Louise Dickinson Rich Correspondence

Entries include a typed letter on personal stationery, a typed letter on Hotel Floridian stationery with a research question for a hotel guest, correspondence concerning the provision of a general lending collection copy of Rice\u27s book to the Maine State Library, and a letter of correspondence on receipt of the book for the Maine Author Collection

Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews

Psychosocial interventions for carers of people with dementia are increasingly recognized as playing an important role in dementia care. We aim to systematically review the evidence from existing systematic reviews of psychosocial interventions for informal carers of people with dementia.  Thirty-one systematic reviews were identified; following quality appraisal, data from 13 reviews, rated as high or moderate quality, were extracted.  Well-designed, clearly structured multi-component interventions can help maintain the psychological health of carers of people with dementia and delay institutionalization of the latter. To be most effective, such interventions should include both an educational and a therapeutic component; delivery through a support group format may further enhance their effectiveness.  Successful translation of evidence into practice in this area remains a challenge. Future research should focus on determining the most cost-effective means of delivering effective multi-component interventions in real-world settings; the cost-effective potential of technology-based interventions is considerable

The everyday use of assistive technology by people with dementia and their family carers: a qualitative study

Background: Assistive Technology (AT) has been suggested as a means by which people with dementia can be helped to live independently, while also leading to greater efficiencies in care. However little is known about how AT is being used by people with dementia and their carers in their daily routines. This paper reports on a qualitative study exploring the everyday use of AT by people with dementia and their families. Methods: The research employed a qualitative methodology. Semi structured interviews took place with 39 participants, 13 people with dementia and 26 carers. Key themes were identified using thematic analysis and the constant comparative method. Results: Three categories of AT use in everyday settings were identified; formal AT, accessed via social care services, ‘off the shelf AT' purchased privately, and ‘do it yourself' AT, everyday household products adapted by families to fulfil individual need in the absence of specific devices. Access to AT was driven by carers, with the majority of benefits being experienced by carers. Barriers to use included perceptions about AT cost; dilemmas about the best time to use AT; and a lack of information and support from formal health and social care services about how to access AT, where to source it and when and how it can be used. Conclusions: It has been argued that the ‘mixed economy' landscape, with private AT provision supplementing state provision of AT, is a key feature for the mainstreaming of AT services. Our data suggests that such a mixed economy is indeed taking place, with more participants using ‘off the shelf' and ‘DIY' AT purchased privately rather than via health and social care services. However this system has largely arisen due to an inability of formal care services to meet client needs. Such findings therefore raise questions about just who AT in its current provision is working for and whether a mixed market approach is the most appropriate provider model. Everyday technologies play an important role in supporting families with dementia to continue caring; further research is needed however to determine the most effective and person-centred models for future AT provision

Microscopic study of the freeze-thaw stability of particle-stabilised emulsions

Particle-stabilised, or Pickering, emulsions are widely used in the food and personal care industries and are present in common household products such as homogenised milk and food spreads. Pickering stabilisation has also been suggested as a method of increasing product shelf life over conventional surfactant stabilisation. It is therefore important to characterise the behaviour and stability of Pickering emulsions subjected to processes used in industry and daily life. These processes have the potential to alter the taste of food products or the effectiveness of personal care or pharmaceutical products. Freezing is one process of interest as it is used for product transport and in order to increase shelf life. Some products are also used when frozen, such as ice cream and frozen desserts. In this thesis, confocal fluorescence microscopy is used to study the microscopic behaviour of model water-in-oil Pickering emulsions subjected to freeze-thaw cycling of the continuous phase. Hexadecane oil and poly(methyl methacrylate) particles are used and both are fluorescently labelled, allowing all three emulsion components to be distinguished individually. Initially, we study the behaviour of the oil alone, both experimentally and in simulation, under uniform and non-uniform cooling. In non-uniform cooling, the sample is cooled more rapidly from one end, whereas in the uniform setup the sample is cooled evenly. Simulation results show that the two setups lead to different temperature and fluid flow profiles throughout the sample: the nonuniform setup causes a temperature gradient through the oil which is essentially eliminated in the uniform setup. Experiments confirm the presence/absence of these gradients and show that the temperature gradient affects the crystal growth in the oil. Dilute emulsions are studied under two different non-uniform configurations. In the first, droplets interact with crystals growing from many directions. Deformation of the droplets is observed as growing crystals progressively trap the droplets, stretching them towards parts of the sample where the oil is still liquid. The droplet deformation is characterised via image analysis to compare the droplet shape before and after freeze-thaw cycling. Irreversible shape changes are explained by the behaviour of the particles on the interface. Particles initially jammed on the interface become unjammed as the interfacial area increases during droplet deformation in the freezing process. Upon thaw, the particles rejam at a lower packing fraction meaning that droplets are permanently deformed. In the second configuration, the droplets interact with a moving solidification front in which crystal growth is unidirectional. Again deformation of the droplets is observed as droplets are trapped by the front. In some cases particles are trapped and pulled off the droplet interface, temporarily releasing the droplet and leaving it with a lower surface coverage of particles. In both cases, particle behaviour at the interface is key in determining the droplet behaviour. Finally undiluted emulsions are subjected to freeze-thaw cycles under both uniform and non-uniform conditions. In both cases droplets are deformed by the crystal growth, but during non-uniform freezing biliquid foam regions are formed which are not present in the uniformly frozen samples. The effects of droplet size and cooling rate are also explored for uniform freezing. In both cases, irreversible changes are observed in the emulsion structure as a result of the process. As in the single droplet case, these results suggest that particles at the interface become unjammed during the freeze cycle and upon thawing re-jam at a different packing fraction. Here deformation is enhanced by partial coalescence which promotes jamming in a deformed state through reduction of interfacial area at fixed volume. In the absence of particles, similar freeze-thaw cycling of surfactant emulsions does not cause the same irreversible change to the emulsion structure as in the particle-stabilised emulsions. In addition, under certain conditions, Pickering emulsions after a freeze-thaw cycle exhibit some bicontinuity, suggesting that freeze-thaw cycling may be a promising route to producing bicontinuous emulsions. Collectively, these results improve our understanding of the behaviour of particlestabilised emulsions under freeze-thaw cycling, which is an industrially relevant process. They show the importance of the interfacial particles in controlling emulsion structure and they provide insight into the interaction between soft materials, like droplets, and hard materials, such as ice crystals, at the microscopic level. Although freezing can prolong shelf life, and Pickering stabilisation can enhance emulsion stability, the combination of these two must be treated with care as together they can cause irreversible structural damage, reducing rather than enhancing product stability

Hidradenitis suppurativa:From pathogenesis to emerging treatment options

Hidradenitis suppurativa (HS) is a chronic skin disease that is characterized by inflammation of the hair follicles. The cause of HS is largely unknown and the disease remains difficult to treat. Mrs. Janine Dickinson-Blok studied the pathogenesis of HS and the efficacy of existing and emerging therapies. In the first part of her thesis she focused on the pathogenesis of HS. She demonstrated that fragility of hair follicles is not a hallmark of HS, as was previously described by others. She did find that a specific protein called integrine α6β4 is highly present at the sebaceous glands of HS patients. This protein may contribute to activation of the immune system and consequently to an exacerbation of the disease. Additionally, she described that patients with Down syndrome possibly have a functional deficiency of an enzyme called gamma-secretase. This could raise the risk for the development of HS in this patient group. The second part focused on treatment of HS. Based on a systematic review she concluded that the use of specific inhibitors of the immune system, so-called TNF-α inhibitors, is the best medical treatment of HS to date. Furthermore, she showed that ustekinumab (an immune therapy drug) is effective in the majority of a group HS patients. Additionally, she described a new surgical technique for moderate to severe HS (the Skin Tissue sparing Excision with Electrosurgical Peeling procedure). Finally, she concluded that in most cases the combination of surgery with systemic agents is mandatory in order to prevent new inflammatory lesions