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Contemporary monetary institutions are flawed at a foundational level. The reigning paradigm in monetary policy holds up constrained discretion as the preferred operating framework for central banks. But no matter how smart or well-intentioned are central bankers, discretionary policy contains information and incentive problems that make macroeconomic stability systematically unlikely. Furthermore, central bank discretion implicitly violates the basic jurisprudential norms of liberal democracy. Drawing on a wide body of scholarship, this volume presents a novel argument in favor of embedding monetary institutions into a rule of law framework. The authors argue for general, predictable rules to provide a sturdier foundation for economic growth and prosperity. A rule of law approach to monetary policy would remedy the flaws that resulted in misguided monetary responses to the 2007-8 financial crisis and the COVID-19 pandemic. Understanding the case for true monetary rules is the first step toward creating more stable monetary institutions.
Rapid spread of coronavirus disease 2019 (COVID-19) has affected people with intellectual disability disproportionately. Existing data does not provide enough information to understand factors associated with increased deaths in those with intellectual disability. Establishing who is at high risk is important in developing prevention strategies, given risk factors or comorbidities in people with intellectual disability may be different to those in the general population.
To identify comorbidities, demographic and clinical factors of those individuals with intellectual disability who have died from COVID-19.
An observational descriptive case series looking at deaths because of COVID-19 in people with intellectual disability was conducted. Along with established risk factors observed in the general population, possible specific risk factors and comorbidities in people with intellectual disability for deaths related to COVID-19 were examined. Comparisons between mild and moderate-to-profound intellectual disability subcohorts were undertaken.
Data on 66 deaths in individuals with intellectual disability were analysed. This group was younger (mean age 64 years) compared with the age of death in the general population because of COVID-19. High rates of moderate-to-profound intellectual disability (n = 43), epilepsy (n = 29), mental illness (n = 29), dysphagia (n = 23), Down syndrome (n = 20) and dementia (n = 15) were observed.
This is the first study exploring associations between possible risk factors and comorbidities found in COVID-19 deaths in people with intellectual disability. Our data provides insight into possible factors for deaths in people with intellectual disability. Some of the factors varied between the mild and moderate-to-profound intellectual disability groups. This highlights an urgent need for further systemic inquiry and study of the possible cumulative impact of these factors and comorbidities given the possibility of COVID-19 resurgence.
Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
Clinicians are consistently presented with the arduous task of characterizing, identifying, classifying, and evaluating response-to-intervention when treating or examining a broad array of patient populations. The primary aim of this chapter is to outline and define wellness among patients living with chronic medical conditions (PLW-CMC). An operational definition of a chronic medical condition is one requiring ongoing management and treatment over extended periods of time, often comprised of a broad constellation of conditions including heart disease, stroke, cancer, chronic respiratory diseases, infectious diseases, metabolic/endocrine disorders, genetic disorders, and disorders resulting in disability/impairment . The number of persons living with one or more chronic medical conditions continues to increase, both nationally and internationally. Thus, the need for literature pertaining to interventions that optimize a patient's quality of life (QOL) is pertinent, as health status is known to be associated with an individual's perception or appraisal of wellness, life satisfaction, happiness, and overall well-being.
Efforts to address the major health, environmental, and social threats that can be found across the globe rely on changes in human behavior. Yet identifying effective and efficient ways to change behavior remains a vexing challenge. To meet this need, investigators need to design and evaluate behavioral intervention strategies in a manner that affords the creation of evidence-based guidelines that specify not only whether interventions work but also how and under what conditions. In this chapter, the design and testing of interventions are situated within the experimental medicine approach. This approach leverages the strength of the experimental method to test how behavior change intervention strategies work and to identify the conditions under which they operate effectively. Moreover, it organizes how investigators specify the questions that underlie the study of behavior change interventions and requires them to articulate precisely what intervention strategy they are using, how they think the strategy operates, and the outcomes it generates. Through the systematic use of this approach, evidence will emerge that addresses practitioners’ prevailing concerns directly – what intervention strategy is the most effective and efficient way to address the problem at hand. This chapter provides an overview of how to implement the experimental medicine approach, describes its key features, and addresses the importance of precision and, finally, considers this approach within a broader set of initiatives that have emerged to support a programmatic approach to the design, evaluation, and implementation of behavior change interventions.
A key feature of British rule in India was the formation of a class of elite metropolitan lawyers who had an outsized role within the legal profession and a prominent position in Indian politics. This paper analyzes the response of these legal elites to the shifting social and political terrain of post-colonial India, arguing that the advent of the Indian nation-state shaped the discursive strategies of elite lawyers in two crucial ways. First, in response to the slipping grasp of lawyers on Indian political life and increasing competition from developmentalist economics, the elite bar turned their attention towards the consolidation of a national professional identity, imagining an ‘Indian advocate’ as such, whose loyalty would ultimately lie with the nation-state. Second, the creation of the Supreme Court of India, the enactment of the Constitution of India, and the continuous swelling of the post-colonial regulatory welfare state partially reoriented the legal elite towards public law, particularly towards the burgeoning field of administrative law.
We completely describe the algebraic part of the rational cohomology of the Torelli groups of the manifolds
relative to a disc in a stable range, for
. Our calculation is also valid for
assuming that the rational cohomology groups of these Torelli groups are finite-dimensional in a stable range.
The risk of endocarditis varies with CHD complexity and the presence of prosthetic valves. The purpose of the study was therefore to describe incidence and outcomes of prosthetic valve endocarditis in adults with repair tetralogy of Fallot.
Retrospective review of adult tetralogy of Fallot patients who underwent prosthetic valve implantation, 1990–2017. We defined prosthetic valve endocarditis-related complications as prosthetic valve dysfunction, perivalvular extension of infection such abscess/aneurysm/fistula, heart block, pulmonary/systemic embolic events, recurrent endocarditis, and death due to sepsis.
A total of 338 patients (age: 37 ± 15 years) received 352 prosthetic valves (pulmonary [n = 308, 88%], tricuspid [n = 13, 4%], mitral [n = 9, 3%], and aortic position [n = 22, 6%]). The annual incidence of prosthetic valve endocarditis was 0.4%. There were 12 prosthetic valve endocarditis-related complications in six patients, and these complications were prosthetic valve dysfunction (n = 4), systemic/pulmonary embolic events (n = 2), heart block (n = 1), aortic root abscess (n = 1), recurrent endocarditis (n = 2), and death due to sepsis (n = 1). Three (50%) patients required surgery at 2 days, 6 weeks, and 23 weeks from the time of prosthetic valve endocarditis diagnosis. Altogether three of the six (50%) patients died, and one of these deaths was due to sepsis.
The incidence, complication rate, and outcomes of prosthetic valve endocarditis in tetralogy of Fallot patients underscore some of the risks of having a prosthetic valve. It is important to educate the patients on the need for early presentation if they develop systemic symptoms, have a high index of suspicion for prosthetic valve endocarditis, and adopt a multi-disciplinary care approach in this high-risk population.
Public health is defined by the UK’s Faculty of Public Health as ‘The science and art of promoting and protecting health and well being, preventing ill health and prolonging life through the organised efforts of society’.
This definition locates the causes of ill health and the remedies in the realms of personal and societal agency, and not only in the remit of health practitioners. Although the latter have a role as members of society to make prevention a reality for themselves, families and communities, they play a special part in preventing further ill health for people who suffer mental illness and are seeking help for it.
Other chapters in this book attend to the relational and social fabric that enables people to flourish; it is made of good and trusting relationships, and material conditions that permit thought about purpose and meaning beyond survival.
This chapter pulls together key matters in this book. Its title is a quote from a line given to one of the characters in Hamlet by Shakespeare. That sentence perfectly outlines the intention of Section 5 of this book and the function of this final chapter in which I endeavour to align theory, research and the practical impacts of the topics covered by this book with the circumstances in which we find health services as we near the close of the second decade of the twenty-first century. But, first, I return to Chapter 1, to recapture some of those circumstances. Then, I look at the matters on which I think we should focus in order to sustain healthcare services and incorporate the social agenda identified in this book.
This book’s roots are in an impactful seminar series hosted by the Royal College of Psychiatrists in which practitioners and scientists from a wide array of disciplines came together in 2014 to explore the social influences on our health and recovery from ill health. This volume echoes the evocative conversations in that College and is intended to rehearse research of potentially great impact. It presents practitioners, researchers, policymakers and students of a wide array of disciplines and roles with the material to support them in better harnessing what we now know about the impact of social factors on health. Thereby, the editors hope to influence how practitioners and the responsible authorities work together with members of the public and communities to design and deliver services. Our aspiration is to contribute to creating better-targeted approaches to promoting health and mental health and more effective and integrated interventions for people who have health problems or disorders.
This chapter rounds off Section 2. In it, one of the authors, Jonathan Montgomery, begins by highlighting his view of the recurrent themes that arise from all eight chapters in this section.
Then, one of the editors, Alex Haslam, responds by substantially agreeing with Jonathan Montgomery. However, Haslam takes the opportunity to clarify one of the points that Montgomery makes with the intention of drawing attention to a key issue that runs like an artery through the body of this book. This concerns the nature of personalised healthcare and how this should best be understood and delivered. Haslam cautions that, in the process of developing personalised care, we should avoid the temptation to reduce peoples’ maladies to their individual conditions.
This chapter does two things. First, it shows how social identity principles can explain the basic psychological and behavioural effects of crowd membership. Second, it describes some recent research and applied work that shows how these basic effects operate to contribute to harmonious outcomes in potentially dangerous crowd events.
We begin by explaining some of the fundamental psychology of crowd membership in the next section.
The purpose of this chapter is to serve as a bridge between the chapters in the previous three sections and those in this fourth section. Thus far, we have sought to analyse the social bases of mental and physical wellbeing. Now, we turn to the question of how the fruits of these analyses can be applied in practice. That is, we have been reporting and interpreting the way the world impacts individual people for long enough; it is time to consider how we might change the world in order to improve our wellbeing.
Using current societal dilemmas, this book explores how social factors and social identity influence our health and recovery from illness. It includes recent research to present practitioners, researchers, policymakers and students of many disciplines with the material to support them in better harnessing current knowledge of the impact of social factors on health. The contents will influence collaborative working across policy, disciplinary and practice boundaries to design and deliver healthcare services. The book identifies the importance of social connectedness, social support, agency and self and group efficacy in people's health, longevity and resilience after adversity. Core perspectives include the social identity approach and a values framework for taking public health ethics into decision-making, both of which emphasise valuing people and co-productive relationships. Advocating better targeted mental health promotion and integrated interventions, this book strongly argues for a greater emphasis on social factors in evidence-based and cost-effective practice.