Exploring the Impact of Mental Capacity on Breast Screening for Women with Intellectual Disabilities

This study explores the impact of mental capacity in relation to breast screening for women with intellectual disabilities (ID) in the UK. Participation in breast screening is considerably lower for women with ID compared to the general population. Barriers to screening include poor mobility and behavioural difficulties. There is currently no research which primarily explores the relationship between mental capacity and breast screening for this group of individuals. This paper presents the results of a cross sectional survey of 131 women with ID supported by eight Social Care Providers within England and Wales. The data was collected between January 2017 and July 2017. The current research explores the decision-making process surrounding breast screening, considering the impact of associated risk factors during this process. Participants completed a specifically created survey addressing the aforementioned issues. The results indicated that women who lacked capacity, were less likely to engage in breast screening. It was also demonstrated that the process outlined in the Mental Capacity Act (MCA) (2005) was not always followed; women were not routinely assessed if there were doubts regarding their decision-making ability around breast screening and best interest meetings (BIM) were not always held if the person lacked capacity. In order to be able to generalise the current findings, further research is needed to gain a broader understanding of how professionals make decisions surrounding breast screening for women with ID if the individuals are unable to decide this independently

AGENDA: The National Forest Management Act in a Changing Society, 1976-1996: How Well Has It Worked in the Past 20 Years?: Will It Work in the 21st Century?

Conference speakers include University of Colorado School of Law professors David H. Getches and Charles F. Wilkinson. Jack Ward Thomas, Chief of the USDA Forest Service, will be a featured speaker at the Center\u27s annual public lands conference, commemorating the 20th anniversary of the National Forest Management Act. This year\u27s conference is sponsored by Colorado State University, Oregon State University, Pinchot Institute for Conservation, and the Maxwell School of Citizenship and Public Affairs at Syracuse University. When Congress passed NFMA in 1976, few would have imagined the enormity of the changes in the world in technology, science and population we have witnessed in the last 20 years. Has NFMA provided the vision and guidance needed to meet the challenges of our dynamic society? Topics include: NFMA: Our Expectations and the Law; NFMA in Context: Courts, Tribes, Agencies and Laws; NFMA in a Dynamic Society; Reflections from the 7th American Forest Congress; and Looking to the 21st Century: Is NFMA Adequate? Other featured speakers include Charles F. Wilkinson, Moses Lasky Professor of Law at the University of Colorado School of Law, who will provide the keynote address; R. Max Peterson, who was U.S. Forest Service Chief from 1979 to 1987; and John McGuire, Chief during the passage of NFMA

AGENDA: The National Forest Management Act in a Changing Society, 1976-1996: How Well Has It Worked in the Past 20 Years?: Will It Work in the 21st Century?

Conference speakers include University of Colorado School of Law professors David H. Getches and Charles F. Wilkinson. Jack Ward Thomas, Chief of the USDA Forest Service, will be a featured speaker at the Center\u27s annual public lands conference, commemorating the 20th anniversary of the National Forest Management Act. This year\u27s conference is sponsored by Colorado State University, Oregon State University, Pinchot Institute for Conservation, and the Maxwell School of Citizenship and Public Affairs at Syracuse University. When Congress passed NFMA in 1976, few would have imagined the enormity of the changes in the world in technology, science and population we have witnessed in the last 20 years. Has NFMA provided the vision and guidance needed to meet the challenges of our dynamic society? Topics include: NFMA: Our Expectations and the Law; NFMA in Context: Courts, Tribes, Agencies and Laws; NFMA in a Dynamic Society; Reflections from the 7th American Forest Congress; and Looking to the 21st Century: Is NFMA Adequate? Other featured speakers include Charles F. Wilkinson, Moses Lasky Professor of Law at the University of Colorado School of Law, who will provide the keynote address; R. Max Peterson, who was U.S. Forest Service Chief from 1979 to 1987; and John McGuire, Chief during the passage of NFMA

Has primary care antimicrobial use really been increasing? Comparison of changes in different prescribing measures for a complete geographic population 1995-2014

Objectives To elucidate how population trends in total antimicrobials dispensed in the community translate into individual exposure. Methods Retrospective, population-based observational study of all antimicrobial prescribing in a Scottish region in financial years 1995, 2000 and 2005–14. Analysis of temporal changes in all antimicrobials and specific antimicrobials measured in: WHO DDD per 1000 population; prescriptions per 1000 population; proportion of population with ≥1 prescription; mean number of prescriptions per person receiving any; mean DDD per prescription. Results Antimicrobial DDD increased between 1995 and 2014, from 5651 to 6987 per 1000 population [difference 1336 (95% CI 1309–1363)]. Prescriptions per 1000 fell (from 821 to 667, difference –154, –151 to –157), as did the proportion prescribed any antimicrobial [from 39.3% to 30.8% (–8.5, –8.4 to –8.6)]. Rising mean DDD per prescription, from 6.88 in 1995 to 10.47 in 2014 (3.59, 3.55–3.63), drove rising total DDD. In the under-5s, every measure fell over time (68.2% fall in DDD per 1000; 60.7% fall in prescriptions per 1000). Among 5–64 year olds, prescriptions per 1000 were lowest in 2014 but among older people, despite a reduction since 2010, the 2014 rate was still higher than in 2000. Trends in individual antimicrobials provide some explanation for overall trends. Conclusions Rising antimicrobial volumes up to 2011 were mainly due to rising DDD per prescription. Trends in dispensed drug volumes do not readily translate into information on individual exposure, which is more relevant for adverse consequences including emergence of resistance.PostprintPeer reviewe

The UK's exit charge from the EU: insights from modes of accounting

Whatever the final charge on the UK for leaving the EU, the money itself is relatively marginal to the former's public finances. However, this charge is politically sensitive and financially aggravating during one of the longest periods of fiscal austerity in the UK's history. The ways in which leaving is conceptualized have implications for any continuing financial obligations that must be managed within the context of fiscal austerity and political uncertainty. Yet, leaving the EU is a unique transaction: it is not analogous, for example, to a divorce settlement, the leaving of a club, the termination of a commercial contract, the leaving of a treaty‐based international organization, or secession from a state. Analysing the formulation of the charge in terms of the four modes of government accounting—financial reporting, statistical accounting, budgeting, and fiscal sustainability projections—enhances its fiscal transparency. It evidences not only the weakness and inconsistency of the UK's negotiating position but also the dominance in EU thinking of the short‐term budgetary calculations of the 2014–20 Multiannual Financial Framework over its long‐term sustainability without a large net contributor. The final amount paid by the UK will depend on the resolution of competing perspectives as well as on liabilities and contingent liabilities associated with the increasingly complex EU financial architecture

The impact of migration on tuberculosis epidemiology and control in high-income countries: a review.

Tuberculosis (TB) causes significant morbidity and mortality in high-income countries with foreign-born individuals bearing a disproportionate burden of the overall TB case burden in these countries. In this review of tuberculosis and migration we discuss the impact of migration on the epidemiology of TB in low burden countries, describe the various screening strategies to address this issue, review the yield and cost-effectiveness of these programs and describe the gaps in knowledge as well as possible future solutions.The reasons for the TB burden in the migrant population are likely to be the reactivation of remotely-acquired latent tuberculosis infection (LTBI) following migration from low/intermediate-income high TB burden settings to high-income, low TB burden countries.TB control in high-income countries has historically focused on the early identification and treatment of active TB with accompanying contact-tracing. In the face of the TB case-load in migrant populations, however, there is ongoing discussion about how best to identify TB in migrant populations. In general, countries have generally focused on two methods: identification of active TB (either at/post-arrival or increasingly pre-arrival in countries of origin) and secondly, conditionally supported by WHO guidance, through identifying LTBI in migrants from high TB burden countries. Although health-economic analyses have shown that TB control in high income settings would benefit from providing targeted LTBI screening and treatment to certain migrants from high TB burden countries, implementation issues and barriers such as sub-optimal treatment completion will need to be addressed to ensure program efficacy

Industrial SO2 pollution and agricultural losses in China: evidence from heavy air polluters

This paper aims to assess the agricultural losses caused by the 2069 state-monitored heavily air polluting enterprises located in 899 Chinese counties. We examine the correlation between per capita number of state-monitored enterprises and other socio-economic indices to show the negative impacts of sulphur dioxide (SO2) industrial air pollution on agricultural development in the regions. Despite these enterprises being the main drivers of economic development in China’s counties, surrounding agricultural land continues to be degraded because of the associated SO2 emissions. The cost of agricultural losses due to pollution is estimated at US$ 1.43 billion, representing 0.66% of the total agricultural value added of the 899 Chinese counties. The findings highlight the importance of cleaner production and have policy implications for dealing with industrial air pollution

Breast cancer risk and drinking water contaminated by wastewater: a case control study

BACKGROUND: Drinking water contaminated by wastewater is a potential source of exposure to mammary carcinogens and endocrine disrupting compounds from commercial products and excreted natural and pharmaceutical hormones. These contaminants are hypothesized to increase breast cancer risk. Cape Cod, Massachusetts, has a history of wastewater contamination in many, but not all, of its public water supplies; and the region has a history of higher breast cancer incidence that is unexplained by the population's age, in-migration, mammography use, or established breast cancer risk factors. We conducted a case-control study to investigate whether exposure to drinking water contaminated by wastewater increases the risk of breast cancer. METHODS: Participants were 824 Cape Cod women diagnosed with breast cancer in 1988–1995 and 745 controls who lived in homes served by public drinking water supplies and never lived in a home served by a Cape Cod private well. We assessed each woman's exposure yearly since 1972 at each of her Cape Cod addresses, using nitrate nitrogen (nitrate-N) levels measured in public wells and pumping volumes for the wells. Nitrate-N is an established wastewater indicator in the region. As an alternative drinking water quality indicator, we calculated the fraction of recharge zones in residential, commercial, and pesticide land use areas. RESULTS: After controlling for established breast cancer risk factors, mammography, and length of residence on Cape Cod, results showed no consistent association between breast cancer and average annual nitrate-N (OR = 1.8; 95% CI 0.6 – 5.0 for ≥ 1.2 vs. < .3 mg/L), the sum of annual nitrate-N concentrations (OR = 0.9; 95% CI 0.6 – 1.5 for ≥ 10 vs. 1 to < 10 mg/L), or the number of years exposed to nitrate-N over 1 mg/L (OR = 0.9; 95% CI 0.5 – 1.5 for ≥ 8 vs. 0 years). Variation in exposure levels was limited, with 99% of women receiving some of their water from supplies with nitrate-N levels in excess of background. The total fraction of residential, commercial, and pesticide use land in recharge zones of public supply wells was associated with a small statistically unstable higher breast cancer incidence (OR = 1.4; 95% CI 0.8–2.4 for highest compared with lowest land use), but risk did not increase for increasing land use fractions. CONCLUSION: Results did not provide evidence of an association between breast cancer and drinking water contaminated by wastewater. The computer mapping methods used in this study to link routine measurements required by the Safe Drinking Water Act with interview data can enhance individual-level epidemiologic studies of multiple health outcomes, including diseases with substantial latency

Ideas, interests and practical authority in reform politics: Decentralization reform in South Korea in the 2000s

Ministry of Education, Singapore under its Academic Research Funding Tier