To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The AIDS Malignancy Consortium (AMC) conducts clinical trials of therapeutic and prevention strategies for cancer in people living with HIV. With its recent expansion to Sub-Saharan Africa and Latin America, there was a need to increase the competence of Clinical Investigators (CIs) to implement clinical trials in these regions.
AMC Clinical Investigators (CIs) were invited to complete a survey to assess role-relevance and self-perceived competence based on the Joint Task Force for Clinical Trials Competency (JTF-CCT) domains.
A total of 40 AMC CIs were invited to complete the questionnaire and 35 responded to the survey. The data management and informatics and engaging with communities’ domains were lowest in the average proportion of CIs rating themselves high (scores of 3-4) for self-perceived competency (46.6% and 44.2%) and role relevance (61.6% and 67.5), whereas, the ethical and participant safety considerations resulted in the highest score for competency (86.6%) and role-relevance (93.3%). In the scientific concepts and research design domain, a high proportion rated for competency in evaluating study designs and scientific literature (71.4% and 74.3%) but a low proportion for competency for designing trials and specimen collection protocols (51.4% and 54.3%).
Given the complexity of AMC clinical research, these results provide evidence of the need to develop training for clinical research professionals across domains where self-perceived competence is low. This assessment will be used to tailored and prioritized the AMC Training Program in clinical trial development and management for AMC CIs.
But with this story, well, he [Ovid] can't help being the Roman he is, he can't help fixating on what it is that girls don't have under their togas, and it's him who can't imagine what girls would ever do without one. (Smith 2007: 97)
The story of Iphis in Book 9 of Ovid's Metamorphoses is unique in Latin literature. Roman (male) writers make sense of female same-sex desire by casting one woman in the partnership in the active, penetrative role and characterising her as sex-mad (Hallett 1997). Ovid, by contrast, provides us with the singular tale of deep-felt desire felt by one woman or girl for another that is not reduced to this hierarchical, hyper-sexualised stereotype. That is, at least, at the story's beginning. In the end, Iphis’ miraculous sex-change from female to male enables Iphis and the beloved Ianthe to marry, seemingly shutting down any possibility of a lesbian reality and reasserting the Roman heteronormative marital paradigm. This ending has therefore disappointed prominent writers such as classicist Judith Hallett and novelist Ali Smith, who gives this ancient myth an innovative take in her acclaimed Boy Meets Girl (2007). This chapter contends, however, that Iphis’ transformation is in fact unresolved and that such disappointment is therefore misplaced. Iphis’ metamorphosis can be considered in terms of biological sex (Wheeler 1997: 196, 200; Pintabone 2002: 277; Oliensis 2009: 109; Lateiner 2009: 138) but I will show that the change is strictly speaking one of social gender: regarding Iphis’ biological sex the text is silent (Langlands 2002: 99–101; Ormand 2005: 99–100; Ormand 2009: 217–18; Boehringer 2007a: 254–5; Lindheim 2010: 186–8).
Moreover, the Metamorphosesis a poem about changing forms and Iphis’ change should be considered in the context of Ovid's other transformations. Scholarship on the passage overlooks this aspect as it has focused on the rich opportunities to explore ‘what the Iphis story itself can tell us about Ovidian/Roman concepts of gender and sexuality’ (Kamen 2012: 22). Ovidian transformations characteristically lack resolution: as scholars repeatedly remark, no metamorphosis in the poem is fully resolved since elements of a character's final form are always-already present, such as Lycaon's lupine ferocity or Anaxarete's heart of stone.
Aging is associated with numerous stressors that negatively impact older adults’ well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.
A pragmatic modified stepped-wedge trial design.
Five senior housing communities in three states in the US.
Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.
Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.
Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).
Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.
This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.
Our clinical experience at a specialized brain injury clinic suggests that numerous patients with traumatic brain injury (TBI) are using cannabis to alleviate their symptoms. While this patient population often inquires about the evidence of using cannabis post-head injury for the neurosensory, neurocognitive, and neuropsychiatric sequelae, most health professionals have little to no knowledge of this evidence. Given the recent legalization of recreational cannabis in Canada, questions and guidance related to cannabis use following a TBI are likely to become more common. This article reviews the evidence for cannabis use in psychiatric disorders with or without TBI. Overall, we found that the evidence for the use of cannabis among TBI patients is sparse and that patients tend to have little knowledge of the proven benefits and diverse effects of cannabis use. We feel this paper can serve as a stepping stone for future studies that explore the impact of cannabis use in a TBI population and can guide clinicians in advising their patients.
Due to correlations between purchasing patterns and diet disparities, differences in food shopping patterns and strategies across income levels and other socio-economic characteristics is a widely-studied research area. Most extant literature uses either primary or secondary data, which are often characterized by, respectively, limited geographical scope and considerable level of detail, or wide geographical reach but low detail. That literature also reveals contrasting results based on methods, data sources and geographic location. In this paper, we use three different datasets to characterize the differences in purchasing patterns across income levels, rural–urban status and other variables of food shoppers in the Northeastern USA and compare these trends with existing research. While many of the findings corroborate previous studies, new findings include less reliance on superstores overall, except for rural respondents, and a greater reliance on limited assortment supermarkets for SNAP and low-income households. Food purchasing differences are described by race and ethnicity, income and education, and children in the household. The analysis presented here includes a portion of the work performed by an interdisciplinary team of researchers engaged in the USDA National Institute of Food and Agriculture's Agriculture and Food Research Initiative project Enhancing Food Security in the Northeast (EFSNE). By using primary data from shoppers' intercept surveys, and secondary data from two large datasets, one of household food purchases and the other of food expenditures, we identify purchasing decisions holding at both the case-study (limited geography) and broader geographic (entire Northeast) levels, which both support previous findings and reveal the need for additional research in this area.
Compulsivity can be seen across various mental health conditions and refers to a tendency toward repetitive habitual acts that are persistent and functionally impairing. Compulsivity involves dysfunctional reward-related circuitry and is thought to be significantly heritable. Despite this, its measurement from a transdiagnostic perspective has received only scant research attention. Here we examine both the psychometric properties of a recently developed compulsivity scale, as well as its relationship with compulsive symptoms, familial risk, and reward-related attentional capture.
Two-hundred and sixty individuals participated in the study (mean age = 36.0 [SD = 10.8] years; 60.0% male) and completed the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), along with measures of psychiatric symptoms and family history thereof. Participants also completed a task designed to measure reward-related attentional capture (n = 177).
CHI-T total scores had a normal distribution and acceptable Cronbach’s alpha (0.84). CHI-T total scores correlated significantly and positively (all p < 0.05, Bonferroni corrected) with Problematic Usage of the Internet, disordered gambling, obsessive-compulsive symptoms, alcohol misuse, and disordered eating. The scale was correlated significantly with history of addiction and obsessive-compulsive related disorders in first-degree relatives of participants and greater reward-related attentional capture.
These findings suggest that the CHI-T is suitable for use in online studies and constitutes a transdiagnostic marker for a range of compulsive symptoms, their familial loading, and related cognitive markers. Future work should more extensively investigate the scale in normative and clinical cohorts, and the role of value-modulated attentional capture across compulsive disorders.
Individuals with cognitive impairment, whether inborn or acquired as a result of illness or accident, depend on others to manage the financial assets available for their benefit. This chapter examines the latest developments in enduring powers of attorney and special needs trusts (SNT) in Hong Kong as vehicles for financial planning for such individuals. It first examines whether the proposed reform of the enduring power of attorney will bring Hong Kong law in line with other developed jurisdictions, before outlining the advocacy efforts that led to the Hong Kong Government’s decision to launch a territory-wide special needs trust for the benefit of individuals with cognitive impairment. Finally, it examines the challenges in designing the operational framework of such a trust.
This chapter evaluates the operation of Midwest Special Needs Trust (MSNT), an organisation created to establish and administer special needs trusts. A special needs trust is used as a fiduciary tool to serve persons with disabilities so that their assets do not affect the eligibility of means-tested social benefits. It starts with an account of the history of MSNT, and then examines the specific definitions and requirements of MSNT trust accounts, the roles and responsibilities of the Trustee and co-trustees, and the merits of MSNT. This chapter also considers important aspects of the administration of MSNT, such as the establishment and termination of trust accounts, staffing, fees and expenses, data management, and investment policy. Real-life cases are discussed throughout to show how MSNT helps to improve the quality of life of the disabled. This chapter concludes with thoughts on the future development of special needs trusts, including MSNT service enhancements and other financial tools, to assist the population with disabilities.
This chapter reviews legal instruments and avenues available for planning support for people with cognitive impairments in Australia, including adult guardianship, durable powers of attorney, representative payee and nominee appointments, and special needs disability trusts; the associated public institutions such as guardianship tribunals, office of the public advocate, and public trustees; and their interaction with service delivery programs such as the National Disability Insurance Scheme and social security. It is argued that the configuration of planning instruments, and the timing of their introduction, reflects adaption to the architecture of its welfare state, including its somewhat unique combination of extensive access to tightly means-tested income support (and reforms to overcome tax minimisation or avoidance), the absence of any expectation of family support, and acceptance of state responsibility for funding of services for disabled people least able to care for themselves.
This chapter examines adult guardianship and powers of attorney in England and Wales today. Section I considers the origin of modern adult guardianship law in Roman law and traces its development in English common law through to the current legal and institutional infrastructure of mental capacity jurisdiction. It then introduces the procedures of appointing a deputy, and evaluates the safeguards provided by the Office of the Public Guardian. Section II focuses on the policy considerations underpinning the legislation on enduring and lasting powers of attorney, the development of policy and legislation over the past 35 years, and potential developments in the foreseeable future. The author also compares deputyship with attorneyship, and explains the advantages of the former over lasting powers of attorney.