Brexit means Brexit: What does it mean for the Protection of Third Party Victims and the Road Traffic Act?

The UK’s referendum decision of 23 June 2016, where voters elected to leave the European Union (EU), will fundamentally change aspects of national law. Much debate has focused on the constitutional implications of the decision and the procedure by which the government seeks to facilitate the exit. Further, issues of substance including the part played by immigration and the control of the UK’s borders have also dominated legal and political commentary. Yet there has been no critical examination of the effects it will have on motor vehicle insurance law. The statute governing much of the law (the Road Traffic Act 1988), along with the extra-statutory agreements providing protection for the third party victims of negligent uninsured drivers and untraced vehicles, are each profoundly influenced by EU directives. Given the Brexit decision and the resolution of the government to facilitate the UK’s exit of the Union, we argue that the protective rights for such victims of motor accidents are likely to be reduced. Further, the advancement of the law, developed through the jurisprudence of the Court of Justice, will be lost

Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda.

BACKGROUND:Few studies have explored how economic incentives influence behavioral outcomes. This study aimed to identify pathways of action of an incentives-based intervention to increase men's participation in HIV testing. METHODS:The qualitative study was embedded in a randomized-controlled trial that compared effectiveness of gain-framed, loss-framed and lottery-based incentives to increase HIV testing among men. Following testing at a community health campaign, 60 in-depth interviews were conducted with men systematically sampled on the basis of age, incentive group, and campaign attendance. Data were coded deductively and inductively for thematic content analysis. RESULTS:Incentives addressed men's structural, interpersonal and individual-level barriers to testing: offered at convenient locations, incentives offset costs of testing, in lost wages, which are exacerbated when livelihoods required mobility. Interpersonal barriers included anticipated stigma/fear of disclosure, social obligations, and negative peer influences. Providing incentives in public settings provided "social proof" that prizes could be won, and facilitated social support and positive norms by promoting testing with trusted others. Incentives had little influence when men appraised prize values to be low, disbelieved they would win a prize, or were already intrinsically motivated to test. Yet, incentives provided a behavioral 'cue to action' for many men who perceived themselves to be susceptible to HIV and perceived HIV disease to be severe, acting as secondary motivator for testing that "sweetened the deal". CONCLUSION:Incentives can be an important 'lever' to promote men's healthy behaviors in resource-poor settings. HIV testing in convenient, public settings, when paired with incentives, provides multiple pathways to stimulate men's testing uptake. TRIAL REGISTRATION:Registered with ClinicalTrials.gov on 08/10/2016, ID: NCT02890459. The first participant was enrolled on 11th April 2016

Determination of blood glucose threshold in boys: descriptive analysis

The blood glucose threshold (GT) has been used for the assessment of the aerobic capacity for trained individuals in replace of the blood lactate and ventilatory parameters for anaerobic threshold determination. But, there are no studies with boys. The purpose of this study was to measure the intensity corresponding to the GT in a group of boys. Eight boys (11±1.12 years; 38±6.93 kg; 1.44±0.09 m; 18±1.79 kg/m2) performed a graded maximal exercise test on a cycloergometer to determine the Watts peak (WP), heart rate maximum (HRmax), Watts at GT (GTw) and heart rate at GT (GThr). The initial intensity was 15 Watts with 15 Watts of increment every three minutes. The results showed (M±SD) that the WP was 128±12; HRmax: 193±10.64; GTw: 96±19.47; GThr: 161±20.08. The GT was at 75±11.97% of the WP. The results were similar to those reported in studies with children using other physiological variables for anaerobic threshold determination. In conclusion, the study shows that GT is possible to be determined in boys during incremental test

LYSINE FOR PRIMIPAROUS LACTATING SOWS AND EFFECT IN THE PERFORMANCE OF THE PIGLETS

The present study aimed to determinate optimum lysine levels to be used in the ration of primiparous sows in lactation, in relation to piglets performance at weaning. Fifty primiparous sows in lactation were used, and distributed among five treatments (10 animals per treatments), and each treatments contained different levels of digestible lysine in the ration, corresponding to 0.88; 0.99; 1.04; 1.08 e 1.24%, with the same relations between the remaining amino acids. The litters were standardized with 11 piglets. These animals were distributed in a completely randomized blocks experimental design, and each litter was considered an experimental unit, in a total of 10 repetitions. The results were evaluated through statistical variance models, using linear regression or quadratic corresponding to the adjustment. The analysis of variance demonstrated that there was no statistic difference concerning the piglets weaning weights, and number of embryos in second parturition. It was concluded, that the different lysine levels did not influence the performance of piglets, and so, it is possible to use the lower studied level (0.88% of digestible lysine) in the diet of primiparous sows in lactation.O objetivo foi avaliar o melhor nível de lisina a ser utilizado na ração de fêmeas suínas de primeiro parto em lactação, em relação ao desempenho dos leitões ao desmame, e também avaliar o número de fetos e peso dos leitões no segundo parto. Foram utilizadas inicialmente 50 porcas primíparas em lactação, distribuídas entre os 5 tratamentos (10 animais por tratamento), sendo que os tratamentos foram os diferentes níveis de lisina digestível na ração, correspondendo a 0,88; 0,99; 1,04; 1,08 e 1,24%, mantidas as relações entre os demais aminoácidos. As leitegadas foram padronizadas com 11 leitões. Esses animais foram distribuídos em um delineamento experimental de blocos ao acaso, sendo cada leitegada uma unidade experimental, assim obtendo-se 10 repetições. As variáveis analisadas foram submetidas à análise de variância e regressão. Não houve diferença estatística em relação ao peso dos leitões ao desmame, e tampouco do peso e número de fetos no segundo parto em função dos níveis de lisina. Conclui-se que os diferentes níveis de lisina não influenciam o desempenho dos leitões, podendo assim, ser utilizado o menor nível estudado (0,88% de lisina digestível) na dieta de porcas primíparas em lactação

Computational analysis of antibody dynamics identifies recent HIV-1 infection.

CAPRISA, 2017.Abstract available in pdf

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Ultra-rare genetic variation in common epilepsies: a case-control sequencing study

BACKGROUND:Despite progress in understanding the genetics of rare epilepsies, the more common epilepsies have proven less amenable to traditional gene-discovery analyses. We aimed to assess the contribution of ultra-rare genetic variation to common epilepsies. METHODS:We did a case-control sequencing study with exome sequence data from unrelated individuals clinically evaluated for one of the two most common epilepsy syndromes: familial genetic generalised epilepsy, or familial or sporadic non-acquired focal epilepsy. Individuals of any age were recruited between Nov 26, 2007, and Aug 2, 2013, through the multicentre Epilepsy Phenome/Genome Project and Epi4K collaborations, and samples were sequenced at the Institute for Genomic Medicine (New York, USA) between Feb 6, 2013, and Aug 18, 2015. To identify epilepsy risk signals, we tested all protein-coding genes for an excess of ultra-rare genetic variation among the cases, compared with control samples with no known epilepsy or epilepsy comorbidity sequenced through unrelated studies. FINDINGS:We separately compared the sequence data from 640 individuals with familial genetic generalised epilepsy and 525 individuals with familial non-acquired focal epilepsy to the same group of 3877 controls, and found significantly higher rates of ultra-rare deleterious variation in genes established as causative for dominant epilepsy disorders (familial genetic generalised epilepsy: odd ratio [OR] 2·3, 95% CI 1·7-3·2, p=9·1 × 10-8; familial non-acquired focal epilepsy 3·6, 2·7-4·9, p=1·1 × 10-17). Comparison of an additional cohort of 662 individuals with sporadic non-acquired focal epilepsy to controls did not identify study-wide significant signals. For the individuals with familial non-acquired focal epilepsy, we found that five known epilepsy genes ranked as the top five genes enriched for ultra-rare deleterious variation. After accounting for the control carrier rate, we estimate that these five genes contribute to the risk of epilepsy in approximately 8% of individuals with familial non-acquired focal epilepsy. Our analyses showed that no individual gene was significantly associated with familial genetic generalised epilepsy; however, known epilepsy genes had lower p values relative to the rest of the protein-coding genes (p=5·8 × 10-8) that were lower than expected from a random sampling of genes. INTERPRETATION:We identified excess ultra-rare variation in known epilepsy genes, which establishes a clear connection between the genetics of common and rare, severe epilepsies, and shows that the variants responsible for epilepsy risk are exceptionally rare in the general population. Our results suggest that the emerging paradigm of targeting of treatments to the genetic cause in rare devastating epilepsies might also extend to a proportion of common epilepsies. These findings might allow clinicians to broadly explain the cause of these syndromes to patients, and lay the foundation for possible precision treatments in the future. FUNDING:National Institute of Neurological Disorders and Stroke (NINDS), and Epilepsy Research UK

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Irreconcilable Differences? The Road Traffic Act and the European Motor Vehicle Insurance Directives

The UK has a chequered past in relation to its compliance with EU law. In some instances, it has gone beyond the minimum requirements imposed by its EU parent in providing protection for individuals (see for instance the UK’s implementation of art.9 of the Motor Vehicle Insurance Directive 2009/103). Regrettably, however, there are a greater number of examples where the UK has failed in its transposition obligations. One area where a significant disconnect exists between national and EU law is third-party motor vehicle insurance. This is perhaps justifiable in some instances given the evolution of the domestic and EU laws, their original incarnation compared with modern requirements, and the effects of judicial interpretation and the creativity of the Court of Justice of the EU. However, other inconsistencies are less easy to accept. There are an increasing number of errors in interpretation, historic and contemporary, which necessitate a comprehensive review of the national law, a policy review of the state’s abrogation of its responsibilities to the victims of uninsured and untraced drivers, and corrective action to prevent liability being imposed on the UK