The UK waste input–output table : Linking waste generation to the UK economy

Peer reviewe

Turning to art as a positive way of living with cancer: A qualitative study of personal motives and contextual influences

Why do some women turn to creative art-making after a diagnosis of cancer? Eleven women provided qualitative accounts that were analyzed following guidelines for interpretative phenomenological analysis (IPA). Some described taking up artistic leisure activities initially in order to manage emotional distress. Others emphasized their need for positive well-being, taking up art to experience achievement and satisfaction, to regain a positive identity, and to normalize family dynamics in the context of living with cancer. Participants’ turn to art-making was facilitated by biographical and contextual factors, including pre-existing craft skills, long-standing personal values and coping philosophies, family role models for managing adversity, and the supportive encouragement of family and friends. Other research has acknowledged that positive lifestyle change and post-traumatic growth can occur after a cancer diagnosis, and this study reveals a multi-faceted process. The findings suggest a need for further research into the experiences that facilitate positive lifestyle change and subjective well-being among people who are living with cancer

Breaking Barriers to Successful Implementation of Day Case Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy is a common procedure performed in both emergency and elective settings. Our aim was to analyse the trends in laparoscopic surgery in Ireland in the public and private healthcare systems. In particular we studied the trend in day case laparoscopic cholecystectomy. National HIPE data for the years 2010-2012 was obtained. Similar datasets were obtained from the three main health insurers. 19,214 laparoscopic cholecystectomies were carried out in Ireland over the 3-year period. More procedures were performed in the public system than the private system from 2010-2012. There was a steady increase in surgeries performed in the public sector, while the private sector remained static. Although the ALOS was significantly higher in the public sector, there was an increase in the rate of day case procedures from 416 (13%) to 762 (21.9%). The day case rates in private hospitals increased only slightly from 29 (5.1%) in 2010 to 40 (5.9%) in 2012. Day case laparoscopic cholecystectomy has been shown to be a safe procedure, however significant barriers remain in place to the implementation of successful day case units nationwide

The parasitic helminth product ES-62 suppresses pathogenesis in collagen-induced arthritis by targeting the interleukin-17–producing cellular network at multiple sites

Among many survival strategies, parasitic worms secrete molecules to modulate host immune responses. One such product, ES-62, is protective in the collagen-induced arthritis (CIA) model of rheumatoid arthritis. As IL-17 has been reported to play a pathological role in the development of rheumatoid arthritis, we investigated whether targeting of IL-17 may explain the protection afforded by ES-62 in the CIA model. DBA/1 mice progressively display arthritis following immunization with type-II collagen. The protective effects of ES-62 were assessed by determination of cytokine levels, flow cytometric analysis of relevant cellular populations and in situ analysis of joint inflammation. ES-62 was found to downregulate IL-17 responses in the CIA model. Firstly, it acts to inhibit priming and polarisation of IL-17 responses by targeting a complex IL-17-producing network, involving signalling between dendritic cells and γδ or CD4+ T cells. In addition, ES-62 directly targets Th17 cells by downregulating MyD88 expression to suppress responses mediated by IL-1 and TLR ligands. Moreover, ES-62 modulates migration of γδ T cells and this is reflected by direct suppression of CD44 upregulation and, as evidenced by in situ analysis, dramatically reduced levels of IL-17-producing cells, including lymphocytes, infiltrating the joint. Finally, there is strong suppression of IL-17 production by cells resident in the joint, such as osteoclasts within the bone areas. Such unique multi-site manipulation of the initiation and effector phases of the IL-17 inflammatory network could be exploited in the development of novel therapeutics for rheumatoid arthritis

POWERFUL, ROTATING DISK WINDS from STELLAR-MASS BLACK HOLES

We present an analysis of ionized X-ray disk winds observed in the Fe K band of four stellar-mass black holes observed with Chandra, including 4U 1630-47, GRO J1655-40, H 1743-322, and GRS 1915+105. High-resolution photoionization grids were generated in order to model the data. Third-order gratings spectra were used to resolve complex absorption profiles into atomic effects and multiple velocity components. The Fe XXV line is found to be shaped by contributions from the intercombination line (in absorption), and the Fe XXVI line is detected as a spin-orbit doublet. The data require 2-3 absorption zones, depending on the source. The fastest components have velocities approaching or exceeding 0.01c, increasing mass outflow rates and wind kinetic power by orders of magnitude over prior single-zone models. The first-order spectra require re-emission from the wind, broadened by a degree that is loosely consistent with Keplerian orbital velocities at the photoionization radius. This suggests that disk winds are rotating with the orbital velocity of the underlying disk, and provides a new means of estimating launching radii -- crucial to understanding wind driving mechanisms. Some aspects of the wind velocities and radii correspond well to the broad-line region (BLR) in active galactic nuclei, suggesting a physical connection. We discuss these results in terms of prevalent models for disk wind production and disk accretion itself, and implications for massive black holes in active galactic nuclei

Religious faith and psychosocial adaptation among stroke patients in Kuwait: A mixed method study

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2012 Springer Science+Business Media.Religious faith is central to life for Muslim patients in Kuwait, so it may influence adaptation and rehabilitation. This study explored quantitative associations among religious faith, self-efficacy, and life satisfaction in 40 female stroke patients and explored the influence of religion within stroke rehabilitation through qualitative interviews with 12 health professionals. The quantitative measure of religious faith did not relate to life satisfaction or self-efficacy in stroke patients. However, the health professionals described religious coping as influencing adaptation post-stroke. Fatalistic beliefs were thought to have mixed influences on rehabilitation. Measuring religious faith among Muslims through a standardized scale is debated. The qualitative accounts suggest that religious beliefs need to be acknowledged in stroke rehabilitation in Kuwait

"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

THE ACCRETION DISK WIND IN THE BLACK HOLE GRS 1915+105

© 2016. The American Astronomical Society. All rights reserved. We report on a 120 ks Chandra/HETG spectrum of the black hole GRS 1915+105. The observation was made during an extended and bright soft state in 2015 June. An extremely rich disk wind absorption spectrum is detected, similar to that observed at lower sensitivity in 2007. The very high resolution of the third-order spectrum reveals four components to the disk wind in the Fe K band alone; the fastest has a blueshift of v = 0.03c. Broadened re-emission from the wind is also detected in the first-order spectrum, giving rise to clear accretion disk P Cygni profiles. Dynamical modeling of the re-emission spectrum gives wind launching radii of r ≃ 102-4 GM/c2. Wind density values of n ≃ 1013-16 cm-3 are then required by the ionization parameter formalism. The small launching radii, high density values, and inferred high mass outflow rates signal a role for magnetic driving. With simple, reasonable assumptions, the wind properties constrain the magnitude of the emergent magnetic field to be B ≃ 103-4 G if the wind is driven via magnetohydrodynamic (MHD) pressure from within the disk and B ≃ 104-5 G if the wind is driven by magnetocentrifugal acceleration. The MHD estimates are below upper limits predicted by the canonical α-disk model. We discuss these results in terms of fundamental disk physics and black hole accretion modes