205 research outputs found

    Fun environmentalism! Potential contributions of autonomy supportive psychology to developing low carbon lifestyles in Australian households

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    To achieve sustainable levels of Australian household carbon emissions, individuals will have to adopt and maintain high impact pro-environmental behaviours across a number of behavioural domains. It is hypothesised that motivation type will be a critical factor in bringing about personally sustainable changes. In particular, selfdetermined (autonomous) motivation will be essential for generalisation of proenvironmental behaviour. If this hypothesis is supported, the next challenge is to identify optimal ways of promoting autonomous behaviour change, drawing on and expanding from Self-Determination Theory. It is proposed that a general move towards a positive, holistic approach to environmentalism is necessary, one aspect of which is to make environmental action more satisfying, interesting, and fun

    Eating Together: Early Modern Gentry Commensality in the Northwest of England, c.1530-1670

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    Early modern commensality represented an opportunity for early modern gentry communities potentially split along religious lines to come together while simultaneously being occasions for the display of social status, a mechanism for social advancement, and the persuasion of important county figures. This thesis demonstrates that the northwest gentry families of the Heskeths, Norrises, and Moretons used commensality and hospitality to navigate the religious and social changes of the sixteenth and seventeenth centuries. Successful commensal occasions required detailed knowledge and implementation of culture, dietetics, information, and accomplished social skills. This was demonstrated through décor, tableware, conversation, entertainments, and food. Careful stage-management of these elements ensured commensal atmospheres that could shape and influence guests. Immersive food spaces featured aspects of material culture which acted as pillars of support for Catholic hosts, such as the Heskeths and Norrises, when deviating from the prescriptions of their faith in dining with Protestants. These symbols of devotion rooted Catholic hosts in religious piety even as they made concessions over foods served or who they broke bread with. They also represent changing conceptions of the early modern gentry home during the Reformation as food and dining rooms became increasingly sanctified in lieu of ecclesiastical buildings and amid anxieties over mixed-faith commensality. Gentry commensality was increasingly centred on London in the seventeenth century and this change is reflected in the experiences of the Protestant Moreton family. Changes in hospitality shifted the location of commensality around different food spaces of the gentry house and then beyond the home in line with changing social fashions. Added to the assemblage of gentry commensality came influences from metropolitan, colonial, and diplomatic centres including associated material culture, conversation, and different markers of gentry belonging. Analysis of how each of the families achieved this at Rufford Old Hall, Speke Hall, and Little Moreton Hall uses affect and assemblage theories. These are combined with early modern understandings of domestic environments based on embodiment, humoral bodies, and the interconnected nature of mind, body, sensation, and soul

    TB Fast Track patient cost data

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    A tabular dataset containing information provided by 99 HIV-positive individuals – men and women aged 18 or above who had a low CD4 count and were not yet on TB or HIV treatment - enrolled in the TB FastTrack trial, a cluster randomised trial to establish the direct and indirect costs of illness incurred at the patient/household level. Data was collected through patient interviews conducted at the health facility where they were receiving treatment in North West Limpopo and Gauteng provinces between June 2014 and March 2015. The dataset contains 450+ variables, including details on quantity of visits, time spent in seeking care, direct medical and non-medical costs incurred, and individual and estimated household income. Household income was established using 4 approaches: (1) self-reported (detail), (2) self-reported (brackets), (3) by matching through an asset index, and (4) national average income

    The patient costs of care for those with TB and HIV: a cross-sectional study from South Africa.

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    BACKGROUND: This study describes the post-diagnosis care-seeking costs incurred by people living with TB and/or HIV and their households, in order to identify the potential benefits of integrated care. METHODS: We conducted a cross-sectional study with 454 participants with TB or HIV or both in public primary health care clinics in Ekurhuleni North Sub-District, South Africa. We collected information on visits to health facilities, direct and indirect costs for participants and for their guardians and caregivers. We define 'integration' as receipt of both TB and HIV services at the same facility, on the same day. Costs were presented and compared across participants with TB/HIV, TB-only and HIV-only. Costs exceeding 10% of participant income were considered catastrophic. RESULTS: Participants with both TB and HIV faced a greater economic burden (US74/month)thanthosewithTBonly(US74/month) than those with TB-only (US68/month) or HIV-only (US$40/month). On average, people with TB/HIV made 18.4 visits to health facilities, more than TB-only participants or HIV-only participants who made 16 and 5.1 visits, respectively. However, people with TB/HIV had fewer standalone TB (10.9) and HIV (2.2) visits than those with TB-only (14.5) or HIV-only (4.4). Although people with TB/HIV had access to 'integrated' services, their time loss was substantially higher than for other participants. Overall, 55% of participants encountered catastrophic costs. Access to official social protection schemes was minimal. CONCLUSIONS: People with TB/HIV in South Africa are at high risk of catastrophic costs. To some extent, integration of services reduces the number of standalone TB and HIV of visits to the health facility. It is however unlikely that catastrophic costs can be averted by service integration alone. Our results point to the need for timely social protection, particularly for HIV-positive people starting TB treatment

    Experimental determination of reflectance spectra of Antarctic krill (Euphausia superba) in the Scotia Sea

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    Antarctic krill are the dominant metazoan in the Southern Ocean in terms of biomass; however, their wide and patchy distribution means that estimates of their biomass are still uncertain. Most currently employed methods do not sample the upper surface layers, yet historical records indicate that large surface swarms can change the water colour. Ocean colour satellites are able to measure the surface ocean synoptically and should theoretically provide a means for detecting and measuring surface krill swarms. Before we can assess the feasibility of remote detection, more must be known about the reflectance spectra of krill. Here, we measure the reflectance spectral signature of Antarctic krill collected in situ from the Scotia Sea and compare it to that of in situ water. Using a spectroradiometer, we measure a strong absorption feature between 500 and 550 nm, which corresponds to the pigment astaxanthin, and high reflectance in the 600–700 nm range due to the krill's red colouration. We find that the spectra of seawater containing krill is significantly different from seawater only. We conclude that it is tractable to detect high-density swarms of krill remotely using platforms such as optical satellites and unmanned aerial vehicles, and further steps to carry out ground-truthing campaigns are now warranted

    Cost-effectiveness of Xpert MTB/RIF for tuberculosis diagnosis in South Africa: a real-world cost analysis and economic evaluation

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    Background In 2010 a new diagnostic test for tuberculosis, Xpert MTB/RIF, received a conditional programmatic recommendation from WHO. Several model-based economic evaluations predicted that Xpert would be cost-effective across sub-Saharan Africa. We investigated the cost-effectiveness of Xpert in the real world during national roll-out in South Africa. Methods For this real-world cost analysis and economic evaluation, we applied extensive primary cost and patient event data from the XTEND study, a pragmatic trial examining Xpert introduction for people investigated for tuberculosis in 40 primary health facilities (20 clusters) in South Africa enrolled between June 8, and Nov 16, 2012, to estimate the costs and cost per disability-adjusted life-year averted of introducing Xpert as the initial diagnostic test for tuberculosis, compared with sputum smear microscopy (the standard of care). Findings The mean total cost per study participant for tuberculosis investigation and treatment was US31258(95312·58 (95% CI 252·46–372·70) in the Xpert group and 298·58 (246·35–350·82) in the microscopy group. The mean health service (provider) cost per study participant was 16879(1491618842)fortheXpertgroupand168·79 (149·16–188·42) for the Xpert group and 160·46 (143·24–177·68) for the microscopy group of the study. Considering uncertainty in both cost and effect using a wide range of willingness to pay thresholds, we found less than 3% probability that Xpert introduction improved the costeffectiveness of tuberculosis diagnostics. Interpretation After analysing extensive primary data collection during roll-out, we found that Xpert introduction in South Africa was cost-neutral, but found no evidence that Xpert improved the cost-effectiveness of tuberculosis diagnosis. Our study highlights the importance of considering implementation constraints, when predicting and evaluating the cost-effectiveness of new tuberculosis diagnostics in South Africa

    Respiration of mesopelagic fish: a comparison of respiratory electron transport system (ETS) measurements and allometrically calculated rates in the Southern Ocean and Benguela Current

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    Mesopelagic fish are an important component of marine ecosystems, and their contribution to marine biogeochemical cycles is becoming increasingly recognized. However, major uncertainties remain in the rates at which they remineralize organic matter. We present respiration rate estimates of mesopelagic fish from two oceanographically contrasting regions: the Scotia Sea and the Benguela Current. Respiration rates were estimated by measuring the enzyme activities of the electron transport system. Regression analysis of respiration with wet mass highlights regional and inter-specific differences. The mean respiration rates of all mesopelagic fish sampled were 593.6 and 354.9 µl O2 individual−1 h−1 in the Scotia Sea and Benguela Current, respectively. Global allometric models performed poorly in colder regions compared with our observations, underestimating respiratory flux in the Scotia Sea by 67–88%. This may reflect that most data used to fit such models are derived from temperate and subtropical regions. We recommend caution when applying globally derived allometric models to regional data, particularly in cold (<5°C) temperature environments where empirical data are limited. More mesopelagic fish respiration rate measurements are required, particularly in polar regions, to increase the accuracy with which we can assess their importance in marine biogeochemical cycles

    Evaluation of a point-of-care tuberculosis test-and-treat algorithm on early mortality in people with HIV accessing antiretroviral therapy (TB Fast Track study): study protocol for a cluster randomised controlled trial.

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    BACKGROUND: Early mortality for HIV-positive people starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis the most important cause. Existing rapid diagnostic tests for tuberculosis lack sensitivity among HIV-positive people, and consequently, tuberculosis treatment is either delayed or started empirically (without bacteriological confirmation). We developed a management algorithm for ambulatory HIV-positive people, based on body mass index and point-of-care tests for haemoglobin and urine lipoarabinomannan (LAM), to identify those at high risk of tuberculosis and mortality. We designed a clinical trial to test whether implementation of this algorithm reduces six-month mortality among HIV-positive people with advanced immunosuppression. METHODS/DESIGN: The TB Fast Track study is an open, pragmatic, cluster randomised superiority trial, with 24 primary health clinics randomised to implement the intervention or standard of care. Adults (aged ≥18 years) with a CD4 count of 150 cells/μL or less, who have not received any tuberculosis treatment in the last three months, or ART in the last six months, are eligible. In intervention clinics, the study algorithm is used to classify individuals as at high, medium or low probability of tuberculosis. Those classified as high probability start tuberculosis treatment immediately, followed by ART after two weeks. Medium-probability patients follow the South African guidelines for test-negative tuberculosis and are reviewed within a week, to be re-categorised as low or high probability. Low-probability patients start ART as soon as possible. The primary outcome is all-cause mortality at six months. Secondary outcomes include severe morbidity, time to ART start and cost-effectiveness. DISCUSSION: This trial will test whether a primary care-friendly management algorithm will enable nurses to identify HIV-positive patients at the highest risk of tuberculosis, to facilitate prompt treatment and reduce early mortality. There remains an urgent need for better diagnostic tests for tuberculosis, especially for people with advanced HIV disease, which may render empirical treatment unnecessary. TRIAL REGISTRATION: This trial was registered with Current Controlled Trials (identifier: ISRCTN35344604 ) on 12 September 2012

    Do health behaviours change after colonoscopy? A prospective cohort study on diet, alcohol, physical activity and smoking among patients and their partners

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    Objectives: To describe diet, alcohol, physical activity and tobacco use prospectively, that is, before and 10 months after colonoscopy for patients and their partners. Design: Prospective cohort study of health behaviour change in patients and partners. Comparison groups are patients receiving a normal result notification (NRN) versus patients receiving an abnormal result notification (ARN). Patients and partners (controls) are also compared. Setting: 5 Scottish hospitals. Participants: Of 5798 colonoscopy registrations, 2577 (44%) patients met the eligibility criteria of whom 565 (22%) were recruited; 460 partners were also recruited. Measures: International Physical Activity Questionnaire, Scottish Collaborative Group Food Frequency Questionnaire (includes alcohol), smoking status, sociodemographic characteristics, body mass index, medical conditions, colonoscopy result, Multidimensional Health Locus of Control Scale, behaviour-specific self-efficacy scales. Results: 57% of patients were men, with a mean age of 60.8 years (SE 0.5) and 43% were from more affluent areas. 72% (n=387) of patients received an ARN and 28% (n=149) received an NRN. Response rate of the second questionnaire was 68.9%. Overall, 27% of patients consumed < 5 measures of fruit and vegetables/day, 20% exceeded alcohol limits, 50% had low levels of physical activity and 21% were obese. At 10-month follow-up, a 5% reduction in excessive alcohol consumption and an 8% increase in low levels of physical activity were observed among patients; no significant changes occurred in partners. Baseline high alcohol consumption and low physical activity were the strongest predictors of these behaviours at follow-up. Low alcohol self-efficacy and increasing age were associated with poorer health-related behaviours at follow-up for alcohol consumption and physical activity, respectively. Conclusions: Colonoscopy is associated with marginal beneficial changes in some behaviours but not others. Further work is needed to explore how services can optimise increases in beneficial behaviours and mitigate increases in harmful ones
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