Mental illnesses are functional illnesses. It is therefore necessary to look for modalities of connection, and not of lesion, between different psychic factors. Addiction should be systematically considered as a comorbid factor of a psychotraumatic syndrome. Between an addiction and PTSD: the persistence of one favors the relapse or worsening of the other. The imputability link seems interesting to us to explore according to the hypotheses developed in the somatoform or bipolar comorbidity models. We suggest several standard questions that may help in the pursuit of clinical reasoning around the imputability of disorders. Is the traumatic disorder primary and the addiction sequel? Is addictive behavior primary and after effects disorders? Are the two disorders primary and independent? Are the two disorders the outcome of the same underlying cause? Is the traumatic disorder altered by the addiction? Are the traumatic disorder and the addictive disorder combined to form a neopathology? Is addiction a symptom of traumatic disorder? Does the addiction bring out the traumatic disorder? Is the addiction an attempt to self-medicate for the traumatic disorder? Do addiction and traumatic disorder share common risk factors? Circular causality model: are addiction and traumatic disorder mutually reinforcing?
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Transmission pipelines deliver natural gas to consumers around the world for the production of heat, electricity, and organic chemicals. In the United States, 2.56 million miles (4.12 million km) of ...pipelines carry natural gas to more than 75 million customers. With the benefits of pipelines come the risks to health and property posed by leaks and explosions. Proposals for new and recommissioned pipelines challenge host communities with uncertainty and difficult decisions about risk management. The appropriate community response depends on the risk level, the potential cost, and the prospect for compensation in the event of an incident. This article provides information on the risks and expected costs of pipeline leaks and explosions in the United States, including the incident rates, risk factors, and magnitude of harm. Although aggregated data on pipeline incidents are available, broadly inclusive data do not serve the needs of communities that must make critical decisions about hosting a pipeline for natural gas transmission. This article breaks down the data relevant to such communities and omits incidents that occurred offshore or as part of gas gathering or local distribution. The article then explains possible approaches to risk management relevant to communities, pipeline companies, and policymakers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Minimal responsibility threateners (MRTs) are epistemically justified but mistaken in thinking that imposing a nonnegligible risk on others is permissible. On standard accounts, an MRT forfeits her ...right not to be defensively killed. I propose an alternative account: an MRT is liable only to the degree of harm equivalent to what she risks causing multiplied by her degree of responsibility. Harm imposed on the MRT above that amount is justified as a lesser evil, relative to allowing the MRT to kill her victim. This hybrid account, which generalizes to those are who are more than minimally responsible, has considerable advantages.
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Purpose
To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair.
Methods
An insurance ...database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0–2, 2–4, and 4–6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair. Rates of failure requiring revision rotator cuff repair were compared within 2 years.
Results
A total of 1292 patients were prescribed fluoroquinolones within 6 months after rotator cuff repair, including 442 within 2 months, 433 within 2 to 4 months, and 417 within 4 to 6 months, and were compared to 5225 matched negative controls and 1597 matched positive controls. The rate of revision rotator cuff repair was significantly higher in patients prescribed fluoroquinolones within 2 months (6.1 %) compared to matched negative (2.2 %,
P
= 0.0009) and positive controls (2.4 %,
P
= 0.0026). There were no significant differences in the rate of revision rotator cuff repair when fluoroquinolones were prescribed >2 months after rotator cuff repair.
Conclusions
Early use of fluoroquinolones following rotator cuff repair was independently associated with significantly increased rates of failure requiring revision rotator cuff repair. This is the first clinical study examining the association of postoperative fluoroquinolone use with failure following arthroscopic rotator cuff repair.
Level of evidence
III.
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EMUNI, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Aims: Functional disorders, defined as functional somatic syndromes (FSS) or bodily distress syndrome (BDS), are prevalent in the general Danish population. However, more knowledge about ...characteristics of the disorders is needed. The aim of this study was to characterize cases of FSS and BDS by several social, mental, physical, and lifestyle outcome measures and compare them for similarities and differences between mutual syndromes and non-cases. Methods: Cases of FSS, i.e. irritable bowel syndrome (n=337), fibromyalgia (n=442) and chronic fatigue syndrome (n=823), and cases of BDS, i.e. cardiopulmonary (n=137), gastrointestinal (n=405), musculoskeletal (n=1063), and general symptoms (n=408) subtypes were identified from the DanFunD general population cohort (n=9656) by means of pre-defined diagnostic algorithms and compared on 1) Social parameters: Age, sex. and education: 2) Mental parameters: Number of adverse life events, health anxiety (Whiteley-7), mental distress (SCL-8) and kinesophobia (Tampa-7); 3) Physical parameters: Fitness, systolic blood pressure, handgrip and BM1; 4) Lifestyle parameters: Alcohol consumption, diet, smoking and physical activity, and 5) Self-perceived health. Cases and non-cases were compared with linear regression for continuous outcomes and logistic regression for binary and categorical outcomes. The analyses were adjusted for age, sex and education level. Results: Generally, cases differed from non-cases, and there was a strong association between positive case status and reporting a poor self-perceived health (p<0.00l). Cases were more prone to be females, having less education, consuming less alcohol, eating unhealthily, being a previous or current smoker, and having a more sedentary lifestyle (p<0.05). As for mental parameters, cases had a higher score on all measurements (p<0.001). Besides systolic blood pressure, the majority of cases differed from non-cases regarding physical parameters (p<0.005), having higher BMI. less exercise capacity and lower handgrip strength. Differences between the various syndromes will be further explored. Conclusion: Cases of FSS and BDS differed significantly from non-cases regarding aspects of social, mental, physical, and lifestyle parameters, and they were more prone to report a poor self-perceived.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Cuts to legal aid have helped fuel rises in the amount that clinical negligence costs the NHS, Robert Francis QC has said. There was the halcyon period when legal aid was available to bring claims, ...the abolition of which has caused, I suspect, many of the problems we see in the NAO report."
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The UK government is again to change the method for setting the personal injury discount rate, after deciding that the last change, made six months ago, has overcompensated people who have been ...seriously injured through negligence. 1 The rate, the notional return to be expected from investing a lump sum award, is used in calculating payouts for injury, including those for clinical negligence. Matthew Lee, professional services director at the MDU, said, "The MDU has held off passing on the cost of the previous discount rate change to GPs-which would be simply unaffordable for many-to give the government time to develop a promised solution to protect GPs. The plan for new legislation to reform the discount rate came on the same day that the National Audit Office called for a "coherent, cross-government strategy" to try to curb the spiralling cost of clinical negligence claims. 2 Its report said, "The government needs to take a stronger and more integrated approach to fundamentally change the biggest drivers of increasing cost across the health and justice systems.
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