Where's the harm? A social marketing approach to reframing 'problem' drinking cultures

Alcohol consumption is often linked to a broad range of social and health problems, yet alcohol also plays a fundamental role in social bonding between people. This paper considers the potential of social marketing to contribute to alcohol consumption reduction and reframe social norms that encourage 'problem' drinking. Based on qualitative research with a variety of Scottish drinkers, the paper emphasises how and why a better understanding of the culturally bound meanings of alcohol (e.g. social identity, self-concept) are of crucial importance to inform any social marketing approach to reframing excessive drinking

Transatlantic Issues: Report from Scotland

Several bioethical topics received a great deal of news coverage here in Scotland in 2009. Three important issues with transatlantic connections are the swine flu outbreak, which was handled very differently in Scotland, England, and America; the U.S. debate over healthcare reform, which drew the British National Health Service (NHS) into the controversy; and the release to Libya of the Lockerbie bomber, which at first glance might not seem particularly bioethical, but which actually hinged on the very public discussion of the prisoner’s medical records. On a national level, there have been attempts in both Scotland and England to change the law on assisted suicide, where success looks more likely than ever. This paper discusses each of these issues and hopefully will raise awareness of how these issues were dealt with in the United Kingdom and its component countries

Development and evaluation of an early detection intervention for mouth cancer using a mass media approach

Scotland has a high incidence of mouth cancer, but public awareness and knowledge are low compared with other cancers. The West of Scotland Cancer Awareness Project sought to increase public awareness and knowledge of mouth cancer and to encourage early detection of symptoms among an at-risk population of people aged over 40 years from lower socio-economic groups using a mass media approach. The media campaign aimed to increase people’s feelings of personal risk, while also enhancing feelings of efficacy and control. To achieve this, a testimonial approach (using real people to tell their own stories) was adopted

A Two-Phase Model of Early Fibrous Cap Formation in Atherosclerosis

Atherosclerotic plaque growth is characterised by chronic inflammation that promotes accumulation of cellular debris and extracellular fat in the inner artery wall. This material is highly thrombogenic, and plaque rupture can lead to the formation of blood clots that occlude major arteries and cause myocardial infarction or stroke. In advanced plaques, vascular smooth muscle cells (SMCs) migrate from deeper in the artery wall to synthesise a cap of fibrous tissue that stabilises the plaque and sequesters the thrombogenic plaque content from the bloodstream. The fibrous cap provides crucial protection against the clinical consequences of atherosclerosis, but the mechanisms of cap formation are poorly understood. In particular, it is unclear why certain plaques become stable and robust while others become fragile and vulnerable to rupture. We develop a multiphase model with non-standard boundary conditions to investigate early fibrous cap formation in the atherosclerotic plaque. The model is parameterised using a range of in vitro and in vivo data, and includes highly nonlinear mechanisms of SMC proliferation and migration in response to an endothelium-derived chemical signal. We demonstrate that the model SMC population naturally evolves towards a steady-state, and predict a rate of cap formation and a final plaque SMC content consistent with experimental observations in mice. Parameter sensitivity simulations show that SMC proliferation makes a limited contribution to cap formation, and highlight that stable cap formation relies on a critical balance between SMC recruitment to the plaque, SMC migration within the plaque and SMC loss by apoptosis. The model represents the first detailed in silico study of fibrous cap formation in atherosclerosis, and establishes a multiphase modelling framework that can be readily extended to investigate many other aspects of plaque development

A Multiphase Model of Growth Factor-Regulated Atherosclerotic Cap Formation

Atherosclerosis is characterised by the growth of fatty plaques in the inner (intimal) layer of the artery wall. In mature plaques, vascular smooth muscle cells (SMCs) are recruited from the adjacent medial layer to deposit a cap of fibrous collagen over the fatty plaque core. The fibrous cap isolates the thrombogenic content of the plaque from the bloodstream and prevents the formation of blood clots that cause myocardial infarction or stroke. Despite the important protective role of the cap, the mechanisms that regulate cap formation and maintenance are not well understood. It remains unclear why certain caps become stable, while others become vulnerable to rupture. We develop a multiphase PDE model with non-standard boundary conditions to investigate collagen cap formation by SMCs in response to growth factor signals from the endothelium. Diffusible platelet-derived growth factor (PDGF) stimulates SMC migration, proliferation and collagen degradation, while diffusible transforming growth factor (TGF)-$\beta$ stimulates SMC collagen synthesis and inhibits collagen degradation. The model SMCs respond haptotactically to gradients in the collagen phase and have reduced rates of migration and proliferation in dense collagenous tissue. The model, which is parameterised using a range of in vivo and in vitro experimental data, reproduces several observations from studies of plaque growth in atherosclerosis-prone mice. Numerical simulations and model analysis demonstrate that a stable cap can be formed by a relatively small SMC population and emphasise the critical role of TGF-$\beta$ in effective cap formation and maintenance. These findings provide unique insight into the cellular and biochemical mechanisms that may lead to plaque destabilisation and rupture. This work represents an important step towards the development of a comprehensive in silico plaque

Detecting contour crossings in contour dynamical and contour-advective semi-Lagrangian simulations

Contour dynamics and contour-advective methods are commonly used numerical techniques for simulating inviscid fluid motions. In these methods the vorticity or potential vorticity of a flow is represented by a series of contours which are advected according to the prevailing velocity field. In some circumstances the contours may cross, eroding the accuracy of the numerical solution and violating the equations of motion. This paper describes an automated method for explicitly revealing such crossings, first considering the case of determining if two contours cross and then later the more general case of determining if and where an arbitrary number of contours cross

Defining forgiveness: Christian clergy and general population perspectives.

The lack of any consensual definition of forgiveness is a serious weakness in the research literature (McCullough, Pargament &amp; Thoresen, 2000). As forgiveness is at the core of Christianity, this study returns to the Christian source of the concept to explore the meaning of forgiveness for practicing Christian clergy. Comparisons are made with a general population sample and social science definitions of forgiveness to ensure that a shared meaning of forgiveness is articulated. Anglican and Roman Catholic clergy (N = 209) and a general population sample (N = 159) completed a postal questionnaire about forgiveness. There is agreement on the existence of individual differences in forgiveness. Clergy and the general population perceive reconciliation as necessary for forgiveness while there is no consensus within psychology. The clergy suggests that forgiveness is limitless and that repentance is unnecessary while the general population suggests that there are limits and that repentance is necessary. Psychological definitions do not conceptualize repentance as necessary for forgiveness and the question of limits has not been addressed although within therapy the implicit assumption is that forgiveness is limitless.</p

Accuracy of the "traffic light" clinical decision rule for serious bacterial infections in young children with fever: A retrospective cohort study

Objectives To determine the accuracy of a clinical decision rule (the traffic light system developed by the National Institute for Health and Clinical Excellence (NICE)) for detecting three common serious bacterial infections (urinary tract infection, pneumonia, and bacteraemia) in young febrile children. Design Retrospective analysis of data from a two year prospective cohort study Setting A paediatric emergency department. Participants 15 781 cases of children under 5 years of age presenting with a febrile illness. Main outcome measures Clinical features were used to categorise each febrile episodes as low, intermediate, or high probability of serious bacterial infection (green, amber, and red zones of the traffic light system); these results were checked (using standard radiological and microbiological tests) for each of the infections of interest and for any serious bacterial infection. Results After combination of the intermediate and high risk categories, the NICE traffic light system had a test sensitivity of 85.8% (95% confidence interval 83.6% to 87.7%) and specificity of 28.5% (27.8% to 29.3%) for the detection of any serious bacterial infection. Of the 1140 cases of serious bacterial infection, 157 (13.8%) were test negative (in the green zone), and, of these, 108 (68.8%) were urinary tract infections. Adding urine analysis (leucocyte esterase or nitrite positive), reported in 3653 (23.1%) episodes, to the traffic light system improved the test performance: sensitivity 92.1% (89.3% to 94.1%), specificity 22.3% (20.9% to 23.8%), and relative positive likelihood ratio 1.10 (1.06 to 1.14). Conclusion The NICE traffic light system failed to identify a substantial proportion of serious bacterial infections, particularly urinary tract infections. The addition of urine analysis significantly improved test sensitivity, making the traffic light system a more useful triage tool for the detection of serious bacterial infections in young febrile children