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About 65 million people use wheelchairs worldwide. Powered wheelchairs offer independent mobility for those who find it difficult to propel a manual wheelchair. Previous studies have described powered wheelchairs as a mixed blessing for the users in terms of usability, accessibility, safety, cost and stigma; however, few studies have explored their impact on mobility and participation over time. Therefore, as part of a larger longitudinal study, we used a combined retrospective and prospective lifecourse perspective to explore the experiences of older adult powered wheelchair users. Based on the interpretive description approach, 19 participants took part in a series of semi-structured interviews over a two-year period about their mobility, social participation and ageing process. The participants were powered wheelchair users, at least 50 years of age, recruited in Vancouver, Montreal and Quebec City (Canada). We identified three themes that highlighted how the powered wheelchair experience was integrated into the life continuum of the users. ‘It's my legs’ emphasised how powered wheelchairs are a form of mobility that not only enables users to take part in activities, but also impacts their identities, past and present. ‘Wheels of change’ explored the dynamic nature of powered wheelchair use and changes related to ageing. ‘Getting around’ illustrated how users’ mobility was affected by the interaction with their physical and social environments. Developing public policies to advance social and environmental changes could help countries to ensure equity of access and social inclusion of those ageing with disabilities.
During the past three decades worldwide dairy policies have been implemented to promote the consumption of milk and milk products in urban areas and the production from rural areas close to big cities (Alderman et al., 1987). Bolivia and the city of Santa Cruz de la Sierra have been influenced by these worldwide directives and this current study examines the impact of policies on the demand and supply side of the sector, but with particular emphasis on smallholder milk producers and poor urban consumers. The current research is part of a multi-country study on the supply, demand and impact of dairy and other policies over a 10 to 15 year period (1985 to 2000) of the milk sectors of Santa Cruz, Bolivia; Nairobi, Kenya; and Kathmandu, Nepal.
Livestock make a significant contribution to the world's supply of protein and energy. They occupy dry and cold areas where crop farming is not possible, as well as integrating with crops in warmer, wetter zones. In developing countries they play a major part in household dynamics and family social status. This implies that they should be given serious consideration when agricultural research agendas are set and resources allocated. This paper examines some of the processes used for research priority setting and comments on the likely impact of these processes in setting research agendas for livestock. One case study is considered in detail, that of the Kenya Agricultural Research Institute (KARI).
Methods for prioritization of research range from the very informal, where priorities are determined by discussion in small expert groups, to the comparatively formal and quantitative estimation of economic surpluses. Between those extremes are a variety of methodologies for selecting and ranking research programmes and projects. In a liberalized economy, market forces will play a large part in determining the research agenda; in a centrally planned economy, the national research agenda will be determined by the government, although the trend is towards focusing on the needs of the end user. No one method can guarantee results, since effective research prioritization depends on accurate prediction of future demand. All methods have a degree of subjectivity and may be biased by the selection of stakeholders involved in the debate.
This paper proposes that more rigorous methodology will tend to make results more objective, more transparent and by introducing an explicit market orientation will facilitate the transition from central planning to competitive bidding, but users of any method should be aware of its limitations. The economic surplus method, possibly the most rigorous currently available for setting a national research agenda, is limited by thefact that it does not require measures of social or environmental impact, and to include these requires an additional weighting process. Any trend towards methodological rigour, whether quantitative or qualitative, has costs in terms of data gathering, time and the necessary training to carry out the analyses.
KARI has over the last 10 years moved through the full spectrum of priority-setting methods from informal to formal. It is at present engaged in setting priorities for the next 5-year span, using an economic surplus approach. Some of its experiences and lessons are described in this paper, with particular reference to livestock programmes. The authors conclude that a systematic process of setting research agendas will, on the whole, be favourable to livestock. There has in some cases been a tendency to exclude them because they are harder to work with than annual crops, research can be more costly, their value is harder to estimate and benefits take longer to accrue. A rigorous process of’ estimating benefits from research, with a reasonably long time horizon, should provide a realistic assessment of the value of livestock to an economy and is likely to encourage investment in livestock research.
The paper presents the main findings of a set of comparative milk sector surveys carried out in Kathmandu (Nepal), Nairobi (Kenya) and Santa Cruz (Bolivia). The surveys assessed changes in demand, supply and marketing of milk and milk products over a ten to fifteen year period to 2001. The paper considers demand for milk and milk products, changes in milk supply and trading pathways, the policy frameworks, changes in demand and market share, and growth in the sector and poverty reduction. The policy implications for propoor development of the milk sector are discussed.
Despite policy and practice mandates for patient involvement, people with serious mental illness often feel marginalised in decisions about antipsychotic medication.
To examine stakeholder perspectives of barriers and facilitators to involving people with serious mental illness in antipsychotic prescribing decisions.
Systematic thematic synthesis.
Synthesis of 29 studies identified the following key influences on involvement: patient's capability, desire and expectation for involvement, organisational context, and the consultation setting and processes.
Optimal patient involvement in antipsychotic decisions demands that individual and contextual barriers are addressed. There was divergence in perceived barriers to involvement identified by patients and prescribers. For example, patients felt that lack of time in consultations was a barrier to involvement, something seldom raised by prescribers, who identified organisational barriers. Patients must understand their rights to involvement and the value of their expertise. Organisational initiatives should mandate prescriber responsibility to overcome barriers to involvement.
Gwenda Morgan, completed her PhD at John Hopkins University before teaching at universities on both sides of the Atlantic, principally the University of Sunderland.,
Peter Rushton, Professor of Historical Sociology at the University of Sunderland.
Sunderland was always about more than coal. Though the shipping of coal to the continent, London and the rest of the country dominated the economy of the River Wear, it was the development of other skills and the exploitation of other relationships that made that development possible. The argument here is that without the development of a distinctive local culture, above all in political organisation and exploiting contacts and patrons, both regionally and nationally, the economy at the mouth of the River Wear could not have developed so successfully between 1700 and 1800. It required a cohesive local business and landed class, participation in the political networks of County Durham and the region with regard to handling the problems of the coal trade and industrial disputes, and the passage through parliament of many enabling pieces of legislation. The integration of the place and its leaders into local and national politics was fundamental to the economic development of the river and port. The communities at the mouths of the Rivers Wear and Tyne, though growing rapidly between 1660 and 1800, did not form an incorporated town or parliamentary borough. Yet the course of the River Wear was deepened through the powers of the River Wear commissioners set up by an Act of Parliament in 1717, and many other improvements were made by the powers granted in subsequent legislation. The Wear became the other coal-exporting river along with the Tyne, vital to London's growing need for coal, and providing at least the possibility of competitive prices. Its national importance, however, could not be taken for granted, and it was the formation of personal and political links that made it possible.
The area widely known as ‘Sunderland’ was not a single place or, officially, a community, but rather, three parishes, one ancient ecclesiastical borough, one major industry (though with others competing for space and attention) and one river. There was no civic authority that encompassed all the people at the mouth of the river, nor a single form of representation to the county or the nation. The challenge is how to make sense of a town without formal civic government which was, nevertheless, able to operate effectively at all the levels of parish, river, region and nation.