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The New Jersey Kids Study (NJKS) is a transdisciplinary statewide initiative to understand influences on child health, development, and disease. We conducted a mixed-methods study of project planning teams to investigate team effectiveness and relationships between team dynamics and quality of deliverables.
Methods:
Ten theme-based working groups (WGs) (e.g., Neurodevelopment, Nutrition) informed protocol development and submitted final reports. WG members (n = 79, 75%) completed questionnaires including de-identified demographic and professional information and a modified TeamSTEPPS Team Assessment Questionnaire (TAQ). Reviewers independently evaluated final reports using a standardized tool. We analyzed questionnaire results and final report assessments using linear regression and performed constant comparative qualitative analysis to identify central themes.
Results:
WG-level factors associated with greater team effectiveness included proportion of full professors (β = 31.24, 95% CI 27.65–34.82), team size (β = 0.81, 95% CI 0.70–0.92), and percent dedicated research effort (β = 0.11, 95% CI 0.09–0.13); age distribution (β = −2.67, 95% CI –3.00 to –2.38) and diversity of school affiliations (β = –33.32, 95% CI –36.84 to –29.80) were inversely associated with team effectiveness. No factors were associated with final report assessments. Perceptions of overall initiative leadership were associated with expressed enthusiasm for future NJKS participation. Qualitative analyses of final reports yielded four themes related to team science practices: organization and process, collaboration, task delegation, and decision-making patterns.
Conclusions:
We identified several correlates of team effectiveness in a team science initiative's early planning phase. Extra effort may be needed to bridge differences in team members' backgrounds to enhance the effectiveness of diverse teams. This work also highlights leadership as an important component in future investigator engagement.
Mindfulness-based cognitive therapy (MBCT) seems a promising intervention for bipolar disorder (BD), but there is a lack of randomised controlled trials (RCT) investigating this. The purpose of this multicentre, evaluator blinded RCT was to investigate the added value of MBCT to treatment as usual (TAU) in BD up to 15 months follow-up (NCT03507647).
Methods
A total of 144 participants with BD type I and II were randomised to MBCT + TAU (n = 72) and TAU (n = 72). Primary outcome was current depressive symptoms. Secondary outcomes were current (hypo)manic and anxiety symptoms, recurrence rates, rumination, dampening of positive affect, functional impairment, mindfulness skills, self-compassion, and positive mental health. Potential moderators of treatment outcome were examined.
Results
MBCT + TAU was not more efficacious than TAU in reducing current depressive symptoms at post-treatment (95% CI [−7.0 to 1.8], p = 0.303, d = 0.24) or follow-up (95% CI [−2.2 to 6.3], p = 0.037, d = 0.13). At post-treatment, MBCT + TAU was more effective than TAU in improving mindfulness skills. At follow-up, TAU was more effective than MBCT + TAU in reducing trait anxiety and improving mindfulness skills and positive mental health. Exploratory analysis revealed that participants with higher depressive symptoms and functional impairment at baseline benefitted more from MBCT + TAU than TAU.
Conclusions
In these participants with highly recurrent BD, MBCT may be a treatment option in addition to TAU for those who suffer from moderate to severe levels of depression and functional impairment.
The 1689 Toleration Act marked a profound shift in the English religious landscape. By permitting the public worship of Protestant Dissenters (largely Presbyterian), the statute laid the foundations for legal religious pluralism, albeit limited, and ensured that eighteenth-century English society would be multi-denominational.
In a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.
Methods
In a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.
Results
A lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).
Conclusions
In this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.
The ambiguity inherent in the Toleration Act was particularly visible in the controversies surrounding education. Since 1662 Dissenters had been educated, despite legal restrictions, outside of the Church-controlled grammar schools and universities, but the Toleration Act fundamentally confused matters. Was unlicensed education, at least for Dissenters, no longer illegal under canon and criminal law? Dissenters pushed at the limits of their ambiguous toleration, while clergy and their allies attempted to uphold what they still regarded as a Church monopoly. Dissenters were sometimes shielded from harassment by combinations of local sympathy or pragmatic tolerance, protection by elites, and the effects of the ongoing jurisdictional struggle between the ecclesiastical and secular courts. Disputes came to centre on the university-level ‘academies’ instructing future generations of Dissenting pastors, which promised – or threatened, depending upon perspective – to embed tolerated Dissent permanently in English society. During Queen Anne's reign Dissenting education came under sustained polemical and political assault, culminating in the 1714 Schism Act which confirmed its illegality. This legislative intervention would be overturned in 1719 following the Hanoverian succession, but the disputes about education after 1689 illustrate the profoundly unsettled nature of the post- Revolution religious landscape.
The existing literature on Dissenting education before and after the Toleration Act is in many ways problematic. It has generally displayed a dominating preoccupation with the university-level academies and in particular their curricula and teaching methodologies. Very little research has been conducted on grammar school-level learning outside the oversight of the Church. Stereotyped contrasts with the contemporary universities, supposedly notorious for intellectual lethargy, have been increasingly challenged, but the representation of the academies as a crucible of innovative, ‘modern’ education dominates what are still standard texts. Recent specialised studies, while eschewing progressive teleologies, have not entirely escaped this focus on content rather than context. However, new approaches emphasising the lives of educators and students have done much to revise previously misleading impressions of size, complexity, and stability in the later seventeenth century. With the notable exception of the work of David Wykes, the literature hardly addresses how it was the ambiguities of the Toleration Act which fuelled bitter controversies about education.
The 1689 Toleration Act marked the foundation of enduring legal religious pluralism in England, permitting Protestant Dissenters to worship publicly according to conscience. The legislation exempted them ‘from the Penalties of certaine Lawes’, nullifying much of the legal framework of religious conformity. Protestants estranged from the Church of England were now free to absent themselves from parish worship and form alternative congregations. The granting of statutory toleration would fundamentally transform the English religious landscape, sealing an end to establishment persecution of fellow Protestants while triggering decades of controversy rooted in the profound ambiguities of the 1689 law. The clergy of the Church of England would have to come to terms with dramatically changed circumstances for their institution and its spiritual mission. At the same time, groups of Protestants outside the Church would develop the architecture of distinct denominations, asserting a lasting place in public life. This study explores the process of adaption to a new religious reality, primarily by examining specific points of controversy between the ecclesiastical establishment and tolerated Protestants. It emphasises ambiguity, uncertainty, and confusion, yet highlights how the practical experience of toleration nonetheless generated new paradigms for the structuring of English society. Religious plurality presented significant practical challenges for establishment clergy. Some controversial ambiguities would resolve themselves over time, while others would be settled by the authorities following the succession of the Hanoverian dynasty. The decades after 1689 were a period in which the pastoral, as well as the political, consequences of toleration were debated and negotiated.
The significance of the Toleration Act
Statutory toleration both secured Protestant plurality in England and at the same time entrenched official anti-Catholicism in English politics and government; the legislation was both tolerant and exclusionary. The Toleration Act is inseparable from the political transformation which immediately preceded it, the so-called ‘Glorious Revolution’ of 1688–89. In a remarkably brief period the Catholic monarch James II had succeeded in alienating the Protestant loyalists whose support had secured his succession to the throne in 1685.
For all its symbolic importance, the religious legislation which followed the Revolution of 1688–89 settled very little about the future ecclesiastical landscape of England. Dissenters were now free to worship publicly according to conscience, but this provision barely touched upon the social realities of late Stuart nonconformity. The Toleration Act was in many respects an ambiguous document whose implications would need to be resolved over the following decades. This ambiguity was due in large measure to the unexpected failure of a parallel scheme to ‘comprehend’ non-sectarian Dissenters within the Church of England through conciliatory reforms. The legalisation of Protestant plurality would pose significant pastoral challenges for the established clergy, while those at the highest levels of the Church would endorse new ‘moderate’ pastoral strategies. Episcopal moderation would, however, provoke a furious reaction from among the largely conservative lower clergy. This conservative backlash generated considerable polemical noise and political heat, particularly in the reign of Queen Anne, but this should not obscure the confusion experienced by many parish clergy.
The religious ‘settlement’ of 1689
In the immediate aftermath of the Revolution, religious toleration seemed an almost inevitable development. Toleration offered a method to secure regime change upon a broad Protestant foundation, binding even sectarian Dissenters into the new dispensation. As Jonathan Israel has highlighted, the Protestant deliverer William of Orange was renowned throughout Europe for his personal commitment to a policy of religious toleration, while his Dutch homeland provided a working model of religious pluralism. In his printed Declaration of October 1688, explaining his intervention into England's political crisis, William had announced his intention to shield ‘good subjects, from all persecution on account of their religion’. His hope to improve the treatment of English Catholics swiftly foundered in the face of ingrained Protestant prejudice, only heightened by the events of James II's reign, but William would keep his promise to Protestant Dissenters. The experience of Catholic monarchy had done much to bring English Protestants together. Striving to neutralise James's dual policy of toleration for Catholics and Dissenters, the bishops had notably abandoned the language of Protestant schism and sinful separation.
Protestant pluralism was a fact of life in early Hanoverian England. After 1714 George I and his Whig ministers acted to suppress clerical agitation against Dissenters and reverse the restrictions placed on the Toleration Act during Queen Anne's reign. The age of Whig oligarchy, as historians have described it, would see the maturing of Dissenting groups as distinct denominations within English society, even as their demographic and cultural prominence declined. This securing of religious freedoms would be accompanied, however, by the delineation of lasting limits on Dissenting political participation and the continuation of at least something of a confessional state. Despite arguments for repeal, the sacramental test on public office would remain until 1828. Even Whigs instinctively averse to persecuting Protestant consciences would support such limitations, as the ability of Tories to attack the Toleration Act swiftly faded and the prospect of a Jacobite counter-revolution gradually receded.
The Protestant succession
The death of Queen Anne on 1 August 1714 marked the close of the Stuart age, delivering the throne to a German cousin qualified primarily by his Protestant faith. Dissenters had been assured by their Whig allies that the arrival of the Hanoverian dynasty, provided for since the 1701 Act of Settlement, would reverse Tory inroads on their religious liberties. The Elector of Hanover's diplomatic envoy had made similar assurances, urging Dissenters to remain engaged in political life, even at the cost of forbearing tolerated worship, and await the repeal of the 1711 Occasional Conformity Act and ‘other hardships’. Dissenters were identified by the regime-in-waiting as a crucial element in a Protestant coalition committed not only to the change of dynasty, but moreover to shared strategic interests in Europe. The role of Hanover in the ‘Grand Alliance’ against Catholic France had made the Elector Georg Ludwig, like William of Orange before him, into an icon of militant Protestantism. In September 1714 the newly arrived George I declared to the Privy Council that he would rule ‘without the least impairing the Toleration’, while two years later he would pointedly ask the bishop of Carlisle if Dissenters had not ‘deserved well’ from his government. Dissenters were understandably joyful at the achievement of the Protestant succession.
Few issues relating to the Toleration Act generated more controversy than ‘occasional conformity’. The Revolution did nothing to alter the sacramental test on public office set during the Restoration era, but after 1689 Dissenters were able serve in local and even central government through what was perceived of by many as a legislative loophole. Dissenters could attend parish churches occasionally to receive the sacrament of communion, thereby fulfilling statutory requirements for public office, but otherwise participate in their choice of tolerated Protestant worship. The first years of Queen Anne's reign would be dominated by a Tory crusade to exclude Dissenters from the political nation, which understandably looms large in standard accounts of the ‘first age of party’. The roles of the established clergy in the controversy, as polemicists and political actors, have received significant attention, but at the heart of clerical involvement lay a fundamental disagreement over pastoral strategy. The clerical cases for and against tolerating occasional conformity were as much spiritual as political.
Conformity and public office
The Revolution of 1688–89 did nothing to alter the religious tests for public office set in the Restoration period, but at the time hopes for change were high in some quarters. The fall of James II had abruptly ended his prerogative suspension of the ‘oaths or tests, that have been usually administered’, returning to force the 1661 Corporation Act and 1673 Test Act. The statutes demanded respectively that those entering ‘Imployment relating to or concerning the Government’ of borough corporations or any ‘Command or Place of Trust’ under the Crown receive communion in a parish church according to the Prayer Book liturgy. However, the oath of supremacy's denunciation of papal authority and the additional denial of transubstantiation required for Crown employment might on their own offer sufficient security against Catholics entering public office. The sacramental test could conceivably be fulfilled in Dissenting congregations as well as parish churches. Was the broadening of the political nation to encompass all Protestants the natural partner to ‘comprehensive’ ecclesiastical reforms and the toleration of those Protestants remaining outside the Church?
Of all the controversies triggered by the Toleration Act, those relating to the use of chapels within parishes are some of the least well known. Though many Dissenters marked their new freedom by constructing meeting houses, some appropriated existing worship venues, particularly in the vast rural parishes of northern England. Dissenters attempted to employ one of the limitations of the Toleration Act, the requirement for the registration of meeting places, to legitimate their possession of such chapels. Contested chapels became physical manifestations of the controversies raised by the transition to limited legal religious plurality, as tolerated Protestant groups evolved into distinct denominations and asserted their place within English society. The strong attachment of many Presbyterians to chapels pointed to their tenacious commitment to the ideal of a suitably reformed Church and their self-conception as non-sectarian. Action by clergy and local lay elites to recover chapels for establishment use forced godly Protestants out of traditional worship spaces, signalling an end to the partial conformity that had characterised the mainstream of Restoration puritanism. The financial grants of Queen Anne's Bounty formed an element in the resolution of many disputes. Establishment successes in reclaiming ‘usurped’ chapels meant control of physical fabric, yet at the same time fostered the development of the multi-denominational society that so troubled many churchmen.
Chapels within parishes
The Restoration jurist Sir Simon Degge's much reprinted manual on ecclesiastical law, The Parson's Counsellor, defined a chapel as ‘a Church in a smaller caracter [sic] … differing nothing from a Church but in the dimension, or content, and that the Church is the Elder Sister’. This definition captures the usual connotations of both modest physical extent and inferior status, but the term was applied by contemporaries in a variety of ways. It was used, for example, for distinct spaces within churches, formerly employed for the celebration of private masses and perhaps still used for the interment of specific families. However, in a general sense a ‘chapel’ was a dedicated worship venue other than the church of a parish or cathedral of a diocese. A single parish might therefore contain within its bounds multiple chapels. Such chapels within parishes can be divided broadly into two categories: those which were domestic and those of a more public character.
In the decades after 1689 controversy over the sacrament of baptism significantly disturbed the ecclesiastical peace. The performance of baptisms by Dissenting ministers developed into a point of fierce contention because it stretched the meaning of ambiguous statutory language. Separate baptism signified the spiritual authority of the leaders of Dissenting congregations and demonstrated the denominational status particularly of the Presbyterians, sealing their long drift away from the establishment. Whatever their feelings on the concept of toleration itself, many churchmen felt that Dissenting pastors should be limited to preaching and the administration of communion, with the ceremony marking admission into England's Christian commonwealth remaining the sole prerogative of establishment clergy. The provision of baptisms by Dissenters engendered not only furious complaints from those bitter at any toleration, but also concerned responses from those confused by the lack of clear boundaries. Some were moved to deny the validity of baptism outside the Church of England and hence the full Christian status of Dissenters. Furious debates in the literary public sphere were linked to a few publicised cases in which Dissenters received second baptisms from establishment clergy. In response, ‘moderate’ bishops sought to chart a path through the uncertain religious and legal landscape.
The sacrament of baptism
It would be difficult to overstate the importance of baptism in early modern England. In the language of the Thirty-Nine Articles, the Church of England's doctrinal standard, it was one of the two sacraments ‘ordained of Christ our Lord in the Gospel’. The Articles described baptism in a variety of ways, both symbolic and instrumental. It was a ‘mark of difference whereby Christian men are discerned’ and the method through which new Christians were ‘grafted into the Church’. It was the means by which the Gospel's promises of forgiveness of sins and ‘adoption to be the sons of God’ were ‘visibly signed and sealed’ to the faithful. The baptismal rite in the Book of Common Prayer, replete with imagery of washing and rebirth, assured parents that ‘children which are baptized, dying before they commit actual sin, are undoubtedly saved’. However, the precise connection between the sacrament and salvation was subject to differing interpretations throughout the early modern period. The Prayer Book catechism, intended to be learnt by ‘children, servants, and [ap]prentices’, included the statement that baptism made one ‘a member of Christ, the child of God, and an inheritor of the kingdom of heaven’.
The key point to be drawn from this study is that the Toleration Act settled very little about the future relationship between the Church of England and Protestant Dissenters. The legislation was so vague on many significant points that it all but guaranteed a troubled transition to limited religious plurality. The issues highlighted in previous chapters stemmed not just from profound disagreement among clergy about how the Church should relate to tolerated Protestants, but in large measure from the shortcomings of the 1689 law itself. Unexpectedly shorn of the parallel measures for Comprehension, without which loopholes and ambiguities emerged, the Toleration Act was not entirely undeserving of the charge from a Tory critic that it was ‘full of nonsense and tautology’. It was at the very least a piece of legislation immediately under severe strain, applying to perhaps four times as many ‘Protestant Subjects’ as had been envisaged and doing something it was never intended to do.
This is not to diminish the immense significance of the statute. It secured freedom of worship according to conscience for Protestants, embedding limited religious diversity in English society. The legislation marked an official acceptance, pragmatic or positive, that the long campaign to coerce the nation to be of one religion had failed and that Protestant pluralism was unavoidable. It should be appreciated, though, that the religious stability apparent by the 1720s had developed during a period of transition in which the practicalities of denominational coexistence were debated and often bitterly contested. A lasting pattern of Protestant pluralism, secured by Hanoverian rule and Whig government, emerged from experience of the Toleration Act's deficiencies and the working out of issues it conspicuously failed to address. Toleration was conceded in the immediate aftermath of a revolution and in the name of political stability, but what this would mean in practice depended on the experience of toleration as a political and social reality. It was a process of adjustment as much as a constitutional moment.
This process deserves a nuanced understanding. The fundamentally binary nature of the ‘first age of party’, Tory against Whig, makes it easy to view the decades following the Revolution as a struggle between supporters and opponents of a religious settlement enacted alongside a political one.
One issue which fostered both collaboration and rivalry between churchmen and Dissenters was that of national moral reform. Concerted attempts to better England's moral character certainly predated the Revolution of 1688–89, but the particular methods employed in the 1690s presented new challenges in a world of legal religious pluralism. Moral reform was strongly associated with the vocation of the clergy and the work of the ecclesiastical courts, although by the later seventeenth century there was an established history of secular involvement through the workings of the criminal justice system. To what extent were tolerated Protestants now to share in the work of national moral correction? The ‘societies for the reformation of manners’ which emerged in London and the provinces during the 1690s have received a great deal of attention, but the linked themes of toleration, Protestant identities, and emerging denominational status have only rarely been drawn together. The national reformation movement was to be undermined significantly by the controversial involvement of Dissenters in its work.
Protestants and moral reform
‘Reformation of manners’ was and is a phrase with many meanings. In the context of early modern England, it has usually been used by historians to denote concerted campaigns for the punishment of activities which were believed to offend God as much as man: drunkenness, sexual transgression, swearing, blasphemy, and the ‘profaning’ of the Sabbath. Reformers of manners often sought, through regulation of external behaviour, to alter the internal moral character of their subjects; ‘manners’ could even refer to the perceived moral climate of the entire nation. The phrase was particularly used by moral activists from the 1690s to the 1730s to describe their efforts to reform English society, but social historians have highlighted how the late Elizabethan and early Stuart periods also witnessed significant efforts to exert what has variously been called ‘social discipline’, ‘social control’, and ‘reformation of manners’. There is broad agreement among historians that ‘reformation of manners’ was one element in the disciplining of English society through both ecclesiastical and secular channels. Martin Ingram has called it an ‘almost continually persistent … feature of English social life over several centuries’. The ‘societies for reformation of manners’ established in the 1690s were only the latest incarnation of a long-standing impulse for social discipline, fortified by the conviction that immorality would draw God's punishment down upon England.