The compromise of conscience: Conscientious objection in healthcare

This paper discusses a medical practitioner’s right to conscientiously object to providing a legally available healthcare service in New Zealand, on the grounds of their personal beliefs. Currently, the right to conscientiously object is enshrined in the Health Practitioners Competence Assurance Act 2003 and the Contraception, Sterilisation and Abortion Act. This paper argues the current legislative arrangement regulating a health practitioner’s right to conscientiously object under New Zealand law is vague, and risks cementing uncertainty, due to scope of the protection being unclear. In addition, the current protection risks patient safety, as it does not exclude the right to conscientiously object in medical emergencies, or when the efficacy of the treatment is time dependent. To remedy this unsatisfactory situation, it is recommended that the right to conscientiously object in healthcare be rendered impermissible in the aforementioned scenarios. It is further recommended that direct referral to a non-objecting colleague be mandatory in the event a practitioner wishes to exercise their right to conscientiously object. This is because access to healthcare may be compromised by a practitioner exercising the right to conscientiously object, with no corresponding direct referral requirement, a risk borne by patients

The Growth of a Nation: Child health and development in the Industrial Revolution in England, c. AD 1750-1850

The Industrial Revolution of 18th-19th century England was a period of marked social, economic, and political change through which urban landscapes were irrevocably transformed. Increasing industrialisation brought with it issues of overcrowding, deteriorating sanitary conditions, and rising air pollution. Disease was rife, and life on the epidemic streets brought significant risks to child mortality and morbidity. This study undertook a comprehensive analysis of health in urban children from the 18th-19th centuries. Six skeletal collections were selected from urban-based sites to attempt to broaden existing knowledge on the impact of industrialisation on child health from a range of geographical and social contexts. Growth parameters (long bone length, cortical thickness, and vertebral dimensions) and non-specific indicators of stress (dental enamel hypoplasia, metabolic disease, cribra orbitalia, and periosteal new bone formation) were selected to assess health status in both children and adults, to identify differing patterns in health stress and longevity. No significant differences were identified between northern and southern-based sites, with social status being the primary determinant of child health. Lower status groups demonstrated the highest perinatal mortality rates, lowest growth values, some of the highest rates of pathology, and intrauterine onset of deficiency diseases, indicating a heightened exposure to poor maternal health and detrimental exogenous influences associated with poverty. However, the high status group from Chelsea Old Church, London, also showed significant deficiencies in growth values and a high rate of metabolic disease, suggestive of “fashionable” child-care practices. A potential association between the presence of non-specific indicators of stress and an earlier age-at-death was identified in adults, suggestive of a reduction in longevity associated with early life stress. Life in the city came with significant health risks for children, and the use of multiple growth parameters and indicators of stress proved an effective means to increase the osteobiographical understanding of past populations

Asymmetric synthesis : approaches via enantiomerically pure acetal and oxazoline ligands

This thesis describes the synthesis of novel ligands that include enantiomerically pure acetal and oxazoline moieties. These ligands are utilised in a number of metalmediated asymmetric syntheses. All asymmetric acetals and pyridine based acetals are synthesised in good yield in a single step from their corresponding enantiomerically pure diols. C2 symmetric bisacetals are investigated as ligands in the organolithium and Grignard additions to benzaldehyde with promising results. C2 symmetric bisacetals and pyridine based acetals are tested for their ability to induce asymmetry in copper(l) catalysed cyclopropanation of styrene using ethyl diazoacetate and the lanthanide(lII) catalysed Diels-Alder cycloaddition involving Danishefsky's diene with little success. Enantiomerically pure phosphinooxazoline ligands are available in good yield in two steps from their corresponding enantiomerically pure aminoalcohols. Enantiomerically pure acetal substituted pyridines and phosphinooxazoline ligands are considered in the rhodium (I) catalysed hydrosilylation of ketones. Reaction conditions for the more successful phosphinooxazoline ligands are optimised. Using these ligands a range of enantiomerically enriched alcohols is presented in good yield and enantiomeric excess. Novel phosphinooxazoline ligands are applied to the palladium(O) catalysed allylic substitution reaction with excellent enantioselectivities of the substitution product

Adoption of better agronomic practices for improving establishment of pasture legumes in the sub-tropics

Pasture legumes have been identified as the best long-term option to increase the productivity and returns from grass pastures in Queensland, however successful adoption rates remain low in the Brigalow Belt bioregion. Poor establishment is the most common reason for legumes failing. As part of a series of legume management workshops, 267 graziers and farm advisors were surveyed about their plans for sowing legumes and what agronomic practices they intended to use. Two-thirds of participants intended to change the practices they use to establish legumes through changing fallowing or seed-bed preparation, rhizobia application, sowing method or other practices. Despite the on-going drought the surveyed participants intend to establish 105,000 additional hectares of legumes using improved agronomic practices in the next 5 years. Adoption of better agronomic practices is likely to lead to more reliable legume establishment thereby increasing productivity for an important cattle production region of northern Australia

Dementia ambient care: multi-sensor support to enable independent home-based living for people with dementia

The quality of life of the person with dementia is often impacted by the loss of autonomy and independence that can arise during dementia progression. Ambient assistive technologies represent a way of enabling independence and facilitating “ageing in place”, by supporting the health, lifestyle, and safety of the person with dementia in an unobtrusive manner. Dem@Care is a European FP7 funded project, which is using ambient and wearable sensors to maintain independent home-based living for as long as possible. We have identified five frequently problematic areas for the person with dementia that can be supported by technology: Sleep, Activities of Daily Living, Physical Activity, Social Interaction, and Mood. In Dem@Care, a clinical assessment is carried out with the person with dementia and their family to identify their unique needs in each of the 5 areas. An individualised sensor “toolbox” is tailored and discussed with the individual and their family, and an acceptable and useful system is configured and deployed. Over time, information gathered by sensors is used to provide feedback to identify changes in patterns of behaviour that may indicate deterioration, improvement, stasis, or the risk of future deterioration, and to increase awareness of behaviours that are detrimental to health and well-being. We report relevant guiding principles from the literature, and findings from the first Dem@Care pilot evaluation, regarding user-centred design, individualization, ethics, and the acceptability and usability of current Dem@Care sensors. We present results from the monitoring of sleep, physical activity, and daily-living activities and following promising initial results, we are expanding data collection to incorporate additional sensors and new participants with the expectation that we can demonstrate the ability of the Dem@Care system to enable persons with dementia to remain independent and living in their own homes for longer

Dementia ambient care: ethical issues arising from the use of a home-based multi-sensor support system

Background: With the worldwide increase in dementia prevalence acceptable cost-effective home-based solutions are needed to support people with dementia (PwD) living in the community and to delay institutionalisation. Ambient assistive technologies represent a way of enabling independence and facilitating “ageing in place”, by supporting the health, lifestyle, and safety of PwD in an unobtrusive manner. However, ethical issues associated with their use remain under-reported. Methods: Dem@Care is an FP7 project that uses ambient and wearable sensors to support physical activity, sleep, activities of daily living, social interaction, and mood in PwD. It uses a multiple case study design with purposive sampling of people with early stage dementia. An individualised sensor “toolbox” and intervention strategy is developed for participants based on a clinical assessment of their needs. Sensor data is aggregated over time to identify changes in patterns of behaviour that could signify improvement, stasis, or deterioration of function. Results: Our first two case studies raised important ethical issues associated with sensor use. Difficulties using the technologies resulted in heightened anxiety for the PwD and their carer. Sensor ‘privacy’ buttons were often forgotten resulting in image capture that might not have been intended and was potentially embarrassing to the PwD, and ambient video recording could not be deployed given the lack of an acceptable solution to obtaining third party consent. Conclusions: Although potentially beneficial to PwD, the ethical issues associated with the use of ambient assistive technologies require further discussion given the vulnerability of this population

Development and evaluation of neuroscience lesson content to improve Key Stage 3 (11–14 year old) students' understanding of the early years in England

The Oxford SEEN (Secondary Education around Early Neurodevelopment) project developed Key Stage 3 (11–14 year olds) science lesson content about the importance of the early years for lifelong health and evaluated its impact on students' knowledge of the neuroscience and practical application to a real‐world scenario. A mixed methods approach was used collecting quantitative and qualitative data from students and staff using pre‐ and post‐lesson surveys and focus groups. Data were analysed from 2767 students from 20 schools in England. The new curriculum successfully increased both student's scientific understanding and practical application of knowledge about neurodevelopment and the role of the caregiver. students’ mean multiple choice question scores (assessing knowledge) were higher post‐lesson compared to pre‐lesson; this increase was consistent across gender and year group. The post‐lesson and 6–8‐week follow‐up scores were similar, indicating a retention in students' knowledge. Students were also asked how they would care for a 2‐year‐old child to promote brain development; before the lessons 89% of students provided no or a basic level answer, but after the lessons 50% of students provided detailed or advanced comments. The lessons were feasible and acceptable; both teachers and students stated the curriculum should be taught to other students. Qualitative analyses indicated that the lessons inspired the curiosity of both teachers and students and were perceived to impact on students' interaction with children in their current lives and their future career choices. The Oxford SEEN curriculum could serve as a foundation to build community‐wide knowledge about the importance of the early years, with the aim of enhancing mental and physical health outcomes for future generations

Female teat size is a reliable indicator of annual breeding success in European badgers: Genetic validation

Assessing which females have bred successfully is a central requirement in many ecological field studies, providing an estimate of the effective female population size. Researchers have applied teat measurements previously to assess whether females, in a variety of mammalian species, have bred; however, this technique has not been validated genetically. Furthermore, several analytical techniques are available to classify individuals, but their misclassification rates have not been compared. We used 22 microsatellite loci to assign maternity, with 95% confidence, within a high-density population of European badgers Meles meles, as plural and subterranean breeding means that maternity cannot be inferred from behavioural observations. The teat lengths and diameters of 136 females, measured May–July 1994–2005, from social groups in which all offspring were assigned a mother, were reliable indicators of recent breeding success. A Generalised Linear Mixed Model (GLMM) classified both breeding and non-breeding females with lower error rates than discriminant analyses and crude teat-size criteria. The GLMM model logit probability = −20 + 1.8 month + 1.6 mean teat length + 1.0 mean teat diameter can be applied quickly in the field to assess the probability with which a female badger should be assigned maternity. This is a low-cost measure which, after validation, could be used in other badger or mammalian populations to assess the breeding success of females. This may be a particularly useful welfare tool for veterinary practitioners, especially during badger culls

The marketing of food to children : moving the debate beyond television advertising.

Whilst food marketing to children has been heavily discussed in both the political and marketing arenas over the past few years, it has predominately concentrated on television advertising. However, it is now recognised that contemporary marketers are moving away from television advertising and expanding their range of communications. Therefore, this thesis looks to widen the debate to other forms of food marketing communications. From previous literature and four background interviews a conceptual framework is developed which highlights the importance of four parties: the food companies (and their communication agencies), the regulatory bodies, parents and children. The first two parties are predominantly investigated using secondary data, whilst the primary research for this study concentrates on the second two parties. As such fourteen qualitative family interviews with children aged between seven and eleven are undertaken. From my findings, the original conceptual framework is developed into an expanded framework. The framework has four sections. The first section details seventeen types of communications currently being used by the UK food industry. The second shows four types of restrictions (two frequency restrictions and two impact restrictions) which parents use to mediate some of these communications. The third section confirms that children possess differing levels of understanding across the range of communications. Finally the fourth section highlights (1) that there are five communications (television advertising, free gifts, price promotions, tie-ins with television, film and cartoon characters and children's speciality foods) which children perceive they encounter frequently and which have an impact on their purchase requests and (2) that there are seven communications (print advertising, product placement in television and films, product placement in video games, online advertising, advergames, in-school communications and branded toys) which they perceive they infrequently encounter and which have little impact. Overall this thesis is, to my knowledge, the first to present a holistic consideration of the marketing of food to children in the UK. It not only includes a full range of communications but also all the complete process, from the food companies to the children

Audiovisual Processing is Abnormal in Parkinson\u27s Disease and Correlates with Freezing of Gait and Disease Duration

Background: Sensory and perceptual disturbances progress with disease duration in Parkinson’s disease (PD) and probably contribute to motor deficits such as bradykinesia and gait disturbances, including freezing of gait (FOG). Simple reaction time tests are ideal to explore sensory processing, as they require little cognitive processing. Multisensory integration is the ability of the brain to integrate sensory information from multiple modalities into a single coherent percept, which is crucial for complex motor tasks such as gait. 9 10 11 12 13 Objectives: The aims of this study were to: 1. Assess differences in unisensory (auditory and visual) and multisensory processing speed in people with PD and age-matched healthy controls. 2. Compare relative differences in unisensory processing in people with PD with disease duration and freezing of gait status taking into account the motor delays, which are invariably present in PD. 3. Compare relative differences in multisensory (audiovisual) processing between the PD cohort and age-matched controls. 14 15 16 17 Methods: 39 people with PD (23 with FOG) and 17 age-matched healthy controls performed a reaction time task in response to unisensory (auditory-alone, visual-alone) and multisensory (audiovisual) stimuli. 18 19 Results: The PD group were significantly slower than controls for all conditions compared with healthy controls but auditory reaction times were significantly faster than visual for the PD group only. These relative unisensory differences are correlated with disease duration and divide the PD group by FOG status, but these factors are co-dependent. Although multisensory facilitation occurs in PD, it is significantly less enhanced than in healthy controls. 20 21 22 23 Conclusion: There are significant unisensory and multisensory processing abnormalities in PD. The relative differences in unisensory processing are specific to PD progression, providing a link between these sensory abnormalities and a motor feature of PD. Sensory disturbances have previously been postulated to be central to FOG but this is the first study to predict audiovisual processing abnormalities using FOG status. The multisensory processing abnormalities are independent of disease duration and FOG status and may be a potential biomarker for the disease