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Introduction: The prescribing of opioids has increased internationally in developed countries in recent decades within primary and secondary care. The majority of patients with chronic non-malignant pain (CNMP) are managed by their general practitioner (GP). Recent qualitative studies have examined the issue of opioid prescribing for CNMP from a GP viewpoint. The aim of this study is to identify and synthesise the qualitative literature describing the factors influencing the nature and extent of opioid prescribing by GPs for patients with CNMP in primary care. Methods: MEDLINE, Embase, PsycINFO, Cochrane Database, International Pharmaceutical Abstracts, Database of Abstracts of Reviews of Effects, CINAHL and Web of Science were systematically searched from January 1986 to February 2018. The full text of included articles was reviewed using the Critical Appraisal Skills Programme (CASP) tool for qualitative research. The papers were coded by two researchers and themes organised using Thematic Network Analysis. Themes were constructed in a hierarchical manner, basic themes informed organising themes which informed global themes. A theoretical model was derived using global themes to explain the interplay between factors influencing opioid prescribing decisions. Results: From 7020 records, 21 full text papers were assessed, and 13 studies included in the synthesis; 9 were from the United States, 3 from the United Kingdom and 1 from Canada. Four global themes emerged: suspicion, risk, agreement and encompassing systems level factors. These global themes are inter-related and capture the complex decision-making processes underlying opioid prescribing whereby the physician both consciously and unconsciously quantifies the risk–benefit relationship associated with initiating or continuing an opioid prescription. Conclusion: Recognising the inherent complexity of opioid prescribing and the limitations of healthcare systems is crucial to developing opioid stewardship strategies to combat the rise in opioid prescription morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapists can improve the quality of life of people receiving palliative care through the management of communication and swallowing difficulties (dysphagia). However, their role in this domain is poorly defined and little is understood about the current international professional practice in this field. Aims: To examine how speech and language therapists perceive their role in the delivery of palliative care to clients, to discover current international speech and language therapist practices and to explore the similarities and differences in speech and language therapists’ practice in palliative care internationally. This will inform professional clinical guidelines and practice in this area.Design:Anonymous, non-experimental, cross-sectional survey design.Participants:Speech and language therapists working with adult and paediatric palliative care populations in Republic of Ireland, United Kingdom, United States, Canada, Australia and New Zealand where the speech and language therapist profession is well established. Method: Purposive and snowball sampling were used to recruit participants internationally using gatekeepers. An online survey was disseminated using Survey Monkey (http://www.surveymonkey.com). Results: A total of 322 speech and language therapists responded to the survey. Speech and language therapist practices in palliative care were similar across continents. Current speech and language therapist practices along with barriers and facilitators to practice were identified. The need for a speech and language therapist professional position paper on this topic was emphasised by respondents. Conclusion: Internationally, speech and language therapists believe they have a role in palliative care. The speech and language therapist respondents highlighted that this area of practice is under-resourced, under-acknowledged and poorly developed. They highlighted the need for additional research as well as specialist training and education for speech and language therapists and other multidisciplinary team members in the area of palliative care. [ABSTRACT FROM AUTHOR]

The article presents a research paper that examines effects of intervention of supermarkets on fruit and vegetable consumption in areas of limited retail access with reference to the findings of Intervention Study for Seacroft, Great Britain. The topics discussed include analysis of the findings of quantile regression, factors for low intake of food that include attitude towards healthy eating, relative cost of fruit and vegetables, and deprivation, and accessibility of food.

Background/Context: On January 29, 2008 the Toronto District School Board (TDSB) approved a city-wide Africentric elementary school under their Alternative School policy, sparking a contentious debate. Calls for Black-focused schools also arose in 2008 in London in response to the disengagement of African Caribbean youth. The historical record indicates, however, that community campaigns for Black educational programs stretch back over 40 years in both cities. Focus of the Study: This paper analyzes the development of Black-focused education in Toronto and London from 1968 to 2008 through the responses of Black parents and community activists to the historic underachievement of African Caribbean students (particularly males) in the public schools of both cities. Black-focused education is situated within the larger social, political, and national contexts and the critical incidents that fueled the development of race equality policy. The article explores how the "politics of place" influenced the trajectory of Black-focused education in each city. Research Methodology: Two parallel historical case studies were conducted using primary source material from community-based archives, secondary sources on the history of African Caribbean immigration and the development of Black community organizations, and oral history interviews with 10 Black education activists in Toronto and 7 activists in London. Conclusions: This comparative study conceptualizes this transnational phenomena as "resistance to racism" and examines how Black-focused curriculum and ideology was adapted to local conditions in Canada and Britain. Parents and community activists aimed to develop the citizenship rights of African Caribbean students, establish a diasporic sensibility, and promote the right of children of African descent to a quality education wherever they may reside. [ABSTRACT FROM AUTHOR]

A remarkable study was carried out during the Second World War on the feasibility of building large ships from ice. It received support at the highest political level because of the need for floating platforms to support aircraft operations. Extensive investigations were carried out on the mechanical properties of plain and reinforced ice and on the structural and operational characteristics of the proposed vessels. Investigations on methods for reinforcing ice led to the development of 'pykrete', a frozen mixture of water and wood pulp that was appreciably stronger and tougher than plain ice. The studies on the structural and operational characteristics of the vessels showed that the work required to design, construct and demonstrate the effectiveness and safety of the ships would be far greater than originally thought. This paper gives an abbreviated description of the work that was done, based on project files in Great Britain and Canada, which led to the conclusion that it was technically possible to build ships from ice, but that during wartime it would be too costly in terms of manpower and strategic materials. [ABSTRACT FROM AUTHOR]

This paper explores the process of elite sport policy change in two sports (swimming and track and field athletics) and their respective national sport organizations (NSOs) in Canada and national governing bodies of sport (NGBs) in the United Kingdom (UK). The nature of policy change is a complex and multifaceted process and a primary aim is to identify and analyse key sources of policy change through insights provided by the advocacy coalition framework (ACF). In Canada, it is evident that the preoccupation with high performance sport over the past 30 years, at federal government level, has perceptibly altered over the past two to three years. In contrast, in the UK, from the mid-1990s onwards, there has been a noticeable shift towards supporting elite sport objectives from both Conservative and Labour administrations. Most notably, the ACF throws into sharp relief the part played by the state in using its resource control to shape the context within which debates on beliefs and values within NSOs/NGBs takes place. While the ACF has proved useful in drawing attention to the notion of changing values and belief systems as a key source of policy change, as well as highlighting the need to take into account factors external to the policy subsystem under investigation, potential additions to the framework's logic are suggested for future applications. [ABSTRACT FROM AUTHOR]