Individual Consent Research Articles

An Investigation of Parental Consent Principles and Their Effects on TGDNB Minors Access to Hormone Therapy in Australia

In Australia, the legal and ethical discourse regarding parental consent for gender-affirming hormone therapy (GAHT) has significant complexity and represents an evolving dynamic of discourse. The role of parental consent in minors access to GAHT has become increasingly complicated with laws and policies changing in response to societal perspectives on gender identity, the involvement and role of the courts is a determining factor in minors' access to GAHT. Simultaneously it is intensely associated with the minors individual consent and the scope of medical practitioners' responsibilities. As established by Gillick V. West Norfolk and Wisbech Area Healthy Authority, the Gillick competency principle recognises that minors are allowed to make decisions independently if they have sufficient maturity and capacity to understand the implications and consequences of such decisions. The Australian jurisprudence, at present, was initially considered to recognise the Gillick competency principle. However, as the jurisprudence continues to evolve, the legal attitude regarding minors' access to GAHT treatment in Australia has deviated from the Gillick competency principle due to the tendency of parental protectionism in Australia. This thesis starts with the content and the reasoning of the Gillick Competency Principle, to discuss its practice and applications in Australia, as well as its implications regarding the Parental Consent Principle and the accessibility of GAHT to minors. Meanwhile, providing suggestions regarding the improvement of the present situation.

RETRACTION: The Design for Supply Chain Management of Intelligent Logistics System Using Cloud Computing and the Internet of Things

Retraction: H. Wang, Y. Yin, and X. Wang, “,” Expert Systems 41, no. (2024): . https://doi.org/10.1111/exsy.13271. The above article, published online on 02 March 2023, in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor‐in‐Chief, David Camacho; and John Wiley & Sons Ltd. The article was submitted as part of a guest‐edited special issue. Following publication, it has come to the attention of the journal that this article was accepted solely on the basis of a compromised peer review process. In addition, the authors did not provide a statement regarding individual consent for the images used in Figure 13, which violates the journal's and the publisher's guidelines. The editors have therefore decided to retract the article. The authors did not respond to the notice of retraction.

Estimating the potential impact of pneumococcal vaccination for new residents entering care homes for older adults in England

BackgroundThe incidence of invasive pneumococcal disease (IPD) increases exponentially in older adults, with very high case fatality rates. In the UK, the 23-valent pneumococcal polysaccharide vaccine (PPV23) is offered to all adults at age 65. PPV23 has moderate vaccine effectiveness against 23 pneumococcal serotypes in older adults, with rapid waning after 5–10 years. The median resident age in care homes for older adults is 86 years, therefore no longer protected by their PPV23 dose, despite increased risk due to advanced age, underlying comorbidities and living in closed settings. We used national surveillance data to estimate the potential impact of vaccinating new care home residents with PPV23 additional to existing national immunisation programme for 65-year-olds. MethodsThe UK Health Security Agency conducts enhanced IPD surveillance in England. National IPD incidence of IPD and care home resident population and life expectancy data were used to calculate the numbers needed to vaccinate (NNV) new care home residents with PPV23 to prevent one IPD case compared to 65-year-olds receiving PPV23 as part of the national immunisation programme. The study did not involve collection of primary data and did not meet the UK Medical Research Council definition of research and therefore no ethical approval was required. Furthermore, UKHSA has legal permission to process confidential information for the purpose of national surveillance of communicable diseases without individual patient consent (Regulation 3 of Health Service Regulations 2002). FindingsIn 2022/23, there were 2574 IPD cases among 603 109 ≥65-year-olds including 1786 (69%) caused by PPV23 serotypes, after correcting for missing serotypes, among confirmed IPD cases. With national vaccine uptake of 71% and PPV23 effectiveness of 36%, the NNV was 3706 to prevent one IPD case in the national immunisation programme for 65-year-olds. Among 121 587 new residents entering English care homes annually, the NNV was 3026. InterpretationVaccinating residents when they enter care homes for older adults with PPV23 has potential to prevent more cases per dose than the national PPV23 programme for 65-year-olds. Pneumococcal conjugate vaccines, such as the recently licensed PCV20, are expected to have higher vaccine effectiveness with longer duration of protection so could prevent even more cases in this vulnerable population. FundingNone.

CONTACT: a non-randomised feasibility study of bluetooth-enabled wearables for contact tracing in UK care homes during the COVID-19 pandemic

BackgroundThe need for effective non-pharmaceutical infection prevention measures such as contact tracing in pandemics remains in care homes, but traditional approaches to contact tracing are not feasible in care homes. The CONTACT intervention introduces Bluetooth-enabled wearable devices (BLE wearables) as a potential solution for automated contact tracing. Using structured reports and reports triggered by positive COVID-19 cases in homes, we fed contact patterns and trends back to homes to support better-informed infection prevention decisions and reduce blanket application of restrictive measures. This paper reports on the evaluation of feasibility and acceptability of the intervention prior to a planned definitive cluster randomised trial of the CONTACT BLE wearable intervention.MethodsCONTACT was a non-randomised mixed-method feasibility study over 2 months in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection methods included routine data from the devices, case report forms, qualitative interviews (with staff and residents), field observation of care, and an adapted version of the NoMaD survey instrument to explore implementation using Normalisation Process Theory. Quantitative data were analysed using descriptive statistical methods. Qualitative data were thematically analysed using a framework approach and Normalisation Process Theory. Intervention and study delivery were evaluated against predefined progression criteria.ResultsOf 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82% (n = 178) participated. Device loss and damage were significant: 11% of resident devices were lost or damaged, ~ 50% were replaced. Staff lost fewer devices, just 6%, but less than 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Structured and reactive feedback was variably understood by homes but unlikely to be acted on. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. Study participation benefits did not outweigh perceived burden and were amplified by the pandemic context. CONTACT did not meet its quantitative or qualitative progression criteria.ConclusionCONTACT found a large-scale definitive trial of BLE wearables for contact tracing and feedback-informed IPC in care homes unfeasible and unacceptable — at least in the context of shifting COVID-19 pandemic demands. Future research should co-design interventions and studies with care homes, focusing on successful intervention implementation as well as technical effectiveness.Trial registrationISRCTN registration: 11204126 registered 17/02/2021.

Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

BackgroundThe ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.MethodsThe GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.ResultsWe describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.ConclusionsThe 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Understanding Chinese Internet Users' Perceptions of, and Online Platforms' Compliance with, the Personal Information Protection Law (PIPL)

The Personal Information Protection Law (PIPL) was implemented in November 2021 to safeguard the personal information rights and interests of Internet users in China. However, the impact and existing shortcomings of the PIPL remain unclear, carrying significant implications for policymakers. This study examined privacy policies on 13 online platforms before and after the PIPL. Concurrently, it conducted semi-structured interviews with 30 Chinese Internet users to assess their perceptions of the PIPL. Users were also given tasks to identify non-compliance within the platforms, assessing their ability to address related privacy concerns effectively. The research revealed various instances of non-compliance in post-PIPL privacy policies, especially concerning inadequate risk assessments for sensitive data. Although users identified some non-compliant activities like app eavesdropping, issues related to individual consent proved challenging. Surprisingly, over half of the interviewees believed that the government could access their personal data without explicit consent. Our findings and implications can be valuable for lawmakers, online platforms, users, and future researchers seeking to enhance personal privacy practices both in China and globally.

Abstract 6974: Spatial exosome analysis reveals the location heterogeneity of exosomal miRNAs in ovarian cancer patients

Abstract Extracellular vesicles (EVs), including exosomes, are recognized as promising functional tools involved in cancer progression. Although evidence of the functions of EV in cancer biology has been accumulating, optimizing EV isolation is still a major challenge. In ovarian cancer, peritoneal dissemination is a crucial prognostic factor due to the lack of effective treatment, and EVs in malignant ascites play a key role for progression. In this study, we invented cellulose nanofiber (CNF) sheets which enable to capture EVs from approximately 10 μL of biofluids and enabled the analysis of the bioactive molecules included in the EVs (Nature Communications 2023). By attaching CNF sheets to moistened organs, the EVs in trace amounts of ascites were collected, which was sufficient to perform small RNA sequence analyses. In the ovarian cancer mouse model, CNF sheets enabled the detection of cancer-associated miRNAs from the very early phase when the mice did not have apparent ascites, and the EVs from different locations, such as pelvic walls or liver surfaces, had unique miRNA profiles. To confirm the utility of the CNF sheets in cancer patients, we directly collected the EVs on the organ surfaces by the EV attachment method during surgery under appropriate ethical institutional approval with individual consent. EVs were collected from the pelvic peritoneum, omentum, liver surface, or tumor surface, and the miRNA profiling demonstrated each location formed unique clusters. Notably, several tumor-suppressive miRNAs have been identified in liver surface EVs, such as miR-122-3p, and this is consistent with actual ovarian cancer cell progression, which tends to metastasize to the diaphragm rather than to the liver surface. In addition, the trajectory analysis revealed that the pattern of connection in each site was different between patients with localized and advanced disease. We identified ten miRNAs were high in tumors and in EVs from tumor rupture sites, and the level of each miRNA decreased with distance from the primary tumors. Among ten miRNAs, hsa-miR-200b-3p and hsa-miR-429 were confirmed as highly expressed in tumor tissues compared to adjacent normal tissues or benign tumors, and three miRNAs in serum, urine and saliva decreased post-surgery. In summary, spatial CNF sheet analyses in patient bodies identified location-based heterogeneity in EV-miRNA profiles, and the profiles reflected disease conditions. This new method could provide unveiled biological aspects of EVs, and suggest a clinical strategy contributing to cancer diagnosis, staging evaluation, and therapy planning. Citation Format: Akira Yokoi, Kosuke Yoshida, Yusuke Yamamoto, Takao Yasui, Hiroaki Kajiyama. Spatial exosome analysis reveals the location heterogeneity of exosomal miRNAs in ovarian cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6974.

Forensic DNA Profiling: Legal and Ethical Considerations

Forensic DNA analysis is vital in criminal investigations, posing intricate legal and ethical dilemmas. This emphasises the need to balance DNA technology benefits with individual rights, prioritizing privacy, consent, and ethical practices. Stringent regulation of DNA data management is essential to prevent misuse and ensure privacy protection. Advances like probabilistic genotyping software improve interpretation accuracy, addressing complexities in mixture analysis. Responsible DNA use also requires navigating emerging technologies like next-generation sequencing while upholding ethical standards. Establishing transparency, accuracy, and ethical conduct throughout the analysis process is crucial for building public trust. Regulatory oversight and accountability mechanisms are necessary to address errors and maintain fairness in DNA data management. Through continuous dialogue and adherence to ethical standards, the forensic community can uphold scientific integrity and preserve public confidence in DNA analysis.

A novel approach for constructing privacy‐aware architecture utilizing Shannon's entropy

SummaryThe right to privacy refers to an individual's decision about how personal information can be gathered, utilized, and disseminated. Individual consent and openness are the most important foundations for gaining consumers' confidence, and this pushes businesses to use privacy‐enhancing techniques while developing systems. The purpose of a privacy‐aware design is to safeguard data in such a manner that it does not expand an adversary's current understanding of an individual beyond what would be permitted. When these data pieces are coupled with the plethora of source data accessible outside the system to identify a user, this becomes crucial. Individual privacy is protected by privacy rules all around the globe, but they are often complicated and ambiguous, making their translation into practical and technologically privacy‐friendly structures difficult. The main contribution of this article is that we use Shannon's entropy (SE) to construct an objective measure that may guide our major technical design choices. And for privacy‐aware architecture, simplifying the state‐of‐the‐art security approaches given in the literature.

Reimbursment of Cardiac Leadless Pacemakers AD 2024

The first implantations of leadless pacemakers in Poland were carried out in January 2016, i.e. just over two years after the first implantation in the world. In total, more than 500 systems of this type have been implanted in the country. For most of the last 8 years, it has been possible to reimburse the procedure under the payer’s individual consent, although for over a year it has not been possible at all, and many regional branches of the National Health Fund have had a negative attitude towards applications for reimbursement. It was not until the Regulation of the Minister of Health of 1 December 2023 and the Regulation of the President of the National Health Fund of 29 December 2023 that the procedure could be fully reimbursed in selected groups of patients. The article discusses the requirements for the implementation of the service.

Community engagement in genetics and genomics research: a qualitative study of the perspectives of genetics and genomics researchers in Uganda

BackgroundGenerally, there is unanimity about the value of community engagement in health-related research. There is also a growing tendency to view genetics and genomics research (GGR) as a special category of research, the conduct of which including community engagement (CE) as needing additional caution. One of the motivations of this study was to establish how differently if at all, we should think about CE in GGR.AimTo assess the perspectives of genetics and genomics researchers in Uganda on CE in GGR.MethodA cross-sectional qualitative study was conducted at Makerere University and Uganda Virus Research Institute. Twenty-five individuals participated, the majority being male (sixteen). Participants included nineteen genetics and genomics researchers (researchers and research coordinators), two CE officers, three nurses and one nursing counsellor. Data were collected using in-depth interviews and analyzed in a thematic manner using NVivo version 12 Plus.Study findingsThirteen of the respondents had conducted CE in their GGR in either a geographical and disease-specific community. Some respondents said CE principles are the same and there is no need for special consideration for CE in GGR. Others gave ethical issues in GGR that require special consideration for CE in such research and these were categorized into six themes: GGR is new to communities, Difficulty in communicating GGR by the researchers, Genes are shared in communities, Cultural sensitivities against GGR, Community attitude toward GGR, Some GGR studies take long to end, and Negotiation of research benefits. Special considerations for CE when conducting GGR were suggested and categorized into seven themes: creating awareness of GGR in communities, obtaining both community acceptance and individual consent, CE team composition, involve communities in solving GGR challenges, prolong CE in some GGR, develop guidelines for CE in GGR, and legal considerations on GGR.ConclusionGGR was characterized by special issues that require special CE considerations for such research.

EVALUATION OF ANATOMICAL VARIATIONS OF EXTRARENAL RENAL ARTERIAL VASCULATURE IN VOLUNTARY KIDNEY DONORS

Objective: The present study was aimed at evaluating the variations in extrarenal renal arterial vasculature in voluntary kidney donors who had undergone Multi-Detector Computed Tomography (MDCT) renal angiography for preoperative workup. Methods: A retrospective hospital based cross-sectional study was carried out in a tertiary care Army hospital in Delhi from Jan 2019 to June 2020. All voluntary kidney donors included in the study underwent Multi-Detector Computed Tomography Angiography (MDCTA) of renal arteries as a part of routine pre-operative imaging protocol and were referred by the treating physician/surgeon for MDCTA study. Retrospective analysis of the image datasets was undertaken by the principal investigator and individual patient consent was waived off by the institutional Ethics committee. Results: The mean age of study participants was 45.9±10.2 y. Accessory renal artery was relatively more common on left side (p-value 0.001). There was statistically no significant difference between gender and the presence of accessory renal artery. There was statistically no significant difference on the comparison of side and gender with distance of segmentary bifurcation of MRA. The orthogonal diameters at the origin of the MRA and accessory renal artery on both sides were also comparable. Origin of accessory renal arteries were caudal to MRA was more frequently seen. Early segmentary bifurcation of MRA was commoner on the right side. Conclusion: The study emphasizes the importance of meticulous preoperative assessment, highlighting the need for surgeons to be cognizant of the potential variations in extrarenal renal artery anatomy. Such awareness is crucial for planning successful kidney transplant surgeries.

Predictive value of infiltrating tumor border configuration of rectal cancer on MRI

BackgroundInfiltrating tumor border configuration (iTBC) is assessed by postoperative pathological examination, thus, is not helpful for preoperative treatment strategies. The study aimed to detect iTBC by magnetic resonance imaging (MRI) and evaluate its predictive value.Materials and methodsA total of 153 patients with rectal cancer were retrospectively analyzed. Clinicopathological and MRI data mainly including tumor border configuration (TBC) on MRI, MRI-detected extramural vascular invasion (MEMVI), tumor length, tumor growth pattern, maximal extramural depth, pathology-proven lymph node metastasis (PLN) and pathology-proven extramural vascular invasion (PEMVI) were analyzed. The correlation of MRI factors with PEMVI and PLN was analyzed by univariate and multivariate logistic regression analyses. The nomograms were established based on multivariate logistic regression analysis and were confirmed by Bootstrap self-sampling. The receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) were used to evaluate the diagnostic efficiency.ResultsFifty cases of PEMVI and 48 cases of PLN were found. Forty cases of PEMVI and 34 cases of PLN in 62 cases of iTBC were also found. iTBC, MEMVI and maximal extramural depth were significantly associated with PEMVI and PLN (P < 0.05). iTBC (odds ratio = 3.84 and 3.02) and MEMVI (odds ratio = 7.27 and 3.22) were independent risk factors for PEMVI and PLN. The C-indices of the two nomograms for predicting PEMVI and PLN were 0.863 and 0.752, respectively. The calibration curves and ROC curves of the two nomograms showed that the correlation between the predicted and the actual incidence of PEMVI and PLN was good. The AUCs of iTBC for predicting PEMVI and PLN were 0.793 (95% CI: 0.714–0.872) and 0.721 (95% CI: 0.632–0.810), respectively. The DeLong test showed that the predictive efficiency of the nomogram in predicting PEMVI was better than that of iTBC (P = 0.0009) and MEMVI (P = 0.0095).ConclusioniTBC and MEMVI are risk factors for PEMVI and pelvic lymph node metastasis. The nomograms based on iTBC show a good performance in predicting PEMVI and pelvic lymph node metastasis, possessing a certain clinical reference value.Trial registrationThis study was approved by the Ethics Committee of Beijing Friendship Hospital, and individual consent was waived for this retrospective analysis.

Evaluation of CTRL: a web application for dynamic consent and engagement with individuals involved in a cardiovascular genetic disorders cohort

There has been keen interest in whether dynamic consent should be used in health research but few real-world studies have evaluated its use. Australian Genomics piloted and evaluated CTRL (‘control’), a digital consent tool incorporating granular, dynamic decision-making and communication for genomic research. Individuals from a Cardiovascular Genetic Disorders Flagship were invited in person (prospective cohort) or by email (retrospective cohort) to register for CTRL after initial study recruitment. Demographics, consent choices, experience surveys and website analytics were analysed using descriptive statistics. Ninety-one individuals registered to CTRL (15.5% of the prospective cohort and 11.8% of the retrospective cohort). Significantly more males than females registered when invited retrospectively, but there was no difference in age, gender, or education level between those who did and did not use CTRL. Variation in individual consent choices about secondary data use and return of results supports the desirability of providing granular consent options. Robust conclusions were not drawn from satisfaction, trust, decision regret and knowledge outcome measures: differences between CTRL and non-CTRL cohorts did not emerge. Analytics indicate CTRL is acceptable, although underutilised. This is one of the first studies evaluating uptake and decision making using online consent tools and will inform refinement of future designs.

Information and Communication Technology (ICT) and Employee Performance: Relationship

This paper aimed to gain an insight about the relationship between Information and Communication Technology (ICT) and employee performance at Private Management Colleges in the Kathmandu District. Descriptive analysis was used to explore the dimensions of academic performance. To conduct this research, a quantitative methodology was employed. Questionnaires was the main instrument used for the data collection. The study restricts to the private management colleges and institutions only. A Total of 45 teaching faculties of Kathmandu district were selected for the study to explore the use of ICT in relation to the employee performance. Individual consent was taken for ethical consideration. Mean, Standard deviation and Correlation was adopted to measure the objectives. The findings showed that the role of ICT to uplift teaching and learning practice at Private Management College seems to be substantial in the current scenario. The performance of faculty members in private management colleges in the sense of efficiency of work (r=0.612**, p=0.00), planning the work(r=0.632**, p=0.00), creativity and innovation(r=0.547**, p=0.00) and making effort(r=0.454**, p=0.02) was significantly contributed by the use of ICT. ICT played a significant role to uplift the performance of faculty members of private management college of the Kathmandu district. All the results presented so far in the study have been found to be indicating strong and positive relationship between ICT and employee performance. Statistically, it can be concluded in one sentence that if one point changes in ICT, it can bring 4 to 6 times positive changes in employee performance. In the future, the researcher should also investigate the impact of workforce diversity on team performance.

Commercial genetic information and criminal investigations: The case for social privacy

Taking a DNA test with a commercial company is an increasingly popular enterprise, with tens of millions of consumers worldwide. In recent years, these genetic databases have also been used for so-called investigative genetic genealogy (IGG): uploading a crime scene DNA sample in these databases to find a distant relative of the unknown suspect. This forensic use of genetic consumer information has already helped solve many crimes. The debate on IGG tends to focus on individual rights and values, such as individual consent, individual control over information, and – perhaps most prominently – individual privacy. In this paper, I propose to approach IGG through the lens of privacy's social value, in contrast to merely its individual value. First, I discuss the conceptualization of privacy as a social value. Next, I explore several issues of IGG that privacy's social value allows consideration for: the informational and decisional interconnectedness, the risk of a tyranny of the minority, the involvement of multiple contexts, and the relationship between citizens and state. I conclude that this approach offers a fruitful perspective to evaluate the ethical and social desirability of IGG, evading the simplified dichotomy between individual privacy versus the security of society, in which the former will almost automatically lose. A focus on privacy's social value recognizes the effects for society on both sides of the balance. It brings into the light fundamental ethical, social, and political concerns of IGG, that extend beyond individual data control or consent.

A National Resource Sharing Program Is Feasible Even in Challenging Lung Recoveries

BackgroundMobile ex vivo lung perfusion (mEVLP) allows transportation of lung allografts while maintaining ventilation and perfusion and has demonstrated safety and efficacy with the potential to expand organ utilization. A nationwide organ recovery service has been implemented to provide surgical expertise for recovery alongside mEVLP transportation services. MethodsWe reviewed patients at our institution who underwent lung transplantation with donor lungs procured with this program. Donor and recipient characteristics, procurement details, and outcomes were collected and descriptively analyzed. Individual patient consent was obtained. ResultsThree patients underwent bilateral lung transplantation and 1 patient received a unilateral lung transplant with allografts procured by the recovery service. Three of the grafts were recovered from donation after circulatory death (DCD) donors and 1 from a brain-dead donor. One DCD donor was particularly challenging, requiring resternotomy. All allografts recovered were of acceptable quality and ultimately used for transplantation. The incidence of adverse events was low, and all patients survived to discharge. ConclusionsA novel national mEVLP procurement service is safe and effective even in challenging procurements. Such a program may be beneficial to increase organ utilization through expanded use of lung donors in general and DCD donors in particular. Further study is warranted for the impact on transplant program resources, organ utilization, and outcomes.

Stenting versus medical therapy alone for symptomatic intracranial arterial stenosis: protocol for a systematic review and individual patient data meta-analysis

IntroductionIntracranial atherosclerotic stenosis (ICAS) is a common cause of stroke worldwide. However, whether the treatment options for symptomatic ICAS is stent placement or medical therapy alone is still controversial. At...

Caste is a Betrayal to Natural Justice, Accommodating Inequality as a Driving License: A Narrative of Oppression in a Parallel of Democracy

From dropping out of college seats to analyzing meritocracy the paper explores how the question of caste is essentially Brahmanical which is decided on birth and how ideological state apparatus like family or educational institutions practise caste as a ‘natural component’ to the human life to maintain the status quo of Indian social order. This paper will discover how on the Indian enlivened screen ‘democracy for all’ plays in absentia where caste for few others gets mechanically reproduced with a presence of a protagonist obligated to democracy. It will further analyze the way caste has seeped into democratic institutions to maintain inequality in profession isolating class while overlapping with it. Counter arguments also will appear where caste struggle is seen independently as a form of right separated from the question of dignity. This paper will track down the seed of discrimination that was usurped around 1500 BCE through the line of the struggle between two groups of people and try to do a comparative study on consent and hegemony through the reproduction of the silver screen. If Indian Parliament as an established ruling power incorporates equality, then caste goes against the whole idea of Parliament. Interestingly often caste politics submits itself to the worship of Parliament to segregate people not by default. It will track down democracy that embeds natural law and rights where caste is a betrayed natural justice. In this paper, the role of humans as genetically engineered beings will be placed against the unnatural component of Brahmanism that is often decided by production relations. It will also discuss how a written code of conduct could replace blood feuds, a power struggle that gave birth to democracy, and caste was born to accommodate inequality. John Locke’s idea of consent of individuals will be discussed further.

Consent, Background Justice and Patterned Privacy Principles

Notice and consent approaches, being the most prevalent legal frameworks, have in recent years come under fire. I suggest they fail because they rest on a historical approach to privacy justice, whereby the justice of a particular state of affairs is a function of whether each transaction on the way was just. Instead, I make use of a background justice framing. Even where consent is present it is inadequate to secure the values at stake. When we only assess the fairness or freedom of individual information transactions, we fail to see the way many can undercut the very values we seek to secure by requiring consent for disclosures in the first place. I propose a patterned principle to regulate the distribution of individual control over privacy, and to set the background against which individual notice and consent can still play a role, albeit a limited one.