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The British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides low-income households with coupons valued at $21/week for 16 weeks to purchase healthy foods in farmers’ markets. Our objective was to explore FMNCP participants’ experiences of accessing nutritious foods, and perceived programme outcomes.
The current study used qualitative description methodology. Semi-structured interviews were conducted with FMNCP participants during the 2019 farmers' market season. Directed content analysis was used to analyse the data, whereby the five domains of Freedman et al.’s framework of nutritious food access provided the basis for an initial coding scheme. Data that did not fit within the framework’s domains were coded inductively.
One urban and two rural communities in British Columbia, Canada.
Twenty-eight adults who were participating in the FMNCP.
Three themes emerged: autonomy and dignity, social connections and community building, and environmental and programmatic constraints. Firstly, the programme promoted a sense of autonomy and dignity through financial support, increased access to high-quality produce, food-related education and skill development and mitigating stigma and shame. Secondly, shopping in farmers' markets increased social connections and fostered a sense of community. Finally, participants experienced limited food variety in rural farmers' markets, lack of transportation and challenges with redeeming coupons.
Participation in the FMNCP facilitated access to nutritious foods and enhanced participants’ diet quality, well-being and health. Strategies such as increasing the amount and duration of subsidies and expanding programmes may help improve participants’ experiences and outcomes of farmers' market food subsidy programmes.
Before coronavirus disease 2019 (COVID-19), few hospitals had fully tested emergency surge plans. Uncertainty in the timing and degree of surge complicates planning efforts, putting hospitals at risk of being overwhelmed. Many lack access to hospital-specific, data-driven projections of future patient demand to guide operational planning. Our hospital experienced one of the largest surges in New England. We developed statistical models to project hospitalizations during the first wave of the pandemic. We describe how we used these models to meet key planning objectives. To build the models successfully, we emphasize the criticality of having a team that combines data scientists with frontline operational and clinical leadership. While modeling was a cornerstone of our response, models currently available to most hospitals are built outside of their institution and are difficult to translate to their environment for operational planning. Creating data-driven, hospital-specific, and operationally relevant surge targets and activation triggers should be a major objective of all health systems.
This chapter explores the appropriate characteristic through which law should protect transgender (trans) and non-binary populations from discrimination. In recent years, there has been a dramatic growth in public awareness of gender diversity and lives beyond the binary. From politics to the media, and from sport to culture, trans and non-binary individuals are increasingly evident across society – sometimes spearheading important movements for reform; but more ofter seeking a liveable life, free from prejudice and violence.
This growing social and political visibility of trans and non-binary experiences has – in some ways – been mirrored in emerging legal reform. Since 2002, an increasing number of jurisdictions across Europe, Asia and South America have permitted individuals to legally amend their gender status. This development means that, for persons who obtain formal gender recognition (as this process is known), national law acknowledges their identity and permits them to officially live in their self-identified status.
Yet, legal change for trans and non-binary communities has been neither consistent nor comprehensive – both in terms of the geographic reach of legal progress and the type of protections that such populations can enjoy. While domestic and regional human rights tribunals have emphasised the right to identity, there has been less agreement (and considerably more difficulty) in achieving explicit anti-discrimination protections. This relates to both the actual introduction of equality guarantees, as well as the question of how any such protection should be framed.
This chapter considers potential grounds for protecting trans and non-binary populations against discrimination. It explores three overarching characteristics – disability, sex and trans-specific categories – and it assesses their individual suitability as frameworks for safeguarding trans and non-binary lives. Engaging with the lived experience of gender diversity, and the forms of discrimination to which it gives rise, the chapter identifies both the merits and disadvantages in each of the disability, sex and trans-specific approaches. Although the chapter ultimately recommends gender identity as the optimal non-discrimination model, it acknowledges the potential utility of disability and sex – appropriately understood and applied – to defending the equality rights of trans and non-binary communities.
Digital health is rapidly expanding due to surging healthcare costs, deteriorating health outcomes, and the growing prevalence and accessibility of mobile health (mHealth) and wearable technology. Data from Biometric Monitoring Technologies (BioMeTs), including mHealth and wearables, can be transformed into digital biomarkers that act as indicators of health outcomes and can be used to diagnose and monitor a number of chronic diseases and conditions. There are many challenges faced by digital biomarker development, including a lack of regulatory oversight, limited funding opportunities, general mistrust of sharing personal data, and a shortage of open-source data and code. Further, the process of transforming data into digital biomarkers is computationally expensive, and standards and validation methods in digital biomarker research are lacking.
In order to provide a collaborative, standardized space for digital biomarker research and validation, we present the first comprehensive, open-source software platform for end-to-end digital biomarker development: The Digital Biomarker Discovery Pipeline (DBDP).
Here, we detail the general DBDP framework as well as three robust modules within the DBDP that have been developed for specific digital biomarker discovery use cases.
The clear need for such a platform will accelerate the DBDP’s adoption as the industry standard for digital biomarker development and will support its role as the epicenter of digital biomarker collaboration and exploration.
In recent years, the rights and experiences of transgender (‘trans’) individuals have gained increasing legal, political and social visibility. In the United Kingdom, the landmark Gender Recognition Act 2004 (‘ the 2004 Act’ ) transformed the relationship between trans identities and the law, and began (what is now) a global movement towards affirming individuals ‘preferred gender in a more humane and dignified manner. The emergence of high-profile trans personalities, such as Laverne Cox, Caitlyn Jenner and Chelsea Manning, has thrust trans and gender non-conforming identities into the media spotlight. While the ensuing press coverage has sometimes reproduced unwelcome social prejudices, which have long characterised public responses to non-cisgender expression, more often than not social commentators now engage with trans identities in a sensitive and respectful tone.
Despite the advances being made in trans consciousness-raising, however, the lived-realities (and, indeed, the very existence) of those who experience intersex variance remains underexplored, both within legal academia and wider social discourse. While well-publicised ‘coming out'stories (such as the personal narrative of model Hanne Gaby Odiele) exist, general public awareness of intersex, and intersex visibility, is significantly lower than compared to knowledge of the trans community. To the extent that, like lesbian, gay and bisexual (LGB) equality, greater legal and social acceptance for trans identities has resulted from increasing social familiarity, populations that experience intersex variance would likely benefit from enhanced protection if both political representatives and the general public better understood intersex realities.
This chapter considers the overlap in modern efforts to secure trans and intersex legal rights. For many scholars, the aims and strategies of these movements appear, at least superficially, as inherently oppositional. Since the 1970s, much trans advocacy has focused on fairer, safer and more affordable access to gender-affirming healthcare. Within global trans communities, there are large numbers of people who seek to affirm their preferred gender through medical transition pathways, aligning their physical bodies with their internalised sense of gender.
This Case Note discusses the recent judgment of the German Constitutional Court (1 BvR 2019/16) requiring either the legal recognition of sex categories beyond male or female, or the aboltion of sex registration requirements. The Note considers the Court's decision within the broader constitutional case law on gender identity, and explores both the progressive potential, and the future—perhaps unforeseen—consequences, of the ruling. The Case Note proceeds in three sections. Section A introduces the facts of the constitutional challenge, and sets out both the submissions of the complainant, as well as the reasoning of the Constitutional Court. In Section B, the Case Note explores the domestic law novelty of the decision, placing particular emphasis on the application of a constitutional equality framework to persons who experience intersex variance. Finally, in Section C, the Case Note contextualizes the judgment, situating the reasoning of the Constitutional Court within wider movements for transgender—otherwise known as trans—and intersex rights.
Acting on harmful command hallucinations is a major clinical concern. Our COMMAND CBT trial approximately halved the rate of harmful compliance (OR = 0.45, 95% CI 0.23–0.88, p = 0.021). The focus of the therapy was a single mechanism, the power dimension of voice appraisal, was also significantly reduced. We hypothesised that voice power differential (between voice and voice hearer) was the mediator of the treatment effect.
The trial sample (n = 197) was used. A logistic regression model predicting 18-month compliance was used to identify predictors, and an exploratory principal component analysis (PCA) of baseline variables used as potential predictors (confounders) in their own right. Stata's paramed command used to obtain estimates of the direct, indirect and total effects of treatment.
Voice omnipotence was the best predictor although the PCA identified a highly predictive cognitive-affective dimension comprising: voices’ power, childhood trauma, depression and self-harm. In the mediation analysis, the indirect effect of treatment was fully explained by its effect on the hypothesised mediator: voice power differential.
Voice power and treatment allocation were the best predictors of harmful compliance up to 18 months; post-treatment, voice power differential measured at nine months was the mediator of the effect of treatment on compliance at 18 months.
IN Identoba and Others v Georgia (Application No 73235/12), 12
May 2015, the Fourth Section of the European Court of Human Rights held that
Georgia's failure to prevent, and effectively investigate, attacks
against an anti-homophobia march violated Articles 3 and 11 of the European
Convention on Human Rights (ECHR), read in conjunction with Article 14.
In Argentina, the current law on the legal recognition of preferred gender is set out in Act No. 26.743 (‘Gender Identity Act’ or ‘2012 Act’), which was enacted in May 2012. The Gender Identity Act has established a radically new regime for legal gender recognition in Argentina, moving away from the previous, courtcentred system towards a process which prioritises the self-identification and self-perception of transgender individuals. This new departure is evident not only in the way persons can obtain legal recognition but also in the extended and simplified rights which transgender individuals now enjoy regarding appropriate health care. The far-reaching changes which have been enacted by the 2012 Act are evident in Article 2 of the 2012 Act, which defines ‘gender identity’ as ‘the internal and individual way in which gender is perceived by persons, that can correspond or not to the gender assigned at birth, including the personal experience of the body’ (emphasis added). Article 2 continues that a person's perception of their own gender ‘can involve modifying bodily appearance or functions through pharmacological, surgical or other means, provided it is freely chosen.’ Gender identity also includes ‘other expressions of gender such as dress, ways of speaking and gestures.’
Argentina's Constitutional Regime
The Gender Identity Act is a product of Argentina's constitutional environment, particularly the right to privacy set out in Article 19 of the National Constitution. Article 19 declares that ‘private personal’ acts, which offend neither public order nor morals and which do not harm third parties, fall within God's will and are not subject to review by judges. Under Article 19, a person cannot be compelled to engage in any act which is not prescribed by law nor can he be prevented from actions which are not proscribed by law. Article 75, subsection 22, incorporates a number of international treaties, conventions and charters into Argentina's constitutional regime. These international agreements, many of which have already recognised the protection of individuals on the basis of gender identity, include, inter alia, the International Covenant on Economic, Social and Cultural Rights, the International Covenant on Civil and Political Rights and the American Convention on Human Rights.
PURPOSE OF THE COMPARATIVE ANALYSIS AND RECOMMENDATIONS
When comparing and analysing the development of the legal status of transsexual and transgender persons, what is striking is how fraught with – at best – misapprehensions and misunderstandings and – at worst – social rejection and even hatred the debates have been and, in many jurisdictions, still are. Looking back, the history of recognition of the preferred gender of transsexual and transgender persons has been, and remains, a battle against discrimination, stigmatisation, social exclusion, anxiety, pain and suffering, violation of dignity and physical integrity, and sometimes even prosecution and persecution.
While the legal and social situation of transsexual and transgender persons has improved greatly in many jurisdictions, that certainly is not the case globally. As already said in the introduction, this book therefore aims to make a contribution to the ongoing scholarly and political debates concerning the legal status of transsexual and transgender persons, both inside and outside of potential legislative reform processes. It is also meant to function as a resource for judicial and administrative decisions. One purpose of this final chapter is to compare, categorise and, where possible, explain the legal developments in the jurisdictions covered in this book. This hopefully will enable readers to see where their home jurisdictions stand, and whether the positions taken there are tenable in the light of social developments, current medical and psychological research, and international human rights standards. The other purpose of this final chapter is to identify what the developing trends are. This should allow readers to not only see the stages of development and surrounding discussions – which are surprisingly similar in many, socially diverse jurisdictions – but perhaps also see why some of the points and concerns raised in the discussions are considered to lack sufficient basis in other jurisdictions. This, it is hoped, ideally (and perhaps somewhat over-optimistically) might lead to legislatures and courts avoiding what can be referred to as ‘repeating other people's mistakes’ – in the sense that certain development stages could be ‘leap-frogged’ and a better legal standard of recognition and protection for the persons concerned achieved at the outset. In order to achieve this, the chapter will make recommendations on the criteria for legal recognition of preferred gender which are based on the comparative analysis, as well as general policy and human rights considerations.
IN Hämäläinen v Finland (Application no. 37359/09), 16 July 2014, the Grand Chamber of the European Court of Human Rights held that Contracting States of the Council of Europe may require the dissolution of an existing marriage before extending the right to legal gender recognition.
Within a longitudinal study of 1,005 adolescents, we investigated how exposure to childhood psychosocial adversities was associated with the emergence of depressive symptoms between 14 and 17 years of age. The cohort was classified into four empirically determined adversity subtypes for two age periods in childhood (0–5 and 6–11 years). One subtype reflects normative/optimal family environments (n = 692, 69%), while the other three subtypes reflect differential suboptimal family environments (aberrant parenting: n = 71, 7%; discordant: n = 185, 18%; and hazardous: n = 57, 6%). Parent-rated child temperament at 14 years and adolescent self-reported recent negative life events in early and late adolescence were included in models implementing path analysis. There were gender-differentiated associations between childhood adversity subtypes and adolescent depressive symptoms. The discordant and hazardous subtypes were associated with elevated depressive symptoms in both genders but the aberrant parenting subtype only so in girls. Across adolescence the associations between early childhood adversity and depressive symptoms diminished for boys but remained for girls. Emotional temperament was also associated with depressive symptoms in both genders, while proximal negative life events related to depressive symptoms in girls only. There may be neurodevelopmental factors that emerge in adolescence that reduce depressogenic symptoms in boys but increase such formation in girls.
It is uncertain whether antipsychotic long-acting injection (LAI) medication in schizophrenia is associated with better clinical outcomes than oral preparations.
To examine the impact of prior treatment delivery route on treatment outcomes and whether any differences are moderated by adherence.
Analysis of data from two pragmatic 1-year clinical trials in which patients with schizophrenia were randomised to either an oral first-generation antipsychotic (FGA), or a non-clozapine second-generation antipsychotic (SGA, CUtLASS 1 study), or a non-clozapine SGA or clozapine (CUtLASS 2 study).
Across both trials, 43% (n = 155) of participants were prescribed an FGA-LAI before randomisation. At 1-year follow-up they showed less improvement in quality of life, symptoms and global functioning than those randomised from oral medication. This difference was confined to patients rated as less than consistently adherent pre-randomisation. The relatively poor improvement in the patients prescribed an LAI pre-randomisation was ameliorated if they had been randomised to clozapine rather than another SGA. There was no advantage to being randomly assigned from an LAI at baseline to a non-clozapine oral SGA rather than an oral FGA.
A switch at randomisation from an LAI to an oral antipsychotic was associated with poorer clinical and functional outcomes at 1-year follow-up compared with switching from one oral antipsychotic to another. This effect appears to be moderated by adherence, and may not extend to switching to clozapine. This has implications for clinical trial design: the drug from which a participant is randomised may have a greater effect than the drug to which they are randomised.
Aims: Problem or pathological gambling is associated with significant disruption to the individual, family and community with a range of adverse outcomes, including legal, financial and mental health impairment. It occurs more frequently in younger populations, and comorbid conditions are common. Cognitive–behaviour therapy (CBT) is the most empirically established class of treatments for problematic gambling. This article reports on a systematic review and evaluation of randomised clinical trials (RCTs) concerning two core techniques of CBT: cognitive and behavioural (exposure-based) therapies. Methods: PsycINFO, MEDLINE and the Cochrane library were searched from database inception to December 2012. The CONsolidated Standards Of Reporting Trials (CONSORT) for non-pharmacological treatments was used to evaluate each study. Results: The initial search identified 104 references. After two screening phases, seven RCTs evaluating either cognitive (n = 3), exposure (n = 3) or both (n = 1) interventions remained. The studies were published between 1983 and 2003 and conducted across Australia, Canada, and Spain. On average, approximately 31% of CONSORT items were rated as ‘absent’ for each study and more than 52% rated as ‘present with some limitations’. For all studies, 70.83% of items rated as ‘absent’ were in the methods section. Conclusions: The findings from this review of randomised clinical trials involving cognitive and exposure-based treatments for gambling disorders show that the current evidence base is limited. Trials with low risk of bias are needed to be reported before recommendations are given on their effectiveness and clinicians can appraise their potential utility with confidence.