You can't take it with you: asset run-down at the end of the life cycle

This article presents evidence on the extent to which households run down their assets after retirement. The authors show that, once corrections are made for several econometric problems, households engage in very little asset decumulation after retirement.Retirement ; Income ; Wealth

Guest editorial: Complexity as a model for social innovation and social entrepreneurship: is there order in the chaos?

The complexity sciences are subject to increasing policy interest from governments and international organisations as a means for fostering both social innovation and social entrepreneurship. However, there remains little conceptual clarity in how theories, concepts and ideas can be used consistently and productively. This article reviews the application of the complexity sciences in social innovation and social entrepreneurship scholarship overall and considers its implications for both fields. We outline how social innovation and social entrepreneurship can be conceptualised as complex processes, set within complex environments, tackling complex goals, and present a suitably revised model of the social innovation lifecycle. Based on this review - and the articles contributed to this special issue of Social Enterprise Journal – we argue that a complexity-informed perspective can contribute to scholarship and practice in three ways: as a rhetorical device, as an analytical framework for empirical analysis, and as a basis for developing new tools and methods for social innovation and social entrepreneurship. In this way academics can play a crucial role in helping policymakers and practitioners interested in the complexity sciences walk a line between fatalism and overstatement

An evaluation of the West of Scotland in-programme Chief Resident role

Background Postgraduate leadership education is an evolving field. Locally we have an established ‘Chief Residency’ programme where centres have two to four senior trainees completing leadership duties alongside clinical workload, supported by local directors of medical education. This is twinned with a 4-day central training programme and peer-support network. Methods To assess perspectives of the CR role, we adopted a qualitative case-study design using an electronic questionnaire delivered to previous chief residents between 2020 and 2023. Results were analysed using thematic analysis. Results Trainees valued involvement within quality improvement and trainee support, demonstrating successful multi-departmental projects. Leadership education was viewed ubiquitously positively but participants felt further work is needed to address role legitimacy locally. A proposed solution was junior doctor leadership teams to address workload and emotional challenges. Conclusion This model provides further evidence of the value in investing in trainee leadership positions, demonstrating organisational impact. Future work will research hospital peer leadership teams

DiSSCo Prepare WP7 –D7.3 Assessment tools and direction map to the implementation of common DiSSCo policies

The Distributed System for Scientific Collections (DiSSCo) Research Infrastructure will operate a number of e-services, all of which will have policy requirements for participating institutions. These policies include those related to digital and physical access to specimens, digital image and specimen metadata, and FAIR / Open Data. Previous projects have shown that the policy landscape is complex, and Task 7.3 has developed a policy self-assessment tool that will allow DiSSCo to assess policy alignment across the consortium. This deliverable describes the development of the policy self-assessment tool and provides a walkthrough of the key features. The same technical framework was used to create a digital maturity tool, which was initially proposed by Task 3.1, and this is also described within this document. A set of recommendations are included that outline the future direction for the development of the policy tool.The Distributed System for Scientific Collections (DiSSCo) Research Infrastructure will operate a number´of e-services, all of which will have policy requirements for participating institutions. These policies include those related to digital and physical access to specimens, digital image and specimen metadata, and FAIR / Open Data. Previous projects have shown that the policy landscape is complex, and Task 7.3 has developed a policy self-assessment tool that will allow DiSSCo to assess policy alignment across the consortium. This deliverable describes the development of the policy self-assessment tool and provides a walkthrough of the key features. The same technical framework was used to create a digital maturity tool, which was initially proposed by Task 3.1, and this is also described within this document. A set of recommendations are included that outline the future direction for the development of the policy tool

Impact of opioid substitution therapy on antiretroviral therapy outcomes:a systematic review and meta-analysis

BACKGROUND: Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID's engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID. METHODS: We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic. RESULTS: We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25). CONCLUSIONS: These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID

Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID). Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART. Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART

Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID). Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART. Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART

Consumo e gênero: uma revisão da produção historiográfica recente sobre a América Latina no século XX

A partir de una revisión de la producción historiográfica reciente que estudia el siglo XX, este artículo muestra la relevancia del género para la construcción de una historia del consumo en América Latina. Con este objetivo, se enfoca el análisis en tres líneas de investigación que, desde una aproximación interseccional, aportan nuevas miradas y preguntas: la primera destaca la dimensión política del consumo, centrándose en la relación entre género y clase; la segunda aborda consumo y trabajo doméstico, señalando el vínculo entre género y nación; y la tercera analiza cultura material y corporalidades, destacando la articulación entre género y edad.Starting from a recent historiographical production’s revision studying the 20th Century, this article depicts the relevance of gender for the history of consumption-building in Latin America. Bearing that in mind, the analysis is geared to three researching lines, contributing with new perspectives and questions, as from an inter sectorial approach: the first one highlights the political dimension of consumption based upon the interaction between gender and class; the second addresses consumption and domestic work, displaying a link between gender and nation, and the third one analyses material culture and corporality emphasizing upon the articulation between gender and age.A partir de uma revisão da produção historiográfica recente que estuda o século XX, este artigo mostra a relevância do gênero para a construção de uma história do consumo na América Latina. Com esse objetivo, a análise está focada em três linhas de pesquisa que, sob uma aproximação interseccional, contribuem com novos olhares e perguntas: a primeira destaca a dimensão política do consumo e foca-se na relação gênero e classe; a segunda aborda consumo e trabalho doméstico, e sinaliza o vínculo entre gênero e nação; a terceira analisa cultura material e corporalidade, e destaca a articulação entre gênero e idade.Fil: Pérez, Inés. Universidad Nacional de Mar del Plata. Facultad de Humanidades. Departamento de Sociologia; Argentina. Universidad Nacional de Mar del Plata. Facultad de Humanidades. Departamento de Historia. Centro de Estudios Históricos; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata; Argentin

STEPWISE - STructured lifestyle Education for People WIth SchizophrEnia : a study protocol for a randomised controlled trial

BACKGROUND: People with schizophrenia are two to three times more likely to be overweight than the general population. The UK National Institute of Health and Care Excellence (NICE) recommends an annual physical health review with signposting to, or provision of, a lifestyle programme to address weight concerns and obesity. The purpose of this randomised controlled trial is to assess whether a group-based structured education programme can help people with schizophrenia to lose weight. METHODS: Design: a randomised controlled trial of a group-based structured education programme. SETTING: 10 UK community mental health trusts. PARTICIPANTS: 396 adults with schizophrenia, schizoaffective, or first-episode psychosis who are prescribed antipsychotic medication will be recruited. Participants will be overweight, obese or be concerned about their weight. INTERVENTION: participants will be randomised to either the intervention or treatment as usual (TAU). The intervention arm will receive TAU plus four 2.5-h weekly sessions of theory-based lifestyle structured group education, with maintenance contact every 2 weeks and 'booster' sessions every 3 months. All participants will receive standardised written information about healthy eating, physical activity, alcohol and smoking. OUTCOMES: the primary outcome is weight (kg) change at 1 year post randomisation. Secondary outcomes, which will be assessed at 3 and 12 months, include: the proportion of participants who maintained or reduced their weight; waist circumference; body mass index; objectively measured physical activity (wrist accelerometer); self-reported diet; blood pressure; fasting plasma glucose, lipid profile and HbA1c (baseline and 1 year only); health-related quality of life (EQ-5D-5L and RAND SF-36); (adapted) brief illness perception questionnaire; the Brief Psychiatric Rating Scale; the Client Service Receipt Inventory; medication use; smoking status; adverse events; depression symptoms (Patient Health Questionnaire-9); use of weight-loss programmes; and session feedback (intervention only). Outcome assessors will be blind to trial group allocation. Qualitative interviews with a subsample of facilitators and invention-arm participants will provide data on intervention feasibility and acceptability. Assessment of intervention fidelity will also be performed. DISCUSSION: The STEPWISE trial will provide evidence for the clinical and cost-effectiveness of a tailored intervention, which, if successful, could be implemented rapidly in the NHS. TRIAL REGISTRATION: ISRCTN19447796 , registered on 20 March 2014

Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT.

BACKGROUND: Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES: To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN: A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING: Ten community mental health trusts in England. PARTICIPANTS: People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS: Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES: The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS: The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS: Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN19447796. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information