The legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment : part 3 (Victoria)

This is the final article in a series of three that examines the legal role of medical professionals in decisions to withhold or withdraw life-sustaining treatment from adults who lack capacity. This article considers the position in Victoria. A review of the law in this State reveals that medical professionals play significant legal roles in these decisions. However, the law is problematic in a number of respects and this is likely to impede medical professionals’ legal knowledge in this area. The article examines the level of training that medical professionals receive on issues such as refusal of treatment certificates and substitute decision-making, and the available empirical evidence as to the state of medical professionals’ knowledge of the law at the end of life. It concludes that there are gaps in legal knowledge and that law reform is needed in Victoria. The article also draws together themes from the series as a whole, including conclusions about the need for more and better medical education and about law reform generally.

Moving tele-monitoring and tele-treatment from promise to practice : a business model approach for a chronic lower back pain application

The availability of new information and communication technologies creates opportunities for new, mobile tele-health services. While many promising tele-health projects deliver working R&D prototypes, they often do not result in actual deployment. We aim to identify critical issues than can increase our understanding and enhance the viability of the mobile tele-health services beyond the R&D phase by developing a business model. The present study describes the systematic development and evaluation of a service-oriented business model for tele-monitoring and -treatment of chronic lower back pain patients based on a mobile technology prototype. We address challenges of multi-sector collaboration and disruptive innovation.

Flow field investigation in a water treatment reactor using computational fluid dynamics

The hydrodynamic behaviour of a novel flat plate photocatalytic reactor for water treatment is investigated using CFD code FLUENT. The reactor consists of a reactive section that features negligible pressure drop and uniform illumination of the photocatalyst to ensure enhanced photocatalytic efficiency. The numerical simulations allowed the identification of several design issues in the original reactor, which include extensive boundary layer separation near the photocatalyst support and regions of flow recirculation that render a significant portion of the reactive area. The simulations reveal that this issue could be addressed by selecting the appropriate inlet positions and configurations. This modification can cause minimal pressure drop across the reactive zone and achieves significant uniformization of the tested pollutant on the photocatalyst surface. The influence of roughness elements type has also been studied with a view to identify their role on the distribution of pollutant concentration on the photocatalyst surface. The results presented here indicate that the flow and pollutant concentration field strongly depend on the geometric parameters and flow conditions.

CFD Simulation of turbulence promoters in a water treatment reactor

A new immobilized flat plate photocatalytic reactor for wastewater treatment has been proposed in this study to avoid subsequent catalyst removal from the treated water. The reactor consists of an inlet, reactive section where catalyst is coated and an outlet parts. In order to optimize the fluid mixing and reactor design, this study aims to investigate the influence of baffles and its arrangement on the flat plate reactor hydrodynamics using computational fluid dynamics (CFD) simulation. For simulation, an array of baffles acting as turbulence promoters is inserted in the reactive zone of the reactor. In this regard, results obtained from the simulation of a baffled- flat plate photoreactor hydrodynamics for different baffle positions, heights and intervals are presented utilizing RNG k-ε turbulence model. Under the conditions simulated, the qualitative flow features, such as the development and separation of boundary layers, vortex formation, the presence of high shear regions and recirculation zones, and the underlying mechanism are examined. The influence of various baffle sizes on the distribution of pollutant concentration is also highlighted. The results presented here indicate that the spanning of recirculation increases the degree of interfacial distortion with a larger interfacial area between fluids which results in substantial enhancement in fluid mixing. The simulation results suggest that the qualitative and quantitative properties of fluid dynamics in a baffled reactor can be obtained which provides valuable insight to fully understand the effect of baffles and its arrangements on the flow pattern, behaviour, and feature.

In silico experimental modeling of cancer treatment

In silico experimental modeling of cancer involves combining findings from biological literature with computer-based models of biological systems in order to conduct investigations of hypotheses entirely in the computer laboratory. In this paper, we discuss the use of in silico modeling as a precursor to traditional clinical and laboratory research, allowing researchers to refine their experimental programs with an aim to reducing costs and increasing research efficiency. We explain the methodology of in silico experimental trials before providing an example of in silico modeling from the biomathematical literature with a view to promoting more widespread use and understanding of this research strategy.

Characteristics of Impaired Drivers Who Enter Substance Abuse Treatment

Driving under the influence (DUI) remains a serious concern. Most of the data on characteristics of DUI offenders come from driving records, with little data on the levels of impairment of DUI arrestees. This paper examines data on 103,181DUI offenders admitted to Texas treatment programs between 1988 and 2008. They reported past-year DUI arrests or came to treatment on DUI probation. The changes in the characteristics of DUI offenders over time are examined, along with the factors associated with treatment completion and abstinence 90 days after program discharge. Incorporation of substance abuse treatment with effective DUI education and intervention can improve road safety and reduce the burden of substance-related illness.

Defending the sanctity of life principle : a reply to John Keown

This article is a response to Professor Keown’s criticism of my paper “Finding a Way Through the Ethical and Legal Maze: Withdrawal of Medical Treatment and Euthanasia” (2005) 13 (3) Medical Law Review 357. The article takes up and responds to a number of criticisms raised by Keown in an attempt to further the debate concerning the moral and legal status of withdrawing life-sustaining measures, its distinction from euthanasia, and the implications of the lawfulness of withdrawal for the principle of the sanctity of life.

Tailoring Consumer Resources to Enhance Self-Care in Chronic Heart Failure

Background Chronic heart failure (CHF) is associated with high hospitalisation and mortality rates and debilitating symptoms. In an effort to reduce hospitalisations and improve symptoms individuals must be supported in managing their condition. Patients who can effectively self-manage their symptoms through lifestyle modification and adherence to complex medication regimens will experience less hospitalisations and other adverse events. Aim The purpose of this paper is to explain how providing evidence-based information, using patient education resources, can support self-care. Discussion Self-care relates to the activities that individuals engage in relation to health seeking behaviours. Supporting self-care practices through tailored and relevant information can provide patients with resources and advice on strategies to manage their condition. Evidence-based approaches to improve adherence to self-care practices in patients with heart failure are not often reported. Low health literacy can result in poor understanding of the information about CHF and is related to adverse health outcomes. Also a lack of knowledge can lead to non-adherence with self-care practices such as following fluid restriction, low sodium diet and daily weighing routines. However these issues need to be addressed to improve self-management skills. Outcome Recently the Heart Foundation CHF consumer resource was updated based on evidence-based national clinical guidelines. The aim of this resource is to help consumers improve understanding of the disease, reduce uncertainty and anxiety about what to do when symptoms appear, encourage discussions with local doctors, and build confidence in self-care management. Conclusion Evidence-based CHF patient education resources promote self-care practices and early detection of symptom change that may reduce hospitalisations and improve the quality of life for people with CHF.