Environmental ethics and the search for an ecological ethic.

Dept. of Philosophy. Paper copy at Leddy Library: Theses & Major Papers - Basement, West Bldg. / Call Number: Thesis1986 .C687. Source: Masters Abstracts International, Volume: 40-07, page: . Thesis (M.A.)--University of Windsor (Canada), 1986

Environmental Education in Costa Rica: Building a Framework for Sustainable Development?

Environmental education is commonly claimed to be at the centre of efforts to achieve sustainable development. Since the 1980s, Costa Rica has been one of the acknowledged leaders in efforts to promote environmental learning, and national policy includes a threefold national development strategy which simultaneously promotes education, conservation and ecotourism. As of yet, however, what is happening ‘on the ground’ has not been examined in much detail. This article addresses this gap in the literature by providing an overview of the diverse programmes and actors involved in environmental education in Costa Rica, as well as analysing the politics of its implementation

The case of veterinary interprofessional practice: From one health to a world of its own

BACKGROUND: Research regarding the veterinary professions' involvement in interprofessional practice and education (IPE), either with health care professionals as part of One Health, or specifically within the veterinary health care team, is sparse. PURPOSE: To investigate veterinary interprofessional working and learning in veterinary practices; then ultimately to make recommendations for IPE. METHOD: Two case studies in typical but contrasting practices were conducted. The study consisted of three sequential and complementary weeks: 1) observing the whole team, 2) shadowing selected focus individuals from each profession and 3) interviewing focus individuals regarding teamwork. Triangulation was achieved by synthesis of emergent themes from observational field notes and interview transcripts. DISCUSSION: Facilitators to interprofessional practices included hierarchy, trust and value, different perspectives, formal infrastructure and professionalization. Challenges included hierarchy, spatial and temporal work patterns, professional motivations, and error and blame. CONCLUSION: The veterinary and human health care fields face similar interprofessional challenges. Real life observations, as described here, can provide important insight relevant to the design of IPE initiatives

Presuming the influence of the media: teenagers’ constructions of gender identity through sexual/romantic relationships and alcohol consumption

Using empirical data from group discussions and in-depth interviews with 13 to 15-year olds in Scotland, this study explores how teenagers’ alcohol drinking and sexual/romantic relationships were shaped by their quest for appropriate gendered identities. In this, they acknowledged the influence of the media, but primarily in relation to others, not to themselves, thereby supporting Milkie's ‘presumed media influence’ theory. Media portrayals of romantic/sexual relationships appeared to influence teenagers’ constructions of gender-appropriate sexual behaviour more than did media portrayals of drinking behaviour, perhaps because the teenagers had more firsthand experience of observing drinking than of observing sexual relationships. Presumed media influence may be less influential if one has experience of the behaviour portrayed. Drinking and sexual behaviour were highly interrelated: sexual negotiation and activities were reportedly often accompanied by drinking. For teenagers, being drunk or, importantly, pretending to be drunk, may be a useful way to try out what they perceived to be gender-appropriate identities. In sum, teenagers’ drinking and sexual/romantic relationships are primary ways in which they do gender and the media's influence on their perceptions of appropriate gendered behaviour is mediated through peer relationships

Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England

BACKGROUND: Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. METHOD: Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). RESULTS: Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. CONCLUSIONS: ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community

An Exploration of Community Palliative Care Clinical Nurse Specialists Experiences of Working as Independent Prescribers: Part 2

The Department of Health has recently reiterated its commitment to the improvement in the quality of end of life care and emphasized the importance of all patients having rapid access to medication. The aim of this study was to explore the lived experiences of clinical nurse specialists who are able to prescribe independently in their role in providing support for patients with palliative care needs within the community setting. Interpretive phenomenology was employed in order to understand and interpret the experiences of six nurse independent prescribes employed as community palliative care clinical nurse specialists. This purposive sampling was preferred with semi-structured interviews as the most appropriate data collection technique. Participants interviewed reported that being able to prescribe enabled them to provide seamless, holistic care which facilitated faster access to medicines for their patients. This was particularly apparent at weekends when the patient's usual general practitioner (GP) was unavailable. Several benefits of nurse independent prescribing were also highlighted. However, the main barrier identified by most participants was the difficulty in accessing the patient's records. The overwhelming conclusion was that independent prescribing by community nurse specialists is beneficial for patients in the palliative care phase of their life and those deemed important to them as they are being cared for at home. Such benefits can also impact on other aspects of the patient's life including prompt availability of medicines, effective symptom control and consequently, an improved or enhanced quality of life for the patients and job satisfaction for the prescribing specialists nurses

Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

Introduction: Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs. Methods and analysis: A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams. Ethics and dissemination: The study was approved by the London–Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm’s-length bodies and policymakers via publications, seminars and digital platforms. Trial registration number: ClinicalTrials.gov Registry (NCT03586375)

Evaluating specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: The IST-ID mixed methods study

Background Intensive Support Teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost effectiveness of IST models operating in England. Aims To investigate the clinical and cost effectiveness of IST models. Methods We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n=226) from 21 ISTs (10 independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months measured by the Aberrant Behaviour Checklist-Community 2. Results We found no statistically significant differences between models for the primary outcome (adjusted β: 4.27; 95% CI: -6.34 to 14.87; p=0.430) or any secondary outcomes. Quality Adjusted Life Years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI: -£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated. Study registration number ClinicalTrials.gov NCT03586375 ; IRAS 239820; National Institute for Health Research (NIHR) Central Portfolio Management System (CPMS) 38554

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.// Aims: To investigate the clinical and cost-effectiveness of IST models.// Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.// Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated