Technology acceptance and care self-management: consideration in context of chronic care management

With an aging global population, the number of people living with a chronic illness is expected to increase significantly by 2050. If left unmanaged, chronic care leads to serious health complications, resulting in poor patient quality of life and a costly time bomb for care providers. If effectively managed, patients with chronic care tend to live a richer and more healthy life, resulting in a less costly total care solution. This chapter considers literature from the areas of technology acceptance and care self-management, which aims to alleviate symptoms and/or reason for non-acceptance of care, and thus minimise the risk of long-term complications, which in turn reduces the chance of spiralling health expenditure. By bringing together these areas, the chapter highlights areas where self-management is failing so that changes can be made in care in advance of health deterioration.

Farmers' interest in growing GM crops in the UK, in the context of a range of on-farm coexistence issues

Although no GM crops currently are licensed for commercial production in the UK, as opposition to GM crops by consumers softens, this could change quickly. Although past studies have examined attitudes of UK farmers toward GM technologies in general, there has been little work on the impact of possible coexistence measures on their attitudes toward GM crop production. This could be because the UK Government has not engaged in any public dialogue on the coexistence measures that might be applied on farms. Based on a farm survey, this article examines farmers’ attitudes toward GM technologies and planting intentions for three crops (maize, oilseed rape, and sugar beet) based on a GM availability scenario. The article then nuances this analysis with a review of farmer perceptions of the level of constraint associated with a suite of notional farm-level coexistence measures and issues, based on current European Commission guidelines and practice in other EU Member States.

Mammalian-microbial cometabolism of L-Carnitine in the context of atherosclerosis

g-butyrobetaine has long been known as the precursor of endogenous L-carnitine synthesis. In this issue, Koeth et al. (2014) demonstrate that it is also a major metabolite of L-carnitine degradation by gut bacteria that precedes the enteric production of trimethylamine and trimethylamine-N-oxide.

The notions of 'restriction' and 'discrimination' in the context of the free movement of persons provisions: from a relationship of interdependence to one of (almost complete) independence

This article aims to analyse how the meaning of the notions of ‘restrictions’ and ‘discrimination’ in EU free movement law has developed through the years, and to explore how the relationship between them has evolved. It is explained that the two concepts under examination had originally been closely intertwined, in the sense that one defined the other, the element holding them together being the aim of the relevant provisions to liberalise the inter-State movement of persons in the EU, as part of the process of establishing an internal market. Yet, more recently, the way that the Court has chosen to delimit their scope, illustrates that each of these notions can now have a life of its own, meaning that ‘discrimination’ can include discriminatory measures which do not lead to restrictions that are contrary to the free movement provisions, and ‘restriction’ can cover national measures that are not discriminatory.

Military targeting in the context of self-defence actions

In order to bring conceptual clarity to a particular dimension of the relationship between the jus ad bellum and the jus in bello regimes, this article explores the independent sources of a military targeting rule in both branches of international law. The aim is not to displace the jus in bello as the ‘lead’ regime on how targeting decisions must be made, or to undermine the traditional separation between these regimes. Rather, conceptual light is shed on a sometimes assumed but generally neglected dimension of the jus ad bellum’s necessity and proportionality criteria that may, in limited circumstances, have significance for our understanding of human protection during war, by covering possible gaps in the jus in bello targeting rules.

Treatment of child anxiety in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

Background Cognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design Participants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI). Setting A NHS university clinic in Berkshire, UK. Participants Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures Primary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty. Results MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group. Trial registration Current Controlled Trials ISRCTN19762288. Funding This trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full in Health Technology Assessment; Vol. 19, No. 38.

Parental responsibility beliefs: associations with parental anxiety and behaviours in the context of childhood anxiety disorders

Background: High levels of parental anxiety are associated with poor treatment outcomes for children with anxiety disorders. Associated parental cognitions and behaviours have been implicated as impediments to successful treatment. We examined the association between parental responsibility beliefs, maternal anxiety and parenting behaviours in the context of childhood anxiety disorders. Methods: Anxious and non-anxious mothers of 7-12 year old children with a current anxiety disorder reported their parental responsibility beliefs using a questionnaire measure. Parental behaviours towards their child during a stressor task were measured. Results: Parents with a current anxiety disorder reported a greater sense of responsibility for their child’s actions and wellbeing than parents who scored within the normal range for anxiety. Furthermore, higher parental responsibility was associated with more intrusive and less warm behaviours in parent-child interactions and there was an indirect effect between maternal anxiety and maternal intrusive behaviours via parental responsibility beliefs. Limitations: The sample was limited to a treatment-seeking, relatively high socio-economic population and only mothers were included so replication with more diverse groups is needed. The use of a range of stressor tasks may have allowed for a more comprehensive assessment of parental behaviours. Conclusions: The findings suggest that parental anxiety disorder is associated with an elevated sense of parental responsibility and may promote parental behaviours likely to inhibit optimum child treatment outcomes. Parental responsibility beliefs may therefore be important to target in child anxiety treatments in the context of parental anxiety disorders.

What is Carbon? Conceptualising carbon and capabilities in the context of community sequestration projects in the global South

Carbon has been described as a ‘surreal commodity’. Whilst carbon trading, storage, sequestration and emissions have become a part of the contemporary climate lexicon, how carbon is understood, valued and interpreted by actors responsible for implementing carbon sequestration projects is still unclear. In this review paper, we are concerned with how carbon has come to take on a range of meanings, and in particular, we appraise what is known about the situated meanings that people involved in delivering, and participating in, carbon sequestration projects in the global South assign to this complex element. Whilst there has been some reflection on the new meanings conferred on carbon via the neoliberal processes of marketisation, and how these processes interact with historical and contemporary narratives of environmental change, less is known about how these meanings are (re)produced and (re)interpreted locally. We review how carbon has been defined both as a chemical element and as a tradable, marketable commodity, and discuss the implications these global meanings might have for situated understandings, particularly linked to climate change narratives, amongst communities in the global South. We consider how the concept of carbon capabilities, alongside theoretical notions of networks, assemblages and local knowledges of the environment and nature, might be useful in beginning to understand how communities engage with abstract notions of carbon. We discuss the implications of specific values attributed to carbon, and therefore to different ecologies, for wider conceptualisations of how nature is valued, and climate is understood, and particularly how this may impact on community interactions with carbon sequestration projects. Knowing more about how people understand, value and know carbon allows policies to be better informed and practices more effectively targeted at engaging local populations meaningfully in carbon-related projects.

Comparison of the portion size and frequency of consumption of 156 foods across seven European countries: insights from the Food4ME study

There are no standardised serving/portion sizes defined for foods consumed in the European Union (EU). Typical serving sizes can deviate significantly from the 100 g/100 ml labelling specification required by the EU legislation. Where the nutritional value of a portion is specified, the portion size is determined by the manufacturers. Our objective was to investigate the potential for standardising portion sizes for specific foods, thereby ensuring complementarity across countries. We compared portion size for 156 food items measured using a food frequency questionnaire across the seven countries participating in the Food4me study. The probability of consuming a food and the frequency of consumption differed across countries for 93% and 58% of the foods, respectively. However, the individual country mean portion size differed from the average across countries in only 16% of comparisons. Thus, although dietary choices vary markedly across countries, there is much less variation in portion sizes. Our results highlight the potential for standardisation of portion sizes on nutrition labels in the EU

A semiotic framework for information representation of energy consumption in office buildings

Taking a perspective from a whole building lifecycle, occupier's actions could account for about 50% of energy. However occupants' activities influence building energy performance is still a blind area. Building energy performance is thought to be the result of a combination of building fabrics, building services and occupants' activities, along with their interactions. In this sense, energy consumption in built environment is regarded as a socio-technical system. In order to understand how such a system works, a range of physical, technical and social information is involved that needs to be integrated and aligned. This paper has proposed a semiotic framework to add value for Building Information Modelling, incorporating energy-related occupancy factors in a context of office buildings. Further, building information has been addressed semantically to describe a building space from the facility management perspective. Finally, the framework guides to set up building information representation system, which can help facility managers to manage buildings efficiently by improving their understanding on how office buildings are operated and used.

In-service training needs in an African context: a study of headteacher and teacher perspectives in the Gucha District of Kenya

Improving the quality of teaching is an educational priority in Kenya, as in many developing countries. The present paper considers various aspects of in-service education, including views on the effectiveness of in-service, teacher and headteacher priorities in determining in-service needs and the constraints on providing in-service courses. These issues are examined though an empirical study of 30 secondary headteachers and 109 teachers in a district of Kenya. The results show a strong felt need for in-service provision together with a firm belief in the efficacy of in-service in raising pupil achievement. Headteachers had a stronger belief in the need for in-service for their teachers than did the teachers themselves. The priorities of both headteachers and teachers were dominated by the external pressures of the schools, in particular the pressures for curriculum innovation and examination success. The resource constraints on supporting attendance at in-service courses were the major problems facing headteachers. The results reflect the difficulties that responding to an externally driven in-service agenda creates in a context of scarce resources.

Exploring the construction of social class in educational discourse: the rational order of the nation state versus global uncertainties

This article aims to create intellectual space in which issues of social inequality and education can be analyzed and discussed in relation to the multifaceted and multi-levelled complexities of the modern world. It is divided into three sections. Section One locates the concept of social class in the context of the modern nation state during the period after the Second World War. Focusing particularly on the impact of 'Fordism' on social organization and cultural relations, it revisits the articulation of social justice issues in the United Kingdom, and the structures put into place at the time to alleviate educational and social inequalities. Section Two problematizes the traditional concept of social class in relation to economic, technological and sociocultural changes that have taken place around the world since the mid-1980s. In particular, it charts some of the changes to the international labour market and global patterns of consumption, and their collective impact on the re-constitution of class boundaries in 'developed countries'. This is juxtaposed with some of the major social effects of neo-classical economic policies in recent years on the sociocultural base in developing countries. It discusses some of the ways these inequalities are reflected in education. Section Three explores tensions between the educational ideals of the 'knowledge economy' and the discursive range of social inequalities that are emerging within and beyond the nation state. Drawing on key motifs identified throughout, the article concludes with a reassessment of the concept of social class within the global cultural economy. This is discussed in relation to some of the major equity and human rights issues in education today.

Frequency of fruit and vegetable consumption and blood antioxidants in the Caerphilly cohort of older men

Objective: To assess the number of portions of fruit and vegetables consumed daily by a large representative sample of older men, and to determine how blood antioxidant (vitamins E, A and carotenoids) concentrations vary with fruit and vegetable consumption. Design: Cross-sectional study of free-living men. Subjects: Men aged 55-69 y (dietary data, n=1957; blood data, n=1874) participating in Phase III (1989-1993) of the Caerphilly and Speedwell Collaborative Heart Disease Studies. Methods: Dietary data were obtained by semi-quantitative food-frequency questionnaire and blood samples were analysed for antioxidant vitamins. Men were subdivided into groups on the basis of portions per day of fruit and vegetables. Within these sub-groups, mean and 95% ranges of intakes and of blood antioxidant levels were obtained. Log transformations were performed where appropriate. Results: Only 4.3% of the men met the recommended target of five portions, while 33.3% of the men consumed one or fewer portions of fruit and vegetables per day. Those men who consumed the poorest diets with respect to fruit and vegetable intakes were more likely to be from lower socio-economic classes, drink more alcohol and be current smokers. Fruit and vegetable intake reflected plasma concentrations of antioxidants, which showed a dose-response relationship to frequency of consumption. Conclusions: Older men in the UK consume much less fruit and vegetables than current recommendations. Major difficulties are likely to be encountered in trying to meet a dietary target that is clearly much higher than the fruit and vegetable consumption of large sections of the older population in the UK.

Exploring the construction of social class in educational discourse: the rational order of the nation state vs. global uncertainties

This article aims to create intellectual space in which issues of social inequality and education can be analyzed and discussed in relation to the multifaceted and multi-levelled complexities of the modern world. It is divided into three sections. Section One locates the concept of social class in the context of the modern nation state during the period after the Second World War. Focusing particularly on the impact of ‘Fordism’ on social organization and cultural relations, it revisits the articulation of social justice issues in the United Kingdom, and the structures put into place at the time to alleviate educational and social inequalities. Section Two problematizes the traditional concept of social class in relation to economic, technological and sociocultural changes that have taken place around the world since the mid-1980s. In particular, it charts some of the changes to the international labour market and global patterns of consumption, and their collective impact on the re-constitution of class boundaries in ‘developed countries’. This is juxtaposed with some of the major social effects of neo-classical economic policies in recent years on the sociocultural base in developing countries. It discusses some of the ways these inequalities are reflected in education. Section Three explores tensions between the educational ideals of the ‘knowledge economy’ and the discursive range of social inequalities that are emerging within and beyond the nation state. Drawing on key motifs identified throughout, the article concludes with a reassessment of the concept of social class within the global cultural economy. This is discussed in relation to some of the major equity and human rights issues in education today.