This passionate and monumental biography reassesses the life and legacy of one of the most significant cultural figures of the twentieth century Unevenly respected, easily hated, almost always ...suspected of being inferior to his reputation, Jean Cocteau has often been thought of as a jack-of-all-trades, master of none. In this landmark biography, Claude Arnaud thoroughly contests this characterization, as he celebrates Cocteau's "fragile genius-a combination almost unlivable in art" but in his case so fertile. Arnaud narrates the life of this legendary French novelist, poet, playwright, director, filmmaker, and designer who, as a young man, pretended to be a sort of a god, but who died as a humble and exhausted craftsman. His moving and compassionate account examines the nature of Cocteau's chameleon-like genius, his romantic attachments, his controversial politics, and his intimate involvement with many of the century's leading artistic lights, including Picasso, Proust, Hemingway, Stravinsky, and Tennessee Williams. Already published to great critical acclaim in France, Arnaud's penetrating and deeply researched work reveals a uniquely gifted artist while offering a magnificent cultural history of the twentieth century.
This article reviews the Trump Administration's impact on US investment policy - meaning, US policy regarding the promotion and protection of US investment abroad - at the close of the ...Administration. In short, the Administration's impact on US investment policy was substantial by any measure. It withdrew the United States from the Trans-Pacific Partnership, which was effectively the largest investment agreement ever negotiated, and it also renegotiated the North American Free Trade Agreement and replaced it with the United States-Mexico-Canada Agreement (USMCA), which features a novel approach to investor-state dispute settlement. The Administration's impact on US investment policy was also shaped by steps it chose not to take, including its decision not to replicate its approach in the USMCA in its amendments to the Korea-United States Free Trade Agreement, re-start the United States-China Bilateral Investment Treaty or Trans-Atlantic Trade and Investment Partnership negotiations or re-visit dozens of US investment agreements that are currently in force. This article reviews these decisions with a view to considering the challenges and opportunities that await future US policymakers in the executive and legislative branches with respect to US investment policy.
Most autistic adults struggle with mental health problems, and traditional mental
health services generally do not meet their needs. This study used qualitative
methods to identify ways to improve ...community mental health services for
autistic adults for treatment of their co-occurring psychiatric conditions. We
conducted semistructured, open-ended interviews with 22 autistic adults with
mental healthcare experience, 44 community mental health clinicians, and 11
community mental health agency leaders in the United States. The participants
identified clinician-, client-, and systems-level barriers and facilitators to
providing quality mental healthcare to autistic adults. Across all three
stakeholder groups, most of the reported barriers involved clinicians’ limited
knowledge, lack of experience, poor competence, and low confidence working with
autistic adults. All three groups also discussed the disconnect between the
community mental health and developmental disabilities systems, which can result
in autistic adults being turned away from services when they contact the mental
health division and disclose their autism diagnosis during the intake process.
Further efforts are needed to train clinicians to work more effectively with
autistic adults and to increase coordination between the mental health and
developmental disabilities systems.
Lay Abstract
Most autistic adults struggle with mental health problems, such as anxiety
and depression. However, they often have trouble finding effective mental
health treatment in their community. The goal of this study was to identify
ways to improve community mental health services for autistic adults. We
interviewed 22 autistic adults with mental healthcare experience, 44
community mental health clinicians (outpatient therapists, case managers,
and intake coordinators), and 11 community mental health agency leaders in
the United States. Our participants identified a variety of barriers to
providing quality mental healthcare to autistic adults. Across all three
groups, most of the reported barriers involved clinicians’ limited
knowledge, lack of experience, poor competence, and low confidence working
with autistic adults. All three groups also discussed the disconnect between
the community mental health and developmental disabilities systems and the
need to improve communication between these two systems. Further efforts are
needed to train clinicians and provide follow-up consultation to work more
effectively with autistic adults. A common suggestion from all three groups
was to include autistic adults in creating and delivering the clinician
training. The autistic participants provided concrete recommendations for
clinicians, such as consider sensory issues, slow the pace, incorporate
special interests, use direct language, and set clear expectations. Our
findings also highlight a need for community education about co-occurring
psychiatric conditions with autism and available treatments, in order to
increase awareness about treatment options.
To meet the growing consumer demand for chicken meat, the poultry industry has selected broiler chickens for increasing efficiency and breast yield. While this high productivity means affordable and ...consistent product, it has come at a cost to broiler welfare. There has been increasing advocacy and consumer pressure on primary breeders, producers, processors, and retailers to improve the welfare of the billions of chickens processed annually. Several small-scale studies have reported better welfare outcomes for slower-growing strains compared to fast-growing, conventional strains. However, these studies often housed birds with range access or used strains with vastly different growth rates. Additionally, there may be traits other than growth, such as body conformation, that influence welfare. As the global poultry industries consider the implications of using slower growing strains, there was a need for a comprehensive, multidisciplinary examination of broiler chickens with a wide range of genotypes differing in growth rate and other phenotypic traits. To meet this need, our team designed a study to benchmark data on conventional and slower-growing strains of broiler chickens reared in standardized laboratory conditions. Over a 2-year period, we studied 7,528 broilers from 16 different genetic strains. In this paper, we compare the growth, efficiency, and mortality of broilers to one of two target weights (TW): 2.1 kg (TW1) and 3.2 kg (TW2). We categorized strains by their growth rate to TW2 as conventional (CONV), fastest-slow strains (FAST), moderate-slow strains (MOD), and slowest-slow strains (SLOW). When incubated, hatched, housed, managed, and fed the same, the categories of strains differed in body weights, growth rates, feed intake, and feed efficiency. At 48 d of age, strains in the CONV category were 835 to 1,264 g heavier than strains in the other categories. By TW2, differences in body weights and feed intake resulted in a 22 to 43-point difference in feed conversion ratios. Categories of strains did not differ in their overall mortality rates.
The authors sought to determine whether providing summaries of patients' social media and other digital data to patients and their clinicians improves patients' health-related quality of life (HRQoL) ...measured by the RAND 36-Item Short Form Health Survey (SF-36).
The authors randomly assigned 115 adults receiving outpatient mental health therapy to usual care or to periodic sharing of summaries of their digital data with their clinician providing psychosocial therapy. The study was conducted October 2020-December 2021.
Patients' mean±SD age was 31.3±10.5 years, and 82% were women. At 60 days after enrollment, no statistically significant change was detected in SF-36 scores for patients randomly allocated to the intervention (mean difference=-0.39, 95% CI=-4.17, 3.39) or to usual care (mean difference=-1.98, 95% CI=-5.74, 1.77), and no significant between-arm difference was observed (between-arm difference=1.60, 95% CI=-3.67, 6.86).
Collecting and summarizing digital data for use in mental health treatment was feasible for patients but did not significantly improve their HRQoL or other measures of mental health.
Purpose of Review
This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare ...for this population.
Recent Findings
Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services.
Summary
Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
We sought to determine if and to what extent a woman's exposure to stressful life events prior to conception (PSLEs) were associated with subsequent infant birth weight by using a nationally ...representative sample of US women.
We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort in 2001. Weighted regressions estimated the effect of exposure on very low and low birth weight, adjusting for maternal sociodemographic and health factors and stress during pregnancy.
Twenty percent of women experienced any PSLE. In adjusted analyses, exposed women were 38% more likely to have a very low birth weight infant than nonexposed women. Furthermore, the accumulation of PSLEs was associated with reduced infant birth weight.
This was the first nationally representative study to our knowledge to investigate the impact of PSLEs on very low and low birth weight in the United States. Interventions aimed to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women's exposure to stress over the life course and improve the long-term health of children.
Cognitive–behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians’ use of CBT ...with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (
p
= .001), more favorable attitudes (
p
< .001), greater normative pressure (
p
< .001), and higher self-efficacy (
p
< .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians’ attitudes (
p
< .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians’ adoption of CBT for autistic adults.
BackgroundThe life course perspective suggests a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birth weight and subsequent offspring health, ...whereby PSLEs are part of a ‘chains-of-risk’ that set children on a certain health pathway. No prior study has examined the link between PSLEs and offspring health in a nationally representative sample of US mothers and their children. We used longitudinal, nationally representative data to evaluate the relation between maternal exposure to PSLEs and subsequent measures of infant and toddler health, taking both maternal and obstetric characteristics into account.MethodsWe examined 6900 mother-child dyads participating in 2 waves of the nationally representative Early Childhood Longitudinal Study-Birth Cohort (n=6900). Infant and toddler health outcomes assessed at 9 and 24 months included overall health status, special healthcare needs and severe health conditions. Adjusted path analyses examined associations between PSLEs, birth weight and child health outcomes.ResultsIn adjusted analyses, PSLEs increased the risk for very low birth weight (VLBW, <1500 g), which, in turn, predicted poor health at both 9 and 24 months of age. Path analyses demonstrated that PSLEs had small indirect effects on children's subsequent health that operated through VLBW.ConclusionsOur analysis suggests a chains-of-risk model in which women's exposure to PSLEs increases the risk for giving birth to a VLBW infant, which, in turn, adversely affects infant and toddler health. Addressing women's preconception health may have important downstream benefits for their children, although more research is needed to replicate these findings.
Challenging behavior, such as aggression, is highly prevalent in children and adolescents on the autism spectrum and can have a devastating impact. Previous reviews of challenging behavior ...interventions did not include interventions targeting emotion dysregulation, a common cause of challenging behavior. We reviewed emotion dysregulation and challenging behavior interventions for preschoolers to adolescents to determine which evidence-based strategies have the most empirical support for reducing/preventing emotion dysregulation/challenging behavior. We reviewed 95 studies, including 29 group and 66 single case designs. We excluded non-behavioral/psychosocial interventions and those targeting internalizing symptoms only. We applied a coding system to identify discrete strategies based on autism practice guidelines with the addition of strategies common in childhood mental health disorders, and an evidence grading system. Strategies with the highest quality evidence (multiple randomized controlled trials with low bias risk) were Parent-Implemented Intervention, Emotion Regulation Training, Reinforcement, Visual Supports, Cognitive Behavioral/Instructional Strategies and Antecedent-Based Interventions. Regarding outcomes, most studies included challenging behavior measures, while few included emotion dysregulation measures. This review highlights the importance of teaching emotion regulation skills explicitly, positively reinforcing replacement/alternative behaviors, using visuals and metacognition, addressing stressors proactively, and involving parents. It also calls for more rigorously designed studies and for including emotion dysregulation as an outcome/mediator in future trials.
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