Federal Office Research Articles

Clinical trial deserts: US urban vs rural patient enrollment among patients with advanced cancer in phase 1 clinical trials at a major cancer center.

e18594 Background: Ethically and scientifically clinical trials must be equally accessible. Unfortunately, racial and ethnic minorities, socioeconomically disadvantaged, elderly and rural populations continue to be underrepresented in all phases of cancer clinical trials due to multiple interrelated economic, cultural, social and medical barriers. Per U.S. 2010 census data about 57 million people (18-19% of the population) and 84% of the U.S. land mass qualify as rural. Examining the affect of geographic distance from trial sites and rural residency on patient enrollment in early phase cancer trials will aid in prioritizing how to address these barriers. Methods: We reviewed EMR data from 8/1/2016 to 8/1/2022 on all initial visits of consults and new patients with advanced cancer ( > 18 years of age) to a single institution phase 1 clinical trials unit. International patients and those without provided addresses were excluded. Bing geocode data for patient’s home zip codes was used in conjunction with the haversine distance formula to determine geographic distance to the cancer center. Rural-Urban Commuting Area codes, which classify U.S. 2010 census tracts based on zip codes using measures of population density, urbanization and daily commuting, were used to determine rural vs urban areas based on the Rural Health Research Center Categorization A and the Federal Office of Rural Health Policy definitions. Results: Among the 10,630 patients with diverse cancers referred to the phase 1 unit, 9182 patients (86.4%) were urban vs. 1448 (13.6%) rural. Patients from urban areas were more likely female 53.8% (4939) vs rural areas 49.2% (712). In terms of race, full data is provided in Table 1 with significantly less diversity in rural enrollment. Travel distance for study inclusion in urban vs rural patients was: 32.8% (3012) vs. 11.1% (161) < 100 miles, 37.0% (3396) vs. 53.9% (781) 100-499 miles, 19.7% (1813) vs. 26.2% (379) 500-1000 miles and 10.5% (961) vs. 8.8% (127) > 1000 miles. Overall, 75.6% (6944) patients from urban and 77.1% (1117) patients from rural areas consented to ≤ 1 study. Of those that consented 62.5% (4337) of urban patients and 64.0% (715) of rural patients enrolled in study. Conclusions: The largest Phase 1 cancer trial cohort of patients with advanced cancer with provided demographics and distance traveled for trial participation reveals disparities among U.S. rural vs. urban enrollment. Clearer understanding of these populations will allow for improved trial design and broad accrual. [Table: see text]

Risk factors for infectious foot -disorders on two Swiss cattle -mountain pastures

In the present study, risk groups for infectious foot disorders were identified on two large Swiss cattle mountain pastures by analyzing animal and treatment data of a total of 3256 animals of the bovine species. Both mountain pastures were part of the Federal Office for Agriculture (FOAG) consultancy project «Healthy animals, attractive herdsmen positions and less medication on large cattle mountain pastures». The project was launched in 2020 following the increased incidence of lameness on these mountain pastures. Bacteriological and histological analyses were to provide information as to whether the most common foot disorder was interdigital phlegmon (IP) or whether digital dermatitis also occurred. Further, the temporal distribution of cases over the mountain pasture season and the influence of mountain pasture and year were investigated and interpreted for the project years 2020 to 2022, and treatment incidences were compared between years. Multiple treatment cycles in the same individual were classified into persistent infections and new infections. Nineteen of 394 first-treated cattle were clinically examined, 12 of them were additionally sampled for bacteriological and histological analyses. All cases examined showed, both clinically and following laboratory analyses, typical characteristics for IP. In contrast, there was no specific evidence for the presence of digital dermatitis. No persistent infections occurred during treatment with benzylpenicillin. Multivariate logistic regression analyses identified > 365-730-day-old cattle (odds ratio OR 8,29), as well as inseminated (OR 5,30) and non-inseminated (OR 7,85) heifers as risk groups for the disease studied (p < 0,05). Association with the oestrus activity of non-inseminated heifers and a generally higher locomotor activity in heifers compared to cows - with a correspondingly increased risk of injury - is conceivable. Meat breeds had a reduced risk compared to dairy breeds (OR 0,29). Breed differences in behavior and/or the effectiveness of the local immune response might have an impact. Knowing about these risk groups can be put to use in the future when selecting animals to be taken to the mountain pastures and/or when planning pasture management in order to reduce the prevalence of infectious foot disorders and thereby the use of antibiotics.

Switzerland's good offices in light of the American hostage-taking in Iran (1979-1981)

Switzerland's neutrality during the Cold War allowed it, without joining any of the opposing blocs, to take an active part in international politics. This, in particular, was reflected in the so-called good offices and a series of protective mandates of Switzerland in Iran. The article presents a brief historical digression into the process of development of diplomatic relations between Switzerland and Iran. The purpose of the article is to determine the role of Swiss diplomacy in negotiations on the release of American hostages in Iran (1979-1981). The study was carried out on the basis of declassified archival documents, a significant part of which is being introduced into scientific circulation for the first time (documents of the US State Department and the Swiss Federal Department of Foreign Affairs devoted to the settlement of the crisis with American hostages). This determined the scientific novelty of the study. The use of the historical-genetic method allowed us to study the genesis of bilateral relations between Switzerland and Iran before the 1979 Islamic Revolution. A narrative (descriptive-narrative) method was used to describe Switzerland's diplomatic services to the United States in Iran after the 1979 Islamic Revolution. Through the structural and functional method, it was possible to identify the mechanisms of Swiss diplomacy during secret meetings between the American and Iranian sides and the execution of the protective mandate to represent the interests of the United States in Iran. The historical-retrospective method helped to evaluate the results of Switzerland's "good offices" in Iran from the perspective of time distance.

HIPAA Compliance for Telehealth to Be Required Again on August 9

Back to table of contents Next article Government & LegalFull AccessHIPAA Compliance for Telehealth to Be Required Again on August 9Mark MoranMark MoranSearch for more papers by this authorPublished Online:31 May 2023AbstractHIPAA compliance is about more than just technology—it also means having physical or environmental and process security measures in place. A business associate agreement with a vendor may be necessary to ensure compliance with HIPAA.The federal Office of Civil Rights (OCR) in April extended the deadline for requiring telehealth compliance with the Health Insurance Portability and Accountability Act (HIPAA) by 90 days to August 9.At that time, health care professionals practicing telehealth must comply with HIPAA’s Security Rule and will no longer be able to use standard video technologies such as Zoom, Skype, or Facebook to meet with patients, as they had been allowed to do during the Public Health Emergency (PHE), which ended on May 11. Even before the new deadline, psychiatrists and other health care professionals need to pay attention to state rules about HIPAA compliance as well as the requirements of their institution, organization, or practice.“Best practices to ensure environmental privacy include clinicians connecting from a private space and letting patients know if there are others in the room with them,” said Shabana Khan, M.D. “This demonstrates to patients that their telehealth clinician values protecting their health information.”“OCR is providing this transition period to allow health care practitioners and practices to make necessary changes to ensure that their telehealth technologies are private and secure in a way that is adherent with HIPAA rules,” said Shabana Khan, M.D., chair of the APA Committee on Telepsychiatry. “Though OCR has provided this 90-day transition period through August 9, telehealth clinicians must also consider state rules and practice or organization requirements when deciding which technologies to use for telehealth services. We have this flexibility at the federal level, but an organization may require that their clinicians use approved HIPAA-adherent technologies.”HIPAA, which was signed in 1996 by President Bill Clinton, sets national standards for health information protections. The U.S. Department of Health and Human Services (HHS) established these standards to ensure protected health information (PHI) processed and utilized by “covered entities” is private and secure. OCR is responsible for implementing and enforcing this rule. HIPAA requirements cover a broad range of patient data and information, including making an appointment, conducting the appointment, and billing the patient’s insurance.HIPAA encompasses two major rules: the Privacy Rule and the Security Rule. The Privacy Rule protects all identifiable data of an individual patient; the Security Rule, a subset of the Privacy Rule, protects information that a covered entity creates, receives, maintains, or transmits in electronic form.So what does it mean to be HIPAA compliant when providing telehealth services? Importantly, it’s not just about technology. It also means having physical or environmental and process security measures in place to ensure that only those who are supposed to have access to patients’ information are able to get it.“Environmental privacy best practices include clinicians connecting from a private space and letting patients know if there are others in the room with them—for instance, a nurse or medical student who may be off screen,” Khan said. “Clinicians should also provide guidance to their patients on the importance of connecting to telehealth visits from a private space and avoiding public or semi-public settings. Clinicians can also ask patients if there is anyone in the room with them at the start of the visit. This demonstrates to patients that their telehealth clinician values protecting their health information.”Technology features that can help a HIPAA-covered entity meet compliance requirements include the following:Fully encrypted data transmission.Additional authentication and security through required passwords.Secure point-to-point connection.Private high-speed network.Administrative, physical, and technical safeguards for electronic protected health information.Audit controls.Breach notification.John Torous, M.D., chair of the APA Committee on Mental Health IT, said psychiatrists must use vendors of telehealth technology who can assure HIPAA compliance and have a signed business associate agreement (BAA).“Often you can use the same product (such as Zoom) without a BAA, but to make it HIPAA complaint, a psychiatrist needs to use the version of Zoom that requires the signature of a BAA,” he wrote in an email. “Regardless of the technology, being HIPAA complaint means the psychiatrist still has to offer reasonable physical safeguards (such as keeping computer passwords secure) and have process safeguards in place too (restricting access to patient files, creating plans for appropriate use of data).” ■ResourcesHHS Office for Civil Rights AnnouncementHIPAA & HIT: A PrimerSummary of the HIPAA Privacy RuleThe Security Rule ISSUES NewArchived

미국 연방불법행위청구법(FTCA)상 재량기능 예외와 그 시사점

On July 14, 2022, the Supreme Court of Korea made a ruling on the “state compensation claim case due to overcrowded incarceration.”(Korean Supreme Court Decision No. 2017Da266771) One ex-prisoner, recognized the overcrowded confinement period as 186 days, was awarded 1.5 million Korean Won in state compensation and the other ex-prisoner, recognized the overcrowded confinement period as 323 days, was awarded 3 million Korean Won in state compensation. The Supreme Court of Korea acknowledged the state’s damages liability based on the violation of ‘dignity and value as a human being’ Sect. 10 of Korean Constitution, not the violation of specific laws in this ruling. Unlike the National Compensation Act in Korea, the state compensation liability based on the tort of a public officer’s in the United States, which separately stipulates the state compensation liability due to the public officer’s intentional torts and the state compensation liability caused by the public officer’s negligence. The Federal Tort Claims Act has a discretionary function exclusion clause, and the U.S. Supreme Court recognizes this exclusion in its rulings. The U.S. Federal Circuit courts have presented different rulings on the scope of exclusion from discretionary function in relation to the illegal acts of federal officers. In Bivens claims, the alleged violation of the federal constitution here is a violation of very specific constitutional provisions, such as the 1st and 8th Amendments. It did not target violations of the ideology of guaranteeing basic human rights such as ‘dignity and value as a human being’. Regarding the Bivens claim, the U.S. Supreme Court would not hardly find cases in which the state recognized torts liability for the human rights violations of prisoners. Even considering these points, the state compensation liability should not be based on a violation of the Korean Constitution Sect. 10 ‘dignity and value as a human being’, but on a violation of the actual laws or specific regulations. There are concerns that the recognition of state compensation liability due to a violation of the Korean Constitution Sect. 10 ‘dignity and value as a human being’ would have provided a starting point for similar state compensation lawsuits in the future in Korea. If it becomes a catalyst to promote supplementary works such as new legislations and construction of new facilities to improve prisoner’s basic human rights, it might be also considered to be meaningful Korean Supreme Court’s decision in Korea.

Assesment of Use of Performance-Enhancing Substances and Methods among Wrestlers, Boxers, and Bodybuilders in Kenya

Measuring prevalence of usage of performance enhancing drugs in Boxing, wrestling, and bodybuilding is difficult. However, to fit their initiatives, National Anti-Doping Organizations are interested in knowing the numbers so that their scarce resources are not wasted. The purpose of this study was to establish knowledge levels, attitudes towards the use of performance enhancing substances (PES), among athletes from boxing, wrestling, and bodybuilding federations in Kenya. The study utilized cross-sectional analytical research design. The study population comprised of 1900 athletes from the three sports disciplines with a sample size of 384 athletes. Close ended questionnaires were used as the data collection instrument. Data obtained from the respondents was coded and organized for analysis by use of SPSS version 25. Hypotheses were tested using one-way ANOVA and t-test at confidence level of 0.05. Post hoc analysis was carried out using Duncan Multiple Range Test where differences were found to be significant. Results on usage showed that majority of the respondents (74.2%) never used food supplements (FS) to improve sports performance. Many of the respondents (93.8%) had never used traditional herbs (TH) to improve sports performance. 91.9% never used PES to improve sports performance. Majority of the respondents (96.6%) indicated as never having been given food supplements by a coach, doctor, or physiotherapist to enhance performance. On supply of PES, 91.7% of the respondents had no information of if medical practitioner, local chemist, or sports agents supplied PES and methods. The results of one-way ANOVA showed that there was a significant difference in the use of FS, TH, PES, and Methods by athletes from the three sports disciplines, [F (2, 381) = 24.050, p &lt; 0.000]. In conclusion and in light of the limitations of this study generally majority of the respondents did not use PES and methods. There were also significant differences in use of PES and methods across the different sports. The study recommended that sports federation officials from boxing, wrestling and bodybuilding should have a put proper structures for imparting knowledge and proper attitude on use of performance enhancing substances among athletes.

Post‐2015 refugees in Germany: “Culture of welcome”, solidarity or exclusion?

Post‐2015 refugees in Germany: “Culture of welcome”, solidarity or exclusion?

Germanys Rearmament Plan: A Problem of Bureaucracy

The conflict in Ukraine that started on February 24th, 2022, had a transformative effect on the status of European security policy, with the most prominent outcome being Germanys break with its pacifist tradition and its policy of disarmament. The German governments plan to rebuild the Bundeswehr by raising its defense spending to 2% of its GDP, alongside the injection of a 100-billion-euro fund into its armed forces, was seen by many as the first step for Germany to a leading role in the new European Security Policy. However, increased funding is unlikely to be the deciding factor in whether Germany can successfully rearm, as the Bundeswehr is well funded in comparison to other standing armies of European states in similar economic circumstances. The main obstacle standing in the way of a successful German rearmament is Germanys bureaucracy. The Federal Office of Bundeswehr Equipment, Information Technology, and In-Service Support," or the BAAINBw, responsible for procurement of materials for the Bundeswehr, is fully anarchistic and understaffed. Germanys path to a reformed military thus hinges on whether the German government can successfully reform the BAAINBw into a more efficient federal agency.

State of the Field of Plant Pathogen Diagnostic Assay Development and Validation

Diagnostic assays for plant pathogens are a critical component in the surveillance, detection, and management of disease in the production of food, feed, and fiber. Producers, crop consultants, and state and federal officials depend on rapid and accurate diagnostics for response, disease mitigation, crop management, and regulatory decisions affecting trade and export prices. Diagnostic assays undergoing development must be validated to understand how well the assay will perform on given sample matrices, in different user hands, and under varying laboratory conditions before deployment and application in diagnostic clinics and distribution as commercially available assays. The validation of diagnostic assays is a time-consuming, expensive, multitiered process, requiring pathogen and near neighbor reference materials, barcode and/or genome sequence data, and cross-laboratory partnerships. Regulatory agencies and diagnostic clinics do not often have fully validated assays to deploy during an outbreak of a novel pathogen. Our survey of recent publications describing the development of diagnostics for plant pathogens found that those detailing an appropriate and robust diagnostic assay validation process were few in number. The results point out the need for broad application of standards and rigor in the conception, development, and execution of diagnostic assay validation. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .

National Institute on Drug Abuse Clinical Trials Network Meeting Report: Advancing Emergency Department Initiation of Buprenorphine for Opioid Use Disorder

Opioid use disorder and opioid overdose deaths are a major public health crisis, yet highly effective evidence-based treatments are available that reduce morbidity and mortality. One such treatment, buprenorphine, can be initiated in the emergency department (ED). Despite evidence of efficacy and effectiveness for ED-initiated buprenorphine, universal uptake remains elusive. On November 15 and 16, 2021, the National Institute on Drug Abuse Clinical Trials Network convened a meeting of partners, experts, and federal officers to identify research priorities and knowledge gaps for ED-initiated buprenorphine. Meeting participants identified research and knowledge gaps in 8 categories, including ED staff and peer-based interventions; out-of-hospital buprenorphine initiation; buprenorphine dosing and formulations; linkage to care; strategies for scaling ED-initiated buprenorphine; the effect of ancillary technology-based interventions; quality measures; and economic considerations. Additional research and implementation strategies are needed to enhance adoption into standard emergency care and improve patient outcomes.

White Men’s Law: The Roots of Systemic Racism by Peter Irons

Reviewed by: White Men’s Law: The Roots of Systemic Racism by Peter Irons William H. Chafe White Men’s Law: The Roots of Systemic Racism. By Peter Irons. (New York: Oxford University Press, 2022. Pp. xx, 291. $29.95, ISBN 978-0-19-091494-3.) Peter Irons has written a powerful overview of systemic racism in the United States. A retired scholar of constitutional law, he brings passion, insight, and a lifetime of personal experience fighting racism to this extraordinary assessment of just how little progress this country has made—despite pretensions to the contrary—toward eliminating racism in American society. White Men’s Law: The Roots of Systemic Racism begins with a detailed chronicle of how, in 1935, a deputy sheriff in Fort Lauderdale, Florida, personally presided over the lynching of a Black man named Rubin Stacy. A white woman claimed that Stacy had threatened her with assault. The white deputy captured Stacy, tied a clothesline around his neck, hung him from a tree branch, and then led the white crowd as they fired bullets into his dead body. This story highlights the underlying theme of Irons’s book: how our legal system—and the law itself—have sustained “race [as] the one factor that has most divided the country for more than four centuries” (p. 18). It was not always so. Irons points out that in an early draft of the Declaration of Independence, Thomas Jefferson spoke of the “horror” of slavery, saying that the “execrable commerce” of that institution should end (p. 32). But those words never appeared in any official document, and slavery became a centerpiece of southern society. Indeed, Irons blames the eruption of the Civil War on “the legal system and its judiciary” (p. 59). Despite the hopes of Black Americans and some white northerners for major changes after emancipation, Irons recounts that during Reconstruction, “only 20 percent of Blacks—most of them younger—claimed to be literate” (p. 83). Nor did the legal system help. In United States v. Cruikshank (1875), the Supreme Court struck down the Enforcement Acts that were enacted to uphold the Reconstruction Amendments, declining to hold white terrorists accountable for the murders of Black voters. Upon his election as governor of South Carolina in 1890, Benjamin R. Tillman “lauded ‘the triumph of democracy and white supremacy over mongrelism and anarchy’” (p. 101). Tillman also declared that southerners had “‘reorganized the Democratic Party with one plank and only one plank, namely, that this is a white man’s country and the white man must govern it’” (p. 103). This process continued as the Supreme Court “gutted the ‘public accommodations’ provisions of the 1875 Civil Rights Act” in the Civil Rights Cases (1883) and paved the way for segregated schools in Plessy v. Ferguson (1896) (p. 105). As a result, Irons writes, “Black children in the South . . . were robbed of decent educations by White men in black robes” (p. 110). By 1900, “Only 45 percent of Black adults were literate, compared to 95 percent of Whites,” and in the 1890s, “at least 1,100 Blacks were lynched, more than two every week” (p. 113). [End Page 337] Beginning with President Franklin D. Roosevelt’s New Deal, positive changes slowly accumulated. An “informal group known as the ‘Black Cabinet,’” composed of forty-five Black federal officials, came into being (p. 139). Irons notes that this group especially sought to ensure that a proportionate number of Black Americans received relief from New Deal programs—a goal in which “they achieved some success” (p. 139). He also notes an increase in the literacy rate among Black people to 84 percent by 1940. And he describes how, finally, the Supreme Court ruled in Brown v. Board of Education (1954) that segregated schools were unconstitutional. Still, racism remained systemic. In 1960, 55 percent of Black Americans lived in poverty, and Black income was only 55 percent that of whites. Although these figures improved in the 2000s, the fact of two different societies “one black, one white—separate and unequal,” as the Kerner Commission declared in 1968, remained a central American reality (p. 213). With passion and power, Irons documents the role of law and the...

Political representation of medical doctors in Switzerland's executive and legislative branches in 2023.

Background: Healthcare policy is an important societal concern in Switzerland, often dominating the national agenda. In other countries, studies have explored the influence of physicians in public office on healthcare policies, but little is known about the representation of medical doctors in Switzerland's political structures, despite ongoing health-related debates. Methods: In January 2023, we examined the proportion of registered doctors currently serving in Swiss governmental branches: the executive (the Federal Council) and the legislative (the Council of States and the National Council, together the United Federal Assembly). We used publicly available information to demarcate Federal, State, and National Councillors with professional medical backgrounds. We subsequently verified physician registrations using the Federal Office of Public Health's "Register of Medical Professionals" (MedReg) Results: Six physicians registered in MedReg were identified across the Federal Council and the United Federal Assembly in 2023, equivalent to 2.37% of the total number of Councillors in these chambers. This corresponds to 14.20% of members in the Federal Council (the executive chamber) and 2.03% of members in the United Federal Assembly (the legislative chamber). Conclusions: Rates of physicians sitting in Switzerland's Federal Council and United Federal Assembly are higher than general population trends for doctors per person. Nonetheless, physicians in Swiss legislative positions are proportionally lower than comparative data from the United States. We highlight how existing professional frameworks may already ensure medical doctors are sufficiently participating in Swiss healthcare debates outside of formal roles. We also suggest that more international evidence is needed to determine the benefits of physicians serving in public office.

Vaccine-Preventable Infections Among Solid Organ Transplant Recipients in Switzerland

Vaccine responses are decreased in solid organ transplant (SOT) recipients, and given the complexity of implementation, vaccination programs may be suboptimal. The actual burden of vaccine-preventable infections (VPIs) among SOT recipients remains unclear. To assess the incidence rate of VPIs among SOT recipients and to evaluate whether SOT recipients are at increased risk for specific VPIs compared with the general population. This nationwide cohort study used data from the Swiss Transplant Cohort Study on VPIs in individuals who underwent SOT from May 2008 to June 2019 (follow-up until December 2019) and data from the Swiss Federal Office of Public Health on notifiable VPIs in the general population in the same period. Data were analyzed from January 2021 to June 2022. Solid organ transplant. The main outcomes were the incidence rate of the following VPIs in SOT recipients: hepatitis A and B, diphtheria, Haemophilus influenzae infection, influenza, measles, mumps, pertussis, pneumococcal disease, poliomyelitis, meningococcal disease, rubella, tetanus, tick-borne encephalitis, and varicella zoster virus infection. Age-adjusted standardized incidence ratios were used to assess whether VPIs occurred more frequently in SOT recipients compared with the general population. For SOT recipients, factors associated with occurrence of VPIs were explored and the associated morbidity and mortality assessed. Of 4967 SOT recipients enrolled (median age, 54 years [IQR, 42-62 years]; 3191 [64.2%] male), 593 (11.9%) experienced at least 1 VPI. The overall VPI incidence rate was higher in the population that underwent SOT (30.57 per 1000 person-years [PY]; 95% CI, 28.24-33.10 per 1000 PY) compared with the general population (0.71 per 1000 PY). The standardized age-adjusted incidence ratio for notifiable VPIs in SOT recipients was higher compared with the general population (27.84; 95% CI, 25.00-31.00). In SOT recipients, influenza and varicella zoster virus infection accounted for most VPI episodes (16.55 per 1000 PY [95% CI, 14.85-18.46 per 1000 PY] and 12.83 per 1000 PY [95% CI, 11.40-14.44 per 1000 PY], respectively). A total of 198 of 575 VPI episodes in the population that underwent SOT (34.4%) led to hospital admission, and the occurrence of a VPI was associated with an increased risk for death and/or graft loss (hazard ratio, 2.44; 95% CI, 1.50-3.99; P = .002). In multivariable analysis, age 65 years or older at the time of transplant (incidence rate ratio [IRR], 1.29; 95% CI, 1.02-1.62) and receipt of a lung (IRR, 1.77; 95% CI, 1.38-2.26) or a heart (IRR, 1.40; 95% CI, 1.05-1.88) transplant were associated with an increased risk of VPI occurrence. In this study, 11.9% of SOT recipients experienced VPIs, and the incidence rate was higher than in the general population. There was significant morbidity and mortality associated with these infections in the population that underwent SOT, which highlights the need for optimizing immunization strategies.

Real Property Supremacy: Manufactured Housing and the Limits of Inclusion through Finance

Manufactured housing (MH) communities have emerged as a high-profile and lucrative asset class. Despite this, it is costly or impossible to get loans to buy homes in most mobile home parks. This article explores this ostensible contradiction—that whereas MH parks are desirable and liquid assets, the individual homes that compose them are not. We explore the implications of this contradiction for housing justice as well as financial and environmental vulnerability. We argue that the marginality of MH in U.S. housing markets is rooted in the privileging of real property above personal property. We describe the origins and impacts of this “real property supremacy” in two parts. In the first, we outline the macro-historical context of real property supremacy using a variety of sources, including interviews with federal officials and industry experts as well as document analysis. In the second, we connect this macro context to its micro consequences, drawing on interviews with MH residents, nonprofit and social-service practitioners, and park managers and owners in Tucson, Arizona. We conclude that state-supported property hierarchies create conditions where constrained housing options, semiformal financial practices, and unique tenure forms combine to (re)produce unique and intersecting forms of vulnerability in MH communities.

Beloved Rob Kent leaves ONDCP for private consulting

Rob Kent, formerly general counsel of New York's Office of Addiction Services and Supports (OASAS), and since 2021 general counsel of the Office of National Drug Control Policy (ONDCP) has left the federal office as of April 14 for private practice, ADAW has learned. We talked to him in Atlanta last week, and as always, he was confident and articulate about the way to move forward. “I want to focus on providers,” he said. Since going to ONDCP, he has regularly heard from addiction treatment providers across the country about how to handle various issues. He's a lawyer and knows the field from a legal perspective better than anyone.

Abandoning Their Beloved Land: The Politics of Bracero Migration in Mexico. By Alberto García

In a 1948 letter to Mexico’s federal agrarian officials, Cleofas Hernández and Alberto Rodríguez expressed their desire to migrate to the United States as braceros. For years, socio-economic precarity in Southern Guanajuato made it difficult for them to provide for their families. Then came the final straw: Presa del Aguacate’s ejidatarios seized their land. Authorities refused to intervene on campesinos’ behalf. And so, the pair decided, they had one choice: to “abandon their dearly beloved land.” This is one of many evocative testimonies that Alberto García skillfully mines—along with a trove of government documents from federal, state, and municipal archives—to unravel the politics of bracero migration in Mexico. For García, bracero migration was much more than a socio-economic phenomenon. Instead, it was shaped by the ideologies and ambitions of Mexican elites, Catholic activists, local powerbrokers, and migrants themselves. As the author convincingly explains, the roots of bracero migration lie in the failures of the Partido Revolucionario Institucional’s (PRI) agrarian reform and the upheaval generated by conservative Catholic opposition to the revolutionary state’s secular agenda. Importantly, García reveals that while politicians of all stripes treated prospective braceros like pawns, the men who wished to join the program were anything but pliable victims. At its core, the decision to migrate was a shrewd rejection of the PRI regime and the endemic corruption that gripped large swathes of Mexican society.

Securitization of Turkish Nationalist Non-Governmental Organizations in Germany

Since 2013, Non-Governmental Organizations (NGO) that have adopted Turkish nationalism in Germany have been included in the reports for the Federal Office for the Protection of the Constitution. According to the reports, they are considered to be elements that threaten German democratic culture and minorities in Germany. The issue was brought to the German Bundestag and it was brought to the agenda that these NGOs could be a security threat and have radical right wing features. In this regard, the main purpose of this study is to examine how and why the NGOs that adopted Turkish nationalism in Germany, which have been working through umbrella NGOs as legal entities since 1978, are perceived as a security threat. The background of the path to this process is examined from a social constructivist perspective with the theory of securitization.

A Latter-day Saint Apostle's Perception of the Southern Bazaar of Liverpool, October 1864

A Latter-day Saint Apostle's Perception of the Southern Bazaar of Liverpool, October 1864

5586004 INCREASE IN HEMOGLOBINOPATHIES CARRIAGE AMONG PREGNANT WOMEN IN GERMANY PREDICTED BY MIGRATION AND BIRTH DATA ANALYSIS

Background: Germany is one of the most densly populated countries in Europe, yet it has low allele frequencies for hemoglobinopathies in its population. According to estimates by Kohne et al. (2010), approx. 0.48%1 of Germany’s population are carriers for at least one hemoglobinopathy. Modell et al. (2007) estimated the proportion of carriers among pregnant women in Germany at 0.54%2. Given the sharp increase in migration between 2014 and 2016, predominantly from high prevalence countries for hemoglobinopathies (Figure 1), we expect a rise in carrier numbers among present German population. Although new-born screening for sickle cell disease has been introduces as standard of care in Germany in 2021, low awareness for hemoglobinopathies among general medical staff in general and the lack of existing routine screening in later life, e.g. during pregnancy, still pose a major challenge to monitor the development of these disorders and to ensure appropriate clinical care and consulting services.Aims: To estimate hemoglobinopathies carriage rates among pregnant women in Germany during the last decade. Methods: We extracted data on number and origin of foreign women at childbearing age (15 - 50 years) between 2010 and 2020 in Germany by federal state and year3 from the GENESIS database of the German federal statistical office. Using the published data by Modell and Darlison on carriage rates in pregnancies by country4, we calculated the proportion of women at childbearing age with risk for carrying a hemoglobinopathy per state and year. With the help of data on life births by mothers’ citizenship status (German or foreign)3, we calculated a fertility adjustment factor (= fertility rate of all foreign women/ total fertility rate in Germany, both per state and year) and estimated the yearly proportion of pregnancies at risk for carrying a hemoglobinopathy per state. Results: The estimated hemoglobinopathies carriage rates among pregnancies showed an increasing trend in all 16 German federal states in the last decade (Figure 2). The states Bremen, Hamburg, Berlin, and Hesse showed the highest carriage rates in 2020 with 3.84%, 2.78%, 2.66% and 2.64% respectively (HbS heterozygosity included). Notably, the states with lowest estimated carriage rates in 2020 (Thuringia, Saxony, Saxony-Anhalt and Brandenburg) showed the strongest increases compared to its initial rates in 2010 (Figures 2-4). On a national average, we calculated an increase of approximately 60% in pregnancies at risk for hemoglobinopathy carriage (Figure 5).Conclusion: Our analysis indicates a clear and strong increase in hemoglobinopathy carriage rates among pregnancies in all federal states in parallel to the increase in migration into Germany between 2014 and 2016. Further studies are required to verify these findings and to evaluate the necessity of new public health measures as prenatal screening and consulting services for hemoglobinopathies in Germany.

Software Rights: How Patent Law Transformed Software Development in America by Gerardo Con Diaz

Reviewed by: Software Rights: How Patent Law Transformed Software Development in America by Gerardo Con Diaz Dan L. Burk (bio) Software Rights: How Patent Law Transformed Software Development in America By Gerardo Con Diaz. New Haven: Yale University Press, 2019. Pp. 384. In Software Rights, author Gerardo Con Diaz sets out to trace the legal and business history of software in the United States over a period of fifty-five years, from the mid to late twentieth century. Although the primary focus of the work is on software patents, it is also necessarily a history of copyright, the complementary and alternative mode of intellectual property protection for software. Con Diaz draws on a wealth of industry and legal archives to survey a multitude of legal and business decisions that shaped the nature and character of the software industry. To manage this cast of thousands, Con Diaz focuses on individual vignettes, flitting between quick sketches of actors and events. The result is that the reader traverses a narrative landscape that is surprisingly flat: bit players and starring actors receive similar treatment; major and minor events are described in equal detail. The reader who is already familiar with the history of software patenting may be surprised at the relatively cursory treatment of administrative or judicial decisions of great moment—but will be equally surprised at the lengthy discussion of other decisions, some of which the reader has never before heard of, that in hindsight have proved to be entirely unimportant and forgettable. Throughout, the focus of the volume remains squarely on the historical record of the software industry, with little time for background explanation. For example, the American patent statute extends exclusive rights to qualifying processes, machines, articles of manufacture, and compositions of matter. Much of the controversy over software patenting that Con Diaz surveys revolves around which of these categories might fit computer programs: Are they processes? Or are they machines? Could they be articles of manufacture? Con Diaz documents the long struggle to draft patent claims around the statutory subject matter categories—but without ever explicitly examining the statute on which the controversy is based. The astute reader will likely pick up on this from context, albeit with some extra effort. Similarly, much of the action that Con Diaz follows centers on evolving strategies or attempts to procure patents for software. Patents are only obtained by a process of administrative review through the federal Patent Office. Con Diaz does not pause to explain the process of patent procurement, or "prosecution" as it is called in the vernacular of the patent bar. Neither does his historical survey explicitly delve into the organization of the U.S. Patent Office or its administrative procedures. Still, after numerous references and allusions, the astute reader cannot help but come away with a general sense of such procedures, constructed from the activity the book does describe. [End Page 617] However, assembling that overview of patent procedure is left to the reader; it is not set out in detail. The author's overview ends rather abruptly in 2000 with the publication of the U.S. Court of Appeals for the Federal Circuit's patent eligibility opinion in State Street Bank, which the author notes is the last major software case of the twentieth century. To the reader familiar with the field, this sudden halt is rather jarring. The year 2000 is a nice round number, the edge of a new millennium, and a perennial eschatological favorite. And of course, the book must end somewhere. But State Street Bank is perhaps the most disruptive and controversial patent case ever decided, leading to a decade of fierce contention over the scope of patents generally and over software patents in particular. The debates generated by State Street led directly to the dramatic intervention of the U.S. Supreme Court to reshape software patent eligibility and to the intercession of the U.S. Congress to radically revise the American patent system. All of this makes the year 2000 cutoff something of a software cliffhanger. Some of the later developments are mentioned in a brief coda in which the author summarizes his findings and issues a very sensible call for further research...