Marine spatial planning and Good Environmental status: A perspective on spatial and temporal dimensions

The European Union Marine Strategy Framework Directive requires the Good Environmental Status of marine environments in Europe's regional seas; yet, maritime activities, including sources of marine degradation, are diversifying and intensifying in an increasingly globalized world. Marine spatial planning is emerging as a tool for rationalizing competing uses of the marine environment while guarding its quality. A directive guiding the development of such plans by European Union member states is currently being formulated. There is an undeniable need for marine spatial planning. However, we argue that considerable care must be taken with marine spatial planning, as the spatial and temporal scales of maritime activities and of Good Environmental Status may be mismatched. We identify four principles for careful and explicit consideration to align the requirements of the two directives and enable marine spatial planning to support the achievement of Good Environmental Status in Europe's regional seas

When the pain is so acute or if I think that I\u27m going to die : Health care seeking behaviors and experiences of transgender and gender diverse people in an urban area.

IntroductionApproximately 1.4 million transgender and gender diverse (TGD) adults in the United States have unique health and health care needs, including anatomy-driven cancer screening. This study explored the general healthcare experiences of TGD people in the Washington, DC area, and cancer screening experiences in particular.MethodsTwenty-one TGD people were recruited through word of mouth and Lesbian Gay Bisexual Transgender Queer (LGBTQ)-specific community events. Participant interviews were conducted and recorded via WebEx (n = 20; one interview failed to record). Interviews were transcribed using Rev.com. Two coders conducted line-by-line coding for emergent themes in NVivo 12, developed a codebook by consensus, and refined the codebook throughout the coding process. Member checking was conducted to ensure credibility of findings.ResultsThree major themes served as parent nodes: health-care seeking behaviors, quality care, and TGD-specific health care experiences. Within these parent nodes there were 14 child nodes and 4 grand-child nodes. Subthemes for health care seeking behaviors included coverage and costs of care, convenience, trust/mistrust of provider, and provider recommendations for screening. Subthemes for quality of care included professionalism, clinical competence in transgender care, care coordination, provider communication, and patient self-advocacy. Overall, transgender men were less satisfied with care than transgender women.ConclusionsResults suggest a need for improved provider communication skills, including clear explanations of procedures and recommendations for appropriate screenings to TGD patients. Results also suggest a need for improved clinical knowledge and cultural competency. Respondents also wanted better care coordination and insurance navigation. Overall, these findings can inform health care improvements for TGD people