Health States of Exception: unsafe non-care and the (inadvertent) production of ‘bare life’ in complex care transitions

This paper draws on the work of Giorgio Agamben to understand how the social organisation of care transitions can reduce people to their 'bare' life thereby making harmful and degrading treatment seemingly legitimate. The findings of a two-year ethnographic study show how some people experience hospital discharge as undignified, inhumane and unsafe process, expressed through their lack of involvement in care planning, delayed discharge from hospital, and poorly coordinated care. Our analysis explores how these experiences stem from the way patients are constituted as 'unknown' and 'ineligible' subjects and, in turn, how professionals become 'not responsible' for their care. In effect the person is reduce to their 'bare' life with limited value within the care system. We suggest the social productio

Trying to end the war on the world: the campaign to proscribe military ecocide

Military ecocide, the destruction of the natural environment in the course of fighting or preparing for war, has a long history and remains a regular feature of contemporary conflicts. Efforts to prohibit this in international law were initiated after the US’ notorious defoliation campaign in the Vietnam War in the 1960s and have advanced since then. Legal ambiguities and the defence of military necessity have limited the application of this body of law but the proscription of ecocide has, nonetheless, progressed and looks set to develop further. Normative change driven by scientists, environmentalists and legal experts has raised awareness of and stigmatised such practises to the extent that recourse to the worst excesses of ecocide now appears to have lessened and some recompense for past crimes has been made. Military activities, though, still inflict a heavy cost on the environment

Mechanisms and ecological role of carbon transfer within coastal seascapes

Worldwide, coastal systems provide some of the most productive habitats, which potentially influence a range of marine and terrestrial ecosystems through the transfer of nutrients and energy. Several reviews have examined aspects of connectivity within coastal seascapes, but the scope of those reviews has been limited to single systems or single vectors. We use the transfer of carbon to examine the processes of connectivity through multiple vectors in multiple ecosystems using four coastal seascapes as case studies. We discuss and compare the main vectors of carbon connecting different ecosystems, and then the natural and human-induced factors that influence the magnitude of effect for those vectors on recipient systems. Vectors of carbon transfer can be grouped into two main categories: detrital particulate organic carbon (POC) and its associated dissolved organic and inorganic carbon (DOC/DIC) that are transported passively; and mobile consumers that transport carbon actively. High proportions of net primary production can be exported over meters to hundreds of kilometers from seagrass beds, algal reefs and mangroves as POC, with its export dependent on wind-generated currents in the first two of these systems and tidal currents for the last. By contrast, saltmarshes export large quantities of DOC through tidal movement, while land run-off plays a critical role in the transport of terrestrial POC and DOC into temperate fjords. Nekton actively transfers carbon across ecosystem boundaries through foraging movements, ontogenetic migrations, or ‘trophic relays’, into and out of seagrass beds, mangroves or saltmarshes. The magnitude of these vectors is influenced by: the hydrodynamics and geomorphology of the region; the characteristics of the carbon vector, such as their particle size and buoyancy; and for nekton, the extent and frequency of migrations between ecosystems. Through a risk-assessment process, we have identified the most significant human disturbances that affect the integrity of connectivity among ecosystems. Loss of habitat, net primary production (NPP) and overfishing pose the greatest risks to carbon transfer in temperate saltmarsh and tropical estuaries, particularly through their effects on nekton abundance and movement. In comparison, habitat/NPP loss and climate change are likely to be the major risks to carbon transfer in temperate fjords and temperate open coasts through alteration in the amount of POC and/or DOC/DIC being transported. While we have highlighted the importance of these vectors in coastal seascapes, there is limited quantitative data on the effects of these vectors on recipient systems. It is only through quantifying those subsidies that we can effectively incorporate complex interactions into the management of the marine environment and its resources

Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency

Background: In recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature. Method: The paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently. Results: This paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims. Conclusions: There is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver

Epibiotic pressure contributes to biofouling invader success

Reduced competition is a frequent explanation for the success of many introduced species. In benthic marine biofouling communities, space limitation leads to high rates of overgrowth competition. Some species can utilise other living organisms as substrate (epibiosis), proffering a competitive advantage for the epibiont. Additionally, some species can prevent or reduce epibiotic settlement on their surfaces and avoid being basibionts. To test whether epibiotic pressure differs between native and introduced species, we undertook ex situ experiments comparing bryozoan larval settlement to determine if introduced species demonstrate a greater propensity to settle as epibionts, and a reduced propensity to be basibionts, than native species. Here we report that introduced species opportunistically settle on any space (bare, native, or introduced), whereas native species exhibit a strong tendency to settle on and near other natives, but avoid settling on or near introduced basibionts. In addition, larvae of native species experience greater larval wastage (mortality) than introduced species, both in the presence and absence of living substrates. Introduced species’ ability to settle on natives as epibionts, and in turn avoid epibiosis as basibionts, combined with significantly enhanced native larval wastage, provides a comprehensive suite of competitive advantages contributing to the invasion success of these biofouling species

Values associated with public involvement in health and social care research: a narrative review

addresses: Mood Disorders Centre, Psychology, University of Exeter, Exeter, UK.OnlineOpen articleMuch has been written about public involvement (PI) in health and social care research, but underpinning values are rarely made explicit despite the potential for these to have significant influence on the practice and assessment of PI.Medical Research Council’s Methodology Research Programm

The ethics of practical reasoning : exploring the terrain

Social work has been under sustained scrutiny regarding the quality of decision-making. The assumption is that social workers make poor quality decisions. And yet our knowledge and understanding of how social workers make decisions is, at best, partial. In our view, examination of practitioner decision-making will be enhanced by considering the role that ethics plays in practical judgement in practice. Although there has been significant work regarding the role of values and ethics in practice, this work tends to idealise morality setting up external standards by which practice is judged. In this paper, we will argue that ethics in practice needs to be understood as more than simply operationalise ideal standards, ethics also entails critical engagement with social and ethical issues and can challenge idealised statements of values. We outline the idea of the ethical dimension of practical reasoning, consider its relationship to professional discretion, judgments and decision-making in order to provide a clear focus for this research agenda, and identify the practical challenges researching ethics in professional decision-making entails

Reduced occupancy of hedgehogs (Erinaceus europaeus) in rural England and Wales: the influence of habitat and an asymmetric intra-guild predator

Agricultural landscapes have become increasingly intensively managed resulting in population declines across a broad range of taxa, including insectivores such as the hedgehog (Erinaceus europaeus). Hedgehog declines have also been attributed to an increase in the abundance of badgers (Meles meles), an intra-guild predator. The status of hedgehogs across the rural landscape at large spatial scales is, however, unknown. In this study, we used footprint tracking tunnels to conduct the first national survey of rural hedgehog populations in England and Wales. Single and two-species occupancy modelling was used to quantify hedgehog occupancy in relation to habitat and predator covariates. Hedgehog occupancy was low (22% nationally), and significantly negatively related to badger sett density and positively related to the built environment. Hedgehogs were also absent from 71% of sites that had no badger setts, indicating that large areas of the rural landscape are not occupied by hedgehogs. Our results provide the first field based national survey of hedgehogs, providing a robust baseline for future monitoring. Furthermore, the combined effects of increasing badger abundance and intensive agriculture may have provided a perfect storm for hedgehogs in rural Britain, leading to worryingly low levels of occupancy over large spatial scales