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Developing effective, sustainable strategies that promote social inclusion, reduce isolation, and support older adults’ wellbeing continues to be important to aging communities in Canada. One strategy that targets community-living older adults involves identifying naturally occurring retirement communities (NORCs) and supporting them through supportive service programs (NORC-SSPs). This qualitative descriptive study utilized semi-structured interviews to explore how older adults living in a NORC supported by an SSP, sought to build, and maintain, a sense of community during the COVID-19 pandemic. Analysis revealed how changes in context prompted changes in the program and community, and how despite lack of in-person opportunities participants continued to be together and do occupations together in creative ways that supported their sense of community. NORC-SSPs, like Oasis, play an important role in supporting older adults’ capacity to build strong, resilient communities that support wellbeing, during a global pandemic and in non-pandemic times.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
To evaluate postoperative outcomes among patients undergoing colon surgery who receive perioperative prophylaxis with ertapenem compared to other antibiotic regimens.
Design and setting:
Multicenter retrospective cohort study among adults undergoing colon surgery in seven hospitals across three health systems from 1/1/2010 to 9/1/2015.
Methods:
Generalized linear mixed logistic regression models were applied to assess differential odds of select outcomes among patients who received perioperative prophylaxis with ertapenem compared to other regimens. Postoperative outcomes of interest included surgical site infection (SSI), Clostridioides difficile infection (CDI) and clinical culture positivity for carbapenem-resistant Enterobacteraciae (CRE). Inverse probability weights were applied to account for differing covariate distributions across ertapenem and non-ertapenem groups.
Results:
A total of 2,109 patients were included for analysis. The odds of postoperative SSI was 1.56 times higher among individuals who received ertapenem than among those receiving other perioperative antimicrobial prophylaxis regimens in our cohort (46 [3.5%] vs 20 [2.5%]; IPW-weighted OR 1.56, [95% CI, 1.08–2.26], P = .02). No statistically significant differences in odds of postoperative CDI (24 [1.8%] vs 16 [2.0%]; IPW-weighted OR 1.07 [95% CI, .68–1.68], P = .78) were observed between patients who received ertapenem prophylaxis compared to other regimens. Clinical CRE culture positivity was rare in both groups (.2%–.5%) and did not differ statistically.
Conclusions:
Ertapenem use for perioperative prophylaxis was associated with increased odds of SSI among patients undergoing colon surgery in our study population, though no differences in CDI or clinical CRE culture positivity were identified. Further study and replication of these findings are needed.
Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people.
Aims
To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness.
Method
A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach.
Results
A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions.
Conclusion
Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.
Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.
During the COVID-19 pandemic, mental health problems increased as access to mental health services reduced. Recovery colleges are recovery-focused adult education initiatives delivered by people with professional and lived mental health expertise. Designed to be collaborative and inclusive, they were uniquely positioned to support people experiencing mental health problems during the pandemic. There is limited research exploring the lasting impacts of the pandemic on recovery college operation and delivery to students.
Aims
To ascertain how the COVID-19 pandemic changed recovery college operation in England.
Method
We coproduced a qualitative interview study of recovery college managers across the UK. Academics and co-researchers with lived mental health experience collaborated on conducting interviews and analysing data, using a collaborative thematic framework analysis.
Results
Thirty-one managers participated. Five themes were identified: complex organisational relationships, changed ways of working, navigating the rapid transition to digital delivery, responding to isolation and changes to accessibility. Two key pandemic-related changes to recovery college operation were highlighted: their use as accessible services that relieve pressure on mental health services through hybrid face-to-face and digital course delivery, and the development of digitally delivered courses for individuals with mental health needs.
Conclusions
The pandemic either led to or accelerated developments in recovery college operation, leading to a positioning of recovery colleges as a preventative service with wider accessibility to people with mental health problems, people under the care of forensic mental health services and mental healthcare staff. These benefits are strengthened by relationships with partner organisations and autonomy from statutory healthcare infrastructures.
William of Palerne, otherwise known more engagingly as William and the Werewolf, survives in Middle English in only one manuscript, but it was much more widely known than that would suggest. The romance was originally composed in continental French in the late twelfth or early thirteenth century, for a ‘countess Yolande’, probably a countess of Hainault who died c. 1212. The mid-fourteenth-century Middle English translation – and despite its chosen form of alliterative rather than rhymed verse, it frequently comes closer to being a translation than the kind of free adaptation made of many French or Anglo-Norman romances into English – was composed, as the translator (himself called William) tells us, for a grandson of Edward I, Humphrey de Bohun, sixth earl of Hereford, who died in 1361. Both these versions, the French and the English, were printed in prose renderings in the sixteenth century. The French prose, based on the original Guillaume, was produced some time before 1535, and went through a number of editions into the seventeenth century. It was preceded by the English prose, printed around 1515 by Wynkyn de Worde complete with woodcuts. This survives in the form of only two leaves from near the end of the story, though that is sufficient to demonstrate that, exceptionally among prose romances, it was based on the Middle English poem, not on any French version. Those leaves are also enough to show that it was the immediate source of the Irish Eachtra Uilliam, ‘the deeds of William’ (or, as one might put it in a more medieval formulation, the Gesta Guilielmi). It was composed probably towards the end of the sixteenth century for the high-ranking Anglo-Irish Dillon family of county Mayo. This version too is predominantly in prose but, like many Irish romances, it also contains a number of inset lais such as are recurrently found in other Irish romances, but apparently never elsewhere in one translated from another language. All of these, except for the French prose, survive in only a single copy. The rest of this chapter will focus primarily on three of those various texts, the octosyllabic French, the alliterative English, and the prose with interspersed verse of the Irish; but, taken together with the printed prose versions, they indicate how attractive the story was found across a range of cultures, languages, and prosodic forms into the early modern period.
The preceding pages give a fine summary of the impact that Elizabeth has had on the world. She has a reputation for being more of a fox than a hedgehog, skilled across many things, in a way that delights everyone who reads her work or knows her. Medievalists across the globe know her as a scholar and critic, and a first point of recourse for anyone interested in such multilingual topics as Arthurian studies, romance, incest, the long history of the story of Apollonius of Tyre, and macaronic poetry; but her publications in all those fields demonstrate a hedgehog’s powers of focus. To her longest-standing Northumberland neighbours, she is the owner of a castle, or at least the traceable remains of one. To her world-wide friends and colleagues, only a handful of whom it was possible to represent in this volume, she is not only a multitasker of formidable ability but also a loyal, supportive and generous associate. To her students and university colleagues outside her own field, she is a shrewd and efficient administrator, not least in the post from which she is just now retiring, as principal of one of the student communities of the University of Durham, St Cuthbert’s Society. Cuth’s has all the qualities associated with being a college of the University, but it is something more than that. Its central focus is firmly academic, but it also includes people whose own qualities and abilities can enhance the community in other ways – a capacity for generous inclusiveness that again suits Elizabeth’s qualities as fox. Those lucky enough to have been at Cuth’s during her tenure will know how she has enhanced its sense of its own unique identity in unusual and imaginative ways (blindfold dinners, anyone?), and how she has strengthened their sense of belonging. Her appointment as Honorary Colonel of the Northumbrian University Officers’ Training Corps (making her ‘the last line of defence in any national emergency’, as a friend described it) is also just right for her.
This volume of tributes to Elizabeth’s work properly focuses on the illumination her research has brought to the field of medieval studies, and not least to what she herself has described as ‘literary archaeology’.
Sometime around 530, two boats, both at the mercy of the seas and without human control, were voyaging around the North Atlantic and North Sea. One carried St Brendan and his companions, on their quest for the Land of Promise but passing from Ireland towards the Faroes on the way. Their boat was equipped with oars and a sail, but every so often, at Brendan’s urging, they set them aside and let God take them wherever He willed. The other boat contained a single woman, Constance, Chaucer’s Custance, the daughter of a Roman emperor named Constantine, who had been set adrift from Asia Minor and would finally come ashore in Northumberland; later, she would reverse the voyage to return to Rome, this time accompanied by her baby son Maurice, who would in due course become emperor himself. Without any means of steering, she was entirely in God’s hands, and was reliant on miracle alone to preserve her. The two stories invite combining in a meeting far out on the high seas: what might the saint have thought of the lone woman, or she of the small community of monks who formed Brendan’s crew? Might they have exchanged words, or prayers, or food and water, or their stories? And how might the stories themselves engage with each other?
It did not, of course, happen, and not just because Brendan actually existed, and Constance, in so far as she did exist, had a very different biography from the one the story records; nor because a voyage to the Faroes would pass well north of any destination in Northumberland – though that is more likely than that a boat set adrift in the eastern Mediterranean would reach the North Sea. Brendan was markedly long-lived (484–577); the consensus is that he did indeed undertake a voyage into the North Atlantic, perhaps between 512 and 530, and conceivably reaching North America. St Brendan’s Isle, the ‘Isle of the Blest’, a step before the Land of Promise, was regularly marked on early printed maps for some centuries; even if there was some doubt as to the accuracy of the account of his voyage, it was much safer for the purposes of navigation to mark an island that might not exist than omit one that did.
The Subglacial Antarctic Lakes Scientific Access (SALSA) Project accessed Mercer Subglacial Lake using environmentally clean hot-water drilling to examine interactions among ice, water, sediment, rock, microbes and carbon reservoirs within the lake water column and underlying sediments. A ~0.4 m diameter borehole was melted through 1087 m of ice and maintained over ~10 days, allowing observation of ice properties and collection of water and sediment with various tools. Over this period, SALSA collected: 60 L of lake water and 10 L of deep borehole water; microbes >0.2 μm in diameter from in situ filtration of ~100 L of lake water; 10 multicores 0.32–0.49 m long; 1.0 and 1.76 m long gravity cores; three conductivity–temperature–depth profiles of borehole and lake water; five discrete depth current meter measurements in the lake and images of ice, the lake water–ice interface and lake sediments. Temperature and conductivity data showed the hydrodynamic character of water mixing between the borehole and lake after entry. Models simulating melting of the ~6 m thick basal accreted ice layer imply that debris fall-out through the ~15 m water column to the lake sediments from borehole melting had little effect on the stratigraphy of surficial sediment cores.
Literary texts complicate our understanding of medieval emotions; they not only represent characters experiencing emotion and reaction emotionally to the behaviour of others within the text, but also evoke and play upon emotion in the audiences which heard these texts performed or read. The presentation and depiction of emotion in the single most prominent and influential story matter of the Middle Ages, the Arthurian legend, is the subject of this volume. Covering texts written in English, French, Dutch, German, Latin and Norwegian, the essays presented here explore notions of embodiment, the affective quality of the construction of mind, and the intermediary role of the voice as both an embodied and consciously articulating emotion.
Frank Brandsma teaches Comparative Literature (Middle Ages) at Utrecht University; Carolyne Larrington is a Fellow in medieval English at St John's College, Oxford; Corinne Saunders is Professor of Medieval Literature in the Department of English Studies and Co-Director of the Centre for Medical Humanities at the University of Durham.
Contributors: Anne Baden-Daintree, Frank Brandsma, Helen Cooper, Anatole Pierre Fuksas, Jane Gilbert, Carolyne Larrington, Andrew Lynch, Raluca Radulescu, Sif Rikhardsdottir, Corinne Saunders,
High quality evidence for test accuracy can be scarce. We assessed the test accuracy of two tests (Actim Partus and PartoSure) for the prediction of preterm birth. Twenty published full-text papers were included whilst conference abstracts were excluded. Since systematic reviews of diagnostic tests on other topics may need to rely on data from conference abstracts, we test whether the findings of our review would change with conference abstracts included.
Methods:
Conference citations previously excluded (n=108) were re-screened for inclusion using the following criteria: i) the diagnostic test was Actim Partus or PartoSure ii) test accuracy data of preterm delivery within seven days was reported iii) the population was women with signs/symptoms of preterm labor with intact membranes. Relevant test accuracy data were extracted and used to calculate sensitivity and specificity. Pooled sensitivity and specificity for each test were run using data from full-text papers and conference abstracts combined. These values were compared with the pooled sensitivities and specificities produced for the systematic review using full-text papers only.
Results:
Preliminary pooled sensitivities of the sixteen full-text Actim Partus studies and sixteen full-texts and two abstracts were 0.77 (95% confidence interval (CI) 0.68, 0.83) and 0.76 (95% CI 0.69, 0.83) respectively whilst pooled specificities were 0.81 (95% CI 0.76, 0.85).and 0.80 (95% CI 0.75, 0.84) respectively. Preliminary, pooled sensitivities of the four full-text PartoSure studies and four full-texts and three abstracts were 0.83 (95% CI 0.61, 0.94) and 0.82 (95% CI 0.65, 0.92), respectively, whilst pooled specificities were 0.95 (95% CI 0.89, 0.98) and 0.96 (95% CI 0.94, 0.97), respectively.
Conclusions:
Our findings suggest that the test accuracy results would not alter substantially with the inclusion of conference abstracts. However, work is ongoing to investigate how the assessment of heterogeneity and risk of bias across studies would alter given the difficulties associated with limited methodological reporting from conference abstracts.
Skelton's afterlife is rather more complicated than his critical reception alone. That reception has been well charted, in particular by A. S. G. Edwards in his volume in the Critical Heritage series: a volume that doubles as an anthology of criticism and also, in the Introduction, an allusion index (Edwards 1981). Skelton was a poet who divided opinion from within his own lifetime, and it was not until the twentieth century that his reputation decisively recovered from Pope's sneering dismissal of him as ‘beastly Skelton’ (Edwards 1981: No. 27, p. 75). That recovery, significantly, was led not by critics but by other poets, beginning cautiously in the eighteenth century (where this study ends) but bursting into dominance with the rise of modernism. The resurgence of interest in him in turn opened the way for the emphasis in more recent decades on historicism and textual scholarship, fields where fierce disagreement is less likely to thrive. That summary, however, leaves out two of the most striking characteristics of his afterlife. One is that the verse form he invented, skeltonics, was given the link to his name, in the adjectival form ‘skeltonical’, as early as 1589, and the link has been retained ever since: a twinning of form with poet unique in English poetry (even the ‘Shakespearean sonnet’ is a much later term). As the anonymous poem Pimlyco, or Runne Red-Cap noted in 1609, there was no need to name Skelton for him to be recognised: if one
only should hys Rymes recite,
These (all would cry) did Skelton write.
(Edwards 1981: No. 17, p. 67)
The other notable characteristic is that for much of the sixteenth century he was given an alternative afterlife as ‘merry Skelton’, a jestbook character who developed a career of his own, sometimes but by no means always independent of his poetry, such as again bespeaks a high measure of popular recognition. In the 1580s and 1590s, you did not need to belong to a cultural elite to know about Skelton, though what you thought you knew might vary radically depending on whether or not you were a member.
Making predictions about aliens is not an easy task. Most previous work has focused on extrapolating from empirical observations and mechanistic understanding of physics, chemistry and biology. Another approach is to utilize theory to make predictions that are not tied to details of Earth. Here we show how evolutionary theory can be used to make predictions about aliens. We argue that aliens will undergo natural selection – something that should not be taken for granted but that rests on firm theoretical grounds. Given aliens undergo natural selection we can say something about their evolution. In particular, we can say something about how complexity will arise in space. Complexity has increased on the Earth as a result of a handful of events, known as the major transitions in individuality. Major transitions occur when groups of individuals come together to form a new higher level of the individual, such as when single-celled organisms evolved into multicellular organisms. Both theory and empirical data suggest that extreme conditions are required for major transitions to occur. We suggest that major transitions are likely to be the route to complexity on other planets, and that we should expect them to have been favoured by similarly restrictive conditions. Thus, we can make specific predictions about the biological makeup of complex aliens.
A new two-volume edition of the sources and major analogues of all the Canterbury Tales prepared by members of the New Chaucer Society. This collection, the first to appear in over half a century, features such additions as a fresh interpretation of Chaucer's sources for the frame of the work, chapters on the sources of the General Prologue and Retractions, and modern English translations of all foreign language texts. Chapters on the individual tales contain an updated survey of the present state of scholarship on their source materials. Several sources and analogues discovered during the past fifty years are found here together for the first time, and some other familiar sources are re-edited from manuscripts closer to Chaucer's copies. Volume I includes chapters on the Frame and the tales of the Reeve, Cook, Friar, Clerk, Squire, Franklin, Pardoner, Melibee, Monk, Nun's Priest, Second Nun and Parson. Chapters on the other tales, together with the General Prologue and Retractions will appear in Volume Two. ROBERT M. CORREALE teaches at Wright State University, Ohio; MARY HAMEL teaches at Mount St Mary College, Maryland.
Guy of Warwick is England's other Arthur. Elevated to the status of national hero, his legend occupied a central place in the nation's cultural heritage from the Middle Ages to the modern period. Guy of Warwick: Icon and Ancestor spans the Guy tradition from its beginnings in Anglo-Norman and Middle English romance right through to the plays and prints of the early modern period and Spenser's Faerie Queene, including the visual tradition in manuscript illustration and material culture as well as the intersection of the legend with local and national history. This volume addresses important questions regarding the continuities and remaking of romance material, and the relation between life and literature. Topics discussed are sensitive to current critical concerns and include translation, reception, magnate ambition, East-West relations, the construction of "Englishness" and national identity, and the literary value of "popular" romance.
ALISON WIGGINS is Lecturer in English Language at the University of Glasgow; ROSALIND FIELD is Reader in Medieval Literature at Royal Holloway, University of London.
CONTRIBUTORS: JUDITH WEISS, MARIANNE AILES, IVANA DJORDJEVIC, ROSALIND FIELD, ALISON WIGGINS, A.S.G. EDWARDS, ROBERT ALLEN ROUSE, DAVID GRIFFITH, MARTHA W. DRIVER, SIAN ECHARD, ANDREW KING, HELEN COOPER
Gower is the only medieval English author of whom we have a tomb effigy. The tomb erected (and possibly recycled) for Chaucer in the 1550s once had a portrait of him, engraved or perhaps painted on its rear wall tablet, but that has long since gone. Gower lies in splendor with his head resting on the three volumes of his works, watched over by the virtues, and recently repainted in vivid gloss, in what was once the priory church of St. Mary Overy and is now Southwark Cathedral. Between those two incarnations, it was St. Saviour's, the parish church of the Globe Theatre, where Shakespeare's younger brother is buried; and it may perhaps have been Shakespeare's familiarity with the tomb, as well as his familiarity with a widely known story, that encouraged him to turn to Gower as the inspiration for and the presenter of Pericles. The tomb presumably represents the form in which the poet himself wished to be remembered, his works outliving the mortal body represented in the effigy. Gower was a man who thought about mortality; and he did so most evidently, not at the ends of his more overtly religious or moralizing works, but at the end of the Confessio Amantis, in that moment when we are required to rethink all that as readers we thought we knew. When the lover's confession is complete and all the tales are told, the narrator encounters Venus. She asks his name; and he answers, “John Gower.” It is a crucial moment analogous to Beatrice's naming of Dante––a moment of total self-knowledge, though with the opposite import, not about salvation, but about death. For she follows that up with a brutal reminder of his own mortality: “Remembre wel hou thou art old.” It is now one of the most famous lines in the whole poem; but in context, it is an extraordinary statement, because it is completely unexpected, by both lover and readers, and the shock it delivers is enough to knock him unconscious. It may not do that to the readers; but it still has a powerful effect, and not just in narrative terms, in the discovery that this is not a typically young lover, as one had assumed.
Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT).
Aims
To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive–behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years.
Method
Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years.
Results
In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder.
Conclusions
The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.