Psychosocial adjustment in adolescents with a parent with multiple sclerosis

Previous research has shown that children with a parent with a chronic medical condition may face psychosocial difficulties. This thesis presents a series of studies to explore how children adjust to their parents’ Multiple Sclerosis (MS).Study 1: A systematic review of the literature showed a number of factors linked to children's adjustment and also that adolescents might be at increased risk of psychosocial problems compared to younger children with a parent with MS.Study 2: Following the systematic review, a qualitative interview study, is presented, with 15 adolescents with a parent with MS which showed how adolescents view their increased responsibilities and also the importance of the parent without MS to provide practical and emotional support.Study 3: Mixed methods were used in order to develop a questionnaire (Perceptions of Parental Illness Questionnaire, PPIQ) to measure adolescents’ beliefs about their parents’ MS. To assess the psychometric properties of the newly developed questionnaire, 104 adolescents completed the PPIQ together with standardised measures of emotional and behavioural adjustment and illness-related impairment. The PPIQ appeared to be valid and reliable.Study 4: Finally, the data of the questionnaire development study was used in a longitudinal design study in which 56 parents with MS, 40 partners without MS and 75 adolescent children were included. The findings showed that parents’ anxiety and depression symptoms, parents' emotional expression and adolescents' views about MS were associated with adolescents' adjustment. MS characteristics (e.g. MS severity, type, time since diagnosis, relapses) and adolescents' reports on parent-adolescent communication were not associated with their adjustment.Family environment and adolescents’ illness beliefs are important factors to be incorporated in future interventions to support adolescents’ adjustment to parental MS

Steadfastness and the Epistemology of Disagreement

Suppose that you and an intellectual peer disagree about some proposition P in a field like philosophy, ethics, science, religion, politics, etc. As intellectual peers, they are roughly of equal intelligence and equally virtuous with respect to evaluating the evidence E in support of P. What is the epistemic significance of you and an intellectual `peer\u27 disagreeing about whether some body of evidence E supports a given proposition P? Can two epistemic peers reasonably disagree? In Chapter 1, I consider the Equal Weight View according to which rationality requires you to give equal weight to you peer\u27s response to the evidential support for P. When you do, both parties will be required to either suspend judgment about P or radically modify their doxastic stance in the direction of their peer. Since there is only one rational doxastic stance with respect to P, two intellectual peers cannot reasonably disagree. I offer numerous objections to the Equal Weight View. In Chapter 2, I consider the Total Evidence View as articulated by Thomas Kelly. He argues that when an impeccable reasoner disagrees with a consensus of his peers, rationality requires him to reduce his level of confidence in P. I argue that consensus is not sufficient to warrant a reduction in confidence. In Chapter 3, I consider a third type of view I call Steadfastness according to which it is reasonable for an agent to stand firm in his response to E\u27s support of P. Here we discover that there are a variety of token-instances of steadfastness. In Chapter 4, I extend my account by arguing that Steadfastness is a cognitive virtue that helps an agent stand her ground with respect to P while she integrates her newly acquired evidence. My view is unique in its emphasis on diachronic features of epistemic rationality as opposed to synchronic ones. Two upshots are that we can have reasonable disagreements and maintain our beliefs in a number of areas of intractable disagreement

TNT equivalence of C-4 and PE4: a review of traditional sources and recent data

Since standard engineering-level blast models are typically developed to predict airblast parameters (pressure and impulse) from TNT bursts, prediction of airblast from other materials uses an equivalence factor by which an equivalent TNT weight is computed and used in the source term of the model. This approach is widespread in the industry and has been codified in numerous manuals, books, and papers. A recent effort co-sponsored by TSWG (U.S.) and FSTD (Singapore) collected and compiled equivalence data for a wide variety of explosive materials (both military grade as well as home-made) into a single software tool named STREET. The database thus assembled provides a comprehensive and expandable repository for equivalence data. Two of the main achievements in STREET are the consideration of equivalence as a function of scaled standoff (rather than a scalar), and the documentation of uncertainty in the estimated value. In this paper, we consider specifically the manual- and test-derived data related to Composition C-4, and as a first step, we draw some judgments regarding the equivalence implicit in blast curves provided by UFC 3-340-02, for both pressure and impulse. Next, we consider PE4, which is similar in composition to C-4 and is used widely in the UK. A significant body of blast data for this explosive has been generated, from which equivalence is computed and is compared to the available data for C-4, with a view towards determining whether these two materials can in fact be considered as a single explosive (with two alternate names). Finally, considering the combined data for both C-4 and PE4, new curve fits are provided that represent the pressure and impulse equivalence of the C-4/PE4 material (and its uncertainty) as a function of scaled standoff

A comprehensive comparison of methods for clearing effects on reflected airblast impulse

Having calculated the free-field pressure history at the location of a building, an engineer engaged in design or assessment of that building must then calculate the loads on the various surfaces of the structure. Numerous engineering methods have been developed that provide approximate (and generally conservative) approaches towards the calculation of these loads. Of greatest importance is the load on the front face (i.e., the building surface directly facing the explosion source). Depending on the size of the building and the blast load duration, clearing effects due to the building’s boundaries may reduce the reflected impulse on the front face from the fully reflected value predicted by standard blast models. Unfortunately, there are many methods available in the literature for evaluating clearing effects, each using somewhat similar, yet distinctly different, equations. One approach given in UFC 3-340-02 (and reproduced in UFC 3-340-01) has gained widespread acceptance; another is presented in a set of guidelines published by ASCE and used for industrial applications; and lastly, a formerly classified study dating back to 1955 which, although declassified in 1998, seems to have escaped the notice of the blast community. The focus of the present paper is to evaluate all three of these methods empirically, by comparing their results against a series of blast tests with varying charge weights and scaled reflecting building dimensions. A comparative evaluation is then made of the strengths and weaknesses of each approach, with recommendations for future use by researchers and blast engineers

Prioritising target non-pharmacological interventions for research in Parkinson’s Disease: Achieving consensus from key stakeholders

Background: In 2014 Parkinson’s UK conducted a research prioritisation exercise with stakeholders highlighting important clinical research questions. The exercise highlighted the need for effective interventions to be developed and tested to tackle a range of non-motor symptoms including: sleep quality, stress and anxiety, mild cognitive impairment, dementia and urinary problems. The present work set out to build on this exercise by prioritising types of non-pharmacological interventions to be tested to treat the identified non-motor symptoms. Methods: A Patient and Public Involvement Exercise was used to reach consensus on intervention priorities for the treatment on non-motor symptoms. Some Delphi techniques were also used to support the feedback collected. A first-round prioritisation survey was conducted followed by a panel discussion. Nineteen panellists completed the first-round survey (9 people with Parkinson’s and 10 professionals working in Parkinson’s) and 16 participated in the panel discussion (8 people with Parkinson’s and 8 professionals working in Parkinson’s). A second-round prioritization survey was conducted after the panel discussion with 13 people with Parkinson’s. Results: Physical activity, third wave cognitive therapies and cognitive training were rated as priority interventions for the treatment of a range of non-motor symptoms. There was broad agreement on intervention priorities between health care professionals and people with Parkinson’s. A consensus was reached that research should focus on therapies which could be used to treat several different non-motor symptoms. In the context of increasing digitisation, the need for human interaction as an intervention component was highlighted.3 Conclusion: Bringing together Parkinson’s professionals and people with Parkinson’sresulted in a final treatment priority list which should be both feasible to carry out in routine clinical practice and acceptable to both professionals and people with Parkinson’s. The workshop further specified research priorities in Parkinson’s disease based on the current evidence base, stakeholder preferences, and feasibility. Research should focus on developing and testing non-pharmacological treatments which could be effective across a range of symptoms but specifically focusing on tailored physical activity interventions, cognitive therapies and cognitive training

Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study

Objectives Transitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years). Design Semistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis. Setting UK. Participants We interviewed 21 people at baseline and 17 participated in the follow-up interviews. Results The majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS. Conclusions After transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management