What does successful social prescribing look like? Mapping meaningful outcomes

This study aimed to investigate and collate all the outcomes that are being experienced in link worker based social prescribing schemes. We found this reflects a large evidence gap where research money needs to be invested. Data from this study highlighted that VCSE organisations engaged with social prescribing are not receiving full attribution for their contribution to improving the health and wellbeing of people. Within the literature, there are a range of reports and research articles that support the use of community organisations and services. Little of this knowledge or impact, however, is contextualised within the terms of link worker based social prescribing schemes

Letter to Gene Teitelbaum regarding mailings for the Lucile Elliott Scholarship, September 23, 1982

A letter from Brian S. Polley to Gene Teitelbaum discussing Polley\u27s views on offering multiple opportunities for the 1982-1983 Lucile Elliott Scholarship

Oh Canadiana? Atlantic Canada, Joel Thomas Hynes, and heroin realism

The essay locates Joel Thomas Hynes’s We’ll All Be Burnt in Our Beds Some Night (2017), narrated by the social outcaste Johnny, in an international "heroin realism" tradition. Hynes, styled as Canada's "bad boy" author, thus evoking his emotional ties to his protagonist, situates Johnny on the margins of Canada: in Newfoundland, which has been systemically disenfranchised from Canada's centre beside the rest of Atlantic Canada for over a century, as novels by Michael Crummey, Lisa Moore, David Adams Richards, Alistair MacLeod, and Hugh MacLennan show. The regionally representative Johnny complicates romantic figurations of Canada, which prides itself on progressiveness and equal opportunity, and which is globally envisaged as a beacon of mobility and community. Characters like Johnny do not fit into mythical Canada, whether in its pan-Canadian variety, where the East Coast is mythologized as an ocean oasis of what Herb Wyile calls "commercial antimodernism," or in its depressive, alcoholic Atlantic-Canadian version. Limited by his social positioning, ot unlike Rose in Alice Munro’s collection The Beggar Maid (1978), Johnny cannot actualise the mobility Canadiana advertises – this despite his inculcation of this seductive delusion via books. He instead experiences what bell hooks calls "psychic turmoil": the discomfiture of simultaneously occupying two distinct yet continuous narratives. Johnny's regional narrative, then, not only translates to Rose's national one, as well as to the spirit of the Beats, of road novelists, and of Hunter S. Thompson's gonzo, but also to the international dimensions of other personages in "heroin realism." Writers like Joel Thomas Hynes, Harry Crews, Denis Johnson, Antonio Lobo Antunes, Jeet Thayil, Eimear McBride, and Niall Griffiths work to deconstruct romantic idealizations. The figures of heroin realism, like Johnny, are those characters who are neither commoditized by class relations nor by national narratives

Service Evaluation of 'Living Well with the Impact of Cancer' Courses

The aim of the Penny Brohn Cancer Care Living Well Service Evaluation was to measure the level of benefit that participants were receiving from the Penny Brohn Cancer Care(PBCC)Living Well course and to inform current and future service provision at PBCC. The Penny Brohn Whole Person Approach model(PB-WPA model), which underpins the Living Well course, was designed to support the ‘whole person’ and the course was intended to meet the needs of people with cancer, as identified by the National Cancer Survivorship Initiative (NCSI). The combined qualitative and quantitative results of the Living Well Service Evaluation have demonstrated, very clearly at times, that participants were highly satisfied with the course. The immediate benefit of attending was measurable, in terms of improved health related quality of life (HRQoL) and improved MYCaW (Measure yourself Concerns and Wellbeing) concerns and wellbeing. The evaluation results show that the Living Well course experience enabled the majority of participants to regain control over many aspects of their life, and to start taking responsibility for their health. The following aspects of the course were identified as the most helpful: -Specific units of ‘education and explanation’ about cancer and why healthy lifestyle changes to areas such as diet, exercise and relaxation are beneficial -Advice and education from medical doctors -The opportunity to share experiences with other participants For some, this empowerment led to long-term changes in exercise, food consumption,use of self-help techniques and the ability to communicate more freely and openly with family, friends and medical professionals. These improvements were reflected in the 12 month outcome data, where a sustained improvement in HRQoL and MYCaW concerns was reported by many clients. Such patient reported outcome measures (PROMs) are limited in what they can measure, thus qualitative data were also collected to ensure that participants were able to share their experiences (positive or negative) of the Living Well course, and their subsequent experiences of applying the education and techniques learnt on the course. A picture emerged that identified difficulties in sustaining lifestyle changes at around the 3-6 month follow-up. Participants who returned to PBCC within the 12 month follow-up period, however, were more likely to benefit by reporting a greater improvement in HRQoL and MYCaW scores, plus an improved understanding of how to make and maintain healthy lifestyle changes to suit their individual circumstances. In regards to the current NCSI priorities, it is hoped that the data reported in this evaluation go some way to informing the following: -Information and support from the point of diagnosis -Managing the consequences of treatment -Promoting recovery -Sustaining recovery -Supporting people with active and advanced disease -Improving survivorship intelligence Finally, this report demonstrates how a patient-centred model of support can be effectively evaluated to provide relevant, practical and evidence-based information to commissioners. Participant satisfaction: Participants were very satisfied with the course content, course delivery and resources provided which often exceeded their needs and expectations. Participant outcomes: The PB-WPA model successfully encompassed and supported all the types of concerns participants arrived with. The most frequently reported participant concerns were psychological and emotional,about their wellbeing and about their physical health. On average, participants experienced statistically and clinically significant improvements in their MYCaW concern and wellbeing scores, and total HRQoL scores,which remained improved over the 12 month follow-up. The aspects of HRQoL that were most likely to improve after attending the Living Well course were spiritual, emotional and functional wellbeing. Supporters had their own profile of concerns, namely psychological and emotional,supporter specific concerns and practical concerns. Concerns were as severely rated as those from participants with a diagnosis of cancer and also showed statistically significant average improvements throughout the 12 month follow-up. The small group of participants with metastatic disease reported significant improvements in their MYCaW concern scores, in line with the whole evaluation group,and a significantly greater improvement in HRQoL over 12 months compared to participants with primary cancer.Participants who returned for more support from PBCC were in more need of support than those who did not return. They were more likely to have poorer HRQoL at baseline and rate their concerns more severely. Participants who returned to PBCC experienced more improvement in HRQoL that was likely to be clinically significant. These participants also had a greater degree of improvement in their MYCaW concerns, compared to non-returners. Over half of the participants experienced new concerns over the 12 month follow-up period. Concerns were most frequently associated with psychological and emotional and physical issues. Furthermore, at 12 months, participants were still experiencing arange of health issues

Documenting the (Un)official Kevin Carter Narrative: Encyclopedism, Irrealism, and Intimization in House of Leaves

Mark Z. Danielewski extends his critique of reliability – to the “destabilization” of “center” and “origin” and “totality” that Derrida famously exposes in “Structure, Sign and Play in the Discourse of the Human Sciences” in 1966 – to all of House of Leaves’ paratexts, even to the narratives readers traditionally approach non-ironically or -critically, like the copyright page, the index, the cover blurbs, and the footnotes. Danielewski’s much-studied encyclopedic 2000 novel features a mise-en-abyme of competing “narrators,” thus compelling readers to encounter every text in and about the main text with critical suspicion. This unconventional, formal remove, however, is apparent to any reader who simply thumbs through Danielewski’s text. Paradoxically, beneath this deconstructionist instability, the novel is anchored in a form of stability, namely connection. Protagonist Will Navidson is a Pulitzer Prize-winning photo-journalist and documentary filmmaker modelled on actual Pulitzer Prize-winner (and 1994 suicide) Kevin Carter. At stake here is how Danielewski blurs classical boundaries between fact and fiction, between reality and its reportage, in order to reclaim a modernist centre based on “readerly” identification. Danielewski’s encyclopedia of the famous Carter photograph comes to un-complicate the complicated subject positions post-structuralism first exposed. Speaking to this un-complication of complication by way of the irrealism and intimization that recent documentary theory propounds, the article considers House of Leaves as a case study about belief. Realism, which documentary theory shows is all about artifice, has no affective bearing on belief. Belief, Danielewski illustrates, can transcend binaries like official-unofficial and fiction-nonfiction

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed

The Responsiveness, Content Validity, and Convergent Validity of the Measure Yourself Concerns and Wellbeing (MYCaW) Patient-Reported Outcome Measure

Objective Measure Yourself Concerns and Wellbeing (MYCaW) is a patient-centred questionnaire that allows cancer patients to identify and quantify the severity of their ‘Concerns’ and Wellbeing, as opposed to using a pre-determined list. MYCaW administration is brief and aids in prioritising treatment approaches. Our goal was to assess the convergent validity and responsiveness of MYCaW scores over time, the generalisability of the existing qualitative coding framework in different complementary and integrative healthcare settings and content validity. Methods Baseline and 6-week follow-up data (n=82) from MYCaW and FACIT-SpEx questionnaires were collected for a service evaluation of the ‘Living Well With The Impact of Cancer’ course at Penny Brohn Cancer Care. MYCaW construct validity was determined using Spearman's Rank Correlation test, and responsiveness indices assessed score changes over time. The existing qualitative coding framework was reviewed using a new dataset (n=158) and coverage of concern categories compared to items of existing outcome measures. Results Good correlation between MYCaW and FACIT-SpEx score changes were achieved (r= -0.57, p≥0.01). MYCaW Profile and Concern scores were highly responsive to change: SRM=1.02 and 1.08; effect size=1.26 and 1.22. MYCaW change scores showed the anticipated gradient of change according to clinically relevant degrees of change. Categories including ‘Spirituality’, ‘weight change’ and ‘practical concerns’ were added to the coding framework to improve generalisability. Conclusions MYCaW scores were highly responsive to change, allowing personalized patient outcomes to be quantified; the qualitative coding framework is generalisable across different oncology settings and has broader coverage of patient-identified concerns compared with existing cancer-related patient-reported outcome measures

Global Warming Is Changing the Dynamics of Arctic Host-Parasite Systems

Global climate change is altering the ecology of infectious agents and driving the emergence of disease in people, domestic animals, and wildlife. We present a novel, empirically based, predictive model for the impact of climate warming on development rates and availability of an important parasitic nematode of muskoxen in the Canadian Arctic, a region that is particularly vulnerable to climate change. Using this model, we show that warming in the Arctic may have already radically altered the transmission dynamics of this parasite, escalating infection pressure for muskoxen, and that this trend is expected to continue. This work establishes a foundation for understanding responses to climate change of other host-parasite systems, in the Arctic and globally