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The intention of this paper is to develop the personal concept of appropriate access. We report on the service access experiences and opportunities of adults with an acquired brain injury after leaving inpatient rehabilitation. The benefits of appropriate access underpin standards in early and long-term recovery, though users’ access needs are highly personal.
The study used a qualitative design involving 16 semi-structured interviews with Australian adults with an acquired brain injury after discharge from inpatient brain rehabilitation. Data were thematically analysed.
Three main themes were derived from the analysis. Theme 1 shows that participants valued being steered to services that providers thought appropriate for them early after discharge from inpatient rehabilitation. Theme 2 highlights the tensions between timing and personal recovery and perceived needs. Theme 3 captures participants’ insights into the challenges of gaining access vis-a-vis what the system offers and the enablers of actualising appropriate access.
The positive experiences of being directed to specialist services early after discharge suggest that continuity of care constitutes appropriateness of access for participants in this study. However, it is also clear that continuity should not displace flexibility in the timing of services, to accord with individuals’ perceived needs. This, in addition to enablement of access opportunities, through funding and transport, are important in maintaining a personalised approach.
Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking. The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40–65 years). Accuracy and precision of EI were assessed using correlation and Bland–Altman analysis. Test–retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11–88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC). Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement −73 % to +68 %) in the first recall, 22 % (−61 % to +41 %) for average of first two, and 25 % (−60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries. Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.
To determine accessibility of the primary healthcare system for patients with stroke recently discharged from hospital.
This project mapped retrospective patient location data and the location of primary healthcare services in the same region. Patient location data were from all patients with stroke (N = 1595: January 2011–January 2017) discharged from one metropolitan hospital to the local Primary Health Network. Geographic Information System technology was used to map the patient discharge locations and the spatial distribution of primary healthcare services (general practitioner, pharmacy, allied health) across the region. Road network data were used to measure the level of access from each patient’s discharge location to the services.
Access to primary healthcare services was variable. Areas with larger proportions of patients with stroke did not necessarily have good service access. With an increase in travel time, the number of services accessible to patients also increased. However, the spatial variation of access to services remained largely unchanged.
Access to primary healthcare services for patients with stroke varies spatially, with a trend towards relatively low levels of accessibility for many patients. There is an urgent need for future planning to consider geographical access to primary healthcare services for patients with stroke.
This article is an output of a major research project examining the notion of imminence in the law on international protection. It is the first piece of scholarship to identify an emerging trend, namely the introduction of imminence—whether invoked implicitly or explicitly—as a potential barrier to refugee status or complementary protection. The article analyses the jurisprudence of relevant international bodies and courts and critiques the validity of this notion as a tool for assessing States’ protection obligations.
This paper discusses issues arising from a study of referral from acute care following traumatic brain injury (TBI) in Queensland, in which aged care facilities were relied upon for the discharge of those with slow recovery after severe TBI. The discussion considers: (1) recovery following severe TBI; (2) the current policy context; (3) approaches to care beyond acute care; and (4) implications for policy and practice. In the current health care environment, with increasing pressure on scarce resources, it is critical that practitioners advocate for the dignity and care of people who sustain severe TBI and who are slow to recover.
Integral field unit spectrographs allow the 2D exploration of the kinematics and stellar populations of galaxies, although they are generally restricted to small fields-of-view. Using the large field-of-view of the DEIMOS multislit spectrograph on Keck and our Stellar Kinematics using Multiple Slits technique, we are able to extract sky-subtracted stellar light spectra to large galactocentric radii. Here, we present a new DEIMOS mask design named SuperSKiMS that explores large spatial scales without sacrificing high spatial sampling. We simulate a set of observations with such a mask design on the nearby galaxy NGC 1023, measuring stellar kinematics and metallicities out to where the galaxy surface brightness is orders of magnitude fainter than the sky. With this technique we also reproduce the results from literature integral field spectroscopy in the innermost galaxy regions. In particular, we use the simulated NGC 1023 kinematics to model its total mass distribution to large radii, obtaining comparable results with those from published integral field unit observation. Finally, from new spectra of NGC 1023, we obtain stellar 2D kinematics and metallicity distributions that show good agreement with integral field spectroscopy results in the overlapping regions. In particular, we do not find a significant offset between our Stellar Kinematics using Multiple Slits and the ATLAS3D stellar velocity dispersion at the same spatial locations.
To review the deaths of children and young people who took their own life. We conducted a retrospective analysis of serious incident reports from a National Health Service trust and reviews by the child death overview panels of the local safeguarding children boards.
We identified 23 deaths, with annual rates varying considerably between local authorities and over time. Over half of the children (n = 13, 56%) were not known to specialist child and adolescent mental health services, with 11 having no contact with any agency at the time of their death. Hanging was the most common method (n = 20, 87%) and of these, half (n =11, 55%) were low-level hangings.
Training is required to improve awareness, recognition and the assessment of children at risk of taking their own life. Specialist child mental health services should directly assess plans or attempts at hanging and offer advice about the seriousness of attempting this. National data (by age) on children and young people who take their own life should be routinely published to inform clinical and preventive services.
Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment.
Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases.
Intercepts were collected at 192 corner stores in Philadelphia, PA, USA.
Participants were adult, adolescent and child corner store shoppers.
Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2·2 (sd 2·1) items (1·3 (sd 2·0) foods and 0·9 (sd 0·9) beverages) that cost $US 2·74 (sd $US 3·52) and contained 2786·5 (sd 4454·2) kJ (666·0 (sd 1064·6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65·9 % of intercepts and accounted for 39·2 % of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66·2 g of sugar, 921·1 mg of sodium and 2·5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy.
Urban corner store shoppers spent almost $US 3·00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.
Only a person outside her own state can qualify as a Convention refugee. The alienage requirement of the definition – limiting status to an at-risk person who is “outside” her own country – derives from the limited aim of the Refugee Convention to deal “only with the problem of legal protection and status.” The treaty was conceived not to relieve the suffering of all forced migrants, but rather to assist a subset comprised of persons who were “outside their own countries [and] who lacked the protection of a Government.” The intent was to provide this group of enforced expatriates with legal status and protection to offset the disabilities of presence outside their own country until they could acquire new or renewed national protection. Internally displaced persons, while objects of humanitarian concern, were thought to raise “separate problems of a different character,” since such persons did not suffer from the legal disabilities of enforced alienage.
The drafters’ focus on enfranchising persons forced abroad also reflected a candid appraisal that the broader problem of persons dislocated within their own countries would demand a more sustained commitment of resources than was then available to the international community. Indeed, there was concern that the inclusion of internally displaced persons in the international protection regime might prompt states to shift responsibility for the well-being of large parts of their own population to the world community. The obligations of states under the Convention would thereby be increased, inclining fewer states to participate in the treaty regime.
This chapter takes up the provisions of the Convention that deem some persons who face the real chance of being persecuted nonetheless to be undeserving of international protection. Inspired by the prohibition in the Universal Declaration of Human Rights on the granting of asylum “in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations” and following the precedent of the Constitution of the International Refugee Organization, persons seeking to evade legitimate prosecution or punishment for serious domestic crimes, those who have committed serious international crimes, and anyone who is guilty of actions contrary to the principles and purposes of the UN must be denied refugee status.
The decision to exclude these three limited categories of persons from refugee status – even assuming they face the real chance of being persecuted – followed in part from concern to ensure that serious criminals not be able to evade prosecution and punishment for their crimes by claiming asylum. But most fundamentally, the drafters were persuaded that if state parties were expected to admit serious criminals as refugees, they would simply not be willing to be bound to the Convention. France, the most ardent advocate of this view, insisted that the right to exclude limited categories of serious criminals from refugee status was “a prime factor in determining France’s attitude towards the Convention as a whole.” The Yugoslav drafter feared that without a rule on exclusion “there would be a good chance that [his government] would be unable to sign the Convention.” Even the British and Belgian representatives, despite their initial opposition to such a provision, ultimately conceded that the exclusion of serious criminals from refugee status was necessary “to promote maximum adherence to the Convention” and “to make the Convention acceptable to as large a number of governments as possible.” Thus, as the Court of Justice of the European Union determined, the fundamental purpose of Art. 1(F) is essentially instrumentalist, to “maintain the credibility of the protection system.”
The hallmark of a Convention refugee is her inability or unwillingness to return home due to a “well-founded fear of being persecuted.” Not all forced migrants qualify as refugees in law: only those who face a genuine risk of being persecuted for a Convention reason in their own country are entitled to the rights set out in the Convention. The scope and meaning of the “being persecuted” inquiry – which includes both identification of a relevant serious harm and a concomitant failure of state protection – will be discussed in Chapters 3 and 4, while this chapter addresses the notion of well-founded fear.
It is generally asserted that “well-founded fear” entails two requirements. The first criterion is that the person seeking recognition of refugee status perceive herself to stand in “terror of persecution”; her very personal response to the prospect of return to her home country must be an extreme form of anxiety that is neither feigned nor overstated. Second, this subjective perception of risk must be consistent with available information on conditions in the state of origin, as only those persons whose fear is reasonable can be said to stand in need of international protection. Thus, for example, the UN High Commissioner for Refugees (“UNHCR”) opines:
To the element of fear – a state of mind and a subjective condition – is added the qualification “well-founded.” This implies that it is not only the frame of mind of the person concerned that determines his refugee status, but that this frame of mind must be supported by an objective situation. The term “well-founded fear” therefore contains a subjective and an objective element.
Although the requirement to show a well-founded fear of “being persecuted” is at the heart of the refugee definition, the Refugee Convention does not define or elucidate the meaning to be given to this concept. Indeed, it is generally acknowledged that the drafters of the Convention intentionally declined to define “being persecuted” because they recognized the impossibility of enumerating in advance all of the forms of maltreatment that might legitimately entitle persons to benefit from international protection. The need for a flexible approach to “being persecuted” is especially important today given the duty under the 1967 Protocol to apply the refugee definition in a manner that ensures its relevance to “new refugee situations.”
Yet the importance of interpretive flexibility must be balanced against the imperatives of the rule of law, militating against any approach that “abandon[s] the quest for standards” in interpreting what is perhaps the key term of the treaty. Rather, as Lord Justice Laws explained in Sepet:
However wide the canvas facing the judge’s brush, the image he makes has to be firmly based on some conception of objective principle which is recognized as a legitimate source of law.
The challenge, then, is to adopt an approach to interpretation of “being persecuted” that is flexible, yet which provides guidance based on objective principle. The goal must be to understand the core construct of “being persecuted” as “a living thing, adopted by civilised countries for a humanitarian end which is constant in motive but mutable in form.”
The Convention conceives of refugee status as a transitory phenomenon that comes to an end if and when a refugee can reclaim the protection of her own state or has secured an alternative form of enduring national protection. Because the purpose of refugee law is to afford surrogate protection pending the resumption or establishment of meaningful national protection, the cessation clauses in Art. 1(C) of the Convention define various situations in which refugee status may come to an end.
The first sub-chapter therefore considers the applicability of cessation where there is evidence of a refugee’s decision to reclaim the protection of her own country; where an objective assessment by the host country determines that the country of origin has undergone such a fundamental change of circumstances that it can be relied upon to resume its duty of protection; or where the refugee has acquired the nationality of another state that will protect her. In each of these situations, cessation “takes effect naturally,” since the rationale for imposing a duty of substitute national protection on an asylum state will have come to an end.
Refugee law may be the world’s most powerful international human rights mechanism. Not only do millions of people invoke its protections every year in countries spanning the globe, but they do so on the basis of a self-actuating mechanism of international law that, quite literally, allows at-risk persons to vote with their feet. This is because, as the United Nations High Commissioner for Refugees (“UNHCR”) has insisted, refugee status is not a status that is granted by states; it is rather simply recognized by them:
A person is a refugee within the meaning of the 1951 Convention as soon as he fulfils the criteria contained in the definition. This would necessarily occur prior to the time at which his refugee status is formally determined. Recognition of his refugee status does not therefore make him a refugee but declares him to be one. He does not become a refugee because of recognition, but is recognized because he is a refugee.
A person who is a refugee at international law is thus entitled in any of the nearly 150 state parties to the refugee regime to claim a powerful catalog of internationally binding rights – including not only critical civil rights, but also socio-economic rights and rights that enable pursuit of a solution to refugeehood. Because refugee status inheres by virtue of facts rather than formalities, the entitlement to these rights persists until and unless an individual is found not to be a refugee.
The portal to this uniquely valuable protection regime is the definition of a refugee codified in the 1951 Convention relating to the Status of Refugees, made both universal and applicable to contemporary refugees by the 1967 Protocol relating to the Status of Refugees (the “Convention refugee” definition). Article 1A(2) of the Convention provides that the term “refugee” shall apply to any person who
owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it.
The first edition of The Law of Refugee Status (published in 1991) is generally regarded as the seminal text on interpreting the refugee definition set by the UN's 1951 Refugee Convention. Its groundbreaking analysis served as the bedrock for not only much judicial reasoning, but also for a burgeoning academic literature in law and related fields. This second edition builds on the strong critical focus and human rights orientation of the first edition, but undertakes an entirely original analysis of the jurisprudence of leading common law and select civil law states. The authors provide robust responses to the most difficult questions of refugee status in a clear and direct way. The result is a comprehensive and truly global analysis of the central question in asylum law: who is a refugee?