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Can social norms promote sustainable food consumption? A systematic review
No full textAs societies shift toward plant-based diets to address sustainability challenges, social norms have emerged as influential in promoting sustainable food choices. However, there is limited synthesis on the effectiveness of related interventions. This review evaluates existing studies aiming to reduce animal-based consumption and/or increase plant-based choices within the context of climate change. We searched five databases, gray literature, and contacted authors to collect relevant studies, identifying 23 articles (34 studies). Research interest has grown since 2017, but findings suggest that social norm-based interventions have had limited success. We highlight key opportunities for future research, including better identification of referent groups tailored to specific population segments
Tainted idols, global reactions: a cross-cultural study of public responses to K-pop celebrity controversies
No full textThe impact of psychiatric decision units on mental health crisis care pathways: a synthetic control study
No full textPsychiatric crisis care is under great pressure, with the number of psychiatric presentations to emergency departments increasing and inpatient wards operating with occupancy rates above recommended levels. Internationally, hospital-based short-stay crisis units (named Psychiatric Decision Units; (PDU) in the UK) have been introduced to address these challenges, but the current evidence for their effectiveness is limited. We estimated the effects of PDUs in four geographic locations in England, linked to three National Health Service (NHS) mental health trusts and six NHS acute hospital trusts. Using national data sets to create synthetic controls from areas without PDUs (following the generalised synthetic control method), we estimated trust-wide changes to the primary outcomes of psychiatric inpatient admissions and psychiatric presentations to emergency departments (ED), compared to the synthetic controls, alongside secondary outcomes. We used meta-analysis to robustly combine outcomes. We analysed NHS hospital activity data for adults aged between 18 and 75 years covering 24 months preceding and following the introduction of each PDU (November 2012 to January 2021). We found no significant impacts of PDUs on primary outcomes, except at Sheffield Teaching Hospitals NHS Foundation Trust with 1.5 fewer psychiatric presentations to ED per 10,000 trust population per month (relative difference: 24.9%, p = 0.034) than the synthetic control. We found mixed effects of the opening of PDUs on secondary outcomes. Meta-analyses indicated a significantly lower mean length of stay for psychiatric admissions (-6.4 days, p < 0.001) for patients in mental health trusts with a PDU compared to the synthetic control and no significant effects on other outcomes. Heterogeneity of effect across sites probably reflects variation in PDU configuration and implementation. Further research should explore the intended aims of PDUs alongside how they operate in practice
Managerial and financial barriers to the green transition
No full textUsing data on 10,776 firms across 22 emerging markets, we show that both credit constraints and weak green management hold back corporate investment in green technologies embodied in new machinery, equipment, and vehicles. In contrast, investment in measures to explicitly reduce emissions and other pollution is mainly determined by the quality of a firm’s green management and less so by binding credit constraints. Data from the European Pollutant Release and Transfer Register reveal the environmental impact of these organizational constraints. In areas where more firms are credit constrained and weakly managed, industrial facilities systematically emit more CO2 and pollutants. A counterfactual analysis shows that credit constraints and weak management have respectively kept CO2 emissions 4.5% and 2.3% above the levels that would have prevailed without such constraints. This is further corroborated by our finding that in localities where banks had to deleverage more due to the global financial crisis, carbon emissions by industrial facilities remained 5.6% higher a decade later
You like to be in control of your own destiny to a degree, don't you?” conscientious autonomy and planning for future care with dementia
No full textBackground: We explored people with dementia and their family carers’ experiences of future care planning, guided by Kukla's model of conscientious autonomy. This relational autonomy concept focuses on the alignment of self-managed health-care practices with people’s authentic goals and values. It involves people adopting recommended practices for their own authentic reasons, questioning them where necessary, and being supported by the health and care system to understand their rationale and implement them effectively. Methods: In-depth interviews were conducted with 16 people recently diagnosed with dementia and 31 family carers, purposively and selectively sampled from a large research cohort on the basis of their 'conscientiousness,' using the indicator of already having had informal family conversations about future care. Data were analysed thematically using NVivo software and methods informed by interpretive grounded theory. Findings: Participants sought to feel secure by following recommended practices, manage uncertainty, avoid crises, share burdens within families, and avoid poor end-of-life experiences. However, support was often lacking. Many were unable to speak with specialists and described limited conversations with GPs, leaving them with unaddressed questions. Some described feelings of abandonment. Disease progression was commonly poorly explained, with some participants later encountering information they found confronting. Carers who continued researching the condition felt responsible but under-resourced for discussing disease progression with their relative and believed this should be undertaken by a professional. Formal processes - e.g. Lasting Power of Attorney (LPAs), advance care planning, Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) could prompt informal discussions but gaining an overview was difficult, with confusion about how they would be utilised, what information to include and apparent overlap between processes. Misunderstandings about medical and end-of-life decision-making were commonplace. Conclusion: If even those who are most conscientious about planning for future care struggle to access adequate support, others likely face greater challenges. Clearer communication, at an individual and public level, about disease progression, the practical challenges of medical and end-of-life decision-making, and palliative care options is urgently needed. Early group education sessions and communication strategies that engage with existing lay concepts and public discourse are likely to be helpful. Formal care planning processes should be clearer, more streamlined, and better aligned with the practical goals of people with dementia and their family carers
The construction of European society by European lawyers: a methodological critique
No full textArmin von Bogdandy’s recent book is the latest of many attempts, both judicial and scholarly, to conceptualize the European Union as constitutional order founded on the rule of law. This article reviews Bogdandy’s claim that through the processes of European integration European public law has been transformed from a state-centred law of the European powers into a normative structure of a democratic European society. Adopting a methodological critique, the article argues that contrary to his claim to be adopting a ‘Hegelian and anti-Schmittian approach’ Bogdandy’s thesis owes more to Schmitt’s method that he admits and more closely adheres to Kant’s philosophical method than to Hegel
The cost-effectiveness of specialist hospital discharge and intermediate care services for patients who are homeless
No full textBackground: Recognising the diverse healthcare needs of the population, there is a growing emphasis on tailoring hospital discharge processes to address the unique challenges faced by individuals who are homeless, aiming to enhance the efficiency and effectiveness of post-hospitalisation care for this vulnerable demographic. This study aimed to evaluate the costs and consequences of specialist hospital discharge and intermediate care (support after discharge) services for people who are homeless in England. Methods: We estimated the comparative costs and consequences of different types of specialist care provided by 17 homeless hospital discharge and intermediate care services. We compared ‘clinically-led’ (multidisciplinary) services with those that were ‘housing-led’ (uniprofessional). A retrospective observational study was conducted to estimate effectiveness and costs for two 'intervention groups' (clinically-led and housing-led) and a previously published RCT for 'standard care'. Use of resources data for specialist care was sourced through linkage with Hospital Episode Statistics. The measure of effectiveness was the number of bed days avoided (in terms of hospital stays for all readmissions in the follow-up period) per homeless user. Additional secondary analysis of three services looked at quality-adjusted life years (QALYs) and service delivery costs. The perspective adopted was NHS in England. Results: Data from the comparative analysis showed that specialist homeless hospital discharge (HHD) care is likely to be cost-effective compared with standard care. Patients accessing specialist care use fewer bed days per year (including both planned and unplanned readmissions). Patients using specialist care have more planned readmissions to hospital and, overall, use more NHS resources than those who use standard care. We interpret this as a positive outcome indicating that specialist care is likely to work more effectively than standard care to improve access to healthcare for this marginalised group. Specialist care remained cost-effective over a range of sensitivity analyses. Secondary analyses of three specific schemes found better QALY outcomes, but results are not generalisable to all 17 schemes. Conclusion: Specialist HHD services are likely to be cost-effective for the NHS compared with standard care, although further research is needed to access patient level data for both costs and outcomes to conduct a rigorous statistical analysis between groups and address possible underlying biases due to data coming from non-randomised study design
Determinants of SARS-CoV-2 outcomes in patients with cancer vs controls without cancer: a multivariable meta-analysis with genomic imputation
No full textBackground: SARS-CoV-2 is known to impact patients with cancer adversely. Previous meta-analyses have lacked clarity on the recency of cancer diagnosis, anti-cancer treatment durations, and SARS-CoV-2 specific variants of concern (VOC). This study aimed to compare SARS-CoV-2 multivariable-adjusted clinical outcomes between patients with cancer and those without cancer, identifying key risk factors spanning pre- and post-Omicron periods. Methods: In this systematic review and meta-analysis, we identified from Medline, Embase, Cochrane Central, and the WHO COVID-19 Research Database prospective and retrospective case–control studies and cohort studies published from 1st January 2019 to 22nd November 2024. We included case–control and cohort studies comparing at least 10 patients with active cancer (diagnosed or treated within three years prior to SARS-CoV-2 infection) to controls without cancer using multivariable analyses. Exclusion criteria included lack of clarity about active/inactive status of cancer, lack of a control group without cancer, lack of multivariate analysis comparing outcomes of interest in patients with active cancer vs patients without cancer, case reports or case series, and SARS-CoV-2 diagnosis not confirmed via laboratory testing. Outcomes measured were SARS-CoV-2 infection severity (WHO ordinal scale) and mortality differences by tumour type, treatment, and VOC (using sequencing data from NCBI Genbank and GISAID). A random-effects meta-analysis model was applied. The systematic review was PRISMA compliant and was registered with PROSPERO, CRD420234454524. Findings: Of 35,501 studies initially identified, 30 met eligibility criteria and were included in the meta-analysis, comprising 281,270 patients with cancer and 18,876,411 controls. Using the Agency for Healthcare Research and Quality (AHRQ) risk of bias standards, 21 studies were rated good, one study rated was fair, and eight studies were rated poor. We found higher mortality odds ratios (OR) in patients with cancer infected with SARS-CoV-2: 1·40 (95% CI: 1·12–1·73, I2 = 98·1%) for solid tumours and 2·10 (95% CI: 1·43–3·07, I2 = 97·3%) for haematological malignancies, with the difference in mortality between these groups not reaching statistical significance (Q (1) = 3·32; p = 0·0068). Amongst the solid cancers, thoracic and colorectal were linked to increased odds of mortality (ORs: 2·63 [95% CI: 1·65–4·20, I2 = 98·7%], and 1·65 [95% CI: 1·26–2·15, I2 = 92·7%], respectively). Metastatic cancers (OR: 3·59; 95% CI: 1·07–12·04, I2 = 99·5%) were also linked to greater odds of mortality compared to localised cancers (OR: 1·76; 95% CI: 1·32–2·34, I2 = 96·6%; p = 0·26). No cancer types showed a reduced risk vs controls. Mortality varied significantly among VOCs; Alpha (OR: 4·59; 95% CI: 2·66–7·92, I2: N/A) and Omicron (OR: 2·74; 95% CI: 1·84–4·09, I2 = 90·2%) were more associated with death than the ancestral Wu-1 (OR: 1·43; 95% CI: 1·14–1·80, I2 = 98·2%) and Delta (OR: 1·94; 95% CI: 1·65–2·29, I2:N/A) variants (X2 (4) = 20·4; p = 0·0004). Interpretation: This comprehensive meta-analysis indicates that patients with active cancer with SARS-CoV-2 have a higher risk of mortality and hospitalisation than those without cancer. The risk of death was comparable between active solid and haematological tumours. SARS-CoV-2 severity and mortality risks were higher with thoracic, colorectal, or any metastatic cancers. Additionally, differences were noted in mortality risks across VOCs, diverging from VOC-associated mortality patterns in the general population. However, the strict three-year cutoff used to define active cancer excludes studies that used broader cancer criteria (i.e., any history of cancer), which may limit generalisability. Further limitations include varied definitions of disease severity, retrospective data collection, incomplete vaccination or lineage data, and significant between-study heterogeneity, potentially influencing these findings. Funding: Cancer Research UK; UK Research and Innovation
The First World War and the experience of crisis
No full textThis is a redrafted version of Alex Mayhew's Dennis Showalter Memorial Lecture 2022. Originally delivered at the National Army Museum in March 2023, the piece was reworked in early 2025. Drawing upon the author's work to date, it considers what the concept of crisis offers historians, how the Great War was underpinned by crisis, and briefly explores the experience of crisis during the Frist World War
Behavioural insights in the underuse of cardiac resynchronisation therapy in heart failure: a pilot survey on incentive perceptions among referring cardiologists
No full textAims: Heart failure is a leading cause of hospitalisation in patients over 50, significantly impacting both quality of life and survival. Despite the well-established benefits of Cardiac Resynchronisation Therapy (CRT), its utilisation in clinical practice remains suboptimal. Traditional incentives, have shown limited effectiveness in increasing CRT referrals. This manuscript explores how behavioural economics can offer a novel framework for improving CRT uptake by leveraging behavioural incentives, particularly choice architecture and social incentives, to influence physician referral patterns. Methods and results: We underscore key concepts of behavioural economics, including choice architecture (nudges, reference points, sludges), cognitive biases (status quo bias, overconfidence bias, availability bias), and social incentives, which are applied in designing incentives to promote CRT referrals. A survey was conducted with 51 physicians from six European countries, including electrophysiologists, heart failure specialists, and general cardiologists, recruited through cardiology networks and personal contacts. Participants rated their perceptions of five incentive strategies using a Likert scale (1–5). Behavioural incentives, such as peer comparison through league tables (social incentive) and decision prompts in electronic health records (choice architecture nudge), were perceived as more effective than traditional financial incentives, with a median Likert score of 4.0 [IQR 3.0–5.0] versus 2.5 [IQR 1.5–3.0] for traditional incentives (p < 0.001). Conclusions: These findings suggest that interventions drawing on behavioural economics, particularly those utilising social incentives and choice architecture redesign, may offer more effective to increasing CRT referrals than traditional incentives. Such interventions could enhance CRT uptake and outcomes for heart failure patients. Graphical Abstract