How men receive and utilise partner support when trying to change their diet and physical activity within a men’s weight management programme

We thank: the FFIT participants and their partners who took part in the research; The Scottish Premier Football League (SPFL) Trust, the football clubs and the coaches; and the Population Health Research Facility at MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.Peer reviewedPublisher PD

Supernatural and irrational elements in the works of Theodor Fontane

The purpose of this thesis is to examine in the fictional works of Theodor Fontane, the ironic realist, those elements which may be appropriately termed supernatural or irrational. While noting these elements, previous studies have usually singled out individual themes or motifs in selected works. This is an attempt to examine in detail the full range of such irrational material which, at first sight, would seem incongruous and alien in the context of novels celebrated for their representation of social reality. The central supernatural motifs under consideration are ghosts and fairy-tales; irrational concepts examined include fate and predestination, with the attendant themes of grace, prophecy, premonition and omen, together with the closely allied concepts of superstition and religion, and the motif of the character with elemental affinities. A more or less chronological approach has been adopted, in order to bring out the progression or development in the employment of the material; although the novels have, on occasion, been arranged in groups (Chapters IV-VII) in order to facilitate a comparative study, The section on the fictional works is preceded by an examination of the Wanderunven durch die Mark Brandenburg and autobiographical works, as possible sources of supernatural and irrational motifs and themes. The study reveals a complex range of functions performed by the elements under examination, and a degree of progression can be discerned. Broadly speaking, irrational and supernatural material is presented indirectly in the novels, through the perception or utterances of the characters, and the references become more oblique in the later novels. The irrational material can be seen, in many cases, to be fundamental to the structural development of the work in question, and whereas in earlier works the irrationally contrived structure is often obtrusive, in later novels, such as Effi Briest, the integration of these elements with more realistic aspects of motivation and structure is complete. Supernatural elements which appear in Vor dem Sturm (Chapter III) and the crime stories (Chapter IV) as directly experienced phenomena recur in the early social novels (Chapter V) solely in conversational contexts. Supernatural references scarcely figure in the later Berlin novels (Chapter VI), which explore social themes other than marital discord. They re-emerge, however, in Unwiederbringlich and Effi Briest (Chapter VII), where disharmony in marriage is again a central theme. Fairy tale imagery, at first invoked to symbolise ideal or alluring feminine qualities, later serves to deny the validity of the idyll in modern life. In Der Stechlin (Chapter VIII), where the majority of irrational and supernatural elements recur in a conciliatory and reflective context, their conventional functions have been largely superseded, but their continued presence confirms that they are essential features of Fontane's expressive diction, and it is in his final novel that the elemental figure finds her most developed and enigmatic form, in Melusine. The consideration of irrational and supernatural features in the works has resulted in an examination of any of the central themes and distinctive stylistic qualities of Fontane's fictional writing: a fact which clearly indicates the significance of such features as integral, indeed fundamental, aspects of his art

Pharmacoeconomics in COPD: lessons for the future

COPD exerts a substantial burden on health and health care systems globally and will continue to do so for the foreseeable future. Treatment however can be costly and health care providers are interested in both whether treatments can offer improvements in disease burden and whether they represent value for money. Economic evaluations seek to resolve this issue by producing results that can be used to inform and assist the decision maker in allocating scarce health care resources. In this paper we introduce economic evaluation and then use these themes to review and critically appraise the existing COPD economic evaluations, in order to assess quality in light of today’s standards. The use of existing economic evaluations in informing the decision maker is then discussed. Ten out of the fifteen studies were clinical trial or observational study based, and the remaining five on a decision analytic model. Study design, interventions, outcome measures and the use of uncertainty varied considerably; consequentially the results are difficult to compare in any consistent manner. Efforts for future studies to harmonize study design and methodology, particularly towards adopting a modeling framework, using current treatment as comparator and adopting a common effectiveness measure, such as the QALY, should be made in order to produce results that are comparable and useful to a decision maker

Brown Bear Cognition and Welfare

The welfare of large-brained wide-roaming carnivores in captivity has been of longstanding public and professional concern. Bears are one such example. Ursids have unexpectedly large relative brain sizes, indeed showing brain size increases similar to those observed in canids. Bears also have considerable space requirements, with extensive home range sizes seen in the wild. Species with complex requirements often face difficulties when placed in artificial environments. Cognitive enrichment, however, may work to ameliorate this by providing stimulating mental challenges for individuals living in zoological settings. This case study explores the proposed benefits of cognitive trials. To do so, we exposed 17 captive European brown bears ( Ursus arctos arctos ) housed in UK zoos to two experimental tasks (1) a puzzle box and (2) an object-manipulation set-up. A total of 14 of the bears voluntarily engaged with the puzzle box, while 15 individuals interacted with the object-manipulation set-up. The bears that failed to interact with the tests were likely dissuaded due to the collective nature of testing, a lack of motivation or fear of novel objects. Cognitive stimulation, such as that provided in our study, offers one means of improving the welfare of captive bears. We advocate the use of cognition studies for zoo-housed bears to enrich their lived-experiences when housed in zoological settings. Information © The Authors 202

Can behaviour during immunisation be used to identify attachment patterns? A feasibility study

<b>Background</b> Infant attachment is a strong predictor of mental health, and current measures involve placing children into a stressful situation in order to observe how the child uses their primary caregiver to assuage their distress.<p></p> <b>Objectives</b> This study aimed to explore observational correlates of attachment patterns during immunisation.<p></p> <b>Participants and setting</b> 18 parent–child pairs were included in the study. They were all recruited through a single general medical practice.<p></p> <b>Methods</b> Infant immunisation videos were observed and coded for parenting behaviours as well as pain promoting and pain reducing strategies. Results were compared between different attachment groups, as measured with the Manchester Child Attachment Story Task. <p></p> <b>Results</b> Parents of securely attached children scored higher on positive Mellow Parenting Observational System behaviours, but not at a statistically significant level. Parents of securely attached children were also significantly more likely to engage in pain reducing behaviours (p <0.01) than parents of insecurely attached children.<p></p> <b>Conclusions</b> Robust composite measures for attachment informative behaviours in the immunisation situation should be developed and tested in a fully powered study

The subcoronary Toronto stentless versus supra-annular Perimount stented replacement aortic valve: Early clinical and hemodynamic results of a randomized comparison in 160 patients

BackgroundA stentless valve is expected to be hemodynamically superior to a stented valve. The aim of this study was to compare early postoperative hemodynamic function and clinical events in a randomized, prospective series of 160 stentless and stented biological replacement aortic valves.MethodsWe randomized 160 consecutive patients on 1 surgeon’s list to receive either a Toronto stentless porcine valve (St Jude Medical, Inc, St Paul, Minn) or a Perimount stented bovine pericardial valve (Edwards Lifesciences, Irvine, Calif). Echocardiography was performed at discharge, between 3 and 6 months, and at 1 year after surgery. Statistical analysis was performed by both intention to treat and actual valves implanted.ResultsThe mean labeled size of both designs of valve was 24.7. There were no statistically significant differences in results at any time interval or whether analysis was performed by actual valves implanted or intention to treat. At 3 to 6 months for the Toronto versus the Perimount valve, the effective orifice area was 1.58 versus 1.66 cm2, the mean pressure difference was 7.54 versus 7.42 mm Hg, and the peak velocity was 2.07 versus 2.0.1 m/s. There was no difference in mortality, regression of left ventricular hypertrophy, or complications other than paraprosthetic regurgitation at 12 months or on follow-up for a proportion of the sample to 8 years. The incidence of regurgitation through the valves was similar for Toronto (10%) and Perimount (13.8%) at 1 year, but mild paraprosthetic regurgitation was found in 5 patients with the Perimount valve and none with Toronto valves.ConclusionsThere were no significant differences in hemodynamic function or clinical events between the stented and stentless biological valves chosen for comparison in the early postoperative period or in preliminary follow-up to 5 years

To what extent has COVID-19 impacted hard-to-reach energy audiences?

Energy users who don’t participate in efficiency and conservation programmes despite ongoing outreach are often referred to as ‘Hard-to-Reach’ (HTR). These individuals or organisations can include, e.g., low income or vulnerable households; renters; and small businesses. More effectively engaging HTR audiences is key to ensuring everyone benefits equitably from low-carbon energy transitions and related (policy) interventions. This is even more so the case in light of the COVID-19 pandemic, and the ongoing implications for energy use and affordability for the most vulnerable (and newly-vulnerable) members of our society.Within this context, the main purpose of this paper is to explore the extent to which HTR energy audiences have been impacted by COVID-19. Our primary method for this work was a comprehensive, critical literature review and a compilation of official statistics. We also collected survey, interview and focus group data during 2020 COVID-19 pandemic responses in the U.S., UK, NZ and Sweden. The geographical scope is determined by a 3-year project focusing on HTR energy users and implemented in partnership with the User-Centred Energy Systems Technology Collaboration Programme (Users TCP) by the International Energy Agency (IEA). Key findings we highlight and discuss in this paper:● Sweden has taken a different approach to manage COVID-19, yet when it comes to mobility, declines in demand (~25%) have shown relatively similar patterns to countries with stricter measures. ● In the UK, energy debt is growing due to higher domestic consumption arising from lockdown measures and the reduced income of many households. Most households (72%) have increased their energy (monthly gas and electricity bills are up £32) use. In response, 36% are turning thermostats down and 27% limiting lighting.● In the U.S., a survey of 1,000 energy customers found that more than 50% are using more energy, and monitoring their energy use less; 15% reported postponing a utility bill. ● NZ’s model COVID-19 “elimination” response has included housing, financial support, and specific energy payments to date, though unhealthy and unaffordable housing remains a major issue.Whereas the pandemic has exacerbated several elements of the HTR policy discourse (e.g. impacts on vulnerable and/or low-income households), our findings also reveal several opportunities and critical aspects for policy makers, researchers and utilities to identify and engage HTR energy users

Brief online mindfulness training for medical students: a randomized control study

BACKGROUNDMedical students experience high levels of stress during their training. Literature suggests that mindfulness can reduce stress and increase self-compassion levels in medical students. However, most mindfulness training programs are delivered face-to-face and require significant time commitments, which can be challenging for rurally-based students with heavy academic workloads and limited support networks. PURPOSETo evaluate the feasibility and efficacy of a brief online Mindfulness training program for medical students based in rural areas, with regards to reducing stress, increasing self-compassion, mindfulness and study engagement. METHODSThis is a non-registered randomised control trial. Participants included both urban and rural medical students from UWA, University of Notre Dame and the RCSWA from 2018-2020. Participants were randomised to the intervention group, an 8-week online mindfulness training program, or the control group. Using quantitative-qualitative mixed-methods approach, we measured the frequency, duration and quality of the participants mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion, mindfulness and study engagement levels. Further, the intervention group recorded a weekly reflective journal documenting their experience of the program. RESULTS114 participants were recruited to the study. 61 were randomised to the intervention, and 53 to the control. Quantitative analysis of the frequency, duration and quality of mindfulness meditation practice and changes in stress, self-compassion, mindfulness and study engagement is currently being conducted. Preliminary qualitative results reveal that participants experienced increased self-awareness, more mindfulness of their day-to-day activities, improved emotional regulation and increased productivity, while also facing difficulties with making time for their mindfulness practice. CONCLUSIONWe anticipate that this study will demonstrate that an online mindfulness training program tailored to reach rurally located medical students is feasible and effective in modifying their stress levels and psychological wellbeing.