Values and behaviours: using the Ten Essential Shared Capabilities to support policy reform in mental health practice

This paper will review aspects of current policy in mental health with specific reference to policy that has a values focus. In this context, values refers to the standards and expectations we hold and which we use to guide aspects of practice performance. Service users state that core values that support, respect choice, collaboration, and customer service are critical foundation stones of a trusting therapeutic relationship. Attending to these foundations for practice has merit in ensuring the quality of care delivery in mental health. This paper will analyse what this means for the mental health workforce in their engagement with service users and delivery of policy priorities. Finally, the paper will explore resources, such as the Ten Essential Shared Capabilities (see Appendix 1), which support engagement and ongoing promotion of person-centred mental health care

Human responses and non-responses to climatic variations during the last Glacial-Interglacial transition in the eastern Mediterranean

© 2017 Elsevier Ltd. We review and evaluate human adaptations during the last glacial-interglacial climatic transition in southwest Asia. Stable isotope data imply that climatic change was synchronous across the region within the limits of dating uncertainty. Changes in vegetation, as indicated from pollen and charcoal, mirror step-wise shifts between cold-dry and warm-wet climatic conditions, but with lag effects for woody vegetation in some upland and interior areas. Palaeoenvironmental data can be set against regional archaeological evidence for human occupancy and economy from the later Epipalaeolithic to the aceramic Neolithic. Demographic change is evaluated from summed radiocarbon date probability distributions, which indicating contrasting - and in some cases opposite - population trajectories in different regions. Abrupt warming transitions at ∼14.5 and 11.7 ka BP may have acted as pacemakers for rapid cultural change in some areas, notably at the start of the Natufian and Pre-Pottery Neolithic cultures. However temporal synchroneity does not mean that climatic changes had the same environmental or societal consequences in different regions. During cold-dry time intervals, regions such as the Levant acted as refugia for plant and animal resources and human population. In areas where socio-ecological continuity was maintained through periods of adverse climate (e.g. Younger Dryas) human communities were able to respond rapidly to subsequent climatic improvement. By contrast, in areas where there was a break in settlement at these times (e.g. central Anatolia), populations were slower to react to the new opportunities provided by the interglacial world

Physical activity and left-ventricular trabeculation in the UK Biobank community-based cohort study

Objective: Vigorous physical activity (PA) in highly trained athletes has been associated with heightened left ventricular (LV) trabeculation extent. It has therefore been hypothesised that LV trabeculation extent may participate in exercise-induced physiological cardiac remodelling. Our cross-sectional observational study aimed to ascertain whether there is a ‘dose–response’ relationship between PA and LV trabeculation extent and whether this could be identified at opposite PA extremes. Methods: In a cohort of 1030 individuals from the community-based UK Biobank study (male/female ratio: 0.84, mean age: 61 years), PA was measured via total metabolic equivalent of task (MET) min/week and 7-day average acceleration, and trabeculation extent via maximal non-compaction/compaction ratio (NC/C) in long-axis images of cardiovascular magnetic resonance studies. The relationship between PA and NC/C was assessed by multivariate regression (adjusting for potential confounders) as well as between demographic, anthropometric and LV phenotypic parameters and NC/C. Results: There was no significant linear relationship between PA and NC/C (full adjustment, total MET-min/week: ß=−0.0008, 95% CI −0.039 to –0.037, p=0.97; 7-day average acceleration: ß=−0.047, 95% CI −0.110 to –0.115, p=0.13, per IQR increment in PA), or between extreme PA quintiles (full adjustment, total MET-min/week: ß=−0.026, 95% CI −0.146 to –0.094, p=0.67; 7-day average acceleration: ß=−0.129, 95% CI −0.299 to –0.040, p=0.49), across all adjustment levels. A negative relationship was identified between left ventricular ejection fraction and NC/C, significantly modified by PA (ß difference=−0.006, p=0.03). Conclusions: In a community-based general population cohort, there was no relationship at, or between, extremes, between PA and NC/C, suggesting that at typical general population PA levels, trabeculation extent is not influenced by PA changes.British Heart Foundation (BHF) (PG/14/89/31194)National Institute for Health Research (NIHR) Barts Biomedical Research Centre’SmartHeart’ Engineering and Physical Sciences Research Council programme grant (EP/P001009/1

Migration Patterns, Use of Stopover Areas, and Austral Summer Movements of Swainson\u27s Hawks

From 1995 to 1998, we tracked movements of adult Swainson’s Hawks (Buteo swainsoni), using satellite telemetry to characterize migration, important stopover areas, and movements in the austral summer. We tagged 46 hawks from July to September on their nesting grounds in seven U.S. states and two Canadian provinces. Swainson’s Hawks followed three basic routes south on a broad front, converged along the east coast of central Mexico, and followed a concentrated corridor to a communal area in central Argentina for the austral summer. North of 20°N, southward and northward tracks differed little for individuals from east of the continental divide but differed greatly (up to 1700 km) for individuals from west of the continental divide. Hawks left the breeding grounds mid-August to mid-October; departure dates did not differ by location, year, or sex. Southbound migration lasted 42 to 98 days, northbound migration 51 to 82 days. Southbound, 36% of the Swainson’s Hawks departed the nesting grounds nearly 3 weeks earlier than the other radio-marked hawks and made stopovers 9.0–26.0 days long in seven separate areas, mainly in the southern Great Plains, southern Arizona and New Mexico, and northcentral Mexico. The birds stayed in their nonbreeding range for 76 to 128 days. All used a core area in central Argentina within 23% of the 738 800-km2 austral summer range, where they frequently moved long distances (up to 1600 km). Conservation of Swainson’s Hawks must be an international effort that considers habitats used during nesting and non-nesting seasons, including migration stopovers

Variability in feeding habitats of red deer sensu lato in Eurasia in the Late Pleistocene and Holocene

Red deer (Cervus elaphus) is one of the species that is rather wide spread and survived across Europe over the Holocene. The analyses of carbon and nitrogen stable isotopes in bone collagen of ungulate remains have been applied in paleoecological studies as environmental and dietary indicators. In this study we present the carbon and nitrogen stable isotope compositions of previously radiocarbon-dated red deer bone samples (N = 68) found in Central, Southern and Eastern Europe and Asia and aligned to one of two species: European red deer (Cervus elaphus) and wapiti (Cervus canadensis). We showed that the values of carbon and nitrogen stable isotope ratios of European red deer and wapiti overlapped. Among all analysed independent factors (determined for the locality and time period relevant for each of the analysed samples), the variability of δ13C values in European red deer dated to the Holocene is best explained by forest cover and mean July temperature, and variability of δ15N values by the mean July temperature, annual precipitation and altitude. Additionally, combining the results of the present study with isotopic data on European red deer collected from published sources, we revealed that the values of δ13C and of δ15N in C. elaphus bones changed according to environmental oscillations that took place in Europe over the last 50 000 years. We concluded that red deer shifted their feeding habitats in relation to changing environmental conditions, for example, forest expansion during the climate warming, and in the mid to later Holocene in response to deforestation caused by human activity and the spread of agriculture. We also found out that red deer reacted in varied ways to changing local conditions in different regions of Europe. Modern individuals of C. elaphus had the lowest δ13C values among all analysed specimens, so they probably inhabited the most densely forested areas in comparison to other European red deer populations during the last 50 000 years

The use of telehealth for diabetes management: a qualitative study of telehealth provider perceptions

BACKGROUND: Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use. METHODS: We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States. RESULTS: Findings suggest that MMD program enrollment is limited by both clinical and non-clinical factors, and that patients have varying levels of program participation and system use. Telehealth providers see MMDs as a useful tool for monitoring patients who are interested in working on management of their disease, but are concerned with technical challenges and the time commitment required to use MMDs. CONCLUSION: Telehealth includes a rapidly evolving and potentially promising range of technologies for meeting the growing number of patients and clinicians who face the challenges of diabetes care, and future research should explore the most effective means of ensuring successful program implementation

Pollen-inferred regional vegetation patterns and demographic change in Southern Anatolia through the Holocene

Southern Anatolia is a highly significant area within the Mediterranean, particularly in terms of understanding how agriculture moved into Europe from neighbouring regions. This study uses pollen, palaeoclimate and archaeological evidence to investigate the relationships between demography and vegetation change, and to explore how the development of agriculture varied spatially. Data from 21 fossil pollen records have been transformed into forested, parkland and open vegetation types using cluster analysis. Patterns of change have been explored using non-metric multidimensional scaling (nMDS) and through analysis of indicator groups, such as an Anthropogenic Pollen Index, and Simpson’s Diversity. Settlement data, which indicate population densities, and summed radiocarbon dates for archaeological sites have been used as a proxy for demographic change. The pollen and archaeological records confirm that farming can be detected earlier in Anatolia in comparison with many other parts of the Mediterranean. Dynamics of change in grazing indicators and the OJCV (Olea, Juglans, Castanea and Vitis) index for cultivated trees appear to match cycles of population expansion and decline. Vegetation and land use change is also influenced by other factors, such as climate change. Investigating the early impacts of anthropogenic activities (e.g. woodcutting, animal herding, the use of fire and agriculture) is key to understanding how societies have modified the environment since the mid–late Holocene, despite the capacity of ecological systems to absorb recurrent disturbances. The results of this study suggest that shifting human population dynamics played an important role in shaping land cover in central and southern Anatolia

Effect of discriminative plant-sugar feeding on the survival and fecundity of Anopheles gambiae

<p>Abstract</p> <p>Background</p> <p>A previous study showed for <it>Anopheles gambiae s.s</it>. a gradation of feeding preference on common plant species growing in a malaria holoendemic area in western Kenya. The present follow-up study determines whether there is a relationship between the mosquito's preferences and its survival and fecundity.</p> <p>Methods</p> <p>Groups of mosquitoes were separately given <it>ad libitum </it>opportunity to feed on five of the more preferred plant species (<it>Hamelia patens</it>, <it>Parthenium hysterophorus</it>, <it>Ricinus communis</it>, <it>Senna didymobotrya</it>, and <it>Tecoma stans</it>) and one of the less preferred species (<it>Lantana camara</it>). The mosquitoes were monitored daily for survival. Sugar solution (glucose 6%) and water were used as controls. In addition, the fecundity of mosquitoes on each plant after (i) only one blood meal (number of eggs oviposited), and (ii) after three consecutive blood meals (proportion of females ovipositing, number of eggs oviposited and hatchability of eggs), was determined. The composition and concentration of sugar in the fed-on parts of each plant species were determined using gas chromatography. Using SAS statistical package, tests for significant difference of the fitness values between mosquitoes exposed to different plant species were conducted.</p> <p>Results and Conclusion</p> <p><it>Anopheles gambiae </it>that had fed on four of the five more preferred plant species (<it>T. stans</it>, <it>S. didymobotrya</it>, <it>R. communis </it>and <it>H. patens</it>, but not <it>P. hysterophorus</it>) lived longer and laid more eggs after one blood meal, when compared with <it>An. gambiae </it>that had fed on the least preferred plant species <it>L. camara</it>. When given three consecutive blood-meals, the percentage of females that oviposited, but not the number of eggs laid, was significantly higher for mosquitoes that had previously fed on the four more preferred plant species. Total sugar concentration in the preferred plant parts was significantly correlated with survival and with the proportion of females that laid eggs. This effect was associated mainly with three sugar types, namely glucose, fructose, and gulose. Except for <it>P. hysterophorus</it>, the results suggest that feeding by mosquitoes on preferred plant species under natural conditions results in higher fitness-related benefits, and that the sugar content in preferred plant parts is largely responsible for these effects.</p

Action, Knowledge and Embodiment in Berkeley and Locke

Embodiment is a fact of human existence which philosophers should not ignore. They may differ to a great extent in what they have to say about our bodies, but they have to take into account that for each of us our body has a special status, it is not merely one amongst the physical objects, but a physical object to which we have a unique relation. While Descartes approached the issue of embodiment through consideration of sensation and imagination, it is more directly reached by consideration of action and agency: whenever we act upon the world, we act by moving our bodies. So if we can understand what an immaterialist such as Berkeley thinks about agency, we will have gone a fair way to understanding what he thinks about embodiment. §1 discusses a recent flurry of articles on the subject of Berkeley’s account of action. I choose to present Berkeley as a causal-volitional theorist (realist) not because I think it is the uniquely correct interpretation of the texts, but because I find it more philosophically interesting as a version of immaterialism. In particular, it raises the possibility of a substantive account of human embodiment which is completely unavailable to the occasionalist. §2 articulates an apparent philosophical problem for Berkeley qua causal-volitional theorist and show that Locke was aware of a related problem and had a solution of which Berkeley would have known. §3 distinguishes two interpretations of Berkeley’s famous denial of blind agency–as the assertion of a weak representational condition or a strong epistemic one–and provide evidence that there was a well-established debate about blind powers in the seventeenth century which took the metaphor of blindness as indicating an epistemic rather than merely representational failing. What remains to do in §4 is to consider whether Berkeley, with his own peculiar commitments, could in fact accept this account of agency

Late Holocene climate: Natural or anthropogenic?

For more than a decade, scientists have argued about the warmth of the current interglaciation. Was the warmth of the preindustrial late Holocene natural in origin, the result of orbital changes that had not yet driven the system into a new glacial state? Or was it in considerable degree the result of humans intervening in the climate system through greenhouse gas emissions from early agriculture? Here we summarize new evidence that moves this debate forward by testing both hypotheses. By comparing late Holocene responses to those that occurred during previous interglaciations (in section 2), we assess whether the late Holocene responses look different (and thus anthropogenic) or similar (and thus natural). This comparison reveals anomalous (anthropogenic) signals. In section 3, we review paleoecological and archaeological syntheses that provide ground truth evidence on early anthropogenic releases of greenhouse gases. The available data document large early anthropogenic emissions consistent with the anthropogenic ice core anomalies, but more information is needed to constrain their size. A final section compares natural and anthropogenic interpretations of the δ¹³C trend in ice core CO₂