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The urban exposome is the set of environmental factors that are experienced in the outdoor urban environment and that may influence child development. The authors' goal was to describe the urban exposome among European pregnant women and understand its socioeconomic determinants. Using geographic information systems, remote sensing and spatio-temporal modeling we estimated exposure during pregnancy to 28 environmental indicators in almost 30,000 women from six population-based birth cohorts, in nine urban areas from across Europe. Exposures included meteorological factors, air pollutants, traffic noise, traffic indicators, natural space, the built environment, public transport, facilities, and walkability. Socioeconomic position (SEP), assessed at both the area and individual level, was related to the exposome through an exposome-wide association study and principal component (PC) analysis. Mean±standard deviation (SD) NO levels ranged from 13.6±5.1 μg/m (in Heraklion, Crete) to 43.2±11 μg/m (in Sabadell, Spain), mean±SD walkability score ranged from 0.22±0.04 (Kaunas, Lithuania) to 0.32±0.07 (Valencia, Spain) and mean±SD Normalized Difference Vegetation Index ranged from 0.21±0.05 in Heraklion to 0.51±0.1 in Oslo, Norway. Four PCs explained more than half of variation in the urban exposome. There was considerable heterogeneity in social patterning of the urban exposome across cities. For example, high-SEP (based on family education) women lived in greener, less noisy, and less polluted areas in Bradford, UK (0.39 higher PC1 score, 95% confidence interval (CI): 0.31, 0.47), but the reverse was observed in Oslo (-0.57 PC1 score, 95% CI: -0.73, -0.41). For most cities, effects were stronger when SEP was assessed at the area level: In Bradford, women living in high SEP areas had a 1.34 higher average PC1 score (95% CI: 1.21, 1.48). The urban exposome showed considerable variability across Europe. Pregnant women of low SEP were exposed to higher levels of environmental hazards in some cities, but not others, which may contribute to inequities in child health and development. https://doi.org/10.1289/EHP2862.

The need for change within organizations is examined as a main reason for the lack of real change in poor people's livelihoods. Three major drivers of change are discussed: survival, the growing role of civil society in decisions that govern people's lives, and the growing demand within forest departments to move towards a more people-friendly approach. The authors argue that change is needed to narrow the gap between forest authorities' capacity and their roles, roles which demand that they engage with many actors, all of whom have varying needs, varying degrees of power and different aspirations for the forest. A key characteristic in the development of change is that organizations need to become learning organizations with a task driven rather than a hierarchical culture. Changing relationships is seen as a key to facilitating change. External drivers that can change relationships are identified as strengthening rules and restraints, harnessing the power of public opinion, and developing social sector organizations. The major series of relationships we should be considering to respond to the changes in society and to secure forest-based livelihoods, are listed as: between the forest organization and users; between user and user representatives; between frontline staff and management; between the forest organization and political structures; and between political structures and users. Le changement à l'intérieur des organisarions est examiné en tant que raison principale du manque de changement réel dans le niveau de vie des personnes démunies. Trois courant majeurs de changement sont passés en revue: la survie, le rôle croissant de la société civile dans les décisions qui gouvernent la vie des personnes concernées, et la demande grandissante, à l'intérieur des départements de foresterie, d'évoluer vers une approche prenant davantage en compte l'élément humain. Les auteurs expliquent qu'un changement est nécéssaire pour diminuer le schisme entre la capacité des autorités forestières et leur rôles, ces derniers exigeant qu'ils aient à faire avec beaucoup d'agents, lesquels ont tous des besoins variés, des degrés variés de pouvoir, et des aspirations différentes pour la forêt. Une caractéristique clé dans le développement de changements est le besoin qu'ont les organisations de devenir des organisations ouvertes au changement, fondées sur une culture motivée par les tâches plutôt que hiérarchique. La clé d'un changement plus facile semble résider dans un changement des relations. Des motivateurs externes pouvant changer les relations sont identifiés comme étant capables de renforcer les règles et la retenue, de donner une direction au pouvoir de l'opinion publique, et de développer des organisations de secteur social. Les catégories principales de relations que nous devrions prendre en considération pour répondre aux changements de notre société et pour assurer le revenu du travail basé sur la forêt sont ainsi mises en liste: entre l'organisation de la forêt et ses utilisateurs, entre les utilisateurs et leurs représentants, entre les employés sur le terrain et la gérance, entre l'organisation de la forêt et les structures politiques, et entre ces structures politiques et les utilisateurs. Se examina la necesidad de cambio dentro de las organizaciones como una de las razones principales para la carencia de cambio real en la subsistencia de los pobres. Se discuten tres factores principales: la supervivencia, el papel creciente de la sociedad civil en decisiones que gobierna la vida de la gente, y la demanda creciente dentro de los departamentos forestales para moverse hacia un enfoque más amistoso con la gente. Los autores argumentan que este cambio es necesario para estrechar la brecha entre la capacidad de las autoridades forestales y sus roles, roles que demandan que ellos se relacionen con muchos actores, todos quienes tienen necesidades diferentes, variantes grados de poder y diferentes aspiraciones para el bosque. Una característica clave en el desarrollo del cambio es que las organizaciones necesitan convertirse en organizaciones de aprendizaje con una cultura de organización por tareas en vez de una cultura jerárquica. El cambio de relaciones está visto como un clave para facilitar el cambio. Los factores externos que pueden cambiar relaciones se identifican como el fortalecimiento de reglas y restricciones, utilizar el poder de la opinión pública, y desarrollar organizaciones sociales sectoriales. La serie mayor de relaciones que deberíamos considerar para responder a los cambios en sociedad y para garantizar la subsistencia basada en el bosque, se enumeran como: entre las organizaciones y usuarios forestales; entre los usuarios y representantes de los usuarios; entre el equipo técnico y la administración; entre la organización forestal y las estructuras políticas; y entre las estructuras políticas y los usuarios.

Participation is entering mainstream forestry: as it does there are a number of outstanding questions. This paper discusses how participation is challenging development agencies. Drawing on findings from the United Kingdom's Department for International Development's (formerly the Overseas Development Administration) recent review of participatory forest management, key roles for development agencies are discussed along with the opportunities and challenges that these roles imply. The paper then looks forward to what participation can offer to forestry in a changing political climate. La participation pénètre la foresterie et relève un nombre de questions. Cet article discute comment la participation défie les services de développement. Il utilise les constatations dans l'évaluation récente de la gestion forestière participative du Department for International Development (autrefois l'Overseas Development Administration) de la Royaume Unie, et considère les rôles essentiels des agences de développement - et les perspectives et défis de ces rôles. L'article passe alors à ce que la participation peut offrir à la foresterie dans un climat politique changeant. La participación está entrando en el cauce forestal: a medida que esto sucede, sobresalen un número de preguntas. Este artículo discute como la participación está desafiando a las agencias de desarrollo. Basado en hallazgos de recientes revisiones de manejo forestal participativo en el Departamento para el Desarrollo Internacional de Reino Unido (anteriormente Administración para el Desarrollo de Ultramar), el artículo discute los papeles claves de las agencias de desarrollo conjuntamente con las oportunidades y retos que estos roles implican. El artículo discute también, lo que la participación puede ofrecerle a la ingeniería forestal en un clima político cambiante.

The Supportive and Palliative Care Unit (SPCU), Eastern Health is the largest in-patient palliative care unit in Victoria, with 32 beds and a diverse interdisciplinary team.

Patients are systematically assessed using five assessment tools: * the Palliative Care Phase (PC Phase)- a measure of the clinical need of the patient and their family and carers (Masso et al. 2015); * the Palliative Care Problem Severity Score (PCPSS) - clinician assessed severity of problems in each domain (ie. pain, other symptoms, psychological/spiritual and family/ carer) (Masso et al. 2016); * the Symptom Assessment Scale (SAS) - used to capture the patient's perspective on the degree of individual symptom distress (Aoun et al. 2011); * the Resource Utilisation Group Activities Daily Living (RUG-ADL)measures motor function with activities of daily living (ie. bed mobility, toileting, transfer and eating) (Fries et al. 1994), and; * the Australian Karnofsky Performance Scale (AKPS)- overall performance or ability to manage activities of daily living (Abernethy et al. 2005).There has been a consistent improvement over time in patient outcomes, timely access to palliative care services (in community, inpatient and consult settings) and improved family and carer outcomes (Currow et al. 2015).Sarah Aranha, MN RN, Nurse Unit Manager, Supportive and Palliative Care, Eastern Health Claire E Johnson, PhD RN, Vivian Bullwinkel Chair of Palliative Care Nursing (Monash University), Clinical Lead for End of Life Care, Eastern Health, Victoria * Jane Healey, RN, GCPallCare, Quality Improvement Facilitator, Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute, University of Wollongong * Pippa Blackburn, PhD, BSocWk, MPallCare, GCGrief& PalCareCounselling, Quality Improvement Facilitator, Palliative Care Outcomes Collaboration (PCOC), Australian Health Services Research Institute, University of Wollongong * Sam Allingham, BMath(Hons).Improving national hospice/palliative care service symptom outcomes systematically through point-ofcare data collection, structured feedback and benchmarking.