Articles

    1. Sustained effectiveness and cost-effectiveness of Counselling for Alcohol Problems, a brief... 2017

      Nadkarni, Abhijit; Weiss, Helen A; Weobong, Benedict; McDaid, David...

      P Lo S Medicine, Vol. 14, Issue 9.

      Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in... Read more

      Counselling for Alcohol Problems (CAP), a brief intervention delivered by lay counsellors, enhanced remission and abstinence over 3 months among male primary care attendees with harmful drinking in a setting in India. We evaluated the sustainability of the effects after treatment termination, the cost-effectiveness of CAP over 12 months, and the effects of the hypothesized mediator 'readiness to change' on clinical outcomes. Male primary care attendees aged 18-65 years screening with harmful drinking on the Alcohol Use Disorders Identification Test (AUDIT) were randomised to either CAP plus enhanced usual care (EUC) (n = 188) or EUC alone (n = 189), of whom 89% completed assessments at 3 months, and 84% at 12 months. Primary outcomes were remission and mean standard ethanol consumed in the past 14 days, and the proposed mediating variable was readiness to change at 3 months. CAP participants maintained the gains they showed at the end of treatment through the 12-month follow-up, with the proportion with remission (AUDIT score < 8: 54.3% versus 31.9%; adjusted prevalence ratio [aPR] 1.71 [95% CI 1.32, 2.22]; p < 0.001) and abstinence in the past 14 days (45.1% versus 26.4%; adjusted odds ratio 1.92 [95% CI 1.19, 3.10]; p = 0.008) being significantly higher in the CAP plus EUC arm than in the EUC alone arm. CAP participants also fared better on secondary outcomes including recovery (AUDIT score < 8 at 3 and 12 months: 27.4% versus 15.1%; aPR 1.90 [95% CI 1.21, 3.00]; p = 0.006) and percent of days abstinent (mean percent [SD] 71.0% [38.2] versus 55.0% [39.8]; adjusted mean difference 16.1 [95% CI 7.1, 25.0]; p = 0.001). The intervention effect for remission was higher at 12 months than at 3 months (aPR 1.50 [95% CI 1.09, 2.07]). There was no evidence of an intervention effect on Patient Health Questionnaire 9 score, suicidal behaviour, percentage of days of heavy drinking, Short Inventory of Problems score, WHO Disability Assessment Schedule 2.0 score, days unable to work, or perpetration of intimate partner violence. Economic analyses indicated that CAP plus EUC was dominant over EUC alone, with lower costs and better outcomes; uncertainty analysis showed a 99% chance of CAP being cost-effective per remission achieved from a health system perspective, using a willingness to pay threshold equivalent to 1 month's wages for an unskilled manual worker in Goa. Readiness to change level at 3 months mediated the effect of CAP on mean standard ethanol consumption at 12 months (indirect effect -6.014 [95% CI -13.99, -0.046]). Serious adverse events were infrequent, and prevalence was similar by arm. The methodological limitations of this trial are the susceptibility of self-reported drinking to social desirability bias, the modest participation rates of eligible patients, and the examination of mediation effects of only 1 mediator and in only half of our sample. CAP's superiority over EUC at the end of treatment was largely stable over time and was mediated by readiness to change. CAP provides better outcomes at lower costs from a societal perspective. ISRCTN registry ISRCTN76465238. Read less

      Journal Article  |  Full Text Online

    2. A visit to the Foundling Museum 2010

      Edwards, Marini

      London Journal Of Primary Care, Vol. 3, Issue 1, pp. 62 - 63.

      The Foundling Museum is located at 40 Brunswick Square, London WC1, in a renovated building next to the site of the original Foundling Hospital. The Foundling Hospital was founded as ‘The Coram Hos... Read more

      The Foundling Museum is located at 40 Brunswick Square, London WC1, in a renovated building next to the site of the original Foundling Hospital. The Foundling Hospital was founded as ‘The Coram Hospital for the Maintenance and Education of Exposed and Deserted Children’ by Captain Thomas Coram. The museum holds the Foundling Collection, which relates the history of the hospital, with stories and moving images of the lives of the 27 000 foundlings that the hospital cared for from 1741 to 1954. The beautifully restored Georgian period rooms and staircase with their collections of art convey the feeling of the period. Coram was a shipbuilder who acquired his fortune when he worked in the North American colonies. He returned to England in the early 1700s, a childless man. Horrified by the sight of the numerous abandoned and homeless children, he petitioned for and obtained the land for the hospital. The original 56 acres of Lamb's Conduit Fields was bought from the Earl of Salisbury. There was a west wing for the boys and an east wing for the girls. The hospital chapel was opened in 1753, between the two wings, and was partly paid for by concerts given by the composer George Frederick Handel, who was one of the elected governors of the hospital. The hospital/orphanage quickly became popular with poor mothers – so much so that, eventually, these mothers had to petition to have their children accepted. Touchingly, they left mementoes in the hope that their children would have some remembrance of them. Sadly, for many of these children there was no loving family home. They were well fed and housed in the hospital; they were taught to read; they were trained in skills to prepare them for manual work – agricultural or manufacturing work or the Royal Navy for boys, domestic service for girls. The boys were apprenticed at the age of ten years, and the girls at 11. The hospital had its own doctors. The physicians Richard Mead, Robert Nesbitt and Hans Sloane (the President of the Royal Society and founder of the Chelsea Physic Garden) were members of the original General Committee, who were elected as governors to run the hospital. Inoculation against smallpox was forced on all new admissions by Dr Richard Conyers, another governor. The Foundling Hospital was a private charity and initially all children admitted had to be in good health and under two months of age. From 1756 to 1760, the hospital received a direct grant from parliament and accepted all children who were brought there. From 1801, children had to be illegitimate or the children of fathers killed in military service and had to be under the age of one year. Mothers had to give two character references and ‘preference was given to mothers who had been the victims of male deception, such as a false promise of marriage’. The original hospital was demolished in 1926 when it was sold due to financial diffculties to a developer; only the outlying buildings and the Georgian colonnades remain. The colonnades are part of Coram's Fields, London's first public children's playground, opened in July 1936 on seven acres of the original hospital site. It is still a playground and park for children living in or visiting London: no adult can enter Coram's Fields without a child. The playground has a full range of after school and holiday activities as well as events for the under-5s, and there is a community nursery for children aged from 2 to 4 years. The hospital governors bought back the northern part of the original site – the original infirmary, laundry, swimming baths and number 40 Brunswick Square. Although the London headquarters remained at 40 Brunswick Square, the hospital itself moved to a purpose built building at Berkhamsted in Hertfordshire in 1935 and remained there until the institution finally closed in 1954. The hospital then became the ‘Thomas Coram Foundation for Children’. The state now provided for abandoned or illegitimate children. The 1946 National Health Service Act and the 1948 National Assistance Act made local authorities responsible for provision of help to unmarried mothers. The 1948 Children Act made the Home Office responsible for child welfare and local authorities had to provide specialised social workers to protect vulnerable children. The Foundling Museum was established as an independent organisation in 1998 by the childcare charity ‘Thomas Coram Foundation for Children’, now known as ‘Coram’. The museum has the original 18th-century manuscript of the Messiah by Handel and a portrait of Thomas Coram by William Hogarth, who was a benefactor of the hospital. The museum holds concerts as well as special events for children of all ages, and there is a Foundling Community Choir. The museum is well worth a visit, if only to reflect on past attempts to help unwanted children and the children of unmarried mothers at a time when child poverty was a serious problem and there was no state assistance. As author Jamila Gavin says, in the foreword to her children's novel ‘Coram Boy’:1 It was entirely a matter of luck if a child was kindly and lovingly reared, and it was to redress this that Captain Thomas Coram opened his hospital in 1741. It was people like him who gradually changed the whole perception of child care and touched the conscience of the nation. Read less

      Journal Article  |  Full Text Online

    3. Educational Progress for 1907 1908

      Allen, Charles R.

      School Review, Vol. 16, Issue 5, pp. 296 - 319.

      Those of us who believe that there exists a profession of education, just as there exist professions of law and medicine, must also believe that such a profession is based on a science of education... Read more

      Those of us who believe that there exists a profession of education, just as there exist professions of law and medicine, must also believe that such a profession is based on a science of education, on a body of ascertained fact, which is the basis of actual practice. This mass of knowledge cannot be, in education any more than in any other profession, a fixed quantity; but must be continually in a state of flux, taking into itself new material, discarding that which has been found valueless, or modifying concepts in the light of newly discovered truth. Were this not the case there would be little hope for the future of our profession; for, under the rapidly changing conditions of modern life, a profession which cannot keep itself "in touch," so to speak, which does not possess within itself the power of adaptability, will soon cease to fulfil its function and pass, as Carlyle put its, "into the dustbin of history." Progress in educational science must come, as progress in any science must come, from experience. Between the organized body of accepted practice and the wholly unknown methods of the future lies the borderland of experiment: the skirmish line, as it were, of progress. Here or there, perhaps owing to particu1 A report by the Committee on Educational Progress of the Harvard Teachers' Association, read at the annual meeting of the association in Cambridge, March 7, I908. Committee: Charles R. Allen, New Bedford High School, New Bedford, Mass., chairman; Henry W. Holnes, Harvard University, Cambridge, Mass., secretary; Laura Fisher, kindergarten, Boston, Mass.; Florence E. Leadbetter, Roxbury High School, Boston, Mass.; Alice E. Dickinson, Bridgewater State Normal School, Bridgewater, Mass.; Willard Reed, Brown and Nichols School, Cambridge, Mass.; William T. Foster, Bowdoin College, Brunswick, Maine; Charles R. Breck, superintendent, Methuen, Mass.; John W. Wood, Rindge Manual Training School, Cambridge, Mass.; Clair Persons, superintendent, Westerly, R. I. Read less

      Journal Article  |  Full Text Online

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    1. Desegregation and the law; the meaning and effect of the school segregation cases

      Albert P. Blaustein and Clarence Clyde Ferguson, Jr.

      Hill KF4155 .B53 | Book

    2. The Cavalry manual of horse management

      Frederick L. Devereux, Jr.

      Hunt UE460 .D48 1979 | Book

    3. The Law school of tomorrow; the projection of an ideal.

      Edited by David Haber and Julius Cohen.

      Hill KF264 .L3 | Book

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    1. Understanding US Patents: A Deeper Dive

      Get a quick primer on patents for a non-legal audience.

      Get a quick primer on patents for a non-legal audience. Read less

    2. Music Law: Copyrighting a Song

      Learn how to get and protect copyrights for your songs, and understand the critical language, concepts, and business aspects of music copyright.

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