London Social Science

ObjectiveTo synthesise qualitative evidence on clinicians’ views and experiences of defensive practice.DesignSystematic review of qualitative data.Data sourcesMEDLINE, Embase, PsycINFO, AMED, Maternity and Infant Care, CINAHL, ASSIA, Sociological s, Proquest Dissertations & Theses and PROSPERO were searched from 2000 to October 2023.Eligibility criteriaWe included English-language studies of clinicians which reported qualitative data on the impact of litigation or complaints on clinical practice.Data extraction and synthesisWe coded findings data line by line using a grounded theory approach. We assessed quality using Hawker et al’s tool and synthesised data thematically.Results17 studies were included. Participants identify a range of clinical decisions which may be defensively motivated, relating to diagnosis and documentation as well as to treatment. Defensive practice often relates to a diffuse sense of risk rather than the direct threat of litigation and may overlap with other motivations, such as perceived pressure from patients or the desire to avoid harm. Defensive practice is seen to be harmful in many ways, but again, these perceptions may gain force from broader narratives of mistrust and disempowerment, as much as from the risk of litigation.ConclusionsThe idea of defensive practice, as enacted, is more complex than some theoretical accounts suggest and may often function to express broader concerns about the work of clinical care. The qualitative evidence calls into question the view of defensive practice as a key mediator linking litigation risk to inappropriate treatment and excess costs.

Abstract Crops produced using recombinant DNA technology have invaluable food security roles but are not broadly accepted. Food insecurity affects between 45% and 50% of the Ghanaian populace, while the debate to adopt, accept, use, and commercialize genetically modified (GM) crops is ongoing. In this study, a choice‐based conjoint experimental design was adopted to investigate factors driving the acceptance or rejection of GM crops in Ghana. Results from average marginal component effect estimation suggest that safety concern is the major driver for accepting or rejecting GM crops. This was further confirmed using predicted probabilities and marginal means estimation of community acceptance especially when it possesses certain attributes. The safer the GM crop is perceived for human consumption, health, and environment, the more likely the Ghanaian populace will accept it. In addition, yield and taste were observed to be other key driving factors to accept GM crops. Importantly, the country of patency was also observed to be a critical driving factor for whether or not a GM crop is accepted in Ghana. There is a need for active and greater engagement with the Ghanaian populace to put proper legislation, regulations, policies, and knowledge co‐creation process to ensure the proper use of GM crops.

We address the role of non-uniform composition, as measured by energy-dispersive x-ray spectroscopy, in the elastic properties of core/shell nanowires for the Ge/GeSn system. In particular, by finite element method simulations and transmission electron diffraction measurements, we estimate the residual misfit strain when a radial gradient in Sn and a Ge segregation at the nanowire facet edges are present. An elastic stiffening of the structure with respect to the uniform one is concluded, particularly for the axial strain component. More importantly, refined predictions linking the strain and the Sn percentage at the nanowire facets enable us to quantitatively determine the maximum compressive strain value allowing for additional Sn incorporation into a GeSn alloy. The progressive incorporation with increasing shell thickness, under constant growth conditions, is specifically induced by the nanowire configuration, where a larger elastic relaxation of the misfit strain takes place.

Over the last decade there has been a gradual enhancement of British fathers’ rights in the workplace, even though the UK has one of the longest maternity leaves in OECD countries. From April 2003, for the first time, British fathers were given a legal right to take a 2 week paid paternity leave after the birth of a child, building on a 3 month unpaid parental leave entitlement available since 1999. In April 2011 a new right to allow fathers to take up to 6 months Additional Paternity Leave (APL) during the child’s first year, if the mother returns to work before the end of her maternity leave, was introduced.

Abstract Twenty years after the genocide, many Rwandans still suffer from the psychological wounds of the past. The country's mental health agenda is based on individualised and psychiatric approaches that help some but cannot be provided on a large scale. Further, many reconciliation initiatives have been based on public testimonies, which have been shown to be potentially re‐traumatising, leading to calls for small‐scale community‐based approaches to healing, which constitute a middle way between individualised and public approaches. Drawing on the concept of ‘mental health competence’ (Campbell and Burgess, 2012), this study evaluates one such approach: the Life Wounds Healing workshops offered by the African Institute for Integral Psychology. Twenty‐one semi‐structured interviews were conducted with former workshop participants, staff members and the institute's founder to investigate their views on how these workshops can help genocide survivors. The results suggest that the workshops succeed in creating mental health competence by establishing a safe social space for people to open up, increasing people's critical understandings of the processes of pain — and potential for healing — that informs behaviour change, generating bonding social capital and offering participants' income‐generating possibilities. Copyright © 2015 John Wiley & Sons, Ltd.

© 2013 The Cochrane Collaboration. This is the protocol for a review and there is no abstract. The objectives are as follows: Overarching objective: To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise. Specific aims and objectives:: To systematically review the evidence on the impact of physical exercise on patients' pain, physical and psychosocial functioning including: identifying the most effective formats for delivering exercise advice; explaining why some exercise interventions may be more effective than others; recommending exercise formats and content by constructing a toolbox which describes the most effective exercise interventions for healthcare providers and patients to use. These will be achieved by conducting: a synthesis of quantitative data on the benefits and harm of exercise interventions for improving pain, physical and psychosocial functioning; a synthesis of qualitative data on participant's experiences, opinions and preferences of physical exercise; a cross-studies synthesis of the quantitative and qualitative data to assess the extent to which existing evaluated interventions address the needs and concerns of people living with osteoarthritis

Holistic theories of meaning have, at least since Dummett’s Frege: The Philosophy of language, been assumed to be problematic from the perspective of the incremental nature of natural language learning. In this essay I argue that the general relationship between holism and language learning is in fact the opposite of that claimed by Dummett. It is only given a particular form of language learning, and a particular form of holism, that there is a problem at all; in general, for all forms of holism, and irrespective of how language learning is understood, semantic holism is conducive to language learning. The paper has three main parts. In the first, I demonstrate with the use of a simple formal system, that the form of holism that generates the problem that Dummett draws attention to is really decomposable into three distinct components, each of which is necessary for the problem to arise. In the second part, I demonstrate that even Dummett’s strong form of holism is compatible with one natural way in which to understand the incremental nature of language learning. In the third part, I outline the reasons why all forms of holism are conducive to language learning and offer two ways in which this general fact can be spelled out precisely. I end the paper by addressing some possible objections, and in doing so I draw attention to some affinities between semantic holism and the principle of compositionality, a semantic principle which has long been assumed to be conducive to language learning.

The Personal Assessment of Intimacy in Relationships (PAIR) was developed by Schaefer & Olson (1981) to assess both the actual and ideal levels of intimacy in relationships. Attempts to replicate the original factor structure have not been reported. In Stage 1 of the present study, 157 volunteers (34 males, 123 females; mean age 27.76 years) who were currently in committed relationships completed the PAIR. Factor analysis failed to replicate the original structure but yielded a reliable, independent three-factor solution: engagement, communication and shared friendships. There were no gender differences on these factors. Confirmatory factor analysis failed to confirm this three-factor solution in a group of 145 clients (77 males, 68 females; mean age 35.79 years) presenting to a clinic for the treatment of sexual dysfunction. Principal components analysis yielded a unifactorial solution. These results suggest that people from the general population demonstrate three independent but increasingly involved aspects of intimacy, ranging from engagement to communication to shared friendships. People with sexual dysfunction seem to experience a decrement in all aspects of intimacy. The implications of these findings for the treatment of sexual dysfunction are discussed.