Creating change in government to address the social determinants of health: How can efforts be improved?

Background The evidence base for the impact of social determinants of health has been strengthened considerably in the last decade. Increasingly, the public health field is using this as a foundation for arguments and actions to change government policies. The Health in All Policies (HiAP) approach, alongside recommendations from the 2010 Marmot Review into health inequalities in the UK (which we refer to as the ‘Fairness Agenda’), go beyond advocating for the redesign of individual policies, to shaping the government structures and processes that facilitate the implementation of these policies. In doing so, public health is drawing on recent trends in public policy towards ‘joined up government’, where greater integration is sought between government departments, agencies and actors outside of government. Methods In this paper we provide a meta-synthesis of the empirical public policy research into joined up government, drawing out characteristics associated with successful joined up initiatives. We use this thematic synthesis as a basis for comparing and contrasting emerging public health interventions concerned with joined-up action across government. Results We find that HiAP and the Fairness Agenda exhibit some of the characteristics associated with successful joined up initiatives, however they also utilise ‘change instruments’ that have been found to be ineffective. Moreover, we find that – like many joined up initiatives – there is room for improvement in the alignment between the goals of the interventions and their design. Conclusion Drawing on public policy studies, we recommend a number of strategies to increase the efficacy of current interventions. More broadly, we argue that up-stream interventions need to be ‘fit-for-purpose’, and cannot be easily replicated from one context to the next.

Spatially explicit perceptions of ecosystem services and land cover change in forested regions of Borneo

Spatially explicit information on local perceptions of ecosystem services is needed to inform land use planning within rapidly changing landscapes. In this paper we spatially modelled local people's use and perceptions of benefits from forest ecosystem services in Borneo, from interviews of 1837 people in 185 villages. Questions related to provisioning, cultural/spiritual, regulating and supporting ecosystem services derived from forest, and attitudes towards forest conversion. We used boosted regression trees (BRTs) to combine interview data with social and environmental predictors to understand spatial variation of perceptions across Borneo. Our results show that people use a variety of products from intact and highly degraded forests. Perceptions of benefits from forests were strongest: in human-altered forest landscapes for cultural and spiritual benefits; in human-altered and intact forests landscapes for health benefits; intact forest for direct health benefits, such as medicinal plants; and in regions with little forest and extensive plantations, for environmental benefits, such as climatic impacts from deforestation. Forest clearing for small scale agriculture was predicted to be widely supported yet less so for large-scale agriculture. Understanding perceptions of rural communities in dynamic, multi-use landscapes is important where people are often directly affected by the decline in ecosystem services.

Evaluation of a skin self examination attitude scale using an item response theory model approach

Introduction The Skin Self-Examination Attitude Scale (SSEAS) is a brief measure that allows for the assessment of attitudes in relation to skin self-examination. This study evaluated the psychometric properties of the SSEAS using Item Response Theory (IRT) methods in a large sample of men ≥ 50 years in Queensland, Australia. Methods A sample of 831 men (420 intervention and 411 control) completed a telephone assessment at the 13-month follow-up of a randomized-controlled trial of a video-based intervention to improve skin self-examination (SSE) behaviour. Descriptive statistics (mean, standard deviation, item–total correlations, and Cronbach’s alpha) were compiled and difficulty parameters were computed with Winsteps using the polytomous Rasch Rating Scale Model (RRSM). An item person (Wright) map of the SSEAS was examined for content coverage and item targeting. Results The SSEAS have good psychometric properties including good internal consistency (Cronbach’s alpha = 0.80), fit with the model and no evidence for differential item functioning (DIF) due to experimental trial grouping was detected. Conclusions The present study confirms the SSEA scale as a brief, useful and reliable tool for assessing attitudes towards skin self-examination in a population of men 50 years or older in Queensland, Australia. The 8-item scale shows unidimensionality, allowing levels of SSE attitude, and the item difficulties, to be ranked on a single continuous scale. In terms of clinical practice, it is very important to assess skin cancer self-examination attitude to identify people who may need a more extensive intervention to allow early detection of skin cancer.

Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: A randomized controlled trial

Background Multiple health behavior change can ameliorate adverse effects of cancer. Purpose The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life. Methods A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months. Results Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037). Conclusions The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (Trial Registration Number: ACTRN12608000399392).

Dioxin risk reduction programme at the most severe dioxin hot spot in Vietnam: Residual knowledge, attitude and practices five years post intervention

Bien Hoa Airbase was one of the bulk storage and supply facilities for defoliants during the Vietnam War. Environmental and biological samples taken around the airbase have elevated levels of dioxin. In 2007, a pre-intervention knowledge, attitude and practice (KAP) survey of local residents living in Trung Dung and Tan Phong wards was undertaken regarding appropriate strategies to reduce dioxin exposure. A risk reduction programme was implemented in 2008 and post-intervention KAP surveys were undertaken in 2009 and 2013 to evaluate the longer term impacts. Quantitative assessment was undertaken via a KAP survey in 2013 among 600 local residents randomly selected from the two intervention wards and one control ward (Buu Long). Eight in-depth interviews and two focus group discussions were also undertaken for qualitative assessment. Most programme activities had ceased and dioxin risk communication activities had not been integrated into local routine health education programmes; however, main results generally remained and were better than that in Buu Long. In total, 48.2% of households undertook measures to prevent exposure, higher than those in pre- and post-intervention surveys (25.8% and 39.7%) and the control ward (7.7%). Migration and the sensitive nature of dioxin issues were the main challenges for the programme's sustainability

Kissing fish: Rex Hunt, popular culture, sustainability and fishing practices

Natural resource managers and scientists focus on the behaviour of individual recreational fishers to understand environmental problems associated with this leisure activity. They do this in an effort to identify ways to change attitudes in order to facilitate environmentally friendly choices. This applied use of ABC psychology (attitude, behaviour, choice) has not delivered the expected results. This article offers a different approach by investigating an emergent practice in diverse fishing communities, rather than looking to the responsibility of the individual recreational fisher. Using practice theory, I trace the change from take-all to catch-and-release fishing in Australia by analysing the texts of celebrity fisher Rex Hunt, who is an advocate for releasing fish. I combine this with oral history testimony from a sample of recreational fishers from the broader Australian community to show how change happened. The practice of catch-and-release fishing emerged through the combination of sociotechnical and historically specific elements present in popular culture, including the media. Paying attention to the way different elements catalyse provides a rich account of the changing modes of sustainability in recreational fishing communities.

Studying change in popular culture: A "middle-range" approach

"This chapter reviews the capacity of the discipline field to account for the velocity and quality of digitally-driven transformations, while making a case for a "middle range" approach that steers between unbridled optimism ("all-change") and determined scepticism ("Continuity") about the potential of such change. The chapter focuses on online screen distribution as a case study, considering the evidence for, and significance of, change in industry structure and the main payers, how content is produced and by whom, the nature of content, and the degree to which online screen distribution has reached thresholds of mainstream popularity."

Cumulative effects on the change of residual value in PPP projects: A comparative case study

Public private partnerships (PPPs) have been adopted widely to provide public facilities and services. According to the PPP agreement, PPP projects would be transferred to the public sector. However, problems related to the subsequent management of ongoing PPP projects have not been studied thoroughly. Residual value risk (RVR) can occur if the public sector cannot obtain the project in the desired conditions as required in the agreement when a project is being transferred. RVR has been identified as an important risk in PPPs and has greatly influenced the outputs of the projects. In order to further observe the change of residual value (RV) during the process of PPP projects and to reveal the internal mechanism for reducing the RVR, a comparative case study of two PPP projects in mainland China and Hong Kong was conducted. Based on the case study, different factors leading to RVR and a series of key risk indicators (KRIs) were identified. The comparison demonstrates that RVR is an important risk that could influence the success of PPP projects. The cumulative effects during the concession period can play significant roles in the occurrence of RVR. Additionally, the cumulative effects in different cases can make the RVR different because of different stakeholders’ efforts on the projects and ways to treat RVR. Finally, alternatives for the public sector to treat RVR were proposed. The findings of this research can reduce RVR and improve the performance of PPP projects.

Climate change and forests in India

Forests play a critical role in addressing climate change concerns in the broader context of global change and sustainable development. Forests are linked to climate change in three ways. i) Forests are a source of greenhouse gas (GHG) emissions: ii) Forests offer mitigation opportunities to stabilise GHG concentrations: iii) Forests are impacted by climate change. This paper reviews studies related to climate change and forests in India: first, the studies estimating carbon inventory for the Indian land use change and forestry sector (LUCF), then the different models and mitigation potential estimates for the LUCF sector in India. Finally it reviews the studies on the impact of climate change on forest ecosystems in India, identifying the implications for net primary productivity and bio-diversity. The paper highlights data, modelling and research gaps relevant to the GHG inventory, mitigation potential and vulnerability and impact assessments for the forest sector in India.

Problems with geoengineering schemes to combat climate change

The accelerated rate of increase in atmospheric CO2 concentration in recent years has revived the idea of stabilizing the global climate through geoengineering schemes. Majority of the proposed geoengineering schemes will attempt to reduce the amount of solar radiation absorbed by our planet. Climate modelling studies of these so called 'sunshade geoengineering schemes' show that global warming from increasing concentrations of CO2 can be mitigated by intentionally manipulating the amount of sunlight absorbed by the climate system. These studies also suggest that the residual changes could be large on regional scales, so that climate change may not be mitigated on a local basis. More recent modelling studies have shown that these schemes could lead to a slow-down in the global hydrological cycle. Other problems such as changes in the terrestrial carbon cycle and ocean acidification remain unsolved by sunshade geoengineering schemes. In this article, I review the proposed geoengineering schemes, results from climate models and discuss why geoengineering is not the best option to deal with climate change.

Equivariant Birch-Swinnerton-Dyer Conjecture for the Base Change of Elliptic Curves: An Example

Let E be an elliptic curve defined over Q and let K/Q be a finite Galois extension with Galois group G. The equivariant Birch-Swinnerton-Dyer conjecture for h(1)(E x(Q) K)(1) viewed as amotive over Q with coefficients in Q[G] relates the twisted L-values associated with E with the arithmetic invariants of the same. In this paper I prescribe an approach to verify this conjecture for a given data. Using this approach, we verify the conjecture for an elliptic curve of conductor 11 and an S-3-extension of Q.

Energy-based motion control of a slender hull unmanned underwater vehicle

This paper presents a motion control system for tracking of attitude and speed of an underactuated slender-hull unmanned underwater vehicle. The feedback control strategy is developed using the Port-Hamiltonian theory. By shaping of the target dynamics (desired dynamic response in closed loop) with particular attention to the target mass matrix, the influence of the unactuated dynamics on the controlled system is suppressed. This results in achievable dynamics independent of stable uncontrolled states. Throughout the design, the insight of the physical phenomena involved is used to propose the desired target dynamics. Integral action is added to the system for robustness and to reject steady disturbances. This is achieved via a change of coordinates that result in input-to-state stable (ISS) target dynamics. As a final step in the design, an anti-windup scheme is implemented to account for limited actuator capacity, namely saturation. The performance of the design is demonstrated through simulation with a high-fidelity model.

Workers’ attitude towards bus rapid transit: Considering Dhaka, Bangladesh

The Government of Bangladesh is planning to develop and implement Bus Rapid Transit (BRT) in Dhaka city. This paper presents a stated choice survey conducted to understand workers’ attitudes toward BRT in Dhaka. The survey data are analysed using a multinomial logit (MNL) model to scrutinize social and economic factors’ impact on participant’s mode choices. Analysis results reveal that males, workers of higher age, education qualification, and income have a greater tendency towards choosing BRT.

A Jacobian-Based Algorithm for Planning Attitude Maneuvers Using Forward and Reverse Rotations

Algorithms for planning quasistatic attitude maneuvers based on the Jacobian of the forward kinematic mapping of fully-reversed (FR) sequences of rotations are proposed in this paper. An FR sequence of rotations is a series of finite rotations that consists of initial rotations about the axes of a body-fixed coordinate frame and subsequent rotations that undo these initial rotations. Unlike the Jacobian of conventional systems such as a robot manipulator, the Jacobian of the system manipulated through FR rotations is a null matrix at the identity, which leads to a total breakdown of the traditional Jacobian formulation. Therefore, the Jacobian algorithm is reformulated and implemented so as to synthesize an FR sequence for a desired rotational displacement. The Jacobian-based algorithm presented in this paper identifies particular six-rotation FR sequences that synthesize desired orientations. We developed the single-step and the multiple-step Jacobian methods to accomplish a given task using six-rotation FR sequences. The single-step Jacobian method identifies a specific FR sequence for a given desired orientation and the multiple-step Jacobian algorithm synthesizes physically feasible FR rotations on an optimal path. A comparison with existing algorithms verifies the fast convergence ability of the Jacobian-based algorithm. Unlike closed-form solutions to the inverse kinematics problem, the Jacobian-based algorithm determines the most efficient FR sequence that yields a desired rotational displacement through a simple and inexpensive numerical calculation. The procedure presented here is useful for those motion planning problems wherein the Jacobian is singular or null.

Unsteady Natural Convection Flow in a Square Cavity Filled with a Porous Medium Due to Impulsive Change in Wall Temperature

Unsteady natural convection flow in a two- dimensional square cavity filled with a porous material has been studied. The flow is initially steady where the left- hand vertical wall has temperature T-h and the right- hand vertical wall is maintained at temperature T-c ( T-h > T-c) and the horizontal walls are insulated. At time t > 0, the left- hand vertical wall temperature is suddenly raised to (T-h) over bar ((T-h) over bar > T-h) which introduces unsteadiness in the flow field. The partial differential equations governing the unsteady natural convection flow have been solved numerically using a finite control volume method. The computation has been carried out until the final steady state is reached. It is found that the average Nusselt number attains a minimum during the transient period and that the time required to reach the final steady state is longer for low Rayleigh number and shorter for high Rayleigh number.