Armoring the Just Transition Activist

The fossil fuel energy system, reinforced by oppressive policies and practices, has disproportionately harmed poor people, Indigenous people, and Brown and Black people and driven the global climate crisis. A just transition, which displaces fossil fuels and redistributes renewable energy resources, requires policies that are rooted in equity and shift power back to the hands of the most vulnerable. Just Transition Activists, leaders, organizers, and changemakers in the just transition movement, must develop transformative skillsets necessary to radically reimagine our world and dismantle the current unequal system of law and policy. This analysis explores the skills, attributes, beliefs, and attitudes for Just Transition Activists required in the pursuit of systemic change in the energy system. Section I discusses the lessons learned from the environmental justice and climate justice movements, which have yet to create the transformative change in the energy system required for a just transition. Section II describes the Just Transition Framework that provides a reimagined path forward to justice in the energy system. And Section III explores a transformative skillset for Just Transition Activists engaged in the energy justice movement. These recommendations were crafted for activists and advocates to build upon lessons learned from earlier movements and develop the skillsets necessary to achieve a truly just society

Prescription drug use among detainees: Prevalence, sources and links to crime

Concern regarding the diversion and non-medical use of prescription pharmaceuticals continues to grow as anecdotal evidence and other research points to a sizeable increase in the illegal market for such drugs. Estimating the prevalence of illegal use and understanding how pharmaceutical drugs come to be traded in the illegal drug market remain key research priorities for policymakers and practitioners in both the public health and law enforcement sectors. This report is the first of its kind in Australia to examine the self-reported use of illicit pharmaceuticals among a sample of police detainees surveyed as part of the Australian Institute of Criminology’s Drug Use Monitoring in Australia (DUMA) program. In all, 986 detainees were interviewed, of which 19 percent reported having recently used pharmaceutical drugs for non-medical purposes in the past 12 months—nearly five times as high as reported by the general Australian population, once again highlighting the value of conducting drug use research among criminal justice populations. In addition, this paper provides policymakers with valuable information about the reasons for use and the methods by which pharmaceuticals are typically accessed for non-medical purposes

HIV/AIDS and time allocation in rural Malawi

AIDS morbidity and mortality are expected to have a large impact on households’ labor supply in rural Malawi since they reduce the time that adults can spend on production for subsistence and on income generating activities. However, the data demands for estimating this impact are high, limiting the amount of empirical evidence. In this paper, we utilize a unique combination of quantitative and qualitative data, including biomarkers for HIV, collected by the Malawi Diffusion and Ideational Change Project, to analyze the impact of AIDS-related morbidity and mortality on time allocation decisions for rural Malawians. We evaluate both the direct effect of HIV/AIDS on the time allocation of affected individuals as well as its indirect effect on the time allocation of surviving household members. We find that the latter is the most important effect of AIDS-related morbidity and mortality, especially on women’s time. Specifically, AIDS induces diversification of income sources, with women reallocating their time from work-intensive (typically farming and heavy chores) to cash-generating tasks (such as casual labor).Africa, AIDS/HIV, economic impact, Malawi, time allocation

The relation of perceptual factors and speed of handwriting to spelling ability.

Thesis (Ed.M.)--Boston Universit

The epidemiology of cirrhosis and abnormal liver function in the general population of the UK

Background Liver disease is a serious problem both in the UK and globally. While the incidence and mortality from several chronic diseases are decreasing, mortality from liver disease is increasing. As well as the medical sequelae for an individual with liver disease, in the UK the increase in chronic liver disease poses particular problems with respect to increasing hospital admissions, mortality and significant costs to the public both in terms of treatment and in loss of productivity. The increase in society of several risk factors for chronic liver disease, notably alcohol intake, obesity and type 2 diabetes, mean that these problems are likely to increase in the future. Despite these apparent problems there are surprisingly few reliable sources of data on the occurrence of chronic liver disease (cirrhosis) in the general population of the UK and the rate and consequence of disease progression particularly among ambulatory patients. Nor are their robust estimates of the prevalence of abnormal liver function tests (which may represent undiagnosed liver disease) and their associations with mortality. This thesis utilises two distinct datasets to examine separate areas of interest in the epidemiology of liver disease in the UK. The first three studies contained within this thesis are concerned with the epidemiology of cirrhosis in the general population of the UK. The second group of three studies focuses on the prevalence of elevated liver function tests in a population of older people in the UK, the demographic, clinical and lifestyle factors associated with such and the mortality following an elevated liver function test. Objectives 1. To estimate the incidence and prevalence of cirrhosis in the population of the UK 2. To describe the mortality associated with cirrhosis compared with the general population and the disease progression of cirrhosis 3. To estimate the prevalence of elevated liver function tests among people aged 75 and over in the UK 4. To describe the association between elevated liver function test and demographic, lifestyle, clinical characteristics and mortality among people aged 75 and over. Methods To examine objectives 1 and 2 I utilised the General Practice Research Database (GPRD) constructing a population based cohort of 4537 subjects with cirrhosis and 44,403 age, sex and practice matched controls. I used Poisson regression to estimate incidence rate ratios and describe trends in alcoholic and non-alcohol-related cirrhosis. Using Cox regression within an historical matched cohort design I estimated the absolute excess mortality rates and hazard ratios for mortality in people with cirrhosis compared to the general population. I described the probability of progressing from one disease state to another. To examine objectives 3 and 4 I accessed data from one arm of the Medical Research Council (MRC) Trial of Assessment and Management of Older People in the Community, a representative sample of community dwelling people aged 75 and over, totalling 15,308 participants. The prevalence of abnormal liver function was described as the proportion of study participants with elevated aspartate transaminase, alkaline phosphatase or serum bilirubin. Associations between elevated liver function and demographic, lifestyle and clinical factors were examined using multivariable logistic regression. I determined the absolute mortality rates and hazard ratios for all-cause and cause-specific mortality using a Cox proportional hazards model. Findings Epidemiology of cirrhosis (GPRD) These studies have shown an increasing trend in both the incidence and prevalence of cirrhosis in the UK with an estimated 45% increase in incidence of cirrhosis in the 10-year period studied. I estimate that 76 per 100,000 people were living with cirrhosis in 2001. Just over half of all cirrhosis was associated with alcoholism. Disease progression with cirrhosis among this mainly ambulatory population was rapid with a rate of decompensation in people with compensated disease of 5% per year and 1 in 10 dying in the first year following diagnosis. This figure increased to 25% of people dying within one year for those with decompensated disease. Mortality in subjects with compensated and decompensated cirrhosis was 93.4 and 178.0 per 1000 person years compared with only 19.2 per 1000 person years in the general control population. Following adjustment for age and sex people with compensated and decompensated disease were respectively 5 and 10 times more likely to die than the general population. Epidemiology of abnormal liver function tests (MRC cohort) Abnormalities in liver function were common with roughly 1 in 6 people aged 75 and over having at least one elevated liver enzyme, although most of these elevations were mild. A single elevated measurement of aspartate transaminase was associated with an increased consumption of alcohol and a lower age in contrast with that of a single measurement of alkaline phosphatase which showed an association with higher age and lower alcohol consumption. An elevated bilirubin measurement was strongly associated with being male. Having a single elevated liver function test was associated with a modest increase in the hazard of death compared with people with normal liver function tests (adjusted hazard ratio for death 1.27 (95% CI[1.19, 1.36]). As well as an unsurprising increase in the hazard ratio for death from liver disease, elevated aspartate transaminase or alkaline phosphatase were both associated with modest increases in the hazard of death from cancer (adjusted hazard ratios of 1.56 (95%CI[1.21, 2.01]) and 1.61 (95%CI[1.39, 1.86]) respectively). Elevated alkaline phosphatase was additionally associated with increases in the hazard of death from respiratory disease (adjusted hazard ratio 1.58 (95%CI[1.32, 1.90])) and cardiovascular disease (adjusted hazard ratio 1.34 (95%CI[1.17, 1.55])). Conclusions From my work on the incidence and prevalence of cirrhosis I estimate that a minimum of 31,000 people in the UK are living with cirrhosis, a figure which is likely to rise given increasing trends in the incidence of cirrhosis described in this thesis. The significant mortality and disease progression associated with cirrhosis means that more needs to be done to combat both the incidence and progression of this disease both on an individual and population level. Elevations in enzymes regarded as reflecting liver function are common in people aged 75 and over and in most people these abnormalities are less than 2x the upper limit of normal for the assays used. These elevations I observed are associated with both a modest increase in all-cause mortality and also with an increase in death due to specific causes. Rather than simply a marker of liver function the investigation of people with elevated liver function tests, particularly those with severely elevated tests, may lead to the identification of potentially treatable conditions that underlie death

The epidemiology of cirrhosis and abnormal liver function in the general population of the UK

Background Liver disease is a serious problem both in the UK and globally. While the incidence and mortality from several chronic diseases are decreasing, mortality from liver disease is increasing. As well as the medical sequelae for an individual with liver disease, in the UK the increase in chronic liver disease poses particular problems with respect to increasing hospital admissions, mortality and significant costs to the public both in terms of treatment and in loss of productivity. The increase in society of several risk factors for chronic liver disease, notably alcohol intake, obesity and type 2 diabetes, mean that these problems are likely to increase in the future. Despite these apparent problems there are surprisingly few reliable sources of data on the occurrence of chronic liver disease (cirrhosis) in the general population of the UK and the rate and consequence of disease progression particularly among ambulatory patients. Nor are their robust estimates of the prevalence of abnormal liver function tests (which may represent undiagnosed liver disease) and their associations with mortality. This thesis utilises two distinct datasets to examine separate areas of interest in the epidemiology of liver disease in the UK. The first three studies contained within this thesis are concerned with the epidemiology of cirrhosis in the general population of the UK. The second group of three studies focuses on the prevalence of elevated liver function tests in a population of older people in the UK, the demographic, clinical and lifestyle factors associated with such and the mortality following an elevated liver function test. Objectives 1. To estimate the incidence and prevalence of cirrhosis in the population of the UK 2. To describe the mortality associated with cirrhosis compared with the general population and the disease progression of cirrhosis 3. To estimate the prevalence of elevated liver function tests among people aged 75 and over in the UK 4. To describe the association between elevated liver function test and demographic, lifestyle, clinical characteristics and mortality among people aged 75 and over. Methods To examine objectives 1 and 2 I utilised the General Practice Research Database (GPRD) constructing a population based cohort of 4537 subjects with cirrhosis and 44,403 age, sex and practice matched controls. I used Poisson regression to estimate incidence rate ratios and describe trends in alcoholic and non-alcohol-related cirrhosis. Using Cox regression within an historical matched cohort design I estimated the absolute excess mortality rates and hazard ratios for mortality in people with cirrhosis compared to the general population. I described the probability of progressing from one disease state to another. To examine objectives 3 and 4 I accessed data from one arm of the Medical Research Council (MRC) Trial of Assessment and Management of Older People in the Community, a representative sample of community dwelling people aged 75 and over, totalling 15,308 participants. The prevalence of abnormal liver function was described as the proportion of study participants with elevated aspartate transaminase, alkaline phosphatase or serum bilirubin. Associations between elevated liver function and demographic, lifestyle and clinical factors were examined using multivariable logistic regression. I determined the absolute mortality rates and hazard ratios for all-cause and cause-specific mortality using a Cox proportional hazards model. Findings Epidemiology of cirrhosis (GPRD) These studies have shown an increasing trend in both the incidence and prevalence of cirrhosis in the UK with an estimated 45% increase in incidence of cirrhosis in the 10-year period studied. I estimate that 76 per 100,000 people were living with cirrhosis in 2001. Just over half of all cirrhosis was associated with alcoholism. Disease progression with cirrhosis among this mainly ambulatory population was rapid with a rate of decompensation in people with compensated disease of 5% per year and 1 in 10 dying in the first year following diagnosis. This figure increased to 25% of people dying within one year for those with decompensated disease. Mortality in subjects with compensated and decompensated cirrhosis was 93.4 and 178.0 per 1000 person years compared with only 19.2 per 1000 person years in the general control population. Following adjustment for age and sex people with compensated and decompensated disease were respectively 5 and 10 times more likely to die than the general population. Epidemiology of abnormal liver function tests (MRC cohort) Abnormalities in liver function were common with roughly 1 in 6 people aged 75 and over having at least one elevated liver enzyme, although most of these elevations were mild. A single elevated measurement of aspartate transaminase was associated with an increased consumption of alcohol and a lower age in contrast with that of a single measurement of alkaline phosphatase which showed an association with higher age and lower alcohol consumption. An elevated bilirubin measurement was strongly associated with being male. Having a single elevated liver function test was associated with a modest increase in the hazard of death compared with people with normal liver function tests (adjusted hazard ratio for death 1.27 (95% CI[1.19, 1.36]). As well as an unsurprising increase in the hazard ratio for death from liver disease, elevated aspartate transaminase or alkaline phosphatase were both associated with modest increases in the hazard of death from cancer (adjusted hazard ratios of 1.56 (95%CI[1.21, 2.01]) and 1.61 (95%CI[1.39, 1.86]) respectively). Elevated alkaline phosphatase was additionally associated with increases in the hazard of death from respiratory disease (adjusted hazard ratio 1.58 (95%CI[1.32, 1.90])) and cardiovascular disease (adjusted hazard ratio 1.34 (95%CI[1.17, 1.55])). Conclusions From my work on the incidence and prevalence of cirrhosis I estimate that a minimum of 31,000 people in the UK are living with cirrhosis, a figure which is likely to rise given increasing trends in the incidence of cirrhosis described in this thesis. The significant mortality and disease progression associated with cirrhosis means that more needs to be done to combat both the incidence and progression of this disease both on an individual and population level. Elevations in enzymes regarded as reflecting liver function are common in people aged 75 and over and in most people these abnormalities are less than 2x the upper limit of normal for the assays used. These elevations I observed are associated with both a modest increase in all-cause mortality and also with an increase in death due to specific causes. Rather than simply a marker of liver function the investigation of people with elevated liver function tests, particularly those with severely elevated tests, may lead to the identification of potentially treatable conditions that underlie death

The Impact of Complications and Errors on Surgeons

Background Adverse events within the context of healthcare can lead to significant physician psychological distress. Contemporary research links the experience of adverse events to the prevalence of burnout, depression, and impaired quality of life. Most of the prevailing literature focuses on the impact of adverse events on all healthcare professionals. This PhD thesis recognises that some aspects of medical practice are exclusive to surgery, and the role of the surgeon. Therefore, this research investigates the unique impact of adverse events on surgeons. Furthermore, sub-types of adverse event (complication vs error) experienced within healthcare are often conflated within the literature, with very little differentiation made between a recognised complication of a surgery, and an error made by the surgeon. This research comprises a quantitative study exploring the impact of complications and errors on surgeons: Exploring the effect of type of adverse event on psychological outcomes and providing insight into the experience of surgeons following an adverse event, using surgeon responses to standardised measures to establish predictive statistical models. Methods UK Surgeons were invited to participate in an online survey. An opportunistic sampling strategy was used, involving organisations such as the Royal College of Surgeons of England and appeals at surgeons’ conferences and events. A single-factor (event: error or complication) between-groups design was used. Demographic and professional information, such as current grade and surgical specialty was collected. A detailed account of the nominated adverse event and the impact that this had on them in both a professional and personal capacity was then gathered. Standardised measures utilised within the survey, included the Work-related Acceptance and Action Questionnaire (WAAQ), the Primary Care PTSD Screen (PC-PTSD), the Brief Resilience Scale (BRS), the 21 item Depression, Anxiety and Stress Scale (DASS-21) and the Big Five Inventory personality measure (BFI). Results 445 surgeons completed the online survey. The extent to which surgeons are negatively affected by adverse events is significant. The data demonstrates that surgeons are negatively affected by adverse events, but do not possess the adaptive coping strategies to deal with them effectively. Confirmatory factor analysis confirmed five input variables within the model: event type (complication or error), nature of event (emergency or elective), severity of patient outcome (categorised by Clavien-Dindo score), timeframe of event occurring, and formal investigation. SEM identified three observed variables; feelings, PTS symptomology and worry about colleagues. The relationships between the input and observed variables were found to be moderated by training and personality factors and were mediated by resilience and psychological flexibility. Conclusion Prior to this research, it was unclear how surgeons were psychologically affected when they experienced an adverse surgical event. This gap within our understanding meant that any training, support, or intervention strategies would be unlikely to meet the specific needs of surgeons who were negatively affected. Given the mediating effects of resilience and psychological flexibility against negative outcomes, strategies should be incorporated to maximise these traits within surgeons. The findings from this research support targeted interventions focussing on the development of individual resilience and psychological flexibility. The need for changes to surgical culture are addressed, and recommendations are made to ensure that training, interventions, and support pathways within surgical training and the wider NHS are fit for purpose

Design Innovation for Engaging and Accessible Digital Aphasia Therapies: Framework Analysis of the iReadMore App Co-Design Process

Background: iReadMore is a digital therapy for people with acquired reading impairments (known as alexia) caused by brain injury or neurodegeneration. A phase II clinical trial demonstrated the efficacy of the digital therapy research prototype for improving reading speed and accuracy in people with poststroke aphasia (acquired language impairment) and alexia. However, it also highlighted the complexities and barriers to delivering self-managed therapies at home. Therefore, in order to translate the positive study results into real-world benefits, iReadMore required subsequent design innovation. Here, we present qualitative findings from the co-design process as well as the methodology. / Objective: We aimed to present a methodology for inclusive co-design in the redesign of a digital therapy prototype, focusing on elements of accessibility and user engagement. We used framework analysis to explore the themes of the communications and interactions from the co-design process. / Methods: This study included 2 stages. In the first stage, 5 in-person co-design sessions were held with participants living with poststroke aphasia (n=22) and their carers (n=3), and in the second stage, remote one-to-one beta-testing sessions were held with participants with aphasia (n=20) and their carers (n=5) to test and refine the final design. Data collection included video recordings of the co-design sessions in addition to participants’ written notes and drawings. Framework analysis was used to identify themes within the data relevant to the design of digital aphasia therapies in general. / Results: From a qualitative framework analysis of the data generated in the co-design process, 7 key areas of consideration for digital aphasia therapies have been proposed and discussed in context. The themes generated were agency, intuitive design, motivation, personal trajectory, recognizable and relatable content, social and sharing, and widening participation. This study enabled the deployment of the iReadMore app in an accessible and engaging format. Conclusions: Co-design is a valuable strategy for innovating beyond traditional therapy designs to utilize what is achievable with technology-based therapies in user-centered design. The co-designed iReadMore app has been publicly released for use in the rehabilitation of acquired reading impairments. This paper details the co-design process for the iReadMore therapy app and provides a methodology for how inclusive co-design can be conducted with people with aphasia. The findings of the framework analysis offer insights into design considerations for digital therapies that are important to people living with aphasia

OPTIMA Case Study 1 : TransMed Student Conference

TransMed was a student-driven cross-CDT competition held in Edinburgh in May 2016. More than 100 attendees enjoyed two days of science, socialising and inter-CDT cohort building. This has now become a regular addition to the CDT calendar, with other CDTs hosting the conference around the country

Is the infant car seat challenge useful?:A pilot study in a simulated moving vehicle

Background and objective The American Academy of Pediatrics recommends that preterm infants complete a predischarge 'car seat challenge' observation for cardiorespiratory compromise while in a car seat. This static challenge does not consider the more upright position in a car or the vibration of the seat when the car is moving. This pilot study was designed to assess the cardiorespiratory effects of vibration, mimicking the effect of being in a moving car, on preterm and term infants. Methods A simulator was designed to reproduce vertical vibration similar to that in a rear-facing car seat at 30 mph. 19 healthy newborn term and 21 preterm infants, ready for hospital discharge, underwent cardiorespiratory measurements while lying flat in a cot (baseline), static in the seat (30°), simulator (40°) and during motion (vibration 40°). Results Median test age was 13 days (range 1-65 days) and median weight was 2.5 kg (IQR: 2.1-3.1 kg). Compared with baseline observations, only the total number of desaturations was significantly increased when infants were placed at 30° (p=0.03). At 40°, or with vibration, respiratory and heart rates increased and oxygen saturation decreased significantly. Profound desaturations &lt;85% significantly increased during motion, regardless of gestational age. Conclusions This is the first study to assess the effect of motion on infants seated in a car safety seat. Term and preterm infants showed significant signs of potentially adverse cardiorespiratory effects in the upright position at 40°, particularly with simulated motion, not identified in the standard challenge. A larger study is required to investigate the significance of these results.</p