The American Law Institute (ALI) recently approved its first ever Restatement of Medical Malpractice law. One Restatement subsection embraces the position that an authoritative clinical practice guideline, if admissible and sufficiently relevant, can be prima facie evidence of a provider’s compliance with the standard of care. This article responds to a forceful critique of that position by two of the Restatement’s advisors, who are nationally esteemed members of the plaintiff’s bar. They argue that caselaw does not support this provision, that it is unsound public policy, and that the provision is unfair because it does not afford the same prima facie proof status to plaintiffs’ use of practice guidelines.

This article addresses each of those critiques. It starts with the observation that, at bottom, this opposition is fundamentally at odds with the primary governing principle of professional liability, namely, that professional standards have greater force in medical liability cases than do industry standards in general negligence cases. Because professional standards determine professional negligence, a relevant clinical practice guideline that speaks with authority for a relevant segment of medical professionals, if admissible, should be sufficient to support a jury finding of non-negligence for a doctor who complies.

The same conclusion does not apply, however, when a plaintiff presents a single relevant guideline that a physician failed to follow, for the simple reason that it is often the case that more than one approach can reasonably apply to a given clinical situation. Also, guidelines often set ideal rather than minimal standards. Thus, this provision’s differential effect is not fundamentally unfair. Instead, it flows directly from a plaintiff’s burden of establishing professional negligence, much like numerous other conventional legal rules can affect opposing sides of a case differently.

As accomplished advocates, it is no surprise these authors have made the strongest possible case against any enhanced legal status for defensive use of exculpatory practice guidelines. Thoughtful inspection and reflection reveal, though, that their analysis significantly misstates or over-states the Restatement’s position, and so their attacks are mostly misdirected. If this Restatement’s position were truly as radical or poorly considered as these authors portray, the ALI likely would not have adopted it. Nevertheless, engaging with this critique can better elucidate reasons that courts might view this Restatement provision as well-considered.

Following the 2020 Karabakh War, the emerging geopolitical realities compelled Iran to recalibrate its South Caucasus policy, prompting a shift away from its longstanding posture of neutrality. Despite the potential for Tehran to engage in cooperation through proposed regionalist projects by other actors, a significant shift towards regionalism in Iran’s approach to the South Caucasus remains elusive. This article delves into two primary sets of factors to understand the reasons behind this absence of regionalism in Iran’s foreign policy towards the South Caucasus. The first set encompasses general approaches in Iran’s foreign policy and the impact of domestic political dynamics on their development. It discusses Iran’s perceived impossibility of aligning with the South Caucasus states, the absence of a robust neighborhood policy, and Iran’s strategic isolation in the region, attributed to its unique political system and the ideological stance of its ruling elite. The second set examines external dynamics, including constant international pressure on the Islamic Republic, Iran’s deep-seated ideological and security attachment to the Arab Middle East, and the fluctuating nature of Tehran’s relations with the West. Collectively, these factors significantly limit Iran’s capacity to craft a coherent strategy for regional integration in the South Caucasus.

This essay aims to clarify the characteristics of the political theories of Montesquieu and Adam Smith by comparing their views on liberty. Montesquieu divides political liberty into two categories: “liberty in its relation with the constitution” and “liberty in relation to the citizens.” The former concerns the security of the governed in their relationship with those who govern, whereas the latter concerns the security of citizens and their property against infringements by other citizens. Smith concentrates on civil liberty and elaborates on Montesquieu’s framework to develop a more refined theory of the separation of powers. However, their views diverge on constitutional liberty. Montesquieu expects the nobility, as an intermediate group, to restrain sovereign despotism, whereas Smith emphasizes that this group historically threatened citizens’ security and valued the central government’s role in checking it. A comparison of their views deepens our understanding of the foundations of a free society.

This paper considers the complex entanglements from which stones and stone craftspeople emerged in the precolonial Maya world. Drawing from recent scholarship that emphasizes the relational and processual nature of making and knowing, it adopts a multi-practice perspective to explore how humans transformed limestone into knowable and workable materials and how, in turn, limestone transformed humans into knowledgeable and skilled individuals. Geoarchaeological, archaeometric, and experimental data from the central and northern Maya lowlands are combined to identify choices and preferences in selecting, extracting, and processing calcareous materials, and to examine what these reveal about past knowledge and skills. We then turn our attention to the ways in which quarry workers, lime producers, and toolmakers learned to work with stone. We argue that becoming attuned to limestone was a sociomaterial process that involved repeated interactions with both material elements and social actors. Our discussion highlights the active role of limestone not only in shaping learning experiences but also in facilitating connections between diverse practices, and thus contributing to a dynamic, interconnected landscape of knowledge.

Progression towards elevated blood pressure (BP) may begin as early as adolescence. In low- and middle-income countries (LMICs), consumption of ultra-processed foods (UPFs), which are linked to poor cardiometabolic health, is often highest in adolescence. We examined sex- and age-specific associations of systolic and diastolic BP (SBP and DBP) with concurrent and lagged UPF intake from age 15 to 25 in a Filipino cohort. We used data from the 1998–2009 waves of the Cebu Longitudinal Health and Nutrition Survey (n 2124, 52 % male); participants were 15, 18, 21 and 25 years old. UPFs (% daily kilocalories) were classified using NOVA. Linear mixed-effects models estimated differences in SBP and DBP associated with a 5-percentage point difference in concurrent and lagged UPF intake (3–4 years earlier). Mean UPF intake was 10–11 % of total energy intake among males and 14–17 % among females over the study period. At age 21, intake of ultra-processed meats and fish was positively associated with DBP (β = 0·48 (95 % CI: 0·02, 0·94)) among males and intake of ultra-processed sugary beverages was positively associated with SBP (0·80 (0·13, 1·48)) and DBP (0·93 (0·34, 1·51)) among females. Among females only, SBP at age 18 was positively associated with total UPF intake at age 15 (0·25 (0·00, 0·50)). In this cohort, there were modest, positive associations between BP and UPF intake, which varied by sex and age. UPF intake during the transition to adulthood may be linked to higher BP, supporting efforts to limit adolescents’ intake in LMICs.

Late Iron Age and Early Roman human depictions are often thought to display stylistic influences from European La Tène art and, later, Roman classical art. However, with the analysis of metal figurines attributed to the period, many reported to the Portable Antiquities Scheme, this paper argues that some of these artefacts could include stylistic influences from an earlier wooden tradition, which appears to originate in the Bronze Age. This paper therefore presents a new hypothesis regarding the development of anthropomorphic art in later Iron Age Britain, whilst also highlighting the importance of contributions of data from the Portable Antiquities Scheme.