(Per)forming identity in the mind-sport bridge: Self, partnership and community

Mind-sports are a relatively under-explored area within the sociology of sport, especially the internationally played game of bridge. In this qualitative sociological study of tournament bridge, we examine the formation and performance of elite bridge player identities through interviews with 52 US and European players. Drawing on symbolic interactionism and Goffman specifically, the paper explores elite players’ social interaction across frontstage and backstage contexts, considering the performativity of self, impression management and values of character. The paper advances the sociology of mind-sport, contributing new insights into how identity is (per)formed by elite players as embodied social interaction within the bridge interaction order. We propose a recursive and layered model of identities across the self, partnership and community. The partnership element is particularly unique to the bridge sports world, which represents an interesting case for the sociological study of international mind-sports

Understanding Substance Use and the Wider Support Needs of Scotland’s Prison Population

Introduction: The Scottish Government has committed to undertaking a comprehensive, national assessment of the health and social care needs of Scotland’s prison population. The last prison health needs assessment was conducted in 2007 and a great deal has changed in the policy and service delivery landscape since then. This needs assessment is one of four commissioned studies1 and focuses on an assessment of the needs of the prison population relating to alcohol, drugs, and tobacco use. Background Substance use has long been a concern for the health and wellbeing of people living in Scotland’s prisons and remains one of the most prominent challenges to Scotland’s prison system. People who live in prison are disproportionately more likely to use alcohol, drugs, and tobacco than those individuals who do not enter prison (Toomey et al., 2022). Crime and substance use are known to be closely associated2. Problemetic substance use often contributes to the factors involved in why someone is in prison and often continues (or for some begins) whilst living in prison (Carnie and Boderick, 2019). Many people living in prison have substance use needs that pre-date their imprisonment and can stem from multiple factors, such as experiencing trauma and social and economic inequality (Devries et al., 2014; Najavits, 2015). Within custody, people experience limited access to family and community supports, bullying, and feelings of hopelessness which risks perpetuating and escalating substance use. The prevalence of substance use within prisons is a serious threat to the health of people living there and to general public health. It threatens the safety of prison officers and healthcare staff and creates challenges in terms of maintaining good order and discipline (O’Hagan, 2017). With the recent rates in drug-related deaths continuing to soar across Scotland, there is increasing pressure to take more urgent action to address substances and the harms that they present (NRS, 2021). The exact picture of substance use in Scottish prisons is unclear. There is a lack of available data, which will be highlighted later in this report. Estimating the prevalence of substance use in Scottish prisons is therefore highly challenging, particularly in relation to drug use (Toomey et al., 2022). What is apparent though is that levels of drug deaths across Scotland are very high. In 2019, in reponse to the high levels of drug deaths in Scotland, the Drug Deaths Taskforce [DDTF] was established.3 This group is made up of volunteer members who have been proactive about pushing for the implementation of the MAT [Medical Assisted Treatment] Standards.4 1 The other three studies are: (1) physical and general health, including major clinical and long-term conditions, infectious disease, non-communicable disease, sexual health; (2) mental health; and (3) social care and support needs. 2 The Scottish Parliament - Healthcare in Prisons 3 Drug Deaths Task Force 4 MAT Standards, introduced by the Scottish Government in 2021, are an evidence-based set of standards to enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland. 2 Current substance use data often relies on self-reporting5 or upon incident reports which do not present the full picture of substance use. In the most recent Scottish Prison Service [SPS] Prisoner Survey (Carnie and Boderick, 2019), 41% self reported that they engaged in problematic drug use prior to imprisonment; 45% had been under the influence of drugs, and 40% reported being drunk at the time of their offence. This is indicative of a high level of need. People living in prison experience substantially poorer health than the general population, in part because of the high prevalence of smoking amongst those living in prison (Spaulding, 2018). High rates of smoking in prisons had been consistently reported in the SPS Prisoner Survey prior to the introduction of a smoke free prison environment (2018). The 2013 survey reported that 74% of people living in prison smoked which contrasts with a prevalence rate of around 20% in Scotland as a whole. Whilst the prison system continues to be the host for many of those who are found to have committed substance related crimes, there have been increasing conversations about whether this is in fact the right place for them (Scottish Parliament, 2022). It has long been acknowledged that the opportunities and provisions for rehabilitation within a prison setting are limited (ibid.)6. So too there is a real sense that the revolving door of prisons can exacerbate and encourage substance use: ‘We do not rehabilitate prisoners well, we do not prepare them for release well and we do not support them on release well, because our system is chock-a-block with people who should not be in it.’ (Professor Fergus McNeill, evidence provided to Scottish Parliament, 2022, pg. 11) Alcohol and Drugs Each prison in Scotland has developed its own policies and procedures to manage drug and alcohol use. In part this can be traced back to the NHS takeover of addictions work in Scottish prisons from Phoenix Futures (2011). In the absence of universal guidance, each NHS Board that had a prison in its catchment area decided what approach to take (NHS, 2016). One requirement, however, was that services should be available on an equitable basis to community-based services. Whilst there are different approaches across prisons, there are a number of policies and documents that offer guidance to all prisons. One of these is the National Naloxone Programme which has been active in Scottish Prisons since 2011. This has provided all those leaving prison with Naloxone in an attempt to address opioid related overdoses upon release (Bird et al. 2014). As data collection for this study progressed, some respondents informed us that naloxone provision had continued to be developed. For example, intranasal naloxone is now offered, making it a needle-less product. Online service, training and learning opportunities have been expanded, and there has also been a move to educate and organise peer naloxone 5 Self-reporting results in limited findings as, particularly in relation to substance use, it is uncommon for people to be completely honest in their self-disclosures and so results in data consisting of what people are willing to self-disclose. 6 It should be acknowledged here that rehabilitation opportunities do vary across prisons and prisoner categories. 3 distributors and trainers, something which has enjoyed much success (DDTF, 2021). Across Scotland, the SPS’ Management of Offender at Risk Due to Any Substance [MORS] policy was introduced in December 2014. This guidance instructs prison staff on how to respond if they identify someone as being at risk from a substance and how healthcare staff should engage with the incident. Rights, Respect and Recovery, Scotland’s strategy for reducing drug and alcohol related harms and deaths, was published in 2018 (Scottish Government, 2018). The strategy provided a specific focus on prisons as one of the key organisations that should be involved in delivering on national substance use goals. In January 2021, the strategic approach was further enhanced through the announcement by the First Minister of a new ‘National Mission’ to reduce drug-related deaths and harms, supported by an additional £50 million funding per year (for the next five years). 7 In response to the Covid-19 pandemic, the Scottish Government allocated £1.9 million to support people to switch to Buvidal as an OST treatment option (MacNeill, 2021). Buvidal is a longer-acting form of OST that means people can switch from a daily medication regime to only needing to take their presciption on a weekly or monthly basis. Intial small-scale feedback on Buvidal has highlighted its potential to support people to make positive changes to their lives and demonstrated it may improve outcomes for prison leavers, such avoiding relapses in the community or helping them look employment (MacNeill, 2020). Increasing the number of people being prescribed Buvidal in Scotland’s prisons may also go some way towards alleviating the current burden placed on prison operations and healthcare by the daily administration of methadone. Tobacco SPS and partners have successfully delivered smoke free environments since November 2018. This change was introduced as part of a wider Scottish Government focus on changing smoking habits for future generations. In the lead up to, and in the aftermath of the introduction of a smoke free policy, smoking in prison has transformed from an under-researched and poorly understood policy area, to one which is underpinned by a rich literature base which engenders ongoing policy and practice conversations. In January 2022 the final report for the Tobacco in Prisons Study [TiPS] was published (Hunt et al., 2022). The study documents the impact of smoke free prisons in Scotland. It indicates that smoke free prisons policy have quickly become the ‘new normal’. Second hand smoking has been reduced by 90% and e-cigarette use has became commonplace. TiPS was the first study internationally to explore this topic and did so extensively. As such it has not been appropriate nor useful for this needs assessment to 7 National mission - Alcohol and drugs 4 replicate or duplicate evidence gathering with regard to current policy and programmes around Tobacco. Therefore, the team has focused on alcohol and drug use as a priority for the data collection for this project whilst considering the place of tobacco use alongside other substance use. Study Aim and Objectives The aim of this needs assessment study was to help the Scottish Government and its partners better understand what the healthcare needs of people with substance use problems living in Scotland’s prisons are. The specific objectives of the needs assessment were to: 1. Conduct a rapid review of the research literature from the UK and (if there is a strong rationale for it) comparable jurisdictions on the nature and extent of substance use needs and support within prison populations. 2. Synthesise available national and local-level data and research to report on the epidemiology of substance use experienced by Scotland’s prison population, including newer trends such as New Psychoactive Substances [NPS] usage, compared to others in the criminal justice system (e.g. people serving community sentences) and the general population. 3. Map current models of substance use care/interventions within Scotland’s prisons, how they interface with other healthcare interventions within prisons, and how they interface with community care models and services, including assessing aspects of treatment continuity, finding examples of best practice, and throughcare pathways during transition from custody to the community. 4. Assess the scope for the improved collection of routine data that can be made available to analysts, managers, and service providers for continued monitoring and analysis of support needs relating to substance use. 5. Offer insights for future data linkage and data collection priorities. 6. Include the perspectives of people with lived experience of prison and substance use to incorporate their views and insights. Methodology Study methods The core elements of the study focused on qualitative approaches (comprising of: (1) semi-structured interviews with a broad range of professional stakeholder groups; (2) a short-life working group with a diverse range of professional stakeholders from key partners in SPS, NHS, and the Third Sector; and (3) interviews with those who have lived and/or living experience). These approaches were supplemented with a rapid literature review, a review of existing (published) data, and a mapping exercise (see Table 1 below). Although the original study design included a desk-based review and synthesis of all available (published) datasets, and that this would be expected to be seen within a Health Needs Assessment report, it is not included in the usual way in this report. 5 From our early review of available Scottish health datasets, it became evident that published healthcare data regarding substance use for Scotland’s prisons was deficient and would not provide meaningful, real-time insights. We have included (see Table 2 in Chapter 5) an overview of the available datasets (including comments upon their individual strengths and limitations), but have focused our approach on a qualitative high-level strategic review of how healthcare data is gathered and used in order to identify the areas where substance use data collection, analysis and linkaging needs to improve (see Chapter 5). The context of the Covid-19 pandemic necessitated a flexible approach, with all working group sessions and semi-structured interviews conducted remotely or on the phone. Full details of study methods and our approach to analysis is provided in Appendix A. Recruitment, sampling, and activity completed A summary of study methods, recruitment, sampling and activity completed is presented in the table below. Fieldwork activities took place between October 2021 and February 2022

Assessing the Experiences and Impact of Minimum Pricing for Alcohol on Service Users and Service Providers: Interim Findings

1. Introduction 1.1 In May 2018, Welsh Government issued a specification for an evaluation that would assess the process and impact of the introduction of a Minimum Price for Alcohol [MPA] in Wales. The contract was split into four ‘lots’: (1) a contribution analysis, (2) work with retailers, (3) qualitative work with services and service users, and (4) an assessment of impact on the wider population of drinkers. 1.2 Three of the contracts (Lots 1, 3 and 4) were awarded to a consortium of researchers based at Glyndŵr University (Wrexham), Figure 8 Consultancy Services Ltd (Dundee), and University of South Wales1. Lot 2 was awarded to the National Centre for Social Research2. 1.3 The explicit aim of this component of the research is to assess both the experience and impact of MPA on service users (harmful, hazardous, and dependent drinkers) and services across Wales (including exploring the extent to which switching between substances may have been a consequence of the legislation and the impacts of minimum pricing on household budgets). 1.4 The original plan was to assess the impact of MPA at 18 months and 42 months post-implementation. As a result of the ongoing impact of the COVID-19 pandemic, the 18-month follow-up was postponed for six months. This report therefore presents findings from data collected 24 months post-implementation of the legislation. The second follow-up study will still be conducted at 42 months post-implementation, at which point a final evaluation report will be completed and submitted to Welsh Government. 1.5 At this early stage of the evaluation process it is not possible to detail with certainty the full impact of the policy on service users and services without conflating the impact of MPA with the impact of COVID-19 and the current cost of living crisis. We are, however, able to frame early evidence around the ‘early effects’ of the policy, rather than purporting any actual impact(s) of the policy. 1.6 Therefore, this report, which is based on research conducted two years post-implementation of the legislation, provides an important interim assessment of the experience and early effects of MPA on those drinkers who are: (1) directly targeted 1 Lot 1 is led by Glyndŵr University, Lot 3 is led by Figure 8 Consultancy Services Ltd, and Lot 4 is led by University of South Wales. 2 National Centre for Social Research 5 by the legislation (i.e. harmful and hazardous drinkers); and (2) the most vulnerable population group that are directly impacted, but not directly targeted, by the legislation (i.e. low income dependent drinkers). 1.7 The research gathered the views and opinions of both service users and service providers using a combination of qualitative interviews and online survey questionnaires (see sections 1.11-1.13 ‘Language’ and Chapter 3 for further detail on the use of these labels/descriptors). 1.8 In relation to service users, the key objectives of the study were to explore: • how they prepared for the change in the legislation; • their perceptions of the legislation; • what changes they made, if any, to their use of alcohol after the introduction of a minimum unit price for alcohol; • what changes, if any, they made to their use of alternative substances after the change in legislation; • their perceptions of changes (including substance switching) that other people made after the introduction of the legislation; and • the impact of the new legislation on their household expenditure and other aspects of their lives (e.g. relationships, employment, health). 1.9 In relation to service providers, the key objectives of the study were to explore: • the approaches they used to help people prepare for the introduction of a minimum price for alcohol; • their perceptions of changes in substance use (including substance switching) that service users made after the introduction of minimum unit pricing for alcohol; • the impact of the new legislation on the lives of service users (e.g. household expenditure, health, relationships, employment, etc); and • how useful the support materials or guidance that were provided were, as well as any additional materials that may be required. Structure of the report 1.10 The report is divided into three key parts: • The first (Chapters 2-4) provides contextual information, an overview of the research methods, as well as the characteristics of the interview and survey samples. 6 • The second (Chapters 5-6) presents the results of the study and is structured into two core chapters which present the analysed views of the two key stakeholder groups (service users and service providers). • The third (Chapters 7-8) summarises the results, provides a comparative discussion of the views of service users and service providers, and includes a set of ‘next steps’ for consideration by the Welsh Government. Language (labels and descriptors) 1.11 For clarity, the research team have chosen to adopt two labels/descriptors: ‘service users’ (drinkers) and ‘service providers’. Detailed characteristics of these groups, for both survey and interview samples, are provided in Chapter 4. 1.12 Within the report, additional and nuanced terms are used to reflect the specifics of delineated sub-populations within these overall groups. 1.13 In relation to the term ‘service users’, the report acknowledges that survey and interviewing sampling focused on those individuals whose level of drinking is categorised3 as either hazardous, harmful, or dependent4

Hospital Bioterrorism Planning and Burn Surge

On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity

‘Why would we not want to keep everybody safe?’ The views of family members of people who use drugs on the implementation of drug consumption rooms in Scotland

BackgroundPeople who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy.MethodsScotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to ‘family’ was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique.ResultsFamily members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care.ConclusionsReporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond

Drug Consumption Rooms and Public Health Policy: Perspectives of Scottish Strategic Decision-Makers

There is widespread support for the introduction of Drug Consumption Rooms (DCRs) in Scotland as part of a policy response to record levels of drug-related harm. However, existing legal barriers are made more complex by the division of relevant powers between the UK and Scottish Governments. This paper reports on a national, qualitative study of key decision-makers in both local and national roles across Scotland. It explores views on the political barriers and enablers to the adoption of Drug Consumption Rooms and the potential role of these facilities in the wider treatment system. It also considers approaches to evidence, especially the types of evidence that are considered valuable in supporting decision-making in this area. The study found that Scottish decision-makers are strongly supportive of DCR adoption; however, they remain unclear as to the legal and political mechanisms that would make this possible. They view DCRs as part of a complex treatment and support system rather than a uniquely transformative intervention. They see the case for introduction as sufficient, on the basis of need and available evidence, thus adopting a pragmatic and iterative approach to evidence, in contrast to an appeal to traditional evidence hierarchies more commonly adopted by the UK Government

Media reporting of tenofovir trials in Cambodia and Cameroon

BACKGROUND: Two planned trials of pre-exposure prophylaxis tenofovir in Cambodia and Cameroon to prevent HIV infection in high-risk populations were closed due to activist pressure on host country governments. The international news media contributed substantially as the primary source of knowledge transfer regarding the trials. We aimed to characterize the nature of reporting, specifically focusing on the issues identified by media reports regarding each trial. METHODS: With the aid of an information specialist, we searched 3 electronic media databases, 5 electronic medical databases and extensively searched the Internet. In addition we contacted stakeholder groups. We included media reports addressing the trial closures, the reasons for the trial closures, and who was interviewed. We extracted data using content analysis independently, in duplicate. RESULTS: We included 24 reports on the Cambodian trial closure and 13 reports on the Cameroon trial closure. One academic news account incorrectly reported that it was an HIV vaccine trial that closed early. The primary reasons cited for the Cambodian trial closure were: a lack of medical insurance for trial related injuries (71%); human rights considerations (71%); study protocol concerns (46%); general suspicions regarding trial location (37%) and inadequate prevention counseling (29%). The primary reasons cited for the Cameroon trial closure were: inadequate access to care for seroconverters (69%); participants not sufficiently informed of risks (69%); inadequate number of staff (46%); participants being exploited (46%) and an unethical study design (38%). Only 3/23 (13%) reports acknowledged interviewing research personnel regarding the Cambodian trial, while 4/13 (30.8%) reports interviewed researchers involved in the Cameroon trial. CONCLUSION: Our review indicates that the issues addressed and validity of the media reports of these trials is highly variable. Given the potential impact of the media in formulation of health policy related to HIV, efforts are needed to effectively engage the media during periods of controversy in the HIV/AIDS epidemic

Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma (FiTNEss (UK-MRA Myeloma XIV Trial)): a study protocol for a randomised phase III trial

INTRODUCTION: Multiple myeloma is a bone marrow cancer, which predominantly affects older people. The incidence is increasing in an ageing population.Over the last 10 years, patient outcomes have improved. However, this is less apparent in older, less fit patients, who are ineligible for stem cell transplant. Research is required in this patient group, taking into account frailty and aiming to improve: treatment tolerability, clinical outcomes and quality of life. METHODS AND ANALYSIS: Frailty-adjusted therapy in Transplant Non-Eligible patients with newly diagnosed Multiple Myeloma is a national, phase III, multicentre, randomised controlled trial comparing standard (reactive) and frailty-adjusted (adaptive) induction therapy delivery with ixazomib, lenalidomide and dexamethasone (IRD), and to compare maintenance lenalidomide to lenalidomide+ixazomib, in patients with newly diagnosed multiple myeloma not suitable for stem cell transplant. Overall, 740 participants will be registered into the trial to allow 720 and 478 to be randomised at induction and maintenance, respectively.All participants will receive IRD induction with the dosing strategy randomised (1:1) at trial entry. Patients randomised to the standard, reactive arm will commence at the full dose followed by toxicity dependent reactive modifications. Patients randomised to the adaptive arm will commence at a dose level determined by their International Myeloma Working Group frailty score. Following 12 cycles of induction treatment, participants alive and progression free will undergo a second (double-blind) randomisation on a 1:1 basis to maintenance treatment with lenalidomide+placebo versus lenalidomide+ixazomib until disease progression or intolerance. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the North East-Tyne & Wear South Research Ethics Committee (19/NE/0125) and capacity and capability confirmed by local research and development departments for each participating centre prior to opening to recruitment. Participants are required to provide written informed consent prior to trial registration. Trial results will be disseminated by conference presentations and peer-reviewed publications

Generation of a reference transcriptome for evaluating rainbow trout responses to various stressors

<p>Abstract</p> <p>Background</p> <p>Fish under intensive culture conditions are exposed to a variety of acute and chronic stressors, including high rearing densities, sub-optimal water quality, and severe thermal fluctuations. Such stressors are inherent in aquaculture production and can induce physiological responses with adverse effects on traits important to producers and consumers, including those associated with growth, nutrition, reproduction, immune response, and fillet quality. Understanding and monitoring the biological mechanisms underlying stress responses will facilitate alleviating their negative effects through selective breeding and changes in management practices, resulting in improved animal welfare and production efficiency.</p> <p>Results</p> <p>Physiological responses to five treatments associated with stress were characterized by measuring plasma lysozyme activity, glucose, lactate, chloride, and cortisol concentrations, in addition to stress-associated transcripts by quantitative PCR. Results indicate that the fish had significant stressor-specific changes in their physiological conditions. Sequencing of a pooled normalized transcriptome library created from gill, brain, liver, spleen, kidney and muscle RNA of control and stressed fish produced 3,160,306 expressed sequence tags which were assembled and annotated. SNP discovery resulted in identification of ~58,000 putative single nucleotide polymorphisms including 24,479 which were predicted to fall within exons. Of these, 4907 were predicted to occupy the first position of a codon and 4110 the second, increasing the probability to impact amino acid sequence variation and potentially gene function.</p> <p>Conclusion</p> <p>We have generated and characterized a reference transcriptome for rainbow trout that represents multiple tissues responding to multiple stressors common to aquaculture production environments. This resource compliments existing public transcriptome data and will facilitate approaches aiming to evaluate gene expression associated with stress in this species.</p