Role of the community matron in advance care planning and ‘do not attempt CPR’ decision-making: a qualitative study

The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase

Rights and the Rule of Law in Third Way Constitutionalism

A review of Stephen Gardbaum's The New Commonwealth Model of Constitutionalism (CUP 2013)

The Instrumental Value of Legal Accountability

This chapter aims to present an account of the value of legal accountability by focusing on its role as an instrument that produces certain prima facie benefits. In Section B, it introduces the instrumentalist approach, defines legal accountability by reference to its core institutional attributes, and justifies speaking of the value of legal accountability in general and prima facie terms rather than only in particular contexts. In Section C, the chapter presents a list of ten prima facie benefits: focus; principled reasoning; constitutional authority; independence and impartiality; rule interpretation competence; procedural fairness competence; participation; expressiveness; publicity; and inter-institutional collaboration. It is argued both that these benefits are in fact features of legal accountability, and that they do or can produce valuable ends. Both claims are defended against some common objections, the ultimate conclusion being that the better objections justify judicial restraint but do not refute any of the core claims

Do structural differences along strike of the Himalaya range represent changes in the pre-collision geometry of Greater India prior to collision?

Over the past few decades understanding of orogen development has evolved at a rapid pace, with classic geologic principles being combined with complex computer aided thermo-mechanical simulations, to produce testable models of orogenic growth1, 2. Typically, Greater India’s pre-collisional northern edge, is usually modeled as a rifted passive margin. However, some workers3 have argued for a quite different geometry resulting from its prior tectonic history. Whilst the western portion of the paleoboundary is seen as a Triassic rifted margin, the central and eastern portions developed more recently as India separated from Australia along a dextral ‘scything’ transform fault. This envisages the central-northern boundary to be a ...postprin

Water dimer diffusion on Pd{111} assisted by an H-bond donor-acceptor tunneling exchange

Based on the results of density functional theory calculations, a novel mechanism for the diffusion of water dimers on metal surfaces is proposed, which relies on the ability of H bonds to rearrange through quantum tunneling. The mechanism involves quasifree rotation of the dimer and exchange of H-bond donor and acceptor molecules. At appropriate temperatures, water dimers diffuse more rapidly than water monomers, thus providing a physical explanation for the experimentally measured high diffusivity of water dimers on Pd{111} [Mitsui et al., Science 297, 1850 (2002)]

Acute effects of exercise on appetite, ad libitum energy intake and appetite-regulatory hormones in lean and overweight/obese men and women

Background: Acute exercise does not elicit compensatory changes in appetite parameters in lean individuals; however, less is known about responses in overweight individuals. This study compared the acute effects of moderate-intensity exercise on appetite, energy intake and appetite-regulatory hormones in lean and overweight/obese individuals. Methods: Forty-seven healthy lean (n=22, 11 females; mean (s.d.) 37.5 (15.2) years; 22.4 (1.5) kg m−2) and overweight/obese (n=25, 11 females; 45.0 (12.4) years, 29.2 (2.9) kg m−2) individuals completed two, 8 h trials (exercise and control). In the exercise trial, participants completed 60 min treadmill exercise (59 (4)% peak oxygen uptake) at 0–1 h and rested thereafter while participants rested throughout the control trial. Appetite ratings and concentrations of acylated ghrelin, peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) were measured at predetermined intervals. Standardised meals were consumed at 1.5 and 4 h and an ad libitum buffet meal was provided at 7 h. Results: Exercise suppressed appetite (95% confidence interval (CI) −3.1 to −0.5 mm, P=0.01), and elevated delta PYY (95% CI 10 to 17 pg ml−1, P<0.001) and GLP-1 (95% CI 7 to 10 pmol l−1, P<0.001) concentrations. Delta acylated ghrelin concentrations (95% CI −5 to 3 pg ml−1, P=0.76) and ad libitum energy intake (95% CI −391 to 346 kJ, P=0.90) were similar between trials. Subjective and hormonal appetite parameters and ad libitum energy intake were similar between lean and overweight/obese individuals (Pgreater than or equal to0.27). The exercise-induced elevation in delta GLP-1 was greater in overweight/obese individuals (trial-by-group interaction P=0.01), whereas lean individuals exhibited a greater exercise-induced increase in delta PYY (trial-by-group interaction P<0.001). Conclusions: Acute moderate-intensity exercise transiently suppressed appetite and increased PYY and GLP-1 in the hours after exercise without stimulating compensatory changes in appetite in lean or overweight/obese individuals. These findings underscore the ability of exercise to induce a short-term energy deficit without any compensatory effects on appetite regardless of weight status

Social Rights, Constitutionalism and the German Social State Principle

In this article I focus on the constitutional role of the German social state principle and the questions it generates for foreign jurists. Although the German Basic Law contains no set of social rights, the social state principle has invigorated readings of the basic rights constitutional provisions in a manner that invites comparison with, and raises the same competence questions, as the adjudication of social rights. On the other hand, the principle focuses on a general state duty to take responsibility for the ‘social question’, and take an active role in the society. Although the German Constitutional Court has found that the Basic Law is neutral in respect of economic policy, the commitment to the social state principle does not appear neutral or apolitical under in the Anglo-American sense. There are two ways in which the social state principle seems to have had an important impact. Firstly, the German Constitutional Court has developed the principle as a basis for interpreting the Constitution, using it occasionally “in conjunction with” other basic rights provisions to provide affirmative entitlements. Secondly, there is a clear link between the social state principle and the major achievements of the legal protection of social rights in Germany: the Social Code. Finally, I underline the important role of the social state principle in a nation that takes seriously both the welfare state and the rule of law (Rechtsstaat), and raise some questions concerning its relevance from the point of view of comparative constitutional law