The development of family mediation: Practitioner perspectives on education.

This study explores the education and training required of family-law mediators as well as professional obstacles to further educational developments in the field. The interdisciplinary disputes occurring within the emergent family-mediation discipline and the issues of existing mediator education, the attitudes of family lawyers and mediators towards one another, and mediation's professionalization process, are examined through the eyes of mediators and family-lawyers practising in Greater London in 1987 and 1988. The basis for this study and its conclusions are: one hundred two extensive interviews with practising mediators; twenty interviews with advisors and senior representatives of all seventeen mediation services; seventeen interviews with registrars and court officials; eighty-eight responses to mediator questionnaires; one hundred fifty-three responses to solicitor questionnaires; visits to thirty-one mediation locations; and observation of sixty-one actual mediation sessions. The most important theoretical divisions among the mediation practitioners revolved around disputant autonomy, child advocacy, and therapy: the majority argued the importance to mediation of the first of these and the inappropriateness of the second and third. The study isolates and explores these divisions. Most practitioners isolated respect for disputant autonomy and conflict- resolution skills as the core attributes needed by mediators. Both the lawyers and non -lawyer mediators expressed reservations about the ability of others to engage in mediation. Most did not suggest limiting mediation to members of their own discipline. The study reveals the lack of justification for such limitations and suggests, instead, the importance of the mediator's personal characteristics. The study also reveals the educational short-comings of the practising mediators and the problematic tendency of untrained mediators to rely on methods emended from other disciplines. Both lawyers and mediators suggested fundamental changes and improvements in the education and training of family mediators

Proteomics Analyses of the Opportunistic Pathogen Burkholderia vietnamiensis Using Protein Fractionations and Mass Spectrometry

The main objectives of this work were to obtain a more extensive coverage of the Burkholderia vietnamiensis proteome than previously reported and to identify virulence factors using tandem mass spectrometry. The proteome of B. vietnamiensis was precipitated into four fractions to as extracellular, intracellular, cell surface and cell wall proteins. Two different approaches were used to analyze the proteins. The first was a gel-based method where 1D SDS-PAGE was used for separation of the proteins prior to reverse phase liquid chromatography tandem mass spectrometry (LC-MS/MS). The second method used MudPIT analysis (Multi dimensional Protein Identification Technique), where proteins are digested and separated using cation exchange and reversed phase separations before the MS/MS analysis (LC/LC-MS/MS). Overall, gel-based LC-MS/MS analysis resulted in more protein identifications than the MudPIT analysis. Combination of the results lead to identification of more than 1200 proteins, approximately 16% of the proteins coded from the annotated genome of Burkholderia species. Several virulence factors were detected including flagellin, porin, peroxiredoxin and zinc proteases

Patient experience of gastrointestinal endoscopy: Informing the development of the Newcastle ENDOPREM

Background Measuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM. Methods Patients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken. Results 35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five ‘procedural stages’ were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety). Conclusion We identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™

The Newcastle ENDOPREM™: a validated patient reported experience measure for gastrointestinal endoscopy

Objectives Measuring patient experience of gastrointestinal (GI) procedures is a key component of evaluation of quality of care. Current measures of patient experience within GI endoscopy are largely clinician derived and measured; however, these do not fully represent the experiences of patients themselves. It is important to measure the entirety of experience and not just experience directly during the procedure. We aimed to develop a patient-reported experience measure (PREM) for GI procedures. Design Phase 1: semi-structured interviews were conducted in patients who had recently undergone GI endoscopy or CT colonography (CTC) (included as a comparator). Thematic analysis identified the aspects of experience important to patients. Phase 2: a question bank was developed from phase 1 findings, and iteratively refined through rounds of cognitive interviews with patients who had undergone GI procedures, resulting in a pilot PREM. Phase 3: patients who had attended for GI endoscopy or CTC were invited to complete the PREM. Psychometric properties were investigated. Phase 4 involved item reduction and refinement. Results Phase 1: interviews with 35 patients identified six overarching themes: anxiety, expectations, information & communication, embarrassment & dignity, choice & control and comfort. Phase 2: cognitive interviews refined questionnaire items and response options. Phase 3: the PREM was distributed to 1650 patients with 799 completing (48%). Psychometric properties were found to be robust. Phase 4: final questionnaire refined including 54 questions assessing patient experience across five temporal procedural stages. Conclusion This manuscript gives an overview of the development and validation of the Newcastle ENDOPREM™, which assesses all aspects of the GI procedure experience from the patient perspective. It may be used to measure patient experience in clinical care and, in research, to compare patients’ experiences of different endoscopic interventions

Identifying invasive species threats, pathways, and impacts to improve biosecurity

Managing invasive species with prevention and early-detection strategies can avert severe ecological and economic impacts. Horizon scanning, an evidence-based process combining risk screening and consensus building to identify threats, has become a valuable tool for prioritizing invasive species management and prevention. We assembled a working group of experts from academic, government, and nonprofit agencies and organizations, and conducted a multi-taxa horizon scan for Florida, USA, the first of its kind in North America. Our primary objectives were to identify high-risk species and their introduction pathways, to detail the magnitude and mechanism of potential impacts, and, more broadly, to demonstrate the utility of horizon scanning. As a means to facilitate future horizon scans, we document the process used to generate the list of taxa for screening. We evaluated 460 taxa for their potential to arrive, establish, and cause negative ecological and socioeconomic impacts, and identified 40 potential invaders, including alewife, zebra mussel, crab-eating macaque, and red swamp crayfish. Vertebrates and aquatic invertebrates posed the greatest invasion threat, over half of the high-risk taxa were omnivores, and there was high confidence in the scoring of high-risk taxa. Common arrival pathways were ballast water, biofouling of vessels, and escape from the pet/aquarium/horticulture trade. Competition, predation, and damage to agriculture/forestry/aquaculture were common impact mechanisms. We recommend full risk analysis for the high-risk taxa; increased surveillance at Florida's ports, state borders, and high-risk pathways; and periodic review and revision of the list. Few horizon scans detail the comprehensive methodology (including list-building), certainty estimates for all scoring categories and the final score, detailed pathways, and the magnitude and mechanism of impact. Providing this information can further inform prevention efforts and can be efficiently replicated in other regions. Moreover, harmonizing methodology can facilitate data sharing and enhance interpretation of results for stakeholders and the general public.</p

Climate change and forest disturbances

Studies of the effects of climate change on forests have focused on the ability of species to tolerate temperature and moisture changes and to disperse, but they have ignored the effects of disturbances caused by climate change (e.g., Ojima et al. 1991). Yet modeling studies indicate the importance of climate effects on disturbance regimes (He et al. 1999). Local, regional, and global changes in temperature and precipitation can influence the occurrence, timing, frequency, duration, extent, and intensity of disturbances (Baker 1995, Turner et al. 1998). Because trees can survive from decades to centuries and take years to become established, climate-change impacts are expressed in forests, in part, through alterations in disturbance regimes (Franklin et al. 1992, Dale et al. 2000). Disturbances, both human-induced and natural, shape forest systems by influencing their composition, structure, and functional processes. Indeed, the forests of the United States are molded by their land-use and disturbance history. Within the United States, natural disturbances having the greatest effects on forests include fire, drought, introduced species, insect and pathogen outbreaks, hurricanes, windstorms, ice storms, and landslides (Figure 1). Each disturbance affects forests differently. Some cause large-scale tree mortality, whereas others affect community structure and organization without causing massive mortality (e.g., ground fires). Forest disturbances influence how much carbon is stored in trees or dead wood. All these natural disturbances interact with human-induced effects on the environment, such as air pollution and land-use change resulting from resource extraction, agriculture, urban and suburban expansion, and recreation. Some disturbances can be functions of both natural and human conditions (e.g., forest fire ignition and spread) (Figure 2). This article examines how eight disturbances influence forest structure, composition, and function and how climate change may influence the severity, frequency, and magnitude of disturbances to forests. We focus on examples from the United States, although these influences occur worldwide. We also consider options for coping with disturbance under changing climate. This analysis points to specific research needs that should improve the understanding of how climate change affects forest disturbances. This paper is one in a series developed by the forest sector of the US National Assessment of the Potential Consequences of Climate Variability and Change. In examining how forests may be affected by climate change, the Forest Sector Committee divided the topic into four areas (processes, diversity, disturbances, and socioeconomics), each of which is the focus of an article in this issue of BioScience. Impacts of climate changes on aquatic disturbances are critical, but this paper focuses on direct terrestrial impacts. The effects of a rise in sea level, coastal processes, and salinity on terrestrial systems are examined in the coastal sector of the national assessment (NAST 2000)

Climate change and forest disturbances

Studies of the effects of climate change on forests have focused on the ability of species to tolerate temperature and moisture changes and to disperse, but they have ignored the effects of disturbances caused by climate change (e.g., Ojima et al. 1991).Yet modeling studies indicate the importance of climate effects on disturbance regimes (He et al. 1999). Local, regional, and global changes in temperature and precipitation can influence the occurrence, timing, frequency, duration, extent, and intensity of disturbances (Baker 1995, Turner et al. 1998). Because trees can survive from decades to centuries and take years to become established, climate-change impacts are expressed in forests, in part, through alterations in disturbance regimes (Franklin et al. 1992, Dale et al. 2000)