Category Archives: events

International law of military operations: Mapping the field to improve compliance with the law

 

In June 2006, the University of Exeter Law School and The International Society for Military Law and the Law of War held a three day international conference focusing on the scope and concept of operations law, its current challenges and future training needs.

logoThis post first appeared on  the International committee of the red cross Humanitarian Law and Policy blog, which is powered by the International Review of the Red Cross.

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On 21-23 June 2016, the International Society for Military Law and the Law of War (ISMLLW) and Exeter Law School convened an international conference in Exeter, United Kingdom, entitled ‘The International Law of Military Operations: Mapping the Field’. The conference brought together more than 130 legal experts from academia and the armed forces to map the current state of operational law from a comparative and practical perspective and to explore some of the most pressing legal challenges facing the conduct of military operations.

Military deployments in the territory of other States are subject to a diverse range of rules under international law. In recent years, it has become increasingly common to refer to these rules as ‘operations law’ or the ‘international law of military operations’” (ILMO). The 3-day conference aimed at clarifying the concept and scope of this relatively new field, its current challenges and impact on military training needs.

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Held in Exeter on 21-23 June 2016, the conference brought together more than 130 legal experts from academia and the armed forces to map the current state of operational law.

 

Opening the event, Brig Gen Jan-Peter Spijk, ISMLLW President, and Dr. Aurel Sari, Exeter Law School, reflected on the complexity of modern military operations and associated legal challenges:

We live in politically unstable times, marked by the spectre of political fragmentation, rapid technological development, seemingly uncontrollable social dynamics, increased global competition and the emergence of new security threats. In such circumstances, the rule of law and military force remain as relevant to our security as ever. However, the rules of international law governing military operations are complex, multifaceted and in many respects uncertain. Events such as our conference are crucial for understanding and addressing these difficulties more effectively.

Operations law can be broadly defined as combining international and domestic law and policy related to the planning and conduct of military operations in a variety of contexts, including but not limited to armed conflict. As such, it derives from different bodies of legal rules such as international humanitarian law (IHL, or Law of Armed Conflict), human rights law, targeting law, weapons law, cyber operations law, but also from bodies combining legal and policy considerations, such as rules of engagement. According to Professor Terry Gill, editor of the Handbook of International Law of Military Operations, international law of military operations can be framed as an attempt to counterbalance the fragmentation of international law.

The conference opened by exploring the conceptual aspects of operational law, focusing on its sources, nature and scope of application, before delving into different national understandings and into specific areas of practice. Among other subjects, speakers addressed the current state of weapons law and its future prospects, targeting issues and air power, autonomous weapons and pre-deployment duties, developments in cyber operations law (including the upcoming Tallinn Manual 2.0), challenges of military operations at sea as well as information operations. Sessions were dedicated to questions of accountability, including a panel on the manifold responsibilities of military commanders in ensuring compliance with different branches of the law, as well as a panel on the judicialization of military operations. The latter focused on recent developments in litigation in national and international courts on the conduct of military operations, and reflected on the broader question of appropriate mechanisms for accountability. Finally, speakers and participants shared best practices relating to the dissemination, instruction and training of operational law.

Jean-Marie Henckaerts presented the updated ICRC Commentary on the First Geneva Convention.

Jean-Marie Henckaerts presented the updated ICRC Commentary on the First Geneva Convention.

Every branch of law applicable to military operations needs to be translated into operational standards. This is true of the Geneva Conventions and the Additional Protocols, which are the foundational treaties of IHL, the body of law governing the conduct of hostilities and treatment of persons ‘hors de combat’ in situations of armed conflict. During the event, ICRC’s Jean-Marie Henckaerts presented the newly released updated Commentary on the First Geneva Convention. He highlighted how the new publication is an essential tool for any military or civilian practitioner working within the field of IHL. An updated version of the ‘Pictet Commentary’, the new Commentary offers the same level of academic quality as its original edition, while building on more than 60 years of subsequent practice in interpreting and applying the Geneva Conventions. The practical legitimacy of the new Commentaries stems not only from the ICRC’s 150 years of experience in armed conflicts and in engaging with weapons bearers, but also from the involvement of numerous military lawyers in the Commentaries update project as members of the reading committee and peer reviewers. The new text is also more user-friendly with each commentary being divided into thematic sections. As such, the ICRC Commentary will play an essential role in guiding commanders and military lawyers through the operational challenges they face in contemporary armed conflicts.

Respect for the law in armed conflict today is facing challenges stemming from the increasing complexity of both military operations and the many international legal branches that apply to them. The Operational Law Conference convened by the ISMLLW and Exeter Law School was a significant initiative that brought together leading experts from academia and legal practice to share their expertise and experiences in the field of operational law, opening the door towards a deeper understanding of the challenges in this area and greater collaboration in meeting them.

Waking up to epilepsy

The University of Exeter Medical School’s Waking up to Epilepsy event took place in  2016; in this review of the day, Dr Bill Vennells gives us an overview of what took place at the event; including knowledge sharing between attendees and presentations.

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Awake! For morning in the bowl of night

Has cast the stone that puts the stars to flight.

The Rubaiyat of Omar Khayyam

Waking up to epilepsy

We do wake up to the topic before coming on a course, at first a rather dim awareness that one could know more about the subject.  We draw on stored memories and knowledge.

There were eighty of us in the lecture theatre, nine GPs. We started with a run through the causes and types of epilepsy, generalised or focal, different anatomical sites.

A video from the 80s: German medical students squat, hyperventilate, and then stand up to induce epileptiform seizures in a significant percentage of them. We noted it was a sign of the times that we probably could not expect modern medical students to do anything like this, even while the Daily Mail complains about “political correctness gone mad.”

Non epileptic attacks

Videos of epilepsy and nonepileptic attack disorder demonstrated quite violent movements and sounds which were a bit alarming but also educational. We were invited to consider the fundamental question of whether the patient is “present” or not.

It turned out on a show of hands that 50 per cent of the audience had suffered from another cause of loss of consciousness: syncope. An ignoble episode from my past when I found myself face down on a toilet cistern flashed through my mind: micturition syncope.

Syncope is sub-classified: reflex (situational), orthostatic (volume depletion /autonomic), cardiac, structural (cardiac valve disorders / cardiomyopathy/ pulmonary embolism), or miscellaneous (hypoglycaemia/ pseudosyncope).

Some very practical nuggets of information included the fact that a cut tongue favours epilepsy rather than syncope. Counter-intuitively incontinence of urine can occur quite commonly in both. You do not see cyanosis in vasovagal syncope but you do in syncope associated with arrhythmia. The importance of ECG monitoring in suspected syncope with arrhythmia was emphasised. There is a particular condition where bradycardia can occur during seizures.  A pacemaker should be considered if the heart is beating so slowly that it causes any distress.

A “syncope or seizure” game broke up the presentation.

Captain Barbossa

We apparently share with the pirate Captain Barbossa the spirit behind: “the (Pirate) Code is really what you might call Guidelines”. It appears that if NICE suggest scanning then we do so.  However when scanning may not really be necessary we can rather disingenuously interpret the code and justify a scan to assuage our anxiety.  Not exactly the same motives as Captain Barbossa however.

The presentation on scanning was quite technical, giving an insight into what goes on behind the scenes before reports are generated. The images themselves were interesting, and the concepts of hypertrophic dysplasia and focal cortical dysplasia were worth considering, not being phrases that we often used in our applied fields.

The coffee break was welcome, having assimilated a lot of information. The multi-disciplinary quality of the day now came into its own, our name badges proclaim our respective roles.

Knowledge sharing

I talked to someone from the Royal London Hospital, where I did my training.  He was a volunteer who spent time with patients after their consultations. They often had not understood everything, had misconceptions and anxieties.

I also talked to a pure scientist whose work involved manipulating the chromosomes of fish to induce convulsions, then investigating the effects of anti-epileptic drugs.  Apparently fish are a bit more ethically acceptable then mice and yet do you have metabolism in common with us. I suppose there’s an equation of maximising animal welfare versus benefit to patients, a whole other area of debate.

Refreshed, we return to a presentation by Epilepsy Nurses.  They are a valuable resource in short supply who have a very significant clinical and decision-making, as well as supportive and educational, role.

Patients’ experiences

The nurses’ presentation included patients’ experience, the important issues of transport, IT access of information, and finding one’s way around the benefits’ system. A patient in the audience expressed how crucial the nurses’ contribution had been to her. I felt more patient input would have added value to the day.

The keynote speakers took us back to first principles, starting with my A-level physics, and reminding me of medical school subjects. The knowledge was still there, having been applied in different ways over the years. It is good to be reminded that there is a logical basis for our pragmatic work. It helps the thinking process to go back to these principles.

We covered the basis of wave theory and neurological synapses. The EEG tracing it is not like an ECG – it picks up patterns of oscillations detected on the surface of the scalp from within. Different regions of the brain share information. Similar patterns of oscillation demonstrate areas of the brain that communicate with each other. The thalamocortical system is involved in generalised convulsions, which nevertheless start from a focal point, the focal seizures OFTEN start in the hippocampus.

Brain networks

We were introduced to brain networks: in effect wiring diagrams of brain connections, some being long range connections.

The functional MRI scan also measures activity of networks as do other scanning methods. There are correlations between signals from different brain regions.

A mathematical equation can reproduce the tendency to seizures, a hyper-excitable focus producing a seizure pattern on mathematical modelling, either at foci of the equation or by modifying connections between them. Humbling, to see an aspect of our experience reduced to a quite simple equation.

EEG patterns also obey the rules of graph theory, another mathematical concept. First degree relatives of sufferers show similar patterns. Patterns can predict epilepsy, in silico diagnostics, a possible prognostic tool.

A welcome lunch break, excellent catering, the support to the day was well organised. I found myself in the queue with the patient who had expressed appreciation of the Nurses’s role, and heard about the impact on her life. She appreciated the GPs’ role, but found consultations had to be very focused and could have a sort of clipped, moving-on quality. This is useful learning too, necessary to hear.

Non Epileptic Attack Disorder

Non Epileptic Attack Disorder is associated with past traumas, learning difficulty, and social learning. Traumas are remembered at a muscular and emotional level. They occur because of four Ps:

  • Predisposing: perhaps a strong drive to succeed, plenty of that among us, it was suggested.
  • Precipitating trauma: physical and psychological disaster.
  • Perpetuating: pressing on regardless, for example.
  • Protecting: the other side of the equation, supportive social networks. When things go wrong they can be disrupted though, and isolation aggravates the situation. A friend in need is a friend indeed.

There followed a presentation on EEGs, alpha – fastest, beta, theta and delta – slowest rhythms.

Brain maps are coloured representations of rhythms and are more attractive to those of us who are put off by the conventional wavy lines, but sadly are not so practically useful.

There are quite specific clinical implications and uses apart from the type of epilepsy. The elderly patient who is a bit confused with a preponderance of delta waves is probably hypoxic and needs oxygen. The EEG is a biomarker for types of epilepsy. However it is not very specific: 0.5 per cent of normal adults have ictal changes that falsely suggest epilepsy, nor is it very sensitive: the EEG can be quite normal in a person who suffers epilepsy.

More nuggets of information. A dyscognitive seizure state exists where a patient can obey simple commands and speak. Infantile spasms are a variety of seizure occurring at three – six months of age, that delay a child’s development, as does childhood absences, even though the latter are otherwise benign.

We saw a video of a childhood breath-holding attack, to contrast with epileptic seizures.

Medication

A neuropsychiatrist took us from the earliest antiepileptic drug – bromide, from the time of Queen Victoria – to the present panoply of dozens of medications. Barbiturates were also one of the earlier treatments.

This certainly makes sense to me. When I was training as a student you could probably memorise all the anti-convulsant medications. Nowadays that is quite impossible. They literally range from A to Z in the alphabet. From Acetozolamide to Zonisamide. Many are also mood stabilisers, particularly type 2 bipolar disorder where episodes of depression are more prominent. Broadly they fall into two groups, the Gamma Amino Benzoic Acid (GABA) AGONISTS and the anti-glutamatergic drugs.

Dostoevsky suffered epilepsy, and described a state of calm, serene knowledge that can precede convulsions in some, a type of aura. He also suffered a gambling addiction, which is associated with epilepsy, described in his novel, The Gambler.

Depression is also associated with epilepsy. Just as in non-epileptic patients, if antidepressants are used they should continue for at least six months after a first episode, and twelve months after a second one.

We were told of a distressing condition, forced normalisation. In this situation when convulsions are controlled, psychosis occurs, so a choice between uncontrolled fits or psychosis has to be made.

I was really surprised to learn that the earliest versions of the drink Seven-Up contained the mood stabiliser Lithium.

Channel blockers

The concept of channel blockers, gated channels between the inside and outside of cells was presented to us. Sodium, calcium, and potassium atoms all go through these different channels. The concept of physically blocking a channel at a microscopic level is quite remarkable to reflect on. Nature has a way of countering what we do. Drugs that block these channels are opposed at microscopic level, and so become less effective after a while.

NICE guidance recommends treatment for more than one convulsion, or after one convulsion with an abnormal EEG, abnormal imaging, if the patient is at increased risk of convulsions or if there is neurological deficit after a fit.

It seems monotherapy is the best policy, increasing the dosage to the maximum. If the patient is not fit free then a second drug is to be added. The first drug can then be tapered off if this is possible without convulsions occurring

If there are no fits for two years and there is a normal MRI scan, then treatment can be tapered off.

We were reminded that carbamazepine and sodium valproate can reduce serum sodium levels.

Cytochrome 250 enzymes break down and eliminate medications after they’ve done their work. Anticonvulsants really speed up that process, so the liver gobbles up and chucks out anticoagulants, antibiotics and oral contraceptives. We need to be aware of increased dosing and monitoring in these situations, as I suspect the General Medical Council has explained to more than one doctor. I’d rather hear it from Exeter University. In the opposite direction, painkillers and the universal panacea alcohol decrease the fit threshold, another nugget of knowledge to keep the patients and ourselves out of harm’s way. Sodium valproate in particular is associated with neural tube defects, the higher five mg dose of folic acid is necessary in pregnant women or those planning a child, and the issue should be raised with all couples of child-bearing age.

Epilepsy savvy

The “Wake Up to” Exeter teaching is wide-ranging. There were light-hearted apologies for the presentation on syncope, as that this is not actually epilepsy. However I really value the fact that the presentations covered general medicine, psychiatry and pharmacology. That is certainly of value for those of us in primary care. Taking us through to the present state of knowledge from first principles is also very useful. We are now epilepsy-savvy. We go out armed with a better understanding in the world of diagnosis and treatment, paraphrasing Omar Khayyam:

“Awake my little ones and fill the cup

E’re life’s liquor in it’s cup be dry.”

Fantasy Figures: A New Art Exhibition in Toulouse

Professor Melissa Percival, Associate Professor (French, Art History and Visual Culture), talks about an exhibition she has curated that is currently showing at the Musée des Augustins until 6 March 2016.

This post first appeared on the Humanities blog.

Michael Sweerts (1618-1664) Garçon au turban tenant un bouquet de fleurs Vers 1658 Collection Thyssen-Bornemisza ©Museo Thyssen-Bornemisza. Madrid

Michael Sweerts (1618-1664) Garçon au turban tenant un bouquet de fleurs Vers 1658 Collection Thyssen-Bornemisza ©Museo Thyssen-Bornemisza. Madrid

Faces, heads, bodies. A busy gathering of ragged beggars, dashing soldiers, haughty courtesans, absorbed readers and sleeping children. Young and old, tender and wrinkled. Flashes of artistic brilliance, humour and eccentricity. These are the key ingredients of a new exhibition of 80 European old master paintings that I have curated at the Musée des Augustins in Toulouse, France.

Whereas portraits depict a real person in a well-defined social context (professional or domestic), fantasy figures are much more mysterious. They are hard to read with their dark backgrounds, minimal objects, flamboyant costumes and ambiguous expressions. Instead they lend themselves to fiction and dreams. When you ‘meet’ these characters it is not always clear who you are looking at: some actively engage with you; others make you feel like you shouldn’t be looking at all. This type of informal, experimental work was greatly admired by collectors. Our exhibition – the first of its kind – brings together works from Italy, the Netherlands, Spain, France and England from the late sixteenth to the late eighteenth centuries.

The idea for the exhibition came from my book Fragonard and the Fantasy Figure (2012).

Bernardo Strozzi (Gênes, 1581/1582-Venise, 1644) Le Joueur de piffero (Il Pifferaio) Gênes, Galleria di Palazzo Rosso © Musei di Strada Nuova

Bernardo Strozzi (Gênes, 1581/1582-Venise, 1644) Le Joueur de piffero (Il Pifferaio) Gênes, Galleria di Palazzo Rosso © Musei di Strada Nuova

Around 1769 Jean-Honoré Fragonard painted a famous series of sixteen fantasy figures that have long puzzled the experts. I discovered a large number of similar works by Fragonard’s predecessors and contemporaries that had never been compared with each other, or regarded as a distinct type of artwork. They were far too beautiful and fascinating to remain hidden in picture archives or scattered in museum collections.

After two years of preparation, the paintings are finally up on the walls. It has been one of the most exciting few days of my life, seeing packing cases delivered from all over Europe, and opened up to reveal much anticipated treasures. (Not being an experienced picture handler, I’m not allowed to touch anything!) The paintings were thoroughly checked by a paintings conservation expert before being placed in a pre-arranged spot and carefully aligned.

 In the show we have ‘big names’ like Annibale Carracci, Murillo, Van Dyck and Frans Hals and of course Fragonard. But it’s also great to be showing the public less well-known but mesmerizing artists such as the Flemish Michiel Sweerts, who on his good days was as brilliant as Vermeer.

Jean-Baptiste Santerre (1658-1717) [d’après] Jeune femme endormie à la chandelle Fin XVIIe-début XVIIe siècle © Nantes, Musée des beaux-arts Photo C. Clos

Jean-Baptiste Santerre (1658-1717) [d’après] Jeune femme endormie à la chandelle Fin XVIIe-début XVIIe siècle © Nantes, Musée des beaux-arts Photo C. Clos

The designer has done an incredible job of creating an intimate yet dynamic exhibition space at the heart of the vast gothic church (the museum is a former Augustinian convent). Instead of ordering the pictures by chronology or artistic school, we have a less conventional themed arrangement: the sections are called such things as Musicians, Inner Lives, Laughter and Sarcasm, and The Laboratory of the Face. Alongside the serious scholarly purpose of remapping art history, the exhibition explores in so many ways what it is to be human.

I was fortunate to find a like mind in Axel Hémery, Director of the Musée des Augustins, one of France’s oldest and most prestigious museums. Together we made a long-list of loans, knowing that each would require careful negotiation, and that quite a number of our requests would not be met. It’s no easy feat to borrow an old master painting! I got to work on the catalogue, writing the main essay, shorter essays on each painting, and commissioning scholars to write chapters. Background research of this vast subject area tested not only my art historical knowledge but also my ability to read in several foreign languages.

Ceci n’est pas un portrait: Figures de fantaisie de Murillo, Fragonard, Tiepolo is at the Musée des Augustins from 21st November 2015 to 6th March 2016. ‪#Figures2fantaisie‬‪ ‬‬

Professor Melissa Percival is an expert in eighteenth-century French studies with research interests in Eighteenth-century art, literature and history of ideas. She has published widely on theories of physiognomy and facial expression.

Singing the Past

University of ~Exeter academic Dr Freyja Cox Jensen will be joined by her brother, to discuss how music and song connect the past and the present.

In this blog, Dr Oskar Cox Jensen poses the question Where has all the singing gone?

This post first appeared on the Humanities blog.

Singing the Past is an event with Dr Freyja Cox Jensen, Lecturer in History at the University of Exeter, and her brother, Dr Oskar Cox Jensen, Research Fellow at King’s College London, running as part of the Being Human Festival 2015. In the post below, Dr Oskar Cox Jensen asks, Where has all the singing gone?

We may think that we are surrounded by song as never before – in shops, on television, at sporting events, and of course in the privacy of our headphones, commuting to work, exercising, or simply strolling down the street.

But it was in the age before recorded sound that song mattered most to people’s lives: before CDs were spun or Spotify streamed, music was something you had to make.

To take that list above: as the tradition of ‘London Cries’ makes clear, goods and services used to be sold with a song, the milkmaid using one tune, the dustman another. Popular entertainment was stuffed with songs, especially in the theatre, where this was normally demanded by law. Even a tragedy would end with the latest hit and a dance, to send people away with a smile on their face and a song on their lips. Work song, on farms or factories, was crucial to the existence of millions, whilst Victorian children’s exercise was organised by communal singing. It was in the street that you heard the most singing, from buskers, as time went on, but for centuries, by ballad-singers, the people who sold you the words and taught you the tune of a song: all-in-one human jukeboxes, record shops, and songbooks. And at home, in the pub, on the road, if you wanted to hear one of these songs, you sang it yourself.

It is perhaps only in sport – think of the crowd at a football match – that this age-old involvement with singing lives on, with rival crowds showing both their support and their enmity with crude or clever parodies. In the past, parody was the main source of new songs: fitting new words to existing tunes.

In modern times, parodies tend to be comic (Monty Python, Weird Al Yankovic, and, er, Chris Moyles), but they could also be serious. Because no specific musical skill was needed to adapt a song’s lyrics, this meant songwriting was something everyone could participate in, making it in a very real sense the art-form of the people.

Clearly, songs still matter to people. Look at the fuss over Jeremy Corbyn not singing ‘God save the Queen’; at the student nightclubs when whatever this year’s ‘Sex on Fire’ or ‘Mister Brightside’ comes on; at the frankly disconcerting love people show for Les Mis. And people really, really love karaoke. Even – especially – those who can’t sing. Song electrifies brain, body, and soul (whatever that is) in a way nothing else can, and has always done so.

Just as looking at the past connects us to song, so song connects us to the past. People used to sing about everything: the love, sex, and money that make up most hits today, but also murder, politics, shipwreck, death, ghosts, God, theft, war, adventure, work, race, justice, drink – the list goes on. All the stuff of life that mattered to children, men, women, the stuff that didn’t make the history books, went into songs. Anyone interested in the past of this country, in music, or in the lives of ordinary people, would do well to look at their songs. Except ‘look’ is the wrong word. There’s really only one way . . . and that’s to sing them.

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Singing the Past is on three dates throughout the Being Human Festival: Thursday 12 November, Friday 13 November and Saturday 14 November.

Dr. Oskar Cox Jensen recently wrote an article that appeared in the New Statesman about Jeremy Corbyn’s decision to not sing the National Anthem and how this can be regarded within a political historical context.

Cornwall can be at forefront of radical UK healthcare reform.

Professor Sir John Tooke, President of the Academy of Medical Science, discusses how Cornwall could be at the forefront of healthcare reform following his Duchy Health Charity Lecture which was sponsored by the University of Exeter and Plymouth University.

The NHS, one of the greatest institutions a civilised democracy has produced, needs to evolve to be fit for purpose in a very different world from that which saw the passing of the Act in 1946.

A remarkable sense of social solidarity in the aftermath of the Second World War created the conditions for a comprehensive service available to all, regardless of ability to pay.

A recent ranking of national health systems put the UK first with the US 11th, largely reflecting the inclusion of equity and access in the ranking metrics. On some measures, such as survival rates for common cancers, UK performance is far less impressive. There is a huge gulf between life expectancy for the advantaged in our society compared to the disadvantaged, reflecting the economic and social determinants of health.

The  success of our health system has helped shift the age profile such that by 2030 there will be twice as many citizens over the age of 85 than in 2010,  increasing the burden of degenerative diseases, especially dementia, failing joints, vision and hearing. Life style changes related to diet and sedentary behaviour are resulting in a cumulative expression of diseases such as Type 2 diabetes and ischaemic heart disease.

At the same time the prospect of new, highly effective and specific treatment has never been greater, reflecting our ability to interrogate the human genetic code and vast data sets. Such promise has led to soaring public expectation. While medical therapeutic innovation holds great promise, technological advances that add only marginal incremental benefit are major cost drivers, a critical consideration in the current affordability crisis.

Despite these residual deficiencies and new challenges, society’s allegiance to the NHS and its iconic status make it hard for those in power to question fundamental precepts.  It follows that political will can only be galvanised if i) a new social compact can be struck with society that reflects the need for evolution while retaining public confidence, and ii) if clinical leaders champion the need for change, threatening in many cases their own vested interests.

A simple, relatively uncontentious purpose for a 21st Century National Health ‘System’, is the optimisation of health and wellbeing for the whole population in a manner that is accessible and affordable and tackles health inequalities. The requirements include: a service that seamlessly integrates primary and secondary care, public health and social care, organised around the needs of patients/citizens, not professions or NHS structures; a shift towards prevention; empowerment of patients and frontline health workers, and the adoption of genuine shared decision making.

Key points

To bring this about I suggest seven key proposals.

  1. The system should be organised around the needs of patients and citizens, recognising that control lies with the patients, not professionals.
  2. An holistic approach recognising that environmental factors, social factors and local economy are major determinants of health outcomes. ‘Integration’ needs to embrace that reality and dissolve divisions between primary and secondary care. Public health needs redefining for the changes of the next 20 years.
  3. Funding per head that reflects local factors such as rurality and health burden, for a comprehensive integrated system (the current commissioning arrangements add cost and risk of aggravating divisions between primary and secondary care). Contract periods need to be long enough (say 15 years) to incentivise investment in primary care, preventive medicine and the ‘new’ public health.
  4. ‘Digitalisation’ should continue apace to i) act as the ‘glue’ for integration; ii) provide the means to improve productivity of systems and processes; iii) empower patients in the co-development of their own health; and iv) provide the data to drive research, innovation and a ‘learning’ organisation culture.
  5. Academic alliances should be fostered to: i) Promote excellence, innovation and evidence-based practice; academic health science systems should oversee the faster adoption of  therapies of true benefit. ii) Provide the education and training. iii) Take advantage of the digital revolution. iv) Stimulate the local economy.
  6. The medical profession needs to recognise that many technical procedures and protocol-driven care can be delivered by trained others. Doctors should be advocates for public health as well as the patient in front of them, and recognise a role as managers of resources.
  7. A social compact should be forged that reflects a mutual commitment to a new National Health ‘System’ that involves rights and responsibilities and reflects economic reality. We should learn from less advantaged nations which are creating high-quality transformative approaches based on limited affordability.

The solutions to health care challenges are often context specific. Cornwall has 31 per cent more residents over the age of 75 than the rest of England; rurality and relatively low population density; economic challenges; and scale and cost effectiveness of specialist services for a relatively small population. But Cornwall could harness its strong regional identity, be in the vanguard, and champion radical, integrative solutions for health, social care and public health, exploiting unitary authority status.

The health system in Cornwall has long championed the importance of education and medical school alliances can be fostered to drive innovation and evaluation. The path will not be easy – specialist services will need to be realistically distributed and health care professionals adjust to new roles and ways of working. But the prize is a locally responsive sustainable health and social care service for Cornwall, fit for the 21st Century, not post-war Britain.

Professor Sir John Tooke is president of the Academy of Medical Sciences and helped create the Peninsula College of Medicine and Dentistry for the South West. He was in Cornwall this week giving the 2015 President’s Lecture for the Duchy Health Charity

Discover the scary side of science at Science in the Square 2015

On 14 August 2015, the Penryn campus was transformed into an, at times scary, nature wonderland – full of erupting volcanoes and intestinal parasites for the annual Science in the Square event.

In this blog Stephanie Wheeler, Student Engagement, Widening Participation and Internationalisation Co-ordinator, writes about coordinating her first Science in the Square.

TarantulaI had never attended Science in the Square before so when I started my job, it was fairly daunting to think that I would be coordinating the event this year. I had only ever heard amazing things about previous events and seen the wonderful pictures and videos of everybody having a great time so the pressure was on!

After months of planning, I couldn’t believe how quickly 14 August came around. Bright eyed and excited for the day ahead, we arrived at Events Square at 7.30am to start the mammoth set-up.

Seeing the empty marquee, still scattered with sticky tables and empty beer glasses from the party the previous night, it was hard to imagine that in just a few hours the event would be underway. Yet, by 12 noon, it had been completely transformed by our army of staff and volunteers- the banners were hung in place to proudly announce that our scientists had descended for the afternoon, seven zones were set up around the main marquee with a whole host of hands on activities, and chairs were neatly lined up in front of the stage ready for the talks- we were all set!

At 12 we finally opened the gates, much to the delight of those who had been queueing outside for the past half hour, and within a matter of minutes the marquee was buzzing.

Visitors were able to hold insects and snakes in Live Zone, play with glacier goo in Earth Zone, examine critters under the microscope in Mini Beast Zone, inspect skulls in Bone Zone, and were transported to a jungle camp in Adventure Zone.

A few dedicated members of staff had even been out rock pooling until midnight the previous night to fill the tanks in Marine Zone with starfish, crabs, and other amazing sea creatures. This year, for the first time, we also set up a photo booth which was extremely popular and, thanks to a green screen, allowed visitors to act out fun animal encounters.

31As if this wasn’t enough, we also ran four interactive talks throughout the day, themed around ‘Scary Science?’. Dr Chris Lowe kicked things off with ‘Scary Seas’, taking a look at the frightening creatures, big and small, living in the marine environment.

Chris was followed by Dr Regan Early who explored ‘Petrifying Plants’, and at one point had three willing volunteers eating the world’s hottest chillies live on stage, and Dr Kate Smith, whose talk on ‘Violent Volcanoes’ involved a simulation of a volcanic eruption.

To round things off, Dr Andy Young delved into the world of ‘Perilous Parasites’, with tales of tapeworms in humans, a parasite that lives on fish tongues, and a ‘zombie disco snail’. Even though I have a science background, I learnt something new from each talk and I think it was a real testament to the speakers that they managed to engage an audience of children and adults for up to 30 minutes with everything else that was going on in the tent!

Science in the Square is great for so many reasons – it allows us to raise the profile of the Penryn Campus, to give back to the local community, but most importantly, in my opinion, it enables us to inspire and excite the next generation of scientists.

When Professor Brendan Godley kicked off the event he made the statement ‘Science is fun, science is everywhere, and science is for everyone’, and I hope we were able to prove that.

Defeating Depression, What Hope?

 An event organised by Dr Ali Haggett, and Professor Mark Jackson of the Centre for Medical History. Dr Haggett recounts the event….

The #DefeatingDepression event, broadly explored two questions: ‘What progress has been made in treating depression in the last twenty years?’ and ‘How should mental health conditions be addressed in the future?

We were delighted that Sue Baker, Director of the organisation Time to Change came to chair the debate. She was joined by five panellists with a combination of professional expertise and lived experience who were invited to join us to speak from their own perspective for a few minutes on the topic,

The panellists were:

The contributions from the panellists, and the audience participation that followed, reflected a range of current anxieties about mental health care in the UK. Most prominent among these was the importance of preventing depression by promoting resilience and combatting a host of social and economic problems that are known to cause vulnerability to the most common mental disorders.

Niall Macleod and Gavin Thistlethwaite identified a range of social problems such as isolation and poverty that impact negatively on mental and physical health. Tackling these issues, they argued, requires a new model of healthcare in which we must firstly look to our own communities to foster and renew social relationships and promote social cohesion.

Secondly, they noted, ‘patients’ will increasingly dictate the direction of service provision with personalised care and personal budgets. ‘Men in suits’, argued Gavin, ‘may collect the data’; however, ‘service-users are now beginning to dictate the interventions they want’.

Central to these developments nonetheless, must be government support that is genuinely committed to parity of esteem in terms of funding between physical and mental health. Action, not words, argued Keven Jones, is what is required.

Particular groups were identified as being especially vulnerable, with recent cuts to Child and Adolescent Mental Health Services (CAMHS) being viewed as of particular concern.

Louise Howard proposed that equitable distribution of funding was essential and should be ring-fenced. However, to separate physical health from mental health in the first place was in fact entirely illogical, she noted. This was a point reflected strongly in Julie Harvey’s honest (and at times moving) account of her own experience, in which she reminded the audience that the way in which she presented with depression was often with physical symptoms that led her initially to A and E. Similarly, many physical illnesses and chronic disorders may lead to symptoms of depression.

Despite such palpable concerns and anxieties, the most important message of the evening was nonetheless one of optimism. In terms of service provision, Gavin Thistlethwaite reminded us that the concept of user-engagement and personalised commissioning now underpins the framework of the Care and Quality Commission and provision of services.

Perhaps most strikingly, the personal accounts of depression from the panellists and the audience also served to remind us all that people with mental illness make significant and positive contributions to society. On a personal level, Kevan Jones pointed out that depression had, in many ways made him a better person – it was, he noted, ‘part of him’.

The evening was enhanced by the hospitality of the staff at the RAMM and a collection of stands showcasing the University’s research on mental health from the Medical School, the Centre for Medical History and the Mood Disorders Centre.

Meg Smith, a local artist, displayed a selection of her striking photographs depicting depression.

Double Elephant, known and respected locally for their work in mental health, also displayed a range of artwork.

The organisers would like to thank everyone who contributed to or was involved with the evening and we look forward to fostering further links with local organisations and individuals working in the field of mental health.

The public event organised by the University’s Centre for Medical History, in conjunction with the Humanities and Social Science research strategy, took place at the Royal Albert Memorial Museum on 24th June

Exeter pub serves up a Pint of Science

Dr Thomas Constant, Associate Research Fellow in Physics and Astronomy spoke at this week’s Pint of Science festival. He recalls his experience…

It was my immense pleasure to participate in this year’s Pint of Science festival that took place over three nights in Exeter, and concurrently in another forty-nine cities around the world.

The premise was for university researchers to give public talks in pubs, with an emphasis on casual and engaging talks in a far-less stuffy environment than the traditional lecture halls. As an additional incentive, for both attendees and speakers, plenty of beer was available throughout.

I presented at the Ship Inn, near Exeter Cathedral. A very traditional 16th century alehouse which Exeter legend would have you believe was a favorite of Sir Francis Drake. The conditions were intimate to say the least!

Due to the space requirements my colleague, Professor Roy Sambles, and I stood amongst the audience, as we extolled the benefits and the quirky physics that lies behind things as simple as colour, liquid crystals or fluorescent light bulbs.

Such a format was a wonderful catalyst for discussions and questions, and also an enjoyable challenge when demonstrating potentially dangerous experiments using things like lasers, tesla coils and the surprisingly useful and often overlooked scientific apparatus: a pint of G&T.

About thirty people came to listen, quiz and challenge the research I conduct at Exeter, which focuses on the science of light. The United Nations has declared 2015 the international year of light, chiefly to raise awareness of how research into light profoundly affects our everyday lives.

My primary research at Exeter is all about trapping light at the surface of materials. Since 1902, when a rather eccentric scientist named Robert Wood was playing with some scratched gold, we have known that if we shine light on a metal mirror that has some tiny grooves in its surface, sometimes the light doesn’t reflect but ‘hangs around’ on the surface, trapped their as a new type of quantized quasi-particle we call a ‘surface plasmon’.

The advances this discovery are leading towards are not yet fully realised, but we know enough so far to be confident that trapping light in this way will lead to some significant advances we will be seeing very soon in everyday life.

The best sensors in the world already use this effect, and we have now reached the point where just a single molecule of material on a metal surface can be detected. My favorite use of this is in Mexico, where they use sensors like this to detect bootleg tequila. Light hanging around a surface also improves solar cells, a technology at a tipping point of truly becoming a viable alternative to fossil fuels, if only we could push their efficiency a tiny bit further.

There are countless more applications that are just starting to bear the fruit of the global research in these areas, from stealth technologies, anti-counterfeiting products, light generation, quantum computing, and even in one case possible cancer treatments using just light and harmless gold particles.

Whatever the final products that result from our research, our goal is a simpler one: to understand the subtleties of how light behaves. It is a passion our research group shares with many others around the world and now, with a little bit of luck, an additional thirty or so Exeter pub-goers.

Remembering Mahatma Gandhi: the first statue of an Indian unveiled in Parliament Square

As we commemorate  the 100th anniversary of Mahatma Gandhi’s return to India from South Africa, University of Exeter English lecturer. Dr Florian Stadtler  and Open University Postdoctoral Research Associate, Maya Panmar tell us about how Gandhi’s association with this country influenced both Britain and Gandhi.

This blog originally appeared in The Conversation.Conversation logo

 

By Maya Parmar, The Open University and Florian Stadtler, University of Exeter

A new monument of political activist and leader of the Indian independence movement Mahatma Gandhi has been unveiled in London’s Parliament Square. Gandhi’s statue will join that of his famous adversary in the independence campaign, Winston Churchill, as well as others, among them Nelson Mandela and Abraham Lincoln. He is the only person never to have been in public office to be honoured with a statue in the square, and the first Indian.

The memorial’s inauguration coincides with a season of commemorations that mark the 100th anniversary of Gandhi’s return to India from South Africa to begin the struggle for self-rule. Yet the statue in London is also testament to Gandhi’s profound relationship with Britain: of both the considerable influence and impact Gandhi had in Britain itself, but also the influence Britain had on Gandhi.

Shaping Gandhi

Mahatma Gandhi and friend in South Africa, 1908. PA Photos/PA Archive

Mahatma Gandhi and friend in South Africa, 1908.
PA Photos/PA Archive

Mohandas Karamchand Gandhi first arrived in Britain at the age of 19 on September 29 1888 to study law. He initially found lodgings in West Kensington. His ambition then was to transform himself into an English gentleman – and pictures from the time show him in contemporary Victorian court dress.

He trained as a lawyer at London’s Inner Temple. While in London, Gandhi discovered the Vegetarian Society, a lively London-based reformist movement that originated in the late 19th century. This shaped his own views on vegetarianism and formed part of his political awakening. Non-violence and vegetarianism soon became aligned in Gandhi’s thinking on politics and ethics.

His involvement in the society provided Gandhi with access to some of the notable thinkers of the time. While in London, Gandhi attended meetings of the London Indian Society as well as other organisations that campaigned for greater self-rule. He also got involved with the Theosophical Society.

Gandhi’s three years in London profoundly shaped him and his thinking. After he was called to the Bar in 1891, he returned to India, before moving to South Africa.

The home front

In 1906 Gandhi returned to the UK, travelling to London to campaign for the rights of the Indian community in South Africa as the spokesman for Natal and Transvaal. He again represented the cause in London in 1909.

In August 1914, a longer four-month stay coincided with the outbreak of World War I. While in the city he reconnected with many activists for Indian self-government, including the poet Sarojini Naidu. Gandhi galvanised the local Indian community to support Britain’s war effort. He was a driving force behind the creation of the Indian Ambulance Volunteer Corps and also contributed to the recruitment of Indian medical staff for the hospitals along Britain’s south coast. These hospitals were set up to care for Indian soldiers wounded on the Western Front.

The British working class

Gandhi visited Britain for the last time in September 1931 to attend the Second Round Table Conference on the future of India. By this point, his reputation as a campaigner had grown exponentially and so his visit elicited much interest in the press.

However, his activism and humility also connected him to the British working classes, as archival footage reveals. Rather than staying with other delegates in central London hotels, Gandhi instead resided in lodgings in the humbler area of Poplar, East London.

During this visit the East End doctor Chuni Lal Katial, who acted as Gandhi’s chaperone, arranged for Gandhi to meet with Charlie Chaplin. Gandhi also visited mill workers in Darwen, Lancashire at the invitation of the mill-owning Davies family.

The intention was to alert Gandhi to the impact the Indian boycott of British goods had in north-west England, and in particular the hardship being suffered by the local textile industry and its workers. Though the circumstances of his visit were potentially contentious, he was accorded a warm reception. Gandhi expressed his sympathies with the workers’ plight, though not necessarily the mill owners’. His prominent visit helped to explain the issues of poverty and oppression India and her people faced. It became clear that unless an agreement for Indian self-government could be reached the campaign for independence would continue.

Gandhi’s influence has left a lasting legacy on non-violent resistance struggles across the world. The new London statue is testament to his work, and the ongoing, manifold connections between India and Britain. More than this though, the unveiling of the first statue of an Indian in Parliament Square is a tribute to the broader and complex underrepresented contributions South Asians have made to Britain across the decades.

Darwin Day celebrations

On 12 February, the University of Exeter marked Darwin’s birthday by looking at the work of Darwin’s contemporary, and fellow evolutionist, Alfred Russel Wallace.

This blog was written by PhD student Sarah Lane.

On the 12 February, evolutionary biologists around the globe celebrate Darwin Day, the anniversary of Charles Darwin’s birthday. It has become an annual tradition in the College of Life and Environmental Sciences (CLES) Cornwall to use Darwin Day to stop, think and celebrate on the work of Darwin and its influence on modern day biology. However, this year, on Darwin’s 206th birthday, the focus of these celebrations was given to evolution’s other discoverer, Alfred Russel Wallace.

Wallace and Darwin proposed the idea of evolution by natural selection at the same time and in fact published the very first paper on the subject together. But despite this shared origin, the works and influence of Wallace have become overshadowed by the popularity of Darwin, leaving Wallace as a mere footnote in the story. In an effort to develop our understanding and appreciation of Wallace, we invited evolutionary biologist and Wallace historian Dr. Andrew Berry, from Harvard University, to give us not one, but two fantastic talks on the life and works of Alfred Russel Wallace. Dr. Berry led us ardently through Wallace’s epic journeys to unchartered lands and new ideas.

First, the Amazon River – the four years of ground-breaking research that tragically went up in flames on his voyage home – then onto his love affair with the beauty and richness of the Malay Archipelago. Dr. Berry reminded us not only of the incredible feat of Wallace’s journeys and the influence of his work, but also of the fascination and fervour with which it was undertaken, captured in the beautiful language of Wallace’s book ‘The Malay Archipelago’.

Phylum feast

Alongside Dr. Berry’s talks, we challenged some of CLES’ own academics to explain their research in a way that Alfred Russel Wallace himself would understand. With our very own Dr. Andrew Russell posing as Wallace, Professor Richard-Ffrench Constant explained his work on insecticide resistance with the use of some brilliant props, followed by Dr. Lena Wilfert. who described her work on the global spread of insect diseases.

Dr. Chris Lowe introduced Wallace to the idea of merging lineages and the incredible world of Kleptokaryochloroplastidy(!) – the theft of chloroplasts and nuclei by one planktonic species on another. Finally, Professor Dave Hosken enlightened Wallace on the wonders of sexual selection after copulation and his formative work on sperm competition in dung flies.

As is tradition in CLES Cornwall, the talks were followed by a phylum feast, at which people are encouraged to bring delicacies of every phyla imaginable. This year brought many intriguing offerings including lemon drizzle grasshopper cake, sushi with sea urchin gonads, lichen, seaweed and Hákarl – a rather potent Icelandic delicacy of rotten fish.