Study links community C difficile cases in kids to antibioticsA study published this week in Pediatrics suggests that most Clostridium difficile infections in children are unrelated to hospitalization and that a majority of these community-associated cases involve children who recently received antibiotic treatment for unrelated conditions.C difficile causes at least 250,000 infections in hospital patients and 14,000 deaths each year in adults and children, according to the Centers for Disease Control and Prevention (CDC), which was involved in the study. Antibiotics can reduce beneficial gut bacteria, allowing C difficile to flourish.The authors used data from an active C difficile surveillance system covering 10 US regions to identify cases, defined as a positive stool test without a positive test in the previous 8 weeks. Community-associated cases were those in which stool was collected from outpatients or hospitalized patients within 3 days of admission.Of 944 pediatric cases that were identified, 71% were community-associated. C difficile incidence per 100,000 children was highest among 1-year-olds (66.3) and white children (23.9). The share of cases with documented diarrhea (72%) or severe disease (8%) was similar across age-groups, and there were no deaths. Among 84 patients who were interviewed and who reported diarrhea on the day of stool collection, 73% had received antibiotics during the previous 12 weeks.In a press release, the CDC said most of the children who had previously received antibiotics had been treated for ear, sinus, or upper respiratory infections. The agency said other studies have shown that at least 50% of antibiotics clinicians prescribe for children are for respiratory infections, most of which don’t require antibiotics.”When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including C difficile infection and dangerous antibiotic resistant infections,” CDC Director Tom Frieden, MD, MPH, commented in the release. Mar 3 Pediatrics abstract Mar 7 CDC press release Report details GBS complication in likely Zika virus caseResearchers from French Polynesia yesterday reported what they call the first known case of Guillain-Barre syndrome (GBS) following a probable Zika virus infection, detailing their findings related to an outbreak in the region. The case is reported in the latest issue of Eurosurveillance.The region is experiencing ongoing epidemics of Zika virus and dengue infections, and the authors noted that Zika virus illnesses are usually benign and rarely lead to hospitalization.In a weekly communicable disease update today, the European Centre for Disease Prevention and Control (ECDC) estimated that more than 29,000 people in French Polynesia have sought medical care for Zika-like symptoms since the outbreak began in October. As of Feb 21, there were more than 8,500 suspected cases; 74 were in patients neurologic and autoimmune complications, including 41 with GBS.The case report describes a woman in her early 40s who was hospitalized for neurologic symptoms, which included paresthesia in four extremities. Over the next few days she experienced more symptoms, including muscle weakness and bilateral but asymmetric facial palsy, consistent with GBS.The medical work-up suggested that she had been sick with a flu-like illness about a week before the onset of her neurologic symptoms; her medical team suspected Zika fever because the outbreak was ongoing.Further, serologic tests suggested a recent Zika virus infection, without cross-reactions suggestive of an earlier dengue infection, according to the report.The authors said the case raises the possibility of GBS as a complication in Zika virus infections. Although the mechanism is unknown, it could resemble an immunologic pattern seen with other infectious agents, they noted, adding that the case could hint at a more pathogenic Zika genotype or increased susceptibility in the Polynesian population.Mar 6 Eurosurveill report Mar 7 ECDC weekly communicable disease threat report
Though the disease’s spread in crowded urban settings has been a unique feature of West Africa’s Ebola situation, rural areas feeling the outbreak’s impact have faced their own challenges, such as investigation teams in Liberia walking up to 8 hours and crossing several rivers to probe new cases.The issues that four rural counties in Liberia grapple with in responding to the epidemic were detailed in a report today from experts with the US Centers for Disease Control and Prevention (CDC) and a partner from Liberia’s health ministry, published in an early edition of Morbidity and Mortality Weekly Report (MMWR).Rural areas unprepared when first cases hitDuring the first months of the outbreak, resources poured into the areas of Liberia reporting the most cases, Lofa and Montserrado counties, where disease activity has started to tail off. By October, the disease had spread to all 15 of Liberia’s counties. In late August and early September the research team took a close look at the experience of four rural counties—Grand Cape Mount, Grand Bassa, Rivercress, and Sinoe—to identify challenges and response needs.Their initial assessment found that county health teams weren’t adequately trained in core Ebola response steps and struggled with poor transportation and communication networks, critical for successfully managing Ebola in remote locations. At that time, the four counties had reported 25 suspected, 16 probable, and 19 confirmed cases.Counties varied in their response gaps, the authors found. For example, only Grand Bassa county reported that teams had been trained to investigate cases and trace contacts when the first Ebola case was reported. Three countries reported that corpses had been transported by people who hadn’t been trained in safe burial practices. Only two of the counties had a functioning ambulance, and only one of those had a crew trained to handle suspected Ebola patients. Sinoe county didn’t have any lab technicians that were trained to handle Ebola specimens.During the rainy season that ran from July through December, county health workers struggled with impassable or difficult roads that made it hard to transport lab specimens or get sick patients to Ebola treatment centers in Monrovia. In addition, many communities didn’t have telephone coverage, which made it hard for local health officials to report suspected patients, to arrange clinical evaluation, or get timely lab results. For example, workers in Rivercress county had to take a 6-hour round trip to a neighboring county to submit an online surveillance report to Liberia’s health ministry, and health officials in Sinoe county reported a 3-day delay in getting lab results back.When the researchers checked back in November, they found that some areas still didn’t have trained personnel and continued to have problems with transportation and communication. They concluded that, like their urban counterparts, rural health workers need adequate training in case reporting, investigation, case management, contact tracing, safe burials, safe blood specimen management, and county-level incident management systems. The group also emphasized that innovative solutions are needed to help rural locations navigate challenges ranging from poor road conditions to lack of internet access.Report offers bird’s-eye view of outbreakIn a separate report in the same edition of MMWR on the status of the outbreak in the three hardest-hit countries, Guinea, Liberia, and Sierra Leone, the CDC’s incident management team and country health ministries said cases are widely distributed among districts in all three, with Mamou prefecture in Guinea as a newly affected area.During the 4-week period between Nov 9 and Dec 6, the three countries reported 4,281 new Ebola cases, compared to the 2,705 new cases reported during the 3-week period between Oct 19 and Nov 8. During both time spans, Ebola case counts were highest around Monrovia in Liberia, in the western and northwestern districts of Sierra Leone, and in Conakry in Guinea.The team said that although decreasing disease incidence has been reported in Lofa and Montserrado districts in Liberia, cases continue to be reported there, especially in Montserrado.Other developmentsMali has released the final 13 people who were undergoing Ebola monitoring, and the country has no other suspected cases, Reuters reported today, citing a World Health Organization (WHO) official. All patients finished their 21-day quarantine at midnight yesterday. So far the country’s total stands at 8 cases, 6 of them fatal.The first trial of convalescent therapy for Ebola in West Africa was launched in Liberia last week, with researchers collecting plasma from survivors at the ELWA 2 hospital in Monrovia and treating the trial’s first patient, according to a news story yesterday in Nature. The trial, funded by the Bill & Melinda Gates Foundation, is being conducted by ClinicalRM in coordination with Liberian health authorities and the WHO. The trial will involve 70 participants and will include a control group of Ebola patients who will not receive plasma, because their blood type is incompatible with available plasma, but who will be given the same standard of care as the treatment group. The report said a larger trial will launch in Guinea at the end of the year, led by a consortium of European and African researchers along with blood transfusion organizations.Men recovering from Ebola should follow the current recommendation of waiting at least 3 months before having unprotected sex, despite a lack of research supporting the advice, according to a report today in the journal Reproductive Sciences. A research team from Colombia reviewed studies between 1977 and 2007 on men who were recovering from Ebola. They identified only four involving male survivors who donated convalescent semen. The virus persisted an average of 66.6 days, and in one case 91 days. The authors wrote that larger studies are needed to flesh out the social, clinical, and biological determinants of Ebola disease.See also:Dec 16 MMWR report on challenges in rural GuineaDec 16 MMWR Ebola epidemic updateDec 16 Reuters storyDec 15 Nature news storyDec 15 Clin Infect Dis abstractDec 16 Reproductive Sciences report
The Australian Maritime Safety Authority’s decision to detain a Hong Kong-flagged container ship which dumped food waste near the Fraser Island in May 2016 was affirmed by the Administrative Appeals Tribunal (AAT) at a hearing on November 25, 2016.AMSA detained the 4,578 TEU vessel OOCL Le Havre in Brisbane after a Port State Control inspection on May 24 found that its Safety Management System had failed to ensure crew had an adequate understanding of the rules and regulations related to the management and discharge of garbage at sea in accordance with the international convention for the prevention of pollution from ships (MARPOL).The inspection also found that on May 23 crew dumped 0.08 cubic metres of food waste into the ocean less than 3 nautical miles from the nearest land.Hong Kong-based container shipping company Orient Overseas Container Line, the owner of the vessel, sought review of AMSA’s decision to detain its vessel at the AAT. At the conclusion of the AAT hearing in late November, with the company’s consent, the AAT affirmed AMSA’s decision to detain for a Safety Management System failure, finding that it was “the correct and preferable decision in the circumstances.”“Ships operating in Australian waters must have adequate Safety Management Systems which detail the correct management and discharge of garbage at sea, as per MARPOL,” Alex Schultz-Altmann, AMSA Acting General Manager of Ship Safety, said.
1 Attorneys and solicitorsOn the other side of the profession was the attorney at law who was in some ways the forerunner of the present day solicitor, although the office of attorney was abolished in 1875 as a result of the Judicature Acts. The Ordinance of 1292 had recognised attorneys as a separate part of the legal profession, confirming their monopoly on the right to practise in the courts of the Common Bench, and may well be the origin of solicitors being officers of the court. Attorneys dealt with procedural matters and managed litigation on behalf of their clients. They began to develop similar professional standards to those adopted by the serjeants under the supervision (in their capacity as officers of the court) of the judges of the Common Pleas. There were in fact also ‘solicitors’, practising in Tudor England, who were not necessarily trained lawyers of any description, although some of them were members of one of the inns of court. It was not until the 19th century that the expression ‘attorney’ was dropped in favour of the term ‘solicitor’. The earliest surviving form of the attorney’s oath dates from the mid 1550s, although it is known that the oath was in use as early as the 1520s and possibly even before that. The oath contained the following requirements: ‘You shall do no falsehood nor consent to any to be done in this court; and if you know of any to be done you shall give knowledge thereof to my lord chief justice and other my masters his brethren, that it may be reformed. You shall delay no man for lucre or for malice. You shall increase no fees, but be content with the fees accustomed. You shall plead no foreign pleas nor sue any foreign suits unlawfully to hurt any man, but such as shall stand with the order of the law and your conscience. You shall seal all such process as you shall sue out of this court with the seal thereof or see the king’s majesty or my lord chief justice satisfied for the same. Also, you shall not wittingly sue or procure any false suit, nor give aid or counsel to the same, on pain to be expelled from this court for ever. And further use yourself in the office of an attorney within this court according to your learning and discretion. So help you God etc.’ An oath was also taken as early as the 15th century by court officers in which they were required to use every effort to hinder falsehoods and reveal them to the court. In the attorney’s oath can be seen an early reference to the disciplinary consequences of falling short of the required standards of ethical behaviour. The penalty for deliberately making or assisting in making false claims was permanent expulsion from the court and, thereby, legal practice. An attorney expelled from the court after formal investigation on oath was said to be ‘forejudged’ and it was customary for the penalty to be physically enforced by throwing the attorney over the bar of the court. This gave rise to the colloquial expression ‘to turn up one’s heels’. Some form of suspension from practice was imposed while a complaint of professional misconduct against an attorney was investigated and in serious cases the investigation could be by a grand jury of attorneys. It is believed that less serious offences such as continuing with a matter without good cause were punished by a fine or a term of imprisonment. As with all lawyers, the court regulated the professional conduct of attorneys. Up to the 13th century a litigant was required to appear in person and to plead his case. Practising attorneys became more commonplace during the 13th to 15th centuries. However judges appear always to have exercised an inherent power to control the admission of lawyers to practise in their courts and to sanction them when they misbehaved. (Indeed, the overriding power to refuse to hear a particular advocate has recently been placed on a statutory footing in sections 27(4) and (5) of the Courts and Legal Services Act 1990, subject to the requirement to give reasons for exercising the power.) It appears that the disciplinary function was carried out publicly, at least in serious cases. In 1558, the court summoned all the attorneys and court officers to hear the sentence of forejudging passed on a senior attorney of 40 years’ standing ‘to the terror of other offenders’. To assist the poor and oppressed without reward; To give counsel to anyone who should seek it – one of the earliest statements of what is now called the ‘cab rank rule’ comes from the Scottish Court of Session in 1532: ‘No advocate without very good cause shall refuse to act for any person tendering a reasonable fee, under pain of deprivation of his office of advocate’; To dissuade clients from pursuing unjust causes and to advise them to abandon causes if it appeared that they were in the wrong; To deal with business expeditiously and not to prolong it for gain; To keep clients’ business secret (by 1647, the allegation that an attorney ‘revealed the secrets of my cause’ was considered so shocking that it was actionable for slander); To avoid corruption by money or favour, not merely in deceiving clients but also for instance in pretending to be ‘blind’ – unable to assist in a worthy cause; To ‘stick with hand, foot and nail’ to the truth, never pretending that a wrong is right; and To do nothing contrary to good conscience. In spite of the wealth of legal training offered by the inns of court, whose principal function was the education of students and practitioners of the law, it seems that no specific instruction on professional ethics was provided. Formal instruction on ethics may have been considered unnecessary, not least because lawyers no doubt discussed professional conduct matters and specific recent examples of misconduct among themselves. Concepts such as the importance of loyalty and confidentiality would no doubt have evolved and developed from those discussions, influenced both by Christian religious education as well as developing humanist learning, such as the lawyer’s duty to justice. The academic Jonathan Rose suggests that senior lawyers, as role models, may well have influenced the development of ethical sensitivities. The similarities between the ethics of the lawyers practising before the church courts and those of the lawyers practising at the common law bar are no doubt explained partly by the fact that principles of ethics, in common with substantive legal principles, were originally based on biblical precepts. By way of example, the medieval ethical principle that it was wrong knowingly to defend an unjust cause can be traced to the writings of the theologian St Thomas Aquinas. St Thomas taught that lex humana was subordinate to the eternal law of God. Additionally, it appears that early lawyers practised in both the ecclesiastical and common law courts and that, although the two legal professions developed separately, there would no doubt have been some cross-fertilisation between them. The king’s serjeants, who were appointed from the ranks of the serjeants at law and represented the Crown in important criminal and civil cases, were not allowed to appear or advise against the Crown except in certain limited circumstances; and then, if the verdict went the other way, they could change sides and ‘pray judgment for the king’. Conflicts of interest remained a very serious matter. There are a number of reported defamation cases in the 16th century containing judicial pronouncements suggesting that accusing a lawyer of being an ‘ambidexter’ or, colloquially, a ‘daffy-down-dilly’ was reckoned to be as serious a charge as to accuse a doctor of killing a patient. Sir Nicholas Bacon, the Lord Keeper of the Great Seal in the reign of Elizabeth I, suggested in 1559 that it was improper to ‘offer jeofail or error’ – to take technical points after a hearing – although this may not have been a universally held opinion. 2 The litigation and advocacy divideHistorically, barristers had exclusive rights of audience in the higher courts including the Crown courts, High Court and Court of Appeal, although solicitors have always had rights of audience in the lower courts, including the magistrates’ courts and the county courts and, in interim matters, in the higher courts. Barristers could not generally appear in court, except on dock briefs, unless instructed by an attorney (or, later, a solicitor). They had to be attended in court by a member of the solicitor’s practice. Barristers expected their ‘professional clients’ (solicitors) to visit them for ‘consultations’ at their chambers, in the manner of a consultant doctor, and negotiations over fees were conducted by barristers’ clerks and not by barristers themselves who regarded such matters as unprofessional. In the early 18th century, the notion developed that barristers received an ‘honorarium’ rather than ‘merces’. In recent times many of these traditions of the bar have been swept away. The legal profession, spilt into two branches for several centuries by historical accident, is now in a period of uneasy transition. In 1990, all solicitors were given full rights of audience in all courts upon qualification, albeit with restrictions on the exercise of some of those rights until the grant of a higher courts qualification following training and monitored experience. Solicitors began to appear in the higher courts in 1994. Barristers are no longer prevented from visiting solicitors at their offices and may freely accept instructions from professional persons other than solicitors who have been approved to instruct barristers directly, or even, subject to certain restrictions, directly from a lay client. The profession of barrister is undergoing a transformation to accommodate modern legal practice while continuing to provide a service to the public specialising in advisory work and advocacy. At the same time, solicitors are beginning to take advantage of the increased work opportunities made available by the relaxation of restrictions on their rights of audience. Mark Humphries has 25 years’ experience of contentious legal practice. Until recently a litigation partner and head of advocacy at Linklaters in London, he is now the director of his own commercial disputes firm Mark Humphries Ltd. He is a past chairman of the Solicitors Association of Higher Court Advocates In the second of three articles tracing the history of ethics and the legal profession, Mark Humphries recalls a time when accusing a lawyer of being a ‘daffy-down-dilly’ was as serious as accusing a doctor of killing a patientIn the period 1483–1558, principles of professional conduct above and beyond mere honesty began to be formulated for the bar by the Court of Common Pleas, the main common law courts of the time. The principal evidence of this formulation consists of three speeches to the new serjeants at law during the reign of Henry VIII in which the lord chief justice would explain the ethics of the profession and the high standards of conduct expected of practitioners. A number of specific requirements can be identified from these speeches: Part 3 of this series, published online next week, will analyse the development of ‘modern’ ethics and professional regulation.
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Lie joins from Finnish chemicals company Kemira, where she was responsible for communications, marketing and corporate responsibility. She will be a member of Cargotec’s extended executive board and report to president and ceo, Mika Vehviläinen.Leena Liewww.cargotec.com
Boosting exports and improving skills levels in professional firms are the key priorities of the government’s industrial strategy for professional and business services, published today.The 48-page document, from the Department for Business, Innovation and Skills, highlights the importance of broadening higher apprenticeship routes in the professions, in particular the possibility of ‘opening up a new route to becoming a qualified solicitor’.‘These HAs will provide equivalent opportunities and should have parity of esteem to graduate entry,’ the report says. ‘The ability to reach partner status through the vocational route will transform perceptions about the value of apprenticeships more generally.’BIS wants to treble the number of higher apprenticeships in the sector – which is defined as including accountancy, management consultancy and architecture, as well as legal services – to 10,000 starts in five years’ time.The report goes on to stress that trade agreements provide an opportunity to open up new markets. It cites with approval the EU-Korea Free Trade Agreement, where the agreement set out a timetable for the opening up of the Korean legal services market to EU providers.Commenting on the report, Rhian Kelly, CBI director for business environment, said: ‘This strategy recognises we cannot stand still if we want our professional and business services to retain their world-leading status.Increasing the number of higher apprenticeships could help businesses access the wider pool of talent they need to stay on top, as will making the most of trade missions and business leaders to sell the sector overseas.’
Lady Hale questioned the bill’s ‘one size fits all’ approachLady Hale has made no secret of her support for divorce law reform. She said the government’s Divorce, Dissolution and Separation Bill ‘bears a remarkable resemblance to the proposals which the Law Commission made back in 1990: the replacement of the need to prove facts before getting a decree with a waiting period during which the post-divorce arrangements can be agreed. But the idea is to strengthen the system by reducing the acrimony involved in having to prove facts and so create a better climate for making amicable agreements about the financial and child arrangements’.Lady Hale also directly attacked government policy over the Supreme Court case through which opposite-sex couples won the right to enter civil partnerships. Lady Hale said: ‘The astonishing thing about that case was how hard the government had fought it at every stage. They successfully claimed in the High Court that this was not sufficiently close to the core values protected by article 8 to engage the duty not to discriminate – but if the right to respect for family life is not about the legal recognition for family relationships what is it about?’Lady Hale took up her presidential post in September 2017 and retires in January. The president of the Supreme Court has taken the constitutionally unusual step of publicly criticising a bill that is making its way through parliament. Lady Hale said the Divorce (Financial Provision) Bill, introduced by crossbench peer Baroness Deech, was ‘more threatening’ to the support system of the family than the perceived threat from no-fault divorce.Lady Hale made her comments in a speech entitled ‘What is a 21st Century Family’, delivered at the International Centre for Family Law, Policy and Practice on 1 July but published by the Supreme Court yesterday. Baroness Deech’s bill had its third reading in the House of Lords in December. It is now before the Commons, though no date for a second reading has been set. Under the bill, pre- and post-nuptial agreements would be binding provided certain conditions are met. Matrimonial property would be divided equally and spousal maintenance limited to five years unless the spouse would otherwise suffer serious financial hardship. Lady Hale questioned the bill’s ‘one size fits all’ approach. Referring to critics who say that ‘no-fault’ divorce legislation will weaken the stability of marriage, she said: ‘More threatening in my view is Baroness Deech’s bill, which has made its way through the House of Lords and is now before the commons.’She said: ‘I can see the attractions of all of this when set against the agony, the uncertainty and the expense of seeking our tailor-made solutions. But I question how one size fits all can possible meet the justice of the case or fulfill the role of the family in shouldering the burdens which it has created rather than placing them upon the state. I fear that it assumes an equality between the spouses which is simply not there in many, perhaps most, cases.’
WEST Indies cricket legend Sir Wes Hall will this evening at the Guyana Pegasus deliver the keynote address at the Rotary Club of Georgetown’s commemoration of ‘World Understanding Month’, under the theme: ‘Lessons learnt from the noble game of cricket’.World Understanding includes the anniversary of the first meeting of Rotary held on February 23, 1905, and as a chance for every Rotary club to pause, plan and promote the Fourth Avenue of Service – Rotary’s continued quest for goodwill, peace and understanding among peoples of the world.Rotary Club of Georgetown’s Foundation Director and former West Indies player and coach, Roger Harper, told Chronicle Sport that the theme of the dinner fits perfectly into the gentleman, the former Barbados Senator.“I thought that someone like Wes Hall is perfect for this occasion because of who he is; being an example to so many people, especially our young generation,” Harper said.Harper, who played 25 Test matches for the West Indies in his 10-year career in the ‘gentleman’s game’, said, “Wes is an accomplished man of the game, both on and off the field, a director in a number of companies around the Caribbean, he’s a Minister, so he’ll be sharing, like the title said, his lessons learnt from the noble game.”For over a decade Wes Hall terrified batsmen the world over. Muscular and tall with a classical action, Hall presented a fearsome sight. A long, lithe approach ended with a fast and well-aimed delivery.He started his cricket career as a wicketkeeper-batsman but converted to a bowler when the regular opener for his club side failed to turn up. He took the new ball, six wickets, and never looked back.He toured England in 1957 with only one first-class game to his name, but he struggled for form and with his run-up and looked unimpressive.Called into the side to tour India and Pakistan in 1958-59, he took 46 wickets in eight Tests, and he was a regular thereafter. In the classic Tied Test on 1961 at Brisbane he took 9 for 203, and bowled the last over with six runs needed for victory with three wickets left.Hall took one wicket, dropped a crucial catch, and there were two run-outs. Against India in 1961-62 he grabbed 27 wickets at 15.74 and in 1963, partnered by Charlie Griffith, he blasted England to defeat.At Lord’s, in another epic finish, he bowled unchanged for three-and-a-half hours and took 4 for 93 (as well as breaking Colin Cowdrey’s arm).In 1964-65 his 16 wickets were instrumental in guiding West Indies to their first series win over Australia, but by the time he toured England in 1966 the signs were there that he was on the wane.Hall retired, along with his partner Griffith, at the end of the tour of Australia and New Zealand in 1968-69. An immensely popular man, he played two seasons for Queensland and the bulk of his career with Barbados (although that amounted to 13 matches in 15 seasons) with a few appearances for Trinidad in his twilight years.In retirement he became an ordained minister as well as a Minister of Tourism and Sport in the Barbados government. He also managed West Indies touring sides and in 2001 took over as president of the West Indies Cricket Board.