Evolving the narrative for protecting a rapidly changing ocean, post‐COVID‐19. Aquatic Conservation: Marine and Freshwater Ecosystems. DOI: 10.1002/aqc.3512

Calls for global action on environmental issues have been popular since the 1970s and public interest in them has been raised by rallying people to the notion that we all share one world. One need look no further than the COVID-19 pandemic to realize that sharing a world does not mean an equally felt impact or equally shared burden among all people when that world is threatened. Despite the initial good intentions of this ‘one world’ voice, when applied to the oceans the term ‘one’ risks reflecting only the more privileged sectors of society and their worldviews, rather than the diverse circumstances and values underpinning the complexity of human–ocean relationships. While we support the authors' sentiments of unity, their recognition of the oceans' roles in our interconnectedness, and the lack of a planet (or ocean) ‘B’, we also want to stress that humanity is not all in the same boat, people do not have the same destination in mind and we set out into the ocean future from very different home ports. Even within a region or nation, different people in society are poised to benefit differently from the future ocean economy and environment, depending on how ocean governance is developed, and on the conservation actions that support its sustainability. Thus, while the paper by Laffoley et al. makes the important point that the biophysical properties of the ocean play a significant role in every society and every Earth system, we must question ‘the first, simple step of dropping the “s”, recognizing the ocean as a single entity, and referring to the ocean in the singular’ (Laffoley et al., 2020, p. 13) with regard to three risks associated with that seemingly ‘modest proposal’. The first risk is that calls for ‘one ocean’ can undermine the notion of and action for ocean or blue justice. Although air, water, soil and oceans are all interconnected global biophysical systems, their degradation is often felt most acutely at local levels, and by poor and historically marginalized peoples. Thus, while the ‘one ocean’ narrative plays well in global, high-level discussions, it underplays the historical experiences of fighting environmental injustice. The environmental justice movement is rooted in local people's resistance to the actions of governments and corporations who located their most polluting industries and processes in proximity to the poorest people, thereby reducing their health and quality of life much more than that of wealthier people located further away (Bullard, 1990). Managing diverse local impacts in equitable ways requires different actions along different pathways. Each of these calls for different actors, knowledge, policies, objectives, financing, institutions and organizations. The diversity and local specificity of the required responses are not well served by global homogenization. The second risk is that appealing to the biophysical fluidity implicit in ‘one ocean’ panders to a view that ocean economic benefits will also mix, flow – or trickle down – to all. The reality is that the ocean ‘estate’ is unequally resource-endowed and inequitably claimed and allocated, and there are structural barriers to economic fluidity. Taking fisheries as an example, those making economic profit from the ocean – industrial fisheries and retailers – and those taken advantage of by those sectors – fish workers and artisanal fisheries – do not share the same ocean from an economic perspective. Inequities and barriers to ocean economic fluidity extend to all sectors of the ocean economy – who gets to live by the ocean, derive cultural identity from it or get nutrient rich food from it (Cisneros-Montemayor et al., 2016). All of these inequities are hidden by the idea of ‘one ocean’. Third, ‘one ocean’ thinking risks undermining certain kinds of knowledge about the ocean: knowledge that is local and/or Indigenous, practical or ‘phronetic’ (Allison et al., 2020). In designing policies to be implemented, context and diverse values need to be considered throughout decision-making processes and assessments of effectiveness. The holistic nature of the ‘One Health’ framing espoused by Laffoley et al. (2020) provides a more diverse and inclusive knowledge base beyond the ocean governance model of science-based regulations of economic development. In this current world that is increasingly demanding diversity, equity and inclusion, we must focus on governance models built on solidarity borne from the recognition of this diversity, not through another top-down call for unity. Finding and building the way for such solidarity is critical in times of disasters. When the 2011 Tohoku Earthquake and Tsunami struck Japan's northern coasts, English fisher friends approached Ota, eager to send money in support for the affected communities. They reasoned that they all shared the oceans. They cared for the heritage and the ways of life in Japan's coastal communities – heritage and ways of life that are not of their own – and wanted to contribute to their survival. We recognize that Laffoley and colleagues share this same spirit in proposing ‘one ocean’ and that they prioritize the heritages and lives of coastal peoples no less than biodiversity. Yet the ‘one ocean’ narrative risks concealing the localized costs of and responses to environmental degradation, downplaying the ways in which benefits from the ocean are inequitably distributed and minimizing diverse knowledge contributions

Essential trauma management training: addressing service delivery needs in active conflict zones in eastern Myanmar

<p>Abstract</p> <p>Introduction</p> <p>Access to governmental and international nongovernmental sources of health care within eastern Myanmar's conflict regions is virtually nonexistent. Historically, under these circumstances effective care for the victims of trauma, particularly landmine injuries, has been severely deficient. Recognizing this, community-based organizations (CBOs) providing health care in these regions sought to scale up the capacity of indigenous health workers to provide trauma care.</p> <p>Case description</p> <p>The Trauma Management Program (TMP) was developed by CBOs in cooperation with a United States-based health care NGO. The goal of the TMP is to improve the capacity of local health workers to deliver effective trauma care. From 2000 to the present, international and local health care educators have conducted regular workshops to train indigenous health workers in the management of landmine injuries, penetrating and blunt trauma, shock, wound and infection care, and orthopedics. Health workers have been regularly resupplied with the surgical instruments, supplies and medications needed to provide the care learnt through TMP training workshops.</p> <p>Discussion and Evaluation</p> <p>Since 2000, approximately 300 health workers have received training through the TMP, as part of a CBO-run health system providing care for approximately 250 000 internally displaced persons (IDPs) and war-affected residents. Based on interviews with health workers, trauma registry inputs and photo/video documentation, protocols and procedures taught during training workshops have been implemented effectively in the field. Between June 2005 and June 2007, more than 200 patients were recorded in the trauma patient registry. The majority were victims of weapons-related trauma.</p> <p>Conclusion</p> <p>This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible populations in remote and conflicted regions. The principles learnt during the implementation of the TMP might be applied in similar settings.</p

Changing storminess and global capture fisheries

This is the author accepted manuscript. The final version is available from Nature Publishing Group via the DOI in this record.Climate change-driven alterations in storminess pose a signifcant threat to global capture fsheries. Understanding how storms interact with fshery social-ecological systems can inform adaptive action and help to reduce the vulnerability of those dependent on fisheries for life and livelihood.N.C.S. acknowledges the financial support of the UK Natural Environment Research Council (NERC; GW4+ studentship NE/L002434/1), Centre for Environment, Fisheries and Aquaculture Science and Willis Research Network

Morals and climate decision-making: insights from social and behavioural sciences

Decisions about climate change are inherently moral. They require making moral judgements about important values and the desired state of the present and future world. Hence there are potential benefits in explaining climate action by integrating well-established and emerging knowledge on the role of morality in decision-making. Insights from the social and behavioural sciences can help ground climate change decisions in empirical understandings of how moral values and worldviews manifest in people and societies. Here, we provide an overview of progress in research on morals in the behavioural and social sciences, with an emphasis on empirical research. We highlight the role morals play in motivating and framing climate decisions; outline work describing morals as relational, situated, and dynamic; and review how uneven power dynamics between people and groups with multiple moralities shape climate decision-making. Effective and fair climate decisions require practical understandings of how morality manifests to shape decisions and action. To this end, we aim to better connect insights from social and behavioural scholarship on morality with real-world climate change decision-making

A bi-directional relationship between obesity and health-related quality of life : evidence from the longitudinal AusDiab study

Objective: To assess the prospective relationship between obesity and health-related quality of life, including a novel assessment of the impact of health-related quality of life on weight gain.Design and setting: Longitudinal, national, population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study, with surveys conducted in 1999/2000 and 2004/2005.Participants: A total of 5985 men and women aged 25 years at study entry.Main outcome measure(s): At both time points, height, weight and waist circumference were measured and self-report data on health-related quality of life from the SF-36 questionnaire were obtained. Cross-sectional and bi-directional, prospective associations between obesity categories and health-related quality of life were assessed.Results: Higher body mass index (BMI) at baseline was associated with deterioration in health-related quality of life over 5 years for seven of the eight health-related quality of life domains in women (all P0.01, with the exception of mental health, P&gt;0.05), and six out of eight in men (all P&lt;0.05, with the exception of role-emotional, P=0.055, and mental health, P&gt;0.05). Each of the quality-of-life domains related to mental health as well as the mental component summary were inversely associated with BMI change (all P&lt;0.0001 for women and P0.01 for men), with the exception of vitality, which was significant in women only (P=0.008). For the physical domains, change in BMI was inversely associated with baseline general health in women only (P=0.023).Conclusions: Obesity was associated with a deterioration in health-related quality of life (including both physical and mental health domains) in this cohort of Australian adults followed over 5 years. Health-related quality of life was also a predictor of weight gain over 5 years, indicating a bi-directional association between obesity and health-related quality of life. The identification of those with poor health-related quality of life may be important in assessing the risk of future weight gain, and a focus on health-related quality of life may be beneficial in weight management strategies.<br /

Assessing health centre systems for guiding improvement in diabetes care

BACKGROUND: Aboriginal people in Australia experience the highest prevalence of diabetes in the country, an excess of preventable complications and early death. There is increasing evidence demonstrating the importance of healthcare systems for improvement of chronic illness care. The aims of this study were to assess the status of systems for chronic illness care in Aboriginal community health centres, and to explore whether more developed systems were associated with better quality of diabetes care. METHODS: This cross-sectional study was conducted in 12 Aboriginal community health centres in the Northern Territory of Australia. Assessment of Chronic Illness Care scale was adapted to measure system development in health centres, and administered by interview with health centre staff and managers. Based on a random sample of 295 clinical records from attending clients with diagnosed type 2 diabetes, processes of diabetes care were measured by rating of health service delivery against best-practice guidelines. Intermediate outcomes included the control of HbA1c, blood pressure, and total cholesterol. RESULTS: Health centre systems were in the low to mid-range of development and had distinct areas of strength and weakness. Four of the six system components were independently associated with quality of diabetes care: an increase of 1 unit of score for organisational influence, community linkages, and clinical information systems, respectively, was associated with 4.3%, 3.8%, and 4.5% improvement in adherence to process standards; likewise, organisational influence, delivery system design and clinical information systems were related to control of HbA1c, blood pressure, and total cholesterol. CONCLUSION: The state of development of health centre systems is reflected in quality of care outcome measures for patients. The health centre systems assessment tool should be useful in assessing and guiding development of systems for improvement of diabetes care in similar settings in Australia and internationally

Examining intra-rater and inter-rater response agreement: A medical chart abstraction study of a community-based asthma care program

<p>Abstract</p> <p>Background</p> <p>To assess the intra- and inter-rater agreement of chart abstractors from multiple sites involved in the evaluation of an Asthma Care Program (ACP).</p> <p>Methods</p> <p>For intra-rater agreement, 110 charts randomly selected from 1,433 patients enrolled in the ACP across eight Ontario communities were re-abstracted by 10 abstractors. For inter-rater agreement, data abstractors reviewed a set of eight fictitious charts. Data abstraction involved information pertaining to six categories: physical assessment, asthma control, spirometry, asthma education, referral visits, and medication side effects. Percentage agreement and the kappa statistic (κ) were used to measure agreement. Sensitivity and specificity estimates were calculated comparing results from all raters against the gold standard.</p> <p>Results</p> <p>Intra-rater re-abstraction yielded an overall kappa of 0.81. Kappa values for the chart abstraction categories were: physical assessment (κ 0.84), asthma control (κ 0.83), spirometry (κ 0.84), asthma education (κ 0.72), referral visits (κ 0.59) and medication side effects (κ 0.51). Inter-rater abstraction of the fictitious charts produced an overall kappa of 0.75, sensitivity of 0.91 and specificity of 0.89. Abstractors demonstrated agreement for physical assessment (κ 0.88, sensitivity and specificity 0.95), asthma control (κ 0.68, sensitivity 0.89, specificity 0.85), referral visits (κ 0.77, sensitivity 0.88, specificity 0.95), and asthma education (κ 0.49, sensitivity 0.87, specificity 0.77).</p> <p>Conclusion</p> <p>Though collected by multiple abstractors, the results show high sensitivity and specificity and substantial to excellent inter- and intra-rater agreement, assuring confidence in the use of chart abstraction for evaluating the ACP.</p