The response to receiving phenotypic and genetic coronary heart disease risk scores and lifestyle advice – a qualitative study

BACKGROUND: Individuals routinely receive information about their risk of coronary heart disease (CHD) based on traditional risk factors as part of their primary care. We are also able to calculate individual's risk of CHD based on their genetic information and at present genetic testing for common diseases is available to the public. Due to the limitations in previous studies further understanding is needed about the impact of the risk information on individual's well-being and health-behaviour. We aimed to explore the short term response to receiving different forms of CHD risk information and lifestyle advice for risk reduction. METHODS: We conducted fourty-one face-to-face interviews and two focus groups across England with participants from the INFORM trial who received a combination of individualised phenotypic and genotypic CHD risk scores and web-based lifestyle advice. Risk scores were presented in different formats, e.g. absolute 10 year risk was presented as a thermometer and expressed as a percentage, natural frequency and 'heart age'. Interviews and focus groups explored participants' understanding and reaction to the risk scores and attempts to change lifestyle during the intervention. We tape-recorded and transcribed the interviews and focus groups and analysed them using thematic analysis. RESULTS: Three main themes were identified: limitations of risk scores to generate concern about CHD risk; the advantages of the 'heart age' format of risk score presentation in communicating a message of sub-optimal lifestyle; and intentions and attempts to make moderate lifestyle changes which were prompted by the web-based lifestyle advice. CONCLUSIONS: There are a number of limitations to the use of risk scores to communicate a message about the need for a lifestyle change. Of the formats used, the 'heart age', if noticed, appears to convey the most powerful message about how far from optimal risk an individual person is. An interactive, user friendly, goal setting based lifestyle website can act as a trigger to initiate moderate lifestyle changes, regardless of concerns about risk scores.INFORM is funded by European Commission Framework 7 EPIC-CVD Grant agreement no: 279233. NHS Blood and Transplant funded the INTERVAL trial. DNA extraction and genotyping in INTERVAL/INFORM was funded by the UK National Institute of Health Research. The coordinating team for INTERVAL/INFORM at the Cardiovascular Epidemiology Unit of the University of Cambridge was supported by core funding from: UK Medical Research Council (G0800270), British Heart Foundation (SP/09/002), British Heart Foundation Cambridge Cardiovascular Centre of Excellence, and UK National Institute for Health Research Cambridge Biomedical Research Centre

First record of the Indo-Pacific species Iphione muricata Savigny in Lamarck, 1818 (Polychaeta: Iphionidae) from the Mediterranean Sea, Israel

The Indo-Pacific scaleworm Iphione muricata was observed and caught in the Mediterranean Sea along the coast of Israel. Morphological and molecular diagnostic characters of the species are discussed. This is the first record of this alien species in the Mediterranean Sea, and its previous reports in the Suez Canal suggest its introduction via Lessepsian migration

Student accounts of space and safety at a South African university: implications for social identities and diversity

Transformation efforts in South African higher education have been under increased scrutiny in recent years, especially following the last years of student activism and calls for decolonization of universities. This article presents data from a participatory photovoice study in which a group of students reflect on their experiences of feeling safe and unsafe at an urban-based historically disadvantaged university. Findings highlight the way in which historical inequalities on the basis of social identities of race, class, and gender, among others, continue to shape experiences, both materially and social-psychologically, in South African higher education. However, and of particular relevance in thinking about a socially just university, participants speak about the value of diversity in facilitating their sense of both material and subjective safety. Thus, a diverse classroom and one that acknowledges and recognizes students across diversities, is experienced as a space of comfort, belonging and safety. Drawing on feminist work on social justice, we argue the importance of lecturer sensitivity and reflexivity to their own practices, as well as the value of social justice pedagogies that not only focus on issues of diversity and equality but also destabilize dominant forms of didactic pedagogy, and engage students’ diverse experiences and perceptions

Asbestos and cancer: An overview of current trends in Europe.

This review assesses the contribution of occupational asbestos exposure to the occurrence of mesothelioma and lung cancer in Europe. Available information on national asbestos consumption, proportions of the population exposed, and exposure levels is summarized. Population-based studies from various European regions on occupational asbestos exposure, mesothelioma, and lung cancer are reviewed. Asbestos consumption in 1994 ranged, per capita, between 0. 004 kg in northern Europe and 2.4 kg in the former Soviet Union. Population surveys from northern Europe indicate that 15 to 30% of the male (and a few percent of the female) population has ever had occupational exposure to asbestos, mainly in construction (75% in Finland) or in shipyards. Studies on mesothelioma combining occupational history with biologic exposure indices indicate occupational asbestos exposure in 62 to 85% of the cases. Population attributable risks for lung cancer among males range between 2 and 50% for definite asbestos exposure. After exclusion of the most extreme values because of methodologic aspects, most of the remaining estimates are within the range of 10 to 20%. Estimates of women are lower. Extrapolation of the results to national figures would decrease the estimates. Norwegian estimates indicate that one-third of expected asbestos-related lung cancers might be avoided if former asbestos workers quit smoking. The combination of a current high asbestos consumption per capita, high exposure levels, and high underlying lung cancer rates in Central Europe and the former Soviet Union suggests that the lung cancers will arise from the smoking-asbestos interaction should be a major concern

Conception of low-rise earthquake-resistant energy-efficient buildings

The article proposes a new earthquake-resistant technology of low-rise building with increased energy efficiency and long-life operation. The proposed solution allows to build low-rise buildings with increased resistance to natural and man-made disasters. The building is frame (made of tube-concrete) and also completely monolithic, where foundation, all walls, floors and roof are filled of polystirolconcrete (composed of concrete and polystyrene), which forms a monolithic construction

Applying manufacturing systems methods towards understanding and redesigning a hospital emergency department

Thesis (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division, Technology and Policy Program, 2008.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Includes bibliographical references (p. 85-88).Emergency Departments have been referred to as the "Safety Net" of our Healthcare system. This is because of their ability to catch all patients who would otherwise slip through the system, due to lack of funds, insurance, time, transportation and knowledge, etc. Because of this, as demand for health treatment increases, the occurrence of crowding in our nation's emergency departments is also increasing. At the same time hospitals are being expected to perform more, with lower funding. Observation of a hospital emergency department yields similarities between the emergency department and a manufacturing system. This is not completely a new concept, yet there have been barriers towards adopting manufacturing system practices into healthcare systems due to differences in culture, economics, politics, and the nature of the system itself. The focus of this thesis is to select manufacturing systems methods and apply them to an emergency department. This application is done with an understanding of the fundamental differences between the two systems. The first applied method is Axiomatic Design, a system design method that clearly maps out the functional requirements of a system to design solutions more efficiently. Upon applying Axiomatic Design to show that it can be used to discover and describe problems in an Emergency Department, the specific problem of patient flow is selected. Discrete Event Simulation is used in order to analyze patient flow in the Emergency Department. This results in actionable changes in the operations of an emergency department fast track. One significant actionable change is the creation of a new index for assigning patients a level based on their expected time in the Emergency Room to be used in conjunction with the current index which is based on acuity level. The purpose of this exercise is to show that manufacturing methods can be applied in an emergency department/healthcare system while taking the differences between the two systems into account.by Jordan S. PeckS.M

Using prediction to facilitate patient flow in a health care delivery chain

Thesis (Ph. D.)--Massachusetts Institute of Technology, Engineering Systems Division, 2013.Cataloged from PDF version of thesis.Includes bibliographical references (p. 163-178).A health care delivery chain is a series of treatment steps through which patients flow. The Emergency Department (ED)/Inpatient Unit (IU) chain is an example chain, common to many hospitals. Recent literature has suggested that predictions of IU admission, when patients enter the ED, could be used to initiate IU bed preparations before the patient has completed emergency treatment and improve flow through the chain. This dissertation explores the merit and implications of this suggestion. Using retrospective data collected at the ED of the Veterans Health Administration Boston Health Care System (VHA BHS), three methods are selected for making admission predictions: expert opinion, naive Bayes conditional probability and linear regression with a logit link function (logit-linear regression). The logit-linear regression is found to perform best. Databases of historic data are collected from four hospitals including VHA BHS. Logit-linear regression prediction models generated for each individual hospital perform well based on multiple measures. The prediction model generated for the VHA BHS hospital continues to perform well when predictive data are collected and coded prospectively by nurses. For two weeks, predictions are made on each patient that enters the VHA BHS ED. This data is then summarized and displayed on the VHA BHS internet homepage. No change was observed in key ED flow measures; however, interviews with hospital staff exposed ways in which the prediction information was valuable: planning individual patient admissions, personal scheduling, resource scheduling, resource alignment, and hospital network coordination. A discrete event simulation of the system shows that if IU staff emphasizes discharge before noon, flow measures improve as compared to a baseline scenario where discharge priority begins at 1pm. Sharing ED crowding or prediction information leads to best patient flow performance when using specific schedules dictating IU response to the information. This dissertation targets the practical and theoretical implications of using prediction to improve flow through the ED/IU health care delivery chain. It is suggested that the results will have impact on many other levels of health care delivery that share the delivery chain structure.by Jordan Shefer Peck.Ph.D

Masculinity, sexuality and vulnerability in 'working' with young men in South African contexts: 'you feel like a fool and an idiot...a loser'

South Africa has seen a rapid increase in scholarship and programmatic interventions focusing on gender and sexuality, and more recently on boys, men and masculinities. In this paper, we argue that a deterministic discourse on men's sexuality and masculinity in general is inherent in many current understandings of adolescent male sexuality, which tend to assume that young women are vulnerable and powerless and young men are sexually powerful and inevitably also the perpetrators of sexual violence. Framed within a feminist, social constructionist the oretical perspective, the current research looked at how the masculinity and sexuality of South African young men is constructed, challenged or maintained. Focus groups were conducted with young men between the ages of 15 and 20 years from five different schools in two regions of South Africa, the Western and Eastern Cape. Data were analysed using Gilligan's listening guide method. Findings suggest that participants in this study have internalised the notion of themselves as dangerous, but were also exploring other possible ways of being male and being sexual, demonstrating more complex experiences of manhood. We argue for the importance of documenting and highlighting the precariousness, vulnerability and uncertainty of young men in scholarly and programmatic work on masculinities.IBS

Who needs a father? South African men reflect on being fathered

The legacy of apartheid and continued social and economic change have meant that many South African men and women have grown up in families from which biological fathers are missing. In both popular and professional knowledge and practice this has been posed as inherently a problem particularly for boys who are assumed to lack a positive male role model. In drawing on qualitative interviews with a group of South African men in which they speak about their understandings of being fathered as boys, this paper makes two key arguments. The first is that contemporary South African discourses tend to pathologize the absence of the biological father while simultaneously undermining the role of social fathers. Yet, this study shows that in the absence of biological fathers other men such as maternal or paternal uncles, grandfathers, neighbours, and teachers often serve as social fathers. Most of the men who participated in this study are able to identify men who - as social rather than biological fathers - played significant roles in their lives. Secondly, we suggest that while dominant discourses around social fatherhood foreground authoritarian and controlling behaviours, there are moments when alternative more nurturing and consultative versions of being a father and/or being fathered are evident in the experiences of this group of men.IS