Report of the HIA to the Minister for Health, in accordance with Section 7E(1)(b) of the Health Insurance Acts, 1994-2009 (Redacted Version)

The Authority has been asked by the Minister for Health to prepare a Report under Section 7E (1) (b) of the Health Insurance Acts 1994-2009 (“the Health Insurance Acts”). For the purposes of the legislation, the relevant period is 1 July 2010 to 30 June 2011. The basis of the Report is specified in the legislation   Click here to download PDF 7.3mb Click here to download the supplementary document PDF 3.2mb

Interim Report of the Steering Group on the Review of the Mental Health Act 2001

Interim Report of the Steering Group on the Review of the Mental Health Act 2001 There is a commitment in the Programme for Government to review the Mental Health Act 2001. In line with this, Minister Lynch appointed a Steering Group to review the Mental Health Act 2001. Their report is now with an Expert Group. The review takes accounts of the significant changes in thinking about the delivery of mental health services that have taken place in the last ten years (including the introduction of the UN Convention on the Rights of People with Disabilities (CRPD), the shift to community based services, the adoption of a recovery approach in every aspect of service delivery and the involvement of service users as partners in their own care and in the development of the service). Click here to download PDF 471kb

Report of the Consultation Process on new legislation to replace the Dentists Act, 1985

  This is a report of a public consultation which the Department of Health undertook in June 2013 on new legislation to replace the Dentists Act 1985. The report outlines the views and opinions of those who completed questionnaires or made submissions to the Department on the proposed new legislation. One hundred and twenty five questionnaires/submissions were received. Of these, 98 were submissions made by personal respondents and 27 were made by corporate respondents. Download this document as a PDF The breakdown of these respondents is as follows: This report will inform the development of policy on the key issues, which will be the next stage in the process towards developing new dental legislation.

Ceftriaxone acts synergistically with levofloxacin in experimental meningitis and reduces levofloxacin-induced resistance in penicillin-resistant pneumococci.

Ceftriaxone acted synergistically with levofloxacin in time-killing assays in vitro over 8 h against two penicillin-resistant pneumococcal strains (WB4 and KR4; MIC of penicillin: 4 mg/L). Synergy was confirmed with the chequerboard method, showing FIC indices of 0.25. In the experimental rabbit meningitis model, ceftriaxone (1x 125 mg/kg) was slightly less bactericidal (-0.30 Deltalog(10) cfu/mL(.)h) compared with levofloxacin (-0.45 Deltalog(10) cfu/mL(.)h) against the penicillin-resistant strain WB4. The combination therapy (levofloxacin and ceftriaxone) was significantly superior (-0.64 Deltalog(10) cfu/mL(.)h) to either monotherapy. In cycling experiments in vitro, the addition of ceftriaxone at a sub-MIC concentration (1/16 MIC) reduced levofloxacin-induced resistance in the two strains KR4 and WB4. After 12 cycles with levofloxacin monotherapy, the MIC increased 64-fold in both strains versus a 16-fold increase with the combination (levofloxacin + ceftriaxone 1/16 MIC). In both strains, levofloxacin-induced resistance was confirmed by mutations detected in the genes parC and gyrA, encoding for subunits of topoisomerase IV and gyrase, respectively. The addition of ceftriaxone suppressed mutations in parC but led to a new mutation in parE in both strains.

Interpretation of array comparative genome hybridization data: a major challenge.

The advent and application of high-resolution array-based comparative genome hybridization (array CGH) has led to the detection of large numbers of copy number variants (CNVs) in patients with developmental delay and/or multiple congenital anomalies as well as in healthy individuals. The notion that CNVs are also abundantly present in the normal population challenges the interpretation of the clinical significance of detected CNVs in patients. In this review we will illustrate a general clinical workflow based on our own experience that can be used in routine diagnostics for the interpretation of CNVs.

Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarters 1 to 3 2009/10

Hospitals and care homes are making use of new measures designed to protect people unable to give consent for their care.The Mental Capacity Act Deprivation of Liberty Safeguards were introduced by law on 1 April 2009 to provide a legal framework for depriving someone of their liberty where they are unable to give informed consent regarding their care. The statistics presented here provide the first official information about authorisations to legally detain a person using the legislation.The safeguards apply to people aged 18 and above who suffer from a mental disorder of the mind (such as dementia or a profound learning disability) and who lack capacity to give consent to the arrangements made for their care and / or treatment. The safeguards cover people in all hospitals and care homes in the statutory, independent and voluntary sectors.A rigorous, standardised assessment and authorisation process is used to ensure only appropriate use is made of the safeguards.Key facts?The number of authorisation requests were: 1,772 in quarter 1 1,681 in quarter 2 and, 1,869 in quarter 3. ?Of the total assessments completed in each quarter, a higher proportion were for females than for males ?For each quarter, around three out of four assessments were made by local authorities while the remaining ones were made by primary care trusts. ?The percentage of authorisations granted leading to someone being deprived of their liberty varied between 33.5 per cent and 50.7 per cent across quarters 1 to 3. ?At 31 December 2009 1,074 people were subject to such authorisations.Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 1 (0.31MB)Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 2 (0.31MB)Quarterly analysis of Mental Capacity Act 2005, Deprivation of Liberty Safeguards Assessments (England) Quarter 3 (0.31MB)Have your say - give us your comments on this publication��

Plaisir et souffrance au travail : une lecture psychodynamique au sein d'un office régional de placement suisse

En Suisse, comme dans la plupart des pays industrialisés, le stress au travail et l'épuisement qui en découle sont devenus, au cours des dernières décennies, une réalité qui ne cesse de s'accentuer. Différentes disciplines scientifiques ont tenté de rendre compte, depuis le milieu du siècle dernier, des difficultés rencontrées par les individus dans le cadre de leur travail, avec une prédominance marquée pour des analyses de type causaliste. Dans le cadre de cette étude doctorale, nous nous sommes penché sur le cas d'un office régional de placement, mais avec une perspective sensiblement différente. La grille de lecture psychodynamique utilisée permet en effet de donner accès au sens des situations de travail et d'ouvrir sur une compréhension originale des mécanismes à l'origine des problèmes de santé mentale au travail. Cette approche permet ainsi de comprendre les rapports complexes que les individus entretiennent avec leur travail tel que structuré et organisé, et d'analyser leur expérience en termes de plaisir, de souffrance, de défenses face à la souffrance et de répercussions sur la santé. Dans ce but, nous avons utilisé une méthodologie basée sur des entrevues collectives, afin de stimuler l'expression libre des travailleurs. L'enquête s'est déroulée en deux temps : une première série d'entretiens de groupe a permis la récolte des données empiriques, puis une seconde série, appelée entretiens de restitution, a donné la possibilité aux participants de réagir sur l'interprétation de leur parole faite par le chercheur, et de valider l'analyse. Nos résultats mettent alors en évidence que le travail, tel qu'organisé au sein de cette institution de service public, apparaît considérablement pathogène, mais heureusement compensé par le pouvoir structurant de la relation d'aide aux assurés. Ils montrent également que l'expérience subjective de travail des participants a pour principales sources de souffrance la perception désagréable d'un manque de reconnaissance, d'autonomie et de pouvoir sur leurs actes. - In Switzerland and in other industrialized countries, work-related stress and resulting burn-out has become an ever increasing problem in recent decades. Many researchers Jrom many different fields have made efforts to understand the difficulties employees encounter at work since the middle of the last century. Most of this research is based on a cause and effect analysis approach. For this doctoral research project, we have analyzed cases handled by an unemployment office in Switzerland. We have taken a novel approach by using a number of psychodynamic criteria which permitted us to interpret situations at work and to open up a new way of understanding the mechanisms at work which lead to mental health problems. This approach allows us to understand account the complex relationship people have towards structured and organized work as well as to take into account and to analyze their experience in terms of pleasure, suffering, defense mechanisms against suffering and the consequences on their mental health. In order to achieve this goal we performed collective interviews in order to encourage workers to express themselves freely. The interviews were divided into two series. The first series of group interviews allowed us to collect empirical statistics and the second series gave the workers an opportunity to react to the researchers ' analysis of their answers and to validate the researchers ' interpretation of their answers. Our results show that work has considerable negative effects on mental health. Fortunately, these negative effects are counterbalanced by the psychological support system offered by the unemployment office. Our project also shows that the subjective negative experiences of workers are caused by their perceptions of being under-appreciated, lack of autonomy and having no power over their acts.

Relevé des consultations et des transferts de patients par enquête directe auprès des médecins: méthode d'une enquête, acceptabilité et limites d'interprétation. [Summary of consultations and transfer of patients by a direct survey of physicians: survey methods, acceptability and limits of interpretation].

A survey of medical ambulatory practice was carried out in February-March 1981 in the two Swiss cantons of Vaud and Fribourg (total population: 700,000), in which 205 physicians participated. The methodology used was inspired from the U.S. National Ambulatory Medical Care Survey, the data collection instrument of which was adapted to our conditions; in addition, data were gathered on all referrals prescribed by 154 physicians during two weeks. (The instruments used are presented.) The potential and limits of this type of survey are discussed, as well as the representativity of the participating physicians and of the recorded visits, which are a systematic sample of over 43,000 visits.

The Growing Importance of CNVs: New Insights for Detection and Clinical Interpretation.

Differences between genomes can be due to single nucleotide variants, translocations, inversions, and copy number variants (CNVs, gain or loss of DNA). The latter can range from sub-microscopic events to complete chromosomal aneuploidies. Small CNVs are often benign but those larger than 500 kb are strongly associated with morbid consequences such as developmental disorders and cancer. Detecting CNVs within and between populations is essential to better understand the plasticity of our genome and to elucidate its possible contribution to disease. Hence there is a need for better-tailored and more robust tools for the detection and genome-wide analyses of CNVs. While a link between a given CNV and a disease may have often been established, the relative CNV contribution to disease progression and impact on drug response is not necessarily understood. In this review we discuss the progress, challenges, and limitations that occur at different stages of CNV analysis from the detection (using DNA microarrays and next-generation sequencing) and identification of recurrent CNVs to the association with phenotypes. We emphasize the importance of germline CNVs and propose strategies to aid clinicians to better interpret structural variations and assess their clinical implications.

Danger signaling through the inflammasome acts as a master switch between tolerance and sensitization.

Efficient priming of adaptive immunity depends on danger signals provided by innate immune pathways. As an example, inflammasome-mediated activation of caspase-1 and IL-1beta is crucial for the development of reactive T cells targeting sensitizers like dinitrofluorobenzene (DNFB). Surprisingly, DNFB and dinitrothiocyanobenzene provide cross-reactive Ags yet drive opposing, sensitizing vs tolerizing, T cell responses. In this study, we show that, in mice, inflammasome-signaling levels can be modulated to turn dinitrothiocyanobenzene into a sensitizer and DNFB into a tolerizer, and that it correlates with the IL-6 and IL-12 secretion levels, affecting Th1, Th17, and regulatory T cell development. Hence, our data provide the first evidence that the inflammasome can define the type of adaptive immune response elicited by an Ag, and hint at new strategies to modulate T cell responses in vivo.

Religious act, public space: reflections on some Geertzian concepts

This paper examines theoretical and methodological implications of Clifford Geertz's approach to religion as he formulated it in 'Religion as a cultural system' (Geertz 1966), where religion and culture seem to be defined as functional equivalents. The paper considers religious symbols in the public space, using two examples from contemporary reality - one being a certain expression spoken by the copilot of Egypt Air Flight 990, the other being the headscarf controversy in France - in order to explore how the anthropologist relates the microsituations he observes to an all-embracing context

A rice cis-natural antisense RNA acts as a translational enhancer for its cognate mRNA and contributes to phosphate homeostasis and plant fitness.

cis-natural antisense transcripts (cis-NATs) are widespread in plants and are often associated with downregulation of their associated sense genes. We found that a cis-NAT positively regulates the level of a protein critical for phosphate homeostasis in rice (Oryza sativa). PHOSPHATE1;2 (PHO1;2), a gene involved in phosphate loading into the xylem in rice, and its associated cis-NATPHO1;2 are both controlled by promoters active in the vascular cylinder of roots and leaves. While the PHO1;2 promoter is unresponsive to the plant phosphate status, the cis-NATPHO1;2 promoter is strongly upregulated under phosphate deficiency. Expression of both cis-NATPHO1;2 and the PHO1;2 protein increased in phosphate-deficient plants, while the PHO1;2 mRNA level remained stable. Downregulation of cis-NATPHO1;2 expression by RNA interference resulted in a decrease in PHO1;2 protein, impaired the transfer of phosphate from root to shoot, and decreased seed yield. Constitutive overexpression of NATPHO1;2 in trans led to a strong increase of PHO1;2, even under phosphate-sufficient conditions. Under all conditions, no changes occurred in the level of expression, sequence, or nuclear export of PHO1;2 mRNA. However, expression of cis-NATPHO1;2 was associated with a shift of both PHO1;2 and cis-NATPHO1;2 toward the polysomes. These findings reveal an unexpected role for cis-NATPHO1;2 in promoting PHO1;2 translation and affecting phosphate homeostasis and plant fitness.

A fetal sheep liver extract containing immunostimulatory substances including LPS acts as leukocyte activator in cells of LPS responder and non responder mice.

Purified fractions from a fetal sheep liver extract (FSLE) were investigated, in a murine model, for induction of leukocyte stimulating activities. The fractions FSLE-1 and FSLE-2 induced splenocyte proliferation in vitro in C57Bl/10ScSn (LPS responder) mice comparable to LPS, and in C57Bl/10ScCr (LPS non responder) mice. They also stimulated the release of nitrogen radicals in bone marrow-derived macrophages (BMDM) from several mouse inbred strains including both C57Bl/10ScSn and C57Bl/10ScCr mice. Stimulation of NO production could be blocked by L-NMMA, an inhibitor of iNOS, and enhanced by the simultaneous addition of IFN-gamma. Moreover, stimulation of macrophages by FSLE-1 and FSLE-2 induced a cytostatic effect of the activated macrophages for Abelson 8-1 tumor cells. The stimulatory activity of the purified fractions is partially due to trace amounts of LPS derived from the fetal liver extract which was enriched during purification. Our results may help to explain the beneficial effect of the extract in patients which has been observed clinically.