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To explore and monitor experience of hospital care provided to patients of Stoke Community Drug and Alcohol Services (CDAS) and Edward Myers Unit (EMU; detox inpatient based unit).
The sample was collected from patients who attended face-face clinics at CDAS and patients living in Stoke-On-Trent who were admitted to the Edward Myers Unit. The survey pertains to four locations, which include Royal Stoke Hospital, A + E, Harplands Hospital (Mental Health Unit), and EMU.
We collected data of over two months from September–November 2020. The cohort of patients from CDAS included new presentations or restart Opioid Substitution Treatment (OST) clinics and people known to the alcohol team at CDAS.
We delivered a survey pertaining to experience of hospital care in the last 12 months. This includes treatment at A&E Royal Stoke Hopital, any of the wards at Royal Stoke Hospital, Harplands Hospital and Edward Myers Unit.
The uptake for the survey was 53/83 (64%) at CDAS clinic and 23/44 (52%) at Edward Myers Unit. The sample comprised more men than women. The majority were aged 31–40 years. Most common substances used were alcohol.
Majority of patients has been admitted to the general hospital, either in the ward or seen at A + E. Most people were very satisfied with their treatment in all four locations. This include withdrawal symptoms, pain, mental health, and discharge plan. There were diverse reasons given of the satisfactory scores. EMU seems to have the best overall scores comparatively to the other units, with Harplands Hospital seems to be doing worse.
The free text comments revealed that the staffs' courtesy, respect, careful listening and easy access of care was particularly the strongest driver of overall patient satisfaction. Patients look for supportive relationships, to be involved in treatment decisions, effective approaches to care, easy treatment access and a non-judgemental treatment environment. In some aspects, patients were dissatisfied with pain management, longer waiting times and inability to treat them as equal to non drug/alcohol users.
On objective measures, patients were satisfied with treatment received, however, some has point out their dissatisfaction, particularly in the mental health setting. This project calls for greater attention and support for addiction service provision in emergency departments and hospital wards. Although these findings do not represent the views of all patients in SUD treatment, findings give insight into the ways treatment providers, service managers and policy makers might enhance the patient experience to improve patient treatment prognosis and outcomes
This study examines the prevalence and associations between recent violence experience, mental health and physical health impairment among Female Sex Workers (FSWs) in north Karnataka, India.
Multi-morbidity, in particular the overlap between physical and mental health problems, is an important global health challenge to address. FSWs experience high levels of gender-based violence, which increases the risk of poor mental health, however there is limited information on the prevalence of physical health impairments and how this interacts with mental health and violence.
We conducted secondary analysis of cross-sectional quantitative survey data collected in 2016 as part of a cluster-RCT with FSWs called Samvedana Plus. Bivariate and multivariate analyses were used to examine associations between physical impairment, recent (past 6 months) physical or sexual violence from any perpetrator, and mental health problems measured by PHQ-2 (depression), GAD-2 (anxiety), any common mental health problem (depression or anxiety), self-harm ever and suicidal ideation ever.
511 FSWs participated. One fifth had symptoms of depression (21.5%) or anxiety (22.1%), one third (34.1%) reported symptoms of either, 4.5% had ever self-harmed and 5.5% reported suicidal ideation ever. Over half (58.1%) reported recent violence. A quarter (27.6%) reported one or more chronic physical impairments. Mental health problems such as depression were higher among those who reported recent violence (29%) compared to those who reported no recent violence (11%). There was a step-wise increase in the proportion of women with mental health problems as the number of physical impairments increased (e.g. depression 18.1% no impairment; 30.2% one impairment; 31.4% ≥ two impairments). In adjusted analyses, mental health problems were significantly more likely among women who reported recent violence (e.g. depression and violence AOR 2.42 (1.24–4.72) with rates highest among women reporting recent violence and one or more physical impairments (AOR 5.23 (2.49–10.97).
Our study suggests multi-morbidity of mental and physical health problems is a concern amongst FSWs and is associated with recent violence experience. Programmes working with FSWs need to be mindful of these intersecting vulnerabilities, inclusive of women with physical health impairments and include treatment for mental health problems as part of core-programming.
Samvedana Plus was funded by UKaid through Department for International Development as part of STRIVE (structural drivers of HIV) led by London School of Hygiene and Tropical Medicine and the What Works to Prevent Violence Against Women and Girls Global Programme led by South African Medical Research Council
Repetition is the process in which the original potential of a received form of thought or existence gets released anew. As officially introduced in Being and Time, repetition describes a specific mode of projective self-understanding.
Remembrance is a distinctive orientation toward history; especially, the history of philosophy. Remembrance is, namely, a way of being attuned to history as fundamentally disclosing “the relationship between the human being and being” (GA6.2:440/EP 76).
Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care.
A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ).
We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference −1.48 points, 95% confidence interval from −3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011).
We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
This chapter discusses the overlapping interest in political communication and mediation in recent Chinese and European historiographies. It explores a shared trend towards the social appropriation and reproduction of central (or ‘state’) authority by various kinds of intermediaries in the late Middle Ages, and underscores the use of a comparative historical inquiry in analyzing the different modalities and effects of the social appropriation of state authority in Chinese and European history.
Keywords: political communication, mediation, literati, Catholic Church, clergy, political community
Comparisons between European and Chinese history are in danger of becoming the cliché of the global turn. Whether it is a case of comparative studies of empire, the exploration of ‘Great Divergence’, or the study of ‘Eurasian Transformations’, the choice of ‘Europe’ and ‘China’ as comparators seems inescapable. While there is some comparative work that deliberately takes a different line — Victor Lieberman's ‘Strange Parallels’ between Eurasian ‘rimlands’ would be one obvious example — it is not hard to see why discussion so often focuses on these two major centres of culture and power: there are rich Anglophone historiographies; there are equalities of scale; there is topicality; and there is a pre-existing comparative literature which inevitably raises questions for further examination. We make no apology for adding yet another layer of Chinese-European comparison in this volume. Although we shall draw on some established approaches — above all, the ground-breaking work of Shmuel Eisenstadt in the 1960s — we shall also seek to strike out in new directions.
As a starting point, we will build our comparison upwards, starting from themes that are more prominent in the regional literatures of European and Chinese history than in the comparative literature. We hope that this might help us to break free from some of the familiar repertoires of analysis — particularly the comparison of ‘states’ — and to do justice to the specificity of social experience, capturing something of the micro- and meso-levels of political life as well as the macro-level. Second, we aim to explore process more than structure or development. Like Eisenstadt, but resisting the pressure to create taxonomies, we want to get at patterns of interaction rather than grand narratives. Third, as the Introduction indicates, we want to extend our examination into periods less frequently compared.
Hamit Bozarslan, Ecole des Hautes Etudes en Sciences Sociales, Paris,Cengiz Gunes, The Open University, Milton Keynes,Veli Yadirgi, School of Oriental and African Studies, University of London
This chapter examines protest in the Kurdistan Region of Iraq. Prior to 1991, street protests in Iraqi Kurdistan played important roles in perpetuating local claims and broadcasting popular perspectives in a series of regimes that gave ordinary people few avenues for exercising influence. Attention to such protests highlights the fact that the Kurdish struggle under the Ba’ath was waged not only by peshmerga in the mountains but by civilians in towns and cities whose public manifestations of discontent continually pushed the limits of Iraqi authority and validated collective action as a legitimate form of political expression. Since 1991 and especially after 2003, street demonstrations have played an increasingly significant role in Iraqi Kurdish political life. The chapter divides such protests into three main phases, each differentiated primarily by shifts in state society relations, resources and mobilization capacity. Initially focused on improving service provision and infrastructure in specific locales, popular protests soon broadened in geographic and political scope to encompass systemic reforms calling for the redistribution of resources and the rule of law. Expanded meso-level mobilization capacity combined with newly potent master frames and forms of mobilization helped build and sustain a significant level of popular challenge to Kurdish authorities.
Pre-harvest sprouting (PHS) induced by the absence of seed dormancy causes a severe reduction in crop yield and flour quality. In this study, we isolated and characterized TaABI4, an ABA-responsive transcription factor that participates in regulating seed germination in wheat. Sequence analysis revealed that TaABI4 has three homologues, located on chromosomes 1A/1B/1D. TaABI4 contains a conserved AP2 domain, and AP2-associated, LRP and potential PEST motifs. Putative cis-acting regulatory elements (CE1-like box, W-box, ABRE elements and RY elements) were identified in the TaABI4 promoter region that showed high conservation in 17 wheat cultivars and wheat-related species. Expression profiling of TaABI4 indicated that it is a seed-specific gene accumulating during the middle stages of seed development. Transcript accumulation of TaABI4 in wheat cultivar Chuanmai 32 (CM32, PHS susceptible) was 5.07-fold and 1.39-fold higher than that in synthetic hexaploidy wheat SHW-L1 (PHS resistant) at 15 and 20 DPA, respectively. Six expression quantitative trait loci (eQTL) of TaABI4 on chromosomes 2A, 2D, 3B and 4A were characterized based on the accumulated transcripts of TaABI4 in SHW-L1 and CM32-derived recombinant inbred lines. These QTLs explained 10.7 to 46.1% of the trait variation with 4.53–10.59 of LOD scores, which contain genes that may affect the expression of TaABI4.
The topic of norm creation by contract is to a certain extent a mainstay of private international law, at least as applied to markets. It rests on what is arguably the most significant contemporary principle within the discipline, ‘party autonomy’’, or contractual freedom of choice of the governing law. Such a principle fulfils a key function within the political economy of private ordering in today's global context. Indeed, while such a principle emerged as part and parcel of the ‘mythology of modern law’’, it has also worked, less visibly, to destabilise modernity's assumptions about the relationship between law and sovereignty, which are now, in the ‘era of the post’ at the heart of considerable turmoil. Critical legal scholarship has highlighted the ways in which the principle of party autonomy empowers the fiction of an autonomous private transnational legal order and, by the same token, fits it into the wider debate on the future of law beyond the state.
The potential relevance of this project for an audience of contract lawyers is obviously linked to the fact that contract is the cardinal tool by means of which market players with local affiliations may rise above the constraints and contingencies of restrictive regulation designed for domestic consumption and thereby deploy their activities unhindered in a disembedded ‘space’ beyond the state. Indeed, the conceptual correlate of this empowerment of private actors to create their own normative space is the existence of an original lawless hinterland beyond the jurisdiction of nation states. According to the received wisdom of the discipline, that hinterland came to be filled up (at various points in history, according to the particular narrative) with the spontaneous self-regulating contractual practices, for the greater benefit of international trade, or the worldwide community of merchants, under the benevolent gaze of territorial sovereigns. Classical historiography locates the genesis of party autonomy in a famous consultation by Charles du Moulin on the conflict of laws in matrimonial property in the early 16th century. Five centuries on, it is still the legal linchpin of some of the most powerful drivers of the global economy.
Marcel Proust’s A la recherche du temps perdu (1913–27) is a modern classic, arguably the most influential French novel of the twentieth century. This chapter examines its landmark status, its composition, structure and thematic preoccupations. It investigates why Proust’s novel stands apart from others produced contemporaneously and why its appeal endures to this day. Proust’s novel is shown to be a work characterized by plurality and multiplicity, an echo chamber of earlier works of art, and a vital staging post in the history of the novel. The reception of Proust's novel is considered, together with its place in the development of European modernism. Its long gestation and piecemeal publication are discussed and related to contemporary publications and the ways in which Proust adapted his novel and its architecture to the events—geopolitical and personal—that occurred during this time. The chapter examines the demands made of Proust’s readers by his narrative techniques and the strategies we develop to cope with the scale and ambition of his novel. It closes with a reflection on the ways in which twentieth- and twenty-first century French novelists have responded to Proust’s achievements.