The need for best practice standards in electronic governance of patient medical records to facilitate innovation

Background : Optimising the use of electronic data offers many opportunities to health services, particularly in rural and remote areas. These include reducing the effect of distance on access to clinical information and sharing information where there are multiple service providers for a single patient. The increasing compilation of large electronic databases of patient information and the ease with which electronic information can be transferred has raised concerns about the privacy and confidentiality of such records.
Aims & rationale/Objectives : This review aims to identify legal and ethical standards for areas of electronic governance where a lack of clarity may currently impede innovation in health service delivery.
Methods : This paper describes best practices for storage and transfer of electronic patient data based on an examination of Australian legislative requirements and a review of a number of current models. This will firstly allow us to identify basic legal requirements of electronic governance as well as areas of ambiguity not fully addressed by legislation. An examination of current models will suggest recommendations for best practice in areas lacking sufficient legal guidance.
Principal findings : We have identified the following four areas of importance, and shall discuss relevant details:
1) Patients' right of ownership to electronic patient records. 2) Custodial issues with data stored in centralised health care institutions 3) IT Security, including hierarchical level access, data encryption, data transfer standards and physical security 4) Software applications usage.
Discussion : Our examination of several models of best practice for the transfer of electronic patient data, both in Australia and internationally, identifies and clarifies many unresolved issues of electronic governance. This paper will also inform future policy in this area.
Implications : Clarification will facilitate the future development of beneficial technology-based innovations by rural health services.
Presentation type : Poster

Competition and unitization in oil extraction : a tale of two tragedies

This paper compares two organizational modes for extracting oil from a common pool: unitization and competitive extraction. The analysis suggests that the general presumption that unitization is surplus enhancing relative to competitive extraction may not always be valid due to contractual incompleteness associated with unitization contracts. While competitive extraction suffers from the tragedy of the commons, unitization can be subject to the dual tragedy of the anticommons. This provides an explanation for the puzzle confronting the oil industry that firms are often reluctant to voluntarily enter unitization agreements.

After hours schools as core to the spatial politics of in-betweeness

In this article the authors draw on a larger study in which their overall concern is to illustrate how diasporic identifications develop through a range of scales related to self, family, community, nation and beyond. They consider the Melbourne Greek community as an exemplar of diasporic experience and use it as a case study for their investigation, which is aimed at exploring how transcultural literacies relate to spaces which complicate and enrich identifications. In this article they consider the role of 'after hours' schools in the shaping of diasporic identities. These are community-based schools where Greek language and culture is taught. Commonly, classes are held on Saturday morning or in the evenings during the week. Such schools operate in classrooms that are rented from 'real' schools. By existing in spaces that are commonly occupied by mainstream day schools, students who attend 'after hours' schools experience a form of marginalisation that is also a right of passage. Here the authors argue that such 'in-between' spaces assist with the formation of 'in-between' identities that are emblematic of globalization.

Operation of guardianship laws in the emergency ward

Enduring and workable legislative schemes typically include (a) a balanced approach to the rights and duties of all parties under their purview; and (b) consideration of all major consequences that may flow from the codification of underpinning doctrines. This column examines the 1999 amendments to the Guardianship and Administration Act 1986 (Vic) regulating patients’ consent to medical treatment focusing on their application in modern emergency departments. The legislation needs to reconcile the human rights principle that humane and appropriate treatment is a fundamental right of all those who suffer from ill health and disease, with the principle that all patients (including those with impaired, but not totally absent, decisional capacity) have an absolute right to refuse life-saving treatment. Consent and refusal of treatment provisions should be based on the notion of reasonableness, including recognition that the mental and emotional states experienced by physically ill people may, in the short term, adversely affect their decision-making capacity. Unless the consent legislation factors in the realities of modern emergency practice and resources, statutory thresholds for decisional competence, instead of affording protection, may result in much worse outcomes for vulnerable patients.

The nature and scope of rights of removal

The rationale underlying the fixtures and accession presumptions is the need to protect the value of the chattel as well as the need to protect third-party interests. The destruction of the independent legal status of an attached chattel is generally deemed appropriate where the value of the co-mingled asset will be diminished if the chattel retains a separate legal title and this would generate unfairness because third parties have dealt with the co-mingled asset on the basis of its overall value. Rights to remove have evolved under both common law and equity to moderate the scope of these presumptions. Common law will uphold the right of a tenant to remove chattels that have been attached to leased premises during the currency of the lease. Equity on the other hand will uphold the right to remove affixed chattels in circumstances where the enforcement of such an entitlement is consistent with contractual intention and transactional fairness. This article examines the different rights of removal that have evolved under Australian law to date and the emergent statutory framework supporting these rights. It discusses the historical purpose and structural utility of these entitlements within a land framework that supports fixtures presumptions. Rights of removal, whether validated at law or in equity, confer positive entitlements upon the holder to access and remove affixed goods in circumstances where, because of the fixtures and accession presumptions, those goods no longer retain any separate legal status. The capacity of the holder to enforce this right against third parties is illustrative of their distinctive proprietary perspective.

Freedom of choice of occupation and academic freedom in Hong Kong

This chapter discusses two unrelated topics which are successively provided for in the Basic Law of the Hong Kong Administrative Region (HKSAR). These are the right of Hong Kong residents to a freedom of choice of occupations (art..33) and the right to academic freedom of Hong Kong's academic institutions and by implication of their academics (art.34). The first section of this chapter will focus on art.33, while the second section will focus on art.34.

Effects of lithium and myoinositol on the rat bisected vas deferens

1. The effects of lithium (Li+) on the concentration-response curves (CRC) to norepinephrine (NE) and acetylcholine (Ach) on the bisected rat vas deferens (RVD) were investigated, as well as its action on the neuronal uptake of [H-3] NE.2. Li+ did not affect the 50% effective concentration (EC(50)) of NE and Ach in the epididymal (EP) portion of the RVD.3. Li+ caused a significant increase of the EC(50) to NE and Ach in the prostatic (PP) portion of the RVD. This shift to the right of the CRC to NE was prevented by the presence of myoinositol.4. Incubation of the PP of the RVD with Li+, increased the neuronal uptake of NE. The simultaneous incubation with myoinositol prevented this increase.5. After the pre-treatment of the rats with 6-hydroxydopamine (6-OHDA), or in the presence of cocaine, Li+ failed to desensitize the PP of the RVD to NE.6. These results suggest that the effect of Li+ on the PP of the RVD occurs mainly at the pre-synaptic level and may be related to the increase of neuronal uptake and to the interference of Li+ on phosphatidylinositol hydrolysis.

Changes in sensitivity of the isolated guinea-pig vas deferens induced by a lyophilized Phoradendron latifolium leaf infusion

The effect of a lyophilized mistletoe infusion (LMI) was studied on isolated guinea-pig vas deferens. LMI caused a contraction which was partially blocked by phentolamine but not by atropine. LMI caused a shift to the left of the norepinephrine concentration-effect curve (CEC), an effect which appeared to be blocked by atropine and was absent in animals previously treated with reserpine and α-methyl-para-tyrosine. The increase of the norepinephrine maximal response induced by LMI was not blocked by atropine or pharmacological denervation. LMI caused a shift to the right of the acetylcholine CEC and had no effect on the acetylcholine maximal response. These results suggest that the effects seem to be due mainly to the presence of potassium ion in the LMI; however, the participation of muscarinic agonist(s) of reduced intrinsic activity or some tyramine-like substance could not be ruled out.

Renal effects of angiotensin II receptor subtype 1 and 2-selective ligands injected into the paraventricular nucleus of conscious rats

We determined the effects of losartan and CGP42112A (selective ligands of the AT1 and AT2 angiotensin receptors, respectively) and salarasin (a relatively nonselective angiotensin receptor antagonist) on urinary volume and urinary sodium and potassium excretion induced by administration of angiotensin II (ANG II) into the paraventricular nucleus (PVN) of conscious rats. Both the AT1 and AT2 ligands and salarasin administered in the presence of ANG II elicited a concentration-dependent inhibition of urine excretion, but losartan inhibited only 75% of this response. The IC50 for salarasin, CGP42112A, and losartan was 0.01, 0.05, and 6 nM, respectively. Previous treatment with saralasin, CGP42112A and losartan competitively antagonized the natriuretic responses to PVN administration of ANG II, and the IC50 values were 0.09, 0.48, and 10 nM, respectively. The maximum response to losartan was 65% of that obtained with saralasin. Pretreatment with saralasin, losartan, and CGP42112A injected into the PVN caused shifts to the right of the concentration-response curves, but the losartan concentrations were disproportionately greater compared with salarasin or CGP42112A. The IC50 values were 0.06, 0.5, and 7.0 for salarasin, CGP42112A, and losartan, respectively. These results suggest that both AT1 and AT2 receptor subtypes in the PVN are involved in ANG II-related urine, sodium, and potassium excretion, and that the inhibitory responses to AT2 blockade are predominant. Copyright (C) 1999 Elsevier Science B.V.

The right to education: An unfinished task for Latin America and the Caribbean

The right to education.Our newsletter once again takes on the challenges set forth by the Millennium Declaration and the human rights approach embedded in the Convention on the Rights of the Child. In this issue, we will examine the right of children and adolescents to education.

Adolescents and the right to education

The inalienable right of all people to education is enshrined in various international covenants, conventions and agreements, yet the actual fulfilment of this right varies in quantity and quality from one country to the other. On average, the compulsory length of schooling in the countries of the region is 10 years. Half of these countries have already made all secondary education mandatory, which is eminently reasonable since it is commonly accepted as a minimum threshold for lifelong well-being and skills-building. The main article in this edition of Challenges discusses this subject in depth, and shows how far behind we are in ensuring that all adolescents have access to the education to which they are entitled. It focuses on the low secondary school-completion rate and low level of learning acquisition, the strong socioeconomic and sociocultural stratification, the lack of citizenship skills, and the persistence of a relatively high dropout rate at all levels of secondary education. The main challenge in guaranteeing the right to education lies in reducing learning and attainment gaps by helping the groups that are presently lagging behind the most. As is customary, there are also reports on relevant meetings and conferences held in the region over the past half-year, together with the opinions of experts and adolescents and success stories in promoting school attendance in Uruguay and the Dominican Republic.

La condizione degli stranieri nello spazio dell'Unione Europea verso una nozione autonoma di cittadinanza europea?

The thesis analyses and examines the relevant developments of EU law since the EU institutions have been granted competence in matters of entry and residence of nationals of third countries within the space of the European Union, as governed by Title IV of the Treaty establishing the European Community (now Title V of the Treaty on the Functioning of the European Union) and by the ensuing norms. Based on these data my research aims to reconstruct the current state of EU legislation in matters of entry and residence of third country nationals in order to establish the extent of the EU’s competence into immigration and asylum, also in relation to the erosion of the Member States’ competence into the same areas. The most significant sign of this evolution is the recognition of the right of third-country nationals who are long-term residents to move and reside within the territory of other Member States. The increased use of the EU’s territory by third country nationals has led to the problem of the evolution of the concept of EU citizenship, and in particular to the most significant content of the question, namely the right to move freely. With regard to this aspect EU citizenship could be free from the requirement of nationality of a Member State, so as to be strictly related to the right of free use of the territory, as established by the internal market. This concept could also include the nationals of third countries.

The special rights other than shares in cross-border mergers of limited liability companies within the European Union. A perspective from the Spanish Law

The present research aims to study the special rights other than shares in Spanish Law and the protection of their holders in cross-border mergers of limited liability companies within the European Union frame. Special rights other than shares are recognised as an independent legal category within legal systems of some EU Member States, such as Germany or Spain, through the implementation of the Third Directive 78/855/CEE concerning mergers of public limited liability companies. The above-cited Directive contains a special regime of protection for the holders of securities, other than shares, to which special rights are attached, consisting of being given rights in the acquiring company, at least equivalent to those they possessed in the company being acquired. This safeguard is to highlight the intimate connection between this type of rights and the company whose extinction determines the existence of those. Pursuant to the Directive 2005/56/CE on cross-border mergers of limited liability companies, each company taking part in these operations shall comply with the safeguards of members and third parties provided in their respective national law to which is subject. In this regard, the protection for holders of special rights other than shares shall be ruled by the domestic M&A regime. As far as Spanish Law are concerned, holders of these special rights are recognized a right of merger information, in the same terms as shareholders, as well as equal rights in the company resulting from the cross-border merger. However, these measures are not enough guarantee for a suitable protection, thus considering those holders of special rights as special creditors, sometimes it will be necessary to go to the general protection regime for creditors. In Spanish Law, it would involve the recognition of right to the merger opposition, whose exercise would prevent the operation was completed until ensuring equal rights.

Bilateral impairment of concurrent saccade programming in hemispatial neglect

When healthy observers make a saccade that is erroneously directed toward a distracter stimulus, they often produce a corrective saccade within 100ms after the end of the primary saccade. Such short inter-saccadic intervals indicate that programming of the secondary saccade has been initiated prior to the execution of the primary saccade and hence that the two saccades have been programmed concurrently. Here we show that concurrent saccade programming is bilaterally impaired in left spatial neglect, a strongly lateralized disorder of visual attention resulting from extensive right cerebral damage. Neglect patients were asked to make saccades to targets presented left or right of fixation while disregarding a distracter presented in the opposite hemifield. We examined those experimental trials on which participants first made a saccade to the distracter, followed by a secondary (corrective) saccade to the target. Compared to healthy and right-hemisphere damaged control participants the proportion of secondary saccades directing gaze to the target instead of bringing it even closer to the distracter was bilaterally reduced in neglect patients. In addition, the characteristic reduction of secondary saccade latency observed in both control groups was absent in neglect patients, whether the secondary saccade was directed to the left or right hemifield. This pattern is consistent with a severe, bilateral impairment of concurrent saccade programming in left spatial neglect.

The Jurisprudence of the World Trade Organization 2014

In 2014, the Dispute Settlement Body (DSB) of the World Trade Organization (WTO) adopted seven panel reports and six Appellate Body rulings. Two of the cases relate to anti-dumping measures. Three cases, comprising five complaints, are of particular interest and these are summarized and discussed below. China – Rare Earths further refines the relationship between protocols of accession and the general provisions of WTO agreements, in particular the exceptions of Article XX GATT. Recourse to that provision is no longer excluded but depends on a careful case-by-case analysis. While China failed to comply with the conditions for export restrictions, the case reiterates the problem of insufficiently developed disciplines on export restrictions on strategic minerals and other commodities in WTO law. EC – Seals Products is a landmark case for two reasons. Firstly, it limits the application of the Agreement on Technical Barriers to Trade (TBT Agreement) resulting henceforth in a narrow reading of technical regulations. Normative rules prescribing conditions for importation are to be dealt with under the rules of the General Agreement on Tariffs and Trade (GATT) instead. Secondly, the ruling permits recourse to public morals in justifying import restrictions essentially on the basis of process and production methods (PPMs). Meanwhile, the more detailed implications for extraterritorial application of such rules and for the concept of PPMs remain open as these key issues were not raised by the parties to the case. Peru – Agricultural Products adds to the interpretation of the Agreement on Agriculture (AoA), but most importantly, it confirms the existing segregation of WTO law and the law of free trade agreements. The case is of particular importance for Switzerland in its relations with the European Union (EU). The case raises, but does not fully answer, the question whether in a bilateral agreement, Switzerland or the EU can, as a matter of WTO law, lawfully waive their right of lodging complaints against each other under WTO law within the scope of their bilateral agreement, for example the Agreement on Agriculture where such a clause exists.