Genuine Risk Research Articles

Unarmed but How Dangerous? Civilian Augmentees, the Law of Armed Conflict, and the Search for a More Effective Test for Permissible Civilian Battlefield Functions

In the approximate four years since the United States initiated military combat operations under the rubric of the Global War on Terror, the most highly visible legal issues have been the legality of the use of force and the treatment of detained opposition personnel. However, during this same period, U.S. planners and government legal advisers have struggled with another less sensational issue: the legally permissible role of civilians supporting these operations. While not a new issue, the unprecedented level of reliance on such civilian support, coupled with the ever-increasing technological sophistication of the contemporary battlefield, has pushed these civilians ever closer to performing roles historically reserved for uniformed personnel. Unfortunately, the rapidly evolving and ever increasing nature of civilian support has not been matched by any significant update to the decisional criteria for determining the legally permissible roles for such civilians. This reality has led to tremendous uncertainty at all levels of command. This is particular true during the current era of ever increasing pressure on operational commanders to maximize such civilian support in order to reduce demands on the uniformed force and increase the ?tooth to tail? ratio. There are several detrimental consequences that flow from this disparity. First, subordinate commands are left to ponder where the line of compliance is located. Second, abdicating the responsibility for determining what is or is not legal increases the possibility of disparate resolutions of this issue among different commands. Third, the lack of uniform decisional criteria disables the ability of strategic planning and force development because it is impossible to make any meaningful assessment of the legal constraints on civilianization. Finally, there is no effective standard available for the legal advisers who are called upon to recommend resolution of civilianization issues at the command levels responsible for compliance with this policy mandate.Throughout this era of increasing civilianization, reliance on the direct participation standard derived from the law of armed conflict has served as the primary criteria for defining permissible civilian support functions. However, this standard is no longer sufficiently effective to address this complex issue. While it is undoubtedly true that civilian support personnel are prohibited from performing any function that can legitimately be deemed to amount to direct participation in hostilities, this prohibition is not, as previously assumed, derived exclusively from the direct participation provisions of the law of armed conflict. Instead, it is derived from a much more complex interrelationship between the principle of distinction, the link between genuine military command authority and respect for the law of armed conflict, and an equitable synergy between the scope of command responsibility and the scope of command authority. This article will analyze the direct participation standard, and illustrate why it is no longer sufficient, either in scope or purpose, to provide a solution to this complex issue. The article will then propose a new test - the functional discretion test. The focus of this test will be the discretion associated with each function proposed for civilianization. In application, this test will assess the risk of law of armed conflict violation associated with the performance of each task. If the discretion associated with a task involves genuine risk of a violation of this law, it must be reserved for members of the armed forces. The article will then illustrate why this test is both more comprehensive than the direct participation standard, and more feasible in application. The article will also offer comparative illustrations for this proposition.The article will conclude with a proposal that the Department of Defense adopt this new standard, which will provide the foundation for a coding system for all functions associated with military operations. This will permit subordinate commands to effectively plan for the use of civilian support with a high degree of confidence that such use will be in compliance with law of armed conflict obligations and will carry minimal risk of exposing commanders to liability for the conduct of personnel over whom they lack proscriptive disciplinary authority.

Rape's Metatheatrical Return: Rehearsing Sexual Violence Among the Early Moderns

What happens when theatre crosses the line, risks danger in the real? This paper explores the pernicious theatricalization of sexual violence in early modern England, its trouble-making uptake in Shakespeare's Titus Andronicus, and Julie Taymor's contemporary response in her 1999 film version of the play. Along the way the article probes a handful of questions about theatre's social efficacy: what are the consequences of understanding theatre as a potentially malevolent form of public art and expression? How do we account for those moments when theatre poses genuine risk? And, more importantly, how do we build a response to, an ethics of, that risk into our own work as scholars and practitioners?

Finding Inflammatory Bowel Disease Genes Will Lead to a Cure

The opinion that finding inflammatory bowel disease (IBD) genes will lead to a cure is based on the fact that genetic variation provides a vast reservoir of information specific to individual patients that is only beginning to be acknowledged on a large scale. Complementary to this is that, in many respects, IBD represents an ideal genetic disorder(s). First, the significant role of genetics in IBD is firmly established based on the significant familial clustering observed, combined with significantly higher concordance of monozygotic twins compared with dizygotic twins (1). The diagnostic pathogenic certainty associated with the diagnoses of Crohn’s disease (CD) and ulcerative colitis (UC) is high; heterogeneity probably exists in clinically similar cases but is likely relatively limited. Compared with other multigenic disorders, the relevant tissues – the peripheral blood leukocytes and the intestinal tissues – are easy to obtain for expression studies. There are numerous, excellent animal models that exist in IBD (2) for which several lines of evidence provide correlative support in humans. The fact that at least two well-replicated disease associations exist in IBD – nucleotide oligomerization domain 2/caspase activation and recruitment domain 15 (NOD2/CARD15) (3,4) and IBD5 on chromosome 5q (5,6) – holds out the promise that the increased understanding of disease pathophysiology will accrue from genetic approaches. At least three mechanisms can be defined through which genetics can effect cures for IBD. First, if effective, preventive approaches can be developed, feasibly powered studies will require the identification and prospective follow-up of high-risk individuals which will be best achieved through testing of established IBD genes. Second, the identification of genuine IBD risk alleles will often provide very novel insights into the mechanisms of disease pathogenesis that fundamentally change existing paradigms of disease pathogenesis. Finally, genetic approaches refine the understanding of key pathways that lead to human IBD.

Internal Sphincterotomy Versus Rotation Flap to Treat Chronic Anal Fissures

The motivation to develop alternatives to lateral internal sphincterotomy for the treatment of anal fissure rests mainly on the risk of anal incontinence following the procedure. In recent years, pharmacological treatment with smooth muscle relaxants has been the most widely studied. Surgical alternatives have taken the form of flap procedures that purport to heal fissures by resurfacing and revascularization. In this issue of the Asian Journal of Surgery, Singh et al reports a case series using a rotational flap procedure.1 The series, though small, describes treatment of chronic anal fissure without impairment of continence. The paper does not make it clear how successful the rotation flap was in healing anal fissure. In two of their 14 patients, the anal fissure failed to heal. A randomized comparison with internal sphincterotomy would have been useful in determining technical superiority. A randomized controlled trial comparing an advancement flap with internal sphincterotomy in the treatment of anal fissure showed no statistical difference in healing rate between the two.2 There was a trend towards non-healing in the flap procedure group due to flap failure. Interestingly, no incontinence was reported in either group. There has been a tendency to over-emphasize the risk of incontinence following internal sphincterotomy. A 2% rate of anal incontinence has been reported with tailored sphincterotomy where there was careful attention to the amount of sphincter divided.3 A prospective trial of lateral internal sphincterotomy reported by Hyman showed similarly low rates of incontinence, with even fewer patients reporting an impairment in quality of life.4 Despite the grim prognostication of advocates of medical and flap alternatives, lateral internal sphincterotomy is some way from becoming a relic of surgery for anal fissure. Flap procedures have a role in the treatment of anal fissure in cases where incontinence is a genuine risk following sphincterotomy. Examples of this would include female patients with short anal canals and the elderly or multiparous who already have a degree of impaired anal continence.

Driver distraction by advertising: genuine risk or urban myth?

Drivers operate in an increasingly complex visual environment, and yet there has been little recent research on the effects this might have on driving ability and accident rates. This paper is based on research carried out for the Scottish Executive's Central Research Unit on the subject of external-to-vehicle driver distraction. A literature review/meta-analysis was carried out with a view to answering the following questions: is there a serious risk to safe driving caused by features in the external environment, and if there is, what can be done about it? Review of the existing literature suggests that, although the subject is under-researched, there is evidence that in some cases overcomplex visual fields can distract drivers and that it is unlikely that existing guidelines and legislation adequately regulate this. Theoretical explanations for the phenomenon are offered and areas for future research highlighted.

Driver distraction by advertising: genuine risk or urban myth?

Drivers operate in an increasingly complex visual environment, and yet there has been little recent research on the effects this might have on driving ability and accident rates. This paper is based on research carried out for the Scottish Executive's Central Research Unit on the subject of external-to-vehicle driver distraction. A literature review/meta-analysis was carried out with a view to answering the following questions: is there a serious risk to safe driving caused by features in the external environment, and if there is, what can be done about it? Review of the existing literature suggests that, although the subject is under-researched, there is evidence that in some cases overcomplex visual fields can distract drivers and that it is unlikely that existing guidelines and legislation adequately regulate this. Theoretical explanations for the phenomenon are offered and areas for future research highlighted.

Technical note: linkage disequilibrium and disease-associated CTLA4 gene polymorphisms.

CTLA4 and CD28 are important regulators of T lymphocyte activation. Gene region 2q33 carrying genes for both CTLA4 and CD28 has been shown to be linked to many autoimmune diseases. Disease associations with particular CTLA4 gene polymorphisms have been reported. Recently, first lines of evidence emerged for functional effects of CTLA4 gene polymorphisms. Two independent studies reported a reduced inhibitory function of CTLA4 in individuals with certain CTLA4 genotypes: those with a high number of microsatellite repeats in one study and those with allele +49*G in exon 1 in the other one. We analyzed the strength of linkage disequilibrium between the three known CTLA4 polymorphisms among 577 independent chromosomes. Our results show that the polymorphisms previously suggested to be the functional risk factors nearly always occur together in a very frequent haplotype. Due to this strong linkage disequilibrium, we conclude that the previous reports studying merely a single polymorphism could not distinguish which variation actually caused the functional difference. Hence, either mutagenesis approaches or studies with data on all linked polymorphisms are still needed to determine the genuine functional risk polymorphism in this gene region.

This month in J Lab Clin Med: Issue highlights for June 2001

This month in J Lab Clin Med: Issue highlights for June 2001

Can Law Learn from Social Science?

In this paper I shall be discussing a fundamental problem in the relationship between law and the social sciences. Many social scientists have pointed out that the “pull of the policy audience” in legislative and administrative exercises and the confines of practical decision-making in legal settings can compromise the proper development of academic social science and blunt the edge of political critique. The danger is real enough. But they have given insufficient attention to the opposite concern which will be my topic in this article. Here the charge is that the introduction of social scientific styles of reasoning can have ill effects for legal practice by threatening the integrity of legal processes and the values they embody. How can social scientists be sure that they have properly understood the nature of law or the meaning and point of the legal rules, procedures, and institutions which they attempt to analyze and seek to improve? What warrant can they have that social scientific interpretation, at any level, does not end up creating law in its own image? If this is a genuine risk, what implications follow for the way law should learn from social science? I shall argue that there are no easy answers to these questions even, or especially, where law apparently welcomes contributions from social science.

Measles vaccination and inflammatory bowel disease: a national British Cohort Study.

Measles vaccination has been suggested as a risk for inflammatory bowel disease. Atypical age of measles infection has also been associated with Crohn's disease. This study was designed to examine the relationship of measles vaccination and age of measles vaccination with later inflammatory bowel disease. A prospective population-based national birth cohort was used, of those born in 1 wk in April 1970 in Great Britain. The data are from 7616 responding members of the 1970 British Cohort Study with complete vaccination data, who were traced at age 26 yr. A diagnosis of Crohn's disease, ulcerative colitis, and diabetes mellitus (a control disease) was obtained by survey at age 26 yr, and confirmed by physicians. Vaccination data were from survey at age 5 yr. Measles and mumps infection data were obtained from the survey at age 10 yr. Adjustment was made for sex, household crowding in childhood, and father's social class at birth. No statistically significant association was found between measles vaccination status at 5 yr and Crohn's disease (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.27-1.63), ulcerative colitis (adjusted OR 0.57, 95% CI 0.20-1.61), or diabetes (adjusted OR 0.75, 95% CI 0.33-1.74). There was a statistically significant trend (p = 0.040) with increasing age of measles vaccination for risk of Crohn' s disease, although this was based on very few cases vaccinated after age 2 yr. In this cohort, monovalent measles vaccination status is not associated with inflammatory bowel disease by age 26 yr. Older age at measles vaccination needs to be examined in other studies to confirm whether it is a genuine risk for Crohn's disease.

Measles vaccination and inflammatory bowel disease: a national British cohort study

OBJECTIVE: Measles vaccination has been suggested as a risk for inflammatory bowel disease. Atypical age of measles infection has also been associated with Crohn’s disease. This study was designed to examine the relationship of measles vaccination and age of measles vaccination with later inflammatory bowel disease. METHODS: A prospective population-based national birth cohort was used, of those born in 1 wk in April 1970 in Great Britain. The data are from 7616 responding members of the 1970 British Cohort Study with complete vaccination data, who were traced at age 26 yr. A diagnosis of Crohn’s disease, ulcerative colitis, and diabetes mellitus (a control disease) was obtained by survey at age 26 yr, and confirmed by physicians. Vaccination data were from survey at age 5 yr. Measles and mumps infection data were obtained from the survey at age 10 yr. Adjustment was made for sex, household crowding in childhood, and father’s social class at birth. RESULTS: No statistically significant association was found between measles vaccination status at 5 yr and Crohn’s disease (adjusted odds ratio [OR] 0.67, 95% confidence interval [CI] 0.27–1.63), ulcerative colitis (adjusted OR 0.57, 95% CI 0.20–1.61), or diabetes (adjusted OR 0.75, 95% CI 0.33–1.74). There was a statistically significant trend (p = 0.040) with increasing age of measles vaccination for risk of Crohn’s disease, although this was based on very few cases vaccinated after age 2 yr. CONCLUSIONS: In this cohort, monovalent measles vaccination status is not associated with inflammatory bowel disease by age 26 yr. Older age at measles vaccination needs to be examined in other studies to confirm whether it is a genuine risk for Crohn’s disease.

The financing of small firm product innovation within the UK

This paper investigates the funding environment facing product innovating small manufacturing firms and both supports and contradicts a number of “stylised facts” which have emerged over the last decade. Amongst the key findings it appears that, whilst innovators were no more nor less likely to have sought external funds, they were significantly less likely to have successfully accessed bank finance. This finding is of particular gravity since bank debt remains the primary source of external finance employed. Further, the paper notes the low use of genuine risk capital to fund product innovation and raises the question as to what extent this reflects supply or demand side deficiencies. The role of public subsidies, in the form of grant funding, is also investigated with some tentative evidence pointing to the role grants play in validating technology or as leverage to access further funds.

Lifetime panic-depression comorbidity in the National Comorbidity Survey.

The National Comorbidity Survey is a nationally representative survey of the prevalences and correlates of DSM-III-R disorders in the US household population. Retrospective age-at-onset reports were used to study predictive relationships between lifetime panic and depression. Strong associations were found between the lifetime prevalences of panic and major depressive episodes (odds ratios: for panic attacks with depression, 6.2; for panic disorder with depression, 6.8). These associations were not significantly influenced by the inclusion or exclusion of respondents with mania. Temporally primary depression predicted a first onset of subsequent panic attacks but not of panic disorder. Temporally primary panic attacks, with or without panic disorder and whether or not the panic was persistent, predicted a first onset of subsequent major depression. The associations between panic attack and depression were attenuated in models that controlled for prior traumatic life experiences and histories of other DSM-III-R disorders. Lifetime panic-depression comorbidity characterizes most community respondents with panic disorder and a substantial few of those with major depression. The absence of a dose-response relationship suggests that primary panic attack is a marker, rather than a causal risk factor, of subsequent depression. Primary depression, in comparison, appears to be a genuine risk factor for secondary panic attacks. That primary depression predicts panic attacks but not panic disorder suggests that secondary panic is a severity marker of depression rather than a comorbid condition. These results are far from definitive because they are based on retrospective reports, lay-administered diagnostic interviews, and only 1 survey. However, they raise important questions that could lead to a fundamental rethinking of panic-depression comorbidity if they are replicated in future epidemiological and clinical studies.

The pharmacokinetics, metabolism, and tissue residues of beta-adrenergic agonists in livestock.

Since the early 1980s the usefulness of dietary beta-agonists to improve the efficiency of feed utilization and(or) to enhance carcass leanness in livestock species has been well documented. Less well documented are the pharmacokinetic properties, biotransformation pathways, and tissue residue profiles of beta-agonists used to enhance leanness in experimentally or illegally treated animals. Pharmacokinetic data for clenbuterol, cimaterol, fenoterol, L-644,969, ractopamine, salbutamol, and terbutaline have been published but biotransformation and tissue residue studies for these compounds in livestock species are sparse. In general, beta-agonists having halogenated aromatic ring systems are metabolized by oxidative and conjugative pathways and have long plasma half-lives, whereas beta-agonists having hydroxylated aromatic rings are metabolized solely by conjugation and have relatively short plasma half-lives. Beta-Agonists having high oral bioavailabilities, long plasma half-lives, and relatively slow rates of elimination have high oral potencies in humans. Residues of such illegally used compounds in edible tissues of livestock represent a genuine risk to consumers. Conversely, beta-agonists having low oral bioavailabilities, short plasma half-lives, and rapid rates of elimination have low oral potencies in humans. Residues of such compounds in edible tissues of properly treated animals would not likely represent a credible risk to consumers of such products. The reviewed data indicate that the development of a safe and effective beta-agonist for use in livestock is possible.

Mental Disabilities and the Americans with Disabilities Act: A Dysfunctional Handbook?

Mental Disabilities and the Americans with Disabilities Act: A Dysfunctional Handbook? by John F. Fielder (Quorum Books, 1994). Reviewer: Richard A. Stohlman, Towson, Maryland John F. Fielder, president and founder of San Francisco's California Institute of Psychology, has made a creditable effort to create a resource for organizations which will enable them to comply with the mental disabilities portion of the Americans with Disabilities Act (ADA). His reason for writing the book is to help U.S. businesses avoid the penalties and punitive damages associated with noncompliance. Fielder's premise is that, since the ADA fails to explicate useful guidelines for providing reasonable accommodations to employees with mental disabilities, organizations with 15 or more employees are at risk of violating federal law. Fielder attempts to reduce this risk by giving businesses a road map with which to navigate safely through both the vagaries of the Act and the maze of terms and diagnoses associated with the identification and treatment of mental disability. The question is whether the good doctor's prescription will really cure the ills brought on by vague legislation which is afflicting a growing number of businesses. Unfortunately, the prognosis is not very good. Fielder begins well, by identifying a genuine business risk with significant consequences for risk management failures. As his publishers promise, the author does a good job of discussing complex issues in clear and concise terms. The book is well structured, easy to read, and can be finished in just a few hours. The preface is rather badly dated, however, owing to the tendency to ignore the rapid obsolescence of the printed word, especially in book form. In the few years since this book was released, for example, the number of mental illness-related ADA claims to the Equal Employment Opportunity Commission (EEOC) has risen from the 9.8 percent quoted by Fielder, to nearly 13 percent, a healthy jump of definite interest to executives. Any business or employee assistance program may also obtain more current information by calling the EEOC at (800) 669-3362 or by visiting its Website at www.eeoc.gov/docs/ psych.txt. In addition to the challenges inherent in writing a timely book about a rapidly changing area of law, commerce, and social discourse, it is also worth noting that much of the research and professional opinion cited by the author in his own field is two to three decades old. This distraction is noticed almost immediately and may be a disappointment to some readers. Similarly, the book's central flaw is contained in the introduction and will be spotted at once by alert readers: the author's candid admission that he has written this book from the standpoint of what makes practical sense to a psychologist. This dubious perspective is the prism through which Fielder views the challenge and shapes the solutions put forth in his book. Ironically, it blinds him to contradictions which may be obvious to those who lack his clinical training and experience. While allowing, for example, that determining accommodations for mental disabilities [is] an area that remains unclear even for most mental health professionals, Fielder blithely asserts in the same paragraph that,regardless of the mental disability, it should be neither costly nor difficult to offer reasonable accommodations for most qualified employees. …

Development of Food Safety Risk Assessment Guidelines for Foods of Animal Origin in International Trade

The international food safety environment is currently in a unique period of reevaluation and change. In an emerging trading environment regulated more according to food safety requirements than nontariff trade protection barriers, food safety risk analysis is pivotal to future Codex activities and implementation of the World Trade Organisation (WTO) Sanitary and Phytosanitary (SPS) Agreement. Development of guidelines for food safety risk assessment requires determination of scope, internationally agreed definitions, general principles, guidelines tailored for each class of foodborne hazards, and linkages and interactions with risk management and risk communication. Food safety risk assessments need to be soundly based on science, should incorporate the four analytical steps of the risk assessment paradigm, and should be documented in a transparent and readily understandable form. The particular needs of Codex, the WTO, national governments, industry, and consumers need to be taken into account, and this includes identification of the essential linkages between risk assessment and the design of HACCP plans. With respect to chemical hazards in food, a risk assessment approach provides the opportunity to broaden the understanding of acceptable daily intakes, maximum residue levels, and their public health significance. Guidelines for chemicals in foods will inevitably have to address the differences between safety evaluation and a genuine risk assessment approach. With respect to microbiological hazards, the unique problems associated with risk assessment of living organisms in food make it likely that application of guidelines in the medium term will more commonly use qualitative approaches. In the absence of a history of safety evaluation according to a notionally zero risk baseline, as is the case with chemicals, the objective of microbiological risk analysis to reduce microbial risks to “the minimum which is technologically feasible and practical” represents a genuine focus for risk assessment. As risk assessment is increasing applied and internationally accepted guidelines become established, decision criteria for risk management arguably present the greatest challenge in establishing and maintaining quantitative SPS measures for food in international trade and judging their equivalence. However, the desire of all interested parties for scientifically justified food safety measures may be tempered according to the ability of the global scientific community to generate the necessary data and the political will to accept food safety programmes in different countries that have equivalent outputs.

Low education is a genuine risk factor for accelerated memory decline and dementia

A relatively high prevalence and incidence of dementia have been found in population strata with low levels of education in comparison to population strata with high levels of education. However, doubt remains whether this may be an artifact of education bias in the screening tests used. To investigate this matter, we analyzed results of two Dutch population surveys in which unbiased measures of memory decline were used. In the Longitudinal Aging Study Amsterdam ( n = 1774) the percentage of words retained in a verbal learning test was found to be disproportionately low in the oldest age cohort (80–85 years) with less than 11 years of education. The Amsterdam Study of the Elderly ( n = 4051) found a “dose-response” relationship between education and dementia prevalence. Cross-sectional and longitudinal results showed that, in less educated people, memory decline is faster and sets in at an earlier age. These findings indicate that the relationship between dementia and education is not just an artifact of case detection methods.

Multicentre trials in obstetrics and gynaecology

Multicentre trials in obstetrics and gynaecology

Consuelo Kanaga: An American Photographer

When those meant to uphold the law become a law unto themselves, where are we to turn? Are the gung-ho guys in uniform bending the rules to lock up those who pose a genuine risk, or are they bent on sadiwm, like the notorious Volpe and Schwartz? Jack Sargeant looks at notorious cases of good cops gone bad - and those who started out that way. Read about lone cops who couldn't take the pressure anymore and went on killing sprees, through to the corruption that spread through the Met in the 1970s. Bad Cop, Bad Cop also digs out the truth from the controversy surrounding the beating of Rodney King and looks at the current state of play in the LAPD. Ultimately, the book poses the question: would you be any better when faced with a job dealing with an increasingly lawless society.

Relation between education and dementia: the role of test bias revisited.

Several authors have suggested that dementia screening tests may be biased against low levels of education, whereas others find that a low level of education is a genuine risk factor for dementia. The present paper attempts to reconcile these conflicting views by examining item bias and test bias indices of the mini mental state examination (MMSE). Psychometric calculations and receiver operating characteristics (ROC) analyses of sensitivity and specificity as performed by earlier studies were replicated and extended from the database of the Amsterdam Study of the Elderly. This is a population survey on cognitive decline and dementia (age range 65-84). Subjects with a low level of education (primary school) were compared with better educated subjects (at least some secondary education). Cases were matched by age and sex. The results indicate that the MMSE is not educationally biased as far as item characteristics, reliability, and construct validity are concerned. Yet its predictive validity as a screening test for dementia is educationally biased. This bias will effectively be eliminated with a two point higher cut off score for the subjects whose education extends beyond primary school. Even after such score correction, a low level of education probably remains a genuine risk factor for dementia.