No More Laissez Faire? Expert Evidence, Rule Changes and Reliability: Can More Effective Training for the Bar and Judiciary Prevent Miscarriages of Justice?

The apparent link between miscarriages of justice in prosecutions involving expert evidence and the level of training provided to the legal profession (the Bar in particular) and the judiciary in respect of such evidence was highlighted in 2005 with the publication of the House of Commons Science and Technology Committee Report Expert Evidence on Trial.2 The Law Commission, in the 2011 Report Expert Evidence in England and Wales 3 subsequently comprehensively addressed the same issue. This article seeks to consider why appropriate training in relation to expert evidence is so necessary and questions whether, in the context of the amendments to what is now Part 19 of the Criminal Procedure Rules (CrimPR19) and Part 19A of the Criminal Practice Direction (CrimPD19A), there have been sufficient developments in training to effect a cultural change within the legal profession and ultimately substantially reduce the risk of future miscarriages of justice. Finally, the article debates the nature of required training, arguing that much more detailed training is required than has previously been considered and addresses where this training best sits

Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

Background:Opioid prescribing in the UK has increased significantly since the start of the millennium and has been associated with a rise in chronic pain reporting. In Wales, despite concern about rising rates of opioid analgesic prescribing, no detailed examination of the data had been undertaken to assess the changes in prescribing and its consequent impact on the population. Methods:In this study, anonymised, individual level data of people diagnosed with non-cancer pain in Wales was extracted from the Secure Anonymised Information Linkage (SAIL) Databank and used to scrutinise opioid analgesic prescribing trends in people aged 18 years and over, establish whether legislation or clinical guidance impacted on those trends and examine associations with increased healthcare use. The study was conducted in two phases. Phase 1 included a retrospective, repeated cross-sectional analysis of opioid analgesics issued from Primary Care, stratified by gender, age and socioeconomic status. Phase 2 of the study evaluated differences in healthcare service use and costs between individuals receiving opioids for defined non-cancer pain-related diagnoses and matched patients not receiving opioids. Results:Total opioid prescribing increased by 43.6% and strong opioids by 306.2% between 2005 and 2015. Women received 1.5 times more prescriptions than men. Increasing age was associated with higher prescribing rates. People in the most deprived areas received 2.4 times more prescriptions than in least deprived. People receiving opioid prescriptions accessed primary care four times more frequently than controls and had twice the number of hospital admissions. Opioid prescription was associated with 41% higher healthcare costs than noted in controls. Conclusion:This research highlights the need to develop a national strategy to address pain management and opioid stewardship in Wales. We must consider how to address the wide variability observed, particularly between areas of differing socioeconomic status. Further research should investigate what underlies continued opioid prescribing and how alternative strategies can be implemented in practice to reduce population harm and optimise the use of limited healthcare resources

Predicting trajectories of symptom change during and following treatment in adolescents with Unipolar Major Depression.

Objective: Definitions of treatment response used in randomised controlled trials for unipolar major depression are non-standardised and arbitrary. Proportion of non-responders has been estimated as ranging from 20%-40% across such trials. I aimed to classify depressed adolescents recruited to the UK IMPACT trial into different trajectories of depression symptom response using a longitudinal data-driven approach: growth mixture modelling (GMM) and investigate potential predictors of trajectory classes in this cohort. Method: 465 depressed adolescents received manualised psychological therapies in the IMPACT trial. GMM was used to plot the trajectories of self-reported depressive symptoms measured at 6 nominal time points over 86 weeks from randomisation, and categorise patients into their most likely trajectory class. Chapters 2-4 investigated the prognostic value of a number of variables. Chapter 2 investigated a battery of demographic and clinical variables including subclinical psychotic symptoms. Chapter 3 focused on a subsample of patients: 109 of the 465 with structural magnetic resonance imaging (MRI) data. FreeSurfer was used to extract cortical thickness (CT) and surface area (SA) measures from 4 regions of interest (ROI; rostral anterior cingulate, dorsolateral prefrontal cortex, orbitofrontal cortex, and insular cortex). Chapter 4 focused on another subsample of patients: 166 of the 465 with salivary basal cortisol data at both waking and evening. Logistic regressions were used in Chapters 2-4 to investigate whether these variables were associated with increased likelihood of membership to a certain GMM class. Results: A piecewise GMM categorised patients into two classes with initially similar and subsequently distinct trajectories. Both groups had a significant decline in depressive symptoms over the first 18 weeks. Eighty-four per cent of patients were classed as “continued-improvers” through reporting an improvement in symptoms over the full duration of the study. A further class of 15.9% of patients were termed “halted-improvers” who had higher depression scores at baseline, faster recovery but no further improvement after 18 weeks. This data-driven method of classification showed only moderate agreement with a priori classification methods, and suggested misclassification rate could be as great as 31%. Co-morbid psychiatric disorders at baseline moderately increased the liability of being a member of the halted-improvers class (OR = 1.40, CI 1.00-1.96). No other clinical, neurological or cortisol variable reached statistical significance for predicting trajectory class. Conclusion: A fast reduction in depressive symptoms in the first few weeks of treatment may not indicate a good prognosis. Further, halted-improvement may not be apparent until after 18 weeks of treatment. Capitalizing on repeated symptom assessments with longitudinal data driven modelling may improve the precision of revealing patient groups with differential responses to treatment. Further work should seek to validate these trajectories in a separate sample of adolescents.The IMPACT study was funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 06/05/01). MR-IMPACT was funded by the Medical Research Council (grant: G0802226) and IMPACT-GH was funded by the Evelyn Trust. My doctoral studentship was awarded by the Neuroscience in Psychiatry (NSPN.Org) Consortium itself funded by a strategic award from the Wellcome Trust (095844/Z/11/Z) awarded to Professor Ian Goodyer and Professor Peter Fonagy

Similarity to prototypical heavy drinkers and non-drinkers predicts AUDIT-C and risky drinking in young adults: prospective study

Objective. The aim of the present study was to explore whether constructs within the Prototype Willingness Model (PWM) predicted risky drinking as measured by AUDIT-C, drinking harms and unplanned drunkenness in a sample of UK young adults. Previous studies exploring the PWM often do not use validated measures of alcohol consumption, and the outcomes of risky drinking are underexplored. Design. An online prospective study design with four week follow up was employed and 385 young adults completed the study (M age = 21.76, SD = 3.39, 69.6% female; 85.2% students). Main outcome measures. Intentions to get drunk, AUDIT-C, drinking harms experienced in the last four weeks, and unplanned drunkenness in the last four weeks. Results. Heavy and non-drinker prototype similarity predicted AUDIT-C, drinking harms and unplanned drunkenness when controlling for past behaviour and reasoned action pathway constructs. Intentions and willingness both mediated the relationship between prototype perceptions and AUDIT-C. Conclusion. This study supports the use of the PWM in the prediction of AUDIT-C, drinking harms and unplanned drinking in a UK sample. Prototype perceptions influenced behaviour via both reasoned and reactive cognitions. Targeting similarity to heavy and non-drinker prototypes should be the focus of future interventions in this population

Effect Sizes for Single Word Recognition Across Adults and Children:A Meta-Analysis

Theories explaining skilled and disordered reading are based on observations about the effects of psycholinguistic variables on word naming and lexical decision performance. My interest is in reading processes in adolescents and adults who, in the absence of diagnosed organic difficulties, still struggle to attain skilled reading. In thinking about these learners, knowledge of which predictors inhibit or facilitate strong performance, and their relative importance with each other, may shape teaching practices or resources, so it's important that we have robust estimates upon which to base teaching decisions. As a baseline from which to measure this group's performance in future studies, I embarked upon a meta-analysis of the psycholinguistic research literature that studies contrasting groups and their performance in word naming and lexical decision task

Somatic cell gene therapy for diabetes mellitus: engineering a surrogate B-cell

Improved methods of insulin delivery are required for the treatment of insulin-dependent diabetes mellitus (IDDM) to achieve a more physiological profile of glucose homeostasis. Somatic cell gene therapy offers the prospect that insulin could be delivered by an autologous cell implant, engineered to secrete insulin in response to glucose. This study explores the feasibility of manipulating somatic cells to behave as a surrogate insulin-secreting β-cells. Initial studies were conducted using mouse pituitary AtT20 cells as a model, since these cells possess an endogenous complement of enzymes capable of processing proinsulin to mature insulin. Glucose sensitive insulin secretion was conferred to these cells by transfection with plasmids containing the human preproinsulin gene (hppI-1) and the GLUT2 gene for the glucose transporter isoform 2. Insulin secretion was responsive to changes in the glucose concentration up to about 50μM. Further studies to up-rate this glucose sensitivity into the mM range will require manipulation of the hexokinase and glucokinase enzymes. Intraperitoneal implantation of the manipulated AtT20 cells into athymic nude mice with streptozotocin-induced diabetes resulted in decreased plasma glucose concentrations. The cells formed vascularised tumours in vivo which were shown to contain insulin-secreting cells. To achieve proinsulin processing in non-endocrine cells, co-transfection with a suitable enzyme, or mutagenesis of the proinsulin itself are necessary. The mutation of the human preproinsulin gene to the consensus sequence for cleavage by the subtilisin-like serine protease, furin, was carried out. Co-transfection of human fibroblasts with wild-type proinsulin and furin resulted in 58% conversion to mature insulin by these cells. Intraperitoneal implantation of the mature-insulin secreting human fibroblasts into the diabetic nude mouse animal model gave less encouraging results than the AtT20 cells, apparently due to poor vascularisation. Cell aggregations removed from the mice at autopsy were shown to contain insulin secreting cells only at the periphery. This thesis provides evidence that it is possible to construct, by cellular engineering, a glucose-sensitive insulin-secreting surrogate β-cell. Therefore, somatic cell gene therapy offers a feasible alternative for insulin delivery in IDDM patients

Public self-consciousness, pre-loading and drinking harms among university students

Background: Social anxiety and self-consciousness are associated with alcohol-related problems in students. The practice of pre-loading is one avenue for exploration regarding this relationship. Individuals may pre-load to reduce social anxiety and feel more confident when socialising, which could lead to the increased harms experienced. The current study aimed to explore reasons for pre-loading, and whether public and private self-consciousness and social anxiety were related to pre-loading, increased drinking and harms. Method: Prospective study with four-week follow up of 325 UK students aged 18-30 years old. Participants completed measures of private and public self-consciousness, social anxiety, alcohol consumption, alcohol-related harms and pre-loading. Results: Financial motives and mood-related reasons, such as gaining confidence were reported as reasons for pre-loading. Pre-loading predicted hazardous alcohol consumption, but social anxiety, and public and private self-consciousness did not. However, pre-loading, public self-consciousness and social anxiety predicted alcohol-related harms. Furthermore, public self-consciousness mediated the relationship between pre-loading and harms in a positive direction and this appeared to be more relevant in high risk (AUDIT 8+) than low risk drinkers. Conclusion: Students who scored higher in public self-consciousness appeared to be at greater risk of harms from pre-loading. Further research should examine this relationship further with particular attention to high risk drinkers, and explore which aspects of a night out are related to heightened self-consciousness. Interventions could incorporate measures to reduce public self-consciousness, in order to reduce the negative impacts of pre-loading