Bolam with the benefit of hindsight

The aim of this article is to consider the effects of hindsight bias on findings of negligence in medico-legal litigation and of the potential of the original Bolam direction to eliminate bias from the decision making process. The Bolam test may have been expanded beyond its appropriate scope in the past but these excesses have now largely been undone. It will be shown that Bolam still has an important role to play in tort cases. By considering breach of duty cases in which the Bolitho “gloss” has been applied attention is drawn to the potential dangers of disregarding practices within the medical profession

Midwives fear of litigation: justified or not?

Existing research has identified links between the fear of litigation and defensive practice (Symons 2006; 1998; Hood et al 2010; Charles et al 1985). Although there have been studies of doctors perceptions of litigation little has been written about the position on midwives (Vincent et al 1994). Specifically there is a lack of research in England on measuring the actual likelihood of litigation set against midwives’ perceptions of the threat. This project explores midwives' fear of legal action, and if present, what they fear and their perceived assessment on how this may affect their practice. The project will assess whether fears match the reality as measured by the number and types of clinical negligence claims brought against midwives nationally in a specified period. The research strategy will use: (1) qualitative assessment of midwives’ perceptions in a focus group of a sample of midwives working in an NHS Trust (2) quantitative assessment of the extent of the identified fears (3) evaluation of the extent of fears against the actual incidences of litigation. The project challenges the perceptions, myths and misunderstandings midwives may have by reference to the likelihood of legal action and therefore its consequent impact on professional practice. The anticipated benefits of the research include additions to the body of knowledge which informs the training of midwives in respect of their perceptions of the threat of litigation as well as identifying any myths or misunderstandings

RCM Conference poster: law and the midwife: collaborative working

Maternity claims account for the second most numerous but most costly negligence claims (NHSLA 2012). Existing research has identified links between the fear of litigation and defensive medicine (Symons 2006; 1998; Hood et al 2010). Prompted by Government calls for more collaborative working practices, lecturers from the Law and Midwifery departments united to explore and implement collaborative teaching and learning. The initial aim was to dispel fears of litigation by creating a teaching event involving final year law and midwifery undergraduate students. Interprofessional education (IPE) is when two or more professions learn with, from and about each other to improve collaboration and the quality of care (CAIPE). IPE has been found to enhance collaborative practice (WHO 2010). Hammick et al suggest that adapting Interprofessional education to show “reality of practice” and “authenticity” for specific groups of learners leads to beneficial results (Hammick et al 2007). Gilligan’s study noted that students found most valuable those sessions where they were able to work alongside other professional students on an actual problem thereby learning from each other. Interaction with other professional student groups was valued over a simple lecture by a lecturer from another professional group, for instance. (Gilligan et al 2014). We applied these examples of good practice to a law and midwifery setting in a combined workshop. The teaching event fostered an exchange of ideas through problem based learning, case study review and debate surrounding high profile cases. The debate was lively, analytical and reflective. This interprofessional learning was well received by both sets of students and they requested further sessions scheduled earlier in the academic year. These workshops are being planned using the same model of teaching both groups together working on solving problems ensuring interaction between the two professional groups. To encourage further communication between the professional cohorts, a series of evening seminars “Health and the Law: Round table discussions” are planned during 2014/15 to tackle complex topics medico-legal issues such as forced caesarean, mental health and vulnerable families. Speakers from multiple disciplines will discuss issues related to and seen from their professional perspective. The aim is to initiate contact and debate between the professions to enhance good practice in NHS trusts, give students further opportunities for interprofessional learning and to also provide a platform to assist staff in their Continuing Professional Development. The collaborative model has also led to a qualitative research project we are planning on assessing midwives’ fear of litigation matched against the actual incidence of litigation due to be completed by September 2015

Clinical Outcomes of Gamma Knife Radiosurgery in the Treatment of Patients with Trigeminal Neuralgia

Since its introduction by Leksell, Gamma Knife radiosurgery (GKRS) has become increasingly popular as a management approach for patients diagnosed with trigeminal neuralgia (TN). For this reason, we performed a modern review of the literature analyzing the efficacy of GKRS in the treatment of patients who suffer from TN. For patients with medically refractory forms of the condition, GKRS has proven to be an effective initial and repeat treatment option. Cumulative research suggests that patients treated a single time with GKRS exhibit similar levels of facial pain control when compared to patients treated multiple times with GKRS. However, patients treated on multiple occasions with GKRS are more likely to experience facial numbness and other facial sensory changes when compared to patients treated once with GKRS. Although numerous articles have reported MVD to be superior to GKRS in achieving facial pain relief, the findings of these comparison studies are weakened by the vast differences in patient age and comorbidities between the two studied groups and cannot be considered conclusive. Questions remain regarding optimal GKRS dosing and targeting strategies, which warrants further investigation into this controversial matter

X-ray absorption spectroscopy systematics at the tungsten L-edge

A series of mononuclear six-coordinate tungsten compounds spanning formal oxidation states from 0 to +VI, largely in a ligand environment of inert chloride and/or phosphine, has been interrogated by tungsten L-edge X-ray absorption spectroscopy. The L-edge spectra of this compound set, comprised of [W<sup>0</sup>(PMe<sub>3</sub>)<sub>6</sub>], [W<sup>II</sup>Cl<sub>2</sub>(PMePh<sub>2</sub>)<sub>4</sub>], [W<sup>III</sup>Cl<sub>2</sub>(dppe)<sub>2</sub>][PF<sub>6</sub>] (dppe = 1,2-bis(diphenylphosphino)ethane), [W<sup>IV</sup>Cl<sub>4</sub>(PMePh<sub>2</sub>)<sub>2</sub>], [W<sup>V</sup>(NPh)Cl<sub>3</sub>(PMe<sub>3</sub>)<sub>2</sub>], and [W<sup>VI</sup>Cl<sub>6</sub>] correlate with formal oxidation state and have usefulness as references for the interpretation of the L-edge spectra of tungsten compounds with redox-active ligands and ambiguous electronic structure descriptions. The utility of these spectra arises from the combined correlation of the estimated branching ratio (EBR) of the L<sub>3,2</sub>-edges and the L<sub>1</sub> rising-edge energy with metal Z<sub>eff</sub>, thereby permitting an assessment of effective metal oxidation state. An application of these reference spectra is illustrated by their use as backdrop for the L-edge X-ray absorption spectra of [W<sup>IV</sup>(mdt)<sub>2</sub>(CO)<sub>2</sub>] and [W<sup>IV</sup>(mdt)<sub>2</sub>(CN)<sub>2</sub>]<sup>2–</sup> (mdt<sup>2–</sup> = 1,2-dimethylethene-1,2-dithiolate), which shows that both compounds are effectively W<sup>IV</sup> species. Use of metal L-edge XAS to assess a compound of uncertain formulation requires: 1) Placement of that data within the context of spectra offered by unambiguous calibrant compounds, preferably with the same coordination number and similar metal ligand distances. Such spectra assist in defining upper and/or lower limits for metal Z<sub>eff</sub> in the species of interest; 2) Evaluation of that data in conjunction with information from other physical methods, especially ligand K-edge XAS; 3) Increased care in interpretation if strong π-acceptor ligands, particularly CO, or π-donor ligands are present. The electron-withdrawing/donating nature of these ligand types, combined with relatively short metal-ligand distances, exaggerate the difference between formal oxidation state and metal Z<sub>eff</sub> or, as in the case of [W<sup>IV</sup>(mdt)<sub>2</sub>(CO)<sub>2</sub>], add other subtlety by modulating the redox level of other ligands in the coordination sphere

Seismic isolation and suspension systems for advanced LIGO

To meet the overall isolation and alignment requirements for the optics in Advanced LIGO, the planned upgrade to LIGO, the US laser interferometric gravitational wave observatory, we are developing three sub-systems: a hydraulic external pre-isolator for low frequency alignment and control, a two-stage active isolation platform designed to give a factor of ∼1000 attenuation at 10 Hz, and a multiple pendulum suspension system that provides passive isolation above a few hertz. The hydraulic stage uses laminar-flow quiet hydraulic actuators with millimeter range, and provides isolation and alignment for the optics payload below 10 Hz, including correction for measured Earth tides and the microseism. This stage supports the in-vacuum two-stage active isolation platform, which reduces vibration using force feedback from inertial sensor signals in six degrees of freedom. The platform provides a quiet, controlled structure to mount the suspension system. This latter system has been developed from the triple pendulum suspension used in GEO 600, the German/UK gravitational wave detector. To meet the more stringent noise levels required in Advanced LIGO, the baseline design for the most sensitive optics calls for a quadruple pendulum, whose final stage consists of a 40 kg sapphire mirror suspended on fused silica ribbons to reduce suspension thermal noise

The role of rock joint frictional strength in the containment of fracture propagation

The fracturing phenomenon within the reservoir environment is a complex process that is controlled by several factors and may occur either naturally or by artificial drivers. Even when deliberately induced, the fracturing behaviour is greatly influenced by the subsurface architecture and existing features. The presence of discontinuities such as joints, artificial and naturally occurring faults and interfaces between rock layers and microfractures plays an important role in the fracturing process and has been known to significantly alter the course of fracture growth. In this paper, an important property (joint friction) that governs the shear behaviour of discontinuities is considered. The applied numerical procedure entails the implementation of the discrete element method to enable a more dynamic monitoring of the fracturing process, where the joint frictional property is considered in isolation. Whereas fracture propagation is constrained by joints of low frictional resistance, in non-frictional joints, the unrestricted sliding of the joint plane increases the tendency for reinitiation and proliferation of fractures at other locations. The ability of a frictional joint to suppress fracture growth decreases as the frictional resistance increases; however, this phenomenon exacerbates the influence of other factors including in situ stresses and overburden conditions. The effect of the joint frictional property is not limited to the strength of rock formations; it also impacts on fracturing processes, which could be particularly evident in jointed rock masses or formations with prominent faults and/or discontinuities

Search for Gravitational Wave Bursts from Soft Gamma Repeaters

We present the results of a LIGO search for short-duration gravitational waves (GWs) associated with Soft Gamma Repeater (SGR) bursts. This is the first search sensitive to neutron star f-modes, usually considered the most efficient GW emitting modes. We find no evidence of GWs associated with any SGR burst in a sample consisting of the 27 Dec. 2004 giant flare from SGR 1806-20 and 190 lesser events from SGR 1806-20 and SGR 1900+14 which occurred during the first year of LIGO's fifth science run. GW strain upper limits and model-dependent GW emission energy upper limits are estimated for individual bursts using a variety of simulated waveforms. The unprecedented sensitivity of the detectors allows us to set the most stringent limits on transient GW amplitudes published to date. We find upper limit estimates on the model-dependent isotropic GW emission energies (at a nominal distance of 10 kpc) between 3x10^45 and 9x10^52 erg depending on waveform type, detector antenna factors and noise characteristics at the time of the burst. These upper limits are within the theoretically predicted range of some SGR models.Comment: 6 pages, 1 Postscript figur

First LIGO search for gravitational wave bursts from cosmic (super)strings

We report on a matched-filter search for gravitational wave bursts from cosmic string cusps using LIGO data from the fourth science run (S4) which took place in February and March 2005. No gravitational waves were detected in 14.9 days of data from times when all three LIGO detectors were operating. We interpret the result in terms of a frequentist upper limit on the rate of gravitational wave bursts and use the limits on the rate to constrain the parameter space (string tension, reconnection probability, and loop sizes) of cosmic string models.Comment: 11 pages, 3 figures. Replaced with version submitted to PR

All-sky LIGO Search for Periodic Gravitational Waves in the Early S5 Data

We report on an all-sky search with the LIGO detectors for periodic gravitational waves in the frequency range 50--1100 Hz and with the frequency's time derivative in the range -5.0E-9 Hz/s to zero. Data from the first eight months of the fifth LIGO science run (S5) have been used in this search, which is based on a semi-coherent method (PowerFlux) of summing strain power. Observing no evidence of periodic gravitational radiation, we report 95% confidence-level upper limits on radiation emitted by any unknown isolated rotating neutron stars within the search range. Strain limits below 1.E-24 are obtained over a 200-Hz band, and the sensitivity improvement over previous searches increases the spatial volume sampled by an average factor of about 100 over the entire search band. For a neutron star with nominal equatorial ellipticity of 1.0E-6, the search is sensitive to distances as great as 500 pc--a range that could encompass many undiscovered neutron stars, albeit only a tiny fraction of which would likely be rotating fast enough to be accessible to LIGO. This ellipticity is at the upper range thought to be sustainable by conventional neutron stars and well below the maximum sustainable by a strange quark star.Comment: 6 pages, 1 figur