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This article by Ian Hunter, which has been adapted from his BIALL Conference presentation at the Belfast Europa Hotel, examines increasing the visibility of law firm library and information services in terms of what should be done and what should not be done. Or, as Ian puts it: “Is saying yes to everything really the right thing to do?”
Financing work is an important source of revenue for many law firms, so it's no surprise that the finance practice group is often one of the largest in a City firm. But what is finance and what do finance lawyers do? Ian Hunter, Content & Research Manager (EMEA) at Shearman & Sterling (London) LLP, gives LIM the benefit of his wide experience in the sector.
Peer support interventions for dietary change may offer cost-effective alternatives to interventions led by health professionals. This process evaluation of a trial to encourage the adoption and maintenance of a Mediterranean diet in a Northern European population at high CVD risk (TEAM-MED) aimed to investigate the feasibility of implementing a group-based peer support intervention for dietary change, positive elements of the intervention and aspects that could be improved. Data on training and support for the peer supporters; intervention fidelity and acceptability; acceptability of data collection processes for the trial and reasons for withdrawal from the trial were considered. Data were collected from observations, questionnaires and interviews, with both peer supporters and trial participants. Peer supporters were recruited and trained to result in successful implementation of the intervention; all intended sessions were run, with the majority of elements included. Peer supporters were complimentary of the training, and positive comments from participants centred around the peer supporters, the intervention materials and the supportive nature of the group sessions. Attendance at the group sessions, however, waned over the intervention, with suggested effects on intervention engagement, enthusiasm and group cohesion. Reduced attendance was reportedly a result of meeting (in)frequency and organisational concerns, but increased social activities and group-based activities may also increase engagement, group cohesion and attendance. The peer support intervention was successfully implemented and tested, but improvements can be suggested and may enhance the successful nature of these types of interventions. Some consideration of personal preferences may also improve outcomes.
In the same intellectual league as Grotius, Hobbes and Locke, but today less well known, Samuel Pufendorf was an early modern master of political, juridical, historical and theological thought. Trained in an erudite humanism, he brought his copious command of ancient and modern literature to bear on precisely honed arguments designed to engage directly with contemporary political and religious problems. Through his fundamental reconstruction of the discipline of natural law, Pufendorf offered a new rationale for the sovereign territorial state, providing it with non-religious foundations in order to fit it for governance of multi-religious societies and to protect his own Protestant faith. He also drew on his humanist learning to write important political histories, a significant lay theology, and vivid polemics against his many opponents. This volume makes the full scope of his thought and writing accessible to English readers for the first time.
Pufendorf was a political humanist, that is, an intellectual who engaged with political and religious thought through an erudite philological and analytical scrutiny of classical and modern texts in these fields. Born into a Saxon Lutheran clerical household in the middle of the Thirty Years’ War, he had first-hand experience of religious and political conflict during his childhood. His mastery of Latinate humanistic erudition was formed through his rhetorical education at the Grimma grammar school and then through his studies in history, philology and politics at the University of Leipzig. Pufendorf used his humanistic erudition as a key resource in his fundamental reconstruction of the discipline of natural law in his Law of Nature and Nations of 1672. In this work he sought to provide a model of political authority suited to governing divided religious communities, in part to defend the Protestant religion against the threat of political Catholicism, but primarily to achieve peaceful co-existence among different religions under the umbrella of a secular sovereign state. His work as an historian and political adviser to the Swedish and Brandenburg courts reflects the engaged nature of his humanistic learning.
Pacts or “social contracts” form the basis of sovereignty in many early modern theories of political authority, and in Pufendorf’s too. Most such theories treat the pact as the means by which a pre-existing right—for example, divine right, or the natural right of individuals grounded in their strength, reason, or property—is transferred to a sovereign on the condition that the right be protected, to be rescinded if it is not. For Pufendorf, however, there is no pre-existing right since the sovereignty pact creates a new right—the right to issue unchallengeable commands for the purposes of achieving social peace—by instituting two new moral personae: the citizen who obeys the sovereign in exchange for protection, and the sovereign invested with the right of absolute command to provide social peace. Since Pufendorf’s sovereignty is constituted not by a prior moral right, but rather by the capacity to exercise unchallengeable authority for the end of social peace, there is no naturally rightful form of government. Pufendorf thus takes a neutral and pluralistic view of the three traditional forms of government—monarchical, aristocratic and democratic—insofar as each is capable of exercising the capacity for sovereign rule.
In providing a new foundation for natural law and thence political authority, Pufendorf engaged in a major and explicit reconstruction of the discipline. Scholastic natural law derived the law of nature from a prior nature held to contain norms for moral and civil conduct; for example, from a divine nature whose will imprinted the human will, or a rational nature that was supposed to guide the will, or from humanity’s supposedly sociable nature as the source of the key norm of sociality. Pufendorf’s radical intervention into this field lay in his declaration that since it had been “imposed” or instituted as a “moral entity” by God for unaccountable reasons, human nature was not itself normative, rationally or socially. Rather, as a set of given conducts and predispositions—seen most clearly humanity’s paradoxical need for co-operation in order to survive and its ineradicable proclivity to envy, malice and mutual predation—human nature supplied only the observable basis from which it was possible to deduce the natural law: that man should cultivate sociality as a disposition needed for security and social thriving. This formed the basis for political sovereignty as the unchallengeable deployment of civil power required to obtain social peace and security.
Reforming Healthcare: What's the Evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics.
Project ECHO is a virtual, case-based capacity-building education program for healthcare providers. It was developed in New Mexico, USA but, due to its effectiveness, the model has now spread to 40 countries around the globe. Baycrest, the Canadian Coalition for Seniors’ Mental Health and the Canadian Academy of Geriatric Psychiatry collaborated to launch a national ECHO for mental health and aging. This partnership, coordinated by a cross-Canadian Steering Group, allows for broad reach, including registration of learning partners from almost all Canadian provinces and territories. The program was funded by the RBC Foundation.
Methods
ECHO COE: Mental Health pilot consisted of 2 cycles:
6 weekly sessions focused on broader mental health topics (e.g., delirium, mood disorders)
10 weeks with more specific topics (e.g., substance use disorders, sleep disorders)
Needs assessments of healthcare providers and older adults informed the program curricula. Evaluation included weekly satisfaction surveys, and pre and post evaluations.
Results
Participants:
154 healthcare providers participated in the 6-week session
39% of registrants were nurses or nurse practitioners, 35% allied health professionals, 14% physicians and 12% others
9 out of 10 provinces, 1 territory represented
Preliminary findings (based on the first 6 sessions):
High overall satisfaction (average of 4.5 out of 5).
99% would recommend the program to others
67% had already shared information with team members and colleagues.
Conclusion
A national ECHO program is an effective way to bring together clinicians who work with and are interested in the mental health and wellbeing of older adults for education sessions, collaborative and mutual learning as well as for cross-jurisdictional knowledge transfer. Collaborative, cross-professional learning supports the exchange of best practice in mental health for older adults, supports the development of collegial national professional support and can address health system inequities. An international ECHO through IPA would be an exciting and valuable next step.
Adhering to a Mediterranean diet (MD) is associated with reduced CVD risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet was a 12-month pilot parallel group RCT involving individuals aged ≥ 40 year, with low MD adherence, who were overweight, and had an estimated CVD risk ≥ 20 % over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64 %) were eligible. After 12 months, there was a retention rate of 69 % (peer support group 59 %; DSG 88 %; MSG 63 %). For all participants, increases in MDS were observed over 12 months (P < 0·001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards an MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.
Current discussions of the early Jewish reception of Kantian philosophy are dominated by two major approaches. According to the first, this reception was governed by a universal Enlightenment rationalism that was present in Judaism no less than in Kantian philosophy. According to the second, it was the fact that Kantianism contained a latent Judaic kabbalistic philosophy that made it attractive to Jewish intellectuals. This paper departs from both approaches by showing that when Jewish intellectuals encountered Kantianism they found neither a universal rationality to which Judaism should conform, nor an esoteric Jewish metaphysics to which Kantian philosophy had already conformed, but something else entirely, namely a hostile philosophical religion that sought to reconstruct Judaism in its own image. As a result of the historical context in which this challenge arose, some Jewish intellectuals accepted this reconstruction as a rational reform, while others repudiated it as a Christian-rationalist assault on Jewish law and tradition. Characterized first by the absence of a defensive Jewish Schulmetaphysik that might combat Kantianism on its own grounds, and second by the preparedness of enlightened intellectuals to extort Jewish acceptance of Christian rationalism by withholding citizenship rights, this context made Kantian philosophy into an offer that was difficult for Jewish intellectuals to refuse, or accept.
In this article Ian Hunter considers his experiences, learning points and recommendations on running an international law firm research service from home for 6 months, after being sent home at one hour's notice. In the article he considers working from home, including the psychological benefits of having a ‘journey’ to work, providing a research service and a library service, managing a team and the use of communications technology.
Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs).
Aims
We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276).
Method
We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective.
Results
Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI −0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI −603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold.
Conclusions
There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.