Boscombe Community Hospital

This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be ‘better off dead’. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an ‘anchor’ for the surveyed preferences on which QALYs are based. In the context of the debate over euthanasia, the QALY assumes an ability to make meaningful comparisons between life-states and death. Not only is this assumption questionable, but the ethical debate is much more broad than the question of whether death is preferable to a state of living. QALYs are derived from preferences about health states, so do not necessarily reflect preferences about events (eg, dying) or actions (eg, killing). This paper presents a new kind of problem for the QALY. As it stands, the QALY provides confused and unreliable information when it reports zero or negative values, and faces further problems when it appears to recommend death. This should preclude its use in the debate over euthanasia and assisted suicide. These problems only apply where the QALY involves or seems to involve a comparison between life-states and death, and are not relevant to the more general discussion of the use of QALYs as a tool for comparing the benefits derived from treatment options.

International Journal of Nautical ArchaeologyVolume 42, Issue 1 p. 193-196 Note A Pascual 1 Roman Amphora from Catalonia from the sea at Saint Alban's Head Ledge, Dorset, England D. Parham, D. Parham School of Conservation Sciences, Bournemouth University, Talbot Campus, Poole, Dorset, GB-BH12 5BBSearch for more papers by this authorA. P. Fitzpatrick, A. P. Fitzpatrick 102 Boscombe Grove Road, Bournemouth, Dorset, GB-BH1 4PGSearch for more papers by this author D. Parham, D. Parham School of Conservation Sciences, Bournemouth University, Talbot Campus, Poole, Dorset, GB-BH12 5BBSearch for more papers by this authorA. P. Fitzpatrick, A. P. Fitzpatrick 102 Boscombe Grove Road, Bournemouth, Dorset, GB-BH1 4PGSearch for more papers by this author First published: 04 February 2013 https://doi.org/10.1111/j.1095-9270.2012.00368.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume42, Issue1March 2013Pages 193-196 RelatedInformation

Severe recent declines of amphibians around the world have highlighted the need to identify factors that affect their population dynamics and viability. This study used a long-term (>30 years) dataset collected for a British population of natterjack toads Bufo calamita, a rare and endangered species in much of northern Europe. Modelling was employed to test a series of hypotheses concerning the effects of anthropogenic (conservation management) and climatic factors on toad demographics. The best models accounted for >72% of the variance in population size, as judged by spawn string counts, between 1975 and 2007. Conservation management (pond creation) was important, as were spring and summer climate variables relating to larval survival, and winter conditions associated with hibernation mortality. The implications of trends associated with future climate change are also considered.

This paper describes an early intervention project which combines a three tiered approach to speech and language provision for pre-school children. Jointly funded by I CAN, AFASIC, Dorset Healthcare NHS Trust and the Department of Health, this two and a half year project aims to reduce the numbers of children and severity of their speech and language difficulties on entering school. The project uses the following approaches--the Ward Infant Language Screening Test Assessment Acceleration Remediation (WILSTAAR), the Hanen parent programmes and a specialist speech and language playgroup. In this paper these approaches are described with an explanation of how each is being evaluated and where possible interim results have been presented.