Accessibility of ‘essential’ alcohol in the time of COVID-19: casting light on the blind spots of licensing?

Among the Australian and UK governments’ responses to the COVID-19 pandemic has been the designation of outlets selling alcohol for off-premise consumption as ‘essential’ services, allowing them to remain open while pubs, hotels and restaurants have been forced to close. In a context of restrictions on movement outside the home in both countries, and where alcohol providers are trying to find new ways to reach their customers, this may lead to an intensification of the social and health harms associated with home drinking. By examining the current situation in both Australia and the UK, we argue that heightened risks from home drinking amid COVID-19 bring into sharp focus long-standing weaknesses within licensing systems in both countries: the regulation of offpremise outlets to minimise harms from drinking at home. We call for critical conversations on how licensing systems should be revised to take more responsibility for protecting people from the health and social harms associated with home drinking, both under COVID-19 and in the future

Ecology of a reestablished population of muskoxen in northeastern Alaska

Thesis (Ph.D.) University of Alaska Fairbanks, 1998The restoration of muskoxen (Ovibos moschatus) to regions of former range in northeastern Alaska presented an opportunity to study population dynamics, seasonal patterns, and dispersal in an expanding population of ungulates. Muskoxen were returned to the Arctic National Wildlife Refuge (Arctic NWR) in 1969-70 after an absence of $>$100 years. In 1982-97, I used annual censuses, counts by sex and age, radio and satellite telemetry, and data from Landsat-TM maps to determine rates of population growth, changes in production, survival, and group size over time, seasonal habitat use, activity patterns, and dispersal of mixed-sex groups. In 1982-86, mixed-sex groups of muskoxen occupied the same regions as in 1977-81, but annual rates of increase and calf production declined (1977-81: rate = 0.24, 87 calves/100 adult females; 1982-86: rate = 0.14, 61 calves/100 adult females). In 1987-95, numbers of muskoxen in regions first occupied declined and stabilized at $$ availability) riparian and moist sedge vegetation along rivers in all seasons. Dispersal of mixed-sex groups occurred infrequently through periodic pulses. Population density likely influenced patterns of dispersal through social interactions and habitat change. Weather conditions that affected the length of the growing season and availability of winter forage were major factors in the dynamics, distribution, and dispersal patterns of this reestablished population of muskoxen

SURVEY ON THE KNOWLEDGE AND EXPECTATIONS OF PSYCHIATRY OF INTELLECTUAL DISABILITY (ID) IN JUNIOR DOCTORS JOINING A NHS MENTAL HEALTH TRUST

Background: Nationally, there is a drive to rotate more Foundation and GP Trainee Doctors through Psychiatry posts. In East London Foundation Trust (ELFT) in Bedfordshire, doctors from Core Psychiatry, Foundation and GP training programmes come to train in Psychiatry. Many will not have worked in Psychiatry before and have little experience of patients with ID. The prevalence of people with ID is increasing with improved life expectancy. They are a complex and vulnerable group with considerable wider legal, ethical and social issues. Recent national reports including the Confidential Inquiry in to Premature Deaths in People with Learning Disability3 and Transforming Care4 have recommended increased training and awareness of the roles and responsibilities for all health staff who provide care to people with ID. Aim: To survey the knowledge level and expectations of junior doctors on Psychiatry placements in Bedfordshire in relation to ID and local logistical arrangements of services and on call duties. Methodology: The local ID governance committee together with the Postgraduate Medical Education Department created a questionnaire which was circulated to new trainee Doctors on placements with ELFT. The questionnaire was distributed to new trainees after 3 different inductions throughout the year. This combined self-rating questions using Likert scales, multiple choice answers and others allowing for expanded free text answers. Discussion: The results show the self-rated knowledge levels of ID psychiatry in general and with regard to local services and on call arrangements amongst new trainees was low. The majority of trainees indicated they would have liked to have received information on the suggested areas at the start of the placement. When given the option of themes of information the psychiatric and medical presentation was most sought, although general and on call specific information was also indicated to be useful. The most popular delivery of information was found to be oral presentation and hand out at induction, followed by an electronic document. 8 trainees were interested in attending clinical sessions in ID and most felt it would be feasible in their posts to get to these. Conclusions: This survey shows that Junior Doctors from different training programmes rate their knowledge of ID psychiatry to be low. This has implications during their rotation in a mental health trust as they are expected to cover an ID ward whilst on call, but also going forward in their careers as all specialties will encounter patients with ID. It is known that awareness of patients with ID is lacking in many healthcare professionals and we know that people with ID are living longer, however continue to have worse health than the general population. The results show trainees would like more education on ID and would be interested in attending clinical sessions in ID psychiatry. The results will enable clinicians in ID services how best to improve the local induction experience for trainees. It also will guide how to educate colleagues outside of the specialty to improve their practice with people with ID, which will improve standards in the quality of care people with ID receive from doctors who treat them

Governance and Reporting in a Complex Global Environment

The purpose of this paper is to explore whether there are extant mechanisms that are utilized to meet the challenges of diverse corporate governance needs in modern global society. We adopt the nonlinear lens utilized in complex adaptive systems. The examination is advanced using three examples drawn from published academic research. The three examples selected allow consideration of differing levels of analysis, regions and entity types. Levels of analysis include societal, institutional and firm. Regions include Asia Pacific, United States and international. The governance types are governmental, charitable and corporate. Distinct world views are represented by considering the holistic worldview of the indigenous Maori as well as an emerging CSR agenda for an international corporation. Diverse objectives are exemplified by the inclusion of required not-for-profit reporting

STUDY ON THE USE OF ANTIPSYCHOTIC MEDICATION IN AN INTELLECTUAL DISABILITY (ID) COMMUNITY CASELOAD

Background: People with intellectual disabilities (ID) are prescribed antipsychotic medications for different reasons; sometimes this is for a mental illness such as psychotic or affective symptoms, however antipsychotics are also used to improve behaviours that challenge, which are common in people with intellectual disabilities (ID) or autism or both. Antipsychotic medications can have many unwanted side effects and these should be monitored for. Guidelines also indicate that reductions in medication should be considered at psychiatry reviews and alternative interventions should be trialled. Methodology: Using national recommendations on antipsychotic prescribing and monitoring and also on reducing antipsychotics in people with intellectual disabilities (ID), audit standards were determined. Results: The Bedford caseload included 192 service users; of these 2 were new referrals and had yet to be seen so were not included. 70 of the remaining 190 were not on an antipsychotic medication. 120 patients were on an antipsychotic medication. Medical records of 60 of these were audited against the identified standards. The records over the previous year were observed to see either how an antipsychotic was started or an existing antipsychotic was monitored compared to the standards

Conceptualising austerity in Scotland as a risk shift: ideas and implications

There is growing recognition that UK austerity measures impact adversely and more acutely on the most disadvantaged individuals, communities and groups. These changes may be understood as representing a shift of responsibility away from collectives to individuals. This paper explores these issues through the lens of risk analysis. Drawing on case study research from one neighbourhood in one Scottish local authority, it considers how the distinctive polity in Scotland, in the context of austerity, is redistributing social risk to vulnerable communities, groups and individuals. The local community is adapting, with varying degrees of success, to the risk transfers they are experiencing. Formal and informal risk mitigation measures are ameliorating, but not countering, these risks. The penultimate section of the paper is a collaborative endeavour. Drawing from a seminar discussion with key informants from academia, the Third Sector and government in Scotland, some of the implications of this ‘risk shift’ are discussed; particularly in relation to extending personalisation, stresses on social capital, changing understanding of securities, demographic developments, widening social divisions and alternatives to austerity economics

Cancer Cachexia: Mechanisms and Clinical Implications

Cachexia is a multifactorial process of skeletal muscle and adipose tissue atrophy resulting in progressive weight loss. It is associated with poor quality of life, poor physical function, and poor prognosis in cancer patients. It involves multiple pathways: procachectic and proinflammatory signals from tumour cells, systemic inflammation in the host, and widespread metabolic changes (increased resting energy expenditure and alterations in metabolism of protein, fat, and carbohydrate). Whether it is primarily driven by the tumour or as a result of the host response to the tumour has yet to be fully elucidated. Cachexia is compounded by anorexia and the relationship between these two entities has not been clarified fully. Inconsistencies in the definition of cachexia have limited the epidemiological characterisation of the condition and there has been slow progress in identifying therapeutic agents and trialling them in the clinical setting. Understanding the complex interplay of tumour and host factors will uncover new therapeutic targets