Managing bereavement in the classroom: a conspiracy of silence?

The ways in which teachers in British schools manage bereaved children are under-reported. This article reports the impact of students' bereavement and their subsequent management in primary and secondary school classrooms in Southeast London. Thirteen school staff working in inner-city schools took part in in-depth interviews that focused on the impact of bereaved children on the school and how teachers responded to these children. All respondents had previously had contact with a local child bereavement service that aims to provide support, advice, and consultancy to children, their parents, and teachers. Interviews were audiotaped, transcribed verbatim, and analyzed using ATLAS-ti. Three main themes were identified from analysis of interview data. Firstly, British society, culture, local communities, and the family were significant influences in these teachers' involvement with bereaved students. Secondly, school staff managed bereaved students through contact with other adults and using practical classroom measures such as "time out" cards and contact books. Lastly, teachers felt they had to be strong, even when they were distressed. Surprise was expressed at the mature reaction of secondary school students to deaths of others. The article recommends that future research needs to concentrate on finding the most effective way of supporting routinely bereaved children, their families, and teachers

The tilt of mean sea level along the east coast of North America

The tilt of mean sea level along the North American east coast has been a subject of debate for many decades. Improvements in geoid and ocean circulation models, and GPS positioning of tide gauge benchmarks, provide an opportunity to produce new tilt estimates. Tilts estimated using tide gauge measurements referenced to high-resolution geoid models (the geodetic approach) and ocean circulation models (the ocean approach) are compared. The geodetic estimates are broadly similar, with tilts downward to the north through the Florida Straits and at Cape Hatteras. Estimates from the ocean approach show good agreement with the geodetic estimates, indicating a convergence of the two approaches and resolving the long standing debate as to the sign of the tilt. These tilts differ from those used by Yin and Goddard (2013) to support a link between changing ocean circulation and coastal sea level rise

Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools.

BACKGROUND: Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people. METHODS: A systematic mixed-methods review with a results-based convergent synthesis design: a process-based iterative logic model was used, starting with a conceptual framework of clinical uncertainty in older people towards the end of life. This underpinned the methods. Medline, PsycINFO, CINAHL and ASSIA were searched from 2000 to December 2019, using a combination of terms: "uncertainty" AND "palliative care" AND "assessment" OR "care planning". Studies were included if they developed or evaluated a person-centred tool to manage clinical uncertainty in people aged ≥65 years approaching the end of life and quality appraised using QualSyst. Quantitative and qualitative data were narratively synthesised and thematically analysed respectively and integrated into the logic model. RESULTS: Of the 17,095 articles identified, 44 were included, involving 63 tools. There was strong evidence that tools used in clinical care could improve identification of patient priorities and needs (n = 14 studies); that tools support partnership working between patients and practitioners (n = 8) and that tools support integrated care within and across teams and with patients and families (n = 14), improving patient outcomes such as quality of death and dying and satisfaction with care. Communication of clinical uncertainty to patients and families had the least evidence and is challenging to do well. CONCLUSION: The identified logic model moves current knowledge from conceptualising clinical uncertainty to applying evidence-based tools to optimise person-centred management and improve patient outcomes. Key causal pathways are identification of individual priorities and needs, individual care and treatment and integrated care. Communication of clinical uncertainty to patients is challenging and requires training and skill and the use of tools to support practice

Isotopic and Compositional Variations in Single Nuclear Fuel Pellet Particles Analyzed by Nanoscale Secondary Ion Mass Spectrometry

Article published under an ACS AuthorChoice LicenseThe Collaborative Materials Exercise (CMX) is organized by the Nuclear Forensics International Technical Working Group, with the aim of advancing the analytical capabilities of the participating organizations and providing feedback on the best approaches to a nuclear forensic investigation. Here, model nuclear fuel materials from the 5th CMX iteration were analyzed using a NanoSIMS 50L (CAMECA) in order to examine inhomogeneities in the U-235/U-238 ratio and trace element abundance within individual, micrometer scale particles. Two fuel pellets were manufactured for the exercise and labelled CMX-5A and CMX-5B. These pellets were created using different processing techniques, but both had a target enrichment value of U-235/U-238 = 0.01. Particles from these pellets were isolated for isotopic and trace element analysis. Fifteen CMX-5A particles and 20 CMX-5B particles were analyzed, with both sample types displaying inhomogeneities in the U isotopic composition at a sub-micrometer scale within individual particles. Typical particle diameters were similar to 1.5 to 41 mu m for CMX-5A and similar to 1 to 61 mu m for CMX-5B. The CMX-5A particles were shown to be more isotopically homogeneous, with a mean U-235/U-238 atom ratio of 0.0130 +/- 0.0066. The CMX-5B particles showed a predominantly depleted mean U-235/U-238 atom ratio of 0.0063 +/- 0.0094, which is significantly different to the target enrichment value of the pellet and highlights the potential variation of U-235/U-238 in U fuel pellets at the micrometer scale. This study details the successful application of the NanoSIMS 50L in a mock nuclear forensic investigation by optimizing high-resolution imaging for uranium isotopics.Peer reviewe

Living arrangements and place of death of older people with cancer in England and Wales: a record linkage study

The main objectives of the study were to (1) see whether the household circumstances of people aged 50 years and over with cancer, and trends in these, differ from those of the rest of the population and (2) whether living arrangements and presence and health status of a primary coresident are associated with place of death among older people dying of cancer and those dying from other causes. The design included prospective record linkage study of people aged 50 years and over included in a 1% sample of the population of England and Wales (the Office for National Statistics Longitudinal Study). The main outcome measures comprised family and household type, and death at home. The household circumstances of older people with cancer were very similar to those of the rest of the population of the same age and both showed a large increase in living alone, and decrease in living with relatives, between 1981 and 1991. The primary coresident of cancer sufferers who did not live alone was in most cases a spouse, with much smaller proportions living with a child, sibling or other person. In all, 30% of spouse, and 23% of other, primary coresidents had a limiting long-term illness. Compared with people who lived alone in 1991, odds of a home death among those dying of cancer between 1991 and 1995 were highest for those who lived with a spouse who had no limiting long-term illness (odds ratio (OR) 2.52, 95% confidence interval (CI) 2.15-2.97) and raised for those living with a spouse with a long-term illness (OR 2.14, CI 1.79-2.56) and those living with someone else who was free of long-term illness (OR 2.13, CI 1.69-2.68). Higher socioeconomic status, both individual and area, was positively associated with increased chance of a home death, while older age reduced the chance of dying at home. The changing living arrangements of older people have important implications for planning and provision of care and treatment for cancer sufferers

Patterns and predictors of place of cancer death for the oldest old

BACKGROUND: Cancer patients increasingly are among older age groups, but to date little work has examined the trends in cancer among older people, particularly in relation to end of life care and death. This study describes the older population who die of cancer and the factors which may affect their place of death. METHODS: A Cross-sectional analysis of national data was performed. The study included all people aged 75 and over dying of cancer in England and Wales between 1995 and 1999. The population was divided into exclusive 5 year age cohorts, up to 100 years and over. Descriptive analysis explored demographic characteristics, cancer type and place of death. RESULTS: Between 1995 and 1999, 315,462 people aged 75 and over were registered as dying from cancer. The number who died increased each year slightly over the 5 year period (1.2%). In the 75–79 age group, 55 % were men, in those aged 100 and over this fell to 16%. On reaching their hundreds, the most common cause of death for men was malignancies of the genital organs; and for women it was breast cancer. The most frequent place of death for women in their hundreds was the care home; for men it was hospitals. Those dying from lymphatic and haematopoietic malignancies were most likely to die in hospitals, those with head and neck malignancies in hospices and breast cancer patients in a care home. CONCLUSION: The finding of rising proportions of cancer deaths in institutions with increasing age suggests a need to ensure that appropriate high quality care is available to this growing section of the population

A theoretical and empirical investigation of nutritional label use

Due in part to increasing diet-related health problems caused, among others, by obesity, nutritional labelling has been considered important, mainly because it can provide consumers with information that can be used to make informed and healthier food choices. Several studies have focused on the empirical perspective of nutritional label use. None of these studies, however, have focused on developing a theoretical economic model that would adequately describe nutritional label use based on a utility theoretic framework. We attempt to fill this void by developing a simple theoretical model of nutritional label use, incorporating the time a consumer spends reading labels as part of the food choice process. The demand equations of the model are then empirically tested. Results suggest the significant role of several variables that flow directly from the model which, to our knowledge, have not been used in any previous empirical work

Epidemiologic approaches to assessing human cancer risk from consuming aquatic food resources from chemically contaminated water.

Epidemiologic approaches to assessing human cancer risk from consuming fish from contaminated waters must confront the problems of long latency and rarity of the end point (cancer). The latency problem makes determination of diet history more difficult, while the low frequency of cancer as an end point reduces the statistical power of the study. These factors are discussed in relation to the study designs most commonly employed in epidemiology. It is suggested that the use of biomarkers for persistent chemicals may be useful to mitigate the difficulty of determining exposure, while the use of more prevalent and timely end points, such as carcinogen-DNA adducts or oncogene proteins, may make the latency and rarity problems more tractable