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The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.
Methods
We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.
Results
Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.
Conclusions
Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.
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.
This chapter takes the example of the International Criminal Court’s ‘Independent Expert Review’ (IER) of 2020 to reflect on the theory and practice of expert reform work. Taking actor-network theory’s prompt that systems – like international organisations – are neither static nor fixed, but ‘in a perpetual state of forming and reforming’, I read reform neither as rational science nor as a mere reproduction of hegemony, but as the expert reassembly of the ICC’s context, problems, resources, and priorities. In the IER example, the expert work of reform and reassembly effected nothing less than the recalibration of the relationship between the Court and its states parties. Through their work, experts knit together ideas of autonomy and accountability, their training, investigatory processes, documents, and resource and time constraints to centre the efficiency concerns of wealthy states parties in the judicial and prosecutorial function. In this way, expert reform work illustrates the power of expert articulation by putting abstract expectations, ideas, ‘realities’, constraints, and materials into organisational action in deeply distributive ways.
There has been limited consideration of the training and support needs of therapists from minoritised ethnic backgrounds. This study quantitatively evaluates a novel application of self-practice/self-reflection (SP/SR) to CBT therapists from minoritised ethnic backgrounds. The study aimed to explore the impact of the SP/SR programme on (1) therapists’ skills in working with ethnicity in their clinical practice; (2) their ethnic identity development; and (3) their perceived levels of personal and professional wellbeing, during the intervention and at follow-up. A multiple baseline single case experimental design was adopted. Measures were developed and adapted for this evaluation and weekly outcomes relating to therapist skill development, ethnic identity development, and personal and professional wellbeing were collected. The outcomes of six participants were analysed using visual and statistical analysis. The results indicated that the SP/SR programme significantly improved therapist skills in identifying and addressing similarities and differences in ethnicity within therapy during the intervention. Improvements were also seen across other skills, ethnic identity developmental and wellbeing outcomes between the baseline and SP/SR phases, with some participants showing significant improvements. Outcomes from the follow-up phase presented a more mixed picture. Therefore, the findings give some support for the SP/SR programme in developing therapist skills in working with ethnicity, as well as highlighting differential outcomes for participants related to their levels of experience and engagement. The findings may have possible implications for the personal and professional development of ethnically minoritised therapists, as well as future quantitative SP/SR research.
Key learning aims
(1) To provide an overview of self-practice/self-reflection (SP/SR) and its theoretical underpinnings.
(2) To summarise the current issues around the development of cultural competence, particularly for therapists from minoritised ethnic backgrounds.
(3) To introduce and describe a novel SP/SR programme for CBT therapists from minoritised ethnic backgrounds.
(4) To highlight the importance of considering ethnicity within clinical practice, both in terms of the provision of culturally competent therapy as well as to support the personal and professional development of therapists from minoritised ethnic backgrounds.
In situ elemental imaging of planetary surface regolith at a spatial resolution of 100s to 1000s of microns can provide evidence of the provenance of rocks or sediments and their habitability, and can identify post-depositional diagenetic alteration affecting preservation. We use high-resolution elemental maps and XRF spectra from MapX, a flight prototype in situ X-ray imaging instrument, to demonstrate this technology in rock types relevant to astrobiology. Examples are given for various petrologies and depositional/diagenetic environments, including ultramafic/mafic rocks, serpentinites, hydrothermal carbonates, evaporites, stromatolitic cherts and diagenetic concretions.
Managerial justice continues apace with the recent Independent Expert Review of 2020. Yet such an exercise – managerial in its assumptions, diagnoses, and techniques – sounds a familiar tune once we observe the court’s managerial present and its macro, micro, and meso scales of managerial governance. This concluding chapter therefore asks how this institutional terrain, saturated with management thought and practices, might be navigated by those concerned about its relationship to global justice efforts. Rather than posing a series of policy prescriptions, this chapter instead suggests a professional posture or strategy of discomfort that experts and others might assume in resisting managerial justice. Drawing on Vergès’s strategy of rupture, Weber’s ethic of responsibility, and the decolonial movement, a strategy of discomfort resists the urge to look for solutions in either the complete removal or partial renovation of management. Rather, it proposes that experts admit to their politics, experience the force of such managerial politics as violence, and experience the responsibility of justice-seeking beyond efficiency savings and the strategic plan.
In 2019, ICC Pre-Trial Chamber II decided not to open an investigation into potential Taliban and US crimes in Afghanistan on the grounds that it would not be in the ‘interests of justice’. In arriving at this conclusion, the judges relied upon management concerns about organisational sustainability and the proposed use of resources to justify their position. While heavily criticised by scholars at the time, the judges’ reasoning alludes to the pervasiveness of management ideas and reasoning throughout the court, even in the realm of legal argumentation. This chapter takes the Afghanistan decision as the starting point for a discussion on management’s relationship to core argumentative dilemmas comprising the ICC legal field. Whether in framing case selection as a matter of court capacity or fashioning past obstacles to victim participation as ‘lessons learnt’, management ideas and practices enact a flight from the dilemmas and complexities of ICC-style justice by experts, deferring critique and sustaining the institutional project of global justice.
This chapter examines the context and consequences of the Registry ReVision project from the perspective of its management ideas and practices. While championed by Herman von Hebel, newly elected registrar of the court in 2013, ReVision was a long-term project of institutional transformation fostered and executed by external consultants, internal experts, judges, and staff members. While taking place in a wider context of court contention and dissent from certain quarters, ReVision told a uniquely managerial story about the court’s deficiencies and future organisational needs in ways that prioritised certain contexts, problems, and voices over others. And although its effect was to depoliticise the court, it simultaneously offered this effort as the extent and limit of the court’s own political ambitions. By surveying the actors, practices, and documentation of ReVision, this chapter offers an account of the reorganisation as a project of professional comfort.
Chapter 3 offers an account of management’s introduction to, proliferation within, and influence upon the International Criminal Court from its inception until its twentieth anniversary year. This is the first of three scales of management dealing with the macro level of large-scale organisational optimisation. Efficiency arguments featured at various points during the early drafting stage, and management concerns loomed large in Rome. The nascent management frameworks of audit and minor restructuring exercises soon paved the way for court-wide strategic planning and the austerity politics of the post-2008 Global Financial Crisis. Throughout the court’s brief lifespan, management practices such as strategic planning, auditing, and performance indicators have been invoked, deployed, and critiqued by court officials, judges, scholars, NGOs, and external consultants. That process has also witnessed the narrowing of global justice down to what is deemed institutionally palatable, rather than anything more ambitious.
Practitioners and scholars of the International Criminal Court are now bilingual: they speak the familiar language of anti-impunity, justice, and mass violence alongside the more unfamiliar but no less language of strategic planning, audit, appraisal, and optimisation. But how has it happened that such management language now finds a home in this primary institution of global justice? This introductory chapter begins to answer this question by introducing international (criminal) lawyers to management as an expert practice, before positioning the phenomenon within the wider dispositif of the International Criminal Court. The chapter further brings the study of management to international lawyers by offering four axioms of expertise that guide the book’s approach to both international law and management expertise. After briefly outlining the key arguments, the introduction provides an outline of the chapters and a note on the book’s stylistic choices.
Most ICC commentators are enthusiastic about the promise of management as a way to optimise the court’s performance. Yet few are as eager to historicise the practices they advocate. Chapter 2 seeks to read the court’s managerial present through its past deployments, journeys, and consequences for other institutional projects long predating the contemporary Rome Statute system. The chapter begins by tracing the uses of management in such institutions as the plantation, war, and the nineteenth-century factory before following them as they entered the practice of early international institutions. Beyond these spaces, a major part of management’s pre-history lies in its invocation at the United Nations after decolonisation. The chapter demonstrates that two of management’s key assumptions – regarding its lack of history and its claim to political neutrality – are only the ‘truth effects’ of protracted expert and political struggle within various institutional spaces. The most important of these for the ICC has been the United Nations, where management formed part of a counter-strategy against the democratisation efforts of newly decolonised states. Whilst purportedly neutral today, the management practices taken up at the ICC continue to bear the scars of these earlier political wins and losses.
The ICC expert, especially the court lawyer, combines their everyday international legal work with the managerial work of having their performance appraised, committing to the court’s core competencies, and assisting with audit exercises. Indeed, the very process of applying for and getting a job at the court is guided by management ideas and practices. Throughout their ‘career’, from the moment they begin to apply for an ICC vacancy until their departure from the court, the ICC expert is mediated by a range of human resource management techniques. This chapter traces that professional journey into, through, and up the court organisation and the consequences of such identity work for the professional imagination of the international criminal lawyer. By engaging with management’s principles, models, meetings, forms, and reports, the ICC expert makes court, and self-optimisation, a lodestar of global justice.