Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

OBJECTIVE: To develop and validate a new scale to assess treatment burden (the effort of looking after one's health) for patients with multimorbidity. DESIGN: Mixed-methods. SETTING: UK primary care. PARTICIPANTS: Content of the Multimorbidity Treatment Burden Questionnaire (MTBQ) was based on a literature review and views from a patient and public involvement group. Face validity was assessed through cognitive interviews. The scale was piloted and the final version was tested in 1546 adults with multimorbidity (mean age 71 years) who took part in the 3D Study, a cluster randomised controlled trial. For each question, we examined the proportion of missing data and the distribution of responses. Factor analysis, Cronbach's alpha, Spearman's rank correlations and longitudinal regression assessed dimensional structure, internal consistency reliability, construct validity and responsiveness, respectively. We assessed interpretability by grouping the global MTBQ scores into zero and tertiles (>0) and comparing participant characteristics across these categories. RESULTS: Cognitive interviews found good acceptability and content validity. Factor analysis supported a one-factor solution. Cronbach's alpha was 0.83, indicating internal consistency reliability. The MTBQ score had a positive association with a comparator treatment burden scale (rs 0.58, P<0.0001) and with self-reported disease burden (rs 0.43, P<0.0001), and a negative association with quality of life (rs-0.36, P<0.0001) and self-rated health (rs-0.36, P<0.0001). Female participants, younger participants and participants with mental health conditions were more likely to have high treatment burden scores. Changes in MTBQ score over 9-month follow-up were associated, as expected, with changes in measures of quality of life (EuroQol five dimensions, five level questionnaire) and patient-centred care (Patient Assessment of Chronic Illness Care). CONCLUSION: The MTBQ is a 10-item measure of treatment burden for patients with multimorbidity that has demonstrated good content validity, construct validity, reliability and responsiveness. It is a useful research tool for assessing the impact of interventions on treatment burden. TRIAL REGISTRATION NUMBER: ISRCTN06180958

The ambivalent shadow of the pre-Wilsonian rise of international law

The generation of American international lawyers who founded the American Society of International Law in 1906 and nurtured the soil for what has been retrospectively called a “moralistic legalistic approach to international relations” remains little studied. A survey of the rise of international legal literature in the U.S. from the mid-19th century to the eve of the Great War serves as a backdrop to the examination of the boosting effect on international law of the Spanish American War in 1898. An examination of the Insular Cases before the US Supreme Court is then accompanied by the analysis of a number of influential factors behind the pre-war rise of international law in the U.S. The work concludes with an examination of the rise of natural law doctrines in international law during the interwar period and the critiques addressed.by the realist founders of the field of “international relations” to the “moralistic legalistic approach to international relation

What Remains: Pseudotranslation as Salvage

Pseudotranslations are literary works which purport to be translations of lost or suppressed originals, i.e. to be ‘salvaged’ from oblivion or obscurity. Pseudotranslation has attracted a good deal of attention within translation studies in recent years, but as a practice it can be traced back a long way. This article discusses a number of examples of the type, from Cervantes’ Don Quixote and modern works treating Shakespeare as pseudotranslated (Star Trek VI, Tom Stoppard’s Arcadia) through notable eighteenth-century examples (Walpole’s The Castle of Otranto, MacPherson’s Ossian) to non-fictional fictions The Book of Mormon and ‘Nietzsche’s’ fraudulent late autobiography My Sister and I. Readers of translations usually trust that an original exists, and pseudotranslations abuse that trust. But even when an original does exist, translation performs a kind of salvage operation, acting as a kind of lifeboat which rescues a text from the passing of time and keeps it afloat for posterity

The Law of Society: Governance Through Contract

This paper focuses on contract law as a central field in contemporary regulatory practice. In recent years, governance by contract has emerged as the central concept in the context of domestic privatization, domestic and transnational commercial relations and law-and-development projects. Meanwhile, as a result of the neo-formalist attack on contract law, governance of contract through contract adjudication, consumer protection law and judicial intervention into private law relations has come under severe pressure. Building on early historical critique of the formalist foundations of an allegedly private law of the market, the paper assesses the current justifications for contractual governance and posits that only an expanded legal realist perspective can adequately explain the complex nature of contractual agreements in contemporary practice. The paper argues for an understanding of contracts as complex societal arrangements that visibilize and negotiate conflicting rationalities and interests. Institutionally, contractual governance has been unfolding in a complex, historically grown and ideologically continually contested regulatory field. Governance through contract, then, denotes a wide field of conflicting concepts, ideas and symbols, that are themselves deeply entrenched in theories of society, market and the state. From this perspective, we are well advised to study contracts in their socio-economic, historical and cultural context. A careful reading of scholars such as Henry Sumner Maine, Morris Cohen, Robert Hale, Karl Llewellyn, Stewart Macaulay and Ian Macneil offers a deeper understanding of the institutional and normative dimensions of contractual governance. Their analysis is particularly helpful in assessing currently ongoing shifts away from a welfare state based regulation (governance) of contractual relations. Such shifts are occurring on two levels. First, they take place against the backdrop of a neo-liberal critique of government interference into allegedly private relations. Secondly, the increasingly influential return to formalism in contract law, which privileges a functionalist, purportedly technical and autonomous design and execution of contractual agreements over the view of regulated contracts, is linked to a particular concept of sovereignty. The ensuing revival of freedom of contract occurs in remarkable neglect of the experiences of welfare state adjudication of private law adjudication and a continuing contestation of the political in private relationships. The paper takes up the Legal Realists\u27 search for the \u27basis of contract\u27, but seeks to redirect the focus from the traditional perspective on state vs. market to a disembedded understanding of contractual governance as delineating multipolar and multirational regulatory regimes. Where Globalization has led to a fragmentation, disembeddedness and transnationalization of contexts and, thus, has been challenging traditional understanding of embeddedness, the task should no longer be to try applying a largely nation-state oriented Legal Realist perspective and critique to the sphere of contemporary contractual governance, but - rather - to translate its aims into a more reflexive set of instruments of legal critique. Even if Globalization has led to a dramatic denationalization of many regulatory fields and functions, it is still not clear, whether and how Globalization replaces, complements or aggravates transformations of societal governance, with and through contract

Enabling Indigenous wellbeing in higher education: Indigenous Australian youth-devised strategies and solutions

Indigenous youth comprise over half of the Indigenous Australian population; however, there is a scarcity of research that focuses on improving Indigenous Australians’ wellbeing in higher education. The purpose of this study was to identify Indigenous-devised strategies to support wellbeing of salience to Indigenous Australian higher education students. Using Indigenous methodology, Indigenous youth (N = 7; aged between 18 and 25 years) studying at three higher education institutions in Australia participated in semi-structured interviews. Thematic analysis identified strategies and solutions for supporting and enhancing Indigenous youth wellbeing in higher education. Participants suggested that their wellbeing would benefit from increased opportunities for them to gain role models. They also suggested culturally supportive higher education environments were critical and could be achieved by employing more Indigenous academics and Indigenous mentors to implement personalised student support, introducing mandatory cultural competency training for all staff, and employing culturally safe counselling services. Indigenous youth also suggested strategies for enhancing institutional policy such as ensuring Indigenous culture and perspectives were taught across all faculties; developing reconciliation action plans, financial support, and scholarships to require proof of Aboriginality and evidence of hardship; and an institutional wellbeing strategy designed to support Indigenous students’ wellbeing

Advanced technology for gait rehabilitation --- An overview

Most gait training systems are designed for acute and subacute neurological inpatients. Many systems are used forrelearning gait movements (nonfunctional training) or gait cycle training (functional gait training). Each system presentsits own advantages and disadvantages in terms of functional outcomes. However, training gait cycle movements is notsufficient for the rehabilitation of ambulation. There is a need for new solutions to overcome the limitations of existingsystems in order to ensure individually tailored training conditions for each of the potential users, no matter the complexityof his or her condition. There is also a need for a new, integrative approach in gait rehabilitation, one that encompassesand addresses all aspects of physical as well as psychological aspects of ambulation in real-life multitaskingsituations. In this respect, a multidisciplinary multinational team performed an overview of the current technology forgait rehabilitation and reviewed the principles of ambulation training