WHOSE LAND IS IT ANYWAY? ENDANGERED SPECIES, PRIVATE PROPERTY, AND THE FIGHT FOR THE ENVIRONMENT

Land Economics/Use,

An Integrated Assessment of Archaeobotanical Recovery Methods in the Neotropical Rainforest of Northern Belize: Flotation and Dry Screening

This report presents results of a study examining the ancient use of plants at four Late Classic (CE 600-900) Maya rural farmsteads in northwestern Belize. Our research specifically targeted residential middens for macrobotanical recovery. Samples yielded the remains of more than a dozen plant families, representing some genera that do not currently grow in the area. These plants were used in the Late Classic, countering the idea that ancient botanical remains do not survive in Neotropical archaeological contexts. We also evaluated two macrobotanical sample processing methods vis-à-vis one another: flotation and dry screening. Our results indicate that flotation recovered 58% more seeds than dry screening, while dry screening yielded almost twice as much charcoal and other wood as flotation. The divergent quantities in the types of material recovered suggest a comprehensive macrobotanical recovery program should include the use of both processing methods

Improving Medication Management after a Hospitalization with Pharmacist Home Visits and Electronic Personal Health Records: An Observational Study

Background: Substantial opportunity exists to improve medication management in the period following a hospital discharge. The objective of this study was to assess and improve medication management during care transitions through pharmacist home visits and the use of an electronic personal health record (ePHR) system. Methods: Recently discharged patients aged 50 years or older and having a chronic medical condition were offered the opportunity to meet with a pharmacist in the home setting to review medication instructions and receive a demonstration of an ePHR system. Patients agreeable to using the ePHR system were offered pharmacist support with setting up the ePHR system, having emphasis on documenting and reviewing medication regimens. Medication-related problems identified by the pharmacist during the visit were categorized according to ePHR use and by other characteristics. Results: Thirty recently discharged patients with chronic disease were visited by a pharmacist over a 6-month period. The percentage of medication-related problems identified by the pharmacist was greater among those patients who agreed to use the ePHR system, as compared with patients whose visit did not include use of the ePHR (75% versus 40%, respectively; P=0.06). Differing types of medication-related problems were identified, including therapy duplications, lack of use of clinically important therapies, and patient nonadherence. Conclusion: For some patients, the home setting can be a suitable venue for medication review and education after discharge from hospital. Assisting patients with setting up the ePHR system may enhance pharmacists’ ability to identify and resolve medication-related problems that may lead to rehospitalization

Reflections on the CODES trial for adults with Dissociative Seizures: what we found and considerations for future studies

The COgnitive behavioural therapy versus standardised medical care for adults with Dissociative non-Epileptic Seizures (CODES) multi-centre randomised controlled trial is the largest, fully-powered study to test the clinical and cost effectiveness of a psychotherapeutic intervention in this population. We also explored predictors or moderators of outcomes and investigated mechanisms of change in therapy. In this current review of findings, we discuss issues related to the design of the trial and consider the study’s nested qualitative studies which were done not only to shed light on the original research questions but to provide insights and recommendations for other researchers in the field of functional neurological disorder. Finally, we consider issues relating to the possible clinical application of our study findings

How does cognitive behaviour therapy for dissociative seizures work? A mediation analysis of the CODES Trial

Background We compared dissociative seizure specific cognitive behaviour therapy (DS-CBT) plus standardised medical care (SMC) to SMC alone in a randomised controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. Methods We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: a) beliefs about emotions, b) a measure of avoidance behaviour, c) anxiety and d) depression. Results All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures, WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behaviour, anxiety and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behaviour. Conclusions Our findings largely confirmed the logic model underlying the development of CBT for patients with dissociative seizures. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes. <br/