National Service Research Articles

A Spatial–Seasonal Study on the Danube River in the Adjacent Danube Delta Area: Case Study—Monitored Heavy Metals

Monitoring and protecting flowing watercourses is a complex and challenging task that requires the collaboration and coordination of various stakeholders such as governments, industries, farmers, consumers and environmental groups. The study of the dynamics of the concentration of polluting factors and especially the concentrations of heavy metals and highlighting a seasonal variation is a necessary element from this point of view. In this article, we present the results of our analyses carried out in two measurement campaigns executed in 10 monitoring points along the Danube River, between Braila city and Isaccea city in the pre-deltaic area, during the summer season and autumn season 2022. The importance of this area is given by the fact that the Danube Delta is part of the UNESCO heritage, and the monitoring of polluting factors is a necessity in the desire to protect this area. The data measured during the July and August 2022 campaign cover a wide range of chemical species: Phosphate, CCO, CBO5, NH4+, N-NO2, N-NO3−, N-Total, P-PO4 3−, SO42−, Cl−, phenols, as well as metals with a harmful effect: Al, As, Cd, Cr, Fe. The study includes an evaluation based on the statistical approach of the results to highlight the significant correlations and differences identified between the two data sets. Next, to highlight the obtained results, a numerical model was considered using HEC-RAS and ESRI ArcGIS applications in a two-dimensional unsteady flow model in order to obtain the non-homogenous concentrations’ distributions in the studied area. These two-dimensional models have been less studied in the specialized literature. In this way, interesting results could be obtained, and prediction methods regarding the dynamics of metal concentrations could be structured. The data obtained were used for the terrain model from the USGS service, and the flows of the Danube and its two tributaries were simulated using the data provided by the national services. In this work, we present the results obtained for the dynamics of the concentrations of the metals Al, As, Cd, Cr and Fe and the evaluation of the specific absorption coefficients for the explanation and correlation with the results of the measurements. Except for the numerical model presented, we would like to highlight the existence of some contributions of the main tributaries of the Danube in the study area. Such a systematic study has not been carried out due to conditions imposed by the border authorities. From this point of view, this study has an element of originality. The study is part of a more complex project in which the spatio-temporal distribution of the polluting factors in the water was evaluated, and the habitats in the study area were inventoried—especially those of community interest. In this way, we were able to expose the self-purification capacity of the Danube and highlight the existence of a concentration reduction gradient along the course of the river. The aspects related to the influence of the distribution of polluting factors on the state of health will be the subject of another article.

Implementation of Village Governance on Public Services in Langensari Village

This research explains public services in Langensari Village by emphasizing aspects of accountability, transparency, effectiveness and efficiency. The focus includes planning and development to advance village welfare. In regional development, the government emphasizes the bottom-up system, namely villages. Village governance is a form of government administration in realizing development in the village. In this case, creating good governance can improve public services in the village which can support the performance of village officials in serving the community. Optimal service must always be provided by regional government officials, especially village governments. That one of the goals of village regulation is to improve public services for service providers as well as possible is one of the performance results that village governments can carry out to achieve the goals set out in national service standards, namely service quality. Optimal public services can create village government that is professional, efficient and effective, open and responsible, or good governance. This research explains public services in Langensari Village by emphasizing aspects of accountability, transparency, effectiveness and efficiency. The focus includes planning and development to advance village welfare. In regional development, the government emphasizes the bottom-up system, namely villages. Village governance is a form of government administration in realizing development in the village. In this case, creating good governance can improve public services in the village which can support the performance of village officials in serving the community. Optimal service must always be provided by regional government officials, especially village governments. That one of the goals of village regulation is to improve public services for service providers as well as possible is one of the performance results that village governments can carry out to achieve the goals set out in national service standards, namely service quality. Optimal public services can create village government that is professional, efficient and effective, open and responsible, or good governance.

Influence of patient body weight on the probability of return of spontaneous circulation following out-of-hospital cardiac arrest: an exploratory analysis.

In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates. To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA. This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC. Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight. Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC.

Mediating Effect Of Employee Wellbeing On The Relationship Between Recruitment And Selection Practices And Employee Commitment Of National Police Service In Uasin Gishu County, Kenya

Low employee commitment has been a prevalent issue within the National Police Service (NPS), often leading to negative consequences such as low morale, poor service delivery, and public distrust. Therefore, this study sought to determine the mediating effect of employee wellbeing on the relationship between recruitment and selection on employee commitment of National Police Service in Uasin Gishu County, Kenya. The study was guided by Ability motivation opportunity theory. This study adopted explanatory research design. The sample size of 328 for this study was calculated based on Yamane’s formula. The researcher used a questionnaire as research instrument. A pilot study was conducted in national police service in Nandi County. Quantitative data collected using the questionnaires for all the objectives were analysed using descriptive statistics that is frequency, percentages, mean and standard deviation. Inferential analysis was carried through correlation and multiple regression analysis. Analyzed data were presented in form of tables and charts. The study findings revealed that the effect of recruitment and selection practices on employee commitment through employee wellbeing is 0.3041, indicating that for every standard deviation increase in recruitment and selection practices. The study concluded that improving recruitment and selection practices can lead to higher levels of employee wellbeing, which in turn can enhance employee commitment. The study recommended that organizations should focus on improving recruitment and selection practices to enhance employee wellbeing and ultimately increase employee commitment.

침략전쟁 시기(1931~1945) 朝鮮 馬政計劃의 추이와 건마보국운동

This study focuses on Colonial-Korean horse administration during the period of aggressive war (1931-1945) and analyzes: ①The progress of the 'Second Phase Korean Horse Production Plan' which began after the Manchurian War(1931).②The twists and turns surrounding the establishment of the 'First Phase Korean Horse Administration Plan' led by the Governor-General of Chosen before and after the Sino-Japanese War.③ The failure of the privately-driven horse production policies during the Pacific War, including the emotional movement such as the “Healthy Horse National Service Movement” and the process of frugal mobilization. These analyses confirm the deceptive nature of the colonial horse administration. To summarize the findings: Following the Manchurian Incident, the demand for military horses increased, leading the Governor-General’s office to plan ‘the first phase of horse production’ starting in 1932. This plan aimed to increase the number of military-eligible horses to 30,000, focusing on the three northern provinces of Korea. However, from 1935, Japan urged the Governor-General to expand the number of horses to 40,000 over an 18-year period. This was known as Japan's 'Second Phase Horse Administration Plan (1932-1936)'. Japan dismissed the Governor-General’s request for financial support and demanded an increase of 50,000 horses over the 18 years. In response, the Governor- General claimed that the 'reality of Korea' justified a target of increasing 30,000 horses over 15 years. After about a year of negotiation, the Korean Horse Administration 15-Year Plan was settled, aiming to increase the number of horses by 40,000 over 15 years. However, due to financial issues, the plan did not fully begin implementation until 1939. In the case of Hamnam, the second horse administration area, the plan was to secure approximately 16,000 horses from 1939 to 1951, primarily through the importation of about 9,000 horses from Japan. The plan emphasized importation over domestic production. In reality, the increase in the number of horses did not proceed as planned. The number of horses showed a decreasing trend up until 1938, and the numbers of donkeys and mules sharply declined until 1943. After 1938, Japan reduced Korea's role in its horse administration plans and increased the focus on Manchuria, leading to a stagnation of the plan. The Governor-General attributed this failure not to policy issues but to a lack of knowledge or enthusiasm among private breeders. With the outbreak of the Pacific War, the Governor-General anticipated a surge in demand for military horses. Consequently, the responsibilities of the existing 'Korean Horse Administration 15-Year Plan' were transferred to the semi-official private organization, the Korean Horse Society, and the National Mobilization Association, in an attempt to increase the voluntary efforts of horse production. The Korean Horse Society was established on April 1, 1942. However, its establishment undermined the plan to increase military-eligible horses through breeding with high-quality horses from Japan. Instead, the focus shifted to a so-called 'Korean Horse Mobilization Policy', which aimed to convert existing Korean horses into military horses. Yet, by early 1944, the increase in military horses had not been achieved according to the plan. As noted in the Korean Horse Society Chairman’s address on March 1, 1944, during the Healthy Horse National Service Movement, many of the horses in the horse administration area were 'useless broken-down horses.' In summary, while the Governor-General boasted about increasing the number of military horses to 40,000, the priority from the beginning was mobilizing Korean horses and importing Japanese horses rather than actual production. Even the Korean military did not trust Korean horses and preferred mobilization and importation over production.

Optimizing Teacher Recruitment and Compensation: Enhancing HR Practices in Basic Schools

This study examined the recruitment, selection, and compensation processes at Basic School A, identifying areas for improvement in human resource management. Using a qualitative approach, semi-structured interviews were conducted with the headteacher and a purposive sample of teachers. Thematic analysis revealed that the recruitment process involves completing education, national service, applying through the GES portal, and documentation before posting. Teachers preferred the previous decentralized system for greater commitment and reduced transportation costs. The compensation process includes validation by the Accountant Generals’ Department to eliminate absenteeism and “ghost” employees, though some teachers are only aware of monthly credits. Both teachers and the headteacher highlight staffing as needing improvement, suggesting that decentralizing recruitment to consider teachers’ residences would enhance job satisfaction and performance. Recommendations include decentralizing recruitment to allow district selection, establishing transparent validation guidelines, and shifting towards decentralized staffing for better resource management and improved teacher commitment.

A priory allocation of ecosystem services to forest stands in a forest management context considering scientific suitability, stakeholder engagement and sustainability concept with multi-criteria decision analysis (MCDA) technique: A case study in Turkey

Various research endeavours are designed to identify ecosystem services, assess their spatial distribution, and prioritize them in a given forest landscape. The Turkish State Forest Organization has introduced an ecosystem-based multiple-use forest management philosophy since 2008, which emphasizes the need for identifying and allocating ecosystem services to each forest planning unit. This paper aims to investigate the use of Multiple Criteria Decision Analysis (MCDA) techniques and explores their effectiveness and suitability in identifying and allocating ecosystem services to forest units, considering scientific suitability, stakeholder engagement and the sustainability concept in the context of ecosystem-based forest management decision-making processes in a case study area of Turkey. We propose a framework that entails an iterative process comprising various stages, starting from identifying ecosystem services (ES) to allocating them to forest stands with a participatory approach. We employed the Analytical Hierarchy Process (AHP) and the Delphi method to determine stakeholder preferences and allocate ecosystem services to forest stands. This was achieved through an equation newly developed using scientific suitability, stakeholder preferences, and the sustainability concept. The landscape percentage allocated primarily to ES was as follows: water regulation (55.44%), soil protection (16.47%), biodiversity conservation (14.03%), wood production (13.08%), and aesthetic-recreation (0.84%). Notably, no allocations were made for national defence and climate regulation services. In conclusion, the stratification of Posof forests into zones was efficiently achieved a priori, considering both scientific-technical and socio-cultural criteria through MCDA techniques based on stakeholder preferences. This study streamlines the decision-making process involved in spatially allocating ecosystem services and provides crucial information instrumental in determining management objectives and optimal forest activities.

Developing a validated methodology for identifying clozapine treatment periods in electronic health records

BackgroundClozapine is the only recommended antipsychotic medication for individuals diagnosed with treatment-resistant schizophrenia. Unfortunately, its wider use is hindered by several possible adverse effects, some of which are rare but potentially life threatening. As such, there is a growing interest in studying clozapine use and safety in routinely collected healthcare data. However, previous attempts to characterise clozapine treatment have had low accuracy.AimTo develop a methodology for identifying clozapine treatment dates by combining several data sources and implement this on a large clinical database.MethodsNon-identifiable electronic health records from a large mental health provider in London and a linked database from a national clozapine blood monitoring service were used to obtain information regarding patients' clozapine treatment status, blood tests and pharmacy dispensing records. A rule-based algorithm was developed to determine the dates of starting and stopping treatment based on these data, and more than 10% of the outcomes were validated by manual review of de-identified case note text.ResultsA total of 3,212 possible clozapine treatment periods were identified, of which 425 (13.2%) were excluded due to insufficient data to verify clozapine administration. Of the 2,787 treatments remaining, 1,902 (68.2%) had an identified start-date. On evaluation, the algorithm identified treatments with 96.4% accuracy; start dates were 96.2% accurate within 15 days, and end dates were 85.1% accurate within 30 days.ConclusionsThe algorithm produced a reliable database of clozapine treatment periods. Beyond underpinning future observational clozapine studies, we envisage it will facilitate similar implementations on additional large clinical databases worldwide.

Use of routinely collected blood donation data for expanded HIV and Syphilis surveillance in Blantyre district, Malawi.

The World Health Organization recommends that all blood donations be screened for transfusion transmissible infections; these data are currently not incorporated into national disease surveillance efforts. We set out to use routinely collected data from blood donors in Blantyre district, Malawi to explore HIV and syphilis prevalence and identify sero-conversions among repeat donors. We conducted a retrospective cohort analysis of blood donation data collected by the Malawi Blood Transfusion Service from 2015 to 2021. All blood donations were routinely screened for HIV and syphilis. We characterized donor demographics as well as screening outcomes, including identifying sero-conversions among repeat donors who previously tested negative on their last donation. A total of 23,280 donations from 5,051 donors were recorded, with a median frequency of donations of 3 (IQR:2-6). Most donors were male (4,294; 85%) and students (3,262; 64.6%). Prevalence of HIV at first donation was 1.0% (52/5,051) and prevalence of syphilis was 1.6% (80/5,051); 52 HIV sero-conversions and 126 syphilis sero-conversions were identified, indicating an incidence rate per 1,000 person-years of 5.9 (95% CI: 4.7, 7.4) and 13.3 (95% CI:11.4, 15.4) respectively. Students had a lower prevalence of HIV and syphilis but higher risk of syphilis seroconversion. While blood donors are generally considered a low-risk population for HIV and syphilis, we were able to identify relatively high rates of undiagnosed HIV and syphilis infections among donors. Routinely collected data from national blood donation services may be used to better understand local HIV and syphilis epidemiology, with the potential to enhance disease surveillance systems. These findings may be used to identify priority prevention areas and populations in Blantyre district that can inform targeted interventions for improved disease prevention, testing and treatment.

Beyond the Preamble: Legislating the right to self-determination in a NSW Human Rights Act

This article examines the inclusion of the right to self-determination in existing models of state and territory human rights legislation and proposes its inclusion in a future human rights act in New South Wales (NSW), to advance the rights of First Peoples in the criminal justice system. I explore how this would provide a mechanism for state restraint and a legal framework for prioritising self-determined First Nations critique, research and service delivery in carceral systems. The role of courts in holding the state to account and developing legal pluralism in rights jurisprudence is also discussed.

Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service.

Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints. We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed. The study population was 58.6% female with a median age of 55years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1. People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.

Performance evaluation of the national air quality testing services V2000 Condensation Particle Counter

Performance evaluation of the national air quality testing services V2000 Condensation Particle Counter

Comparative analysis of models of organization of forensic activities: International experience

The purpose of the study was to identify the main models of organisation of the forensic system in Ukraine and to assess international experience in the field of expert support of justice, as well as to analyse ways to adapt modern world standards to national expert practice. The theoretical basis of the study was the documents defining the status and organisation of forensic experts in Ukraine, Latvia and the Czech Republic. The functions related to forensic examinations, examination, and seizure were analysed. It was revealed that the organisation of forensic expert activity in European countries is focused on creating an effective system of expert institutions and ensuring optimal conditions for conducting examinations by qualified specialists who are appropriately accredited and included in the official registers of forensic experts. It was emphasised that in Ukraine there is a mixture of two approaches to structuring forensic expert activity. The advantages of such a mixed model include harmonisation of forensic examinations, standardization of expert methods, accreditation of forensic laboratories and publicity of the register of forensic experts. The author substantiated the need to integrate the Ukrainian system of expert support of justice into the international context and to participate Ukrainian forensic institutions in international organisations that bring together foreign expert institutions. This will help to improve the procedures for the participation of forensic experts in justice. The author proposed to establish a single body – the National Service for the Provision of Forensic Expertise, which will be subordinated to the Ministry of Justice of Ukraine. Thus, the practical significance of the study is that its results can be used to centrally address the problem of methodological and information support of expert activity, which in turn will improve the organisation of forensic activities in Ukraine

Evaluating the Decision-Making Proficiency Among Medical Residents at Tehran University of Medical Sciences in the Year 2022-2023: A Descriptive Cross-Sectional Study

Background: To evaluate the decision-making proficiency among medical residents at Tehran University of Medical Sciences in the year 2022-2023. Methods: A structured online web-survey via national approved services Author’s designed questionnaire was used to collect the relative data based on variables of the study and was developed by the authors of the study by reviewing the previously conducted studies. The forms were sent to the medical residents at Tehran University of Medical Sciences as a link via electronic mail and social media; assistance was offered via direct or indirect contact upon request. Results: In this study, 88 medical residents of Tehran University of Medical Sciences were evaluated. Out of 88 participants, the frequency of females was 52(59.09%) and frequency of males was found out to be 36(40.91%). The frequency of the first- year residents was 28(37.50), second year residents was 33(21.59), third year residents was 19(9.09) and the fourth- year residents was found out to be 8(31.82). The frequency of different specialties were: Pathology 1(1.14%), Infectious diseases 1(1.14%), Cardio vascular diseases 1(1.14%), Emergency medicine 1(1.14%), Orthopedics2(2.27%), Psychiatry 3(3.41%), ENT 12(13.64%), Internal Medicine 13(14.77%), Pediatrics13(14.77%), OB&amp;GYN 19(21.59%), Anesthesiology19(21.59%), Dermatology 2(2.27%), General Surgery 1(1.14%). Conclusion: There is a significant relationship based on linear regression between not having self - reported availability bias and surgical residency specialties. The surgical specialty is less prone to the availability bias. A difference of communication exists between the surgical and nonsurgical speciality and the nonsurgical specialties need to confirm their decision using other methods to prevent the patient harm.

Study of seasonality of attacks in MOG antibody-associated disease

BackgroundSeasonal variation in attacks of acute disseminated encephalomyelitis (ADEM11ADEM: acute disseminated encephalomyelitis; BS: brainstem; MOG myelin oligodendrocyte glycoprotein; MOGAD: myelin oligodendrocyte glycoprotein antibody-associated disease; NMO neuromyelitis optica; ON: optic neuritis; TM: transverse myelitis) is reported in some studies. Myelin oligodendrocyte glycoprotein (MOG) antibodies are found in up to 50 % of ADEM cases. Despite this, there has been no adequately powered study of seasonality in MOG antibody-associated disease (MOGAD). We sought to determine whether there was an effect of season on incidence of total attacks and onset attacks of MOGAD. MethodsWe searched the large national Oxford-based NMO Service database to identify attacks of MOGAD occurring between 2010 and 2021. Month of each attack was extracted and Edwards’ test of seasonal variation was applied to determine whether there was a seasonal effect on total attacks and onset attacks. ResultsNeither incidence of total attacks nor incidence of onset attacks varied significantly by month. ConclusionThere is no evidence of seasonal fluctuations in the incidence of MOGAD attacks in the UK.

The AutoICE Challenge

Abstract. Mapping sea ice in the Arctic is essential for maritime navigation, and growing vessel traffic highlights the necessity of the timeliness and accuracy of sea ice charts. In addition, with the increased availability of satellite imagery, automation is becoming more important. The AutoICE Challenge investigates the possibility of creating deep learning models capable of mapping multiple sea ice parameters automatically from spaceborne synthetic aperture radar (SAR) imagery and assesses the current state of the automatic-sea-ice-mapping scientific field. This was achieved by providing the tools and encouraging participants to adopt the paradigm of retrieving multiple sea ice parameters rather than the current focus on single sea ice parameters, such as concentration. The paper documents the efforts and analyses, compares, and discusses the performance of the top-five participants’ submissions. Participants were tasked with the development of machine learning algorithms mapping the total sea ice concentration, stage of development, and floe size using a state-of-the-art sea ice dataset with dual-polarised Sentinel-1 SAR images and 22 other relevant variables while using professionally labelled sea ice charts from multiple national ice services as reference data. The challenge had 129 teams representing a total of 179 participants, with 34 teams delivering 494 submissions, resulting in a participation rate of 26.4 %, and it was won by a team from the University of Waterloo. Participants were successful in training models capable of retrieving multiple sea ice parameters with convolutional neural networks and vision transformer models. The top participants scored best on the total sea ice concentration and stage of development, while the floe size was more difficult. Furthermore, participants offered intriguing approaches and ideas that could help propel future research within automatic sea ice mapping, such as applying high downsampling of SAR data to improve model efficiency and produce better results.

Experiences of family carers supporting older people within the last year of life in rural and remote areas in the UK.

In the UK, a large proportion of older adults live in rural/remote locations. More people are dying at home and require care from their families. Little is known about the experiences of family carers of older people in rural/remote areas in the last year of life. To explore the experiences of current and bereaved family carers who support/ed an older person in a rural area in the UK towards the end-of-life. Qualitative methodology using semi-structured interviews and reflexive thematic analysis methods. Interviews were conducted with family carers of rural/remote-dwelling older people in the last year of life. Participants were recruited through national support services, third sector organisations and social media. Interviews were conducted with 20 family carers. Most were female (n = 17) and aged 52-80years. Family carers experienced difficulties in accessing health and social care in rural/remote areas due to workforce and skills shortages within their regions. The wider community helped with practical tasks and made carers feel less alone. Community-based services, such as day care, helped to provide respite for carers and promoted meaningful activity and social inclusion for older people. Although internet access was problematic, family carers gained support remotely via social media and telehealth services. Family carers of older people in the last year of life in rural/remote areas value support from the wider community. Further work is required to understand how Public Health approaches to palliative care and workforce distribution can support rural/remote carers and older people.

Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation

Randomised controlled trials have shown that total diet replacement (TDR) can lead to remission of type 2 diabetes. In 2019, the English National Health Service (NHS) committed to establishing a TDR-based interventional programme delivered at scale within real-world environments; development followed of the NHS Type 2 Diabetes Path to Remission (T2DR) programme, a 12-month behavioural intervention to support weight loss involving an initial 3-month period of TDR. We assessed remission of type 2 diabetes for programme participants. In this national prospective service evaluation of programme implementation, people in England aged 18-65 years and diagnosed with type 2 diabetes in the last 6 years were referred to the programme between programme launch on Sept 1, 2020, and Dec 31, 2022. Programme data were linked to the National Diabetes Audit to ascertain HbA1c measurements and glucose-lowering medication prescriptions. The primary outcome was remission of type 2 diabetes at 1 year, defined as two HbA1c measurements of less than 48 mmol/mol recorded at least 3 months apart with no glucose-lowering medications prescribed from 3 months before the first HbA1c measurement, and the second HbA1c measurement recorded 11-15 months after the programme start date. Outcomes were assessed in two ways: for all participants who started TDR on the 12-month programme before January, 2022, for whom there were no missing data; and for all participants who started TDR on the 12-month programme before January, 2022, and had completed the programme (ie, had a valid weight recorded at month 12) by Dec 31, 2022, for whom there were no missing data. Between Sept 1, 2020, and Dec 31, 2022, 7540 people were referred to the programme; of those, 1740 started TDR before January, 2022, and therefore had a full 12-month opportunity to undertake the programme by the time of data extraction at the end of December, 2022. Of those who started TDR before January, 2022, 960 (55%) completed the programme (defined as having a weight recorded at 12 months). The mean weight loss for the 1710 participants who started the programme before January, 2022 and had no missing data was 8·3% (95% CI 7·9-8·6) or 9·4 kg (8·9-9·8), and the mean weight loss for the 945 participants who completed the programme and had no missing data was 9·3% (8·8-9·8) or 10·3 kg (9·7-10·9). For the subgroup of 710 (42%) of 1710 participants who started the programme before January, 2022, and also had two HbA1c measurements recorded, 190 (27%) had remission, with mean weight loss of 13·4% (12·3-14·5) or 14·8 kg (13·4-16·3). Of the 945 participants who completed the programme, 450 (48%) had two HbA1c measurements recorded; of these, 145 (32%) had remission, with mean weight loss of 14·4% (13·2-15·5) or 15·9 kg (14·3-17·4). Findings from the NHS T2DR programme show that remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery. However, the rate of remission achieved is lower and the ascertainment of data is more limited with implementation in the real world than in randomised controlled trial settings. None.

Mental Health and Suicidal Behaviour in Chilean Youth during the Covid-19 Pandemic.

The pandemic caused by the SARS-CoV-2 virus led to a series of containment and mitigation measures through lockdowns, social distancing, and the closure of educational establishments, which have had a profound impact on the mental health of the adolescent population. The main objective of the present study has been to identify the sociodemographic and mental health variables related to suicidal ideation, planning, and attempts in young people participating in outpatient intervention projects within the Chilean protection network since the onset of the pandemic and the strictest lockdowns. The study's sample consists of 125 young people aged 14 to 18 years (M = 15.65; SD = 1.22), participating in outpatient intervention projects within the National Service for Minors (SENAME)/Better Childhood protection network. Through a self-report survey, the young participants provided responses on sociodemographic variables and suicidal behaviour (ideation, planning, and attempts). 29.9% of the participants reported suicidal ideation during the onset of the pandemic and the established lockdowns; 29.2% reported having devised a plan to do so, and 18.2% indicated having attempted suicide during the evaluated period. A higher occurrence of suicidal behaviour was observed in females, sexual minorities, respondents over 15 years old, and respondents presenting depressive symptoms. The Covid-19 pandemic has had a significant impact on suicidal behaviour among the adolescent population served by the protection network in Chile. The prior violation of their rights may have contributed to the issue, particularly affecting young females in late adolescence with indicators of depression, who require specialized intervention due to the high risk detected.

Climate storylines as a tool for interdisciplinary dialogue on risk decision-making: Analyzing a severe drought in southeastern South America

Recently, we are witnessing a growing interest in the study of climate narratives and storylines. These are seen as critical tools both for improving shared understandings involving different stakeholders (including scientists from different disciplines) and guiding initiatives for transformative adaptation actions and decision making. This paper approaches the storylines about a severe drought event that took place in southeastern South America (SESA) in 2008/2009 from an interdisciplinary dialogue between climatologists and anthropologists. This approach responds to the need for a more robust understanding of the event and the responses adopted locally, i.e: not restricted to physical aspects but considering socio-economic and political aspects, with the aim of contributing to the development of socially relevant climatic information for realistic climate risk decision making contexts. In particular it intends to contribute to the decision-making processes of government agencies focused on climate communication and public climate services, such as national and weather services and regional agencies. Considering disciplinary differences, we account for the interpretative polyphony regarding this event, i.e.: what each actor/sector is talking about (for what and to whom they are talking about) when referring to "the drought", and analyze climate storylines as an agonistic field of meanings. This implies recognizing the disputes and contradictions among them, how different storylines promote certain lines of argumentation and meanings to the detriment of others, knowledge gaps, the role of social power relations, socio-political order factors and their impact in terms of the necessary transformations towards an environmentally sustainable and socially just horizon.