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‘Write about inspiring fieldwork’; that was the instruction. Easy, of course. It’s always a pleasure to write about one’s enthusiasms. Yet also rather ironic. For me, the point of fieldwork is that it brings insights and emotions that I cannot possibly get from words on a page, not even words crafted by the very best writers. That isn’t surprising. They haven’t seen what I have seen. Nobody has.
A community company, designed to look beyond profits and provide for community involvement in decision making, was introduced in Solomon Islands in 2010. This chapter assesses the extent to which business, social and customary norms have impacted the slow take up of this entity. Business interests, both domestic and foreign, show preference for the easily identifiable traditional corporate form, shying away from this innovative entity. Facilitating institutions such as banks and insurance companies are reluctant to deal with unfamiliar corporate structures, making it difficult for such entities to grow. Participation by community members reiterates social norms, leaving control in the hands of individuals with high status, which rarely challenges dominant understandings of development. This chapter explores ways to overcome the resistance to the community company and realise its potential for enabling sustainable development across the Pacific.
We give a new proof of a result of Sullivan [Hyperbolic geometry and homeomorphisms, in Geometric topology (ed. J. C. Cantrell), pp. 543–555 (Academic Press, New York, 1979)] establishing that all finite volume hyperbolic n-manifolds have a finite cover admitting a spin structure. In addition, in all dimensions greater than or equal to 5, we give the first examples of finite-volume hyperbolic n-manifolds that do not admit a spin structure.
John Calvin converted to evangelical doctrines in his homeland, France, where Protestantism was officially proscribed. In 1535, during a spike in heresy persecution, like scores of evangelicals before him and thousands afterward, he fled as a religious refugee. By the time of his death in 1564, though ever an exile in Geneva, he had done more than any other person to transform the religious politics of France, which had plunged into the beginning of a long “war of religion” (1562–1598). That civil war’s chief protagonists, French Reformed Protestants, “Huguenots,” were his disciples. In attempting to put Calvin in proper context, one must describe both the political environment that shaped his and other French people’s response to Protestantism as well as his role, among all the other major actors, in reshaping it.
As life expectancy increases, more people have chronic psychiatric and medical health disorders. Comorbidity may increase the risk of premature mortality, an important challenge for health service delivery.
Population-based cohort study in Ontario, Canada of all 11 246 910 residents aged ⩾16 and <105 on 1 April 2012 and alive on 31 March 2014. Secondary analyses included subjects having common medical disorders in 10 separate cohorts. Exposures were psychiatric morbidity categories identified using aggregated diagnosis groups (ADGs) from Johns Hopkins Adjusted Clinical Groups software® (v10.0); ADG 25: Persistent/Recurrent unstable conditions; e.g. acute schizophrenic episode, major depressive disorder (recurrent episode), ADG 24: Persistent/Recurrent stable conditions; e.g. depressive disorder, paranoid personality disorder, ADG 23: Time-limited/minor conditions; e.g. adjustment reaction with brief depressive reaction. The outcome was all-cause mortality (April 2014–March 2016).
Over 2 years' follow-up, there were 188 014 deaths (1.7%). ADG 25 conferred an almost threefold excess mortality after adjustment compared to having no psychiatric morbidity [adjusted hazard ratio 2.94 (95% CI 2.91–2.98, p < 0.0001)]. Adjusted hazard ratios for ADG 24 and ADG 23 were 1.12 (95% CI 1.11–1.14, p < 0.0001) and 1.31 (95% CI 1.26–1.36, p < 0.0001). In all 10 medical disorder cohorts, ADG 25 carried significantly greater mortality risk compared to no psychiatric comorbidity.
Psychiatric disorders, particularly those graded persistent/recurrent and unstable, were associated with excess mortality in the whole population, and in the medical disorder cohorts examined. Future research should examine whether service design accounting for psychiatric disorder comorbidity improves outcomes across the spectrum of medical disorders.
The air gap technique (AGT) is an approach to radiation dose optimisation during fluoroscopy where an “air gap” is used in place of an anti-scatter grid to reduce scatter irradiation. The AGT is effective in adults but remains largely untested in children. Effects are expected to vary depending on patient size and the amount of scatter irradiation produced.
Fluoroscopy and cineangiography were performed using a Phillips Allura Fluoroscope on tissue simulation anthropomorphic phantoms representing a neonate, 5-year-old, and teenager. Monte Carlo simulations were then used to estimate effective radiation dose first using a standard recommended imaging approach and then repeated using the AGT. Objective image quality assessments were performed using an image quality phantom.
Effective radiation doses for the neonate and 5-year-old phantom increased consistently (2–92%) when the AGT was used compared to the standard recommended imaging approaches in which the anti-scatter grid is removed at baseline. In the teenage phantom, the AGT reduced effective doses by 5–59%, with greater dose reductions for imaging across the greater thoracic dimension of lateral projection. The AGT increased geometric magnification but with no detectable change in image blur or contrast differentiation.
The AGT is an effective approach for dose reduction in larger patients, particularly for lateral imaging. Compared to the current dose optimisation guidelines, the technique may be harmful in smaller children where scatter irradiation is minimal.
This paper is concerned with East Africans’ perceptions of the intersection between their own, highly charged and contested, local histories, and the global past, as well as their place in it. The two case studies on which the paper is based – Eritrea and Uganda – have much in common in terms of recent history, not least in their experience of prolonged violence, and thus taken together they elucidate distinctive characteristics. Yet they also illustrate broader phenomena. On one level, particular interpretations of local history – both the deeper, precolonial past and the more recent, twentieth-century past – are utilised to critique the flow of global history, as well as the impositions of globalisation, and to emphasise the bitter experience of marginality and lack of agency. At the same time, the global past – conceptualised as the evolution of an intrusive, imperialist, hypocritical global order imposed by foreigners, usually Western in provenance – is seen as omnipresent and pervasive, and thus the arguments made around marginality serve to remind us, paradoxically, how central these communities are (or should be) to the framing of global history.
Health care system capacity and sustainability to address the needs of an aging population are a challenge worldwide. An aging population has brought attention to the limitations associated with existing health systems, specifically the heavy emphasis on costly acute care and insufficient investments in comprehensive primary health care (PHC). Health system reform demands capacity building of academic trainees in PHC research to meet this challenge. The Aging, Community and Health Research Unit at McMaster University has purposefully employed a capacity building model for interdisciplinary trainee development. This paper will describe the processes and outcomes of the model, outlining how the provision of funding, mentorship, and a unique learning environment enables capacity building in networking, collaboration, leadership development, and knowledge mobilization among its trainees. The reciprocal advancement of the research unit through the knowledge and productivity of trainees will also be detailed.
Growth in emergency department (ED) attendance and acute medical admissions has been managed to very low rates for 18 years in Canterbury, New Zealand, using a combination of community and hospital avoidance strategies. This paper describes the specific strategies that supported management of acutely unwell patients in the community as part of a programme to integrate health services.
Community-based acute care was established by a culture of close collaboration and trust between all sectors of the health system, with general practice closely involved in the design and management of the services, and support provided by hospital specialists, coordination and diagnostic units, and competent informatics. Introduction of the community-based services was aided by a clinical guidance website and an education programme for general practice teams and allied health professionals.
Attendance at EDs and acute medical admission rates have been held at low growth and, in some cases, shorter lengths of hospital stay. This trend was especially evident in elderly patients and those with ambulatory care sensitive or chronic disorders.
A system of community-based care and education has resulted in sustained gains for the Canterbury health system and freed-up hospital resources. This outcome has engendered a sense of empowerment for general practice teams and their patients.
Hop production has expanded dramatically in recent years along with the number of local craft breweries, but to date the relationship between these two phenomena has not been explored systematically. Using a state-level pooled count data model with observations from 2007, 2012, and 2017, we examine the independent lagged effects of breweries on the number of hop farms and acres grown, holding constant fixed effects and key economic and geographic factors. Our results confirm that the number of breweries is associated with more hop production (farms and acres) five years later, while warmer temperatures and higher land prices discourage it. (JEL Classifications: L66, Q11, R30)
The purpose of this study was to identify the self-report physical activity (PA) tool best suited for assessment of PA in community-dwelling older adults with multiple chronic conditions (MCC). PA can positively influence physical and psychological health in this population. Although self-report PA tools exist, little is known about the psychometric properties and feasibility of using these tools in older adults with MCC. A systematic literature review from 2000 to 2018 was conducted of studies reporting on the psychometric properties and feasibility of 18 self-report PA tools for community-dwelling older adults (≥ 65 years) to determine the suitability of these tools for use in older adults with MCC. Based on an assessment of the available evidence for the psychometric properties and feasibility of 18 different self-report PA tools, the Physical Activity Assessment Scale for the Elderly (PASE) is recommended as the best-suited self-report PA tool for older adults with MCC.
Nitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.
After reading this article you will be able to:
•understand the epidemiological and clinical features of nitrous oxide misuse
•understand the mechanisms of action of nitrous oxide
•describe potential treatment options in nitrous oxide misuse.
Intersectionality analysis is the study of overlapping or intersecting social identities. Intersecting social identities may have an impact on the perception of burden by family caregivers of older persons with multiple chronic conditions (MCC). The purpose of this study was to explore the interaction of social factors on the burden of caring for older adults with MCC. A total of 194 caregivers of older adults with MCC were recruited from Alberta and Ontario. Survey data were collected at two time points, six months apart. Additive and multiplicative models were analysed using a generalised linear model to determine the level of caregiver burden. Medium-high social interference (impact on social life) was associated with higher burden when adjusted for age, gender, education, and employment status. The overall results of the five-way interaction suggest that males in general had lower burden scores than females. Irrespective of their education and employment status, females had generally higher burden scores. These results add to the current body of literature, suggesting areas for further research to fill knowledge gaps, and promoting ideas for evidence-guided public health interventions that focus on caregivers.
Internalism about normative reasons is the view that an agent’s normative reasons depend on her motivational constitution. On the assumption that there are reasons for emotion I argue that (a) externalism about reasons for emotion entails that all rational agents have reasons to be morally motivated and (b) internalism about reasons for emotion is implausible. If the arguments are sound we can conclude that all rational agents have reasons to be morally motivated. Resisting this conclusion requires either justifying internalism about reasons for emotion in a way hitherto unarticulated or giving up on reasons for emotion altogether.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Although antipsychotic medication remains the mainstay of treatment for schizophrenia, medications alone are not always successful. Cognitive–behavioural therapy (CBT) is recommended as an adjunct to pharmacological treatment. The Cochrane review under consideration evaluates the effects of offering CBT as an add-on to standard care compared with standard care alone, and this commentary puts those findings into their clinical context.
Childhood obesity is a global issue. Excessive weight gain in early pregnancy is independently associated with obesity in the next generation. Given the uptake of e-health, our primary aim was to pilot the feasibility of an e-health intervention, starting in the first trimester, to promote healthy lifestyle and prevent excess weight gain in early pregnancy. Methods: Women were recruited between 8 and 11 weeks gestation and randomised to the intervention or routine antenatal care. The intervention involved an e-health program providing diet, physical activity and well-being advice over 12 weeks.
Women (n = 57, 43.9% overweight/obese) were recruited at 9.38 ± 1.12 (control) and 9.06 ± 1.29 (intervention) weeks’ gestation, mainly from obstetric private practices (81.2%). Retention was 73.7% for the 12-week intervention, 64.9% at birth and 55.8% at 3 months after birth.
No difference in gestational weight gain or birth size was detected. Overall treatment effect showed a mean increase in score ranking the perceived confidence of dietary change (1.2 ± 0.46, p = 0.009) and score ranking readiness to exercise (1.21 ± 0.51, p = 0.016) over the intervention. At 3 months, infants weighed less in the intervention group (5405 versus 6193 g, p = 0.008) and had a lower ponderal index (25.5 ± 3.0 versus 28.8 ± 4.0 kg/m3) compared with the control group.
Conclusion and Discussion:
A lifestyle intervention starting in the first-trimester pregnancy utilising e-health mode of delivery is feasible. Future studies need strategies to target recruitment of participants of lower socio-economic status and ensure maximal blinding. Larger trials (using technology and focused on early pregnancy) are needed to confirm if decreased infant adiposity is maintained.