Rethinking fuelwood: people, policy and the anatomy of a charcoal supply chain in a decentralizing Peru

In Peru, as in many developing countries, charcoal is an important source of fuel. We examine the commercial charcoal commodity chain from its production in Ucayali, in the Peruvian Amazon, to its sale in the national market. Using a mixed-methods approach, we look at the actors involved in the commodity chain and their relationships, including the distribution of benefits along the chain. We outline the obstacles and opportunities for a more equitable charcoal supply chain within a multi-level governance context. The results show that charcoal provides an important livelihood for most of the actors along the supply chain, including rural poor and women. We find that the decentralisation process in Peru has implications for the formalisation of charcoal supply chains, a traditionally informal, particularly related to multi-level institutional obstacles to equitable commerce. This results in inequity in the supply chain, which persecutes the poorest participants and supports the most powerful actors

PROJECTING THE IMPACT OF DEMOGRAPHIC CHANGE ON THE DEMAND FOR AND DELIVERY OF HEALTH CARE IN IRELAND. RESEARCH SERIES NUMBER 13 OCTOBER 2009

Primary care is often the first point of contact with the health care system for people requiring care. Primary care is often thought synonymous with general practitioners, but actually encompasses a large range of different professionals and services including nurses/midwives; physiotherapists; occupational therapists; dentists; opticians; chiropodists; psychologists and pharmacists. The list is not exhaustive, but still gives an indication of the wide range of services that can be grouped under the general heading of primary care. Nonetheless, GPs do have a core part to play in primary care as well as performing the role of ‘gate keeper’ to other health services such as accident and emergency or outpatient care in hospitals. The balance of treatment and referral between general practice and secondary care is, therefore, a very important issue and it has been argued that the under development of primary care services in Ireland in recent decades has contributed, and indeed, may be the most important reason, for the over-crowding of accident and emergency services and long waiting lists for elective procedures in Irish health care (Layte et al., 2007b; Tussing and Wren, 2006)

Decision rules for determining terrestrial movement and the consequences for filtering high-resolution global positioning system tracks: a case study using the African lion ( Panthera leo )

The combined use of global positioning system (GPS) technology and motion sensors within the discipline of movement ecology has increased over recent years. This is particularly the case for instrumented wildlife, with many studies now opting to record parameters at high (infra-second) sampling frequencies. However, the detail with which GPS loggers can elucidate fine-scale movement depends on the precision and accuracy of fixes, with accuracy being affected by signal reception. We hypothesized that animal behaviour was the main factor affecting fix inaccuracy, with inherent GPS positional noise (jitter) being most apparent during GPS fixes for non-moving locations, thereby producing disproportionate error during rest periods. A movement-verified filtering (MVF) protocol was constructed to compare GPS-derived speed data with dynamic body acceleration, to provide a computationally quick method for identifying genuine travelling movement. This method was tested on 11 free-ranging lions (Panthera leo) fitted with collar-mounted GPS units and tri-axial motion sensors recording at 1 and 40 Hz, respectively. The findings support the hypothesis and show that distance moved estimates were, on average, overestimated by greater than 80% prior to GPS screening. We present the conceptual and mathematical protocols for screening fix inaccuracy within high-resolution GPS datasets and demonstrate the importance that MVF has for avoiding inaccurate and biased estimates of movement

Healthcare of Indigenous Amazonian Peoples in response to COVID-19: marginality, discrimination and revaluation of ancestral knowledge in Ucayali, Peru.

Editorial - No abstract available

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Legalizing Abortion in Ireland: Success and Failure in the First Years of Reform

On May 25, 2018, the people of Ireland voted overwhelmingly to remove the Eighth Amendment from the Irish Constitution. The Eighth Amendment was a total ban on abortion, and was added to the Constitution in 1983, though its origins date back legislatively to 1861 and culturally to the beginning of the influence of the Catholic Church in Ireland. Between 1983 and 2012, multiple conflicts with the Amendment arose that either called for the removal of it in its entirety or the marginal liberalization of the restrictive law. While activists were able to win marginal liberalization on few occasions, influence from the Catholic Church and the Irish pro-life community was too strong to expand further. However, in the years between 2012 and 2018, the political landscape of Ireland changed due to many factors, with the most prominent change being the fall of the Catholic Church and its influence. Because of this political change, activists from many societal spheres were able to coalesce under a movement to repeal the Eighth, and in 2018 they succeeded. There was global news coverage about the shock of a Catholic country like Ireland voting to remove an abortion ban. But what was not covered by the news was what would take the place of the ban – regulation in the form of legislation. What would that legislation look like? How liberalizing should it be? How should the legislation balance between the pro-choice majority and the outspoken and powerful pro-life minority? These were all essential questions for the government to answer, because without regulation in place, Irish women could not receive abortions in-country despite them being legal. Those questions were answered by the legislation that the government put into effect on January 1, 2019, the Health (Regulation of Termination of Pregnancy) Act 2018, but the choices that the Oireachtas (Irish Parliament) made in that legislation have not yet received enough scrutiny or analysis. Through qualitative analysis of interviews from prominent figures involved in the creation of this Act and substantive readings of state- published documents, news articles that tracked the referendum and legislative efforts, and research articles published by various non-profit groups on what legislation should and could look like, this thesis finds that the regulations codified by the Oireachtas did not parallel the liberalization the public had voted for in the referendum. Political influences from the pro-life opposition played an outsized role in the writing of the legislation, which in turn led to gaps in access and unnecessary and detrimental restrictions that placed an undue burden on women trying to legally receive abortions in their home country. During the referendum, many pro-choice politicians promised that this new legislation would mean an end to the disregard of Irish women and the exportation of Irish problems, but in reality, the legislation only served to provide more marginal change instead of revolutionary change that would have reflected the revolutionary referendum. This thesis ultimately attempts to provide feasible recommendations for the further liberalization of Irish abortion legislation, with the hope that eventually the legislative change will reflect the social and political change that took place in 2018

Legalizing Abortion in Ireland: Success and Failure in the First Years of Reform

On May 25, 2018, the people of Ireland voted overwhelmingly to remove the Eighth Amendment from the Irish Constitution. The Eighth Amendment was a total ban on abortion, and was added to the Constitution in 1983, though its origins date back legislatively to 1861 and culturally to the beginning of the influence of the Catholic Church in Ireland. Between 1983 and 2012, multiple conflicts with the Amendment arose that either called for the removal of it in its entirety or the marginal liberalization of the restrictive law. While activists were able to win marginal liberalization on few occasions, influence from the Catholic Church and the Irish pro-life community was too strong to expand further. However, in the years between 2012 and 2018, the political landscape of Ireland changed due to many factors, with the most prominent change being the fall of the Catholic Church and its influence. Because of this political change, activists from many societal spheres were able to coalesce under a movement to repeal the Eighth, and in 2018 they succeeded. There was global news coverage about the shock of a Catholic country like Ireland voting to remove an abortion ban. But what was not covered by the news was what would take the place of the ban – regulation in the form of legislation. What would that legislation look like? How liberalizing should it be? How should the legislation balance between the pro-choice majority and the outspoken and powerful pro-life minority? These were all essential questions for the government to answer, because without regulation in place, Irish women could not receive abortions in-country despite them being legal. Those questions were answered by the legislation that the government put into effect on January 1, 2019, the Health (Regulation of Termination of Pregnancy) Act 2018, but the choices that the Oireachtas (Irish Parliament) made in that legislation have not yet received enough scrutiny or analysis. Through qualitative analysis of interviews from prominent figures involved in the creation of this Act and substantive readings of state- published documents, news articles that tracked the referendum and legislative efforts, and research articles published by various non-profit groups on what legislation should and could look like, this thesis finds that the regulations codified by the Oireachtas did not parallel the liberalization the public had voted for in the referendum. Political influences from the pro-life opposition played an outsized role in the writing of the legislation, which in turn led to gaps in access and unnecessary and detrimental restrictions that placed an undue burden on women trying to legally receive abortions in their home country. During the referendum, many pro-choice politicians promised that this new legislation would mean an end to the disregard of Irish women and the exportation of Irish problems, but in reality, the legislation only served to provide more marginal change instead of revolutionary change that would have reflected the revolutionary referendum. This thesis ultimately attempts to provide feasible recommendations for the further liberalization of Irish abortion legislation, with the hope that eventually the legislative change will reflect the social and political change that took place in 2018

Legalizing Abortion in Ireland: Success and Failure in the First Years of Reform

On May 25, 2018, the people of Ireland voted overwhelmingly to remove the Eighth Amendment from the Irish Constitution. The Eighth Amendment was a total ban on abortion, and was added to the Constitution in 1983, though its origins date back legislatively to 1861 and culturally to the beginning of the influence of the Catholic Church in Ireland. Between 1983 and 2012, multiple conflicts with the Amendment arose that either called for the removal of it in its entirety or the marginal liberalization of the restrictive law. While activists were able to win marginal liberalization on few occasions, influence from the Catholic Church and the Irish pro-life community was too strong to expand further. However, in the years between 2012 and 2018, the political landscape of Ireland changed due to many factors, with the most prominent change being the fall of the Catholic Church and its influence. Because of this political change, activists from many societal spheres were able to coalesce under a movement to repeal the Eighth, and in 2018 they succeeded. There was global news coverage about the shock of a Catholic country like Ireland voting to remove an abortion ban. But what was not covered by the news was what would take the place of the ban – regulation in the form of legislation. What would that legislation look like? How liberalizing should it be? How should the legislation balance between the pro-choice majority and the outspoken and powerful pro-life minority? These were all essential questions for the government to answer, because without regulation in place, Irish women could not receive abortions in-country despite them being legal. Those questions were answered by the legislation that the government put into effect on January 1, 2019, the Health (Regulation of Termination of Pregnancy) Act 2018, but the choices that the Oireachtas (Irish Parliament) made in that legislation have not yet received enough scrutiny or analysis. Through qualitative analysis of interviews from prominent figures involved in the creation of this Act and substantive readings of state- published documents, news articles that tracked the referendum and legislative efforts, and research articles published by various non-profit groups on what legislation should and could look like, this thesis finds that the regulations codified by the Oireachtas did not parallel the liberalization the public had voted for in the referendum. Political influences from the pro-life opposition played an outsized role in the writing of the legislation, which in turn led to gaps in access and unnecessary and detrimental restrictions that placed an undue burden on women trying to legally receive abortions in their home country. During the referendum, many pro-choice politicians promised that this new legislation would mean an end to the disregard of Irish women and the exportation of Irish problems, but in reality, the legislation only served to provide more marginal change instead of revolutionary change that would have reflected the revolutionary referendum. This thesis ultimately attempts to provide feasible recommendations for the further liberalization of Irish abortion legislation, with the hope that eventually the legislative change will reflect the social and political change that took place in 2018

Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial

Background: Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections.Methods: We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing.Results: The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention.Interpretation: A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice.peer-reviewe