Revisiting the judicial role in the allocation of healthcare resources: on deference, democratic dialogue and deliberation

The objective of this paper is to engage in critical reconsideration of the nature and value of the judicial role in situations where courts adjudicate upon questions connected to the allocation of scarce healthcare resources via the processes of public law. The argument posited is that the predominantly negative perspective which is adopted towards judicial involvement in issues of this type, although to some extent explicable, fails to capture the potential for public law adjudication to function as a deliberative mechanism. This is important because the dominant strand in contemporary health policy theory identifies proceduralisation through deliberative arrangements as a response to the problems, notably those of legitimacy, which have been generated by the evolution and development of explicit strategies of priority-setting or the ‘rationing’ of access to healthcare resources. In order to assess the prospects of the courts fulfilling a deliberative role of this type, a comparative survey of three jurisdictions in which such issues have come before the courts — England, Canada and South Africa — will be conducted

Supporting adjective learning by children with Developmental Language Disorder: Enhancing metalinguistic approaches.

BACKGROUND: Adjectives are essential for communication, conceptual development and academic success. However, they are semantically and syntactically complex and can be particularly challenging for children with Developmental Language Disorder (DLD). Surprisingly, language interventions have not typically focused on this important word class. AIMS: (1) To provide a supportive and accessible primer on adjectives for practitioners; (2) to explore how the SHAPE CODINGTM system can be adapted to support adjective learning in DLD; and (3) to provide practical recommendations on how to support adjective learning in clinical practice and education. METHODS/PROCEDURE: We synthesise linguistic and psychological research on adjective semantics, clinical insights into DLD and pedagogical practice supporting this population. MAIN CONTRIBUTION: We address the lack of specific training in the nature and acquisition of adjectives for speech and language therapists (SLTs) by providing an accessible primer. We also provide an innovative guide detailing how an established metalinguistic intervention might be adapted to support adjective learning. CONCLUSIONS/IMPLICATIONS: Without targeted support for adjective learning, the communicative potential of children with DLD is compromised. Our recommendations can be used across a range of therapeutic and educational contexts to guide SLTs and teaching staff in developing practice in this area. WHAT THIS PAPER ADDS: What is already known on the subject Adjectives are an essential word class needed for effective communication. They are also vital to successfully achieve academic objectives across all curriculum areas. For example, most subjects require children to be able to describe, evaluate, compare and discriminate different events, objects or techniques. Children with Developmental Language Disorder (DLD) have deficits in various domains of language that can affect adjective learning and use. What this paper adds to existing knowledge Despite the importance of adjectives, speech and language therapists (SLTs) and other professionals supporting language development rarely receive specific training regarding their structure and meanings, and how to teach and support their use. This article provides an accessible primer on the many subtypes of adjectives and how these behave syntactically and semantically. It explores how adjective teaching could be enhanced for children with DLD by adapting an established metalinguistic technique and provides practical recommendations for implementing this approach. What are the potential or actual clinical implications of this work? By raising awareness of the complexities of adjectives and providing strategies to support their acquisition by children with DLD, this article will enable SLTs and teaching staff to improve their understanding and practice in this area and, with further research, to develop robust, effective interventions for children with DLD. This will contribute to enhancing the long-term academic, social and employment success of children with DLD

The Politics of Evidence Use in Health Policy Making in Germany-the Case of Regulating Hospital Minimum Volumes.

This article examines the role of scientific evidence in informing health policy decisions in Germany, using minimum volumes policy as a case study. It argues that scientific evidence was used strategically at various stages of the policy process both by individual corporatist actors and by the Federal Joint Committee as the regulator. Minimum volumes regulation was inspired by scientific evidence suggesting a positive relationship between service volume and patient outcomes for complex surgical interventions. Federal legislation was introduced in 2002 to delegate the selection of services and the setting of volumes to corporatist decision makers. Yet, despite being represented in the Federal Joint Committee, hospitals affected by its decisions took the Committee to court to seek legal redress and prevent policy implementation. Evidence has been key to support, and challenge, decisions about minimum volumes, including in court. The analysis of the role of scientific evidence in minimum volumes regulation in Germany highlights the dynamic relationship between evidence use and the political and institutional context of health policy making, which in this case is characterized by the legislative nature of policy making, corporatism, and the role of the judiciary in reviewing policy decisions

SAFETEL randomised controlled feasibility trial of a safety planning intervention with follow-up telephone contact to reduce suicidal behaviour: study protocol

Introduction: There are no evidence-based interventions that can be administered in hospital settings following a general hospital admission after a suicide attempt. Aim: To determine whether a safety planning intervention (SPI) with follow-up telephone support (SAFETEL) is feasible and acceptable to patients admitted to UK hospitals following a suicide attempt. Methods and Analysis: Three-phase development and feasibility study with embedded process evaluation. Phase I comprises tailoring an SPI with telephone follow-up originally designed for veterans in the USA, for use in the UK. Phase II involves piloting the intervention with patients (n=30) who have been hospitalised following a suicide attempt. Phase III is a feasibility randomised controlled trial of 120 patients who have been hospitalised following a suicide attempt with a 6-month follow-up. Phase III participants will be recruited from across four National Health Service hospitals in Scotland and randomised to receive either the SPI with telephone follow-up and treatment as usual (n=80) or treatment as usual only (n=40). The primary outcomes are feasibility outcomes and include the acceptability of the intervention to participants and intervention staff, the feasibility of delivery in this setting, recruitment, retention and intervention adherence as well as the feasibility of collecting the self-harm readmission to hospital outcome data. Statistical analyses will include description of recruitment rates, intervention adherence/use, response rates and estimates of the primary outcome event rates, and intervention effect size (Phase III). Thematic analyses will be conducted on interview and focus group data. Ethics and Dissemination: The East of Scotland Research Ethics Service (EoSRES) approved this study in March 2017 (GN17MH101 Ref: 17/ES/0036). The study results will be disseminated via peer-reviewed publication and conference presentations. A participant summary paper will also be disseminated to patients, service providers and policy makers alongside the main publication. Trial Registration Number: ISRCTN62181241

The role of nutrient loading and eutrophication in estuarine ecology.

Eutrophication is a process that can be defined as an increase in the rate of supply of organic matter (OM) to an ecosystem. We provide a general overview of the major features driving estuarine eutrophication and outline some of the consequences of that process. The main chemical constituent of OM is carbon (C), and therefore rates of eutrophication are expressed in units of C per area per unit time. OM occurs in both particulate and dissolved forms. Allochthonous OM originates outside the estuary, whereas autochthonous OM is generated within the system, mostly by primary producers or by benthic regeneration of OM. The supply rates of limiting nutrients regulate phytoplankton productivity that contributes to inputs of autochthonous OM. The trophic status of an estuary is often based on eutrophication rates and can be categorized as oligotrophic (<100 g C m(-2) y(-1), mesotrophic (100-300 g C m(-2) y(-1), eutrophic (300-500 g C m(-2) y(-1), or hypertrophic (>500 g C m(-2) y(-1). Ecosystem responses to eutrophication depend on both export rates (flushing, microbially mediated losses through respiration, and denitrification) and recycling/regeneration rates within the estuary. The mitigation of the effects of eutrophication involves the regulation of inorganic nutrient (primarily N and P) inputs into receiving waters. Appropriately scaled and parameterized nutrient and hydrologic controls are the only realistic options for controlling phytoplankton blooms, algal toxicity, and other symptoms of eutrophication in estuarine ecosystems

Super diversity and city branding: Rotterdam in perspective

As many other cities around the world, Rotterdam has been investing in improving its image to stimulate urban development and to attract visitors, residents and investors. In particular, during the last 15 years the municipality of Rotterdam has intensified its attempts to develop a ‘brand’ that fits the ‘new Rotterdam’, which was gradually rebuilt after destructive bombardments during the Second World War (Riezebos 2014). In 2014 Rotterdam was ranked 8th by ‘Rough Guide’ in the list of ‘Top 10 Cities to See’, whereas the ‘New York Times’ listed Rotterdam in the top 10 of 52 Places to Go. These rankings demonstrate Rotterdam’s success in repositioning itself, using the physical interior of the city as a key element in its branding strategy.</p

Evidence Use and the Institutions of the State: The Role of Parliament and the Judiciary

This chapter explores the role of parliaments and the judiciary in shaping evidence use in health policy making. Most analyses of the role of scientific evidence focus on the executive, i.e. national governments and ministries of health, as the key state actors in health policy and health system governance. This chapter shifts attention to the other two powers within the state, the legislative and the judiciary. Using the examples analysed in this book the chapter examines how parliaments can use evidence to inform legislative processes and to hold governments to account, although there are substantial differences between countries and political systems. However, there was little suggestion that such approaches were undertaken systematically. In cases in which policies are brought to court, judges may have to deal with scientific evidence within a country’s legal and constitutional framework, again with significant differences between national legal practices

Color adjectives, standards, and thresholds: an experimental investigation

Are color adjectives (“red”, “green”, etc.) relative adjectives or absolute adjectives? Existing theories of the meaning of color adjectives attempt to answer that question using informal (“armchair”) judgments. The informal judgments of theorists conflict: it has been proposed that color adjectives are absolute with standards anchored at the minimum degree on the scale, that they are absolute but have near- midpoint standards, and that they are relative. In this paper we report two experiments, one based on entailment patterns and one based on presupposition accommodation, that investigate the meaning of scalar adjectives. We find evidence confirming the existence of subgroups of the population who operate with different standards for color adjectives. The evidence of interpersonal variation in where standards are located on the relevant scale and how those standards can be adjusted indicates that the existing theories of the meaning of color adjectives are at best only partially correct. We also find evidence that paradigmatic relative adjectives (“tall”, “wide”) behave in ways that are not predicted by the standard theory of scalar adjectives. We discuss several different possible explanations for this unexpected behavior. We conclude by discussing the relevance of our findings for philosophical debates about the nature and extent of semantically encoded context sensitivity in which color adjectives have played a key role

Studying Public Health Law::Principles, Politics, and Populations as Patients

Public health law is firmly establishing itself as a crucial area of scholarly inquiry. Its vital importance has been sharply underscored following the outbreak of COVID-19, in response to which we have seen the institution of extreme legal measures—suchas the UK’s Coronavirus Act 2020—in efforts to control and contain the spread ofthe disease. The pandemic has also starkly exposed the complex nature of the regulatory challenges, nationally, internationally, and globally, to which such public health problems give rise. In approaching these, and other questions concerning the public’s health, such as non-communicable disease, public health law, as a field, brings notable distinctive features: these include a practical focus on populations, institutions, the prevention of ill health, protection of good health, and thepromotion of positive states of well-being; and concomitant critical approaches rooted in theories of social justice as contrasted with more narrow biomedical ethics. Such features make it in some senses atypical territory within the field of health law. Furthermore, the inherent role of political institutions places law conceptually within public health in a way that may be seen as distinguishable from law’s relationship with clinical medicine. This chapter explains how the broad reach and distinct features of public health require a commensurately broad approach to conceptualising public health law, and how distinct practical and theoretical features may be integrated into academic public health law. It also shows how public health law, with its distinct conceptualisations concerning ‘the body’ of medical jurisprudence, can both challenge and enrich medico-legal studies, and bring important perspectives within the broader field of health law