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Unwell this is a term used when someone with mental illness is experiencing an episode of mental illness medicine keychain buy duphalac 100 ml on-line. Just as you would describe someone as having the fu and being unwell medicine recall safe 100 ml duphalac, this is the same for a person with mental illness treatment quad strain best duphalac 100 ml. If a person becomes unwell you may describe this symptoms 2 dpo cheap duphalac 100 ml without prescription, for example: Bruce has diagnosed depression and is currently experiencing an episode. Acute mental illness is characterised by signifcant and distressing symptoms requiring immediate treatment. Just as you would describe someone as having chronic arthritis or a chronic back condition, this is the same for a person with mental illness. Last month or so, I noticed Alex wasn?t himself, even his work mates noticed a big change in him. Observe confdentiality with them, just as you would for someone who has a It is a big decision for a person with mental illness to back injury or illness, for the purposes of identifying disclose their disability to a manager. It is important It is appropriate to ofer your worker the opportunity to to be aware of this when you are meeting with the worker bring a support person to any meeting you arrange to to discuss sensitive issues. Example of what not to do include sitting behind a desk, with arms and legs crossed and limited eye contact. Initiate the meeting this does not help to create a supportive and trusting It is your role as manager to initiate the conversation. Let them Consider: know that you are concerned about their workplace performance, and whether this may be due to health. It is important not to try to personal space) diagnose mental illness or to try to be a counsellor. Prepare for possible responses Be prepared for the meeting to become uncomfortable or for the discussion not to go the way you wanted it to go. Do Some people can feel very threatened when any attempt is made by a manager to discuss personal issues such as. It is important to stay calm, frm, fair, before providing it consistent and in control. If you feel there is a health and safety risk in continuing to allow the person to work, or to carry out certain work duties, then you have a duty of care to take action to ensure the person is safe in the workplace (refer to Appendix A Knowing the Law). A Review of the Evidence, Australia 25 Work-Related Alcohol and Drug Use A Fit for Work Issue: Student might be viewed athletes who suffer from depression after an injury illustrate the relationship between as secondary to physical? and mental? health. At the same time, some depressed student-athletes are physical health; at increased risk of injury. Given the inter relationship between the physical and men however, it is every tal, it might be helpful to think of student athletes with mental health problems as bit as important injured? just as you would of a student athlete who has a physical or medical prob for healthy lem. As with physical injuries, mental health problems may, by their severity, affect athlet performance. These pressures are often unrelated to sport participation, but sport participa tion may also increase pressure for cer tain student-athletes. General Signs and Symptoms that May Indicate a Possible Mental Health Problem Some signs and symptoms of possible mental health problems in your student-ath letes might surprise you. You may notice prob 3 lems in your student-athletes? behavior, cogni Behavioral Symptoms tive/intellectual functioning, physical/medical Disruption of daily activities status, and/or psychological/emotional condi Social withdrawal tion. On this page, there is a list of general Irresponsibility, lying signs and symptoms that are present across Legal issues, fighting, difficulty many, if not most, psychological disorders. The cate Substance use gories of Behavioral,? Cognitive,? Emotional/Psychological,? and Physical/Medical? are not intended to repre Cognitive Symptoms sent separate and exclusive groups. Because Suicidal thoughts many signs and symptoms are related, con Poor concentration siderable overlap exists among the different Confusion/difficulty making decisions categories. These signs and symptoms do not Obsessive thoughts necessarily confirm the presence of mental All-or-nothing thinking health problems; however, a stronger case for Negative self-talk a referral to a mental health professional can be made as the number of such signs and symptoms increases. Emotional/Psychological Symptoms Disclaimers Feeling out of control this handbook does not cover all mental Mood Swings health problems. Such an undertaking Excessive worry/fear would be well beyond the scope of the Agitation/irritability handbook. The disorders included were Low self-esteem chosen because of their prevalence in the Lack of motivation general population and because they are prevalent in the college-age population. Physical/Medical Symptoms the purpose of this handbook is to assist Sleep difficulty coaches in identifying student-athletes who Change in appetite and/or weight may be having difficulty and to help coaches Shaking, trembling learn to respond appropriately and effective Fatigue, tiredness, weakness ly with those student-athletes. It should be Gastrointestinal complaints, headaches considered as a very important part of a Overuse injuries larger cooperative effort involving other sport and healthcare professionals. The purpose is not to train coaches to be therapists or treat this is not intended to be an exhaustive list of symptoms, but rather a list of more common symptoms. It No one sign or symptom is indicative of a mental health is not meant to be a substitute for psycho problem, but the need for a referral for an evaluation increases with the number of signs and symptoms logical evaluation and treatment by qualified reported or observed. Certainly, most people will feel depressed for short periods from time to time for various reasons. However, when the depression becomes more severe, lasts longer and occurs more frequently, evalua tion and treatment are warranted. Although most mood disorders primarily involve low mood or depression, bipolar disorder con sists of episodes of abnormally elevated (high) moods, in addition to the character istic low moods. Chapter 1 Signs and Symptoms/Identification Mood Disorders Typically, mood disorders (or depression) are characterized by: If a student-athlete is not eating or sleeping well and feels tired or fatigued, you would expect performance to decrease from a physiological perspec tive. Add in emotional and cognitive com ponents of low mood, decreased motiva Case Illustration tion, poor concentration, and negative thinking, and you could not expect a stu Sam, a member of a college dent-athlete to perform well. Poor sport swim team, had been missing his performance can increase a student-ath morning swim practices. A He could not explain to them why thorough discussion of the causes of he could not get up and get to depression is beyond the scope of this practice, other than to say that he handbook. However, you should be aware was tired because he kept wak of the three most common causes of ing up between 3 and 4 a. Teammates had individual feels out of control with his or remarked that Sam was less talk her life, depression may follow. Some mate reported that Sam told him depressions are believed to be more bio that he felt so bad that he would logical or neurobiological in nature. That rather be dead than feel the way is, there appears to be a genetic vulnera he was feeling. Also, depression 6 for some people appears to involve an imbalance in brain chemicals called neu Difficulty in Identification rotransmitters. These individuals may of Depression need or benefit from antidepressant medication. Antidepressant medications Although depressive symptoms can have numerous side effects. As a and easy to recognize, identifying consequence, athletic performance may depression can be difficult for be affected. Thus, you may with this type of depression constantly have less opportunity to notice make negative self-statements that a problem. Although most depressions probably occur from the aforementioned causes, do not believe they deserve? student-athletes may get depressed your time and attention. For fact, they often do not want to example, some student-athletes become bother? others with their diffi depressed in response to an injury. Others may hide their symp tively affected by their inability to do the toms by smiling and acting as thing that they do best and enjoy most play their sport. The decrease in tract themselves, you and oth performance as a result of this syndrome ers from their underlying can further depress a student-athlete. Depression and Risk of Injury A student-athlete may become depressed after an injury, but the relation ship between depression and injury may also occur in reverse order. For such student athletes, their depression or more specif ically their depressive symptoms may increase the likelihood of injury primarily through distraction (decreased concentra tion resulting in being less alert, responding more slowly, or making poor decisions or judgments). A Depression can diver might more easily lose where she is in space before impacting the water. When Research suggests that suicide is the second leading cause of death among col depression is lege students. Approximately three suicides related to sport, it occur daily among college students, and seven to 10 percent of college students is often in either attempt or contemplate suicide in a given year.
It should be given by the most accessible route medicine glossary discount duphalac 100 ml otc, which in the delivery room is usually the umbilical vein medicine stick order duphalac without a prescription. It may be advisable to treatment integrity checklist duphalac 100 ml visa give the infusion more slowly in preterm infants because rapid infusion of large volumes may increase the risk of intraventricular hemorrhage treatment integrity order generic duphalac canada. Adequate support of ventilation should be sufficient to restore normal heart rate and oxygenation. Apgar Score the Apgar score is useful for describing the status of the newborn at birth and his or her subsequent adaptation to the extrauterine environment. It should not be used to determine the need for resuscitation or the steps to be taken. If resus citation is indicated, it is initiated before the 1-minute Apgar score is obtained. Apgar scores should be assigned at 1 minute and 5 minutes after birth, and if the 5-minute Apgar score is less than 7, additional scores should be assigned every 5 minutes for up to 20 minutes until the Apgar score is greater than 7. Assessment of the Newborn in the Delivery Room After delivery, the newborn must be assessed for individual needs to determine the best location for care. If the mother has chosen to breastfeed, the newborn should be placed at the breast in the delivery room within the first hour after birth. Initial skin-to-skin contact has been associated with a longer duration of breastfeeding and improved temperature stability. The nursing staff in the labor, delivery, recovery, and postpartum areas should be trained in assessing and recognizing problems in the newborn. Newborns with depressed breathing, depressed activity, or persistent cyano sis at birth who require intervention in the delivery room but respond promptly, or those with continuing symptoms, including mild respiratory distress, are at risk of developing problems and should be evaluated frequently during the immediate neonatal period. This may occur in an observation?admission? transition nursery, where frequent vital signs can be obtained and the nursing staff is familiar with the signs and symptoms of an infant who is in distress. If the vital signs stabilize and the infant has no other risk factors, the newborn can then room-in with the mother. Infants who require more extensive resuscitation are at risk of developing subsequent complications and may require ongoing support. These infants should be managed in an area where ongoing evaluation and monitoring are available. This may take place in the birth hospital, if it is an appropriate facil ity, or may require transport to another hospital for a higher level of care. Immediate plans for the newborn should be discussed with the parents or other support person(s), preferably before leaving the delivery room. Whenever possible, the parents should have the opportunity to see, touch, and hold the newborn before transfer to a nursery or before transfer to another facility. Noninitiation or Withdrawal of Intensive Care for High-Risk Infants ^ Parents should be active participants in the decision-making process concern ing the treatment of severely ill infants. Ongoing evaluation of the condition and prognosis of the high-risk infant is essential, and the physician, as the spokesperson for the health care team, must convey this information accurately and openly to the parents of the infant. Compassionate and Comfort Care Compassionate care to ensure comfort must be provided to all infants, includ ing those for whom intensive care is not being provided. The decision to initiate or continue intensive care should be based only on the judgment that the infant will benefit from the intensive care. It is inappropriate for life-prolonging treat ment to be continued when the condition is incompatible with life or when the treatment is judged to be harmful, of no benefit, or futile. Whenever nonresuscitation is considered an option, a qualified individual should be involved and present in the delivery room to manage this com plex situation. Comfort care should be provided for all infants for whom resuscitation is not initiated or is not successful. Parent Counseling Regarding Resuscitation of Extremely Low Gestational Age Infants Whether to initiate resuscitation of an infant born at an extremely low ges tational age is a difficult decision because the consequences of this decision are either the inevitable death of the infant or the uncertainties of providing intensive care for an unknown length of time with an uncertain outcome. Each hospital that provides obstetric care should have a comprehensive and consistent approach to counseling parents and decision making. Parents should be provided the most accurate prognostic data available to help them make decisions. These predictions should not be based on gestational age alone but should include all relevant information affecting the prognosis. It is not pos sible to develop specific criteria for when the initiation of resuscitation should or should not be offered. Rather, the following general guidelines are suggested when discussing this situation with parents. If the physicians involved believe that there is no chance of survival, resuscitation is not indicated and should not be initiated. If the physicians consider a good outcome to be very unlikely, then parents should be given the choice of whether resuscitation should be initiated, and physicians should respect their preference. When the physicians? judgment is that a good outcome is reasonably likely, physicians should initiate resuscita 278 Guidelines for Perinatal Care tion and, together with the parents, continually re-evaluate whether intensive care should be continued. Identification the possibility of newborns being switched in the hospital requires strict guidelines to prevent these events. Human error continues to be the major cause of infants being accidentally switched, and establishing procedures with multiple checks or electronic matching systems minimizes this risk. Infant identification procedures should begin in the delivery room with matching bands for the infant and the mother. The nurse in the delivery room should be responsible for preparing and securely fastening these identification bands on the newborn and the mother while the newborn is still in the delivery room. Footprinting and fingerprinting alone are not adequate methods of patient identification. The birth records and identification bands should be checked and verified for accuracy before the newborn leaves the delivery room. Policies and procedures requiring personnel to match identification bands each time the infant is taken to the mother while in the hospital and at discharge will minimize errors. If the condition of the newborn does not allow place ment of identification bands (eg, extreme preterm birth), the identification bands should accompany the infant and should be placed on the incubator or warmer. In these instances, the identification bands should be attached to the infant as soon as is practical. With multiple births, each of the newborns should be identified according to birth order (eg, A, B, C or 1, 2, 3), and the corresponding umbilical cords should be identified according to hospital policy (eg, use of different number of clamps). This will ensure that umbilical cord blood specimens will be labeled correctly and can be correlated with the correct newborn. The birth order may or may not correlate with the number assigned to the fetus in utero (see also Infant Safety? later in this chapter). Communication of Information Care of the newborn is aided by effective communication of information about the mother and her fetus to the pediatrician or other health care provider. Care of the Newborn 279 With an uncomplicated pregnancy, labor, and delivery, the information on the medical record accompanying the newborn, if complete, may be sufficient. For some high-risk pregnancies, a neonatal consulta tion during the antepartum period may be helpful in obstetric management and can assist the parents in understanding what to expect for their newborn. This is of particular importance when fetal anomalies are significant or the delivery of a very preterm infant is expected. Each newborn should be weighed shortly after birth or after the first breastfeeding, and daily thereafter. Additional targeted evaluations may include assessment of capillary refill, blood pressure, oxygen saturation, and need for supplemental oxygen. Gestational age should be assigned after all nursing, pediatric, and obstetric data have been assessed. Any marked dis crepancy between the presumed duration of pregnancy by obstetric assessment and the physical and neurologic findings in the newborn should be documented on the medical record. Growth parameters should be plotted on a birth weight? gestational age record appropriate for the community. Determination of ges tational age and its relationship to weight should be used to identify newborns at risk of postnatal complications. For example, newborns who are either large or small for their gestational ages are at increased risk of alterations of glucose homeostasis, and appropriate tests (eg, serum glucose screen) are indicated. Assessment of Late-Preterm Status Infants born at 34 0/7?36 6/7 weeks of gestation (239?259 days since the first day of the last menstrual period) are referred to as late preterm. Late preterm infants are physiologically immature and have limited compensatory responses to the extrauterine environment compared with term infants.
Data sources include all health facilities within the catchment area where births occur medications like xanax order generic duphalac, vital records treatment strep throat generic duphalac 100 ml mastercard. Catchment area for a population-based surveillance programme R = fetus or neonate with congenital anomaly whose mother is a resident symptoms genital herpes order duphalac with amex. The steps for calculating prevalence medicine quest duphalac 100 ml visa, and information on how to defne the denominator, are described later on in this chapter. Hospital-based surveillance programmes Hospital-based congenital anomalies surveillance programmes capture all pregnancy outcomes with congenital anomalies that occur in selected hospitals in a defned geographic area. The denominator used to estimate prevalence in a hospital-based programme consists of births occurring in the participating hospitals. The numerator (cases) typically consists of afected live births and stillbirths occurring in these hospitals. Fetuses or neonates with congenital anomalies who are delivered at home are not included, even if they are identifed and captured in participating hospitals (because they are not part of the denominator). This becomes an issue in the surveillance of congenital anomalies when referral patterns skew the likelihood that an affected fetus or neonate is delivered at a hospital in the system. Thus, a major concern in hospital based programmes is referral bias of cases, that is, the selective delivery of affected pregnancies in hospitals participating in the hospital-based programme. This referral bias can also vary over time, either because referral patterns change or because hospitals are added or removed from the surveillance programme. This, in turn, adds to the problem of using these hospital-based data longitudinally for monitoring. Such hospital-based programmes typically collect data on live births and stillbirths. Because neonates are discharged from maternity hospitals within days following birth, hospital-based programmes typically capture only those congenital anomalies that are evident during the hospital stay, unless those readmitted to the hospital for surgery or other procedures are captured. Note that fetuses or neonates diagnosed after delivery in a hospital participating in a hospital-based programme are not included for the purposes of surveillance, unless they were also delivered at a participating site in a hospital-based programme. All fetuses or neonates with congenital anomalies born to mothers in participating hospitals, regardless of maternal residency, are included in the programme (1 to 4 in Fig. Fetuses or neonates with congenital anomalies born to resident mothers but born outside of a participating hospital or at home are not included. Fetuses or neonates with congenital anomalies born to non? resident mothers are included if they are born in a participating hospital. Ascertainment of fetuses or neonates identifed with congenital anomalies in participating hospitals can vary. While some are primary hospitals, others may be specialized centres for certain conditions, or for prenatal diagnosis and care, and serve as referral hospitals for patients outside the catchment area. As discussed, such hospitals would disproportionately serve fetuses or neonates with congenital anomalies, thus introducing bias in the calculation of their birth prevalence. Catchment area for a hospital-based surveillance programme R = fetus or neonate with a congenital anomaly whose mother is a resident; included if the fetus or neonate is identifed at a participating hospital. The magnitude of bias may change over time, with fuctuations in referral patterns and the proportion of births occurring outside the hospital setting. This could lead to changes in rates that have nothing to do with the underlying prevalence, but are the result of referral patterns. Also, the bias will depend on how many hospitals or facilities are included all, half or only a small percentage. Estimates of birth outcomes with congenital anomalies in hospital-based surveillance programmes represent only those births at reporting hospitals in which data are collected. The prevalence estimates could, therefore, be biased, particularly if the hospital births are a minority of all births, if they receive a high proportion of difcult or complicated pregnancies, and/or if they are not representative of the population of interest. However, if nearly all hospitals in a country participate in the surveillance programme and nearly all births occur in hospitals, the surveillance programme may approximate a population-based surveillance programme. Because congenital anomalies are relatively rare events, sentinel surveillance programmes may not be very efective for capturing congenital anomalies. Although population-based and hospital-based surveillance programmes have clear diferences, there are some characteristics that are common to both. Case ascertainment Once the type of population coverage has been decided, the next step is to determine how cases will be ascertained. Case ascertainment Active case ascertainment With active case ascertainment, the surveillance personnel typically are hired and trained to conduct data abstraction (abstractors). Abstractors regularly visit, or have electronic access to, participating institutions. Therefore, visiting all areas of the hospital where a potential fetus or neonate with a congenital anomaly can be identifed could be important. It is noted that for this process to work well, medical records need to contain relevant information in a format that can be identifed and abstracted easily by the abstractors, who usually have limited medical background. Although this type of case ascertainment requires considerable resources and personnel, active case ascertainment tends to improve case detection and case reporting, and improves data quality because more extensive clinical details are collected. To improve case ascertainment, the surveillance programme can link administrative databases. The identifed cases will require verifcation by personnel going to the maternity hospitals and reviewing the medical records. Passive case ascertainment With passive case ascertainment, hospital personnel who identify a fetus or neonate with a congenital anomaly or anomalies report this information directly to the surveillance registry. With passive case ascertainment, the information that is reported to the surveillance registry is typically not verified by direct abstraction of the medical record. This type of case ascertainment is less expensive because fewer resources and personnel are required. However, the burden of reporting falls on hospitals or clinics, which may require time and efort of hospital staf who are already busy. This could result in a less than optimal reporting rate, less complete documentation or less timely reporting, or a combination thereof. It also usually yields less complete detail on each case and underestimates the number of congenital anomalies that occur. In addition, because reported information is not validated, it could also overestimate certain congenital anomalies. Hybrid case ascertainment Hybrid case ascertainment refers to a combination of passive case ascertainment of most types of congenital anomalies, with active case ascertainment of specifc congenital anomalies, or for a percentage of all reported congenital anomalies as a quality control tool. For example, a surveillance programme can conduct active ascertainment of neural tube defects to gather more detailed case information in a more timely manner, but carry out passive ascertainment of all other congenital anomalies under surveillance. Similarly, a programme can use passive reporting with active follow-up verifcation of certain congenital anomalies. Regardless of the method selected for case ascertainment (active or passive), each participating hospital can identify a champion? who is committed to the programme. This could help to ensure more complete participation of the diferent hospital units and services participating in the surveillance programme. Also, the role of this leader could 19 be to train other personnel (such as doctors, nurses and technicians) on how to identify cases, record the information and oversee the information fow, so as to maintain an ongoing and active quality control on the quantity and completeness of information. Case fnding Congenital anomalies surveillance programmes can decide the sources from which cases will be identifed (see Fig. Case fnding Data sources Using multiple sources may improve the completeness of case ascertainment by identifying cases that are not available from only one individual source. Additionally, it may improve the quality of the data, as having multiple sources may increase the amount and level of information available for a given case. For example, a diagnosis may not be possible in the delivery unit but may be established by specialists in the paediatric unit and further confrmed by laboratory tests. While the use of multiple data sources is more time consuming and delays the process of gathering information, it can improve overall case ascertainment and data quality. Using a single source for case ascertainment does not allow for ascertainment of the majority of fetuses or neonates with a congenital anomaly in most settings. Source: Birth Defects Surveillance Programme Puerto Rico Department of Health, and Auxiliary Secretariat for Planning and Development, San Juan, Puerto Rico. Case inclusion Each surveillance programme decides which congenital anomalies to include. A programme may choose to include all major congenital anomalies, while another programme may decide to include selected congenital anomalies, according to the needs of the country (see Fig. As discussed in Chapter 4, one consideration is to start with a small number of easily recognizable congenital anomalies and then expand to include additional anomalies, as a programme gains experience and resources. From a quality standpoint, checkboxes alone are typically insufcient to achieve high data quality, both in initial data abstraction and in case review.
For example medicine cabinet with lights buy duphalac with visa, there is a need for smoother transitions from pediatric to treatment 2 degree burns buy duphalac online pills adult care and also a need for uniform data standards to medications safe for dogs order cheapest duphalac and duphalac track clinical outcomes and improve the quality of care medicine 5 rights cheap 100 ml duphalac with mastercard. When I think about the fact that my which the body cannot properly everything I love about life has life could have been so different, break down protein. I didn?t choose the family not have been able to do any of cheese, I don?t drink milk. But all of those factors just that the quality of life for everyone I?ve spent the last ten years in aligned at the right time for me with this disease depends upon the professional video production. I covered different family, had I been born who don?t have a very powerful Hurricane Katrina; I was down in in a different country. I have interviewed numerous been on diet, had I not always do whatever you can to help us, celebrities. I?ve interviewed sena been on my [medical] formula, it because we would greatly, greatly tors. Available at New technology, old controversies, Archives of Pediatrics. Newborn screening: toward a uniform economic costs of newborn screening for congenital hypo screening panel and system. More information: Newborn Screening Program, Association of Public Health Laboratories | bit. Although petitioners had re sponded with the testimony of eight other well-credentialed experts, who based their conclusion that Bendectin can cause birth defects on animal studies, chemical structure analyses, and the unpublished re analysis? of previously published human statistical studies, the court determined that this evidence did not meet the applicable general ac ceptance? standard for the admission of expert testimony. Held: the Federal Rules of Evidence, not Frye, provide the standard for admitting expert scienti? Nothing in the Rules as a whole or in the text and drafting history of Rule 702, which speci? Moreover, such a rigid standard would be at odds with the Rules? liberal thrust and their general approach of relaxing the traditional barriers to opinion? testimony. Many considerations will bear on the inquiry, including whether the the ory or technique in question can be (and has been) tested, whether it has been subjected to peer review and publication, its known or poten tial error rate and the existence and maintenance of standards control ling its operation, and whether it has attracted widespread acceptance within a relevant scienti? That even limited screening by the trial judge, on occasion, will prevent the jury from hearing of authentic scienti? Meyerhoff; for the Association of Trial Lawyers of America by Jeffrey Robert White and Roxanne Barton Conlin; for Ronald Bayer et al. Zaremski; for the Carnegie Commission on Science, Technology, and Government by Steven G. In this case we are called upon to determine the standard for admitting expert scienti? I Petitioners Jason Daubert and Eric Schuller are minor children born with serious birth defects. They and their parents sued respondent in California state court, alleging that the birth defects had been caused by the mothers? inges tion of Bendectin, a prescription antinausea drug marketed by respondent. After extensive discovery, respondent moved for summary judgment, contending that Bendectin does not cause birth defects in humans and that petitioners would be unable to come forward with any admissible evidence that it does. Lamm, physician and epidemiologist, who is a well-credentialed expert on the risks from exposure to vari ous chemical substances. On the basis of this review, Doctor Lamm concluded that maternal use of Bendectin during the? He has served as a consult ant in birth-defect epidemiology for the National Center for Health Statis tics and has published numerous articles on the magnitude of risk from exposure to various chemical and biological substances. Their conclusions were based upon in vitro? (test tube) and in vivo? (live) animal studies that found a link between Bendectin and malforma tions; pharmacological studies of the chemical structure of Bendectin that purported to show similarities between the structure of the drug and that of other substances known to cause birth defects; and the reanalysis? of previously pub lished epidemiological (human statistical) studies. Thus, the animal-cell studies, live-animal studies, and chemical-structure analyses on which petitioners had re lied could not raise by themselves a reasonably disputable jury issue regarding causation. Petitioners? epidemi ological analyses, based as they were on recalculations of data in previously published studies that had found no causal link between the drug and birth defects, were ruled to be inadmissible because they had not been published or sub jected to peer review. The court emphasized that other Courts of Appeals consid ering the risks of Bendectin had refused to admit reanalyses of epidemiological studies that had been neither published nor subjected to peer review. Although under increas ing attack of late, the rule continues to be followed by a ma jority of courts, including the Ninth Circuit. In what has become a famous (perhaps infamous) passage, the then Court of Ap peals for the District of Columbia described the device and its operation and declared: Just when a scienti? Somewhere in this twilight zone the evidential force of the principle must be recognized, and while courts will go a long way in admitting expert testimony deduced from a well-recognized scienti? The merits of the Frye test have been much debated, and scholarship on its proper scope and application is legion. Indeed, the debates over Frye are such a well-established part of the academic landscape that a distinct term?Frye-ologist?has been ad vanced to describe those who take part. See Behringer, Introduction, Proposals for a Model Rule on the Admissibility of Scienti? They contend that the Frye test was superseded by the adoption of the Federal Rules of Evidence. We interpret the legislatively enacted Federal Rules of Evidence as we would any statute. Rule 402 provides the baseline: All relevant evidence is admissible, except as other wise provided by the Constitution of the United States, by Act of Congress, by these rules, or by other rules prescribed by the Supreme Court pursuant to statutory authority. Opinion of the Court explained that the common law nevertheless could serve as an aid to their application: In principle, under the Federal Rules no common law of evidence remains. Nor does respondent present any clear indication that Rule 702 or the Rules as a whole were intended to incorporate a general acceptance? standard. The drafting history makes no men tion of Frye, and a rigid general acceptance? requirement would be at odds with the liberal thrust? of the Federal Rules and their general approach of relaxing the traditional barriers to opinion? testimony. That austere standard, absent from, and incompatible with, the Federal Rules of Evidence, should not be applied in federal trials. To the contrary, under the Rules the trial judge must ensure that any and all scienti? The primary locus of this obligation is Rule 702, which clearly contemplates some degree of regulation of the sub jects and theories about which an expert may testify. Similarly, the word knowledge? connotes more than subjective belief or unsupported speculation. The term ap plies to any body of known facts or to any body of ideas inferred from such facts or accepted as truths on good grounds. United States Re structured and Revitalized: A Proposal to Amend Federal Evidence Rule 702, 26 Jurimetrics J. However (absent creditable grounds supporting such a link), evidence that the moon was full on a certain night will not assist the trier of fact in deter mining whether an individual was unusually likely to have behaved irrationally on that night. Unlike an ordinary witness, see Rule 701, an expert is permitted wide latitude to offer opinions, including those that are not based on? In making its determination it is not bound by the rules of evidence except those with respect to privi leges. Of course, well established propositions are less likely to be challenged than those that are novel, and they are more handily defended. Ordinarily, a key question to be answered in determining whether a theory or technique is scienti? Hempel, Philosophy of Natural Science 49 (1966) (?[T]he statements constituting a scienti? Another pertinent consideration is whether the theory or technique has been subjected to peer review and publication. Publication (which is but one element of peer review) is not a sine qua non of admissibility; it does not necessarily corre late with reliability, see S. Some propositions, moreover, are too particu lar, too new, or of too limited interest to be published. Opinion of the Court of the Grounds for Belief in Science 130?133 (1978); Rel man & Angell, How Good Is Peer Review? The fact of publication (or lack thereof) in a peer reviewed journal thus will be a relevant, though not dispositive, consideration in assessing the scienti? A reliability assessment does not require, al though it does permit, explicit identi? Widespread acceptance can be an important factor in ruling particular evidence admissible, and a known technique which has been able to attract only minimal support within the community,? Downing, 753 F. The focus, of course, must be solely on principles and methodol ogy, not on the conclusions that they generate. Rule 703 provides that expert opinions based on otherwise inadmissible hearsay are to be admitted only if the facts or data are of a type reasonably relied upon by experts in the particular?
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