Interview with Erma Woods

An interview with Erma Wood regarding her experiences in a one-room school house.https://scholars.fhsu.edu/ors/1152/thumbnail.jp

An education for life: The process of learning the Alexander technique

The Alexander technique is an educational self-development self-management method with therapeutic benefits. The primary focus of the technique is learning about the self, conceptualized as a mind-body unity. Skills in the technique are gained experientially, including through hands-on and spoken guidance from a certified Alexander teacher, often using everyday movement such as walking and standing. In this article the authors summarize key evidence for the effectiveness of learning the Alexander technique and describe how the method was developed. They attempt to convey a sense of the unique all-encompassing and fundamental nature of the technique by exploring the perspectives of those engaged in teaching and learning it and conclude by bringing together elements of this account with relevant strands of qualitative research to view this lived experience in a broader context

’I am teaching them and they are teaching me’: Experiences of teaching Alexander Technique to people with dementia

Introduction: To enable people with dementia to live well we must support the person as a whole. The Alexander Technique (AT) offers an approach which addresses both physical and psychological issues which may be suitable to help people with dementia. In this new area of research, this study aimed to establish whether the AT is currently taught to people with dementia and if so to bring together the experiences of AT teachers in relation to the perceived benefits and suitability of the AT for this group.Methods: This qualitative study included data from responses to survey questions, interview transcripts and published articles.Results : A total of 84 AT teachers took part in an international survey of whom 18 (21%) had taught one or more people with dementia. Thematic analysis generated the following superordinate themes: ‘The AT can help people with dementia’, ‘How change comes about’, and ‘Adapting the AT for people with dementia’.Conclusions : AT teachers described perceiving improvements in movement, pain and flexibility; increased calm, sociability and environmental awareness. They highlighted the reciprocal nature of the relationship between teacher and student and highly valued this. Touch was seen as a key means of communication, helping people with dementia to feel safe. It seems that the AT does not require major adaptation to work with this group although the challenges of working in a care setting were discussed. The AT offers the potential to be a valuable intervention for people with dementia and further research is warranted

An investigation into the impact of microvascular leakage on neutrophil transendothelial migration as analysed using murine models of inflammation.

PhD ThesisControlled opening of endothelial-cell (EC) junctions is vital in regulating vascular permeability and neutrophil transendothelial migration (TEM) during acute inflammation. Although both phenomena can occur independently, as supported by distinct molecular pathways, the potential inter-play of these two responses requires further exploration. In this thesis, we investigated the impact of microvascular leakage on neutrophil TEM and the potential downstream pathophysiological consequences. To this aim, as part of this project, a confocal intravital microscopy platform was developed for simultaneous analysis of neutrophil TEM and vascular permeability within the murine cremaster muscle microcirculation. The inflammatory reactions employed were driven by locally administered LTB4, or IL-1β ± vasoactive agents (e.g. histamine/VEGF), or by a model of IR-injury. The findings provide direct evidence for the ability of inflammatory reactions characterised by enhanced microvascular leakage to promote an aberrant mode of neutrophil TEM, known as reverse (r)TEM. This response is characterised by neutrophils that have partially breached the endothelium and move in a retrograde mode, thus returning into the lumen. Interestingly, genetic functional deficiency or pharmacological blockade of VE-cadherin-dependent hyper-permeability reduced the frequency of neutrophil rTEM. Mechanistically, this migration behaviour was driven by excessive diffusion of tissue-derived CXCL1 through EC junctions into the plasma, resulting in a disrupted chemotactic gradient across the endothelium. Development of a novel tracking method allowed us to demonstrate that rTEM neutrophils exhibited a pro-inflammatory phenotype and disseminated into the blood and lung circulation. Presence of these cells in lungs was associated with vascular damage. Finally, we identified distinct roles for TNF-receptors in controlling vascular permeability and neutrophil migration during IR-injury. Collectively, the findings of this thesis provide a causal link between increased local microvascular leakage induction and disrupted localisation of chemotactic directional cues across the endothelial barrier, resulting in aberrant mode of neutrophil migration and subsequent distant organ damage

Breaking the habit: a qualitative exploration of barriers and facilitators to smoking cessation in people with enduring mental health problems

BACKGROUND: Smoking in people with mental health problems (MHPs) is an important public health concern as rates are two to three times higher than in the general population. While a strong evidence base exists to encourage and support smoking cessation in the wider population, there is limited evidence to guide the tailoring of interventions for people with MHPs, including minimal understanding of their needs. This paper presents findings from theoretically-driven formative research which explored the barriers and facilitators to smoking cessation in people with MHPs. The aim, guided by the MRC Framework for the development and evaluation of complex interventions, was to gather evidence to inform the design and content of smoking cessation interventions for this client group. METHODS: Following a review of the empirical and theoretical literature, and taking a critical realist perspective, a qualitative approach was used to gather data from key stakeholders, including people with enduring MHPs (n = 27) and professionals who have regular contact with this client group (n = 54). RESULTS: There was a strong social norm for smoking in participants with MHPs and most were heavily addicted to nicotine. They acknowledged that their physical health would improve if they stopped smoking and their disposable income would increase; however, more important was the expectation that, if they attempted to stop smoking, their anxiety levels would increase, they would lose an important coping resource, they would have given up something they found pleasurable and, most importantly, their mental health would deteriorate. Barriers to smoking cessation therefore outweighed potential facilitators and, as a consequence, impacted negatively on levels of motivation and self-efficacy. The potential for professionals to encourage cessation attempts was apparent; however, they often failed to raise the issue of smoking/cessation as they believed it would damage their relationship with clients. The professionals’ own smoking status also appeared to influence their health promoting role. CONCLUSIONS: Many opportunities to encourage and support smoking cessation in people with MHPs are currently missed. The increased understanding provided by our study findings and literature review have been used to shape recommendations for the content of tailored smoking cessation interventions for this client group

Can an ethics officer role reduce delays in research ethics approval? A mixed-method evaluation of an improvement project.

OBJECTIVE: Frustration continues to be directed at delays in gaining approvals for undertaking health research in the UK. We aimed to evaluate the impact of an ethics officer intervention on rates of favourable opinions (approval) and provisional opinions (requiring revision and resubmission) and on the time taken to reach a final opinion by research ethics committees (RECs), to characterise how the role operated in practice, and to investigate applicants' views. DESIGN: Mixed-method study involving (i) a 2-group, non-randomised before-and-after intervention study of RECs assigned an ethics officer and a matched comparator group; (ii) a process evaluation involving a survey of applicants and documentary analysis. PARTICIPANTS: 6 RECs and 3 associated ethics officers; 18 comparator RECs; REC applicants. RESULTS: Rates of provisional and favourable opinions between ethics officer and comparator RECs did not show a statistically significant effect of the intervention (logistic regression, p=0.26 for favourable opinions and p=0.31 for provisional opinions). Mean time to reach a decision showed a non-significant reduction (ANOVA, p=0.22) from 33.3 to 32.0 days in the ethics officer RECs compared with the comparator RECs (32.6 to 32.9 days). The survey (30% response rate) indicated applicant satisfaction and also suggested that ethics officer support might be more useful before submission. Ethics officers were successful in identifying many issues with applications, but the intervention did not function exactly as designed: in 31% of applicants, no contact between the applicants and the ethics officer took place before REC review. LIMITATIONS: This study was a non-randomised comparison cohort study. Some data were missing. CONCLUSIONS: An ethics officer intervention, as designed and implemented in this study, did not increase the proportion of applications to RECs that were approved on first review and did not reduce the time to a committee decision.The ethics officer pilot and the controlled evaluation was funded by the HRA. The process evaluation was conducted and funded separately by MD-W’s Wellcome Trust Investigator Award WT097899 with no HRA oversight or involvement beyond facilitating access to the database. MD-W’s contribution to this paper was also supported by University of Leicester study leave at the Dartmouth Institute for Health Policy and Clinical Practice. RA-SS was funded by a Medical Research Council senior clinical fellowship.This is the final version of the article. It first appeared from BMJ Group via http://dx.doi.org/10.1136/bmjopen-2016-01197

Numbers and narratives: How qualitative methods can strengthen the science of paediatric antimicrobial stewardship

Antimicrobial and diagnostic stewardship initiatives have become increasingly important in paediatric settings. The value of qualitative approaches to conduct stewardship work in paediatric patients is being increasingly recognized. This article seeks to provide an introduction to basic elements of qualitative study designs and provide an overview of how these methods have successfully been applied to both antimicrobial and diagnostic stewardship work in paediatric patients. A multidisciplinary team of experts in paediatric infectious diseases, paediatric critical care and qualitative methods has written a perspective piece introducing readers to qualitative stewardship work in children, intended as an overview to highlight the importance of such methods and as a starting point for further work. We describe key differences between qualitative and quantitative methods, and the potential benefits of qualitative approaches. We present examples of qualitative research in five discrete topic areas of high relevance for paediatric stewardship work: provider attitudes; provider prescribing behaviours; stewardship in low-resource settings; parents\u27 perspectives on stewardship; and stewardship work focusing on select high-risk patients. Finally, we explore the opportunities for multidisciplinary academic collaboration, incorporation of innovative scientific disciplines and young investigator growth through the use of qualitative research in paediatric stewardship. Qualitative approaches can bring rich insights and critically needed new information to antimicrobial and diagnostic stewardship efforts in children. Such methods are an important tool in the armamentarium against worsening antimicrobial resistance, and a major opportunity for investigators interested in moving the needle forward for stewardship in paediatric patients

Hyaluronidase-2 regulates RhoA signalling, myofibroblast contractility and other key pro-fibrotic myofibroblast functions

Hyaluronidase-2 (HYAL2) is a weak, acid-active hyaluronan-degrading enzyme that is broadly expressed in somatic tissues. Aberrant HYAL2 expression is implicated in diverse pathology. However, a significant proportion of HYAL2 is enzymatically inactive, thus the mechanisms through which HYAL2 dysregulation influences pathobiology is unclear. Recently, non-enzymatic HYAL2 functions have been described and our group has shown that nuclear HYAL2 can influence mRNA splicing to prevent myofibroblast differentiation. Myofibroblasts drive fibrosis, thereby promoting progressive tissue damage and leading to multimorbidity. This study identifies a novel HYAL2 cytoplasmic function in myofibroblasts that is unrelated to its enzymatic activity. In fibroblasts and myofibroblasts HYAL2 interacts with the small GTPase signaling molecule, RhoA. Transforming Growth Factor (TGF)-β1-driven fibroblast-to-myofibroblast differentiation promotes HYAL2 cytoplasmic re-localization to bind to the actin cytoskeleton. Cytoskeletal-bound HYAL2 functions as a key regulator of downstream RhoA signaling and influences pro-fibrotic myofibroblast functions including myosin light-chain kinase (MLCK) mediated myofibroblast contractility, myofibroblast migration, myofibroblast collagen/fibronectin deposition, as well as connective tissue growth factor (CTGF/CCN2) and matrix metalloproteinase-2 (MMP2) expression. These data demonstrate that in certain biological contexts the non-enzymatic effects of HYAL2 are critical in orchestrating RhoA signaling and downstream pathways that are important for full pro-fibrotic myofibroblast functionality. In conjunction with previous data demonstrating the influence of HYAL2 on RNA splicing, these findings begin to explain the broad biological effects of HYAL2