This thesis explores how social networking platforms influence the production of identity, status and capital amongst adolescents. This includes an exploration of how some digital communication ...platforms have negatively impacted on the social experiences of some teenagers and resulted in these users adapting their digital communicative practices to overcome communicative challenges. The study draws upon data collected via 9 semi-structured interviews, 9 focus groups and 84 surveys with boys and girls aged 11-16 from three schools in England. It explores specific social norms which relate to gender, and how they are negotiated within both masculine and feminine interactions through the respective practices of banter and gossip or stalking. These interactional processes are used as a means of negotiating status and of in-group inclusion and out-group rejection (Goffman, 1963). Furthermore they are important elements in the formation of relationships, identity and social capital. For Bourdieu social capital is the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition (1980, 2). The production of social capital is linked to an individual s capacity to manage group norms and approved values. This study demonstrates that online displays of gender are part of adolescents attempts to generate social capital through gaining positive public affirmations (for example in the form of likes). This has led to a new form of capital which has been titled virtual capital , and which is revealed to be a crucial element in adolescents self-worth and status. Although social networking sites can facilitate the creation of these capitals, they can also simultaneously hinder their creation. Facebook s system of widespread automatic information sharing, alongside a lack user of control in managing the flow of data which is received and shared, has led to many teens experiencing challenges in how they produce identity and gain popularity. This has led to negative social experiences, a growing disillusionment with Facebook, and increased use of more contemporary platforms such as Snap Chat which offer a solution to these problems. Therefore this thesis presents findings on how adolescents use social networking to negotiate gender and identity, produce social status and how these attempts can be confounded by the very technology that facilitates their production.
This thesis explores how social networking platforms influence the production of identity, status and capital amongst adolescents. This includes an exploration of how some digital communication ...platforms have negatively impacted on the social experiences of some teenagers and resulted in these users adapting their digital communicative practices to overcome communicative challenges. The study draws upon data collected via 9 semi-structured interviews, 9 focus groups and 84 surveys with boys and girls aged 11-16 from three schools in England. It explores specific social norms which relate to gender, and how they are negotiated within both masculine and feminine interactions through the respective practices of banter and gossip or stalking. These interactional processes are used as a means of negotiating status and of in-group inclusion and out-group rejection (Goffman, 1963). Furthermore they are important elements in the formation of relationships, identity and social capital. For Bourdieu social capital is the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition (1980, 2). The production of social capital is linked to an individual s capacity to manage group norms and approved values. This study demonstrates that online displays of gender are part of adolescents attempts to generate social capital through gaining positive public affirmations (for example in the form of likes). This has led to a new form of capital which has been titled virtual capital , and which is revealed to be a crucial element in adolescents self-worth and status. Although social networking sites can facilitate the creation of these capitals, they can also simultaneously hinder their creation. Facebook s system of widespread automatic information sharing, alongside a lack user of control in managing the flow of data which is received and shared, has led to many teens experiencing challenges in how they produce identity and gain popularity. This has led to negative social experiences, a growing disillusionment with Facebook, and increased use of more contemporary platforms such as Snap Chat which offer a solution to these problems. Therefore this thesis presents findings on how adolescents use social networking to negotiate gender and identity, produce social status and how these attempts can be confounded by the very technology that facilitates their production.
Background:
Delirium is a common post-operative complication, particularly in older adults undergoing major or emergency procedures. It is associated with increased length of intensive care and ...hospital stay, post-operative mortality and subsequent dementia risk. Current methods of predicting delirium incidence, duration and severity have limitations. Investigation of blood and cerebrospinal fluid (CSF) biomarkers linked to delirium may improve understanding of the underlying pathophysiology, particularly with regard to the extent this is shared or distinct with underlying dementia. Together, these have the potential for development of better risk stratification tools and perioperative interventions.
Methods:
200 patients over the age of 70 scheduled for surgery with routine spinal anaesthetic will be recruited from UK hospitals. Their cognitive and functional baseline status will be assessed pre-operatively by telephone. Time-matched CSF and blood samples will be taken at the time of surgery and analysed for known biomarkers of neurodegeneration and neuroinflammation. Patients will be assessed daily for delirium until hospital discharge and will have regular cognitive follow-up for two years. Primary outcomes will be change in modified Telephone Interview for Cognitive Status (TICS-m) score at 12 months and rate of change of TICS-m score. Delirium severity, duration and biomarker levels will be treated as exposures in a random effects linear regression models. PRIMED Risk has received regulatory approvals from Health Research Authority and London – South East Research Ethics Committee.
Discussion:
The main anticipated output from this study will be the quantification of biomarkers of acute and chronic contributors to cognitive impairment after surgery. In addition, we aim to develop better risk prediction models for adverse cognitive outcomes.
ObjectiveReduced exercise capacity is well documented in end-stage chronic kidney disease (CKD), preceded by changes in cardiac morphology in CKD stage 3. However, it is unknown whether subclinical ...cardiopulmonary dysfunction occurs in CKD stage 3 independently of heart failure.MethodsProspective observational cross-sectional study of exercise capacity assessed by cardiopulmonary exercise testing in 993 preoperative patients. Primary outcome was peak oxygen consumption (VO2peak). Anaerobic threshold (AT), oxygen pulse and exercise-evoked measures of autonomic function were analysed, controlling for CKD stage 3, age, gender, diabetes mellitus and hypertension.ResultsCKD stage 3 was present in 93/993 (9.97%) patients. Diabetes mellitus (RR 2.49 (95% CI 1.59 to 3.89); p<0.001), and hypertension (RR 3.20 (95% CI 2.04 to 5.03); p<0.001)) were more common in CKD stage 3. Cardiac failure (RR 0.83 (95% CI 0.30 to 2.24); p=0.70) and ischaemic heart disease (RR 1.40 (95% CI 0.97 to 2.02); p=0.09) were not more common in CKD stage 3. Patients with CKD stage 3 had lower predicted VO2peak (mean difference: 6% (95% CI 1% to 11%); p=0.02), lower peak heart rate (mean difference:9 bpm (95% CI 3 to 14); p=0.03)), lower AT (mean difference: 1.1 mL/min/kg (95% CI 0.4 to 1.7); p<0.001) and impaired heart rate recovery (mean difference: 4 bpm (95% CI 1 to 7); p<0.001)).ConclusionsSubclinical cardiopulmonary dysfunction in CKD stage 3 is common. This study suggests that maladaptive cardiovascular/autonomic dysfunction may be established in CKD stage 3, preceding pathophysiology reported in end-stage CKD.
Background
Studies of interventions to prevent the many neurological complications of sickle cell disease must take into account multiple outcomes of variable severity, with limited sample size. The ...goals of the studies presented were to use investigator preferences across outcomes to determine an attitude-based weighting of relevant clinical outcomes and to establish a valid composite outcome for a clinical trial.
Methods
In Study 1, investigators were surveyed about their practice regarding hydroxyurea therapy and opinions about outcomes for the “Hydroxyurea to Prevent the Central Nervous System Complications of Sickle Cell Disease Trial” (HU Prevent), and their minimally acceptable relative risk reduction for the two outcome components, motor and neurocognitive deficits. In Study 2, HU Prevent investigators provided overall weights for these two components. In Study 3, they provided more granular rankings, ratings, and maximum number acceptable to harm. A weighted composite outcome, the Stroke Consequences Risk Score, was constructed that incorporates the major neurologic complications of sickle cell disease. The Stroke Consequences Risk Score represents the 3-year risk of suffering the adverse consequences of stroke. In Study 4, the results of the Optimizing Primary Stroke Prevention in Sickle Cell Anemia (STOP2) and Silent Infarct Transfusion Trials were reanalyzed in light of the composite outcome.
Results
In total, 22 to 27 investigators participated per study. In Study 1, across three samplings between 2009 and 2015, the average minimally acceptable relative risk reduction ranged from 0.36 to 0.50, at or below the target effect size of 0.50. In 2015, 21 (91%) reported that a placebo-controlled trial is reasonable; 23 (100%), that it is ethical; and 22 (96%), that they would change their practice, if the results of the trial were positive. In Studies 2 and 3, the weight elicited for a cognitive decline (of 10 IQ points) from the overall assessment was 0.67 (and for motor deficit, the complementary 0.33); from ranking, 0.6; from rating, 0.58; and from maximal number acceptable to harm, 0.5. Using data from two major clinical trials, Study 4 demonstrated the same conclusions as the original trials using the Stroke Consequences Risk Score, with smaller p-values for both reanalyses. An assessment of acceptability was performed as well.
Conclusion
This set of studies provides the rationale, justification, and validation for the use of a weighted composite outcome and confirms the need for the phase III HU Prevent study. Surveys of investigators in multi-center studies can provide the basis of clinically meaningful outcomes that foster the translation of study results into practice while increasing the efficiency of a study.
ObjectiveRecent perioperative trials have highlighted the urgent need for a better understanding of why sympatholytic drugs intended to reduce myocardial injury are paradoxically associated with harm ...(stroke, myocardial infarction). We hypothesised that following a standardised autonomic challenge, a subset of patients may demonstrate excessive sympathetic activation which is associated with exercise-induced ischaemia and impaired cardiac output.MethodsHeart rate rise during unloaded pedalling (zero workload) prior to the onset of cardiopulmonary exercise testing (CPET) was measured in 2 observation cohorts of elective surgical patients. The primary outcome was exercise-evoked, ECG-defined ischaemia (>1 mm depression; lead II) associated with an exaggerated increase in heart rate (EHRR ≥12 bpm based on prognostic data for all-cause cardiac death in preceding epidemiological studies). Secondary outcomes included cardiopulmonary performance (oxygen pulse (surrogate for left ventricular stroke volume), peak oxygen consumption (VO2peak), anaerobic threshold (AT)) and perioperative heart rate.ResultsEHRR was present in 40.4–42.7% in both centres (n=232, n=586 patients). Patients with EHRR had higher heart rates perioperatively (p<0.05). Significant ST segment depression during CPET was more common in EHRR patients (relative risk 1.7 (95% CI 1.3 to 2.1); p<0.001). EHRR was associated with 11% (95%CI 7% to 15%) lower predicted oxygen pulse (p<0.0001), consistent with impaired left ventricular function.ConclusionsEHRR is common and associated with ECG-defined ischaemia and impaired cardiac performance. Perioperative sympatholysis may further detrimentally affect cardiac output in patients with this phenotype.
This study examines the facial surfaces of different groups of cleft babies aged up to eleven months, prior to any corrective surgery, with the aim of identifying and assessing differences in their ...facial morphology. Measurements of standard anthropometric landmarks were made on plaster casts taken pre-operatively of the faces of babies presenting for surgical correction of lip and palate deformities. Periorbital and mid face measurements show no difference between control and cleft groups. The nasal base is shown to be wider in infants with cleft lip on both cleft and non-cleft sides. Upper lip measurements indicate shortening, lateral deviation and superolateral rotation. A diagrammatic model is proposed to illustrate facial anatomy in control and cleft individuals. Modifications to the technique are proposed. Further study in this field is suggested, in order to produce a comprehensive database of facial morphological changes in the cleft and non-cleft populations both pre-operatively and over time, with a view to producing a potential redefinition of the cleft syndrome based on anthropometric principles.
Hurricane Rita made landfall in the area of southeast Texas and southwest Louisiana in the late evening of September 24, 2005. This event closed Lamar University in Beaumont, Texas until October 19, ...2005 while leaders of the University, the Texas State University System, and the State of Texas made heroic efforts to salvage the Fall 2005 semester and return the University to full physical and fiscal health. Due to both planning and luck the operations of the Chemistry Department were minimally effected by the hurricane. The effects on, responses of, and lessons learned by the University and Chemistry Department are discussed.
The objective of the ENIQ 2nd pilot study was to show how to fully exploit the potential of technical justifications (TJ) in the qualification of inspection procedures and thereby reduce the number ...of test-piece trials on full-scale components. As the subject of the study,
a ferritic BWR-type nozzle to shell weld was selected. A TJ was produced, partly relying on modelling, to predict whether a designated ultrasonic inspection would be successful in detecting the specified defects. In parallel, a test-piece with deliberately introduced defects was fabricated
and inspected with the inspection system specified in the TJ. Predictions and inspection results were compared. In addition, as a separate exercise, three different mathematical models were used to predict the responses of the defects in the test-piece to provide information on model applicability
and accuracy of prediction. The ENIQ 2nd pilot study has been largely successful in showing that TJs have the potential to predict the outcome of specific inspections and so reduce or remove the need for large scale test-pieces in qualification. The project has shown that models
are available which give largely conservative predictions of defect response when used within their regimes of validity.
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