Bereavement through substance use: findings from an interview study with adults in England and Scotland

Background Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. © 2016 Taylor & Franci

On the orientation of the Sagittarius A* system

The near-infrared emission from the black hole at the Galactic center (Sgr A*) has unique properties. The most striking feature is a suggestive periodic sub-structure that has been observed in a couple of flares so far. Using near-infrared polarimetric observations and modelling the quasi-periodicity in terms of an orbiting blob, we try to constrain the three dimensional orientation of the Sgr A* system. We report on so far unpublished polarimetric data from 2003. They support the observations of a roughly constant mean polarization angle of 60 degr \pm 20 degr from 2004-2006. Prior investigations of the 2006 data are deepened. In particular, the blob model fits are evaluated such that constraints on the position angle of Sgr A* can be derived. Confidence contours in the position-inclination angle plane are derived. On a 3sigma level the position angle of the equatorial plane normal is in the range 60 degr - 108 degr (east of north) in combination with a large inclination angle. This agrees well with recent independent work in which radio spectral/morphological properties of Sgr A* and X-ray observations, respectively, have been used. However, the quality of the presently available data and the uncertainties in our model bring some ambiguity to our conclusions.Comment: 10 pages, 4 figures; Research Note accepted by A&A for publicatio

K-band polarimetry of an Sgr A* flare with a clear sub-flare structure

Context: The supermassive black hole at the Galactic center, SgrA*, shows frequent radiation outbursts, often called 'flares'. In the near-infrared some of these flares were reported as showing intrinsic quasi-periodicities. The flux peaks associated with the quasi-periodic behavior were found to be highly polarized. Aims: The aim of this work is to present new evidence to support previous findings of the properties of the polarized radiation from SgrA* and to again provide strong support for the quasi-periodicity of ~18+-3 min reported earlier. Methods: Observations were carried out at the European Southern Observatory's Very Large Telescope on Paranal, Chile. We used the NAOS/CONICA adaptive optics/near-infrared camera instrument. By fitting the polarimetric lightcurves with a hot-spot model, we addressed the question of whether the data are consistent with this model. To fit the observed data we used a general relativistic ray-tracing code in combination with a simple hot-spot/ring model. Results: We report on new polarization measurements of a K-band flare from the supermassive black hole at the Galactic center. The data provide very strong support for a quasi-periodicity of 15.5+-2 min. The mean polarization of the flare is consistent with the direction of the electric field vector that was reported in previous observations. The data can be modeled successfully with a combined blob/ring model. The inclination i of the blob orbit must be i > 20 deg on a 3sigma level, and the dimensionless spin parameter of the black hole is derived to be a > 0.5.Comment: accepted by A&A Letters for publication; 5 pages, 9 figure

Rethinking the employability of international graduate migrants: reflections on the experiences of Zimbabweans with degrees from England

The last decade has seen the rise of literatures that have focused on the rapid expansion of the numbers of international students in higher education globally and the growing policy discourse around improving graduate employability. However, both, inevitably, have limitations. Together, they tend to homogenise international learners and see them narrowly as simply economic actors. More recently, however, there have been signs of important new developments in both literatures, drawing on interactive employability and capability accounts that stress both agency and structure in more satisfactory ways. We seek to further the development of an account that bridges the new wave of student mobility research and the capability-employability account. In doing so, we offer two further elements to the literature. First, we aim to bridge the gap between international higher education accounts and those of migration and diasporic studies. Second, we deliberately focus on a group that is marginal to the mainstream discourse but who are migrants that have engaged in international higher education in order to improve their labour market prospects, amongst other motivations. We do this through examining the stories of five Zimbabweans who embarked on additional higher educational studies in England after migrating to the country. Through this unique approach, we offer an important new perspective on how the debates on international higher education, employability and migration can be taken forward through closer articulation between these accounts

British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 3: special circumstances

\ua9 2023 BMJ Publishing Group. All rights reserved.The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis

The role of attachment in body weight gain and weight loss in bariatric patients

Purpose: To explore the role of attachment styles in obesity. Material and methods: The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n=195) and an age, sex and height matched normal weight control group (n=195). It then explored the role of attachment styles in predicting change in BMI one year post bariatric surgery (n=143). Results: The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non obese group. Baseline attachment styles did not, however, predict change in BMI post-surgery. Conclusion: Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post-surgery

Near-infrared polarimetry setting constraints on the orbiting spot model for Sgr A* flares

Context: Recent near-infrared polarization measurements of SgrA* show that its emission is significantly polarized during flares and consists of a non- or weakly polarized main flare with highly polarized sub-flares. The flare activity suggests a quasi-periodicity of ~20 minutes in agreement with previous observations. Aims: By simultaneous fitting of the lightcurve fluctuations and the time-variable polarization angle, we address the question of whether these changes are consistent with a simple hot spot/ring model, in which the interplay of relativistic effects plays the major role, or whether some more complex dependency of the intrinsic emissivity is required. Methods: We discuss the significance of the 20min peak in the periodogram of a flare from 2003. We consider all general relativistic effects that imprint on the polarization degree and angle and fit the recent polarimetric data, assuming that the synchrotron mechanism is responsible for the intrinsic polarization and considering two different magnetic field configurations. Results: Within the quality of the available data, we think that the model of a single spot in addition to an underlying ring is favoured. In this model the broad near-infrared flares of Sgr A* are due to a sound wave that travels around the MBH once while the sub-flares, superimposed on the broad flare, are due to transiently heated and accelerated electrons which can be modeled as a plasma blob. Within this model it turns out that a strong statement about the spin parameter is difficult to achieve, while the inclination can be constrained to values > 35 deg on a 3sigma level.Comment: accepted by A&A for publicatio

British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 1: compensated cirrhosis

\ua9 2023 BMJ Publishing Group. All rights reserved.The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Here, in part one, we focus on outpatient management of compensated cirrhosis, encompassing hepatocellular cancer surveillance, screening for varices and osteoporosis, vaccination and lifestyle measures. We also introduce a compensated cirrhosis care bundle for use in the outpatient setting. Part two concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. The third part of the guidance covers special circumstances encountered in managing people with cirrhosis: surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis

The impact of psychological support on weight loss post weight loss surgery: a randomised control trial

Background The purpose of the present study is to evaluate the impact of a health psychology-led bariatric rehabilitation service (BRS) on patient weight loss following bariatric surgery at 1 year. Methods A single-site open-randomised parallel group control trial based at St. Richard’s Hospital in Chichester in the UK. Patients (n=162) were recruited immediately prior to Roux-en-Y gastric bypass and randomly allocated to receive either treatment as usual (n=80) or the BRS (n=82). The BRS involved three 50-min one-to-one sessions with a health psychologist and provided information, support and mentoring pre and post surgery addressing psychological issues such as dietary control, self esteem, coping and emotional eating. Weight loss was assessed at 1 year. The key outcome variable was BMI and change in BMI. Results Follow-up weight was available for 145 patients. Intention-to-treat analysis (n=162) using last measured weights showed that mean change in BMI by 1 year post surgery was −16.49. There was no significant difference between the two groups (control group=−16.37, 95 % CI= 15.15–17.57; intervention=−16.6, 95 % CI=15.42–17.81; ηp 2=0.001). Similarly, explanatory analysis (n=145) showed a mean change inBMI of −17.17. The difference between the two groups was not significant (control group=−16.9, 95 % CI=15.78–18.18; intervention=−17.35, 95 % CI=18.5– 16.16; ηp 2=0.001). Conclusions Psychological support pre and post bariatric surgery had no impact on weight loss as measured by BMI and change in BMI by 1 year. It is argued that psychological support should be targeted to patients who start to demonstrate weight regain at a later stage

Critical review of behaviour change techniques applied in intervention studies to improve cooking skills and food skills among adults

BACKGROUND: Cooking and food skills interventions have grown in popularity; however, there is a lack of transparency as to how these interventions were designed, highlighting a need to identify and understand the mechanisms of behavior change so that effective components may be introduced in future work. This study critiques cooking and food skills interventions in relation to their design, behavior change techniques (BCTs), theoretical underpinnings, and outcomes. METHODS: A 40-item CALO-RE taxonomy was used to examine the components of 59 cooking and food skills interventions identified by two systematic reviews. Studies were coded by three independent coders. RESULTS: The three most frequently occurring BCTs identified were #1 Provide information on consequences of behavior in general; #21 Provide instruction on how to perform the behavior; and #26 Prompt Practice. Fifty-six interventions reported positive short-term outcomes. Only 14 interventions reported long-term outcomes containing BCTs relating to information provision. CONCLUSION: This study reviewed cooking and food skills interventions highlighting the most commonly used BCTs, and those associated with long-term positive outcomes for cooking skills and diet. This study indicates the potential for using the BCT CALO-RE taxonomy to inform the design, planning, delivery and evaluation of future interventions