Making sense of joint commissioning: three discourses of prevention, empowerment and efficiency

Background: In recent years joint commissioning has assumed an important place in the policy and practice of English health and social care. Yet, despite much being claimed for this way of working there is a lack of evidence to demonstrate the outcomes of joint commissioning. This paper examines the types of impacts that have been claimed for joint commissioning within the literature. Method: The paper reviews the extant literature concerning joint commissioning employing an interpretive schema to examine the different meanings afforded to this concept. The paper reviews over 100 documents that discuss joint commissioning, adopting an interpretive approach which sought to identify a series of discourses, each of which view the processes and outcomes of joint commissioning differently. Results: This paper finds that although much has been written about joint commissioning there is little evidence to link it to changes in outcomes. Much of the evidence base focuses on the processes of joint commissioning and few studies have systematically studied the outcomes of this way of working. Further, there does not appear to be one single definition of joint commissioning and it is used in a variety of different ways across health and social care. The paper identifies three dominant discourses of joint commissioning – prevention, empowerment and efficiency. Each of these offers a different way of seeing joint commissioning and suggests that it should achieve different aims. Conclusions: There is a lack of clarity not only in terms of what joint commissioning has been demonstrated to achieve but even in terms of what it should achieve. Joint commissioning is far from a clear concept with a number of different potential meanings. Although this ambiguity can be helpful in some ways in the sense that it can bring together disparate groups, for example, if joint commissioning is to be delivered at a local level then more specificity may be required in terms of what they are being asked to deliver

Developing an emotional coping skills workbook for inpatient psychiatric settings: a focus group investigation

Background: Evidence suggests an unmet need for provision of psychological interventions in inpatient psychiatric settings. However, inpatient wards can present a challenging environment in which to implement interventions. The authors developed the Emotional Coping Skills workbook, a psychosocial intervention designed to overcome these challenges and provide inpatients with an opportunity for psychologically-informed therapeutic engagement. The workbook includes information and exercises to empower inpatients to understand their emotions and learn to cope with their distress. Methods: A qualitative study using thematic analysis was undertaken in two UK inpatient psychiatric hospitals to explore staff’s views about whether and how the workbook could be implemented, and on barriers to its use. Thirty-five nursing and occupational therapy staff members participated in four focus groups, and a further two psychologists in semi-structured interviews. Results: Staff identified key barriers to successful implementation of the workbook. These were firstly, the difficulty in finding time and space for therapeutic work in the stressful ward environment. Secondly, staff identified a culture of emotional neglect whereby neither staff nor inpatients felt able to talk about emotions, and patients’ physical needs and medication were prioritised. Thirdly, staff discussed how psychotic symptoms and emotional distress could limit patients’ ability to engage with the workbook material. Staff suggested ways in which the feasibility of using the workbook could be enhanced. Firstly, they discussed the importance of encouraging staff to value psychological approaches and to view the workbook as a resource to help them manage their existing tasks. Secondly, they emphasised the value of staff drawing on their expertise to deliver the workbook flexibly in different formats and settings, depending on each patient’s particular presentation. Thirdly, they advocated empowering staff to decide the timing of intervention delivery in the context of each inpatient’s fluctuations in distress and progress towards recovery. Conclusions: The study has highlighted key principles for flexible and well-integrated intervention delivery; these principles will be helpful for enhancing the feasibility of any nurse-delivered psychological intervention in inpatient settings

A Tri-Oceanic Perspective: DNA Barcoding Reveals Geographic Structure and Cryptic Diversity in Canadian Polychaetes

Although polychaetes are one of the dominant taxa in marine communities, their distributions and taxonomic diversity are poorly understood. Recent studies have shown that many species thought to have broad distributions are actually a complex of allied species. In Canada, 12% of polychaete species are thought to occur in Atlantic, Arctic, and Pacific Oceans, but the extent of gene flow among their populations has not been tested.Sequence variation in a segment of the mitochondrial cytochrome c oxidase I (COI) gene was employed to compare morphological versus molecular diversity estimates, to examine gene flow among populations of widespread species, and to explore connectivity patterns among Canada's three oceans. Analysis of 1876 specimens, representing 333 provisional species, revealed 40 times more sequence divergence between than within species (16.5% versus 0.38%). Genetic data suggest that one quarter of previously recognized species actually include two or more divergent lineages, indicating that richness in this region is currently underestimated. Few species with a tri-oceanic distribution showed genetic cohesion. Instead, large genetic breaks occur between Pacific and Atlantic-Arctic lineages, suggesting their long-term separation. High connectivity among Arctic and Atlantic regions and low connectivity with the Pacific further supports the conclusion that Canadian polychaetes are partitioned into two distinct faunas.Results of this study confirm that COI sequences are an effective tool for species identification in polychaetes, and suggest that DNA barcoding will aid the recognition of species overlooked by the current taxonomic system. The consistent geographic structuring within presumed widespread species suggests that historical range fragmentation during the Pleistocene ultimately increased Canadian polychaete diversity and that the coastal British Columbia fauna played a minor role in Arctic recolonization following deglaciation. This study highlights the value of DNA barcoding for providing rapid insights into species distributions and biogeographic patterns in understudied groups

Connectivity of larval stages of sedentary marine communities between hard substrates and offshore structures in the North Sea

Man-made structures including rigs, pipelines, cables, renewable energy devices, and ship wrecks, offer hard substrate in the largely soft-sediment environment of the North Sea. These structures become colonised by sedentary organisms and non-migratory reef fish, and form local ecosystems that attract larger predators including seals, birds, and fish. It is possible that these structures form a system of interconnected reef environments through the planktonic dispersal of the pelagic stages of organisms by ocean currents. Changes to the overall arrangement of hard substrate areas through removal or addition of individual man-made structures will affect the interconnectivity and could impact on the ecosystem. Here, we assessed the connectivity of sectors with oil and gas structures, wind farms, wrecks, and natural hard substrate, using a model that simulates the drift of planktonic stages of seven organisms with sedentary adult stages associated with hard substrate, applied to the period 2001–2010. Connectivity was assessed using a classification system designed to address the function of sectors in the network. Results showed a relatively stable overall spatial distribution of sector function but with distinct variations between species and years. The results are discussed in the context of decommissioning of oil and gas infrastructure in the North Sea

Patterns of deep-sea genetic connectivity in the New Zealand region : implications for management of benthic ecosystems

© The Author(s), 2012. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in PLoS One 7 (2012): e49474, doi:10.1371/journal.pone.0049474.Patterns of genetic connectivity are increasingly considered in the design of marine protected areas (MPAs) in both shallow and deep water. In the New Zealand Exclusive Economic Zone (EEZ), deep-sea communities at upper bathyal depths (<2000 m) are vulnerable to anthropogenic disturbance from fishing and potential mining operations. Currently, patterns of genetic connectivity among deep-sea populations throughout New Zealand’s EEZ are not well understood. Using the mitochondrial Cytochrome Oxidase I and 16S rRNA genes as genetic markers, this study aimed to elucidate patterns of genetic connectivity among populations of two common benthic invertebrates with contrasting life history strategies. Populations of the squat lobster Munida gracilis and the polychaete Hyalinoecia longibranchiata were sampled from continental slope, seamount, and offshore rise habitats on the Chatham Rise, Hikurangi Margin, and Challenger Plateau. For the polychaete, significant population structure was detected among distinct populations on the Chatham Rise, the Hikurangi Margin, and the Challenger Plateau. Significant genetic differences existed between slope and seamount populations on the Hikurangi Margin, as did evidence of population differentiation between the northeast and southwest parts of the Chatham Rise. In contrast, no significant population structure was detected across the study area for the squat lobster. Patterns of genetic connectivity in Hyalinoecia longibranchiata are likely influenced by a number of factors including current regimes that operate on varying spatial and temporal scales to produce potential barriers to dispersal. The striking difference in population structure between species can be attributed to differences in life history strategies. The results of this study are discussed in the context of existing conservation areas that are intended to manage anthropogenic threats to deep-sea benthic communities in the New Zealand region.This work was funded in part by a Fulbright Fellowship administered by Fulbright New Zealand and the U.S. Department of State, awarded in 2011 to EKB. Funding and support for research expedition was provided by Land Information New Zealand, New Zealand Ministry of Fisheries, NIWA, Census of Marine Life on Seamounts (CenSeam), and the Foundation for Research, Science and Technology. Other research funding was provided by the New Zealand Ministry of Science and Innovation project “Impacts of resource use on vulnerable deep-sea communities” (FRST contract CO1X0906), the National Science Foundation (OCE-0647612), and the Deep Ocean Exploration Institute (Fellowship support to TMS)

Causes of decoupling between larval supply and settlement and consequences for understanding recruitment and population connectivity

Author Posting. © The Author(s), 2010. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Journal of Experimental Marine Biology and Ecology 392 (2010): 9-21, doi:10.1016/j.jembe.2010.04.008.Marine broadcast spawners have two-phase life cycles, with pelagic larvae and benthic adults. Larval supply and settlement link these two phases and are crucial for the persistence of marine populations. Mainly due to the complexity in sampling larval supply accurately, many researchers use settlement as a proxy for larval supply. Larval supply is a constraining variable for settlement because, without larval supply, there is no settlement. Larval supply and settlement may not be well correlated, however, and settlement may not consistently estimate larval supply. This paper explores the argument that larval supply (i.e., larval abundance near settlement sites) may not relate linearly to settlement. We review the relationship between larval supply and settlement, from estimates and biases in larval supply sampling, to non-behavioral and behavioral components, including small-scale hydrodynamics, competency, gregarious behavior, intensification of settlement, lunar periodicity, predation and cannibalism. Physical and structural processes coupled with behavior, such as small-scale hydrodynamics and intensification of settlement, sometimes result in under- or overestimation of larval supply, where it is predicted from a linear relationship with settlement. Although settlement is a function of larval supply, spatial and temporal processes interact with larval behavior to distort the relationship between larval supply and settlement, and when these distortions act consistently in time and space, they cause biased estimates of larval supply from settlement data. Most of the examples discussed here suggest that behavior is the main source of the decoupling between larval supply and settlement because larval behavior affects the vertical distribution of larvae, the response of larvae to hydrodynamics, intensification of settlement, gregariousness, predation and cannibalism. Thus, larval behavior seems to limit broad generalizations on the regulation of settlement by larval supply. Knowledge of the relationship is further hindered by the lack of a well founded theoretical relationship between the two variables. The larval supply- settlement transition may have strong general consequences for population connectivity, since larval supply is a result of larval transport, and settlement constrains recruitment. Thus, measuring larval supply and settlement effectively allows more accurate quantification and understanding of larval transport, recruitment and population connectivity.JP would like to thank WHOI Ocean Life Institute for partial funding. FP’s contribution is based upon research supported by the South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation

Organotin compounds in surface sediments of the Southern Baltic coastal zone: a study on the main factors for their accumulation and degradation

Abstract Sediment samples were collected in the Gulf of Gdańsk, and the Vistula and Szczecin Lagoons—all located in the coastal zone of the Southern Baltic Sea—just after the total ban on using harmful organotins in antifouling paints on ships came into force, to assess their butyltin and phenyltin contamination extent. Altogether, 26 sampling stations were chosen to account for different potential exposure to organotin pollution and environmental conditions: from shallow and well-oxygenated waters, shipping routes and river mouths, to deep and anoxic sites. Additionally, the organic carbon content, pigment content, and grain size of all the sediment samples were determined, and some parameters of the nearbottom water (oxygen content, salinity, temperature) were measured as well. Total concentrations of butyltin compounds ranged between 2 and 182 ng Sn g−1 d.w., whereas phenyltins were below the detection limit. Sediments from the Gulf of Gdańsk and Vistula Lagoon were found moderately contaminated with tributyltin, whereas those from the Szczecin Lagoon were ranked as highly contaminated. Butyltin degradation indices prove a recent tributyltin input into the sediments adjacent to sites used for dumping for dredged harbor materials and for anchorage in the Gulf of Gdańsk (where two big international ports are located), and into those collected in the Szczecin Lagoon. Essential factors affecting the degradation and distribution of organotins, based on significant correlations between butyltins and environmental variables, were found in the study area

Current status and trends of biological invasions in the Lagoon of Venice, a hotspot of marine NIS introductions in the Mediterranean Sea

This paper provides an updated account of the occurrence and abundance of non-indigenous species (NIS) in an area of high risk of introduction: the Lagoon of Venice (Italy). This site is a known hotspot of NIS introductions within the Mediterranean Sea, hosting all the most important vectors of introduction of marine NIS—shipping, recreational boating, shellfish culture and live seafood trade. The recent literature demonstrates that the number of NIS in Venice is continuously changing, because new species are being introduced or identified, and new evidence shows either an exotic origin of species previously believed to be native, or a native origin of formerly believed ‘‘aliens’’, or demonstrates the cryptogenic nature of others. The number of NIS introduced in the Venetian lagoon currently totals 71, out of which 55 are established. This number exceeds those displayed by some nations like Finland, Portugal or Libya. Macroalgae are the taxonomic group with the highest number of introduced species (41 % of NIS): the most likely vector for their introduction is shellfish culture. The source region of NIS introduced to Venice is mainly represented by other Mediterranean or European sites (76 %). The Lagoon of Venice represents a sink but also a source of NIS in the Mediterranean Sea, as it is the site of first record of several NIS, which have since further spread elsewhere.This paper provides an updated account of the occurrence and abundance of non-indigenous species (NIS) in an area of high risk of introduction: the Lagoon of Venice (Italy). This site is a known hotspot of NIS introductions within the Mediterranean Sea, hosting all the most important vectors of introduction of marine NIS-shipping, recreational boating, shellfish culture and live seafood trade. The recent literature demonstrates that the number of NIS in Venice is continuously changing, because new species are being introduced or identified, and new evidence shows either an exotic origin of species previously believed to be native, or a native origin of formerly believed "aliens", or demonstrates the cryptogenic nature of others. The number of NIS introduced in the Venetian lagoon currently totals 71, out of which 55 are established. This number exceeds those displayed by some nations like Finland, Portugal or Libya. Macroalgae are the taxonomic group with the highest number of introduced species (41 % of NIS): the most likely vector for their introduction is shellfish culture. The source region of NIS introduced to Venice is mainly represented by other Mediterranean or European sites (76 %). The Lagoon of Venice represents a sink but also a source of NIS in the Mediterranean Sea, as it is the site of first record of several NIS, which have since further spread elsewhere