A Food Secure World: Is the United Nation’s Food and Agriculture Organisation in a position to provide this Global Public Good?

The challenges faced by the global food and agriculture system in the twenty-first century are unlikely to be resolved through the implementation of neoliberal policies, most notably promoting market liberalisation, privatisation and financialisation. Many of these policies have also supported industrial agriculture, which has led to the production of many global public bads, such as significant greenhouse gas emissions and water pollution. However, industrial agriculture is not the only method of food production: sustainable agriculture is better placed to provide a wide range of global public goods (GPGs), including environmental protection and rural livelihood development, in addition to sufficient nutritious food. Therefore, there should be a move towards promoting sustainable agriculture with a focus on eradicating hunger and improving food security. The United Nations’ Food and Agriculture Organisation (FAO) can play a crucial role in ensuring agriculture provides the GPGs required. FAO also produces a number of GPGs through its three main roles; measurement, convening and norms and standards setting. This thesis asks if FAO is in a position to provide a food secure world. It also asks if the organisation is in a stronger position to provide the GPGs required following its extensive recent reform. Finally, it asks if a shift in emphasis towards the provision of GPGs will offer an alternative to neoliberalism

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Making Connections between Teaching Practice and Learning Experience in First Year Design Education

At the College of Fine Arts (COFA), School of Design Studies we offer a four year, integrated, Bachelor of Design, where design is the discipline, not the individual studio practices. One of the challenges in designing the First Year Design Studio Curriculum is that it is necessary to prepare students for six possible studios in years 2 and 3, and they are: Applied/Object, Environments/Spatial, Graphics/Media, Ceramics, Jewellery and Textiles. The first year also includes a number of contextual courses, Computing 1 & 2, Design History and Interactive Systems. How is it possible to incorporate into 2X14 week sessions all that is required? The first year of the Bachelor of Design, integrates theory, conceptual development and studio practice. As first year is the time to establish independent and critical ways of thinking, an integrated approach in the First Year is constructed to introduce an integrated approach. The current structure has been in place since Session 1 2005. This structure introduces students to a mix of experiences and diverse values: - A diverse range of skills - a diverse knowledge base - Global thinking patterns - Effective problem solving skills and - Learning transfer, where connections are made During the continual development of first year studios the aim has always been to develop ways to teach critical and independent thinking skills, a design process and the practical studio skills needed to achieve innovative design outcomes. Three key questions arise within an integrated design program are: 1. What does integration mean in design? 2. What does integration mean in a First Year design education? 3. How does integration translate in the upper years of a program when studio courses are specialised

Project X experiences of multidisciplinary Arch/COFA/Eng teaching

The present paper describes two multidisciplinary design courses, named Project X and Project X2, that were available for the first time in 2007 to students from three design-based faculties at the University of New South Wales (UNSW): Faculty of the Built Environment (FBE), College of Fine Arts (COFA) and Faculty of Engineering (FE). During these courses the students designed, fabricated and constructed from cardboard and timber an enormous sculpture of a snake, nick-named Ed and consisting of five massive arches and a five meter tall head

Project X: A Multi Disciplinary Design Workshop

This paper describes the development and implementation of two multi disciplinary design courses at UNSW, dubbed Project X and Project X2. The courses were originally proposed by the Organising Committee of the ConnectED 2007 Conference, as demonstration courses that might embody the spirit of the Conference. They have been coordinated by representatives from the three design-based faculties at UNSW: Faculty of the Built Environment (FBE), College of Fine Arts (COFA) and Faculty of Engineering (FOE). These faculties are also the host faculties for the Conference. Project X (the Scheme Design Course), ran as an intensive course for three weeks in February 2007. Students from the three Faculties worked together in teams to produce scheme designs against a brief set by the Conference Organising Committee as client for the design. The scheme designs were evaluated first within the course and then by an external Project X Jury. The Jury selected the winning design which was then to be developed and constructed by multidisciplinary teams in Project X2 (the Fabrication and Construction Course). This course is currently running in a standard once-a-week mode in Session 1, 2007. Together, Project X and Project X2 celebrate both the design process and the design education process, and both in their multi-disciplinary dimension. The Project X cross-disciplinary mix, with Faculty of Engineering students working alongside students from the College of Fine Arts, and Faculty of the Built Environment students, is so rich it has been described as cross-cultural. Whether despite or because of this richness, evidence so far from surveys of students and staff indicates a successful outcome in terms of design education experience

Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study

Purpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients

The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections

Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients