Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

BackgroundAdverse Childhood Experiences have been associated with long-term physical and mental health conditions, toxic stress levels, developing unstable interpersonal relationships, and substance use disorders due to unresolved childhood adversities.AimsThis study assessed the perspectives of mental health providers regarding their adult patients’ coping with ACEs during COVID-19 in Houston, Texas. Specifically, we explored how individuals with ACEs are coping with the increased stresses of the pandemic, how MHPs may provide therapeutic support for individuals with ACEs during this pandemic, pandemic-related challenges of (...) accessing and utilizing mental health services for individuals with ACEs, and the awareness and treatment of ACEs among MHPs.MethodsTen in-depth semi-structured virtual interviews were conducted with licensed MHPs from November 2021 to April 2022 in Houston, Texas. Interviews were coded and analyzed for emerging themes through an inductive open coding approach to discover insights regarding coping with ACEs during COVID-19.ResultsFour key themes experienced by individuals with ACEs emerged from the MHP interviews: Maladaptive emotional dissonance and coping outlets during the pandemic, Difficulties with social connectedness and significance of social support, Heightened daily life stressors and coping with the ongoing disruption of the pandemic, and Changing interactions with the mental health system. Themes from this study highlighted that resilience, seeking treatment, and strong social support can help develop healthy coping strategies among individuals with ACEs.ConclusionThis study may help inform best clinical practices to develop interventions and policies regarding ACEs such as a resilience-promotion approach that targets all the socio-ecological levels. In addition, findings highlight the synergy of psychotherapeutic and pharmacological management via tele-health modalities, in helping individuals with ACEs continue receiving the care they deserve and need during a persistent pandemic and an uncertain future. (shrink)

Australia and India have had few reasons in the past to develop systematic and significant levels of economic engagement. This was due to very different positions they have held in the world-system since the Second World War. De-colonization, the fall of the British Empire, the weak status of the British Commonwealth, and the realpolitik of the Cold War saw India and Australia located on different parts of the geo-political and economic world map with small demographic and cultural flows, and insignificant (...) economic trade. Both countries developed similar economic policy regimes that were essentially state-led nationalist projects of economic development with concomitant policies of import-substitution, local industry-subsidization, highly-regulated financial systems, and high tariffs. The last quarter of the 20th century saw a radical revision of both nations’ economic strategies, with Australia moving first to drop many of its trade barriers in the 1970s and ’80s. It is now one of the most open economies in the world. India’s liberalization programme commenced much later in 1991 but nonetheless has had a dramatic impact on its economic fortunes and growing status in the world economy. With these changes there are increasing opportunities for bilateral trade and a greater economic enmeshment in regional engagements and alignments in the Indian Ocean and in wider Asian fora. One significant indicator of change in growing Australia-India economic engagement is to look at Foreign Direct Investment (hereafter FDI). Currently, the movement of FDI between these two countries is still not very large but has a strong potential to grow over the short to medium term. This paper looks at the future prospect of this growth and asserts that, by engaging in areas of comparative advantage, it will benefit both national economies. Moreover, economic flows are also indicators of great social and cultural traffic. The movement of FDI between the two countries will not only encourage greater flow of peoples, especially outward migration from India to Australia, but also trigger more Australian expatriates living in India (from a very low base). Greater economic trade promises more cultural exchange. (shrink)

Adolescent brain development has become an important target for governments to act upon, in the name of healthy individuals and economic prosperity. In the Foresight Project on Mental Capital and Wellbeing , initiated by the Government Office for Science, adolescent behaviour was identified as one of the key challenges for UK policy. The report draws on 'state of the art′ evidence from scientific experts, to recommend ways in which to 'capitalize′ on mental faculties to improve, boost, and make maximum use (...) of the cognitive resources and mental health of individuals during the entire lifespan. Specifically, through a close analysis of the category of adolescence in cognitive neuroscience, we examine the perspective of personhood espoused by MCW. We show how the notion of 'plasticity′, which underpins the recommendations about how to “make the most” of adolescents′ developing brains and cognitive resources, creates vital linkages between neuroscience and neosocial policy. (shrink)

The development of action representation during adolescence was investigated using a visually guided pointing motor task to test motor imagery. Forty adolescents and 33 adults were instructed to both execute and imagine hand movements from a starting point to a target of varying size. Reaction time was measured for both Execution and Imagery conditions. There is typically a close association between time taken to execute and image actions in adults because action execution and action simulation rely on overlapping neural circuitry. (...) Further, representations of actions are governed by the same speed-accuracy trade-off as real actions, as expressed by Fitts’ Law. In the current study, performance on the VGPT in both adolescents and adults conformed to Fitts’ Law in E and I conditions. However, the strength of association between E and I significantly increased with age, reflecting a refinement in action representation between adolescence and adulthood. (shrink)