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Public engagement (PE) is part of the contemporary landscape of health research and innovation and considered a panacea for what is often characterised as a problem of trust in science or scientific research, as well as a way to ward off actual or potential opposition to new developments. In this chapter we provide a synthesis of current conceptualisations of PE. We then consider what kinds of publics are ‘engaged with’ and what this means for the kinds of information exchanges and dialogues that are undertaken. Different forms of PE ‘make up’ different kinds of publics: engagements do not, indeed cannot, start with a clean sheet – neither with a pure public nor through a pure engagement. As Irwin, among others, has noted, PE is a political exercise and this wider context serves to frame what is engaged about. It is therefore all the more important to reflect on the practice of PE and what it is hoped will be achieved. We argue that clarity and transparency about the intention, practice and impact of PE are required if PE is to provide an authentic and meaningful tool within health research governance.
We evaluated adverse drug events (ADEs) by chart review in a random national sample of 428 veterans with coronavirus disease 2019 (COVID-19) who received tocilizumab (n = 173 of 428). ADEs (median time, 5 days) occurred in 51 of 173 (29%) and included hepatoxicity (n = 29) and infection (n = 13). Concomitant medication discontinuation occurred in 22% of ADE patients; mortality was 39%.
Moving forward to the later twentieth and early twenty-first centuries, Chapter 14 provides a survey of contemporary female and gender-non-conforming artists using electronics for music. Margaret Schedel and Flannery Cunningham highlight how greater access to affordable means to manipulate digital sound from the autonomy of personal computers – away from difficult-to-access studios staffed by technicians and equipped with complex technology, which were previously largely the domain of male ‘experts’ – has opened up electronic music to a wider demographic of people (in terms of gender, race, and class). Taking an ethnographic approach which draws upon questionnaire material from twenty-four respondents variously identifying as composers, sound artists, instruments builders, and programmers, this chapter explores some of this diversity through the artists’ own words.
Unemployment and being not in the labour force (NILF) are risk factors for suicide, but their association with self-harm is unclear, and there is continuing debate about the role of confounding by prior mental health conditions. We examine associations between employment status and self-harm and suicide in a prospective cohort, taking into account prior mental-health-related factors.
We used linked data from the New Zealand Integrated Data Infrastructure. The outcomes were chosen to be hospital presentation for self-harm and death by suicide. The exposure was employment status, defined as employed, unemployed, or NILF, measured at the 2013 Census. Confounders included demographic factors and mental health history (use of antidepressant medication, use of mental health services, and prior self-harm). Logistic regression was used to model effects. Analyses were stratified by gender.
For males, unemployment was associated with an increased risk of suicide [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.20–1.84] and self-harm (OR: 1.55, 95% CI: 1.45–1.68) after full adjustment for confounders. NILF was associated with an increased risk of self-harm (OR: 1.43, 95% CI: 1.32–1.55), but less of an association was seen with suicide (OR: 1.19, 95% CI: 0.94–1.49). For females, unemployment was associated with an increased risk of suicide (OR: 1.30, 95% CI: 0.93–1.80) and of self-harm (OR: 1.52, 95% CI: 1.43–1.62), and NILF was associated with a similar increase in risk for suicide (OR: 1.31, 95% CI: 0.98–1.75) and self-harm (OR: 1.32, 95% CI: 1.26–1.40).
Exclusion from employment is associated with a considerably heightened risk of suicide and self-harm for both men and women, even among those without prior mental health problems.
To paraphrase Brian Maskell, a prominent lean accounting pioneer, lean accounting is aligning financial management with the economics of lean. Traditional cost accounting or standard cost accounting has not changed its methodology in over 100 years, and often reports and other information generated are only superficially understood and hard to apply to real-world decision making even in non-lean companies. Then, as a company transitions to lean management and production, the accounting information becomes even less viable and much of it is useless. When accounting transitions to lean accounting, it partners with other functions including manufacturing. Through these partnerships, accounting gains a greater understanding of the company’s product and customer strategies. As a result, accounting informational output can be redesigned and enhanced to be more applicable, timelier, much easier to understand, and to better support the company’s lean transition needs. Decision makers at all levels will have more valuable information that can be utilized deeply in analysis and decision making. New output might include higher-value reports, box scores, visual displays in production, trend charts, key performance indicators, etc. In turn, accounting becomes a more collaborative and valuable partner and consultant in a company’s lean transition.
Agitated behaviors are frequently encountered in the prehospital setting and require emergent treatment to prevent harm to patients and prehospital personnel. Chemical sedation with ketamine works faster than traditional pharmacologic agents, though it has a higher incidence of adverse events, including intubation. Outcomes following varying initial doses of prehospital intramuscular (IM) ketamine use have been incompletely described.
To determine whether using a lower dose IM ketamine protocol for agitation is associated with more favorable outcomes.
This study was a pre-/post-intervention retrospective chart review of prehospital care reports (PCRs). Adult patients who received chemical sedation in the form of IM ketamine for agitated behaviors were included. Patients were divided into two cohorts based on the standard IM ketamine dose of 4mg/kg and the lower IM dose of 3mg/kg with the option for an additional 1mg/kg if required. Primary outcomes included intubation and hospital admission. Secondary outcomes included emergency department (ED) length of stay, additional chemical or physical restraints, assaults on prehospital or ED employees, and documented adverse events.
The standard dose cohort consisted of 211 patients. The lower dose cohort consisted of 81 patients, 17 of whom received supplemental ketamine administration. Demographics did not significantly differ between the cohorts (mean age 35.14 versus 35.65 years; P = .484; and 67.8% versus 65.4% male; P = .89). Lower dose subjects were administered a lower ketamine dose (mean 3.24mg/kg) compared to the standard dose cohort (mean 3.51mg/kg). There was no statistically significant difference between the cohorts in intubation rate (14.2% versus 18.5%; P = .455), ED length of stay (14.31 versus 14.88 hours; P = .118), need for additional restraint and sedation (P = .787), or admission rate (26.1% versus 25.9%; P = .677). In the lower dose cohort, 41.2% (7/17) of patients who received supplemental ketamine doses were intubated, a higher rate than the patients in this cohort who did not receive supplemental ketamine (8/64, 12.5%; P <.01).
Access to effective, fast-acting chemical sedation is paramount for prehospital providers. No significant outcomes differences existed when a lower dose IM ketamine protocol was implemented for prehospital chemical sedation. Patients who received a second dose of ketamine had a significant increase in intubation rate. A lower dose protocol may be considered for an agitation protocol to limit the amount of medication administered to a population of high-risk patients.
Over recent decades, Chinese giant salamanders Andrias spp. have declined dramatically across much of their range. Overexploitation and habitat degradation have been widely cited as the cause of these declines. To investigate the relative contribution of each of these factors in driving the declines, we carried out standardized ecological and questionnaire surveys at 98 sites across the range of giant salamanders in China. We did not find any statistically significant differences between water parameters (temperature, dissolved oxygen, ammonia, nitrite, nitrate, salinity, alkalinity, hardness and flow rate) recorded at sites where giant salamanders were detected by survey teams and/or had been recently seen by local respondents, and sites where they were not detected and/or from which they had recently been extirpated. Additionally, we found direct and indirect evidence that the extraction of giant salamanders from the wild is ongoing, including within protected areas. Our results support the hypothesis that the decline of giant salamanders across China has been primarily driven by overexploitation. Data on water parameters may be informative for the establishment of conservation breeding programmes, an initiative recommended for the conservation of these species.
When the South Carolina legislature created the anti-NAACP oath in 1956, teachers across the state lost their positions. But it was the dismissal of twenty-one teachers at the Elloree Training School that captured the attention of the NAACP and Black media outlets. In the years following Brown v. Board of Education, South Carolina's Black and White communities went head-to-head in the battle over White supremacy versus expanded civil rights. The desegregation movement in 1955 and 1956 placed Black teachers’ activism in the spotlight—activism that mirrored what was happening in their community. This largely unknown episode of civil rights activism demonstrates that Black teachers were willing to serve not only as behind-the-scenes supporters in the equal education struggle but as frontline activists. Furthermore, it shows that South Carolina was an integral site of the long civil rights movement.
Heuristics and cognitive biases constantly influence clinical decision-making and often facilitate judgements under uncertainty. They can frequently, however, lead to diagnostic errors and adverse outcomes, particularly when considering rare disease processes that have common, masquerading presentations. Herein, we present two such cases of newborn infants with hypertensive renal disorders that were initially thought to have cardiomyopathy.
Farwell v. Keaton is the classic torts case that has introduced generations of law students to the “no-duty-to-rescue” rule which allows individuals to refrain from aiding persons in peril. The case is an exception, imposing a duty on a teenage boy who failed to come to the aid of his companion who died after being beaten by a group of boys. The court emphasized the relationship between the parties and the fact that the defendant had rendered some initial aid to his friend. The rewritten feminist opinion also imposes a duty but replaces the myriad common-law exceptions to the “no-duty-to-rescue” rule. Embracing a humanitarian approach based on the circumstantial connection between the parties in the case, the feminist judgment imposes liability whenever failure to do so would “shock the conscience,” placing US tort law on par with the law in many European nations. The accompanying commentary recharacterizes the case as one involving sexual harassment and stalking, focusing on the behavior of the defendant and his companion who set the chain of events in motion when they followed two teenaged girls who later complained to the assailants.
Acute kidney injury leads to worse outcomes following paediatric cardiac surgery. There is a lack of literature focusing on acute kidney injury after the Hybrid stage 1 palliation for single ventricle physiology. Patients undergoing the Hybrid Stage 1, as a primary option, may have a lower incidence of kidney injury than previously reported. When present, kidney injury may increase the risk of post-operative morbidity and mortality.
A retrospective, single centre review was conducted in patients with hypoplastic left heart syndrome who underwent Hybrid Stage 1 from 2008 to 2018. Acute kidney injury was defined as a dichotomous yes (meeting any injury criteria) or no (no injury) utilising two different criteria utilised in paediatrics. The impact of kidney injury on perioperative characteristics and 30-day mortality was analysed.
The incidence of acute kidney injury is 13.4–20.7%, with a severe injury rate of 2.4%. Patients without a prenatal diagnosis of hypoplastic left heart syndrome have a higher incidence of kidney injury than those prenatally diagnosed, (40% versus 14.5%, p = 0.024). Patients with acute kidney injury have a significantly higher incidence of 30-day mortality, 27.3%, compared to without, 5.6% (p = 0.047).
The incidence of severe acute kidney injury after the Hybrid Stage 1 palliation is low. A prenatal diagnosis may be associated with a lower incidence of kidney injury following the Hybrid Stage 1. Though uncommon, severe acute kidney injury following Hybrid Stage 1 may be associated with higher 30-day mortality.
At the start of Henry VII's reign the legacy of the fifteenth-century civil wars was felt in a variety of ways within the Welsh marches. More than in many other regions, local leadership of the English marcher counties had changed hands in step with the struggle for the crown and the alignment of allies behind the contenders. The overlapping and interconnected lordship of marcher families, however, meant that very few networks had been completely eclipsed by their political decision-making during previous crises. A.J. Pollard's Ph.D. thesis of 1968 considered the role of the Talbots, earls of Shrewsbury, in this phase of the Wars of the Roses, and analysed how they were eventually reconciled to Edward IV, both nationally and in the marcher region. As the fifteenth century progressed the lordship of Mortimer, York, Talbot, Stafford and Herbert enjoyed periods of prominence in alignment with the crown or independently, sometimes representing directly the interests of the Westminster government, though in other periods counter-balancing them. The regional landed power of the prince of Wales also ensured that all monarchs had a variety of routes through which the aristocracy and gentry of the march were connected to each other and to the crown.
At first glance, Henry, earl of Richmond (the future Henry VII), had little personal connection with the march. His paternal Tudor ancestry linked him to north Wales and Anglesey. His mother's Beaufort relatives had few connections in the region. Of his surviving family only his uncle, Jasper, earl of Pembroke, could claim any direct lordship in Wales; but that was in Pembrokeshire and the south, and even that link had become dormant once Jasper, Henry and a handful of their Lancastrian Beaufort allies were forced into exile in spring 1471 at the end of their brief restoration during Henry VI's six-month readeption of the crown. Before then, during his childhood after February 1462, Henry had been a ward of William, Lord Herbert, who acquired Jasper's earldom of Pembroke in 1468. A year later, after Herbert's death at the battle of Edgcote, his widow Anne Devereux continued to look afterHenry until October 1470, when he was reunited with his mother, Margaret Beaufort, countess of Richmond.
The purpose of this chapter is to explore the impact of the Global Financial Crisis (GFC) and austerity on collective bargaining and wage outcomes internationally. It takes as the starting point for its analysis the argument advanced in Chapter 1 that the current wave of austerity policies stems from a neoliberal economic consensus that has pervaded developed economies and emphasizes free markets, the removal of rigidities to capital and shrinking the state. That is a philosophy that in policy terms is the antithesis of one supportive of trade unions and collective bargaining, which are themselves under this ideology seen as impediments to markets and economic growth (Harvey, 2007). The chapter therefore adopts a perspective that sees the GFC and austerity as providing a convenient point from which to further consolidate neoliberalism's hold on society (McCann, 2013) and simultaneously undermine one of the chief forms of resistance – trade unions and collective bargaining.
The first part of the chapter focuses attention on exploring trends in collective bargaining in the EU and North America (US and Canada) in the post-GFC period. In doing so, it identifies a common trajectory in nation-state policies that encompasses a shift towards identifying the GFC as a public debt crisis; the blaming of trade unions and their members (in particular public sector workers) for the crisis; and the introduction of reforms to collective bargaining and union security designed to reinforce deflationary austerity policies. The chapter's second part then examines trends in wage growth and equality since 2008 and discusses the factors influencing them and the extent to which they can be viewed as a product of the neoliberal-informed economic policies and reforms adopted in response to the crisis.
Changes to collective bargaining in the EU
Institutional context of collective bargaining in the EU under austerity
Since 2000 there have been significant social, economic and political policy shifts that have fundamentally challenged the status of collective bargaining in the EU. Policies associated with a neoliberal agenda that view unions and collective bargaining as sources of rigidities in the market have been central to this change as the EU has focused on the neoliberal free market agenda of labour-market flexibility and downward pressure on terms and conditions to sustain economic growth (Waddington, Muller and Vandaele, 2019). This process of change received support from EU enlargement and the move towards economic and monetary union (EMU).