Just Keeping Hope: Margaret\u27s Story

A first-person narrative about life in Dayton, Ohio, composed as part of the Facing Project, a nationwide storytelling initiative

Green Exercise Linking Nature, Health and Well-being

The concept of Green Exercise has now been widely adopted and implies a synergistic health benefit of being active in the presence of nature. This book provides a balanced overview and synthesis text on all aspects of Green Exercise and integrates evidence from many different disciplines including physiology, ecology, psychology, sociology and the environmental sciences, and across a wide range of countries. It describes the impact of Green Exercise on human health and well-being through all stages of the lifecourse and covers a wide spectrum from cellular processes such as immune function through to facilitating human behavioural change. It demonstrates the value of Green Exercise for activity and education purposes in both schools and the workplace, as well as its therapeutic properties. Green Exercise is an effective intervention for vulnerable groups and promoting healthy ageing, with activities including wilderness therapy, therapeutic horticulture and the use of forests and water. Chapters also integrate cross-cutting key themes which are relevant to all stages of the lifecourse and have significantly contributed to the Green Exercise research base, such as forest bathing and blue exercise. The book also explores the future of Green Exercise, the way in which research can be used to influence green design and planning and how health, social care and environmental agendas can be integrated to enable Green Exercise to be more widely used as a mechanism for improving health

Challenging dyke ascent models using novel laboratory experiments: Implications for reinterpreting evidence of magma ascent and volcanism

Volcanic eruptions are fed by plumbing systems that transport magma from its source to the surface, mostly fed by dykes. Here we present laboratory experiments that model dyke ascent to eruption using a tank filled with a crust analogue (gelatine, which is transparent and elastic) that is injected from below by a magma analogue (dyed water). This novel experimental setup allows, for the first time, the simultaneous measurement of fluid flow, sub-surface and surface deformation during dyke ascent. During injection, a penny-shaped fluid-filled crack is formed, intrudes, and traverses the gelatine slab vertically to then erupt at the surface. Polarised light shows the internal stress evolution as the dyke ascends, and an overhead laser scanner measures the surface elevation change in the lead-up to dyke eruption. Fluorescent passive-tracer particles that are illuminated by a laser sheet are monitored, and the intruding fluid's flow dynamics and gelatine's sub-surface strain evolution is measured using particle image velocimetry and digital image correlation, respectively. We identify 4 previously undescribed stages of dyke ascent. Stage 1, early dyke growth: the initial dyke grows from the source, and two fluid jets circulate as the penny-shaped crack is formed. Stage 2, pseudo-steady dyke growth: characterised by the development of a rapidly uprising, central, single pseudo-steady fluid jet, as the dyke grows equally in length and width, and the fluid down-wells at the dyke margin. Sub-surface host strain is localised at the head region and the tail of the dyke is largely static. Stage 3, pre-eruption unsteady dyke growth: an instability in the fluid flow appears as the central fluid jet meanders, the dyke tip accelerates towards the surface and the tail thins. Surface deformation is only detected in the immediate lead-up to eruption and is characterised by an overall topographic increase, with axis-symmetric topographic highs developed above the dyke tip. Stage 4 is the onset of eruption, when fluid flow is projected outwards and focused towards the erupting fissure as the dyke closes. A simultaneous and abrupt decrease in sub-surface strain occurs as the fluid pressure is released. Our results provide a comprehensive physical framework upon which to interpret evidence of dyke ascent in nature, and suggest dyke ascent models need to be re-evaluated to account for coupled intrusive and extrusive processes and improve the recognition of monitoring signals that lead to volcanic eruptions in nature

Comparison of techniques for handling missing covariate data within prognostic modelling studies: a simulation study

Background: There is no consensus on the most appropriate approach to handle missing covariate data within prognostic modelling studies. Therefore a simulation study was performed to assess the effects of different missing data techniques on the performance of a prognostic model. Methods: Datasets were generated to resemble the skewed distributions seen in a motivating breast cancer example. Multivariate missing data were imposed on four covariates using four different mechanisms; missing completely at random (MCAR), missing at random (MAR), missing not at random (MNAR) and a combination of all three mechanisms. Five amounts of incomplete cases from 5% to 75% were considered. Complete case analysis (CC), single imputation (SI) and five multiple imputation (MI) techniques available within the R statistical software were investigated: a) data augmentation (DA) approach assuming a multivariate normal distribution, b) DA assuming a general location model, c) regression switching imputation, d) regression switching with predictive mean matching (MICE-PMM) and e) flexible additive imputation models. A Cox proportional hazards model was fitted and appropriate estimates for the regression coefficients and model performance measures were obtained. Results: Performing a CC analysis produced unbiased regression estimates, but inflated standard errors, which affected the significance of the covariates in the model with 25% or more missingness. Using SI, underestimated the variability; resulting in poor coverage even with 10% missingness. Of the MI approaches, applying MICE-PMM produced, in general, the least biased estimates and better coverage for the incomplete covariates and better model performance for all mechanisms. However, this MI approach still produced biased regression coefficient estimates for the incomplete skewed continuous covariates when 50% or more cases had missing data imposed with a MCAR, MAR or combined mechanism. When the missingness depended on the incomplete covariates, i.e. MNAR, estimates were biased with more than 10% incomplete cases for all MI approaches. Conclusion: The results from this simulation study suggest that performing MICE-PMM may be the preferred MI approach provided that less than 50% of the cases have missing data and the missing data are not MNAR

UK survey of non-medical use of prescription drugs (NMURx) as a valuable source of general population illicit drug use data.

PURPOSE OF STUDY: The aim of the study is to describe the prevalence of illicit drug use in England and Wales using data from the UK Survey of Non-Medical Use of Prescription Drugs (NMURx) programme and to compare against the well-established Crime Survey England and Wales (CSEW). The rationale is that recreational and illicit drug use is common, but the prevalence is difficult to estimate with personal interviewing methods. STUDY DESIGN: We compared two cross-sectional population surveys (NMURx, n=8903 and CSEW, n=20 685) with data regarding self-reported recreational drug use and demographics. NMURx is an online survey using non-probability sampling methodology with preset demographical quotas based on census data. CSEW surveys drug use via computer-assisted self-interviewing as part of a computer-assisted personal-interviewing crime survey. RESULTS: Cannabis was the most frequently used drug regardless of demographics. Prevalence of drug use for specific substances was generally higher for males, younger ages and students. The relationship between income and drug misuse is less clear. Self-reported prevalence of drug use in the NMURx survey is consistently higher than CSEW (absolute difference 1%-3 % across substances and timescales) and persists after stratification for gender, age, student status and household income. CONCLUSIONS: The NMURx survey has a broad reach of participants, and a sampling scheme that achieves external validity, compared with general population demographics. NMURx's online format allows flexibility in items surveyed and in response to emerging trends. The self-reported drug use in the NMURx cohort is comparable, although slightly higher, than the CSEW estimates

Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function

Improvement of the quality of life in Type 1 (insulin-dependent) diabetic patients with severe late complications is one of the main goals of pancreas and/or kidney grafting. To assess the influences of these treatment modalities on the different aspects of the quality of life a cross-sectional study in 157 patients was conducted. They were categorized into patients pre-transplant without dialysis (n=29; Group A), pre-transplant under dialysis (n=44; Group B), post-transplant with pancreas and kidney functioning (n=31; Group C), post-transplant with functioning kidney, but insulin therapy (n=29; Group D), post-transplant under dialysis and insulin therapy again (n=15; Group E) and patients after single pancreas transplantation and rejection, with good renal function, but insulin therapy (n=9; Group F). All patients answered a mailed, self-administered questionnaire (217 questions) consisting of a broad spectrum of rehabilitation criteria. The results indicate a better quality of life in Groups C and D as compared to the other groups. In general the scores are highest in C, but without any significant difference to D. Impressive significant differences between C or D and the other groups were found especially in their satisfaction with physical capacity, leisure-time activities or the overall quality of life. The satisfaction with the latter is highest in C (mean±SEM: 4.0±0.2 on a 1 to 5-rating scale; significantly different from A: 3.1±0.1, B: 2.7±0.2 and E: 2.6±0.3; p<0.01), followed by D (3.8±0.2; significantly different from B and E; p<0.01). Group F shows a mean of 3.1±0.4, which is not significantly different from C. The percentages of patients in each group, who are not working: A: 38 %, B: 64 %, C: 74 %, D: 66 %, E: 87 % and F: 78 % indicate that there is no marked improvement in the vocational situation after successful grafting

Thrombophlebitis migrans in a man with pancreatic adenocarcinoma: a case report

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