Beyond the Biography of a Gene

Collins approaches the ethical nuances of Cal’s intersex narrative in Middlesex, drawing comparisons with current debates in North Carolina concerning gender-normative bathroom use and trans rights, in order to advocate for more ethical practices of relation and responsibility outside of mere knowledge creation and policy

Therapeutic pluralism in mental health nursing practice

Cognitive behaviour therapy (CBT) is a much-debated subject in terms of its efficacy and status as the ‘treatment of choice’ for depression and anxiety. This article critically analyses the claimed merits of this therapy over others, and evaluates its efficacy as a standalone ‘combined therapy’, by examining dismantling, additive, comparative and component studies. The article examines behavioural activation in particular, as the contested active ingredient in the cognitive behavioural model, and the application of this and CBT in the context of evidence-based, person-centred and holistic mental health nursing practice

Stakeholder engagement in water governance as social learning: lessons from practice

The OECD Principles on Water Governance set out various requirements for stakeholder engagement. Coupled with conceptualizations of social learning, this article asks how we define and enact stakeholder engagement and explores the actual practice of engagement of stakeholders in three fields of water governance. The results suggest that a key consideration is the purpose of the stakeholder engagement, requiring consideration of its ethics, process, roles and expected outcomes. While facilitators cannot be held accountable if stakeholder engagement ‘fails’ in terms of social learning, they are responsible for ensuring that the enabling conditions for social learning are met

Extending life for people with a terminal illness: a moral right and an expensive death? Exploring societal perspectives

BACKGROUND: Many publicly-funded health systems apply cost-benefit frameworks in response to the moral dilemma of how best to allocate scarce healthcare resources. However, implementation of recommendations based on costs and benefit calculations and subsequent challenges have led to ‘special cases’ with certain types of health benefits considered more valuable than others. Recent debate and research has focused on the relative value of life extensions for people with terminal illnesses. This research investigates societal perspectives in relation to this issue, in the UK. METHODS: Q methodology was used to elicit societal perspectives from a purposively selected sample of data-rich respondents. Participants ranked 49 statements of opinion (developed for this study), onto a grid, according to level of agreement. These ‘Q sorts’ were followed by brief interviews. Factor analysis was used to identify shared points of view (patterns of similarity between individuals’ Q sorts). RESULTS: Analysis produced a three factor solution. These rich, shared accounts can be broadly summarised as: i) ‘A population perspective – value for money, no special cases’, ii) ‘Life is precious – valuing life-extension and patient choice’, iii) ‘Valuing wider benefits and opportunity cost - the quality of life and death’. From the factor descriptions it is clear that the main philosophical positions that have long dominated debates on the just allocation of resources have a basis in public opinion. CONCLUSIONS: The existence of certain moral positions in the views of society does not ethically imply, and pragmatically cannot mean, that all are translated into policy. Our findings highlight normative tensions and the importance of critically engaging with these normative issues (in addition to the current focus on a procedural justice approach to health policy). Future research should focus on i) the extent to which these perspectives are supported in society, ii) how respondents' perspectives relate to specific resource allocation questions, and iii) the characteristics of respondents associated with each perspective

The REF’s focus on linear and direct impact is problematic and silences certain types of research

In the last Research Excellence Framework (REF), the new element of research impact was understood in very linear and direct terms. Aoileann Ní Mhurchú, Laura McLeod, Stephanie Collins and Gabriel Siles-Brügge consider how accepted definitions of impact may have had the effect of silencing certain types of research. Research and impact should be seen as a two-way street, where academics engage with their research subjects as part of a process of co-production. Moreover, impact must be thought of as a collective endeavour that captures the broader social and cultural benefits of academic work. The Stern Review recommendations are to be welcomed but whether and how they are adopted remains to be seen

Improving Postdischarge Outcomes in Acute Heart Failure

The global burden that acute heart failure (AHF) carries has remained unchanged over the past several decades (1). European registries (2–5) showed that 1-year outcome rates remain unacceptably high (Table 1) and confirm that hospitalization for AHF represents a change in the natural history of the disease process(6). As patients hospitalized for HF have a bad prognosis, it is crucial to utilize hospitalization as an opportunity to: 1) assess the individual components of the cardiac substrate; 2) identify and treat comorbidities; 3) identify early, safe endpoints of therapy to facilitate timely hospital discharge and outpatient follow-up; and 4) implement and begin optimization guideline-directed medical therapies (GDMTs). As outcomes are influenced by many factors, many of which are incompletely understood, a systematic approach is proposed that should start with admission and continues through post-discharge (7)

The predictors of diet quality among Australian children aged 3.5 years

BACKGROUND: It is critical to promote healthy eating early in life. OBJECTIVE: The aim of this study was to examine diet quality and its predictors among Australian preschool-aged children. DESIGN: Diet was assessed at age 3.5 years using multiple 24-hour recalls. Diet quality was assessed using an adapted version of the Revised Children\u27s Diet Quality Index (RC-DQI). Potential predictors of diet quality were from questionnaires at age 3, 9, and 18 months and informed by the ecologic model of childhood overweight. Potential predictors included child\u27s sex, age of introduction to solid foods, breastfeeding status, food acceptance, maternal nutrition knowledge, modeling of healthy eating, self-efficacy, education, and home food availability. PARTICIPANTS: Data from 244 children participating in the Melbourne Infant Feeding, Activity, and Nutrition Trial in 2008-2010 and follow-up data collection in 2011-2013 were examined. MAIN OUTCOME MEASURES: Diet quality at age 3.5 years. STATISTICAL ANALYSES PERFORMED: Bivariate logistic regression was performed to assess the relationship between diet quality and each predictor. A multivariable logistic regression model accounting for influences of covariates, treatment arm, and clustering by group tested associations between diet quality and significant predictors from bivariate analyses. RESULTS: RC-DQI scores had a mean±standard deviation score of 62.8±8.3 points out of a maximum of 85 points. Breastfeeding status (odds ratio [OR] 2.34, 95% CI 1.33 to 4.10) and maternal modeling of healthy eating (OR 1.75, 95% CI 1.01 to 3.03) were positively associated with RC-DQI scores. Both breastfeeding status (OR 3.09, 95% CI 1.63 to 5.85) and modeling (OR 2.01, 95% CI 1.04 to 3.88) remained positively associated with diet quality after adjustment for child age, body mass index z score, energy intake, treatment arm, and clustering. CONCLUSIONS: Breastfeeding status and modeling of healthy eating were independently associated with children\u27s diet quality. Early intervention could assist mothers to practice these behaviors to provide support for improving child diet quality

Towards optimal cluster power spectrum analysis

The power spectrum of galaxy clusters is an important probe of the cosmological model. In this paper we determine the optimal weighting scheme for maximizing the signal-to-noise ratio for such measurements. We find a closed form analytic expression for the optimal weights. Our expression takes into account: cluster mass, finite survey volume effects, survey masking, and a flux limit. The implementation of this weighting scheme requires knowledge of the measured cluster masses, and analytic models for the bias and space-density of clusters as a function of mass and redshift. Recent studies have suggested that the optimal method for reconstruction of the matter density field from a set of clusters is mass-weighting (Seljak et al 2009, Hamaus et al 2010, Cai et al 2011). We compare our optimal weighting scheme with this approach and also with the original power spectrum scheme of Feldman et al (1994). We show that our optimal weighting scheme outperforms these approaches for both volume- and flux-limited cluster surveys. Finally, we present a new expression for the Fisher information matrix for cluster power spectrum analysis. Our expression shows that for an optimally weighted cluster survey the cosmological information content is boosted, relative to the standard approach of Tegmark (1997).Comment: Significantly shortened: 20 pages; 3 figure