To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Honoring a patient’s wishes for end-of-life care can be challenging if the patient loses decision-making capacity and the identified alternate decision-maker will not respect the patient’s wishes. This article discusses how to proceed ethically and legally when the alternate decision-maker and care team disagree about respecting a patient’s end-of-life preferences.
Objectives/Goals: Mayo Clinic launched the Community Health Assessment and Improvement Measures Program (CHAMP) Awards to support community–academic partnerships that address community health needs through community-engaged research. This abstract describes the development, implementation, and impact of CHAMP. Methods/Study Population: Launched in 2014, CHAMP offers two awards: Research Awards for discreet community-engaged research projects and Partnership Development to develop infrastructure for future community-engaged research. Awardees must address identified community health needs and involve community partners. The awards span two years; Year 1 focuses on partnership development and Year 2 on implementing project aims. Projects are reviewed and scored by internal investigators and community partners, and top-scoring proposals are selected by a review committee. Budgets must support community partners and teams submit progress and final reports to track the impact of the awards. Outcomes such as grants, publications, and career advancement are tracked by program staff. Results/Anticipated Results: The CHAMP Awards have completed seven funding cycles, supporting 28 community–academic projects and partnerships across Arizona, Florida, and the Midwest. To date, 23 awardees have published over 250 peer-reviewed articles related to community-engaged research. Of the 28 projects, over 60 subsequent grants have been secured from agencies such as the National Institute of Health, National Cancer Institute, and others, expanding both impact and sustainability. Project topics include school-based vaccinations, cardiovascular disease prevention, cancer advocacy, screening, and diabetes management. Awardees and partners continue to advance science, build lasting relationships, and secure additional resources. Discussion/Significance of Impact: The CHAMP Awards advance community-engaged research by developing and funding strong community–academic partnerships that address identified community health needs. The program supports early-career investigators, promotes workforce development, and has catalyzed new funding through subsequent grants.
Objectives/Goals: Community Advisory Boards (CABs) offer researchers community perspectives and empower CAB members to learn about research. The Mayo Clinic Center for Clinical and Translational Science (CCaTS) engages communities through six CABs. We describe our efforts over the past 17 years to develop, implement, align, and evaluate the six Mayo Clinic CCaTS CABs. Methods/Study Population: CABs were established in Jacksonville, FL (2008), Rochester, MN (2011), Phoenix, AZ (2014), Pediatrics, MN (2019), Native Tribal Health, MN (2021), Rural, Midwest (2022), and each operated independently. To harmonize CAB structure and function, a framework was developed in 2024 through an assessment of current CAB practices, guidelines, and feedback from CAB members. Through this process, a shared vision, mission, and strategy were created. The goal of harmonization was to align the six CABs with community health needs identified through local Community Health Needs Assessments (CHNAs). This information was consolidated into a new Guiding Document that outlines our unified approach to engaging the community in research through CABs. This harmonization framework provides both structure and flexibility. Results/Anticipated Results: As part of CAB harmonization framework, annual evaluations assess CAB impact, satisfaction, and growth opportunities. One CAB was evaluated in 2023, two in 2024, four in 2025, and all in 2026. CABs have four roles: Members, Board Chairs, Coordinators, and Scientific Leads. Each CAB has 15–20 members serving 3-year terms. CABs meet quarterly, with one in-person meeting annually. Meeting topics fall into four categories: site-based programs, planning, or evaluation; community-engaged research partnerships; research addressing an identified community health need; or a member selected topic that enhances information, education, or capacity building. Members receive orientation, annual training, and compensation. This framework supports community voices in research and aligns with local needs. Discussion/Significance of Impact: By aligning the purpose, structure, and function through a harmonization framework, we unified and amplified community voices in research. Few institutions support such a broad CAB network. With no existing model to meet our unique needs, we developed this flexible framework that fosters alignment while addressing each community’s unique needs.
A test which allows for errors of measurement is derived for the hypothesis that all the members of a population who possess a certain skill are a sub-set of the members who possess another skill. Formulae are given for one particular case when two questions are used for each skill, and for when three questions are used for each skill. An illustrative example is given for the two-question case.
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.
A great swathe of the rapidly expanding fields of critical animal geographies and vegan geographies (Hodge et al, 2022) are driven by a desire to better articulate, conceptualize and respond to a range of complex themes and questions rooted in multispecies justice (MSJ). In contrast, when considering broader (inter)disciplinary ‘critical’ geographies narratives of social justice, the appeal for multispecies accounts of justice to come to the fore is still seen to be a deeply contentious and ‘radical’ or extreme position to take. Yet, if there is one thing that the ongoing crises and injustice evident within our world(s) might teach us – from climate catastrophe, species extinction and zoonotic diseases, to the normalized (racist, casteist, colonial, classist, capitalist) geographies of the meat, egg and dairy industries – it is that anthropocentric narratives of justice ‘for us’ are not fit for purpose. In this sense we stand in complete agreement with Celermajer et al's arguments as to why a MSJ politics is so important now, more so than ever:
An account of MSJ is required to rectify false assumptions and longstanding misconceptions in justice theory. Principal amongst these is the fictitious idea of human beings as individual, isolated, unattached and unencumbered, and the correlative presumption that more- than- human nature is mere passive background. Beyond rejecting the belief that humans alone merit ethical or political consideration, multispecies justice rejects three related ideas central to human exceptionalism: a) that humans are physically separate or separable from other species and non- human nature, b) that humans are unique from all other species because they possess minds (or consciousness) and agency and c) that humans are therefore more important than other species. (Celermajer et al, 2021: 120)
While acknowledging and welcoming a multispecies praxes that is diverse, contingent and ephemeral in nature, this chapter considers what ‘justice for all’ means in the context of our experiences across a variety of settings and roles: as ‘scholars’, as ‘activists’, as ‘parents’ and so on. One of the common threads that link these experiences together is the question of ‘How can we more justly share [and help shape] space?’
Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups.
Aims
To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire.
Method
Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas.
Results
A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased.
Conclusions
Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.
The UK Soft Drinks Industry Levy (SDIL) (announced in March 2016; implemented in April 2018) aims to incentivise reformulation of soft drinks to reduce added sugar levels. The SDIL has been applauded as a policy success, and it has survived calls from parliamentarians for it to be repealed. We aimed to explore parliamentary reaction to the SDIL following its announcement until two years post-implementation in order to understand how health policy can become established and resilient to opposition.
Design:
Searches of Hansard for parliamentary debate transcripts that discussed the SDIL retrieved 186 transcripts, with 160 included after screening. Five stages of Applied Thematic Analysis were conducted: familiarisation and creation of initial codebooks; independent second coding; codebook finalisation through team consensus; final coding of the dataset to the complete codebook; and theme finalisation through team consensus.
Setting:
The United Kingdom Parliament
Participants:
N/A
Results:
Between the announcement (16/03/2016) – royal assent (26/04/2017), two themes were identified 1: SDIL welcomed cross-party 2: SDIL a good start but not enough. Between royal assent – implementation (5/04/2018), one theme was identified 3: The SDIL worked – what next? The final theme identified from implementation until 16/03/2020 was 4: Moving on from the SDIL.
Conclusions:
After the announcement, the SDIL had cross-party support and was recognised to have encouraged reformulation prior to implementation. Lessons for governments indicate that the combination of cross-party support and a policy’s documented success in achieving its aim can help cement the resilience of it to opposition and threats of repeal.
To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Design:
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
Setting:
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Participants:
Adults aged 18–99; n 19 393.
Results:
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Conclusions:
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
Three volumes of detailed description of Bedfordshire parish churches, presented with text from five important nineteenth-century sources; Appendices and Index complete the set.
This is to be a series of three volumes covering Bedfordshire churches in the nineteenth century. The volumes will contain descriptions of churches “on the eve of restoration” together with contemporary illustrations –most of which will be published for the first time.
For each church, there will be extracts from original records amplified by a commentary and explanatory footnotes. The main source material consists of:
1. Extracts from church inventories – mainly 1822
2. Antiquarian notes on churches by Archdeacon Bonney, c.1840
4. Articles on churches by W.A. – John Martin, the librarian at Woburn Abbey - 1845-1854
5. Church descriptions by Sir Stephen Glynne 1830-1870
There is considerable value in having these key sources, with illustrations and commentary, in one place. The descriptions by Bonney and Glynne are purely factual, but John Martin’s articles, highlighting abuses and neglect, make colourful and at times controversial reading. Bonney’s visitation notes - and the supporting evidence from contemporary records such as churchwardens’ accounts – give a clear indication that church buildings were far from neglected in the opening decades of the nineteenth century. Together these sources document features that can still be seen today, and provide information on others that have been lost.
The aim has been to present the text of contemporary sources in their original state, to convey a feeling for the times as well as to provide information. It is recognised that most of the sources could have been condensed by editing - for instance the lists of registers in the glebe terriers and the quotations in the articles by W.A. – but the Editorial Group felt that they should nevertheless be published in extenso.
The introductory commentary for each church includes a summary of the history of the building, focusing especially on eighteenth and nineteenth century restoration and alterations. These introductory notes are generally brief, but may be longer where differences between present and past external appearance merit detailed discussion. Detailed footnotes explain and amplify features mentioned in the text of the original sources and so lead the reader to additional research material.
Bedfordshire churches on the eve of restoration are well documented in a number of sources. First, there are a great many pictures of churches by artists such as Thomas Fisher and George Shepherd dating from the early Cl9th. Secondly, there are the manuscript sources which describe the condition of church buildings and ornaments in the years leading up to “the age of restoration”.
These sources are described and discussed in detail below. In outline, however, they include the glebe terriers for 1822 which describe the plan of each church and list the ornaments and furnishings. As Archdeacon of Bedford from 1821 to 1844, Dr. Henry Kaye Bonney compiled two notebooks on the churches in his care. In the one, he made detailed architectural notes on each church and its fittings, and in the other he kept a record of the orders made at his archidiaconal visitations between 1823 and 1839. Another commentator was John Martin, the Librarian at Woburn Abbey, who using the signature W.A. wrote a series of pithy articles on Bedfordshire churches for the Northampton Mercury and Bedfordshire Times between 1845 and 1854. Lastly, there are the notebooks of Sir Stephen Glynne who visited over a third of the churches in the County between 1830 and 1870.
Together these sources provide a colourful image of the appearance, condition and atmosphere of Bedfordshire churches at a time when on the one hand they were nearer their mediaeval state than they are today but when on the other they were arguably in their greatest need of attention.
Glebe Terriers (extracts) 1822
After the Reformation, the ecclesiastical authorities became increasingly aware of the need to keep proper records of church possessions. The documents known as glebe terriers fulfil this purpose, and include terriers (recording property and endowments) and inventories (listing goods and chattels). The existence of such records helped to prevent the loss and misappropriation of church property.
Terriers had been compiled for purely parochial purposes in mediaeval times, but in compliance with an archiepiscopal order or canon of 1571 it became a requirement for copies of these documents to be lodged in diocesan registries for safe-keeping.
Although the present church dates chiefly from the Cl4th and Cl5th, the foundations of the Cl2th church were discovered during excavations in 1975. The later church has a chancel, nave with north and south aisles, south porch and west tower. It retains its Cl5th roof with angels and shields (though the painted decoration is modem) and there is a ceilure above the former rood.
In 1696 a private pew was constructed for Lord Ashbumham of Ampthill Park in the south aisle of the church. Sir Christopher Wren and his pupil Nicholas Hawksmoor were involved in the design, and the pew was built by Alexander Fort, the King’s joiner. There was a heated legal dispute between Lord Ashburnham and Lord Ailesbury of Houghton House about this pew, which was eventually removed in 1847. The entrance through the east wall of the south aisle is shown in Buckler’s drawing dated 1835 (Plate 2). Lord Ailesbury had his own pew in the church, and there are faculties and papers regarding other Cl8th pews. In 1827 Boissier described the church as “crowded with pews & galleries”. Between 1823 and 1839 Bonney ordered several improvements to the pews, and in 1845 W.A. was highly critical of the arrangement of the church interior.
A faculty was obtained in 1728 to replace the pulpit, take down the chancel screen, and alter various windows. It was probably at this date that the pulpit was placed centrally in the chancel arch where it remained until 1847. Other repairs and alterations in the Cl8th and early Cl9th are recorded in the churchwardens’ accounts from 1718, vestry minutes from 1767, and churchwardens bills from 1823 (listed individually by Andrew Underwood) in the parish records.
Restoration came in 1847-8 under James Tacy Wing of Bedford, who provided new seats and galleries in the nave (Plate 3) and renewed the east window, repaired the roof and stonework, and added a small vestry on the north side of the chancel. In 1851-2 the church was lit by gas.
The tracery of the windows in the south aisle was renewed in 1872-3. Further work followed in 1877 when the vestry on the north side of the chancel was enlarged under James Piers St. Aubyn, although not all the work authorised by the faculty was carried out.
The parish churches of England are among the most noble and conspicuous of the nation’s architectural monuments. Their survival, however, owes more to chance than to good stewardship. Neglect, decay, and deliberate destruction are as much a part of their history as the work of dedicated benefactors and parishioners who strove to make our churches worthy for Christian worship.
As the sources selected for inclusion in this series demonstrate all too clearly, many Bedfordshire churches were in a dilapidated state in the opening decades of the nineteenth century. Others, whilst structurally sound and decently furnished for the worship of the day, needed “restoration” – a term meaning much more than just repair. This was the situation facing the Victorians who – far from vandalising our heritage – sought to restore these precious buildings from years of neglect and adapt them to suit the new liturgical arrangements of the time.
The coming of the ecclesiological movement in the 1840s brought a new concern for the ceremonial aspects of worship – the ministry of the sacraments instead of the ministry of the word. This entailed a change in the arrangement of church buildings, the old “preaching boxes” of the Cl8th giving way to churches in which all attention focused on the chancel and the holy table in the sanctuary. The reformers often exaggerated the poor state of church buildings as a means of drawing attention to the need for change, and the Victorians were invariably critical of alterations and repairs carried out in previous centuries when utility had been regarded as more important than sanctity.
Between about 1840 and 1914 virtually every parish church in England was in some measure restored, and vast sums of money were spent on what was seen to be one of the most worthy causes of the Victorian era. Many churches were rescued from the brink of collapse and given a new lease of life. Some were restored to their former glory. Others were mutilated beyond recognition or wholly rebuilt. Churches viewed by the Victorians as “tainted by classical alterations” were gothicised. Sound buildings were “improved” to suit the needs of a new religious age.