Plastics Derived From Derelict Fishing Gear in the Arctic: Looking at Sustainable Fisheries for a Strategy of Mitigation, Remediation and Prevention in Iceland and Alaska

Marine plastics are not just a problem, they are a silent, sinister epidemic. Marine plastics are the largest economic and ecological threat to our marine ecosystems, particularly marine plastics derived from lost and or discarded fishing gear, which affects sensitive marine communities, the chemical composition of the ocean water, and the physical makeup of the seafloor. With 6.4 million tons of marine debris entering our oceans annually, a third of which is lost fishing gear, it is estimated that, by weight, in 2050 there will be an accumulation of more plastic than fish in the ocean (Heath, 2018; Wilcox, 2015). Marine litter derived from plastic fishing gear, primarily passive gear, when lost in the ocean causes a series of consequences to the marine ecosystem, that of which increases when there are high concentrations of fishing activity in the geographic area. Arctic countries have some of the most abundant fisheries, that of which is projected to increase due to anthropogenic climate change. In the context of climate change affecting the Arctic ecosystem, in this thesis, we will review the consequences of plastics derived from fishing gear for the Arctic marine ecosystem, estimate the potential influx of derelict gear plastics originating from data obtained in Alaska and Iceland, and then confidently present effective forms of remediation, prevention, and mitigation strategized from models of sustainable fisheries to resolve the ramifications of lost and or discarded gear in Arctic communities

Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future?

No description supplie

Contextual barriers to implementation in primary care:an ethnographic study of a program to improve chronic kidney disease care

Background. Context is important in implementation—we know that what works in one setting may not work in the same way elsewhere. Primary care has been described as a unique context both in relation to the care delivered and efforts to carry out research and implementation of new evidence. Objective. To explore some of the distinctive features of the primary care environment that may influence implementation. Methods. We conducted an ethnographic study involving observations, interviews and documentary analysis of the ENABLE-CKD project, which involved general practices implementing a chronic kidney disease care bundle and offering self-management support tools to patients. Analysis was based on the constant comparative method. Results. Four elements of the primary care environment emerged as important influences on the extent to which implementation was successful. First, the nature of delivering care in this setting meant that prioritizing one condition over others was problematic. Second, the lack of alignment with financial and other incentives affected engagement. Third, the project team lacked mechanisms through which engagement could be mandated. Fourth, working relationships within practices impacted on engagement. Conclusions. Those seeking to implement interventions in primary care need to consider the particular context if they are to secure successful implementation. We suggest that there are particular kinds of interventions, which may be best suited to the primary care context

Carer experiences with rehabilitation in the home: speech pathology services for stroke survivors

Caring for a stroke survivor can be a complex role with carers at an increased risk of mental health difficulties. Early supported discharge from hospital with rehabilitation in the home (RITH) allows stroke survivors to return home at an earlier stage in the recovery process, potentially placing an extra burden on carers. Being involved in intensive therapy,in the home, in the early days post-stroke may be difficult with the role and experiences of carers in RITH being underresearched. This paper identifies the roles, experiences and preferences of ten carers of stroke survivors with dysarthia and dysphagia. Many carers were involved with RITH speech pathology rehabilitation and reported positively on services. Cultural and linguistic issues and the implications of home practice for carers are also discussed

Cervical Screening: women's resistance to the official discourse

This study is an empirical exploration of Foucault's theoretical ideas on resistance, through a case study of cervical cancer screening and women's responses to the official discourse surrounding it. In England, this form of screening is organised through a national programme and consistently achieves coverage of over 80%. Given this high attendance it may appear that any resistance is negligible. However, this thesis argues that such a focus on attendance, or behaviour, is misguided and that, by focusing attention on the level at which the official discourse on screening is interpreted, understood and made sense of by individual women, it is possible to identify instances of thought and talk based resistance. Using qualitative interviews with a sample structured to include a range of ethnic backgrounds and ages, the thesis identifies three key forms of resistance. Firstly, women may resist the general subject position suggested within the official discourse and make sense of screening in ways that are meaningful to them as individuals. Secondly, many women resist the general 'at risk' status suggested and negotiate their own position drawing on a range of risk factors that do not always fit well with those medically recognised. Thirdly, in making sense of the information they receive, women frequently attempt to create a rational framework of knowledge and understanding which can lead to them interpreting issues such as risk factors or disease development in different ways. Based upon these, the thesis argues for conceptualising power and resistance in terms of a complex network of possibilities with multiple points of potential difference or divergence that can lead to individuals adopting very different subject positions. Although the majority of resistance detailed is thought and talk based, this is nevertheless important as it provides the means for challenges to the official discourse and constitutes a necessary prerequisite for further behavioural resistance

Stakeholder perspectives on the development of a virtual clinic for diabetes care : qualitative study

Background: The development of the Internet has created new opportunities for health care provision, including its use as a tool to aid the self-management of chronic conditions. We studied stakeholder reactions to an Internet-based “virtual clinic,” which would allow people with diabetes to communicate with their health care providers, find information about their condition, and share information and support with other users. Objective: The aim of the study was to present the results of a detailed consultation with a variety of stakeholder groups in order to identify what they regard as the desirable, important, and feasible characteristics of an Internet-based intervention to aid diabetes self-management. Methods: Three focus groups were conducted with 12 people with type 1 diabetes who used insulin pumps. Participants were recruited through a local diabetes clinic. One-on-one interviews were conducted with 5 health care professionals from the same clinic (2 doctors, 2 nurses, 1 dietitian) and with 1 representative of an insulin pump company. We gathered patient consensus via email on the important and useful features of Internet-based systems used for other chronic conditions (asthma, epilepsy, myalgic encephalopathy, mental health problems). A workshop to gather expert consensus on the use of information technology to improve the care of young people with diabetes was organized. Results: Stakeholder groups identified the following important characteristics of an Internet-based virtual clinic: being grounded on personal needs rather than only providing general information; having the facility to communicate with, and learn from, peers; providing information on the latest developments and news in diabetes; being quick and easy to use. This paper discusses these characteristics in light of a review of the relevant literature. The development of a virtual clinic for diabetes that embodies these principles, and that is based on self-efficacy theory, is described. Conclusions: Involvement of stakeholders is vital early in the development of a complex intervention. Stakeholders have clear and relevant views on what a virtual clinic system should provide, and these views can be captured and synthesized with relative ease. This work has led to the design of a system that is able to meet user needs and is currently being evaluated in a pilot study

Cervical Screening: women's resistance to the official discourse

This study is an empirical exploration of Foucault's theoretical ideas on resistance, through a case study of cervical cancer screening and women's responses to the official discourse surrounding it. In England, this form of screening is organised through a national programme and consistently achieves coverage of over 80%. Given this high attendance it may appear that any resistance is negligible. However, this thesis argues that such a focus on attendance, or behaviour, is misguided and that, by focusing attention on the level at which the official discourse on screening is interpreted, understood and made sense of by individual women, it is possible to identify instances of thought and talk based resistance. Using qualitative interviews with a sample structured to include a range of ethnic backgrounds and ages, the thesis identifies three key forms of resistance. Firstly, women may resist the general subject position suggested within the official discourse and make sense of screening in ways that are meaningful to them as individuals. Secondly, many women resist the general 'at risk' status suggested and negotiate their own position drawing on a range of risk factors that do not always fit well with those medically recognised. Thirdly, in making sense of the information they receive, women frequently attempt to create a rational framework of knowledge and understanding which can lead to them interpreting issues such as risk factors or disease development in different ways. Based upon these, the thesis argues for conceptualising power and resistance in terms of a complex network of possibilities with multiple points of potential difference or divergence that can lead to individuals adopting very different subject positions. Although the majority of resistance detailed is thought and talk based, this is nevertheless important as it provides the means for challenges to the official discourse and constitutes a necessary prerequisite for further behavioural resistance

Doing diagnosis: whether and how clinicians use a diagnostic tool of uncertain clinical utility. Soc Sci Med

a b s t r a c t Diagnosis is fundamental to the practice of medicine and mastery of it is central to the process of both becoming and practicing as a doctor. We focus on diagnosis as a process, in particular from the perspective of clinicians performing it. We explore how UK clinicians exercise discretion about whether and how to use a diagnostic tool (invasive urodynamic tests e IUT) for which there is, currently, no clear, high-quality evidence. Interviews were conducted with a purposive sample of 18 clinicians who had previously completed a survey on their use of IUT. Analysis was based on the constant comparative method. Participants tended to be polarised in their view of IUT. While many regarded it as a valuable diagnostic tool that they used frequently and thought was important, others reported using it only infrequently, and some were sceptical of its value in the diagnostic process even if they commonly used it. In addition to the anticipated clinical functions (e.g. adding to understanding of the condition, helping determine best treatment) there were additional, more social, functions that IUT could serve, including fitting in with local practice and helping to defend against possible future litigation. We discern two distinct approaches to the practice of diagnosis: one approach means 'leaving no stone unturned' and seeking all available evidence, proven or otherwise; while a second means using clinical judgement to say 'enough is enough' and thereby avoid exposing patients to possibly unnecessary tests and potentially wasting scarce healthcare resources

When choice becomes limited:Women's experiences of delay in labour

Choice and patient involvement in decision-making are strong aspirations of contemporary healthcare. One of the most striking areas in which this is played out is maternity care where recent policy has focused on choice and supporting normal birth. However, birth is sometimes not straightforward and unanticipated complications can rapidly reduce choice. We draw on the accounts of women who experienced delay during labour with their first child. This occurs when progress is slow, and syntocinon is administered to strengthen and regulate contractions. Once delay has been recognised the clinical circumstances limit choice. Drawing on Mol’s work on the logics of choice and care, we explore how, although often upsetting, women accepted that their choices and plans were no longer feasible. The majority were happy to defer to professionals who they regarded as having the necessary technical expertise, while some adopted a more traditional medical model and actively rejected involvement in decision making altogether. Only a minority wanted to continue active involvement in decision-making, although the extent to which the possibility existed for them to do so was questionable. Women appeared to accept that their ideals of choice and involvement had to be abandoned, and that clinical circumstances legitimately changed events