Physician recommendation for invasive prenatal testing: the case of the 'precious baby'

Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies?

Clinicians decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception.

Research thus far has shown that patients decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or precious than pregnancies conceived without treatment.

In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire.

Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n 78 versus spontaneous; n 85). Clinicians were asked to provide their recommendations regarding amniocentesis.

The response rate among all clinicians invited to complete the questionnaire was 16.7. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2) recommended the test. Clinicians were 3.2 (95 confidence interval [CI]: 1.66.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy.

The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting.

Our findings show that fertility history and use of ART may affect clinicians recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians decisions regarding other aspects of pregnancy management.

There was no funding source to this study. The authors declare no conflicts of interest.

Anniversaries

The hundredth anniversary of the outbreak of the First World War is only the first of a large number of major European historical anniversaries that will occur in the coming four years. Other twentieth-century anniversaries include that of the Russian Revolution and the Easter Uprising; notable corollaries from earlier centuries include the Battle of Bannockburn, the Hanoverian succession, the Battle of Waterloo and, perhaps most significant of all, the five hundredth anniversary of the Lutheran Reformation. Rather than commission special issues or other features to tie in to individual anniversaries centred on or relevant to German history in a manner which repeats unthinkingly the conventions of scholarly and popular culture, the editors elected to reflect more fundamentally on what might be at stake in major anniversaries for professional scholars of history. In anticipation of the major wave of scholarly and popular publications, commemorative activities and memory conflicts that each of these will generate, and in order to reflect upon the dynamics of German history, memory and commemoration in a more overtly comparative context, the editors invited a number of scholars working on different national histories to reflect on the possibilities and potential pitfalls such anniversaries offer to historians who tie their work in to such moments. They are Jörg Arnold (Nottingham), Thomas A. Brady (Berkeley), Fearghal McGarry (Queen’s University, Belfast), Tim Grady (Chester) and Dan Healey (St Antony’s College, Oxford). The questions were posed by the editors.

Empowering Art: Reconfiguring narratives of trauma and hope in the Australian national imaginary

Aboriginal art has been the source of much contention between art curators, gallery owners, art critics and Aboriginal artists themselves. Early aesthetic debates about whether so-called traditional works should be considered ethnographic or artistic have led, at times, to conflicts over the rights of Aboriginal people to have their works exhibited according to the criteria applied to other kinds of Western artworks. This article explores how the dilemmas of troubled ethno-histories are critically embodied and reconfigured in texture and colour. It considers the problems that silenced histories pose for those responsible for their display to the public. As Aboriginal images often conceal troubled intercultural encounters it asks how artworks can be used to provide a counter-polemic to national rhetoric as artists seek to reshape and improve intergenerational futures. This text is published as a counterpart to the contribution to Disturbing Pasts from the artist Heather Kamarra Shearer.

An Enchanted Tool? Humanitarian Assistance and the ILC Draft Articles on the Protection of Persons in the Event of Disasters

Despite previous attempts at codification of international law regarding international responses to natural and human-made disasters, there is currently no binding international legal framework to regulate the provision of humanitarian assistance outside armed conflicts. Nevertheless, since the International Law Commission (ILC) included the protection of persons in the event of disasters on its programme of work in 2006, it has provisionally adopted eleven draft articles that have the potential to create binding obligations on states and humanitarian actors in disaster settings. Draft articles adopted include the definition of ‘a disaster’, the relationship of the draft articles to the international humanitarian law of armed conflict, recognition of the inherent dignity of the human person, and the duty of international cooperation. However, the final form of the draft articles has not been agreed. The Codification Division of the UN Office of Legal Affairs has proposed a framework convention format, which has seen support in the ILC and the UN General Assembly Sixth Committee. The overall aim of this article is to provide an analysis of the potential forms of international regulation open to the ILC and states in the context of humanitarian responses to disasters. However to avoid enchanting the ILC draft articles with unwarranted power, any examination of form requires an understanding of the substantive subject matter of the planned international regulation. The article therefore provides an overview of the international legal regulation of humanitarian assistance following natural and human-made disasters, and the ILC’s work to date on the topic. It then examines two key issues that remain to be addressed by the ILC and representatives of states in the UN General Assembly Sixth Committee. Drawing on the UN Guiding Principles on Internal Displacement, the development and implications of binding and non-binding international texts are examined, followed by an analysis of the suggested framework convention approach identified by the Special Rapporteur as a potential outcome of the ILC work.

Clarifying the acquis humanitaire: a transnational legal perspective on the internalization of humanitarian norms

Although the international obligations and institutional frameworks for disaster response are not yet settled, as evidenced by the International Law Commission’s work on the protection of persons in the event of disasters and the on-going promotion of disaster laws by the Red Cross Movement; the diverse source and nature of such initiatives suggests that the international community is engaged in a process of norm creation, elaboration and interpretation reflecting a desire for legal clarity in humanitarian operations. Situated within the framework of transnational law, this paper argues that an acquis humanitaire, based on the principle of humanity, encapsulates the evolving body of law and practice specifically relating to the protection of persons in times of humanitarian crisis in both armed conflicts and natural or human-made disasters. Reflecting the non-traditional, non-statist, dynamic and normative basis of transnational legal process, as elaborated by Harold Koh, the constant flow of ideas and principles between the national, regional and international spheres provides an analytical framework for the on-going transnational dialogues on the social, political and legal internalization of humanitarian norms. Drawing on the internalization of humanitarian norms within the United Kingdom, this paper concludes that as the international community examines the codification of a universal legal framework for the protection of persons in the event of disasters it is necessary to understand the transnational process of interpretation and internalization of humanitarian norms, and how this may vary across different regions and countries.

Political Posturing or Real Powers: Control of Genetically Modified Crops by the Member States and their Regions

The cultivation of genetically modified (GM) crops in the EU is highly harmonised, involving a central authorisation procedure that aims to ensure a high level of environmental and human health protection. However conflicts over authority persist and the Commission has responded to a combination of internal and external pressures with a more flexible approach to coexistence, a proposed opt-out clause and recently a promise by the head of the Commission to review the existing EU GM legislative regime, providing an opportunity to consider and suggest paths of development. In light of the significance of multilevel governance and subsidiarity for GM cultivation, this paper considers the policy-making powers of the Member States and subnational regions in this regime, focussing upon post-authorisation options in particular. A number of core mechanisms exist, including voluntary measures, safeguard clauses, coexistence measures, a proposed express opt-out and Article 4(2) TEU on ‘national identity. These mechanisms are examined in light of the goals and challenges of multilevel governance, in order to consider whether the relevant powers are located at the appropriate level. Overall, it is apparent that the developments occurring at the EU level are strengthening multilevel governance, but with significant opportunities to improve it further through focussing on the supporting roles and the regional levels in particular.

Sovereignty, Article 4(2) TEU and the Respect of National Identities: Swinging the Balance of Power in Favour of the Member States?

The question of whether and to what extent sovereignty has been transferred to the European Union (EU) from its Member States remains a central debate within the EU and is interlinked with issues such as Kompetenz-Kompetenz, direct effect and primacy. Central to any claim to sovereignty is the principle of primacy, which requires that Member States uphold EU law over national law where there is a conflict. However, limitations to primacy can traditionally be found in national jurisprudence and the Maastricht Treaty introduced a possible EU limitation with the requirement that the EU respect national identities of Member States. The Lisbon Treaty provided only minimal further support to the principle of primacy whilst simultaneously developing the provision on national identities, now found within Article 4(2) TEU. There are indications from the literature, national constitutional courts and the Court of Justice of the EU that the provision is gathering strength as a legal tool and is likely to have a wider scope than the text might indicate. In its new role, Article 4(2) TEU bolsters the Member States’ claim to sovereignty and the possibility to uphold aspects crucial to them in conflict with EU law and the principle of primacy. Consequently, it is central to the relationship between the constitutional courts of the Member States and the CJEU, and where the final elements of control remain in ‘hard cases’. However, it does so as part of EU law, thereby facilitating the evasion of direct fundamental conflicts and reflecting the concept of constitutional pluralism.

Due North? Do American Theories of Legislative Committees Apply to Canada?

Several theories of legislative organisation have been proposed to explain committee selection in American legislatures, but do these theories travel outside the United States? This paper tests whether these theories apply to data from the Canadian House of Commons. It was found that the distributive and partisan models of legislative organisation explain committee composition in Canada. In many cases, committees in the House of Commons are made up of preference outliers. As predicted by partisan models, it was also found that the governing party stacks committees with its members, but this is conditional upon the strength of the governing party.

Model checking support for conflict resolution in multiple non-functional concern management

When implementing autonomic management of multiple non-functional concerns a trade-off must be found between the ability to develop independently management of the individual concerns (following the separation of concerns principle) and the detection and resolution of conflicts that may arise when combining the independently developed management code. Here we discuss strategies to establish this trade-off and introduce a model checking based methodology aimed at simplifying the discovery and handling of conflicts arising from deployment-within the same parallel application-of independently developed management policies. Preliminary results are shown demonstrating the feasibility of the approach.

A European Culture War in the Twentieth Century? Antic-Catholicism and Anti-Bolshevism between Moscow, Berlin, and the Vatican 1922 to 1933

The term “culture war” has become a generic expression for secular-catholic conflicts across nineteenth-century Europe. Yet, if measured by acts of violence, anticlericalism peaked in the years between 1927 and 1939, when thousands of Catholic priests and believers were imprisoned or executed and hundreds of churches razed in Mexico, Spain and Russia. This essay argues that not only in these three countries, but indeed across Europe a culture war raged in the interwar period. It takes, as a case study, the interaction of communist and Catholic actors located in the Vatican, the Soviet Union, and Germany in the period between the beginning of the Pontificate of Pius XI in 1922 and Hitler’s appointment as chancellor of Germany in 1933. Using correspondence and reports from the Vatican archives, this essay shows how Papal officials and communist leaders each sought to mobilize the German populace to achieve their own diplomatic ends. German Catholics and communists gladly responded to the call to arms that sounded from Rome and Moscow in 1930, but they did so also to further their own domestic goals. The case study shows how national contexts inflected the transnational dynamics of radical anti-Catholicism in interwar Europe. In the end, agitation against “godlessness” did not lead to the return of a “Christian State” desired by many conservative Christians. Instead, the culture war further destabilized the republic and added a religious dimension to a landscape well suited to National Socialist efforts to reach a Christian population otherwise mistrustful of its völkisch and anticlerical elements.

The European Union and Peacebuilding: The Cross-Border Dimension

The award of the Nobel Peace Prize to the European Union in 2012 was a reminder of the role of European integration in peacebuilding after the Second World War. For the 'Founding Fathers' of the European integration project, cross-border-cooperation was an integral element in building Europe's peace. Yet, in a Western Europe largely at peace for generations, peacebuilding as a relevant objective for European integration may be questioned. Moreover, the contribution of cross-border cooperation to conflict amelioration may be challenged on the grounds of its overwhelming economic focus. However, enlargement into Central Eastern Europe highlights once again the necessity of a peacebuilding objective for the European Union because of the multitude of real and potential conflicts encompassed within its expanded policy orbit. Drawing on evidence from selected 'borderscapes', this study examines 25 years of European Union cross-border cooperation as conflict amelioration and assesses its prospects in a political climate that emphasises borders as security barriers.

Religion, Violence and Cities

In exploring the connections between religion, violence and cities, the book probes the extent to which religion moderates or exacerbates violence in an increasingly urbanised world. Originating in a five year research project , Conflict in Cities and the Contested State, concerned with Belfast, Jerusalem and other ethno-nationally divided cities, this volume widens the geographical focus to include diverse cities from the Balkans, the Middle East, Nigeria and Japan. In addressing the understudied triangular relationships between religion, violence and cities, contributors stress the multiple forms taken by religion and violence while challenging the compartmentalisation of two highly topical debates – links between religion and violence on the one hand, and the proliferation of violent urban conflicts on the other hand. Their research demonstrates why cities have become so important in conflicts driven by state-building, fundamentalism, religious nationalism, and ethno-religious division and illuminates the conditions under which urban environments can fuel violent conflicts while simultaneously providing opportunities for managing or transforming them.

Religion, Violence and Cities: An Introduction

The catalyst for this special issue was a symposium entitled Religion, Violence and Cities, held under the auspices of a five year inter-disciplinary research project on ethno-nationally divided cities.

While this project expressly addressed cities divided by ethno-national conflict, it was clear from the beginning that there was an important religious dimension to such conflicts in most, if not all, the cities being studied.2 The rationale of the Special Issue is to examine how this religious dimension exacerbates (or moderates) urban violence within a broad comparative context. Although three of the following articles are informed by Project research, we draw the net wider to encompass a broader geographical spread from the Balkans, the Middle East, Nigeria and Japan.