Impact of personality status on the outcomes and cost of cognitive–behavioural therapy for health anxiety

BACKGROUND: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS: To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD: Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS: The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term

Institutionalised Islamophobia in British universities

This thesis is a conceptual study of institutionalised Islamophobia in British universities. Myanalysis is illustrated, although not driven, by exemplars drawn from fieldwork undertaken infour case study universities.The thesis is situated in the paradoxical context of increasing provisions for Muslim studentsthat occurred throughout the 1990s while simultaneously fears of Muslim student'fundamentalism' on campus were also on the increase and resulted in targeted action by theNational Union of Students, the Committee for Vice-Chancellors and Principals, and a numberof individual universities concerned about the possible threat to campus harmony posed byMuslim students.Employing a conceptual vocabulary influenced by anti-foundationalism and psychoanlysis, Iexplore the ways in which racialised governmentality is exercised over Muslim students. Thisanalysis includes consideration of the functions of formal multiculturalist practices asstrategies for the governance of bodies, and through which racialised exercise of disciplinarypower over Muslim students can be exercised. The thesis begins with a generalconsideration of the reasons why perceived distinct changes to the ways in which Muslimsarticulate their identities should so often be seen as potentially transgressive or disruptive, Itthen proceeds to an analysis of the ways in which Muslim students are constructed throughinstitutional practices, paying particular attention to strategies for stabilising representations ofMuslims, whiteness and the west which range from lslamophobic hoaxing to lslamophobicviolence

Technology for automated analysis of maize pollen used as a marker for mutation: 1. Flow-through systems.

Maize pollen is used as a monitor for environmental pollutants. Mutant pollen grains (induced by environmental pollutants) are detectable above a background frequency of 5 or less in 10(5). To enumerate a satisfactory number of mutant grains, it is necessary to count 10(6) grains in a sample, a laborious, time-consuming process which should be amenable to automated analysis techniques. High resolution image analysis technology has been used in the morphologic assessment of rare cells in a sample, provided a suitable training set could be devised to instruct the computer on the characteristics of the rare cells. On the other hand, flow cytometry uses primarily cytochemical means for detection and has been shown to detect rare events. Hence, the two technologies, which may be viewed as complementary, are suitable for the task. Alternatively, a hybrid technology employing both cell sorter and image analysis techniques may be extremely desirable for this problem. The potential for archival storage of analyzed samples is very attractive when considering the possibility of an adversary relationship between a putative regulator and polluter

Development of an instrument to assess social functioning in dementia: The Social Functioning in Dementia scale (SF-DEM)

INTRODUCTION: Social functioning is a core domain in the life of people with dementia, but there is no accepted instrument to measure it. We aimed to develop the Social Functioning in Dementia (SF-DEM) scale and test its psychometric properties for assessing social function in people with dementia. METHODS: We interviewed people with mild dementia and family caregivers to develop patient and caregiver-rated SF-DEM versions and refined them through interviews with health care professionals. We tested its psychometric properties in 30 dyads of people with dementia and family caregivers. RESULTS: Both SF-DEM versions had content validity and demonstrated concurrent validity against a single item rating overall social functioning (patient rated r = 0.42, 95% CI [0.07–0.68]; caregiver rated r = 0.59, 95% CI [0.29–0.78]). All participants found it acceptable. Analyses showed reliability (test–retest, inter-rater, internal consistency) and indications of responsiveness to change. DISCUSSION: SF-DEM shows promise as a valid, reliable, acceptable measure of social functioning in dementia

CHAMP: Cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial

BACKGROUND: Abnormal health anxiety, also called hypochondriasis, has been successfully treated by cognitive behaviour therapy (CBT) in patients recruited from primary care, but only one pilot trial has been carried out among those attending secondary medical clinics where health anxiety is likely to be more common and have a greater impact on services. The CHAMP study extends this work to examine both the clinical and cost effectiveness of CBT in this population. METHOD/DESIGN: The study is a randomized controlled trial with two parallel arms and equal randomization of 466 eligible patients (assuming a 20% drop-out) to an active treatment group of 5-10 sessions of cognitive behaviour therapy and to a control group. The aim at baseline, after completion of all assessments but before randomization, was to give a standard simple explanation of the nature of health anxiety for all participants. Subsequently the control group was to receive whatever care might usually be available in the clinics, which is normally a combination of clinical assessment, appropriate tests and reassurance. Those allocated to the active treatment group were planned to receive between 5 and 10 sessions of an adapted form of cognitive behaviour therapy based on the Salkovskis/Warwick model, in which a set of treatment strategies are chosen aimed at helping patients understand the factors that drive and maintain health anxiety. The therapy was planned to be given by graduate research workers, nurses or other health professionals trained for this intervention whom would also have their competence assessed independently during the course of treatment. The primary outcome is reduction in health anxiety symptoms after one year and the main secondary outcome is the cost of care after two years. DISCUSSION: This represents the first trial of adapted cognitive behaviour therapy in health anxiety that is large enough to test not only the clinical benefits of treatment but also whether the cost of treatment is offset by savings from reduced use of other health services in comparison to the control group.Cognitive behaviour therapy for Health Anxiety in Medical Patients (CHAMP) TRIAL REGISTRATION: Current Controlled Trials ISRCTN14565822

Genomic risk prediction of coronary artery disease in women with breast cancer: a prospective cohort study.

Funder: Wellcome TrustBackgroundAdvancements in cancer therapeutics have resulted in increases in cancer-related survival; however, there is a growing clinical dilemma. The current balancing of survival benefits and future cardiotoxic harms of oncotherapies has resulted in an increased burden of cardiovascular disease in breast cancer survivors. Risk stratification may help address this clinical dilemma. This study is the first to assess the association between a coronary artery disease-specific polygenic risk score and incident coronary artery events in female breast cancer survivors.MethodsWe utilized the Studies in Epidemiology and Research in Cancer Heredity prospective cohort involving 12,413 women with breast cancer with genotype information and without a baseline history of cardiovascular disease. Cause-specific hazard ratios for association of the polygenic risk score and incident coronary artery disease (CAD) were obtained using left-truncated Cox regression adjusting for age, genotype array, conventional risk factors such as smoking and body mass index, as well as other sociodemographic, lifestyle, and medical variables.ResultsOver a median follow-up of 10.3 years (IQR: 16.8) years, 750 incident fatal or non-fatal coronary artery events were recorded. A 1 standard deviation higher polygenic risk score was associated with an adjusted hazard ratio of 1.33 (95% CI 1.20, 1.47) for incident CAD.ConclusionsThis study provides evidence that a coronary artery disease-specific polygenic risk score can risk-stratify breast cancer survivors independently of other established cardiovascular risk factors

Desulfurization Effects on a Light-Duty Diesel Vehicle NOx Adsorber Exhaust Emission Control System

Analyzes the effects on gaseous emissions, before and after desulfurization, on a light-duty diesel vehicle with a NOx adsorber catalyst