Redfearn v UK 2012

Case law report - online

Eweida and others v UK 2012

Case law report - online

Investigating the influence of African American and African Caribbean race on primary care doctors' decision making about depression

This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients. © 2014 The Authors.

Desperately seeking donors: The 'saviour siblings' decision in quintaville v human fertilisation embryology authority (UK)

The recent House of Lords decision in Quintavalle v Human Fertilisation and Embryology Authority has raised difficult and complex issues regarding the extent to which embryo selection and reproductive technology can be used as a means of rectifying genetic disorders and treating critically ill children. This comment outlines the facts of Quintavalle and explores how the House of Lords approached the legal, ethical and policy issues that arose out of the Human Fertilisation and Embryology Authority's (UK) decision to allow reproductive and embryo technology to be used to produce a 'saviour sibling' whose tissue could be used to save the life of a critically ill child. Particular attention will be given to the implications of the decision in Quintavalle for Australian family and medical law and policy. As part of this focus, the comment explores the current Australian legislative and policy framework regarding the use of genetic and reproductive technology as a mechanism through which to assist critically ill siblings. It is argued that the present Australian framework would appear to impose significant limits on the medical uses of genetic technology and, in this context, would seem to reflect many of the principles that were articulated by the House of Lords in Quintavalle.

Payment for performance in the Family Health Programme: lessons from the UK Quality and Outcomes Framework

OBJECTIVE: Payment for performance financial incentive schemes reward doctors based on the quality and the outcomes of their treatment. In Brazil, the Ministry of Health is looking to scale up its use in public hospitals and some municipalities are developing payment for performance schemes even for the Family Health Programme. In this article the Quality and Outcomes Framework used in the UK since 2004 is discussed, as well as its experience to elaborate some important lessons that Brazilian municipalities should consider before embarking on payment for performance scheme in primary care settings.

PRECISION V: Randomisierte Phase II-Studie mit Drug Eluting Beads (DEB) zur Behandlung des hepatozelluläre Karzinoms (HCC) mittels transarterieller Chemoemblisation [PRECISION V: Randomized Phase II-Study with Drug Eluting Beads (DEB) for the Treatment of Hepatocellular cancer (HCC) using transarterial Chemoemblisation.]

Zielsetzung: Vergleich von Drug Eluting Bead (DEB)-TACE mit konventioneller TACE bei der Behandlung von ,,intermediate stage-HCC bei Patienten mit Zirrhose. Material und Methodik: 212 Patienten (185 ♂, 27 ♀; mittleres Alter, 67 Jahre) mit Child-Pugh A oder B Leberzirrhose und großem und/oder multinodulärem, irresektablen HCC wurden randomisiert, um das Therapieansprechen nach der Behandlung mit DEB (DC Bead; Biocompatibles, UK) beladen mit Doxorubicin oder konventioneller TACE mit Doxorubicin zu vergleichen. Die Randomisierung wurde nach Child-Pugh Status (A oder B), Performance Status (ECOG 0 oder 1), bilobärer Erkrankung (ja/nein) und frühere kurative Behandlung (ja/nein) stratifiziert. Der primäre Studienendpunkt war das 6-Monats-Tumoransprechen. Eine unabhängige verblindete MRT-Studie wurde durchgeführt, um das Tumoransprechen nach den RECIST Kriterien zu beurteilen. Ergebnisse: DEB-TACE mit Doxorubicin zeigte eine höhere Rate an komplettem Tumoransprechen, objektivem Ansprechen und Tumorkontrolle im Vergleich zur konventionellen TACE (27% vs 22%; 52% vs 44%; and 63% vs 52%; P>0.05). Patienten mit Child-Pugh B Zirrhose, ECOG 1 Performance Status, bilobärer Erkrankung und Rezidiven nach kurativer Behandlung zeigte einen signifikanten Anstieg des objektiven Ansprechens (p = 0.038) im Vergleich zur Kontrollgruppe. Bei Patienten, die mit DEB-TACE behandelt wurden, konnte eine deutliche Reduktion der gravierenden Lebertoxizität erreicht werden. Die Doxorubicin-Nebenwirkungsrate war in der DEB-TACE Gruppe deutlich geringer (p = 0.0001) als in der konventionellen TACEGruppe. Schlussfolgerung: DEB-TACE mit Doxorubicin ist sicher und effektiv in der Behandlung von ,,intermediate-stage HCC und bietet einen signifikanten Vorteil bei Patienten mit fortgeschrittener Erkrankung.

Baseline nitrate concentration in groundwater of the Chalk in south Dorset, UK

Determining the degree of nitrate pollution in Chalk groundwater is difficult without a clear understanding of concentrations naturally present. In the UK, a general shortage of long-term records of nitrate concentrations in Chalk groundwater prevents a full quantification of baseline concentrations. This paper presents late nineteenth and early twentieth century data on nitrate concentrations in Chalk groundwater in south Dorset, UK and compares them with corresponding data for the last 25 years. The nitrate record is instructive in (1) providing an insight into the baseline nitrate concentration of groundwater; (2) defining the level of nitrate pollution in potable supplies from the Chalk aquifer; and (3) identifying the long-term variations in local nitrate concentrations. Over a period exceeding 100 years mean nitrate concentrations increased from 1.04 mg NO3-N l(-1) to 6.37 mg NO3-N l(-1). Anthropogenic modification of the local groundwater composition is not evident in the early nitrate record. Nitrate data throughout this early period reflect natural background concentrations of approximately I mg NO3-N l(-1) Intensified fertilser use and increased livestock numbers are suggested as the fundamental cause of the rise in nitrate concentrations. The implications of the nitrate record for regional hydrogeological processes are discussed. (C) 2003 Elsevier Science B.V. All rights reserved.

Estimating uncertainty in terrestrial critical loads and their exceedances at four sites in the UK

Critical loads are the basis for policies controlling emissions of acidic substances in Europe and elsewhere. They are assessed by several elaborate and ingenious models, each of which requires many parameters, and have to be applied on a spatially-distributed basis. Often the values of the input parameters are poorly known, calling into question the validity of the calculated critical loads. This paper attempts to quantify the uncertainty in the critical loads due to this "parameter uncertainty", using examples from the UK. Models used for calculating critical loads for deposition of acidity and nitrogen in forest and heathland ecosystems were tested at four contrasting sites. Uncertainty was assessed by Monte Carlo methods. Each input parameter or variable was assigned a value, range and distribution in an objective a fashion as possible. Each model was run 5000 times at each site using parameters sampled from these input distributions. Output distributions of various critical load parameters were calculated. The results were surprising. Confidence limits of the calculated critical loads were typically considerably narrower than those of most of the input parameters. This may be due to a "compensation of errors" mechanism. The range of possible critical load values at a given site is however rather wide, and the tails of the distributions are typically long. The deposition reductions required for a high level of confidence that the critical load is not exceeded are thus likely to be large. The implication for pollutant regulation is that requiring a high probability of non-exceedance is likely to carry high costs. The relative contribution of the input variables to critical load uncertainty varied from site to site: any input variable could be important, and thus it was not possible to identify variables as likely targets for research into narrowing uncertainties. Sites where a number of good measurements of input parameters were available had lower uncertainties, so use of in situ measurement could be a valuable way of reducing critical load uncertainty at particularly valuable or disputed sites. From a restricted number of samples, uncertainties in heathland critical loads appear comparable to those of coniferous forest, and nutrient nitrogen critical loads to those of acidity. It was important to include correlations between input variables in the Monte Carlo analysis, but choice of statistical distribution type was of lesser importance. Overall, the analysis provided objective support for the continued use of critical loads in policy development. (c) 2007 Elsevier B.V. All rights reserved.

Evaluation of two hybrid metric-conceptual models, for simulating phosphorus transfer from agricultural land in the river enborne, a lowland UK catchment

Across Europe, elevated phosphorus (P) concentrations in lowland rivers have made them particularly susceptible to eutrophication. This is compounded in southern and central UK by increasing pressures on water resources, which may be further enhanced by the potential effects of climate change. The EU Water Framework Directive requires an integrated approach to water resources management at the catchment scale and highlights the need for modelling tools that can distinguish relative contributions from multiple nutrient sources and are consistent with the information content of the available data. Two such models are introduced and evaluated within a stochastic framework using daily flow and total phosphorus concentrations recorded in a clay catchment typical of many areas of the lowland UK. Both models disaggregate empirical annual load estimates, derived from land use data, as a function of surface/near surface runoff, generated using a simple conceptual rainfall-runoff model. Estimates of the daily load from agricultural land, together with those from baseflow and point sources, feed into an in-stream routing algorithm. The first model assumes constant concentrations in runoff via surface/near surface pathways and incorporates an additional P store in the river-bed sediments, depleted above a critical discharge, to explicitly simulate resuspension. The second model, which is simpler, simulates P concentrations as a function of surface/near surface runoff, thus emphasising the influence of non-point source loads during flow peaks and mixing of baseflow and point sources during low flows. The temporal consistency of parameter estimates and thus the suitability of each approach is assessed dynamically following a new approach based on Monte-Carlo analysis. (c) 2004 Elsevier B.V. All rights reserved.