15 research outputs found

    Facilitating technology adoption in the NHS: negotiating the organisational and policy context – a qualitative study

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    "WALD BRANDENBURG": WISSENSCHAFTS-INFORMIERTE BÜRGER-DELIBERATIONEN ÜBER NACHHALTIGE WALDNUTZUNG

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    <p>Angesichts zunehmender Klimawandelgefahren wie Dürren und Extremwetter sowie der unvermindert starken Verbissschäden sind die Brandenburger Wälder stark gefährdet in ihrer Multifunktionalität und Nachhaltigkeit (ausbleibende Verjüngung und Diversifizierung der kiefernlastigen Waldstruktur, Krankheiten/Schädlingsbefall, Waldbrände, etc.). Gerade bezüglich des nachhaltigen Managements von Körperschaftswäldern gestaltet sich die Entwicklung von langfristig tragenden und konsensfähigen Nutzungskonzepten oft als äußerst schwierig. Dies ist vorwiegend auf die Komplexität der Herausforderungen sowie teils heftigen Konfliktlinien zwischen diversen Interessensgruppen (Förster- vs. Jägerschaft, Amt/Politik, Naturschutzvereine, Anlieger, Erholungssuchende, Unternehmen, etc.) zurückzuführen. Häufig fühlen sich einige zentrale Akteure zu wenig eingebunden in kommunale Entscheidungsprozesse, was deren Legitimität und Beständigkeit angesichts des langfristigen Zeithorizonts gefährdet. Vor allem aber bleibt den Beteiligten meist unklar, welche eventuell innovativen und kreativen Handlungsoptionen es für die konkreten Kontexte bezüglich einer nachhaltigen Waldnutzung im Klimawandelkontext überhaupt gäbe, und welche Potentiale, Machbarkeit und Nebenwirkungen diese Optionen aus ökologischer, wirtschaftlicher und sozialer Perspektive jeweils haben würden. </p><p>Die Situation des Stadtwaldes in Biesenthal (1.300 ha) steht beispielhaft für diese vielfältigen Problemlagen der Körperschaftswaldstruktur u.a. in Brandenburg. Gesamtziel des DBU-finanzierten, 18-monatigen Vorhabens (2021-22) "Wald Brandenburg" war vor diesem Hintergrund (1) die Durchführung (in Biesenthal) und (2) die inter-kommunale Verbreitung eines neuartigen partizipativen Politikberatungsprozesses über Handlungsalternativen zum Stadtwald. Dieser neuartige Prozess vermag im Unterschied zu üblichen Ansätzen sowohl die inhaltlich-wissenschaftliche als auch die politisch-soziale, konfliktreiche Komplexität von Waldmanagement-Konzepten in sachgerechter und legitimer Weise anzugehen. Es handelt sich um einen gemeinsamen Deliberations- und Lernprozess von Wissenschaft, Bürgerschaft, Politik und Stakeholdern, bei dem Handlungsalternativen zur nachhaltigen Waldnutzung im Lichte der unterschiedlichen Wertvorstellungen und Ziele aller Akteure schrittweise ko-produziert, dann im Lichte ihrer konkreten Auswirkungen bewertet und revidiert und schließlich enggeführt werden, um damit die politischen Entscheidungsträger:innen zu beraten.</p&gt

    Climate change & health: the case for sustainable development.

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    The Earth's climate has been stable for around 10,000 years, though it has been very variable in earlier periods and has occasionally changed abruptly through natural processes. Industrialization and population growth have brought an exponential rise in the use of carbonaceous fuels, which is now having an observable impact on the composition of the atmosphere. Carbon dioxide levels are already substantially above pre-industrial levels, and rising appreciably year on year. Climate models suggest that the anthropogenic rise in carbon dioxide and other greenhouse gases will lead to rapid climate change over the twenty-first century, with an increase in global average temperatures in the region of two to five degrees Celsius. This will present problems of adaptation for many natural systems and have largely negative effects on human health through both direct and indirect mechanisms. There is also a possibility of unpredicted catastrophic impacts arising from non-linear effects of climate change, which may have more damaging effects on human and other populations. Policy responses have to be directed towards both adaptation needs and mitigation. Mitigation in particular presents formidable social, political and technological challenges, but it may bring net health benefits in the short as well as the longer term

    Interdependence

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    How should we respond to the increasingly dense bundle of economic, cultural and ecological interconnections that span the globe and stretch into the future? What kinds of ethical and public engagements are demanded of researchers who work on global environmental, economic and social issues? The term interdependence may provide a powerful framework for advancing thinking and debate both within academia and among wider publics in relation to these questions. Members of the Open University's Geography Department have been working with partners to build the Interdependence Day project. The project combines research, cultural work, communications and public participation in an attempt to make sense of our responsibilities to people distant in space and time, and to the nonhuman natural world. This article reviews nearly a century of deployments of the term interdependence in political and academic writing, introduces the distinctive work that might be done with the term in the critical social sciences, and outlines the Interdependence Day project

    Dousing our inflammatory environment(s): is personal carbon trading an option for reducing obesity- and climate change?

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    Obesity and climate change are two problems currently challenging humanity. Although apparently unrelated, an epidemiological approach to both shows a similar environmental aetiology, based in modern human lifestyles and their driving economic forces. One way of analysing this is through inflammation (defined as ‘. . . a disturbance of function following insult or injury’) of both the internal (biological) and external (ecological) environments. Chronic, low-grade, systemic inflammation has recently been shown to accompany obesity, as well as a range of biological pathologies associated with obesity (diabetes, heart disease, some cancers, etc.). This is influenced by the body\u27s inability to soak up excess glucose as a result of insulin resistance. In a broader sense, inflammation is a metaphor for ecological ‘pathologies’, manifest particularly in unnatural disturbances like climate change, ocean acidity, rising temperatures and species extinction, associated with the inability of the world\u27s environmental ‘sinks’ to soak up carbon dioxide (‘carbon resistance’?). The use of such a metaphorical analysis opens the possibilities for dealing with two interdisciplinary problems simultaneously. Strategies for managing climate change, including personal carbon trading, could provide a ‘stealth intervention’ for reducing population levels of obesity by increasing personal energy expenditure and decreasing energy-dense food intake, as well as reducing the carbon emissions causing climate chang

    Facilitating technology adoption in the NHS : negotiating the organisational and policy context : a qualitative study

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    Background: Proven clinical effectiveness and patient safety are insufficient to ensure adoption and implementation of new clinical technologies. Despite current government policy, clinical technologies are not yet demand-led through commissioning. Hence, adoption and implementation relies on providers. Introducing new technologies initially raises providers’ costs as they necessitate training, alter patient pathways and change patient management, and may lead to reduced patient throughput in the short term. The current funding regime for providers – Payment by Results (PbR) – rewards activity. It is not surprising, therefore, that providers often see new technologies as risky. Objectives: This study investigated the organisational and policy context for the adoption and implementation of clinical technologies, because this context may present barriers that slow – or even prevent – uptake. The research focused on three clinical technologies: insulin pump therapy (IPT); breast lymph node assay (BLNA), a diagnostic tool for metastases; and ultrawide field retinal imaging (UFRI). The implementation of these technologies had been supported by NHS Technology Adoption Centre (NTAC). Methods: The research method was qualitative case studies of these three clinical technologies. The primary data collection technique was semistructured interviews of NTAC staff, clinicians, managers and commissioners, supplemented by documentary evidence, participant and non-participant observation of meetings and videos. For IPT, we also conducted a survey of clinicians and analysed anonymised e-mails from patients. Results: NHS providers did not perceive any central ‘push’ from the Department of Health or the National Institute for Health and Care Excellence (NICE) to adopt, implement or diffuse new clinical technologies. There is a ‘bottom-up’ adoption culture: any trust could choose to adopt any, all or none of the three clinical technologies we investigated. This is undesirable, as clinically efficacious technologies should be equally available to all patients. Where there is NICE guidance, this acted as an enabler for adoption, but some trusts still did not offer IPT despite this. We found that PbR could be a major obstacle to adoption. Our evidence also indicates that, contrary to its intention, commissioning practice is more of a barrier than an enabler of innovation. Protracted negotiations over funding between providers and commissioners delayed implementation of BLNA and IPT. Organisational power and politics between hospitals and community-based services was a significant barrier for adoption of UFRI. Clinicians outside of specialist ophthalmology centres did not understand the clinical utility of UFRI (e.g. its diagnostic potential or how and when to use it). Conclusions: NTAC was successful in assisting trusts over the generic organisational barriers outlined above, particularly with regard to taking responsibility for the logistics of implementation, negotiating new patient pathways and ways of working with relevant stakeholders, and using their skills in project management and stakeholder engagement to drive processes forward. Where there were major obstacles, however, the NTAC process stalled. ‘Bottom-up’ adoption at individual trusts needs to be linked into wider national processes that offer vision, some central direction, further assessment and evaluation, and the infrastructure to ensure diffusion to sites that have the capabilities and capacities to best utilise the clinical technology
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