Malpractice in the United Kingdom

No law exists which precisely determines the liability of a medical practitioner in respect of his patients. However, the basis of a practitioner\u27s responsibility is that he should exercise a reasonable degree of skill and care. The principle was first evoked in the case of Lanphier v. Phipos (1838) and it is obvious that in the absence of any more exact requirements, considerable latitude exists. Gradually, various decisions of the courts have limited the field of responsibility, and indicated to some extent what is meant by reasonable skill and care. With the exception of these modifications, the law has not changed materially for over a century, but at the present time, there is an undoubted increase in the frequency with which actions involving doctors and hospital authorities appear before the courts. The two most obvious factors influencing this tendency are the introduction of the National Health Service in 1948, and the Legal Aid and Advice Act of 1949

Takin\u27 It to the Web : Updating Operations Manuals for Today\u27s Techno-Realities

Inspired by Chelle Batchelor\u27s Training Technologies A-Zed presentation from the 2010 NWILL conference, Kathleen Spring was determined to update the out-of-date operations manual for Linfield College\u27s interlibrary loan (ILL) department while simultaneously morphing it into a more user-friendly training tool and moving it to a web-based system. For those who haven\u27t yet made the leap to web-based training tools for ILL, this presentation offers one example of what you can do to improve the training experience for your employees. Using Blackboard Learn as the content management system to house materials, this presentation demonstrates: how to leverage existing content from other departments to maximize efficiency how to use web-authoring tools like Softchalk™ to create interactive learning materials that reinforce concepts and also serve as reference materials for those less-frequent processes how to incorporate wikis, short videos/screencasts, and evaluation mechanisms

Major and Minor Group Rhinoviruses Elicit Differential Signaling and Cytokine Responses as a Function of Receptor-Mediated Signal Transduction

Major- and minor-group human rhinoviruses (HRV) enter their host by binding to the cell surface molecules ICAM-1 and LDL-R, respectively, which are present on both macrophages and epithelial cells. Although epithelial cells are the primary site of productive HRV infection, previous studies have implicated macrophages in establishing the cytokine dysregulation that occurs during rhinovirus-induced asthma exacerbations. Analysis of the transcriptome of primary human macrophages exposed to major- and minor-group HRV demonstrated differential gene expression. Alterations in gene expression were traced to differential mitochondrial activity and signaling pathway activation between two rhinovirus serotypes, HRV16 (major-group) and HRV1A (minor-group), upon initial HRV binding. Variances in phosphorylation of kinases (p38, JNK, ERK5) and transcription factors (ATF-2, CREB, CEBP-alpha) were observed between the major- and minor-group HRV treatments. Differential activation of signaling pathways led to changes in the production of the asthma-relevant cytokines CCL20, CCL2, and IL-10. This is the first report of genetically similar viruses eliciting dissimilar cytokine release, transcription factor phosphorylation, and MAPK activation from macrophages, suggesting that receptor use is a mechanism for establishing the inflammatory microenvironment in the human airway upon exposure to rhinovirus

Duration of shedding of respiratory syncytial virus in a community study of Kenyan children

Background: Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Methods: In a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods. Results: From 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age. Conclusion: We provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community

Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test

Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths (χ21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.Psycholog

Pre-discovery Activity of New Interstellar Comet 2I/Borisov Beyond 5 AU

Comet 2I/Borisov, the first unambiguous interstellar comet ever found, was discovered in August 2019 at $\sim3$ au from the Sun on its inbound leg. No pre-discovery detection beyond 3 au has yet been reported, mostly due to the comet's proximity to the Sun as seen from the Earth. Here we present a search for pre-discovery detections of comet Borisov using images taken by the Catalina Sky Survey (CSS), Pan-STARRS and Zwicky Transient Facility (ZTF), with a further comprehensive follow-up campaign being presented in \citet{Bolin2019}. We identified comet Borisov in ZTF images taken in May 2019 and use these data to update its orbit. This allowed us to identify the comet in images acquired as far back as December 2018, when it was 7.8 au from the Sun. The comet was not detected in November 2018 when it was 8.6 au from the Sun, possibly implying an onset of activity around this time. This suggests that the activity of the comet is either driven by a more volatile species other than H$_2$O, such as CO or CO$_2$, or by exothermic crystallization of amorphous ice. We derive the radius of the nucleus to be $<7$ km using the non-detection in November 2018, and estimate an area of $\sim0.5$---$10 \mathrm{km^2}$ has been active between December 2018 and September 2019, though this number is model-dependent and is highly uncertain. The behavior of comet Borisov during its inbound leg is observationally consistent with dynamically new comets observed in our solar system, suggesting some similarities between the two.Comment: AJ in pres

Pre-discovery Activity of New Interstellar Comet 2I/Borisov Beyond 5 AU

Comet 2I/Borisov, the first unambiguous interstellar comet ever found, was discovered in 2019 August at ~3 au from the Sun on its inbound leg. No pre-discovery detection beyond 3 au has yet been reported, mostly due to the comet's proximity to the Sun as seen from the Earth. Here we present a search for pre-discovery detections of comet Borisov using images taken by the Catalina Sky Survey, Pan-STARRS, and the Zwicky Transient Facility (ZTF), with a further comprehensive follow-up campaign being presented in Bolin et al. We identified comet Borisov in ZTF images taken in 2019 May and use these data to update its orbit. This allowed us to identify the comet in images acquired as far back as 2018 December, when it was 7.8 au from the Sun. The comet was not detected in 2018 November when it was 8.6 au from the Sun, possibly implying an onset of activity around this time. This suggests that the activity of the comet is either driven by a more volatile species other than H₂O, such as CO or CO₂, or by exothermic crystallization of amorphous ice. We derive the radius of the nucleus to be <7 km using the non-detection in 2018 November, and estimate an area of ~0.5–10 km² has been active between 2018 December and 2019 September, though this number is model-dependent and is highly uncertain. The behavior of comet Borisov during its inbound leg is observationally consistent with dynamically new comets observed in our solar system, suggesting some similarities between the two