Detecting Plasma Leakage in Patients with DHF

Detecting Plasma Leakage in Patients with DHF CHAPTER 1: INTRODUCTION Dengue disease is one of the most rapidly spreading mosquito-borne viral disease in tropical and sub-tropical regions around the world. Dengue has become a major international public health concern. The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion people over 40% of the worlds population are now at risk from dengue. WHO currently estimates there may be 50–100 million dengue infections worldwide every year. Dengue is transmitted to humans by the bite of Aedes mosquitoes. According to WHO (2014), â€Å"Dengue causes a severe flu-like illness, and sometimes a potentially lethal complication called dengue haemorrhagic fever†. About 2.5% of those that are infected by dengue die since dengue has neither treatment nor vaccination.Plasma leakage is the major cause of mortality and morbidity in patients with dengue hemorrhagic fever. So that early recognition of plasma leakage and prompt initiation of appropriate treatment are vital. There are only few researches which are done for plasma leakage detection in patients with DHF. Dengue virus infections may be asymptomatic or may lead to undifferentiated fever, dengue fever (DF) or Dengue haemorrhagic fever (DHF) with plasma leakage that may lead to Dengue shock syndrome (DSS). DF is generally an acute febrile illness, with severe headache, myalgia, arthralgia and rashes. Leucopenia and thrombocytopenia may also be observed. Although DF may be benign, it could be an incapacitating disease with severe headache, muscle and joint and bone pains. Occasionally unusual haemorrhage such as gastrointestinal bleeding, hypermenorrhea and massive epistaxis may occur. Undifferentiated fever and classical dengue fever can be managed as any other viral fever with symptomatic treatment. However, often it is difficult to differentiate DF from DHF in the early phase (febrile phase) of the illness. DHF is characterized by the acute onset of high fever and is associated with signs and symptoms similar to DF in the early febrile phase. Plasma leakage is the hallmark of DHF which occurs soon after the end of the febrile phase. There is a tendency to develop DSS due to plasma leakage. Therefore suspected DF and DHF patients should be closely monitored to identify patients with DHF. The degree and the rate of plasma leakage in DHF can vary. It can be minimal in some patients while in others it can be very significant. The leak usually starts slowly, increases gradually, slows down and then ceases altogether at the end of leakage phase (usually within 48 hours from the onset). (Ministry of Health, 2012) 1.1 Description of the Research project The main purpose of this research study was to design a system to detect the plasma leakage in patients with DHF by analyzing patients’ medical records .Further, by using this system doctors can intervene early treatment of shock. In recent years machine learning methods have been widely used in medical diagnosis. Medical diagnosis is one of major problem in medical application. Several research groups are working world wide on the development of neural networks in medical diagnosis. Neural networks are used to increase the accuracy and objectivity of medical diagnosis.Detecting plasma leakage is considered as a non-linear problem that shows the complex causal relationship between the variables. However, an artificial neural network that is suitable for problems of extreme complexity not addressable with conventional technologies, either by the conventional computer programming or statistical method. In this research project multilayer feed forward neural network was used to train and test medical records of patients with DHF and DF. The trained network used to test more records of DHF patients to see the network performance and in order to make system practical to use in a real time hospital setting. The diagnostic performance of the proposed network is validated with Receiver Operating Characteristics (ROC) analysis to evaluate the sensitivity and specificity. 1.2 Literature Survey 1.2.1 Current methods for plasma leakage detection 1.2.1.1 Hemoconcentration Currently, clinical identification of plasma leakage is difficult until DHF develops. The most common method of monitoring leakage relies on identification of haemo-concentration, determined by tracking changes in HCT measurements, with a rise of more than 20% from baseline considered evidence of significant leakage. However, this method can be rather insensitive, particularly if the patient is receiving parenteral fluid therapy, and it is also limited by the fact that an individual’s baseline value is rarely known. (Ministry of Health, 2012) 1.2.1.2 Ultrasonography Studies using ultrasound have demonstrated that pleural effusions, ascites and gall bladder wall oedema are common during the critical phase, and correlate with disease severity. In addition, serial ultrasound studies indicate that subclinical plasma leakage can be detected as days 2 to 3 of fever, and is better at predicting likely disease progression than other marker of plasma leakage such as HCT measurements. Gallbladder wall oedema appears to precede the development of ascites and effusions, and may therefore be a helpful early predictor of outcome. Thus ultrasonography is a useful monitoring tool, and where available, should be considered in the overall assessment during the febrile phase. However, there are certain limitations, particularly the lack of defined normal ranges for the parameters of interest, the variability in measurements obtained by different operators, and the lack of specificity of the findings. (Srikiatkhachorn, Krautrachue, Ratanaprakarn, al, 2007) 1.2.1.3 Chest X-Ray Chest X-ray is recommended to increase the sensitivity of detecting pleural effution. Pleural effusion detected clinically may not be obvious in a Chest X Ray (CXR)-PA, but may be seen only in a CXR right lateral decubitus film. (Ministry of Health, 2012) 1.2.2 Expert Systems An expert system can be divide into two sub-systems the inference engine and the knowledge base. The knowledge base represents facts and rules. The inference engine applies the rules to the known facts to deduce new facts. Inference engines can also include explanation and debugging capabilities CHAPTER 2: BACKGROUND AND THEORY 2.1 Vital Parameters 2.1.1 Pulse The pulse is how many times a minute that our arteries expand and contract in response to the heart. This rate is exactly equal to the heartbeat. 2.1.2 Pulse Pressure 2.2 Neural network 2.2.1 Artificial Neural network vs Biological Neural Network An artificial neural network is a mathematical model or computational model based on biological neural network. In other words, it is an emulation of biological neural system. An ANN is a network of highly interconnecting processing elements (neurons) operating in parallel. Natural neurons receive signals through synapses located on the dendrites or membrane of the neuron. When the signals received are strong enough (surpass a certain threshold), the neuron is activated and emits a signal though the axon. This signal might be sent to another synapse, and might activate other neurons.(Gershenson,2003) 2.2.2 Model of Neural Network Artificial neuron is a highly abstracted model of the natural neuron. Inputs of artificial neuron behave like synapse of a biological neuron which are multiplied by weights (strength of the respective signals), and then computed by a mathematical function which is called Transfer function (also known as Activation function) in order to determine the activation of the neuron. The model of a neuron also includes an externally applied bias (threshold) that has the effect of lowering or increasing the net input of the activation function. 2.2.3 Multilayer Feed forward (MLF) Neural Network A MLF neural network consists of neurons that are ordered into layers. The first layer is called the input layer, the last layer is called the output layer, and the layers between are hidden layers. A neural network that has no hidden units is called a Perceptron. However, a perceptron can only represent linear functions, so it isn’t powerful enough for the kinds of applications. A multilayer feed forward neural network can represent a very broad set of nonlinear functions. Therefore, it is very useful in practice. 2.2.4 Transfer function The behaviour of an ANN depends on both the weights and transfer function that is specified for the units. There are three transfer functions most commonly used for multilayer networks. 2.2.5 Supervised Learning Supervised learning is an approach to find the input-output relationship based from the training using a set of data. Fig. 2.6 represents the block diagram of supervised learning. Learning system is fed with the input data and generates output, which is then compared with the target to compute the error signal by arbitrator. The error is sent to the learning system for further training until the minimum value of error is generated. (Muhammad Akmal Sapon, 2011) 2.2.6 Backpropagation Algorithm The backpropagation algorithm is used in feed-forward ANNs. Artificial neurons are organized in layers and send their signals â€Å"forward†, and then the errors are propagated backwards. The network receives inputs by neurons in the input layer, and the output of the network is given by the neurons in the output layer. There may be one or more intermediate hidden layers. The backpropagation algorithm used for supervised learning. The network computes the error that is the difference between output and desired target and the backpropagation algorithm calculate how the error depends on the input, output and weights. The backpropagation technique reduces this error, until the ANN learns the training data. 2.2.7 Training the network CHAPTER 3: METHODOLOGY AND IMPLEMENTATION In this research project Microsoft Excel 2010 was used to analysis the collected data and MATLAB R2013a (8.1.0.604), 64-bit(win64) software was used as a tool to implement and to train the Neural Network. 3.1 Data Collection The records of 10patients with DHF and 6 patients with DF from September 2013 to April 2014which are obtained from centre for clinical Management of Dengue and Dengue Hemorrhagic fever government hospital in Negombo. The data consists of total 1081 instances which 164 instances belonged to the leaking phase and 139 instances belonged to the non-leaking phase. Each data consists of 10 variables such as heart rate, systolic and diastolic blood pressures, PCV, Temperature and all are coded as numeric values. The patients are both male and female between 18 to 60 years old and who have over 50kg weight. These measurements are taken at equally spaced time points (hourly) since the patient was admitted to the hospital. 3.2 Data Preparation One of the most important parts in data preparation is to determine the best variables that contribute to the decision-making. The data selection step requires some detailed knowledge of the problem domain and the underlying data. Therefore, the selections of the variables are based on the advice of the doctors and also the review of the literatures. Even though there are quite a number of variables entered into the Observation Chart, only five variables are identified as the important variables that contribute to the detection of plasma leakage. They are as follows, 3.3 Neural Network Training The training method was supervised training. Input vector contained 490 data for leakage phase and 591for non-leakage phase. The respective target for each was2-element class vector with a 1 in the position of the associated leaking or non-leaking. A two-layer feed-forward network with 20 sigmoid hidden neurons was created. The tansig(Tan-Sigmoid) is chosen as the transfer function for both hidden and output layers. The input vectors and target vectors are randomly divided into training, validation and test sets. From input vector 70% are used for training set,15% are used to validate that the network is generalizing and to stop training before overfitting, and the last 15% are used as a completely independent test of network generalization. The network was retrained until the network performance approach a satisfactory level (beyond 85%) of supervised training by using different training algorithms and increasing number of hidden neurons. 3.4 Testing The trained neural network saved and it was used to test the new dataset. The new dataset consist of 50 leakage phase and 50 non-leakage phase data. Correct classifications and misclassifications were recorded. CHAPTER 4: DATA AND ANALYSIS AND RESULTS 4.1 Performance Performance is measured in terms of mean squared error, and shown in log scale below figure 5.1. It rapidly decreased as the network was trained. Performance is shown for each of the training, validation and test sets. The version of the network that did best on the validation set is was after training. This figure does not indicate any major problems with the training. The validation and test curves are very similar.If the test curve had increased significantly before the validation curve increased, then it is possible that some over fitting might have occurred. 4.2 Confusion Matrix Confusion matrix contains information about actual and predicted classifications done by a classification system for supervised learning system. In confusion matrix, diagonal cells (in green cells) show the number of cases that were correctly classified, and the off-diagonal cells (in red cells) show the misclassified cases. The blue cell in the bottom right shows the total percent of correctly classified cases (in green) and the total percent of misclassified cases (in red). In this study, as shown in above figure 5.2, accuracy of training, testing and validation process are 90.9%, 80.9% and 79.0% respectively. Overall accuracy for correct classification is 87.6% and misclassification is 12.4%.Therefore the results show fairly good recognition. 4.3 Receiver Operating Characteristic (ROC) curves The coloured lines (green and blue) in each axis represent the ROC curves for training, testing and validation. The ROC curve is another visualization of quality of the network. It is a plot of the true positive rate (sensitivity) versus the false positive rate (1-specificity) as the threshold is varied. A perfect test shows points in the upper-left corner, with 100% sensitivity and 100% specificity. In this study, the network performs fairly good.

Antony and Cleopatra is based upon a dualistic vision of experience, the world of Rome pitted against the world of Egypt

Antony and Cleopatra is based upon a dualistic vision of experience, the world of Rome pitted against the world of Egypt. Rome is associated with military glory, honor, and moral duty and this is clearly depicted by the imagery used throughout the play. Through Cleopatra's words in Act 1 Scene1, the audience gets some insight into the Roman way even before Shakespeare introduces it on stage. â€Å"If the scarce bearded Caesar have not sent his powerful mandate to you, ‘Do this, or this; Take in that kingdom and enfranchise that. As she tries to predict the message form Rome, she creates an image of a powerful and commanding Caesar whose sole concern is to ensure the political superiority of the Triumvirate. Shakespeare uses the character of Caesar to represent Rome and therefore creates the idea of a politically-motivated nation. The news from the messenger in Act 1 Scene 2 also supports the political urgency of Rome as it creates images of war and conquest that is occurring back in Rome. He speaks of Fulvia coming into â€Å"the field† and the â€Å"conquering banner† of Labenius, who is an enemy of the Trimuvirate. However, the battle of Actium which occurs after the separation of the Triumvirate is where imagery truly serves to illustrate the military urgency that is associated with Rome as images of ships, sails, swords and battle give the audience a greater understanding of the emphasis they place on war and the preservation of power. This is obvious in Caesar's words as delivers commands for war; â€Å"Strike not by land; keep whole. Provoke not battle till we have done at sea. Caesar's words help to define the Roman vision of experience: militaristic and male, marked by heroic restraint in difficult circumstances, a willed ability to combat one's deepest feelings, a sustained composure when everyone else is falling apart. Egypt, on the other hand, presents a stark contrast to the political world of the Romans. Egypt represents instinctive passion, extravagant love, fertility, and magnanimity. Just as Caesar represents Rome, Cleopatra's character is used to represent Egypt as a whole. The extravagance of Egypt becomes immediately obvious as Cleopatra enters in Act 1 Scene 1. She enters with a flourish of fanfare, a train of female servants and eunuchs fanning her which evokes an image of absolute comfort and relaxation. There is no hint of political concern as she and Antony profess their love to each other in extravagant words which highlight their instinctive passion. This is reflected in Antony's response to Cleopatra's question of the extent of his love; â€Å"Then must thou needs find out new heaven, new earth. † There are also various references to food and drink in Cleopatra's words and these images serve to create a sense of pleasure which is associated with eating. She refers to her ‘salad days' as she speaks of her youth. She also requests â€Å"music and moody food† to quell her anxiety about Antony's return to her. The atmosphere of pleasure in Egypt is emphasized by Antony in Act 1Scene 1 as he expresses his wishes to indulge in the gay abandon and revelry of Cleopatra's kingdom; â€Å"There's not a moment of our lives that should stretch without some pleasure now. † Another important illustration of the contrast between Rome and Egypt is the imagery that depicts the change in Antony's character. Through the observations of other characters in the play, Shakespeare makes obvious the deterioration of Antony's political prowess and power. The description of this decline usually consists of a juxtaposition of imagery of strength and fortitude with that of weakness and submission. The strength of character is associated with the Antony in Rome who held his political duties in high regard. He deteriorates into a â€Å"doting mallard† of Cleopatra in Egypt where it appears that the atmosphere of abandon and relaxation has cast a spell over him, making him forget his duties as one of the most powerful men in the world. He is described as â€Å"The triple pillar of the world transformed into a strumpet's fool. † This creates the image of deterioration for one who held great power. The imagery of strength versus weakness used in Scarus' speech in Act 1 Scene 1 also portrays the decline in Antony; â€Å"His captain's heart which in the scuffles of great fights hath burst the buckles on his breast, reneges all temper and becomes the bellows and the fan to cool a gypsy's lust. † The strength of Antony's character before his indulgence in the pleasure of the East is enforced by the imagery used in Caesar's tribute to Antony in Act 1 Scene 4. He describes Antony with images of strength and resilience' â€Å"at thy heel did famine follow, whom thou fought against,† â€Å"thou didst drink the stale of horses The contrast between Rome and Egypt also highlights the underlying themes of masculine order versus feminine order as well as the role of the woman . In Rome the masculine ethos which, while having room to honour women in certain limited ways, has little place for them in public life, other than as useful political tools or upholders of very masculine ideals or as producers of soldiers. There is little respect for them as is obvious in the imagery used by various Romans to describe Cleopatra. She is described as a lustful gypsy which is an image used to degrade her character. When Octavius thinks of how his sister should enter Rome in a manner fitting her importance, the only images he can reach for which might express his feelings are ones taken from the vocabulary of military triumphs: â€Å"The wife of Antony should have an army for an usher. † It is significant that he can convey his high esteem and strong feelings for her only in images more appropriate to a returning triumphant general. On the other hand, the woman holds a role of utmost importance in Egypt. Cleopatra's position as queen is the primary image of this. Enobarbus' tribute to her also creates an image of her infinite power and freedom as a woman. something entirely at odds with the Roman emphasis on predictable order, law, and consistency. â€Å"Age cannot wither her, nor custom stale her infinite variety. † In Cleopatra's palace, women talk openly about explicit sexuality. They are attended by men and this creates an image of female superiority. They express their sexual feelings, joke about sexual matters, and establish a close female community. The image of the horse in relation to Antony and Cleopatra's sexual encounters is one of few images that used to express sexuality. This highlights the ability of the woman to be open and expressive as opposed to that of Rome who is expected to be reserved and serve their men. Another major theme of the play to which imagery gives great insight is that of the love between Antony and Cleopatra. They profess their love for each other in an exaggerated style, using images of vastness to describe the extent of their feelings. In Act 1 Scene 1 when Cleopatra claims that she will set a limit (bourn) on Antony's love, he responds â€Å"Then must thou needs find out new heaven, new earth. † This trend continues throughout the play. Even in death their love is made evident by the imagery used in their speech. Cleopatra's motivation for suicide is her reunion with Antony in death; â€Å"I am again for Cyndus, to meet Marc Antony. † This creates the image of their first meeting and emphasizes the immortality of their love as she wishes to recreate that moment in the afterlife. Cleopatra herself finalizes this as she says â€Å"I have Immortal longings in me. † Another main focus of the play is politics and the desire for power. This gives rise to ‘worldliness' of the play as the Romans seek to preserve and expand their empire. The political strategies never remain confined to Rome and there is frequent mention of the capture of neighbouring countries The imagery used reinforces the sense of grandeur and the huge scope of the drama.. It is seen from Act 1 Scene 2 when the messenger form Rome describes Labenius conquering lands from Asia, Euphrates, Syria, Lydia and Ionia. There are also frequent images of the sea and the earth in relation to politics which give a sense of vastness and help to highlight the importance of politics and world conquest. This is illustrated by Cleopatra as she describes war as â€Å"the world's great snare. † Some of the political imagery used to describe Antony also helps to reinforce the huge scope of the drama. He is called â€Å"the greatest prince of the world,† â€Å"the demi- Atlas of the world,† and â€Å"the crown o'th'earth. † He is not only a strong leader in Rome but a â€Å"triple pillar of the world† as Rome's empire extends all over the globe. In examining the imagery of love and politics in Antony and Cleopatra, the underlying theme of war versus love cannot be ignored. This is made evident in the imagery in Antony's words as he struggles to find a balance between upholding his political duty and indulging in passion with Cleopatra. A prime example of this is when Antony is about to leave for war in Act 4 Scene 4. As Cleopatra tries to lace his armour he calls her â€Å"the armourer of my heart. † The image of armour gives a sense of impending war but Antony uses it to convey that Cleopatra has captured his heart. This contrasting imagery occurs several other times in the play, even in the same scene when he gives her a â€Å"soldier's kiss. † The juxtaposition of war and love illustrates Antony's conflict of choice between love and duty. It also helps to illustrate how he downplays the importance of war and politics in the face of love. Antony himself acknowledges this as he admits that he lost to Caesar at sea because he trusted Cleopatra's fleet to help him win the battle; â€Å"My sword made weak by my affection. â€Å"

Actions that the MLRO of BCD should take

Introduction A Money Laundering Reporting Officer (MLRO) is an officer within a firm or practice that has been nominated to make disclosures to the National Crime Agency (NCA), formerly the Serious Organised Crime Agency (SOCA), under the Proceeds of Crimes Act (POCA) 2007 and the Terrorism Act (TA) 2000. It is provided under Regulation 20 of the Money Laundering Regulations 2007 that if an MLRO receives an internal disclosure of suspected money laundering or terrorist financing, they are required to consider the disclosure and decide whether the grounds of suspicion are sufficient enough to pass the disclosure onto NCA (Ellinger et al; 2011: 98). Since the MLRO of BCD Bank has received an internal money laundering suspicion report from Christian, they will be required to consider whether the matter should be passed onto NCA. Given that Radovan Rankovich (RR) is allegedly wanted by the authorities in the Ukraine for criminal actions against the state, and has received a recent transfer of ?15 mil lion from a Corporate Service Provider in Cyprus, it is likely that this would warrant a disclosure to NCA for investigation. In accordance with this, the MLRO will be required to file a Suspicious Activity Report (SAR) with NCA and subsequently liaise with them to deal with this matter accordingly (Ellinger et al; 2011: 97). Part 7 of POCA makes it a requirement for banks to make a disclosure to NCA if they reasonably suspect that a person is involved in money laundering (s. 329). If the MLRO fails to make such a disclosure then he or she may be found criminally liable under this Act for a failure to disclose (s. 331). This is because a person commits an offence under s. 329 if they; acquire, use or have possession of, criminal property. Since a bank would fall within the scope of this section, it is possible that BCD Bank would be subject to criminal proceedings if they failed to take the appropriate action and thus make the relevant disclosures. If the MLRO does not believe that the grounds of suspicion are sufficient to report the matter to NCA, then the MLRO will be required to make further inquiries (International Monetary Fund, 2011: 65). Once the MLRO has made a report to NCA, the report will be ‘protected’ under s. 337 so that nothing in the report shall be taken to breach any restriction on the disclosure of information. Given that BCD Bank may have engaged in money laundering by allowing RR’s transactions to take place, they may have a defence under s. 338 if they make demonstrate that they made the disclosure as soon as possible. Similar provisions also apply under th e TA if the person is also suspected of terrorist financing. As Christian has received a text message stating that RR is wanted by the authorities in the Ukraine for criminal actions against the state, it is likely that the MLRO will also be required to comply with the provisions under the TA for a reasonable suspicion of terrorist financing. An obligation to report under the TA will therefore arise which means that the MLRO will be required to disclose the identity of RR, any information that relates to the matter and the whereabouts of the laundered property. There are two different types of report that may be made by the MLRO, namely protected reports and authorised reports. A protected disclosure is made by a person during the course of their trade, profession or employment. This type of disclosure is generally made by a person who is carrying our professional activities. An authorised disclosure is made by a person who is about to commit a prohibited act or has already committed a prohibited act (Bastable and Yeo, 2011: 108). Since the bank has already dealt with the property that is suspected of being laundered, it is more appropriate for an authorised disclosure to be made. The MLRO will also be required to obtain consent from NCA under ss. 335 and 336 to determine whether Christian can action any further transfers out of RR’s account. This will be done by making a ‘consent report’ to NCA, which will then block any transactions for seven working days. If NCA gives consent to the MLRO, the MLRO will then be able to give consent to Christian to carry out the transactions (Bastable and Yeo, 2011: 108). If NCA refuse consent, however, the proposed transactions will be frozen for a further 31 days, unless consent is granted during that period; R (on the application of UMBS Online Ltd [2007] WL 1292620. The Risks and Issues for the Bank This particular issue regarding RR is likely to be problematic for the BCD Bank as they will want to act in the best interests of their customer, namely RR, so that they remain in business with them whilst at the same time they are required to fulfil certain obligations imposed upon them by law. Because BCD will be required to disclose their suspicions even if RR has not acted in a criminal manner, this will have a damaging effect upon RR’s reputation and as put by Hislop (2009); â€Å"absent bad faith, little more than a â€Å"bad feeling† can trigger a banks disclosure obligations under POCA 2002, with in some cases catastrophic commercial consequences for the customer and a damning of his hitherto â€Å"good name† in the business community.† If the banks suspicions are incorrect, this can be significantly detrimental for RR. As such, the bank will need to be careful that they are striking a balance between the interests of RR with its duties to disclose . In the recent case of SHAH and another v HSBC private bank (UK) Ltd (2009) EWHC 79 (QB) the implications Part 7 has upon the rights of the individual and the banking business was clearly highlighted. Here, it was demonstrated that where a bank makes a SAR in respect of a suspicious transaction, they may not be provided with protection if the customer decides to challenge the banks suspicions in the future. This is so, despite the fact that a criminal offence may have been committed if the bank failed to make such a disclosure. Customers will have a right to challenge the banks suspicions with the bank then being required to prove that the suspicion was reasonable. It may be difficult to determine how the bank can justify making a disclosure since it was made clear by the court in this case that â€Å"the defendant must think that there is a possibility, which is more than fanciful, that the relevant facts exist. A vague feeling of unease would not suffice.† The bank will therefore be taking a risk in many any disclosure, especially this one since it will have to be shown that the text message was sufficient enough for a disclosure to be made. Furthermore, even if the circu mstances do render a disclosure justified, the bank’s decision may still be challenged which can be costly and time consuming. In K Ltd v National Westminster Bank plc [2007] 1 WLR 311 it was noted by the Court that; â€Å"to intervene between a banker and his customer in the performance of the contract of mandate is a serious interference with the free flow of trade. But Parliament has considered that a limited interference is to be tolerated in preference to allowing the undoubted evil of money-laundering to run rife in the commercial community.† Therefore, even though such a disclosure may interfere with the relationship between the bank and RR, such interference will be necessary if it will be likely to prevent money laundering from taking place. The bank needs to be clear that an interference of RR’s account is appropriate on the circumstances, since a frozen bank account for a period of time has in the past been considered a ‘grave injustice’ in the case of Squirrell Limited v National Westminster Bank plc (Customs and Excise Commissioners intervening [2006] 1 WLR 637. Here, the customer’s funds were frozen resulting in the customer being unable to afford the legal fees it would cost to challenge the decision. Therefore, if RR’s funds were frozen, which subsequently prevented RR from challenging the decision; it is unlikely that this would be deemed appropriate by the court. In accordance with this, it has been said that the test for suspicion is â€Å"a purely subjective matter† ( Medroft, 2010: 190). The decision as to whether the suspicion is reasonable will therefore depend upon whether Christian actually believed that the transaction was suspicious. If it cannot be found that this is the case, the interference cannot be considered justifiable and a breach of the customer’s human rights may also be established as in K Ltd. The bank will therefore be required to consider whether ‘reasonable grounds’ do actually exist, having regard to the elements constituting market abuse offences (Hudson and Hutchinson, 2009: 1). There are many inherent risks that are associated with disclosures and as such, it is vital that the bank is aware of its exact rights and obligations. In SHAH the court found that the bank did not act in an unreasonable manner which is likely to be the case in the instant situation. As such, it will most likely be difficult for RR to show that the bank had not acted in good faith. However, it could be argued that there was an unreasonable delay by the bank to make the disclosure under s. 338(2). As a result of this, the bank could be exposed to liability for breach of its duty of care (Medroft, 2010: 190). Whether this is acceptable remains an arguable subject but as expressed by Benjamin (2007: 62); â€Å"here the objective is not informed consent to risk but combating crime.à ¢â‚¬  Accordingly, it is therefore generally accepted that a bank’s interference will be justified on public policy grounds. The bank will still be subjected to many risks when making a disclosure, nonetheless, and must therefore consider whether the consequences of making a disclosure can be justified (Ellinger et al. 2010: 114). In addition, if the bank decides to make a disclosure, they must be careful not to allow the customer to find out as they can be found liable for ‘tipping off. This is another issue that may arise since a customer could become aware that a disclosure has been made simply due to the fact that their account has been suspended. It could be said that the bank is in a difficult situation as whatever option it takes, sanctions may still be imposed. As one judge noted in Governer & Company of the Bank of Scotland v A Ltd [2000] Lloyd’s Rep Bank 271, 287; â€Å"the bank may commit a criminal offence if it pays or if it refuses to pay.† Furthermore, if the bank makes a disclosure based on its suspicions, which later turn out to be unfounded, the bank risks civil liability for breaching its contract with its customer (Ellinger et al: 2010: 114). This is because the bank will have frozen the customer’s account which would have prevented payments from being made in and out of the account. Because the banks have a significant burden imposed upon them when it comes to dealing with money laundering, some attempt has been made to ensure that banks acting in good faith will not face criminal liability. For example, it was held by the court in C v S [1999] 2 All ER 343 that â€Å"it would not normally be an abuse of process to prosecute a bank which was doing no more than obeying a court order for disclosure.† Still, it is necessary for the bank to consider all of the risks before considering whether to make a disclosure or not. Overall, it is necessary on the facts for the MLRO of BCD Bank to make a disclosure to NCA since it does appear that the suspicions are reasonable. This is based upon the transaction of ?15 million that was made recently as well as the text message that Christian has received. Whilst the bank would be required to examine the potential issues with disclosing such information and freezing the account of RR this appears necessary and in the public interest. It will most likely prevent money laundering activities from taking place and will ensure that Christian, the MLRO and the bank are complying with their obligations. References Bastable, G., and Yeo, N., (2011). Money Laundering Law and Regulation: A Practical Guide, Oxford University Press. Benjamin, J., (2007). Financial Law. OUP Oxford. Ellinger, E. P., Lomnicka, E., and Hare, C., (2011) Ellinger’s Modern Banking Law, (Oxford University Press. Ellinger, E. P., Lomnicka, E., and Hare, C., (2010) Ellinger’s Modern Banking Law. 5th Edition. OUP Oxford. Hislop, D., (2009). ‘Banks, SARS & the Customer’ 159 New Law Journal 1099, Issue 7380. International Monetary Fund., (2011) Banking and Insurance, Business & Economics. Medcroft, N., (2010). A Banker’s Liability for Damages Arising from Compliance with PT 7 POCA’ 4 Journal of International Banking and Financial Law 227, Issue 4. Medcroft, N., (2009). Refusing to Execute Payment Instructions Where a Bank Suspects Money Laundering. 4 Journal of International Banking and Financial Law 190, Issue 4. Hudson, D., and Hutchinson, K., (2009). Suspicious Transactions Reports: Reporting Obligations of Financial Institutions in the UK. Complinet, [Accessed 07 June, 2014]. Cases C v S [1999] 2 All ER 343 Governer & Company of the Bank of Scotland v A Ltd [2000] Lloyd’s Rep Bank 271, 287 K Ltd v National Westminster Bank plc [2007] 1 WLR 311 R (on the application of UMBS Online Ltd [2007] WL 1292620 SHAH and another v HSBC private bank (UK) Ltd (2009) EWHC 79 (QB) Squirrell Limited v National Westminster Bank plc (Customs and Excise Commissioners intervening [2006] 1 WLR 637

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