Alcohol in the lives of first time professional mothers recently returned to work - an interpretative phenomenological analysis

Introduction - The rise in female drinking has been identified as one of the key trends in drinking in the UK. Those in higher socio-economic groups appear to be drinking the most and most frequently (Office for National Statistics [ONS], 2016). Many women become mothers and the wider impact of parental drinking is well documented and causing growing political concern (McGovern et al., 2018). Most mothers give up alcohol during pregnancy and resume drinking in the years that follow (Bailey, Hill, Hawkins, Catalano, & Abbott, 2008; Lui, Mumford, & Petras, 2014; Meurk, Broom, Adams, Hall, & Lucke, 2014). This period represents a teachable moment for behaviour change in relation to mothers and smoking (Baxter et al., 2011; McBride, Emmons, & Lipkus, 2003), and potentially alcohol but this has yet to be explored. This thesis fills a gap in the literature by speaking to first time professional mothers about their experiences of alcohol as they negotiate the transitions of motherhood and the return to professional life. Method - A cross sectional survey was devised for the sole purpose of recruiting first time professional mothers, who had returned to work within the last two years, given up alcohol whilst pregnant, and since resumed drinking as indicated by a positive AUDIT C score. The survey was distributed via on-line forums and nursery mailing lists. Seven purposefully selected participants participated in a semi-structured interview about their lived experience of alcohol. The interviews were recorded and transcripts analysed using Interpretative Phenomenological Analysis. Individual analysis was conducted for each participant before moving on to group analysis. Results - Three super-ordinate themes emerged from the analysis with twelve interrelated sub-ordinate themes. The mothers interviewed revealed ambivalent feelings towards alcohol. They moved between defending past excessive drinking and distancing themselves from it as it threatened their new identity as responsible mothers. The experience of becoming a mother had been isolating and there was a shame in finding it difficult. As new mothers the women had experienced the loss of alcohol as a flag for identity and as an important element of social activity. It felt as if the women were at different points in a journey towards acceptance of this change and re-authoring their relationship with alcohol. Notable was the extent to which the decision not to drink was experienced as socially unacceptable and hidden. Discussion - This study elucidates our understanding of professional women’s relationship with alcohol during this significant period of transition. Findings suggest that this period represents a teachable moment. A positive intervention at this time, offering mothers the opportunity to reflect on their relationship with alcohol, could help them to build on their recent period of abstinence and alter their drinking behaviour in the future. The findings are discussed in relation to psychological theory and clinical implications highlighted. Methodological limitations are discussed and areas for future research recommended

Coventry Creates : developing impact through artist-researcher collaboration

In December 2017, Coventry was announced as the UK City of Culture 2021. The University of Warwick and Coventry University are Principal Partners in the City of Culture project, with both universities engaged in the ongoing development of the regional cultural sector. Following the announcement of Coventry’s success, the two universities have further strengthened their partnership and their connections with the City and its communities, through joint work programmes around monitoring and evaluation and research; a University Partnership group; and a Memorandum of Understanding to underpin long-term collaboration. Seed funding of projects by the University Partnership between 2017 and 2021 (and continuing) has seen researchers collaborating across the two institutions, working with a diverse range of organisations and communities, alongside the universities’ own individual programmes of research.1 Led by Warwick, both universities are also working in partnership with the City of Culture Trust on the monitoring and evaluation of the impact of City of Culture, measuring this against a clear theory of change

Artist-researcher collaborations with Coventry Creates : sharing knowledge and inspiring innovation

In December 2017, Coventry was announced as the UK City of Culture 2021. The University of Warwick and Coventry University are Principal Partners in the City of Culture project, with both universities engaged in the ongoing development of the regional cultural sector. Following the announcement of Coventry’s success, the two universities have further strengthened their partnership and their connections with the city and its communities, through joint work programmes around monitoring and evaluation and research; the City of Culture University Partnership group; and a Memorandum of understanding to underpin long-term collaboration

Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions

Creative Commons Attribution-NonCommercial 4.0 LicenseInnovations in electronic health record (EHR) systems invite new patient and family engagement methods and create opportunities to reduce healthcare disparities. However, many patients and their identified support persons (ie, proxies) are unsure how to interface with the technology. This phenomenological qualitative study served as a pilot study to investigate the patient, proxy, and provider lived experiences utilizing patient-facing EHR portals. Individual interviews and focus groups were utilized to collect qualitative data from 21 patient, proxy, and healthcare provider participants across 3 time points. Colaizzi's phenomenological data analysis method was utilized to interpret the data. Four themes emerged highlighting critical benefits and obstacles for patients and support persons interfacing with a patient portal: (a) agency, (b) connection, (c) support, and (d) technology literacy. Results help highlight strategies and dispel myths essential to advancing patient and family engagement using EHR patient portal systems. The study's outcomes reflect recommendations for onboarding proxies and improving patient/family engagement and family-centered care models.OA publication support through Carolina Consortium agreement with Sag

Effects Of Educational Weight Loss Interventions On Knee Arthroplasty For Obese Patients

Background: Obese patients (BMI \u3e 30) with osteoarthritis undergoing total knee arthroplasty (TKA) surgery are at an increased risk for operative failure, higher pain level, lengthier recovery time, and decreased mobility post-surgery. Objective: To analyze and synthesize existing evidence to determine the efficacy of educational weight loss interventions prior to TKA on adult obese patients’ recovery time, pain level, and mobility post-surgery. Weight loss intervention education was provided to obese patients aged 35-55 years in the form of nutrition and exercise programs to encourage weight loss. The study group was compared to patients who did not receive this pre-surgical education. Methods: Using the Preferred Reporting Items for Systemic Reviews and Meta-Analysis checklist guide, we conducted database searches for peer-reviewed literature published between 2012-2022 regarding osteoarthritis and obesity, TKA on obese adult patients, and weight loss education for obese patients prior to undergoing TKA. Results: A total of 18 studies (17 quantitative and 1 qualitative) matching the pre-determined criteria for literature appropriate for consideration were identified and objectively evaluated. Thirteen studies did not find significant evidence supporting the hypothesis that weight loss improved TKA outcomes. Seven studies did find evidence supporting this hypothesis, but few directly correlated weight loss education as the only intervention that resulted in positive outcomes six months after TKA. Conclusion: A majority of studies did not report evidence that weight loss education for obese patients undergoing TKA had significant effects six months post-operation on improving surgical outcomes by reducing recovery time, improving the efficacy of the prostheses, or decreasing patient pain levels post-surgery. More research is needed to determine the most effective interventions for long-term improvement of these outcomes among adult obese patients undergoing TKA

On Infrared Excesses Associated With Li-Rich K Giants

Infrared (IR) excesses around K-type red giants (RGs) have previously been discovered using IRAS data, and past studies have suggested a link between RGs with overabundant Li and IR excesses, implying the ejection of circumstellar shells or disks. We revisit the question of IR excesses around RGs using higher spatial resolution IR data, primarily from WISE. Our goal was to elucidate the link between three unusual RG properties: fast rotation, enriched Li, and IR excess. We have 316 targets thought to be K giants, about 40% of which we take to be Li-rich. In 24 cases with previous detections of IR excess at low spatial resolution, we believe that source confusion is playing a role, in that either (a) the source that is bright in the optical is not responsible for the IR flux, or (b) there is more than one source responsible for the IR flux as measured in IRAS. We looked for IR excesses in the remaining sources, identifying 28 that have significant IR excesses by ~20 um (with possible excesses for 2 additional sources). There appears to be an intriguing correlation in that the largest IR excesses are all in Li-rich K giants, though very few Li-rich K giants have IR excesses (large or small). These largest IR excesses also tend to be found in the fastest rotators. There is no correlation of IR excess with the carbon isotopic ratio, 12C/13C. IR excesses by 20 um, though relatively rare, are at least twice as common among our sample of Li-rich K giants. If dust shell production is a common by-product of Li enrichment mechanisms, these observations suggest that the IR excess stage is very short-lived, which is supported by theoretical calculations. Conversely, the Li-enrichment mechanism may only occasionally produce dust, and an additional parameter (e.g., rotation) may control whether or not a shell is ejected.Comment: 73 pages, 21 figures (some of which substantially degraded to meet arXiv file size requirements), accepted to AJ. Full table 1 (and full-res figures) available upon request to the autho

Machine Learning Identifies Clinical and Genetic Factors Associated With Anthracycline Cardiotoxicity in Pediatric Cancer Survivors

BACKGROUND Despite known clinical risk factors, predicting anthracycline cardiotoxicity remains challenging. OBJECTIVES This study sought to develop a clinical and genetic risk prediction model for anthracycline cardiotoxicity in childhood cancer survivors. METHODS We performed exome sequencing in 289 childhood cancer survivors at least 3 years from anthracycline exposure. In a nested case-control design, 183 case patients with reduced left ventricular ejection fraction despite low-dose doxorubicin (\u3c= 250 mg/m(2)), and 106 control patients with preserved left ventricular ejection fraction despite doxorubicin \u3e250 mg/m(2) were selected as extreme phenotypes. Rare/low-frequency variants were collapsed to identify genes differentially enriched for variants between case patients and control patients. The expression levels of 5 top-ranked genes were evaluated in human induced pluripotent stem cell-derived cardiomyocytes, and variant enrichment was confirmed in a replication cohort. Using random forest, a risk prediction model that included genetic and clinical predictors was developed. RESULTS Thirty-one genes were differentially enriched for variants between case patients and control patients (p \u3c 0.001). Only 42.6% case patients harbored a variant in these genes compared to 89.6% control patients (odds ratio: 0.09; 95% confidence interval: 0.04 to 0.17; p = 3.98 x 10(-15)). A risk prediction model for cardiotoxicity that included clinical and genetic factors had a higher prediction accuracy and lower misclassification rate compared to the clinical-only model. In vitro inhibition of gene-associated pathways (PI3KR2, ZNF827) provided protection from cardiotoxicity in cardiomyocytes. CONCLUSIONS Our study identified variants in cardiac injury pathway genes that protect against cardiotoxicity and informed the development of a prediction model for delayed anthracycline cardiotoxicity, and it also provided new targets in autophagy genes for the development of cardio-protective drugs

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

LSST: from Science Drivers to Reference Design and Anticipated Data Products

(Abridged) We describe here the most ambitious survey currently planned in the optical, the Large Synoptic Survey Telescope (LSST). A vast array of science will be enabled by a single wide-deep-fast sky survey, and LSST will have unique survey capability in the faint time domain. The LSST design is driven by four main science themes: probing dark energy and dark matter, taking an inventory of the Solar System, exploring the transient optical sky, and mapping the Milky Way. LSST will be a wide-field ground-based system sited at Cerro Pach\'{o}n in northern Chile. The telescope will have an 8.4 m (6.5 m effective) primary mirror, a 9.6 deg$^2$ field of view, and a 3.2 Gigapixel camera. The standard observing sequence will consist of pairs of 15-second exposures in a given field, with two such visits in each pointing in a given night. With these repeats, the LSST system is capable of imaging about 10,000 square degrees of sky in a single filter in three nights. The typical 5$\sigma$ point-source depth in a single visit in $r$ will be $\sim 24.5$ (AB). The project is in the construction phase and will begin regular survey operations by 2022. The survey area will be contained within 30,000 deg$^2$ with $\delta<+34.5^\circ$, and will be imaged multiple times in six bands, $ugrizy$, covering the wavelength range 320--1050 nm. About 90\% of the observing time will be devoted to a deep-wide-fast survey mode which will uniformly observe a 18,000 deg$^2$ region about 800 times (summed over all six bands) during the anticipated 10 years of operations, and yield a coadded map to $r\sim27.5$. The remaining 10\% of the observing time will be allocated to projects such as a Very Deep and Fast time domain survey. The goal is to make LSST data products, including a relational database of about 32 trillion observations of 40 billion objects, available to the public and scientists around the world.Comment: 57 pages, 32 color figures, version with high-resolution figures available from https://www.lsst.org/overvie