The Insidious Foreseeability Revolution.

The laws of medical malpractice have historically differed in significant ways from general liability laws. Until the mid-twentieth century, physician liability in the United States was limited to cases in which the doctor and patient had an established professional relationship. In the 1970s, courts and legislatures began carving out exceptions when patients posed an imminent threat to identifiable third parties.

Metabolite-level regulation of enzymatic activity controls awakening of cyanobacteria from metabolic dormancy.

Transitioning into and out of dormancy is a crucial survival strategy for many organisms. In unicellular cyanobacteria, surviving nitrogen-starved conditions involves tuning down their metabolism and reactivating it once nitrogen becomes available. Glucose-6-phosphate dehydrogenase (G6PDH), the enzyme that catalyzes the first step of the oxidative pentose phosphate (OPP) pathway, plays a key role in this process.

Applying Community-based System Dynamics to promote child health equity: the case of healthy and fit kids in Milwaukee, WI.

Background: Child health equity is influenced by complex systemic factors, including structural racism, socioeconomic disparities, and access to resources. Traditional public health interventions often target individual behaviors, but there is a growing need for systems approaches that address these root causes. This study examines coalition members' perspectives on promoting child health equity in Milwaukee as a result of participating in an intervention that includes Community-based System Dynamics (CBSD).

Advance directives in patients with schizophrenia.

Balancing autonomy and beneficence remains an ongoing challenge in the ethical treatment of patients with schizophrenia and other psychiatric disorders of thought. Psychiatric advance directives (PADs) offer one mechanism through which individuals can guide their own care, but unlike medical advance directives, they are not widely utilized in the United States. They are also highly limited by state law in the scope of their legal authority.

Physicians' Obligation to Disclose Comparative Surgical Outcomes: Distinctive Features of Facial Feminization Surgery.

Physicians are expected to ensure that patients are meaningfully informed and have voluntarily consented prior to engaging in any medical interventions upon a competent patient with decisional capacity. One aspect of informed consent is the disclosure of information that a reasonable patient might require to make a knowledgeable decision. A potential exception to this principle arises regarding the disclosure of a surgeon's degree of skill compared to that of their competitors.

Legal and Ethics Concerns of Psilocybin as Medicine.

Preliminary research shows the psychedelic psilocybin to be a promising potential treatment for psychiatric illnesses. Recent U.S.

Ethical Considerations of Off-Label Prescribing in Disruptive Mood Dysregulation Disorder.

AbstractDisruptive mood dysregulation disorder (DMDD), a relatively new diagnosis in child and adolescent psychiatry that remains without medications approved for its indication, warrants a renewed consideration of the ethics surrounding the off-label use of medications. In the absence of empirical studies, clinicians must work with the best available information regarding treatment, such as case reports demonstrating the success of off-label interventions. Although subject to ethical limitations and the risk-benefit profile of each medication, increased use of this approach in the treatment of DMDD is warranted.

Narratives of Mental Illness and Well-being: A 6-Week Course Aiming to Improve Medical Student Empathy and Resilience Through the Creative Arts.

Objective: Narratives of mental illness and well-being are difficult to communicate in medical education. The arts convey these narratives and may strengthen medical student capabilities.

Methods: This study evaluated the efficacy of a 2021 6-week seminar-style course for medical students focused on five mental states through the lens of visual arts, film, and literature to impact student capabilities.

Changes in systems thinking and health equity considerations across four communities participating in Catalyzing Communities.

Childhood obesity is a persistent public health concern, and community-based interventions have become crucial for addressing it by engaging local communities and implementing comprehensive evidence-based strategies. The Catalyzing Communities intervention takes a "whole-of-community"approach to involve leaders from diverse sectors in thinking systematically about child healthy weights and implementing evidence-based solutions. Using systems thinking and the Getting to Equity framework to guide interview analysis, this study examines changes in participants' use of systems thinking concepts and health equity in 43 participants across four U.

Invisible Victims and the Case for OTC SSRIs.

Major depressive disorder is one of the most common serious illnesses worldwide; the disease is also among those with the lowest rates of treatment. Barriers to access to care, both practical and psychological, contribute significantly to these low treatment rates. Among such barriers are regulations in many nations that require a physician's prescription for most pharmacological treatments including selective serotonin reuptake inhibitors (SSRIs).

Flexibility and Innovation in Decisional Capacity Assessment.

Since the 1980s, the four skills criteria have become the most widely accepted mechanism for the assessment of decisional capacity in the United States. These criteria emerged in response to the paternalistic approach to clinical decision-making that had been widely accepted in an earlier era and offered a means of ensuring that physicians honored the rights of capacitated patients to make their own medical decisions. Unfortunately, the criteria are now applied to situations for which they are not suited and in a manner that is often highly inflexible.

Incarceration Postpartum: Is There a Right to Prison Nurseries?

Rising rates of female incarceration within the United States are incompatible with the lack of federal standards outlining the rights of incarcerated mothers and their children. A robust body of evidence demonstrates that prison nurseries, programmes designed for mothers to keep their infants under their care during detainment or incarceration, provide essential and beneficial care that could not otherwise be achieved within the current carceral infrastructure. These benefits include facilitation of breastfeeding, bonding during a critical period of child development, and decreased recidivism rates for participants.

Insights into electron transfer and bifurcation of the Synechocystis sp. PCC6803 hydrogenase reductase module.

The NAD-reducing soluble [NiFe] hydrogenase (SH) is the key enzyme for production and consumption of molecular hydrogen (H) in Synechocystis sp. PCC6803. In this study, we focused on the reductase module of the SynSH and investigated the structural and functional aspects of its subunits, particularly the so far elusive role of HoxE.

Hospital Nurse Staffing Legislation: Mixed Approaches In Some States, While Others Have No Requirements.

Legislative agendas aimed at regulating nurse staffing in US hospitals have intensified after acute workforce disruptions triggered by COVID-19. Emerging evidence consistently demonstrates the benefits of higher nurse staffing levels, although uncertainty remains regarding whether and which legislative approaches can achieve this outcome. The purpose of this study was to provide a comprehensive updated review of hospital nurse staffing requirements across all fifty states.

Cellular Therapy in Experimental Autoimmune Encephalomyelitis as an Adjuvant Treatment to Translate for Multiple Sclerosis.

This study aims to evaluate and compare cellular therapy with human Wharton's jelly (WJ) mesenchymal stem cells (MSCs) and neural precursors (NPs) in experimental autoimmune encephalomyelitis (EAE), a preclinical model of Multiple Sclerosis. MSCs were isolated from WJ by an explant technique, differentiated to NPs, and characterized by cytometry and immunocytochemistry analysis after ethical approval. Forty-eight rats were EAE-induced by myelin basic protein and Freund's complete adjuvant.

Legal and Ethics Considerations in Capacity Evaluation for Medical Aid in Dying.

Evaluating decisional capacity for patients seeking medical aid in dying (MAID) raises challenging legal, logistical, and ethics questions. The existing literature on the subject has been shaped largely by early disagreements over whether effective capacity assessment for such patients is ever possible, which in turn stemmed from debates over the ethics of MAID itself. In attempting to establish meaningful criteria for assessments, many jurisdictions have sought either to apply or to adapt models of capacity evaluation designed for other forms of medical decision-making, such as the widely used "four skills" model, failing to account for the fundamental differences in kind between these other decisions and MAID.

The Pandemic of Invisible Victims in American Mental Health.

Although considerable attention has been devoted to the concepts of "visible" and "invisible" victims in general medical practice, especially in relation to resource allocation, far less consideration has been devoted to these concepts in behavioral health. Distinctive features of mental health care in the United States help explain this gap. This essay explores three specific ways in which the American mental health care system protects potentially "visible" individuals at the expense of "invisible victims" and otherwise fails to meet the needs of great numbers of people with serious psychiatric conditions: prioritization of the wrong patients, incentivization of excessive caution among providers, and a narrow definition of psychiatry's purview.

Refusal of transplant organs for non-medical reasons including COVID-19 status.

Transplant centers and physicians in the United States have limited guidance on the information which they can and cannot provide to transplant candidates regarding donors of potential organs. Patients may refuse organs for a variety of reasons ranging from pernicious requests including racism to misinformation about emerging medicine as with the COVID-19 vaccine and infection. Patient autonomy, organ stewardship, and equity are often at odds in these cases, but precedent indeed exists to help address these challenges.