The upstream framework presented in public health and medicine considers health problems from a preventive perspective, seeking to understand and address the root causes of poor health. Medical-legal partnerships (MLPs) have demonstrated the value of this upstream framework in the practice of law and engage in upstream lawyering by utilizing systemic advocacy to address root causes of injustices and health inequities. This article explores upstreaming and its use by MLPs in reframing legal practice.

In analyzing the mission of the European Court of Human Rights, it is common to distinguish between what is akin to “individual justice” and what is more akin to “constitutional justice.” The way in which the Court combines the two depends on its “judicial policy.” In this contribution, we will examine how the “systemic” nature of the violations complained of affects the “judicial policy.”

The article looks at how “systemic” irregularities or breaches of law imputable to EU Member States are defined in key legal documents relating to the protection of the EU budget – notably with regards to Agricultural, Structural and Recovery funds, and with regards to the Conditionality Regulation. It is argued that “system deficiencies” arise where the financial interests of the European Union are damaged or put at risk because the systems meant to protect these interests in a Member State are considered deficient themselves. The scope of these systems varies with documents: some systems are defined in sectoral legislation and only have relevance for specific funding programmes; other systems have a more constitutional character and are linked to the protection of the rule of law in EU member states. Moreover, the severity of system deficiencies can be graded on a scale. This has implications regarding the extent of the financial consequences which can be imposed on Member States for the protection of the EU budget – how much EU funding should be withheld from them. It is also argued that the rationales underlying the imposition of financial consequences – putting the EU budget out of harm’s way or incentivizing change to reduce risk? – have implications pertaining to the legal and constitutional relationship established between the EU and its Member States.

Trauma-focused CBT (TF-CBT) is recommended by NICE for adolescents with post-traumatic stress disorder (PTSD). Whilst caregiver involvement is recommended, no specific guidance on the nature of involvement is provided although it is important that involvement takes account of the nature of the trauma. This case report details how Dummett’s systemic CBT formulation was used to plan an intervention such that systemic sessions were included in TF-CBT treatment of an adolescent female with PTSD which arose following interpersonal trauma. Trauma symptoms, trauma cognitions and depressive symptoms were measured throughout, with trauma symptoms showing clinically significant change over the course of therapy. Clinical implications are considered regarding the applicability of systemic CBT formulation and the inclusion of systemic sessions within TF-CBT for adolescents whose traumas arose interpersonally.

Discrimination has been associated with adverse mental health outcomes, though it is unclear how early in life this association becomes apparent. Implicit emotion regulation, developing during childhood, is a foundational skill tied to a range of outcomes. Implicit emotion regulation has yet to be tested as an associated process for mental illness symptoms that can often emerge during this sensitive developmental period. Youth aged 9–11 were recruited for the Adolescent Brain Cognitive Development (ABCD) study. Associations between psychotic-like experiences, depressive symptoms, and total discrimination (due to race, ethnicity, nationality, weight, or sexual minority status) were tested, as well as associations with implicit emotion regulation measures (emotional updating working memory and inhibitory control). Analyses examined whether associations with symptoms were mediated by implicit emotion regulation. Discrimination related to decreased implicit emotion regulation performance, and increased endorsement of depressive symptoms and psychotic-like experiences. Emotional updating working memory performance partially mediated the association between discrimination and psychotic-like experiences, while emotional inhibitory control did not. Discrimination and implicit emotion regulation could serve as putative transdiagnostic markers of vulnerability. Results support the utility of using multiple units of analysis to improve understanding of complex emerging neurocognitive functions and developmentally sensitive periods.

The STARTTerS Early Childhood Programme at the NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS) has been developed in response to the complex refugee experiences of very young children, their families and communities. This biopsychosocial and systemic model is informed by neuroscience, attachment theory and current knowledge of the nature and impact of refugee-specific trauma on very young children and their families. It addresses the complex interactions between, social, cultural and political factors within the trauma and recovery environments, as they influence the clients’ presentations and the choice of interventions with families in cultural transition (FICT).

This paper provides a background to the STARTTerS programme, and reports on the results of a Community Based Participatory Research (CBPR) project with the Karen and Mandaean refugee communities. It explores perceptions and cultural views of signs and symptoms related to early childhood trauma. It also explores help seeking preferences in relation to the recovery, settlement and health needs of families with young children. This research has led to ongoing collaborative and consultative processes with those communities, resulting in the development of services and referral systems, which will build a comprehensive and culturally appropriate early childhood programme.

Background: Staff working on psychiatric intensive care units (PICUs) are routinely exposed to aggression or threats of aggression from the patients they care for. This phenomenon is identified as an ongoing factor that influences both work performance as well as staff sickness, and as such requires understanding and management.

Aims & method: This study utilized questionnaires assessing the extent to which PICU staff thought violence was a problem and how safe and supported they felt. Semi-structured interviews were conducted with five nurses to gather in-depth information on the factors involved in perceptions of safety and support.

Results: The analysis indicated that as a whole, staff feel safe and supported by their immediate team. Interview analysis produced two main domains and ten sub-domains of experiences that contribute to managing threats, these being grouped in either personal or systemic factors. It particularly highlighted that although patient aggression is a concern, the perception of threat most directly relates to beliefs about a lack of support from other teams and senior management, not the patients themselves.

Conclusions: More research and attention is needed on systemic factors in the management of threatening patients.

Seed treatments are used globally on a wide range of field, vegetable and ornamental seeds, for efficient early season control of insects and diseases. However, specific seed-treatment compounds may be phytotoxic and this phytotoxicity is most acute in laboratory germination tests. Several strategies have been developed to alleviate seed-treatment phytotoxicity that include spatial separation of the pesticide from the seed. This can be accomplished by the application of the active compounds at the end of pelleting or by using a two-pellet system, termed ‘smart-pill technology’. Another approach is to detoxify or adsorb the agrochemical in a standard germination test by applying a peat medium over the seeds in a roll towel or blotter test. Many new seed-treatment chemicals have systemic activity, and the efficacy of these systemic seed treatments depends on the ability of these applied chemical compounds to be absorbed, and then transported in the developing plant. The present article describes seed-coat permeability to systemic seed treatments, examined by monitoring the movement of fluorescent tracers into intact seeds during imbibition. Two moderately lipophilic, fluorescent tracers have been used – rhodamine (ionic) and coumarin (non-ionic) – which differ mainly in electrical charge. Seed-coat permeabilities of particular species have been grouped into three categories: (1) permeable to both tracers; (2) selectively permeable to only coumarin; and (3) non-permeable to both tracers. The ability of a particular compound to diffuse through the seed coat is related to the chemical nature of the seed-covering tissues and the physico-chemical properties of the compound applied.

The treatment of challenging behaviour in intellectual disabilities has evolved dramatically since the 1950s, from a reliance on psychopharmacological restraint and operant conditioning to a multifaceted support plan that recognises the communicative intent of the client alongside their need for meaningful community participation. In recent years there has also been an increasing recognition of the critical role of family relationships in the maintenance and amelioration of challenging behaviour, as well as in attempts to integrate the fields of family therapy and applied behaviour analysis. The aim of this article is to describe a model of tertiary consultation that draws on the skills of systemic family therapy to assist clinicians who might be struggling with responding to challenging behaviour in settings characterised by complex and ‘stuck’ mediation problems. This model applies principles of reflective practice to assist such clinicians to develop a sophisticated understanding of the nature of interactions and relationships in the client's life, a critical prerequisite to the application of behavioural intervention. A detailed description of the model and a case study will be provided.

This article discusses an approach to relational ethics in contemporary systemic practice. It explores the possibilities offered by traditions of moral philosophy in attending to problems from a relational ethics perspective. This includes a focus on relationships as a crucial element in the development and maintenance of a moral self and how couples and families construct an ethical platform together, both consciously and unconsciously; and also how relational ethics may inform ideas about the values-driven problems people present in therapy. Finally, it suggests how ethical responsibility and accountability can be constructed as relational responsiveness. Despite our associations with morality as judgmental and rule driven, moral conduct and decision-making can involve imaginative, creative and aesthetic possibilities.

There is a long history of literature concerning integrative practice and how a systemic practice can fit with other models of therapy. Much of this literature has focused on establishing a space for systemic therapy within the dominant medical paradigm, and exploring how the medical model can be enhanced by systemic ideas. The outcome has been better practice, especially in child and adolescent mental health. Interestingly, however, there has been less discussion of the converse: the family therapy literature has rarely considered whether or not systemic practice itself can be enhanced by ideas from the dominant medical model. This article proposes that a biopsychosocial formulation can enhance systemic practice by: (1) holding clinicians accountable for their thinking; (2) facilitating a rigour and attention to detail that may prove useful when therapy falters; (3) opening up other possibilities for intervention; and (4) providing a way to engage with the dominant medical paradigm and support clients in negotiating their way through this system. Potential problems nevertheless arise when integrating a biopsychosocial formulation into a systemic framework. This article identifies these problems and presents ideas for how they can be managed in practice.

The aim of this study was to assess the concentration of penicillin G in mammary tissue and secretion of dry heifers following systemic administration of penethamate hydriodide. Six dairy heifers in late gestation received a single intramuscular injection of 10 g penethamate hydriodide and were sacrificed 24, 48 or 144 h after treatment. Penicillin G concentrations were measured in mammary tissue and secretion samples using HPLC. Penicillin G was detected in the udder of two animals euthanized at 24 h (mammary tissue and secretion) and at 48 h post treatment (mammary secretion only) after administration at concentrations still close to or above MIC90 values reported for the pathogens associated with heifer mastitis. Antibiotic concentration shortly after administration will have been substantially higher indicating a potential for systemic treatment with penethamate hydriodide to control prepartum intramammary infections in heifers without the disadvantages of local therapy such as teat contamination or risk of trauma for the administrator.

The objective was to evaluate the efficacy of a single dose of danofloxacin (6 mg/kg bodyweight) given by the intravenous route for the treatment of acute bovine mastitis induced by intra-cisternal infusion of an Escherichia coli strain (26 cfu into one rear quarter of each cow). Twenty-three Prim'Holstein lactating cows were inoculated. To be challenged, the mammary glands had to be productive, free of pathogenic bacteria, and with somatic cell counts (SCC) of <200 000 cells/ml. The cows were treated on an individual basis when predetermined criteria involving both systemic and local clinical signs were satisfied. Allocation to treatment, danofloxacin or negative saline control, was performed according to a randomized treatment allocation plan. Monitoring during a 21-d period after inoculation included individual clinical examination, bacteriological examination and determination of SCC. Esch. coli was isolated from the milk of all inoculated quarters at the first milking post-inoculation and, together with reference to the clinical scores; the challenge was considered to be successful in 20 of the 23 cows. On study day 7 bacteriological cure rates with danofloxacin and saline control were 89% (8/9) and 44% (4/9) respectively. On days 14 and 21 all milk samples that could be collected were negative for Esch. coli in both groups of animals. Beneficial statistically significant differences were found at the end of the observation period (days 19–21 post treatment) between cows treated with danofloxacin and saline for SCC (P=0·0091) and earlier in the study for milk production (P=0·0003) and udder inflammation (P=0·004). Obvious beneficial trends were recorded in the danofloxacin group for rectal temperature, milk quality, general behaviour and appetite. Danofloxacin-treated cows showed statistically significant lower local clinical scores and a more rapid return to pre-inoculation values. It was concluded that systemically administered danofloxacin is effective in terms of bacteriological results, milk production and both systemic and local signs when used in the treatment of induced acute Esch. coli mastitis. Danofloxacin hastens recovery and return to productivity compared with potential self cure.

In cognitive-behavioural therapy with children, young people and families, formulation-based practice ensures that interventions are based on underlying causative and maintaining processes. Importantly, however, developmental, attachment, family, systemic and other perspectives must be incorporated into therapy. This paper describes a template for systemic cognitive-behavioural formulation that facilitates incorporation of the necessary range of perspectives including processes more traditionally expressed through other psychotherapeutic modes of working. Case formulation based on this template is sufficiently comprehensive, yet simple enough to derive collaboratively and leads to a distinct clinical process for working with individuals, families and wider support systems. This generic formulation process is appropriate for use across the range of presentations encountered in child and adolescent mental health practice and provides a structure for therapist training. It requires formal evaluation and has implications for future research.