24,112 research outputs found
Identifying and responding to people with mild learning disabilities in the probation service
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
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The Epidemiology and Genetic Architecture of Vitamin D Deficiency in African Children
Vitamin D deficiency is a common public health problem worldwide. However, little is known about the epidemiology of vitamin D deficiency in Africa. In this thesis, I aimed to determine: 1) the prevalence of and risk factors associated with vitamin D deficiency in studies conducted in Africa; 2) the prevalence and predictors of vitamin D deficiency in African children; 3) the association between vitamin D and iron deficiency in African children; and 4) genetic variants that influence vitamin D status in Africans.
In a systematic review and meta-analyses of previous vitamin D studies in Africa, the average prevalence of low vitamin D status was 18.5%, 34.2% and 59.5% using cut-offs of 25-hydroxyvitamin D (25(OH)D) levels of <30 nmol/L, <50 nmol/L and <75 nmol/L, respectively. Populations at risk of vitamin D deficiency included newborns, women, and people living in high latitudes or urban areas.
In an epidemiological study of young children living in Africa, the prevalence of low vitamin D status was 0.6%, 7.8% and 44.5% using cut-offs of 25(OH)D levels of GC2 variant of the group-specific component (GC) gene, which encodes vitamin D binding protein.
Vitamin D deficiency was also associated with 80% higher odds of iron deficiency in these children. Adjusted regression models revealed that vitamin D deficiency was associated with higher ferritin and hepcidin levels suggesting lower iron status, and reduced sTfR and transferrin levels and increased TSAT and serum iron levels suggesting improved iron status.
Genome-wide association study (GWAS) in Africans revealed genetic variants that influence vitamin D status in vitamin D metabolism genes: DHCR7/NADSYN1, CYP2R1 and GC. However, the majority of SNPs from previous European GWASs did not replicate in the current GWAS.
Findings from this thesis indicate that vitamin D deficiency is prevalent in many African populations and should be considered in public health strategies in Africa
A Scoping Review of interpreter-mediated assessments under the Mental Health Act (1983) and international equivalents
The purpose of this scoping review is to identify and evaluate available evidence concerning assessments under the Mental Health Act (1983) (MHA) (and international equivalents) which are carried out with the assistance of a spoken or signed language interpreter. âInternational equivalentsâ refers to pieces of legislation in countries other than England and Wales that concern formal assessment for compulsory assessment and treatment, including hospital detention, with respect to a mental disorder. [Both the specific Act that applies to England and Wales and its international equivalents are henceforth
referred to as MHA].The guiding questions are:
âąWhat are the enablers and barriers to good practice in interpreter mediated MHA assessments?
âąTo what extent and how might interpreter mediation support or impede the legal rights and best interests of those assessed under the MHA?
The aim is to determine whether the body of research available to date is sufficient to inform evidence-based guidelines for interpreters and for mental health professionals, in particular those who have the duty to make decisions under the MHA, known in England and Wales as Approved Mental Health Professional (AMHPs), to work in a joint and effective manner
Building body identities - exploring the world of female bodybuilders
This thesis explores how female bodybuilders seek to develop and maintain a viable sense of self despite being stigmatized by the gendered foundations of what Erving Goffman (1983) refers to as the 'interaction order'; the unavoidable presentational context in which identities are forged during the course of social life. Placed in the context of an overview of the historical treatment of women's bodies, and a concern with the development of bodybuilding as a specific form of body modification, the research draws upon a unique two year ethnographic study based in the South of England, complemented by interviews with twenty-six female bodybuilders, all of whom live in the U.K. By mapping these extraordinary women's lives, the research illuminates the pivotal spaces and essential lived experiences that make up the female bodybuilder. Whilst the women appear to be embarking on an 'empowering' radical body project for themselves, the consequences of their activity remains culturally ambivalent. This research exposes the 'Janus-faced' nature of female bodybuilding, exploring the ways in which the women negotiate, accommodate and resist pressures to engage in more orthodox and feminine activities and appearances
An agile development cycle of an online memory program for healthy older adults
Online interventions for older adults should be tailored to their unique needs to increase the efficacy of and adherence to the intervention. The agile development cycle is a dynamic model to solicit and incorporate feedback from older adults during the design process. We combined this approach with the framework of Harvard Universityâs clinical and translational phases that provide a clear structure for evaluating new health programs before they are offered in the community. We based our online memory program on the empirically validated in-person Memory and Aging Program. The aim of the present study was to combine the agile development cycle with the clinical and translational phases framework to develop and pilot an online memory program tailored to the unique needs of older adults. Study 1 involved piloting individual program modules on site and integrating participant feedback into the programâs design to optimize usability. Study 2 involved two sequential pilots of the program accessed remotely to evaluate preliminary clinical outcomes and obtain feedback for iterative modifications. Plans for further validation and limitations are discussed. The successful application of the agile development cycle implemented in this series of studies can be adapted by others seeking to offer online content for targeted end users.
Les interventions en ligne pour les personnes ĂągĂ©es doivent ĂȘtre adaptĂ©es Ă leurs besoins spĂ©cifiques afin dâaugmenter leur efficacitĂ© et lâadhĂ©sion des utilisateurs. Le cycle de dĂ©veloppement agile est un modĂšle dynamique permettant de solliciter et dâintĂ©grer les commentaires des personnes ĂągĂ©es au cours du processus de conception. Nous avons combinĂ© cette approche avec le Cadre des phases cliniques et translationnelles de lâuniversitĂ© Harvard qui fournit une structure claire pour Ă©valuer les nouveaux programmes de santĂ© avant quâils ne soient proposĂ©s dans la communautĂ©. Nous avons Ă©laborĂ© notre programme en ligne sur la mĂ©moire Ă partir du programme sur la mĂ©moire et le vieillissement qui se donnait en prĂ©sentiel, et qui avait Ă©tĂ© validĂ© empiriquement. Lâobjectif de lâĂ©tude Ă©tait dâassocier le cycle de dĂ©veloppement agile avec le Cadre des phases cliniques et translationnelles pour concevoir et tester un programme pilote en ligne sur la mĂ©moire qui est adaptĂ© aux besoins uniques des personnes ĂągĂ©es. LâĂ©tude no 1 a permis de tester dans une phase pilote les modules individuels du programme avec des participants prĂ©sents sur place, et Ă intĂ©grer leurs commentaires lors du dĂ©veloppement du programme afin dâen optimiser la convivialitĂ©. LâĂ©tude no 2 a consistĂ© en deux pilotes sĂ©quentiels du programme accessibles Ă distance dans lesquels les rĂ©sultats cliniques prĂ©liminaires ont Ă©tĂ© Ă©valuĂ©s et des commentaires ont Ă©tĂ© collectĂ©s pour guider les modifications itĂ©ratives. Les plans pour une validation ultĂ©rieure et les limites des Ă©tudes sont discutĂ©s. Lâapplication rĂ©ussie du cycle de dĂ©veloppement agile mis en Ćuvre dans cette sĂ©rie dâĂ©tudes pourra ĂȘtre adaptĂ©e par dâautres Ă©quipes souhaitant proposer un contenu en ligne Ă des groupes dâutilisateurs finaux plus spĂ©cifiques
The association between neurodegeneration and local complement activation in the thalamus to progressive multiple sclerosis outcome
The extent of grey matter demyelination and neurodegeneration in the progressive multiple sclerosis (PMS) brains at postâmortem associates with more severe disease. Regional tissue atrophy, especially affecting the cortical and deep grey matter, including the thalamus, is prognostic for poor outcomes. Microglial and complement activation are important in the pathogenesis and contribute to damaging processes that underlie tissue atrophy in PMS. We investigated the extent of pathology and innate immune activation in the thalamus in comparison to cortical grey and white matter in blocks from 21 cases of PMS and 10 matched controls. Using a digital pathology workflow, we show that the thalamus is invariably affected by demyelination and had a far higher proportion of active inflammatory lesions than forebrain cortical tissue blocks from the same cases. Lesions were larger and more frequent in the medial nuclei near the ventricular margin, whilst neuronal loss was greatest in the lateral thalamic nuclei. The extent of thalamic neuron loss was not associated with thalamic demyelination but correlated with the burden of white matter pathology in other forebrain areas (Spearman r = 0.79, p < 0.0001). Only thalamic neuronal loss, and not that seen in other forebrain cortical areas, correlated with disease duration (Spearman r = â0.58, p = 0.009) and age of death (Spearman r = â0.47, p = 0.045). Immunoreactivity for the complement pattern recognition molecule C1q, and products of complement activation (C4d, Bb and C3b) were elevated in thalamic lesions with an active inflammatory pathology. Complement regulatory protein, C1 inhibitor, was unchanged in expression. We conclude that active inflammatory demyelination, neuronal loss and local complement synthesis and activation in the thalamus, are important to the pathological and clinical disease outcomes of PMS
Unraveling the effect of sex on human genetic architecture
Sex is arguably the most important differentiating characteristic in most mammalian
species, separating populations into different groups, with varying behaviors, morphologies,
and physiologies based on their complement of sex chromosomes, amongst other factors. In
humans, despite males and females sharing nearly identical genomes, there are differences
between the sexes in complex traits and in the risk of a wide array of diseases. Sex provides
the genome with a distinct hormonal milieu, differential gene expression, and environmental
pressures arising from gender societal roles. This thus poses the possibility of observing
gene by sex (GxS) interactions between the sexes that may contribute to some of the
phenotypic differences observed. In recent years, there has been growing evidence of GxS,
with common genetic variation presenting different effects on males and females. These
studies have however been limited in regards to the number of traits studied and/or
statistical power. Understanding sex differences in genetic architecture is of great
importance as this could lead to improved understanding of potential differences in
underlying biological pathways and disease etiology between the sexes and in turn help
inform personalised treatments and precision medicine.
In this thesis we provide insights into both the scope and mechanism of GxS across the
genome of circa 450,000 individuals of European ancestry and 530 complex traits in the UK
Biobank. We found small yet widespread differences in genetic architecture across traits
through the calculation of sex-specific heritability, genetic correlations, and sex-stratified
genome-wide association studies (GWAS). We further investigated whether sex-agnostic
(non-stratified) efforts could potentially be missing information of interest, including sex-specific trait-relevant loci and increased phenotype prediction accuracies. Finally, we
studied the potential functional role of sex differences in genetic architecture through sex
biased expression quantitative trait loci (eQTL) and gene-level analyses.
Overall, this study marks a broad examination of the genetics of sex differences. Our findings
parallel previous reports, suggesting the presence of sexual genetic heterogeneity across
complex traits of generally modest magnitude. Furthermore, our results suggest the need to
consider sex-stratified analyses in future studies in order to shed light into possible sex-specific molecular mechanisms
The Idiosyncrasy of Involuntary Musical Imagery Repetition (IMIR) Experiences: The Role of Tempo and Lyrics
Involuntary musical imagery repetition (IMIR), colloquially known as âearworms,â is a form of musical imagery that arises involuntarily and repeatedly in the mind. A growing number of studies, based on retrospective reports, suggest that IMIR experiences are associated with certain musical features, such as fast tempo and the presence of lyrics, and with individual differences in music training and engagement. However, research to date has not directly assessed the effect of such musical features on IMIR and findings about individual differences in music training and engagement are mixed. Using a cross-sectional design (Study 1, n = 263), we examined IMIR content in terms of tempo (fast, slow) and presence of lyrics (instrumental, vocal), and IMIR characteristics (frequency, duration of episode and section) in relation to 1) the musical content (tempo and lyrics) individuals most commonly expose themselves to (music-listening habits), and 2) music training and engagement. We also used an experimental design (Study 2, n = 80) to test the effects of tempo (fast or slow) and the presence of lyrics (instrumental or vocal) on IMIR retrieval and duration. Results from Study 1 showed that the content of music that individuals are typically exposed to with regard to tempo and lyrics predicted and resembled their IMIR content, and that music engagement, but not music training, predicted IMIR frequency. Music training was, however, shown to predict the duration of IMIR episodes. In the experiment (Study 2), tempo did not predict IMIR retrieval, but the presence of lyrics influenced IMIR duration. Taken together, our findings suggest that IMIR is an idiosyncratic experience primed by the music-listening habits and music engagement of the individual
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