A case report of giant cell myocarditis after a syncope-related motor vehicle accident: an atypical presentation for a life-threatening condition.

Background: Giant cell myocarditis (GCM) is a rare and rapidly progressive disease associated with significant morbidity and mortality. Whilst patients more frequently present with acute heart failure, diagnosis is difficult due to heterogeneity in clinical presentations.

Case Summary: This case report presents a previously healthy 59-year-old Vietnamese woman who initially presented with syncope and a motor vehicle accident who developed rapid decline in left ventricular function.

The End of Life Choice Act: a proposed implementation and research agenda.

Aim: This article outlines the End of Life Choice Act 2019. It highlights some of the key implementation issues to ensure the system operates safely and equitably after the Act comes into force. It also identifies priorities for research to ensure issues are detected and provision of assisted dying (AD) is monitored.

Pacemaker Induced Cardiomyopathy: An Overview of Current Literature.

Pacemaker Induced Cardiomyopathy (PICM) is commonly defined as a reduction in left ventricular (LV) function in the setting of right ventricular (RV) pacing. This condition may be associated with the onset of clinical heart failure in those affected. Recent studies have focused on potential methods of identifying patients at risk of this condition, in addition to hypothesizing the most efficacious ways to manage these patients.

Assisted dying and evidence-based law-making: a critical analysis of an article's role in New Zealand's referendum.

Aim: To critically analyse the reliability of an article which claims to be evidence that the End of Life Choice Act 2019 provides a "potential hotspot for family, community and social discord that may not be easily remedied" should the legislation receive public support in New Zealand's September 2020 referendum.

Methods: The subject article was reviewed multiple times by all authors and critiqued against three criteria: a reliability pyramid developed to weigh evidence about assisted dying; principles that guide the conduct of social science research; and the use of reliable and current social science literature to support factual claims.

Results: The study being analysed involved a single interview and so is located at the second bottom row of the reliability pyramid.

Doctors' rights to conscientiously object to refer patients to abortion service providers.

After five decades of restrictive laws, New Zealand is on the cusp of law reform that may result in abortion being treated as a health, rather than a criminal, matter. Given this possible liberalisation, a pressing issue is the way in which 'conscientious objection' (CO) will be accommodated within the new legislative landscape. In this context, CO constitutes a health provider refusing, on the grounds of personal conscience, to provide care that, although legal and potentially clinically appropriate, conflicts with their personal moral views.

Can facilitated aid in dying be permitted by 'double effect'? Some reflections from a recent New Zealand case.

While the Doctrine of Double Effect (DDE) remains controversial in ethical circles, it continues to be recognised in common law courts. In 2015, the High Court of New Zealand became the latest to acknowledge the existence of the DDE, in a case that challenged the prohibition on physician assisted dying. In so doing, the possibility was raised that the DDE could potentially be used in an untraditional way to provide a prima facie justification of "facilitated aid in dying" (FAID) in some cases.

Genes, blame and loss of control: is there a place in criminal law for a 'genetic defense'?

In 2002, Caspi and colleagues proposed that a specific gene by environment (GxE) interaction is related to antisocial tendencies. Since then, a substantial body of literature has examined the potential implications of such a correlation for the criminal justice system, and in particular, for the attribution of responsibility and blame that lies at the core of that system. It is probably accurate to say that the majority position among criminal theorists is that evidence of such a nature does not undermine or seriously challenge existing notions of responsibility, and could not constitute a full defense to a criminal charge - although it may have a role to play in sentencing.

Medical regulation of cognitive enhancement devices: some concerns.

The authors present a cogent and detailed case for altering the Medical Devices Directive to allow regulation of cognitive enhancement devices (CEDs). Protection against significant risk of harm, especially for the vulnerable, and promotion of benefit through informed use of CEDs are all good features of the proposal. However, the pre-market approval process has limitations, which we explore.

Application of NMR-based metabolomics to the investigation of salt stress in maize (Zea mays).

Introduction: High salinity, caused by either natural (e.g. climatic changes) or anthropic factors (e.

Clinical effects of red-bellied black snake (Pseudechis porphyriacus) envenoming and correlation with venom concentrations: Australian Snakebite Project (ASP-11).

Objective: To describe the clinical features and laboratory findings in patients with definite red-bellied black snake (RBBS; Pseudechis porphyriacus) bites, including correlation with results of venom assays.

Design, Patients And Setting: Prospective cohort study of patients with definite RBBS bites, recruited to the Australian Snakebite Project from January 2002 to June 2010.

Main Outcome Measures: Clinical and laboratory features of envenoming; peak venom concentrations and antivenom treatment.

Pharmacological and electrophysiological characterization of nine, single nucleotide polymorphisms of the hERG-encoded potassium channel.

Background And Purpose: Potencies of compounds blocking K(V)11.1 [human ether-ago-go-related gene (hERG)] are commonly assessed using cell lines expressing the Caucasian wild-type (WT) variant. Here we tested whether such potencies would be different for hERG single nucleotide polymorphisms (SNPs).

Envenoming by the rough-scaled snake (Tropidechis carinatus): a series of confirmed cases.

Objective: To describe demographic, geographical and clinical features of envenoming by the rough-scaled snake (RSS) (Tropidechis carinatus).

Design, Setting And Participants: Prospective cohort study of RSS snakebite victims, recruited between January 2004 and December 2008, as part of the Australian Snakebite Project. RSS envenoming cases were confirmed by snake identification and/or venom-specific enzyme immunoassay.

"You can't handle the truth"; medical paternalism and prenatal alcohol use.

The publication of the latest contribution to the alcohol-in-pregnancy debate, and the now customary flurry of media attention it generated, have precipitated the renewal of a series of ongoing debates about safe levels of consumption and responsible prenatal conduct. The University College London (UCL) study's finding that low levels of alcohol did not contribute to adverse behavioural outcomes-and may indeed have made a positive contribution in some cases-is unlikely to be the last word on the subject. Proving a negative correlation is notoriously difficult (technically, impossible), and other studies have offered alternative claims.

Generation of in-silico cytochrome P450 1A2, 2C9, 2C19, 2D6, and 3A4 inhibition QSAR models.

In-silico models were generated to predict the extent of inhibition of cytochrome P450 isoenzymes using a set of relatively interpretable descriptors in conjunction with partial least squares (PLS) and regression trees (RT). The former was chosen due to the conservative nature of the resultant models built and the latter to more effectively account for any non-linearity between dependent and independent variables. All models are statistically significant and agree with the known SAR and they could be used as a guide to P450 liability through a classification based on the continuous pIC50 prediction given by the model.

Dangerous patients and duties to warn: a European human rights perspective.

The recent case of David Bradley, who shot and killed four members of his family after telling his doctor he 'wanted to kill someone', has raised the question of whether a healthcare professional could ever be held liable for failing to take steps to constrain a potentially dangerous patient. Until recently, it was considered that the United Kingdom courts would be reluctant to impose a duty to protect third parties. However, the European Court of Human Rights' decision in Osman v UK--while not directly concerning healthcare professionals--has opened the door for just such a duty.

A Tarasoff for Europe? A European Human Rights perspective on the duty to protect.

It has long been recognised by British courts that a psychiatrist can be permitted to depart from his/her duty of confidentiality, in order to issue a warning where a patient is deemed to present a real and serious threat to other parties. Until recently, however, it seemed that s/he would not be bound to give such a warning, or to take other steps to protect third parties. The approach adopted throughout much of the USA, and famously expounded in the Tarasoff judgment, appeared to have no relevance to British law.

Development, interpretation and temporal evaluation of a global QSAR of hERG electrophysiology screening data.

A 'global' model of hERG K(+) channel was built to satisfy three basic criteria for QSAR models in drug discovery: (1) assessment of the applicability domain, (2) assuring that model decisions can be interpreted by medicinal chemists and (3) assessment of model performance after the model was built. A combination of D-optimal onion design and hierarchical partial least squares modelling was applied to construct a global model of hERG blockade in order to maximize the applicability domain of the model and to enhance its interpretability. Additionally, easily interpretable hERG specific fragment-based descriptors were developed.