Cold war heritage (and) tourism: exploring heritage processes within Cold War sites in Britain

A thesis submitted to the University of Bedfordshire in partial fulfilment ofthe requirements for the degree of Doctor of PhilosophyFor most of the second half of the 20th century the world's political map was divided by the Cold War, a name given to the 40-year long standoff between the superpowers - the Unites States and the USSR - and their allies. Due to its geographical location and alliance with the United States, Britain was at the 'frontline' of the Cold War. As a response to increasing tensions, the British Government made arrangements by building hundreds of military sites and structures, which were often dismantled or abandoned as the technology on which they relied became rapidly ineffective. Nowadays, there is a growing (academic) recognition of Cold War sites and their new or contemporary uses, including as heritage attractions within a tourism context. This study has brought forward a constructionist approach as to investigate how heritage works as a cultural and social practice that constructs and regulates a range of values and ideologies about what constitutes Cold War heritage (and) tourism in Britain. It has done this by, firstly, exploring the dominant and professional 'authorised heritage discourse', which aims to construct mutually, agreed and shared concepts about the phenomenon of 'Cold War heritage' within a tourism context. The study identified a network of actors, values, policies and discourses that centred on the concept of 'Cold War heritage' at selected sites through which a 'material reality' of the past is constructed. Although various opposing viewpoints were identified, the actors effectively seem to privilege and naturalise certain narratives of cultural and social meanings and values through tourism of what constitutes Cold War heritage and the ways it should be manifested through material and natural places, sites and objects within society. Differences were particularly noticeable in the values, uses and meanings of Cold iii Cold War heritage (and) tourism War heritage within the contemporary context of heritage management in Britain. For some, the sites were connected with a personal 'past', a place to commemorate, celebrate or learn from the past. For others, the sites were a source of income, a tourism asset, or contrary, a financial burden as the sites were not 'old enough' or 'aesthetically pleasing' to be regarded as a monument to be preserved as heritage. Subsequently, the study also explored the (disempowered) role of visitors to the sites as passive receivers, leaving little room for individual reflections on the wider social and cultural processes of Cold War heritage. Although, most visitors believed that the stewardship and professional view of the Cold War representations at the sites should not directly be contested, this study has illustrated the idea that what makes places valuable and gives them meaning as heritage sites is not solely based on contemporary practices by a dominant heritage discourse. Despite the visitors' support for the sole ownership by site managers, and the selective representations of the Cold War and events, they did question or negotiate the idea of 'heritage' as a physical and sole subject of management practices. Despite having little prior knowledge about the Cold War era or events, by pressing the borders of the authorised parameters of 'Cold War heritage', visitors actively constructed their experiences as being, or becoming, part of their personal and collective moments of 'heritage'. By inscribing (new) memories and meaning into their identity, and therefore also changing the nature of that identity, they reflected upon the past, present and future, (some more critically than others. To conclude, understanding these discursive meanings of Cold War heritage (and) tourism, and the ways in which ideas about Cold War heritage are constructed, negotiated and contested within and between discourses also contributes to understandings about the philosophical, historical, conceptual and political barriers that exist in identifying and engaging with different forms of heritage

Assessment of proximal outcomes of self-management programs : translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQtm)

Purpose This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ&trade;), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.Methods The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.Results The items of the German heiQ&trade; were well understood by rehabilitation inpatients. The structure of the eight heiQ&trade; scales was replicated after minor adjustment. heiQ&trade; scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ&trade; scales differentiated between individuals across different levels of depression.Conclusion The German heiQ&trade; is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.<br /

ALIFE2 study : low-molecular-weight heparin for women with recurrent miscarriage and inherited thrombophilia : study protocol for a randomized controlled trial

Background A large number of studies have shown an association between inherited thrombophilia and recurrent miscarriage. It has been hypothesized that anticoagulant therapy might reduce the number of miscarriages and stillbirth in these women. In the absence of randomized controlled trials evaluating the efficacy of anticoagulant therapy in women with inherited thrombophilia and recurrent miscarriage, a randomized trial with adequate power that addresses this question is needed. The objective of the ALIFE2 study is therefore to evaluate the efficacy of low-molecular-weight heparin (LMWH) in women with inherited thrombophilia and recurrent miscarriage, with live birth as the primary outcome. Methods/Design Randomized study of LMWH plus standard pregnancy surveillance versus standard pregnancy surveillance alone. Study population: pregnant women of less than 7 weeks’ gestation, and confirmed inherited thrombophilia with a history of 2 or more miscarriages or intra-uterine fetal deaths, or both. Setting: multi-center study in centers from the Dutch Consortium of Fertility studies; centers outside the Netherlands are currently preparing to participate. Intervention: LMWH enoxaparin 40 mg subcutaneously once daily started prior to 7 weeks gestational age plus standard pregnancy surveillance or standard pregnancy surveillance alone. Main study parameters/endpoints: the primary efficacy outcome is live birth. Secondary efficacy outcomes include adverse pregnancy outcomes, such as miscarriage, pre-eclampsia, syndrome of hemolysis, elevated liver enzymes and low platelets (HELLP syndrome), fetal growth restriction, placental abruption, premature delivery and congenital malformations. Safety outcomes include bleeding episodes, thrombocytopenia and skin reactions. Discussion After an initial period of slow recruitment, the recruitment rate for the study has increased. Improved awareness of the study and acknowledgement of the need for evidence are thought to be contributing to the improved recruitment rates. We aim to increase the number of recruiting centers in order to increase enrollment into the ALIFE2 study. The study website can be accessed via www.ALIFE2study.org. Trial registration The ALIFE2 study was registered on 19 March 2012 under registration number NTR336

Potential and Impact of Incorporating Roof Photovoltaic to Enhance Environmental Sustainability of Historic English Churches in the United Kingdom

The Church of England (CofE) is responding to climate change by taking measures to reduce their CO2 footprint under its flagship programme -'Shrinking the Footprint', to facilitate the CO2 emission reduction target of 80 % by 2050. Meeting this target will require both energy efficiency measures and zero carbon energy generation of which solar PV technology is a frontrunner as it has a substantially lower CO2 footprint than grid's electricity, with no moving parts, low maintenance and a long service life. Conventional church roofs built along the East-West axis offer the ideal pitches and orientation for collecting solar energy. However, within the CofE's vast estate of over 15,000 church buildings, 78 % of these buildings are listed and hence care must be taken to protect the building fabric. With this context in mind, this study identifies the benefits and concerns associated with the application of rooftop solar PV on historic English Churches and evaluates viable technologies currently available. The specific design and procedural requirements have been investigated and the process map of the implementation methodology established and illustrated through a case study of an existing church. Results showed that rooftop solar PV system has the potential to reduce the GHG emissions substantially, ranging between 75 %–84 % for electricity and between 20 %–27 % for gas based on the current demand and the choice of technology option. Findings on the issues, design options and life cycle environmental impacts are analysed with discussion and recommendation of future adaptation at a national level

BRCA2 polymorphic stop codon K3326X and the risk of breast, prostate, and ovarian cancers

Background: The K3326X variant in BRCA2 (BRCA2*c.9976A&gt;T; p.Lys3326*; rs11571833) has been found to be associated with small increased risks of breast cancer. However, it is not clear to what extent linkage disequilibrium with fully pathogenic mutations might account for this association. There is scant information about the effect of K3326X in other hormone-related cancers. Methods: Using weighted logistic regression, we analyzed data from the large iCOGS study including 76 637 cancer case patients and 83 796 control patients to estimate odds ratios (ORw) and 95% confidence intervals (CIs) for K3326X variant carriers in relation to breast, ovarian, and prostate cancer risks, with weights defined as probability of not having a pathogenic BRCA2 variant. Using Cox proportional hazards modeling, we also examined the associations of K3326X with breast and ovarian cancer risks among 7183 BRCA1 variant carriers. All statistical tests were two-sided. Results: The K3326X variant was associated with breast (ORw = 1.28, 95% CI = 1.17 to 1.40, P = 5.9x10- 6) and invasive ovarian cancer (ORw = 1.26, 95% CI = 1.10 to 1.43, P = 3.8x10-3). These associations were stronger for serous ovarian cancer and for estrogen receptor–negative breast cancer (ORw = 1.46, 95% CI = 1.2 to 1.70, P = 3.4x10-5 and ORw = 1.50, 95% CI = 1.28 to 1.76, P = 4.1x10-5, respectively). For BRCA1 mutation carriers, there was a statistically significant inverse association of the K3326X variant with risk of ovarian cancer (HR = 0.43, 95% CI = 0.22 to 0.84, P = .013) but no association with breast cancer. No association with prostate cancer was observed. Conclusions: Our study provides evidence that the K3326X variant is associated with risk of developing breast and ovarian cancers independent of other pathogenic variants in BRCA2. Further studies are needed to determine the biological mechanism of action responsible for these associations

A case-only study to identify genetic modifiers of breast cancer risk for BRCA1/BRCA2 mutation carriers.

Breast cancer (BC) risk for BRCA1 and BRCA2 mutation carriers varies by genetic and familial factors. About 50 common variants have been shown to modify BC risk for mutation carriers. All but three, were identified in general population studies. Other mutation carrier-specific susceptibility variants may exist but studies of mutation carriers have so far been underpowered. We conduct a novel case-only genome-wide association study comparing genotype frequencies between 60,212 general population BC cases and 13,007 cases with BRCA1 or BRCA2 mutations. We identify robust novel associations for 2 variants with BC for BRCA1 and 3 for BRCA2 mutation carriers, P < 10-8, at 5 loci, which are not associated with risk in the general population. They include rs60882887 at 11p11.2 where MADD, SP11 and EIF1, genes previously implicated in BC biology, are predicted as potential targets. These findings will contribute towards customising BC polygenic risk scores for BRCA1 and BRCA2 mutation carriers

Functional mechanisms underlying pleiotropic risk alleles at the 19p13.1 breast-ovarian cancer susceptibility locus

A locus at 19p13 is associated with breast cancer (BC) and ovarian cancer (OC) risk. Here we analyse 438 SNPs in this region in 46,451 BC and 15,438 OC cases, 15,252 BRCA1 mutation carriers and 73,444 controls and identify 13 candidate causal SNPs associated with serous OC (P=9.2 × 10-20), ER-negative BC (P=1.1 × 10-13), BRCA1-associated BC (P=7.7 × 10-16) and triple negative BC (P-diff=2 × 10-5). Genotype-gene expression associations are identified for candidate target genes ANKLE1 (P=2 × 10-3) and ABHD8 (P<2 × 10-3). Chromosome conformation capture identifies interactions between four candidate SNPs and ABHD8, and luciferase assays indicate six risk alleles increased transactivation of the ADHD8 promoter. Targeted deletion of a region containing risk SNP rs56069439 in a putative enhancer induces ANKLE1 downregulation; and mRNA stability assays indicate functional effects for an ANKLE1 3′-UTR SNP. Altogether, these data suggest that multiple SNPs at 19p13 regulate ABHD8 and perhaps ANKLE1 expression, and indicate common mechanisms underlying breast and ovarian cancer risk