bluuebunny/crossref_metadata_2025 huggingface dataset:
8. Inchoate offences
Authors: Allen Michael J. , Edwards Ian
Published: September 2021

Course-focused and contextual, Criminal Law provides a succinct overview of the key areas on the law curriculum balanced with thought-provoking contextual discussion. This chapter discusses inchoate crimes. A person does not break the criminal law simply by having evil thoughts. Where, however, a person takes steps towards effecting that plan to commit a substantive offence which is more than merely preparatory, he may in the process commit one of the inchoate crimes of attempt, conspiracy, or encouraging or assisting the commission of an offence. The chapter examines relevant offences in the Serious Crime Act 2007 concerning encouraging or assisting and the Act’s abolition of the offence of incitement. It outlines the legal protection from prosecution provided to particular vulnerable victims who might otherwise be liable for encouraging others to commit offences against them, such as some child victims of sexual offences. The chapter analyses the statutory offence of conspiracy and outlines common law offences of conspiracy to defraud and conspiracy to corrupt public morals or to outrage public decency. It examines the requirements for liability for attempt. ‘The law in context’ feature in this chapter examines critically the growing range of inchoate offences for terrorist offences.
12. Offences under the Theft Acts 1968 and 1978: Theft and related offences
Authors: Allen Michael J. , Edwards Ian
Published: September 2021

Course-focused and contextual, Criminal Law provides a succinct overview of the key areas on the law curriculum balanced with thought-provoking contextual discussion. This chapter discusses offences under the Theft Acts of 1968 and 1978. Theft and related offences are concerned with interferences with the rights and interests others have in property. The chapter covers each element of the offence of theft, robbery, and offences involving temporary deprivation. It discusses the meaning of ‘dishonesty’, including the Supreme Court’s decision in Ivey v Genting Casinos UK Ltd (2018), which held that the two-part Ghosh test for dishonesty no longer applies. The feature on ‘The law in context’ analyses critically the criminalisation of ‘freeganism’.
13. Fraud
Authors: Allen Michael J. , Edwards Ian
Published: September 2021

Course-focused and contextual, Criminal Law provides a succinct overview of the key areas on the law curriculum balanced with thought-provoking contextual discussion. This chapter examines the offence of fraud, covering offences under the Theft Acts and offences under the Fraud Act (FA) 2006. The FA 2006 repealed various sections of the TA 1968 and TA 1978, replacing a number of individual offences based on deception with the offence of fraud, which may be committed in three ways: fraud by false representation; fraud by failing to disclose information; and fraud by abuse of position. It also creates the offence of dishonestly obtaining services to replace the offence of obtaining services by deception under s. 1 of the TA 1978. These offences are designed to overcome problems in the old law and to simplify the law.
16. Misuse of Drugs Act offences (additional chapter)
Authors: Allen Michael J. , Edwards Ian
Published: September 2021

Course-focused and comprehensive, the Textbook on series provides an accessible overview of the key areas on the law curriculum. The Misuse of Drugs Act 1971 includes the main offences in English law involving prohibited drugs. This chapter discusses the offences of unlawful possession, possession with intent to supply a controlled drug, supplying or offering to supply a controlled drug, production of a controlled drug, and offences related to occupiers and those concerned in management of premises.
2. Actus reus
Authors: Child John , Ormerod David
Published: September 2021

This chapter provides an overview of actus reus, which refers to the ‘external elements’ of an offence. These external elements do not simply relate to D’s conduct. Rather, as we will see, the actus reus of an offence includes any offence elements outside of the fault element (‘mens rea’) of the offence. Before discussing the elements that form the actus reus, this chapter considers the distinction between actus reus and mens rea. It then describes the three elements of actus reus: conduct, circumstances, and results. It also explains the categories of actus reus offences, omissions liability, and causation before concluding with sections that outline potential options for legal reform and a structure for analysing the actus reus of an offence when applying the law in a problem-type question. Relevant cases are highlighted throughout the chapter, with a brief summary of the main facts and judgment.
7. Privity of contract and third party rights
Authors: Merkin Robert , Saintier Séverine , Poole Jill
Published: September 2021

Course-focused and comprehensive, Poole’s Textbook on Contract Law provides an accessible overview of the key areas on the law curriculum. According to the doctrine of privity of contract, only the parties to the contract are bound by, or can enforce, the obligations under the contract. A person who is not a party to a contract does not have any rights under that contract and is not subject to any of its obligations (or burdens). This chapter considers the rules of contract law, and related rules, that are applicable to contracts which stipulate third party rights. It considers the relevant provisions of the Contracts (Rights of Third Parties) Act 1999, the scope of the legislative reform, the test for third party enforceability and how the doctrine of privity of contract is related to the consideration requirement. It also looks at means of circumventing the privity doctrine such as assignment, and exceptions to the privity doctrine such as agency principles as employed in The Eurymedon. The chapter then examines remedies available to the promisee which have the effect of enforcing any promise in favour of a third party beneficiary or enabling substantial damages to be recovered to cover the third party’s loss. Finally, the means by which contractual burdens may bind third parties are examined.
13. Breach of contract
Authors: Merkin Robert , Saintier Séverine , Poole Jill
Published: September 2021

Course-focused and comprehensive, Poole’s Textbook on Contract Law provides an accessible overview of the key areas on the law curriculum. There are four ways to discharge a contract: by performance, agreement, frustration, or breach. The standard of performance required in relation to each contractual obligation needs to be identified because a failure to perform to the required standard constitutes a breach. In the absence of lawful excuse, a breach of contract arises if a party either fails or refuses to perform a contractual obligation imposed on that party by the terms of the contract or performs a contractual obligation in a defective manner. While every breach of contract will give rise to a right to claim damages, the contract will remain in force unless the breach constitutes a repudiatory breach. The chapter examines the types of repudiatory breaches and the election to terminate or affirm, together with an assessment of the law governing the identification of a repudiatory breach and the consequences of terminating when the breach is not in fact repudiatory. It also examines the options available to the non-breaching party when an anticipatory breach occurs.
2. Who makes company law and what is it for?
Authors: French Derek
Published: September 2021

This chapter discusses the sources and purposes of company law. Legislation is the most important source of company law. The effect of EU legislation on UK law is explained, including retained EU Regulations which continue in force despite Brexit. Litigation concerning companies has generated a vast quantity of case law. There are other rules such as the UK Corporate Governance Code and there are practitioner texts and academic articles and books in abundance. There is a discussion of the purpose of company law which notes that its most significant purpose must be to facilitate business, but there is argument over whether mandatory rules of company law are the best way to encourage business enterprise. This leads to the discussion of whether companies should only serve the interests of their members (the shareholder-centred view of the company) or whether wider public interests must be considered.
14. Members
Authors: French Derek
Published: September 2021

This chapter focuses on the members or shareholders of a company and the way in which they take decisions on the company’s affairs. It begins by considering the rules which determine who is a member of a company and the information on the members which a company must record. It then describes the mandatory rules of company law that allow members to participate in decision-making with regard to a company’s affairs, members’ class rights and the alteration of such rights. Relevant provisions of the Companies Act 2006 governing written resolutions of private companies, meetings and annual general meetings, voting, adjournment of meetings and authorisation of political donations by companies are discussed. The chapter analyses a number of particularly significant cases.
Transparency
Authors: French Derek
Published: September 2021

This chapter discusses the obligations imposed on companies and their officers to provide information about the company, other than accounts. Information about a company’s constitution, membership, officers and finances must be provided to Companies House, which makes the information available for inspection by anyone at its website. Much of that information must also be made available for inspection at the company’s registered office or an alternative inspection place. Some other information, including directors’ service contracts, must be kept available for inspection by the company’s members at its registered office or inspection place. Any company must identify itself by its registered name at its registered office, inspection place, and places of business. Further identifying information, including its registered number, must be given on business letters, order forms and websites. The chapter discusses the general rules on disclosure and how they are enforced.
9. Constitutional rights and principles
Authors: Dennett Anne
Published: September 2021

This chapter addresses the doctrine of common law constitutional rights. This is a controversial area where judges uphold the rule of law to restrict not only government power, but occasionally the meaning of statutes in order to protect the fundamental rights and values that permeate the UK constitution. This can create tensions between parliamentary sovereignty, separation of powers, and rule of law. There is no definitive list of common law constitutional rights and values and they are unwritten, but they are essentially the rights and values protected by the rule of law that have evolved as rules of ‘fair play’ and justice. They include justice; legality; fundamental rights such as liberty, freedom of expression, and equality; accountable government; and democracy.
12. The executive
Authors: Dennett Anne
Published: September 2021

This chapter discusses the executive, the administrative branch of government which creates and executes policy, and implements laws. It specifically focuses on the organisation of central government in the UK. Central government in the UK carries out day-to-day administration in relation to England and the whole of the UK on non-devolved matters. Its functions include the conduct of foreign affairs, defence, national security, and oversight of the Civil Service and government agencies. Central government essentially consists of the government and Civil Service but modern government is extensive, multi-layered, and complex. The chapter then studies the sources of ministerial power. Ministers’ legal authority to act can derive from statute, common law, or royal prerogative. The royal prerogative is a source of power which is ‘only available for a case not covered by statute’.
10. Free movement of goods (II): quantitative restrictions and measures having equivalent effect
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter discusses the non-pecuniary obstacles to the law on the free movement of goods in the EU. It discusses the following: prohibition of quantitative restrictions and measures having equivalent effect; grounds of derogation under Article 36 TFEU; indistinctly applicable measures and mandatory requirements, Cassis de Dijon and developing the list of mandatory requirements; principles of mutual recognition and equivalence; Case C-267 and 268/91 Keck and Mithouard (1993) and certain selling arrangements; presentation requirements; the conditions in Keck and the difficulties in finding a consistent rule; the blurred distinction between Article 36 TFEU and ‘mandatory requirements’; Article 35 TFEU; and Directive 98/34 on the provision of information in the field of technical standards and regulations.
12. Free movement of persons and services and freedom of establishment
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter examines the free movement of workers, family members and non-active persons and freedom of establishment, and places this within the framework of citizenship of the European Union. The free movement of workers is one of the original four freedoms in the Treaty of Rome establishing the European Economic Community. Free movement of workers was essential for the construction of an internal market, and for several decades the freedom to move within the Community maintained its strict link with economic activity. Free movement has now evolved beyond the economically active with access, for example, to social advantages and rights for family members. This chapter also considers the exceptions to free movement (e.g. the public health and public security exceptions) and special cases of free movement (e.g. sport and lawyers).
17. EU relations with third states and international organisations
Authors: Horspool Margot , Humphreys Matthew , Wells-Greco Michael
Published: September 2021

This chapter considers the EU’s relationship with third countries and international organisations. It discusses the legal basis and competence for the EU’s external action and offers examples of how the EU exercises this competence. This is followed by an overview of the types of agreements the EU enters into with third countries with a discussion on the treaty arrangements with Switzerland, the EEA (Norway, Iceland and Liechtenstein) and the UK. It then considers the EU’s relationship with a selection of international organisations.
12. Specific remedies
Authors: Taylor Richard , Taylor Damian
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, diagrams and exercises help readers to engage fully with each subject and check their understanding as they progress. This chapter considers remedies that directly address the issue of providing the innocent party with the performance that was expected. Their use depends on a number of factors, which means that they are not universally available, and that the claimant will therefore often be left to his remedy in damages. The discussions cover actions for the price or other agreed sum, the rule in White and Carter v McGregor, affirmation and anticipatory breach. The chapter goes on to discuss specific performance and injunctions and the tests of damages being inadequate, mutuality plus other factors such as personal service contracts and the relevance of the need for supervision.
5. The Human Rights Act 1998 (2): proceedings and remedies
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter continues the analysis of the Human Rights Act. It discusses how cases can be brought under the Human Rights Act 1998 (HRA) and what remedies are available from the courts if a violation of a Convention right is found. The aim here is to delve deeper into the issue of how the rights of the European Convention on Human Rights (ECHR) are given further effect in the law of the UK by the HRA. The main issues discussed in the chapter include the importance of remedies and Article 13 ECHR—the right to a remedy, procedural issues for seeking remedies under the HRA, and remedies available under the HRA.
7. Ancillary rights
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter focuses Convention rights that are considered ancillary by virtue of the fact that they do not in themselves establish any substantive human rights but are relevant to the way the substantive rights are put into effect. Specifically, the chapter discusses Article 14, which prohibits discrimination in the way Convention rights and freedoms are secured; Article 15, which allows states to derogate from their responsibilities under certain circumstances; Article 16, which allows states to restrict the political activities of aliens; Article 17, which authorises the ECtHR and national courts to refuse to uphold the rights of those who would use them to undermine the rights of others; and Article 18, which insists that rights and freedoms in the Convention can be restricted and qualified.
16. Article 9: freedom of thought, conscience, and religion
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter discusses Article 9, which establishes a general right to freedom of ‘thought, conscience, and religion’. The right to ‘manifest’ belief is ‘qualified’ in the sense that justified interferences are allowed. The duty of a court addressing an Article 9 issue is to decide whether there has been an interference, for which the state is responsible, that either restricts a person in holding religious beliefs or restricts the manifestation of belief. Manifestations of belief can be restricted if the restriction can be justified under the terms of Article 9(2). Important issues involving conscientious objection and the wearing of religious dress both in the context of employment and generally are considered in relation to justification. Article 9 can often be invoked in tandem with other Convention rights that also help to secure freedom of religion and belief.
18. Article 11: freedom of assembly and association
Authors: Davis Howard
Published: September 2021

Without assuming prior legal knowledge, books in the Directions series introduce and guide readers through key points of law and legal debate. It discusses European Convention law and relates it to domestic law under the HRA. Questions, discussion points, and thinking points help readers to engage fully with each subject and check their understanding as they progress and knowledge can be tested by self-test questions and exam questions at the chapter end. This chapter considers Article 11 and relates it, in outline, to aspects of public order law in the UK. Article 11 protects the rights of people to ‘peaceful assembly’—to hold and take part in peaceful meetings, marches, and demonstrations. Related issues such as the notion of peaceful assembly and positive duties in respect of facilitating political action are discussed. Article 11 also guarantees the right to ‘associate’: to join and be active in ‘associations’ such as political parties, pressure groups, religious organisations, and trade unions. Both these rights are subject to restriction under the terms of Article 11. The importance of Article 11 rights for democracy is fully recognised, and any restrictions must be consistent with the principles of tolerance and pluralism. Article 11 also permits significant restrictions on the political freedom of police, civil servants, and other public officials.
5. Abortion and prenatal harm
Authors: Samanta Jo , Samanta Ash
Published: September 2021

This chapter is concerned with the statutory provisions governing abortion and prenatal harm. It considers the offence of abortion under sections 58 and 59 of the Offences against the Person Act 1861 and section 1(1) of the Infant Life (Preservation) Act 1929 and the defences available prior to the Abortion Act 1967. It discusses the ethical debates concerning abortion, exploring ‘right-to-life’ arguments and rights of parties such as the foetus and the father. It also looks at the court’s approach towards adult women who lack capacity, before concluding with an analysis of actions for prenatal harm, namely, wrongful birth, wrongful conception, prenatal injury, and wrongful life. Relevant cases are cited.
2. International Governance and the Formulation of Environmental Law and Policy
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter examines the institutions of global governance responsible for formulating and implementing international environmental policy and law. It starts by defining global governance as a continuing process via which conflicting or diverse interests may be accommodated. This provides the environment where cooperative action may be taken. Global governance includes formal institutions and regimes empowered to enforce compliance, as well as informal arrangements. In this situation, there is no single model or form of global governance, nor is there a single structure or set of structures. Global governance, therefor, is a broad, dynamic, complex, process of interactive decision-making. The chapter also looks at the differences in international environmental policy and law today compared to when this book first published twenty-five years previously.
4. State Responsibility, Treaty Compliance, and Dispute Settlement
Authors: Boyle Alan , Redgwell Catherine
Published: September 2021

This chapter looks at the number of ways that secure compliance with international environmental law can be employed. The more traditional approach to this subject is the familiar one of interstate claims for breach of international obligations, employing the variety of forms of dispute settlement machinery contemplated in Article 33 of the UN Charter. There are a number of disadvantages to enforcing international environmental law in this manner, particularly if it involves compulsory resort to judicial institutions. The chapter outlines these disadvantages which include the adverse effect on relations between the relevant states; the complexity, length, and expense of international litigation; the technical character of environmental problems, and the difficulties of proof which legal proceedings may entail, and uncertainty concerning jurisdiction and applicable law in legally complex disputes.
A Case Series: Describing the Coronavirus Pandemic Response in Small Naval OCONUS Military Treatment Facilities
Authors: Latimer Emily R , Parker Christopher A , Swiger Pauline A
Published: September 2021

Introduction

The European SARS-CoV-2 (COVID-19) outbreak threatened military beneficiaries receiving care outside of the United States. Military treatment facilities located outside the United States were the first to respond to the pandemic, requiring immediate action to establish novel protocols. The purpose of this case series is to describe challenges, solutions, and future recommendations during a pandemic response at three small naval military treatment facilities located outside the continental United States (OCONUS).

Results

The analysis and discussion reviews challenges in information processing, communication methods and patterns, process changes, actions for staff protection, and change fatigue experienced during this time.

Conclusions

Recommendations for future work include filling the gaps in the evidence for a prolonged pandemic response and crisis management, such as the current SARS-CoV-2 pandemic, including best practices to communicate, maintain staff resilience, and manage or mitigate associated prolonged stress and uncertainty.
Increase in lamin B1 promotes telomere instability by disrupting the shelterin complex in human cells
Authors: Pennarun Gaëlle , Picotto Julien , Etourneaud Laure , Redavid Anna-Rita , Certain Anaïs , Gauthier Laurent R , Fontanilla-Ramirez Paula , Busso Didier , Chabance-Okumura Caroline , Thézé Benoît , Boussin François D , Bertrand Pascale
Published: September 2021

Telomere maintenance is essential to preserve genomic stability and involves telomere-specific proteins, DNA replication and repair proteins. Lamins are key components of the nuclear envelope and play numerous roles, including maintenance of the nuclear integrity, regulation of transcription, and DNA replication. Elevated levels of lamin B1, one of the major lamins, have been observed in some human pathologies and several cancers. Yet, the effect of lamin B1 dysregulation on telomere maintenance remains unknown. Here, we unveil that lamin B1 overexpression drives telomere instability through the disruption of the shelterin complex. Indeed, lamin B1 dysregulation leads to an increase in telomere dysfunction-induced foci, telomeric fusions and telomere losses in human cells. Telomere aberrations were preceded by mislocalizations of TRF2 and its binding partner RAP1. Interestingly, we identified new interactions between lamin B1 and these shelterin proteins, which are strongly enhanced at the nuclear periphery upon lamin B1 overexpression. Importantly, chromosomal fusions induced by lamin B1 in excess were rescued by TRF2 overexpression. These data indicated that lamin B1 overexpression triggers telomere instability through a mislocalization of TRF2. Altogether our results point to lamin B1 as a new interacting partner of TRF2, that is involved in telomere stability.
Zinc-finger protein MdBBX7/MdCOL9, a target of MdMIEL1 E3 ligase, confers drought tolerance in apple
Authors: Chen Pengxiang , Zhi Fang , Li Xuewei , Shen Wenyun , Yan Mingjia , He Jieqiang , Bao Chana , Fan Tianle , Zhou Shuangxi , Ma Fengwang , Guan Qingmei
Published: September 2021

Water deficit is one of the main challenges for apple (Malus × domestica) growth and productivity. Breeding drought-tolerant cultivars depends on a thorough understanding of the drought responses of apple trees. Here, we identified the zinc-finger protein B-BOX 7/CONSTANS-LIKE 9 (MdBBX7/MdCOL9), which plays a positive role in apple drought tolerance. The overexpression of MdBBX7 enhanced drought tolerance, whereas knocking down MdBBX7 expression reduced it. Chromatin immunoprecipitation-sequencing (ChIP-seq) analysis identified one cis-element of MdBBX7, CCTTG, as well as its known binding motif, the T/G box. ChIP-seq and RNA-seq identified 1,197 direct targets of MdBBX7, including ETHYLENE RESPONSE FACTOR (ERF1), EARLY RESPONSIVE TO DEHYDRATION 15 (ERD15), and GOLDEN2-LIKE 1 (GLK1) and these were further verified by ChIP-qPCR and electronic mobility shift assays. Yeast two-hybrid screen identified an interacting protein of MdBBX7, RING-type E3 ligase MYB30-INTERACTING E3 LIGASE 1 (MIEL1). Further examination revealed that MdMIEL1 could mediate the ubiquitination and degradation of MdBBX7 by the 26S proteasome pathway. Genetic interaction analysis suggested that MdMIEL1 acts as an upstream factor of MdBBX7. In addition, MdMIEL1 was a negative regulator of the apple drought stress response. Taken together, our results illustrate the molecular mechanisms by which the MdMIEL1–MdBBX7 module influences the response of apple to drought stress.
Adequate health literacy is associated with adherence to continuous positive airway pressure in adults with obstructive sleep apnea
Authors: Ellender Claire M , Le Feuvre Sebastian , Boyde Mary , Duce Brett , Winter Sara , Hukins Craig A
Published: September 2021

Study Objectives

Obstructive sleep apnea (OSA) is a chronic disease with significant health implications and adequate adherence to continuous positive airway pressure (CPAP) is essential for effective treatment. In many chronic diseases, health literacy has been found to predict treatment adherence and outcomes. In this study, the aim was to determine the health literacy of a sleep clinic population and evaluate the association between health literacy and CPAP adherence.

Methods

A prospective cohort study was undertaken, recruiting 104 consecutive patients with a variety of sleep diagnoses. The Short Form Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a validated questionnaire, was administered to measure health literacy. In a sub-group of 91 patients prescribed CPAP for OSA, CPAP usage was measured, with adequate usage defined as greater than 4 h/night CPAP therapy.

Results

Seventy-one percent of the sleep clinic cohort was found to have adequate health literacy, as measured by the REALM-SF. In those prescribed CPAP for OSA, inadequate health literacy was associated with a twofold increased risk for inadequate CPAP usage (adjusted odds ratio [OR] 2.9, 95% CI: 1.1 to 8.22, p = 0.045). There was a 1.7 h/night difference in median CPAP usage comparing those with adequate to inadequate health literacy (4.6 h vs. 6.3 h/night).

Conclusions

The majority of this sleep disorders cohort had adequate health literacy as measured by the REALM-SF questionnaire. However, inadequate health literacy appears to be an independent predictor of treatment adherence and may represent a modifiable risk factor of poor treatment outcomes in OSA.
Measuring Phylogenetic Information of Incomplete Sequence Data
Authors: Seo Tae-Kun , Gascuel Olivier , Thorne Jeffrey L
Published: September 2021

Widely used approaches for extracting phylogenetic information from aligned sets of molecular sequences rely upon probabilistic models of nucleotide substitution or amino-acid replacement. The phylogenetic information that can be extracted depends on the number of columns in the sequence alignment and will be decreased when the alignment contains gaps due to insertion or deletion events. Motivated by the measurement of information loss, we suggest assessment of the effective sequence length (ESL) of an aligned data set. The ESL can differ from the actual number of columns in a sequence alignment because of the presence of alignment gaps. Furthermore, the estimation of phylogenetic information is affected by model misspecification. Inevitably, the actual process of molecular evolution differs from the probabilistic models employed to describe this process. This disparity means the amount of phylogenetic information in an actual sequence alignment will differ from the amount in a simulated data set of equal size, which motivated us to develop a new test for model adequacy. Via theory and empirical data analysis, we show how to disentangle the effects of gaps and model misspecification. By comparing the Fisher information of actual and simulated sequences, we identify which alignment sites and tree branches are most affected by gaps and model misspecification. [Fisher information; gaps; insertion; deletion; indel; model adequacy; goodness-of-fit test; sequence alignment.]
Cost Effectiveness of Cognitive Behavioral Therapy for the Treatment of Subjective Tinnitus in Australia
Authors: Patel Niraj , Malicka Alicja N. , McGinnity Siobhan , Anderson Richard B. , Paolini Antonio G. , Crosland Paul
Published: August 2021

Objectives:

The aim of this study was to conduct an economic evaluation for the treatment of subjective tinnitus using different modalities of cognitive behavioral therapy (CBT) in Australia.

Design:

A decision tree model was used to conduct a cost-utility analysis for CBT to determine the cost effectiveness for tinnitus treatments, in terms of cost per responder and cost per quality-adjusted life-year (QALY), from a health system perspective using a 2-year time horizon. Meta-analysis was used to differentiate the levels of effectiveness between three delivery methods for CBT: individual face-to-face care (fCBT), group sessions (gCBT), and a supported internet program (iCBT). One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) explored the uncertainty surrounding model inputs and outcomes. Results were presented as incremental cost-effectiveness ratios compared with no treatment, and as net monetary benefit at a $50,000 willingness-to-pay threshold.

Results:

Compared with no treatment, the incremental cost per responder was $700 for gCBT, $871 for iCBT, and $1380 for fCBT. The base case incremental cost-effectiveness ratio was $35,363 per QALY for fCBT, $17,935 per QALY for gCBT, and $22,321 per QALY for iCBT compared with no treatment, although there was substantial uncertainty around the QALY gain for responders. Net monetary benefit was $356 (fCBT), $555 (gCBT), and $487 (iCBT), indicating the treatments were cost effective compared with no treatment. One-way sensitivity analysis revealed the results were most sensitive to the probability of a positive response to treatment and treatment length. The PSA found the probability of being cost effective compared with no treatment for gCBT was 99.8%, iCBT 98.4%, and fCBT 71.5% at a willingness-to-pay of $50,000 per QALY, although QALY gain remained at a fixed value in the PSA.

Conclusions:

CBT for tinnitus was likely to be cost effective compared with no treatment regardless of treatment modality, assuming they are not mutually exclusive. Of the interventions, gCBT was the lowest cost per responder and lowest cost per QALY. Internet CBT obtained comparable economic outcomes due to similar treatment effectiveness and cost. Group CBT and iCBT warrant greater adoption in clinical practice for the treatment of subjective tinnitus. Further research on preference-based utility measures for varying levels of tinnitus severity and the durability of treatment effect is required to enhance the quality of economic evaluation in this field.
Coccygectomy in the Treatment of Chronic Coccydynia
Authors: Kalstad Ante M. , Knobloch Rainer G. , Finsen Vilhjalmur
Published: September 2021

Study Design.

This is a retrospective cohort study.

Objective.

The aim of this article was to evaluate the results of patients operated for chronic coccydynia, and determine any factors that could affect outcomes.

Summary of Background Data.

Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Studies of results and complications vary considerably and often report on a limited number of patients. Methods. A total of 184 patients were operated with coccygectomy in our department and followed-up with questionnaires after a minimum of 1 year post-operatively. Treatment results were compared to their preoperative state, and any complications or reoperations were recorded and analyzed. Results. A total of 171 patients (93%) responded to final follow-up. The overall success rate was 71%, defined by patients being either completely well or much better at final follow-up. Furthermore, 89% off all patients would have consented to the operation if they had known the outcome in advance. The rate of post-operative infections was reduced from 10% to 2% by increasing the duration of prophylactic postoperative antibiotics from 24 to 48 hours (P = 0.018).

Conclusion.

Coccygectomy, for patients where conservative measures have failed, seems to give acceptable levels of success and high levels of patient satisfaction. The main complication after this procedure is infection, and the risk can be somewhat reduced by using antibiotic prophylaxis for 48 hours after surgery.

Level of Evidence.

4
Efficacy of Hounsfield Units Measured by Lumbar Computer Tomography on Bone Density Assessment: A Systematic Review
Authors: Pinto Eduardo Moreira , Neves Joao Rocha , Teixeira Artur , Frada Ricardo , Atilano Pedro , Oliveira Filipa , Veigas Tania , Miranda Antonio
Published: September 2021

Study Design.

Systematic review.

Objective.

This work aimed to compare the Hounsfield units (HU) value obtained from computed tomography and the t score of dual-energy x-ray absorptiometry (DXA) in the prediction of the lumbar spine bone mineral density (BMD).

Summary of Background Data.

Several reports have found a correlation between HU and BMD values based on DXA. Using HUs to infer bone quality has a thorough clinical relevance as it could triage patients at risk for osteoporotic and fragility fractures or modify surgical indications.

Methods.

A systematic review in Cochrane Library, Medline, Scopus and Web of Science was performed, using the following query: “hounsfield units” AND (“osteoporosis” OR “spine” OR “bone mineral density” OR “dual x-ray absorptiometry”). We included 18 cohort studies that compared HU value obtained from computed tomography and t score of DXA for predicting regional BMD.

Results.

A total of 18 studies were included, enrolling 5307 patients. The HU measurement was most frequently made at L1 (N = 3; 18.8%). The mean HU values differentiated based on BMD measured through DXA were reported in seven studies, with values from 54.7 to 130 for osteoporotic, 78.8 to 146 for osteopenic, and from 120.8 to 230 in normal patients. Eight studies identified thresholds for diagnosing osteoporosis through receiver-operating characteristic (ROC) curves, with values ranging from 0.66 to 0.96. Medium HU values reported as diagnostic of osteoporosis ranged between 110 and 150, after exclusion of the two papers presenting outlier values. We infer an HU interval value of 90.9 to 138.7 (95% CI, P 
< 0.001) for the diagnosis osteoporosis.

Conclusions.

Present data evidence favorable results regarding the possibility of establishing a threshold value for osteoporosis diagnosis from CT measurements of HU. Prospective large-scale studies are needed to more robustly infer the possibility of quantifying BMD based on CT as a screening test and infer a prognostic value of the CT-based evaluation.

Level of Evidence: 2
Risk of gastric cancer in chronic obstructive pulmonary disease
Authors: Ante Zharmaine , Ernst Pierre , Brassard Paul
Published: August 2021

Objective

Owing to the potential role of the gut-lung axis in carcinogenesis, we assessed the incidence of gastric cancer in patients with chronic obstructive pulmonary disease (COPD).

Methods

Using Quebec’s administrative databases, we assembled a cohort of 118 913 patients aged 40 years and older with COPD from 1995 to 2015. We calculated age-standardized incidence rate ratio (IRR) and 95% confidence interval (CI) for gastric cancer, comparing patients with COPD to the Quebec general population. We evaluated temporal changes in incidence by calculating annual percentage change (APC) and stratified the analysis by anatomical site.

Results

Between 1995 and 2015, 279 patients with COPD developed gastric cancer (54.0 cases per 100 000 person-years). The overall age-standardized incidence rate in patients with COPD was comparable to the general population (IRR, 1.05; 95% CI, 0.79–1.39). However, the IRR increased over time (APC, 4.40%; P = 0.0101), due to the growing rate of gastric cancer in patients with COPD (APC, 1.90%; P = 0.2666) and the declining rate in the Quebec population (APC, −2.40%; P < 0.0001).

Conclusions

The overall risk of gastric cancer in patients with COPD did not differ from the general population; however, the risk among patients has increased over the years. These findings provide insights as to whether long-term follow-up for gastric cancer risk in COPD is warranted.
Impact of Direct-to-Consumer Advertising of Cosmetic Procedures on Consumers
Authors: Bastin Reena , Rajanala Susruthi , Maymone Mayra B.C. , De La Garza Henriette , Vashi Neelam A.
Published: September 2021

BACKGROUND

Direct-to-consumer (DTC) advertising is a prominent type of health care communication.

OBJECTIVE

This study aims to determine the impact of DTC advertisements on consumer opinion.

METHODS

A total of 203 participants were recruited from dermatology clinics at an urban academic center. Participants viewed 2 cosmetically oriented DTC advertisements, and prequestionnaires and postquestionnaires were administered to assess consumer opinion.

RESULTS

Postquestionnaire data highlight a 18.8% and 24.6% increase in participants reporting using commercials as an information source (p < .001) and seeking out additional medical knowledge (p < .001), respectively. After watching the advertisements, there was a 14.4% increase in participants who believed advertisements facilitate better discussions between patients and physicians (p < .001) and a 33% increase in patients reporting they would discuss the procedures with their doctors (p < .001). Of the participants, 60% believed the advertisements did not provide enough information about the possible risks of the product and 39.4% believed a physician was not required to perform cosmetic procedures.

CONCLUSION

Direct-to-consumer advertisements instill meaningful information to patients and promote patient–physician communication. They also seem to exaggerate the benefits while making the procedures seem simple and without risks, suggesting trained medical professionals are not needed for administration.
Use of Evidence-Based Technology to Assist the Behavioral Health Workforce
Authors: Heitkamp Thomasine , Schroeder Shawnda , Shogren Maridee , Harsell Christine
Published: September 2021

This article provides examples of the application of technology transfer to improve the delivery of addiction prevention, treatment, and recovery. The article describes a case example of two regional Technology Transfer Centers (TTCs) focused on addiction and mental health. It illustrates the importance of cross-regional and network-wide activities as well as meaningful collaborations with other regional networks, professional associations, and state and federal entities. This article describes a model of identifying and delivering meaningful training and technical assistance (T/TA), which also advances interprofessional collaborations and shared ownership. The described model includes collaboration in assessing behavioral health T/TA needs and preference for delivery of T/TA. The case study presents the process of engaging providers and connecting them with content experts on emerging topics in the field of addiction. This work included T/TA around integrated care, co-occurring disorders, cultural humility and inclusion, and use of data to advance system care. The case also outlines the application and use of evidence-based translation models, including Project ECHO (Extension for Community Healthcare Outcomes) and Communities of Practice.
The Effects of a Social Participation App on Seniors
Authors: HSU Pei-Ti , HO Chen-Shie , HO Ya-Fang , CHEN Jeu-Jung , CHEN I-Ju
Published: September 2021

Background

Advancements in medical care have increased the average life span in many countries, resulting in a generally longer postretirement life span. However, retirees may find it difficult to adapt to retirement. Therefore, encouraging retirees to engage with society is important.

Purpose

In this study, a senior social participation mobile software application (SSP-App) was developed to stimulate social participation among seniors with the goal of improving their social participation intentions and behaviors.

Methods

After developing the SSP-App based on user experiences, a quasi-experimental study was conducted. Participants were recruited from the Keelung Ren'ai Community Center. Next, Random Allocation Software Version 1.0.0 software was used to randomly allocate the participants into experimental and control groups. The 54 participants in the experimental group took part in an SSP-App program, whereas the 53 participants in the control group did not participate in any experimental treatment program. Measurements were conducted at Week 4 (T1) and Week 12 (T2) to evaluate the effects. Data were collected using a demographic datasheet, Geriatric Depression Scale-Short Form, Emotional and Social Support Scale, Social Participation Intention Scale, and Social Participation Behavior Scale. The generalized estimating equations method was used to determine intervention effectiveness.

Results

The SSP-App has six main functions, including an activity partner message board, an activity search function that provides information about different activities, a “Seniors Learning Kiosk” that provides useful information, transportation information, an activity planning and reminder system, and a “First-Aid Station.” Most participants in the SSP-App precursor test expressed approval. At T1, effects were observed in social participation intention only. However, at T2, effects were observed in both social participation intention and social participation behavior.

Conclusions/Implications for Practice

The SSP-App developed in this study uses information and communication technology and multiple strategies covering information provision, social support, education, and reminders. Social participation obstacles must be overcome to effectively provide seniors with social participation opportunities and improve their social participation.
The Lived Experiences of Parents Having a Child With a Brain Tumor During the Shared Decision-Making Process of Treatment
Authors: Huang Ting-Yu , Mu Pei-Fan , Chen Yi-Wei
Published: September 2021

Background

A pediatric brain tumor requires multimodal therapy that can have serious effects on the ill child that can involve shared decision-making (SDM). Understanding this experience of SDM from the parents’ point of view is understudied.

Objective

The aim of this study was to explore the nature of lived experiences of parents during the SDM process when their child is being treated for a brain tumor.

Methods

This was a descriptive phenomenology study using in-depth interviews with parents who had a child with a brain tumor.

Results

Six major themes emerged: (1) early confusion associated with medical decision-making, (2) determining treatment via decision-making, (3) faith strengthening the direction of decision-making, (4) constructing consensus based on partnership, (5) adjusting lifestyle to coexist with the illness, and (6) positive energy and abundant support are able to open a window to the soul.

Conclusion

Shared decision-making is a process, and the experiences start with parental confusion about medical treatment. The process involves building a trusting relationship with health professionals that includes sharing medical treatment information and is eventually associated with normalizing the life of both the child and the rest of the family.

Implications for Practice

Trusting relationships and partnership are vital for SDM to be successful. It is essential during the SDM process to strengthen parental resilience by supplying sufficient information and to support parental efforts to normalize their family life.