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Water resource management has numerous environmental challenges, especially in aquatic ecosystems such as rivers due to the heterogeneous distribution of surface water resources, among other diverse impacting factors. In Iran (one of the countries of the Middle-East), population growth, development of urban communities and development of agricultural and industrial activities provide additional impacts on the functioning of aquatic ecosystems. The United Nations declared the third decade of this century (2021–2030) as the decade of ecosystem restoration. In this study, we have selected the Zayandehroud River as a case study and then evaluated the pathology of existing statuses. Strategies and approaches were studied and analyzed including the need to utilize integrated water resources management (IWRM), approaches for dealing with drought conditions, payment of water rights and dam alternatives, and the need for ecological landscape studies. Then, strategies and approaches appropriate from the perspective of restoration were identified, including the techniques used, and the experiences of different countries. The analysis showed that similar regions of Iran in the Middle-East need to change the paradigm of \"nature control\" to the paradigm of \"nature management\" and reduce reliance on structural and technological solutions in water resources management.

Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009. Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life ( n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose). Results: Almost 54% ( n = 6,186) of the end-of-life study population with cancer ( n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 ( p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ). Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.

To examine HMG-CoA reductase inhibitor (statin) drug dispensing patterns to Nova Scotia Seniors' Pharmacare program (NSSPP) beneficiaries over a 14-year period in response to: 1) rosuvastatin market entry in 2003, 2) JUPITER trial publication in 2008, and 3) generic atorvastatin availability in 2010. All NSSPP beneficiaries who redeemed at least one prescription for a statin from April 1, 1999 to March 31, 2013 were included. Aggregated, anonymous monthly prescription counts were extracted by the Nova Scotia Department of Health and Wellness (Nova Scotia, Canada) and changes in dispensing patterns of statins were measured. Data were analyzed using descriptive analyses and interrupted time series methods. The percentage of NSSPP beneficiaries dispensed any statin increased from 5.3% in April 1999 to 20.7% in March 2013. In 1999, most NSSPP beneficiaries were dispensed either simvastatin (29.5%) or atorvastatin (28.7%). When rosuvastatin was added to the NSSPP Formulary in August 2003, prescriptions dispensed for simvastatin, lovastatin, pravastatin, and fluvastatin declined significantly (slope change, -0.0027; 95% confidence interval (CI), (-0.0046, -0.0009)). This significant decline continued following the publication of JUPITER (level change, -0.1974; 95% CI, (-0.2991, -0.0957)) and the availability of generic atorvastatin (level change, -0.2436; 95% CI, (-0.3314, -0.1558)). Atorvastatin was not significantly affected by any of the three interventions, although it maintained an overall decreasing trend. Only upon the availability of generic atorvastatin did the upward trend in rosuvastatin use decrease significantly (slope change, -0.0010, 95% CI, (-0.0015, -0.0005)). The type and rate of statins dispensed to NSSPP beneficiaries changed from 1999 to 2013 in response to the availability of new agents and publication of the JUPITER trial. The overall proportion of NSSPP beneficiaries dispensed a statin increased approximately 4-fold during the study period. In 2013, rosuvastatin was the most commonly dispensed statin (44.1%) followed by atorvastatin (39.1%).

Background In many families where children have a social worker, parents have experienced challenges in their own childhoods or have neurodevelopmental conditions. These families often endure significant stress, which is frequently worsened by financial or housing challenges. This added pressure can strain relationships and increase the risk of child maltreatment, as well as contribute to mental health issues in children. Relationship-focused interventions show promise in preventing child maltreatment, although there are currently no interventions that simultaneously address neurodevelopmental conditions and the impact of poverty. We have co-produced, alongside parent experts-by-experience, local stakeholders, and infant mental health practitioners, a new service called Infant Parent Support (IPS). IPS will i) adopt a relationship-focused approach to comprehensive understanding of family functioning, ii) incorporate child and parent mental health and neurodevelopmental awareness, and iii) ensure a poverty aware approach throughout. The aim of this phase is to investigate the feasibility of a definitive Randomised Controlled Trial (RCT) of IPS compared with services-as-usual (SAU). Methods The study settings are social care services in two local authorities: Glasgow City Council (Scotland) and the London Borough of Bromley (England). Our target population is children on a ‘child in need’ plan (or the Scottish equivalent) and eligible participants are families where i) the infant(s) are aged 0–5 years and ii) the family has an allocated social worker plus a multi-agency support plan. Thirty participants will be identified by social workers and randomised to receive either IPS or SAU. Families randomised to IPS will receive an intensive multidisciplinary attachment-focused assessment that provides a foundation for relationship-focused interventions. IPS will incorporate child and parent mental health and neurodevelopmental awareness and ensure a poverty aware approach throughout. Families randomised to SAU will receive the assessment and support that social care services normally implement. We will utilise a pre-post and 3/6-month follow-up design with embedded mixed-method process evaluation and exploratory economic analysis. The primary objective is to assess if enough families can be recruited, randomised, and retained in the trial such that a full-scale RCT is likely to be feasible. The secondary objectives are to assess the acceptability and feasibility of the planned outcome measures and the IPS intervention to families and professionals. Conclusions A service like IPS, that uses a relationship-focused approach to child and parent mental health, neurodevelopmental and money/housing problems, has never previously been tested. Therefore, there are several areas of uncertainty that need to be addressed before moving onto a definitive RCT. Trial registration {2a and 2b} Registered in ClinicalTrials.gov Identifier: NCT06003582. Co-production and Feasibility RCT of Intervention to Improve the Mental Health of Children with a Social Worker. Registered 22/08/2023. https://classic.clinicaltrials.gov/ct2/show/NCT06003582 .

Nature is declining globally at unprecedented rates with adverse consequences for both ecological and human systems. This paper argues that only transformative change—a fundamental, system-wide reorganization—will be sufficient to arrest and reverse this loss and to meet globally agreed development goals, including the post-2020 Global Biodiversity Framework. In search for a credible platform to help facilitate such transformative change, this paper explores the potential of multifunctional ‘scape approaches to improve sustainable management outcomes at scale. Beyond a current international focus on nature restoration, this paper emphasizes the urgency and criticality of confirming approaches for sustainably preserving large ‘intact’ natural areas. Through a semi-systematic review of contemporary academic and gray literature and derivation of a theory of change, the authors consider tropical peatland systems—which can interconnect multiple ecosystem types and be of global biodiversity and carbon sequestration significance—to help derive potentially broader sustainable ecosystem management lessons. Beyond identifying key considerations for implementing multifunctional ‘scape approaches, the paper recommends further work to deepen understanding of the multidimensional ‘value’ of nature; strengthen governance frameworks; empower indigenous peoples and their knowledge sharing and community management; align nature-positive and climate-positive goals; andmobilize commensurate business and financial support.

Increased nutrient availability can have a large impact in Australian woodland ecosystems, many of which are very poor in nutrients, particularly phosphorus. A study was conducted in an urban Banksia woodland remnant in Perth, southwest Western Australia to test the hypothesis that the soil nutrient status in areas in good condition (GC), poor condition invaded by the perennial grass Ehrharta calycina (PCe), and poor condition invaded by the perennial herb Pelargonium capitatum (PCp), is reflected in the nutrient status of the native and introduced species. Leaf concentrations of P, K, N, Na, Ca, Mg, S, B, Cu, Fe, Mn and Zn of six native (Banksia attenuata, Banksia menziesii, Allocasuarina humilis, Melaleuca systena, Macrozamia fraseri and Conostylis aculeata) and four introduced species (Ehrharta calycina, Pelargonium capitatum, Gladiolus caryophyllaceus and Briza maxima), were measured. Soil pH, electrical conductivity, N (total), P (total), available P, K, S and organic C were assessed beneath all species on all sites. Significantly higher concentrations of soil P (total) and P (HCO3) were found at PCe and PCp sites than GC sites, while PCp sites also had significantly higher soil concentrations for N (total) and S. Principal Components Analysis of the leaf analyses showed (a) individual species have characteristically different nutrient concentrations; (b) the introduced species Ehrharta calycina and Pelargonium capitatum clustered separately from each other and by vegetation condition. Leaf concentrations of P were significantly (P<0.05) higher, and K and Cu were significantly lower in PCe and PCp sites compared with those at GC sites. Introduced species leaf nutrient concentrations were significantly greater than native species for all nutrients except Mn which was significantly lower, with no differences for Mg and B. The results indicate a key role for P in the Banksia woodland, and we conclude that higher levels of available P at invaded sites are having a detrimental impact on the ecosystem. These results provide new knowledge to enhance conservation practices for the management of the key threatening process of invasion within a biodiversity hot spot.

Sarah introduces her mother to the idea of tea at five that is not a “supper”: “And, ma, I mean one of these new kind of teas, where you don’t get supper at all, but have a cup of tea and bread and butter, or biscuits, or sandwiches. Some authors emptied the ceremony of emotional and moral substance, allowing free play with tea-drinking as an aesthetic game, as in Oscar Wilde’s The Importance of Being Earnest (1895), or as a social and sexual battleground, as in Henry James’s The Awkward Age (1899). In these subverted uses, tea could be an actual poison, as it is in Sheridan Le Fanu’s “Green Tea” (1886); the hypocrisy of sober tea-drinking could be exploited, as it is in the case of the oily Mr. Chadband (Bleak House 1853); or the ceremony could become a morally empty aesthetic performance hiding deadliness, as it is in Lady Audley’s Secret (1862).

L’ostéoarthrite (OA) chez les personnes âgées constitue une condition chronique et répandue associée à des douleurs importantes d’invalidité. L’utilisation d’analgésiques par voie orale est un élément central de la gestion des symptômes. L’utilisation de médicaments par cette population, cependant, est complexe et la nécessité de contrôler les symptômes doivent être mis en balance avec les préoccupations concernant la sécurité des médicaments. Notre étude s’est concentrée à illustrer et à explorer les variations entre divers médicaments différents utilisés pour gérer les symptômes liés à l’ostéoarthrite. Nous avons analysé les données provenant d’un échantillon de personnes âgées de 55 ans et plus, qui vivent dans les communautés, et qui souffrent d’arthrite de la hanche ou du genou pour examiner les facteurs sociaux et médicaux associés à la variation dans les médicaments rapporté. Une conclusion principale est que les types de médicaments utilisés par les patients atteints d’ostéoarthrite varient selon l’âge et le sexe, indépendamment de la maladie et du contexte médical et social. Les explications possibles ont été considérés comme relatives aux préférences des patients et des professionnels. Osteoarthritis (OA) in older adults is a prevalent chronic condition associated with substantial pain and disability. Oral analgesic use is a central component of symptom management. Medication use in this population, however, is complex and must balance the need for symptom control with drug safety concerns. Our study focus was to illustrate and discuss the variability in the medications used to manage OA-related symptoms. We analysed data from a sample of community-dwelling persons aged 55 and older with hip or knee arthritis to examine social and medical factors associated with reported variation in OA drugs. A key finding is that drug types used by OA patients vary by age and gender, independent of disease, and medical and social context. Possible explanations related to patient and professional preferences are considered.

Parce que la prescription et l’utilisation des médicaments sont devenus un aspect normatif des soins de santé pour les personnes âgées, nous cherchons à comprendre comment les individus gérer l’utilisation des médicaments d’ordonnance dans le contexte du vieillissement. Nous soutenons que, pour ceux qui sont ambulatoires, l’utilisation de médicaments est susceptible d’être influencée par des considérations ethno-culturelles en matière de la santé et des expériences avec d’autres approches aux soins de santé. En conséquence, nous avons méné une étude qualitative, avec des entrevues en profondeur, sur un échantillon diversifié de personnes âgées afin d’identifier leurs perceptions et utilisations de médicaments. Nos conclusions dépeignent les personne âgées comme des agents actifs – qui s’appuient sur une vie d’expérience et de connaissances – qui prennent la responsabilité de l’adhésion (our non-adhésion) aux médicaments et leurs effets liés sur leur propre corps. Nous représentons la personne âgée comme une « personne pharmaceutique » dont les expériences du vieillissement sont inextricablement liée à la négociation des soins de santé dépendent sur les médicaments. Because medication prescribing and use have become a normative aspect of health care for older adults, we seek to understand how individuals navigate prescribed-medication use within the context of aging. We reasoned that, for those who are ambulatory, medication use is likely influenced by ethnocultural meanings of health and experiences with alternative approaches to health care. Accordingly, we conducted a qualitative study, with in-depth interviews, on a diverse sample of older adults in order to identify elderly persons’ perceptions and uses of medicines. Our findings depict older adults as active agents – who draw on a lifetime of experience and knowledge – who take responsibility for adherence (or non-adherence) to medicines and their associated effects on their own bodies. We represent the older person as a “pharmaceutical person” whose experiences of aging are inextricably tied up with the negotiation of medicine-reliant health care.