bluuebunny/crossref_metadata_2025 huggingface dataset:
3. The freehold estate
Authors: Clarke Sandra , Greer Sarah
Published: August 2018

One of the most fundamental changes to land law made by the 1925 property legislation was the reduction of the number of legal estates in land to just two: the fee simple absolute in possession (freehold estate) and the term of years absolute (leasehold estate). This chapter focuses on the fee simple absolute in possession, which is the technical name for the freehold estate. It begins by considering each of the terms that make up the legal definition of legal freehold: the ‘fee simple absolute in possession’. Unless an estate satisfies each part of it, the estate cannot be a legal freehold, but must instead be an equitable interest in land. The discussions then turn to the creation and transfer of the legal freehold.
6. Adverse possession
Authors: Clarke Sandra , Greer Sarah
Published: August 2018

This chapter discusses the law on adverse possession. It first considers arguments for and against allowing adverse possession. It then describes changes in the law of adverse possession and outlines the main statutory provisions, namely the Limitation Act 1980, the Land Registration Act 1925, and the Land Registration Act 2002. Next, the chapter discusses what a squatter needs to show to make a claim to the land; the influence of human rights law on adverse possession; and the effects of adverse possession. The old scheme under the Limitation Act 1980 and the new scheme under the Land Registration Act 2002 are compared.
2. Interests in land
Authors: MacKenzie Judith-Anne , Nair Aruna
Published: August 2018

Course-focused and comprehensive, the Textbook on Land Law provides an accessible overview of one key area on the law curriculum. This chapter explains how one person may have rights over land owned by another. It identifies the people who may have rights over Trant House—rights that could be enforced not only against Vernon, the fee simple owner, but also against anyone who acquires the property from him. The discussions cover interests in land; legal interests; equitable interests; legal and equitable interests compared; the multiplicity of rights; the classification of property; and human rights.
13. Express and implied trusts
Authors: MacKenzie Judith-Anne , Nair Aruna
Published: August 2018

Course-focused and comprehensive, the Textbook on Textbook on Land Law provides an accessible overview of one key area on the law curriculum. This chapter provides an outline of certain matters relating to trusts of land. It covers the separation of title and enjoyment; express and implied trusts; statutory trusts; and the pre-1997 methods of creating settlements of land, which are now replaced by the new trust of land under the Trusts of Land and Appointment of Trustees Act 1996. In addition, the chapter includes a more detailed account of resulting and constructive trusts.
3. Medical Negligence
Authors: Herring Jonathan
Published: August 2018

This chapter examines the legal and ethical aspects of medical negligence. It begins with an overview of the law and medical malpractice. It then discusses the law of negligence; the law of contract; medical malpractice litigation in practice; legal costs; the perception that medical negligence litigation is unsatisfactory; the NHS Redress Act 2006; the ‘no fault’ scheme; and the law governing medicines. The law in this area seeks to strike a balance between ensuring patients receive compensation if they have been harmed as a result of bad treatment, and allowing doctors professional freedom to determine which treatment is most appropriate for a particular condition.
4. Consent to Treatment
Authors: Herring Jonathan
Published: August 2018

This chapter examines the legal and ethical aspects of treating a patient without consent. It considers the meaning of ‘consent’ and the position of patients who lack the capacity to consent. For children who lack capacity, consent involves a delicate balance between the rights of the children and those of their parents. For adults lacking capacity, the Mental Capacity Act 2005 has emphasized the ‘best interests’ test, but has largely left open the question of how a person’s best interests are to be ascertained. The chapter also considers what weight should be attached to advance decisions (sometimes called living wills).
6. Contraception, Abortion, and Pregnancy
Authors: Herring Jonathan
Published: August 2018

This chapter examines the legal and ethical aspects of contraception, abortion, and pregnancy. Topics discussed include the use and function of contraception; the availability of contraception; teenage pregnancy rates; tort liability and contraception; ethical issues concerning contraception; the law on abortion; the legal status of the foetus; abortion ethics; and controversial abortions. A major current issue is the extent to which, if at all, the criminal law should be involved in the law of abortion. The chapter also considers arguments on legal interventions for pregnant women; for example, imprisoning a drug-using mother to ensure that her unborn child does not suffer from the consequences of her drug use.
9. Dying and Death
Authors: Herring Jonathan
Published: August 2018

This chapter examines the legal and ethical aspects of death. It begins with a discussion of the difficulty of the choosing a definition of ‘death’. It then sets out the law on a range of ‘end-of-life issues’, including euthanasia, assisted suicide, and refusal of medical treatment. It considers some particularly complex cases in which the law is not always easy to apply. These include the administration of pain-relieving drugs, the treatment of severely disabled newborn children, and the position of patients suffering from PVS. Next, the chapter considers the ethical debates surrounding euthanasia, assisted suicide, and terminating treatment. This is followed by a discussion of palliative care and hospices.
The Modern Law of Evidence
Authors: Keane Adrian , McKeown Paul
Published: August 2018

The Modern Law of Evidence is a comprehensive analysis of the law of criminal and civil evidence and the theory behind the law. It identifies all the key issues, emphasizes recent developments and insights from the academic literature, and makes suggestions for further reading. The work begins with a definition of evidence and the law of evidence and an outline of its development to date. It then describes and analyses the key concepts, such as the facts open to proof, the forms that evidence can take, relevance, admissibility, weight and discretion, including the discretion to exclude evidence obtained by illegal or unfair means. It then proceeds to cover in a logical sequence all aspects of the subject: the burden and standard of proof, witnesses, examination-in-chief, cross-examination and re-examination, corroboration and care warnings, documentary and real evidence, identification evidence, hearsay, confessions, adverse inferences from an accused’s silence, evidence of good and bad character, opinion evidence, public policy, privilege, judgments as evidence of facts on which they were based, and the proof of facts without evidence.
Employment Law in Context
Authors: Cabrelli David
Published: August 2018

Employment Law in Context combines extracts from leading cases, articles, and books with commentary to provide a full critical understanding of employment law. As well as providing a grounding in individual labour law, this title offers detailed analysis of the social, economic, political, and historical context in which employment law operates, drawing attention to key and current areas of debate. An innovative running case study contextualizes employment law and demonstrates its practical applications by following the life-cycle of a company from incorporation, through expansion, to liquidation. Reflection points and further reading suggestions are included. The volume is divided into eight main Parts. The first Part provides an introduction to employment law. The next Part looks at the constitution of employment and personal work contracts. This is followed by Part III which examines the content of the personal employment contract and the obligations imposed by the common law on employers and employees. The fourth Part is about statutory employment rights. The fifth Part covers equality law. Part VI looks at the common law and statutory regulation of dismissals. The Part that follows considers business reorganizations, consultation, and insolvency. Finally, Part VIII describes collective labour law.
9. Entry for work, business, and study: the points-based system
Authors: Clayton Gina , Firth Georgina , Sawyer Caroline , Moffatt Rowena , Wray Helena
Published: August 2018

Course-focused and comprehensive, the Textbook on series provides an accessible overview of the key areas on the law curriculum. This chapter deals with the law relating to entry for work, self-employment, and study. These are the areas covered by the points-based system (PBS), which was implemented from 2008. The chapter is organized around the five tiers of the PBS but makes reference to some of the old rules as well as provides some historical perspective. It also considers those few schemes remaining outside the PBS, including the conditions attached to migrant domestic workers and the problems and risks they face. Briefly, the chapter discusses illegal working.
14. Detention
Authors: Clayton Gina , Firth Georgina , Sawyer Caroline , Moffatt Rowena , Wray Helena
Published: August 2018

Course-focused and comprehensive, the Textbook on series provides an accessible overview of the key areas on the law curriculum. This chapter focuses on the issue of immigration detention. The deprivation of liberty is one of the most serious infringements of fundamental human rights. In immigration law, individuals lose their liberty through the exercise of a statutory discretion by the Home Office or immigration officers. The chapter considers the statutory powers and executive guidelines, together with human rights and common law rules. The use of detention is an increasingly common phenomenon in the asylum process, and the key role of immigration bail is examined. The former use of indefinite detention for foreign terrorist suspects is discussed at the end of the chapter.
2. The Union institutions
Authors: Foster Nigel
Published: August 2018

This chapter focuses on the institutions responsible for executing the different tasks of the European Union (EU). The main seven institutions are complemented by two advisory bodies, the Committee of the Regions and the European Economic and Social Committee (EESC), which are responsible for gathering inputs for use in decision-making. The initial institutions of the Commission, Council, European Parliament, and Court of Justice were expanded to five to include the European Council, Court of Auditors, and the European Central Bank in 2009 with the entry into force of the Maastricht and the Lisbon Treaties. This chapter also describes the roles and responsibilities of the institutions, including the Council of Ministers of the European Union, the European Parliament, and the European Court of Justice (CoJ).
4. Sources and forms of EU law
Authors: Foster Nigel
Published: August 2018

This chapter examines the forms and sources of European Union (EU) law. It describes the nature of the EU legal system and discusses the classification of various elements of EU law, which include institutional laws, procedural laws, and substantive laws. It explains that the Treaty on European Union (TEU) and the Treaty on the Functioning of the European Union (TFEU) are the principal sources of law for the Union. Other sources include regulations, Directives, procedural requirements, and international agreements and conventions. This chapter also discusses the contribution of the European Court of Justice (CoJ) to the sources of EU law.
7. Treaty enforcement actions against member states
Authors: Foster Nigel
Published: August 2018

This chapter examines the enforcement of legal actions against member states in violation of the provisions of the Treaty on the Functioning of the European Union (TFEU). It explains what constitutes a breach of TFEU provisions and the process of identifying and reporting violations. It provides examples of the procedures involved in breaches of Articles 258, 260, 259, and 278–279 of the TFEU. This chapter also considers the actions brought by one member state against another, suspensory orders, and interim measures, and describes alternative actions that can help secure compliance by member states.
8. Remedies: direct and indirect effects and state liability
Authors: Foster Nigel
Published: August 2018

This chapter examines the remedies developed by the European Court of Justice (CoJ) for member states who violate European Union (EU) laws. It considers the concept of direct applicability and reviews the development of the doctrine of direct effects through an analysis of case law. The chapter proposes ways for overcoming the lack of horizontal effect for EU Directives to avoid the result of the ‘Marshall’ ruling and discusses state liability in the CoJ cases ‘C-6’ and ‘9/90 Francovich’. It also considers national procedural law and the system of remedies developed by the CoJ.
10. Free movement of goods I: tariff and tax barriers
Authors: Foster Nigel
Published: August 2018

This chapter examines European Union (EU) law concerning tariff and tax barriers. It explains the legislative provisions of the Treaty on the Functioning of the European Union (TFEU) for the free movement of goods and those of secondary legislation. The coverage of the TFEU provisions includes customs duties and charges having equivalent effect, the Common Customs Tariff, and the equivalent measures with equivalent effects on exports and imports. This chapter also evaluates the progress towards the achievement of the goals of the Treaty and discusses the establishment of the internal market and the prohibition of discriminatory taxation.
1. Introduction
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: August 2018

This introductory chapter traces the development of the European Union. Since its inception in 1952 the EU has matured and developed from a Community of like-minded States into a Union of a greater diversity of states, with a comprehensive legal system which is increasingly penetrating the national legal systems of Member States. From the six original members, the EU now counts 28 Member States, after Croatia’s recent accession. Eleven of the thirteen States which have joined in the last decade are in Central and Eastern Europe and have discarded their old Communist regimes, turning into democracies with the qualifications to join the Union.
2. The constitutional base of the Union
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: August 2018

This chapter discusses the Treaties which together represent the primary law of the European Union; its constitutional base. These include the Single European Act 1986; the Treaty on European Union (the Maastricht Treaty) 1993; the Treaty of Amsterdam (signed June 1997, entered into force 1 May 1999); the Nice Treaty (adopted December 2001, entered into force 1 February 2003); and the Treaty of Lisbon (signed December 2007, entered into force 1 December 2009).
9. Free movement of goods (I): the abolition of customs duties and internal taxation
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: August 2018

This chapter reviews the law on the free movement of goods in the EU. It discusses the following: the customs union; the free movement of goods provisions in the Treaty on the Functioning of the European Union; customs duties and common customs tariffs; charges having equivalent effect to a customs duty; and charges falling within the scope of internal taxation.
11. Free movement of services: the freedom to provide and receive services
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: August 2018

This chapter reviews the law on the free movement of services in the European Union. It discusses the service economy and the law on services; non-discrimination and the direct effect of Article 56 of the TFEU; the meaning of services; remuneration; economic services and other activities; services and cross-border activity; the freedom to provide a service; the freedom to receive services; health care provision and the receipt of services; services that move, where the provider and recipient do not; limitations on services freedom; public interest grounds limiting the freedom of Article 56 TFEU; proportionality and limitations on services; illegal services; and the focus on market access and the facilitation of services in the Services Directive.
13. Citizenship and free movement rights: beyond economic links
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: August 2018

This chapter reviews citizenship and free movement rights in the EU. It first discusses the Charter of Fundamental Rights, the European Convention on Human Rights, the Citizenship Directive, and the principle of equal treatment. It then considers the facets of citizenship, the European Citizens’ Initiative, and problems with citizenship.
1. Introduction
Authors: Abbey Robert M. , Richards Mark B.
Published: August 2018

This introductory chapter begins with an overview of conveyancing, which is the process by which legal title to property is transferred. It then discusses the conveyancing of registered land; defensive lawyering and the conveyancing process; conveyancing and information technology; and the future of conveyancing.
12. Commercial conveyancing
Authors: Abbey Robert M. , Richards Mark B.
Published: August 2018

This chapter focuses on commercial conveyancing, which involves the granting and renewal of business (or commercial) leases as well as the buying and selling of properties that are let to business occupants. It first considers revenue matters then turns to the key commercial area that most conveyancers will encounter in practice, the review of the contents of a commercial lease. The final section is devoted to the particular requirements a practitioner must bear in mind when acting for a client who is selling or buying a tenanted property. It also considers the Standard Commercial Property Conditions (SCPC) being commercial specific standard contractual terms.
11. Cross-Border Banking
Authors: Cranston Ross , Avgouleas Emilios , van Zweiten Kristin , van Sante Theodor , Hare Christoper
Published: August 2018

This chapter first sets out seven cases that illustrate some of the legal problems arising from international banking. Many of these cases are not new, nor are most confined to banking. The chapter outlines of how these problems have been handled followed by an examination of the broader principles underlying the resolution of the harder cases. Comity, balancing, cooperation, and harmonization are considered. Jurisdictional clashes over banking matters continue to occur. Some are resolvable in accordance with established legal doctrine, some in accordance with bilateral and multilateral agreements between states. There remains a question mark over how much is achievable in reducing the conflict by pursuing notions of jurisdiction, comity, and the balancing of interests. Rather, shared concerns on substantive issues, such as money laundering and terrorist financing, are more likely to lead to deference by, and cooperation between, jurisdictions.
12. Principles of Payment
Authors: Cranston Ross , Avgouleas Emilios , van Zweiten Kristin , van Sante Theodor , Hare Christoper
Published: August 2018

Payment and banking generally go hand-in-hand. Except for relatively small-value transactions, where cash, payment cards, and, increasingly, forms of e-money are used, payments are usually made through the banking system. This chapter analyzes some of the legal problems arising with payment through the banking system. The first section sketches the basic elements of payment and the way banks make payment. The second section turns to some specific issues — how payment obligations are discharged, whether payment instructions can be countermanded, the availability of funds to payees, and the completion of payment as between banks. The third section examines clearing and settlement systems. In the main the focus of this chapter is on large payments, rather than retail payments.
17. International Payment Systems and Trade Finance
Authors: Cranston Ross , Avgouleas Emilios , van Zweiten Kristin , van Sante Theodor , Hare Christoper
Published: August 2018

This chapter discusses two distinct but inter-related issues. The first part considers the general ways in which payment may be effected internationally or across borders in respect of any type of consumer or commercial contract. In many ways, the analysis builds upon the discussion in the earlier chapter dealing with domestic payment systems and limits itself to highlighting the additional issues or concerns that arise when such systems are used to effect an international or cross-border payment. The second part analyses the specialist mechanisms designed to facilitate payment in the trade finance context in particular. Some of the issues surrounding international messaging and transfer systems, such as SWIFT and TARGET, have already been considered.
Low-value clinical practices and harm caused by non-adherence to ‘do not do’ recommendations in primary care in Spain: a Delphi study
Authors: Mira José Joaquín , Caro Mendivelso Johanna , Carrillo Irene , González de Dios Javier , Olivera Guadalupe , Pérez-Pérez Pastora , Nebot Cristina , Silvestre Carmen , Agra Yolanda , Fernandez Ana , Valencia-Martín José L , Ariztegui Ana , Aranaz Jesús ,   SOBRINA Research Team
Published: August 2018

Objective

To determine the non-adherence to the primary care ‘do not do’ recommendations (DNDs) and their likelihood to cause harm.

Design

Delphi study.

Setting

Spanish National Health System.

Participants

A total of 128 professionals were recruited (50 general practitioners [GPs], 28 pediatricians [PEDs], 31 nurses who care for adult patients [RNs] and 19 pediatric nurses [PNs]).

Interventions

A selection of 27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs were included in the Delphi technique. A 10-point scale was used to assess whether a given practice was still present and the likelihood of it causing of an adverse event.

Main outcome measure

Impact calculated by multiplying an event’s frequency and likelihood to cause harm.

Results

A total of 100 professionals responded to wave 1 (78% response rate) and 97 of them to wave 2 (97% response rate). In all, 22% (6/27) of the practices for GPs, 12% (1/8) for PEDs, 33% (3/9) for RNs and none for PNs were cataloged as frequent. A total of 37% (10/27) of these practices for GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36 points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or delirium in elderly patients (mean = 57.8, SD = 25.3).

Conclusions

Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.
The ceroplastic collection of the Royal Veterinary School in Madrid: a history waiting to be recovered
Authors: Sánchez de Lollano Prieto Joaquín , Sánchez Ortiz Alicia
Published: August 2018

The principal aim of this article is to raise awareness of a collection whose singular nature endows it with enormous heritage value. It presents a historiographical and artistic analysis of the collection of wax models formed at the Royal Veterinary College in Madrid in the period from 1793 to 1863 and currently preserved in the Complutense Veterinary Museum. The data extracted from primary documentary sources, such as the records from the old school which have been preserved, have been verified using secondary bibliography, complemented by scientific observations on the sculptures in question. The results obtained have enabled us to reconstruct the history of the creation and functioning of the ‘Waxworks Laboratory’, to identify the manufacturers and the technical choices they made, to date each model, and to determine the reasons behind the loss of a significant number of them.
Cancer Risk in Myotonic Dystrophy Type I: Evidence of a Role for Disease Severity
Authors: Alsaggaf Rotana , St. George Diane Marie M , Zhan Min , Pfeiffer Ruth M , Wang Youjin , Wagner Kathryn R , Greene Mark H , Amr Sania , Gadalla Shahinaz M
Published: August 2018

Background

Myotonic dystrophy type 1 (DM1) is an inherited trinucleotide repeat disorder in which specific cancers have been implicated as part of the disease phenotype. This study aimed to assess whether cancer risk in DM1 patients is modified by disease severity.

Methods

Using the United Kingdom Clinical Practice Research Datalink (primary care electronic medical records), we identified a cohort of 927 DM1 and a matched cohort of 13 085 DM1-free individuals between January 1, 1988 and February 29, 2016. We used Cox regression models to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of organ-specific cancer risks. Analyses were stratified by age at DM1 diagnosis as a surrogate for disease severity. Statistical tests were two-sided.

Results

Patients with classic DM1 (age at diagnosis: 11–40 years) were at elevated risk of cancer overall (HR = 1.81; 95% CI = 1.12 to 2.93); cancers of the thyroid (HR = 15.93; 95% CI = 2.45 to 103.64), uterus (HR = 26.76; 95% CI = 2.32 to 309.26), and cutaneous melanoma (HR = 5.98; 95% CI = 1.24 to 28.79) accounted for the excess. In late-onset DM1 patients (age at diagnosis >40 years), a reduced overall cancer risk was observed (HR = 0.53; 95% CI = 0.32 to 0.85), possibly driven by the deficit in hematological malignancies (DM1 = 0 cases, DM1-free = 54 cases; P = .02). The difference between the observed HR for classic and late-onset DM1 was statistically significant (P < .001).

Conclusions

The observed difference in relative cancer risk between classic and late-onset DM1 patients compared with their DM1-free counterparts provides the first evidence that disease severity modifies DM1-related cancer susceptibility. This novel finding may guide clinical management and scientific investigations for the underlying molecular mechanisms in DM-related carcinogenesis.
The obligations of Member States under the EU competition rules
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter examines the obligations of Member States in relation to EU competition law. Specifically, it considers the obligations that Article 4(3) TEU and Articles 37 and 106 TFEU place upon Member States. Article 4(3) requires all Member States to take all appropriate measures to ensure fulfilment of the obligations arising out of the Treaties, and to avoid any measure which could jeopardise the attainment of the EU’s objectives. Article 106 particularly obligates Member States to refrain from enacting or maintaining measures contrary to the rules provided in Article 18 and Articles 101 to 109 of the TFEU. Article 37 is concerned with the procurement of goods.
Articles 101 and 102: private enforcement in the courts of Member States
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter describes the private enforcement of Articles 101 and/or 102 as a matter of EU law, with particular emphasis on the Damages Directive. It also deals with the extensive experience of private actions in the UK courts. The chapter considers the use of competition law as a defence, for example to an action for breach of contract or infringement of an intellectual property right. The chapter concludes with a brief discussion of issues that can arise where competition law disputes are referred to arbitration rather than to a court for resolution.
Enterprise Act 2002: market studies and market investigations
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter describes the UK system of market studies and market investigation references. It begins by describing the CMA’s ‘general function’ of gathering information about markets, followed by an explanation of what is meant by a ‘super-complaint’. It examines the purpose, procedure and outcomes of market studies, including possible outcomes. Market studies sometimes lead to market investigation references, although there are several other possible outcomes of a market study. The chapter describes the making and determination of analyses and the market investigation provisions under Part 4 of the Enterprise Act 2002. Having briefly considered public interest cases, enforcement and other supplementary matters, the chapter discusses how the market investigation provisions have been working in practice. The final section of the chapter briefly refers to the enforcement and review of undertakings and orders still in force under the monopoly provisions in the former Fair Trading Act 1973.
The international dimension of competition law
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter explores the international dimension of competition law. Along with the introduction of the theory of extraterritoriality, sections 2 to 6 are concerned with two questions. The first issue is whether an offended country could apply its competition rules extraterritorially against an undertaking or undertakings in another country behaving anti-competitively. The second issue is whether there should be laws or so-called ‘blocking statutes’ to prevent the ‘excessive’ assertion of extraterritorial jurisdiction. However, the international dimension of competition law has undoubtedly evolved beyond these somewhat parochial concerns: the final section describes the work of international organisations, such as the International Competition Network (‘the ICN’), which encourages cooperation between competition authorities, and more importantly fosters convergence between competition policies, procedures and substantive analysis.
Horizontal agreements (1): cartels
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter is concerned with the prohibition of cartels, also referred to as ‘hard-core’ horizontal agreements. The chapter begins with a discussion of the widespread consensus among competition authorities worldwide that cartels should be condemned, and gives examples of recent enforcement that has led to the imposition of significant fines and sentences of imprisonment. It also looks at the European Commission’s enforcement activity in relation to cartels. The chapter then considers the application of Article 101 to particular types of cartels: price fixing, market sharing, production quotas and other hard-core cartel practices. The final section of the chapter looks at anti-cartel enforcement and judicial practice in the UK.
The relationship between intellectual property rights and competition law
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter considers the relationship between intellectual property rights and competition law. After a brief introduction, it deals in general terms with the application of Article 101 to licences of intellectual property rights. The chapter proceeds to discuss the provisions of Regulation 316/2014, the block exemption for technology transfer agreements. It also considers the application of Article 101 to various other agreements concerning intellectual property rights such as technology pools and settlements of litigation. This is followed by a section on the application of Article 102 to the way in which dominant undertakings exercise their intellectual property rights, including an examination of the controversial subject of refusals to license intellectual property rights which are sometimes found to be abusive. The chapter concludes with a look at the position in UK competition law.
Particular sectors
Authors: Whish Richard , Bailey David
Published: August 2018

This chapter deals with three issues. First it examines those sectors of the economy that are wholly or partly excluded from EU competition law, namely nuclear energy, military equipment and agriculture; the special regime for coal and steel products under the former European Coal and Steel Community (‘the ECSC’) Treaty is briefly referred to. Secondly, it describes how the EU competition rules apply to the transport sector. Finally, the chapter considers the specific circumstances of so-called ‘regulated industries’ such as electronic communications, post and energy and the way in which EU and UK competition law apply to them. Constraints of space mean that these matters can be described only in outline; references to specialised literature on the application of competition law to particular sectors will be provided where appropriate.
Implementation of an Alternative Pathway for Patients Seeking Care for Low Back Pain: A Prospective Observational Cohort Study
Authors: Magel John , Hansen Pamela , Meier Whitney , Cohee Kim , Thackeray Anne , Hiush Matthew , Fritz Julie M
Published: August 2018

Background

In the United States, low back pain (LBP) is among the most common symptoms prompting a health care visit. Patients can receive escalated care, such as advanced imaging or invasive procedures, before guideline-recommended options offered by physical therapists. A guideline-concordant alternative care pathway (RapidAccess) that emphasized early physical therapy for patients with LBP before they consulted a physiatrist was implemented. Evaluating the implementation of care pathways, such as RapidAccess using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, provides a broader understanding of the barriers to implementation.

Objective

The purpose of this study was to evaluate the implementation of a guideline-concordant care pathway for patients with LBP using a RE-AIM framework.

Design

This study used a prospective observational cohort design.

Methods

Patients with a chief complaint of LBP who were scheduling a new appointment with physiatry were eligible. Eligible patients chose whether or not to participate in RapidAccess before a consultation with a physiatrist. Implementation outcomes were evaluated using the RE-AIM framework.

Results

During the study period, 1556 patients with LBP called to schedule a new visit with a physiatrist. Of these, 400 (25.7%) were eligible for RapidAccess, and 124 (31% of those eligible) participated in the program (reach). Of the 400 eligible patients, 225 (56.3%) were offered RapidAccess (adoption). Compared with patients who were managed in physical therapy following a consultation with a physiatrist, RapidAccess participants demonstrated improvement in physical function with physical therapist management (effectiveness); 58.9% cancelled their physiatrist visit (implementation), and rates of imaging and injections were lower (effectiveness). Reach and adoption (maintenance) trended downward beyond the first 6 months of the project.

Limitations

The results are from a single health system and might not be broadly generalizable.

Conclusions

The RE-AIM framework was useful in evaluating the implementation of RapidAccess. Factors influencing reach and adoption must be further examined.
Atorvastatin, but not pravastatin, inhibits cardiac Akt/mTOR signaling and disturbs mitochondrial ultrastructure in cardiac myocytes
Authors: Godoy Joseph C. , Niesman Ingrid R. , Busija Anna R. , Kassan Adam , Schilling Jan M. , Schwarz Anna , Alvarez Erika A. , Dalton Nancy D. , Drummond John C. , Roth David M. , Kararigas Georgios , Patel Hemal H. , Zemljic-Harpf Alice E.
Published: August 2018

Statins, which reduce LDL‐cholesterol by inhibition of 3‐hydroxy‐3‐methylglutaryl–coenzyme A reductase, are among the most widely prescribed drugs. Skeletal myopathy is a known statin‐induced adverse effect associated with mitochondrial changes. We hypothesized that similar effects would occur in cardiac myocytes in a lipophilicity‐dependent manner between 2 common statins: atorvastatin (lipophilic) and pravastatin (hydrophilic). Neonatal cardiac ventricular myocytes were treated with atorvastatin and pravastatin for 48 h. Both statins induced endoplasmic reticular (ER) stress, but only atorvastatin inhibited ERK1/2T202/Y204, AktSer473, and mammalian target of rapamycin signaling; reduced protein abundance of caveolin‐1, dystrophin, epidermal growth factor receptor, and insulin receptor‐β; decreased Ras homolog gene family member A activation; and induced apoptosis. In cardiomyocyte‐equivalent HL‐1 cells, atorvastatin, but not pravastatin, reduced mitochondrial oxygen consumption. When male mice underwent atorvastatin and pravastatin administration per os for up to 7 mo, only long‐term atorvastatin, but not pravastatin, induced elevated serum creatine kinase; swollen, misaligned, size‐variable, and disconnected cardiac mitochondria; alteration of ER structure; repression of mitochondria‐ and endoplasmic reticulum–related genes; and a 21% increase in mortality in cardiac‐specific vinculin‐knockout mice during the first 2 months of administration. To our knowledge, we are the first to demonstrate in vivo that long‐term atorvastatin administration alters cardiac ultrastructure, a finding with important clinical implications.——Godoy, J. C., Niesman, I. R., Busija, A.R., Kassan, A., Schilling, J. M., Schwarz, A., Alvarez, E. A., Dalton, N. D., Drummond, J. C., Roth, D.M., Kararigas, G., Patel, H. H., Zemljic‐Harpf, A. E. Atorvastatin, but not pravastatin, inhibits cardiac Akt/mTOR signaling and disturbs mitochondrial ultrastructure in cardiac myocytes. FASEB J. 33, 1209–1225 (2019). www.fasebj.org
Transcatheter valve repair for mitral regurgitation
Authors: Lugiano Cheryl Ann
Published: August 2018

Mitral regurgitation is the most common valve disease in the United States. This article focuses on a new percutaneous mitral valve treatment for chronic degenerative mitral regurgitation.
Complicated appendicitis and considerations for interval appendectomy
Authors: Perez Kelly Sue , Allen Steven R.
Published: August 2018

Acute appendicitis is one of the most common surgical emergencies. Of the 300,000 appendectomies performed each year, 25% are due to complicated appendicitis. This article reviews the incidence and pathophysiology of acute appendicitis, the nonoperative management of complicated appendicitis, and the rationales for and against interval appendectomy.
Burnout, job satisfaction, and stress levels of PAs
Authors: Coplan Bettie , McCall Timothy C. , Smith Noël , Gellert Vivienne L. , Essary Alison C.
Published: August 2018

Objective:

The main goal of this study was to assess burnout, job satisfaction, and stress to gain insight into the work lives of female and male PAs.

Methods:

Data were obtained from the 2016 American Academy of PAs salary survey. Descriptive statistics were used to assess questions related to burnout, happiness, and stress and to compare responses by sex.

Results:

Analysis revealed that, in general, PAs experience modest levels of burnout but are happy at work. More than half (55.6%) rated spending too many hours at work as an important contributor to stress. A higher percentage of female PAs than male PAs (32.2% versus 25.6%) have quit a job due to stress.

Conclusions:

Overall, PAs rate aspects of work life favorably. Further research on factors that contribute to the PA work experience may help inform interventions aimed at improving job satisfaction among healthcare professionals.
Effects of plus-maze experience and chlordiazepoxide on anxiety-like behavior and serotonin neural activity in the dorsal raphe nucleus in rats
Authors: Grahn Ruth E. , Kalman Brian A. , Vlasaty Jennifer A. , Perna Jaclyn A. , Nevins-Herbert Christine , Patton Stephanie M. , Barison Leah K.
Published: August 2018

The extent to which rats express anxiety-like behavior on the elevated plus-maze (EPM) depends on their previous maze experience. Open-arm avoidance develops in maze-experienced rats, and is often accompanied by a diminished anxiolytic response to benzodiazepines. Regions of the dorsal raphe nucleus (DRN) were examined in male Sprague-Dawley rats using c-Fos and serotonin immunohistochemistry following a single exposure, a second exposure or no exposure to the EPM. We then examined the effect of the benzodiazepine anxiolytic chlordiazepoxide (CDP, 5 mg/kg) on EPM behavior and DRN neural activity. Enhanced open-arm avoidance was evident on the second EPM trial in both experiments. The observed pattern of c-Fos expression suggests that the first exposure to the maze activates serotonin cells in the rostral and dorsal regions of the DRN and that only the dorsal subregion is activated by a second exposure. CDP increased open-arm exploration during the first trial, which corresponded to decreased 5-hydroxytryptamine (5-HT) activity in the rostral and ventral subregions of the DRN. However, 5-HT activity in the DRN was reduced in rats on the second maze trial compared with the first trial, when CDP had no effect on open-arm exploration. These results suggest that open-arm avoidance in maze-experienced rats can be characterized as a coping response that is mediated by specific populations of 5-HT neurons in the DRN.
Attending Follow-up Appointments After Pediatric Traumatic Brain Injury: Caregiver-Perceived Barriers and Facilitators
Authors: Lever Kimberly , Peng Jin , Lundine Jennifer P. , Caupp Sarah , Wheeler Krista K. , Sribnick Eric A. , Xiang Henry
Published: August 2018

Objective:

To examine barriers and facilitators for follow-up care of children with traumatic brain injury (TBI).

Setting:

Urban children's hospital.

Participants:

Caregivers of children (aged 2-18 years) discharged from an inpatient unit with a TBI diagnosis in 2014-2015.

Design:

Survey of caregivers.

Main Measures:

Caregiver-reported barriers and facilitators to follow-up appointment attendance.

Results:

The sample included 159 caregivers who completed the survey. The top 3 barriers were “no need” (38.5%), “schedule conflicts” (14.1%), and “lack of resources” (10.3%). The top 5 identified facilitators were “good hospital experience” (68.6%), “need” (37.8%), “sufficient resources” (35.8%), “well-coordinated appointments” (31.1%), and “provision of counseling and support” (27.6%). Caregivers with higher income were more likely to report “no need” as a barrier; females were less likely to do so. Nonwhite caregivers and those without private insurance were more likely to report “lack of resources” as a barrier. Females were more likely to report “good hospital experience” and “provision of counseling and support” as a facilitator. Nonwhite caregivers were more likely to report “need” but less likely to report “sufficient resources” as facilitators.

Conclusions:

Care coordination, assistance with resources, and improvements in communication and the hospital experience are ways that adherence might be enhanced.
Cognitive Rehabilitation With Mobile Technology and Social Support for Veterans With TBI and PTSD: A Randomized Clinical Trial
Authors: Elbogen Eric B. , Dennis Paul A. , Van Voorhees Elizabeth E. , Blakey Shannon M. , Johnson Jacqueline L. , Johnson Sally C. , Wagner H. Ryan , Hamer Robert M. , Beckham Jean C. , Manly Tom , Belger Aysenil
Published: August 2018

Objective:

To investigate effects of cognitive rehabilitation with mobile technology and social support on veterans with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD).

Participants:

There were 112 dyads, comprised by a veteran and a family member or friend (224 participants in total).

Design:

Dyads were randomized to the following: (1) a novel intervention, Cognitive Applications for Life Management (CALM), involving goal management training plus mobile devices for cueing and training attentional control; or (2) Brain Health Training, involving psychoeducation plus mobile devices to train visual memory.

Main Measures:

Executive dysfunction (disinhibition, impulsivity) and emotional dysregulation (anger, maladaptive interpersonal behaviors) collected prior to randomization and following intervention completion at 6 months.

Results:

The clinical trial yielded negative findings regarding executive dysfunction but positive findings on measures of emotion dysregulation. Veterans randomized to CALM reported a 25% decrease in anger over 6 months compared with 8% reduction in the control (B = −5.27, P = .008). Family/friends reported that veterans randomized to CALM engaged in 26% fewer maladaptive interpersonal behaviors (eg, aggression) over 6 months compared with 6% reduction in the control (B = −2.08, P = .016). An unanticipated result was clinically meaningful change in reduced PTSD symptoms among veterans randomized to CALM (P < .001).

Conclusion:

This preliminary study demonstrated effectiveness of CALM for reducing emotional dysregulation in veterans with TBI and PTSD.
Correlation of Demarcation Line Depth With Medium-Term Efficacy of Different Corneal Collagen Cross-Linking Protocols in Keratoconus
Authors: Mesen Ali , Bozkurt Banu , Kamis Umit , Okudan Suleyman
Published: August 2018

Purpose:

To compare demarcation line depth (DD) and topographic changes among different corneal collagen cross-linking (CXL) protocols and to evaluate the relation of DD with medium-term efficacy of CXL in halting progression of keratoconus.

Methods:

The study included 124 patients (mean age 19 ± 4.8 years) with progressive keratoconus who underwent conventional (3 mW/cm2/30 min), accelerated (18 mW/cm2/5 min), or transepithelial (TE) CXL (3 mW/cm2/30 min) and followed up for at least 2 years. Baseline and final corneal topographic parameters and DD determined with anterior segment optical coherence tomography 1 month after CXL were compared among the protocols and the correlation between DD and topographic changes at the end of 24 months was analyzed. P < 0.05 was considered as statistically significant.

Results:

Mean DD was significantly higher in the conventional and accelerated groups (335.19 ± 71.13 μm and 304.97 ± 94.45 μm, respectively) compared with the TE group (239.92 ± 71.37 μm) (P < 0.001). After conventional and TE CXL, keratometric parameters improved remarkably, whereas accelerated CXL only lowered K1 and Kmax (P < 0.05). No correlation was found between DD and topographic changes (P > 0.05). Progression was detected in 3 eyes in the conventional group (4.1%), 3 in the accelerated group (7.7%), and none in the TE group. The use of either riboflavin D or M made no differences in terms of DD and topographic parameters (P > 0.05).

Conclusions:

In conventional and accelerated protocols, corneal stromal demarcation line is deeper compared with TE CXL; however, the DD has no correlation with topographic changes, which means that DD is not a direct measure for the efficacy of CXL.