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Background: Non-pharmacological interventions that promote self-management are crucial for individuals with mild cognitive impairment (MCI.) Mindfulness training has shown promise but is often not tailored to MCI. Methods: In 2021, the Neil and Susan Manning Cognitive Health Initiative (CHI) - a collaboration between the Vancouver Island Health Authority, Universities of BC and Victoria, and the Victoria Hospitals Foundation - partnered with the BC Association for Living Mindfully (BCALM) to develop a specialized mindfulness program for MCI, based on Mindfulness-Based Stress Reduction (MBSR). This multi-phase initiative aimed to enhance self-management, address the lack of outpatient services for MCI in Victoria, and contribute to the evidence base for mindfulness interventions. Results: Phase 1 assessed the BCALM program’s suitability for MCI; feedback included suggestions to simplify content and meditations. Phase 2 piloted an adapted version, with an 8-week program consisting of weekly sessions. Participants, recruited from the Seniors Outpatient Clinic in Victoria, completed pre- and post-program surveys; results showed over 90% of participants reported improved memory and coping, and 80% managed memory-related challenges better. Conclusions: Now in Phase 3, the MCI program is being transitioned into regular BCALM curriculum, with plans for a clinical trial comparing it to traditional psychoeducational approaches.
Treatment guidelines recommend evidence-based psychological therapies for adults with intellectual disabilities with co-occurring anxiety or depression. No previous research has explored the effectiveness of these therapies in mainstream psychological therapy settings or outside specialist settings.
Aims
To evaluate the effectiveness of psychological therapies delivered in routine primary care settings for people with intellectual disability who are experiencing co-occurring depression or anxiety.
Method
This study used linked electronic healthcare records of 2 048 542 adults who received a course of NHS Talking Therapies for anxiety and depression in England between 2012 and 2019 to build a retrospective, observational cohort of individuals with intellectual disability, matched 1:2 with individuals without intellectual disability. Logistic regressions were used to compare metrics of symptom improvement and deterioration used in the national programme, on the basis of depression and anxiety measures collected before and at the last attended therapy session.
Results
The study included 6870 adults with intellectual disability and 2 041 672 adults without intellectual disability. In unadjusted analyses, symptoms improved on average for people with intellectual disability after a course of therapy, but these individuals experienced poorer outcomes compared with those without intellectual disability (reliable improvement 60.2% for people with intellectual disability v. 69.2% for people without intellectual disability, odds ratio 0.66, 95% CI 0.63–0.70; reliable deterioration 10.3% for people with intellectual disability v. 5.7% for those without intellectual disability, odds ratio 1.89, 95% CI 1.75–2.04). After propensity score matching, some differences were attenuated (reliable improvement, adjusted odds ratio 0.97, 95% CI 1.91–1.04), but some outcomes remained poorer for people with intellectual disability (reliable deterioration, adjusted odds ratio 1.28, 95% CI 1.16–1.42).
Conclusions
Evidence-based psychological therapies may be effective for adults with intellectual disability, but their outcomes may be similar to (for improvement and recovery) or poorer than (for deterioration) those for adults without intellectual disability. Future work should investigate the impact of adaptations of therapies for those with intellectual disability to make such interventions more effective and accessible for this population.
Childhood maltreatment (CM) is a risk factor for mental and physical health problems in adulthood, potentially mediated by long-term autonomic nervous system (ANS) dysregulation. To explore this link, the association between CM and vagal-sensitive heart rate variability (HRV) metrics in adults was examined, accounting for biopsychosocial factors.
Methods
Data from 4,420 participants in the Study of Health in Pomerania were analyzed, with CM assessed using the Childhood Trauma Questionnaire. HRV was derived from 10-second electrocardiograms and 5-minute pre-sleep polysomnographic recordings. Post hoc analyses examined abuse and neglect.
Results
CM was associated with reduced HRV (logRMSSD: β = −0.20 [95%-CI: −0.28, −0.12], p = 1.2e−06), driven by neglect (β = −0.27 [−0.35, −0.18], p = 1.9e−09) rather than abuse (β = 0.01 [−0.12, 0.14], p = 1). Adjustments for age, sex, and medication attenuated these effects, which remained robust after additionally controlling for socioeconomic, lifestyle, body mass index, and depressive symptoms (fully adjusted model: CM β = −0.08 [−0.15, −0.001], p = .047; neglect β = −0.11 [−0.19, −0.03], p = .009; abuse β = −0.08 [−0.20, −0.04], p = .174). Age-related differences were found, with reduced HRV in both young and older participants but not in middle-aged participants (fully adjusted: F(2,743) = 6.75, p = .001).
Conclusions
This study highlights long-term ANS dysregulation following CM, particularly neglect, indicated by altered vagal-sensitive HRV metrics. Although small in magnitude, the effect on the ANS was independent of adult biopsychosocial factors. This long-term dysregulation may contribute to an increased risk of adverse health outcomes in adulthood.
In the 1970s, deindustrialization and urban decay forced national, state, and local policymakers to focus more intensely on public-private partnerships as mechanisms of economic regeneration. This approach to postindustrial regeneration intersected with a rising generation of liberal politicians: labeled variously “Atari Democrats,” “neoliberals,” or “New Democrats,” they sought to orient the Democratic Party towards market-friendly politics. This intersection was evinced in the regeneration of Lowell, Massachusetts, a city dealing with decades-long industrial decline. Contrary to narratives that emphasize public-private partnerships only as instruments of privatization, however, Lowell’s experience exemplified how successful regeneration required an expanded role for the state: this article reinserts the “public” into “public-private partnership.” Excavating this reality in Lowell’s heretofore understudied history also demonstrates that New Liberals’ market-friendly political posture obscured deeper policy continuity with twentieth-century liberalism. Far from emerging locked into an ideological embrace of “neoliberalism,” the New Liberals sought to reimagine liberalism’s commitment to developmentalism.
What legal rules govern how artists live and create artworks and sell those works to collectors and others? This chapter first addresses how artists live and work. It then turns to legal and ethical issues of the primary market for artists’ works, including: how artists sell their works, particularly through dealers; the legal rules that govern consignments, the predominant way artists sell works through dealers; the artist/dealer relationship (for example, what happens when the artist or dealer terminates the relationship, and who bears the loss when works not yet sold by the dealer are damaged or destroyed); statutory protection for artists’ consignments; and the commissioning of an artist to create a work of art.
For centuries, art has been one of the spoils of war, often taken by the victor--and often destroyed in combat. What rules govern how art is treated in and after times of armed conflict? This chapter considers practical and ethical challenges of protecting art and antiquities in times of war and how attitudes toward protection of cultural property have evolved, leading to the Hague Convention of 1954; how art has been treated as part of war reparations; legal and ethical issues applicable to the recovery of art in the aftermath of World War II, particularly in light of the Holocaust and the Third Reich’s historically unprecedented, large-scale dispossession of art; and international efforts to coordinate the return of art wrongfully taken in the years prior to and during World War II
This chapter considers legal and ethical issues affecting art museums. These issues include considering the legal and working definitions of a museum and how museums are legally organized in the United States; the tax status of museums; legal and ethical standards of museum governance,; the rules, practices, and ethical considerations pertaining to museums’ management of their collections; museums acquisitions and deaccessions of collections items; managing donor-imposed restrictions on gifts to museums; legal issues related to museum loans and exhibitions; and how museums address issues concerning access to their collections.
This chapter focuses on the legal and ethical rules applicable to the international trade in antiquities and other forms of cultural property. Over centuries, many countries have been primarily the source of antiquities; others have been primarily collectors of those antiquities . What rules govern the movement of antiquities and determine whether they should be returned to their country of origin? How does the United States deal with antiquities that are imported illegally or imported after being stolen or illicitly exported from other countries? This chapter also considers how museums can ethically collect antiquities and when antiquities can or should be returned to their country or place of origin.
This chapter examines issues concerning the secondary market for visual art--when artworks are resold after their initial sale by the artists. After considering the tension between art as creative expression and art as a commodity, bought and sold for profit, the chapter looks at how art dealers work with collectors; issues that can arise when works of art are entrusted to dealers; conflicts of interest that may arise for dealers; potential issues with appraisals of artworks in connection with resale; the legal rules governing art auctions; and some of the legal and ethical issues that can arise when art auctions go awry, such as the discovery after the auction that a work of art is not authentic.
Chapter 1 introduces the reader to the wide range of issues at the intersection of law, ethics, and the world of visual arts. The chapter then considers two threshold legal and philosophical issues that repeatedly arise throughout the book: how can and should the law define what is art and who is an artist?
Works of art, in addition to being treated at law as tangible personal property, also contain creative expression generally treated as intellectual property. This chapter considers the rules governing art as intellectual property. The chapter first presents copyright law as applied to visual art and how copyright infringement is established and defenses to infringement actions, including the fair use defense, especially as it applies to appropriation art and art that parodies other works. It then addresses how trademark law and the right of publicity (the right of individuals to control the use of their name, image, or likeness for commercial purposes) impact visual art. The chapter next examines resale royalties for art--where artists receive some portion of the price when their works resell in the secondary market--and the limited application of resale royalties in the U.S. Finally, the chapter explains artists’ moral rights,which allow artists to prevent the alteration or destruction of their works after they are sold and to control the use of their name in association with an artwork they did not create or that they created but that has been altered.