11 resultados para BILIOPANCREATIC DIVERSION
Resumo:
Objective: The authors evaluated and synthesised the best-available evidence relating to the effectiveness of CJLD service models with respect to changes in mental health status and/or criminal recidivism.Methods: Research examining the effectiveness of CJLD services when compared to traditional Criminal Justice System (CJS) responses was reviewed and systematically appraised according to Campbell/Cochrane guidelines. Key outcomes included a reduction in offending and post-intervention changes in mental health. Results: Comprehensive searches of published and unpublished literature identified 6571 studies which varied considerably in terms of their methodological approach and overall quality. Ten studies met the inclusion criteria. The synthesised findings indicated that, when compared to traditional CJS outcomes, CJLD services appeared to be effective in terms of identifying MDOs and impacting positively on criminal justice and mental health outcomes.Conclusions: Although the evidence may be deemed to be moderate in terms of methodological rigour, overall, the findings suggest that CJLD services can be beneficial. The effectiveness of services depends upon the model of service delivery, the availability of community services and the engagement of MDOs.The successful implementation of CJLD services requires a clearer recognition of the importance of system of care principles.
Resumo:
There is continued interest in the planning, development and implementation of services designed to identify, detainees with mental illness and connect them to health and social services. However, currently little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison / diversion services and routine health and social services.
Resumo:
NO (nitric oxide) can affect mitochondrial function by interacting with the cytochrome c oxidase (complex IV) of the electron transport chain in a manner that is reversible and in competition with oxygen. Concentrations of NO too low to inhibit respiration can trigger cell defence response mechanisms involving reactive oxygen species and various signalling molecules such as nuclear factor kappa B and AMP kinase. Inhibition of mitochondrial respiration by NO at low oxygen concentrations can cause so-called metabolic hypoxia and divert oxygen towards other oxygen-dependent systems. Such a diversion reactivates prolyl hydroxylases and thus accounts for the prevention by NO of the stabilization of hypoxia-inducible transcription factor. In certain circumstances NO interacts with superoxide radical to form peroxynitrite, which can affect the action of key enzymes, such as mitochondrial complex I, by S-nitrosation. This chapter discusses the physiological and pathophysiological implications of the interactions of NO with the cytochrome c oxidase.
Resumo:
This paper investigates how the Kyoto Protocol has framed political discourse and policy development of greenhouse gas mitigation in Australia. We argue that ‘Kyoto’ has created a veil over the climate issue in Australia in a number of ways. Firstly, its symbolic power has distracted attention from actual environmental outcomes while its accounting rules obscure the real level of carbon emissions and structural trends at the nation-state level. Secondly, a public policy tendency to commit to far off emission targets as a compromise to implementing legislation in the short term has also emerged on the back of Kyoto-style targets. Thirdly, Kyoto’s international flexibility mechanisms can lead to the diversion of mitigation investment away from the nation-state implementing carbon legislation. A final concern of the Kyoto approach is how it has shifted focus away from Australia as the world’s largest coal exporter towards China, its primary customer. While we recognise the crucial role aspirational targets and timetables play in capturing the imagination and coordinating action across nations, our central theme is that ‘Kyoto’ has overshadowed the implementation of other policies in Australia. Understanding how ‘Kyoto’ has framed debate and policy is thus crucial to promoting environmentally effective mitigation measures as nation-states move forward from COP15 in Copenhagen to forge a post-Kyoto international agreement. Recent elections in 2009 in Japan and America and developments at COP15 suggest positive scope for international action on climate change. However, the lesson from the 2007 election and subsequent events in Australia is a caution against elevating the symbolism of ‘Kyoto-style’ targets and timetables above the need for implementation of mitigation policies at the nation-state level
Resumo:
In order to meet the recycling and recovery targets set forth by the European Union's (EU) Waste and Landfill Directives, both the Irish and Czech governments’ policy on waste management is changing to meet these pressures, with major emphasis being placed upon the management of biodegradable municipal waste (BMW). In particular, the EU Landfill Directive requires reductions in the rate of BMW going to landfill to 35% of 1995 values by 2016 and 2020 for Ireland and the Czech Republic, respectively. In this paper, the strategies of how Ireland and the Czech Republic plan to meet this challenge are compared. Ireland either landfills or exports its waste for recovery, while the Czech Republic has a relatively new waste management infrastructure. While Ireland met the first target of 75% diversion of BMW from landfill by 2010 and preliminary 2012 data indicate that Ireland is on track to meet the 2013 target, the achievement of the 2016 target remains at risk. Indicators that were developed to monitor the Czech Republic's path to meeting the targets demonstrate that it did not meet the first target that was set for 2010 and will probably not meet its 2013 target either. The evaluation reports on the implementation of Waste Management Plan of Czech Republic suggest that the currently applied strategy to divert biodegradable waste from landfill is not effective enough. For both countries, the EU Waste Framework and Landfill Directives will be a significant influence and driver of change in waste management practices and governance over the coming decade. This means that both countries will not only have to invest in infrastructure to achieve the targets, but will also have to increase awareness among the public in diverting this waste at the household level. Improving environmental education is part of increased awareness as it is imperative for citizens to understand the consequences of their actions as affluence continues to grow producing increased levels of waste.
Graphical abstract
Despite the differences in the levels of waste generation in both the Czech Republic and Ireland, each country can learn from each other in order to meet the recycling and recovery targets set by the European Union's (EU) Waste and Landfill Directives. Both countries will not only have to invest in infrastructure to achieve the targets, but will also have to increase awareness among the public in diverting this waste at the household level. In addition, there needs to be minimum safe standards when land-spreading organic agricultural and organic municipal and industrial materials on agricultural land used for food production, as well as incentives to increase BMW diversion from landfill such as the increased landfill levy implemented in Ireland and the acceptance of MBT and/or incineration as a means of treating residual waste.
Resumo:
Hulun Lake, China's fifth-largest inland lake, experienced severe declines in water level in the period of 2000-2010. This has prompted concerns whether the lake is drying up gradually. A multi-million US dollar engineering project to construct a water channel to transfer part of the river flow from a nearby river to maintain the water level was completed in August 2010. This study aimed to advance the understanding of the key processes controlling the lake water level variation over the last five decades, as well as investigate the impact of the river transfer engineering project on the water level. A water balance model was developed to investigate the lake water level variations over the last five decades, using hydrological and climatic data as well as satellite-based measurements and results from land surface modelling. The investigation reveals that the severe reduction of river discharge (-364±64 mm/yr, ∼70% of the five-decade average) into the lake was the key factor behind the decline of the lake water level between 2000 and 2010. The decline of river discharge was due to the reduction of total runoff from the lake watershed. This was a result of the reduction of soil moisture due to the decrease of precipitation (-49±45 mm/yr) over this period. The water budget calculation suggests that the groundwater component from the surrounding lake area as well as surface run off from the un-gauged area surrounding the lake contributed ∼ net 210 Mm3/yr (equivalent to ∼ 100 mm/yr) water inflows into the lake. The results also show that the water diversion project did prevent a further water level decline of over 0.5 m by the end of 2012. Overall, the monthly water balance model gave an excellent prediction of the lake water level fluctuation over the last five decades and can be a useful tool to manage lake water resources in the future.
Resumo:
This article draws on an analysis of young people’s offending careers. The research was initiated against a backdrop of changing discourse around youth justice in Ireland with a shift towards prevention of offending and diversion from the criminal justice system. Locating crime and criminal justice contact within a biographical context indicated that participants’ offending, and lives generally, was bound up in marginalized transitions to adulthood, and embedded within social and economic environments characterized by high deprivation. The findings support a further shift in focus towards addressing social injustice as a necessary prerequisite to tackle the origins of youth offending.
Resumo:
The National Institute for Health and Care Excellence's (2008) guidelines for the diagnosis and management of attention deficit hyperactivity disorder (ADHD) recommend a full clinical and psychological assessment by an appropriately trained clinician; this should include a detailed developmental and psychiatric history. Stimulant medications, which are Schedule II controlled drugs, are the most commonly prescribed medicines in the UK and across the world for the management of ADHD. Children and young people with a diagnosis of ADHD receiving these stimulant medications are required to attend regular review appointments with a consultant child and adolescent psychiatrist or specialist nurse under shared care guidelines with general practices, and it has long been recognized that appropriately educated nurses can assist in the management of ADHD. Owing to the pharmacological action of the stimulant medication on neurotransmission, there is potential for misuse and dependence. A growing body of evidence suggests that adolescents with ADHD can become involved in drug diversion and that the topic should be explored during assessment. The level of misuse of prescribed stimulants is increasing, and adolescents and young people with ADHD may misuse to enhance cognitive function for academic purposes. The following scenario highlights some of the challenges and opportunities for independent nurse prescribers working in child and adolescent mental health services.
Resumo:
Little is known about long-term ecological responses in lakes following red mud pollution. Among red mud contaminants, arsenic (As) is of considerable concern. Determination of the species of As accumulated in aquatic organisms provides important information about the biogeochemical cycling of the element and transfer through the aquatic food-web to higher organisms. We used coupled ion chromatography and inductively coupled plasma mass spectrometry (ICP-MS) to assess As speciation in tissues of five macrophyte taxa in Kinghorn Loch, UK, 30 years following the diversion of red mud pollution from the lake. Toxic inorganic As was the dominant species in the studied macrophytes, with As species concentrations varying with macrophyte taxon and tissue type. The highest As content measured in roots of Persicaria amphibia (L.) Gray (87.2 mg kg-1) greatly exceeded the 3 - 10 mg kg-1 range suggested as a potential phytotoxic level. Accumulation of toxic As species by plants suggested toxicological risk to higher organisms known to utilise macrophytes as a food source.