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Introduction Triage is the systematic prioritization of casualties when there is an imbalance between the needs of these casualties and resource availability. The triage sieve is a recognized process for prioritizing casualties for treatment during mass-casualty incidents (MCIs). While the application of a triage sieve generally is well-accepted, the measurement of its accuracy has been somewhat limited. Obtaining reliable measures for triage sieve accuracy rates is viewed as a necessity for future development in this area., Objective: The goal of this study was to investigate how theoretical knowledge acquisition and the practical application of an aide-memoir impacted triage sieve accuracy rates., Method: Two hundred and ninety-two paramedics were allocated randomly to one of four separate sub-groups, a non-intervention control group, and three intervention groups, which involved them receiving either an educational review session and/or an aide-memoir. Participants were asked to triage sieve 20 casualties using a previously trialed questionnaire., Results: The study showed the non-intervention control group had a correct accuracy rate of 47%, a similar proportion of casualties found to be under-triaged (37%), but a significantly lower number of casualties were over-triaged (16%). The provision of either an educational review or aide-memoir significantly increased the correct triage sieve accuracy rate to 77% and 90%, respectively. Participants who received both the educational review and aide-memoir had an overall accuracy rate of 89%. Over-triaged rates were found not to differ significantly across any of the study groups., Conclusion: This study supports the use of an aide-memoir for maximizing MCI triage accuracy rates. A "just-in-time" educational refresher provided comparable benefits, however its practical application to the MCI setting has significant operational limitations. In addition, this study provides some guidance on triage sieve accuracy rate measures that can be applied to define acceptable performance of a triage sieve during a MCI. Cuttance G , Dansie K , Rayner T . Paramedic application of a triage sieve: a paper-based exercise. Prehosp Disaster Med. 2017;32(1):3-13.

This study explores policy makers’, health-care professionals’ and senior volunteers’ perceptions of senior volunteers. Two Norwegian government white papers regarding older adult care and welfare services, which were published over a period of 19 years, were selected for close examination. Furthermore, focus group interviews with a purposeful sample of five senior volunteers and 15 health-care professionals were conducted. The study explores the discursive formations of senior volunteers in the government white papers and how they are negotiated in the senior volunteers’ and the health-care professionals’ narratives. Two dominant discourses were presented in the white papers: a prevention discourse (in which volunteering was presented primarily as a means to prevent volunteers’ loneliness and need for care services) and a sustainability discourse (in which the volunteers were presented as instrumental in future sustainable care services). Both discourses echo a common overarching discourse about a capacity crisis due to the ageing population. The senior volunteers were positioned as partners and active agents in both their own narratives and the health-care professionals’ narratives. Their position as independent and as spokespersons for the less empowered were evident only in the senior volunteers’ own narratives. Only the health-care professionals referenced the prevention discourse and capacity issues. The senior volunteers presented themselves as competent, efficient political actors, and they resisted both the prevention and sustainability discourses. In the senior volunteers’ narratives, social and political participation were interrelated. The study demonstrates that new discursive landscapes must be created to capture the diversity among senior volunteers and their efforts. While senior volunteers must be meaningfully involved in decision making, planning and design, their positions as independent and active agents must also be ensured. Authentic partnerships between senior volunteers and public care services involve a balance between involvement and independence. [ABSTRACT FROM AUTHOR]

‘Landscape’ is relatively underexplored in legal scholarship, notwithstanding its occasional centrality to legal analysis, and the ways in which law contributes to the shaping of landscape.Wind energy is an especially rich area for the exploration of landscape; not only do wind farms consistently raise concerns about landscape, but the existence of climate change complicates the response to local concern. Most of the legal literature on ‘knowledge’ focuses on the ways in which different ‘expert’ knowledges find their way into, and then shape, legal processes and decisions. This article is more concerned with the ways in which the planning system receives different knowledge claims, and validates some of them. The discussion turns around four tentative categories of knowledge claim: expert or technical knowledge claims; lay (or sometimes local) knowledge claims; prior institutional knowledge claims; and professional planning knowledge claims. Knowledge of the complex, dynamic and plural idea of landscape in any particular case is constructed in the process of decision making and reason giving through a careful layering of these different sorts of knowledge claim. [ABSTRACT FROM AUTHOR]

Employment subsidies are important active labour market policy (ALMP) tools, suited to a variety of labour market challenges. This paper engages with recent ALMP categorisation debates by appraising Cronert's (2019) recent typology of employment subsidies. It uses empirical material to assess the typology's explanatory power and produce insights to inform further typological development. The illustrative case of the British ' Wage Incentive' (2012-2014) is used to assess the typology's analytical purchase. Cronert's typology helpfully identifies key distinctions in the distributional profiles of employment subsidies, but further understanding of the category is impeded by the practice of defining them as demand-side interventions. The paper argues for a reappraisal of their supply-side characteristics, maintaining that the (potential) worker should be included in the analysis, and that employment subsidies' relationship with training and job creation should be acknowledged. It proposes a redefinition of employment subsidies reflecting their real-world use, and suggests a framework for further exploring varieties of employment subsidy design from the perspective of beneficiaries. [ABSTRACT FROM AUTHOR]

This review updated a previous review [Gaugler JE (2005) Family involvement in residential long-term care: a synthesis and critical review. Aging and Mental Health 9 , 105–118] and focused on dementia. Fourteen years of development in family involvement with care homes following placement of a relative was explored. The review aimed to investigate two questions: (1) What types of involvement do families have with care homes following placement of people living with dementia? (2) Which factors influence family involvement with care homes? PsycINFO, MEDLINE and CINAHL Plus were searched for publications between January 2005 and December 2018. Thirty-three papers representing 30 studies were included. Papers were appraised using a quality rating tool designed for use with mixed study designs. Studies were of a reasonable quality though some weaknesses included single-site samples, high attrition rates and poor reporting. Twenty-eight papers highlighted types of involvement including collaboration, family–staff relationship development, decision making and visiting. Twenty-five papers pertained to factors influencing involvement, which included outcome of care quality evaluation, wish for recognition and sense of integration into the care team. Type of family involvement has changed over time with increased emphasis on families' desire for partnership, to be active rather than passive advocates, and to focus on care monitoring and evaluation. Seven themes of family involvement activities are featured and a non-linear process is proposed. When compared to patient and family-centred care principles, an analysis of family involvement types found good fit overall and potential for framework improvements. Over 30 diverse factors influence inter-family variation in the level and nature of family involvement. Consideration of these factors and resolution of the gaps in evidence, including intergenerational and cultural concerns, can improve care home facilitation of family participation. This dementia-specific review is a comprehensive timely complement to Gaugler's seminal work about older adults in care. [ABSTRACT FROM AUTHOR]

Paperwork has always been a central part of bureaucratic work. Over the last few years, bureaucratic procedures have become increasingly standardised and digitalised. Based on interviews and ethnographic fieldwork within welfare offices in Switzerland and Belgium, we reflect on the way evidence is constructed within social policy and cases built for or against noncitizen welfare recipients in order to show how paper truths are established and challenged. The focus on digital practices within public policy implementation highlights how it contributes to enhanced control mechanisms on the implementation level and how migration law continues to guide welfare governance for noncitizens. This allows targeting of the most marginalised groups, whose rights to access state support are institutionally impeded. Through database information flows, official forms, paper reports and face-to-face meetings, we further show how a hybrid form of bureaucratic work emerges, where direct contact with the client is still key, yet highly influenced by standardisation processes. [ABSTRACT FROM AUTHOR]

Objective: To achieve resilience in the response of a major incident, it is essential to coordinate major processes and resources with the aim to manage expected and unexpected changes. The coordination is partly done through timely, adequate, and resilience-oriented decisions. Accordingly, the aim of the present paper is to describe factors that affected decision-making in a medical command and control team during the early COVID-19 pandemic., Methods: This study used a qualitative method in which 13 individuals from a regional public healthcare system involved in COVID-19 related command and control were interviewed. Data was collected through semi-structured interviews and analyzed using qualitative content analysis., Results: The factors affecting decision-making in medical command and control during early COVID-19 pandemic were grouped into 5 themes: organization, adaptation, making decisions, and analysis, as well as common operational picture., Conclusions: The present study indicated that decision-making in medical command and control faces many challenges in the response to pandemics. The results may provide knowledge about disaster resilience and can be utilized in educational and training settings for medical command and control.

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive-compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits.

The purpose of this paper is to review the applications of non-cooperative bargaining theory to water management problems. The interest in this subject stems from two considerations: (i) water resources continue to be mismanaged, despite their recognized importance for sustainable development, in particular in developing countries; (ii) negotiated decision making has the potential to improve water management, yet there is still little formal understanding of the forces driving bargaining processes, and applications of formal negotiation theory to water issues are also lacking. This paper surveys the existing non-cooperative bargaining models applied to water management problems, with the purpose of preliminarily assessing whether such a formal approach in the phase of problem exploration and policy formulation can support decision makers in the real world. It is the contention of this paper that the proposed approach may offer direct and indirect support by: shortening the time needed to reach an agreement through the (theoretical) identification of an ‘acceptability space’, and helping select policies which are self-enforcing and, therefore, acceptable. [ABSTRACT FROM AUTHOR]

Introduced as an interdisciplinary area that combines multi-agent systems, data mining and knowledge discovery, agent mining is currently in practice. To develop agent mining applications involves a combination of different approaches (model, architecture, technique and so on) from software agent and data mining (DM) areas. This paper presents an investigation of the approaches used in the agent mining systems by deeply analyzing 121 papers resulting from a systematic literature review. An ontology was defined to capitalize the knowledge collected from this study. The ontology is organized according to seven main facets: the problem addressed, the application domain, the agent-related and the mining-related elements, the models, processes and algorithms. This ontology is aimed at providing support to decisions about agent mining application design. [ABSTRACT FROM AUTHOR]

The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient's underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient's preferences momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized.

It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper - developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting - seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.

An important research programme in the social sciences concerns the theory and practice of individual decision-making under conditions of risk and uncertainty. At the same time, it is apparent that western governments increasingly rely upon individuals to plan and maintain savings programmes to meet their income aspirations: the long-term retirement income of those outside of the welfare state depends a great deal on the competence and consistency of individual decision-making. In this paper, we use a set of problems requiring the same techniques of judgement to test the consistency of trustee decision-making. Respondents were a group of trustees drawn from select UK defined benefit pension plans compared with a larger group of Oxford undergraduates. It was found that many respondents were inconsistent across related problems requiring the application of probabilistic judgement. It is also shown that trustees were more consistent than many undergraduates and it appears that trustee education and professional qualifications can make a positive difference to consistent decision-making. A more challenging test that depends upon understanding the relationship between demographic ageing, immigration, and the financing of pay-as-you-go social security suggests that substantive knowledge and consistency of judgement are crucial components of expertise. Implications are drawn for the trustee institution and the wider debate over the role and significance of individual decision-making with respect to income aspirations. [ABSTRACT FROM AUTHOR]

This paper reviews recent research on take-up with a view to identifying the most promising lines of further enquiry. In the late 1970s take-up research seemed to be foundering in the face of the complexity of the factors affecting claiming decisions. Progress came via the development of models of the claiming process. The most influential postulated a series of thresholds which claimants must pass in a set sequence on the way to claiming a benefit. One question for future research is whether this model is still the best starting point or whether there are others which capture the key factors and their interaction more fully and accurately. Another approach is to look at claiming decisions indirectly by applying multivariate techniques to continuous survey data to examine the relationship between variables such as age, income and housing tenure and differing probabilities of claiming. A second question is what the two approaches can offer each other. Overhanging all the issues facing take-up research is the problem of sampling a population—eligible non-recipients-for which, almost by definition, no suitable sampling frame exists. The paper concludes by examining various options for identifying this elusive group. [ABSTRACT FROM AUTHOR]

This paper examines, in the light of the COVID-19 crisis, the room for judicial oversight of health crisis measures based on the public's expectations of how governments should act in the interplay with experts. The paper explains how trust theory and procedural rationality review help to address concerns related to legitimacy and expertise. The paper argues that courts should distinguish between two stages. In the initial stage, fear as a driver for government support based on expertise justifies that the proportionality test is limited to the question of whether measures were based on virologist expert advice. In the next stage, people expect the government to take expert-informed decisions, but also require that the government takes into account societal needs. Procedural rationality review in this stage demands that courts examine whether the decision was based on an informed balance of rights and interests. [ABSTRACT FROM AUTHOR]

Aim: The aim is to identify important factors for immigrants' health and well-being and for their use (or non-use) of primary health care (PHC) and other non-specialised services, and for possible ways that PHC can support healthy ageing of immigrants. Background: Older persons are an increasing share of the immigrant population in the global north, frequently in contact with various forms of health services, (PHC services most of all. Consequently, PHC services are in a particularly unique position to support healthy ageing of immigrants. Methods: The position paper builds on five international, multi-professional and cross-disciplinary small group discussions as well as an international workshop early summer. During the discussions and the workshop, topics were arrived at as to factors related to the health situation of older immigrants, their needs, and health-seeking behaviour, and to how PHC professionals could support healthy ageing in immigrants. Those main topics in turn guided search for relevant research literature and informed the selection of the main research questions of this paper. Findings: Several factors, in addition to culture and cultural differences, are important to for PHC professionals and decision-makers to take into consideration in encounters with older immigrants. The socio-economic position of the older immigrant and close relatives, inter-generational relationships within the immigrant communities, country-specific factors in the host country like health care expenditure, and communication skills in health professionals are all examples of factors playing an important role regarding the health and health-seeking behaviour of older immigrants. [ABSTRACT FROM AUTHOR]

Capacity evaluation has become a widely used assessment device in clinical practice to determine whether patients have the cognitive ability to render their own medical decisions. Such evaluations, which might be better thought of as "capacity challenges," are generally thought of as benign tools used to facilitate care. This paper proposes that such challenges should be reconceptualized as significant medical interventions with their own set of risks, side effects, and potentially deleterious consequences. As a result, a cost-benefit analysis should be implemented prior to imposing such capacity challenges, and efforts should be made to minimize such challenges in situations where they are unlikely to alter the course of treatment.

Background: This paper investigates whether age of onset of depression, duration of the last episode, number of episodes, and residual symptoms of depression and anxiety are associated with depression relapse in primary care patients who have been on long–term maintenance antidepressant treatment and no longer meet ICD10 criteria for depression. Methods: An observational cohort using data from ANTLER (N = 478), a double-blind placebo-controlled trial. The primary outcome was time to relapse using the retrospective CIS-R. Participants were followed for 12 months. Results: Primary outcome was available for 468 participants. Time to relapse in those with more than five previous episodes of depression was shorter, hazard ratio (HR) 1.84 (95% confidence interval [CI] 1.23–2.75) compared to people with two episodes; HR 1.57 (95% CI 1.01–2.43) after adjustment. The residual symptoms of depression at baseline were also associated with increased relapse: HR 1.05 (95% CI 1.01–1.09) and HR 1.06 (95% CI 1.01–1.12) in the adjusted model. There was evidence of reduced rate of relapse in older age of onset group: HR 0.86 (95% CI 0.78–0.95); HR attenuated after adjustment HR 0.91 (95% CI 0.81–1.02). There was no evidence of an association between duration of the current episode and residual anxiety symptoms with relapse. Conclusions: The number of previous episodes and residual symptoms of depression were associated with increased likelihood of relapse. These factors could inform joint decision making when patients are considering tapering off maintenance antidepressant treatment or considering other treatments to prevent relapse. [ABSTRACT FROM AUTHOR]

Decisions made early in Social Security's history resulted in benefits in excess of contributions for early cohorts. This approach gave away the Trust Fund and the resulting interest that could have accumulated, which has increased the size of the payroll tax required to finance the program. This paper finds that, for the Old-Age and Survivors portion of Social Security, the Missing Trust Fund of $29.5 trillion is driven by the excess benefits given to early cohorts. Should tax increases be considered to improve the program's finances, a broad tax – such as the income tax – could be appropriate since these early payments benefitted all of society. [ABSTRACT FROM AUTHOR]

In 1970 Herbert Simon was invited by the Sociedad Argentina de Organización Industrial to deliver lectures on "Business Management in the Technological Era." He asked for an audience with Jorge Luis Borges, the director of the Argentine National Library. Simon had read Borges's stories and was particularly fascinated by "La Biblioteca de Babel" (The library of Babel), wherein he discovered that Borges, like him, conceived of life as a search through a labyrinth. The Spanish translation of the interview was published in Primera Plana , an Argentine journal. The brief interview sheds light on some of Simon's ideas about determinism and free will. His critique on maximizing rationality and his suggested approach to decision making have contributed to enlarge the concept of rationality as construed by standard economic theory. Consequently, it may be argued that Simon is incorporating free will in economics. However, though Simon's position implies an advancement for the role of free will, the whole context of his ideas conditioned it, thus resulting in a "weak" notion of it. During the course of his conversation with Borges, Simon clarified his personal stance, which is consistent with his ideas. The paper will reveal Borges´s and Simon's understanding of free will. This paper also contains part of the conversation between Simon and Borges that has not been published previously in English. Introducing it in its entirety is a contribution to the knowledge on Borges's and Simon's thought. [ABSTRACT FROM AUTHOR]

This paper discusses two opposing views about the relation between artificial intelligence (AI) and human intelligence: on the one hand, a worry that heavy reliance on AI technologies might make people less intelligent and, on the other, a hope that AI technologies might serve as a form of cognitive enhancement. The worry relates to the notion that if we hand over too many intelligence-requiring tasks to AI technologies, we might end up with fewer opportunities to train our own intelligence. Concerning AI as a potential form of cognitive enhancement, the paper explores two possibilities: (1) AI as extending—and thereby enhancing—people's minds, and (2) AI as enabling people to behave in artificially intelligent ways. That is, using AI technologies might enable people to behave as if they have been cognitively enhanced. The paper considers such enhancements both on the level of individuals and on the level of groups. [ABSTRACT FROM AUTHOR]

The regulatory protection of credit consumers, in general, is paramount due to the considerable use of credit, the imbalanced bargaining positions of the contracting parties and the adverse effect of over-indebtedness on individuals and society alike. These concerning factors are worsened in the case of High-Cost Short-Term Credit (HCSTC) consumers owing to their disadvantaged financial position and other recognised vulnerabilities. In this respect, the paper argues that direct regulatory intervention, despite its importance, is not always a silver bullet. Through the analysis of the overhauling of the UK HCSTC regulatory framework, this paper demonstrates the shortfalls of these regulatory changes. Accordingly, the paper shifts the argument towards improving the decision-making mechanisms of HCSTC consumers, ie the role of 'libertarian paternalism'-based interventions. By using a bespoke experimental survey, the paper demonstrates the type of behavioural interventions that can assist in this endeavour and which the regulator could possibly mandate. [ABSTRACT FROM AUTHOR]

This paper examines the early years of decision making in the award of the Nobel Prize in physics and chemistry, and shows how the prize became a tool in the boundary work which upheld the social demarcations between scientists and inventors, as well as promoting a particular normative view of individual scientific achievement. The Nobel committees were charged with rewarding scientific achievements that benefited humankind: their interpretation of that criterion, however, turned in the first instance on their assessment of the groundbreaking nature of the 'science', with the applied or practical 'benefits' of that discovery being treated as very much secondary factors in the award. Through an interrogation of the reports sent by the committees to the Royal Swedish Academy of Sciences, this paper shows how committee members depended on a notion of 'post-dated utilitarianism' in reconciling potential tension between rewarding basic and applied science, and explores the ways in which the annual prize both shaped, and was shaped by, media perceptions of scientific virtue. [ABSTRACT FROM AUTHOR]

This paper presents a new algorithm to navigate robots in dynamically cluttered environments. The proposed algorithm uses basic concepts of space attraction (hence the term Agoraphilic) to navigate robots through dynamic obstacles. The new algorithm in this paper is an advanced development of the original Agoraphilic navigation algorithm that was only able to navigate robots in static environments. The Agoraphilic algorithm does not look for obstacles (problems) to avoid but rather for a free space (solutions) to follow. Therefore, it is also described as an optimistic navigation algorithm. This algorithm uses only one attractive force created by the available free space. The free-space concept allows the Agoraphilic algorithm to overcome inherited challenges of general navigation algorithms. However, the original Agoraphilic algorithm has the limitation in navigating robots only in static, not in dynamic environments. The presented algorithm was developed to address this limitation of the original Agoraphilic algorithm. The new algorithm uses a developed object tracking module to identify the time-varying free spaces by tracking moving obstacles. The capacity of the algorithm was further strengthened by the new prediction module. Future space prediction allowed the algorithm to make decisions considering future growing/diminishing free spaces. This paper also includes a bench-marking study of the new algorithm compared with a recently published APF-based algorithm under a similar operating environment. Furthermore, the algorithm was validated based on experimental tests and simulation tests. [ABSTRACT FROM AUTHOR]

Little historical work examines the problems, practices and values of 'machine learning' as it was understood and justified within pattern recognition research communities prior to the 1980s. This omission has led to a failure to appreciate how the efficacy of machine learning was often justified by its perceived capacity for 'originality' rooted in machine (and human) subjectivity. This paper examines why and how early 1950s pattern recognition researchers came to see 'machine learning' as a technical and epistemological set of nominalist strategies for performing induction and abduction given incomplete, complex or contradictory information that might also spur 'creative' insight in such diverse activities as political judgement and scientific inquiry. I document local research problems, epistemological commitments, institutional contexts and the circulation of 'machine-learning' practices and values through three cases of early-career researchers imagining, building and programming digital computers to 'learn' from 1950 to 1953. This machine learning implemented in learning programs came to be seen by some researchers as more efficacious descriptions of the natural and social world because these descriptions were perspective-dependent, profoundly contingent and contextually non-exhaustive. Often indexed as colloquial appeals to greater 'generality', conceptions of machine learning's efficacy as the capacity to make meaning from contradictory information continues to inform contemporary debates regarding artificial intelligence, society and possibility. [ABSTRACT FROM AUTHOR]

The Munro Review of Child Protection asserted that the English child protection system had become overly 'defensive', 'bureaucratised' and 'standardised', meaning that social workers were not employing their discretion in the interests of the individual child. This paper reports on the results of an ethnographic case study of one of England's statutory child protection teams. The research sought to explore the extent of social worker discretion relative to Munro's call for 'radical reform' and a move towards a more 'child-centred' system. Employing an iterative mixed methods design – encompassing documentary analysis, observation, focus group, questionnaire, interview and 'Critical Realist Grounded Theory' – the study positioned the UK Government's prolonged policy of 'austerity' as a barrier to social worker discretion. This was because the policy was seen to be contributing to an increased demand for child protection services; and a related sense amongst practitioners that they were afforded insufficient time with the child to garner the requisite knowledge, necessary for discretionary behaviour. Ultimately, despite evidence of progress relative to assertions that social worker discretion had been eroded, the paper concludes that there may still be 'more to do' if we are to achieve the 'child-centred' and 'effective' system that Munro advocated. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the use of the psychedelic drug psilocybin for difficult-to-treat depression. This paper compares the cost-effectiveness of psilocybin-assisted psychotherapy (PAP) with conventional medication, cognitive behavioural therapy (CBT), and the combination of conventional medication and CBT. Methods: A decision model simulated patient events (response, remission, and relapse) following treatment. Data on probabilities, costs and quality-adjusted life years (QALYs) were derived from previous studies or from best estimates. Expected healthcare and societal costs and QALYs over a 6-month time period were calculated. Sensitivity analyses were used to address uncertainty in parameter estimates. Results: The expected healthcare cost of PAP varied from £6132 to £7652 depending on the price of psilocybin. This compares to £3528 for conventional medication alone, £4250 for CBT alone, and £4197 for their combination. QALYs were highest for psilocybin (0.310), followed by CBT alone (0.283), conventional medication alone (0.278), and their combination (0.287). Psilocybin was shown to be cost-effective compared to the other therapies when the cost of therapist support was reduced by 50% and the psilocybin price was reduced from its initial value to £400 to £800 per person. From a societal perspective, psilocybin had improved cost-effectiveness compared to a healthcare perspective. Conclusions: Psilocybin has the potential to be a cost-effective therapy for severe depression. This depends on the level of psychological support that is given to patients receiving psilocybin and the price of the drug itself. Further data on long-term outcomes are required to improve the evidence base. [ABSTRACT FROM AUTHOR]