To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Direct-to-consumer (DTC) genetic testing has raised questions about the accuracy of the test results, which may raise potential novel liability issues. This chapter examines potential liability exposures relating to DTC genetic testing in two main contexts. The first is potential liability for the DTC provider itself for erroneous results. Key issues in such cases will be the validity and effect of the representations and disclosures that the DTC company provides, which often informs the consumer that the results should not be relied on for medical care, disclaim any liability for any harms that may result from such reliance, and require any disputes to be resolved by mandatary arbitration. The second potential type of case is against health care providers who are presented with DTC results by their patients. Providers will often be put in a “damned if they do, damned if they don’t” predicament by such results, as both ignoring or relying on the DTC test results could create potential liabilities in certain situations. While providers can usually protect themselves by requiring validation of the DTC results by an independent laboratory, time and economic constraints may make this infeasible in some cases.
Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both health care and legal actors to address and manage those liability risks.
The revised Common Rule includes a new option for the conduct of secondary research with identifiable data and biospecimens: regulatory broad consent. Motivated by concerns regarding autonomy and trust in the research enterprise, regulators had initially proposed broad consent in a manner that would have rendered it the exclusive approach to secondary research with all biospecimens, regardless of identifiability. Based on public comments from both researchers and patients concerned that this approach would hinder important medical advances, however, regulators decided to largely preserve the status quo approach to secondary research with biospecimens and data. The Final Rule therefore allows such research to proceed without specific informed consent in a number of circumstances, but it also offers regulatory broad consent as a new, optional pathway for secondary research with identifiable data and biospecimens. In this article, we describe the parameters of regulatory broad consent under the new rule, explain why researchers and research institutions are unlikely to utilize it, outline recommendations for regulatory broad consent issued by the Secretary's Advisory Committee on Human Research Protections (SACHRP), and sketch an empirical research agenda for the sorts of questions about regulatory broad consent that remain to be answered as the research community embarks on Final Rule implementation.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.
Archival data from the HI Parkes All-Sky Survey (HIPASS) and the HI Zone of Avoidance (HIZOA) survey have been carefully reprocessed into a new 1.4 GHz continuum map of the sky south of δ = +25°. The wide sky coverage, high sensitivity of 40 mK (limited by confusion), resolution of 14.4 arcmin (compared to 51 arcmin for the Haslam et al. 408 MHz and 35 arcmin for the Reich et al. 1.4 GHz surveys), and low level of artefacts make this map ideal for numerous studies, including: merging into interferometer maps to complete large-scale structures; decomposition of thermal and non-thermal emission components from Galactic and extragalactic sources; and comparison of emission regions with other frequencies. The new map is available for download.
Significant new opportunities for astrophysics and cosmology have been identified at low radio frequencies. The Murchison Widefield Array is the first telescope in the southern hemisphere designed specifically to explore the low-frequency astronomical sky between 80 and 300 MHz with arcminute angular resolution and high survey efficiency. The telescope will enable new advances along four key science themes, including searching for redshifted 21-cm emission from the EoR in the early Universe; Galactic and extragalactic all-sky southern hemisphere surveys; time-domain astrophysics; and solar, heliospheric, and ionospheric science and space weather. The Murchison Widefield Array is located in Western Australia at the site of the planned Square Kilometre Array (SKA) low-band telescope and is the only low-frequency SKA precursor facility. In this paper, we review the performance properties of the Murchison Widefield Array and describe its primary scientific objectives.
Susceptibility-weighted imaging (SWI) has proven to be a very sensitive technique for the identification of cerebral microbleeds (CMBs). Increased sensitivity to CMBs may allow assessment of the rate of microhemorrhage development or regression, allowing more precise analysis of the natural history of disease, or better assessment of response to therapy. Early recognition may be advantageous to patients treated with anticoagulant or aspirin therapy in that they are at increased risk for subsequent and possibly fatal hemorrhage. There are in the order of 1.4 million people a year affected by traumatic brain injury (TBI). For these patients, computed tomography (CT) is the mainstay of imaging in the emergency setting and does a good job detecting major bleeds. Radiation damage to blood vessels and radiation necrosis can result from treating tumors and disease with potentially damaging doses of radiation. Future semiautomated methods hold promise for evaluating large numbers of patients using SWI.
The goal was to compare children with hemiplegia with those with diplegia within Gross Motor Functional Classification System (GMFCS) levels using multiple validated outcome tools. Specifically, we proposed that children with hemiplegia would have better gait and gross motor function within levels while upper extremity function would be poorer. Data were collected on 422 ambulatory children with cerebral palsy: 261 with diplegia and 161 with hemiplegia, across seven centers. Those with hemiplegia in each level performed significantly and consistently better on gait or lower extremity function and poorer on upper extremity and school function than those with diplegia. In GMFCS Level II, the group with hemiplegia walked faster (p=0.017), scored 6.6 points higher on Dimension E of the Gross Motor Function Measure (p=0.017), 6.7 points lower on Upper Extremity subscale of the Pediatric Outcomes Data Collection Instrument, and 9.1 points lower on WeeFIM self-care (p=0.002). Basing motor prognosis on GMFCS level alone may underestimate lower extremity skills of children with hemiplegia, and overestimate those of children with diplegia.
The Aurora programme is the European Space Agency programme of planetary exploration focused primarily on Mars. Although the long-term goals of Aurora are uncertain, the early phases of the Aurora programme are based on a number of robotic explorer missions – the first of these is the ExoMars rover mission currently scheduled for launch in 2013 (originally 2011). The ExoMars rover – developed during a Phase A study – is a 240 kg Mars rover supporting a 40 kg payload (called Pasteur) of scientific instruments specifically designed for astrobiological prospecting to search for evidence of extant or extinct life. In other words, ExoMars represents a new approach to experimental astrobiology in which scientific instruments are robotically deployed at extraterrestrial environments of astrobiological interest. Presented is an outline of the design of the rover, its robotic technology, its instrument complement and aspects of the design decisions made. ExoMars represents a highly challenging mission, both programmatically and technologically. Some comparisons are made with the highly successful Mars Exploration Rovers, Spirit and Opportunity.
Joe Barnes, Research FellowJames A. Baker III Institute for Public Policy, Rice University,
Mark H. Hayes, Research Fellow, Program on Energy and Sustainable DevelopmentFreeman Spogli Institute for International Studies, Stanford University,
Amy M. Jaffe, Rice University,
David G. Victor, Director, Program on Energy and Sustainable DevelopmentFreeman Spogli Institute for International Studies, Stanford University
Natural gas is rapidly gaining importance in global energy markets. Prized for its relatively clean and efficient combustion, gas is becoming the fuel of choice for a wide array of uses, notably the generation of electric power. Natural gas is projected to be the fastest-growing major source of primary energy over the coming decades, with global consumption increasing nearly two-fold by 2030 (EIA 2004; IEA 2004). In the next few years, gas will surpass coal to become the world's second most important energy source; by 2050 gas could surpass oil to occupy the number one slot. Recent price increases do not fundamentally challenge the economic viability of this robust gas future.
There is plenty of gas to satisfy these visions of global gasification. The broadest measure of gas available totals about 350 trillion cubic meters (Tcm), or roughly 130 years at today's rate of consumption (USGS 2000). Even “proved reserves,” a narrower measure of just the gas that has been detected and is commercial to develop using today's technology, suggest that scarcity is unlikely to impede a global shift to gas. The widely referenced BP Statistical Review of World Energy reports 176 Tcm of proved gas worldwide, or nearly 70 years at current production levels (BP 2004).
The geographical, financial and political barriers to gas development, however, will be harder to clear.
Direct payments have been heralded by the disability movement as an important means to achieving independent living and hence greater social justice for disabled people through enhanced recognition as well as financial redistribution. Drawing on data from the ESRC funded project Disabled People and Direct Payments: A UK Comparative Perspective, this paper presents an analysis of policy and official statistics on use of direct payments across the UK. It is argued that the potential of direct payments has only partly been realised as a result of very low and uneven uptake within and between different parts of the UK. This is accounted for in part by resistance from some Labour-controlled local authorities, which regard direct payments as a threat to public sector jobs. In addition, access to direct payments has been uneven across impairment groups. However, from a very low base there has been a rapid expansion in the use of direct payments over the past three years. The extent to which direct payments are able to facilitate the ultimate goal of independent living for disabled people requires careful monitoring.