Individual Harm Research Articles

The Needs of the Many Do Not Outweigh the Needs of the Few: The Limits of Individual Sacrifice across Diverse Cultures

Abstract A long tradition of research in WEIRD (Western, Educated, Industrialized, Rich, Democratic) countries has investigated how people weigh individual welfare versus group welfare in their moral judgments. Relatively less research has investigated the generalizability of results across non-WEIRD populations. In the current study, we ask participants across nine diverse cultures (Bali, Costa Rica, France, Guatemala, Japan, Madagascar, Mongolia, Serbia, and the USA) to make a series of moral judgments regarding both third-party sacrifice for group welfare and first-person sacrifice for group welfare. In addition to finding some amount of cross-cultural variation on most of our questions, we also find two cross-culturally consistent judgments: (1) when individuals are in equivalent situations, overall welfare should be maximized, and (2) harm to individuals should be taken into account, and some types of individual harm can trump overall group welfare. We end by discussing the specific pattern of variable and consistent features in the context of evolutionary theories of the evolution of morality.

Individualizing treatment choices in the systolic blood pressure intervention trial.

Any treatment decision should be tailored to the individual patients' characteristics. A personalized approach aims to help better selecting the patients who are likely to benefit most from a treatment decision. In the systolic blood pressure intervention trial, intensive treatment reduced the rate of major cardiovascular events, but increased the rate of serious adverse events (SAEs). To assess the trade-off between efficacy and safety to simultaneously quantify an individual patient's absolute benefit and absolute harm, helping clinicians making better therapeutic choices in daily practice. Multivariable Poisson regression models were used to identify independent risk factors for: primary composite cardiovascular outcome and major SAEs = safety. Estimates from the models were used to quantify each individual risk. Subclinical cardiovascular disease, number of antihypertensive agents, current smoking, age, urine albumin-to-creatinine ratio, and serum creatinine were associated with increased risk of both primary outcome events and SAEs. Triglycerides were associated with increased primary outcome events only, and chronic kidney disease and female sex with SAEs only. The models were well calibrated and showed good performance (c-index for safety = 0.69 and c-index for efficacy = 0.72). For the primary outcome, there is a steep gradient in risk by fifths of the predicted model and a similar gradient exists for the safety outcome predicted model. Mortality within 1 year of an efficacy outcome (as assessed by the Kaplan-Meier method) was nearly three-fold higher than following a safety outcome (21.9 vs. 7.5%). If one judges the clinical importance of efficacy and safety outcomes based on their 1-year mortality, then there is a net benefit of intensive therapy for almost all patients. Antihypertensive treatment intensification is associated with lower cardiovascular event rates; however, it increases the risk of adverse events. However, having adverse events has less weight when it comes to therapeutic decisions and antihypertensive therapy intensification is beneficial for the great majority of patients included in the systolic blood pressure intervention trial.

The Ethical Status of Social Impact Bonds

This paper develops a framework for assessing the ethical status of social impact bonds (SIBs). Drawing on evidence from SIBs addressing issues of recidivism, education, homelessness and healthcare in the UK and US, it extends existing work on the ethics of markets by Debra Satz (2010) for application to SIBs. It raises a number of ethical concerns regarding the specific structural characteristics of SIBs relating to informational asymmetry and power imbalances and to the extent to which SIBs may cause individual or societal harm.

Multiple Stakeholder Views on Data Sharing in a Biobank in an Integrated Healthcare Delivery System: Implications for Biobank Governance

Background: Beginning in 2005, researchers at Kaiser Permanente Northern California (KPNC) Division of Research developed the Research Program on Genes, Environment, and Health (RPGEH), a research resource of linked biospecimens, health surveys, and electronic health records on more than 200,000 adult KPNC members. This study examined multiple stakeholders’ values and preferences regarding protection of participants’ privacy and wide sharing of participant data by RPGEH. Methods: We conducted 45 semi-structured interviews in person or via phone and two focus groups with seven stakeholder groups, including RPGEH participants and decliners who are KPNC members, KPNC research scientists, external scientists, leadership, Human Subjects Research Protection Program staff, and RPGEH Community Advisory Panel members. Results: Three major themes emerged related to: (1) perceived individual and social harms associated with data sharing; (2) concerns to address when governing access to RPGEH data; and (3) impact of a blurred boundary between research and clinical care in the context of biobanking. Conclusions: The study results were considered in the development of RPGEH data governance and motivated the inclusion of KPNC Community Advisory Panel members and ELSI experts on committees that evaluate data access proposals. Our findings can help inform other biobanks going through similar processes developing data sharing and access policies.

“They Were Treating Me Like a Dog”: The Colonial Continuum of State Harms Against Indigenous Children in Detention in the Northern Territory, Australia

The analytic lens of state crime can inform our understanding of the mistreatment of Indigenous children and young people in settler-colonial state institutions. Based on a critical analysis of the proceedings and findings of the Royal Commission into the Protection and Detention of Children in the Northern Territory (2016–2017), this article identifies state crimes of torture and abuse inflicted on Indigenous children in carceral and non-carceral institutions. These crimes breach international human rights laws but are more than a set of individual harms. They are also part of a pattern of ongoing structural violence that reasserts the settler-colonial state's sovereign position. This article identifies that the Royal Commission itself is complicit in reproducing state sovereignty. It argues that redressing state crimes against Indigenous children requires challenging the structural injustice of the settler-colonial state.

Application of a simple, affordable quality metric tool to colorectal, upper gastrointestinal, hernia, and hepatobiliary surgery patients: the HARM score.

Quality is the major driver for both clinical and financial assessment. There remains a need for simple, affordable, quality metric tools to evaluate patient outcomes, which led us to develop the HospitAl length of stay, Readmission and Mortality (HARM) score. We hypothesized that the HARM score would be a reliable tool to assess patient outcomes across various surgical specialties. From 2011 to 2015, we identified colorectal, hepatobiliary, upper gastrointestinal, and hernia surgery admissions using the Vizient Clinical Database. Individual and hospital HARM scores were calculated from length of stay, 30-day readmission, and mortality rates. We evaluated the correlation of HARM scores with complication rates using the Clavien-Dindo classification. We identified 525,083 surgical patients: 206,981 colorectal, 164,691 hepatobiliary, 97,157 hernia, and 56,254 upper gastrointestinal. Overall, 53.8% of patients were admitted electively with a mean HARM score of 2.24; 46.2% were admitted emergently with a mean HARM score of 1.45 (p < 0.0001). All HARM components correlated with patient complications on logistic regression (p < 0.0001). The mean length of stay increased from 3.2 ± 1.8days for a HARM score < 2 to 15.1 ± 12.2 days for a HARM score > 4 (p < 0.001). In elective admissions, for HARM categories of < 2, 2-< 3, 3-4, and > 4, complication rates were 9.3, 23.2, 38.8, and 71.6%, respectively. There was a similar trend for increasing HARM score in emergent admissions as well. For all surgical procedure categories, increasing HARM score, with and without risk adjustment, correlated with increasing severity of complications by Clavien-Dindo classification. The HARM score is an easy-to-use quality metric that correlates with increasing complication rates and complication severity across multiple surgical disciplines when evaluated on a large administrative database. This inexpensive tool could be adopted across multiple institutions to compare the quality of surgical care.

The Myth of the Litigious Society: Why We Don't Sue. By David Engel. Chicago: University of Chicago Press, 2016.

The Myth of Litigious Society: Why We Don’t Sue. By David Engel. Chicago: University of Chicago Press, 2016.This is a book to be grateful for. It is a joy to teach, and a wellargued corrective to previous ways of thinking about responses to injury. It is a humane and compassionate text, bringing attention to embodied and emotional experiences of injury, and role that these experiences play in channeling reactions of those in pain, those who have been harmed. The best books help us understand our own substantive and theoretical areas; they help us extend our analysis. Engel's book is indeed one of best I have read lately. As I read, I find myself wanting to take insights from The Myth of Litigious Society and travel with them-beyond study of litigation and settlement and into study of legal mobilization and social movement activism.It is a particular strength of this work that to do so is possible; book opens a set of questions that invite us to think more deeply about individuals' reactions-litigious and not-to trauma. And, Engel's analysis shows us that so much of what we think we know is based on assumption that people are rational actors-economic self-determining individuals. He is persuasive, and clear: the decision-tree model [of legal claims making] is deeply flawed. ... [It constructs] an unrealistic image of injury and response that bears little relationship to injuries as they actually occur, or to victims as they actually live, breathe, and cope with dire circumstances in which they find themselves (36). So-called rational choice explanations miss-as Engel points out-cultural explanations. They also, and perhaps most importantly, miss emotional, cognitive, and physical explanations for activism.In some very evocative passages, and quoting others' powerful meditations on pain, Engel notes that when people have experienced trauma, and are in pain, very structure of their lives collapses (39-40). They live through hour-by-hour and even minute-by-minute attempts to endure (39-40). They do not have emotional margin to ponder future, or plan for better days; they exist in struggle, and their pain and struggle constitute their very identities, which limits their ability to make legal claims. In his book, Engel is clear: we cannot expect injured people-those individuals whose injuries have transformed their identity in ways that defy their powers of explanation (46)-to make coherent demands upon corporate and state actors.Here, Engel is writing about personal injury and potential to claim tort harm. But we can, I believe, extend this understanding beyond individual harm caused by a workplace accident, or a tripand-fall incident. Reading about life as struggle to survive, I think about pain of Philando Castile's partner, Sandra Bland's family; I imagine trauma of 60 women who have accused Bill Cosby of sexual predation, and pain of genocide felt through generations of lived experience of Water Keepers who held line against Dakota Access Pipeline. Indeed, pain and trauma at heart of #BlackLivesMatter and #NoDAPL movements, are both motivating forces and constitutive elements of movements.To notice this pain is not to call movements or their founders irrational, or to argue that their decisions are impulsive or ill- considered. It is not to argue that their demands are incoherent- though state often perceives them as such: reparations for slavery and return of stolen land are simply not part of public policy conversation. …

O estresse entre vestibulandos e suas relações com a família e a escolha profissional

O estresse é um tema bastante estudado por pesquisadores de diferentes áreas, contudo, apesar de crescente, ainda é escassa a literatura voltada ao estresse na adolescência e no processo de Orientação Profissional. Os fatores como cobranças em relação à escolha da profissão, aprovação no vestibular, o início do planejamento da carreira, além das mudanças físicas e psicológicas, bem como as expectativas da família e seus próprios anseios podem contribuir para a manifestação de sintomas de estresse. A presente pesquisa teve como objetivos identificar a presença de estresse em jovens em preparação para o vestibular e relacionar com variáveis do contexto familiar e demográficas. Os participantes foram 268 alunos do terceiro ano do ensino médio e curso pré-vestibular, de escolas públicas e privadas, de ambos os sexos, com idade de 16 a 24 anos, da cidade de Curitiba. Para coleta de dados, realizada em sala de aula, foram respondidos os seguintes instrumentos: Escalas de Práticas Parentais, o Inventário de Sintomas de Stress Para Adultos de Lipp (ISSL), questionário de identificação sociodemográfica elaborado com base na literatura e o Critério de Classificação Econômica Brasil. Os resultados, dos dados coletados pelo ISSL, indicam que as respostas de 62% dos participantes indicavam estresse, com média de 5,45 (máximo de 10 pontos e desvio padrão de 2,85). Os resultados apontam que os fatores que mais contribuem para o estresse destes jovens são: estudos (38%) família (24%) e o vestibular (19%). Considerando esses dados, verifica-se a importância de incluir esta temática nos processos de orientação profissional, uma vez que o estresse, quando não administrado de maneira eficaz, pode trazer prejuízos acadêmicos, sociais, psicológicos e físicos para o indivíduo.

The Pituri Learning Circle: central Australian Aboriginal women's knowledge and practices around the use of Nicotiana spp. as a chewing tobacco.

Tobacco smoking has a range of known and predictable adverse outcomes, and across the world sustained smoking reduction campaigns are targeted towards reducing individual and public risk and harm. Conversely, more than 87 million women, mostly in low- and middle-income countries, use smokeless tobacco, yet the research examining the effect of this form of tobacco exposure on women is remarkably scant. In central Australia, the chewing of wild <i>Nicotiana</i> spp., a tobacco plant, commonly known as <i>pituri</i> and <i>mingkulpa</i>, is practised by Aboriginal groups across a broad geographical area. Until recently, there had been no health research conducted on the effects of chewing <i>pituri. This article reports on one component of a multidimensional pituri research agenda. A narrative approach utilising the methodology of the Learning Circle was used to interview three key senior central Australian Aboriginal women representative of three large geographical language groupings. The participants were selected by a regional Aboriginal women's organisation. With the assistance of interpreters, a semistructured interview, and specific trigger resources, participants provided responses to enable an understanding of the women's ethnobotanical pituri knowledge and practices around the use of pituri within the context of Aboriginal women's lives. Data were transcribed, and by using a constant comparison analysis, emergent themes were categorised. The draft findings and manuscript were translated into the participants' language and validated by the participants. Three themes around pituri emerged: (a) the plants, preparation and use; (b) individual health and wellbeing; and (c) family and community connectedness. The findings demonstrated similar participant ethnobotanical knowledge and practices across the geographical area. The participants clearly articulated the ethnopharmacological knowledge associated with mixing pituri with wood ash to facilitate the extraction of nicotine from Nicotiana spp., the results of which were biochemically verified. The participants catalogued the pleasurable and desired effects obtained from pituri use, the miscellaneous uses of pituri, as well as the adverse effects of pituri overdose and toxicity, the catalogue of which matched those of nicotine. The participants' overarching pituri theme was related to the inherent role pituri has in the connectiveness of people to family, friends and community. Central Australian Aboriginal women have a firmly established knowledge and understanding of the pharmacological principles related to the content of Nicotiana spp. and the extraction of nicotine from the plant. Widespread use of Nicotiana spp. as a chewing tobacco by Aboriginal populations in the southern, central and western desert regions of Australia is attested to by participants who assert that everyone uses it, with girls in these remote areas commencing use between 5 and 7 years of age. Central Australian Aboriginal people who chew Nicotiana spp. do not consider it to be a tobacco plant, and will strongly refute that they are tobacco users. Central Australian Aboriginal people do not consider that the Western health information regarding tobacco (as a smoked product) is applicable or aligned to their use of pituri. Nicotiana spp. users will deny tobacco use at health assessment. There is a requirement to develop and provide health information on a broader range of tobacco and nicotine products in ways that are considered credible by the Aboriginal population. Health messages around pituri use need to account for the dominant role that pituri occupies in the context of central Australian Aboriginal women's lives.<br /> Information for readers: A consultative organisation of Aboriginal women has as a strategic intent and operational agenda the improvement of Aboriginal women's and children's health across the research region. The group seeks opportunities to enhance their knowledge based on legitimate collaborative research; accordingly, they sought to participate in a range of research activities regarding the use of pituri and women's health outcomes. Of particular note, the group's participants chose to be identified by name in the publication of this research activity. In this article, the term 'Aboriginal' has been chosen by the central Australian women to refer to both themselves and the Aboriginal people in their communities; 'Indigenous' has been chosen to refer to the wider Australian Aboriginal and Torres Strait Islander people. The term Nicotiana spp. is used when referring to the plants from a Western perspective; pituri is used when referring to the plants, the tobacco quid, and the practice of chewing from a general Aboriginal perspective; and mingkulpa is used when the participants are voicing their specific knowledge and practices.

The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis.

Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.

Comparing healthcare utilization patterns via global differences in the endorsement of current procedural terminology codes

The linkage of electronic medical records (EMR) across clinics, hospitals, and healthcare systems is opening new opportunities to evaluate factors associated with both individual treatment benefit and potential harm. For example, the FDA Sentinel initiative seeks to create a surveillance network with over 100 million patient lives (Behrman et al. [N. Engl. J. Med. 364 (2011) 498–499]), while PCORnet has created multiple networks that include linked electronic medical records from geographic regions such as entire cities or states, with the ultimate goal of facilitating comparative effectiveness research (Collins et al. [Journal of the American Medical Informatics Association 4 (2014) 576–577]). However, one key challenge to the use of electronically assembled cohorts is the potential for variation in both the choice of specific healthcare procedures and coding practices due to differences in patient populations and/or financial incentives within care delivery networks. In order to explore variation in patient care or procedure coding, we review and develop statistical methods that can permit testing and estimation of subgroup differences in code assignments. We focus on Current Procedural Terminology (CPT) codes which are used in a standardized fashion to capture patient treatment details and to record medical histories, but the methods we develop can be used for any structured EMR data. We specifically study testing procedures that can be valid for comparing both rare and common counts as routinely encountered with medical procedure codes, and we transfer methods from studies of genetic association. Hierarchical structure in terms of both thematically grouped medical codes and provider-level clustering adds unique complexity to the analysis of EMR data. We detail penalized regression methods unifying estimation and inference to leverage the hierarchical structure and stabilize rate ratio estimates for rare procedures. We also expand inference methods to account for potential within provider correlation of patient utilization. We illustrate methods comparing the endorsement of CPT codes for subjects enrolled in a back pain cohort study where interest is in the differences across recruitment centers in the use of CPT codes (Jarvik [BMC Musculoskelet Disord. 13 (2012)]).

Study protocol of the ASD-Net, the German research consortium for the study of Autism Spectrum Disorder across the lifespan: from a better etiological understanding, through valid diagnosis, to more effective health care

BackgroundAutism Spectrum Disorder (ASD) is a severe, lifelong neurodevelopmental disorder with early onset that places a heavy burden on affected individuals and their families. Due to the need for highly specialized health, educational and vocational services, ASD is a cost-intensive disorder, and strain on health care systems increases with increasing age of the affected individual.MethodsThe ASD-Net will study Germany’s largest cohort of patients with ASD over the lifespan. By combining methodological expertise from all levels of clinical research, the ASD-Net will follow a translational approach necessary to identify neurobiological pathways of different phenotypes and their appropriate identification and treatment. The work of the ASD-Net will be organized into three clusters concentrating on diagnostics, therapy and health economics. In the diagnostic cluster, data from a large, well-characterized sample (N = 2568) will be analyzed to improve the efficiency of diagnostic procedures. Pattern classification methods (machine learning) will be used to identify algorithms for screening purposes. In a second step, the developed algorithm will be tested in an independent sample. In the therapy cluster, we will unravel how an ASD-specific social skills training with concomitant oxytocin administration can modulate behavior through neurobiological pathways. For the first time, we will characterize long-term effects of a social skills training combined with oxytocin treatment on behavioral and neurobiological phenotypes. Also acute effects of oxytocin will be investigated to delineate general and specific effects of additional oxytocin treatment in order to develop biologically plausible models for symptoms and successful therapeutic interventions in ASD. Finally, in the health economics cluster, we will assess service utilization and ASD-related costs in order to identify potential needs and cost savings specifically tailored to Germany. The ASD-Net has been established as part of the German Research Network for Mental Disorders, funded by the BMBF (German Federal Ministry of Education and Research).DiscussionThe highly integrated structure of the ASD-Net guarantees sustained collaboration of clinicians and researchers to alleviate individual distress, harm, and social disability of patients with ASD and reduce costs to the German health care system.Trial registrationBoth clinical trials of the ASD-Net are registered in the German Clinical Trials Register: DRKS00008952 (registered on August 4, 2015) and DRKS00010053 (registered on April 8, 2016).

Ethics, big data and computing in epidemiology and public health

PurposeThis article reflects on the activities of the Ethics Committee of the American College of Epidemiology (ACE). Members of the Ethics Committee identified an opportunity to elaborate on knowledge gained since the inception of the original Ethics Guidelines published by the ACE Ethics and Standards of Practice Committee in 2000. MethodsThe ACE Ethics Committee presented a symposium session at the 2016 Epidemiology Congress of the Americas in Miami on the evolving complexities of ethics and epidemiology as it pertains to “big data.” This article presents a summary and further discussion of that symposium session. ResultsThree topic areas were presented: the policy implications of big data and computing, the fallacy of “secondary” data sources, and the duty of citizens to contribute to big data. A balanced perspective is needed that provides safeguards for individuals but also furthers research to improve population health. Our in-depth review offers next steps for teaching of ethics and epidemiology, as well as for epidemiological research, public health practice, and health policy. ConclusionsTo address contemporary topics in the area of ethics and epidemiology, the Ethics Committee hosted a symposium session on the timely topic of big data. Technological advancements in clinical medicine and genetic epidemiology research coupled with rapid advancements in data networks, storage, and computation at a lower cost are resulting in the growth of huge data repositories. Big data increases concerns about data integrity; informed consent; protection of individual privacy, confidentiality, and harm; data reidentification; and the reporting of faulty inferences.

Before Privacy, Power: The Structural Constitution and the Challenge of Mass Surveillance

The rich legal literature that has grown up to assess the constitutionality of bulk communications collection by the government has focused overwhelmingly on the challenge such programs pose to discrete claims of individual right against the state. Yet beyond the doctrinal and conceptual challenges such claims of privacy and expressive rights have faced – from restrictive views of standing and territoriality to contested understandings of the constitutional harms deserving rights protection – individual rights talk alone ignores the most apparent reality of current bulk collection programs: the newly developed government capacity and desire to collect zettabytes of data represents a vast expansion of government power. Particularly when a large fraction of U.S. government surveillance today is conducted not pursuant to congressional authority but solely under the executive power of Article II of the Constitution, the same changed empirical reality that has led us to revisit many of the decades-old premises on which Fourth Amendment doctrine is based presents an occasion to look anew at the nature of structural constitutional power. As this Article shows, the classic constitutional case for executive power in foreign intelligence surveillance falls short of supporting the claim that Article II alone supports the kind of bulk data collection the executive currently pursues. More, the Constitution’s structural provisions – here meaning the provisions containing affirmative grants of power to the federal government – have also been the source of a method of constitutional interpretation (structural reasoning), and separately, the basis for recognizing a substantive set of purposes underlying the constitutional project, including not only the promotion of functional effectiveness but also the protection of societal liberty. Where rights claims tend to conceptualize the problem of government action in terms of violations of particular clauses or singular individual harms, structural analysis in these respects invites consideration of what kind of government is consistent with the free republican society the Constitution envisions. These considerations, this Article maintains, more usefully inform our understanding of the constitutional harm of bulk collection. While questions of power surrounding bulk collection are hardly straightforward – the President has at least some intelligence authority, and global communications represent an unmatched trove of information that in certain applications has the potential to help protect far more individuals than it harms – this Article demonstrates at a minimum that the Constitution has more to say about this practice than is contained in the Bill of Rights alone.

‘The line between intervention and abuse’ – autism and applied behaviour analysis

This article outlines the emergence of ABA (Applied Behaviour Analysis) in the mid-20th century, and the current popularity of ABA in the anglophone world. I draw on the work of earlier historians to highlight the role of Ole Ivar Lovaas, the most influential practitioner of ABA. I argue that reception of his initial work was mainly positive, despite concerns regarding its efficacy and use of physical aversives. Lovaas’ work, however, was only cautiously accepted by medical practitioners until he published results in 1987. Many accepted the results as validation of Lovaas’ research, though both his methods and broader understanding of autism had shifted considerably since his early work in the 1960s. The article analyses the controversies surrounding ABA since the early 1990s, considering in particular criticisms made by autistic people in the ‘neurodiversity movement’. As with earlier critics, some condemn the use of painful aversives, exemplified in the campaign against the use of shock therapy at the Judge Rotenberg Center. Unlike earlier, non-autistic critics, however, many in this movement reject the ideological goals of ABA, considering autism a harmless neurological difference rather than a pathology. They argue that eliminating benign autistic behaviour through ABA is impermissible, owing to the individual psychological harm and the wider societal impact. Finally, I compare the claims made by the neurodiversity movement with those made by similar 20th- and 21st-century social movements.

Using typing techniques in a specific outbreak: the ethical reflection of public health professionals.

Typing techniques are laboratory methods used in outbreak management to investigate the degree to which microbes found within an outbreak are related. Knowledge about relational patterns between microbes benefits outbreak management, but inevitably also tells us something about the relational patterns of the people hosting them. Since the technique is often used without explicit consent of all individuals involved, this may raise ethical questions. The aim of this study was to unravel the complex ethical deliberation of professionals over the use of such techniques. We organised group discussions (n = 3) with Dutch outbreak managers (n = 23). The topic list was based on previously identified ethical issues and discussions were analysed for recurrent themes. We found that outbreak managers first and foremost reflect on the balance of individual harm with public health benefit. This key question was approached by way of discussing four more specific ethical themes: (1) justification of governmental intervention, (2) responsibility to prevent infections, (3) scientific uncertainty and (4) legal consequences. The themes found in this study, rephrased into accessible questions, represent the shared ethical understanding of professionals and can help to articulate the ethical dimensions of using molecular science in response to infectious disease outbreaks.

Chemosensory anxiety signals prime defensive behavior in prepubertal girls

Chemosensory anxiety signals effectively prime motor responses related to withdrawal behavior, such as the startle reflex, in adult humans. As the reproductive status strongly affects the response to social chemosignals, the current study examined whether chemosensory anxiety signals would augment the startle response in prepubertal children as it does in adults.Using cotton pads, axillary sweat was collected from 28 men while waiting for an important oral examination (anxiety condition), and during ergometer training (sport control condition). Using a constant-flow olfactometer, sweat samples and pure cotton samples (cotton control) were presented to 10 prepubertal girls aged 9–13years (M=11.25, SD=1.25) for 3000ms during inhalation. White noise bursts of 102dB(A) served as startle probes, and startle responses were recorded via electromyography of the orbicularis oculi muscle.The girls showed larger startle amplitudes to probes presented in the context of chemosensory anxiety signals as compared to a context of sport control sweat (p<0.01) as well as cotton control (p<0.05). This effect was not attributable to differences in stimulus detection rates or stimulus hedonics.The results show that in prepubertal girls, similar to adults, chemosensory anxiety signals prime defensive motor behavior. This effect appears unrelated to the odorous quality of anxiety sweat, but seems to reflect a specific preparedness to respond to the underlying social alarm signal. Thus, chemosensory communication supporting individual harm protection is independent of the reproductive status in humans.

Aerosol from Tobacco Heating System 2.2 has reduced impact on mouse heart gene expression compared with cigarette smoke

Experimental studies clearly demonstrate a causal effect of cigarette smoking on cardiovascular disease. To reduce the individual risk and population harm caused by smoking, alternative products to cigarettes are being developed. We recently reported on an apolipoprotein E-deficient (Apoe−/-) mouse inhalation study that compared the effects of exposure to aerosol from a candidate modified risk tobacco product, Tobacco Heating System 2.2 (THS2.2), and smoke from the reference cigarette (3R4F) on pulmonary and vascular biology. Here, we applied a transcriptomics approach to evaluate the impact of the exposure to 3R4F smoke and THS2.2 aerosol on heart tissues from the same cohort of mice. The systems response profiles demonstrated that 3R4F smoke exposure led to time-dependent transcriptomics changes (False Discovery Rate (FDR) < 0.05; 44 differentially expressed genes at 3-months; 491 at 8-months). Analysis of differentially expressed genes in the heart tissue indicated that 3R4F exposure induced the downregulation of genes involved in cytoskeleton organization and the contractile function of the heart, notably genes that encode beta actin (Actb), actinin alpha 4 (Actn4), and filamin C (Flnc). This was accompanied by the downregulation of genes related to the inflammatory response. None of these effects were observed in the group exposed to THS2.2 aerosol.

The Prevalence of False Allegations of Rape in the United States from 2006-2010

False allegations constitute a public problem since they result in a waste of time spent by the police and justice departments, and may cause public and individual harm. A prevalence study was conducted to obtain recent and valid figures of the prevalence of unfounded allegations of rape and unfounded allegations of other crimes. The most recent published prevalence figures on false allegations in the U. S. are from 1992. At the time cases were cleared by labeling cases as unfounded crimes. Since then guidelines to label a case as unfounded have become more strict. To test whether the new guidelines issued by the Uniform Crime Reporting (UCR) Program of the Federal Bureau of Investigations (FBI) were followed we compared the current results with the prevalence rate of false and baseless allegations of rape before the guidelines were issued. Over a five-year period, from 2006 until 2010, the prevalence of false and baseless allegations of offences in the U. S. was studied. We found that the new guidelines were followed by law enforcement agencies. We performed a Kruskal Wallis Non Parametric Chi Square test of Goodness-of-fit on the proportions of false and baseless allegations to test whether the proportions were equal for all offence types. False and baseless allegations were not equally distributed across offence types X2 (7, N=8000)=120.19, p<0.0001. The post hoc test revealed significant differences with the group average of 1.16% for false and baseless allegations of murder X2 (1, N=1000)=39.94, p<0.0001, false and baseless allegations of rape X2 (1, N=1000)=171.94, p<0.0001, and false and baseless allegations of robbery X2 (1, N=1000)=187.78, p<0.0001. Approximately 5% of the allegations of rape were deemed false or baseless. That was at least five times higher than for most other offence types.

Image-Based Sexual Abuse

Advances in technology have transformed and expanded the ways in which sexual violence can be perpetrated. One new manifestation of such violence is the non-consensual creation and/or distribution of private sexual images: what we conceptualise as ‘image-based sexual abuse’. This article delineates the scope of this new concept and identifies the individual and collective harms it engenders. We argue that the individual harms of physical and mental illness, together with the loss of dignity, privacy and sexual autonomy, combine to constitute a form of cultural harm that impacts directly on individuals, as well as on society as a whole. While recognising the limits of law, we conclude by considering the options for redress and the role of law, seeking to justify the deployment of the expressive and coercive powers of criminal and civil law as a means of encouraging cultural change.