Andreas-Holger Maehle, Contesting Medical Confidentiality, Origins of the Debate in the United States, Britain and Germany

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Medical confidentiality and domestic abuse

This thesis investigates what medical confidentiality means in practice, in the context of a trial for domestic abuse. Despite the recent landmark case of WF (2016), which upheld a complainer’s right to privacy in relation to the use of their medical records, I demonstrate that medical records continue to be used routinely in criminal prosecutions in ways which undermine the supposed protections supported in WF. This points to the need for a more fundamental assessment of the underlying processes of the type that I have carried out in this thesis. There is no other research that properly takes account of these issues, while including the views of the survivors, as well as the front-line clinicians and lawyers involved. This thesis offers a fundamental exploration of how perceptions of medical confidentiality affect how records are made, sought and used in this context. Using data from twenty-eight in-depth interviews with survivors, clinicians and lawyers, I show how medical confidentiality is routinely undermined in cases of domestic abuse and sexual violence. My research demonstrates the need for a new approach to the definition of medical confidentiality and a review of the ways that medical records are used in these kinds of cases. Interview responses are complemented by a questionnaire study, recounting survivors’ experiences with medical and legal services, alongside further quantitative data tracing the medical records requests made to an NHS health board. Throughout, I highlight issues with the consent process, finding that prosecution staff use the potential for failed convictions to encourage survivors to agree to their medical records being recovered and disclosed. The concept of relevance is also discussed, with my data bolstering accusations by other researchers that it is too widely interpreted, by legal professionals in particular. The potential for future legal proceedings is shown to have a powerful impact on the way confidentiality is perceived in the health service, with clinicians, on occasion, willing to amend practice to assist the chance of prosecutions succeeding. Overall, this thesis highlights the importance of medical confidentiality in survivors’ perceptions of the criminal justice process and the health service. Moving away from the simplistic assumptions that confidentiality has no effect on courtroom experiences, my research instead shows that diverging perceptions of confidentiality risk the disclosure of large amounts of sensitive medical information that in turn affects the chances of survivors engaging with clinicians and lawyers in future

Working Towards a Compact Cold Ion Source

This thesis presents work on creating a cold atomic ion source based on a diffraction grating magneto-optical trap using caesium. Due to this technique, the source profile has been minimised in terms of both spatial extent and production cost - characteristics that have been emphasised throughout this work so as to be more applicable to both industrial applications and further research. To ionise the Cs, a novel excitation scheme has been designed involving three low energy transitions from the ground state of 6S$_{1/2}$, to the Rydberg state 21P$_{1/2}$, from which the atoms can be field ionised. In order to maximise the efficiency of the Rydberg state coupling, a new offset frequency reference based on Zeeman detuned ground state spectroscopy of rubidium was devised. Only a weak caesium trap using a grating was observed in this work, however discussion as to the reasons for this are presented. Despite this, full schematics and engineering diagrams for the proposed integrated ion source are presented with the hope of construction once a viable trap is demonstrated as there are no fundamental reasons hindering success

Emergency sanitation: developing criteria for pit latrine lining

Pit latrine linings for emergency sanitation facilities require different performance criteria from those for pits used in longer-term development work. Various international initiatives are currently under way to develop new methods of supporting the pits used for latrines in emergencies, but before a solution can be found, the problem needs to be defined. Current field guidance lacks the level of detail required by humanitarian workers to construct durable pits in a timely manner. Consultations with international humanitarian field staff and UK-based geotechnical engineers were used in this research project to identify design, construction, and operational requirements of emergency pit-lining systems. However, rather than closely defined performance requirements, the study identified a wide range of criteria that need to be considered and clear distinctions between emergency and longer-term solutions. Latrines constructed in the initial stages of emergencies are likely to be communal, with long rectangular pits that require frequent emptying. Current knowledge of suitable pit support methods is sufficient to provide a limited range of standard designs that could be selected to meet local requirements

Early twentieth-century Vogue, George Wolfe Plank and the "Freaks of Mayfair"

Vogue was one of the most influential fashion magazines of the twentieth century. In the 1920s its British edition, launched in 1916, became a focus for various forms of queer visual and cultural expression. The origins of the related ‘amusing style’, which delighted in camp display, can be traced to the romantic and artistic collaboration between the American artist George Wolfe Plank and the British writer E. F. Benson during World War One. The illustrations that Plank produced for Benson’s book of satirical sketches of life in London’s high society, The Freaks of Mayfair (1916), shed light on the camp images that Plank designed for the covers of both the American and British editions of the magazine. Therefore, Plank can be understood to have played a key role in the development of queer visual culture during the early twentieth century

Terahertz electrometry via infrared spectroscopy of atomic vapor

In recent years, the characterisation of radiation falling within the so-called ‘terahertz (THz) gap’ has become an ever more prominent issue due to the increasing use of THz systems in applications such as nondestructive testing, security screening, telecommunications, and medical diagnostics. THz detection technologies have advanced rapidly, yet traceable calibration of THz radiation remains challenging. In this paper, we demonstrate a system of electrometry in which a THz signal can be characterized using laser spectroscopy of highly excited (Rydberg) atomic states. We report on proof-of-principle measurements that reveal a minimum detectable THz electric field amplitude of 1.070.06 V/m at 1.06 THz (3 ms detection), corresponding to a THz power at the atomic cell of approximately 3.4 nW. Due to the relative simplicity and cryogen-free nature of this system, it has the potential to provide a route to a SI traceable ‘atomic candle’ for THz calibration across the terahertz frequency range, and provide an alternative to calorimetric methods

Quantifying the in vivo quasi-static response to loading of sub-dermal tissues in the human buttock using magnetic resonance imaging

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Oct 2017) in accordance with the publisher’s archiving policyBackground The design of seating systems to improve comfort and reduce injury would benefit from improved understanding of the deformation and strain patterns in soft tissues, particularly in the gluteal region. Methods Ten healthy men were positioned in a semi-recumbent posture while their pelvic and thigh region was scanned using a wide-bore magnetic resonance imaging (MRI) scanner. Independent measurements of deformation for muscles and fat were taken for the transition from non-weight-bearing to weight-bearing loads in three stages. A weight-bearing load was achieved through having the subject supported by a flat, rigid surface. A non-weight-bearing condition was achieved by removing the support under the left buttock, leaving all soft tissue layers undeformed. An intermediate condition partially relieved the subject's left buttock by lowering the support relative to the pelvis by 20 mm, which left the buttock partially deformed. For each of these conditions, the thicknesses of muscle and fat tissues below the ischial tuberosity and the greater trochanter were measured from the MRI data. Findings In this dataset, the greatest soft tissue deformation took place below the ischial tuberosity, with muscles (mean = 17.7 mm, SD = 4.8 mm) deforming more than fat tissues (mean = 4.3 mm, SD = 5.6 mm). Muscles deformed through both steps of the transition from weight-bearing to non-weight-bearing conditions, while subcutaneous fat deformed little after the first transition from non-weight-bearing to partial-weight-bearing. High inter-subject variability in muscle and fat tissue strains was observed. Interpretation Our findings highlight the importance of considering inter-subject variability when designing seating systems

The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty