Risk awareness in secondary stroke prevention

Stroke is the single largest cause of disability and second highest cause of death globally. It is estimated that 10 million people a year are affected by stroke in the United Kingdom (UK). Of the 130,000 annual new stroke occurrences in the UK, one third will go on to have a further stroke. Recurrent stroke is more likely to be fatal than first stroke and survivors are more likely to be left with major disability. Many stroke patients do not adhere to secondary prevention strategies due to complex reasons, including lack of appreciation of their high risk of a secondary cardiovascular event. Long-term secondary prevention remains a desired goal in the management of stroke survivors, however, studies have shown that current strategies are not routinely and universally working. Hypothesis: Raising awareness of secondary stroke risk may improve stroke survivor’s adherence to secondary prevention strategies after stroke. Results: A survey of the general public (n=1019) and a population-based study of over 600 stroke survivors found that knowledge about Blood Pressure (BP) and stroke risk factors was poor in high risk populations. Only 55% of stroke survivors were able to cite any well-known vascular risk factors. However, those who were appropriately risk-aware significantly improved their health behaviour post-stroke by consuming less alcohol (P<0.001), less salt (P=0.05) and eating a healthy diet (P=0.02). Further, In a Randomised Controlled Trial setting an intervention to increase risk awareness was successful in increasing awareness (P=0.04) and resulted in a significant increase in knowledge of stroke sub-type (95% CI 0.72-0.677, P<0.001), risk factor control of systolic BP (95% CI 12.1-10.4, P=0.01) and increased the number of healthy lifestyle behaviour changes made at follow-up (P<0.001). Conclusions: Increasing risk awareness is potentially an important mechanism to improve health behaviour following stroke and may improve risk factor control as part of secondary stroke prevention

"Youse awful queer chappie": Reading Black Queer Vernacular in Black Literatures of the Americas, 1903-1967

Read together, twentieth-century representations of black male homoerotism and homosexuality written up to the Black Arts movement shape and complicate traditional definitions of a black racial literary canon. Far from marginal or clandestine, these black men differently depicted in prose and verse continue the kinds of "networks of affiliation" that Saidiya Hartman finds in the communal connections that shaped black life in the nineteenth-century US during slavery and Reconstruction, ones based on the "metaphorical aptitude" demonstrated by black vernacular folk tales and songs. Community founding was necessarily agile. It depended on presence of mind more than melanin as a strategy to wrest the sign of "blackness" from flesh indicating enslavement. It also incorporated rather than homogenized differences within a black racial "community among ourselves," as Hartman calls it. "Youse awful queer chappie" examines how that kind of wily solidarity and resistance supports a body of texts that both contribute to a black literary tradition that Henry Louis Gates, Jr. characterizes as a gathering of "talking books" as well as fashion a particular hermeneutic and technique I call "black queer vernacular." Sometimes, but not always, with the word queer, the black writers I study with this manuscript, tell a story of black masculinity not fungible but mobile. Any individual text or author provides merely one nexus in a textual technique of characters, types, words, and images that demonstrates how the sign of "blackness" incorporates both race and sexuality. Less a rejoinder to scholarship in the fields of African American studies or gay and lesbian studies, the manuscript draws from poststructuralist, feminist, and queer theory to regard an already present dialogue in twentieth century black literary studies. By moving from W.E.B. Du Bois' landmark The Souls of Black Folk, through the Harlem Renaissance and London's Caribbean Artists movement, toward the Black Arts movement, the manuscript highlights how Diaspora informs, even as it fades from, analyses of black representation. It talks back to, and expands, the defining aesthetics of the black racial literary canon

Social contact and the perceived impact of social distancing on health outcomes during the COVID-19 pandemic among community dwelling older adults taking part in the OPAL cohort study

Background: During the COVID-19 pandemic, social distancing and reduced social contact may have affected older adults’ health. Objectives: To evaluate the perceived impact of social distancing on older adults’ health and explore the association between social contact and health outcomes. Design: Cross-sectional and longitudinal analyses of the OPAL cohort study. Subjects: Community dwelling older adults. Methods: We sent questionnaires to participants of an existing cohort study (n = 4328). Questions included the amount and type of social contact, and how often they went outside. Participants rated the impact of social distancing on their health. Sociodemographic factors and quality of life were available from previous questionnaires. We examined quality of life prior to and during the pandemic and explored the cross-sectional relationship between social contact and health using logistic regression. Results: There were 3856/4328 (89%) questionnaires returned. EQ-5D scores changed little compared to pre-pandemic scores but 25% of participants reported their overall health had worsened. The telephone was the most used method of contact (78%). Video calls were used least with 35% of participants not using them or having no access to them. 13% of respondents never went outside. Lower levels of contact were associated with increased risk of reporting worse health (Odds ratio (OR) 1.04 (95% CI 1.01–1.08)). Those experiencing financial strain and who spent less time outside experienced the largest increase in risk of reporting perceived worsened overall health. Those reporting a strain to get by financially were 4 times more likely to report worsened health than those who described themselves as quite comfortably off (OR 4.00 (95% CI 1.86–8.16)). Participants who reported never going outside were twice as likely to report worsened health compared to those who went outside daily (OR 2.00 (95% CI 1.57–2.54)). Conclusions: Less contact with other people was associated with perceived worsening in overall health. Although many older people reported using online technology, such as video calls, a substantial proportion were not using them. Older people facing financial strain were more likely to report worsened health, highlighting the impact of social inequalities during the pandemic. Going outside less was also associated with perceived worsened health

Nursing students' cultural beliefs and understanding of dementia: A phenomenological study across three continents

Background: Migrant nurses have reported difficulties adapting to their new culture and providing culturally sensitive care for people with dementia. However, to date no studies have explored the impact of student nurse's cultural heritage on their beliefs and understanding of dementia. Objectives: To explore the cultural beliefs of dementia of student nurses studying in England, Slovenia, Philippines and New Zealand. Design: An explorative hermeneutic phenomenology design. Settings: Higher Education Institutes delivering undergraduate nursing education in England (University of Greenwich and University of Essex), Slovenia (Angela Boškin Faculty of Health Care), New Zealand (University of Auckland), and the Philippines (University of Silliman). Participants: Student nurses studying nursing in England (n = 81), Slovenia (n = 41), Philippines (n = 53) and New Zealand (n = 6). Participants from England and New Zealand were from diverse cultural backgrounds. Student nurses at the beginning of their studies (n = 100) and towards the end of their studies (n = 81) participated. Methods: Completion of focus groups (n = 23), in England (n = 10), Slovenia (n = 6), Philippines (n = 6), and New Zealand (n = 1). All focus groups were audio recorded and transcribed verbatim. Data was analysed by applying an inductive theoretical approach of the Framework Method, which supports the generation of themes through open unhindered coding, pinpointing, examining, and recording patterns within the data. Results: Two major themes were identified in the data: familial piety and dementia discourse. Familial piety emerged from the importance of family and caring for family members with dementia, subthemes included: ‘my granddad’: familial experience, and ‘better to be with her’: familial home. Dementia discourse emerged from the terminology student nurses applied, such as: ‘preconceptions and misconceptions’ of aggression, and ‘considered crazy’ stigma of dementia due to a lack of awareness. Conclusions: The cultural heritage of student nurses impacted on their beliefs of dementia; however their understanding of the needs, care and support of a person with dementia changed and developed through clinical experience and education

Furan Functionalized Polyesters and Polyurethanes for Thermally Reversible Reactive Hotmelt Adhesives

New reactive hotmelt (RHM) adhesives based on thermally reversible Diels-Alder networks comprising multifunctional furan and maleimide prepolymers are described. The prepolymer mixture is easy to apply in the bulk from the melt and after application to the substrates, the adhesive undergoes polymerization at room temperature resulting in crosslinked bonds. Due to their thermoplastic nature and low melt viscosity at hot melt application temperatures, the adhesives provide processing properties similar to moisture cured polyurethanes (PUR). The technology is isocyanate-free and does not require moisture to initiate the crosslinking. Bonding and tensile properties of the RHM adhesive can be readily tuned by prepolymer design and provide cure rates similar to PUR adhesives. The Diels-Alder adhesives provide versatile adhesion to a variety of substrates and good creep resistance up to the retro temperature. The adhesives show good thermal stability during application and can be recycled multiple times by simple heating/cooling of the bonds providing similar performance. Several furan and maleimide prepolymers were scaled up to multi-Kg quantities to demonstrate the potential for industrial scalability. The results demonstrate that furan-maleimide reversible chemistry can be used for RHM application as a more sustainable alternative to conventional moisture curing PURs which tend to contain harmful residual isocyanate monomers

Enhancement of microphase ordering and mechanical properties of supramolecular hydrogen-bonded polyurethane networks

The improvement of the mechanical properties of supramolecular polymer networks is currently receiving significant interest both within academic and industrial circles in order to enable the application of these desirable stimuli-responsive materials in real world situations. In this study, structural units within phase separated supramolecular polyurethane (SPU) networks have been changed to assess the role of the hard segment composition on the mechanical characteristics of the resultant materials. Notably, increasing the degrees of conformational freedom within the hard segment component of a SPU was found to improve the phase separation and as a consequence also increase the storage modulus of the polymer network. Specifically, replacing 4,4′-methylene diphenyl diisocyanate with 4,4’-dibenzyl diisocyanate within a SPU improved the packing efficiency of the isocyanate derived hard segments and improved the physical properties of the supramolecular polymer network. This study utilised a combination of SAXS, WAXS and AFM analysis to assess the degree of crystallinity within the hard segment component of the polymer network whilst rheological analysis was used to establish the mechanical characteristics of the polymers

Re-usable thermally reversible crosslinked adhesives from robust polyester and poly(ester urethane) Diels–Alder networks

The sustainable design of polymers for applications requires careful consideration of how they can be re-used or recycled at the end of service life. There has been considerable interest in covalent adaptable networks (CANs) which offer the potential of the properties of crosslinked polymers but where the materials can be reprocessed like thermoplastics. Although there have been advances in CAN chemistry, materials tend to creep and industrial applications are limited. Here we show thermally reversible crosslinked adhesives from dissociative Diels–Alder networks which can be re-used repeatedly with versatile adhesion and creep resistance. Monomer and isocyanate-free polyester and poly(ester urethane) prepolymers were successfully synthesized by facile techniques with high atom efficiency and the resulting CANs are easy to apply in bulk from the melt. Mechanical properties can be tuned depending on the prepolymer design with the networks providing versatile adhesion to different substrates and creep resistance to 70–80 °C, above both the Tg and Tm of the networks. The adhesives are thermally stable during application and can be re-used repeatedly by simple heating/cooling cycles in bulk, without solvents or additional process steps, providing the same level of performance. Our results demonstrate that these Diels–Alder networks are robust in mechanical performance up to the temperature where significant dissociation begins to occur. This opens the possibility for the considered design of prepolymer architecture and reversible chemistry to meet the performance requirements of different applications in a truly sustainable fashion via scalable, efficient, industrially facile methodologies – where materials are free of solvents or monomers in their synthesis, processing, application and re-use

The effect of chiral end groups on the assembly of supramolecular polyurethanes

The ability to influence the physical properties of supramolecular polymers has been the subject of numerous synthetic studies in recent years. Tuning properties by adjustment of the polymer composition to modify the degree of phase separation of polar (hard) and apolar (soft) segments in addition to variation of the capability of the polar end groups to self-assemble efficiently via non-covalent interactions (such as hydrogen bonding, aromatic - stacking or metal-ligand binding) has yielded materials with attractive thermo-reversible characteristics. Previously, we have studied supramolecular polyurethanes (SPUs) to understand in more detail the interplay and importance of phase separation and the binding affinity of the polar end group on the physical properties of these interesting thermo-responsive materials. In this paper, we report the positive effect that chirality has upon the self-assembly and physical properties of SPUs. The synthesis of a series of novel SPUs that feature chiral polar end-groups is described in addition to how these chiral moieties improve the order of the relatively weak hydrogen bonding units in this type of supramolecular polymer. The introduction of chiral moieties in the polymer end group induces cooperative arrangements of the components of the hard segments (urethane, urea and aromatic units), leading to SPUs with increased ordered and stronger supramolecular hard segments. The supramolecular interactions of the chiral hard segments were first evaluated by CD and FTIR spectroscopies. In addition, the thermo-responsive nano-segregated structure formed by the columnar aggregates of the SPUs generated was probed by variable temperature CD and FTIR spectroscopies in addition to simultaneous SAXS/WAXS analysis. These studies confirmed the microphase separation morphology also revealed by AFM analysis. Additionally, rheological analysis of the chiral SPUs highlighted the enhancement of the rubbery plateau of chiral SPUs derivatives in comparison to analogous racemic SPUs as a result of the chiral self-assembly motifs. Finally, to explore the mechanical properties of the afforded polymers, electrospinning experiments were undertaken which revealed that defined microfibers were formed at lower concentrations in the case of the homochiral SPUs (ca. 15%) when compared to the racemic analogue, thus confirming the improvement in the supramolecular interactions afforded by the chiral groups

Many happy returns: combining insights from the environmental and behavioural sciences to understand what is required to make reusable packaging mainstream

The introduction of reusable packaging systems (both refill and return) has the potential to significantly reduce waste from single-use plastic packaging. However, for these schemes to be successful, both the environmental impact and the willingness of consumers to engage with such systems need to be carefully considered. This paper combines and discusses two complementary studies: (i) a life cycle assessment comparing the environmental impacts of single-use, refillable, and returnable containers for a takeaway meal, and (ii) a large online survey of UK adults exploring what types of product and packaging consumers are willing to reuse, how, and why. The findings of the life cycle assessment indicate that reusable containers outperform single-use plastic containers on most measures of environmental impact. The survey found that given the choice of disposal, reuse or recycling, that recycling is the preferred method of dealing with packaging once empty in the UK, and that people's decisions with regards to what types of packaging they are willing to reuse are largely driven by the aspects of the packaging itself (e.g., material and type) rather than the nature of the product inside of the packaging (e.g., state of matter of the contents). The survey also showed that people were more willing to engage in reuse systems with which they were already familiar. Additionally the language used to describe these schemes and the term ‘reuse’ needs to be considered. Combined, these factors can be used to determine the best packaging reuse system for a given product and situation