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There seems to be no consensus among comparatists as to the meaning we should give to the expressions «mixed legal system» or «mixed jurisdictions» (they are frequently used interchangeably) but the issues at stake can be put into sharper focus. Unfortunately the classification schemes of mainstream comparative law afford almost no scope to the mixed systems and hardly venture into this subject. There are nevertheless two rival theories as to what these terms actually mean and how they should be applied. They give us different answers to the questions «What is a mixed jurisdiction and who is a mixed-jurisdiction jurist? On the one hand, scholars influenced by legal pluralism often entertain a wide conception of a mixed system. The sole requirement is the presence or interaction of two or more kinds of laws or legal traditions within a system. According to this viewpoint any interaction of laws of a different type or source - indigenous with exogenous, religious with customary - is sufficient to constitute a mixed legal system. This view revolutionizes the legal map offered by mainstream comparative law and leads to important insights that apply to European systems as well, but it has not yet succeeded in putting the resulting proliferation of mixed legal systems into any useful order for the purposes of comparative law. Other scholars on the other hand, particularly those inside classical mixed jurisdictions such as Scotland and Louisiana, have used a restricted and narrower notion of a mixed legal system. For the purposes of research or comparative law theory they have tended to limit this category to private-law systems based upon a core of common law and civil law elements, and other shared features stemming from this mixture. The paper traces the origins of this narrower approach and discusses the benefits of recent research comparing these kinds of jurisdictions. An attempt is made to reconcile the rival theories and to indicate that the classical mixed jurisdictions are a genus of the mixed species, and that the raison d'être of complex plural systems around the world with various «personal laws» is not that different than the reasons which led to the founding of the classical mixed systems. It is argued that comparative law research in the classic mixed systems is therefore strengthened by plurality consciousness and non-western elements in their legal order should not be ignored, for example in countries such as South Africa and Sri Lanka. [ABSTRACT FROM AUTHOR]

This article explores the concept of recovery and the role of vulnerability in suffering. It examines our overall discomfort with vulnerability in the context of narratives of violence, disorder, and the everyday. This discomfort is explored through a voyage of three narrative types: testimony, chaos, and restitution narratives (Frank, 1995). The article offers that while loss and narrative despair are the characteristic response of vulnerability storytelling does not always, contrary to dominant perspectives in narrative therapy and practice, result in narrative repair. Narrative despair--the pain, mourning, grief, and loss involved in telling stories--is central to a recovery of vulnerability [ABSTRACT FROM AUTHOR]

Abstract Background Intervention studies for depression and intimate partner violence (IPV) commonly incorporate screening to identify eligible participants. The challenge is that current ethical evaluation is largely informed by the four principle approach applying principles of beneficence, non-maleficence, and respect for justice and autonomy. We examine three intervention studies for IPV, postnatal depression (PND) and depression that used screening from the perspective of principlism, followed by the perspective of a narrative and relational approach. We suggest that a narrative and relational approach to ethics brings to light concerns that principlism can overlook. Discussion The justification most commonly used to incorporate screening is that the potential benefits of identifying intervention efficacy balance the risk of individual harm. However, considerable risks do exist. The discovery of new information may result in further depression or worries, people might feel burdened, open to further risk, unsure of whether to disclose information to family members and disappointed if they are allocated to a control group. This raises questions about study design and whether the principle of equipoise remains an adequate justification in studies with vulnerable groups. In addition, autonomy is said to be respected because participants give informed consent to participate. However, the context of where recruitment is undertaken has been shown to influence how people make decisions. Summary The four principles have been subjected to criticisms in recent years but they remain prominent in public health and medical research. We provide a set of simple, interrogative questions that are narrative and relationally driven which may assist to further evaluate the potential impacts of using screening to identify eligible research participants in intervention studies. A narrative and relational based approach requires seeing people as situated within their social and cultural contexts, and as existing within relationships that are likely to be affected by the results of screening information.

Abstract Background Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. Methods We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. Results Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how care is organised; and reflexive monitoring, which proposes that depression work requires agreement about how depression work will be monitored at the patient and practice level. We describe how these constructs can be used to guide the design and implementation of effective depression care in a way that can take account of contextual differences. Conclusions Ideas about what is required for an effective model and system of depression care in primary care need to be accompanied by theoretically informed frameworks that consider how these can be implemented. The conceptual framework we have presented can be used to guide organisational and system change to develop common language around each construct between policy makers, service users, professionals, and researchers. This shared understanding across groups is fundamental to the effective implementation of change in primary care for depression.

Abstract Background Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities. Results Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either. Conclusion This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision.

Background: Central centrifugal cicatricial alopecia (CCCA) is a primary lymphocytic scarring alopecia which occurs predominantly in Black middle-aged women.1,2 The benefits and prevalence of shared decision-making (SDM) models for CCCA patients have yet to be studied. Our study investigates the role of SDM in the management of CCCA., Methods: SDM processes were measured by the SDM-Q9, the Decisional Regret Scale (DRS), and the Patient Control Preferences Scale (CPS). Members of the Scarring Alopecia Foundation (n=1192) were recruited between June and August of 2023 via a one-time email sent via the Scarring Alopecia Foundation listserv., Results: 87 respondents were documented. The CPS (n=87) suggested that most patients (47.6% ; n=41) prefer to share responsibility with their doctor for treatment decisions. The SDM Q-9 (Scored 0-45) and DRS [scored 0-100] demonstrated mean scores of 27.5 (11.5) and 38.4 (19.4), with higher and lesser scores, respectively, demonstrating patient satisfaction with SDM., Discussion: SDM is useful in complex decision-making when there are several medically reasonable alternatives available for treatment. Patients with CCCA may benefit from this model, and investments in resources such as patient decision aids and SDM training for further dermatologists will aid integration into clinical practice., Limitation: There was no method of verifying the CCCA diagnosis for respondents. Additionally, most respondents had tertiary education, which limits generalizability to the wider population. Lastly, the low survey response rate (9.7%) predisposes to nonresponse bias., Conclusion: The CPS, SDM-Q-9, and DRS suggest that patients with CCCA prefer to be involved in management decisions., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Background: Frailty is a multi-dimensional syndrome associated with mortality and adverse outcomes in patients admitted to the intensive care unit (ICU). Further investigation is warranted to explore the interplay among factors such as frailty, clinical deterioration triggering a medical emergency team (MET) review, and outcomes following admission to the ICU., Methods: Single-centre, retrospective observational case-control study of adult patients (>18 years) admitted to a medical-surgical ICU with (cases) or without (controls) a preceding MET review between 4 h and 14 days prior. Matching was performed for age, ICU admission diagnosis, Acute Physiology and Chronic Health Evaluation III (APACHE III) score and the 8-point Clinical Frailty Scale (CFS). Cox proportional hazard regression modelling was performed to determine associations with 30-day mortality after admission to ICU., Results: A total of 2314 matched admissions were analysed. Compared to non-frail patients (CFS 1-4), mortality was higher in all frail patients (CFS 5-8), at 31% vs. 13%, and in frail patients admitted after MET review at 33%. After adjusting for age, APACHE, antecedent MET review and CFS in the Cox regression, mortality hazard ratio increased by 26% per CFS point and by 3% per APACHE III point, while a MET review was not an independent predictor. Limitations of medical treatment occurred in 30% of frail patients, either with or without a MET antecedent, and this was five times higher compared to non-frail patients., Conclusion: Frail patients admitted to ICU have a high short-term mortality. An antecedent MET event was associated with increased mortality but did not independently predict short-term survival when adjusting for confounding factors. The intrinsic significance of frailty should be primarily considered during MET review of frail patients. This study suggests that routine frailty assessment of hospitalised patients would be helpful to set goals of care when admission to ICU could be considered., (© 2024 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Background: Prevention and Recovery Care services are residential sub-acute services in Victoria, Australia, guided by a commitment to recovery-oriented practice. The evidence regarding the effectiveness of this service model is limited, largely relying on small, localised evaluations. This study involved a state-wide investigation into the personal recovery, perceived needs for care, well-being and quality-of-life outcomes experienced by Prevention and Recovery Care services' consumers., Methods: A longitudinal cohort design examined the trajectory of self-reported personal recovery and other outcomes for consumers in 19 Victorian Prevention and Recovery Care services over 4 time points (T1 - 1 week after admission; T2 - within 1 week of discharge; T3 - 6 months after discharge; T4 - 12 months after discharge). T2-T4 time frames were extended by approximately 3 weeks due to recruitment challenges. The Questionnaire about the Process of Recovery was the primary outcome measure., Results: At T1, 298 consumers were recruited. By T4, 114 remained in the study. Participants scored higher on the Questionnaire about the Process of Recovery at all three time points after T1. There were also sustained improvements on all secondary outcome measures. Improvements were then sustained at each subsequent post-intervention time point. Community inclusion and having needs for care met also improved., Conclusion: The findings provide a consistent picture of benefits for consumers using Prevention and Recovery Care services, with significant improvement in personal recovery, quality of life, mental health and well-being following an admission to a Prevention and Recovery Care service. Further attention needs to be given to how to sustain the gains made through a Prevention and Recovery Care service admission in the long term., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Magnetic Resonance Imaging (MRI) is commonly used to follow the progression of neurodegenerative conditions, including multiple sclerosis (MS). MRI is limited by a lack of correlation between imaging results and clinical presentations, referred to as the clinico-radiological paradox. Animal models are commonly used to mimic the progression of human neurodegeneration and as a tool to help resolve the paradox. Most studies focus on later stages of white matter (WM) damage whereas few focus on early stages when oligodendrocyte apoptosis has just begun. The current project focused on these time points, namely weeks 2 and 3 of cuprizone (CPZ) administration, a toxin which induces pathophysiology similar to MS. In vivo T 2 -weighted (T 2 W) and Magnetization Transfer Ratio (MTR) maps and ex vivo Diffusion Tensor Imaging (DTI), Magnetization Transfer Imaging (MTI), and relaxometry (T 1 and T 2 ) values were obtained at 7 T. Significant changes in T 2 W signal intensity and non-significant changes in MTR were observed to correspond to early WM damage, whereas significant changes in both corresponded with full demyelination. Some DTI metrics decrease with simultaneous increase in others, indicating acute demyelination. MTI metrics T 2 A , T 2 B , f and R were observed to have contradictory changes across CPZ administration. T 1 relaxation times were observed to have stronger correlations to disease states during later stages of CPZ treatment, whereas T 2 had weak correlations to early WM damage. These results all suggest the need for multiple metrics and further studies at early and late time points of demyelination. Further research is required to continue investigating the interplay between various MR metrics during all weeks of CPZ administration.

Psoriasis is strongly associated with cardiovascular disease (CVD) and metabolic syndrome, with patients having an approximately twofold increased risk of each compared to the general population. This increased risk is based on shared underlying genetic and cytokine profiles, as well as similar environmental risks. Many screening guidelines do not address the development of CVD and metabolic syndrome in these predisposed patients. These deficits are evidenced by the exclusion of psoriasis as a risk factor in validated 10-year CVD risk calculators for adult patients with chronic inflammatory diseases, as well as insufficient screening guidelines for insulin resistance in patients with psoriasis. This manuscript aims to discuss and propose allopathic and lifestyle recommendations for the screening and management of the aforementioned comorbidities in adult patients with psoriasis., (© 2023 the International Society of Dermatology.)

Optimal sleep, both in terms of duration and quality, is important for adolescent health. However, young people's sleeping habits have worsened over recent years. Access to and use of interactive electronic devices (e.g., smartphones, tablets, portable gaming devices) and social media have become deep-rooted elements of adolescents' lives and are associated with poor sleep. Additionally, there is evidence of increases in poor mental health and well-being disorders in adolescents; further linked to poor sleep. This review aimed to summarise the longitudinal and experimental evidence of the impact of device use on adolescents' sleep and subsequent mental health. Nine electronic bibliographical databases were searched for this narrative systematic review in October 2022. Of 5779 identified unique records, 28 studies were selected for inclusion. A total of 26 studies examined the direct link between device use and sleep outcomes, and four reported the indirect link between device use and mental health, with sleep as a mediator. The methodological quality of the studies was generally poor. Results demonstrated that adverse implications of device use (i.e., overuse, problematic use, telepressure, and cyber-victimisation) impacted sleep quality and duration; however, relationships with other types of device use were unclear. A small but consistent body of evidence showed sleep mediates the relationship between device use and mental health and well-being in adolescents. Increasing our understanding of the complexities of device use, sleep, and mental health in adolescents are important contributions to the development of future interventions and guidelines to prevent or increase resilience to cyber-bullying and ensure adequate sleep., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)