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To assess and develop a consensus among a European panel of public health nutrition workforce stakeholders (academics and employers) regarding core functions required for effective public health nutrition practice.
A modified Delphi study involving data from two rounds of questionnaires administered among a panel of public health nutrition workforce stakeholders.
A panel of fifty-three public health nutrition development stakeholders, including thirty-three academics and twenty employers, sampled from eighteen European countries.
Panellists rated 50 % (19/38) of the initially listed functions as core (i.e. without which public health capacity is limited), using a majority cut-off (>50 %). Out of the nineteen core functions seven were categorised under the heading Intervention management, emphasising high agreement on the importance of managing interventions in public health nutrition work. Only one of the identified core public health nutrition functions was rated differently between academics and employers, suggesting consistent identification of core functions between stakeholder groups.
This consensus on core functions of the public health nutrition workforce in Europe can be used to promote a consistent understanding of the role and value of public health nutritionists as a discrete disciplinary sub-specialty of the public health workforce. The convergence of opinions of academics and employers, as well as comparison with previous international studies, indicates that there is a set of core public health nutrition functions transferable between countries that can be used as a benchmark to guide further development of the public health nutrition workforce in Europe.
This paper discusses the impact of the foundation of major cities in Mesopotamia in the early Islamic period (c. 636-900 CE) and their impact on the agricultural economy and rural settlement in the area. It considers the potential agricultural productivity of the area, the availability of river transport, the fiscal structure of the early Islamic state and the way in which it created demand for foodstuffs, and the development of the qaṭīca as a form of landholding which provided security of tenure and hence the encouragement of long-term investment in agricultural infrastructure.
The decline and fall of the Abbasid caliphate in the first half of the fourth/tenth century led to the emergence of a new political order. Many of the post-Abbasid regimes attempted to continue the old system and employ ghilman, with their salaries being paid out of the receipts of taxation. The Ghaznavids rulers followed the middle Abbasid practice of recruiting an army of Turkish ghilman and collecting taxes to pay them. Kurds had inhabited much of the area of the Zagros mountains and the uplands to the north of Mosul for many centuries before the coming of Islam. The Muslim world had come into being because lands from Central Asia to North Africa had been conquered by armies largely made up of Arab Bedouin tribesmen. The newly emerging Shiism was not formally the state religion of the Buyids. The new Sunnism was based on the ideas of the muhaddithun, first developed in the third/ninth centuries.
The ‘Islamic city’ has been an important focus of historical discussion for at least a century; scholars have drawn attention to the importance of cities in Islamic society, the vast size of certain cities in the medieval Muslim world and the importance of merchants, not only as generators of wealth but as religious leaders, intellectuals and exemplars of good and worthy citizens. All this is in implied contrast with the societies of north-west Europe, in which, it is argued, elite power was based in the countryside and the rural estate and where cities were comparatively small and merchants regarded with suspicion and contempt by the upper reaches of both secular and religious hierarchies.
The built environment of the Islamic city also appears to have certain definable characteristics. The most obvious of these was the apparent absence of formal planning, the narrow winding streets, the closed-off residential quarters. The main arteries of such a Muslim city were narrow and sometimes stepped because they were not designed for wheeled vehicles. Medieval Muslim society almost disinvented the wheel: it was the pack animal and the human porter that shifted goods, not the cart. This meant that there was no need for wide, well-engineered streets of the sort that Roman towns had required. The closed residential quarters were a result of the Muslim concern with the privacy and sanctity of domestic family life, which had to be protected from prying eyes.
The Muslim invasions of Iran and Turkistan in the seventh century have been discussed several times in the modern literature (Gibb 1923; Bartold 1968; Daniel 1979; Kennedy 2007). The purpose of this chapter is to attempt to penetrate beyond the political narrative to examine the impact of the Muslim conquest on the topography and social structure of the city. It will consider the geography of Muslim occupation and settlement, the reactions of the local people to the invaders and the impact of the coming of Islam on the topography and built environment of the city.
The course of the military campaigns by which the Arabs achieved control over Bukhara and the rest of Soghdia is fairly well established. Although the Muslims had raided Transoxania from their base at Merv as early as the governorate of Salim b. Ziyad (681–3), they made no permanent conquests until the time of Qutayba b. Muslim (705–15). The exact chronology of the conquest is not clear and it seems as if Qutayba made a number of expeditions to the Bukhara oasis. In 710, he arrived and installed the young Tughshada as Bukhara Khudah, lord of Bukhara, the title held by the kings of the local dynasty. Each time the Muslim armies came to the city, the people made peace and agreed to accept Islamic rule but when the Arab troops left in the winter they reverted to their old ways.
The northern Wanganui Basin, New Zealand, is one of the key global sites for understanding marine cyclic sedimentation during the Quaternary. This paper presents the first evidence of marine cyclic sedimentation from its central-southern parts. Sedimentological, micropalaeontological and palynological analyses on a 280-m-deep borehole encountered units dating back to MIS 10. The sequence includes four marine cycles spanning MIS 9–5, which are overlain by terrestrial fluvial aggradation surfaces dating from MIS 4–2. Each marine unit represents a progressively shallowing depositional environment from the mid-shelf to coastal plain. This is overlain by a terrestrial sequence of lowstand fluvial terraces. Localized fault movements appear to have influenced the sedimentary character of the sequence during MIS 7a and 5e producing basement highs which provided protection to the shoreline. The cyclothems described in this paper now extend the already extensive, previously described record from MIS 17–10 to produce a combined eustatic record of Quaternary sea level change within the basin to MIS 5. They also provide an excellent example of the sedimentary response of a coastal basin to a progressive loss of sedimentation accommodation space.
The mechanism of action of antidepressant drugs is not fully understood. Application of genomic methods enables the identification of biochemical pathways that are regulated by antidepressants, and this may provide novel clues to the molecular and cellular actions of these drugs. The present study examined gene expression profiles in the hippocampus of rats exposed to chronic antidepressant treatment.
Animals were treated for 12 days with the selective serotonin reuptake inhibitor paroxetine; then, hippocampal ribonucleic acid was recovered, and changes in gene expression were assessed by microarray analysis.
A total of 160 genes that showed differential expression after paroxetine exposure were identified. Using functional relevance and observed fold change as selection criteria, the expression changes in a subset of these genes were confirmed by quantitative polymerase chain reaction.
Of this subset, only two genes, cyclin D1 (Ccnd1) and hairy and enhancer of split 6 (Hes6), showed robust and consistent changes in expression. Both genes were downregulated by paroxetine, and both have been previously implicated in neurogenesis. Further investigation of these two genes may provide new insight into the mechanism of action of antidepressants.
Islam came face to face with Christianity from its beginnings. Christians and Jews were regarded as “People of the Book” because they had a revealed monotheistic religion. Even though they had corrupted this religion and turned away from the true path, they deserved a measure of respect and tolerance, unlike pagans with whom no coexistence was possible. Nevertheless, the new religion developed an ideology of confrontation with non-Muslims which almost inevitably led to conflict. The idea of holy war or jihād is developed in a number of suras of the Qur’ān but, as often in the Qur’ān, the message is not a simple and unequivocal one. The sacred text presents apparently conflicting advice to the faithful as to how they should confront the enemies of the new religion. There are a significant number of passages which advise nonviolent argument and preaching when dealing with the “People of the Book.” In contrast there are other passages in which the Muslims are exhorted to go and fight in the path of God, and those who do not are castigated for failing in their religious duties. These culminate in 9.5:
When the sacred months are past, kill the idolators wherever you find them and seize them, besiege them and lie in wait for them in every place of ambush: but if they repent, pray regularly and give the alms tax, then let them go their way, for God is forgiving, merciful.
Traditionally, Muslim scholars have reconciled the apparent contradiction by arguing that the quasi-pacifist exhortations are early revelation, from the time when the Muslims were few and they had to avoid confrontation to survive, while the more militant passages date from later when the Muslims were in a more powerful position and could challenge their enemies openly.
The impact of the plague on the society of the sixth-century Roman Empire remains a subject of controversy. At the heart of the debate lies the question of the size and extent of the mortality. Was it such that it resulted in a significant and lasting demographic decline, or have we been overly impressed by the lurid accounts in the literary sources and imagined a crisis that never really existed? Was this a pandemic on the scale of the Black Death and subsequent visitations? Finding a check on the literary sources is very difficult. Clearly, there are few if any documentary sources to help us out. The only possible moderator for the written accounts would seem to be the archaeological evidence.
In recent years, a number of commentators have pointed out that the archaeological evidence suggests that the literary accounts of mass mortality are greatly exaggerated or, perhaps, that they related to only one small locality and that such evidence should not be extrapolated to include the entire Mediterranean world, or even just the territories under the control of the eastern Roman Empire. Jean Durliat, for example, accuses us of privileging the written accounts and disregarding archaeological material. Discussing the modern literature on the plague, he argues, “All of these studies have in common their privileging of literary sources, and among these, descriptions of the epidemic, whereas specialists in other kinds of documents accord it [the plague] only minor importance. It is from this insufficiently underscored contradiction that indecisive and divergent interpretations stem.”
The first results of the Women's Health Initiative dietary intervention trial were published in the USA in February. This is a colossal intervention designed to see if diets lower in fat and higher in fruits, vegetables and grains than is usual in high-income countries reduce the incidence of breast cancer, colorectal cancer, heart disease and other chronic diseases, in women aged 50–79 years. As interpreted by US government media releases, the results were unimpressive. As interpreted by a global media blitz, the results indicate that food and nutrition has little or
nothing to do with health and disease. But the trial was in key respects not reaching its aims, was methodologically controversial, and in any case has not produced the reported null results. What should the public health nutrition profession do about such messes?
The frontiers of al-Andalus were free from major outside threats: to the north the Christian kingdoms and counties had been repeatedly raided and their armed forces worsted in battle, culminating in the humiliating sack of Santiago de Compostela in 999. The removal of the Fatimids from Tunisia to Egypt in 969 meant that there was no threat to al-Andalus from the Muslim east. With the collapse of the caliphate, al-Andalus broke up into a number of different states, each with its own court and capital. By 1083, the Almoravids had reached the Straits of Gibraltar and were in undisputed control of Morocco. By 1148, only Granada and the Balearic islands remained under Almoravid control: Granada fell to the Almohads in 1155, but the Balearic islands remained in the hands of the Almoravid Banu Ghaniya and the base for repeated raids on Almohad North Africa.
Objectives: Much has been written about the costs and cost-effectiveness of community care for people with learning disabilities resettled from long stay hospital care. However, comparatively little has been published about the cost of hospital services relating to the preparatory process before eventual resettlement and the disengagement of formal, sustained input from hospital staff. This study describes and costs the input provided by a hospital based multi-disciplinary team into the resettlement of adults with learning disabilities from long stay wards in Muckamore Abbey Hospital in Northern Ireland between 1996 and 1999 (n = 71).
Method: The study employs a retrospective survey design. Information about the nature and frequency of the input of each member of hospital multi-disciplinary team was collected for each former client. According to the level of professional resources expended during the resettlement process, each former client was then categorised into one of three categories. One case was then selected at random to represent each category. A summary of clinical information, a description of the resettlement process and an estimate of the cost of the process was provided for each case.
Results: Approximately 55% of people resettled in the community during the study period did so with a modest degree of input from hospital staff. For 18% resettlement proved to be a demanding and prolonged process, requiring intensive input from hospital staff. Financial costs of the resettlement process ranged from approximately stg£1,500 to stg£8,000, with an average of stg£3,400 for each person.
Conclusion: This study provides evidence of the input by hospital staff into the process of community resettlement of long stay hospital clients and the associated costs. These costs must be included in service budgets if quality care and appropriate service provision is to be maintained in resettlement practice.
The ‘collaborative’ method, developed by the US Institute of Health Improvement, has succeeded in motivating staff and responding to patients' concerns about acute in-patient psychiatric care across 37 trusts in the Northern, Yorkshire and Trent regions. The method puts into practice the new values underpinning government policies on ‘modernising’ and ‘shifting the balance of power’ in the NHS, i.e. seeing things through the eyes of patients, empowerment of frontline staff, learning networks and focus on measured outcomes. The evaluation suggests that organisational and management culture crucially determined the level of achievement of the trusts taking part in the collaborative. Evaluations of other collaboratives have raised doubts about the sustainability of the improvements achieved. It is argued that refining the collaborative method is less important than incorporating its principles into the existing management and organisational cultures of NHS trusts, and the leadership styles of chief executives and clinical directors.