End of Life Decision Making, Policy and the Criminal Justice System: Untrained Carers Assuming Responsibility (UCARes) and Their Uncertain Legal Liabilities

This article will explore some previously unrecognised legal and ethical issues associated with informal care-giving and criminal justice in the context of end of life decision-making. It was prompted by a recent case in Leeds Crown Court, which raises important issues for the people who care for their loved ones at home and for the criminal justice system more generally. Government figures estimate that over 5.2 million Britons are responsible for the care of relatives or loved ones. In order to evaluate some of the ways in which they might find themselves exposed to unexpected criminal liability we have characterised this group as untrained carers who assume responsibility (UCARes)

Transableism, Disability and Paternalism in Public Health Ethics: Taxonomies, identity Disorders and Persistent Unexplained Physical Symptoms

Transableism is a term which refers to moving between states of being able and disabled by choice rather than by happenstance. Insofar as this may imply a choice to become dependent, claims upon the healthcare system are likely to result. In this piece we aim to explore some ethical and legal implications of such claims. In order to do so, we draw upon current debates over the place of autonomy, beneficence and paternalism in public health ethics, the taxonomy of disability and the status of persistent unexplained physical symptoms (henceforth, PUPS). We suggest that transableism represents a useful construct which may contribute towards resolution of ongoing difficulties within public health ethics and theories of disability. In addition, we believe that it holds promise for the understanding of a significant proportion of patients presenting PUPS. We focus upon identity disorders, particularly in relation to what is currently termed Body Integrity Identity Disorder (henceforth, BIID), where sufferers report a subjective conviction that one or more of their limbs are superfluous, requesting medical assistance to remove the offending limb[s], repair the results of attempts at their self-removal or to provide prostheses and other assistance after removal. We have considered BIID elsewhere in relation to consent, capacity and the doctor/patient relationship (Mackenzie and Cox, 2005). One of us has also explored how the definition of addiction as a chronic relapsing disease within public health governance enables cycles of transitions between the rigours of rational liberal citizenship and the shriven status of the sick (Mackenzie, 2006). Since a central aim in this piece is evaluate the place of transableism within public health ethics, we will begin by considering the latter as a discursive context for the arguments which follow

Deep Brain Stimulation for Psychopaths—A No Brainer

Guest editoria

Health inequalities and health equity challenges for victims of modern slavery

AbstractBackgroundModern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors.MethodsWe conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care.ResultsSurvivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications.ConclusionsThe importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed

Improving Door-to-Groin Time for Stroke-Alert Patients Arriving at TJUH

Introduction: Due to the large number of endovascular-eligible acute ischemic stroke patients, the urgent nature of effective stroke treatment protocols has become increasingly recognized at TJUH. Due to the hospital’s unique situation with two city blocks between the ER and endovascular lab, in-hospital factors remain a significant reason for the delay of treatment. Objective: The purpose was to conduct a quality-assurance trial to determine whether standardizing imaging modalities for inpatient and ER stroke-alert patients at our institution would improve door-to-puncture times. Methods: After implementation of the new stroke alert protocol, data were prospectively collected for six months for two groups of patients: patients transferred from the ER for possible large vessel occlusions (LVO) who underwent thrombectomy and patients who were transferred for possible LVO but deemed not a candidate for thrombectomy. Retrospective comparison data were obtained from 2015 to 2017 for the same six-month period to account for seasonal variability. Results: The co-primary outcomes were door-to-groin puncture time (DTG) time and door-to-door (ER to endovascular lab (DTD)) time. Average DTD times for 2015, 2016 and 2017 were 114, 129 and 145 minutes and the average DTG times were 263, 207, and 165 minutes, respectively. Discussion: After enactment of the new algorithm, our DTG time decreased to 103 minutes and the DTD time decreased to 107 minutes. Therefore, the emphasis on quality improvement regarding the stroke alert algorithm decreased DTG time for acute stroke patients with large vessel occlusion undergoing mechanical thrombectomy

The implications of ISO 717 spectrum adaption terms for residential dwellings.

In 2001 new proposals were issued for public consultation regarding changes to the English and Welsh Building Regulations Part E "resistance to the passage ofsound" and guidance document Approved Document E. Several major changes were proposed in these documents ...One of the most important changes was the proposal to introduce IS0717 spectrum adaptation terms, Ctr for airborne sound insulation of separating walls and floors and Cl for impact sound transmission for separating floors. The new proposals outlined that changing to the new measurement criteria and sound insulation levels, the current sound insulation performance would be improved by +3dB for walls and +4dB for floors.To evaluate the impact of introducing such proposals to the Scottish Building Regulations Part H "resistance to the transmission of sound" a study was undertaken to investigate their implications in relation to the current standards andmethods of rating sound insulation used in Scotland

The implications of ISO 717 spectrum adaption terms for residential dwellings.

In 2001 new proposals were issued for public consultation regarding changes to the English and Welsh Building Regulations Part E "resistance to the passage ofsound" and guidance document Approved Document E. Several major changes were proposed in these documents ...One of the most important changes was the proposal to introduce IS0717 spectrum adaptation terms, Ctr for airborne sound insulation of separating walls and floors and Cl for impact sound transmission for separating floors. The new proposals outlined that changing to the new measurement criteria and sound insulation levels, the current sound insulation performance would be improved by +3dB for walls and +4dB for floors.To evaluate the impact of introducing such proposals to the Scottish Building Regulations Part H "resistance to the transmission of sound" a study was undertaken to investigate their implications in relation to the current standards andmethods of rating sound insulation used in Scotland

Open/closed window research: sound insulation through ventilated domestic windows.

Planning guidance is required to advise on appropriate standards against which the suitability of development can be assessed. Consideration is needed of the locale, itsexisting character and of future residential amenity. In the noise context, advice is primarily required to define threshold exposure levels relative to extraneous sources of environmental noise. A thorough knowledge of the acoustic transmission characteristics afforded by the building envelope is therefore desirable to assist in the setting of threshold levels and to aid in the design and verification of developmentproposals.The insulation of an open window has been generally accepted as being 10-15 dBA although its precision and affect on opening style, open area and window size, arenot readily available. A programme of laboratory measurements have been undertaken by the Building Performance Centre at Napier University on behalf of theDepartment for Environment, Food and Rural Affairs, in order to quantify the sound insulation provided by a variety of window types, opening styles, areas of openingand ventilator devices.Open Windows: The test regime measured the sound insulation provided by seven separate windows, with a combination of twelve different opening styles. Thevariation in weighted level difference, Dw, across the different opening styles for approximately equivalent area openings has been consistently measured as between 4 and 6 dB.The range of measured insulation ratings, for window with a free open area of 0.05 m2, is Dw 14 – 20 dB. This translates to the following dBA level differences, due to variations in the source noise characteristics:• Road Traffic Noise 12 –18 dBA• Railway Noise 12 –18 dBA• Aircraft Noise 14 – 19 dBA• Amplified Music 15 –20 dBAThe window results do not show any one opening style which provides significantly better insulating characteristics. In general the set of windows with an outward opening light performed well. The windows with no extending opening lights, namely the internal turn and tilt and the sliding sash, were also among the best performing open units; particularly when the source of noise was neither random nor normal incidence. Variations in the window size, frame material and glazing type have little significance on the insulating performance of an open window.Closed Window. The introduction of a ‘closed’ 4000 mm2 slot ventilator within the window frame reduced the overall weighted insulation performance of the window by 6 dB. This reduction increased to 11 dB when the vent was in its ‘open’ condition.Proprietary over frame vents gave a marked improvement in the high frequency acoustic performance; however the weighted insulation rating is generally dominated by low-frequency transmission which is not substantially improved over that of a slot vent.Sound Directivity: Rotation of source incidence away from the normal, within a nondiffuse acoustic environment, is found to consistently improve the resulting open window façade insulation