This exploratory study examined five potential problems with attorneys' questions and 5- to 9-year-old children's responses to before/after questions in 156 child sexual abuse trials. Two problems have received some attention in prior research: the extent to which children were asked to backward sequence through before questions, and order of mention, which considers whether the order in which two events were mentioned in the question matched the order in which the events purportedly occurred. We found that 43% of before/after questions included before, and 55% of questions asking about two events violated order of mention. We also examined three issues involving potential ambiguity that have been overlooked: grain size ambiguity, in which the temporal interval to which before/after refer is unspecified; reference time ambiguity, in which before/after could refer to a prior time or the time when the question is asked; and focal ambiguity, in which the before/after question could be asking about sequence or occurrence. Eighty-four percent of questions exhibited grain size ambiguity, 18% of questions exhibited reference time ambiguity and 40% of questions exhibited focal ambiguity. Overall, 78% of before/after questions were option-posing and 84% of children's responses to those questions were unelaborated, which makes disambiguation of responses difficult. Even when questions were unambiguous, we found suggestive evidence that words used to specify grain size or reference time created other difficulties for children. The results highlight the need for additional research examining difficulties in before/after questions, and for educating attorneys and others who interview children about subtle difficulties.
When forensic mental health professionals find themselves working with seemingly impaired attorneys, a substantial dilemma is presented. The forensic professional must consider how, if at all, to respond to legal performance deficits that may reflect dementia, a substance use disorder, a mood disorder, or some other identifiable psychiatric condition. Two de-identified cases are presented that highlight the difficulty of providing expert witness and consultation services under such circumstances. Codified ethics guidance for attorneys, psychiatrists, and psychologists offers relevant, albeit rather limited, direction. Several overlapping options are proposed, including discreet inquiry, frank discussion, treatment referral, and withdrawal from participation.
In January 1946, the Journal of Industrial Hygiene and Toxicology published "A Health Survey of Pipe Covering Operations in Constructing Naval Vessels." This cross-sectional epidemiological study is one of the most consequential in the history of industrial hygiene and occupational medicine as it errantly concluded that insulation work on ships using asbestos-containing materials was "…not a dangerous occupation." As a consequence of this innocuous conclusion, the U.S. Navy and others neglected to protect insulators and other employees from asbestos dust for the next 25 years, leading to an epidemic of asbestos-related diseases in active and retired workers. Subsequently, attorneys and expert witnesses used this exculpating conclusion to mount "state of the art/science" defenses for asbestos manufacturers in tort actions, arguing that their clients relied on this publication when they failed to protect their own employees from asbestos or warn their customers of the hazard. Both the industrial hygiene and the medical components of this study were deeply flawed. The successor publisher to the original journal has refused to consider retracting this paper, so this catastrophic blunder may remain a part of the literature, available to asbestos tort defense attorneys and their experts. Publishing industry policies and precedent related to retracting very old articles are reviewed.
In 2018, California passed Assembly Bill 1810, creating a pathway for pretrial diversion of individuals with mental health disorders. State statute dictates certain aspects of diversion eligibility and implementation. However, implementation of diversion occurs at the county level and counties have some degree of discretion as to how they implement the policy. This study conducted a qualitative implementation assessment of the contextual factors that have shaped the implementation of the state's mental health diversion policy. We recruited nine counties and conducted semistructured interviews with a total of 29 implementation partners. Qualitative coding was conducted to explore themes related to program implementation and these codes were analyzed using the Consolidated Framework for Implementation Research. An early challenge to the implementation process was the need to create infrastructure to support diversion and ensure oversight of mental health evaluations, treatment plans, and client progress. Many counties started with a decentralized process but found that standardizing the process was an important facilitator (e.g., having a dedicated judge for diversion cases). Some of the key implementation barriers related to perceptions of prosecutors and concerns related to public safety; however, even defense attorneys must balance diversion with other options their clients have (e.g., taking a plea in exchange for a short sentence). Jurisdictions implementing new mental health diversion programs can draw on the implementation science and literature related to other programs, such as drug courts, to address these implementation barriers. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
In March 2025, the National Institute of Standards and Technology (NIST) published a series of primers designed to provide judges and attorneys with a neutral source of information on foundational forensic-science principles. Unfortunately, the primer on "Probability and Likelihood Ratios" gives a misleading negative portrayal of the likelihood-ratio framework. This perspectives paper refutes that misleading portrayal.
The present research aimed to develop a psychometrically sound measure of moral injury for lawyers. In study I, deductive and inductive approaches were used to generate an initial item pool. Furthermore, the item pool was reviewed and finalized with the help of experts' opinions. In order to explore factor structure and ensure psychometric properties of the scale, a purpose sample comprised of lawyers (N = 226, mean age = 31, SD = 5.2) was recruited. Results indicated a three-factor structure of moral injury-betrayal, transgression, and value system conflict. Four items were retained in each factor: betrayal (1,2,3,4), transgression (5,6,7,8), and value system conflict (9,10,11,12). In study II, another independent sample was recruited to confirm the factor structure. The three-factor structure produced by EFA was found to fit the data with three-factor solution with initial item loadings > 0.40. The Chi-square value was 70.41 (df = 51), with CFI = 0.97, GFI .95, TLI = 0.96, RMR = 0.01, and RMSEA = 0.04. The alpha reliability of the overall scale and subscales was 0.78, 0.70, 0.82, and .74, respectively. Study III demonstrated evidence of convergent and discriminant validity. Positive correlation of moral injury with pathological lying (r = 0.50, p < 0.01) and decisional fatigue (r = 0.49, p < 0.01) ensured its convergent validity, while a non-significant relationship with internet addiction provided evidence of discriminant validity.
Knowledge confined within academic or clinical silos has limited utility to influence policy. To bridge the gap between evidence and action, a participatory, co-creation workshop was convened of persons living with dementia, family carers, healthcare professionals, policy actors, spiritual or faith-based leaders, and community advocates in a collective process of dialogue, reflection, and solution design. The research aimed to determine whether stakeholders' knowledge and attitudes towards dementia improved following the workshop. Data were drawn from a multi-method assessment from a participatory research dissemination and co-creation workshop held in Kumasi, Ghana. A non-parametric Wilcoxon signed-rank test was selected as the primary analytical tool for the pre-post-test. A reflexive thematic analysis was implemented for the qualitative data. Following the workshop, participants reported feeling significantly more informed about dementia prevalence in Ghana (Z = 2.510, p = 0.012), the challenges faced by family caregivers (Z = 3.030, p = 0.002), and common caregiver coping strategies (Z = 3.247, p = 0.001). Understanding of socioeconomic (Z = 2.525, p = 0.012) and gender-related (Z = 2.569, p = 0.010) influences on dementia risk, and caregiving also improved. Attitudinally, participants expressed stronger agreement that family caregivers deserve more support (Z = 2.828, p = 0.005), that dementia care should be a higher health system priority (Z = 2.445, p = 0.014), and that faith-based organisations have an important role (Z = 2.001, p = 0.045). Proposed solutions included policy advocacy and systems thinking, community- and home-based care, collaborative networks, caregiver support programmes, stigma reduction and cultural reorientation, and involvement of religious leaders. There is a need to formalise and resource a community of practice, thus ensuring sustained collaboration, structured knowledge exchange, collective action across sectors, whilst piloting a caregiver support programme and home-care model with rigorous monitoring and evaluation. It is time for policymakers to enact a comprehensive dementia care policy to guide and regulate all stakeholders in the continuum of dementia care.
The Digital Personal Data Protection Act, 2023 marks a watershed in the India's data protection regime, building on Supreme Court's recognition of right to privacy including informational privacy, as a fundamental right. As India's first cross-sectoral law on privacy, the Act has come under close scrutiny amidst the proliferation of the data-intensive technologies. Drawing on a survey from 380 respondents-lawyers, employees of corporations, bank employees, and laypersons, the paper employs IBM SPSS, to examine the perception of Act's impact on ease of business and innovation; its effectiveness in protecting data privacy, its capacity to balance privacy with business needs; adequacy of its grievance redressal mechanism, and levels of rights-awareness. The findings reveal sectoral variations in the understanding, expectations and compliance preparedness. The paper argues that, with the Act and its Rules awaiting enforcement, aligning legislative intent with stakeholder experiences is crucial to ensure practical efficacy in India's digital economy.
Breath alcohol analyzers employ algorithmic safeguards to identify samples that may be falsely elevated due to mouth alcohol contamination. One such safeguard in the DataMaster DMT (also known as the Intox DMT) is commonly referred to as the 95% rule. Under this criterion, if the final quarter-second average breath alcohol concentration (BrAC) measured during sample delivery is less than 95% of a previous high value recorded during the same sample test, the instrument is expected to generate an Invalid status message. Four cases are presented in which the stated criterion was met, yet the instrument failed to generate an Invalid status message in three of the four cases. The absence of the Invalid status message in the three cases is not explained by any documented alternative criteria or exceptions in the manufacturer's materials or operator training resources. These findings suggest that the 95% rule is either inconsistently applied or subject to additional parameters that govern its implementation. An independent review of the instrument's source code would help clarify the basis for these discrepancies.
Diabetes Prevention Programs (DPPs) and metformin can prevent or delay onset of type 2 diabetes mellitus (T2DM), yet uptake of these evidence-based preventive strategies is low. The objective was to test whether interventions that promote different types of motivation to engage in evidence-based strategies to prevent T2DM can reduce hemoglobin A1c (HbA1c) and weight, and increase engagement. Parallel four-arm randomized trial. Academic health system. 380 adult patients with prediabetes. Enhanced Usual Care (EUC) Arm participants received 12 months of usual care and educational text messages about T2DM prevention. Incentives Arm participants received 12 months of the EUC Arm intervention plus monthly financial incentives of $50 to $250 for DPP participation or metformin use. Tailored Arm participants received 12 months of the EUC Arm intervention plus tailored text messages promoting autonomous motivation for preventing T2DM. Combined Arm participants received 12 months of the Incentives Arm and Tailored Arm interventions plus additional texts to increase the salience of incentives. The primary outcome was 12-month change in HbA1c. Secondary outcomes were 12-month change in body weight and monthly engagement, defined based on online DPP participation or metformin use. Data were collected 2021 to 2023 and analyzed 2023 to 2026. There were no significant differences across arms in 12-month changes in HbA1c or weight. Mean months of engagement with the DPP or metformin were higher in the Incentives Arm [6.5, P < 0.0001] and the Combined Arm (7.2, P < 0.0001) compared to the EUC Arm (3.6). Interventions that use financial incentives for individuals with prediabetes to engage in evidence-based strategies to prevent T2DM can increase use of these strategies. However, such interventions may need to be modified to translate this increased engagement into improvements in clinical outcomes. ClinicalTrials.gov Identifier NCT04902326.
In this article, we contribute to the literature on state violence against women (VAW) by examining the intersection of domestic violence and welfare fraud tip-off lines. Tip-off lines enable anonymous reporting of suspected welfare fraud, forming part of the punitive welfare-to-work reforms within Western democratic nation states. Via examination of interviews with victims/survivors and community lawyers, alongside analysis of social security appeal decisions, we argue that Australia's welfare system, which claims to prioritize supporting women affected by domestic violence, may instead be complicit in, intensify, and perpetrate VAW through its administrative compliance procedures as a form of state systems abuse.
暂无摘要（点击查看详情）
What should a clinician do when an adolescent refuses a treatment that might save their life? What if the proposed treatment is in the realm of reproductive health care, which demands heightened attention to autonomy and confidentiality? This Ethics Rounds considers the case of a 15-year-old patient who refused treatment of an ectopic pregnancy, a potentially life-threatening condition, raising difficult questions about whether a clinician should override the treatment decisions of a minor patient who has legal authority in her state to make her own decisions, or breach medical confidentiality by notifying her parents. We consider these questions from 3 perspectives-medical, legal, and ethical-guided by practitioners in each area. Two specialists in adolescent medicine and pediatric gynecology and obstetrics, respectively, discuss the clinical dimensions of the case that inform ethical decision-making. An attorney/clinical ethics consultant contextualizes the case in relation to state legal protections for adolescent confidentiality in reproductive health care, as well as the complex legal landscape nationwide. Finally, a clinical ethics consultant identifies relevant ethical frameworks for balancing the realities of adolescent decision-making in high-stakes, high-stress situations with the strong duty to protect adolescents' reproductive autonomy. These perspectives converge to present a multipronged argument: in highly pressured situations, adolescent patients who generally have decision-making capacity may not have the capacity to refuse life-saving treatment and, in that case, should not be permitted to do so; however, they still have a right to confidentiality that should be prioritized and protected.
The Third National Pediatrics Congress was held in Zaragoza in 1925. There were 208 registered delegates. Among those registered were fourteen French pediatricians and three Italian pediatricians. The president of the meeting was Dr Patricio Borobio Díaz. This paper presents an overview of the content of the conference presentations, which were divided into four sections: Pedagogy, Pediatric and Orthopedic Surgery, Hygiene, Nutrition and Child Protection, and Pediatric Medicine. In the latter section, the most common topics were infectious diseases (whooping cough, diphtheria, meningitis/encephalitis). Several papers attested to the effectiveness of ultraviolet light as a treatment for rickets and spasmophilia. Gregorio Vidal Jordana deduced that the increase in phosphatemia levels served as an exact test to verify the effectiveness of ultraviolet treatment and was superior to X-rays. Several pediatric surgeons debated the treatment of pyloric stenosis in infants. There is no record of any female pediatricians attending the Congress. Four women who were not doctors presented papers on legal and family changes in favor of children, abandoned and delinquent children, and education issues. Within the Child Protection Section, there were debates on the subject of illegitimate children and wet nursing. The conference was a harmonious international gathering where current pediatric issues were discussed alongside other topics related to child protection. Participation was diverse, with contributions from doctors, lawyers, teachers and people in other professions.
Comparing lung cancer screening programs worldwide provides insight into the most utilised screening approaches and variations in program eligibility. This study compared the eligibility criteria and parameters for lung cancer screening programs internationally and modelled the reach of each program. Eleven countries with implemented, organised, national or regional lung cancer screening programs were identified; eight (73%) utilised pack-years to measure smoking intensity, with four countries adopting 30-pack-years as a requirement. Three programs (27%) utilised risk prediction models to determine eligibility. Proportions of eligible people who currently smoke range from 10.7% to 27.8%, with the fewest in the Republic of Korea (10.7%) and most in the United States (27.8%). Globally, lung cancer screening eligibility criteria and program parameters vary substantially. There was limited consideration for engaging key population groups. Ensuring programs incorporate relevant local strategies to maximise participation across at-risk groups is essential, especially for those underrepresented in screening programs.
暂无摘要（点击查看详情）
In recent years, terms like platform work, gig work and cloud work have sparked a debate amongst labour lawyers and lawmakers. Even though the circumvention of traditional employment relationships is not a new phenomenon, technological change and the increasing flexibility of work put previously established standards on fair wages and just working conditions anew at stake. Trade Unions have traditionally played a key role in protecting those whose livelihoods depend on providing labour for others. A closer look at the existing legal frameworks in Austria and Germany shows that solo self-employed persons, meaning workers who do not have an employment contract and do not employ others, can benefit only to a very limited extent from the capacity of trade unions to bargain collectively, which is a critical instrument to ensure fair working conditions, including fair wages. This article argues that the European human rights standards require national legislators to take active steps in ensuring the right to bargain collectively for every person in need. In section I, we will start by introducing the central concepts of our analysis and discuss the extent to which the legal frameworks in Austria and Germany allow for collective bargaining on behalf of solo self-employed persons. In section II, we will look at several layers of human rights protection at the European level, with a focus on the personal scope of the right to collective representation. In the final section, we will address the interplay between human rights standards and EU law, before concluding with our recommendations for domestic legal change in Austria and Germany.
The McCabe Centre for Law and Cancer's international legal training programme (ILTP) aims to raise the capacity of government lawyers from low- and middle-income countries to use the law to address noncommunicable diseases (NCDs). We used qualitative data to evaluate impacts of this long-term capacity-building programme to complement tangible impacts, such as law and policy reform found in an earlier evaluation. We undertook 17 interviews with alumni of and stakeholders involved with the ILTP over the period 2014-23. The interviewer conducted semistructured interviews. Two reviewers used inductive content analysis to code the interviews. We found that alumni and stakeholders valued the programme's role in building networks of participants with legal skills relevant to NCDs and in empowering individuals to become champions for NCDs. Interviewees also took a broader view of impact than the completion of individual law and policy reform projects, considering many law and policy changes, regional initiatives, and leadership roles of alumni beyond those formally supported as part of the programme to have been a key impact of the programme. The study highlights the need to invest in NCD legal capacity building and leadership for the long term. We find that building a community of people with the skills, confidence, and commitment to act on NCDs is a key impact of such programmes, in addition to laws and policies developed.
There is growing concern that artificial intelligence (AI) may diminish the quality of human relationships. However, in a context of widespread social importance (empathetic conversations between doctors and patients), AI can actually improve human conversational skills, potentially enhancing professional relationships. Recent advances in AI allow for realistically role-prompted counterparts for practicing professional conversations, enabling relational learning without the need for human counterparts. This study aimed to show the effectiveness of AI chatbots for learning professional communicative skills in medical education. Specifically, we hypothesized that a single conversation with an AI chatbot improves communication skills in medical students across 4 different conversational competencies. We conducted a quasi-experimental intervention study involving 4 distinct role-prompted scenarios (ie, shared decision-making, motivational interviewing, sexually transmitted diseases, and breaking bad news)-each designed to elicit in-depth empathic conversational skills aligned with key learning objectives in medical curricula. Students rated their competence for the 4 scenarios before and after a conversation with GPT-4o (OpenAI) using default settings, without fine-tuning. We expected higher perceived communication competence (PCC) in their conversation topic after the interaction compared with before the interaction in a 2-sided paired t test. Participants received AI-generated feedback, which they rated regarding adequacy. Post hoc analyses addressed gender and case effects, feedback adequacy, and prevalues in PCC. This study shows that a role-prompted GPT chatbot improves PCC in 162 medical students after a single conversation with mean of 13 (SD 4.8; 95% CI 12-14) prompt-response pairs. We found an increase in PCC with a mean difference of 0.94 (SD 1.64; 95% CI 0.69-1.20; Cohen d=0.58) from 5.89 (95% CI 5.55-6.23; scale 0-10) before the conversation to 6.83 (95% CI 6.55-7.12) after the conversation across 4 different patient role prompts. Furthermore, we found participants rating AI feedback of their conversation to be useful (mean 7.92, SD 1.61; 95% CI 7.67-8.17; scale 0-10), but feedback adequacy did not correspond to PCC increase (r=0.08; P=.32). Our results demonstrate how role-prompted GPT increases self-assessed communication competencies, introducing a novel tool for teaching relational learning. Our results present a starting point for using AI in education, particularly teaching communication in professional roles. On the basis of our findings in medical education, we anticipate further studies to investigate conversational training between lawyers and clients, marketers and customers, or managers and employees. Our research thus has implications for any field with a need for conversational training and relational learning.
The European General Data Protection Regulation (GDPR) strictly regulates the processing of personal and health-related data, posing challenges for digital health research, especially when data are collected using participants' own devices. Although scientific data can theoretically be anonymized, standard internet communication protocols inevitably expose transmission metadata, preventing true anonymization. Existing solutions, including virtual private networks, reverse proxies, and trust centers, improve confidentiality but do not technically or legally enable fully anonymized data collection. Consequently, large-scale digital health research often requires extensive organizational measures, complex consent procedures, and high regulatory overhead. This study aimed to develop a GDPR-compliant concept for fully anonymized scientific data collection, ensuring that no entity has simultaneous access to identifying information and donated data. We also implemented and evaluated this concept in a real-world public-private partnership. We designed a data donation architecture based on a blinded deidentification proxy that decouples identifying transmission metadata from encrypted user data at the time of donation. The concept combines symmetric (Advanced Encryption Standard-128 in Cipher Block Chaining) and asymmetric (Rivest-Shamir-Adleman with Optimal Asymmetric Encryption Padding) encryption, enabling end-to-end encrypted and anonymized data transfer without persistent identifiers. The system was integrated into the HerzFit app, a mobile lifestyle coach for cardiovascular disease prevention available in German-speaking countries, and evaluated for adoption, technical feasibility, and performance. Performance overhead was assessed using round-trip time benchmarks. Duplicate donations were identified and merged to estimate unique data donors. The solution was integrated and tested in the HerzFit app with more than 200,000 downloads between April 2022 and December 2025. Since the introduction of the data donation feature, more than 13,000 donations have been received, translating to more than 9000 individual users contributing anonymized datasets. Proxy-based transmission resulted in an average round-trip time of 143 ms, compared to 58 ms for direct transfer, representing a modest overhead while maintaining usability. The operator of the donation database did not gain access to identifying information at any stage, demonstrating full technical anonymization. The approach can be operated reliably at scale with minimal server resources due to the stateless proxy design. This work introduces a novel system architecture enabling fully anonymized, GDPR-compliant data donation directly from participants' devices. By decoupling identifying metadata from encrypted health data, the concept minimizes regulatory effort, strengthens privacy protection, and provides a practical framework for large-scale digital health research in research partnerships, for example, between a private company and a research institution. The real-world deployment in HerzFit demonstrates the feasibility, scalability, and scientific utility of this approach. The concept is broadly transferable to other mobile health apps and has the potential to substantially expand ethically and legally compliant data acquisition.