Radiation litigation and the nuclear industry--the experience in the United Kingdom.

In the United Kingdom, the Nuclear Installations Act 1965 places a "strict" statutory duty on the operators of nuclear facilities to ensure that any exposure to radiation resulting from operations does not cause injury or damage. A claimant does not have to prove fault to receive compensation under the Act, only causation. The 1965 Act has been fundamental in shaping litigation involving the nuclear industry in the UK. Civil law cases brought under the Act will be heard before a single judge (with no jury or technical assessor) who must present his or her decision in a reasoned judgment. This process leads to a considerable volume of expert evidence being presented to the court and extensive cross-examination of witnesses. The expense and uncertain outcome of cases involving claims by nuclear workers that occupational exposure to radiation had caused the development of cancer has led to employers and trade unions setting up the voluntary Compensation Scheme for Radiation-linked Diseases as an alternative to litigation. This Scheme has worked well and is held up as a model of alternative dispute resolution. However, a few cases concerning personal injury or damage to property have come before the courts when the defendant nuclear operator considered that the claims were technically unjustified and where settlement was not a policy option. As anticipated, these cases were lengthy, complex, and expensive. The radiation doses assessed to have been received by the individuals who were the subject of claims, whether workers or members of the public, have been crucial to the outcome. The technical expertise of health physicists and allied specialists has been vital in establishing defensible estimates of dose, and this contribution can be expected to remain of high importance in radiation litigation in the UK.     

浅析医疗产品损害责任：以《侵权责任法》第59条为视角

因使用缺陷药品、消毒药剂及医疗器械造成患者损害产生的责任既是医疗损害责任也是产品责任,适用无过错责任归责原则;血液不属于产品,因使用不合格血液造成患者损害产生的责任也不具有产品责任性质,应适用过错责任归责原则,特殊情况下可有例外。医疗产品损害责任是一种不真正连带责任,个别情况下是一种连带责任。《侵权责任法》第59条对医疗产品损害责任的规定较为模糊,再加上我国有关理论还不够成熟,因此,对相关理论进行探讨以修改完善医疗产品损害责任的规定很有必要。     

Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation

Clinical decision support systems--interactive computer systems that help doctors make clinical choices--can reduce errors in drug prescribing by offering real-time alerts about possible adverse reactions. But physicians and other users often suffer "alert fatigue" caused by excessive numbers of warnings about items such as potentially dangerous drug interactions. As a result, they may pay less attention to or even ignore some vital alerts, thus limiting these systems' effectiveness. Designers and vendors sharply limit the ability to modify alert systems because they fear being exposed to liability if they permit removal of a warning that could have prevented a harmful prescribing error. Our analysis of product liability principles and existing research into the use of clinical decision support systems, however, finds that more finely tailored or parsimonious warnings could ease alert fatigue without imparting a high risk of litigation for vendors, purchasers, and users. Even so, to limit liability in this area, we recommend stronger government regulation of clinical decision support systems and development of international practice guidelines highlighting the most important warnings.     

论医疗过失诉讼的基本特征与缺陷——兼评我国医疗损害责任制度的改革

医疗过失诉讼具有过失认定的专业性和不确定性、医疗损害的基础性和自然进展性、因果关系判断的复杂性与多元性等基本特征,并存在诉讼结果的非预测性、证明责任的医患两难性以及诉讼导致医患对立的缺陷。这些基本特征与缺陷是基于医疗服务和法律的专业性以及医学与法学的局限性而产生的,与一个国家的法律制度与医疗服务模式没有关系。我国当前的医疗损害责任制度改革并没有充分认识到这些因素．以至采取了开放性的医疗过失诉讼制度,并在某些方面基本上视医疗损害责任为一般人身损害责任。这种改革趋势加剧了医疗服务的非医学化,有违医学规律,在某种程度也违背了法律的公平原则。     

Assumption of medical risks and the problem of medical liability in ancient Roman law

The claim of an individual to assure his health and life, to assume and compensate the damage from diseases and accidents, had already appeared in the system of the ancient Roman law in the form of many singular legal institutions. In lack of a unified archetype of regulation, we have to analyse the damages caused in the health or corporal integrity of different personal groups: we have to mention the legal interpretation of the diseases or injuries suffered by serves, people under manus or patria potestas and free Roman citizens. The fragments from the Digest od Justinian do not only demonstrate concrete legal problems, but they can serve as a starting point for further theoretical analyses. For example: if death is the consequence of a medical failure, does the doctor have any kind of liability? Was after-care part of the healing process according to the Roman law? Examining these questions, we should not forget to talk about the complex liability system of the Roman law, the compensation of the damages caused in a contractual or delictual context and about the lex Aquilia. Although these conclusions have no direct relation with the present legal regulation of risk assumption, we have to see that analysing the examples of the Roman law can be useful for developing our view of a certain theoretical problem, like that of the modern liability concept in medicine as well.     

Alopecia areata caused by extreme solar abuse

The Authors present a female patient who suffered from alopecia areata caused by extreme solar abuse. Biological effects of ionizing radiation, the damages by free radicals and protection against oxidative damage are summarized. The main forms and risk factors of UV-radiation, skin damages by UV-light as well as the pathogenesis of the alopecia areata are reviewed.     

Transsexuals: Legal considerations

Archives of Sexual Behavior - An examination of case law in the United States leads to the conclusion that a physician or surgeon may, without fear of criminal liability, perform a sex reassignment...     

姜黄素对紫外线致NIH3T3细胞损伤的保护作用

[目的]研究姜黄素对紫外线致NIH3T3细胞损伤的保护作用。[方法]采用四甲基偶氮唑蓝比色法（MTT试验）和激光扫描共聚焦显微镜技术研究不同浓度（1、5、10μmol／L）的姜黄素对紫外线致细胞损伤的保护作用。[结果]与紫外线照射组（UVR组）相比较，姜黄素预处理（姜黄素＋UVR）组可以提高紫外线辐照细胞的存活率（P〈0．05），减少细胞内活性氧的堆积（P〈0．05），减少细胞线粒体膜电位的下降（P〈0．05）。[结论]姜黄素对紫外线致NIH3T3细胞损伤有保护作用，其作用机制可能与清除细胞内的活性氧，维持细胞的线粒体膜电位有关。     

放射复合伤治疗进展

放射复合伤是核战争和核事故中多见的伤类。因伤情重、发展快、诊治难，是伤亡的重要原因，故是救治的重要对象。放射复合伤的治疗应重视：抗休克和保护心功能，早期外科处理和创伤促愈，控制感染和调节免疫，控制肠源性感染和恢复肠道功能．保护造血和促进造血重建，尽早应用抗辐射药物。     

Sterilization and legal proceedings]

According to data of the central bureau of social insurance, during 1983-87 4 out of a total of 197 damage claims were related to sterilization, and in 2 cases payment was made. From 1976 to 1992 there were fewer than 10 verdicts in sterilization cases. What is charged also has to be proven. If damage is involved, the accused party has to prove that it was not caused by its own negligence. For instance, spontaneous recanalization is the case when usual controls did not take place. The onus of proof is on the patient who has to prove the damage (affecting health and physical integrity) and the causative connection between the service and the damage based on the guidelines of the Commission of the European Community. The provider has to show that no error was committed. The responsibility of doctors is larger because of the insight of science into information not in the public domain and higher expectations of them. A recent case seeking damages for a hemophilic patient who was infected with HIV in June 1983 by a blood preparation was rejected, because at that time the connection between a blood preparation and AIDS was not yet firm. If pregnancy occurs after sterilization, the liability of the doctor is not exclusive; the opposite facts also have to be proven, as spontaneous recanalization is possible. The compensation for damages after failed sterilization will only have a chance of succeeding when the failure was the consequence of a shortcoming of the provider of service. If it was provided in conformity with medical-professional standards then the damage is not accountable. A Maastricht court sentenced a doctor to compensation of damages who did not sterilize a woman completely because of insufficient information. Informing the patient about a procedure that went awry can help avoid unnecessary legal procedures. Defensive health care could have negative results for the doctor-patient relationship.     

A new perspective on severe nuclear accidents

The reactions of the public in Korea to the nuclear accident at the Fukushima Daiichi plants in Japan, particularly over-reactions, are reviewed, with the conclusion that significant radioactive contamination of a small country could lead to a severe national crisis. The most important factor is the socio-economic damage caused by stigma, which in turn is caused by a misunderstanding of the radiation risk. Given that nuclear power is an important choice in the face of the threat of climate change, the public's perceptions need to be changed at any cost, not only in those countries operating nuclear power plants but globally as well.     

基于医疗损害责任纠纷案件的查对制度问题分析与建议

目的 分析因查对制度落实不到位引发的医疗损害责任纠纷案件,了解查对制度落实现状并提出建议,为进一步提高医疗质量提供参考。方法 以“查对制度”为关键词,通过中国裁判文书网检索2011年1月1日-2021年12月31日与查对制度落实不到位相关的38例医疗损害责任纠纷案件,进行实证分析。结果 与查对制度落实不到位相关的医疗损害责任纠纷案件整体呈逐年上升趋势,在2019年达到顶峰,自2020年以后有所下降,但仍处于较高水平。与查对制度落实不到位的医疗损害责任纠纷案件以三级医院为主(44.74%),以药物查对落实不到位居多(73.68%)。结论 医院应重视查对制度落实情况,从培训、文化、信息化以及患者参与等多维度制定干预措施,以提高执行力。     

某新运行核电站所在地居民核辐射风险认知调查分析

目的 了解某新运行的核电站不同距离范围内居民对核辐射风险认知水平，探讨影响对核电认知的因素。方法 采用分层整群随机抽样方法，以该核电站所在地区50 km范围内外共2017名居民为调查对象，采用《核电站所在地区核辐射风险认知调查表》进行面对面调查问卷。结果 共回收有效问卷1952份，在辐射知识认知情况方面，认为在医院做影像检查时受到电离辐射照射、认为不同放射性物质的半衰期不同，50 km范围内均高于50 km范围外的正确回答率，差异均有统计学意义（P < 0.05）。在核电站认知情况方面，认为日本福岛核电站事故对我国居民健康有影响、担心核电站发生严重事故和损害身体健康的比率，50 km范围内均高于50 km范围外，差异均有统计学意义（P < 0.05）。在核辐射应急认知情况方面，认为发生核事故时应当服用稳定性碘的正确回答率、对中央政府和当地政府处理各种突发事件能力认可率的比较，50 km范围内的调查结果均高于50 km范围外，差异均有统计学意义（P < 0.05）。在核辐射影响认知情况方面，认为核电站对所在地区环境影响较大、希望了解核电站的相关信息，50 km范围内均高于50 km范围外的正确回答率，差异均有统计学意义（P < 0.05）。结论 应当通过多种途径加强核电站周围居民的核辐射知识的宣传教育，提升核辐射知识的正确认知水平。     

铈纳米颗粒在辐射领域的研究进展

随着核技术在工业，医学领域等方面应用的迅速发展，人们遭受辐射损伤的可能性也随之增加。辐射损伤防治药物是救治与防护辐射损伤最为有效和直接的手段，但目前的辐射损伤防治药物作用效果有限。铈纳米材料因独特的价态结构，使其具有多种酶学模拟活性和可再生性，体现出优越的抗氧化性，强大的清除自由基功能，可以保护细胞免受辐射损伤，可作为理想的辐射防护剂，并应用于多种生物学领域。对相关文献进行查阅可知，铈纳米颗粒的抗氧化性、高SOD模拟活性、清除自由基能力以及抗辐射能力均源自于Ce³⁺/Ce⁴+相互间的转化、氧空位的形成。本文主要介绍铈纳米颗粒的抗辐射活性基础、辐射防护效应及放疗增敏方面的研究进展，为铈纳米颗粒在辐射方向领域提供理论依据与参考。     

Patient's fears were justified because doctor advised tests

A Connecticut physician faces liability charges for advising a patient to seek HIV testing after surgery was performed using unsterilized instruments. The court allowed the defendant, Dani Ayotte, to sue Dr. Richard Kates for emotional distress because the doctor created a "foreseeability of distress" regarding possible exposure to HIV or other infectious diseases. Connecticut jurisprudence does not require proof of actual exposure to HIV to allow recovery of emotional distress damages arising from the fear of AIDS.     

Scientific research and product development in the United States to address injuries from a radiation public health emergency

The USA has experienced one large-scale nuclear incident in its history. Lessons learned during the Three-Mile Island nuclear accident provided government planners with insight into property damage resulting from a low-level release of radiation, and an awareness concerning how to prepare for future occurrences. However, if there is an incident resulting from detonation of an improvised nuclear device or state-sponsored device/weapon, resulting casualties and the need for medical treatment could overwhelm the nation’s public health system. After the Cold War ended, government investments in radiation preparedness declined; however, the attacks on 9/11 led to re-establishment of research programs to plan for the possibility of a nuclear incident. Funding began in earnest in 2004, to address unmet research needs for radiation biomarkers, devices and products to triage and treat potentially large numbers of injured civilians. There are many biodosimetry approaches and medical countermeasures (MCMs) under study and in advanced development, including those to address radiation-induced injuries to organ systems including bone marrow, the gastrointestinal (GI) tract, lungs, skin, vasculature and kidneys. Biomarkers of interest in determining level of radiation exposure and susceptibility of injury include cytogenetic changes, ‘omics’ technologies and other approaches. Four drugs have been approved by the US Food and Drug Administration (FDA) for the treatment of acute radiation syndrome (ARS), with other licensures being sought; however, there are still no cleared devices to identify radiation-exposed individuals in need of treatment. Although many breakthroughs have been made in the efforts to expand availability of medical products, there is still work to be done.     

造血干细胞移植治疗骨髓型急性放射病的研究进展

核武器爆炸或核物质泄漏导致的核事故,短时间内会造成急性放射病.人体接受剂量＞0.7Gy辐射可导致骨髓持久抑制即急性放射病,引起全血细胞减少、出血、感染等损伤.大量研究显示,造血干细胞移植是治疗骨髓型急性放射性疾病的主要手段.造血干细胞可以修复骨髓造血损伤,改善造血微环境,促进造血重建.在使用造血干细胞移植术前选择供者、...     

Judge allows recovery for fear of AIDS if injury occurs

U.S. District Judge Robert S. Gawthrop III of Pennsylvania ruled that fear of contracting HIV is cause for legal action if the claim originates from physical injury linked to virus exposure. Nurse Mary A. Murphy may continue her case against Abbott Laboratories for product liability and emotional distress. Murphy was punctured with a needle by an IV system used to administer intravenous antibiotics to an AIDS/hepatitis B patient. The system was marketed as needleless. While Murphy never tested positive for HIV or hepatitis B, she claims that Abbott was negligent and should compensate her for her fear of contracting HIV. Abbott argued that Pennsylvania has a history of court decisions rejecting fear as a cause of action. Judge Gawthrop said this history did not apply because Murphy's fear of AIDS arose from the direct physical impact of the needle.     

8th Duncan Memorial Lecture. Childhood cancer and nuclear installations.

So where are we now? I think the first thing to say is that there is a well-established excess around Sellafield of childhood leukaemia, although excesses around other nuclear sites are of a lower magnitude. The excess near Sellafield is strongly associated with fathers having high exposure to external whole-body penetrating radiation while working at the installation before their child's conception. But is this association pointing towards a causal mechanism? One possibility is genetic damage, but most geneticists and radiobiologists would consider that the levels of occupational exposure, even at Sellafield, are too low for this to be a plausible pathway on current knowledge. This is based to some extent on the lack of any similar effect among children born subsequently to Japanese survivors of the atomic bombs--however, the scenario is somewhat different contrasting a high short-term exposure with a lower long-term exposure. As well, some workers at Sellafield will also be exposed to radionuclides, such as plutonium, which we have not yet been able to analyse for. In addition, there are other exposures in a complex environment which may or may not be relevant. One experimental study in the laboratory using animals supports the idea that a pathway through irradiation of the parents is plausible, although this one result needs replication. Other causes have been suggested for the excess childhood leukaemia levels in particular around nuclear establishments--these include population movement, implicating viruses that have long been considered to be associated with childhood leukaemia, high rates in isolated communities, and also selection of areas for nuclear sites that have a natural propensity to high rates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Workers compensation and occupational health and safety in the Australian agricultural industry

Objectives:  The objective of this paper is to review the available workers compensation and occupational health and safety data and the legal framework in relation to the agricultural industry to explore whether any factors highlight the need to pay special attention to the particular circumstances of those engaged in the industry.
Design:  This paper explores some of the special features of the agricultural industry, looking first at agricultural worker fatalities and injuries as a matter of ongoing concern for all participants in this industry, government, as well as occupational health and workers compensation authorities. The paper analyses how occupational health and workers compensation laws may have special application to this industry. Finally, the paper considers some workers compensation provisions that have particular application to the agricultural industry.
Conclusions:  Our survey of the available data and literature leads to the conclusion that the dangerous nature of agricultural work and the special legal and economic framework in which that work is undertaken identify the agricultural industry as presenting Australian Governments and specialist authorities with particular challenges in relation to improving workplace safety and reducing workplace injury.