Evaluation of a dialectical behavior therapy skills group for female inmates who voluntarily seek treatment : a pilot study.

This dissertation examines the effectiveness of a partial skills group component of Dialectical Behavior Therapy (DBT) in female prison inmates. DBT is an evidence-based comprehensive treatment which addresses emotional reactivity, impulsivity and distress tolerance. The psychology staff at the Kentucky Correctional Institution for Women (KCIW) had noted that many of the behaviors leading to disruptive and dangerous situations within their female inmate population are related to inmates reacting to extreme emotionality. In response KCIW staff had implemented DBT on a limited basis. Although the treatment was in place, its effectiveness in promoting safety and security at KCIW had yet to be evaluated. This study used a non-randomized pre-test, post-test control group design to evaluate the effectiveness of this psychoeducational group therapy treatment as offered to volunteering female inmates at KCIW. The evaluation was implemented in order to determine whether the participants developed the adaptive coping skills purported to be taught by the treatment, evidenced a decrease in pathological symptomology, and a decrease in problematic behavior. Data were gathered through inmate self reports and record reviews of disciplinary infractions. A MANCOVA showed a significant overall effect for the treatment. Post hoc analysis showed a significant increase in the level of mindfulness and decrease in anger expression, a measure of distress tolerance, for the treatment participants but not the controls. Analysis of clinically significant change showed that 42% of participants showed significant improvement on the measure of mindfulness, 26% showed significant improvement on the measure of anger expression, and 17% showed significant improvement on the measure of borderline symptomology. There was also a significant increase in the frequency of reported adaptive skills usage between weeks one and two of the treatment. Lastly, there was a decrease in institutional infractions from the month prior to treatment to the month following treatment for the treatment participants, but not the controls. This study shows that delivery of a partial component of DBT may be a useful alternative for correctional institutions for females when the resource-intensive comprehensive DBT program is not feasible

Neurodevelopmental outcome of the high risk infant in Cape Town

The outcome of high risk infants provides an important audit of neonatal care. This audit renders valuable information to clinicians, parents and health care planners. Available outcome data from the developing world are sparse and urgently needed. This work was compiled with three aims in mind: to provide data from Cape Town on outcome of high risk infants (including both infants of very low birthweight and infants who have survived hypoxic ischaemic encephalopathy); to evaluate selected early neurodevelopmental assessments of these infants; and to propose a protocol for their effective follow-up. Three separate cohorts were selected and studied in order to achieve these aims. A prospective six-year follow-up study of infants with birth weights less than 1250 g was undertaken at Groote Schuur Hospital's Neonatal Intensive Care Unit. The aim of the study was to document the morbidity, mortality and neurodevelopmental outcome of these infants. Of 235 liveborn infants, 143 (61 %) survived to discharge. Better survival was documented for infants who weighed more than 900 g and were over 30 weeks gestation and whose mothers attended antenatal care. One hundred and six infants (83% of survivors) underwent clinical assessment at one year of age and were evaluated with the Griffiths Scales of Mental Development. Ninety six (91 %) of these survivors were seen and tested at two years of age and 80 (76%) were seen at six years of age together with 70 matched controls who had normal birthweights. Of the 106 infants assessed at one year of age, six infants were diagnosed as cerebral palsied, six were globally developmentally delayed without signs of cerebral palsy and one infant showed significant motor delay with a normal developmental quotient. At two years of age one further infant had cerebral palsy and nine more infants were developmentally delayed. At six years of age five infants had cerebral palsy, one was intellectually disabled and three were intellectually borderline. The major disability rate at one year of age was 11%, at two years of age was 22% and at six years of age was eight percent. The incidence of low birthweight children with possible learning disability was three times that of their matched controls and overall, the low birthweight children scored significantly less in all developmental measures. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period which had previously been developed at Groote Schuur Hospital was tested. The value of the score in predicting neurodevelopmental outcome at one year of age was assessed. Thirty five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, 4 who died before 6 months of age and one infant who was hospitalised at the time of the 12-month assessment. Twenty three (58%) of the infants were normal, 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. 25 infants were re-evaluated at 3 years of age. 15 of these 25 had been normal at one year of age and were evaluated with ten controls who had had an uneventful perinatal course. The Hypoxic lschaemic Encephalopathy Score was highly predictive for outcome. The best correlation with outcome was a combination of the peak score and evaluation on day seven; giving a positive predictive value of 92% and a negative predictive value of 100% for abnormal outcome, with a sensitivity of 100% and specificity of 93%. At three years of age the HIE survivors without cerebral palsy scored as well as their matched controls on Griffiths developmental evaluation. In these normal survivors no correlation between severity of HIE and developmental quotient was demonstrated. Infants with neurodevelopmental abnormality need to start therapy early and because of this, should be detected as soon as possible. Currently, no widely accepted method of early evaluation exists. A Perinatal Risk Rating, the Dubowitz Neurological Assessment and the Infant Neuromotor Assessment were compared in terms of predicting neurodevelopmental outcome at one year of age. A cohort of 130 consecutive neonatal intensive care unit graduates were selected according to high risk criteria. Each infant was examined at term gestational age on the Dubowitz Neurological Assessment and a Perinatal Risk Rating was allocated. The study infants were seen again at 18 weeks corrected age, when an Infant Neuromotor Assessment was done, and at one year of age the Griffiths Scales of Mental Developmental and full neurological examination were carried out. Of the 130 infants assessed at term, all were seen at 18 weeks. Thereafter five were lost to follow-up and two died. The outcome of all the remaining 123 infants is known. Prediction of a normal outcome at 1 year of age on the Dubowitz Neurological Assessment was 96% and for the Perinatal Risk Rating, 98%, but for an abnormal outcome they predicted only 56% and 42% respectively. The Infant Neurological Assessment at 18 weeks of age predicted a normal outcome at one year in 99% and an abnormal outcome in 82%. Very low birthweight infants are at higher risk for cerebral palsy and intellectual disability. In Groote Schuur Hospital, at six years of age, the major disability rate for infants with birthweights less than 1250 g was eight percent. Forty percent of term infants who survived hypoxic ischaemic encephalopathy had cerebral palsy with associated intellectual disability. The use of the Perinatal Risk Rating is appropriate in newborn facilities where cranial ultrasound is available. Otherwise the Dubowitz Neurological Assessment is an appropriate screening tool in the newborn period. Use of the Hypoxic Ischaemic Encephalopathy Score is recommended for clinical evaluation, prognostication and risk rating. It is proposed that high risk infants should be evaluated at 18 weeks corrected age with the Infant Neuromotor Assessment at a tertiary centre. If this assessment is normal, the infant can then be discharged to community clinic follow-up. Infants with more than one deviant sign at this age need continued review and those with more than three signs should be referred for neurodevelopmental therapy to a comprehensive neurodevelopmental clinic. Even those high-risk infants whose assessments are normal should be enrolled in a pre-school centre at five years of age to facilitate detection of learning problems prior to school entry

Sharing and modifying stories in neonatal peer support: an international mixed‐methods study

While shared personal experiences are a valued prerequisite of the peer supporter–service‐user relationship, they have the potential to create harm. There are challenges in peer supporters being emotionally ready to hear the experiences of others, and how much personal information peers should disclose. As part of an international study that aimed to explore how peer supporters who worked in a neonatal context (providing support to parents whose infant(s) has received neonatal care) were trained and supported, new insights emerged into how peers’ personal stories were used and modified to instil boundaries in peer support services. In this paper, we report on a secondary analysis of the data to describe how peer supporters’ stories were valued, used, assessed and moderated in neonatal peer support services; to safeguard and promote positive outcomes for peers and parents. Following University ethics approval, a mixed‐methods study comprising online surveys and follow‐up interviews was undertaken. Surveys were distributed through existing contacts and via social media. Thirty‐one managers/coordinators/trainers and 77 peer supporters completed the survey from 48 peer support services in 16 different countries, and 26 interviews were held with 27 survey respondents. Three themes describe variations in the types of stories that were preferred and when peers were perceived to be ‘ready’ to share them; the different means by which sharing personal accounts was encouraged and used to assess peer readiness; and the methods used to instil (and assess) boundaries in the stories the peers shared. In neonatal‐related peer support provision, the expected use of peer supporters’ stories resonates with the ‘use of self’ canon in social work practice. Peer supporters were expected to modify personal stories to ensure that service‐user (parents) needs were primary, the information was beneficial, and harm was minimised. Further work to build resilience and emotional intelligence in peer supporters is neede

Interactions between primary cilia length and hedgehog signalling in response to mechanical and thermal stress.

PhDThe primary cilium is a microtubule-based organelle present on the majority of interphase cells where it functions as a hub for numerous signalling pathways including hedgehog signalling. Chondrocytes, the unique cellular component of articular cartilage, possess primary cilia which are required for mechanotransduction and maintenance of a healthy extracellular matrix. However in osteoarthritis there is an increase in primary cilia length and prevalence associated with aberrant activation of hedgehog signalling which promotes cartilage degradation. The aim of this thesis was therefore to examine the influence of biophysical stimuli on chondrocyte primary cilia structure and function, relating changes in ciliary length to perturbations in hedgehog signalling. An in vitro mechanical loading model was established to study the influence of cyclic tensile strain on chondrocyte primary cilia. Loading at 10% strain activated hedgehog signalling measured by expression of Gli1 and Ptch1. Cilia progressively disassembled in response to increasing levels of mechanical strain in a manner dependent upon tubulin deacetylation. Cilia disassembly at 20% strain was associated with the loss of mechanosensitive hedgehog signalling despite continued expression of hedgehog ligand (Ihh). Therefore this behaviour may function as a protective mechanism limiting hedgehog-mediated cartilage degradation in response to high levels of mechanical strain. To further understand the influence the extracellular environment exerts over ciliary function, a second in vitro model was developed investigating the effects of thermal stress. In chondrocytes and fibroblasts, primary cilia underwent rapid resorption in response to elevated temperature and ligand mediated hedgehog signalling was inhibited. These studies demonstrate that regulated disassembly of the cilium in response to physical stress modulates both cilia size and function. In particular, the findings suggest that changes in the chondrocyte physical environment affect cilia structure and function and may therefore be an important factor in the aetiology of cartilage disease.Biotechnology and Biological Sciences Research Council (BBSRC

Aberrant Work Environments, Rationed Care as System Failure or Missed Care as Skills Failure?

Missed’ care has emotional, professional and legal connotations because, as one participant from our study noted, the environment can change so quickly and staffing is not allocated to accommodate this. This study used the MISSCARE survey distributed to nurses in New Zealand to find out what care was routinely missed, and why they missed it. The analysis of data returned from 199 nurses revealed that nurses routinely miss care and become frustrated because they are unable to use the knowledge and skill to provide the care; rather they are forced to prioritise care, some of which is either delayed or consciously missed. Whilst this study supported findings of previous research, the emergence of presenteeism as a factor that affects nurses missing care, was highlighted. This has wider implications to the nursing workforce related to their ability to provide safe and effective care, as well as to the organisations in terms of both budget and safety in care provision

A ‘healthy baby’: The double imperative of preimplantation genetic diagnosis

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2010 The Authors.This article reports from a study exploring the social processes, meanings and institutions that frame and produce ‘ethical problems’ and clinical dilemmas for practitioners, scientists and others working in the specialty of preimplantation genetic diagnosis (PGD). A major topic in the data was that, in contrast to IVF, the aim of PGD is to transfer to the woman’s womb only those embryos likely to be unaffected by serious genetic disorders; that is, to produce ‘healthy babies’. Staff described the complex processes through which embryos in each treatment cycle must meet a double imperative: they must be judged viable by embryologists and ‘unaffected’ by geneticists. In this article, we focus on some of the ethical, social and occupational issues for staff ensuing from PGD’s double imperative.The Wellcome Trus

Co-occurring substance misuse and psychological distress: the influence of social networks and the effectiveness of integrated interventions

Individuals who misuse substances are highly likely to have a co-occurring mental health problems and difficulties; in fact it has been asserted that co-occurring substance misuse and mental health difficulties should be regarded as the rule rather than the exception. This document summarises firstly a systematic review of research considering the effectiveness of group-based treatment for depression and co-occurring substance misuse. The review concluded that ICBT was the only integrated group intervention to demonstrate effectiveness in reducing substance misuse and depressive symptoms. Group-based substance misuse interventions were also effective in reducing substance misuse and depressive symptoms if they were manualised, promoted activity, challenged cognitions and had an interpersonal element. Secondly, this document summarises a research study completed which explored the relationships between psychological distress, substance misuse and social network (e.g. family and friends) characteristics and social support for women attending community addiction services. The research paper concluded that the structural components of participants’ social networks and the clinical profile were consistent with previous research. The relationship between perceptions of social support and psychological distress and substance dependence are discussed in the context of Relational Regulation Theory

Intrinsic and extrinsic factors drive ontogeny of early-life at-sea behaviour in a marine top predator

Young animals must learn to forage effectively to survive the transition from parental provisioning to independent feeding. Rapid development of successful foraging strategies is particularly important for capital breeders that do not receive parental guidance after weaning. The intrinsic and extrinsic drivers of variation in ontogeny of foraging are poorly understood for many species. Grey seals (Halichoerus grypus) are typical capital breeders; pups are abandoned on the natal site after a brief suckling phase, and must develop foraging skills without external input. We collected location and dive data from recently-weaned grey seal pups from two regions of the United Kingdom (the North Sea and the Celtic and Irish Seas) using animal-borne telemetry devices during their first months of independence at sea. Dive duration, depth, bottom time, and benthic diving increased over the first 40 days. The shape and magnitude of changes differed between regions. Females consistently had longer bottom times, and in the Celtic and Irish Seas they used shallower water than males. Regional sex differences suggest that extrinsic factors, such as water depth, contribute to behavioural sexual segregation. We recommend that conservation strategies consider movements of young naïve animals in addition to those of adults to account for developmental behavioural changes

The effect of macronutrients on glycaemic control: a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups

Weight loss is crucial for treating type 2 diabetes mellitus (T2DM). It remains unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements. The objective of this study was to assess the effects of various dietary interventions on glycaemic control in overweight and obese adults with T2DM when controlling for weight loss between dietary interventions. A systematic review of randomised controlled trials (RCT) was conducted. Electronic searches of Medline, Embase, Cinahl and Web of Science databases were conducted. Inclusion criteria included RCT with minimum 6 months duration, with participants having BMI≥25·0 kg/m(2), a diagnosis of T2DM using HbA1c, and no statistically significant difference in mean weight loss at the end point of intervention between dietary arms. Results showed that eleven studies met the inclusion criteria. Only four RCT indicated the benefit of a particular dietary intervention over another in improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI) diets. However the findings from one of the four studies showing a significant benefit are questionable because of failure to control for diabetes medications and poor adherence to the prescribed diets. In conclusion there is currently insufficient evidence to suggest that any particular diet is superior in treating overweight and obese patients with T2DM. Although the Mediterranean, vegan and low-GI diets appear to be promising, further research that controls for weight loss and the effects of diabetes medications in larger samples is needed

Accounting for variability in ULF wave radial diffusion models

Many modern outer radiation belt models simulate the long‐time behavior of high‐energy electrons by solving a three‐dimensional Fokker‐Planck equation for the drift‐ and bounce‐averaged electron phase space density that includes radial, pitch‐angle, and energy diffusion. Radial diffusion is an important process, often characterized by a deterministic diffusion coefficient. One widely used parameterization is based on the median of statistical ultralow frequency (ULF) wave power for a particular geomagnetic index Kp. We perform idealized numerical ensemble experiments on radial diffusion, introducing temporal and spatial variability to the diffusion coefficient through stochastic parameterization, constrained by statistical properties of its underlying observations. Our results demonstrate the sensitivity of radial diffusion over a long time period to the full distribution of the radial diffusion coefficient, highlighting that information is lost when only using median ULF wave power. When temporal variability is included, ensembles exhibit greater diffusion with more rapidly varying diffusion coefficients, larger variance of the diffusion coefficients and for distributions with heavier tails. When we introduce spatial variability, the variance in the set of all ensemble solutions increases with larger spatial scales of variability. Our results demonstrate that the variability of diffusion affects the temporal evolution of phase space density in the outer radiation belt. We discuss the need to identify important temporal and length scales to constrain variability in diffusion models. We suggest that the application of stochastic parameterization techniques in the diffusion equation may allow the inclusion of natural variability and uncertainty in modeling of wave‐particle interactions in the inner magnetosphere