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Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse.
This study aims to evaluate whether the Engager intervention improves mental health outcomes following release.
The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3–5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT).
In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI –1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact.
Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
Glass bangles are found in southern England and Wales from the mid-first century ad and become common in the north of England and southern Scotland in the late first century, before their numbers decline a century later. British bangles develop at a time of change, as Roman glassmaking practices were introduced across large areas of Britain, and as blown, transparent, colourless and naturally-coloured glassware became increasingly popular. In many communities, however, there was still a demand for strongly coloured opaque glass, including for bangles, and glassworkers devised ways of extending their supplies of opaque coloured glass. This study is based on over one hundred and fifty analyses of bangle fragments from sites in Wales, northern England and southern Scotland, spanning this transitional period. The bangle makers recycled coloured glass from imported vessels, and probably beads and bangle-making waste, to supplement supplies of fresh coloured glass. The novel methods used to modify and extend the coloured glass may derive from pre-Roman bead-making industries, and made use of widely available materials, including smithing hammerscale and possibly plant ashes. The results show the shifting balance of indigenous and Roman influences on different bangle types, depending on when and where they were made, and by whom.
Sexual orientation is considered from Savin-Williams’ continuum perspective, and gender and sexual orientation are both conceptualized from a fluid, rather than a categorical viewpoint. A Minority Stress Model is applied to the experience of LGBTQ+ communities, whereby stress reactions relate to concerns about one’s safety, discrimination, oppression, and internalized oppression, among many other negative mental and physical health outcomes. Proximal and distal stressors are presented in conjunction with the Minority Stress Model and applied to several domains illustrating community gaps and interventions in academic, legislative, religious, economic, medical, social, and social-environmental realms. Key policies are presented supporting greater rights for LGBTQ+ communities. Despite these advances, significant gaps remain with regard to responsiveness to the needs of LGBTQ+ communities. A case study highlights adverse effects and policy regarding conversion therapy.
This paper considers the use which both Celsus and Origen made of the Homeric poems and of the prior tradition of interpretative and grammatical exegesis of those poems. The paper sets the exploitation of Homer by Celsus and Origen against the background of the leading role which Homer played in the culture of the so-called Second Sophistic.
The purpose of this study was to determine if the mixed evidence of almond consumption on HbA1c stems from testing people with different body fat distributions (BFD) associated with different risks of glucose intolerance. A 6-month randomised controlled trial in 134 adults was conducted. Participants were randomly assigned to the almond (A) or control (C) group based on their BFD. Those in the almond group consumed 1·5 oz of almonds with their breakfast and as their afternoon snack daily. Those in the control group continued their habitual breakfast and afternoon snack routines. Body weight and composition were measured and blood samples were collected for determination of HbA1c, glycaemia and lipaemia at 0 and 6 months. Appetite ratings, energy intake and diet quality were collected at 0, 2, 4 and 6 months. Participants consuming almonds ingested 816 (sem 364) kJ/d more than participants in the control group (P = 0·03), but this did not result in any differences in body weight (A: –0·3 (sem 0·4), C: –0·4 (sem 0·4); P > 0·3). Participants in the almond, high android subcutaneous adipose tissue (SAT) group had a greater reduction in android fat mass percentage (A: –1·0 (sem 0·6), C: 1·1 (sem 0·6); P = 0·04), preserved android lean mass percentage (A: 0·9 (sem 0·6), C: –1 (sem 0·6); P = 0·04) and tended to decrease android visceral adipose tissue mass (A: –13 (sem 53) g, C: 127 (sem 53) g; P = 0·08) compared with those in the control, high SAT group. There were no differences in HbA1c between groups (A: 5·4 (sem 0·04), C: 5·5 (sem 0·04); P > 0·05). Thus, BFD may not explain the mixed evidence on almond consumption and HbA1c. Long-term almond consumption has limited ability to improve cardiometabolic health in those who are overweight and obese but otherwise healthy.
Chapter 20 of The Cambridge Companion to Sappho looks at Sappho’s significance for the rich poetic culture of the Hellenistic world, including Apollonius, Theocritus, and Posidippus, as a parallel development to the scholarly discourse surrounding the editing of her work during this period.
Dionysius of Halicarnassus was a rhetorician, critic and historiographer in Augustan Rome. This volume seeks to understand Dionysius as a writer positioned between Greece and Rome and between rhetoric and historiography. The introduction discusses the complex relationship between Dionysius’ history of early Rome and his rhetorical and critical works, and it presents Dionysius as both thoroughly Greek and very Roman. Dionysius’ works are interpreted as part of the Greek literature of the Augustan Age and as responding to the political, cultural and intellectual climate of Rome under Augustus. The following chapters are presented in three parts: (1) Dionysius and Augustan Rhetoric and Literary Criticism, (2) Dionysius and Augustan Historiography, and (3) Dionysius and Augustan Rome. The introduction concludes with a consideration of Dionysius’ intended audience.
This essay investigates the assumptions which underlie Dionysius’ critical practice through a close examination of some of the more programmatic passages of the On Thucydides. Dionysius is concerned to determine why classical authors made the choices they did and how such knowledge can be instructive in Dionysius’ own day. In this investigation, Dionysius typically retrojects back on to the subjects of his essays his own sense of what is morally and stylistically appropriate; some of Thucydides’ faults lie in the fact that he did not share Dionysius' own classicising view of the achievements of classical Athens. The essay also discusses Dionysius’ defence against the charge that the best critics must themselves also be able to compose great works in the genres in which they claim expertise.