Impact of Parental Substance Misuse on Attachment in Young Adults: A Qualitative Approach

This study examined the impact of parental substance misuse on young adult development and relationships by interviewing young adults about their experience being raised by a parent who misused substances. A qualitative design based on constructivist grounded theory and informed by constructs from attachment theory was used. Participants consisted of 10 young adults, ages 18-26, who endorsed being raised by a parent who misused substances. The interview questions developed for the study were informed by a measure of adult attachment. Analysis of the data included identification of emergent categories/themes as well as a priori constructs from attachment theory (safe haven, secure base, reflective functioning, coregulation). Based on the analysis, the following emergent categories/themes were identified and described: behavior of the parent with substance misuse, feelings/experience of the offspring, acknowledgement of substance misuse, impact on the parent-child relationship, impact on relationships with others, and impact on mental health and identity. A priori attachment constructs were evident in the narratives and provided a useful frame for understanding the impact of parental substance misuse. This study demonstrated how constructs from attachment theory can be applied to better understand the relationship between a parent’s behavior and the impact on attachment security in the child when substance misuse is occurring. Parental absence, lack of attunement to the child’s needs, and inconsistent behavior may contribute to offspring feeling rejected, unknown, and confused, which may impact their sense of attachment security, feelings of worth, and perception of the reliability of others

The many faces of Cleopatra : from propaganda to myth.

Thesis (M.A.)-University of Natal, Pietermaritzburg, 2003.Few women of antiquity have gripped the public imagination as Cleopatra has. For centuries, she has inspired playwrights, poets, artists and film-makers, with the result that she and Antony are arguably history's most famous lovers. However, I have not yet encountered a study which discusses, in one work, the multiple constructions of Cleopatra across the range of genres in which she has been represented. Certainly, many books and articles are devoted to revealing how Cleopatra has been constructed in one or other specific genre, but it seems as though no attempts have been made to portray, in juxtaposition to one another, the many faces of Cleopatra. This dissertation seeks to do just that. Although I could not possibly include a discussion ofevery genre in which Cleopatra has been constructed, I have chosen six areas for study: ancient Greek biography (using Plutarch's Life ofAntony); the poetry of the Augustan poets: Vergil (the Aeneid), Horace (Ode 1.37) and Propertius (Elegies 3.11); Shakespearean tragedy (Antony and Cleopatra); art (numismatics and ancient sculpture); film (Joseph Mankiewicz's Cleopatra), and, briefly, Africanist historiography. I have chosen these areas because each offers such diverse constructions of Cleopatra that one begins to appreciate how historiography, propaganda and representation have contributed to the shaping ofthe Cleopatra myth, coloured by the ideology ofthe age in which she has been interpreted afresh. Current Africanist appropriations ofCleopatra suggest that historiography is never neutral: race and gender often intersect to create 'historical' identities

Calvinism and the Arts

Susan Hardman Moore's article is a study of the wider impact of Calvin's theological approach to signs and signifieds, i.e., his steady insistence on words and the Word. In this paper, she draws our attention to the nature of the intellectual transformation this insistence brought about in aspects of the thought of Northern Europe

Identifying Developmental Language Disorder in Deaf Children with Cochlear Implants: A Case Study of Three Children

(1) Background: While spoken language learning delays are assumed for deaf and hard of hearing (DHH) children after cochlear implant (CI), many catch up with their hearing peers. Some DHH children with CIs, however, show persistent delays in language, despite protective factors being in place. This suggests a developmental language disorder (DLD). However, at present there is little consensus on how to diagnose DLD in DHH children. (2) Methods: Given the lack of consensus in this area, a set of case studies provides an appropriate first step. The goal of this paper is to show the plausibility of a DLD diagnosis, following careful analysis of protective and risk factors. A retrospective case study review was conducted for three children. Their long-term language outcomes up to four years after CI were considered in the context of access to sound, speech sound discrimination, social skills and non-verbal cognition. (3) Results: It was possible to posit DLD in one child who had experienced good access to sound, alongside good speech discrimination abilities and social development, and normal non-verbal cognition, but who presented with severe language learning difficulties. (4) Conclusions: Finding markers for DLD in DHH children is important for diagnosis and intervention. The implications for clinical practice are discussed

UK population norms for EQ-5D

This discussion paper presents data from the Department of Health funded Measurement and Valuation of Health survey conducted at the Centre for Health Economics in 1993. This was a nationally representative interview survey of 3395 men and women aged 18 or over living in the UK. Amongst other things, the survey collected information on health status using the EuroQol (EQ-5D) descriptive system. The data is presented as a series of tables of age/sex population norms for the EQ-5D, for both self rated health status and weighted health state index. The tables are likely to be useful for researchers, clinicians, health care providers and policy makers, who are using EQ-5D to evaluate health care and who require baseline values for comparative purposes for monitoring population variations in health.MVH, EQ-5D

A nationwide, population‐based study on specialized care for acute heart failure throughout the COVID‐19 pandemic

Aims - The COVID-19 pandemic disrupted the delivery of care for patients with heart failure (HF), leading to fewer HF hospitalizations and increased mortality. However, nationwide data on quality of care and long-term outcomes across the pandemic are scarce.Methods and results - We used data from the National Heart Failure Audit (NHFA) linked to national records for hospitalization and deaths. We compared pre-COVID (2018–2019), COVID (2020), and late/post-COVID (2021–2022) periods. Data for 227 250 patients admitted to hospital with HF were analysed and grouped according to the admission year and the presence of HF with (HFrEF) or without reduced ejection fraction (non-HFrEF). The median age at admission was 81 years (interquartile range 72–88), 55% were men (n = 125 975), 87% were of white ethnicity (n = 102 805), and 51% had HFrEF (n = 116 990). In-hospital management and specialized cardiology care were maintained throughout the pandemic with an increasing percentage of patients discharged on disease-modifying medications over time (p &lt; 0.001). Long-term outcomes improved over time (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.90–0.95, p &lt; 0.001), mainly driven by a reduction in cardiovascular death. Receiving specialized cardiology care was associated with better long-term outcomes both for those who had HFrEF (HR 0.79, 95% CI 0.77–0.82, p &lt; 0.001) and for those who had non-HFrEF (HR 0.87, 95% CI 0.85–0.90, p &lt; 0.001).Conclusions - Despite the disruption of healthcare systems, the clinical characteristics of patients admitted with HF were similar and the overall standard of care was maintained throughout the pandemic. Long-term survival of patients hospitalized with HF continued to improve after COVID-19, especially for HFrEF.<br/

Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan: Validation of risk models in decompensated heart failure

Aims: Prognostic models for hospitalised heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health-care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) & Japan.Methods and Results: Patients in the UK (894) and Japan (3,158) were prospectively enrolled and similar in terms of sex (~60% men) and median age (~77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in-hospital [4.8% vs 2.5%] and 180-day [20.7% vs 9.5%] mortality. The model c-statistics for the published/derivation [range 0.70-0.76] and Japanese [range 0.75-0.77] cohorts were similar and higher than for the UK [0.62-0.75] but models consistently over-estimated mortality in Japan. For in-hospital mortality, OPTIMIZE-HF performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c-indices: 0.75 (0.74-0.77); 0.75 (0.68 - 0.81) and 0.77 (0.70 - 0.83)], and least over-estimated mortality in Japan. For 180-day mortality, the cstatistics for ASCEND-HF were similar in published/derivation [0.70] and UK [0.69 (0.64 - 0.74)] cohorts but higher in Japan [0.75 (0.71 - 0.79)]; calibration was good in the UK but again over-estimated mortality in Japan.Conclusion: Calibration of published prediction models appear moderately accurate and unbiased when applied to British patients but consistently overestimate mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest

Mortality after admission for heart failure in the UK compared with Japan

Objective Mortality amongst patients hospitalised for heart failure (HHF) in Western and Asian countries may differ, but this has not been investigated using individual patient-level data (IPLD). We sought to remedy this through rigorous statistical analysis of HHF registries and variable selection from a systematic literature review.Methods and results IPLD from registries of HHF in Japan (n=3781) and the UK (n=894) were obtained. A systematic literature review identified 23 models for predicting outcome of HHF. Five variables appearing in 10 or more reports were strongly related to prognosis (systolic blood pressure, serum sodium concentration, age, blood urea nitrogen and creatinine). To compare mortality in the UK and Japan, variables were imputed in a propensity model using inverse probability of treatment weighting (IPTW) and IPTW with logistic regression (doubly robust IPTW). Overall, patients in the UK were sicker and in-patient and post-discharge mortalities were greater, suggesting that the threshold for hospital admission was higher. Covariate-adjusted in-hospital mortality was similar in the UK and Japan (IPTW OR: 1.14, 95% CI 0.70 to 1.86), but 180-day postdischarge mortality was substantially higher in the UK (doubly robust IPTW OR: 2.33, 95% CI 1.58 to 3.43).Conclusions Despite robust methods to adjust for differences in patient characteristics and disease severity, HHF patients in the UK have roughly twice the mortality at 180 days compared with those in Japan. Similar analyses should be done using other data sets and in other countries to determine the consistency of these findings and identify factors that might inform healthcare policy and improve outcomes

Let us have articles betwixt us: Papers in Historical and Comparative Linguistics in Honour of Johanna L. Wood

Papers in Historical and Comparative Linguistics in Honour of Johanna L. Woo