Joseph Dute

Abstract: The applicant had been arrested in 1997 on suspicion of carrying out a number of armed robberies on mini-cab drivers. He agreed to participate in identification parades but failed to attend on the day on which they were due to take place. Instead he sent a doctor’s note stating that he was too ill to go to work. The parades were rearranged and notice to that effect was sent to the applicant’s home address. The applicant did not attend the rearranged parade, stating that he had not received notification as he had changed address. A further robbery then occurred for which the applicant was arrested. The applicant again agreed to stand on an identification parade, but again failed to attend on the day that it was to take place. Following this failure to attend two more robberies were committed with which the applicant was subsequently charged. The mainstay of the prosecution’s case against the applicant would be the ability of a number of witnesses to make visual identifications and for this reason submitting the applicant to an identification parade was of great importance. In light of the applicant’s failure to attend the parades that had been arranged, the police decided to arrange a video identification. Permission to film the applicant covertly for this purpose was sought from the Deputy Chief Constable under Home Office guidelines. The applicant was taken from prison, where he was being detained in relation to another matter, to a police station. Both the applicant and the prison authorities had been informed that this was for identification purposes and further interviews regarding the armed robberies. On arrival at the police station he was invited to participate in an identification parade but refused. The custody suite at the police station was fitted with a camera which was kept running at all times and covered an area in which police officers and other suspects came and went. Before the applicant arrived at the police station an engineer made adjustments to the camera to ensure that clear images were obtained that were suitable for use in a video identification. The footage of the applicant was then used in a compilation with footage of 11 other volunteers who imitated the actions of the applicant. Two of the witnesses who viewed the video compilation picked out the applicant. Neither the applicant nor his solicitor were informed that a tape had been made or used for identification purposes and were, therefore, not given an opportunity to view it prior to its use.

Abstract: In any jurisdiction that takes patient autonomy and patient rights seriously, patient competence is a pivotal concept. Competence, which should be distinguished from criminal responsibility and legal capacity, can be defined as the ability to exercise rights, more in particular the ability to exercise one's right to give or refuse informed consent. It depends upon a patient's competence whether or not this patient has the final say in a health care decision and whether or not the patient can legitimately be subjected to compulsory interventions in that context. These possibly far reaching consequences explain why competence is the topic of a growing amount of legal regulation and why policy attempts are made at operationalising the concept in workable criteria. Although agreed upon criteria for competence do not exist, there is consensus about some preconditions of competence assessment. Two kinds of models of substitute decision-making for incompetent patients are available, i.e. best interests models and representational models. The Dutch Contract of medical treatment Act is treated as an example of the latter. It is shown that in the Dutch model, health care professionals are not at the mercy of patient representatives. On the contrary, health care professionals are supposed to judge their patients' subjective interests and may eventually overrule the representatives. A public debate ought to take place about the basis for this authority.

Abstract: On September 1, 2006, the World Health Organisation (WHO) announced that a deadly new strain of extensively drug-resistant tuberculosis (XDR-TB) had been detected in Tugela Ferry (Figure 1), a rural town in the South African province of KwaZulu-Natal (KZN) [1], the epicentre of South Africa's HIV/AIDS epidemic. Of the 544 patients studied in the area in 2005, 221 had multi-drug-resistant tuberculosis (MDR-TB), that is, Mycobacterium tuberculosis that is resistant to at least rifampicin and isoniazid. Of these 221 cases, 53 were identified as XDR-TB (see Table 1 and [2]), i.e., MDR-TB plus resistance to at least three of the six classes of second-line agents [3]. This reportedly represents almost one-sixth of all known XDR-TB cases reported worldwide [4]. Of the 53, 44 were tested for HIV and all were HIV infected. Figure 1 Map of South Africa Showing Tugela Ferry in the Province of KwaZulu-Natal, the Epicentre of South Africa's HIV/AIDS Epidemic Table 1 Characteristics of Patients in South Africa With XDR-TB The median survival from the time of sputum specimen collection was 16 days for 52 of the 53 infected individuals, including six health workers and those reportedly taking antiretrovirals [2]. Such a fatality rate for XDR-TB, especially within such a relatively short period of time, is unprecedented anywhere in the world.

Abstract: The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.

Abstract: Increased concern about global health has focused attention on governance questions, and calls for new governance architecture for global health have appeared. This article examines the growing demand for such architecture and argues that the architecture metaphor is inapt for understanding the challenges global health faces. In addition to traditional problems experienced in coordinating State behavior, global health governance faces a new problem, what I call “open-source anarchy.” The dynamics of open-source anarchy are such that States and non-State actors resist governance reforms that would restrict their freedom of action. In this context, what is emerging is not governance architecture but a normative “source code” that States, international organizations, and non-State actors apply in addressing global health problems. The source code’s application reveals deficiencies in national public health governance capabilities, deficiencies that are difficult to address in conditions of open-source anarchy. Governance initiatives on global health are, therefore, rendered vulnerable.

Abstract: Surveillance of infectious disease outbreaks is important because outbreaks often require immediate intervention by the public health service. In addition, outbreaks may indicate deficiencies in infection control management and provide unique opportunities to investigate clinical and epidemiologic characteristics of the infectious agents, particularly in emerging infectious diseases. Timely and comprehensive outbreak reports need to be available not only at the affected administrative level but also at state, national, and international levels to detect and control multistate outbreaks (1–4). Electronic documentation and transmission of data are needed for rapid information exchange between institutions in charge of conducting, coordinating, or reporting control measures and should minimize additional work load for the public health service (5). International regulations have resulted in increased requirements for outbreak reporting from the local to the international level (6,7). One of the major changes in the new International Health Regulations enacted in May 2005 is that infectious disease outbreaks of international concern must be reported to the World Health Organization, irrespective of the pathogens involved (8). Moreover, member states of the European Union are already obligated to report foodborne outbreaks to the relevant European Union institution according to the regulation on monitoring of zoonoses and zoonotic agents (9). Outbreak surveillance for emerging infectious diseases is a particular challenge because small independent outbreaks may occur before they are recognized as part of a larger epidemiologic phenomenon. The complexity, the prolonged persistence of outbreaks, and the differing degree to which outbreaks are investigated locally make it much more difficult to ensure standardized and timely surveillance of outbreaks compared with surveillance of sporadic cases (10). To overcome these problems, the RKI (the federal institution responsible for infectious disease surveillance in Germany) developed the software and implemented an electronic outbreak reporting system (SurvNet) as part of its existing electronic surveillance system for notifiable diseases. SurvNet was fully implemented in January 2001 at all administrative levels of the German Public Health system and, in January 2006, at all levels of the German armed forces. The objective of the system is timely and easily retrievable epidemiologic information exchange on outbreaks at the local, state, and national levels. We describe the system, present epidemiologic aspects of reported outbreaks, and discuss the strengths and weaknesses after 5 years of practical use in Germany.

Abstract: Poor coordination of care across providers and birth settings has been associated with adverse maternal-newborn outcomes. Research suggests that integration of midwives into regional health systems is a key determinant of optimal maternal-newborn outcomes, yet, to date, the characteristics of an integrated system have not been described, nor linked to health disparities. Methods Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the ‘on the ground’ relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. Results MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. Conclusion The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.