Although epidemics are generally understood as lying within the domain of biomedicine, legal and social arrangements play crucial roles in determining whether or not infectious disease outbreaks grow into epidemics and even pandemics. Yet epidemics are challenging terrain for legal regulation. Because epidemics cross political borders and span jurisdictional boundaries, funding for epidemic prevention, preparedness, and response is always inadequate and coordination is difficult. Because epidemics require rapid and nimble responses, governments and international organizations often declare states of emergency, thereby evading some of the usual strictures of law. And because they involve massive uncertainty and rapidly evolving health crises, they require legal actors to work more quickly and with lower standards of proof than is common in law and to intrude on the turf of medical and scientific professionals. Legal contributions to pandemic management could be improved if legal measures such as global treaties and domestic public health law took account of these special features of epidemics. Expected final online publication date for the Annual Review of Law and Social Science, Volume 18 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
anteroposterior chest diameter. In the decompression phase, the chest was pulled upwards with a force of approximately 20 pounds using a suction cup device.Neutron-activated microspheres were injected before VF and then at 5 and 15 minutes after CPR initiation. Arterial blood gasses (ABG) and reference blood samples were drawn to determine washout curves. At the end of the experiment, animals were sacrificed and tissue samples from multiple areas of the brain, heart, and other organs were sent for analysis. Continuous data recordings included the ECG, aortic pressure, right atrial pressure, intracranial pressure (ICP), pulse oximetry, and end-tidal CO2 (ETCO2). Respiratory effort, or "gasping," by the animals during CPR was timestamped. Cerebral perfusion pressure (CerPP) was calculated.A priori calculations, based on prior studies and assuming an alpha of 0.05 and 80% power, suggested the need for 11 animals per group to detect an 80% difference. Studies that did not meet inclusion criteria due to severe technical difficulties, such as catheter dislodgement or inability to adequately compress the chest, were not included in the results. Data are expressed as mean AE standard deviation. An unpaired Student's t-test was used to calculate p-values.Results: Eighteen female pigs weighing 39.5 AE 8.2 kg were randomized to ACD-CPR + ITD in either HUP (n ¼ 8) or SUP (n ¼ 10). Mean cerebral blood flow after 15 minutes of CPR was 0.42 AE 0.05 mL/min/g in the HUP group and 0.21 AE 0.04 in SUP (p < 0.01). Pigs treated with HUP also had lower ICP and higher CerPP when compared to SUP (see Table ). Time to first gasp was 282 AE 51 seconds for HUP group versus 437 AE 185 seconds for SUP (p < 0.05). There was no difference in ETCO2 or ABG values between SUP and HUP.Conclusions: After prolonged ACD-CPR + ITD with 30 elevation of the thorax and head, cerebral blood flow was two-fold higher when compared to standard, supine body position. These findings provide additional, strong support to proceed with a clinical evaluation of HUP ACD-CPR + ITD in humans in cardiac arrest.
After the turn of the millennium, HIV clinical researchers pivoted from developing and testing new antiretrovirals (ARVs) for treatment, to reconfiguring the same molecules for pre-exposure prophylaxis (PrEP). In 2012, Truvada became the first HIV therapy to also be approved by the FDA for PrEP, regarded as a magic bullet that promised to end the epidemic. However, six years after its approval, it continues to be inaccessible to those who are most vulnerable. In this article, I critically analyze HIV PrEP clinical trials, dissecting the novel techniques researchers use to demonstrate efficacy. I argue that in making sense of the interplay between adherence to a prophylactic regimen and risk for HIV, biomedical HIV prevention research has revealed a new subject of biopolitics, Homo adhaerens. In the early 2000s, clinical researchers operating in the Global South identified Homo adhaerens as the ideal subject, one who embodies both high-risk behavior and diligent adherence to a daily oral regimen. I trace the construction of Homo adhaerens to the United States, where I listen closely to activists engaged with the ongoing DISCOVER trial of PrEP. Activists either aspire for Homo adhaerens as a standard, making the liberal argument that expanding access could make PrEP successful, or they rebuke the framework of clinical research that produces narrow understandings of adherence, efficacy, and universality. Ultimately, I argue that by failing to grapple with the social realities that underlie poor adherence, PrEP clinical trials produce knowledge that is not useful for those who are most vulnerable.
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