“Doing the same puzzle over and over again”: a qualitative analysis of feeling stuck in grief

This research aimed to examine the meanings and constructions underlying narratives on feeling stuck in the grieving process and the interplay between grief experience and the internally and externally sourced expectations about the nature of grief. Four participants who self-referred to a National Bereavement support charity and reported feeling stuck in grief were interviewed and the resultant transcripts were analysed using Interpretative Phenomenological Analysis (IPA). Four Master Themes emerged from the analysis: Eclipsed by the deceased; The power in powerlessness; The double-edged sword of coping behaviours and Living in Purgatory. The results reveal new insights on the significance and consequences of living with unresolved dilemmas of grieving, namely being stuck in a vicious cycle of fear and avoidance and feeling a sense of impending doom, loneliness and stagnancy. Findings support a meaning reconstruction approach to grief therapy and highlight the negative implications of holding a time-limited, stage-based conceptualistion of grief. Suggestions for service providers are made, including the potential for using targeted cognitive-behavioral grief interventions that can help to reduce dissonance and address an over dependence on avoidance and polarised thinking

Risk? Crisis? Emergency? Implications of the new climate emergency framing for governance and policy

The term “climate emergency” represents a new phase in climate change framing that many hope will invigorate more climate action. Yet there has been relatively little discussion of how the new emergency framing might shape broader governance and policy. In this advanced review, we critically review and synthesize existing literature on crisis and emergency to inform our understanding of how this new shift might affect governance and policy. Specifically, we explore the literature on crisis governance and policy to argue that there is no simple answer to whether the “climate emergency” framing will be supportive of climate governance and policy; rather, more work needs to be done to understand how different political actors respond according to their perceptions, interests and values. To assist this endeavor, we develop a typology of four policy pathways, ranging from “no emergency,” to “no emergency, but recognize risk,” “emergency as a threat” and “emergency as an opportunity.” We highlight the need to consider the effects of multiple and overlapping emergency frames, using the example of the intersection of climate change and COVID-19. Finally, we suggest new interdisciplinary research directions for critically analyzing and refining this new phase of climate change framing

Literature-Augmented Clinical Outcome Prediction

We present BEEP (Biomedical Evidence-Enhanced Predictions), a novel approach for clinical outcome prediction that retrieves patient-specific medical literature and incorporates it into predictive models. Based on each individual patient's clinical notes, we train language models (LMs) to find relevant papers and fuse them with information from notes to predict outcomes such as in-hospital mortality. We develop methods to retrieve literature based on noisy, information-dense patient notes, and to augment existing outcome prediction models with retrieved papers in a manner that maximizes predictive accuracy. Our approach boosts predictive performance on three important clinical tasks in comparison to strong recent LM baselines, increasing F1 by up to 5 points and precision@Top-K by a large margin of over 25%.Comment: To appear in Findings of NAACL 2022. Code available at: https://github.com/allenai/BEE

Systematic Review of Peer Support for Breastfeeding Continuation: Metaregression Analysis of the Effect of Setting, Intensity, and Timing

Objective To examine the effect of setting, intensity, and timing of peer support on breast feeding. Design Systematic review and metaregression analysis of randomised controlled trials. Data sources Cochrane Library, Medline, CINAHL, the National Research Register, and British Nursing Index were searched from inception or from 1980 to 2011. Review methods Study selection, data abstraction, and quality assessment were carried out independently and in duplicate. Risk ratios and 95% confidence intervals were calculated for individual studies and pooled. Effects were estimated for studies grouped according to setting (high income countries, low or middle income countries, and the United Kingdom), intensity (<5 and ≥5 planned contacts), and timing of peer support (postnatal period with or without antenatal care), and analysed using metaregression for any and exclusive breast feeding at last study follow-up. Results Peer support interventions had a significantly greater effect on any breast feeding in low or middle income countries (P<0.001), reducing the risk of not breast feeding at all by 30% (relative risk 0.70, 95% confidence interval 0.60 to 0.82) compared with a reduction of 7% (0.93, 0.87 to 1.00) in high income countries. Similarly, the risk of non-exclusive breast feeding decreased significantly more in low or middle income countries than in high income countries: 37% (0.63, 0.52 to 0.78) compared with 10% (0.90, 0.85 to 0.97); P=0.01. No significant effect on breast feeding was observed in UK based studies. Peer support had a greater effect on any breastfeeding rates when given at higher intensity (P=0.02) and only delivered in the postnatal period (P<0.001), although no differences were observed of its effect on exclusive breastfeeding rates by intensity or timing. Conclusion Although peer support interventions increase breastfeeding continuation in low or middle income countries, especially exclusive breast feeding, this does not seem to apply in high income countries, particularly the United Kingdom, where breastfeeding support is part of routine postnatal healthcare. Peer support of low intensity does not seem to be effective. Policy relating to provision of peer support should be based on more specific evidence on setting and any new peer services in high income countries need to undergo concurrent evaluation

What if all children achieved WHO recommendations on physical activity? Estimating the impact on socioeconomic inequalities in childhood overweight in the UK Millennium Cohort Study

Background: The World Health organization (WHO) recommends that children engage in 60 min daily moderate-to-vigorous physical activity (dMVPA). Just half of children in the UK achieve these levels (with similarly low levels in other high-income countries). Thus, the dMVPA target is a focus of national obesity strategies. However, the potential impact of increased physical activity on prevalence and inequalities in childhood overweight is unknown. Using objective data from the Millennium Cohort Study (∼18 000 children born 2000–02) we simulated a series of hypothetical physical activity intervention scenarios: achievement of the target, and more realistic increases demonstrated in trials. Methods: Predicted probabilities of overweight and obesity (using measured heights and weights at age 11) were estimated in multinomial marginal structural models, adjusting for dMVPA (measured with accelerometers at age 7) and confounding. Inequalities were assessed according to household income quintiles [risk ratios (RRs) and risk differences (RDs)]. Intervention scenarios were simulated by re-estimating predicted probabilities of overweight/obesity after manipulating (increasing) dMVPA by varying amounts, for different eligibility criteria and with varying uptake. Analyses included 6493 children with accelerometer data. Survey weights and multiple imputation addressed sampling design, attrition and item missingness. Results: In all, 27% children were overweight/obese, with relative and absolute inequalities in the expected direction; 51% children were achieving 60 min dMVPA, with those from the lowest income quintile achieving, on average, 3 min more dMVPA than those from the highest income quintile. A simulation of universal achievement of the dMVPA target reduced the prevalence of overweight/obesity to 22%, but increased relative inequalities (absolute inequalities were unchanged). Smaller increases in dMVPA (informed by intervention evidence) did little to reduce prevalence or inequalities, even when targeting high-risk groups. Conclusions: Universal achievement of the WHO dMVPA target, if attainable, would reduce prevalence of childhood overweight and obesity but not inequalities. Scale-up of more realistic interventions would have limited impact