[The mandatory diaper peek in newborn girls]

We present a 3 day old girl born at term presenting with an interlabial, cystic mass. Pregnancy, delivery and routine antenatal screening were unremarkable. The smooth lesion was located in the anterior half of the vulva, covered with thin vessels. The medially displaced urethra and the medio-posteriorly displaced hymen were identified. Voiding was not impaired. We discuss the differential diagnosis of vulvar masses in the newborn girl. A thorough clinical examination must be the standard of care of pediatric examinations in infants.

A 5-year comparison of performance of sentinel and mandatory notification surveillance systems for measles in Switzerland

A sensitive, specific and timely surveillance is necessary to monitor progress towards measles elimination. We evaluated the performance of sentinel and mandatory-based surveillance systems for measles in Switzerland during a 5-year period by comparing 145 sentinel and 740 mandatory notified cases. The higher proportion of physicians who reported at least one case per year in the sentinel system suggests underreporting in the recently introduced mandatory surveillance for measles. Accordingly, the latter reported 2-36-fold lower estimates for incidence rates than the sentinel surveillance. However, these estimates were only 0.6-12-fold lower when we considered confirmed cases alone, which indicates a higher specificity of the mandatory surveillance system. In contrast, the sentinel network, which covers 3.5% of all outpatient consultations, detected only weakly and late a major national measles epidemic in 2003 and completely missed 2 of 10 cantonal outbreaks. Despite its better timeliness and greater sensitivity in case detection, the sentinel system, in the current situation of low incidence, is insufficient to perform measles control and to monitor progress towards elimination.

First results on the mandatory notification of dog bite injuries in Switzerland: a questionnaire survey among physicians and veterinarians

In order to expedite targeted interventions, mandatory notification of treated dog bite injuries for Swiss physicians and veterinarians was implemented in 2006. Since the number of notified cases was much lower than expected, the validity of the annually produced statistics with respect to the real situation in Switzerland was discussed controversially. In this study a questionnaire survey among physicians and veterinarians was carried out to evaluate the amount of and reasons for non-compliance with the mandatory notification. 81 % of the physicians and 97 % of the veterinarians reported the treatment of dog bite injuries in the year 2009. Among those, 60 % of the physicians and 41 % of the veterinarians indicated notification of less than 50 % of the treated cases. Our results indicate that the most relevant cases for targeted interventions seem to be notified, but that the statistical analyses have to be interpreted carefully.

Implementation of a mandatory donor RHD screening in Switzerland

Starting in 2013, blood donors must be tested at least using: (1) one monoclonal anti-D and one anti-CDE (alternatively full RhCcEe phenotyping), and (2) all RhD negative donors must be tested for RHD exons 5 and 10 plus one further exonic, or intronic RHD specificity, according to the guidelines of the Blood Transfusion Service of the Swiss Red Cross (BTS SRC). In 2012 an adequate stock of RHD screened donors was built. Of all 25,370 RhD negative Swiss donors tested in 2012, 20,015 tested at BTS Berne and 5355 at BTS Zürich, showed 120 (0.47%) RHD positivity. Thirty-seven (0.15%) had to be redefined as RhD positive. Routine molecular RHD screening is reliable, rapid and cost-effective and provides safer RBC units in Switzerland.

Mandatory communication skills training for oncologists: enforcement does not substantially impact satisfaction.

PURPOSE Even though there is evidence that both patients and oncology clinicians are affected by the quality of communication and that communication skills can be effectively trained, so-called Communication Skills Trainings (CSTs) remain heterogeneously implemented. METHODS A systematic evaluation of the level of satisfaction of oncologists with the Swiss CST before (2000-2005) and after (2006-2012) it became mandatory. RESULTS Levels of satisfaction with the CST were high, and satisfaction of physicians participating on a voluntary or mandatory basis did not significantly differ for the majority of the items. CONCLUSIONS The evaluation of physicians' satisfaction over the years and after introduction of mandatory training supports recommendations for generalized implementation of CST and mandatory training for medical oncologists.

Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions-Is less more?

BACKGROUND Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use. METHODS We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance. RESULTS We assessed 426 HH indications before and 492 indications after the policy change. Compared with 2009, we observed a significantly higher HH compliance in patients on contact precautions in 2012 (52%; 95% confidence interval [95% CI], 47-57) vs 85%; 95% CI, 82-88; P < .001). During the same period, hospital-wide HH compliance also increased from 63% (95% CI, 61-65) to 81% (95% CI 80-83) (P < .001). However, the relative improvement (RI) of HH compliance during contact precautions was significantly higher than the hospital-wide relative improvement (RI, 1.6; 95% CI, 1.49-1.81 vs 1.29; 95% CI, 1.25-1.34), with a relative improvement ratio of 1.27 (95% CI, 1.15-1.41). CONCLUSION Eliminating mandatory glove use in the care of patients on contact precautions increased HH compliance in our institution, particularly before invasive procedures and before patient contacts. Further studies on the effect on pathogen transmission are needed before revisiting the current official guidelines on the topic.

Sentencing Guidelines, Judicial Discretion, And Social Values

This paper studies the institutional structure of criminal sentencing, focusing on the interaction between legislatures, which set sentencing ranges ex ante, and judges, who choose actual sentences from within those ranges ex post. The key question concerns the optimal degree of judicial discretion, given the sequential nature of the process and the possibly divergent interests of legislatures and judges regarding the social function of criminal punishment. The enactment of sentencing reform in the 1970s and 80s provides both a context for the model and an opportunity to evaluate its conclusions.

Crack and powder cocaine federal legislation: A sentencing disparity and potential for policy improvement

Since its introduction into the United States in the 1980s, crack cocaine has been a harsh epidemic that has taken its toll on a countless number of people. This highly addictive, cheap and readily available drug of abuse has permeated many demographic sectors, mostly in low income, lesser educated, and urban communities. This epidemic of crack cocaine use in inner city areas across the Unites States has been described as an expression of economic marginality and “social suffering” coupled with the local and international forces of drug market economies (Agar 2003). As crack cocaine is a derivative of cocaine, it utilizes the psychoactive component of the drug, but delivers it in a much stronger, quicker, and more addictive fashion. This, coupled with its ready availability and cheap price has allowed for users to not only become very addicted very quickly, but to be subject to the stringent and sometimes unequal or inconsistent punishments for possession and distribution of crack-cocaine. ^ There are many public health and social ramifications from the abuse of crack-cocaine, and these epidemics appear to target low income and minority groups. Public health issues relating to the physical, mental, and economic strain will be addressed, as well as the direct and indirect effects of the punishments that come as a result of the disparity in penalties for cocaine and crack-cocaine possession and distribution. ^ Three new policies have recently been introduced into the United Stated Congress that actively address the disparity in sentencing for drug and criminal activities. They are, (1) Powder-Crack Cocaine Penalty Equalization Act of 2009, (HR 18, 111th Cong. 2009), (2) The Drug Sentencing Reform and Cocaine Kingpin Trafficking Act of 2009, (HR 265, 111th Cong. 2009) and (3) The Justice Integrity Act of 2009, (111th Cong. 2009). ^ Although they have only been initiated, if passed, they have potential to not only eliminate the crack-cocaine disparity, but to enact laws that help those affected by this epidemic. The final and overarching goal of this paper is to analyze and ultimately choose the ideal policy that would not only eliminate the cocaine and crack disparity regardless of current or future state statutes, but will provide the best method of rehabilitation, prevention, and justice. ^

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena

La iniciativa privada en los delitos sexuales [Bs. As. 1863-1921]

Los delitos sexuales entre la segunda mitad del siglo XIX y principios del XX presentan problemas particulares en relación a la posibilidad de su imputación y castigo vinculados a la forma particular como se conciben estos crímenes. Propongo, a partir del análisis de expedientes judiciales, problematizar algunas de estas cuestiones partiendo desde el análisis de su concepción como "dependientes de iniciativa privada" y por tanto la necesidad de una "acusación particular" que implicó largos debates en los tribunales ya que la interpretación de esta situación tuvo más de una lectura posible: quedaban satisfechos los requerimientos de la ley con la denuncia o debía continuarse la participación de la parte hasta la misma sentencia, es decir, llegar hasta la vista de acusación? En este contexto se pone entonces en discusión la participación del Agente Fiscal en el proceso en tanto acusador y por lo tanto el interés del Estado como tal en la persecución de estos crímenes. Busco, simultáneamente mostrar las discusiones que se dieron en la práctica penal, que reflejan distintas formas de interpretar y pensar estos delitos; las razones implícitas en su persecución y castigo o por el contrario de su finalización y falta de pena