Additionality and permanence standards in California's Forest Offset Protocol: A review of project and program level implications.

A key component of California's cap-and-trade program is the use of carbon offsets as compliance instruments for reducing statewide GHG emissions. Under this program, offsets are tradable credits representing real, verifiable, quantifiable, enforceable, permanent, and additional reductions or removals of GHG emissions. This paper focuses on the permanence and additionality standards for offset credits as defined and operationalized in California's Compliance Offset Protocol for U.S. Forest Projects. Drawing on a review of the protocol, interviews, current offset projects, and existing literature, we discuss how additionality and permanence standards relate to project participation and overall program effectiveness. Specifically, we provide an overview of offset credits as compliance instruments in California's cap-and-trade program, the timeline for a forest offset project, and the factors shaping participation in offset projects. We then discuss the implications of permanence and additionality at both the project and program levels. Largely consistent with previous work, we find that stringent standards for permanent and additional project activities can present barriers to participation, but also, that there may be a trade-off between project quality and quantity (i.e. levels of participation) when considering overall program effectiveness. We summarize what this implies for California's forest offset program and provide suggestions for improvements in light of potential program diffusion and policy learning.

Using timelines as part of recovery-focused practice in psychosis.

The value of timelines is discussed with regard to the promotion of recovery, particularly emphasizing relapse signature and concordance in medicine-taking. Recovery approaches in contemporary mental health care rely on understanding motivations, aspirations and decision making. In the authors' experience timelines are a useful way of working together with people to make sense of experiences, of which they may only have partial or intermittent awareness. The mental health workers' philosophical approach, the tools available to them and their skills and attributes, shape the therapeutic relationship. Timelines are a useful tool in helping reach the kind of joint understanding within a therapeutic relationship which characterizes concordance. As this relationship develops, decision making including that around medicine-taking and relapse signature, can be based on this shared understanding. Timeline examples (Tables 2 and 3) based on the fictitious experiences of Philip, a young man diagnosed with schizophrenia, show their application in recovery-focused practice. Further research is needed to enhance the limited evidence base underpinning timelines as a method of facilitating concordance.

The enigma of post-natal depression: an update.

This paper aims to provide a critical analysis of key concepts associated with post-natal depression (PND) to facilitate healthcare professionals with improving standards of care. Post-natal depression is often inadequately understood by healthcare professionals. The objective was to clarify and present understandings of PND. Post-natal depression may result in referral to Community Mental Health Teams and although initial contact and management is usually through Primary Care, increasingly there is involvement of liaison mental health nurses. A literature review and synthesis of research papers on PND was conducted. Using the keywords post-natal depression, post-partum, puerperium, perinatal, therapy, trial, review, systematic, 135 articles were yielded and limited to 57, which were critically reviewed and categorized into key concepts and themes. Synthesis of literature in relation to PND has facilitated construction of an evidence-based contemporary picture of clinical manifestation, aetiology, methods of screening, preventing, treating and managing PND. The veracity of the evidence surrounding the aetiology and treatment of PND is variable. Interventions are often ineffective and a vacuum in the evidence base exists leaving a dynamic environment for researchers to identify more successful ways of predicting, detecting, treating and managing PND.

Medicine taking decisions: schizophrenia in comparison to asthma and epilepsy.

This paper outlines a recent PhD study that explored factors underpinning decisions of people with schizophrenia regarding neuroleptic medicine taking. Relevant studies tend to be within the world view of psychiatry, resting on traditional concepts of compliance and insight. These studies examined schizophrenia outwith the context of other illnesses taking a snap shot view of medicine taking decision making, thus de-emphasizing its process. The chosen method of grounded theory (Glaser and Strauss 1967) overcomes these deficiencies. Stage 1 data arose from patient interviews, patients with asthma, epilepsy and schizophrenia contributed (n = 45), carers also sometimes contributed (n = 11), all three conditions being episodic disorders vulnerable to environmental stressors. Stage 2 develops from stage 1, mental health workers involved in the care of people with schizophrenia were interviewed, plus one asthma specialist and one epilepsy specialist (n = 16). Their views were compared to perspectives arising from the patient interviews and were included in the data, out of which an explanatory typology emerged. The three parts of the typology comprise the study's major categories and are labelled as: direct-reactive, deferential-compliant, and active discerning and optimizing. Active discerning and optimizing consists of two stages; experimental-reflective and consolidation. The core category of responsive resolution contains themes which run through all major categories.

Net carbon flux from agricultural ecosystems: methodology for full carbon cycle analyses.

Agricultural ecosystems have the potential to sequester carbon in soils by altering agricultural management practices (i.e. tillage practice, cover crops, and crop rotation) and using agricultural inputs (i.e. fertilizers and irrigation) more efficiently. Changes in agricultural practices can also cause changes in CO2 emissions associated with these practices. In order to account for changes in net CO2 emissions, and thereby estimate the overall impact of carbon sequestration initiatives on the atmospheric CO2 pool, we use a methodology for full carbon cycle analysis of agricultural ecosystems. The analysis accounts for changes in carbon sequestration and emission rates with time, and results in values representing a change in net carbon flux. Comparison among values of net carbon flux for two or more systems, using the initial system as a baseline value, results in a value for relative net carbon flux. Some results from using the full carbon cycle methodology, along with US national average values for agricultural inputs, indicate that the net carbon flux averaged over all crops following conversion from conventional tillage to no-till is -189 kg C ha(-1) year(-1) (a negative value indicates net transfer of carbon from the atmosphere). The relative net carbon flux, using conventional tillage as the baseline, is -371 kg C ha(-1) year(-1), which represents the total atmospheric CO2 reduction caused by changing tillage practices. The methodology used here illustrates the importance of (1) delineating system boundaries, (2) including CO2 emissions associated with sequestration initiatives in the accounting process, and (3) comparing the new management practices associated with sequestration initiatives with the original management practices to obtain the true impact of sequestration projects on the atmospheric CO2 pool.

Long-term illness and patterns of medicine taking: are people with schizophrenia a unique group?

Patients with schizophrenia relapse because of inadequate levels of medicine taking. Therefore, it seems logical to learn about the factors underpinning their medicine-taking decisions. Further research is urgently needed to explore this area and thereby to refine models of practice, to promote therapeutic interactions with medicine. Existing research tends to share three common deficits. * It is grounded in the worldview of the psychiatrist not the patient. * It studies the influence of symptoms on compliance behaviour in isolation from other potential variables. * It overlooks the potential influence of the chronicity experience in general by examining schizophrenia outwith the context of other enduring illnesses. Overall these deficits may combine to distort the influence of schizophrenic symptoms on medicine decision making and justify a coercive rather than an empowering approach. A pernicious self-fulfilling spiral may be contributing to the problem of relapse in schizophrenia. Potentially the mental health nurse has a role in addressing this problem.

Depot neuroleptics, schizophrenia and the role of the nurse: is practice evidence based? A review of the literature.

Nurses are expected to justify their practice with research based evidence. Community psychiatric nurses (CPNs) are under pressure to concentrate more on the 'seriously mentally ill', particularly those with a diagnosis of schizophrenia. Neuroleptic medicines are a recommended therapy in schizophrenia. The administration and monitoring of these drugs is a central part of the CPN's role. The CPN also often assumes an important position as patient advocate in relation to prescribing practices. Neuroleptics are commonly given in depot form to promote compliance, prevent relapse and be of benefit to the patient. This literature review considers the research evidence that these aims are achieved through current practice and reflects on the implications for nursing. In the absence of definitive research work, it may be that important decisions are based on received wisdom rather than research evidence. Whilst the data supporting the use of depots are inconclusive, there is an increasing body of knowledge demonstrating the efficacy of nursing approaches to drug therapy which seek to empower the patient.

Assisting demented patients with feeding: problems in a ward environment. A review of the literature.

A critical review of the literature on assisting demented patients with feeding difficulties identifies that care at mealtimes is often task-centred, causing stress in both patients and staff and inadequate patient care. Nurses may even be inducing dependency in this vulnerable patient group. The staff to whom this care is most often delegated do not receive sufficient education or training to enable them to achieve a sufficient degree of empathy with the patient although there is evidence in the literature to suggest that this is a necessary requirement. It is also apparent that nurses use inadequate assessment criteria, perhaps due to the fact that there is an element of commonality in the feeding behaviour of demented patients which nurses feel they have seen many times and are able to deal with. The introduction of primary nursing, increased education of nursing assistants and improved assessment procedures to combat these problems are recommended. The process of change is briefly outlined and in conclusion some areas for future research are stated.

Atypical neuroleptics: autonomy and compliance?

Non-compliance is a major stumbling block to the effectiveness of drug therapy. The nurse, both in hospital and community, has a crucial role to play in overcoming this problem to the benefit of the patient. Recent treatment advances, 'new-generation' anti-depressants and atypical neuroleptics, make this issue highly topical in mental health nursing. The atypical neuroleptics are a pharmacological breakthrough in the treatment of schizophrenia, which could herald a new era in psychiatry. These medicines give the benefits of the older (typical) neuroleptics but with fewer side-effects. Neuroleptics are sometimes called antipsychotics, antischizophrenics or major tranquillisers. Currently the atypical neuroleptics are not available in depot form. This critical review considers literature on interventions to promote compliance with neuroleptics generally and reflects on nursing implications relevant to the atypical neuroleptics. Three main forms of interventions emerge from the review; these are labelled as: imposed compliance, chosen compliance and active compliance. Historically the literature shows a gradual trend towards a realization by professionals that increased patient autonomy and involvement relates to improved compliance. This change in thinking is reflected in the new name 'adherence', which has begun to replace the term 'compliance'. It is concluded that mental health nurses have a key role to play in enabling this reconceptualization to change practice.

Student discontinuations: is the system failing?

Are nurse educators guilty of hypocrisy? While espousing holism and evidence-based practice, we may be neglecting to support the most distressed and vulnerable in our care--students. Student discontinuation arouses strong emotions, which need to be expressed and resolved. These are often unresolved leaving students and educators frustrated and alienated in 'failure'. Although it cannot be expected that all students will succeed as professionals and academic standards must be maintained, those who fail have a right to expect fairness. With the advent of Subject Quality Review (formally TQA) institutions of higher education may be asked to demonstrate their operational mechanisms for 'managing' the process of student failure. Now would be the best time for departments of nurse education to reflect on experience, review attrition rates and learn from each other in order to establish a model of best practice. Such a review may generate the formulation of national guidelines, safe guarding against the looming threat of litigation.

A dendritic-cell-derived C-C chemokine that preferentially attracts naive T cells.

Dendritic cells form a system of highly efficient antigen-presenting cells. After capturing antigen in the periphery, they migrate to lymphoid organs where they present the antigen to T cells. Their seemingly unique ability to interact with and sensitize naive T cells gives dendritic cells a central role in the initiation of immune responses and allows them to be used in therapeutic strategies against cancer, viral infection and other diseases. How they interact preferentially with naive rather than activated T lymphocytes is still poorly understood. Chemokines direct the transport of white blood cells in immune surveillance. Here we report the identification and characterization of a C-C chemokine (DC-CK1) that is specifically expressed by human dendritic cells at high levels. Tissue distribution analysis demonstrates that dendritic cells present in germinal centres and T-cell areas of secondary lymphoid organs express this chemokine. We show that DC-CK1, in contrast to RANTES, MIP-1alpha and interleukin-8, preferentially attracts naive T cells (CD45RA+). The specific expression of DC-CK1 by dendritic cells at the site of initiation of an immune response, combined with its chemotactic activity for naive T cells, suggests that DC-CK1 has an important rule in the induction of immune responses.