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Placements within high secure forensic hospitals consist of wards providing various different levels of relational security. They should form a coherent pathway through secure care, based on individual patient risks and needs. Moves to less secure wards within high secure forensic hospitals and moves on to lower secure hospital settings have rarely been systematically studied.
The aim of this study was to ascertain if placements within Broadmoor High Secure Hospital and moves from Broadmoor to medium secure hospitals corresponded to measures of violence risk, programme completion and recovery.
A 13-month prospective cohort study was completed. Patients (n = 142) were rated at baseline for violence risk (Historical, Clinical and Risk – 20), therapeutic programme completion and recovery (DUNDRUM tool) and overall functioning (Global Assessment of Functioning). Placements on the care pathway and moves on to medium secure hospitals were observed.
Placements on the care pathway within the high secure hospital were associated with dynamic violence risk (F = 16.324, P<0.001), therapeutic programme completion (F = 4.167, P = 0.003), recovery (F = 2.440, P = 0.050) with better scores on these measures being found in the rehabilitation wards and the poorest scores on the highest levels of dependency. Moves to medium secure hospitals were associated with better scores on dynamic risk of violence (F = 33.199, P<0.001), therapeutic programme completion (F = 9.237 P<0.001), recovery (F = 6.863, P = 0.001).
Placements within Broadmoor Hospital formed a coherent pathway through high secure care. Moves to less secure places were influenced by more than reduction in violence risk. Therapeutic programme completion and recovery in a broad sense were also important.
The COVID-19 pandemic is exerting major pressures on society, health and social care services and science. Understanding the progression and current impact of the pandemic is fundamental to planning, management and mitigation of future impact on the population. Surveillance is the core function of any public health system, and a multi-component surveillance system for COVID-19 is essential to understand the burden across the different strata of any health system and the population. Many countries and public health bodies utilise ‘syndromic surveillance’ (using real-time, often non-specific symptom/preliminary diagnosis information collected during routine healthcare provision) to supplement public health surveillance programmes. The current COVID-19 pandemic has revealed a series of unprecedented challenges to syndromic surveillance including: the impact of media reporting during early stages of the pandemic; changes in healthcare-seeking behaviour resulting from government guidance on social distancing and accessing healthcare services; and changes in clinical coding and patient management systems. These have impacted on the presentation of syndromic outputs, with changes in denominators creating challenges for the interpretation of surveillance data. Monitoring changes in healthcare utilisation is key to interpreting COVID-19 surveillance data, which can then be used to better understand the impact of the pandemic on the population. Syndromic surveillance systems have had to adapt to encompass these changes, whilst also innovating by taking opportunities to work with data providers to establish new data feeds and develop new COVID-19 indicators. These developments are supporting the current public health response to COVID-19, and will also be instrumental in the continued and future fight against the disease.
The development of user-friendly nutrition resources for pregnant women seldom involves end-users. This qualitative study used a citizens’ jury approach to determine if our modification of a longstanding, frequently used dietitian-informed diet and diabetes booklet was deemed to be a good healthy eating resource for pregnant women.
Midwives recruited thirteen first-time pregnant women not requiring specialist obstetric care or specialist dietetic advice for any reason. Participants were sent a copy of the modified healthy eating in pregnancy booklet prior to ‘jury day’. Five women were unable to attend the citizens’ jury citing reasons such as early labour. At the jury, five experts presented evidence. Participants adjourned, with an independent facilitator, to ‘deliberate’ as to whether the resource was suitable or not. The verdict was presented, and subsequent discussion was audio-recorded, transcribed and inductively content analysed.
Southland, New Zealand.
Pregnant women aged 19–35 years (n 8), of whom half had a household income <$NZ30 000.
The verdict was ‘Yes’; the resource was good. Three themes were derived: communication of health information, resource content and harm reduction in pregnancy. Based on these data, ways to enhance the quality and usability of the booklet were evident.
Citizens’ juries can be used to obtain an independent assessment by end-users of health resources. Our modified diet and diabetes booklet was considered suitable for providing healthy eating advice to pregnant women. Inclusion of end-users’ perspectives is critical for end-user relevant content, comprehension and resource credibility.
Successful attainment of SDG17 is essential for implementing the other 16 SDGs, all of which depend upon secure means of implementation and durable partnerships. Funding for forests from ODA and other sources has trended upwards since 2000, providing reason for cautious optimism. However, REDD+ finance is declining. Private sector investment remains important. The idea of impact investment, which aims to solve pressing environmental and social problems while providing a return for investors, could make a significant contribution to the SDGs. However, not all sustainable development finance promotes forest conservation. Increasing funding for agricultural production often incentivises the conversion of forests to agricultural land while generating deforestation. The policy of zero net deforestation (ZND) is leading to the creation of partnerships to promote deforestation-free commodity supply chains for four forest risk commodities (palm oil, soy, beef and timber). Some innovative partnerships have been created to promote sustainable development involving intergovernmental organisations, the private sector, research institutes, NGOs and grass roots organisations. However, such partnerships exist within a neoliberal global economic order in which there are net financial flows from the Global South to the Global North that negate financial flows for sustainable development.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
In 2009 Mark Ormrod, Gwilym Dodd and Anthony Musson broke new ground in the study of supplications in the Middle Ages with their edited volume Medieval Petitions: Grace and Grievance. Inspired by the completion of an AHRC-funded project to catalogue, digitise and study the SC 8 series of ‘Ancient Petitions’ preserved in The National Archives at Kew, Medieval Petitions tapped a rich vein of scholarship on supplications in medieval England and at the papal curia and helped to open up a field of study that has continued to flourish in the following decade. Broadly, there exist two strong traditions of research on petitions to the English crown, on the one hand, and ecclesiastical, specifically papal, petitions, on the other. Since 2009 a number of works have pushed the field in new directions. New research on petitions to the crown has illuminated aspects of petitioning such as supplications for royal pardon, women's petitions, multiple-clause petitions, petitions of complaint, the language of petitioning and the drafting process, as well as more general aspects of the processes and mechanisms of petitioning. These interpretative studies have also been supplemented by the publication of new documents in the form of the early common petitions presented to the English parliament. In the separate scholarly tradition on ecclesiastical supplications, new work has explored petitions regarding marriage, petitions for papal trade licences, the impact of petitioning on papal crusade diplomacy, the roles of proctors and more general aspects of petitioning. A particularly fruitful avenue of research explores supplications to the papal penitentiary, which is illuminating many new aspects of medieval life and the Church. The publication of new documents has also expanded the source base for this strand in the form of late medieval petitions to the penitentiary, as well as papal supplications from the University of Paris.
Despite common themes and the rich comparative possibilities, however, these two scholarly traditions have often remained separate, primarily because the Church and the crown had their own discrete – and extremely complex – systems of petitioning. Recently, however, a number of scholars have pioneered approaches that traverse the boundaries in the attempt to combine the two strands. Through her work on the fourteenth-century Roman Rolls in The National Archives, Barbara Bombi is pointing the way in the study of the interface between royal and papal supplicatory systems.