Interview with the Most Hon PJ Patterson: Commonwealth Oral History Project

Interview with the Most Hon PJ Patterson, conducted 22nd January 2015 in Kingston, Jamaica, as part of the Commonwealth Oral History Project. The project aims to produce a unique digital research resource on the oral history of the Commonwealth since 1965 through sixty oral history interviews with leading figures in the recent history of the organisation. It will provide an essential research tool for anyone investigating the history of the Commonwealth and will serve to promote interest in and understanding of the organisation. Biography: Patterson, Percival Noel James ‘PJ’. 1935- . Born in Hanover, Jamaica. Educated at the University of the West Indies, Mona, and the London School of Economics. Elected Vice-President of the People’s National Party (PNP), 1969. Campaign Director for the PNP in 1972, 1976 and 1989. Deputy Prime Minister of Jamaica, 1978-80, 1989-92. Minister of Foreign Affairs and Foreign Trade, 1978-80. Prime Minister of Jamaica, 1992-2006. Minister of Defence, 1992-2006. Chairman, Committee on Commonwealth Membership, 2006-07

Constraints: An Integrated Viewpoint

The theory of constraints has been researched in both leisure studies and motor behavior within kinesiology. Constraints are limitations or barriers imposed on the individual that may lead to decreased or non-participation in an activity. Findings have led to the formulation of several frameworks in order to direct the research surrounding constraints. The purpose of this paper is to outline the frameworks as designed by Crawford and colleagues KEY WORDS: Constraints, motor behavior, leisure The field of health and human performance has significantly contributed to our understanding of factors that affect the human body in all domains: physical, affective, cognitive, spiritual, and social. Human beings are complex systems. The human body is similar to that of a computer whereby information is taken in from the environment, processed by the brain, and displayed by actions as output. The goal of this output is known as goal directed behavior. The academic field of motor behavior focuses on how goal directed movements originates, how the movement patterns change, and how they persist throughout the life span. Researchers in other related fields, such as recreation and leisure studies, have focused research on such topics including: recreation participation, motives, preferences, and satisfaction. Researchers and practitioners in both disciplines strive to attain a common goal: increased quality of life for an individual. What are the factors that contribute or impede on an individual's attainment of quality of life? An area of research that has gained considerable attention among researchers across disciplines is constraints. On a general level, constraints are those factors that may limit participation and enjoyment in a given activity Researchers within the field of motor behavior have posed an interest in studying constraints. Movement is essentially the way in which one interacts with the environment, and by understanding movement; individuals within therapeutic and educational settings may begin to better understand such things as skillfulnes

Evaluation of Residual Chlorothalonil Levels on Processing Tomato Foliage Using the TOM-CAST Spray Program

Field tomatoes were sprayed with chlorothalonil on a fixed–interval spray program and a TOM–CAST spray program with disease severity value threshold of 18. Foliage samples from upper and lower canopy layers were collected prior to spray re–applications. Chlorothalonil residue data were compared to the chlorothalonil efficacy threshold (1.2 μg/cm2). Using a seven–day interval program, eight of the nine and seven of the nine spray intervals had chlorothalonil residues above the critical level for the upper and lower canopy layers, respectively. Using the TOM–CAST program, four of the five spray intervals had chlorothalonil residues above the critical level for both upper and lower canopy layers when the DSV threshold of 18 was reached. Persistence of chlorothalonil residues at effective concentrations could lengthen the spray interval beyond the DSV–based spray recommendation

Long-acting injectable buprenorphine for opioid use disorder: A systematic review of impact of use on social determinants of health

Objectives: This systematic review synthesizes evidence on both the effects and perspectives of the use of novel long-acting injectable buprenorphine (LAIB) as part of medication-assisted treatment (MAT) and its impact on social determinants of health (SDH), specifically abstinence, accessibility, employment, forensic matters, and gender and social relationships via a framework approach. Methods: The study team searched three databases between January 2010 and June 2020 to identify English-language original research published in peer reviewed journals. This search yielded 9253 papers. A comprehensive search followed by 67 full text publication screenings by two independent reviewers yielded 15 papers meeting inclusion criteria. The study included three randomized control trials, one open label safety study, two case series, and six qualitative papers examining patient perspectives toward the LAIB prior to use. The team assessed the quality of studies via standardized quality assessment tools. Results: The LAIB was positively associated with improvements in abstinence, accessibility, employment, social relationships, and forensic matters. Limited evidence exists on gender equity within the current literature. The qualitative papers highlighted the importance of patients' preferences and individualization of treatment planning to ensure the success of MAT. Conclusion: The quality of evidence was rated as medium or high risk of bias, which does limit interpretation of the results. Overall, the LAIB was positively associated with SDH and should be offered as part of MAT in alignment with the recovery model. Future research should evaluate the implementation and longitudinal impacts of LAI buprenorphine compared to treatment as usual (TAU)

Multidisciplinary integration in the context of integrated care - results from the North West London Integrated Care Pilot

Background: In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. Methods: We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and transcribed Case Discussions. Two coders independently coded utterances according to their 'integrative intensity' which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standardised weighted mean integration scores were calculated for Case Discussions across utterance deciles, indicating how integrative intensity changed during the conversations. Results: Twenty-three Case Discussions in four different Multidisciplinary Groups were transcribed and coded. Inter- and intra-rater reliability was good as shown by the Prevalence and Bias-Adjusted Kappa Scores for one randomly selected Case Discussion. There were differences in the proportion of utterances per participant type (Consultant 14.6%; presenting general practitioner 38.75%; Chair 7.8%; nonpresenting general practitioner 2.25%; Allied Health Professional 4.8%). Utterances were predominantly coded at low levels of integrative intensity; however, there was a gradual increase (R = 0.71) in integrative intensity during the Case Discussions. Based on the analysis of the minutes and action points arising from the Case Discussions, this improved integration did not translate into actions moving forward. Interpretation: We characterise the Multidisciplinary Groups as having consultative characteristics with some trend towards collaboration, but that best resemble Community-Based Ward Rounds. Although integration scores do increase from the beginning to the end of the Case Discussions, this does not tend to translate into actions for the groups to take forward. The role of the Chair and the improved participation of non-presenting general practitioners and Allied Health Professionals seems important, particularly as the latter contribute well to higher integrative scores. Traditional communication patterns of medical dominance seem to be being perpetuated in the Multidisciplinary Groups. This suggests that more could be done to sensitise participants to the value of full participation from all the members of the group. The method we have developed could be used for ongoing and future evaluations of integrated care projects

Energy substitution, technical change and rebound effects

This paper investigates the relationships between energy efficiency improvements by producers, the ease of substitution between energy and other inputs and the size of the resulting “rebound effects”. Fundamentally, easier substitution leads to larger rebounds. Focusing upon conceptual and methodological issues, the paper highlights the challenges of estimating and modeling rebound effects with the help of production and cost functions and questions the robustness of the evidence base in this area. It argues that the multiple definitions of “elasticities of substitution” are a source of confusion, the most commonly estimated elasticity is of little practical value, the empirical literature is contradictory, prone to bias and difficult to use and there are only tenuous links between this literature and the assumptions used within energy-economic models. While “energy-augmenting technical change” provides the natural choice of independent variable for an estimate of rebound effects, most empirical studies do not estimate this form of technical change, many modeling studies do not simulate it and others simulate it in such a way as to underestimate rebound effects. As a result, the paper argues that current econometric and modeling studies do not provide reliable guidance on the magnitude of rebound effects in different industrial sectors

Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Exile Vol. IX No. 1

FICTION The Locust Season by Patterson Bouic 5-11 The Breughel by Hugh K. Duffield II 15-22 Then I Raised My Hand by Les Overlock 25-28 Berry Stew by Barbara Thiele 32-35 The Spectator by Sue Burton 36-37 ESSAY Dialogue by Paul Pottinger 38-40 POETRY Poem by Judith Pistor 11 Poem by Albert Werder 12-13 Salvage by Mary McCarthy 14 Poem by Barbara Thiele 23 Teatime by Hugh K. Duffield II 23 Aeschylus and the Turtle by Robert Hoyt 29 Turning by Sarah Conway 29 A Lucrezia by Christine Cooper 30 GRAPHICS Pen and Wash by Patricia Thomas 4 Pen and Ink by Elizabeth Surbeck 12 Action Drawing by Elizabeth Surbeck 14 Pen and Wash by Beverly Erbacher 24 Wash by Barbara Purdy 31 Expressionistic Head by Ramona Gibbs 3