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Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.
Methods
In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.
Results
The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.
Conclusions
Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.
Acknowledging that August Wilson has often claimed Eugene O’Neill as one of the primary influences for his dramatic art, this chapter consider how his King Hedley II might be read to deconstruct O’Neill’s The Emperor Jones and reconstruct, in contrast, a world in which Wilson’s protagonist develops a functional spiritual center lacking in O’Neill’s, thereby redeeming, through an African American lens, the problematic racial work of the ostensibly progressive O’Neill.
Japan is now embarking on a historic and potentially dangerous journey into space, urged on by the U.S., which seeks a more heavily armed and militarily active partner in the Asia- Pacific.
Space technology is being developed for two primary reasons. One is to give nations the ability to better coordinate warfare on Earth. The second is that many nations and corporations view space as the “new world.” Gold on asteroids, water and helium-3 on the moon, magnesium, cobalt, and uranium are believed to be on Mars. Corporations intend to venture to these planetary bodies and secure massive profits in the years ahead. But first new space technologies have to be created that make it possible, and cost effective, to “mine the skies.” [1]
Abstract: To what extent does immersion contribute to the emotional experience of fictional works? Could it be that emotions are essential ingredients to immersive experiences? How should we distinguish these two states of mind? Many scholars have modelled the viewer's experience of emotion after perception and have connected it with immersion, suggesting that fictional works are similar to illusions. Game studies have mostly turned to motivational theories of emotion and immersion, drawing attention to how both states require investment of the self. This chapter examines both the perceptual model and the motivational account with the intent of laying an appropriate groundwork for understanding the conceptual connection between emotion and immersion in the context of engaging with fictional works.
Keywords: emotion, investment, video game, fiction, fear, guilt
One common assumption about emotions is that they are indicative of a lack of perspective, whether they are caused by works of fiction or not. Emotions are said to denote biases and partiality, not critical distance and considerations. When we experience them, we see the world from a very specific angle, without being able to account for what may be relevant to our understanding of the situation. In art or media analysis classes, we have learned to set our emotions aside, so they do not interfere with the cold, calculating, and all-encompassing judgment that is privileged instead. This is also what expressions such as “love is blind” or “blind rage” suggests. The emotional person is not perceiving the world as it truly is. Hence, following this line of thought, emotions are sources of misguidance of which we should be wary.
This widespread assumption—notably in the history of Western philosophy— is also tied to another common idea about how emotions operate when consuming fictional works. Why do we care about characters and feel invested in their fate? One popular explanation is that we lose awareness, for a moment, of the fictional status of the represented events. It is as if we were there with the characters, thanks to a spell that makes fiction and reality blur together. We may call this spell “immersion” or “presence,” which is also indicative of a lack of perspective.
Les élections municipales de 2021 à la Ville de Québec ont été marquées par une forte compétition entre cinq candidats et une saillance des enjeux concernant la construction d'un tramway et d'un troisième lien autoroutier entre Québec et sa Rive-Sud. Ainsi, cette élection représente un contexte idéal pour étudier le comportement électoral au niveau local et plus spécifiquement le vote sur enjeu qui a été très peu étudié dans le contexte municipal. Nous soutenons que ces deux enjeux ont acquis une valeur symbolique et ont été exploités comme enjeu de brèche par le candidat à la mairie Jean-François Gosselin. À l'aide d'une analyse multivariée, nous testons la relation entre l'appui aux deux projets de transport et l'intention de vote. Nos résultats montrent que les attitudes des électeurs envers ces deux enjeux sont fortement corrélées avec leur choix de vote et suggèrent une continuité entre le comportement électoral municipal, provincial et fédéral, du moins lorsqu'il est question de vote sur les enjeux.
This review explores the benefits of incorporating personal experience(s) with non-ordinary states of consciousness as a core component of Psychedelic-Assisted Therapy (PaT) training.
The program incorporates an optional experiential training component. We collaborate with professionals affiliated with a Canadian non-profit organization specializing in PaT experiential training. As do other stakeholders in this field– including program developers, educators, and researchers–we navigate a rapidly evolving and often ambiguous landscape, where infrastructure and regulations are lagging scientific data and best practices. Given the potential for differing perspectives, the authors acknowledge that their personal experiences could be a potential source of bias, influencing objectivity.
Objectives
Conversely, these lived experiences could be seen as valuable contributions, enriching perspectives on the role of experiential training. In that context, our intention is to provide a comprehensive review, presenting arguments both in favour of and against the integration of experiential training in PaT.
Methods
There is an urgent need for establishing legal training and practice options, bridging the underground with best practices, with all practitioners operating within a regulated and ethically accountable framework. Such a proactive strategy would mitigate the risks associated with unregulated training in a field with relatively few guidelines on how to develop competency.
Results
An in-training PaT experience supports personal comfort, self-assuredness, and confidence supporting others in non-ordinary states of consciousness, with contemporary researchers/experts highlighting the specific challenges among therapists who lack lived experience. These might include holding unrealistic expectations, being unaware of the impacts of set and setting, and misunderstanding
Conclusions
Whether or not therapists engage in experiential training - serving a dual in one’s own healing process, it is imperative that they maintain their own wellness practices. This proactive/primary prevention strategy would improve well-being and resilience, reducing secondary mental health consequences for patients and providers. Cultivating a culture of self-care within the mental health field should be an overarching priority for training programs and professional organizations, without which we are left with broken people in support of broken people. Current rates of burnout, absenteeism and early retirement suggest that we are already on that trajectory and should serve as a call to action.
Notre recherche visait à mettre en lumière les pratiques bientraitantes des préposées aux bénéficiaires en milieux d’hébergement pour aînés au Québec. L’objet de l’article est de faire ressortir la dichotomie entre les définitions de la bientraitance et son opérationnalisation. Dans la première partie, la notion de bientraitance dans le cadre de deux politiques gouvernementales québécoises est présentée. Ensuite, il est question du travail des préposées aux bénéficiaires en tant que vectrices de cette bientraitance dans la pratique. La troisième partie présente les résultats de notre recherche qui viennent soulever trois constats remettant en cause l’applicabilité des politiques publiques en cette matière : l’absence de reconnaissance d’un métier par définition bientraitant; les injonctions normatives à l’encontre du sens attribué à la bientraitance, et les obstacles organisationnels et sociopolitiques à la bientraitance. Ces constats sont réexaminés à la lumière des écrits dans la discussion, laquelle ouvre sur la notion de maltraitance organisationnelle.
According to the Quebec law on health and social services, health technology assessment (HTA) is part of university hospital centers’ mission, together with training, research and care. However, unlike these other functions, HTA is not covered in current affiliation agreements that bind a university with academic health institutions. Université Laval and its affiliated health institutions set up a consultation committee whose mandate is to propose the terms of an agreement to specify collaboration regarding HTA between the university and its affiliated institutions. This study investigates perceptions and needs of stakeholders from Université Laval and its affiliated health institutions with respect to the HTA mission.
Methods
Semi-structured interviews were conducted with four types of participants, namely university faculty members, health professionals and managers from institutions with and without HTA units, as well as external partners. Interview guides were developed based on the integrated analysis framework of Greenhalgh et al., and adapted to each group of respondents. Most interviews were conducted in groups and were facilitated by a research associate and a senior investigator. Interviews were recorded and uploaded to NVivo 1.6.2 software for codification and analysis.
Results
A total of 57 people were interviewed (nine group interviews and 35 individual interviews). Three main themes emerged, namely knowledge of HTA, factors related to the relevance of the HTA function, and organizational factors. Results showed that half of the respondents have a vague knowledge of HTA or have never heard of it. Most of the respondents agreed that the HTA function fits well with the mission of a health institution. They would accept getting involved with HTA activities at different levels if all conditions are met. Nevertheless, almost half of respondents believed that others strategies than including HTA into contracts of affiliation should be explored to regulate this function. Finally, organizational obstacles such as the lack of funding, shortage of staff and the lack of well-structured collaborations were highlighted by respondents.
Conclusions
Despite recognition of the importance of the HTA function in university health centers, interventions will be required at different levels to support the development of local HTA capacity. In particular, popularization of the HTA function and collaboration networks through specific projects should be developed.
In October 2022, Netflix's remake of All Quiet on the Western Front (Im Westen nichts Neues) opened to great acclaim in the United States, Great Britain, and other countries, receiving rave reviews from critics and movie-goers alike, eventually winning seven BAFTAs and four Oscars, the most awards ever for a German-language production. In Germany, however, reactions could not have been more different. The film was roundly panned by historians as “flawed, cliché-laden, and unauthentic [all translations from German by Michael Geheran],” and derided by critics as Oscar bait, an anti-American trope often used to disparage a cultural production. In what has now become something of a punchline, the Süddeutsche Zeitung quipped that “No book is so good you can't make a bad film out of it,” while the Frankfurter Allgemeine Zeitung charged that the producers were “horny for an Oscar,” having removed “the inner plot, the brains of the story” and “replaced them with a Hollywood program.” How to make sense of such dramatically different reactions to the same film? Germans’ responses cannot simply be explained by the historical liberties taken by the director, Edward Berger, or disappointment with the plot differences between the movie and Erich Maria Remarque's novel, but arguably reveal deeper anxieties as the long shadow of Germany's past continues to weigh heavily on German minds. Does the film pander to popular images about war in a way that has different meaning in Germany than, say, in the US or the UK, with their different memory cultures? How much is German dislike of the film shaped by the legacy of the Second World War and not just the First? With these questions in mind, this essay will consider German reactions to the 2022 film and what they say about Germany's memory culture, paying close attention to the film's language, connotations, and imagery that may be particularly meaningful to German audiences. To be sure, film reviews are not the most reliable source for getting at popular attitudes and mentalities, but the stark divergence of opinion about Netflix's All Quiet say something important about how and whether memories of militarism and the Holocaust continue to shape how Germans think about war.
We explored ecological aspects of the early establishment of the association between the Japanese beetle, Popillia japonica (Newman) (Coleoptera: Scarabaeidae), and the adult tachinid parasitoid, Istocheta aldrichi (Mesnil) (Diptera: Tachinidae), in the province of Québec, Canada. The Japanese beetle started its invasion in the late 1930s, whereas I. aldrichi was detected only in 2009. It is assumed that I. aldrichi spread in the province from its introduced range in the northeastern United States of America. Throughout the summer, we used baited traps in eight localities of southern Québec (2018–2019) and in 13 raspberry (Rubus idaeus) fields (2022) localised along a latitudinal gradient to describe the distribution and seasonal occurrence of both species and the parasitism rates of I. aldrichi. We also mapped observational data from the online platform iNaturalist to further describe the current distribution of both the host and its parasitoid. Results indicate that I. aldrichi is well spread in southern Québec and along the St. Lawrence River in most areas where the Japanese beetle is present. Parasitism mostly occurs from late June to mid-July, before the peak of Japanese beetle populations, and levels of total seasonal parasitism range from 3.9 to 27.3% across sampled sites. Together, trap captures and data from iNaturalist provide evidence that I. aldrichi is now established in most areas of the province of Québec where the Japanese beetle is present.
An individual’s birthweight, a marker of in utero exposures, was recently associated with certain psychiatric conditions. However, studies investigating the relationship between an individual’s preterm birth status and/or birthweight and risk for depression during adulthood are sparse; we used data from the Women’s Health Initiative (WHI) to investigate these potential associations. At study entry, 86,925 postmenopausal women reported their birthweight by category (<6 lbs., 6–7 lbs. 15 oz., 8–9 lbs. 15 oz., or ≥10 lbs.) and their preterm birth status (full-term or ≥4 weeks premature). Women also completed the Burnham screen for depression and were asked to self-report if: (a) they had ever been diagnosed with depression, or (b) if they were taking antidepressant medications. Linear and logistic regression models were used to estimate unadjusted and adjusted effect estimates. Compared to those born weighing between 6 and 7 lbs. 15 oz., individuals born weighing <6 lbs. (βadj = 0.007, P < 0.0001) and ≥10 lbs. (βadj = 0.006, P = 0.02) had significantly higher Burnam scores. Individuals born weighing <6 lbs. were also more likely to have depression (adjOR 1.21, 95% CI 1.11–1.31). Individuals born preterm were also more likely to have depression (adjOR 1.18, 95% CI 1.02–1.35); while attenuated, this association remained in analyses limited to only those reportedly born weighing <6 lbs. Our research supports the role of early life exposures on health risks across the life course. Individuals born at low or high birthweights and those born preterm may benefit from early evaluation and long-term follow-up for the prevention and treatment of mental health outcomes.
La retraite au Canada a fait l’objet de plusieurs recherches, mais peu d’études ont comparé le passage de la vie active à la retraite des natifs et des immigrants ainsi que leurs caractéristiques une fois à la retraite, une lacune importante compte tenu de l’augmentation de la part des immigrants parmi les futures cohortes canadiennes de retraités. Cette étude descriptive vise à pallier cette lacune à l’aide des données de l’Enquête sociale générale de 2016. Les résultats montrent, entre autres, que les femmes et les hommes natifs ont plus de chances de prendre leur retraite que les immigrants, quel que soit le groupe d’âge étudié, et que l’âge moyen à la retraite des femmes et hommes immigrants est de deux ans supérieur à celui des natifs. Cette étude suggère que le statut d’immigrant implique une transition vers la retraite différente de celle vécue par les natifs ; différence qui devrait être considérée dans la structure du système de revenus de retraite.
Background: The Neuromuscular Disease Network for Canada (NMD4C) aims to improve the care of Canadians with neuromuscular diseases. It has identified a need to support clinicians in implementing clinical guidelines with the use of checklists for initial evaluation and clinical follow-ups. The objective of the study was to develop a pragmatic management checklist to support clinical guidelines for diagnosis and follow-up of myotonic dystrophy type 1 (DM1). Methods: A practice-based DM1 checklist will be reviewed by a panel of 35 experts using an online survey. The survey has been drafted using the Appraisal of Guidelines Research and Evaluation tool for assessing Recommendation Excellence (AGREE-REX). The experts will rate: (1) the quality of each checklist recommendation, and (2) the applicability of each recommendation based on their clinical setting. Scores will be compiled and discussed among experts to achieve consensus. Results: The compiled checklist items were organized into three sections: (1) initial evaluation, (2) follow-up visit and (3) general treatment recommendations. Feedback from experts across Canada, results on feasibility, and a finalized checklist will be presented. Conclusions: The development of a feasible treatment checklist is a useful KT tool that DM1 experts across Canada could apply in their own clinical settings.
Parents of children with CHD face several barriers when trying to access the services needed to support their child’s development. In fact, current developmental follow-up practices may not identify developmental challenges in a timely manner and important opportunities for interventions may be lost. This study aimed to explore the perspectives of parents of children and adolescents with CHD with respect to developmental follow-up in Canada.
Methods:
Interpretive description was used as a methodological approach for this qualitative study. Parents of children aged 5–15 years with complex CHD were eligible. Semi-structured interviews that aimed to explore their perspectives regarding their child’s developmental follow-up were conducted.
Results:
Fifteen parents of children with CHD were recruited for this study. They expressed that the lack of systematic and responsive developmental follow-up services and limited access to resources to support their child’s development placed an undue burden on their families, and as a result, they needed to assume new roles as case managers or advocates to address these limitations. This additional burden resulted in a high level of parental stress, which, in turn, affected the parent–child relationship and siblings.
Conclusions:
The limitations of the current Canadian developmental follow-up practices put undue pressure on the parents of children with complex CHD. The parents stressed the importance of implementing a universal and systematic approach to developmental follow-up to allow for the timely identification of challenges, enabling the initiation of interventions and supports and promoting more positive parent–child relationships.
Sequential thermal analysis allows for deconvoluting the refractory nature and complexity of carbon mixtures embedded in mineral matrices for subsequent offline stable carbon and radiocarbon (14C) isotope analyses. Originally developed to separate Holocene from more ancient sedimentary organic matter to improve dating of marine sediments, the Ramped Pyrolysis and Oxidation (RPO) apparatus, or informally, the “dirt burner” is now used to address pressing questions in the broad field of biogeochemistry. The growing interest in the community now necessitates improved handling and procedures for routine analyses of difficult sample types. Here we report on advances in CO2 purification during sample processing, modifications to the instrumentation at the National Ocean Sciences Accelerator Mass Spectrometry (NOSAMS) facility, and introduce sodium bicarbonate procedural standards with differing natural abundance 14C signatures for blank assessment. Measurements from different environmental samples are used to compare the procedure to the different generations of sequential thermal analyses. With this study, we aim to improve the standardization of the procedures and prepare this instrumentation for innovations in online stable carbon isotopes and direct AMS-interface measurements in the future.
The objective was to characterize the progression of sleep complaints in 115 dystrophy type 1 (DM1) patients who filled out a sleep questionnaire twice at a 9-year interval. Daytime napping (22.1% vs. 34.5%, p < 0.05), early awakenings (11.4% vs 21.1%, p < 0.05), nonrestorative sleep (39.5% vs 51.8%, p < 0.05), stimulant use (7.0% vs 19.3%, p < 0.01), breathing cessation (10.7% vs 23.2%, p < 0.01), and nighttime urination (42.5% vs 54.9%, p < 0.05) increased between Time 1 and Time 2. Sleep-related complaints are prominent and augment rapidly in DM1 patients. Physicians need to better identify and treat them to help alleviate the burden they impose on patients and their caregivers.
‘I feel like a monster’, typed Chelsea Manning, referring partly to her gender identity but mostly to her job in the US military. Morally conflicted by what she saw and read while serving in Iraq, extremely isolated from her unit and experiencing emotional distress in relation to her gender identity, Manning would act on these stressors by leaking hundreds of documents to Wikileaks, and coming out as a (trans) woman. While she was quick to be classified as either a hero or a traitor, her case evades such dichotomisation and calls for more sophisticated readings. While a lot has been written on Manning in queer and transgender studies, surprisingly little has been published on this case in International Relations, not even in the quickly growing field of Queer IR. Yet Manning’s case helps highlight many of its core concerns in relation to issues of power, security, and sovereignty. In fact, what is often lost when reading the Manning case are the queer and trans logics of protection that were disrupted by Manning’s disclosures and that made such disruption possible. These dominant logics rely upon a culture of secrecy that must be preserved for performances of national security to hold true.
We evaluated the added value of infection control-guided, on demand, and locally performed severe acute respiratory coronavirus virus 2 (SARS-CoV-2) genomic sequencing to support outbreak investigation and control in acute-care settings.
Design and setting:
This 18-month prospective molecular epidemiology study was conducted at a tertiary-care hospital in Montreal, Canada. When nosocomial transmission was suspected by local infection control, viral genomic sequencing was performed locally for all putative outbreak cases. Molecular and conventional epidemiology data were correlated on a just-in-time basis to improve understanding of coronavirus disease 2019 (COVID-19) transmission and reinforce or adapt control measures.
Results:
Between April 2020 and October 2021, 6 outbreaks including 59 nosocomial infections (per the epidemiological definition) were investigated. Genomic data supported 7 distinct transmission clusters involving 6 patients and 26 healthcare workers. We identified multiple distinct modes of transmission, which led to reinforcement and adaptation of infection control measures. Molecular epidemiology data also refuted (n = 14) suspected transmission events in favor of community acquired but institutionally clustered cases.
Conclusion:
SARS-CoV-2 genomic sequencing can refute or strengthen transmission hypotheses from conventional nosocomial epidemiological investigations, and guide implementation of setting-specific control strategies. Our study represents a template for prospective, on site, outbreak-focused SARS-CoV-2 sequencing. This approach may become increasingly relevant in a COVID-19 endemic state where systematic sequencing within centralized surveillance programs is not available.
You are covering an obstetrics clinic for your colleague who left for vacation. A 30-year-old G2P1 at 37+2 weeks’ gestation by first-trimester sonogram presents for a prenatal visit. Screening tests revealed a male fetus with a low risk of aneuploidy and a normal second-trimester morphology sonogram. Maternal investigations were unremarkable in the first trimester. Your colleague’s note from a second-trimester prenatal visit details the counseling provided with regard to prior shoulder dystocia; a recent note indicates the intent to review management during this visit.