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Climate change is both global in scope and unprecedented in scale and has been described by the UN as ‘the defining issue of our time’ (UN, 2020). There has been scientific consensus that human activity has been causing climate change for some time (Oreskes, 2004; Cook et al, 2013), with the latest report of the Intergovernmental Panel on Climate Change (IPCC, 2021) confirming that it is ‘unequivocal’ that human activity has warmed the atmosphere, land and oceans. There is also substantial evidence surrounding the impacts of climate change; it threatens food, water and energy security, and it poses acute risks to lives and livelihoods through extreme weather events, especially heatwaves, droughts, cyclones and sea level rise (UN, 2020).
The urgency of addressing climate change was encapsulated by the UN Secretary General in a speech given on 21 September 2021:
It is a wake-up call to instill a sense of urgency on the dire state of the climate process … Based on the present commitments of Member States, the world is on a catastrophic pathway to 2.7 degrees of heating, instead of 1.5 we all agreed should be the limit. Science tells us that anything above 1.5 degrees would be a disaster … (UN, 2021)
Additionally, it is clear that the impacts of climate change have significant potential to heighten inequalities across society (Roberts and Parks, 2006; Gough, 2013; UN, 2019; Snell, 2022). As such, fundamental policy transformations are required to ensure just processes of adaptation (ways of living with climate change) and mitigation (ways of reducing our contribution to climate change). Since the Paris Agreement in 2015, the discourse around climate policy has emphasised the importance of a ‘just transition’ (UN, 2015; Wang and Lo, 2021). Broadly conceived, the concept of a just transition underscores the importance of protecting those affected by the transition to a low carbon economy and taking early action to minimise negative impacts and maximise positive opportunities (IISD, 2021).
There has been increasing recognition that healthy cultures within NHS organisations are key to delivering high-quality, safe care (King's Fund). A focus towards developing systems which recognise and learn from excellence has been shown to improve services’ safety and contribute to staff's morale (Kelly et al. 2016). In 2019 Secure Services at Devon Partnership NHS Trust (DPT) developed an Excellence reporting system. Once successfully piloted, the intention was to extend to other departments before expanding to the entire Trust. Our aims initially were SMART: for 13 reports per week in Secure services and 8 in Perinatal (a smaller team). As we expanded the aim became qualitative: for a system to be embedded so staff could as readily and instinctively report Excellence as they could an error.
We developed our Theory of Change using Deming's theory of profound knowledge, ran a series of PDSAs, and introduced an Excellence system. We engaged early adopters, sent hand-written cards and shared data widely.
Learning included understanding setting up the system, and the importance of a team rather than an individual holding the system. We took this forward to bring the system to Perinatal. We continued to run PDSAs, then ran monthly trust-wide meetings providing space to learn from other directorates.
Staff were initially excited, reports submitted, feedback good, then a plateau and slump.
Something was stopping the system perpetuating. When staff received timely thanks, and others heard about it, staff would go on to promote excellence. However, this was not possible without sufficient admin resources.
In early 2021 we changed tact and approached the top: we presented data to Directors who recognised the value and agreed to support. We then set about publicising the system, and demonstrating at trust-wide meetings.
By July 2021 we saw 10 reports per week in the Specialist Directorate.
By early 2022 reports were being inputted from staff across all directorates and our monthly meetings began to focus on sharing the learning.
We recognised the system's potential impact on safety and staff morale but struggled to sustain the system and support dwindled when staff were stretched.
After approaching leaders, then allocated resources, it allowed for more success. However, it is not yet fully embedded in our Trust's culture.
A lot of our work happened during COVID-19 and despite challenges there has been a new-found flexibility to innovate, greater ease to negotiate, and instigate change.
Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
To quantify the extent of food and beverage advertising on bus shelters in a deprived area of the UK, to identify the healthfulness of advertised products, and any differences by level of deprivation. The study also sought to assess the creative strategies used and extent of appeal to young people.
Images of bus shelter advertisements were collected via in person photography (in 2019) and Google Street View (photos recorded in 2018). Food and beverage advertisements were grouped into one of seventeen food categories and classified as healthy/less healthy using the UK Nutrient Profile Model. The deprivation level of the advertisement location was identified using the UK Index of Multiple Deprivation.
Middlesbrough and Redcar and Cleveland in South Teesside.
Eight hundred and thirty-two advertisements were identified, almost half (48·9 %) of which were for foods or beverages. Of food and non-alcoholic beverage adverts, 35·1 % were less healthy. Most food advertisements (98·9 %) used at least one of the persuasive creative strategies. Food advertisements were found to be of appeal to children under 18 years of age (71·9 %). No differences in healthiness of advertised foods were found by level of deprivation.
Food advertising is extensive on bus shelters in parts of the UK, and a substantial proportion of this advertising is classified as less healthy and would not be permitted to be advertised around television programming for children. Bus shelter advertising should be considered part of the UK policy deliberations around restricting less healthy food marketing exposure.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Black, Asian and minority ethnicity groups may experience better health outcomes when living in areas of high own-group ethnic density – the so-called ‘ethnic density’ hypothesis. We tested this hypothesis for the treatment outcome of compulsory admission.
Data from the 2010–2011 Mental Health Minimum Dataset (N = 1 053 617) was linked to the 2011 Census and 2010 Index of Multiple Deprivation. Own-group ethnic density was calculated by dividing the number of residents per ethnic group for each lower layer super output area (LSOA) in the Census by the LSOA total population. Multilevel modelling estimated the effect of own-group ethnic density on the risk of compulsory admission by ethnic group (White British, White other, Black, Asian and mixed), accounting for patient characteristics (age and gender), area-level deprivation and population density.
Asian and White British patients experienced a reduced risk of compulsory admission when living in the areas of high own-group ethnic density [odds ratios (OR) 0.97, 95% credible interval (CI) 0.95–0.99 and 0.94, 95% CI 0.93–0.95, respectively], whereas White minority patients were at increased risk when living in neighbourhoods of higher own-group ethnic concentration (OR 1.18, 95% CI 1.11–1.26). Higher levels of own-group ethnic density were associated with an increased risk of compulsory admission for mixed-ethnicity patients, but only when deprivation and population density were excluded from the model. Neighbourhood-level concentration of own-group ethnicity for Black patients did not influence the risk of compulsory admission.
We found only minimal support for the ethnic density hypothesis for the treatment outcome of compulsory admission to under the Mental Health Act.
The ‘16Up’ study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16−18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.
People living with serious mental illness (SMI) experience debilitating symptoms that worsen their physical health and quality of life. Regular physical activity (PA) may bring symptomatic improvements and enhance wellbeing. When undertaken in community-based group settings, PA may yield additional benefits such as reduced isolation. Initiating PA can be difficult for people with SMI, so PA engagement is commonly low. Designing acceptable and effective PA programs requires a better understanding of the lived experiences of PA initiation among people with SMI.
This systematic review of qualitative studies used the meta-ethnography approach by Noblit and Hare (1988). Electronic databases were searched from inception to November 2017. Eligible studies used qualitative methodology; involved adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder, or psychosis; reported community-based group PA; and captured the experience of PA initiation, including key features of social support. Study selection and quality assessment were performed by four reviewers.
Sixteen studies were included in the review. We identified a “journey” that depicted a long sequence of phases involved in initiating PA. The journey demonstrated the thought processes, expectations, barriers, and support needs of people with SMI. In particular, social support from a trusted source played an important role in getting people to the activity, both physically and emotionally.
The journey illustrated that initiation of PA for people with SMI is a long complex transition. This complex process needs to be understood before ongoing participation in PA can be addressed. Registration—The review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017 (registration number CRD42017059948).
Ice shelves play a critical role in modulating dynamic loss of ice from the grounded portion of the Antarctic Ice Sheet and its contribution to sea-level rise. Measurements of ice-shelf motion provide insights into processes modifying buttressing. Here we investigate the effect of seasonal variability of basal melting on ice flow of Ross Ice Shelf. Velocities were measured from November 2015 to December 2016 at 12 GPS stations deployed from the ice front to 430 km upstream. The flow-parallel velocity anomaly at each station, relative to the annual mean, was small during early austral summer (November–January), negative during February–April, and positive during austral winter (May–September). The maximum velocity anomaly reached several metres per year at most stations. We used a 2-D ice-sheet model of the RIS and its grounded tributaries to explore the seasonal response of the ice sheet to time-varying basal melt rates. We find that melt-rate response to changes in summer upper-ocean heating near the ice front will affect the future flow of RIS and its tributary glaciers. However, modelled seasonal flow variations from increased summer basal melting near the ice front are much smaller than observed, suggesting that other as-yet-unidentified seasonal processes are currently dominant.
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 early village at Çatalhöyük (7100–6150 BC) provides important evidence for the Neolithic and Chalcolithic people of central Anatolia. This article reports on the use of lipid biomarker analysis to identify human coprolites from midden deposits, and microscopy to analyse these coprolites and soil samples from human burials. Whipworm (Trichuris trichiura) eggs are identified in two coprolites, but the pelvic soil samples are negative for parasites. Çatalhöyük is one of the earliest Eurasian sites to undergo palaeoparasitological analysis to date. The results inform how intestinal parasitic infection changed as humans modified their subsistence strategies from hunting and gathering to settled farming.
To evaluate the feasibility and acceptability of the Takeaway Masterclass, a three-hour training session delivered to staff of independent takeaway food outlets that promoted healthy cooking practices and menu options.
A mixed-methods study design. All participating food outlets provided progress feedback at 6 weeks post-intervention. Baseline and 6-week post-intervention observational and self-reported data were collected in half of participating takeaway food outlets.
North East England.
Independent takeaway food outlet owners and managers.
Staff from eighteen (10 % of invited) takeaway food outlets attended the training; attendance did not appear to be associated with the level of deprivation of food outlet location. Changes made by staff that required minimal effort or cost to the business were the most likely to be implemented and sustained. Less popular changes included using products that are difficult (or expensive) to source from suppliers, or changes perceived to be unpopular with customers.
The Takeaway Masterclass appears to be a feasible and acceptable intervention for improving cooking practices and menu options in takeaway food outlets for those who attended the training. Further work is required to increase participation and retention and explore effectiveness, paying particular attention to minimising adverse inequality effects.
Imagination – the ability to mentally simulate situations and ideas not perceived by the physical senses – lays the foundation for creativity. Yet imagination alone is insufficient to produce creativity. We define two types of imagination important for creativity: social-emotional and temporal. Social-emotional imagination is the ability to conceive of and reflect on multiple social perspectives and scenarios and the implications of these for one’s own and others’ lives. It promotes creativity by helping individuals understand multiplicities of identity and experience within themselves and others, reason ethically, and appreciate human diversity and potential. Temporal imagination is the ability to engage in mental time travel, counterfactual thinking, and mind-wandering. It can lead to creativity by allowing individuals to engage in the kind of nonliteral, divergent, and future-oriented thought creativity necessitates. For creativity to happen, imaginative thought is infused into mental simulations that are regulated, evaluated, and integrated to conjure new ideas and concepts. As such, in the brain, creativity relies heavily on the default mode network, which is known to be involved in mental simulations across time and especially about social content. Creativity also relies on organized interactions between the default mode network and the executive attention and salience networks, in order for imaginings to be strategically organized into coherent, meaningful plans and actionable ideas. To harness the potential of imagination, individuals need conducive personal qualities, including openness to experience and intrinsic motivation, as well as a supportive context. To better support individuals in developing their creative potential, for example in schools and in the workplace, we must continue to explore the mechanisms by which imagination leads to creativity and the biological, mental, and cultural constraints and affordances.
Conventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.
Declaration of interest
All authors had financial support from the National Institute for Health Research Health Services and Delivery Research Programme while completing this work. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, the Medical Research Council, Central Commissioning Facility, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, the Health Services and Delivery Research Programme or the Department of Health. S.P.S. is part funded by Collaboration for Leadership in Applied Health Research and Care West Midlands. K.B. is editor of the British Journal of Psychiatry.
Scotland was an independent kingdom until the union of the crowns of Scotland and England in 1603 with the accession of James VI of Scotland to the English crown. Scotland ceased to be a separate state only in 1707 when, by the Acts of Union, it combined with England (and Wales) as constituents of the single state of Great Britain. This union later came to include Ireland; hence Scotland is now part of the union state of the United Kingdom of Great Britain and Northern Ireland (UK). Under the terms of the union the Scottish Parliament in Edinburgh was dissolved and in its place a single parliament was based at the Palace of Westminster in London which hitherto had been the seat of the English Parliament. The Parliament of the UK comprises two chambers, the House of Commons and the House of Lords. In a referendum in 1997 the Scots voted in favour of devolution from Westminster and in 1999 a new devolved Scottish Parliament met for the first time in Edinburgh (Holyrood). Private law matters fall within the competence of the Scottish Parliament. In 2014 a referendum was held on whether Scotland should become an independent state once more (Indyref1). By a margin of 55 per cent to 45 per cent the Scots voted to maintain the union. One issue of some influence on the result was the doubt, strongly encouraged by the European Union (EU) itself, that Scotland could remain within the EU if it became independent from the UK. In June 2016 a referendum on whether the UK should leave the EU was held (Brexit). By a margin of 51.9 per cent to 48.1 per cent the UK voted to leave. In Scotland 62 per cent of the electorate voted to remain. The Scottish First Minister has now announced (March 2017) that she will ask the Scottish Parliament to support an application to Westminster to give the Scottish Government the power to hold a second referendum on independence (Indyref2). If the Scottish people were to vote for independence it is hoped by the present Scottish Government that this would enable Scotland to remain within the European Union. As things stand (September 2017) there may be a second referendum, but only once the details of Brexit are known.
To compare rates of admission for different types of severe mental illness between ethnic groups, and to test the hypothesis that larger and more clustered ethnic groups will have lower admission rates. This was a descriptive study of routinely collected data from the National Health Service in England.
There was an eightfold difference in admission rates between ethnic groups for schizophreniform and mania admissions, and a fivefold variation in depression admissions. On average, Black and minority ethnic (BME) groups had higher rates of admission for schizophreniform and mania admissions but not for depression. This increased rate was greatest in the teenage years and early adulthood. Larger ethnic group size was associated with lower admission rates. However, greater clustering was associated with higher admission rates.
Our findings support the hypothesis that larger ethnic groups have lower rates of admission. This was a between-group comparison rather than within each group. Our findings do not support the hypothesis that more clustered groups have lower rates of admission. In fact, they suggest the opposite: groups with low clustering had lower admission rates. The BME population in the UK is increasing in size and becoming less clustered. Our results suggest that both of these factors should ameliorate the overrepresentation of BME groups among psychiatric in-patients. However, this overrepresentation continues, and our results suggest a possible explanation, namely, changes in the delivery of mental health services, particularly the marked reduction in admissions for depression.
There are two distinct ways in which risk-reasoning features in the South African law of delict. The first, which is the subject of section 9.2 below, relies on the concept of ‘risk-taking’. The second, which is discussed in section 9.3, relies on the notion of ‘risk generation’.
Risk-taking is the ground upon which the South African law of delict imposes Aquilian liability on negligent harm-doers. A harm-doer was negligent if he created the risk of the harm that eventuated and was at fault in doing so: because a reasonable person in his position would have foreseen the risk and, having foreseen it, would have guarded against it. The law disapproves of the risk-taking conduct, and that is the reason for the imposition of liability in respect of the harm suffered. However, risk-taking may also serve as a reason to deny liability. Thus the defence of volenti non fit iniuria deprives the plaintiff in a delictual action of an otherwise valid claim on the ground that he has assumed responsibility for the negative outcome of a risk generated by the defendant. This is similar to the way in which a claim in unjustified enrichment – in so far as it arises in whole or in part from mistake on the part of the plaintiff – is refused if he can be said to have taken the risk of his mistake. The effect of risk-taking on the part of the plaintiff is to neutralise mistake as a cause of action, since his mistake can no longer be said to have caused him to confer the benefit in question.
When we consider the efforts of the South African law of delict to regulate risk, it seems that we are concerned not only with risky conduct of which the law disapproves, but also with risky activities which the law wishes to encourage, or at least has no reason to discourage. Even socially beneficial activities generate risks of harm, and the question then arises whether the law of delict should regulate these risks through the imposition of liability on the risk-generator, as opposed to letting the loss lie where it falls, or – outside the immediate domain of private law – creating some form of insurance scheme by means of which the loss is spread throughout the general population or some part thereof.
Making predictions about aliens is not an easy task. Most previous work has focused on extrapolating from empirical observations and mechanistic understanding of physics, chemistry and biology. Another approach is to utilize theory to make predictions that are not tied to details of Earth. Here we show how evolutionary theory can be used to make predictions about aliens. We argue that aliens will undergo natural selection – something that should not be taken for granted but that rests on firm theoretical grounds. Given aliens undergo natural selection we can say something about their evolution. In particular, we can say something about how complexity will arise in space. Complexity has increased on the Earth as a result of a handful of events, known as the major transitions in individuality. Major transitions occur when groups of individuals come together to form a new higher level of the individual, such as when single-celled organisms evolved into multicellular organisms. Both theory and empirical data suggest that extreme conditions are required for major transitions to occur. We suggest that major transitions are likely to be the route to complexity on other planets, and that we should expect them to have been favoured by similarly restrictive conditions. Thus, we can make specific predictions about the biological makeup of complex aliens.