Plus ca change? Continuity and change in UK legislative drafting practice

This article is taken from the text of the Sir William Dale Lecture for 2008, given on November 3 2008 by Stephen Laws CB, First Parliamentary Counsel, Office of the Parliamentary Counsel. Article by Stephen Laws published in Amicus Curiae - Journal of the Society for Advanced Legal Studies. The Journal is produced by the Society for Advanced Legal Studies at the Institute of Advanced Legal Studies, University of London

Demand responsive transport: A review of schemes in England and Wales

Local-authority-administered Demand Responsive Transport (DRT) schemes are increasingly prevalent in England and Wales, partly as a result of the growth in the availability of government funding. However, insufficient research has been undertaken into the nature of these schemes and their performance, making it difficult to predict their future role. In this respect, a survey was undertaken to collect data on the background, operation, and performance of DRT schemes in England and Wales. It found that DRT schemes are often designed in an attempt to tackle social problems caused by poor accessibility and that they took time to become established, to achieve their objectives, and to reach an acceptable performance in terms of subsidy level. The paper concludes that local-authority-led DRT schemes have a role to play, but that lessons learned from schemes currently in operation must be heeded by those contemplating new scheme development

Demand responsive transport : a review of schemes in England and Wales

Local Authority administered Demand Responsive Transport (DRT) schemes are increasingly prevalent in England and Wales, partly as a result of the growth in the availability of Government funding. However insufficient research has been undertaken into the nature of these schemes and their performance making it difficult to predict their future role. In this respect, a survey was undertaken in order to collect data on the background, operation and performance of DRT schemes in England and Wales. It found that DRT schemes are often designed in an attempt to tackle social problems caused by poor accessibility, and that they took time to become established, to achieve their objectives and to reach an acceptable performance in terms of subsidy level. The paper concludes that Local Authority led DRT schemes have a role to play but that lessons learnt from schemes currently in operation must be heeded by those contemplating new scheme development

Kaneohe Bay Sewage Diversion Experiment: Perspectives on Ecosystem Responses to Nutritional Perturbation

Kaneohe Bay, Hawaii, received increasing amounts of sewage from the 1950s through 1977. Most sewage was diverted from the bay in 1977 and early 1978. This investigation, begun in January 1976 and continued through August 1979, described the bay over that period, with particular reference to the responses of the ecosystem to sewage diversion. The sewage was a nutritional subsidy. All of the inorganic nitrogen and most of the inorganic phosphorus introduced into the ecosystem were taken up biologically before being advected from the bay. The major uptake was by phytoplankton, and the internal water-column cycle between dissolved nutrients, phytoplankton, zooplankton, microheterotrophs, and detritus supported a rate of productivity far exceeding the rate of nutrient loading. These water-column particles were partly washed out of the ecosystem and partly sedimented and became available to the benthos. The primary benthic response to nutrient loading was a large buildup of detritivorous heterotrophic biomass. Cycling of nutrients among heterotrophs, autotrophs, detritus, and inorganic nutrients was important. With sewage diversion, the biomass of both plankton and benthos decreased rapidly. Benthic biological composition has not yet returned to presewage conditions, partly because some key organisms are long-lived and partly because the bay substratum has been perturbed by both the sewage and other human influences

SimPS-Net: Simultaneous Pose & Segmentation Network of Surgical Tools

Localisation of surgical tools during operation is of paramount importance in the context of robotic assisted surgery. 3D pose estimation can be utilised to explore the interaction of tools with registered tissue and improve the motion planning of robotic platforms, thus avoiding potential collisions with external agents. With the problems of traditional tracking systems being cost and the need to redesign surgical tools to accommodate markers, there has been a shift towards image-based, markerless tracking techniques. This study introduces a network capable of detecting and localising tools in 3D using a monocular setup. For training and validation, a novel dataset, 3dStool, was produced, and the network was trained to obtain a mean Dice coefficient of 85.0% for detection, along with a mean position and orientation error of 5.5mm and 3.3. respectively. The presented method is significantly more versatile than various state of the art solutions, as it requires no prior knowledge regarding the 3D structure of the tracked tools. The results were compared to standard pose estimation networks using the same dataset and demonstrated lower errors along most metrics. In addition, the generalisation capabilities of the proposed network were explored by performing inference on a previously unseen pair of scissors

Is there scope for community health nurses to address lifestyle risk factors? : the community nursing SNAP trial

Background: This paper examines the opportunity and need for lifestyle interventions for patients attending generalist community nursing services in Australia. This will help determine the scope for risk factor management within community health care by generalist community nurses (GCNs).Methods: This was a quasi-experimental study conducted in four generalist community nursing services in NSW, Australia. Prior to service contacts, clients were offered a computer-assisted telephone interview to collect baseline data on socio-demographics, health conditions, smoking status, physical activity levels, alcohol consumption, height and weight, fruit and vegetable intake and 'readiness-to-change' for lifestyle risk factors.Results: 804 clients participated (a response rate of 34.1%). Participants had higher rates of obesity (40.5% vs 32.1%) and higher prevalence of multiple risk factors (40.4% vs 29.5%) than in the general population. Few with a SNAPW (Smoking-Nutrition-Alcohol-Physical-Activity-Weight) risk factor had received advice or referral in the previous 3 months. The proportion of clients identified as at risk and who were open to change (i.e. contemplative, in preparation or in action phase) were 65.0% for obese/overweight; 73.8% for smokers; 48.2% for individuals with high alcohol intake; 83.5% for the physically inactive and 59.0% for those with poor nutrition.Conclusions: There was high prevalence of lifestyle risk factors. Although most were ready to change, few clients recalled having received any recent lifestyle advice. This suggests that there is considerable scope for intervention by GCNs. The results of this trial will shed light on how best to implement the lifestyle risk factor management in routine practice

Mantle cell lymphoma of the gastrointestinal tract presenting with multiple intussusceptions – case report and review of literature

<p>Abstract</p> <p>Background</p> <p>Mantle cell lymphoma (MCL) is an aggressive type of B-cell non-Hodgkin's lymphoma that originates from small to medium sized lymphocytes located in the mantle zone of the lymph node. Extra nodal involvement is present in the majority of cases, with a peculiar tendency to invade the gastro-intestinal tract in the form of multiple lymphomatous polyposis. MCL can be accurately diagnosed with the use of the highly specific marker Cyclin D1. Few cases of mantle cell lymphoma presenting with intussuception have been reported. Here we present a rare case of multiple intussusceptions caused by mantle cell lymphoma and review the literature of this disease.</p> <p>Case presentation</p> <p>A 68-year-old male presented with pain, tenderness in the right lower abdomen, associated with nausea and non-bilious vomiting. CT scan of abdomen revealed ileo-colic intussusception. Laparoscopy confirmed multiple intussusceptions involving ileo-colic and ileo-ileal segments of gastrointestinal tract. A laparoscopically assisted right hemicolectomy and extended ileal resection was performed. Postoperative recovery was uneventful. The histology and immuno-histochemistry of the excised small and large bowel revealed mantle cell lymphoma with multiple lymphomatous polyposis and positivity to Cyclin D1 marker. The patient was successfully treated with Rituximab-CHOP chemotherapy and remains in complete remission at one-year follow-up.</p> <p>Conclusion</p> <p>This is a rare case of intestinal lymphomatous polyposis due to mantle cell lymphoma presenting with multiple small bowel intussusceptions. Our case highlights laparoscopic-assisted bowel resection as a potential and feasible option in the multi-disciplinary treatment of mantle cell lymphoma.</p

Polygenic resilience scores capture protective genetic effects for Alzheimer’s disease

Polygenic risk scores (PRSs) can boost risk prediction in late-onset Alzheimer’s disease (LOAD) beyond apolipoprotein E (APOE) but have not been leveraged to identify genetic resilience factors. Here, we sought to identify resilience-conferring common genetic variants in (1) unaffected individuals having high PRSs for LOAD, and (2) unaffected APOE-ε4 carriers also having high PRSs for LOAD. We used genome-wide association study (GWAS) to contrast “resilient” unaffected individuals at the highest genetic risk for LOAD with LOAD cases at comparable risk. From GWAS results, we constructed polygenic resilience scores to aggregate the addictive contributions of risk-orthogonal common variants that promote resilience to LOAD. Replication of resilience scores was undertaken in eight independent studies. We successfully replicated two polygenic resilience scores that reduce genetic risk penetrance for LOAD. We also showed that polygenic resilience scores positively correlate with polygenic risk scores in unaffected individuals, perhaps aiding in staving off disease. Our findings align with the hypothesis that a combination of risk-independent common variants mediates resilience to LOAD by moderating genetic disease risk

Factors influencing participant enrolment in a diabetes prevention program in general practice: lessons from the Sydney diabetes prevention program

Background: The effectiveness of lifestyle interventions in reducing diabetes incidence has been well established. Little is known, however, about factors influencing the reach of diabetes prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based diabetes prevention program conducted in general practice, New South Wales, Australia from 2008&ndash;2011.Methods: SDPP was an effectiveness trial. Participating general practitioners (GPs) from three Divisions of General Practice invited individuals aged 50&ndash;65 years without known diabetes to complete the Australian Type 2 Diabetes Risk Assessment tool. Individuals at high risk of diabetes were invited to participate in a lifestyle modification program. A multivariate model using generalized estimating equations to control for clustering of enrolment outcomes by GPs was used to examine independent predictors of enrolment in the program. Predictors included age, gender, indigenous status, region of birth, socio-economic status, family history of diabetes, history of high glucose, use of anti-hypertensive medication, smoking status, fruit and vegetable intake, physical activity level and waist measurement.Results: Of the 1821 eligible people identified as high risk, one third chose not to enrol in the lifestyle program. In multivariant analysis, physically inactive individuals (OR: 1.48, P = 0.004) and those with a family history of diabetes (OR: 1.67, P = 0.000) and history of high blood glucose levels (OR: 1.48, P = 0.001) were significantly more likely to enrol in the program. However, high risk individuals who smoked (OR: 0.52, P = 0.000), were born in a country with high diabetes risk (OR: 0.52, P = 0.000), were taking blood pressure lowering medications (OR: 0.80, P = 0.040) and consumed little fruit and vegetables (OR: 0.76, P = 0.047) were significantly less likely to take up the program.Conclusions: Targeted strategies are likely to be needed to engage groups such as smokers and high risk ethnic groups. Further research is required to better understand factors influencing enrolment in diabetes prevention programs in the primary health care setting, both at the GP and individual level.<br /