Takotsubo Cardiomyopathy: Current Treatment

Management of takotsubo syndrome (TTS) is currently empirical and supportive, via extrapolation of therapeutic principles worked out for other cardiovascular pathologies. Although it has been emphasized that such non-specific therapies for TTS are consequent to its still elusive pathophysiology, one wonders whether it does not necessarily follow that the absence of knowledge of TTS’ pathophysiological underpinnings should prevent us for searching, designing, or even finding, therapies efficacious for its management. Additionally, it is conceivable that therapy for TTS may be in response to pathophysiological/pathoanatomic/pathohistological consequences (e.g., “myocardial stunning/reperfusion injury”), common to both TTS and coronary artery disease, or other cardiovascular disorders). The present review outlines the whole range of management principles of TTS during its acute phase and at follow-up, including considerations pertaining to the recurrence of TTS, and commences with the idea that occasionally management of TTS should consist of mere observation along the “first do no harm” principle, while self-healing is under way. Finally, some new therapeutic hypotheses (i.e., large doses of insulin infusions in association with the employment of intravenous short- and ultrashort-acting β-blockers) are being entertained, based on previous extensive animal work and limited application in patients with neurogenic cardiomyopathy and TTS.

Collaboration with people with lived experience of prison: reflections on researching cancer care in custodial settings

Background Patient and public involvement is increasingly considered important in health research. This paper reflects, from both academic and lived experience perspectives, on involving people with lived experience in a study exploring cancer care in prison and how by doing this it enriched the research process. Methods This paper is based on written and verbal reflections of the lived experience researchers and academic researchers involved in a study exploring the diagnosis and treatment of people with cancer in prison. The study comprised interviews with people with cancer in prison, prison healthcare staff, oncology specialists and custodial staff. Lived experience researchers were involved throughout the research process, including co-conducting interviews with patients and analysing interviews. Results This paper highlights the importance and value of including lived experience researchers across the research process. We reflect on how lived experience of prison shapes the experience of conducting interviews and analysing data gathered in prison. We reflect on the working relationships between academic and lived experience researchers. We demonstrate how prison research is challenging, but collaboration between lived experience and academic researchers can help to better prepare for the field, to ask more meaningful questions and to create rapport with participants. These types of collaborations can be powerful avenues for skill development for both academic and lived experience researchers, but they require an investment of time and a willingness for shared learning. Conclusions For academics and lived experience researchers to collaborate successfully and meaningfully care needs to be taken to develop open, honest and equal working relationships. Skills development for academic and lived experience researchers is important. A commitment to building and maintaining relationships is crucial. Having a third party as a mediator can facilitate and foster these relationships. Particularly with people with lived experience of prison it is essential to put the ‘do no harm’ principle into practice and to have support in place to minimise this.

Do No Harm in refugee humanitarian aid: the case of the Rohingya humanitarian response

The article broadly examines how humanitarian aid for Rohingya refugees inadvertently harmed poorer hosts and adversely affected local capacities for peace. The article also discusses possible ways of easing tension and improving social cohesion in the refugee-hosting areas, while also highlighting how policy- and mandate-related constraints hinder a humanitarian response anchored in the "Do No Harm" principle. Finally, the article concludes with the argument that the humanitarian agencies should not just limit themselves to identifying the unintended consequences and lapses in the intervention. Instead, the Do No Harm principle should lead humanitarian aid agencies to make an active effort to accept responsibility for the harm while taking all necessary steps to mitigate or avoid harming in future interventions.

Liberalism, rationality, and Pareto optimality

Rational players in game theory are neoliberal in the sense that they can choose any available action so as to maximize their payoffs. It is well known that this can result in Pareto inferior outcomes (e.g. the Prisoner's Dilemma). Classical liberalism, in contrast, argues that people should be constrained by a no-harm principle (NHP) when they act. We show, for the first time to the best of our knowledge, that rational players constrained by the NHP will produce Pareto efficient outcomes in n-person non-cooperative games. We also show that both rationality and the NHP are required for this result.

Development of a Language Tourism Village Based on Environmental Ethics and Social Entrepreneurship (A Case Study in Karanganyar Regency, Central Java, Indonesia)

Numerous environmental problems have emerged along with the development of tourism villages in various areas of Indonesia. This research aims to discover a concept of sustainable tourism village development, and to describe principles of environmental ethics and social entrepreneurship that are line with global demands. The research uses a qualitative method. The location of the research is the District of Karangpandan in Karanganyar Regency, the first language tourism village in Central Java. Data sources include both primary and secondary data. The data collection techniques were interviews, observation, and documentation. The data analysis included the stages of data collection, data reduction, data presentation, and conclusion. The research results show that the model of developing a language tourism village based on the principles of environmental ethics and social entrepreneurship has been proven to contribute to the success of developing village tourism. The principles of environmental ethics consist of respect for nature, moral responsibility for nature, cosmic solidarity, principle of care and concern for nature, principle of “no harm”, principle of living simply and in harmony with nature, principle of justice the principles of environmental ethics inspire stakeholders in preserving the environment. Furthermore, the components of social entrepreneurship include: resources, networking, research and development, packaging, marketing, and branding, Leadership and Entrepreneurship and all that gives inspiration for empowering the surrounding community.

Emerging respiratory virus: COVID-19-Basic concepts and its impact on immunisation of vaccine preventable diseases

In Dec 2019, pneumonia cluster in China caused by a previously unknown virus, now called Novel Coronavirus 2019, occurred, causing respiratory as well as gastrointestinal symptoms. The respiratory symptoms usually include common cold; pneumonia causing generally mild disease. There are, however, several examples of severe disease-causing coronaviruses that include severe acute respiratory syndrome (SARS)-Cov first identified in China in 2003; and Middle East Respiratory Syndrome (MERS) Cov, first identified in Saudi Arabia in 2012. In 2019 the n-COV was first detected in China. At present, there are many cases in China and along with it, this has spread to other countries as well. The article aims at giving general information about the novel coronavirus and its impact on vaccine preventable diseases. Currently, there is a big outbreak in India and other countries as well. By ensuring early immunisation, protecting people and groups of persons, reducing the susceptibility of a vaccine preventable disease (VPD) outbreak not only saves lives but also requires less resources and helps to reduce the health care burden. Immunizations are important resources for health care that protect people vulnerable to VPD. Countries may therefore contribute to the maintenance of immunisation programmes by using methods that adopt the do-no-harm principle and limit the transmission of COVID-19 when conducting immunisation activities.

Prevent, Respond, Cooperate

While disease outbreaks remain to a certain extent unforeseeable, international law provides a comprehensive legal framework requiring States to prevent their harmful consequences, effectively respond to ensuing health emergencies, and cooperate in achieving those aims. This contribution shows that, within this framework, many rules take the form of ‘due diligence’ obligations. Obligations of due diligence, albeit inherently flexible to accommodate different capabilities and circumstances, are binding on States. They impose a duty to act according to a standard of ‘good governance’: a State must employ its best efforts to realise certain common goals. At least five key sets of rules establishing due diligence duties are relevant to the Covid-19 outbreak: a) the ‘no-harm’ principle; b) international disaster law; c) the International Health Regulations; d) international human rights law; and e) international humanitarian law. We preliminarily identify some of the actions required from States to prevent new outbreaks and respond to the pandemic, whilst assessing compliance with applicable rules. We conclude that hard lessons learned during the current crisis should spur more decisive action to prevent and address future public health emergencies.

Future proofing the principle of no significant harm

The principle of ‘no significant harm’ as a way of addressing transboundary environmental challenges is both inadequately researched and inadequately implemented in many parts of the world. This paper addresses the questions: What is the nature of transboundary harm in the Anthropocene? Is the principle of no significant harm able to address current and pre-empt future transboundary harm in the field of water and environmental law? This special issue has focused on this principle in the arena of water law. This article integrates the findings in the context of a broader understanding of global harm in the Anthropocene. We draw 4 conclusions. First, conceptually harm is moving beyond direct inter-state harm between neighbouring countries to a multi-directional, multi-actor/multi-level harm, which is increasingly creeping and cumulative, with growing spatial and temporal characteristics. It thus requires moving beyond quibbling over what is ‘significant’ harm to recognize the climate emergency, the sixth biodiversity extinction, the huge damage to water systems and to realize that the threshold of ecosystem and human tolerance of damage are reducing rapidly. Second, however, the no-harm principle tends to be better developed in qualifying sovereignty in relation to transboundary harm on rivers than in the broader environmental and development arena as demonstrated by agenda 2030 which reverts to full permanent sovereignty. Third, legal scholarship, however, does provide a wide range of instruments for addressing harm before it occurs, after it has happened, and considering the differentiated economic capacity of the actors. Finally, the larger problem is that it is not individual projects or programmes that cause problems as much as national prioritization of economic growth which has led to externalizing the environment. The no-harm principle will be ineffective if it cannot be used to question the content of ‘growth’-led policies. There is need to future proof the no-harm principle.

The Principle of Prevention

This chapter begins by explaining that the preventive principle is complementary to the polluter-pays principle by requiring the adoption of measures intended to prevent damage from arising. It then briefly reviews the evolution of the prevention principle in international law, EU law, and several national legal systems. Having determined the scope of the preventive principle in relation to other principles of environmental law (no harm principle, precautionary), the chapter systematizes its various facets (environmental standards, best available technologies, etc.). It goes on to consider the role of proportionality in determining the degree of prevention sought. It examines the sometimes ambivalent nature of the instruments typical of the preventive principle, using several case studies.