Showing papers by "Coventry University published in 2014"

Chilling outweighs photoperiod in preventing precocious spring development.

Abstract: It is well known that increased spring temperatures cause earlier onset dates of leaf unfolding and flowering. However, a temperature increase in winter may be associated with delayed development when species' chilling requirements are not fulfilled. Furthermore, photosensitivity is supposed to interfere with temperature triggers. To date, neither the relative importance nor possible interactions of these three factors have been elucidated. In this study, we present a multispecies climate chamber experiment to test the effects of chilling and photoperiod on the spring phenology of 36 woody species. Several hypotheses regarding their variation with species traits (successional strategy, floristic status, climate of their native range) were tested. Long photoperiods advanced budburst for one-third of the studied species, but magnitudes of these effects were generally minor. In contrast to prior hypotheses, photosensitive responses were not restricted to climax or oceanic species. Increased chilling length advanced budburst for almost all species; its effect greatly exceeding that of photoperiod. Moreover, we suggest that photosensitivity and chilling effects have to be rigorously disentangled, as the response to photoperiod was restricted to individuals that had not been fully chilled. The results indicate that temperature requirements and successional strategy are linked, with climax species having higher chilling and forcing requirements than pioneer species. Temperature requirements of invasive species closely matched those of native species, suggesting that high phenological concordance is a prerequisite for successful establishment. Lack of chilling not only led to a considerable delay in budburst but also caused substantial changes in the chronological order of species' budburst. The results reveal that increased winter temperatures might impact forest ecosystems more than formerly assumed. Species with lower chilling requirements, such as pioneer or invasive species, might profit from warming winters, if late spring frost events would in parallel occur earlier.

A review on delignification of lignocellulosic biomass for enhancement of ethanol production potential

Abstract: In the recent past, significant research has been made by thermal, mechanical, chemical and microbial pretreatments in the process of delignification. Production of ethanol from the lignocellulosic material has been done in three major steps: (i) delignification; (ii) depolymerization and (iii) fermentation. Pretreatment has been one of the most expensive processing steps in cellulosic biomass to fermentable sugar conversion. Present review article presents recent advances in the field of delignification. Research article also comprehensively discusses the different pretreatment methods along with effect of delignification on ethanol production and the uses of lignin in different industries. It has been found out that; pretreatment methods have significant impact on production efficiency of ethanol from biomass. This further signifies that, the pretreatment results must be balanced against their impact on cost of the processing steps and the trade-off between operating costs, capital costs and biomass cost.

Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial

Abstract: Summary Background Evidence is scarce for the effectiveness of therapies for oesophageal cancer progressing after chemotherapy, and no randomised trials have been reported. We aimed to compare gefitinib with placebo in previously treated advanced oesophageal cancer. Methods For this phase 3, parallel, randomised, placebo-controlled trial, eligible patients were adults with advanced oesophageal cancer or type I/II Siewert junctional tumours, histologically confirmed squamous-cell carcinoma or adenocarcinoma, who had progressed after chemotherapy, with WHO performance status 0–2, and with measurable or evaluable disease on CT scan. Participants were recruited from 48 UK centres and randomly assigned (1:1) to gefitinib (500 mg) or matching placebo by simple randomisation with no stratification factors. Patients, clinicians, and trial office staff were masked to treatment allocation. Treatment continued until disease progression, unacceptable toxicity, or patient choice. The primary outcome was overall survival, analysed by intention to treat. This trial is registered, number ISRCTN29580179. Findings Between March 30, 2009, and Nov 18, 2011, 450 patients were randomly assigned to treatment groups (one patient withdrew consent; 224 patients allocated gefitinib and 225 allocated placebo included in analyses). Overall survival did not differ between groups (median 3·73 months, 95% CI 3·23–4·50, for gefitinib vs 3·67 months, 95% CI 2·97–4·37, for placebo; hazard ratio [HR] 0·90, 95% CI 0·74–1·09, p=0·29). Among the prespecified patient-reported outcomes (110 patients on gefitinib and 121 on placebo completed both baseline and 4 week questionnaires and were included in analyses), odynophagia was significantly better in the gefitinib group (adjusted mean difference −8·61, 95% CI −14·49 to −2·73; n=227; p=0·004), whereas the other outcomes were not significantly improved compared with placebo: global quality of life (2·69, 95% CI −2·33 to 7·72, n=231, p=0·293), dysphagia (−3·18, 95% CI −8·36 to 2·00, n=231, p=0·228), and eating (−4·11, 95% CI −9·96 to 1·75, n=229, p=0·168). Median progression-free survival was marginally longer with gefitinib than it was with placebo (1·57 months, 95% CI 1·23–1·90 in the gefitinib group vs 1·17 months, 95% CI 1·07–1·37 in the placebo group; HR 0·80, 95% CI 0·66–0·96, p=0·020). The most common toxicities were diarrhoea (36 [16%] of 224 patients on gefitinib vs six [3%] of 225 on placebo) and skin toxicity (46 [21%] vs two [1%]), both mostly grade 2. The commonest grade 3–4 toxicities were fatigue (24 [11%] vs 13 [6%] patients) and diarrhoea (13 [6%] vs two [1%]). Serious adverse events were reported in 109 (49%) of 224 patients assigned to gefitinib and 101 (45%) of 225 on placebo. 54 (24%) of patients in the gefitinib group achieved disease control at 8 weeks, as did 35 (16%) of patients on placebo (p=0·023). Interpretation The use of gefitinib as a second-line treatment in oesophageal cancer in unselected patients does not improve overall survival, but has palliative benefits in a subgroup of these difficult-to-treat patients with short life expectancy. Future research should focus on identification of predictive biomarkers to identify this subgroup of benefiting patients. Funding Cancer Research UK.

Horizon scanning for invasive alien species with the potential to threaten biodiversity in Great Britain

Abstract: Invasive alien species (IAS) are considered one of the greatest threats to biodiversity, particularly through their interactions with other drivers of change. Horizon scanning, the systematic examination of future potential threats and opportunities, leading to prioritization of IAS threats is seen as an essential component of IAS management. Our aim was to consider IAS that were likely to impact on native biodiversity but were not yet established in the wild in Great Britain. To achieve this, we developed an approach which coupled consensus methods (which have previously been used for collaboratively identifying priorities in other contexts) with rapid risk assessment. The process involved two distinct phases: 1. Preliminary consultation with experts within five groups (plants, terrestrial invertebrates, freshwater invertebrates, vertebrates and marine species) to derive ranked lists of potential IAS. 2. Consensus-building across expert groups to compile and rank the entire list of potential IAS. Five hundred and ninety-one species not native to Great Britain were considered. Ninety-three of these species were agreed to constitute at least a medium risk (based on score and consensus) with respect to them arriving, establishing and posing a threat to native biodiversity. The quagga mussel, Dreissena rostriformis bugensis, received maximum scores for risk of arrival, establishment and impact; following discussions the unanimous consensus was to rank it in the top position. A further 29 species were considered to constitute a high risk and were grouped according to their ranked risk. The remaining 63 species were considered as medium risk, and included in an unranked long list. The information collated through this novel extension of the consensus method for horizon scanning provides evidence for underpinning and prioritizing management both for the species and, perhaps more importantly, their pathways of arrival. Although our study focused on Great Britain, we suggest that the methods adopted are applicable globally.

A comprehensive review on applications of ohmic heating (OH)

Abstract: Recently, there is growing demand for alternative new heating technology, ohmic heating is an alternative and fast heating method has a large number of actual and potential application exits in food industry, water distillation, waste treatment, chemical processing etc. This paper presents a comprehensive review of ohmic heating current application, design configurations and operation parameters. The review highlights that ohmic heating are prospective alternative new heating technology to meet the demand of industrial and domestic heating utilizing. The recommendations for further research are made to provide more robust analysis in assessing ohmic heating performance.

A review and recent developments in the optimal wind-turbine micro-siting problem

Abstract: This paper presents a review of the current state of the art solutions to the problem of wind farm optimal design. The aim of this work is to present the problem by identifying the most relevant issues involved in the design of a wind farm, as well as to discuss the optimization techniques and wind farm models used in the published literature. An appropriate wind turbine layout is vital in order to obtain adequate performance in relation to the exploitation and operation of the plant during its lifespan. There are several factors that influence wind farm design, chief among them are the calculation of the overall energy yield by the wind farm and the initial investment. The energy produced depends on the local wind conditions and the interference caused by wind turbines nearby. The investment is mainly related to wind turbine acquisition, civil works and electrical infrastructure. However, these are not the only items that influence the design of a wind farm since economic indicators, environmental issues, local regulations, or the presence of wind farms should also be taken into account when deciding the design of the wind farm. Even in the case of the most simplified objective function (maximizing the annual energy produced) the optimization problem cannot be solved by classical optimization techniques. To cope with this problem, most authors have used meta-heuristics techniques which have proved to be efficient when searching for the optimal solution to this problem. The purpose of this paper is to review previous work by offering a clear outline of the latest advances, as well as to highlight the main aspects which need to be taken into account when tackling the wind farm design problem. In addition, in a conclusion of the review, future needs have been identified.

Agroecological Research: Conforming—or Transforming the Dominant Agro-Food Regime?

Abstract: Agroecology has three practical forms—a scientific discipline, an agricultural practice, and a social movement. Their integration has provided a collective-action mode for contesting the dominant agro-food regime and creating alternatives, especially through a linkage with food sovereignty. At the same time, agroecology has been recently adopted by some actors who also promote conventional agriculture. Agroecology can play different roles—either conforming to the dominant regime, or else helping to transform it—contingent on specific empowerment strategies. Tensions between “conform versus transform” roles can be identified in European agroecological research, especially in three areas: farm-level agroecosystems development; participatory plant breeding; and short food-supply chains remunerating agroecological methods. To play a transformative role, collaborative strategies need to go beyond the linear stereotype whereby scientists “transfer” technology or farmers “apply” scientific research results. To the extent that farmer–scientist alliances co-create and exchange knowledge, such gains can transform the research system.

Depletion: THE COST OF SOCIAL REPRODUCTION

Abstract: In this article we explore the concept of depletion through social reproduction (DSR). We describe depletion, identify its key indicators and suggest different methodologies that could be used to measure it. We discuss issues having to do with gendered harm as well as questions about how depletion might be reversed. We conclude that recognizing DSR in this way can be a powerful tool for understanding the consequences of non-recognition of the value of domestic work to national economies, as well as the harm that might accrue in the doing of this work at both a systemic and individual level.

Exact distributions for stochastic gene expression models with bursting and feedback.

Abstract: Stochasticity in gene expression can give rise to fluctuations in protein levels and lead to phenotypic variation across a population of genetically identical cells. Recent experiments indicate that bursting and feedback mechanisms play important roles in controlling noise in gene expression and phenotypic variation. A quantitative understanding of the impact of these factors requires analysis of the corresponding stochastic models. However, for stochastic models of gene expression with feedback and bursting, exact analytical results for protein distributions have not been obtained so far. Here, we analyze a model of gene expression with bursting and feedback regulation and obtain exact results for the corresponding protein steady-state distribution. The results obtained provide new insights into the role of bursting and feedback in noise regulation and optimization. Furthermore, for a specific choice of parameters, the system studied maps on to a two-state biochemical switch driven by a bursty input noise source. The analytical results derived provide quantitative insights into diverse cellular processes involving noise in gene expression and biochemical switching.

Trustworthiness and trust: influences and implications

Abstract: This paper frames trustworthiness as the key upstream construct of trust and recognises that trust operates at two levels in services relationships, with a number of key drivers that are mediated by trustworthiness. Our findings are supported by survey data from customers of UK financial services, with the data points captured over a number of years which allow for fluctuations in trust level.Empirically we find that trustworthiness impacts both the cognitive and affecting dimensions of trust, with the impact being greatest on cognitive trust. As a result of our findings it is possible for practitioner to implement policies to not only build trust but also deal with issues where there is a need to rebuild it, as in the case of our research setting.

The dark side of trust : when trust becomes a ‘poisoned chalice’.

Abstract: Trust is typically portrayed as beneficial to all concerned; something which is inherently good. In this article we focus on interpersonal trust and argue that, while there are undoubted benefits, trust can also be problematic; there are circumstances in which it can become a ‘poisoned chalice’ for one or other of the parties involved. We question whether the potential for negative experiences in relation to trust has been fully explored and argue that its true dark side lies within the dynamics of the trust relationship. From this stance we use the social exchange and gift giving literatures to re-appraise trust in a way that highlights the importance of expectation and intent and demonstrates the circumstances in which trust may not be beneficial for one of the parties involved. We conclude with a research agenda which we believe will further develop our understanding of this complex human interaction.

The implications of neoliberalism for social work: Reflections from a six-country international research collaboration

Abstract: The near global implementation of public sector and social welfare reform as a result of neoliberal economic reform has impacted on social work and social inequality. State strategies to reduce soc...

A Web-Based Program Improves Physical Activity Outcomes in a Primary Care Angina Population: Randomized Controlled Trial

Abstract: Background: Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative. Objective: Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina. Methods: We conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program (“ActivateYourHeart”). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL). Results: A total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and –861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (–7.79 minutes, 95% CI –55.01 to –7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (–0.56 kg, 95% CI –1.78 to –0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up. Conclusions: An Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness.

Tranexamic acid for upper gastrointestinal bleeding

Abstract: Background Tranexamic acid reduces haemorrhage through its antifibrinolytic effects. In a previous version of the present review, we found that tranexamic acid may reduce mortality. This review includes updated searches and new trials.Objectives To assess the effects of tranexamic acid versus no intervention, placebo or other antiulcer drugs for upper gastrointestinal bleeding.Search methods We updated the review by performing electronic database searches (Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, Science Citation Index) and manual searches in July 2014.Selection criteriaRandomised controlled trials, irrespective of language or publication status.Data collection and analysis We used the standard methodological procedures of the The Cochrane Collaboration. All-cause mortality, bleeding and adverse events were the primary outcome measures. We performed fixed-effect and random-effects model meta-analyses and presented results as risk ratios (RRs) with 95% confidence intervals (CIs) and used I² as a measure of between-trial heterogeneity. We analysed tranexamic acid versus placebo or no intervention and tranexamic acid versus antiulcer drugs separately. To analyse sources of heterogeneity and robustness of the overall results, we performed subgroup, sensitivity and sequential analyses.Main results We included eight randomised controlled trials on tranexamic acid for upper gastrointestinal bleeding. Additionally, we identified one large ongoing pragmatic randomised controlled trial from which data are not yet available. Control groups were randomly assigned to placebo (seven trials) or no intervention (one trial). Two trials also included a control group randomly assigned to antiulcer drugs(lansoprazole or cimetidine). The included studies were published from 1973 to 2011. The number of participants randomly assigned ranged from 47 to 216 (median 204). All trials reported mortality. In total, 42 of 851 participants randomly assigned to tranexamic acid and 71 of 850 in the control group died (RR 0.60, 95% CI 0.42 to 0.87; P value 0.007; I² = 0%). The analysis was not confirmed when all participants in the intervention group with missing outcome data were included as treatment failures, or when the analysis was limited to trials with low risk of attrition bias. Rebleeding was diagnosed for 117 of 826 participants in the tranexamic acid group and for 146 of 825 participants in the control group (RR 0.80, 95% CI 0.64 to 1.00; P value 0.07; I² = 49%).We were able to evaluate the risk of serious adverse events on the basis of only four trials. Our analyses showed 'no evidence of a difference between tranexamic acid and control interventions regarding the risk of thromboembolic events.’ Tranexamic acid appeared to reduce the risk of surgery ina fixed-effect meta-analysis (RR 0.73, 95% CI 0.56 to 0.95), but this result was no longer statistically significant in a random-effects meta-analysis (RR 0.61, 95% CI 0.35 to 1.04; P value 0.07). No difference was apparent between tranexamic acid and placebo in the assessment of transfusion (RR 1.02, 95% CI 0.94 to 1.11; I² = 0%), and meta-analyses that compared tranexamic acid versus antiulcer drugs did not identify beneficial or detrimental effects of tranexamic acid for any of the outcomes assessed.Authors' conclusions This review found that tranexamic acid appears to have a beneficial effect on mortality, but a high dropout rate in some trials means that we cannot be sure of this until the findings of additional research are published. At the time of this update in 2014, one large study(8000 participants) is in progress, so this review will be much more informative in a few years. Further examination of tranexamic acid would require inclusion of high-quality randomised controlled trials. Timing of randomisation is essential to avoid attrition bias and to limit the number of withdrawals. Future trials may use a pragmatic design and should include all participants with suspected bleeding or with endoscopically verified bleeding, as well as a tranexamic placebo arm and co-administration of pump inhibitors and endoscopic therapy. Assessment of outcome measures in such studies should be clearly defined. Endoscopic examination with appropriate control of severe bleeding should be performed, as should endoscopic verification of clinically significant rebleeding. In addition, clinical measures of rebleeding should be included. Other important outcome measures include mortality (30-day or in-hospital), need for emergency surgery or blood transfusion and adverse events (major or minor).

An optimization approach for analysing nonlinear stability with transition to turbulence in fluids as an exemplar.

Abstract: This article introduces and reviews recent work using a simple optimization technique for analysing the nonlinear stability of a state in a dynamical system. The technique can be used to identify the most efficient way to disturb a system such that it transits from one stable state to another. The key idea is introduced within the framework of a finite-dimensional set of ordinary differential equations (ODEs) and then illustrated for a very simple system of two ODEs which possesses bistability. Then the transition to turbulence problem in fluid mechanics is used to show how the technique can be formulated for a spatially-extended system described by a set of partial differential equations (the well-known Navier–Stokes equations). Within that context, the optimization technique bridges the gap between (linear) optimal perturbation theory and the (nonlinear) dynamical systems approach to fluid flows. The fact that the technique has now been recently shown to work in this very high dimensional setting augurs well for its utility in other physical systems.

The impact of innovativeness on supply chain performance: is supply chain integration a missing link?

Abstract: Purpose – This purpose of this paper is to study the impact of innovativeness on supply chain integration (SCI) and supply chain performance (SCP) and the role of SCI in mediating between innovativeness in the supply chain and SCP. Innovativeness is an accepted driver to leverage firm performance. SCI and SCP require innovativeness in the supply chain, but their interrelationships have rarely been researched empirically. Design/methodology/approach – A questionnaire survey and structural equation modelling were used in this work. After a structural and measurement model was devised from existing supply chain literature, the main data were collected in a web-based questionnaire survey of South Korean manufacturers. Structural equation modelling was applied to test proposed hypotheses on the associations between variables, following a hierarchical analysis process. Findings – Innovativeness in the supply chain had a positive impact on both SCI and SCP. However, the direct impact of innovativeness on SCP dis...

A self-management programme for COPD: a randomised controlled trial

Abstract: Studies of programmes of self-management support for chronic obstructive pulmonary disease (COPD) have been inconclusive. The Self-Management Programme of Activity, Coping and Education (SPACE) FOR COPD is a 6-week self-management intervention for COPD, and this study aimed to evaluate the effectiveness of this intervention in primary care. A single-blind randomised controlled trial recruited people with COPD from primary care and randomised participants to receive usual care or SPACE FOR COPD. Outcome measures were performed at baseline, 6 weeks and 6 months. The primary outcome was symptom burden, measured by the self-reported Chronic Respiratory Questionnaire (CRQ-SR) dyspnoea domain. Secondary outcomes included other domains of the CRQ-SR, shuttle walking tests, disease knowledge, anxiety, depression, self-efficacy, smoking status and healthcare utilisation. 184 people with COPD were recruited and randomised. At 6 weeks, there were significant differences between groups in CRQ-SR dyspnoea, fatigue and emotion scores, exercise performance, anxiety, and disease knowledge. At 6 months, there was no between-group difference in change in CRQ-SR dyspnoea. Exercise performance, anxiety and smoking status were significantly different between groups at 6 months, in favour of the intervention. This brief self-management intervention did not improve dyspnoea over and above usual care at 6 months; however, there were gains in anxiety, exercise performance, and disease knowledge.

Ultrasound-assisted electrodeposition of composite coatings with particles

Abstract: The electrodeposition of multifunctional composite coatings has rapidly emerged in the last decade due to the enhanced mechanical properties and corrosion resistance that such composite coatings exhibit compared to electroplated single metal and alloy deposits. Many studies have indicated that the implementation of ultrasound in composite electroplating processes can bring about many benefits, not only as a tool to improve the dispersion and de-agglomeration of particles in the electroplating bath, but also to enhance the incorporation of finely dispersed and uniformly distributed particles into the metal matrix. The present paper summarizes the fundamentals of the use of ultrasound and acoustic cavitation and how it may influence the electrodeposition of composite coatings with particles by commenting on some of the most significant works on this topic presented by the scientific community in the last 10 years. This paper will review these investigations and discuss how the ultrasonic parameters may affect the dispersion of the particles in the electrolyte and its effect on the characteristics of the composite coatings, generally resulting in the enhancement of the mechanical properties and corrosion resistance of the composite coatings. In addition, this paper will review some of the issues that may arise when using ultrasound in such processes and the pros and cons of the different transducer systems available, highlighting the need for detailed information regarding the ultrasonic parameters and equipment used when utilising sonication.

Globalization and Modernity

Abstract: As we move into the global century, several aspects of social and economic life are changing and post-industrial shifts are unparalleled by virtue of the interconnectedness that brings together the corners of the globe. New technologies, new economic relationships, new social processes, and new political developments are all characteristics of globalization (Hudson and Lowe, 2004: 22) in a post-industrial age featured by information, innovation, finance and services. As the world has contracted, people’s quality of life has changed regardless of where they live. In fact, the propagation of free market mindsets in emerging economies has created collective network connections with considerable good but pervasive inequalities as well. A fundamental aim of this book is to argue that these changes are part of a economic transition to post-industrialism associated with risks and inequalities that shape human experience in the midst of a formidable global financial climate. There is an obvious tension with this. On the one hand, life expectancy, health statuses and per capital incomes are at an all-time high and many feudal practices have been relegated to the past (Phillipson, 2006). On the other hand, vast numbers of people struggle with poverty and significant pockets of poverty portend more than lack of income. Those living on the bottom of the socio-economic ladder labor under the burden of avoidable, lifestyle diseases, hunger and related maladies, not to mention myriad social risks (Turner, 2008). Those on the upper reaches of the same ladder garner disproportionate shares of the resources and are able to support comfortable lifestyles.