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The present study explored chronic disease management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, PA, USA.
In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households.
Interviews and surveys were conducted in a clinical setting at Children’s Hospital of Philadelphia, at participants’ homes, and in food procurement settings including grocery stores, food pantries and soup kitchens.
Eighteen adults who received SNAP; five with a diet-related chronic condition, five managing the chronic condition of a family member and thirteen with overweight or obesity.
All households had at least one member with a chronic disease or condition. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programmes, often had negative impacts on chronic disease self-management.
Drawing from nearly 50 h of in-depth qualitative interviews with SNAP participants, the study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations.
A new species, Contarinia brassicola Sinclair (Diptera: Cecidomyiidae), which induces flower galls on canola (Brassica napus Linnaeus and Brassica rapa Linnaeus (Brassicaceae)), is described from Saskatchewan and Alberta, Canada. Larvae develop in the flowers of canola, which causes swelling and prevents opening, pod formation, and seed set. Mature larvae exit the galls, fall to the soil, and form cocoons. Depending on conditions, larvae will either pupate and eclose in the same calendar year or enter facultative diapause and emerge the following year. At least two generations of C. brassicola occur each year. Adults emerge from overwintering cocoons in the spring and lay eggs on developing canola flower buds. The galls produced by C. brassicola were previously attributed to the swede midge, Contarinia nasturtii (Kieffer) in Saskatchewan; here, we compare and list several characters to differentiate the two species.
Hearing loss is highly prevalent in older adults and can pose challenges for neuropsychologists, as assessment and intervention procedures often involve orally presented information which must be accurately heard. This project examined the hearing status of 20 clients (mean age = 71 years) in a hospital-based outpatient neuropsychology clinic, and explored whether information about hearing loss informed neuropsychologists’ clinical practice. A research assistant administered a brief hearing screening test to each participant. Four treating neuropsychologists were asked to comment on their client’s hearing status before and after being shown their client’s hearing screen test results. Screening revealed that the majority of participants had at least mild hearing loss, and that the neuropsychologists were relatively accurate (60%) at estimating their clients’ hearing status. Neuropsychologists used information about a client’s hearing status to make recommendations that clients pursue audiologic services, and to educate clients and family members about hearing loss and communication.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Given the urgency of finding cost-effective and innovative solutions to providing community services for aging in place, novel solutions that take advantage of existing infrastructure are clearly needed. In this sequential mixed-method study, we chose to explore the role that nursing homes could play in offering services to a non-traditional target population, namely seniors with loss of independence living in the community. Forty-two (n = 42) nursing homes in the province of New Brunswick completed an online survey, and 10 agreed to participate in face-to-face interviews. Results show that 100 per cent of participants agreed that nursing homes could offer services to seniors in their communities for aging in place. Results suggest that nursing homes are cost-effective, innovative solutions for aging in place.
In this paper, we report the analysis, design, and implementation of stacked transistors for power amplifiers realized on InP Double Heterojunction Bipolar Transistors (DHBTs) technology. A theoretical analysis based on the interstage matching between all the single transistors has been developed starting from the small-signal equivalent circuit. The analysis has been extended by including large-signal effects and layout-related limitations. An evaluation of the maximum number of transistors for positive incremental power and gain is also carried out. To validate the analysis, E-band three- and four-stacked InP DHBT matched power cells have been realized for the first time as monolithic microwave integrated circuits (MMICs). For the three-stacked transistor, a small-signal gain of 8.3 dB, a saturated output power of 15 dBm, and a peak power added efficiency (PAE) of 5.2% have been obtained at 81 GHz. At the same frequency, the four-stacked transistor achieves a small-signal gain of 11.5 dB, a saturated output power of 14.9 dBm and a peak PAE of 3.8%. A four-way combined three-stacked MMIC power amplifier has been implemented as well. It exhibits a linear gain of 8.1 dB, a saturated output power higher than 18 dBm, and a PAE higher than 3% at 84 GHz.
Environmental protection and human rights law have influenced each other in many ways. The main prism through which this complex relationship has been analysed and understood is that of ‘synergies’. One underlying condition for the full respect of at least some human rights is an environment of sufficient quality to avoid significant impacts on human health and living standards. One obvious illustration of this point concerns the devastating impact that water or air pollution can have on health or even on the lifespan of humans in many regions of the world. From a legal standpoint, this has resulted in an expansion of human rights provisions to account for some measure of environmental protection, thus bringing human rights (provided in treaties but also in domestic constitutions) and their institutional arsenal (regional courts, committees, domestic adjudication) to bear on questions of environmental regulation.
This basic observation suffices to introduce the two main questions that will be analysed in this chapter, namely (i) which human rights can be mobilised as a tool for environmental protection, and (ii) to what extent. The answer to these questions has kept commentators, advocacy groups, policy-makers and adjudicators busy for several decades, and it has raised many other questions relating to ‘human rights approaches to environmental protection’, such as the formulation of a right to an environment of a certain quality or the connection between human rights and climate change. It is noteworthy, however, that in more than twenty years of debates, little attention has been paid to a third question discussed in this chapter, i.e. (iii) the potential conflicts between human rights and environmental protection. One conspicuous illustration of this omission is provided by the absence of any clear reference to such conflicts in the Analytical Study on the Relationship between Human Rights and the Environment commissioned by the Office of the High Commissioner for Human Rights, following the initiative of the UN Human Rights Council. Such an omission may be the result of simple inadvertence or of a policy stance, but it must be highlighted because such conflicts do exist and they may further develop as environmental policies become increasingly demanding.
The first section of the chapter explores the conceptual relationship between human rights and environmental protection (10.2).
As early as 1987, the World Commission on Environment and Development called, in its report Our Common Future, for States to expand their understanding of the concept of security to incorporate environmental considerations:
The first step in creating a more satisfactory basis for managing the interrelationships between security and sustainable development is to broaden our vision. Conflicts may arise not only because of political and military threats to national sovereignty; they may derive also from environmental degradation and the pre-emption of development options.
Starting in the 1990s and particularly in the last decade, this core message has increasingly found expression in a number of concrete initiatives undertaken not only by environmental organisations but also, and remarkably, by organisations focusing on international security.
An apposite example is provided by the joint initiative launched in 2002 by the UNEP, the UNDP and the Organization for Security and Cooperation in Europe (OSCE) called ‘An Environment Agenda for Security and Co-operation in South Eastern Europe and Central Asia’ or ‘ENVSEC Initiative’. This initiative aims to incorporate the environmental dimension into the security policies relating to countries and regions with significant exposure to conflict, such as the Balkans, the Caucasus or Central Asia. The initiative was subsequently enlarged to three other organisations, namely the North Atlantic Treaty Organization (NATO), the United Nations Economic Commission for Europe (UNECE) and the Regional Environmental Centre for Central and Eastern Europe (REC). The main idea underpinning this and other efforts to redefine the concept of security is the need to understand the impact of problems such as environmental degradation, asymmetric access to natural resources or the transboundary movement of dangerous substances on the triggering, amplification or duration of conflicts or their resumption.More generally, these efforts highlight the active rather than merely passive role played by environmental change in connection with conflict.
The purpose of this chapter is to analyse how the environmental dimension of international security has been increasingly reflected in international law, whether to protect the environment from armed conflict or, conversely, to address environmental threats as conflict drivers. The first section focuses on the protection of the environment in what has traditionally been called the law of war (11.2), which encompasses both the laws applicable to the conduct of hostilities and the law governing recourse to force.
As discussed in previous chapters, the regulation of the sources of atmospheric, water and soil pollution has been one of the primary concerns of international environmental law, from the perspective of both customary and treaty law. This ‘first generation’ of environmental problems has, in fact, led to the adoption of many domestic laws and international instruments. In general, we can consider this body of law from two different angles, namely the protection of a specific object and the regulation of a particular source of pollution. A combination of these two angles is also possible (for example, the protection of a specific object from a specific source of pollution). A few examples will illustrate this point.
An important aspect of the instruments that we have studied in previous chapters is that they are designed to protect a certain object against various threats, including pollution (e.g. as a factor in habitat degradation). This applies, in particular, to many conventions on the protection of species, spaces and biodiversity. Conversely, other instruments are structured in such a way as to regulate specific sources of pollution (e.g. operational discharges, oil spills, dumping or the incineration of wastes, emissions of certain substances that pollute the atmosphere, the production and consumption of certain substances that deplete the ozone layer, or the emission of certain substances that have an adverse effect on the climate). The goal pursued by these instruments is often to protect a specific object (e.g. the marine environment, the ozone layer, the climate system). However, their focus is on some (not all) threats to such objects, which have often been added progressively at a pace dictated by the understanding of their environmental implications as well as by political feasibility. Alternatively, the regulation of these pollutants may be aimed at the protection of various objects simultaneously, whether they are clearly identified or not.
This chapter focuses on the regulation of certain substances and activities with specific hazards or risks, not as regards a specific object but, more broadly, the environment and/or public health. Among the many instruments potentially relevant in this connection, we focus only on those aimed at the prevention and control of these substances and activities. Instruments providing for compensation for damages resulting from the use of these substances or the conduct of such activities will be studied in Chapter 8.
This chapter begins the presentation of substantive regulation in international environmental law by focusing on the rules governing oceans, seas and freshwater.
These objects (the marine environment and freshwater), although separate from a regulatory standpoint, are closely related in that the main cause of marine pollution originates from land-based sources and is partly carried by rivers. In addition, both the law of the sea and that of watercourses, particularly regarding navigation, can be traced back very far in the history of international law, even though the regulation of environmental issues within those areas is relatively recent. Another common feature is the customary character of some of the rules governing these two objects. More generally, from an environmental perspective, these different regulatory regimes are all concerned with the ‘hydrosphere’ or the waterbodies of the planet. For these reasons, it is useful to examine oceans, seas and freshwater in the same chapter.
The first substantive section covers the regulation of the marine environment (4.2). Broadly speaking, the law of the sea protects the marine environment in two principal ways. On the one hand, it distributes the jurisdiction over vast marine areas (and therefore the primary responsibility for their protection) among different States. On the other hand, it introduces a set of duties to protect the marine environment, which are, in turn, specified by other instruments. These instruments are either concerned with specific issues (e.g. a source of marine pollution) or a particular marine area or object (e.g. the Regional Seas Conventions or the on-going negotiation on ‘biodiversity beyond national jurisdiction’ discussed in Chapter 6). Following this structure, we analyse, first, the distribution of jurisdiction under the United Nations Convention on the Law of the Sea (UNCLOS) (4.2.1) and then turn to the duties of States in the protection of the marine environment, both in general (4.2.2) and in connection with specific sources of pollution (4.2.3) or geographical areas (4.2.4).
The following section of this chapter examines the international regulation of freshwater (4.3). After presenting the overall structure of this body of law (4.3.1), we discuss the law governing international watercourses (4.3.2), groundwater (4.3.3) and freshwater locked in the form of ice (4.3.4). The question of access to water as a human right and its expression in environmental treaties, such as the Protocol on Water and Health, is left for Chapter 10.
In the preceding chapters, we have discussed the substantive regulation of environmental problems at the international level. In particular, we have analysed the obligations imposed on States in relation to the protection of the hydrosphere, the atmosphere, the biosphere and dangerous substances and activities. We now turn to the processes through which these obligations are implemented.
The traditional approach in this area assumed that compliance with international obligations only depended upon a State's will to comply. From a substantive law perspective, the main mechanism to encourage compliance was to make any violation costly for the State, notably through the application of secondary norms of State responsibility. From a procedural standpoint, breaching a norm could have several consequences, ranging from the first allegations of non-compliance, often followed by negotiations and consultations between the States concerned, to judicial mechanisms of dispute settlement and, where appropriate, alternative dispute settlement, such as mediation, conciliation or inquiry.
However, the transition from compliance to non-compliance with the requirements of a norm is better understood as a process, which admits degrees. Such degrees provide a useful basis for the discussion in this chapter because they help to locate the different implementation mechanisms at the stage where they are most likely to intervene. Four ‘stages’ may be distinguished along the compliance spectrum. Figure 8.1 summarises this understanding graphically.
Some mechanisms only play a role ‘upstream’ before allegations of noncompliance emerge (Stage 1). The main mechanism at this stage is the monitoring and reporting of information showing a State's behaviour in relation to its international obligations (section 8.2). By contrast, ‘downstream’ (Stage 4), we find the more formal mechanisms for the characterisation of a breach by third parties (adjudicatory or quasi-adjudicatory mechanisms) and the determination of the ensuing consequences attached by the law of State responsibility (section 8.3) or other secondary norms. Between these two extremes lies a grey area where the level of compliance is unclear. This area has traditionally been the province of so-called diplomatic or political mechanisms for the peaceful settlement of disputes. However, we will see in Chapter 9 that in international environmental law, this area has been populated by new methods of facilitating compliance (Stage 2) and managing non-compliance (Stage 3) with environmental standards.