In-Between What Once Was and What is Yet to Come: On the Phenomena of Bereavement and Grieving

When a significant other dies, our lives can be shattered and our worlds upended. We may find that we no longer know how to make sense of our experiences or how to engage in our practical activities. Nothing can be as it was before because the world as we once knew it has ended, and we are no longer the same persons we once were. Nonetheless this ending opens up something new because the death of the other changes the possibilities of our lived world. A phenomenological analysis of the phenomena of grief and bereavement reveals that while bereavement undermines meaning as such, there is nonetheless something existentially meaningful about the experience in general. Insofar as bereavement is a disorienting, disruptive event, it opens us to our openness by asking us to respond differently, and responding differently can recuperate us from the event by transforming us and our worlds

Wind-accretion disks in wide binaries, second generation protoplanetary disks and accretion onto white dwarfs

Mass transfer from an evolved donor star to its binary companion is a standard feature of stellar evolution in binaries. In wide binaries, the companion star captures some of the mass ejected in a wind by the primary star. The captured material forms an accretion disk. Here, we study the evolution of wind-accretion disks, using a numerical approach which allows us to follow the long term evolution. For a broad range of initial conditions, we derive the radial density and temperature profiles of the disk. In most cases, wind-accretion leads to long-lived stable disks over the lifetime of the AGB donor star. The disks have masses of a few times 10^{-5}-10^{-3} M_sun, with surface density and temperature profiles that follow broken power-laws. The total mass in the disk scales approximately linearly with the viscosity parameter used. Roughly 50% to 80% of the mass falling into the disk accretes onto the central star; the rest flows out through the outer edge of the disk into the stellar wind of the primary. For systems with large accretion rates, the secondary accretes as much as 0.1 M_sun. When the secondary is a white dwarf, accretion naturally leads to nova and supernova eruptions. For all types of secondary star, the surface density and temperature profiles of massive disks resemble structures observed in protoplanetary disks, suggesting that coordinated observational programs might improve our understanding of uncertain disk physics.Comment: ApJ, in press. Some discussion on thermal instabilities, and different viscosities adde

Dipyridamole plus aspirin versus aspirin alone in the secondary prevention after TIA or stroke: a meta-analysis by risk

Objectives: Our aim was to study the effect of combination therapy with aspirin and dipyridamole (A+D) over aspirin alone (ASA) in secondary prevention after transient ischemic attack or minor stroke of presumed arterial origin and to perform subgroup analyses to identify patients that might benefit most from secondary prevention with A+D. Data sources: The previously published meta-analysis of individual patient data was updated with data from ESPRIT (N=2,739); trials without data on the comparison of A+D versus ASA were excluded. Review methods: A meta-analysis was performed using Cox regression, including several subgroup analyses and following baseline risk stratification. Results: A total of 7,612 patients (5 trials) were included in the analyses, 3,800 allocated to A+D and 3,812 to ASA alone. The trial-adjusted hazard ratio for the composite event of vascular death, non-fatal myocardial infarction and non-fatal stroke was 0.82 (95% confidence interval 0.72-0.92). Hazard ratios did not differ in subgroup analyses based on age, sex, qualifying event, hypertension, diabetes, previous stroke, ischemic heart disease, aspirin dose, type of vessel disease and dipyridamole formulation, nor across baseline risk strata as assessed with two different risk scores. A+D were also more effective than ASA alone in preventing recurrent stroke, HR 0.78 (95% CI 0.68 – 0.90). Conclusion: The combination of aspirin and dipyridamole is more effective than aspirin alone in patients with TIA or ischemic stroke of presumed arterial origin in the secondary prevention of stroke and other vascular events. This superiority was found in all subgroups and was independent of baseline risk. ---------------------------7dc3521430776 Content-Disposition: form-data; name="c14_creators_1_name_family" Halke

A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service

Context. At present, there is no widely used systematic, evidence-based holistic approach to assessment of patients’ supportive and palliative care needs. Objectives To determine whether the use of a holistic needs assessment questionnaire, SPARC, will lead to improved health care outcomes for patients referred to a palliative care service. Methods This was an open, pragmatic, randomized controlled trial. Patients (N=182) referred to the palliative care service were randomized to receive SPARC at baseline (n=87) or after a period of two weeks (waiting list control n=95). Primary outcome measure: difference in score between MYCAW patient-nominated concern 1 on the patient self-scoring visual analogue scale at baseline and the two-week follow-up. Secondary outcomes: difference in scores in the MYCAW, EQ-5D, and PEI scores at weeks 2, 4 and 6. Results There was a significant association between change in MYCAW score and whether the patients were in the intervention or control group (χ2trend = 5.51; df = 1; P = 0.019). A higher proportion of patients in the control group had an improvement in MYCAW score from baseline to week 2: Control: 34 of 70 (48.6%) vs. Intervention: 19 of 66 (28.8%). There were no significant differences (no detectable effect) between the control and intervention groups in the scores for EQ5D and PEI at 2-, 4-, or 6-week follow-up. Conclusion This trial result identifies a potential negative effect of SPARC in specialist palliative care services, raising questions that standardized holistic needs assessment questionnaires may be counterproductive if not integrated with a clinical assessment that informs the care plan

Interference with the lower gut-liver axis induces remission of primary sclerosing cholangitis in a patient with ulcerative colitis.

The gut-liver axis describes the complex interactions between gut microbiota, the small and large bowel, the immune system and the liver. Current evidence associates abnormalities within the gut-liver axis with liver disease such as primary sclerosing cholangitis (PSC). PSC is believed to be an immune-mediated disease though the exact mechanism of its pathogenesis remains unknown. Here, we report a case of a 66 -year-old woman with treatment-resistant ulcerative colitis and PSC which continued to be active following subtotal colectomy. Interestingly, her PSC achieved full remission after proctectomy for treatment-resistant proctitis in the rectal stump. This case report supports existing hypotheses that PSC is an immune-mediated disease triggered by antigens within the gut. More notably, it suggests the yet unidentified pathogens may be localised to the lower gastrointestinal tract including the rectum

Attitudes and perceived social norms towards drug use among gay and bisexual men in Australia

Background: Gay and bisexual men (GBM) report distinctive patterns and contexts of drug use, yet little has been published about their attitudes towards drug use. Objectives: We developed measures of attitudes and perceived social norms towards drug use, and examined covariates of more accepting attitudes and norms among GBM in Australia. Methods: We analysed baseline data from the [removed for blinded review] study. This is an online prospective observational study of drug use among Australian GBM. We used principal components factor analysis to generate two attitudinal scales assessing “drug use for social and sexual enhancement” and “perceptions of drug risk”. A third perceived social norms scale examined “acceptability of drug use among gay friends”. Results: Among 2,112 participants, 61% reported illicit drug use in the preceding 6 months. Stronger endorsement of drug use for social and sexual engagement and lower perceptions of drug risk were found among men who were more socially engaged with other gay men and reported regular drug use and drug use for sex. In multivariate analyses, all three scales were associated with recent drug use (any use in the previous six months), but only the drug use for social and sexual enhancement scale was associated with regular (at least monthly) use. Conclusions: Drug use and sex are difficult to disentangle for some GBM, and health services and policies could benefit from a better understanding of attitudinal and normative factors associated with drug use in gay social networks, while recognising the role of pleasure in substance use

A new nektaspid euarthropod from the Lower Ordovician strata of Morocco

International audienceNektaspids are Palaeozoic non-biomineralized euarthropods that were at the peak of their diversity during the Cambrian Period. Post-Cambrian nektaspids are a low-diversity group with only a few species described so far. Here we describe Tariccoia tazagurtensis , a new species of small-bodied nektaspid from the Lower Ordovician Fezouata Shale of Morocco. The new species differs from the type (and only other known) species from the Ordovician strata of Sardinia (Italy), Tariccoia arrusensis , in possessing more pointed genal angles, a cephalon with marginal rim, a pygidium with anterior margin curved forwards, a rounded posterior margin, and longer and more curved thoracic tergites. The two specimens of T. tazagurtensis sp. nov. show remains of digestive glands that are comparable to those seen in the Cambrian nektaspid Naraoia . The rare occurrence of T. tazagurtensis sp. nov. in the Fezouata Shale and the distribution of other liwiids suggest that these liwiids were originally minor members of open-marine communities during the Cambrian Period, and migrated into colder brackish or restricted seas during the Ordovician Period

The effect of a natural maedi-visna virus infection on the productivity of South African sheep

A cohort study was conducted in order to measure the effect of the chronic indurative lymphocytic mastitis caused by the South African strain of maedi visna virus (MVV) on the pre-weaning growth of lambs born either of naturally infected or uninfected ewes kept under similar conditions. Fifty naturally infected ewes as well as another 40 from a maedi-visna-free source to be used as control animals, were purchased and kept in separate flocks which were managed in a similar way. All the ewes were of the same breed and 3-4 years old. During the adaptation period, and through the mating, pregnancy and lactation periods they were periodically monitored for the presence of MVV serum antibodies. The lambs were weighed at birth and thereafter every 2 weeks until the age of 90 days, when they were weaned. The ewes were then slaughtered, and their udders examined histologically and the number of lymphocytic follicles were counted and assessed. Although the calculated values indicated a correlation between the number of follicles in the udder and the reduction in the growth rate of the lambs, this was not statistically significant. Similarly, despite higher counts of lymphoid follicles in the udders of sero-positive ewes as compared to those that were sero-negative and the lower ewe productivity indexes in infected ewes, no statistically significant differences were found in the indexes of ewes in different follicle categories.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.South African Wool and Meat Board. South African Agricultural Research Council.mn201

A review of the surgical conversion rate and independent management of spinal extended scope practitioners in a secondary care setting

INTRODUCTION Spinal orthopaedic triage aims to reduce unnecessary referrals to surgical consultants, thereby reducing waiting times to be seen by a surgeon and to surgical intervention. This paper presents an evaluation of a spinal orthopaedic triage service in the third largest spinal unit in the UK. METHODS A retrospective service evaluation spanning 2012 to 2014 was undertaken by members of the extended scope practitioner (ESP) team to evaluate the ESPs’ ability to manage patient care independently and triage surgical referrals appropriately. Data collected included rates of independent management, referral rates for surgical consideration and conversion to surgery. Patient satisfaction rates were evaluated retrospectively from questionnaires given to 5% of discharged patients. RESULTS A total of 2,651 patients were seen. The vast majority (92%) of all referrals seen by ESPs were managed independently. Only 8% required either a discussion with a surgeon to confirm management or for surgical review. Of the latter, 81% were considered to be suitable surgical referrals. A 99% satisfaction rate was reported by discharged patients. CONCLUSIONS ESP services in a specialist spinal service are effective in managing spinal conditions conservatively and identifying surgical candidates appropriately. Further research is needed to confirm ESPs’ diagnostic accuracy, patient outcomes and cost effectiveness

When does the action start and finish? Making the case for an ethnographic action research in educational research

This paper explores how ethnographic and action research methodologies can be justifiably combined to create a new methodological approach in educational research. It draws on existing examples in both educational research and development studies that have discussed the use of ethnography and action research in specific projects. Interpretations of ethnography and action research are developed that aim to minimise the epistemological differences between them. The paper also contextualises an ‘ethnographic action research’ approach with reference to an example of the author’s research into participation in three ‘reception’ (first year of schooling) classes in the United Kingdom. It is argued that research into the theme of participation in early years education, using participative methods, was particularly suitable for this new methodological approach