10,091 research outputs found
Victims' Access to Justice in Trinidad and Tobago: An exploratory study of experiences and challenges of accessing criminal justice in a post-colonial society
This thesis investigates victims' access to justice in Trinidad and Tobago, using their own narratives. It seeks to capture how their experiences affected their identities as victims and citizens, alongside their perceptions of legitimacy regarding the criminal justice system. While there have been some reforms in the administration of criminal justice in Trinidad and Tobago, such reforms have not focused on victims' accessibility to the justice system. Using grounded theory methodology, qualitative data was collected through 31 in-depth interviews with victims and victim advocates. The analysis found that victims experienced interpersonal, structural, and systemic barriers at varying levels throughout the criminal justice system, which manifested as institutionalized secondary victimization, silencing and inequality. This thesis argues that such experiences not only served to appropriate conflict but demonstrates that access is often given in a very narrow sense. Furthermore, it shows a failure to encompass access to justice as appropriated conflicts are left to stagnate in the system as there is often very little resolution. Adopting a postcolonial lens to analyse victims' experiences, the analysis identified othering practices that served to institutionalize the vulnerability and powerlessness associated with victim identities. Here, it is argued that these othering practices also affected the rights consciousness of victims, delegitimating their identities as citizens. Moreover, as a result of their experiences, victims had mixed perceptions of the justice system. It is argued that while the system is a legitimate authority victims' endorsement of the system is questionable, therefore victims' experiences suggest that there is a reinforcement of the system's legal hegemony. The findings suggest that within the legal system of Trinidad and Tobago, legacies of colonialism shape the postcolonial present as the psychology and inequalities of the past are present in the interactions and processes of justice. These findings are relevant for policymakers in Trinidad and Tobago and other regions. From this study it is recognized that, to improve access to justice for victims, there needs to be a move towards victim empowerment that promotes resilience and enhances social capital. Going forward it is noted that there is a need for further research
Implementing Health Impact Assessment as a Required Component of Government Policymaking: A Multi-Level Exploration of the Determinants of Healthy Public Policy
It is widely understood that the public policies of ânon-healthâ government sectors have greater impacts on population health than those of the traditional healthcare realm. Health Impact Assessment (HIA) is a decision support tool that identifies and promotes the health benefits of policies while also mitigating their unintended negative consequences. Despite numerous calls to do so, the Ontario government has yet to implement HIA as a required component of policy development. This dissertation therefore sought to identify the contexts and factors that may both enable and impede HIA use at the sub-national (i.e., provincial, territorial, or state) government level.
The three integrated articles of this dissertation provide insights into specific aspects of the policy process as they relate to HIA. Chapter one details a case study of purposive information-seeking among public servants within Ontarioâs Ministry of Education (MOE). Situated within Ontarioâs Ministry of Health (MOH), chapter two presents a case study of policy collaboration between health and ânon-healthâ ministries. Finally, chapter three details a framework analysis of the political factors supporting health impact tool use in two sub-national jurisdictions â namely, QuĂ©bec and South Australia.
MOE respondents (N=9) identified four components of policymaking âdue diligenceâ, including evidence retrieval, consultation and collaboration, referencing, and risk analysis. As prospective HIA users, they also confirmed that information is not routinely sought to mitigate the potential negative health impacts of education-based policies. MOH respondents (N=8) identified the bureaucratic hierarchy as the brokering mechanism for inter-ministerial policy development. As prospective HIA stewards, they also confirmed that the ministry does not proactively flag the potential negative health impacts of non-health sector policies. Finally, âlessons learnedâ from case articles specific to QuĂ©bec (n=12) and South Australia (n=17) identified the political factors supporting tool use at different stages of the policy cycle, including agenda setting (âpolicy elitesâ and âpolitical cultureâ), implementation (âjurisdictionâ), and sustained implementation (âinstitutional powerâ).
This work provides important insights into âreal lifeâ policymaking. By highlighting existing facilitators of and barriers to HIA use, the findings offer a useful starting point from which proponents may tailor context-specific strategies to sustainably implement HIA at the sub-national government level
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European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases.
International comparison of health spending and utilization among people with complex multimorbidity.
OBJECTIVE: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. DATA SOURCES: We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). DATA COLLECTION/EXTRACTION METHODS: Data collected by ICCONIC partners. STUDY DESIGN: We retrospectively analyzed age-sex standardized utilization and spending of an older person (65-90âyears) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. PRINCIPAL FINDINGS: Sample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent 30,877. The United States had a shorter length of stay over the year (18.9âdays) compared to France (32.9) and Germany (33.4). The United States spent more days in facility-based rehabilitative care than other countries. Australia spent 1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. CONCLUSION: Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care
Development and Implementation of a Standardized Protocol for Nurse Practitioners Working in an AUD Treatment Telehealth Program
Background
Alcohol Use Disorder (AUD) is a major public health concern in the United States. Ria Health is a growing telehealth provider delivering AUD treatment through pharmacotherapy combined with behavioral health counseling.
Local Problem
Ria Health employs six California licensed nurse practitioners, but two of them have not yet met all the California provisions to practice independently without protocols. Ria Health has not put any standardized protocols in place.
Methods
This DNP project involved the creation of an evidence-based standardized protocol for AUD. The Student Satisfaction and Self-Confidence in Learning questionnaire was disseminated to participating nurse practitioners to measure student satisfaction and self-confidence in learning.
Intervention
Because the nursing curriculum for most nurse practitioners does not include addiction medicine, the implementation of a standardized protocol is likely to improve quality significantly by setting high standards of care through evidence-based practices.
Results
The standardized protocol was successfully implemented for only one out of two nurse practitioners not already authorized to practice independently. One, who helped edit the protocol, joined in its implementation. The other was dissatisfied with the orientation, did not find the protocol helpful, and declined to participate in its implementation.
Conclusion
Standardized protocols are the legal authority for the nurse practitioner to exceed the usual scope of practice from a registered nurse. Involvement in drafting the standard protocol may affect the willingness of participants to implement it. This DNP project may also benefit other AUD programs which may not have standardized protocols in place
Towards the development of care management in community care for elderly people in Korea
This study is concerned with the feasibility of several forms of care management in the development of community care for elderly people in Korea. Chapter one introduces the background of community care in Korea in the light of demographic, socio-economic, and political realities. This chapter reviews the changing Korean society as a barometer to understand the scope, size, and speed of social needs, especially community care for elderly people, over the last few decades. Chapter two explores various definitions, concepts, and theories of community, community care, and care management by building upon trends previously established in the research. This helps to identify the different models of care management and the pre-conditions necessary for the application of different models in Korea. Chapter three explores what factors have affected the development of community care, and what community dare has achieved for elderly people in the UK. Especially, care management in community care for elderly people in the UK is examined in detail. Chapter four details the findings of field research on community care for elderly people in Korea. This covers the needs of elderly people and their carers, and the social worker's tasks and available resources. The potential for the use of care management based on the findings of field research is assessed. Chapter five investigates whether the UK models of care management are suitable for Korean society, which interventions are useful for developing care management, and the strategies, and principles involved
In search of 'The people of La Manche': A comparative study of funerary practices in the Transmanche region during the late Neolithic and Early Bronze Age (250BC-1500BC)
This research project sets out to discover whether archaeological evidence dating between 2500 BC - 1500 BC from supposed funerary contexts in Kent, flanders and north-eastern Transmanche France is sufficient to make valid comparisons between social and cultural structures on either side of the short-sea Channel region. Evidence from the beginning of the period primarily comes in the form of the widespread Beaker phenomenon. Chapter 5 shows that this class of data is abundant in Kent but quite sparse in the Continental zones - most probably because it has not survived well. This problem also affects the human depositional evidence catalogued in Chapter 6, particularly in Fanders but also in north-eastern Transmanche France. This constricts comparative analysis, however, the abundant data from Kent means that general trends are still discernible. The quality and volume of data relating to the distribution, location, morphology and use of circular monuments in all three zones is far better - as demonstrated in Chapter 7 -mostly due to extensive aerial surveying over several decades. When the datasets are taken as a whole, it becomes possible to successfully apply various forms of comparative analyses. Most remarkably, this has revealed that some monuments apparently have encoded within them a sophisticated and potentially symbolically charged geometric shape. This, along with other less contentious evidence, demonstrates a level of conformity that strongly suggests a stratum of cultural homogeneity existed throughout the Transmanche region during the period 2500 BC - 1500 BC. The fact that such changes as are apparent seem to have developed simultaneously in each of the zones adds additional weight to the theory that contact throughout the Transmanche region was endemic. Even so, it may not have been continuous; there may actually have been times of relative isolation - the data is simply too course to eliminate such a possibility
Disunity in society, fractures at home: family relating in the context of divisive socio-political issues
Section A
A systematic literature review conducted to identify and explore research that has investigated adult intrafamilial relationships and divisive political issues since 2016. Ten papers are included in the review. The studies are critiqued using a mixed-methods risk of bias tool. Findings are collated using narrative synthesis. The synthesis focuses on relational responsesâto divisive political issuesâthe potential reasons for these responses, and their consequences. Review findings are discussed in relation to previous theoretical and empirical literature. Finally, clinical and research implications are presented.
Section B
A grounded theory study to develop an understanding of adult intrafamilial invalidation in the context of social and political change. Brexit and COVID-19 serve as the contextual lens through which the phenomenon was observed. Data from 11 participants and 45 screening questionnaire respondents were analysed as part of the study. A model of family âRejection of Youâ experiences is presented outlining foundational and contextual factors that frame the experience, the experience itself, and relational, behavioural, cognitive, and emotional consequences. Findings are discussed in relation to previous theory and previous empirical research. Clinical implications are considered and possible directions for future research are set out
Psychosis and COVID-19: tele-mental health and Team Formulation
Abstract not available
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