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Growth in resource consumption and associated environmental degradation threatens food systems, with millions of people living in hunger globally, demonstrating the need for greater socio-ecological efficiency in food provisioning. This paper considers how sustainable consumption can ensure that human needs with regards to food provisioning (food security) are met within globally sustainable limits. It follows a sectoral approach to sustainable consumption corridors (SCCs), to develop an indicator framework for a food provisioning systems SCC.
Technical summary
Bridging social and ecological evaluations of sustainability in food systems has proved to be a challenge, illustrating the need for indicator sets which link environmental impacts and social achievement within a single framework. This work aims to fill that research gap by considering how the sustainable consumption corridor (SCC) framework can be used to examine the socio-ecological efficiency of food provisioning systems and developing a comprehensive SCC framework for food provisioning. The framework uses domains to define the minimum level of consumption needed to meet human needs (social foundation [SF]) and the maximum level of environmental impact the earth system can tolerate (ecological ceiling [EC]) while sustainably meeting those needs. It does so through the production of an indicator set for food provisioning systems that gives indicators and thresholds for the EC and SF domains within a single framework. This output is followed by a discussion of how this global SCC framework could be altered for use in different contexts, and suggestions for how such a framework could inform consumption linked sustainability policy.
Social-media summary
This work puts forth a sustainable consumption corridor framework to evaluate if food provisioning systems are meeting human needs within sustainable limits.
This article engages in a comparative analysis of espionage law in the UK and Australia to determine whether the laws in each country are effective and appropriate. It finds that, while the espionage laws in both countries are largely capable of effectively addressing modern espionage, this has come at the expense of appropriateness – specifically, aspects of the laws in both jurisdictions are complex, uncertain and overly broad, and defences and other safeguards for legitimate conduct have limitations. The article argues that, while the effectiveness of espionage (and other national security) laws is an important consideration, this must be balanced with appropriateness to ensure that core rule of law values and legal principles are not undermined.
Background: Outpatient parenteral antimicrobial therapy (OPAT) involves the administration of intravenous antimicrobial therapy outside the hospital. The literature suggests that inpatient providers are often unaware of OPAT programs and may not engage this multidisciplinary group in a timely fashion, leading to potentially inappropriate OPAT use. However, few studies have directly addressed this issue. We characterized current practices for coordinating OPAT and assessed provider understanding of OPAT services. We also conducted an exploratory analysis of placement of a peripherally inserted central catheter (PICC) consultation prior to an infectious disease (ID) consultation as a proxy for potentially avoidable OPAT use. Methods: This study was conducted between September and December 2021 at the Ann Arbor VA Healthcare System. All charts (n = 212) in which a consultation for a PICC was placed between January and September 2021 were reviewed, including free-text data entered by patient teams and inpatient progress notes in the days leading up to and following PICC consultation. Additionally, inpatient providers were surveyed using an online format regarding knowledge, utilization, and perceptions of OPAT. Results: Of the 212 charts reviewed, 108 patient encounters resulted in PICC placement; 80 (74.1%) were placed for the indication of home IV antibiotics. Of these, 3 (4.0%) had the PICC consult placed prior to the ID consultation. Of the 104 PICC consultations that were cancelled, 9 (8.7%) were cancelled because the ID staff did not recommend home IV antibiotics. Other reasons for cancellation included alternative device placement, duplicate order, referral to interventional radiology, failure to meet criteria, or unsuccessful placement. Of the 285 inpatient providers sent the electronic survey, 121 (46.9%) completed at least some portion. Overall, 17 respondents (14.0%) were familiar with the acronym OPAT; however, only 10 were able to expand the acronym correctly. Of the 118 respondents asked about their familiarity with the OPAT program at the local institution, 98 (83.1%) were not familiar at all or were only slightly familiar with the program. In contrast, 7 respondents (6.0%) were very or extremely familiar with the OPAT program. Conclusions: Further education and structural interventions are necessary to improve inpatient providers’ awareness and early engagement of local OPAT programs to ensure appropriate OPAT use. An educational intervention with an informative flowchart diagramming the steps for engaging the OPAT team could raise awareness and improve engagement when potential OPAT needs are identified (Fig. 1).
Involving children and young people in NHS services has become an imperative for Hospital Trusts and given momentum by the Patient and Public Involvement (PPI) initiative and organisations such as National Institute for Health Research (NIHR) INVOLVE. An overriding concern with attempts to ‘involve’ children and young people in health settings has been on seeking their views or advice on matters defined by health professionals and researchers. Yet with a growing ethos towards shared decision-making, co‑production, and developments to the theory and practice of children's participation (Banks et al, 2018; Tisdall, 2013; Percy-Smith, 2018), there is a shift towards more active approaches to children's participation in healthcare settings that recognise the importance of involving children and young people in all phases of the project cycle and in a wider range of contexts. This chapter draws on a collaborative action inquiry project with a UK NHS Hospital Trust to share the experience of developing meaningful and effective opportunities for involving children and young people across the Trust. Different strategies adopted, as well as some of the issues and challenges faced, will be discussed. In particular, the chapter will critically reflect on the significance of participation as patient experience and the challenges of integrating children's participation into organisational cultures and systems. Emphasis is placed on the need for creativity and flexibility in work with children, the critical role of adults as advocates and the importance of integrating a learning ethos into systems and practices across the Trust.
Developing the participation of children and young people in healthcare settings has been slower than in many other sectors such as schools and broader contexts of local governance in local authorities (ECORYS, 2015), in spite of the PPI initiative. Emphasis in involving children and young people has predominantly focused on seeking consultation and advice from children and young people, for example, through the gold standard of young people's research advisory groups (Nuffield Council on Bioethics, 2015; Caldwell and Jarrett, 2018). Children's participation in health settings is primarily about influencing the way in which hospital services are delivered, and in turn experienced, by children and young people.
Mimbres painted pottery from the U.S. Southwest is renowned for its spectacular designs. Literature on style and identity suggests three concepts helpful for understanding its social significance: boundaries, multiple dimensions of variation, and historical context. This article investigates these concepts by synthesizing past studies with new analyses. The distribution of Mimbres pottery is strongly bounded, demonstrated with data from the cyberSW project. Variation in designs is multidimensional: (1) individual artists created distinctive styles; (2) specific designs are distributed homogeneously across the region, a conclusion demonstrated in part with new analyses of the geometric designs; and (3) pan-regionally, the designs’ content, regular structure, and appearance on multiple media suggest they were meaning-charged. Considering these findings in their historical context provides insights into the pottery's social significance and elaboration: population growth in the resource-rich Mimbres region engendered land tenure systems, marked in part by burials that included pottery. The pottery came to convey the message “I belong here” from two perspectives. By adopting the pottery, people, including migrants, signaled their acceptance of established ways of life in the region, and their access to the pottery indicated their acceptance in the social milieu.
Bulimia nervosa (BN) is a severe eating disorder that can be managed using a variety of treatments including pharmacological, psychological, and combination treatments. We aimed to compare their effectiveness and to identify the most effective for the treatment of BN in adults.
Methods
A search was conducted in Embase, Medline, PsycINFO, and Central from their inception to July 2016. Studies were included if they reported on treatments for adults who fulfilled diagnostic criteria for BN. Only randomised controlled trials (RCTs) that examined available psychological, pharmacological, or combination therapies licensed in the UK were included. We conducted a network meta-analysis (NMA) of RCTs. The outcome analysed was full remission at the end of treatment.
Results
We identified 21 eligible trials with 1828 participants involving 12 treatments, including wait list. The results of the NMA suggested that individual cognitive behavioural therapy (CBT) (specific to eating disorders) was most effective in achieving remission at the end of treatment compared with wait list (OR 3.89, 95% CrI 1.19–14.02), followed by guided cognitive behavioural self-help (OR 3.81, 95% CrI 1.51–10.90). Inconsistency checks did not identify any significant inconsistency between the direct and indirect evidence.
Conclusions
The analysis suggested that the treatments that are most likely to achieve full remission are individual CBT (specific to eating disorders) and guided cognitive behavioural self-help, although no firm conclusions could be drawn due to the limited evidence base. There is a need for further research on the maintenance of treatment effects and the mediators of treatment outcome.
People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex.
Aims
To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm.
Method
We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable.
Results
Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the metaanalysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%.
Conclusions
The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.
Pour qu’un héritage soit réellement grand, il faut que la main du défunt ne se voie pas.
In 2014, a year of memorial ceremonies commemorating the twentieth anniversary of the Rwandan genocide, the International Criminal Tribunal for Rwanda (ICTR) marked its own twentieth year with the launch of a “legacy website.” With the closing of the Tribunal scheduled for December 2015, the question of its legacy had become increasingly pressing. The website premiered a video that “celebrates the accomplishments of the ICTR” in a “visually compelling” style. Blurring the distinction between documentary account and film trailer, the video begins with iconic images of the African continent: a boy rolling a hoop down a dirt road; laborers ferrying wares; women in colorful dresses tending children. These scenes of daily life are interrupted by images of men wielding machetes and corpses, interspersed with the figure of the radio, reminding the viewer that the 1994 genocide was encouraged through broadcasts inciting Hutus to take up arms against their Tutsi neighbors. The video lists the Tribunal’s contributions to international criminal law, but also describes a much broader impact: “a record of legal reform in Rwanda, and outreach, education, legal training, and healing.” Young boys leap into a body of water to punctuate the final term, suggesting the hope of a new Rwanda. The narrator proclaims, “today in Rwanda, it’s safe to listen to the radio again: the sound is of a nation rebuilding.” The film’s final words reach beyond the Rwandan context, affirming that ours is “a world pushing forward despite great imperfection, each day closer to a time when international law offers justice to all people, everywhere.”
Fiber diffraction data have been obtained from Narcissus mosaic virus, a potexvirus from the family Flexiviridae, and soybean mosaic virus (SMV), a potyvirus from the family Potyviridae. Analysis of the data in conjunction with cryo-electron microscopy data allowed us to determine the symmetry of the viruses and to make reconstructions of SMV at 19 Å resolution and of another potexvirus, papaya mosaic virus, at 18 Å resolution. These data include the first well-ordered data ever obtained for the potyviruses and the best-ordered data from the potexviruses, and offer the promise of eventual high resolution structure determinations.
Temperature has a key influence over seed dormancy and germination, allowing wild plants to synchronize their life history with the seasons. In this review we discuss the signalling pathways through which temperature is integrated into seed physiology and the control of primary and secondary dormancy, with an emphasis on understanding maternal effects and responses dictated by the zygotic tissues. A key emerging paradigm is that temperature signalling in seeds must be understood in relation to whole plant genetics and physiology, as overlapping pleiotropic roles for temperature sensing and hormone signalling pathways are commonplace.
Bioimpedance spectroscopy (BIS) has been used to track changes in total body water (TBW). Accurate TBW estimations can be influenced by both methodological and biological factors. One methodological variation that contributes to BIS TBW errors is the electrode placement. The purpose of the present study was to compare the reproducibility and validity of fixed-distance electrode placements (5 cm) with the standard single-site electrode placements. Twenty-nine subjects (fifteen men and fourteen women) participated in the reproducibility study, while sixty-nine subjects (thirty-three men and thirty-six women) participated in the validity study. The reproducibility study included two measurements that were taken 24 h apart, while the validity study consisted of a 12-week exercise intervention with measurements taken at weeks 1 and 12. TBW was estimated using BIS and 2H techniques. Reproducibility results indicated that fixed-distance electrodes reduced the day-to-day standard error of the measurement in men (from 1·13 to 0·81 litres) but not in women (0·47 litres). sem values were lower for women than for men, suggesting that BIS TBW estimates are sex dependent. Validity results produced similar accurate findings (mean difference < 0·21 litres). However, fixed-distance electrodes improved delta TBW errors (mean difference improvements>0·04 litres in men, women, and men and women combined). When tracking changes in TBW, fixed-distance electrodes may reduce reproducibility errors and allow for smaller changes to be detected. However, the reduction of reproducibility errors may be greater for men than for women. Therefore, reproducibility calculations should be based on the sex of the sample population.
Background: Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. Aims: The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. Method: Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. Results: Child's peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. Conclusions: Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.
Social phobia (SP) is characterized by a fear of one or more social or performance situations. Studies of comorbidity in SP youth find anxiety and affective disorders co-occurring. The present study examined children with primary SP and compared them to children with primary Separation Anxiety Disorder (SAD) or Generalized Anxiety Disorder (GAD) prior to treatment and in response to treatment. The groups differed significantly on self-, parent- and teacher-rated pretreatment measures. Additionally, the two groups showed differential treatment outcomes. When the SP youth with comorbid Affective Disorder were excluded in treatment outcome analyses, there were non significant differences, indicating that comorbid affective disorders likely contributed to differential treatment outcome. Results are discussed in terms of treatment recommendations for socially phobic youth.
To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ).
Results
There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts', leading to problematic levels of psychological distress among some consultants.
Clinical Implications
Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts', to reduce attrition in the most pressured individuals.
Previous research suggests that social workers experience high levels of stress and burnout but most remain committed to their work.
Aims
To examine the prevalence of stress and burnout, and job satisfaction among mental health social workers (MHSWs) and the factors responsible for this.
Method
A postal survey incorporating the General Health Questionnaire, Maslach Burnout Inventory, Karasek Job Content Questionnaire and a job satisfaction measure was sent to 610 MHSWs in England and Wales.
Results
Eligible respondents (n=237) reported high levels of stress and emotional exhaustion and low levels of job satisfaction; 111 (47%) showed significant symptomatology and distress, which is twice the level reported by similar surveys of psychiatrists. Feeling undervalued at work, excessive job demands, limited latitude in decision-making, and unhappiness about the place of MHSWs in modern services contributed to the poor job satisfaction and most aspects of burnout. Those who had approved social worker status had greater dissatisfaction.
Conclusions
Stress may exacerbate recruitment and retention problems. Employers must recognise the demands placed upon MHSWs and value their contribution to mental health services.
The aim of the study was to explore how different styles of working relate to measures of occupational pressure experienced by consultant psychiatrists. A questionnaire was sent to a random sample of 500 consultant psychiatrists enquiring about work patterns, roles and responsibilities; it also contained validated tools, including the 12-item General Health Questionnaire.
Results
A total of 185 usable questionnaires were returned; an adjusted response rate of 41%. More ‘progressive’ styles of working were found to be linked with less occupational pressure on consultant psychiatrists. Three scales were derived: positive workload pattern, clarity of role and perceived support.
Clinical Implications
Alterations in working style may be helpful in combating occupational stress, and therefore in reducing attrition in the psychiatric workforce. Consultants and their teams should give consideration to reviewing their roles and patterns of working.
The project gathered data from a cohort of 300 flexibly trained female consultants in psychiatry in order to understand how their careers had progressed since the completion of their training. A postal questionnaire was used to gather this information.
Results
These consultants were generally satisfied with their training, and were succeeding in pursuing their careers. Flexible training was developed to enable people with family commitments to train in psychiatry, and this is what it is being used for.
Clinical Implications
Flexible training is an important avenue for an increasing number of psychiatrists to continue in their profession. With the current shortfall in consultant numbers, flexible training should be maintained and developed, and should be seen as a useful route to a consultant position.
This survey gathered data on the retirement intentions of consultant psychiatrists over the age of 50 years, in order to address retention issues. A questionnaire was sent to all 1438 consultants over this age in the UK.
Results
A total of 848 questionnaires were returned, an adjusted response rate of 59%. The mean age at which consultants intended to retire in this sample was 60 years (s.d. 4.16), suggesting a potential loss of 5725 consultant years. Reasons for early retirement are complex: factors encouraging retirement include too much bureaucracy, lack of free time and heavy case-loads; those discouraging retirement include enjoyment of work, having a good team and money. Mental Health Officer status is an important determinant in the decision to retire early.
Clinical Implications
With numerous vacancies in consultant psychiatrist posts throughout the UK, premature retirement is a cause for concern, possibly contributing to an overall reduction in consultant numbers of 5%. Addressing factors that influence consultants' decisions to leave the health service early should form an important part of an overall strategy to increase consultant numbers.
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