A visible geography of invisible journeys: Central American migration and the politics of survival

Human rights groups have called undocumented Central American migrants the ‘invisible victims’ of criminal violence in Mexico. However, the geography of the unauthorised migration route through Mexico is highly visible; its location, protocols and violent practices constitute common knowledge in the communities through which it cuts its path. This paper examines the visual cues of the route. Images of places, such as the trailhead, the river at the borders, the migrant shelter and the train yard, provide focal points that orient migrants to the physical terrain. These images also orient activists, providing potent symbols for political contestation in favour of migrants’ rights. However, visibility attracts criminal gangs who rob, kidnap and rape migrants, and the gaze of state officials who detain and deport migrants. Thus, this paper traces how geographic icons become beacons to migrants, activists, criminal predators and state actors, and it examines the nature of information and representation under this strategic interaction. It examines how victims and perpetrators become visible to one another

Matryoshka journeys: im/mobility during migration

Acts of mobility require corresponding acts of immobility (or suspended mobility). Migrant journeys are not only about movement. Indeed, in the present policy context, this is ever more true. Whether a migrant is contained within a hidden compartment, detained by migration authorities, waiting for remittances to continue, or marooned within a drifting boat at sea, these moments of immobility have become an inherent part of migrant journeys especially as states have increased controls at and beyond their borders. Migrants themselves view this fragmentation – the stopping, waiting and containment – as part of the journey to be endured. Drawing on the authors’ fieldwork in Central America and Southern Europe, this paper destabilises the boundary between transit and settlement, speaking to a larger policy discourse that justifies detentions and deportations from the United States and countries on the periphery of Europe. We argue that migrants’ nested experiences of these ‘matryoshka journeys’ reveal how increased migration controls encourage them not only to take greater risks during the journey, but also to forfeit their agency at opportune moments. In turn, states exploit images of such im/mobility during the journey in order to emphasise the irrational risks migrants take in order to traverse seas and deserts and to cloak their own border policies in a humanitarian discourse of rescue

An overview of reflective learning in Years 1 and 2 of the medical curriculum at the University of Liverpool

Reflective practice is a method of continual learning from clinical experience, identifying learning needs and implementing changes in practice. It is an important learning tool for both medical students and qualified doctors. Despite the importance of refection, medical students, in their earlier years, can struggle to see its value and are often reluctant to engage with the process beyond superficial levels. In Years 1 and 2 of the MBChB Curriculum at the University of Liverpool, reflective practice is taught and assessed via several modules using a variety of approaches. We describe those approaches and discuss our methods for developing a standardised framework for reflective learning, with the aim of increasing consistency of teaching and assessment and improving student engagement and performance

“It’s personal to me”:A qualitative study of depression in young people with CFS/ME

Background: Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has a prevalence of 0.4–2.4% and is defined as ‘generalised disabling fatigue persisting after routine tests and investigations have failed to identify an obvious underlying cause’. One-third of young people with CFS/ME have probable depression. Little is known about why depression develops, the relationship between depression and CFS/ME, or what treatment might be helpful. Methods: We conducted nine semi-structured interviews with young people with CFS/ME (aged 13–17 years, 8/9 female) and probable depression, covering perceived causes of depression, the relationship between CFS/ME and depression, and treatment strategies. Results: Most thought CFS/ME caused depression. Many discussed a cyclical relationship: low mood made CFS/ME worse. A sense of loss was common. CFS/ME restricted activities participants valued and changed systemic structures, causing depression. There was no single helpful treatment approach. Individualised approaches using combinations of cognitive behavioural therapy (CBT), medication, activity management and other strategies were described. Conclusion: This study suggests that depression may be secondary to CFS/ME in young people because of the impact of CFS/ME on quality of life. Clinicians treating young people with CFS/ME need to consider strategies to prevent development of depression, and research is needed into approaches that are effective in treating CFS/ME with co-morbid depression. </jats:sec

Evaluation of the Primary Care Mental Health Specialist role: Final Report

This report details an evaluation to assess the impact of the new primary care mental health specialist (PCMHS) role in Kent and Medway. The evaluation was undertaken by the Centre for Health Services Studies (CHSS) at the University of Kent and was conducted June 2013 to December 2014. The evaluation was commissioned by NHS Kent and Medway and supported by Kent and Medway Commissioning Support. The evaluation encompasses six CCG areas across Kent and Medway, with 13 PCMHS employed in these areas (see Table 1-1 for breakdown). The number of posts per CCG is dependent on the amount CCGs invest (roughly equating to population size), rather than prevalence of illness. The PCMHS have been seconded from Kent and Medway NHS and Social Care Partnership Trust (KMPT) for the duration of the pilot, and are either community psychiatric nurses (CPN) or occupational therapists (OT) by profession. The majority of PCMHS are hosted by a voluntary organisation (mcch); three are hosted by GP practices and two by a community Interest Company, Invicta CIC. The main objectives of the evaluation are: 1. To assess the impact on patients by capturing their experience of the service; 2. To assess the impact by capturing experiences of those delivering the service (i.e., PCMHS); 3. To assess the impact by capturing experiences of other professions who work alongside the service (i.e., mental health professionals in secondary care, GPs); 4. To assess the economic cost of the new service via a unit cost analysis

Outcomes of clofazimine for the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

Background Current anti-tuberculosis therapeutics are not sufficiently effective against drug-resistant tuberculosis (DR-TB), and there is a need for new drugs and therapeutic approaches. It has been proposed that repurposing clofazimine for DR-TB treatment might be one way to increase therapeutic options. Methods We conducted a systematic review of studies reporting on the efficacy and safety of clofazimine as part of combination therapy for DR-TB. Six databases and six conference abstract sites were searched from inception until April 2012. All studies involving the use of clofazimine in the treatment of DR-TB were included. Results Twelve studies, comprising 3489 patients across 10 countries, were included in this review. Treatment success ranged from 16.5% (95% CI 2.7%-38.7%) to 87.8% (95% CI 76.8%-95.6%), with an overall pooled proportion of 61.96% achieving treatment success (95% CI 52.79%-71.12%) (τ2 0.07). Mortality, treatment interruptions, defaulting and adverse events were all in line with DR-TB treatment outcomes overall. The most commonly reported adverse events were gastrointestinal disturbances and skin pigmentation. Conclusions The available evidence to date suggests that clofazimine could be considered as an additional therapeutic option in the treatment of DR-TB. The optimal dose of clofazimine and duration of use require further investigatio

Quantification of α-particle radiation damage in zircon

Analysis of radiation damage in natural mineral analogs such as zircon is important for the evaluation of the long-term behavior of nuclear waste forms and for geochronology. Here we present results of experiments to determine the partitioning of radiation damage due to the heavy nuclear recoil of uranium and thorium daughters and the α-particles ejected in an α-decay event in zircon. Synthetic polycrystalline zircon ceramics were doped with 10B and irradiated in a slow neutron flux for 1, 10, and 28 days to achieve the reaction 10B + n → 7Li + α (+2.79 MeV), creating an α event without a heavy nuclear recoil. The 7Li atoms produced in the nuclear reaction were directly detected by NMR “spin-counting”, providing a precise measurement of the α-dose applied to each sample. The amount of damage (number fraction and volume fraction) created by each α-event (one α-event being a 7Li + α-particle) has been quantified using radiological nuclear magnetic resonance and X-ray diffraction data. The number of permanently displaced atoms in the amorphous fraction was determined by 29Si NMR to be 252 ± 24 atoms for the 10B(n,α) event when the heavy recoil is absent, which is broadly in agreement with ballistic Monte Carlo calculations. The unit-cell swelling of the crystalline fraction, determined by X-ray diffraction, is small and anisotropic. The anisotropy is similar to that observed in ancient natural samples and implies an initial anisotropic swelling mechanism rather than an anisotropic recovery mechanism occurring over geological timescales. The small unit-cell volume swelling is only ~6% of the expansion frequently attributed to α-particles associated with an actinide α-decay event. The lattice parameters indicate a volume increase as α function of a dose of 0.21 A3/1018 α-events/g, which is significantly less than the increase of 3.55 A3/1018 α-events/g seen in Pu-doped zircon and 2.18 A3/1018 α-events/g seen in natural zircon. It is concluded that the heavy recoil plays a more important role in unit-cell swelling than previously predicted. The likely mechanism for such an effect is the rapid, and thus defect-rich, recrystallization of material initially displaced by the heavy recoil

The effect of magnesium on the local structure and initial dissolution rate of simplified UK Magnox waste glasses

A series of simplified glasses were prepared to mimic the United Kingdom’'s Magnox radioactive waste glasses and determine the separate effect of the presence of Mg on the glass structure and the initial dissolution rate. These glasses had an alkaline earth (Ca/Mg) content of 6.5 mol% and relative ratios of Si, B and Na similar to 25 wt% waste loaded Magnox waste glass simulant. Each simplified glass had similar macroscopic properties, differing only in Ca/Mg ratio. 25Mg magic angle spinning nuclear magnetic resonance (MASNMR) spectra of the simplified Mg endmember (MgEM) glass (with no Ca) and the full-component simulant glass were similar, consistent with the similar Mg local environments in both glasses. 11B MASNMR spectra of the series of simplified glasses showed a systematic increase in the amount of three-coordinated boron ([3]B) with increasing amounts of Mg. A clear change in the charge balancing of four-coordinated boron ([4]B) by Mg compared with Ca is observed. However, 11B NMR measurements of the leached material showed that the additional [3]B was not preferentially leached from the Mg containing samples. Despite the structural changes in the glass induced by Ca/Mg substitution, initial dissolution rates (r0) remained invariant, within error, with Ca/Mg ratio. This indicates that the poorer aqueous durability of Mg-containing Magnox waste glass measured experimentally in long-term leaching experiments, compared with SON68 glass containing Ca, is not caused by a primary structural effect in the glass.R. Guo acknowledges the EPSRC and the University of Cambridge for an International Doctoral Scholarship. A portion of this work was funded by Radioactive Waste Management Limited (C.T. Brigden, S.W. Swanton and I. Farnan). The UK 850 MHz solid-state NMR Facility used in this research was funded by EPSRC and BBSRC (contract reference PR140003), as well as the University of Warwick including via part funding through Birmingham Science City Advanced Materials Projects 1 and 2 supported by Advantage West Midlands (AWM) and the European Regional Development Fund (ERDF). Collaborative assistance from the 850 MHz Facility Manager (Dinu Iuga, University of Warwick) is acknowledged