6,968 research outputs found

    Identifying and responding to people with mild learning disabilities in the probation service

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    It has long been recognised that, like many other individuals, people with learningdisabilities find their way into the criminal justice system. This fact is not disputed. Whathas been disputed, however, is the extent to which those with learning disabilities arerepresented within the various agencies of the criminal justice system and the ways inwhich the criminal justice system (and society) should address this. Recently, social andlegislative confusion over the best way to deal with offenders with learning disabilities andmental health problems has meant that the waters have become even more muddied.Despite current government uncertainty concerning the best way to support offenders withlearning disabilities, the probation service is likely to continue to play a key role in thesupervision of such offenders. The three studies contained herein aim to clarify the extentto which those with learning disabilities are represented in the probation service, toexamine the effectiveness of probation for them and to explore some of the ways in whichprobation could be adapted to fit their needs.Study 1 and study 2 showed that around 10% of offenders on probation in Kent appearedto have an IQ below 75, putting them in the bottom 5% of the general population. Study 3was designed to assess some of the support needs of those with learning disabilities in theprobation service, finding that many of the materials used by the probation service arelikely to be too complex for those with learning disabilities to use effectively. To addressthis, a model for service provision is tentatively suggested. This is based on the findings ofthe three studies and a pragmatic assessment of what the probation service is likely to becapable of achieving in the near future

    Examination of a Brief, Self-Paced Online Self-Compassion Intervention Targeting Intuitive Eating and Body Image Outcomes among Men and Women

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    Ideals for appearance and body image are pervasive in Western culture in which men and women are portrayed with unrealistic and often unattainable standards (Ferguson, 2013; Martin, 2010). Exposure and reinforcement have created a culture of social acceptance and internalization of these ideals, contributing to pervasive body image disturbance (i.e., body dissatisfaction; Fallon et al., 2014; Stice, 2001; Thompson & Stice, 2001; Thompson et al., 1999). Research has suggested that body dissatisfaction is expressed differently across sexes (Grossbard et al., 2008), with attention to thin ideals among women and muscular ideals among men. Body dissatisfaction has been linked to numerous poor outcomes, including dieting, unhealthy weight control behaviors, disordered eating, and increased psychopathology. Although dieting is one of the primary mechanisms employed to reduce body dissatisfaction (Thompson & Stice, 2001), research has shown that such efforts are contraindicated as dieting predicts weight gain over time (Pietiläinen et al., 2012) as well as preoccupation with food, disordered eating, eating disorders, emotional distress, and higher body dissatisfaction (Grabe et al., 2007; Johnson & Wardle, 2005; Neumark- Sztianer et al., 2006; Paxton et al., 2006; Tiggemann, 2005). Restrictive dietary behaviors suppress physiological cues to eat (e.g., hunger) that presents a vulnerability to eating in response to alternative cues, both internal (e.g., emotions) and external (e.g., availability of food). Intuitive eating is a non-restrictive approach to eating that encourages adherence to internal physiological cues to indicate when, what, and how much to eat (Tylka, 2006) and has demonstrated an inverse relationship with disordered eating, restrained eating, food preoccupation, dieting, body dissatisfaction, and negative affect (Bruce & Ricciardelli, 2016). Self-compassion, relating to oneself in a caring and supportive manner (Neff, 2003a), has been proposed as a pathway to increase intuitive eating and reduce body dissatisfaction (Neff & Knox, 2017; Schoenefeld & Webb, 2013; Webb & Hardin, 2016). Research has highlighted the efficacy of self-compassion interventions in addressing weight-related concerns (Rahimi-Ardabili et al., 2018) as well as brief experiential exercises for reducing body dissatisfaction (Moffitt et al., 2018). Additionally, there is a growing body of evidence supporting the efficacy of internet-based self-compassion interventions (Mak et al., 2018; Kelman et al., 2018; Nadeau et al., 2020). The purpose of the current study was to examine the effectiveness of a brief, self-paced online self-compassion intervention targeting body image and adaptive eating behaviors and potential mechanisms of change (e.g., self-compassion and psychological flexibility) among undergraduate men and women. This study also examined outcomes among men and women in the area of self-compassion, body dissatisfaction, and intuitive eating as research has highlighted the need to determine who benefits more from self-compassion interventions (Rahimi-Ardabili et al., 2018). The study compared a one-hour, self-guided online self-compassion intervention to an active control condition. The intervention was comprised of psychoeducation, experiential exercises, and mindfulness practice designed to increase self-compassion surrounding body image and eating behaviors. In contrast, the active control condition consisted of self-care recommendations and self-assessments for nutrition, exercise, and sleep. The study was administered over three parts (e.g., baseline, intervention, and follow-up) in which variables of interest were assessed at each time point. Outcome variables included self-compassion, intuitive eating, disordered eating, body appreciation, muscle dysmorphia, internalized weight bias, fear of self-compassion, and psychological inflexibility. Participants were randomized on a 2:1 intervention to control ratio at the second time point in order to make comparisons between groups while simultaneously having sufficient power for examining mediation and moderation within the treatment condition. Overall, 1023 individuals (64% women, Mage = 18.9, 67.4% white) signed informed consent and participated in at least one part of the study whereas 101 participants (71% women, Mage = 19.3, 71% white) completed all three study portions. As predicted, self-compassion was correlated with all variables of interest, and all study variables were correlated with each other (p < .01). In contrast to hypothesized outcomes, the self-compassion condition failed to demonstrate improvements across time or between conditions on all study outcomes. These results persisted when participants were screened for levels of intuitive eating as well. Contrary to prediction, internalized weight bias, muscle dysmorphia, and fear of self-compassion demonstrated increased levels within the intervention condition and decreases in the control condition. There were significant gender differences on multiple outcome variables, with men demonstrating higher levels of self-compassion and body appreciation whereas women endorsed higher levels of disordered eating, internalized weight bias, muscle dysmorphia, and psychological inflexibility. Additionally, there were significant gender interactions for internalized weight bias, body appreciation, and muscle dysmorphia. The interactions existed such that men demonstrated increased internalized weight bias and muscle dysmorphia across time whereas women displayed decreased weight bias and muscle dysmorphia. The opposite pattern was found within body appreciation; women demonstrated increased body appreciation across time while men reported decreased levels of body appreciation. Despite this study’s intent to examine underlying mechanisms of change, the condition in which participants were randomly selected did not have any relationship, positive or negative, with the outcome variables of interest. As such, mediation within the current study was not conducted as it would violate statistical assumptions required to examine this hypothesis. Finally, upon examining the moderating relationship of fear of self-compassion between self-compassion and outcome variables, there were main effects for self-compassion on intuitive eating, emotional eating, internalized weight bias, body appreciation, and psychological inflexibility as well as main effects of fear of self-compassion on psychological inflexibility. There were significant interactions for intuitive eating and emotional eating, such that as fear of self-compassion increased, the effect of self-compassion on intuitive eating decreased, and the effect of self-compassion on reducing emotional eating behaviors decreased. Overall, the brief, self-paced online intervention delivered in the current study did not prove to be an effective means for improving self-compassion, intuitive eating, body appreciation, disordered eating, muscle dysmorphia, and psychological inflexibility. Nevertheless, the relationships between self-compassion and outcome variables of interest throughout the study mirror that of the existing literature. Findings from this study, in general, were also consistent with differences between men and women despite a gap in the research for intervention outcomes. Although fear of self-compassion demonstrated a moderating effect on the relationship between self-compassion and intuitive eating as well as emotional eating, this does not account for the lack of significant findings. The context surrounding this study, such as the COVID-19 pandemic, provided a considerable challenge to examining the efficacy of the current intervention. However, the findings of this study suggest future research will likely need to identify ways to enhance the delivery of experiential exercises that encourage engagement, provide a safe and warm environment for participants, and create flexibility and willingness surrounding painful and difficult experiences in order to undermine internalized and socially accepted beliefs about body image and eating behaviors

    Attitudes towards Animals and Meat Consumption: The Role of Ideology and Individual Differences

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    Humans' relationships with non-human animals are complicated and complex. This thesis aims to address questions on how people think about animals' moral standing, how information about food animals' sentience is (mis)remembered, and how people evaluate laboratory-grown meat relative to traditional meat. The first empirical chapter of the thesis, Chapter 3, explores the question of whether higher human supremacy beliefs are associated with a greater perceived moral divide between animals of high and low status. Across two studies (N = 196 and N = 256), the findings suggest that people holding stronger human supremacy beliefs also perceive a greater moral divide between animals, which may serve as a legitimising strategy to preserve not only the existing human-animal hierarchy, but also greater hierarchical divides between other animals. The second set of studies, presented in Chapter 4 (N = 253 and N = 255), focuses on food animals specifically, investigating the ideologically motivated memory processes involved in the processing of objective information about these animals' sentience. Indeed, dominance-based ideologies were significant predictors for targeted memory errors for information on food animals' sentience, but not for information on their uses (e.g., in medical science), suggesting that differences in ideological attitudes interfere with the correct recall of sentience information for food animals. The final set of studies, presented in Chapter 5 (total N = 1,169), turns its focus to the psychological barriers to acceptance of laboratory-grown meat, which is structurally identical to traditionally farmed meat and presents solutions to the ethical, environmental, and public health issues associated with traditional animal agriculture. The three experiments consistently demonstrated that omnivores who were wearier about new food technologies evaluated clean meat more negatively than traditional meat. Experiment 3 further demonstrated that safety concerns, but not naturalness concerns, partly explained why those wearier of novel food technologies evaluated clean meat less positively. Taken together, the findings highlight the role of general concerns about the use of new food technology as a psychological barrier to clean meat acceptance. This thesis thus adds to the growing body of literature on human-animal intergroup relations, providing further evidence for the ways in which individual differences and ideology affect peoples' thinking about animals of different socio-cultural status, as well as attitudes towards meat substitutes

    Physiological and Fitness Profile of Female Lacrosse Athletes

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    Lacrosse was a Native Americans game that originated long before it was first documented in the 17th century. Its purpose was not only used for religious, medical, and ceremonial purposes, but for fitness and teaching life lessons. Though the men’s game was developed in the mid 1800s, the first women’s lacrosse game was not played until the late 1800s in St. Andrews Scotland as it had previously been deemed inappropriate and too physically demanding for women. Since its start in 1890, the women’s game has changed dramatically. The modern game of lacrosse is characterized as a highly competitive field-based team sport that implements repeated bouts of sprinting and continuous change of direction. In the last four years, women’s lacrosse has undergone rule changes that have fundamentally changed the way the game is played. As such, the aim of this thesis was to highlight how these rule changes have affected the physiological profile of a female lacrosse athlete and if any positional differences could be determined. Nine female lacrosse athletes from a BUCS premier league team participated in a study that measured anthropometrics (stature, body mass, and sum of 8 skinfold thickness), body composition (FFM, FM and BF%) and a battery of fitness tests used to quantify the key elements of lacrosse: speed (36.6 m sprint), agility (pro- agility test), power (CMJ), and endurance (Yo-Yo IR Test Level 1). The participants in this study were taller, heavier, and had more FFM but a higher BF% compared to previous research on the anthropometric and body composition measures of women’s lacrosse athletes. In the physiological testing, the participants had a faster acceleration (9.1 m sprint), but slower agility (pro-agility test) and less explosive power (CMJ height). These measures could reflect a decreased reliance on the anaerobic ATP-PC system and increased reliance on the aerobic energy system because the recent rule changes. Alternatively, these results could be affirming the importance of maintaining a high FFM, low FM, and therefore lower BF%, and its effect on performance. Because of the uneven distribution of positions among participants, no positional differences could be confirmed. It is of note that the midfielders in this thesis had the best overall performance on the physiological testing battery, which supports previous theories about the position. More research should be completed provide a better understanding of the physiological profile of a female lacrosse athlete as well as if positional differences exist considering the recent rule changes

    Pedunculopontine-Induced cortical decoupling as the neurophysiological locus of dissociation

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    Mounting evidence suggests an association between aberrant sleep phenomena and dissociative experiences. However, no wake-sleep boundary theory provides a compelling explanation of dissociation or specifies its physiological substrates. We present a theoretical account of dissociation that integrates theories and empirical results from multiple lines of research concerning the domain of dissociation and the regulation of rapid eye movement (REM) sleep. This theory posits that individual differences in the circuitry governing the REM sleep promoting Pedunculopontine Nucleus and Laterodorsal Tegmental Nucleus determine the degree of similarity in the cortical connectivity profiles of wakefulness and REM sleep. We propose that a latent trait characterized by elevated dissociative experiences emerges from the decoupling of frontal executive regions due to a REM sleep-like aminergic/cholinergic balance. The Pedunculopontine Induced Cortical Decoupling Account of Dissociation (PICDAD) suggests multiple fruitful lines of inquiry and provides novel insights

    Foot and Ankle Impairments Affecting Mobility in Stroke

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    Introduction: Altered foot characteristics are common in people with stroke, with a third presenting with abnormal foot posture which is associated with ambulatory difficulties. Understanding the relationship between measures of foot and ankle impairment and their association with mobility and balance outcomes is therefore important; however, poor clinimetric properties of foot and ankle measures after stroke precludes evaluation of these relationships. Therefore, this research, undertaken as part of a multicentred research project, had the following aims: Study 1: To evaluate the clinimetric properties (feasibility, test–retest reliability, and clinical relevance) of measures of foot and ankle impairments, for application in people with stroke. Study 2: To examine how these measures differ between people with stroke and normal controls; and whether they are associated with mobility and balance outcomes. Methods: In Study 1, community-dwelling people with stroke, able to walk 10 m (metres), attended two testing sessions to evaluate the clinimetric properties of different foot and ankle measures. These included: static foot posture and dynamic foot loading (peak plantar pressure, PPP, contact area, CA and centre of pressure, CP) using a plantar pressure mat; isometric muscle strength using a hand-held dynamometer (HHD); peak ankle and hallux dorsiflexion and stiffness using bespoke rigs; and ankle plantarflexion spasticity using the Tardieu scale. Statistical analysis used intraclass correlation coefficients (ICCs₍₃,₁₎), standard error of measurement (SEM) and Bland–Altman plots. In Study 2, measures identified as reliable from Study 1 were incorporated in a cross-sectional study design. Participants were recruited from acute and community neurological services in East London and North Devon. Statistical analysis tested the differences between groups and between affected limbs in people with stroke. Impairment measures were evaluated using multivariate regression analysis for their association with functional outcomes: walking speed (over 10 m); Timed Up and Go (TUAG), Forward Functional Reach Test (FFRT) and presence of falls (> 1 in the last 3 months). Results: In Study 1, 21 people with stroke tested the measures. These were found to be feasible and easy to administer, although loss of data (up to 33%) was observed. All measures had moderate to excellent test–retest reliability (coefficients 0.50‒0.98), except ankle plantarflexion stiffness (ICCs₍₃,₁₎ = 0.00‒0.11). In Study 2, there were significant differences in all measures between people with stroke (n = 180) and controls (n = 46), apart from static foot posture (p = 0.670), toe deformity (p = 0.782) and peak hallux dorsiflexion (p = 0.320). Between limb differences were identified for all measures except foot posture (p = 0.489) and foot CA (p > 0.05). Multicollinearity analysis found 10 measures appropriate for multivariate regression which identified the following R² and variance explained: 59% walking speed (R² = 0.543); 49% TUAG (R² = 0.435); 36% FFRT (R² = 0.285) and 26% for Falls Presence. Conclusion: The study demonstrated that seven foot and ankle measures of impairment after stroke were clinically feasible, reliable and associated with mobility and balance outcomes. The measures were ankle and foot isometric muscle strength, sway velocity, PPP (RFT and FFT), CA (MFT and FFT) and peak ankle dorsiflexion. These measures can now be incorporated into research to examine methods to improve the treatment of foot and ankle after stroke

    Network based analysis to identify master regulators in prostate carcinogenesis

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    Prostate cancer (PCa) is the second most common tumor diagnosed in man, for which robust prognostic markers and novel targets for therapy are lacking. Major challenges in PCa therapeutical management arise from the marked intra and inter-tumors heterogeneity, hampering the discernment of molecular subtypes that can be used to guide treatment decisions. For this reason, virtually all patients undergoing standard of care androgen deprivation therapy for locally advanced or metastatic cancer, will eventually progress into the more aggressive and currently incurable form of PCa, referred to as castration resistant prostate cancer (CRPC). By exploiting the richness of information stored in gene-gene interactions, I tested the hypothesis that a gene regulatory network derived from transcriptomic profiles of PCa orthografts can reveal transcriptional regulators to be subsequently adopted as robust biomarkers or as target for novel therapies. Among the 1308 regulons identified from the preclinical models, Cox regression analysis coherently associated JMJD6 regulon activity with disease-free survival in three clinical cohorts, outperforming three published prognostic gene signatures (TMCC11, BROMO-10 and HYPOXIA-28). Given its potential role in a number of cancers, in-depth investigations of JMJD6 mediated function in PCa is warranted to test if it has a driver role in tumor progression. Encouraged by the predictive abilities of the gene regulatory network inferred from transcriptomics data, I explored the possibility of integrating the regulons structure with data from the proteomes of the same preclinical orthografts studied by RNA sequencing. This approach leverages the complementarity between gene and protein expression, to increase the robustness of the statistical analysis. Similar to gene-gene co-expression profiles, protein-protein co-expression data can provide a distinct representation of the molecular alterations underlying a biological phenotype. By implementing a pipeline to integrate modules derived from transcriptomic based regulons and proteinprotein interactions respectively from matched RNA-seq and quantitative proteomic data, I obtained 516 joint modules entailing a median of four protein complexes (range 1-41) per individual transcription factor regulon, providing new insight into its regulatory mechanisms. In the final step of the analysis, a permutation-based enrichment of the genes/proteins integrative modules implicated MID1 (an E3 ubiquitin ligase belonging to the family of tripartite motif containing protein) to be a driver transcriptional regulator in CRPC. In fact, MID1 module was the only candidate for which gene-gene and proteinprotein interactions were supported (p-value < 0.05) by both differentially expressed genes and proteins obtained from the CRPC vs PC contrast. Finally, I wished to test the usefulness of a network based investigation as a tool to identify predictors of treatment response. To this end, I obtained transcriptomics data from an in vivo subcutaneous xenograft treatment experiment (namely mychophenolic acid or abiraterone/ARN-509 as stand alone treatment or in combination) and determined which regulons were inferred to be active in the tumours following treatment. The androgen receptor positive human LNCaP C4-2b prostate cancer cells were injected into mice. The effects of treatment were assessed by collecting serial tumor sizes and by performing RNAseq at the designed endpoint of the study. Noteworthy, the gene graph enrichment analysis provided novel hypothesisbehind the anti- proliferative effect of mychophenolic acid (MPA), suggesting the SET proto-oncogene to be a target for MPA mediated suppression of proliferation. Of note, standard gene-set enrichment analysis, without input on specific gene-gene interactions, was not effective in prioritising the SET protooncogene, demonstrating the usefulness of the network based investigation. Collectively, data presented in this thesis provides an alternative perspective for the analysis of multi-omics profiles from PCa and highlights the importance of gene-gene and protein protein interactions in prostate cancer growth and progression

    Modelling approaches for histology-independent cancer drugs to inform NICE appraisals : a systematic review and decision-framework

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    Background The first histology-independent marketing authorisation in Europe was granted in 2019. This was the first time that a cancer treatment was approved based on a common biomarker rather than the location in the body at which the tumour originated. This research aims to explore the implications for National Institute for Health and Care Excellence appraisals. Methods Targeted reviews were undertaken to determine the type of evidence that is likely to be available at the point of marketing authorisation and the analyses required to support National Institute for Health and Care Excellence appraisals. Several challenges were identified concerning the design and conduct of trials for histology-independent products, the greater levels of heterogeneity within the licensed population and the use of surrogate end points. We identified approaches to address these challenges by reviewing key statistical literature that focuses on the design and analysis of histology-independent trials and by undertaking a systematic review to evaluate the use of response end points as surrogate outcomes for survival end points. We developed a decision framework to help to inform approval and research policies for histology-independent products. The framework explored the uncertainties and risks associated with different approval policies, including the role of further data collection, pricing schemes and stratified decision-making. Results We found that the potential for heterogeneity in treatment effects, across tumour types or other characteristics, is likely to be a central issue for National Institute for Health and Care Excellence appraisals. Bayesian hierarchical methods may serve as a useful vehicle to assess the level of heterogeneity across tumours and to estimate the pooled treatment effects for each tumour, which can inform whether or not the assumption of homogeneity is reasonable. Our review suggests that response end points may not be reliable surrogates for survival end points. However, a surrogate-based modelling approach, which captures all relevant uncertainty, may be preferable to the use of immature survival data. Several additional sources of heterogeneity were identified as presenting potential challenges to National Institute for Health and Care Excellence appraisal, including the cost of testing, baseline risk, quality of life and routine management costs. We concluded that a range of alternative approaches will be required to address different sources of heterogeneity to support National Institute for Health and Care Excellence appraisals. An exemplar case study was developed to illustrate the nature of the assessments that may be required. Conclusions Adequately designed and analysed basket studies that assess the homogeneity of outcomes and allow borrowing of information across baskets, where appropriate, are recommended. Where there is evidence of heterogeneity in treatment effects and estimates of cost-effectiveness, consideration should be given to optimised recommendations. Routine presentation of the scale of the consequences of heterogeneity and decision uncertainty may provide an important additional approach to the assessments specified in the current National Institute for Health and Care Excellence methods guide. Further research Further exploration of Bayesian hierarchical methods could help to inform decision-makers on whether or not there is sufficient evidence of homogeneity to support pooled analyses. Further research is also required to determine the appropriate basis for apportioning genomic testing costs where there are multiple targets and to address the challenges of uncontrolled Phase II studies, including the role and use of surrogate end points

    Developing a Person-Centred, Multi-level Physical Activity Intervention for Older Adults

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    Physical inactivity in older adults presents a significant problem within contemporary society. Governments around the world are recognising this importance and the large impact of physical inactivity on health and health-related expenditure, yet interventions promoting physical activity have typically produced only small or short‐lived behaviour change. Through three related studies, this thesis aims to develop a person-centred, multi-level physical activity intervention within a residential estate of older adults. The first study used qualitative methods to develop a person-centred understanding of the multi-level influencers of physical activity engagement within the targeted individuals. These findings were then applied within study 2, which implemented a 12-week physical activity intervention within the residential estate and used a mixed-methods approach to assess its implementation and explore personal experiences of the intervention strategies designed by the person-centred approach. The final study explored the transitions associated with older adults to develop an understanding of purpose, meaning and identity in later life, and how this can influence physical activity behaviour. The findings of the third study were presented within a composite vignette of the transition experiences of 4 older adults within the residential estate. The thesis presents an effective and appropriate strategy for developing person-centred, multi-level physical activity intervention for older adults. Contrary to the health-focused emphasis that is predominantly adopted by public health initiatives, the findings of this thesis highlight the importance of purpose, and related constructs such as meaning and identity for understanding and promoting physical activity behaviour in older adults. The findings suggest that future person-centred physical activity interventions for older adults should take into consideration the changes in sense of purpose as individuals become older and design intervention strategies to maximise a sense of purpose in life, and to provide more meaningful sources of physical activity
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