Summary Resilience is becoming influential in development and vulnerability reduction sectors such as social protection, disaster risk reduction and climate change adaptation. Policy makers, donors and international development agencies are now increasingly referring to the term. In that context, the objective of this paper was to assess in a critical manner the advantages and limits of resilience. While the review highlights some positive elements –in particular the ability of the term to foster integrated approach across sectors– it also shows that resilience has important limitations. In particular it is not a pro‐poor concept, and the objective of poverty reduction cannot simply be substituted by resilience building.

Resilience has become prominent in academia where it is used as a central framework in disciplines such as ecology, climate change adaptation or urban planning. Policy makers and international development agencies also increasingly refer to it. The objective of this paper is to assess the advantages and limits of resilience in the context of development. Although the review highlights some positive elements—for example, the ability to foster an integrated approach—it also shows that resilience has important limitations. In particular, it is not a pro‐poor concept, in the sense that it does not exclusively apply to, or benefit, the poor. As such, resilience building cannot replace poverty reduction. Copyright © 2014 John Wiley & Sons, Ltd.

Reliance on subsistence agriculture means the impact of stresses and shocks (such as droughts or floods) are felt keenly by rural poor people, who depend directly on food system outcomes for their survival, with profound implications for the security of their livelihoods and welfare. However, such stresses and shocks will not necessarily lead to negative impacts, as risks and uncertainties, often associated with seasonality, are embedded in the practice of agriculture and there is considerable experience of coping and risk management strategies among people working in this sector. With climate change, the magnitude and frequency of stresses and shocks is changing and approaches such as social protection, disaster risk reduction (DRR) and climate change adaptation (CCA) will be needed to bolster local resilience and supplement people's experience. This study examines the opportunities for linking social protection, CCA and DRR in the context of agriculture and rural growth, exploring whether linking these three approaches together will help enhance resilience to shocks and stresses in agriculture-dependent rural communities. The study does this by (i) reviewing conceptual and policy-related similarities and differences between the three disciplines, by (ii) collecting evidence from case studies where climate change-resilient social protection approaches have been trialled and by (iii) developing an adaptive social protection framework that highlight opportunities better coordination. This paper suggests social protection and DRR measures designed to limit damages from shocks and stresses may not be sufficient in the longer term. For social protection to be resilient to climate change impacts, it will need to consider how reducing dependence on climate sensitive livelihood activities can be part of adaptive strategies. Similarly, CCA and DRR cannot effectively address the root causes of poverty and vulnerability without taking a differentiated view of poverty, something that further integration with social protection can help with.

Adaptive Social Protection refers to efforts to integrate social protection (SP), disaster risk reduction (DRR) and climate change adaptation (CCA), the need for which is increasingly recognised by practitioners and academics. Relying on 124 agricultural programmes implemented in five countries in Asia, this article considers how these elements are being brought together, and explores the potential gains of these linkages. It shows that full integration is still relatively limited but that, when it occurs, it helps to shift the time horizon beyond short-term interventions aimed at supporting peoples' coping strategies and/or graduation objectives, towards longer-term interventions that can help promote transformation towards climate and disaster resilient livelihood options.

BackgroundClinical activities that trainees can be trusted to perform with minimal or no supervision have been labelled as Entrustable Professional Activities (EPAs). We sought to examine what activities could be entrusted to psychiatry trainees in their first year of specialist training.MethodsWe conducted an online survey of Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).ResultsThe majority of respondents considered initiating patients with the common medications, discharging patient suffering from schizophrenia, bipolar disorder or following a crisis admission, conducting risk assessments and managing psychiatric emergencies were activities that trainees could be entrusted with by the end of the first stage of training.ConclusionsFour activities were identified that trainees should be entrusted with by the end of their first year of training. Each of these activities comprises a set of competencies in each of the CanMEDS roles. When a trainee is unable to satisfactorily perform an EPA, deficits in the underpinning competencies can be a focus for remediation. Further EPAs are being identified in areas of more specialised practice for use within more advanced training.

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We assessed the accuracy of magnetic resonance imaging in detecting clinically significant lesions of the anterior horn of the meniscus by reviewing 947 consecutive knee magnetic resonance imaging reports. Of these, 76 (8%) indicated a tear of the anterior horn of the medial or lateral meniscus. Thirty-one of these 76 patients underwent a subsequent arthroscopic examination, and their operative reports were reviewed. The 45 patients who were not examined arthroscopically were contacted and interviewed for clinical follow-up. Among the 31 patients who underwent arthroscopic examination, 8 anterior horn tears were noted in the predicted area (26% true-positive results), 23 patients had intact anterior horns (74% false-positive results), and 18 had normal intact menisci in all zones. Of the 45 patients who did not undergo arthroscopic surgery, 6 had isolated anterior horn tears reported on magnetic resonance imaging, and 5 of the 6 were asymptomatic at follow-up. The other 39 patients had multiple pathologic conditions noted on the magnetic resonance imaging report and continued to report knee pain at the follow-up interview. Increased signal intensity at the anterior horn of the meniscus seen on magnetic resonance imaging commonly does not represent a clinically significant lesion. We recommend correlation with the physical examination when interpreting this "positive" finding on knee magnetic resonance imaging examinations.

Pedicle screw constructs have been shown to increase fusion rates in the lumbar spine. Manufacturers have created pedicle screws with one or two degrees of freedom built into the screw head to allow for easier incorporation of the interlocking rod, but the effects of these screws on construct stiffness has not been tested. The purpose of this study is to compare and contrast the stiffness of lumbar pedicle screw constructs with and without the use of polyaxial pedicle screws. Nontapered, self-taping pedicle screws (6.0-mm diameter x 30-mm length, titanium) were used in the fixation of porcine spines from L3-L5. Group 1 (n = 5) contained six standard pedicle screws from one manufacturer. Group 2 (n = 5) contained six standard pedicle screws from a second manufacturer. Group 3 (n = 5) contained four standard pedicle screws placed at L3 and L5, as well as two polyaxial screws placed at L4. Group 4 (n = 5) contained six polyaxial pedicle screws. A rotational variable differential transformer was used to record angular displacement between vertebrae in the construct as it is loaded in flexion, extension, right bend, left bend, clockwise torque, and counterclockwise torque. Stiffness curves were linear throughout the range of applied force. The average r2 value for the generated stiffness graphs was 0.94 (SD = 0.06). No construct failure occurred during any of the testing. There were no significant differences (p < 0.05, two-way analysis of variance) in moment versus angle noted in any of the four groups tested. For torque tests, the all-polyaxial screw constructs showed significantly increased stiffness compared with the other groups. The current study has shown that the incorporation of polyaxial screws in pedicle screw constructs did not significantly decrease the construct stiffness. There is a suggestion that the use of all polyaxial screws may increase the resistance to torque by allowing better purchase of intervertebral rods.