Ethical dilemmas : balancing choice and risk with a duty of care in extending personalisation into the care home

The article reports the perspectives of senior care staff as part of a study exploring personalisation in care homes. Behind the conceptual sword and shield of 'choice and control' associated with personalisation in the United Kingdom (UK) lie irreconcilable flaws, thrown into sharp relief in this context. Personalisation, which originated in community-based social services, has recently been extended into UK care homes. This service development has been stimulated by a desire to promote a humane response to caring for an ageing population, whilst containing costs. Seemingly promoting a relational approach, personalisation also entails consumerist underpinnings, with consequent tensions resulting in weakened policy mechanisms. Discussing findings pertaining to 'food and eating', the article illustrates the complex interplay between supporting resident capabilities with poor staff ratios; when choice is not really choice at all; balancing choice, risk and the duty of care; and responding to diverse perspectives about what matters. This complexity reflects the highly skilled nature of care work as promoted by care ethicists. The tensions permeated care home life and found parallels in the wider system of care. Honesty about the limitations of choice and control is essential to achieve ethical care in care homes. The care home constitutes fertile ground for exposing and exploring the shortcomings of the 'logic of choice' and for advancing a more relational, inclusive and sustainable conceptualisation of personalisation

Narrative recording as relational practice in social services : a case study from a Scottish carer support organisation

Narrative recording in case records and individual plans within social services represents the means by which stories can be constructed with and about the people with whom services work, influencing relationship building, and outcomes. Identities and decision-making are forged in records, shaping people’s lives. Yet, limited attention is paid to narrative recording in research and practice. Indeed, recording, which increasingly veers towards ‘box-ticking,’ is viewed by practitioners as a bureaucratic burden, limiting time for the ‘real job’ of face-to-face work. Drawing on Ricoeur’s narrative hermeneutics in exploring qualitative data from a carer support organisation, we identify the potential contribution of narrative recording. Carers often seek support when their sense of identity and quality of life are diminished by their unpaid caring role. We explore practitioners’ views about the role of the narrative record in holding memories, feeding into recognition of capable agency, clarifying possibilities for action, restoration of identity, and wellbeing. Applying a Ricoeurian lens demonstrates how attaining these benefits requires recording practice which supports recognition through relational practice, in pursuit of better outcomes for carers. Carer benefits could be enhanced by carers holding a copy of and being able to reflect on and further contribute to their own plan

Setting the Bar for Social Work in Scotland

Scottish policy ambitions include the formation of a National Care Service, the embedding of human rights and delivery of “The Promise” to Scotland’s children. For social work, the vision requires ‘a skilled and valued workforce’ with ‘a focus on prevention, early intervention and enablement.26. Several issues have been identified as precluding this vision. In particular, high caseloads have been reported as making it difficult for social work staff to achieve best practice and support people effectively23 . Setting the Bar set out to establish an evidence-based indicative caseload limit for social work staff in Scotland, with consideration given as to how this might be used. This report presents the findings

The social value of public spaces in mixed-use high-rise buildings

A growing consensus recognises the impact of the built environment on creating thriving communities, particularly as societies face significant social challenges, including increasing population densification and diversification. This raises important questions about how buildings and neighbourhoods play a role in improving people’s lives; and the inherent social value of good building design. A social values framework is used to explore a unique Australian case study: U City in the City of Adelaide, an extreme mixed-use, high-rise building hosting retirement living, disability accommodation, services for some of the communities’ most vulnerable groups, commercial tenants, café/retail outlets and corporate conference facilities. Three public spaces in U City are examined for their role in fostering positive emotions and a sense of belonging among diverse groups of residents, workers and casual users. Qualitative data are gathered from regular focus groups, surveys, observations and innovative resident audits of building spaces. The focus here is on results showing that public spaces in U City are key to fostering ‘community’—expressed in ways that are dynamic, evolving and inclusive—where the successful generation of community is as much about championing the actors involved as it is about the provision and design of building spaces. Practice relevance What social outcomes can the creation of quality spaces for ‘public good’ provide? What social value can be placed on incorporating non-hierarchical, dynamic and flexible public spaces into high-rise building design, and what impact does it have on the appeal and functionality of the building? This case study reveals that the design and operation of public places can bring diverse groups of users together by providing opportunities for interaction, engagement, expression and community-building. This study supports improved design/project briefings and promotes new market opportunities for innovative, regenerative vertical urban villages that incorporate flexible, engaging public spaces for community to thrive. Providing end-user benefits for a more diverse community than is typically seen in traditional architectural brief formulation, U City showcases the versatility that can be incorporated into building design to create highly functional, multipurpose, socially engaging and highly valued collective spaces

Patron offending and intoxication in night time entertainment districts (POINTED) : a study protocol

Risky alcohol consumption is the subject of considerable community concern in Australia and internationally, particularly the risky drinking practices of young people consuming alcohol in the night-time economy. This study will determine some of the factors and correlates associated with alcohol-related risk-taking, offending and harm in and around licensed venues and night-time entertainment precincts across five Australian cities (three metropolitan and two regional). The primary aim of the study is to measure levels of pre-drinking, drinking in venues, intoxication, illicit drug use and potentially harmful drinking practices (such as mixing with energy drinks) of patrons in entertainment areas, and relating this to offending, risky behaviour and harms experienced. The study will also investigate the effects of license type, trading hours, duration of drinking episodes and geographical location on intoxication, offending, risk-taking and experience of harm. Data collection involves patron interviews (incorporating breathalysing and drug testing) with 7500 people attending licensed venues. Intensive venue observations (n=112) will also be undertaken in a range of venues, including pubs, bars and nightclubs. The information gathered through this study will inform prevention and enforcement approaches of policy makers, police and venue staff.<br /

Development of an advanced on-line position-specific stable carbon isotope system and application to methyl tert-butyl ether

We present an advanced system for on-line position-specific carbon isotope analysis. The main limitation of on-line intramolecular isotope ratio measurements has been that optimal pyrolytic fragments are obtained mostly at temperatures where the analyte has not completely reacted. As a result of undetermined isotopic fractionation, the isotopic signatures of the pyrolysis products are not strictly equal to these of the equivalent moieties in the parent molecule. We designed a pyrolytic unit in which both temperature and reaction time are variable parameters, enabling determination of the enrichment factor of the pyrolysis at optimal temperature by construction of a Rayleigh plot. In the case of methyl tert-butyl ether (MTBE) presented here, a 'pre-pyrolysis' fractionation of MTBE leading to a depletion of 0.9 parts per thousand was discovered and the enrichment factor of the optimal pyrolysis reaction was determined at -1.7 parts per thousand. Absolute delta C-13 values of two functional groups of MTBE - the methoxy group and the 2-methylpropane group - could be determined with 95% confidence intervals of 0.4 parts per thousand and 0.5 parts per thousand, respectively

An Earth-system prediction initiative for the twenty-first century

International audienceSome scientists have proposed the Earth-System Prediction Initiative (EPI) at the 2007 GEO Summit in Cape Town, South Africa. EPI will draw upon coordination between international programs for Earth system observations, prediction, and warning, such as the WCRP, WWRP, GCOS, and hence contribute to GEO and the GEOSS. It will link with international organizations, such as the International Council for Science (ICSU), Intergovernmental Oceanographic Commission (IOC), UNEP, WMO, and World Health Organization (WHO). The proposed initiative will provide high-resolution climate models that capture the properties of regional high-impact weather events, such as tropical cyclones, heat wave, and sand and dust storms associated within multi-decadal climate projections of climate variability and change. Unprecedented international collaboration and goodwill are necessary for the success of EPI

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Seasonal-to-interannual prediction of North American coastal marine ecosystems: forecast methods, mechanisms of predictability, and priority developments

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Jacox, M. G., Alexander, M. A., Siedlecki, S., Chen, K., Kwon, Y., Brodie, S., Ortiz, I., Tommasi, D., Widlansky, M. J., Barrie, D., Capotondi, A., Cheng, W., Di Lorenzo, E., Edwards, C., Fiechter, J., Fratantoni, P., Hazen, E. L., Hermann, A. J., Kumar, A., Miller, A. J., Pirhalla, D., Buil, M. P., Ray, S., Sheridan, S. C., Subramanian, A., Thompson, P., Thorne, L., Annamalai, H., Aydin, K., Bograd, S. J., Griffis, R. B., Kearney, K., Kim, H., Mariotti, A., Merrifield, M., & Rykaczewski, R. Seasonal-to-interannual prediction of North American coastal marine ecosystems: forecast methods, mechanisms of predictability, and priority developments. Progress in Oceanography, 183, (2020): 102307, doi:10.1016/j.pocean.2020.102307.Marine ecosystem forecasting is an area of active research and rapid development. Promise has been shown for skillful prediction of physical, biogeochemical, and ecological variables on a range of timescales, suggesting potential for forecasts to aid in the management of living marine resources and coastal communities. However, the mechanisms underlying forecast skill in marine ecosystems are often poorly understood, and many forecasts, especially for biological variables, rely on empirical statistical relationships developed from historical observations. Here, we review statistical and dynamical marine ecosystem forecasting methods and highlight examples of their application along U.S. coastlines for seasonal-to-interannual (1–24 month) prediction of properties ranging from coastal sea level to marine top predator distributions. We then describe known mechanisms governing marine ecosystem predictability and how they have been used in forecasts to date. These mechanisms include physical atmospheric and oceanic processes, biogeochemical and ecological responses to physical forcing, and intrinsic characteristics of species themselves. In reviewing the state of the knowledge on forecasting techniques and mechanisms underlying marine ecosystem predictability, we aim to facilitate forecast development and uptake by (i) identifying methods and processes that can be exploited for development of skillful regional forecasts, (ii) informing priorities for forecast development and verification, and (iii) improving understanding of conditional forecast skill (i.e., a priori knowledge of whether a forecast is likely to be skillful). While we focus primarily on coastal marine ecosystems surrounding North America (and the U.S. in particular), we detail forecast methods, physical and biological mechanisms, and priority developments that are globally relevant.This study was supported by the NOAA Climate Program Office’s Modeling, Analysis, Predictions, and Projections (MAPP) program through grants NA17OAR4310108, NA17OAR4310112, NA17OAR4310111, NA17OAR4310110, NA17OAR4310109, NA17OAR4310104, NA17OAR4310106, and NA17OAR4310113. This paper is a product of the NOAA/MAPP Marine Prediction Task Force

CYP17 blockade by abiraterone: further evidence for frequent continued hormone-dependence in castration-resistant prostate cancer

The limited prognosis of patients with castration-resistant prostate cancer (CRPC) on existing hormonal manipulation therapies calls out for the urgent need for new management strategies. The novel, orally available, small-molecule compound, abiraterone acetate, is undergoing evaluation in early clinical trials and emerging data have shown that the selective, irreversible and continuous inhibition of CYP17 is safe with durable responses in CRPC. Importantly, these efficacy data along with strong preclinical evidence indicate that a significant proportion of CRPC remains dependant on ligand-activated androgen receptor (AR) signalling. Coupled with the use of innovative biological molecular techniques, including the characterisation of circulating tumour cells and ETS gene fusion analyses, we have gained insights into the molecular basis of CRPC. We envision that a better understanding of the mechanisms underlying resistance to abiraterone acetate, as well as the development of validated predictive and intermediate endpoint biomarkers to aid both patient selection and monitor response to treatment, will improve the outcome of CRPC patients