Influence of antigen processing in the shaping of an autoimmune T cell repertoire

My work sought to unravel the process by which targets (usually peptides) are generated or destroyed from intact antigen using a well characterised antigen that is attacked in an autoimmune kidney disease as a model. In doing this I hoped to account for how this process may lead to the survival of self-reactive T cells into the peripheral T cell repertoire as a possible mechanism of tolerance breakdown and the development of autoimmune disease.In the following sections I will introduce the basic concept of tolerance and discuss the possible mechanisms leading to the breakdown of tolerance and development of autoimmunity. Key to my work is the understanding of how antigen is processed and recognised by T cells. This will be covered in detail before considering how alterations in the processing pathway may lead to deviations in the immune response to self. The second section of this chapter will deal with the model of autoimmune kidney disease used for my research, Goodpasture's disease. I hope to highlight its strengths as a model of autoimmunity and cover in some detail what is already known about the immunopathogenesis of the disease including previous research within our own group. I will conclude with how this work lead on to my own research, detailing the aims of the study including an outline of the research approach used

A grounded theory study of the role of disclosure in the management of long-term conditions: who needs to know?

A high and increasing proportion of people in the United Kingdom are living with a long-term condition (DH, 2005a). The National Health Service is facing the challenge of increased pressure on its service provision. Government Policy has placed emphasis on supporting individuals to self-care (Department of Health, 2005a, c). However, there are specific challenges associated with living with a long-term condition, and in particular the psychosocial aspects of illness when set alongside a clinical approach to care (Gabe et al, 2004, Bury et al, 2005) It has been argued that disclosure of illness may in itself be a self-care strategy (Munir et al, 2005). However, to date individuals‟ experiences of disclosure of long-term conditions are neither clearly defined nor its role in managing a long-term condition fully understood. The aims of the study were to explore the role of disclosure in the management of a long-term health condition. The study drew on constructivist grounded theory (Charmaz, 2006) undertaking thirty-five in-depth qualitative interviews (fifteen people living with epilepsy, and twenty people living with type 1 diabetes) recruited from patient support groups and clinical nurse specialist‟s clinics. This study identified that strategies of disclosure are not necessarily fixed but may be subject to change over time. “Learning about disclosure” is an integral part of living with a long-term condition. Three key disclosure roles were identified: (1) access to self-care and social support, (2) non-disclosure (concealment) of the condition to protect one‟s identity from stigma. (3) redressing myths about the condition in advance: to avoid perceived stigma. The findings provide important insights that could enable health care professionals to develop more of an emphasis on including disclosure as an issue when talking to patients about managing type 1 diabetes and epilepsy and this is also relevant to a broad spectrum of long-term conditions

A grounded theory study of the role of disclosure in the management of long-term conditions : who needs to know?

A high and increasing proportion of people in the United Kingdom are living with a long-term condition (DH, 2005a). The National Health Service is facing the challenge of increased pressure on its service provision. Government Policy has placed emphasis on supporting individuals to self-care (Department of Health, 2005a, c). However, there are specific challenges associated with living with a long-term condition, and in particular the psychosocial aspects of illness when set alongside a clinical approach to care (Gabe et al, 2004, Bury et al, 2005) It has been argued that disclosure of illness may in itself be a self-care strategy (Munir et al, 2005). However, to date individuals‟ experiences of disclosure of long-term conditions are neither clearly defined nor its role in managing a long-term condition fully understood. The aims of the study were to explore the role of disclosure in the management of a long-term health condition. The study drew on constructivist grounded theory (Charmaz, 2006) undertaking thirty-five in-depth qualitative interviews (fifteen people living with epilepsy, and twenty people living with type 1 diabetes) recruited from patient support groups and clinical nurse specialist‟s clinics. This study identified that strategies of disclosure are not necessarily fixed but may be subject to change over time. “Learning about disclosure” is an integral part of living with a long-term condition. Three key disclosure roles were identified: (1) access to self-care and social support, (2) non-disclosure (concealment) of the condition to protect one‟s identity from stigma. (3) redressing myths about the condition in advance: to avoid perceived stigma. The findings provide important insights that could enable health care professionals to develop more of an emphasis on including disclosure as an issue when talking to patients about managing type 1 diabetes and epilepsy and this is also relevant to a broad spectrum of long-term conditions.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units : a systematic review

Funding The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.Peer reviewedPublisher PD

‘A false sense of security’? Understanding the role of the HPV vaccine on future cervical screening behaviour: a qualitative study of UK parents and girls of vaccination age

OBJECTIVES: The UK Human Papillomavirus (HPV) vaccination programme was introduced in 2008 for girls aged 12-13. The vaccine offers protection against HPV types 16 and 18, which together cause about 70% of cervical cancers. Vaccinated girls will receive future invitations to the NHS Cervical Screening Programme, to prevent cancers associated with HPV types not included in the vaccine, and in case of prior infection with HPV 16 or 18. Little is known about parents' and girls' understandings of the protection offered by the vaccine, or the need for future screening. DESIGN: Qualitative interviews with twenty-six parents, and nine girls aged 12-13 who were offered HPV vaccination through a Primary Care Trust (PCT) in the South-east of England, UK. SETTING: Thirty-nine schools, and four general practices. RESULTS: Uncertainty about the level of protection offered by the HPV vaccine was evident among parents, and to a lesser extent among vaccination-aged girls. There was a lack of understanding among parents and girls that cervical screening would be required irrespective of vaccination status; some parental decisions to accept the vaccine were made on the misunderstanding that vaccination provided complete protection against cervical cancer. CONCLUSIONS: Sufficient awareness of the issues related to screening is necessary for informed decision-making about whether or not to accept the HPV vaccine. Clearer information is needed concerning the incomplete protection offered by the vaccine, and that cervical screening will still be required. Future invitations for cervical screening should stress the necessity to attend regardless of HPV vaccination status, to ensure that high levels of prevention of cervical cancer through screening are maintained

Changes in vitamin biomarkers during a 2-year intervention trial involving increased fruit and vegetable consumption by free-living volunteers

Peer reviewedPublisher PD

Trends and challenges in the use of drugs as forensic evidence:A scientometric approach to map the current literature

The rapid increase in the production and distribution of illicit drugs has led to vast amounts of data being generated through research and other publications, making it difficult to effectively distill and analyze current and emerging trends. The present study used a scientometric approach to identify trends and challenges in the use of drugs as an evidence type in forensic science by examining reference lists available in the INTERPOL IFSMS reports and the citation database Scopus. It has been identified that “new psychoactive substances” is one of the most frequently used keywords by authors, highlighting the swift response by communities to characterize these emerging compounds. However, it was also noted that despite drugs being a global threat, only limited international collaboration was observed between research groups and the majority of the studies are from authors affiliated within the same country. Finally, an argument is made to encourage a more comprehensive approach in aggregating results on drugs for greater transparency and broader distribution of findings

How prepared are newly qualified allied health professionals for practice in the UK? A systematic review

Objectives: It is important that allied health professionals (AHPs) are prepared for clinical practice from the very start of their working lives to provide quality care for patients, for their personal well-being and for retention of the workforce. The aim of this study was to understand how well newly qualified AHPs were prepared for practice in the UK. Design: Systematic review. Data sources: Embase, MEDLINE, CINAHL, ERIC and BEI were searched from 2012 to 2024. Grey literature searching and citation chasing were also conducted. Eligibility criteria: We included primary studies reporting the preparedness for practice of UK graduates across 15 professions; all study types; participants included graduates who were up to 2 years postgraduation, their supervisors, trainers, practice educators and employers; and all outcome measures. Data extraction and synthesis: A standardised data extraction form was used. Studies were quality assessed using the Quality Appraisal for Diverse Studies tool. 10% of articles were independently double-screened, extracted and quality assessed; 90% was completed by one researcher. Results: 14 reports were included (9 qualitative, 3 mixed-method and 2 quantitative). Six papers focused on radiographers, three on a mixture of professions, two on paramedics, and one each on physiotherapists, clinical psychologists and orthotists. An important finding of the review is the paucity and low-medium quality of research on the topic. The narrative synthesis tentatively suggests that graduates are adequately prepared for practice with different professions having different strengths and weaknesses. Common areas of underpreparedness across the professions were responsibility and decision-making, leadership and research. Graduates were generally well prepared in terms of their knowledge base. Conclusion: High-quality in-depth research is urgently needed across AHPs to elucidate the specific roles, their nuances and the areas of underpreparedness. Further work is also needed to understand the transition into early clinical practice, ongoing learning opportunities through work, and the supervision and support structures in place. PROSPERO registration number: CRD42022382065