Monsters: monstrous identities in young adult romance

Monstrous identities in fantasy for young adults often function as metaphors for cultural tensions about romantic and sexual relations between young people, and about how the young interact with the generation that precedes them. This essay considers four monster figures prevalent in Young Adult (YA) fantasy: the vampire, the werewolf, the monstrous mother, and the monstrous father and analyses their manifestation in YA romances by Robin McKinley, Stephenie Meyer, L. K. Smith and Maggie Stiefvater. It considers what these representations tell us about cultural anxieties over the sexuality of young women, and how they are positioned as reading subjects.

Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings

Objectives:
To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation setting versus an alternative setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes.

Data Sources:
Electronic databases from the earliest possible date until May 2011. All languages were included.

Study Selection
Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation with an alternative. There were 29 included trials with 6746 participants.

Data Extraction
Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation.

Data Synthesis:
Results were synthesized using standardized mean differences (SMDs) and meta-analyses for the primary outcome of cost. The Grading of Recommendations Assessment, Development, and Evaluation was applied to assess for risk of bias across studies for meta-analyses. There was high-quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke (pooled SMD [δ]=−.28; 95% confidence interval [CI], −.47 to −.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients poststroke (δ=.31; 95% CI, .15–.48), with improvement to patient outcomes. These results were not replicated in 2 individual trials with a geriatric and a mixed cohort, where costs did not differ between general acute care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of a stroke or orthopedic population, reported less cost for an intensive inpatient rehabilitation program compared with usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses.

Conclusions:
Based on this systematic review and meta-analyses, a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients, inpatient rehabilitation may be the most cost-effective method of providing rehabilitation; yet, for other patients, rehabilitation in the home or community may be the most cost-effective model of care. To achieve cost-effective outcomes, the ideal combination of rehabilitation services and patient inclusion criteria, as well as further data for nonstroke populations, warrants further research.

Trauma-related symptoms in Sri Lankan adult survivors after the tsunami: pretraumatic and peritraumatic factors

Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.

The implications of adult morphology for clutch size in the flatback turtle (Natator depressa)

When the mean adult length and mean clutch volume of marine turtles are examined, a clear pattern for larger species to lay larger clutches is evident, in accord with predictions that female size constrains the available space for carrying eggs. However, when compared with this general trend, the volume of clutches laid by flatback turtles (Natator depressa) are smaller than expected. The implication is that the unusually flat morphology of flatback turtles, provides an additional constraint on their egg carrying capacity.

Clinical translation of the research article titled "The influence of early drinking contexts on current drinking among adult lesbian and bisexual women"

The article reported on a questionnaire-based study of 94 lesbian and 51 bisexual women that investigated the relationship between current drinking and early alcohol drinking patterns associated with coming out and a variety of social networks. The findings were that there was a “more permissive drinking culture” among lesbian and bisexual women than among heterosexual women. Furthermore, the more exposed women were to this culture through socializing in lesbian/bisexual networks during coming out, the more likely they were to drink heavily later in life. There were no differences in early drinking patterns of bisexual compared with lesbian women. One of the central hypotheses of the study that an earlier age at coming out would increase current problem drinking was not borne out.

Physical activity and exercise in the maintenance of the adult skeleton and the prevention of osteoporotic fractures

In the prevention of osteoporosis and osteoporoticrelated fractures, strategies aimed at maximizing peak bone mass during childhood and adolescence; maintaining or attenuating bone loss during the adult years; and increasing or preserving muscle mass, strength, power, and function are all considered critical. To this end, physical activity and exercise are recognized as important modifiable lifestyle variables that can strengthen the skeleton and muscles and reduce the risk of falls and subsequent fracture, as well as enhance quality of life... 

The site of 'becoming' - music and adolescence as liminal spaces in a selection of young adult fictions

Both the experience of music (Boyce-Tillman 2009, DeChaine 2002) and that of adolescence (Bettis and Adams 2005, Bradford 2013, Meyer and Land 2005) have been described as "liminal spaces" - that is, spaces in which transformation of those involved can occur. This paper will examine three texts with an implied young adult audience - Marion's Angels (K. M. Peyton, 1979, later republished as Falling Angels), The Bamboo Flute (Gary Disher, 1992), and The Carbon Diaries 2017 (Saci Lloyd, 2009) - to demonstrate how engagement with music assists the young adult protagonist with negotiating certain necessary developmental tasks of adolescence.

The emotional toll of being a twice exceptional adult : a case study

This article presents a case study of a twice exceptional young woman