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Access to safe, clean and affordable water is a basic human right and a global goal towards which climate change poses new challenges that heavily impact the health and wellbeing of people across the globe and exacerbate or create new inequalities. These challenges are shaped by a number of geographical and social conditions that, apart from the risks of weather-driven impacts on water, include water governance and management arrangements in place, including pricing tariffs, and the interplay of social and economic inequalities. Building on examples from Australia, Scotland and England and Wales that illustrate access to water in different types of water provision systems, and regarding to aspects of access, quality and affordability, this paper explores the types of challenges related to water poverty in the context of climate crisis and reflects on the multiple dimensions of water poverty oriented social policy at the interplay of climate change associated risks.
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
Why did it take so long to start writing the history of close reading? For the best part of a century, close reading has grounded literary studies in the university, structuring assessment, teaching, employment, and publication. A basic proficiency in close reading has long been a professional obligation for faculty members and a course requirement for students. It makes sense, then, that Caroline Levine's Forms begins with a description of our method in action. A reader is settling down to work with a copy of Jane Eyre. She has a lengthy education behind her and a wealth of interpretive techniques for the book in front of her. Still, one thing is certain: our critic will broach the forms of the novel by drawing from “close reading methods” while using “historical research methods to analyze sociopolitical experience.” “But,” Caroline Levine asks, “would our critic be right to distinguish between the formal and the social?” (1).
Competition between parasite species or genotypes can play an important role in the establishment of parasites in new host populations. Here, we investigate a mechanism by which a rare parasite is unable to establish itself in a host population if a common resident parasite is already present (a ‘priority effect’). We develop a simple epidemiological model and show that a rare parasite genotype is unable to invade if coinfecting parasite genotypes inhibit each other's transmission more than expected from simple resource partitioning. This is because a rare parasite is more likely to be in multiply-infected hosts than the common genotype, and hence more likely to pay the cost of reduced transmission. Experiments competing interfering clones of bacteriophage infecting a bacterium support the model prediction that the clones are unable to invade each other from rare. We briefly discuss the implications of these results for host-parasite ecology and (co)evolution.
Neuropsychological, neuroimaging, and genetic studies have demonstrated the biological underpinnings of attention deficits hyperactivity disorder (ADHD). These studies have correlated deficits in executive functioning, response inhibition and planning with specific regions of the brain. The multimodal treatment study (MTA) study randomized participants to intensive behavioral therapy, pharmacotherapy with systematically delivered methylphenidate, a combination of the two, or standard community care. The American Academy of Child & Adolescent Psychiatry (AACAP) Practice Parameters for ADHD published in 2007 combine short- and long-term empirical evidence with expert opinion from pediatric mental health researchers and clinicians. A meta-analysis of atomoxetine and stimulant studies revealed a robust effect size for atomoxetine and the stimulants, both of which are currently approved by the food and drug administration (FDA) for the treatment of ADHD. In the interim, appropriate diagnosis, informed prescribing, clinical monitoring, and collaborative treatment planning can all help to optimize outcomes in ADHD management.
We present a narrative review of evidence-based treatment for obsessive–compulsive disorder (OCD), covering first-line pharmacological treatment, augmentation strategies, approaches for treatment-refractory OCD and the management of OCD in special populations (children and adolescents, pregnant and breast-feeding women, and elderly people).
Pre-eclampsia (PE) remains the leading cause of maternal and fetal mortality in the developed world and parts of the developing world. Morbidity and mortality from PE is increased in the developing world compared to the developed world, as availability and access to antenatal care and pathology services are limited.
In recent years, the most common technique for radiocarbon dating of deep-ocean sediments has been accelerator mass spectrometry (AMS) analysis of hand-picked planktonic foraminifera (forams). Some studies have exposed age offsets between different sediment size fractions from the same depth within a core and this has important implications when establishing a chronological framework for palaeoceanographic records associated with a particular sediment component. The mechanisms generating the age offsets are not fully understood, a problem compounded by the fact that the fraction defined as “large” varies between different studies. To explore this problem, we dated samples of hand-picked forams from two Biogeochemical Ocean Flux Study (BOFS) cores, for which the presence of an offset between the bulk carbonate and >150 μm foraminiferal calcite had already been demonstrated. The presence of a constant age offset between bulk carbonate and coarse fraction material at the two BOFS sites has been confirmed, but the magnitude of the offset is dependent on whether a simple size-separation technique or hand-picking of well-preserved forams is applied. This may be explained if the selection of well preserved forams biases the sample towards those specimens that have spent least time in the surface mixed layer (SML) or have undergone less size selective mixing. Modeling of the 14C profiles demonstrates that SML depth and sediment accumulation rates are the same for both the bulk and coarse sediment fractions, which is consistent with the hypothesis that size-selective mixing is responsible for the age offset.
The Resource Teachers Learning and Behaviour (RTLB) program is a unique special education development in New Zealand. The aim of this program is the creation of a nation-wide network of more than 700 RTLB operating as itinerant consulting teachers providing support in inclusive classrooms. The principles underlying the program are described and an outline provided of the curriculum and methods of delivery. The program also acknowledges the need to address the important bi-cultural elements of New Zealand society. The paper reports on RTLB demographic profiles and the initial responses of teachers to their training. Preliminary indices of program effectiveness are also presented. The paper indicates ways in which the RTLB initiative is likely to develop and notes issues within the New Zealand education system that will both strengthen and constrain the overall development of the program.