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Clinical response to a second course of electroconvulsive therapy: within- and between-person analysis of a retrospective cohort
No full textElectroconvulsive therapy (ECT) is an established treatment for a host of severe mental disorders, and many patients undergo multiple courses across their illness trajectory. In this study, we investigated whether clinical response to ECT remains consistent across successive courses and whether prior response predicts future outcomes. We analyzed a retrospective cohort of 351 ECT courses conducted in adult inpatients from 2009 to 2015 in Brazil. The main outcome was change in Clinical Global Impression scores. For patients with more than one course (n = 25), we compared responses between the first and second series using paired t-tests and correlation analysis. We also applied mixed-effects regression models to the full sample to disentangle within-person and between-person variability. In the second course, patients had significantly less clinical improvement compared to the first (p = 0.003), despite a strong correlation in response within individuals (r = 0.77). Mixed models confirmed a significant within-person decline in ECT effectiveness (β = 0.53, p = 0.004), while between-person differences were not significant. These findings are limited by the small sample of people with two courses, but suggest that while repeated ECT courses may yield diminishing average benefit, patients tend to retain stable individual response patterns, and prior response may thus inform clinical expectations and decisions
Food choice with increased visibility - a field experiment at an environmental economics conference
Get PDFFood choices and in particular meat consumption have major impacts on the local and global environment, which is why the topic is gaining attention in environmental economics and other disciplines. In this study, we investigate the effect of increased visibility on food choices, for which there has been little research to date. We present findings from a field experiment among researchers at a large environmental economics conference. When registering for the three-days conference and prior to choosing between vegan, vegetarian, or meat/fish lunches, half of the participants were informed that their choice would be visibly printed on their conference name badge. The remaining half were informed of this saliency only after their food choice (at the conference venue). Despite the conference setting in which environmentally friendly choices and signals are likely to be valued, we find no significant effect of the treatment on lunch choices. We discuss possible reasons for the null effect, including that the consequences of visibility are ignored, discounted, or already factored in
Ecologies in flight: black environmental knowledge and human-bird interactions between the Caribbean and Britain
No full textPeople interacted with birds and created ecological knowledge about them while enslaved and during the transition to emancipation from 1848 onward in the Danish colony of St Croix. These Black ecologies can be reconstructed through a close reading of the archives of two of the leading ornithologists of the period: Alfred and Edward Newton. Their notebooks, correspondence, and publications are contextualized alongside plantation records and missionary accounts. These sources provide the basis for a new analytic frame: “ecologies in flight” in which flight refers to bird migration, escape from enslavement, circum-Caribbean passages, and ephemeral sources. Through ecologies in flight, this paper makes two connected claims. First, freed Black people developed ecological knowledge, which by its very existence transcended the plantation, and enabled freed people to spend time doing things outside the plantation economy. Kalinago and maritime maroon people provided precedents for ecologies in flight. Second, connections with the more-than-human provided support to oppressed people in ways not fully captured by colonial scientific research. Ecologies in flight became a method for humans and birds to survive the plantation regime that continued from the era of slavery to that of emancipation
Evaluating the value for money of global fund's expenditures (2017-2019)
Get PDFBackground: The Global Fund to Fight AIDS, Tuberculosis, and Malaria is one of the world’s largest global health donor agencies, playing a key role by filling recipient countries’ domestic health financing gaps; however, little is known about how well it achieves value for money. Given the current uncertainty regarding global health development assistance, it is critical to understand how to prioritize external donor funding allocations in an effort to maximize health impact. Methods: In this study, we evaluated 66 recipient countries’ efficiency relative to peers in achieving improvement in health outcomes for TB, malaria, and HIV given their 2017–2019 Global Fund expenditures for (1) health products, (2) program activities, and (3) program management. Using a combination of frontier analysis, linear regression, and cluster analysis, we examined how macroeconomic conditions, epidemiological context, health system factors, and Global Fund spending decisions explain variation in country program performance. Results: For malaria and HIV, we found a negative relationship between Global Fund spending on program activity and health product costs respectively and countries’ efficiency at translating funds to health impact. For malaria and HIV, there was also significant variation in efficiency across countries according to their economic capacity, disease burden, and most prominent spending area. Conclusions: Our results suggest possible structural inefficiencies in country program management, dampening the health impact of frontline programs. The lack of broad patterns to predict performance signals the importance of tailoring spending strategies to country-specific contexts
Prejudicial but not unduly so? Addressing the epistemic and non-epistemic dangers of rap evidence
No full textRecent years have seen mounting concern about the use of rap music as evidence in criminal proceedings, alongside an ever-increasing number of cases involving ‘rap evidence’. Yet, while rap music is widely recognised to be highly prejudicial as evidence in court, little is known about how ‘prejudicial effect’ is, or should be, conceptualised and addressed in these cases. This article unpacks the meaning of prejudicial effect in criminal trials, offering a broad interpretation that encapsulates epistemic (accuracy) and non-epistemic (fairness) concerns; interrogates how the social and cultural context of rap music can make it ‘unduly prejudicial’ as evidence; and explores how the appellate courts approach the prejudicial effect of rap evidence. The article proposes more informative directions to jurors and advocates for legislation to restrict the admissibility of rap evidence, emphasising the importance of assessing evidence in its proper social and cultural context
The institutional politics of WPS: three lessons on resistance from feminist pedagogy
Get PDFCivil society activists famously pushed the UN Security Council to pass a resolution on Women, Peace and Security (WPS) in the year 2000, and the agenda has since become remarkable for how successfully it has been institutionalized in formal state bodies and international organizations. Twenty-five years since its adoption, the agenda is now under threat from intensifying anti-gender politics across the world. In this chapter, Holvikivi proposes that WPS scholars and practitioners can learn important lessons for contending with this threat from other fields of study and activism. The chapter outlines three key lessons for dealing with resistance to WPS work, drawing on work in feminist pedagogies and anti-gender politics
Victim-perpetrator narratives in international climate litigation: rights discourse, postcolonial critique, and the binary framings
Get PDFClimate litigation within the international judicial system has emerged as a central arena of global climate governance. This article examines climate cases across international judicial fora. Alongside the invocation of legal norms, strategic climate litigation increasingly deploys rights-based and postcolonial narratives while relying on binary ‘victim–perpetrator’ narratives to justify judicial intervention. As much as the strategic combination of narrative framing and legal techniques has facilitated certain successes, its construction of ‘climate victims’ and ‘climate perpetrators’ through rights-based and postcolonial frames exposes the limitations of international adjudication in addressing the climate crisis. Rights discourse expands access to standing and links climate claims to identity politics and intergenerational justice, but it also risks expanding the scope of judicial intervention and invites challenges grounded in cultural and institutional diversity. Postcolonial narratives situate climate change within broader patterns of historical and economic injustice, yet claims for accountability continue to face obstacles under existing frameworks of state responsibility. Overall, climate litigation both shapes understandings of climate change and influences the trajectory of climate governance, while simultaneously revealing the limits of orthodox approaches to and understandings of the law. Responding effectively to the climate crisis, therefore, requires an expanded legal imagination that moves beyond the confines of current judicial approaches
A Bayesian small area estimation approach for district-level fertility and mortality estimates in India, 2015–16 to 2019–21
Get PDFBackground and Aims: Fertility and child mortality are critical public health indicators in India, directly influencing health policy, planning, and intervention effectiveness. The relationship between declining fertility and decreasing child mortality has been widely debated. This study aims to estimate and compare fertility and child mortality rates at the district level using data from the National Family Health Survey (NFHS) rounds 4 and 5, with a focus on understanding regional trends and their implications for health interventions. Methods: The study investigates four key demographic indicators: Total Fertility Rate (TFR), Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR), and Under‐Five Mortality Rate (U5MR). Fertility and child mortality rates were estimated using Bayesian methods, aligned with Demographic and Health Survey (DHS) standards. Fertility rates were computed in two stages: first, birth history data were transformed into table of birth, followed by the calculation of fertility rates through Poisson regression models at the district level. Results: Between 2015–16 and 2019–21, the number of districts with a TFR below 1.6 increased from 21 to 166, while number of districts with a TFR between 1.6 and 2.1 remained stable at 328. Additionally, the number of districts with an NMR under 10 per 1,000 live births grew from 79 to 140. The study found a strong association between the reduction in child mortality and the decline in fertility rates. Conclusion: This study suggests that addressing regional variations in fertility and child mortality rates could enhance the effectiveness of health interventions in India. Policymakers should prioritize expanding access to family planning and maternal‐child health services. The availability of district‐level data will support more targeted and effective health policies tailored to local needs
Sources of inequality in ‘living well’ with dementia: an intersectional analysis using a British cohort study
No full textBackground and Objectives A key aim of national dementia policies is to enable people to ‘live well’ with the condition, but the experience of living with dementia, including access to health and social care services, is markedly affected by numerous sources of socioeconomic disparity. We explored how combinations of these disparities among groups of people with dementia are associated with the capability to ‘live well’. Research Design and Methods We used baseline data from 1,537 people with mild-to-moderate dementia in the British IDEAL cohort (2014-2016). This included personal characteristics, living situation, socioeconomic position, and geographical area, and three indices of ‘living well’ – quality of life, satisfaction with life, and well-being. Through regression-tree analyses, we explored how the intersection of factors beyond type of dementia and co-morbidity is associated with subgroups of people with dementia experiencing higher or lower capability for ‘living well’. Results Age, education, living situation, income, and home ownership emerged as the strongest differentiators. Drawing on the concept of precarity, we show how the connections between unequal distribution of resources and personal vulnerabilities lead to an accumulation of pressures and shape outcomes. Discussion and Implications These findings from a cohort of people with dementia in a major Western economy represent the tip of the iceberg relative to the full extent of national and especially global inequalities. Addressing the impact of these social inequalities requires a sustained focus on developing and implementing policies that improve equity of access to care and support and increase the potential for ‘living well’