Investigating the impact of providing a cognitive behavioural therapy intervention for frequent attenders at the Emergency Department with medically unexplained symptoms: A mixed method study

AbstractBackgroundThere are a cohort of people who attend the Emergency Department (ED) extremely frequently. In many cases the symptoms driving their presentations are medically unexplained (MUS). ObjectivesThe aim of the research was to identify if providing a CBT intervention to frequently attending (high risk) patients with MUS in the healthcare setting they are comfortable with (ED) had impacted attendance patterns and if so how?DesignA mixed method approach was utilised to investigate the impact of providing CBT to ‘high risk’ group of frequent attenders with Medically Unexplained Symptoms at the Emergency Department. Quantitative participants were an opportunistic sample consisting of 50 of the most frequently attending (high risk) patients at the Emergency Department allocated to either control or intervention group. The qualitative research design employed semi-structured interviews. Ten participants were recruited from patients who had attended the CBT intervention. Interviews were transcribed verbatim and analysed using Thematic Analysis.ResultsThe patients who received the CBT intervention had significantly (p=0.001) reduced their ED attendances and inpatient bed days (p=0.001) following the intervention. In addition, the qualitative approach identified four meaningful themes through thematic analysis: The ED and Me; Psychological Impact; My Treatment and The Long-term Impact: What’s Changed?ConclusionThis study has given a detailed insight into the patients’ perspectives that supports the statistical data of their behaviour pre and post intervention. This study supported the declaration that providing a CBT intervention to high risk frequent attenders with MUS in the ED has a measurable impact on their health care utilisation, not only in the ED, but across the hospital.

Using Primary Sources to Support Student-Centered Pedagogy

In this hands-on workshop, attendees will navigate the Digital Public Library of America and its instructor-vetted Primary Source Sets, which draw on diverse resources—from newsreel footage to oral histories—held by libraries, archives, and museums across the US. Presenters will lead an interactive exploration of these free resources; share student-centered implementation strategies including guided questioning, class openers, and media analysis; and collaborate with participants to develop approaches to incorporating primary sources that are optimized for their students and curricula. Laptops/devices highly recommended

Recent advances in topical therapeutics for vitreoretinal diseases

Eye drops are convenient for patients, but achieving therapeutic doses and maintaining sustained drug release without frequent re-application to treat diseases of the retina has been largely unsuccessful. Topical administration of drugs is hindered by the anatomy, physiology, and biochemistry of the eye and its highly effective defence mechanisms. Advances in nanotechnology have led to the experimental use of topical permeation-enhancing liposomes, emulsions, and microspheres to enhance absorption and penetration of drugs across membranes; allow controlled release of the drug; and to target drugs at distinct tissues to allow sufficient local bioavailability. In the near future it is hoped that improved technologies may provide means of sustained topical drug delivery for retinal therapy, with improved side-effect profiles and reduced cost compared with currently available clinical treatments

The 5S RNP and the regulation of the tumour suppressor

PhD ThesisRibosomes are vital molecular machines involved in catalysing mRNA translation into proteins. Understandably, when ribosome production is disrupted, there are mechanisms available to prevent further cell growth. The main complex involved in this process is the 5S RNP, a ribosome assembly intermediate consisting of the ribosomal proteins RPL5 and RPL11, and the 5S rRNA. The 5S RNP induces the tumour suppressor p53 by interacting with, and inhibiting, MDM2 an ubiquitin ligase responsible for maintaining low levels of p53 in the cell. The 5S RNP-p53 pathway has been implicated in diseases known as ribosomopathies, however the regulation of these pathways have not been fully characterised and there is still much that is unknown. The aim of this project was to identify the components involved in regulating 5S RNP integration into the ribosome and to determine what further components may be required for 5S RNP-mediated p53 activation. There have been many recent studies elucidating the mechanism by which the 5S RNP is incorporated into the ribosome in yeast, however this mechanism appears to vary in humans. The data presented in this thesis determined that mimicking phosphorylation of RPL5 Y30 prevented 5S RNP incorporation into the ribosome. Furthermore, depletion of RPL7, RPL18, and RPL21 resulted in large subunit biogenesis defects and abrogated 5S RNP incorporation into the ribosome. Previous studies have suggested that SRSF1 and PRAS40 may be involved in the regulation of p53 via RPL5 and RPL11 respectively. In congruence with this, the data presented here showed SRSF1 interacts with the 5S RNP. Furthermore, depletion of SRSF1 results in reduction in 5S RNP-dependent p53 activation, mis-localisation of RPL11, and reduction in 5S RNP integration. Collectively, these data suggest that SRSF1 may be important for both ribosome production and p53 regulation. The role of PRAS40, however, still remains unclear. Despite not interacting with the 5S RNP, depletion of PRAS40 appeared to abrogate 5S-RNP mediated p53 induction. In summary, this work has provided a basis for studies into how the 5S RNP is recruited into the ribosome and provides evidence to suggest that SRSF1 is a component of the 5S RNP complex to activate p53.BBSRC and the Diamond Blackfan Anaemia Foundatio

N → S acyl transfer in peptides and regioselective dihalohydration reactions of propargylic alcohols

This thesis describes results obtained during the investigation of peptide thioester formation and regioselective dihalohydration reactions of propargylic alcohols. Chapter 1 explores the formation of peptide thioesters via N S acyl transfer. Firstly, native chemical ligation (NCL) will be introduced as a powerful tool to join a peptide thioester and a peptide fragment containing an N terminal cysteine. The challenges of making a peptide thioester will be discussed. Following this, the synthesis of model peptides will be reported, including the first synthesis of boronocysteine. The model peptides are then used to investigate the rate of peptide thioester formation. Alongside this, the effects of guanidine hydrochloride and the thiol additive will be explored. Chapter 2 describes regioselective dihalohydration reactions of propargylic alcohols. Previous research in this area will be reviewed, including previous work within the Sheppard group involving dichloro- and diiodohydration reactions. Following this, the development of the dibromohydration reaction will be detailed which was used to synthesise a wide range of dibromoketoalcohols and dibromolactols. These products have been further manipulated to give a wide variety of products. The difluorohydration reactions of propargylic alcohols will be briefly explored. Chapter 3 details the experimental procedures and compound characterisation for the results discussed in Chapters 1 and 2

Respite and connection:Autistic adults' reflections upon nature and well-being during the Covid-19 pandemic

The Covid-19 pandemic and associated lockdowns provided opportunities to engage and reconnect with nature, with many people noting associated benefits to well-being. Research from the pandemic period has largely focused on the way neurotypical or general populations experienced nature; less is known about how autistic people used nature to support well-being during this time. In this qualitative survey study of 127 autistic adults in the United Kingdom, we used reflexive thematic analysis of text box responses to develop two themes: respite in nature and connecting amid widespread disconnection. For some autistic adults during the pandemic, nature provided physical distance from others or from crowded homes, enabling them to use nature to experience relief from stress. In addition, some participants felt more psychologically connected to nature itself during the pandemic, while for others, nature served as a way of connecting with others during a potentially isolating time. These findings have implications for autistic people and their families and carers who may want to seek out nature-based activities to support well-being in the wake of the pandemic

Place, community and information behavior: Spatially oriented information seeking zones and information source preferences

Even in a digitally advanced society, much of our daily lives is based in place, but information behavior research has largely ignored place as theoretically relevant to information behavior. This study explores the implications of a place-based approach to studying information practices, and examines factors that influence information seeking and sharing in place-based communities among parents of individuals with disabilities. Based on qualitative data gathered from 35 parents of individuals with disabilities, it proposes a spatial model of information source preferences based on the theory of information horizons, and discusses implications of the model for future research related to information seeking and places. It also presents substantive place-related findings about local information needs, including discussion of the local parent network as an information seeking system

Validation of the Environmental Audit Scoring Evaluation (Ease) Tool for LTC Households

This poster will share the results from a research initiative funded by the National Institutes of Health to assess the validity of the Environmental Audit Scoring Evaluation (EASE) tool in its ability to distinguish between different types of skilled care models based on the environmental and operational practices that can be observed and documented. The EASE tool was compared against three existing tools; PEAP, TESS-NH, and EAT-HC. Twenty-eight living areas in nursing homes across the state of Kansas identified as a traditional, household, or hybrid model were observed. The scores of the EASE were compared against the scores of three existing tools in order to evaluate its construct validity. The EAT-HC was most closely related to the EASE, with an R-value of 0.8817. The PEAP and the TESS-NH were less correlated to the EASE, with R-values of 0.8175 and 0.7097, respectively. Results found that the EASE was able to distinguish between traditional and homelike settings, though it could not identify hybrid models with a high degree of certainty. The analysis of variance between homelike and traditional homes was significant at 0.016, while the variance between homelike and hybrid and between hybrid and traditional were not significant. Inter-rater reliability of the EASE was consistently high (.96 and above). The outcomes demonstrated the EASE tool was able to assess the homelike characteristics of the environment of nursing homes better than or equally as well as previously validated tools