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In response to the 2013–2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF).
A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care.
Setting and participants:
The questionnaire was sent to 82 ETCs.
We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not.
Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication.
There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.
This chapter surveys the principal features of the legal system of the later sixteenth century, beginning with the courts and their functions. Trials took place at the assizes in the country, separated from the legal argument in Westminster Hall. The court at Westminster did not hear the evidence but had to take the facts as encapsulated in Latin; the effect of this separation is considered. In absence of appeals as we know them, judges were unwilling to decide difficult cases, though the desire for unanimity was giving way to an acceptance of majority decisions. The cost of litigation was much lower than today, and most litigants in the highest courts were of a social status below the gentry. The chapter ends with an account of the legal profession in this period, which saw the rise of the solicitor. The inns of court played a central role as a residential legal university, attended by a substantial proportion of the English gentry.
This chapter surveys the substantive common law in the later sixteenth century. The rise of habeas corpus enabled the judicial review of prerogative jurisdictions and powers, so that the rule of law was now firmly rooted. The new atmosphere of rights was linked to Magna Carta, now rescued from oblivion. Private law was still dominated by the land law. Remedies for the protection of real property were simplified, but much confusion had been introduced by the Statutes of Uses and Wills, and a major new concern was the use of perpetuity clauses in family settlements to prevent the barring of entails. The law of contract is largely timeless, but the doctrine of consideration belongs to this period, and a decision of 1602 finally sanctioned an action for recovering debts without the archaic obstacle called wager of law. The law of tort was dominated by defamation rather than negligence. Criminal law was not the concern of practising lawyers and was relatively undeveloped, especially at the level of misdemeanours. The role of the Star Chamber is considered. The chapter ends with a brief assessment of Elizabeth I’s attitudes to law and justice.
This chapter focuses on comparison. It considers the effect on access to justice of abolishing the assizes and disposing of court buildings. Civil procedure has been transformed, formalism is less important, but there is eternal tension between practical efficiency and desire for absolute justice. Land law is less dominant today, even though for the first time a majority of householders are freehold-owners. Torts law has been transformed by the ever-expanding boundaries of negligence, though contract law looks very similar. While public law has moved in several new directions, judicial review’s roots are Elizabethan. Most of today’s human rights were recognised then. Judicial decisions have changed in character as a result of abolishing the civil jury; the public is less involved with traditional-type law. Debt-collection aside, horizontal disputes are less prominent than vertical claims, and tribunals have grown in importance. The complexity of statute-law and regulation today means that citizens have less understanding of the law than Elizabethans. One consequence is that the legal profession is ten times larger (in proportion to the population) than that of Elizabethan England.
This chapter continues with the differences between then and now and explores the difficulties of an evaluative comparison. The question is approached in terms of the rule of law, as now understood. In terms of accessibility, efficiency and fairness, in the sphere of civil justice the scales seem to be evenly balanced between the two periods. The criminal law, on the other hand, is now more protective of the accused and less severe; the removal of the death penalty, however, has led to the removal of some of the older safeguards. A meaningful comparison of the substantive content of the law in both periods is hindered by the intervening social changes and by changing attitudes to property and personal autonomy. The transformation of family law is a case in point. Nevertheless, the ultimate conclusion is that the law under two Elizabeths is in essence the same organism, facing similar challenges, and tackling them in recognisably similar ways. Much of what we regard as achievements of modern enlightenment should in fact be credited to the lawyers of the sixteenth century and the common-law heritage.
This chapter examines the common assumption that, whereas Elizabeth I’s reign was at the zenith of the age of common law, we have now moved into an age of statute. The Elizabethans themselves thought this was already happening: there were so many matters, such as poor relief and economic regulation, which the common law was powerless to tackle. The volume of legislation has continued to increase dramatically, and yet the sphere of the common law is still large and the interpretation of statutes is governed by common-law principles. The fiction of legislative intent, the concept of equity, and the mischief rule were all much the same as today’s interpretative techniques. The largest jurisprudential change has been the common law’s loss of immortality. A statute can, in an instant, extinguish an immemorial principle of law. The extinction survives the repeal of the statute, so that much of the current law is contained in repealed statutes. In this connection, the effects of the Interpretation Acts are considered. Legislation has come to dominate the law in terms of abrogative power as well as bulk, but the common law is superior in terms of clarity, flexibility and self-correction.
Comparative legal history is generally understood to involve the comparison of legal systems in different countries. This is an experiment in a different kind of comparison. The legal world of the first Elizabethans is separated from that of today by nearly half a millennium. But the past is not a wholly different country. The common law is still, in an organic sense, the same common law as it was in Tudor times and Parliament is legally the same Parliament. The concerns of Tudor lawyers turn out to resonate with those of the present and this book concentrates on three of them: access to justice, in terms of both cost and public awareness; the respective roles of common law and legislation; and the means of protecting the rule of law through the courts. Central to the story is the development of judicial review in the time of Elizabeth I.
High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England.
This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment.
A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach.
Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important.
For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.
To assess the utility of an automated, statistically-based outbreak detection system to identify clusters of hospital-acquired microorganisms.
Multicenter retrospective cohort study.
The study included 43 hospitals using a common infection prevention surveillance system.
A space–time permutation scan statistic was applied to hospital microbiology, admission, discharge, and transfer data to identify clustering of microorganisms within hospital locations and services. Infection preventionists were asked to rate the importance of each cluster. A convenience sample of 10 hospitals also provided information about clusters previously identified through their usual surveillance methods.
We identified 230 clusters in 43 hospitals involving Gram-positive and -negative bacteria and fungi. Half of the clusters progressed after initial detection, suggesting that early detection could trigger interventions to curtail further spread. Infection preventionists reported that they would have wanted to be alerted about 81% of these clusters. Factors associated with clusters judged to be moderately or highly concerning included high statistical significance, large size, and clusters involving Clostridioides difficile or multidrug-resistant organisms. Based on comparison data provided by the convenience sample of hospitals, only 9 (18%) of 51 clusters detected by usual surveillance met statistical significance, and of the 70 clusters not previously detected, 58 (83%) involved organisms not routinely targeted by the hospitals’ surveillance programs. All infection prevention programs felt that an automated outbreak detection tool would improve their ability to detect outbreaks and streamline their work.
Automated, statistically-based outbreak detection can increase the consistency, scope, and comprehensiveness of detecting hospital-associated transmission.
The boll weevil spread across the South from 1892 to 1922 with devastating effect on cotton cultivation. The resulting shift away from this child labor–intensive crop lowered the opportunity cost of school attendance. We investigate the insect’s long-run effect on educational attainment using a sample of adults from the 1940 census linked back to their childhood census records. Both white and black children who were young (ages 4 to 9) when the weevil arrived saw increased educational attainment by 0.24 to 0.36 years. Our results demonstrate the potential for conflict between child labor in agriculture and educational attainment.
Cognition refers to a set of mental actions or processes by which we create, use or store knowledge. We can conceptualise a global measure of overall cognitive ability, however, it is possible to distinguish a range of individual components or core cognitive domains. This is informative as cognitive disorders often selectively affect some functions, while sparing others. As well as providing diagnostic help, cognitive assessment can be valuable in monitoring progression or improvement of a disorder. It is particularly powerful used in combination with information from clinical interview and measurement of biomarkers (e.g., through brain imaging, or CSF examination).