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The aim of this review was to explore hospital socio-natural disaster resilience by identifying: studies assessing structural and non-structural aspects of building resilience; components required to maintain a safe and functional health facility; and if the checklists used were comprehensive and easily performed.
A review systemic approach using PRISMA was taken to search the literature. The search focused on articles that discuss hospital disaster resilience. This includes assessments and checklists for facility structural and non-structural components.
This review identified 22 articles describing hospital assessments using checklists containing structural and non-structural elements of resilience. These studies identified assessments undertaken in ten countries, with eight occurring across Iran. A total of seven differing checklists were identified as containing aspects of structural or non-structural aspects of building resilience. The World Health Organization (WHO) has authored three checklists and four others were developed independently.
The structural resilience domain includes building integrity, building materials, design standards, and previous event damages as important elements to determine resilience. Within the internal safety and resilience domains, 11 differing elements were identified as important to non-structural or internal infrastructure resilience. These included the safety of power, water, telecommunication, medical gas supply, and medical equipment resupply systems.
Independent evaluation methods were reported in the majority of articles, with a small number highlighting the benefits of both self-evaluation and independent review processes. Implementation of training programs to evaluators was mentioned in three papers with the assessor’s knowledge and understanding of all checklist elements being highlighted as important to the validity of the evaluation.
The review identified the assessment of hospital resilience as important for management to determine areas of vulnerability within the hospital’s infrastructure and to inform improvement strategies. Assessment criteria must be comprehensive, highlighting structural and non-structural aspects of facility infrastructure. These assessments are best done as a multi-disciplinary collective of experts, involving hospital employees in the journey. This collaborative approach provides a key educational tool for developing disaster capacity, engaging ownership of the process, and the resulting improvements.
The on-going development of health facility and wider health system resilience must remain a key strategic focus of national governments and health authorities. The development of standardized procedures and guidelines must be embedded into daily practice.
To identify sources of phenotypic heterogeneity in attention-deficit/hyperactivity disorder (ADHD) accounting for diversity in developmental/ pathogenic pathways, we examined, in a large sample of youth (N = 354), (a) associations between observed temperamental emotionality at age 3, an electrocortical index (i.e., reward positivity [RewP]) of initial responsiveness to reward at age 9, and ADHD symptoms at age 12, and (b) whether the association between emotionality and ADHD symptoms is mediated by initial responsiveness to reward. Bivariate analyses indicated greater positive emotionality (PE) was associated with enhanced RewP, lower age-9ADHD and lower age-12 inattention (IA). Negative emotionality (NE) was not associated with RewP or ADHD. Mediation analyses revealed the association between PE and hyperactivity/impulsivity (H/I) was mediated by RewP; enhanced RewP was associated with greater H/I. Greater PE was associated with enhanced RewP at a trend level. These effects held accounting for age-9 ADHD, age-12 IA and age-12 oppositional defiant and conduct disorder symptoms. As such, preschool emotionality is associated with adolescent ADHD-H/I symptoms through late childhood initial responsiveness to reward. These relations indicate that individual differences in emotionality and reward responsiveness may be informative for personalizing ADHD interventions.
Manuscripts pertaining to paediatric cardiology and CHD have been published in a variety of different journals. Some of these journals are journals dedicated to paediatric cardiology, while others are focused on adult cardiology. Historically, it has been considered that manuscripts published in journals devoted to adult cardiology have greater citation potential. Our objective was to compare citation performance between manuscripts related to paediatric cardiology and CHD published in paediatric as opposed to adult cardiology journals.
We identified manuscripts related to paediatric cardiology and CHD published in five journals of interest during 2014. Of these journals, two were primarily concerned with adult cardiology, while the other three focused on paediatric cardiology. The number of citations for these identified manuscripts was gathered from Google Scholar. We compared the number of citations (median, mean, and 25th, 75th, 90th, and 95th percentiles), the potential for citation, and the h-index for the identified manuscripts.
We identified a total of 828 manuscripts related to paediatric cardiology and congenital heart as published in the 5 journals during 2014. Of these, 783 (95%) were published in journals focused on paediatric cardiology, and the remaining 45 (5%) were published in journals focused on adult cardiology. The median number of citations was 41 in the manuscripts published in the journals focused on adult cardiology, as opposed to 7 in journals focused on paediatric cardiology (p < 0.001). The h-index, however, was greater for the journals dedicated to paediatric cardiology (36 versus 27).
Approximately one-twentieth of the work relating to paediatric cardiology and CHD is published in journals that focus predominantly on adult cardiology. The median number of citations is greater when manuscripts concerning paediatric cardiology and CHD are published in these journals focused on adult cardiology. The h-index, however, is higher when the manuscripts are published in journals dedicated to paediatric cardiology. While such publications in journals that focus on adult cardiology tend to generate a greater number of citations than those achieved for works published in specialised paediatric cardiology journals, the potential for citation is no different between the journals. Due to the drastically lower number of manuscripts published in journals dedicated to adult cardiology, however, median performance is different.
Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements.
The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare.
Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals.
The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.
An interesting and original contribution to comparative criminal law scholarship [...] This book is a valuable addition to this important new body of scholarship.' -- Andrew Cornford, The Edinburgh Law Review, 2020. The Limits of Criminal Law shines light from the outer edges of the criminal law in to better understand its core. From a framework of core principles, different borders are explored to test out where criminal law's normative or performative limits are, in particular, the borders of crime with tort, non-criminal enforcement, medical law, business regulation, administrative sanctions, counter-terrorism and intelligence law. The volume carefully juxtaposes and compares English and German law on each of these borders, drawing out underlying concepts and key comparative lessons. Each country offers insights beyond their own laws. This double perspective sharpens readers' critical understanding of the criminal law, and at the same time produces insights that go beyond the perspective of one legal tradition. The book does not promote a single normative view of the limits of criminal law, but builds a detailed picture of the limits that exist now and why they exist now. This evidence-led approach is particularly important in an ever more interconnected world in which different perceptions of criminal law can lead to profound misunderstandings between countries. The Limits of Criminal Law builds picture of what shapes the criminal law, where those limits come from, and what might motivate legal systems to strain, ignore or strengthen those limits. Some of the most interesting insights come out of the comparison between German systematic approach and doctrinal limits with English law's focus on process and judgment on individual questions. Matthew Dyson is an Associate Professor in the Faculty of Law, University of Oxford. He is an associate member of 6KBW College Hill Chambers, a Research Fellow of the Utrecht Centre for Accountability and Liability Law and Vice President of the European Society for Comparative Legal History. Benjamin Vogel is Senior Research Fellow at the Max Planck Institute for Foreign and International Criminal Law in Freiburg, Germany. He is Assistant Editor of the Foreign Review of the Zeitschrift für die gesamte Straf-rechtswissenschaft.
The volume began by asking what the limits of criminal law are. Having examined the core principles of the criminal law of England and Wales and of Germany, as well as seven areas where the criminal law meets and interacts with other areas of law, what then are its limits?
This concluding chapter will turn to reflect on what insights the volume offers about the criminal law generally, and in particular in both the English and German legal systems. It will do so with more explicit references to how the criminal law affects and is affected by the culture of legal actors and wider societal values in each legal system. After some brief preliminary observations on the meaning of criminal law enforcement, this conclusion will first focus on the higher-order features of criminal law itself. As the preceding chapters have shown, the criminal laws of the two jurisdictions differ in many ways, but they also share many similarities. While the law is a product partly of a country's legal culture and its history, the law in both jurisdictions, despite many important differences, aims at overall largely similar objectives and, in order to reach these objectives, has to overcome similar hurdles and accommodate similar concerns. Those similarities might be thought of as higher-order features of the criminal law, or of law more generally, and clarity about them allows us to contextualise the findings. In particular, it assists with finding and analysing functional equivalents, seeing whether they differ in substance or only in form, and, combined with good comparative law techniques, helps prevent projecting one system's reasoning or rules onto another’s, as well as the discrepancies of language and cultural predispositions of the individual observer. After having examined those general features, this chapter will then discuss those key features of the two domestic legal systems explored in this volume that, in view of the editors, have particular relevance for explaining the sometimes stark differences. Consequently, these concluding reflections do not focus on the details of how each law answers specific questions, but their aim is to contextualise the more detailed findings of the paired chapters and conclusions. It is hoped that the reader will finish the book with a wealth of material, and a sharpened sense of what criminal law is and what limits it.
This book represents the work of a community of criminal lawyers connected to the University of Oxford and the Max Planck Institute for Foreign and International Criminal Law in Freiburg, and there are many people who deserve thanks for it coming to life on the page. While the editors were lucky to work with such talented and diligent authors, they were particularly lucky to have the sage guidance of Ulrich Sieber, Director at the Max Planck Institute. From the English side, Lucia Zedner, Rebecca Williams and Grant Lamond also helped in numerous ways, from logistics to detailed discussions of the finer points making a book about criminal law. The funding for the two workshops came from the Research Support Fund of the Faculty of Law, University of Oxford, and from the Max Planck Institute, to whom all participants in the project are very grateful. The project benefitted greatly from the assistance of Anna Riddell-Roberts in preparing the texts, and in bringing the book from ideas through to the hands of readers, the wonderful team at Intersentia, with Ann-Christin Maak-Scherpe and Rebecca Moffat deserving particular thanks.
What characterises criminal conduct? Few questions have more obvious relevance when inquiring into the limits of criminal law, yet answers are far from evident. The introductory pair of chapters of this volume already briefly addressed limits on criminalisation in both jurisdictions and indicated that, at least at the level of constitutional law, Parliament enjoys broad discretion. The preceding pair of chapters further investigates this topic by looking at what limits to substantive criminal law might be implicit in how the criminal law operates, even if these limits are not formulated as such by constitutional law. To this end, the two chapters look at the relationship between criminal law and regulatory law, the latter being an area of law where legislative recourse to the criminal law is, for various reasons, often controversial. Regulation is here understood as sets of norms that the state uses to organise particular sectors of social life, providing conditions which individuals or private legal entities need to meet in order to operate within that particular sphere. In addition to a set of norms governing the behaviour of the private operators, regulatory regimes will normally include regulatory agencies which organise operations though measures such as licences, prohibitions and supervisory controls. To enforce regulatory norms, the state will often make use of sanctions. Two questions then arise: first, whether such sanctions are or should be part of the criminal law; and second, whether regulation is or should, alternatively or complementarily, be enforced through some kind of non-criminal sanctions, that is a sanctions regime outside the criminal law the function and principles of which might (partially) differ from the criminal law. Both questions presuppose criteria to distinguish criminal from non-criminal wrongdoing and thereby inquire into the very core of criminal law's normative identity.
WHAT THE LIMITS ARE LIMITING
In trying to understand the normative limits applied within criminal law and regulation, we face a problem. At first glance the two jurisdictions are somewhat unlikely comparators for the question at hand, for only German law formally recognises a distinct category of non-criminal regulatory offences.
In many areas of life, the state enforces the law through sanctions imposed by administrative agencies without prior judicial involvement. Such sanctions can take many forms, most notably fines, but also for example the confiscation of assets, restrictions on or the complete withdrawal of professional licences, debarment from public tenders, or even publically naming and shaming people or companies by blacklisting them. Administrative sanctions can apply to very broad sectors of public life, as seen in the example of the enforcement of road traffic rules, but also to narrower, more specialised areas, in particular the enforcement of economic regulation by supervisory authorities like financial market regulators or consumer protection supervisors. While administrative sanctions can in many cases overlap with the criminal law, the present pair of chapters has demonstrated that they do in fact constitute a distinct category of enforcement in that they differ in fundamental ways from the imposition of sanctions by criminal courts following a trial. Given these differences, administrative sanctions, by implication, provide important insights into the nature of the criminal process. In addition, administrative sanctions highlight questions about the legitimacy of sanctions being imposed by the executive, especially how far the state may have recourse to administrative sanctions as opposed to criminal enforcement.
WHAT THE LIMITS ARE LIMITING
As the present pair of chapters shows, a major difference between the two jurisdictions appears at the level of the substantive law, in that only Germany recognises administrative sanctions as an independent category of sanctions and keeps them strictly outside the criminal law. In contrast to the situation under English law, but very much in line with the general approach in German law of focusing primarily on substance and only to a lesser extent on procedure, the categorisation is thus dependent on the formal classification of an offence, not on who imposes the sanctions. On closer inspection, the substantive dichotomy in German law reflects the German understanding that criminal and administrative sanctions serve categorically different purposes.
Unlike English law, German law differentiates between criminal offences and regulatory offences, and allows for the imposition of sanctions by administrative agencies only in the case of regulatory offences. Sieber demonstrates that this non-criminal category of offences does not preclude the imposition of sometimes very heavy fines, especially for serious economic wrongdoing.
‘Intelligence’, short for ‘intelligence operations’ or similar, usually describes covert forms of state action, in particular, though not exclusively, the collection of information through covert means. While such activities are primarily the domain of intelligence services, covert measures might also be performed by other state bodies, especially police authorities. As explained by Arslan, the distinction between criminal law and intelligence thus does not always correlate with the institutional distinction between criminal justice and police on the one hand and intelligence services on the other hand. At the core of the distinction are differences in modes of operation: whereas interaction between citizens and the state usually happens openly and transparently and thus allows for review in a court of law, intelligence is characterised by a culture of secrecy and usually operates outside the institutional sphere of police, prosecutors and, more generally, the courts. However, as shown in this volume, especially by the chapters on terrorism, the role of covert investigations in the enforcement of criminal law is today increasing in scope and relevance: both the police and intelligence services are using covert investigative methods in their efforts to prevent and respond to crime. The preceding pair of chapters offers a fascinating perspective into how in many different ways the two legal orders define the role of intelligence services as regards criminal justice. The comparative perspective also exemplifies how history impacts on today's legal frameworks in that German law continues to be clearly influenced by the country's experiences with immensely powerful secret services under the Third Reich and in communist East Germany. By contrast, the English experience is more nuanced, having experienced smaller-scale domestic terrorism for decades but not the response of the pervasive use of state apparatus of surveillance, let alone direct control.
While covert measures by the state are today widely recognised as a necessity for addressing serious crime, the hallmarks of such activities do in many ways radically depart from the standards of the criminal law and today in both England and Germany urgently raise questions of how to define the boundaries between intelligence and criminal law enforcement.
WHAT THE LIMITS ARE LIMITING
The use of intelligence points to several key normative limits of criminal justice.
Terrorism offences ‘sit at the very limits’: the limits here mean not only a physical, liminal space, but also on the edge of the conceptual brakes or constraints the criminal law can apply. There are a number of key limitations, but the overarching question in the two chapters is where limits come from: are counter-terrorism purposes limited by rules of criminal law, constitutional law or something else, and how far can the fear of terrorism take us from our established structures of norms. One trend is away from the established legal categories, and their known abilities to limit the reach of the criminal law, and into a brave new world. However, what lies ‘beyond the limits of criminal liability’ differs by country.
In both England and Germany, counter-terrorism is not confined to the criminal law, but extends to other instruments, notably administrative preventive measures, immigration law and intelligence law. A large part of legal debates on terrorism and the law circles around two separate questions: on the one hand, whether those non-criminal measures effectively circumvent criminal law safeguards and whether the criminal law should therefore play a greater role; on the other hand, whether the adaptation of the criminal law to terrorist threats dilutes criminal law's safeguards and whether non-criminal measures should instead be given greater prominence in order to protect the integrity of the criminal law. What characterises both questions is the observation that the borders between the criminal law and other areas of law are increasingly blurred and that clear criteria for maintaining those borders and the respective safeguards they embody are often not clearly discernible.
In that light, probably the most significant difference between the two jurisdictions is the long-standing presence, in Germany, and the absence, in England and Wales, of a body of law known as police law. Police law has long historical roots and creates an important distinction from criminal law. Police law is proactive, and responds to dangerousness, rather than to past wrongdoing as the criminal law does. As further explained by Arslan and Brodowski in this volume, it is a category given meaning by its exclusively forward-looking preventive nature, framed and specified by an extensive jurisprudence of administrative courts and the Federal Constitutional Court.
The relationship between criminal law and tort law can help us understand how the limits of criminal law play out across a legal system. That relationship exemplifies what the limits of criminal law do, and how they try to do it.
First, exploring where the border between crime and tort has been thought to be, and why it developed, suggests that only in specific circumstances is it actually the limits of the criminal law which are determining the contours of liability. That is, lawyers think that it is punishment which requires limitation and punishment is most obviously a criminal law matter. A key question, then, is what matters are criminal, and what are part of another area of law, like tort. Yet English law has had a rough-and-ready approach to that question, found only in rules of procedure. That means that procedure both defines, and is limited by, criminal legal principles. The procedure and the outcome have been more important to the development of English law thus far, more so than substantive law itself. The substance of criminal law has developed only loosely in connection with the limitation of punishment, making that limit of criminal law less effective than might be thought.
Second, there is a complex collection of instances where criminal and civil law overlap and where they have been separated. Where, as is often the case, the same questions are being asked in criminal and civil law, there are many overlapping concepts and doctrines. In some cases, there is direct integration from one to the other. Yet in other cases, mostly questions of procedure, the ultimate possible outcome – the imposition of a penalty – has meant criminal forms have diverged from tort law.
Finally, the limits of the criminal law are sometimes circumvented by creating a hybrid institution, part criminal and part civil. Given that the need to justify punishment has had a stronger effect on rules of procedure, it is not surprising that the most notable hybrids are procedural, attempting to evade the full force of the limit on punishment. This chapter will look at criminal hybrids, like compensation and confiscation in criminal courts, and civil hybrids, like injunctions to prevent breaches of the criminal law and punitive damages.
Our opening two chapters capture the value criminal lawyers in each jurisdiction place on limits within the criminal law. The content of those limits is what a national lawyer would recognise and the terminology, though made accessible to those from other legal systems, conveys how the issues are framed by and for those legal actors. The core principles discussed in these two chapters will be picked up throughout the rest of this volume. They are essential reading for readers of this volume just as much as they are essential knowledge for legal actors within the criminal justice system of each jurisdiction. Each legal system structures and values those principles differently and this brief comparative conclusion cannot explore them all. This comparative conclusion will draw out some of the key limits and explore what characteristics those limits suggest for each system. It will do so by first considering what is being limited and two categories are useful here: the criminal law's normative limits – how its principled constraints are placed, or chafed against, within the criminal law, or put another way, that which demarcates criminal principles from some other area of law; and then, its performative limits – the practical constraints on the effectiveness of the law, and the practical reasons why the limits themselves might not contain the criminal law. The final section of this conclusion will look at the nature of the limits teased out in the two chapters on general principles: how they are perceived, how they shape the law and how they interrelate to each other.
WHAT THE CORE PRINCIPLES ARE LIMITING
The normative limits of criminal law explored in this pair of chapters have a great deal in common. Each aim would be recognised by lawyers in each system, though the form of those limits, and how strictly that form must be adhered to, vary significantly. We might usefully distinguish between substantive law, criminal procedure and the sanctions the systems impose.
Both chapters give numerous examples of substantive principles, like legal certainty, the importance of moral stigma through to agency and culpability, and the role of doctrinal concepts of fair attribution in giving shape to legislative and judicial development of the law. These principles appear to be defined in similar ways, often virtually identical ways, and are used to do the same work in broadly the same way.
The preceding pair of chapters shows neatly how stepping outside the criminal trial, and its limits, can raise powerful questions about what the criminal law is. First, we might start with a definition of alternative enforcement. Alternative measures of the enforcement of criminal prohibitions are those state encroachments on liberty which, despite being based on the commission of a criminal offence or a mere suspicion of one having been committed, are not the outcome of a criminal trial. These non-trial dispositions help us understand the criminal law's scope and enforcement. They also highlight its limits, since not only might alternative instruments inside criminal justice unduly depart form criminal law principles, but alternative mechanisms outside criminal justice might also effectively lead to a circumvention of criminal law safeguards.
WHAT THE LIMITS ARE LIMITING
Turning first to the normative limits of the criminal law, alternative sanctions raise important questions about the scope and purpose of the law. In particular, they engage with the role of prevention within the criminal law, and closely related to this, about the equal treatment of suspects and the risk that prevention-oriented sanctions might lead to arbitrary curtailment of liberty.
Alternative measures also force lawyers to define criteria for differentiating criminal from non-criminal instruments in order to impede inappropriate circumventions of criminal safeguards.
Most commonly, alternative enforcement mechanisms are simply a flexible and exclusively punitive response to the commission of a crime. This is especially so where the legislator creates diversions from the criminal trial, such as fixed penalty notices and conditional cautions in England or German penal orders. Whether through such diversions, or indeed after a trial, measures can also be motivated in part by preventive consideration. In diversions, this consideration is seen notably in English conditional cautions or German conditional non-prosecution agreements to the extent that such measures include rehabilitative conditions that aim to contribute to the future law-abidingness of the perpetrator. In contrast, some other enforcement measures are exclusively preventive in nature, in that they are not meant to respond to past crime but solely address the danger that the targeted person might commit crimes in the future.