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The current legal test for capacity under the common law is a functional test. It determines whether a person can make a particular decision at a particular time; it focuses on retained abilities rather than on presumed deficits - in order to promote patient autonomy in decision-making. International evidence suggests however that the test is not well understood and consequently not being correctly applied in practice by a range of medical professionals. Donnelly has argued that gaining a better understanding of how capacity assessments are actually employed is essential to improving the quality of assessments. To date, there is little data on how doctors in particular make their assessments in practice. Using a socio-legal methodology, this quantitative study aims to assess understanding of capacity among a group of general practitioners/family medicine doctors in Ireland, and to determine how they assess capacity in clinical practice. Our study found that notwithstanding a lack of confidence in their ability to assess decision-making capacity, that respondents in fact demonstrated a high level of understanding and of ability to correctly apply the functional test in practice.

Objectives: Medico-legal and regulatory culture has a significant impact on medical practitioners, including the decision of graduates to enter high-risk specialties. This study explores the impact of the current medico-legal and regulatory culture in Ireland on the decision of graduate entry medical students to enter one high risk specialty, obstetrics and gynecology., Study Design: We conducted a survey of 146 final-year, graduate-entry medical students pre- and post- a 6-week rotation in obstetrics and gynecology in Ireland. Participants were asked to rate the influence (on a four-point scale) of factors such as fear of being sued, being reported to the regulatory body or criminal prosecution on their decision to pursue a career in obstetrics or gynaecology. Data were matched pre- and post-rotation and McNemar-Bowker's test was used to test for differences in related data. All analysis was conducted using SPSS for Windows version 25., Results: The responses of 72 students to both questionnaires could be matched (response rate 49.3%). The majority of participants pre-rotation reported that fear of being sued (74%), fear of being reported to the regulatory body (70%) and fear of criminal prosecution (55%) were factors influencing their decision (somewhat or to a great extent) to pursue a career in obstetrics. There were no significant changes post-rotation. Compared to obstetrics, lower proportions of participants pre-rotation considered fear of being sued (54%), fear of being reported to the regulatory body (50%) and fear of criminal prosecution (40%) as factors influencing their decision to pursue a career in gynecology. There were no significant changes post-rotation., Conclusions: Medico-legal and regulatory culture is shaping the perceptions of graduate entry medical students of obstetrics and gynecology and influencing their decision to pursue a career in the speciality. Understanding the impact of medico-legal culture on career choices including a high-risk specialty such as obstetrics and gynecology is important from both a policy and reform context, and if the healthcare service is to recruit and retain adequate numbers to ensure the safe provision of healthcare., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

To achieve insights in antiviral immune defense of the central nervous system (CNS), we investigated T cells and CD45 cells in the marine fish model Dicentrarchus labrax infected with the CNS-tropic virus betanodavirus. By employing markers for pan-T cells (mAb DLT15) and CD45-cells (mAb DLT22) in immunofluorescence (IIF) of leukocytes from brain, we obtained 3,7 ± 2.3 % of T cells and 7.3 ± 3.2 % of CD45 + cells. Both IIF and immunoelectron microscopy confirmed a leukocyte/glial morphology for the immunoreactive cells. Quantitative immunohistochemistry (qIHC) of brain/eye sections showed 1.9 ± 0.8 % of T + cells and 2 ± 0.9 % of CD45 + cells in the brain, and 3.6 ± 1.9 % and 4.1 ± 2.2 % in the eye, respectively. After in vivo RGNNV infection the number of T cells/CD45 + leukocytes in the brain increased to 8.3 ± 2.1 % and 11.6 ± 4.4 % (by IIF), and 26.1 ± 3.4 % and 45.6 ± 5.9 % (by qIHC), respectively. In the eye we counted after infection 8.5 ± 4.4 % of T cells and 10.2 ± 5.8 % of CD45 cells. Gene transcription analysis of brain mRNA revealed a strong increase of gene transcripts coding for: antiviral proteins Mx and ISG-12; T-cell related CD3ε/δ, TcRβ, CD4, CD8α, CD45; and for immuno-modulatory cytokines TNFα, IL-2, IL-10. A RAG-1 gene product was also present and upregulated, suggesting somatic recombination in the fish brain. Similar transcription data were obtained in the eye, albeit with differences. Our findings provide first evidence for a recruitment and involvement of T cells and CD45 + leukocytes in the fish eye-brain axis during antiviral responses and suggest similarities in the CNS immune defense across evolutionary distant vertebrates., Competing Interests: Declaration of competing interest Authors declare there are no competing financial interests in relation to the work described., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)