text:
Estimated financial and human resources requirements for the treatment of malaria in Malawi
Adamson S Muula1, 2Email author,
Emmanuel Rudatsikira3,
Seter Siziya4 and
Ronald H Mataya5
© Muula et al; licensee BioMed Central Ltd. 2007
Malaria fever is a common medical presentation and diagnosis in Malawi. The national malaria policy supports self-diagnosis and self-medication for uncomplicated malaria with first line anti-malaria drugs. While a qualitative appreciation of the burden of malaria on the health system is recognized, there is limited quantitative estimation of the burden malaria exacts on the health system, especially with regard to human resources and financial burden on Malawi.
The burden of malaria was assessed based on estimated incidence rates for a high endemic country of which Malawi is one. Data on the available human resources and financial resources committed towards malaria from official Malawi government documents and programme reports were obtained. The amount of human and financial resources that would be required to treat 65% or 85% of symptomatic malaria cases as per the Roll Back Malaria partnership and the US President's Malaria Initiative targets.
Based on a malaria incidence rate of 1.4 episodes per year per person it was estimated that there would be 3.71 million symptomatic episodes of malaria among children <5 years of age based on mid-2007 census projections. At 0.59 episodes each year per person there would be 2.13 million episodes in the 5 to 14 year age group and 1.02 million episodes in. There would be 761,848 malaria cases when HIV is not factored in among those 15 years of age or above; this figure rose to 2.2 million when the impact of HIV in increasing malaria incidence was considered. The prevalence of HIV has resulted in 42.3% increase in symptomatic malaria cases. Treating 65% to 85% of cases would result in using 8.9% to 12.2% of the national health budget or 22.2% to 33.2% of the national drug budget. Furthermore, having 65% to 85% of cases treated at a health facility would consume 55.5% to 61.1% of full-time equivalents of all the clinicians registered in the country. While this study's estimated time of 5 and 10 minutes per consultation may differ in actual practice, due to time constraints patients may not be seen for longer consultation in resources limited settings.
Malaria exacts a heavy toll on the health system in Malawi. The national recommendation of self-medication with first-line drug for uncomplicated malaria is justified as there are not enough clinicians to provide clinical care for all cases. The Malawi Ministry of Health's promotion of malaria drug prescription including other lower cadre health workers may be justified.
Uncomplicated Malaria
Symptomatic Malaria
Sulphadoxine Pyrimethamine
Malaria Incidence Rate
Malaria is the leading cause of morbidity and mortality in Malawi. Children under the age of 5 years and pregnant women are especially vulnerable. The Ministry of Health estimates that 40–50 percent of all out-patient health facility attendances are due to malaria [1, 2]. It has been reported that an estimated 8 million symptomatic malaria episodes occurs each year in a country of about 13 million people [2].
The Malawi government through the National Malaria Control Programme (NMCP) aims to reduce the public health burden that malaria exacts on the country through improved case management, intermittent presumptive treatment of pregnant women and prevention mostly through the promotion of the use of insecticide-treated bed nets [1]. The treatment for uncomplicated malaria in Malawi has been single dose oral sulphadoxine pyrimethamine (SP) since 1993 [3–5]. Recently however the Malawi Ministry of Health's Policy has changed based on published results [3–5] from SP to a artemisinin-containing combination therapy (ACT), artemether-lafumentrine (coarterm).
While the burden of malaria in terms of clinical outcomes such as deaths, anaemia, prematurity and low birth weight have been described [6–8], the toll that the disease exacts on Malawi's human resources for health and the national health budget has received limited attention. Yet many health systems in developing countries are unable to deliver adequate quality and quantity of health services because of limited human resources for health (HRH) available for service [9–11]. Malawi's health system has experienced severe shortage of HRH from a combination of factors: low output from the training institutions, migration of health professionals and attrition to deaths largely estimated to be from AIDS [12–14].
The main aim of the study was to estimate how much clinician-time that malaria exacts on Malawi's Ministry of Health resources. Secondary aims were to estimate the proportion of finances that anti-malarial medications exact on the country's health budget. Furthermore the study also aimed to compare the estimated whether the Malawi public health sector had adequate human resources to provide treatment to 65 percent or 85 percent of symptomatic malaria as per the Roll Back Malaria partnership and the US President's Malaria Initiative targets [15, 16]. Incidence of malaria in Malawi was based on the MARA (Mapping Malaria Risk in Africa) index [17, 18].
Population estimates and number of clinicians
The age-specific population estimates from the National Statistical Office which were based on projections from the 1998 Malawi Population and Housing Census [19]. By mid 2007, there were 2,648,694 persons <5 years, 3,612,050 ages 5 to 14 years and 6,925,888 for those aged 15 year or above.
The incidence of malaria
The incidence of symptomatic malaria by level of transmission intensity and age group was estimated as reported elsewhere [17, 18]. As a high malaria endemic area the incidence rate of malaria in Malawi was estimated at 1.4 episodes per-year among children less than 5 years of age, 0.59 episodes in the 5 to 14 years age group and 0.11 episodes per year for those 15 years or older The 2004 Malawi Demographic and Health Survey estimated that 11.8 percent of Malawians ≥ 15 years were infected with HIV [1]. HIV prevalence estimates in children are not known. This then translate to 817,255 persons estimated to be HIV infected in mid-2007.
Incidence rates of malaria among HIV infected adults in Malawi have been estimated at 3.2, 4.9 and 5.4 per 1,000 person-years for those with CD4 count of >400/μL, 200–399/μl and <200/μL [12]. Based on the fact that 11.8% of adult Malawians were estimated to be infected with HIV, the burden of malaria in this group based on population estimated and incidence rates as reported by Patnaik et al [20].
The national budget data to enable us assess what proportion of the overall national health budget and drug budget would malaria consume was obtained. Data for the national expenditure was obtained from the Malawi Poverty Reduction Strategy Report [21] and from a report by Kabuluzi [2]. In Malawi, drugs are estimated to consume 30 percent of the total health affairs budget [21]. The estimated medications cost for adult full course was US$ 1.35 and US$ 0.45 for <5 year olds and 5 to 14 year olds [22].
Number of clinicians in Malawi
There were 610 clinicians (physicians and clinical officers) registered with the Malawi Medical Council in Malawi in 2005 [23]. There were also 485 registered medical assistants. The total clinician pool was therefore 1,095; all clinician cadres included.
The estimated case numbers of symptomatic malaria in Malawi
Based on a malaria incidence rate of 1.4 episodes per year, there were an estimated 3,709,572 symptomatic episodes of malaria among children <5 years old in 2005. At 0.59 episodes each year, there were 2,131,110 episodes in 5 to 14 year age group and 761,848 episodes in those aged 15 years or above. An estimated 6,602,530 episodes of malaria would have occurred for the whole population. These estimates were obtained without considering the impact of HIV on malaria.
The estimated number of adult Malawians infected with HIV in the ≥ 15 years age group, based on prevalence of infection at 11.8 percent was 817,255. There is paucity of data that have categorized CD4 count levels of HIV infected Malawians at the population level. It is however generally accepted that 15 percent of HIV infected have CD4 counts less than 200/μL [11]. With 15 percent of 817,255 HIV infected persons with CD4 counts less than 200/μL and assuming the rest have CD4 counts greater than 400/μL, the number of malaria episodes would be 2,222,934 for those will low CD4 counts and 661,975 for those with CD4 counts of >400/μL. The total burden of malaria among adult HIV infected persons would be 2,884,491 compared to 89,898 if HIV was not a factor among this group i.e. a factor of 32 in the presence of HIV. The total number of case in the whole population would then be 9,397,123, an increase of 42.3 percent. The budget and human resources burden that follow were estimated with incidence estimates that factored in HIV's influence in raising the incidence in the 15+ year old group.
The burden of malaria on the national drug budget
A total US$ 54.3 million (MK 6,412.16 million) was reported to have been spent on health affairs in the 2004/2005 Malawi national budget. The drug budget was US$ 19, 916,101.7. While assessing the cost of treating all cases of malaria would be informative, that would probably be unrealistic. It was therefore perceived that there was need to assess the medication cost of treating 65 percent and 85 percent of all symptomatic cases as outlined in the Roll Back Malaria partnership and the US President's Malaria Initiative targets.
As shown in the tables 1,2,3 and 4, without factoring in the contribution of HIV on malaria, drug costs for treatment of uncomplicated malaria with coartem would consume about 8.9–12.2 percent of the total national budget and about 24.2–33.2 percent of the total drug budget. The proportion of the amount of expenditure differed according to whether only 65 percent or 85 percent of the cases were being treated.
Burden of malaria treatment on total national health budget at 65% clinical cases treated
Estimated number of cases
Total malaria drug costs in US$
Expressed as % of national health affairs budget
Burden of malaria treatment on total national drug budget at 65% clinical cases treated
Expressed as % of national drug budget
Expressed as % of national drug affairs budget
In 2005–6 financial year, the Malawi government allocated US$ 23,080,000 as total funds for malaria treatment, prevention and control [2]. This allocation came from the country's own national budget, WHO, UNICEF, USAID and the Global Fund. From these funds, Coartem costs for all patients would cost 20.9–28.7 percent of that budget.
The burden of malaria on the clinician pool
The clinician full time equivalents (FTEs) required to treat 65 percent and 85 percent of symptomatic malaria was assessed based on an assumed patient-clinician contact time of 5 minutes and 10 minutes. In fact Nsimba et al [24] have reported a 3.8 minute consultation of under-five children with fever in Tanzania. Makombe et al [25] have reported that each health professional spends 4.4 work-days each week i.e. a total of 230 days each year providing clinical care. Each health professional would potentially consult 11,040 patients each year at 10 minutes and twice the number at 5 minutes. To treat 65% and 85% of all the cases at 10 minutes per visit would require 553 and 724 clinicians respectively working full time i.e. 55.5 or 66.1 percent of all registered clinicians. The number and proportions of clinicians required reduce by half if a consultation time is reduced to 5 minutes.
It was estimated that about 9.4 million cases of uncomplicated malaria would be expected to occur in Malawi in 2007/08. Comparing age groups 0 to 4 years, 5 to 14 years and those >14 years, the number of cases were highest in the youngest group i.e. about 3.7 million cases. Among the oldest group, incidence increased by a factor of 42.3 percent when the impact of HIV in increasing incidence of malaria was factored in.
Malawi, like many other African health systems, relies heavily on non-physician clinicians [26]. Clinical care is, therefore, provided by medical assistants, clinical officers and physicians. It was estimated that 55.5 to 66.1 percent of all registered clinicians would be required to treat 65 percent to 85 percent of the cases of uncomplicated symptomatic malaria in the country. While it is currently unrealistic that all these cases would present for care, the estimate still demonstrates that malaria is a large public health problem in Malawi. Probably a major finding of the current assessment is that both the Roll Back Malaria and the US President's Malaria Initiative targets are unlikely to be achieved in Malawi for the treatment of patients by medical assistants, clinical officers and medical doctors.
The Ministry of Health in Malawi promotes the mobilization of community health workers and lower cadre health professionals for the management of malaria [22]. While such recommendations are certainly realistic, they may contribute to the development of antimalarial drug resistance due to inappropriate use of medications by limited trained health workers.
The burden that malaria would exact on the national health affairs budget is large. However in practice, this is not the case as patients self-medicate at home from drugs obtained from various sources including grocery stores and the private sector [27]. Also health facilities do not always stock adequate medications all the time, so the actual expense may be lower than what has been estimated in the study. A recent survey of health facilities in Lilongwe district, capital district of Malawi by Lufesi et al found that the government-run Central Medical Stores was only able to satisfy 63 percent of antimalarial drug orders [28]. Some health facilities had no antimalarial on the survey at some periods. This study had several limitations. It was estimated that all symptomatic malaria episodes would be effectively treated at the first presentation. Some cases would have to be re-treated with a second line anti-malarial drug. It has also been previously reported that in high endemic areas HIV increases the likelihood of malaria to become severe [29]. With an adult HIV prevalence of 11.8 percent, many cases of malaria in this age group have potential to becoming severe and therefore not amenable to first line treatment regimen.
Furthermore, we assessed the clinician time requirements based at 5 and 10 minutes consultations with patients. This assumption of how much time may be committed was based on the authors' experience in managing patients with malaria in Africa. Rowe et al [30] have reported that 70% of clinicians in their study of malaria management spent not more than 9 minutes per patient consultation. In fact a third of their clinicians spent less than 6 minutes per consult. This should not be seen as an endorsement by the authors as to how much time ought to be spent by clinicians on a single patient, but rather an attempt to justify the current study's estimate of how much time clinician may be actually devoting to care for malaria patients.
The challenges experienced by the Central Medical Stores in ensuring transparency of resources along the chain of drug supply, distribution and eventual use have been described by Lufesi et al [28]. Wastage is a constant threat within the public sector in Malawi. Finally, while only anti-malarial drug expenses were estimated, many patients who present with malaria fever, myalgia, athralgia and other symptoms will also likely be prescribed analgesics; thus an added medication cost. These estimates have been restricted to financial resources within the Ministry of Health and HRH within the whole sector. The financial expenses of the medication costs within the private sector have not been estimated. However, the findings of the study clearly highlight how much resources the country as a whole, requires to treat malaria.
The financial and human resource burden let alone the human suffering caused by malaria cannot be underestimated especially in a country where the per capita spending on health is only $12, Community based preventive approaches such as the use of insecticide treated bed nets, proper drainage of stagnant water, intermittent preventive therapy of pregnant women and use of community "pharmacies" e.g. grocery stores as distribution centers for malaria drugs will be less costly. As the main provider of healthcare, government needs to study disaggregated data (qualitative and quantitative) pertaining to vertical programmes such as TB, HIV and malaria. This will help health planners and policy makers in formulating policies to improve the quality of services and efficient use of the limited resources the country has.
HIV:
UNICEF:
United Nations Children's Fund
USAID:
United States Agency for International Development
US$:
World Health Organization.
The authors thank Dr. Storn B. Kabuluzi, Malawi National Malaria Control Programme for his contribution at the conception of the study. Adamson Muula receives support from Fogarty International Center's Infectious Disease Epidemiology Training Grant for Malawians, Grant Number 5 D43 TW006568-05.
ASM: designed the study, collected data and participated in drafting the manuscript.
ER: participated in the interpretation of the findings and drafting of manuscript.
SS: participated in the interpretation of the findings and drafting of manuscript
RHM: participated in the interpretation of the findings and drafting of manuscript
Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
Departments of Epidemiology and Biostatistics and Global Health, School of Public Health, Loma Linda University, Loma Linda, California, USA
Department of Community Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
Department of Global Health, School of Public Health, Loma Linda University, California, USA
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text:
Tristan Angelini
On the Financial Stress Experienced by Victorians
Financial stress is something that a lot of individuals are going through right now. With all the stress that started last year when the pandemic began – the restrictions and all, it is safe to say that people are faced with uncertainties. It is a good thing that currently, the economy of Australia is stabilizing and industries have opened. However, there's still some worry about whether things will continue to get better in the next few months.
Jobkeeper Scheme
Financial stress is caused by a variety of factors, not just the restrictions. Losing a job is one thing. Another is being unable to find work full-time, thus not being able to pay bills. The cost of living continues to increase, which would challenge anyone's bank account.
The Andrews Labor Government has announced an expansion of the Good Money Program which was designed to provide no-interest loans and financial advice for Victorians going through financial stress. Loan sharks and other lenders tend to become such nightmares among individuals, so should be a good way to give options.
On May 14th, Minister for Disability, Ageing and Carers Luke Donnellan announced the Victorian Budget 2021/2022 investment of $14.6 million in Good Money hubs, which also includes phone-based and digital services expansion. The Good Money program was brought by the partnership between the government, Good Shepherd Australia New Zealand, and National Australia Bank. The expansion of this program in terms of phone and digital services would allow Victorians to access it from anywhere in the country. This should make everything much easier.
Aside from low-interest and no-interest loans, low-cost insurance and advice of budgeting are also given to Victorians who are seeking support regarding this matter. Well-being initiatives such as those bushfire-affected communities will also be given support with the help of the Good Money Program. The program also specifically delivers through three community finance stores such as Collingwood, Dandenong, Morwell, and Geelong.
Luke Donnellan adds, as the country recovers from the effects of the pandemic as well as the bushfires, the Good Money program is necessary in order to help more Victorians receive safe and fair support. In the next new several months, there will be more information regarding the program but right now, the services that will be provided will be strengthened.
In addition, the Andrews Labor Government is stimulating investment in towns and cities across the state. This is by helping local councils with the planning as well as the delivery of residential lands. Speeding up this investment will make wonders for the economy, for sure.
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John was excellent on our wedding day. Not only did he take amazing photos, he was helpful on the day, so friendly and we felt at ease. My bridal party and a few guests even commented on his professional yet friendly approach on the day. If anyone asked me for a recommendation for a wedding photographer I would 100% recommend John.


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Home|Get Support|Asthma Smoke Alert
Asthma Alert is a pilot program funded by the Australian Commonwealth Government and supported by the WA State Emergency Management Committee. The Asthma Alert pilot has been developed in consultation with the Department of Fire and Emergency Services (DFES), the Department of Biodiversity, Conservation and Attractions' Parks and Wildlife Service, the Bureau of Meteorology and the Department of Health in Western Australia.
The Asthma Alert Facebook Group aims to reduce the impact that smoke has on the lives of people who may be living with or caring for someone with asthma or other respiratory conditions, particularly where smoke is known to be a trigger for them.
How many times have you walked out of your home or office to smell smoke in the air?
It may be isolated to your local area or it may be far spread. Sometimes, the smoke you are experiencing may not be recorded by our State emergency services yet but you can play a significant role in helping warn people with asthma and other respiratory conditions to a potential smoke hazard. Through the Asthma Alert community, we can share information and support one another as we aim to reduce the risk of a life-threatening asthma emergency.
In the Asthma Alert group, we will refer to existing alert systems that have been developed and are coordinated by our State's environmental and emergency services (emergency.wa.gov.au) and call upon the Asthma Alert community to help their peers by sharing when they observe smoke in the air in their local area.
Through the Asthma Alert, we will provide you with tips and tools on how to reduce the impact of smoke on people who are affected by asthma, Chronic Obstructive Pulmonary Disease or other respiratory conditions and we encourage members to provide feedback and share their experiences of how smoke may impact them.
Join the Asthma Alert community on Facebook
It's easy to do. Simply click the button to access the Asthma Alert group. Become a member to receive updates and connect with others living with asthma in Western Australia.
Not on Facebook?
We understand not everyone is on Facebook so this may be limiting to some people. As this is a pilot program, we are doing as best we can with the resources we have. Your feedback on how you would like to receive an Asthma Alert or what it could look like is important to us. Feedback and suggestions are warmly welcomed at asthma.alert@asthmawa.org.au
Join the Asthma Alert
ALERTS AND UPDATES
PLANNED BURNING PROCESSES
The Asthma Alert pilot program is made possible thanks to funding and support from the Australian Government.


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HomeAll ArticlesUK picks 'tough negotiator' Tim Barrow as new EU ambassador
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UK picks 'tough negotiator' Tim Barrow as new EU ambassador
The United Kingdom has picked career diplomat Tim Barrow to replace its ambassador to the EU. The unexpected resignation of former envoy Ivan Rogers came just weeks before the UK's Brexit negotiations are due to start.
Tim Barrow, a former ambassador to Moscow who has twice served in Brussels, has been tapped to take over from Ivan Rogers, who resigned on Tuesday.
Barrow was Britain's ambassador to Moscow until 2015, and in March 2016 he became political director at the Foreign Office. He has formerly acted as first secretary at UKRep, Britain's mission to the EU.
Announcing his resignation on Tuesday, Rogers sent an email to staff condemning "ill-founded arguments and muddled thinking" over Brexit.
He made it clear he was still in the dark over Prime Minister Theresa May's objectives.
"We do not yet know what the government will set as negotiating objectives for the UK's relationship with the EU after exit," Rogers said in his email, adding that he was quitting nine months early so his successor could see through the whole negotiation process.
Rogers was criticized last month for saying it could take 10 years for Britain to conclude a trade deal with the EU.
"His resignation is not a surprise for those who work with him," one European diplomat told French agency Agence France-Presse.
"He was very competent, but not convinced by the Brexit decision and the British government line, leading the UK into an area of dangerous uncertainty."
Barrow to play a 'crucial role': Davis
The appointment of the new ambassador was welcomed by Britain's Brexit minister, David Davis. He said Barrow's office will play a "crucial role" in negotiations to leave the EU.
"His knowledge of Brussels means he will be able to hit the ground running at a vital time, and steer UKRep throughout the negotiation period," he said.
"I am confident that with his help, the UK will be able to forge a new relationship with the EU that works to the mutual benefit of both sides."
UK Foreign Minister Boris Johnson said Barrow had been "invaluable" and thanked him for his "relentless energy, wise counsel and steadfast commitment."
The move, meanwhile, was attacked by Nigel Farage, a leading anti-EU figure in the Brexit campaign.
"Good to see that the government have replaced a knighted career diplomat with…. a knighted career diplomat,"
jbh/cmk (AFP, Reuters)
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With its four brands BMW, MINI, Rolls-Royce and BMW Motorrad, the BMW Group is the world's leading premium manufacturer of automobiles and motorcycles.
Architect and designer Patricia Urquiola and BMW Group's Design Director Adrian van Hooydonk will discuss the increasing importance of interior design in the context of new mobility.
Spanish architect and designer Patricia Urquiola is one of the most influential present-day designers. As Art Director at Cassina, she has been elected Designer of the Year several times. Adrian van Hooydonk has been heading all of BMW Group's design teams since 2009 and is responsible for designing cars, motorcycles and other products. The two designers will present the new jointly created exhibition space at BMW Welt and will discuss mobility and the growing importance of interior design.


A mesothelioma diagnosis is hard on everyone involved, and caregivers must deal with personal difficulties that are uniquely their own.
Mesothelioma is a rare disease with an unfortunately short prognosis for most patients, making the role of the caregiver priceless. Caring for someone with cancer can take its toll on the caregiver. However, caregivers can prepare themselves for what's ahead.
The caregiver perspective can be useful in determining whether certain treatments should be continued or not. Caregivers are expected to help manage medications for their loved one and report any new or changed health issues to their doctors.
One of the caregiver's most important roles is to comfort and listen to their loved one through any rough patches. Mesothelioma develops seemingly out of nowhere and patients can expect to face a series of new challenges. Having the companionship of the caregiver makes getting through this difficult time easier.
Caregivers play a big part in the decision-making process, which can often be the hardest role. These decisions may regard treatment, financial and legal issues, insurance and end-of-life care.
The roles of the caregiver change with development of the patient's mesothelioma. As the cancer becomes more advanced, caregivers have to address more of the day-to-day needs that the patient. Conversely, patients may also have improvements in health, reducing the need for this kind of support.
Some people may be concerned about taking time off from work, which is often required of caregivers. When their disease advances, patients may require more care. Caregivers may have to travel with the patient for medical procedures that can take up to a week, including recovery and travel time. The Family and Medical Leave Act of 1993 provides certain caregivers with up to 12 weeks of unpaid time off to protect them from losing their jobs when caregiving starts taking more time.
Talking about cancer with a patient can be difficult as everyone reacts differently to this emotional topic. However, opening the lines of communication is one of the best ways to support your loved one. You may even find that talking is exactly what the patient is looking for as a means of relief. Talking about the patient's diagnosis can also be a tremendous emotional relief to you, as the caregiver, as well.
Expressing your fears in a genuine way can get the conversation started. Some people also employ the help of a counselor or spiritual leader. If you are unsure how to begin the conversation, support groups can open the door by allowing you to share your feelings with them first. They may also have ideas for how you can get started on this important discussion with your loved one.
Anticipatory grief is something that affects virtually all mesothelioma caregivers. Because of the short survival time associated with mesothelioma, this is a particularly hard disease to cope with when it involves a family member. There are several support groups and organizations specifically for mesothelioma caregivers that can help.
Support groups can offer peace of mind by sharing personal experiences relating to caring for someone with mesothelioma. Support groups can also offer advice that can take some of the stress off of caring the patient. These support groups take place online, over the phone and face-to-face.
Sleep is one of the most essential functions of staying healthy and productive. Getting rest is essential to staying on your toes and in control.
The reasons for eating well fall under the same philosophy as for getting enough rest: maintaining your health helps you stay more productive and stress-free.
By planning ahead, caregivers can avoid some of the overwhelming feelings associated with caregiving and curtail some of the stress.
Educating yourself about mesothelioma can make you a better caregiver by knowing what to expect and understanding what your loved one is going through.
Whether it's with a family member, support group or the patient, talking about your concerns and fears is healthy. It also helps relieve stress.
We can't do everything on our own. Being a caregiver is no easy task and asking for help to lighten the load can benefit both you and the patient.
Whether it's finding a doctor, legal help or a support group, we can help. The team at Mesothelioma Guide has been helping patients and families for over ten years. There are patient advocates available to answer any questions you may have or just get our our free Mesothelioma Guide.
Caregivers. American Cancer Society. Retrieved from: http://www.cancer.org/treatment/caregivers/. Accessed: 10/18/18.
Last Edited: October 19, 2018.


Marcus was ranked as the only Star Individual Personal Injury Junior Barrister in Chambers & Partners (London) in 2017, 2018 and 2019. He was named Personal Injury/Clinical Negligence Junior of the Year in Chambers & Partners UK Bar Awards 2016 and was nominated as the 2017 Legal 500 Personal Injury and Clinical Negligence Junior of the Year.
Also, he is ranked a Band 1 Barrister in Motor Insurance Fraud in Chambers & Partners 2019, and also as a Tier 1 Personal Injury and a Tier 1 Insurance Fraud Leading Junior in the Legal 500 2019. His specialism is head injury, chronic pain and spinal litigation. He is noted for his leadership in exploring recent neurological and chronic pain developments in the Courts and is regarded for his insight into the nuances of the medicine and his tenacity in handling medical experts in his specialist areas.
He balances his claimant practice with a committal practice for Insurance Companies. He is frequently instructed to take on cases where allegations of dishonesty are contemplated or have been made.
In the late 1990's he was at the forefront of developing the technical Consumer Credit Act arguments underpinning the Insurance Industry's attack on credit hire agreements culminating in the House of Lords decision in Dimond v. Lovell and appeared in the cases of Burdis v. Livesey and Clark v. Ardington.
He devised the Credit Hire Initiative that set the framework for testing the various arguments before the senior Courts.
He negotiated on behalf of the entire motor insurance industry to settle large accruals of credit hire and credit repair debts between 1999 and 2001.
He provided leadership from the junior Bar to tackle motor insurance fraud in a forensic and coordinated manner, applying scientific evidence to tackle low velocity impact claims, refining the use of similar fact evidence to tackle organised motor fraud and dusting down the Old Order 52 of the RSC (now CPR 81) to commit dishonest injury litigants to prison.
He was involved in many of the leading committal cases between 2010 to 2018 including Barnes v. Seabrooke, South Wales Fire & Rescue v. Smith, Liverpool Victoria v. Bashir & Nield v. Loveday.
He has tested the legitimacy of surveillance before the Courts, challenging the authenticity of the footage and the legitimacy of the techniques used to obtain it including the case of Samson v. Ali.
He has worked hard to raise awareness of the concept of post traumatic fibromyalgia and to clarify how the medicine and the law work in tandem to establish or refute clinical causation in such cases appearing in the case of Maguire v. Carillion.
He has litigated cases where the use of covert and overt recordings of expert appointments have proved to be critical to the outcome of cases.
Many of his cases fight to trial. He is noted for his thoroughness and tenacity on medical issues and in his dealings with medical experts.
He does not charge any success fees on post April 2013 cases.
He works at a reduced rate on MIB claims under the Untraced Driver's Agreement and CICA Claims.
He takes on occasional Direct Access cases and occasional Pro Bono cases.
He was Counsel in the case of Nield v. Loveday that won the award of 'Outstanding Case of the Year' at the Personal Injury Awards 2011.
He was shortlisted as Barrister of the Year in the 2012 'Pro Claim' Personal Injury Awards.
He has presented six Seminars to his peers at the Personal Injury Bar Association including a lecture on brain injury at the 2010 Winter PIBA Conference, committal proceedings at the 2015 Spring PIBA Conference and on Section 69 of the Enterprise and Regulatory Reform Act 2013 at the Spring 2019 PIBA conference.
He has presented four 2 hour live Webinars on chronic pain, spinal injuries, subtle brain injury litigation and fraudulent claims for Thompson Reuters.
He was published in 2012 by the British Pain Society and spoke at the Society's annual 2012 conference in Liverpool and at the Cambridge Medico-Legal Society's 2012, 2015, 2016 and 2018 Conferences and at the Field Fisher 2016 Brain Injury Conference 'Hidden in Plain Sight' at City Hall. He spoke on Chronic Pain at the annual ABI Solutions Seminar in October 2018. He organised the 2015 TGC Fraud Conferences.
He is a Member of the Ogden Working Party.
He is a member of Lincoln's Inn and teaches on the Inn's Student Advocacy Training Programme.
He is on the PI panel of the Bar Pro Bono Unit. He has mentored 10 pupils through Temple Garden Chambers.
Away from the Bar his interests include his family adventures with teenage daughters, Andalucía, Headway, volunteering at the Glass Door Homeless Charity over the winter months, the Athenaeum, Rachmaninov, tennis and occasionally Liverpool FC.
A pioneer in the areas of complex subtle brain injury and chronic pain syndrome. He has been at the cutting edge of fibromyalgia litigation for many years, and is a vigorous advocate for its recognition by courts and insurers. He is also instructed by insurers for committal proceedings for dishonest litigants.
Recent work: Instructed in Brown v Gray, a brain injury case in which a 54 year old builder recovered over £1 million after sustaining a closed head injury in a fall.
Leading junior for motor insurance fraud cases, particularly those that involve contempt of court. He is knowledgeable when it comes to fraud ring and fundamental dishonesty issues.
Recent work: Acted in Liverpool Victoria v Yavuz et al, committal proceedings against nine individuals who brought injury claims arising from three alleged accidents.
A pioneer in the areas of complex subtle brain injury and chronic pain syndrome. He has been at the cutting edge of fibromyalgia litigation for many years, and is a vigorous advocate for its recognition by courts and insurers. His tremendous medical knowledge and unwavering commitment are singled out by solicitors, while he is also instructed by insurers for committal proceedings for dishonest litigants.
Leading junior for motor insurance fraud cases, particularly those that involve contempt of court.
Recent work: Successfully proved contempt of court in a case where four individuals were accused of staging a 'crash for cash' incident in April 2011.
"He is able to understand the injuries and the medicine to ensure that such cases do result in the right level of damages." Recent work: Counsel for the claimant in Siegel v Pummell, where a head injury after a car accident resulted in an award of £1.59 million.
"A barrister with no faults at all, and the hardest working member of the Bar".
"His cross-examination skills are a wonder to behold".
'Has been at the forefront of tackling fraud in the motor insurance industry and has involvement with a number of reported cases concerning contempt of Court.
'Recognised as a standout junior for complex and catastrophic personal injury claims, he is lauded not only for his formidable expertise in the area but also for his ability to deal with clients. He also acts for defendants in claims with an element of fraud.
Recent work: Acted in Clarke v Maltby, a claim concerning a subtle brain injury that involved complex expert evidence'.
'courageous, determined, and excellent with clients'.
'The "utterly brilliant" Marcus Grant'.
£1.84 m settlement for a 45-year-old man who suffered a ceiling collapse on his head.
Simon Browne QC and Marcus Grant represented the Claimant who was left with enduring neuro-psychiatric and vestibular symptoms.
Dingemans J approved a £4.78m settlement for a 26-year-old motorcycle head injury crash victim who was left with enduring behavioural symptoms when he was aged 20. Marcus Grant represented the Claimant.
Marcus Grant represented a 50-year-old sales manager who sustained thoracolumbar and wrist fractures and PTSD in a high energy head-on road accident, and compromised her claim for damages in the sum of £1m.
Marcus Grant represented a 47-year-old senior manager who sustained a soft tissue neck injury when she was knocked from her bicycle by a van, compromised her claim for damages in the sum of £675,000.
Marcus Grant represented a 44-year-old café proprietor who sustained a mild traumatic brain injury and developed chronic neuropathic pain and headaches in a high energy car accident, compromised his claim for damages in the sum of £250,000.
Marcus Grant represented a 23-year-old retail worker who recovered £620,000 in respect of a leg injury in a cycling accident which befell him at the age of 18.
He was left with enduring symptoms of pain and reduced stamina for prolonged weightbearing and loading that left the leg unsuited to his preferred trades of bricklaying or working in the motor trade. On his case he had suffered a significant reduction in earning capacity in being forced to look for less physically demanding work away from these trades.
Marcus Grant represented a 35-year-old Trainee Paramedic who recovered £700,000 in respect of a bladder injury whilst attempting to assist in lifting a bariatric patient.
On her case she sustained a low back strain requiring medication that then resulted in her suffering bladder distension leading to an acontractile bladder which caused her profound urinary complications, leading to an entrenched depressive disorder. She was unable to work, needed to self-catheterise for life and required a lot of care in her home life.
Marcus Grant represented a 27-year-old dock worker who recovered £1.75m in respect of a brain injury in a high energy road accident.
He was left with a disabling syndrome of physical (including vestibular), neuro-cognitive, neuro-behavioural and psychological symptoms that precluded him from being able to work, and in need of at least a light touch support regime involving a case manager and support worker.
Marcus Grant represented a 31-year-old highway worker who recovered £643,000 in respect of a brachial plexus injury to his non-dominant arm sustained in a motorcycle accident where liability was contested.
Marcus Grant represented a 61-year-old construction worker who recovered £495,000 in respect of a head injury in a workplace accident following which he developed epilepsy. He managed to continue working, albeit in difficulty and with a colleague covering for him for two years after the initial accident when he injured his head again whilst having a seizure. His employment was terminated 18 months after that second incident and he developed depressed mood following the loss of his job and financial security and suffered further seizures and some suicidal ideation.
Marcus Grant appeared for the Claimant, a 34-year-old English teacher working in China who recovered £535,000 in respect of a head injury in the UK that left him with a syndrome of physical, neuro-cognitive, neuro-behavioural and psychological symptoms consistent on his case with diffuse axonal brain injury.
Marcus Grant represented a 50-year-old factory worker who recovered £375,000 in respect of a head injury in a workplace accident when he stood up whilst standing on a table and struck his head on a metal hook attached to a crane overhead.
Marcus Grant appeared for the Claimant, a 51-year-old unemployed lady who recovered £1.7m in respect of serious injuries to her right leg in a scooter accident. She underwent multiple operations on her leg, knee and ankle following which her mobility was severely restricted.
Marcus Grant represented a 41-year-old nurse who recovered £672,000 in respect of a centrally sensitized chronic pain condition that developed following a low speed rear end shunting road accident causing soft tissue injury.
Marcus Grant represented a 59-year-old self-employed taxi driver recovered £500,000 in respect of an ankle injury that progressed into CRPS following a tripping accident.
Marcus Grant represented a 55-year-old benefits assistant who recovered £400,000 net of CRU and interims in respect of a centrally sensitized chronic pain condition (diagnosed as 'fibromyalgia') that developed following a rear end shunting road accident causing soft tissue injury.
Marcus Grant, instructed by Christopher Dickinson of Dickinson Solicitors Limited appeared for a 35-year-old claimant teacher who brought a claim for damages for the consequences of a syndrome of enduring physical (including vestibular), neuro-cognitive, neuro-behavioural and psychological symptoms she claimed were caused by a rear-end shunting car accident that exposed her head to acceleration-deceleration forces. She claimed, through her experts, that this syndrome of enduring symptoms was likely attributable to diffuse axonal injury ["DAI"] to the connections and pathways of the white matter of her brain.
Marcus Grant represented a 54-year-old ex-head teacher who settled his stress at work claim for a six-figure sum on the eve of trial, 6 years after his employment was terminated.
Marcus Grant, instructed by Nick Godwin of Slater & Gordon Solicitors, appeared for a widow whose late husband was killed in a running down accident when he was struck by a car travelling at 86 mph in a 40 mph zone during the hours of darkness.
Marcus Grant, instructed by Alexander Cohen of Brian Barr, appeared for a claimant who developed CRPS following a tripping accident in the course of her employment at premises occupied by a Third Party.
Marcus Grant, instructed by Christopher Dickinson of Dickinson Solicitors Limited, appeared for the Appellant psychologist in appealing a decision of a Panel representing his regulatory body, the HCPC, in erasing him from the register.
Marcus Grant, instructed by Phillip Cohen of Brian Barr Solicitors, represented a 41-year-old trainee doctor who sustained soft tissue whiplash injuries in a rear end shunting road accident, which on his case then progressed into a chronic widespread pain condition diagnosed by his experts as fibromyalgia. He was able to continue working, despite his symptoms, but was forced to reduce his hours, which put back the date of his qualification as a doctor. His claim was presented on the basis that he had lost the chance of a more lucrative career in medicine as a consequence of the condition, for which the prognosis of significant further recovery was poor.
Marcus Grant, instructed by Phillip Cohen of Brian Barr Solicitors, represented a 36-year-old property developer who sustained a significant crush injury to his non-dominant hand when an anti roll bar on an excavator hired by his sub-contractor from a hire company rotated 180 degrees unexpectedly. The manufacturer had designed the roll bar to be held in place by a lynch pin held in place with an 'R clip'.
Marcus Grant, instructed by Chris Kardahji of Irwin Mitchell LLP, represented a 52-year-old pilot who sustained a whiplash associated disorder and psychological injuries in a head on car accident in which the other driver died. He was unable to work for 14 months after the accident and then returned to flying.
Marcus Grant instructed by Tristan Hallam of Penningtons Manches LLP, represented a Police Officer who sustained soft tissue injuries that progressed into a chronic widespread pain condition (fibromyalgia) after the Defendant drove into head on collision with her parked Police BMW on a fast, unlit country road at night.
Mr Justice Martin Spencer approves £1.35m lump sum settlement in a brain injury case. Instructed by Amina Ali of Barings Solicitors. Marcus Grant instructed by Amina Ali of Barings Solicitors, represented a 27 year old pedestrian who sustained a severe brain injury in a running down accident when he walked into the path of a car at night whilst intoxicated.
90 year old lady recovers £298,000 gross of contributory negligence for a shoulder injury in a running down accident. Marcus Grant, instructed by Amina Ali of Barings Solicitors represented the Claimant.
32 year old healthcare manager recovers £950,000 for the consequences of a mild traumatic brain injury following a moped accident. Marcus Grant, instructed by Julie Reynolds of Julie Reynolds Solicitors represented the Claimant.
Dispensing Optician recovers £320,000 for a suspected mild Traumatic Brain Injury. Marcus Grant, instructed by Tom Ranson of Ashton's Legal, represented the Claimant.
PA and Personal Trainer recovers £1.5 m for severe post traumatic fibromyalgia/somatic symptom disorder. Marcus Grant, instructed by Alex Cohen of Brian Barr Solicitors, represented the Claimant.
28 year old Barrista Trainer recovered £2.2m after sustaining a multiple injuries in a car that overturned and struck a tree. Marcus Grant, instructed by Peregrine Redgrave of Stewarts LLP, represented the Claimant.
36 year old Police Sergeant recovered £1.65m after sustaining a brachial plexus injury when her hand became caught in the door handle of a car being driven by a thief who was attempting to evade arrest. Marcus Grant, instructed by Tracey Benson of Slater & Gordon, represented the Claimant.
54 year old builder recovered £1.16m gross of 10% contributory negligence, after sustaining a head injury when he stumbled and fell on a defective brick on a set of steps leading to his rental property. Marcus Grant, instructed by Christopher Dickinson of Dickinson Solicitors represented the Claimant.
38 year old former Police Officer recovered £492,000 for the consequences of an ankle injury and PTSD in a workplace accident. Marcus Grant (instructed by Phillip Cohen of Brain Barr Solicitors) appeared for the Claimant.
46 year old middle manager recovered £579,000 for the consequences of a diffuse axonal brain injury and vestibular damage sustained in a workplace accident. Marcus Grant (instructed by Mark Ellis of CFG Law) appeared for the Claimant.
43-year-old Warehouse Worker recovered £539,000 for post traumatic fibromyalgia following a workplace accident – Marcus Grant instructed by Steven Akerman of Brian Barr Solicitors represented the Claimant.
Widow recovers £150,000 from a landowner in respect of the death of her husband killed by a falling branch from one of his trees. Marcus Grant instructed by Nick Godwin of Slater & Gordon, represented a 68-year-old widow whose 64 year old husband died when a branch from an oak tree struck his passing car on an A road in Berkshire. Liability was disputed.
HHJ Wood QC permits committal proceedings for contempt of Court to proceed against 9 injury claimants. Marcus Grant instructed by Marsha Crossland of DWF LLP, represented Liverpool Victoria Insurance who applied to commit to prison for contempt off Court nine members of the Turkish community in North London who brought injury claims arising from three alleged accidents.
HHJ Main QC accepted evidence of a scientific link between trauma and fibromyalgia. Marcus Grant instructed by Lindsay Ryan of Brian Barr Solicitors, represented a 54 year old civil servant who was involved in a lift accident.
Marcus Grant, instructed by Alexander Wormald of Clarkson, Wright & Jakes, represented a 17 year old pillion passenger on a motorcycle who sustained a severe brain injury in a road accident with an uninsured driver.
44 year old IT Project Manager recovered £700,000 for the consequences of developing fibromyalgia after a road accident. Marcus Grant (instructed by Alex Cohen of Brian Barr Solicitors) appeared for the Claimant.
34 year old Police Officer recovered £600,000 net of contributory negligence for the consequences of a brain injury sustained in a motorcycle accident. Marcus Grant (instructed by Nigel Mills of New Law Solicitors) appeared for the Claimant.
Garnham J finds one count of contempt proved and two counts not proved. Marcus Grant (instructed by Laura Sales of Keoghs LLP) appeared for Aviva Insurance in committal proceedings in the Queen's Bench Division for contempt of court in respect of signing a statement of truth on one or more documents in County Court proceedings that Aviva asserted the Respondent knew to be untrue.
Fraud established and exemplary damages recovered. Marcus Grant (instructed by Hamida Khatun of Keoghs LLP) appeared for Direct Line Insurance to resist three injury claims arising from an alleged road accident that generated 11 intimated injury claims from occupants in three vehicles.
31 year old Trainee Chef recovered £3,650,000 for the consequences of a spinal injury sustained in a cycling accident. Marcus Grant (instructed by Iona Smith of Gaby Hardwicke) appeared for the Claimant.
49 year old Conductor recovered £200,000 for the consequences of a whiplash injury that developed after a road accident. Marcus Grant (instructed by Darren Wilson of Irwin Mitchell) appeared for the Claimant.
24 year old Construction Labourer recovered £300,000 for the consequences of a fractured toe and compartment syndrome in a workplace accident. Marcus Grant (instructed by Tracey Bennett of Slater & Gordon) appeared for the Claimant.
32 year old Solicitor recovered £527,000 gross for the consequences of chronic pain disorder that developed after a road accident. Marcus Grant (instructed by Ardip Khalon of Irwin Mitchell) appeared for the Claimant.
30 year old Teacher with lupus recovered £200,000 for the consequences of fibromyalgia that developed after a road accident. Marcus Grant (instructed by Christopher Kardahji of Irwin Mitchell) appeared for the Claimant.
Appeal based on perversity and insufficient reasons succeeds in slam on fraud case. Marcus Grant (instructed by Hamida Khatun of Keoghs LLP) appeared for the Appellant.
51 year old Mining Engineer recovered £200,000 (gross of contributory negligence) for the consequences of fibromyalgia that developed two years after a workplace accident. Marcus Grant (instructed by Phillip Cohen of Brian Barr Solicitors) appeared for the Claimant.
82 year old retired Ghurka recovered £305,000 for the consequences of developing dementia following a running down accident. Marcus Grant (instructed by Nick Godwin of Slater & Gordon Solicitors) appeared for the Claimant.
48 year old part time Care Worker and Masters Student recovers £145,000 for the consequences of fibromyalgia that developed following a road accident – instructed by Phillip Cohen of Brian Barr Solicitors.
55 year old unemployed lady recovers £385,500 for a Mixed Dissociative Conversion Disorder and vestibular damage suffered in a lift accident – instructed by Daniel Denton of Slater & Gordon Solicitors.
Claim by a middle aged man who sustained a severe traumatic brain injury in a running down accident.
Marcus Grant (instructed by Gemma Wilkinson of Keoghs LLP) appeared for Direct Line Insurance in a tort of deceit action against 29 Defendants, all of whom had intimated or facilitated claims arising from nine separate fictitious accidents in an attempt to defraud the insurer.
Court of Appeal dismissed Claimants appeal against a finding of fraud. Instructed by Ruth Needham of Keoghs LLP.
Committal case for contempt of Court before His Honour Judge Wood QC sitting as a Judge of the QBD in Liverpool who found the four Defendants guilty of contempt.
Jonathan Watt-Pringle QC and Marcus Grant represented the Claimant in a claim arising out of a low speed bicycle accident. The Claimant, then a 49-year-old Company Director, fell off his bicycle and struck his head on the road. He suffered no PTA but presented with a cluster of subtle neuro-cognitive, neuro-behavioural and neuro-psychological symptoms. A Telsa 3T MRI brain scan was normal, apart from evidence of a small haemosiderin deposit in the tentorium adjacent to the temporal lobe. There was no evidence of any macroscopic diffuse axonal injury to the white matter. He sustained partial shearing of his olfactory bulb and presented with very subtle patterns on neuro-psychological testing.
What appeared to be a minor impact in a road traffic accident had been sufficient to cause the claimant subtle brain injuries resulting in impaired cognitive function. The evidence of the defendant's expert witness that she had exaggerated her symptoms was discredited and the claimant's evidence about the nature and extent of her symptoms was accepted.
Welcome to the inaugural edition of TGC Fraud Update, a new publication from the fraud team at Temple Garden Chambers containing a number of articles on legal matters relevant to insurance fraud practitioners and a digest of recent noteworthy cases in which Members of Chambers have been involved.
Marcus Grant, Emma Northey and Elizabeth Gallagher spoke on different subjects at the Annual PIBA Conference.
Marcus Grant represented the Claimant who was left with enduring dysexecutive symptoms.
Marcus Grant represented the Claimant, a 50-year-old sales manager who sustained thoracolumbar and wrist fractures and PTSD in a high energy head-on road accident, and compromised her claim for damages in the sum of £1m.
Marcus Grant represented the Claimant, a 47-year-old senior manager who sustained a soft tissue neck injury when she was knocked from her bicycle by a van, compromised her claim for damages in the sum of £675,000.
Marcus Grant represented the Claimant, a 44-year-old café proprietor who sustained a mild traumatic brain injury and developed chronic neuropathic pain and headaches in a high energy car accident, compromised his claim for damages in the sum of £250,000.
Marcus Grant represented the Claimant, a 31-year-old highway worker, who recovered £643,000 in respect of a brachial plexus injury to his non-dominant arm sustained in a motorcycle accident where liability was contested.
Marcus Grant represented the Claimant, a 61-year-old construction worker who sustained a head injury in a workplace accident following which he developed epilepsy. He managed to continue working, albeit in difficulty and with a colleague covering for him for two years after the initial accident when he injured his head again whilst having a seizure. His employment was terminated 18 months after that second incident and he developed depressed mood following the loss of his job and financial security and suffered further seizures and some suicidal ideation.
Marcus Grant represented the Claimant, a 50-year-old factory worker who sustained a head injury in a workplace accident when he stood up whilst standing on a table and struck his head on a metal hook attached to a crane overhead.
Marcus Grant appeared for the Claimant, a 51-year-old unemployed lady who sustained serious injuries to her right leg in a scooter accident. She underwent multiple operations on her leg, knee and ankle following which her mobility was severely restricted.
Marcus Grant represented the Claimant, a 41-year-old nurse in respect of a centrally sensitized chronic pain condition that developed following a low speed rear end shunting road accident causing soft tissue injury.
Marcus Grant represented the Claimant, a 59-year-old self-employed taxi driver who recovered £500,000 in respect of an ankle injury that progressed into CRPS following a tripping accident.
Marcus Grant represented the Claimant, a 55-year-old benefits assistant who recovered £400,000 net of CRU and interims in respect of a centrally sensitized chronic pain condition (diagnosed as 'fibromyalgia') that developed following a rear end shunting road accident causing soft tissue injury.
Marcus Grant represented the Claimant, a 54-year-old ex-head teacher who settled his stress at work claim for a six-figure sum on the eve of trial, 6 years after his employment was terminated.
Marcus Grant, instructed by Christopher Dickinson of Dickinson Solicitors Limited, appeared for the Appellant.
Marcus Grant, instructed by Phillip Cohen of Brian Barr Solicitors, appeared for the Claimant, a 41-year-old trainee doctor who sustained soft tissue whiplash injuries in a rear end shunting road accident, which on his case then progressed into a chronic widespread pain condition diagnosed by his experts as fibromyalgia. He was able to continue working, despite his symptoms, but was forced to reduce his hours, which put back the date of his qualification as a doctor.
Marcus Grant, instructed by Phillip Cohen of Brian Barr Solicitors, appeared for the claimant, a 36-year-old property developer who sustained a significant crush injury to his non-dominant hand when an anti roll bar on an excavator hired by his sub-contractor from a hire company rotated 180 degrees unexpectedly.
Marcus Grant, instructed by Chris Kardahji of Irwin Mitchell LLP, represented a 52-year-old pilot who sustained a whiplash associated disorder and psychological injuries in a head on car accident in which the other driver died.
Marcus Grant, instructed by Tristan Hallam of Penningtons Manches LLP, appeared for the Claimant, a Police Officer who sustained soft tissue injuries that progressed into a chronic widespread pain condition (fibromyalgia) after the Defendant drove into head on collision with her parked Police BMW on a fast, unlit country road at night.
Mr Justice Martin Spencer approves £1.35m lump sum settlement in a brain injury case. Marcus Grant appeared for the Claimant.
Marcus Grant appeared for UK Insurance in bringing tort of deceit and committal proceedings arising out of a staged car crash that went to the Court of Appeal.
TGC are delighted to announce that Marcus Grant has been shortlisted as The Legal 500 Personal Injury & Clinical Negligence Junior of the Year 2018. The winners in all categories will be announced next week.
Marcus Grant, instructed by Tom Ranson of Ashton's Legal represented a 38 year old claimant who sustained injuries in a rear end shunting car accident.
Marcus Grant, instructed by Alex Cohen of Brian Barr Solicitors represented a 42 year old claimant who sustained injuries in a rear end shunting car accident.
Marcus Grant, instructed by Peregrine Redgrave of Stewarts LLP, represented a 28 year old Barrista Trainer who sustained multiple injuries in a car that overturned and struck a tree.
Marcus Grant, instructed by Tracey Benson of Slater & Gordon represented a 36 year old Police Sergeant who sustained injury when she was dragged by a car driven by a suspect attempting to evade arrest.
Marcus Grant, instructed by Christopher Dickinson of Dickinson Solicitors represented a 54 year old builder who sustained head injuries in a falling accident on a set of steps.
Marcus Grant (instructed by Phillip Cohen of Brain Barr Solicitors) appeared for the Claimant.
Marcus Grant (instructed by Mark Ellis of CFG Law) appeared for the Claimant.
Marcus Grant instructed by Marsha Crossland of DWF LLP, represented Liverpool Victoria Insurance who applied to commit to prison for contempt off Court nine members of the Turkish community in North London who brought injury claims arising from three alleged accidents.
Fraser J approves combined PPO and lump sum settlement following the introduction of the new discount rate in a case involving the MIB.
Widow recovers £150,000 from a landowner in respect of the death of her husband killed by a falling branch from one of his trees.
Marcus Grant instructed by Nick Godwin of Slater & Gordon, represented a 68-year-old widow whose 64 year old husband died when a branch from an oak tree struck his passing car on an A road in Berkshire.
44 year old IT Project Manager recovered £700,000 for the consequences of developing fibromyalgia . Marcus Grant (instructed by Alex Cohen of Brian Barr Solicitors) appeared for the Claimant.
In September 2012 the Claimant, then a Sergeant in the Police Service, on his case sustained a closed head injury with suspected diffuse axonal injury and some bony injuries in a motorcycle accident when the Defendant began to turn across his path, changed his mind and stopped blocking part of the carriageway. The Defendant alleged contributory negligence against the Claimant for riding at 13.5 mph above the 50 mph speed limit, and for capsizing his motorcycle whilst braking.
31 year old Trainee Chef recovered £3,650,000 for the consequences of a spinal injury sustained in a cycling accident.
Marcus Grant (instructed by Iona Smith of Gaby Hardwicke) appeared for the Claimant.
In April 2015 the Claimant sustained unstable fractures of the T12, L2 and L4 vertebrae causing a complete thoracic spinal cord injury. He spent much of the first year post accident in a spinal unit undergoing repeated surgeries to enable him to sit upright in a wheelchair.
Marcus Grant (instructed by Laura Sales of Keoghs LLP) appeared for Aviva Insurance in committal proceedings in the Queen's Bench Division for contempt of court in respect of signing a statement of truth on one or more documents in County Court proceedings that Aviva asserted the Respondent knew to be untrue.
Marcus Grant (instructed by Hamida Khatun of Keoghs LLP) appeared for Direct Line Insurance to resist three injury claims arising from an alleged road accident that generated 11 intimated injury claims from occupants in three vehicles.
With 36 rankings over 9 practice areas members of TGC receive the deserved accolade from the legal directory following market research.
A 24 year old Construction Labourer recovered £300,000 for the consequences of a fractured toe and compartment syndrome in a workplace accident. Marcus Grant (instructed by Tracey Bennett of Slater & Gordon) appeared for the Claimant.
In February 2011 the Claimant sustained a soft tissue 'whiplash' injury to her cervical and lumbar spine in a moderate energy rear end shunting road accident. Marcus Grant (instructed by Ardip Khalon of Irwin Mitchell) appeared for the Claimant.
TGC are delighted to announce that Marcus Grant has been shortlisted for the Junior of the Year award for Personal Injury/Clinical Negligence at the forthcoming 2016 Chambers UK Bar Awards to be held at at The London Hilton on Park Lane on Thursday, 27th October 2016.
Marcus Grant (instructed by Christopher Kardahji of Irwin Mitchell) appeared for the Claimant.
Marcus Grant (instructed by Hamida Khatun of Keoghs LLP) appeared for the Appellant.
Marcus Grant (instructed by Phillip Cohen of Brian Barr Solicitors) appeared for the Claimant.
Marcus Grant (instructed by Nick Godwin of Slater & Gordon Solicitors) appeared for the Claimant.
Marcus Grant (instructed by Daniel Denton of Slater & Gordon Solicitors) appeared for the Claimant. The lift in which she was travelling came off its runners and caused her acute psychiatric shock that damaged her sympathetic nervous system; she presented with symptoms akin to Diffuse Axonal Injury and chronic spinal pain and impaired balance.
Marcus Grant (instructed by Hamida Khatun of Keoghs LLP) appeared for UK Insurance in its pursuit of Mr Gentry for dishonesty in the presentation of his claim that culminated in the Court of Appeal refusing to grant relief from sanctions to an insurer who was late in applying to set aside a default judgment on the ground that the judgment was obtained on a claim that was likely to be fraudulent see: Gentry v. Miller & UKI Limited  EWCA Civ 141.
Marcus Grant (instructed by Richard Foyster of Ashtons Legal) appeared for the Claimant in an injury claim arising from a crushing injury to his pelvis.
Marcus Grant was invited by Jill Greenfield, Partner at Fieldfisher to speak at their annual head injury conference entitled "Hidden in Plain Sight" held at City Hall with c. 200 delegates from across the legal, medical and caring professions.
Marcus Grant (instructed by Tom Ranson of Ashtons Legal) appeared for the Claimant. Alex Glassbrook (instructed by Gurbir Thethy of DWF LLP) appeared for the Defendant.
The claim involved a middle aged man who sustained a severe traumatic brain injury in a running down accident. The Parties agreed to settle the claim on a combined lump sum and Periodical Payment Order basis with periodical payments being agreed in respect of future claims for loss of earnings, case management and care / support worker provision.
Marcus Grant appeared for Amlin Insurance in two injury claims.
Marcus Grant appeared for Aviva Insurance in obtaining permission to bring committal proceedings arising out of a car crash.
Marcus Grant appeared for Tesco Insurance in two injury claims.
Marcus Grant (instructed by Laura Harper of Thompsons) appeared for the Claimant in an action arising from a motorcycle accident.
A 42-year-old Account Manager settles his fibromyalgia claim for £494,000.
Marcus Grant (instructed by Phillip Cohen of Brian Barr Solicitors) appeared for the Claimant in an action arising out of a car accident.
18-year-old Model settles her subtle head injury claim for £348,000, less 25% contributory negligence.
Marcus Grant (instructed by Tom Ranson of Ashton KCJ) appeared for the Claimant in an action arising out of a car accident.
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This maternity session has quickly become one of my favorites to date! When Lexi first emailed me that she was visiting from Dallas and wanted to incorporate the desert in her maternity pictures my mind started racing with all the GORGEOUS landscapes that Tucson has to offer. Then, after talking to Lexi a bit more I learned that her extended family was in Oro Vallery, and it is really what she thinks of when she is here. Learning all these details made Honeybee canyon the obvious choice, and I am so glad it was! The canyon is still so green, it has easy walking paths, and absolutely stunning views of the mountains!
The day of the session Lexi and Jonathan were full of laughter and love! They brought their dog with them, and really enjoyed the time in each others company. After we had parted ways Lexi sent me a text telling me how fun and relaxing they found the whole experience. Those sort of moments are why I do what I do, and I am so excited to share it with you!


text:
Cyber Security in Higher Ed: How to Avoid Becoming the Next Target
DZone's Guide to
While the main subjects of this article are universities, private companies and organizations should learn from their cloud and network security faux-pas.
by ·
Discover an in-depth knowledge about the different kinds of iOS hacking tools and techniques with the free iOS Hacking Guide from Security Innovation.
Higher education institutions are major targets for hackers. Their databases contain a perfect trifecta of personal information, financial, and health data for what's considered high-value targets on the black market. Last year, a hacker known as Rasputin breached over 60 universities and government agencies and the tally continued to grow into 2017, becoming one of the largest higher education breaches in history. This sole cybercriminal made news, but hacks are really just the tip of a very large iceberg of breaches that are primarily caused by negligence.
In 2016, the U.S. Department of Education said they would require colleges and universities to comply with requirements laid out in the National Institute of Standards and Technology (NIST) Special Publication 800-171, which are designed to protect the confidentiality of "controlled unclassified information." The first compliance deadline schools must meet is December 31, 2017.
Colleges and universities have a wide array of vulnerabilities, but in the interest of brevity and relevance, we're going to focus on a few recent cloud email and storage related events in higher education that will be addressed by several of the 800-171 requirements.
After Oregon Health and Science University (OHSU) suffered its fourth major breach in 2012, two employees were placed on administrative leave for the "unlawful release" of 22,00 pages of records from the university president's office. These records included confidential information on faculty, staff, and students. The data was stored in Google's Gmail and Drive applications by resident physicians and discovered by another faculty member in 2013. In addition to the 1,361 individuals facing significant harm due to their diagnoses being leaked, credit card data, payment information, procedures, photos, driver's license numbers, and Social Security numbers were included in the breach for thousands of others.
The OHSU breach is about as bad as they come since it included both HIPAA and FERPA violations. To prevent future breaches, the university agreed to a four-point strategy:
Identify and isolate sensitive and/or regulated data.
Encrypt the data.
Monitor and restrict access to the data.
Educate campus community on best practices.
The remediation process, fines, and strategy cost the university $2.7 million. This entire event could have easily been prevented with a cloud security solution that monitored files for sensitive data. However, given that this situation was handled beginning in 2013, OHSU was able to get ahead of about 99% of their fellow universities that have been dealt one blow after another in more recent years.
This year, the University of Oklahoma (OU) experienced a similar data leak to OHSU. OU uses Microsoft Office Delver, an internal intelligent search engine. In just 30 of the hundreds of documents made publicly discoverable on Delve, there were more than 29,000 instances in which students' private information was made available to users within OU's email system. With a simple Delve search, student journalists discovered four spreadsheets that included students financial information along with the amounts of money they received in scholarships, grants, loans or waivers from 2012 through 2016! But wait, there's more.
Another series of spreadsheets listed students who had received a grade of incomplete during the six semesters starting Fall 2014 through Fall 2016. One document listed the names and social security numbers of 30 students, including the names of athletes now playing professionally. It's not clear why the document existed or how these students were related.
Two other documents listed the visa statuses of more than 500 international students. Several documents included information about current OU athletes' scholarships and their eligibility statuses, including one that listed which students were barred from practice this past summer due to failed drug tests, recruiting violations, or academic misconduct.
These files were easily discovered by the student journalists who reported it, so the impact and breadth of the leak are still unknown and the investigation is ongoing.
Washington State University and the University of Ottawa
At this point, you might be dismissing these examples, since all these breaches took place in the cloud. But this year there have also been several instances of physical theft. A Washington State University (WSU) researcher noticed that an 85-pound safe that contained a hard drive was missing from a WSU storage unit. The drive contained names of about a million people, and the social security numbers and health history of some of them.
Think this is just a one-off? The University of Ottawa also found itself the subject of an investigation after the information of some 900 students was exposed when an external hard drive went missing. The data included people with disabilities and mental health issues.
In both cases, the hard drives are assumed to be unencrypted and investigations are ongoing.
A new set of federal regulations is set to tighten the cybersecurity practices of colleges and universities. There are six major steps higher education leaders can take to develop a program that fulfills new contractual obligations required for continuing federal grants, research contracts and other transactions in which institutions receive data from the federal government, which is most of them, according to Deloitte and EDUCAUSE:
Form a working group with representatives from each of the institution's three main business units: academics, administration, and research. The working group should have top-down support and the sustained engagement of leadership.
Analyze the impact and scope by determining the applicable contracts and identifying data that must be controlled.
Assess the current state of security and understand where CUI data resides (in on-premise campus systems and in cloud systems) and how it's processed from the point of receiving through the lifecycle.
Develop a plan to achieve compliance and mitigate existing gaps by defining roles and responsibilities to achieve and maintain compliance.
Establish responsibilities and efficient processes to achieve sustained compliance over the long haul.
Employ third parties to provide a thorough review of current practices across the entire academic enterprise.
What Are the 800-171 Requirements?
There are 14 categories of security requirements that must be met. Each category has a unique set of policy tests in which affected programs must meet.
Audit and Accountability
Awareness and Training
Identification and Authentication
Media Protection
Physical Protection
Personnel Security
System and Communications Protection
System and Information Integrity
For a complete list of policy tests included under each of the 14 categories, please refer to the NIST SP800-171 web page. A deadline to comply or to report delays in compliance has been set for December 31, 2017.
Learn about the importance of a strong culture of cybersecurity, and examine key activities for building – or improving – that culture within your organization.
cloud security ,cybersecurity ,application security ,security compliance ,security
http://dzone.com/articles/cyber-security-in-higher-ed-how-to-avoid-becoming
Madison City Schools hosts Cyber Security Week – Story
FA to increase 2018 World Cup cyber security over hacking concerns : Football, News


Our process starts with a team of anthropologists and psychologists working in our design group. They spend time with specific types of people around the world to understand how they behave and communicate. This helps us to understand better and to spot early signals of new patterns of behavior that could be harnessed into mobile communication. Our designers often go out into the field to understand the world they are designing for. All of these observations are brought into the design process to inspire and inform our ideas.
We have an advanced design team that is looking 5 to 15 years out, working on spotting and predicting megatrends in society and coming up with thought-provoking ideas on what mobile design could do to influence and react to these.
We also have a large research group within Nokia design. It looks at long-term, macro, and societal trends as well as more short-term trends around colors, fashions, and textures. We identify local, country-specific trends, but we also look across countries to identify similarities in lifestyles and global trends. In practice, this means localized colors, surface textures, and user-interface content such as wallpaper, services, or ring tones. In our emerging-markets research, a key finding was that everybody wanted a range of options.
How do tastes in India and China differ?
In India, there's a lot of aspiration in a purchase. It's about looks, style, and projecting the right image. [A phone is] not just a status symbol but about people trying to acquire things to move to the next level.
It has to be the right bargain in China. So you have to hit certain price points. Africa is a lot like that, too. The next big thing is going to be how to understand these global traits and translate them into functionality and usefulness while designing a product.
Did you adapt any global design traits for emerging-market customers?
Take the Nokia 2630, which is an entry-level phone. We wanted to create a phone that focused on style and fashion, bringing the same sleek design that you see in other parts of our range to this market while at the same time making it affordable. We wanted to avoid the look of some of the other designs produced for this market, which tend to look ?cheaper??square boxes that look brittle and lack robustness.