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Background: This protocol outlines a scoping review with the objective of identifying and exploring planetary health considerations within existing health guidelines and health technology assessments (HTA). The insights gained from this review will serve as a basis for shaping future Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidance on planetary health. Methods: We will adhere to the JBI methodology for scoping reviews. We will conduct a comprehensive search and screening of results in all languages across various databases including MEDLINE, EMBASE, CINAHL, Global Health, Health Systems Evidence, Greenfile, and Environmental Issues. Additionally, we will supplement this search with resources such as the GIN library, BIGG database, Epistemonikos, GRADE guidelines repository, GRADEpro Guideline Development Tool Database, MAGICapp, NICE website, WHO websites, and a manual exploration of unpublished relevant documents using Google incognito mode. Two independent reviewers will screen and assess the full texts of identified documents according to the eligibility criteria. The following information from each full text will be extracted: document title; first author's name; publication year; language; document type; document as a guideline or HTA; the topic/discipline; document purpose/study objective; developing/sponsoring organization; the country in which the study/guideline/HTA report was conducted; definition of planetary health or related concept provided; types of planetary health experts engaged; study methods; suggested methods to assess planetary health; use of secondary data on planetary health outcomes; description for use of life cycle assessment; description for assessing the quality of life cycle; population/intended audience; interventions; category; applicable planetary health boundaries; consideration of social justice/global equity; phase of intervention in life cycle related to planetary health addressed; the measure of planetary health impact; impact on biodiversity/land use; one health/animal welfare mention; funding; and conflict of interest. Data analysis will involve a combination of descriptive statistics and directed content analysis, with results presented in a narrative format and displayed in tables and graphs. Discussion: The final review results will be submitted to open-access peer-reviewed journals for publication when they become available. The research findings will also be disseminated at relevant planetary health conferences and workshops. Systematic review registration: Open Science Framework (https://osf.io/3jmsa). [ABSTRACT FROM AUTHOR]

This document provides an overview of interventional radiology services in the UK, emphasizing the importance of access to emergency procedures and the need for network arrangements between hospitals. It discusses the different types of interventional radiologists, the interventional radiology team, and the requirements for an interventional radiology theatre. The document also addresses issues such as the lack of anaesthetic provision for pediatric and adult IR procedures. It highlights the need for research and innovation in the field and concludes with a summary of key points. The article further explores the applications of interventional radiology in various medical procedures and discusses turf issues and challenges faced by the specialty, including collaboration, research, and burnout among practitioners. [Extracted from the article]

Background Respiratory care is an important site for climate action, given that common treatments for conditions such as asthma and COPD produce significant greenhouse gas emissions, even as respiratory health is negatively impacted by climate change. Clinical guidelines provide key information for healthcare professionals and can promote approaches to healthcare that can mitigate negative environmental impacts, and optimise patient treatment, care delivery, and equitable outcomes, and bring awareness and legitimacy to sustainable healthcare practices. Methods Twenty national and international clinical respiratory guidelines were purposively selected and screened for inclusion of four principles of sustainable clinical practice: prevention, patient empowerment and self-care, lean service delivery, and low carbon alternatives. A screening framework specific to respiratory care implications was developed and used to review each guideline for mention of relevant topics, recommendations, and explicit links to sustainability in relation to each principle. Findings Sustainable clinical care principles were evident in most guidelines reviewed, environmental sustainability was mentioned infrequently. Many guidelines emphasised prevention (more secondary than primary) and support for patient preference and streamlining care, yet there was rarely mention of how these recommendations could contribute to lowering the environmental impacts of health systems. Low carbon alternatives were mentioned in only three guidelines. Conclusions While many clinical respiratory guidelines make recommendations in accordance with the principles of prevention, patient empowerment and self-care, and lean service delivery, reducing the carbon footprint of healthcare was rarely mentioned in the guidelines. Including explicit attention to the environmental impact of clinical care in guidance could support efforts to reduce the wider harms of healthcare, meanwhile, noting the clinical benefits of sustainable approaches could promote the uptake of recommendations. [ABSTRACT FROM AUTHOR]

Following a series of flooding events in New South Wales and Queensland during the period January to July 2022, Natural Hazards Research Australia funded a large post-event research project to understand and learn from the experiences of those affected. A major aim of the study was to identify insights of relevance to policy and practice across emergency management with a goal of using these findings to inform a broad set of stakeholder organisations and provide an evidence base to support future improvements in community safety in future severe natural hazard events. In-depth interviews were conducted between August and October 2021 with 194 residents affected by these floods. An online survey was completed by 430 flood-affected residents during the period November 2022 to February 2023. The data collected included details of prior flood exposure, damage or losses from the floods, information and warnings received, protective actions taken, decisions and actions taken during the flood and details about the clean-up, community and other sources of support as well as flood resilient adaptations made to homes before the floods and any future (planned) adaptations and actions. Three reports are available: a summary of policy implications, a main report detailing key findings and a technical report that includes summary data. [ABSTRACT FROM AUTHOR]

Background: Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence. Methods: We conducted bibliometric and funding analyses of decision impact studies in genomic medicine research. We searched databases from inception to June 2022. The datasets used were primarily from Web of Science. Biblioshiny, additional R-based applications, and Microsoft Excel were used for publication, co-authorship and co-word analyses. Results: 163 publications were included for the bibliometric analysis; a subset of 125 studies were included for the funding analysis. Included publications started in 2010 and increased steadily over time. Decision impact studies were primarily produced for proprietary genomic assays for use in cancer care. The author and affiliate analyses reveal that these studies were produced by 'invisible colleges' of researchers and industry actors with collaborations focused on producing evidence for proprietary assays. Most authors had an industry affiliation, and the majority of studies were funded by industry. While studies were conducted in 22 countries, the majority had at least one author from the USA. Discussion: This study is a critical step in understanding the role of industry in the production of new types of research. Based on the data collected, we conclude that decision impact studies are industry-conceived and -produced evidence. The findings of this study demonstrate the depth of industry involvement and highlight a need for further research into the use of these studies in decision-making for coverage and reimbursement. [ABSTRACT FROM AUTHOR]

This paper presents the results of a detailed review of the research literature on how nomadic pastoralists are being affected by climate change, how they are adapting, and challenges with using traditional knowledge in adaptation. It focuses on research that investigates local, and particularly traditional, knowledge of water, pasture, their variability, and livestock. This knowledge underpins nomadic livelihoods, so is a foundation for effective adaptation. Changes in the total amount of precipitation, and particularly shifts in its timing, and increases in the frequency and intensity of extreme events, are having the greatest impacts on herding livelihoods. Herders in drylands worldwide face common adaptation challenges: declining traditional water sources and pasture degradation. Herders' adaptation strategies fall into five major categories: movement to areas with better water and pasture, improving seasonal access to water, improving seasonal access to feed, shifts in herd composition, and livelihood diversification. Movement is central to nomads' adaptation, yet, as climate change takes hold, restrictions on movement are increasing for both socio-economic reasons and climate reasons. Many papers emphasised the importance of combining traditional knowledge and current science to guide adaptation decision-making at household, locality, and national levels. There is widespread concern about the decline in traditional knowledge. All the papers reviewed emphasised the need to support passing on traditional know-how. Herder women's know-how, in particular, is marginalised in the research literature, so their traditional knowledge should be a focus in further research. Herders' adaptations are mostly localised, incremental, and have a relatively short-term focus. As nomadic pastoralism moves further outside the range of historical experience, the possibility of more profound transformations looms. [ABSTRACT FROM AUTHOR]

Background: While processes of adoption and the impacts of various health technologies have been extensively studied by health services and policy researchers, the influence of policy makers' governing styles on these processes have been largely neglected. Through a comparative analysis of non-invasive prenatal testing (NIPT) in the Canadian provinces of Ontario and Quebec, this article examines how decisions about this technology were shaped by contrasting political ideologies, resulting in vastly different innovation and adoption strategies and outcomes. Methods: A comparative qualitative investigation comprising of a document analysis followed by semi-structured interviews with key informants. Interview participants were researchers, clinicians, and private sector medical laboratory employees based in Ontario and Quebec, Canada. Interviews were conducted both in person and virtually– owing partly to the COVID-19 pandemic – to garner perspectives regarding the adoption and innovation processes surrounding non-invasive prenatal testing in both provinces. All interviews were recorded and transcribed verbatim and data were analyzed using thematic analysis. Results: Through an analysis of 21 in-depth interview transcripts and key documents, the research team identified three central themes: 1) health officials in each province demonstrated a unique approach to using the existing scholarly literature on NIPT; 2) each provincial government demonstrated its own preference for service delivery, with Ontario preferring private and Quebec preferring public; and finally, 3) both Ontario and Quebec's strategies to NIPT adoption and innovation was contextualized within each province's unique financial positioning and concerns. These findings illustrate how both Quebec's nationalist focus and use of industrial policy and Ontario's 'New Public Management' style had implications for how this emerging healthcare technology was made available within each province's publicly-financed health system. Conclusions: Our study reveals how these governments' differing approaches to using data and research, public versus private service delivery, and financial goals and concerns resulted in distinct testing technologies, access, and timelines for NIPT adoption. Our analysis demonstrates the need for health policy researchers, policy makers, and others to move beyond analyses solely considering clinical and health economic evidence to understand the impact of political ideologies and governing styles. [ABSTRACT FROM AUTHOR]

Background: Decision impact studies have become increasingly prevalent in cancer prognostic research in recent years. These studies aim to evaluate the impact of a genomic test on decision-making and appear to be a new form of evidence of clinical utility. The objectives of this review were to identify and characterize decision impact studies in genomic medicine in cancer care and categorize the types of clinical utility outcomes reported. Methods: We conducted a search of four databases, Medline, Embase, Scopus and Web of Science, from inception to June 2022. Empirical studies that reported a "decision impact" assessment of a genomic assay on treatment decisions or recommendations for cancer patients were included. We followed scoping review methodology and adapted the Fryback and Thornbury Model to collect and analyze data on clinical utility. The database searches identified 1803 unique articles for title/abstract screening; 269 articles moved to full-text review. Results: 87 studies met inclusion criteria. All studies were published in the last 12 years with the majority for breast cancer (72%); followed by other cancers (28%) (lung, prostate, colon). Studies reported on the impact of 19 different proprietary (18) and generic (1) assays. Across all four levels of clinical utility, outcomes were reported for 22 discrete measures, including the impact on provider/team decision-making (100%), provider confidence (31%); change in treatment received (46%); patient psychological impacts (17%); and costing or savings impacts (21%). Based on the data synthesis, we created a comprehensive table of outcomes reported for clinical utility. Conclusions: This scoping review is a first step in understanding the evolution and uses of decision impact studies and their influence on the integration of emerging genomic technologies in cancer care. The results imply that DIS are positioned to provide evidence of clinical utility and impact clinical practice and reimbursement decision-making in cancer care. Systematic review registration: Open Science Framework osf.io/hm3jr. [ABSTRACT FROM AUTHOR]

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Objectives: Health technology assessment (HTA) traditionally informs decision making for single health technologies, which could lead to ill-informed decisions, suboptimal care, and system inefficiencies. We explored opportunities for conceptualizing the decision space in HTA as a disease management question versus an intervention management question. Methods: Semistructured interviews were conducted between April 2022 and October 2022 with purposefully selected individuals from national and provincial HTA agencies and related organizations in Canada. We conducted manual line by line coding of data informed by our interview guide and sensitizing concepts from the literature. One author coded the data, and findings were independently verified by a second author who coded a subset of transcripts Results: Twenty-four invitations were distributed, and eighteen individuals agreed to participate. A disease management approach to HTA was differentiated from traditional approaches as being disease-based, multi-interventional, and dynamic. There was general support for an explicit care pathway approach to HTA by informing discussions around patient choice and suboptimal care, creating a space where decision makers can collaborate on shared objectives, and in setting up a platform for open dialogue about managing high-cost and high-severity diseases. There are opportunities for a care pathway approach to be implemented that build on the strengths of the existing HTA system in Canada. Conclusions: A disease management approach may enhance the impact of HTA by supporting dynamic decision making that could better inform a proactive, resilient, and sustainable healthcare system in Canada. [ABSTRACT FROM AUTHOR]

In this article, on behalf of The Shadow Places Network, we outline a working manifesto of politics and practice. We mobilise the format of the manifesto to speak to an uncertain and damaged future, to begin to imagine other possible worlds. For feminist philosopher Val Plumwood, whose thinking inspires this network, shadow places are the underside of the capitalist fantasy, 'the multiple disregarded places of economic and ecological support'. In turning towards shadow places, and the unjust and unsustainable processes that produce them, we call for an environmental humanities that reaches beyond abstraction, fosters new responsibilities, considers the uncomfortable, and generates reparative possibilities and alternative futures. We aim to continue to trace out a world of shadow places. We acknowledge that these shadow places cannot be known in full, but through a willingness to engage in careful conversation with the beings and places harmed by (or strategically shielded from) processes of the Anthropocene, we can learn how to relate to each other and these places in more just ways. Recognising that shadow places are impermanent and contingent, this working manifesto does not look to predetermine or prescribe but rather invites conversation, encounter and exchange. In so doing we choose to contribute to making different worlds possible by pursuing new collaborations, new methods and new politics. [ABSTRACT FROM AUTHOR]

The potential for bias in industry‐developed information about noninvasive prenatal testing (NIPT), in addition to the lack of regulatory oversight for this type of product, raises questions about clinical communication and adoption. We identify NIPTs marketed globally and analyze their English‐language consumer‐oriented brochures to determine whether they meet existing policy and ethical guidance from the Nuffield Council on Bioethics on NIPT marketing, how they establish the legitimacy of the test given the lack of regulatory oversight for NIPT, and whether content differs between the brochures from for‐profit and nonprofit entities. In many of these brochures, NIPTs are misrepresented as diagnostic tests, claims lack supporting evidence, regulatory bodies that do not evaluate the test itself are referenced, and clinicians are invoked as authorities on specific NIPTs. Our findings substantiate concerns about the extent to which commercial imperatives operating in the absence of market‐access regulation could exacerbate problems of misrepresentation and inaccuracy in marketing materials. [ABSTRACT FROM AUTHOR]

Nomadic Mongolians move in specific areas in search of the best pastures and campsites for their herds and are highly dependent on natural resources for their livelihoods. Pastureland ecosystems are increasingly being affected by climate and other anthropogenic changes, such as socio-economic and cultural changes, challenging nomadic livelihoods in the drylands. The research presented in this paper is based on extensive semi-structured interviews with local herders, key informants, and focus group discussions in Northeast Mongolia. Nomadic herders’ perception and practices, supported by meteorological data, reveal that climate change has affected the provisioning of key ecosystem services, especially the availability of water and the quality and availability of pastureland. Many herders are now moving three times per year, not four, because of problems with water availability and increased dependence on local centres. For pastureland, changes in the absolute volume of rainfall is not the main problem. Rather, fine-grained changes in the timing of rainfall are interfering with plant growth, reducing pastureland quality. Together these are impacting livelihoods substantially. Such changes present challenges for current and future management of pastureland and adaptation to climate change at local and regional scales. Herd sizes have also increased in response to expanding market opportunities. Common property management changes are beginning to increase local herders' control over access to their neighbouring groups' traditional pasture and water. More extensive adaptation will be needed. The study suggests that valuing, maintaining, and conserving traditional ecological knowledge is essential if nomadic livelihoods are to be sustained through these changes. [ABSTRACT FROM AUTHOR]

Our purpose was to explore genetics health professionals' (GHPs) expectations of primary care providers' (PCPs) role in genomic medicine now and in the future. Focus groups/interviews were conducted with GHPs in Ontario, Canada. Recordings were transcribed and analysed using qualitative descriptive analysis. Five focus groups (6 clinical geneticists, 24 genetic counselors, 1 nurse, 4 laboratory staff, 3 genetics program administrators) and 3 interviews (nurses) were conducted. GHPs described a key role for PCPs in genomic medicine that could be enhanced if GHPs and PCPs worked together more effectively, making better use of GHPs as a scarce specialist resource, improving PCP knowledge and awareness of genomics, and increasing GHPs' understanding of primary care practice and how to provide PCPs meaningful education and support. Health system change is needed to facilitate the GHP/PCP relationship and improve care. This might include: PCPs ordering more genetic tests independently or with GHP guidance prior to GHP consultations, genomic expertise in primary care clinics or GHPs being accessible through buddy systems or virtually through telemedicine or electronic consultation, and developing educational materials and electronic decision support for PCPs. Our findings highlight need for change in delivering genomic medicine, which requires building the relationship between GHPs and PCPs, and creating new service delivery models to meet future needs. [ABSTRACT FROM AUTHOR]

Responsible Research and Innovation (RRI) seeks to steer innovation toward important societal challenges and, by doing so, calls for entrepreneurial activities that create economic, social, and environmental value. Nonetheless, little is known about the way different types of organization can produce responsible products and services and the challenges they face when implementing new business models remain largely uncharted. By linking the RRI and the business model literatures, the aim of this article is to generate a better understanding of the challenges underlying responsible value creation. To do so, we approach the business model as a dynamic construct that crosses organizational boundaries and develop an empirically grounded multilevel model that links entrepreneurs' practices (micro‐level), organizational management (meso‐level), and innovation system dynamics (macro‐level). Our multiple case studies include for‐profit and not‐for‐profit Canadian and Brazilian organizations (n = 16) engaged in the production of responsible health innovations and explore the following research questions: "What business model challenges do these organizations face in their attempt to produce responsible innovations? How do these challenges affect the implementation of their business model and capacity to achieve responsible value creation?" Our findings focus on cross‐case commonalities that clarify how specific business model components are dynamically adapted in response to eight micro‐, meso‐, and macro‐level business model challenges, while the organizations' capacity to adequately align these components remains precarious. Our study provides innovation management scholars with an empirically grounded model that brings conceptual clarity to responsible value creation. This groundwork may foster cumulative knowledge growth on the way RRI‐oriented organizations can orchestrate their activities toward responsible value creation, which simultaneously requires individual entrepreneurial skills, organizational capacities, and the support of other innovation stakeholders. [ABSTRACT FROM AUTHOR]

COVID‐19 has radically changed the higher education sector in Australia and beyond. Restrictions on student movement (especially for international students) and on gatherings (which limited on‐campus sessions) saw universities transition to fully online teaching modes almost overnight. In this commentary, we reflect on this transition and consider the implications for teaching the disciplines of geography and planning. Reflecting on experiences at the Department of Geography and Planning at Macquarie University, we explore a series of challenges, responses and opportunities for teaching core disciplinary skills and knowledge across three COVID‐19 moments: transition, advocacy, and hybridity. Our focus is on the teaching of core disciplinary skills and knowledge and specifically on geographical theory, methods, and fieldwork and professional practice skills. In drawing on this case from Macquarie University, we offer insights for the future of teaching geography and planning in universities more broadly. [ABSTRACT FROM AUTHOR]

This paper investigates what 'cultural ecosystem services' are important for nomadic herders' well-being in Mongolian pasturelands, and how nomads' knowledge facilitates understanding of these cultural ecosystem services. Nomads' appreciation of cultural ecosystem services is an aspect of their local knowledge and practices. Interviews, focus group discussions, and a household survey were conducted in the case study area of north-east Mongolia to understand what the main cultural ecosystem services relied upon at a local level are, and how people perceive their benefits. The key cultural ecosystem services supporting their well-being are historical and cultural heritage, sacred and religious landscape values, inspirational values of landscape and the symbolic and aesthetic meaning of the landscape. The paper contributes to debates regarding cultural ecosystem services assessment by addressing the importance of memories and perceptions of local communities and emphasising its importance for local decision making. [ABSTRACT FROM AUTHOR]

Climate change will affect communities in diverse and differentiated ways, so adaptation approaches must strive to address social justice in order to reduce inequality. This paper applies a social justice framework to examine planning for sea level rise in a densely populated coastal settlement in eastern Australia. The Lake Macquarie area is highly vulnerable to sea level rise with local adaptation planning already underway. An in-depth case study is presented that draws upon 19 interviews with key informants and householders and a structured document and media analysis from 12 newspapers. This qualitative data was analysed to identify: the range of understandings of what is just in planning for sea level rise; and key factors that influence perceptions of justice in planned retreat scenarios. The study concludes that there is a need for guiding principles in decision-making that explicitly address social justice in order to realise more equitable outcomes. [ABSTRACT FROM AUTHOR]

Transgenerational trauma is a potential barrier to achieving a healthy and holistic patient-physician relationship, particularly for Black Americans. Examination of deeply rooted historical injustices that Black patients suffer in health care and how they undermine trust can help clarify connections between historical trauma, distrust, and health outcomes. Furthering clinicians' understanding of how daily practice can respond to Black patients' experiences can help restore trust and mitigate racial and ethnic health inequity. [ABSTRACT FROM AUTHOR]

Herders in Mongolia have adapted to changing environmental conditions over thousands of years through innovations in pasture and herd management practices, knowledge, collective institutions and mobility strategies, yet they now face unprecedented climate risks threatening their livelihoods, economies and ways of life. This paper presents the results of a study into how herder communities adapt to climate change and the potential role an ecosystem services approach could play in informing the development of effective adaptation strategies. The findings are based on semi-structured interviews with herders, key informants, focus group discussions and a survey of nomadic households in Northeast Mongolia. The benefits of pasture ecosystem services have changed considerably due to climatic and socio-economic changes in the Mongolian steppe resulting in degradation of the pastureland and water resources. The ways that traditional ecological knowledge and practices can support adaptation to climate change are explored. In particular, the seasonal movement of nomads represents a valuable form of knowledge and practice of adaptation in response to the changes in temperate dryland ecosystems. To continue to maintain mobility as part of adaptation strategies other adaptation actions are required, such as the implementation of an appropriate livestock insurance systems that addresses climate and weather risks, and restoration of dryland ecosystem services, notably through reforestation and improvement of water supplies. Further changes in the pastureland ecosystems may lead to further adaptations in nomadic livelihoods, leveraging nomadic herders' knowledge of local ecosystem services. [ABSTRACT FROM AUTHOR]

Joined-up governance (JUG) approaches have gained attention as mechanisms for tackling wicked policy problems, particularly in intersectoral areas such as child health, where multiple ministries that deliver health and social services must collaborate if they are to be effective. Growing attention to the need to invest in early childhood to improve health and developmental trajectories, including through developmental screening, illustrate the challenges of JUG for child health. Using a comparative case study design comprised of the qualitative analysis of documents and key informant interviews, this work sought to explain how and why visible differences in policy choices have been made across two Canadian jurisdictions (Ontario and Manitoba). Specifically, we sought to understand two dimensions of governance (structure and process) alongside an illustrative example—the case of developmental screening, including how insiders viewed the impacts of governance arrangements in this instance. The two jurisdictions shared a commitment to evidence-based policy making and a similar vision of JUG for child health. Despite this, we found divergence in both governance arrangements and outcomes for developmental screening. In Manitoba, collaboration was prioritized, interests were aligned in a structured decision-making process, evidence and evaluation capacity were inherent to agenda setting, and implementation was considered up front. In Ontario, interests were not aligned and instead decision making operated in an opaque and siloed manner, with little consideration of implementation issues. In these contexts, Ontario pursued developmental screening, whereas Manitoba did not. While both jurisdictions aimed at JUG, only Manitoba developed a coordinated JUG system, whereas Ontario operated as a non-system. As a result, Manitoba’s governance system had the capacity to stop ‘rogue’ action, prioritizing investments in accordance with authorized evidence. In contrast, in the absence of a formal system in Ontario, policy ‘entrepreneurs’ were able to seize a window of opportunity to invest in child health. [ABSTRACT FROM AUTHOR]

Copyright of Urban Policy & Research is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The potential benefits of developing a research agenda that explicitly reconstructs a world regional political ecology are explored through a focus on climate change mitigation and adaptation in the Asia Pacific. Through an examination of scale in political ecology, world regional political ecology is identified as a promising analytical and political approach to understanding and addressing the current challenges associated with climate change. In light of this, political ecology scholarship in the region is reviewed to identify current strengths and lacunae. Whilst there is indeed a rich tradition of political ecology research across the Asia Pacific, much of this research focuses upon local/national/global dynamics with relatively little attention devoted to supra-national processes, missing important social, political, financial and material processes constructed at the world regional scale. It is argued that a world regional political ecology of climate change should build upon strengths in previous political ecology work yet extend these in three generative directions: comparative analysis of place-based, single issue research; generation of diverse counter-narratives at the regional scale; and consideration of flows and networks. We argue a rescaled political ecology that incorporates world regional scales opens a range of possibilities for practicing and pursuing more just and progressive climate politics and initiatives. [ABSTRACT FROM AUTHOR]

Connections to place and relations between people are being radically reconfigured in response to climate risks. Climate change is likely to increase the scale of displacement in the Asia Pacific region, leading to intensified patterns of migration as well as resettlement. These two processes, though differing in terms of individual agency and the role of the state, are likely to further exacerbate pressure on urban areas. As the limits to adaptation in risky places are reached, people are increasingly pursuing migration as a way of coping. This strategy demonstrates people's agency to respond to risks and opportunities. Resettlement, in contrast, tends to undermine people's agency. This risk response is increasingly being implemented by states as part of climate change adaptation plans, yet, it often results in the creation of new vulnerabilities for those forcibly resettled. Through a focus on the 'climate hotspot' of the Mekong Delta, Vietnam, this paper explores how communities and governments might anticipate and resolve some of the humanitarian, livelihood and ecological challenges associated with resettlement in an increasingly resource-constrained and risky climate future. The concept of just resilience is proposed as a lens through which the consequences of resettlement for people's connections to place, each other and familiar ways of life can be understood. It is argued that a focus on just resilience reveals opportunities and threats to procedural, distributive and recognition elements of justice associated with adapting to climate change. [ABSTRACT FROM AUTHOR]

Background: The health-care community has a responsibility to address the environmental impact of delivering health-care services. Educational programmes present ideal fora to confer 'environmental competencies' to future health system leaders, managers, practitioners and researchers. The aim of this review is to synthesise the literature on health-care competencies, education and training of relevance to issues of environmental sustainability and climate change in the health sector. Methods: We conducted a systematic review of English language articles on environmental competencies in healthcare in the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and ProQuest databases published from inception to April 2019. Thematic analysis and descriptive statistics were used to synthesise the findings and develop a typology of environmental competencies. Results: Of the 902 unique citations, we identified 23 articles that met our inclusion criteria. Environmental competencies that align with general management skills were most frequent (40%), followed by research skills (37%). Three competencies specific to the environment (22%) were identified: resource stewardship (n = 16), systems thinking (n = 14) and social and environmental justice (n = 7). The majority of work was identified in nursing, medicine and public health. Competencies were most commonly embedded in existing curricula or offered as new courses or workshops. Conclusion: Incorporating environmental competencies into education programmes will serve to raise awareness of, and advance the significance of, the health sector's impact on climate change and environmental sustainability. Our findings that environmental competencies align with previously validated health-care competencies support the perspective that these competencies represent essential knowledge and skills for the health-care workforce. [ABSTRACT FROM AUTHOR]

Technical transport models are commonly relied upon in planning practice for the development of urban rail infrastructure projects. By considering the assessment and management of social impacts in the planning and decision-making of two rail megaprojects (the North-South Metro line in Amsterdam, the Netherlands, and the Parramatta Rail Link in Sydney, Australia), we found that technical approaches continued to overlook social impacts, and had an overemphasis on economic and engineering considerations. We conclude that good practice Social Impact Assessment (SIA) offers opportunities to better consider social issues as a critical component of transport projects. [ABSTRACT FROM AUTHOR]

The paper conceptualises the process of voluntary relocation undertaken by rural farmers to informal settlements in coastal cities. These are journeys that occur without formal institutional support, utilising migrants' own agency. Learning from these community‐driven relocations has merit in rethinking climate change adaptation at the regional level. In this paper we present stories of 17 families who have progressively relocated to the fringes of Khulna city in southwestern Bangladesh. We observe three key attributes: first, relocations are slow, neither singular nor immediately completed, but rather take months of careful back and forth journeys of family members between their places of origin and destination. Second, relocations rely on small networks of relatives and acquaintances at the destination. Third, relocations are built on shared responsibilities distributed among a range of actors in places of origin and destination. We conclude that these slow, small and shared relocations are likely to be realised as forms of ongoing adaptation by rural farmers if their aspirational mobilities, social relations and supports are maintained at a regional scale. This kind of migration as adaptation may bring about just outcomes for those displaced without necessarily promoting rigid planning interventions that tend to fix resettlement solutions in place and time. [ABSTRACT FROM AUTHOR]

Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers' perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians' (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods : A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs' current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion : FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists. [ABSTRACT FROM AUTHOR]

Climate change will likely increase the scale of this displacement, leading to new and intensified patterns of migration as well as planned resettlement (also known as retreat or relocation) of people from high-risk areas (de Sherbinin et al., [11]). Recognising resettlement as evidence of loss and damage is likely to elevate attention on the seriousness of the impacts of resettlement and resist the normalisation of resettlement as anything other than the option of last resort. Price argues that, '[a]ny laws governing climate change relocations must protect rights, livelihoods, well-being, inclusive decision-making and community initiatives with procedures whilst not relinquishing climate-change-reducing action'. 30 Wilmsen, B. and M. Webber (2015) What can we learn from the practice of development-forced displacement and resettlement for organised resettlements in response to climate change?. [Extracted from the article]

Increasingly the environment, and climate risks in particular, are influencing migration and planned resettlement in Vietnam, raising the spectre of increased displacement in a country already confronting serious challenges around sustainable land and water use as well as urbanisation. Planned resettlement has emerged as part of a suite of measures being pursued as part of disaster risk reduction and climate change adaptation strategies. This paper provides an historical, political, legal and environmental overview of resettlement in Vietnam identifying key challenges for framing resettlement as climate change adaptation. The paper outlines the scale of past resettlement in Vietnam, identifying the drivers and implications for vulnerability. Detailed case studies of resettlement are reviewed. Through this review, the paper reflects on the growing threat of climate change and the likelihood of increased displacement associated with worsening climate risks to identify some critical considerations for planned resettlement in climate change adaptation planning. [ABSTRACT FROM AUTHOR]

Preimplantation genetic diagnosis (PGD) allows couples to test for a genetically affected embryo prior to implantation. Patient access to this ethically complex and expensive technology differs markedly across jurisdictions, with differences in private/public insurance coverage and variations in patient inclusion and diagnostic criteria. The objective of the study was to identify trade‐offs regarding PGD coverage decisions amongst genetic counselors. To quantify stated preferences for PGD coverage, we conducted a discrete choice experiment with Canadian genetic counselors (GC) considering attributes regarding the scope of testing (PGD indication, risk of the condition and number of cycles covered) and patient inclusion criteria (fertility status and family history). Multinomial logit regression was used to estimate trade‐offs amongst attributes using part‐worth utilities and importance scores. The completed response rate was 41% with 126 GC completing the survey. Risk of the genetic condition was the most important attribute. Overall, GC were more responsive to the scope of testing criteria including the condition's risk (importance score of 42%) and PGD indication (31%) rather than family history (11%) and fertility status (8%). Based on this study's attributes and levels, condition characteristics are prioritized even above patient characteristics for PGD coverage. [ABSTRACT FROM AUTHOR]

Purpose Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patientcentred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research. Methods We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions. Results After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW. Conclusion There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW. [ABSTRACT FROM AUTHOR]

Objectives: Procurement's important role in healthcare decision making has encouraged criticism and calls for greater collaboration with health technology assessment (HTA), and necessitates detailed analysis of how procurement approaches the decision task.Methods: We reviewed tender documents that solicit medical technologies for patient care in Canada, focusing on request for proposal (RFP) tenders that assess quality and cost, supplemented by a census of all tender types. We extracted data to assess (i) use of group purchasing organizations (GPOs) as buyers, (ii) evaluation criteria and rubrics, and (iii) contract terms, as indicators of supplier type and market conditions.Results: GPOs were dominant buyers for RFPs (54/97) and all tender types (120/226), and RFPs were the most common tender (92/226), with few price-only tenders (11/226). Evaluation criteria for quality were technical, including clinical or material specifications, as well as vendor experience and qualifications; "total cost" was frequently referenced (83/97), but inconsistently used. The most common (47/97) evaluative rubric was summed scores, or summed scores after excluding those below a mandatory minimum (22/97), with majority weight (64.1 percent, 62.9 percent) assigned to quality criteria. Where specified, expected contract lengths with successful suppliers were high (mean, 3.93 years; average renewal, 2.14 years), and most buyers (37/42) expected to award to a single supplier.Conclusions: Procurement's evaluative approach is distinctive. While aiming to go beyond price in the acquisition of most medical technologies, it adopts a narrow approach to assessing quality and costs, but also attends to factors little considered by HTA, suggesting opportunities for mutual lesson learning. [ABSTRACT FROM AUTHOR]

Connections between people and water have received considerable attention within geographic research. This paper draws on cultural and historical geographies, political ecology and the environmental humanities to extend understandings of the hydrosocial cycle by focusing on the cultural dimensions of society–water relations through the concept of shadow waters. Shadow waters centres attention on the cultures that privilege certain waters while rendering other waters invisible and marginalised. Inspired by Val Plumwood's notion of "shadow places," shadow waters brings to light the way power intersects with cultural practices. We bring this concept of shadow waters into conversation with Indigenous water knowledges. Shadow waters can be conceptualised vertically, with surface water receiving more policy and research attention than ground water, and also horizontally, as some sub‐catchments, uses and values have been ignored or undervalued in macro‐catchment processes. Temporally, in considering the past, complex and contested histories of human–environment relations are often overlooked in favour of simple historical narratives that ultimately reinforce dominant management structures and trajectories. Shadow waters are thus historically created as particular power structures and narratives are reinforced and "normalised" over time. This paper examines shadow waters in southeastern Australia, elucidating the way two rivers are interwoven and co‐determined in cultures of water use in this context. We show how the rethinking of dominant water cultures, made possible by cross‐cultural engagement, generates new possibilities for reconnection, restoration and protection; a different water ethics based on care and responsibility that addresses power relations and injustices. [ABSTRACT FROM AUTHOR]

Objectives: In 2007, the Ontario Health Technology Advisory Committee (OHTAC) developed a decision framework to guide decision making around nondrug health technologies. In 2012, OHTAC commissioned a revision of this framework to enhance its usability and deepen its conceptual and theoretical foundations.Methods: The committee overseeing this work used several methods: (a) a priori consensus on guiding principles, (b) a scoping review of decision attributes and processes used globally in health technology assessment (HTA), (c) presentations by methods experts and members of review committees, and (d) committee deliberations over a period of 3 years.Results: The committee adopted a multi-criteria decision-making approach, but rejected the formal use of multi-criteria decision analysis. Three broad categories of attributes were identified: (I) context criteria attributes included factors such as stakeholders, adoption pressures from neighboring jurisdictions, and potential conflicts of interest; (II) primary appraisal criteria attributes included (i) benefits and harms, (ii) economics, and (iii) patient-centered care; (III) feasibility criteria attributes included budget impact and organizational feasibility.Conclusion: The revised Ontario Decision Framework is similar in some respects to frameworks used in HTA worldwide. Its distinctive characteristics are that: it is based on an explicit set of social values; HTA paradigms (evidence based medicine, economics, and bioethics/social science) are used to aggregate decision attributes; and that it is rooted in a theoretical framework of optimal decision making, rather than one related to broad social goals, such as health or welfare maximization. [ABSTRACT FROM AUTHOR]