Life after Stroke: Coping mechanisms among African Caribbean Women

In the UK stroke is the third most common cause of death for women and the incidence in African Caribbean women is higher than the general population. Stroke burden has major consequences for the physical, mental and social health of African Caribbean women. In order to adjust to life after stroke individuals affected employ a range of strategies which may include personal, religious (church) or spiritual support (i.e. prayer), individual motivation, or resignation to life with a disability. This study explored these areas through the coping mechanisms that African Caribbean women utilised post stroke in the context of stroke recovery and lifestyle modification efforts needed to promote healthy living post stroke. A qualitative approach using Interpretative Phenomenological Analysis was adopted. Eight women were recruited into the study. Semi structured in-depth interviews were audio recorded and were transcribed verbatim. Data were analysed using a four-stage framework: familiarisation, sense making, developing themes and data refinement and analysis. Three main themes on coping emerged: the need to follow medical rules to manage stroke, strength and determination, and the use of religion and faith to cope with life after stroke. These findings illustrate both a tension between religious beliefs and the medical approach to stroke and highlight the potential benefits that religion and the church can play in stroke recovery. Implications for practice include acknowledgement and inclusion of religion and church based health promotion in post stroke recovery.

Failure Mechanisms and Local Scour at Coastal Structures induced by Tsunamis

On March 11 2011, an exceptionally large tsunami event was triggered by a massive earthquake offshore, the northeast coast of Japan, which affected coastal infrastructure such as seawalls, coastal dikes and breakwaters in the Tohoku region. Such infrastructure was built to protect against the Level 1 tsunamis that previously hit the region, but not for events as significant as the 2011 Tohoku tsunami, which was categorized as a Level 2 tsunami [Shibayama et al. 2013]. The failure mechanisms of concrete-armoured dikes, breakwaters and seawalls due to Level 2 tsunamis are still not fully understood by researchers and engineers. This paper investigates the failure modes and mechanisms of damaged coastal structures in Miyagi and Fukushima Prefectures, following the authors' post-disaster field surveys carried out between 2011 and 2013. Six significant failure mechanisms were identified for the coastal dikes and seawalls affected by this tsunami: 1) Leeward toe scour failure, 2) Crown armour failure, 3) Leeward slope armour failure, 4) Seaward toe and armour failure, 5) Overturning failure, and 6) Parapet wall failure, in which leeward toe scour being recognized as the major failure mechanism in most surveyed locations. The authors also propose a simple practical mathematical model for predicting the scour depth at the leeward toe of the coastal dikes, by considering the effects of the tsunami hydrodynamics, the soil properties and the type of structure. The key advantage of this model is that it depends entirely on quantities that are measurable in the field. Furthermore this model was further refined by conducting a series of hydraulic model experiments aimed to understand the governing factors of the leeward toe scour failure. Finally, based on the results obtained, key recommendations are given for the design of resilient coastal defence structures that can survive a level 2 tsunami event.

Conspicuous by their abstinence: the limited engagement of heroin users in English and Welsh Drug Recovery Wings

Background In recent years, an abstinence-focused, ‘recovery’ agenda has emerged in UK drug policy, largely in response to the perception that many opioid users had been ‘parked indefinitely’ on Opioid Substitution Therapy (OST). The introduction of ten pilot ‘Drug Recovery Wings’ (DRWs) in 2011 represents the application of this recovery agenda to prisons. This paper describes the DRWs’ operational models, the place of opiate dependent prisoners within them, and the challenges of delivering ‘recovery’ in prison. Methods In 2013, the implementation and operational models of all ten pilot DRWs were rapidly assessed. Up to three days were spent in each DRW, undertaking semi-structured interviews with a sample of 94 DRW staff and 102 DRW residents. Interviews were fully transcribed, and coded using grounded theory. Findings from the nine adult prisons are presented here. Results Four types of DRW were identified, distinguished by their size and selection criteria. Strikingly, no mid- or large-sized units regularly supported OST recipients through detoxification. Type A were large units whose residents were mostly on OST with long criminal records and few social or personal resources. Detoxification was rare, and medication reduction slow. Type B's mid-sized DRW was developed as a psychosocial support service for OST clients seeking detoxification. However, staff struggled to find such prisoners, and detoxification again proved rare. Type C DRWs focused on abstinence from all drugs, including OST. Though OST clients were not intentionally excluded, very few applied to these wings. Only Type D DRWs, offering intensive treatment on very small wings, regularly recruited OST recipients into abstinence-focused interventions. Conclusion Prison units wishing to support OST recipients in making greater progress towards abstinence may need to be small, intensive and take a stepped approach based on preparatory motivational work and extensive preparation for release. However, concerns about post-release deaths will remain.