Suchergebnisse

In Effective Knowledge Management for Law Firms, Matthew Parsons draws on his work with a leading commercial law firm, Mallesons Stephen Jaques. He examines how law firms can implement a knowledge strategy to support their business strategy, rather than getting beguiled by fad and technology

As a sub study of another study we examined older people with complex health and disability support needs' desire for change. The aim was to compare this across different ages, residence, and gender. Semi-structured interviews were held with 129 participants and the data were analyzed using a General Inductive Approach. Six themes emerged, Health, No Change, Personal Changes, Family, Housing, and Services. The two most popular themes were a desire for health changes and to have no change. Health professionals might note that older people in their 80s with significant health and disability impairments have a decrease in both the desire for health changes and any other changes.

Oil sands upgrading facilities in the Athabasca oil sands region (AOSR) in Alberta, Canada, have been reporting mercury (Hg) emissions to public government databases (National Pollutant Release Inventory (NPRI)) since the year 2000, yet the relative contribution of these emissions to ambient Hg deposition remains unknown. The impact of oil sands emissions (OSE) on Hg levels in and around the AOSR, relative to contributions from global (anthropogenic, geogenic and legacy) emissions and regional biomass burning emissions (BBE), was assessed using a global 3D-process-based Hg model, GEM-MACH-Hg, from 2012 to 2015. In addition, the relative importance of year-to-year changes in Hg emissions from the above sources and meteorological conditions to inter-annual variations in Hg deposition was examined. Surface air concentrations of Hg species and annual snowpack Hg loadings simulated by the model were found comparable to measured levels in the AOSR, suggesting consistency between reported Hg emissions from oil sands activities and Hg levels in the region. As a result of global-scale transport and the long lifetime of gaseous elemental Hg (Hg(0)), surface air concentrations of Hg(0) in the AOSR reflected the background Hg(0) levels in Canada. By comparison, average air concentrations of total oxidized Hg (efficiently deposited Hg species) in the AOSR were elevated up to 60 % within 50 km of the oil sands Hg emission sources. Hg emissions from wildfire events led to episodes of high ambient Hg(0) concentrations and deposition enrichments in northern Alberta, including the AOSR, during the burning season. Hg deposition fluxes in the AOSR were within the range of the deposition fluxes measured for the entire province of Alberta. On a broad spatial scale, contribution from imported Hg from global sources dominated the annual background Hg deposition in the AOSR, with present-day global anthropogenic emissions contributing to 40 % ( < 1 % from Canada excluding OSE) and geogenic and legacy emissions contributing to 60 % of the background Hg deposition. In contrast, oil sands Hg emissions were responsible for significant enhancements in Hg deposition in the immediate vicinity of oil sands Hg emission sources, which were ∼ 10 times larger in winter than summer (250 %–350 % in winter and ∼ 35 % in summer within 10 km of OSE, 2012–2013). The spatial extent of the influence of oil sands emissions on Hg deposition was also greater in winter relative to summer ( ∼ 100 km vs. 30 km from Hg-emitting facilities). In addition, inter-annual changes in meteorological conditions and oil sands emissions also led to significantly higher inter-annual variations in wintertime Hg deposition compared to summer. In 2015, within 10 km of major oil sands sources, relative to 2012, Hg deposition declined by 46 % in winter but 22 % annually, due to a larger OSE-led reduction in wintertime deposition. Inter-annual variations in meteorological conditions were found to both exacerbate and diminish the impacts of OSE on Hg deposition in the AOSR, which can confound the interpretation of trends in short-term environmental Hg monitoring data. Hg runoff in spring flood, comprising the majority of annual Hg runoff, is mainly derived from seasonal snowpack Hg loadings and mobilization of Hg deposited in surface soils, both of which are sensitive to Hg emissions from oil sands developments in the proximity of sources. Model results suggest that sustained efforts to reduce anthropogenic Hg emissions from both global and oil sands sources are required to reduce Hg deposition in the AOSR.

Oil sands upgrading facilities in the Athabasca oil sands region (AOSR) in Alberta, Canada, have been reporting mercury (Hg) emissions to public government databases (National Pollutant Release Inventory (NPRI)) since the year 2000, yet the relative contribution of these emissions to ambient Hg deposition remains unknown. The impact of oil sands emissions (OSE) on Hg levels in and around the AOSR, relative to contributions from global (anthropogenic, geogenic and legacy) emissions and regional biomass burning emissions (BBE), was assessed using a global 3D-process-based Hg model, GEM-MACH-Hg, from 2012 to 2015. In addition, the relative importance of year-to-year changes in Hg emissions from the above sources and meteorological conditions to inter-annual variations in Hg deposition was examined. Surface air concentrations of Hg species and annual snowpack Hg loadings simulated by the model were found comparable to measured levels in the AOSR, suggesting consistency between reported Hg emissions from oil sands activities and Hg levels in the region. As a result of global-scale transport and the long lifetime of gaseous elemental Hg (Hg(0)), surface air concentrations of Hg(0) in the AOSR reflected the background Hg(0) levels in Canada. By comparison, average air concentrations of total oxidized Hg (efficiently deposited Hg species) in the AOSR were elevated up to 60 % within 50 km of the oil sands Hg emission sources. Hg emissions from wildfire events led to episodes of high ambient Hg(0) concentrations and deposition enrichments in northern Alberta, including the AOSR, during the burning season. Hg deposition fluxes in the AOSR were within the range of the deposition fluxes measured for the entire province of Alberta. On a broad spatial scale, contribution from imported Hg from global sources dominated the annual background Hg deposition in the AOSR, with present-day global anthropogenic emissions contributing to 40 % (< 1 % from Canada excluding OSE) and geogenic and legacy emissions contributing to 60 % of the background Hg deposition. In contrast, oil sands Hg emissions were responsible for significant enhancements in Hg deposition in the immediate vicinity of oil sands Hg emission sources, which were ∼ 10 times larger in winter than summer (250 %–350 % in winter and ∼ 35 % in summer within 10 km of OSE, 2012–2013). The spatial extent of the influence of oil sands emissions on Hg deposition was also greater in winter relative to summer (∼ 100 km vs. 30 km from Hg-emitting facilities). In addition, inter-annual changes in meteorological conditions and oil sands emissions also led to significantly higher inter-annual variations in wintertime Hg deposition compared to summer. In 2015, within 10 km of major oil sands sources, relative to 2012, Hg deposition declined by 46 % in winter but 22 % annually, due to a larger OSE-led reduction in wintertime deposition. Inter-annual variations in meteorological conditions were found to both exacerbate and diminish the impacts of OSE on Hg deposition in the AOSR, which can confound the interpretation of trends in short-term environmental Hg monitoring data. Hg runoff in spring flood, comprising the majority of annual Hg runoff, is mainly derived from seasonal snowpack Hg loadings and mobilization of Hg deposited in surface soils, both of which are sensitive to Hg emissions from oil sands developments in the proximity of sources. Model results suggest that sustained efforts to reduce anthropogenic Hg emissions from both global and oil sands sources are required to reduce Hg deposition in the AOSR.

Oil sands upgrading facilities in the Athabasca Oil Sands Region (AOSR) in Alberta, Canada, have been reporting mercury (Hg) emissions to public government databases (National Pollutant Release Inventory (NPRI)) since the year 2000, yet the relative contribution of these emissions to ambient Hg deposition remains unknown. A 3D process-based global Hg model, GEM-MACH-Hg, was applied to simulate the Hg burden in and around the AOSR using NPRI reported oil sands Hg emissions from 2012 (59 kg) to 2015 (25 kg) and other regional and global Hg emissions. The impact of oil sands emissions (OSE) on Hg levels in the AOSR, relative to contributions from sources such as global anthropogenic and biomass burning emissions (BBE), was assessed. In addition, the relative importance of year-to-year changes in Hg emissions from the above sources and meteorological conditions to inter-annual variations in Hg deposition was examined. Model simulated surface air concentrations of Hg species and annually accumulated Hg in snowpacks were found comparable to independently obtained measurements in the AOSR, suggesting consistency between reported Hg emissions from oil sands activities and Hg levels in the region. As a result of global-scale transport of gaseous elemental Hg (Hg(0)), surface air concentrations of Hg(0) in the AOSR reflected the background Hg(0) levels in Canada (1.4 ng m −3 , AOSR; 1.2 1.6 ng m −3 , Canada) with negligible impact from OSE. Highly spatiotemporally variable wildfire Hg emission events led to episodes of high ambient Hg(0) air concentrations of up to 2.5 ng m −3 during the burning season. By comparison, average air concentrations of total oxidised Hg (gaseous plus particulate; efficiently deposited Hg species) in the AOSR were elevated by 60 % above background levels (2012–2013) within 50 km of the oil sands major upgraders as a result of OSE. Annual average Hg deposition fluxes in the AOSR were within the range of the deposition fluxes measured for the entire province of Alberta (15.6–18.3 µg m −2 y −1 , AOSR (2012–2015); ~14–25 µg m −2 y −1 , Alberta (2015)). Winter (November–April) and summer (June–August), respectively, accounted for 20 % and 50 % of the annual Hg deposition in the AOSR. On a broad spatial scale, imported Hg from global sources dominated the annual Hg deposition in the AOSR, with present-day global anthropogenic emissions contributing to 40 % (< 1 % from Canada excluding OSE), and geogenic emissions and re-emissions of legacy mercury deposition contributing to 60 % of the background Hg deposition. Further, wildfire events contributed to regional Hg deposition with enhancements of 1–13 % across 200 km range of major oil sands sources. In contrast, oil sands Hg emissions were responsible for significant Hg deposition enhancements in the immediate vicinity of oil sands Hg emission sources, up to 100 km in winter and up to 30 km in summer. Hg deposition enhancements related to oil sands emissions were about 10 times larger in winter than summer (average enhancement of 250–350 % in winter and ~35 % in summer within 10 km of OSE, 2012–2013). In addition, snowpack Hg loadings and wintertime Hg deposition displayed significantly higher inter-annual variations compared to summertime deposition due to changes in meteorological conditions (such as precipitation amounts, wind speed, surface air temperature, solar insolation, and snowpack dynamics) as well as oil sands emissions. For example, a large snowmelt event at the end of February in 2015 effectively removed about half of the accumulated mercury in snow, contributing to (observed and modeled) low annual snow Hg loadings. Inter-annual variations in meteorological conditions were found to both exacerbate and diminish the impacts of OSE on Hg deposition in the AOSR, which can confound the interpretation of trends in short-term environmental Hg monitoring data. In winter, within 10 km of major oil sands sources, variations in meteorology led to Hg deposition reduction by 17 % in 2014 and increase by 10 % in 2015 and decline in OSE lowered Hg deposition by 35 % (2014) and 56 % ( 2015), resulting in overall reductions in wintertime Hg deposition of 52 % (2014) and 46 % (2015), relative to 2012. By comparison, annually, changes in meteorology and BBE in 2014–2015 (relative to 2012) led to Hg deposition increases of 1–6 % and 2 %, respectively, and decline in OSE lowered deposition by 15–22 %, resulting in overall reduction in Hg deposition of 7–20 % within 10 km of oil sands sources. Hg runoff in spring flood, comprising the majority of annual Hg runoff, is mainly derived from seasonal snowpack Hg loadings and mobilization of Hg deposited in surface soils, both of which are sensitive to Hg emissions from oil sands developments in proximity of sources. Model results suggest that sustained efforts to reduce anthropogenic Hg emissions from both global and oil sands sources are required to reduce Hg deposition in the AOSR.

Structured Abstract
Objectives
Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand.

Method
This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital.

Results
A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams.

Conclusions
The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient.

Implications for Public Health
The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms.

Abstract
Purpose
LGBTQ + people who have experienced intimate partner violence (IPV) and family of origin violence (FOV) are known to face significant barriers to reporting or seeking support for these experiences and may not always feel supported when do so.

Method
Data from 4,607 participants of a nationwide survey of LGBTQ + adults in Australia who indicated having ever experienced IPV or FOV was analysed. Multivariable logistic regression analyses were conducted to identify factors associated with reporting the most recent experience of IPV or FOV and with feeling supported when reporting.

Results
In total, 1,188 (25.9%) participants indicated that they reported their most recent experience of IPV or FOV and 1,112 (84.6%) of those felt supported. Participants' sexual orientation, level of education, engagement with a regular general practitioner (GP), experience of homelessness and country of birth were associated with reporting their most recent experience of IPV or FOV. Of those who reported their experience, participants were most likely to feel supported if they had a regular GP and least likely to feel supported if they had ever experienced homelessness.

Conclusion
The findings of this study highlight inadequacies in family violence frameworks in promoting or facilitating access to services that could benefit this population. Encouraging LGBTQ + people to engage with a regular GP, establishing family violence services that cater to the specific needs of LGBTQ + people, and training family violence responders and service providers to recognise diverse relationship dynamics may improve support outcomes for LGBTQ + survivors of family violence.

Abstract
Purpose
LGBTQ people are less likely to seek support and face significant barriers in accessing affirmative family violence support services. Efforts to improve family violence service access must be grounded in the preferences of LGBTQ people themselves.

Method
Data from a large nationwide Australian survey of the health and wellbeing of LGBTQ adults were analysed. 4,148 participants expressed a preference for family violence service provision. Multivariable logistic regressions were used to identify factors associated with preferences for family violence service provision, comparing mainstream services that are not known to be inclusive, mainstream services that are known to be LGBTQ-inclusive, and LGBTQ-specific services.

Results
In total, 8.8% (n = 363) of participants indicated a preference for mainstream services, 57.5% (n = 2,383) for mainstream services that are known to be LGBTQ-inclusive and 33.8% (n = 1,402) for LGBTQ-specific services. Trans and non-binary identified people were more likely to prefer LGBTQ-specific services than cisgender participants, while bisexual, pansexual and asexual people were more likely to prefer mainstream LGBTQ-inclusive services. Participants with a regular general practitioner were more likely to prefer LGBTQ-inclusive services. Participants who had not felt supported the most recent time they reported an experience of family violence were more likely to prefer LGBTQ-specific services.

Conclusion
Family violence and healthcare services require training in LGBTQ issues to provide inclusive and affirming care. The findings have implications for policy and practice in family violence care and illustrate an urgent need to reform the current narrative of family violence, which frequently excludes LGBTQ communities.

AbstractDespite racial disparities in breast cancer mortality, Black women remain underrepresented in clinical trials. In this mixed methods research, 48 Black women were engaged via focus group discussions and in-depth interviews to better understand the lived experience of women with breast cancer. The results of this qualitative study informed the development of a subsequent online survey to identify barriers, motivators, and other factors that influence decision-making by Black women diagnosed with breast cancer when considering clinical trial participation. Among the 257 Black survey participants, most (95%) were aware of clinical trials; of those, most viewed them as lifesaving (81%) and/or benefiting others (90%). Negative perceptions such as serious side effects (58%), not receiving real treatment (52%), or risk of potential harm (62%) were indicated. Barriers included financial expenses (49%), concerns that their condition could be made worse (29%), that they would receive a placebo (28%), or that treatment was unapproved (28%). Participants were more likely than their health care providers (HCPs) to initiate discussions of clinical trials (53% versus 33%), and 29% of participants indicated a need for more information about risks and benefits, even after having those conversations. The most trustworthy sources of information on clinical trials were HCPs (66%) and breast cancer support groups (64%). These results suggest that trusted communities are key for providing education on clinical trials. However, there is also a need for HCPs to proactively discuss clinical trials with patients to ensure that they are adequately informed about all aspects of participation.