Developing clinical practice : personal therapy and supervision

This portfolio thesis comprises of four parts: a systematic literature review paper, an empirical paper, a reflective statement and appendices.Part one is a systematic literature review which examines whether personal therapy is an effective method of professional development for therapists. Quantitative and qualitative literature is critically reviewed. A model of the reported benefits of personal therapy for therapists is proposed. Implications for clinical practice are discussed.Part two is an empirical paper examining the relationship between stage of development and behaviour in clinical supervision for trainee clinical psychologists. Forty trainee clinical psychologists, from three years of a training course, completed a questionnaire (the SLQ-R[A]) measuring their stage of development as supervisees. A subsample submitted DVD-recordings of their supervision sessions which were coded using the Teacher's PET to analyse the supervision behaviours. Comparisons were made between the supervision behaviour of first (n = 8) and third (n = 3) year trainee clinical psychologists and their supervisors. Correlations between questionnaire responses and supervision behaviours were examined. Results are discussed in the context of the Integrated Developmental Model of Supervision. Implications for clinical practice are highlighted.Part three is a reflective statement which considers the process of conducting the research and developing this portfolio thesis.Part four is the appendices

Cinderella Services in the NHS Internal Market:Does Contracting Make a Difference?

This paper examines the impact of the NHS internal market reforms on an aspect of equity in the British system that features little in recent policy commentary: the allocation of resources between acute services for the entire population and nonacute services for the elderly, the mentally ill, and the disabled (the so-called Cinderella services). The authors\u27 research on health planning and contracting in the NHS in Wales suggests that patterns of services have remained largely unchanged, and that pressures in the reformed system, such as the Patient\u27s Charter initiative, prevent any major reallocation of resources away from the acute sector. Given the ineffectiveness of the contract mechanism in changing funding patterns, the authors consider whether the wider NHS reforms have nevertheless extended the legal remedies available to patients from the Cinderella groups faced with inadequate services. Recent cases suggest that, while the courts are reassessing the principles applied in reviewing administrative action affecting the allocation of health care resources, it is patients requiring acute care who are most likely to benefit. The authors conclude that, in terms of progress towards a more equitable distribution of resources between sectors, the NHS internal market is not a good model for other nations to emulate

Health utilities and costs for neuromyelitis optica spectrum disorder

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) is a rare, neurological disease that places a significant burden on patients, their carers, and healthcare systems.ObjectivesTo estimate patient and carer health utilities and costs of NMOSD within the UK setting.MethodsPatients with NMOSD and their carers, recruited via a regional specialist treatment centre, completed a postal questionnaire that included a resource use measure, the EuroQoL (EQ)-5D-5L, EQ-5D-VAS, Vision and Quality of Life Index (VisQoL), Carer Experience Survey (CES) and the Expanded Disability Status Scale (EDSS). The questionnaire asked about respondents' use of health and community care services, non-medical costs, informal care and work capacity. Data were analysed descriptively. Uncertainties in costs and utilities were assessed using bootstrap analysis.Results117 patients and 74 informal carers responded to the survey. Patients' mean EQ-5D-5L and VisQoL health utilities (95% central range) were 0.54 (- 0.29, 1.00) and 0.79 (0.11, 0.99), respectively. EQ-5D-5L utility decreased with increasing EDSS score bandings, from 0.80 (0.75, 0.85) for EDSS ≤ 4.0, to 0.20 (- 0.29, 0.56) for EDSS 8.0 to 9.5. Mean, 3-month total costs were £5623 (£2096, £12,156), but ranged from £562 (£381, £812) to £32,717 (£2888, £98,568) for these EDSS bandings. Carer-reported EQ-5D-5L utility and CES index scores were 0.85 (0.82, 0.89) and 57.67 (52.69, 62.66). Mean, 3-month costs of informal care were £13,150 to £24,560.ConclusionsNMOSD has significant impacts on health utilities and NHS and carer costs. These data can be used as inputs to cost-effectiveness analyses of new medicines for NMOSD

Investigation of Van Gogh-like 2 mRNA Regulation and Localisation in Response to Nociception in the Brain of Adult Common Carp (Cyprinus carpio)

The Van Gogh-like 2 (vangl2) gene is typically associated with planar cell polarity pathways, which is essential for correct orientation of epithelial cells during development. The encoded protein of this gene is a transmembrane protein and is highly conserved through evolution. Van Gogh-like 2 was selected for further study on the basis of consistent regulation after a nociceptive stimulus in adult common carp and rainbow trout in a microarray study. An in situ hybridisation was conducted in the brain of mature common carp (Cyprinus carpio), 1.5 and 3 h after a nociceptive stimulus comprising of an acetic acid injection to the lips of the fish and compared with a saline-injected control. The vangl2 gene was expressed in all brain regions, and particularly intensely in neurons of the telencephalon and in ependymal cells. In the cerebellum, a greater number (P = 0.018) of Purkinje cells expressed vangl2 after nociception (n=7) compared with controls (n = 5). This regulation opens the possibility that vangl2 is involved in nociceptive processing in the adult fish brain and may be a novel target for central nociception in vertebrates

Ecosystem-level effects of re-oligotrophication and N:P imbalances in rivers and estuaries on a global scale

Trends and ecological consequences of phosphorus (P) decline and increasing nitrogen (N) to phosphorus (N:P) ratios in rivers and estuaries are reviewed and discussed. Results suggest that re-oligotrophication is a dominant trend in rivers and estuaries of high-income countries in the last two-three decades, while in low-income countries widespread eutrophication occurs. The decline in P is well documented in hundreds of rivers of United States and the European Union, but the biotic response of rivers and estuaries besides phytoplankton decline such as trends in phytoplankton composition, changes in primary production, ecosystem shifts, cascading effects, changes in ecosystem metabolism, etc., have not been sufficiently monitored and investigated, neither the effects of N:P imbalance. N:P imbalance has significant ecological effects that need to be further investigated. There is a growing number of cases in which phytoplankton biomass have been shown to decrease due to re-oligotrophication, but the potential regime shift from phytoplankton to macrophyte dominance described in shallow lakes has been documented only in a few rivers and estuaries yet. The main reasons why regime shifts are rarely described in rivers and estuaries are, from one hand the scarcity of data on macrophyte cover trends, and from the other hand physical factors such as peak flows or high turbidity that could prevent a general spread of submerged macrophytes as observed in shallow lakes. Moreover, re-oligotrophication effects on rivers may be different compared to lakes (e.g., lower dominance of macrophytes) or estuaries (e.g., limitation of primary production by N instead of P) or may be dependent on river/estuary type. We conclude that river and estuary re-oligotrophication effects are complex, diverse and still little known, and in some cases are equivalent to those described in shallow lakes, but the regime shift is more likely to occur in mid to high-order rivers and shallow estuaries.info:eu-repo/semantics/publishedVersio

Ecosystem-level effects of re-oligotrophication and N:P imbalances in rivers and estuaries on a global scale

Trends and ecological consequences of phosphorus (P) decline and increasing nitrogen (N) to phosphorus (N:P) ratios in rivers and estuaries are reviewed and discussed. Results suggest that re-oligotrophication is a dominant trend in rivers and estuaries of high-income countries in the last two–three decades, while in low-income countries widespread eutrophication occurs. The decline in P is well documented in hundreds of rivers of United States and the European Union, but the biotic response of rivers and estuaries besides phytoplankton decline such as trends in phytoplankton composition, changes in primary production, ecosystem shifts, cascading effects, changes in ecosystem metabolism, etc., have not been sufficiently monitored and investigated, neither the effects of N:P imbalance. N:P imbalance has significant ecological effects that need to be further investigated. There is a growing number of cases in which phytoplankton biomass have been shown to decrease due to re-oligotrophication, but the potential regime shift from phytoplankton to macrophyte dominance described in shallow lakes has been documented only in a few rivers and estuaries yet. The main reasons why regime shifts are rarely described in rivers and estuaries are, from one hand the scarcity of data on macrophyte cover trends, and from the other hand physical factors such as peak flows or high turbidity that could prevent a general spread of submerged macrophytes as observed in shallow lakes. Moreover, re-oligotrophication effects on rivers may be different compared to lakes (e.g., lower dominance of macrophytes) or estuaries (e.g., limitation of primary production by N instead of P) or may be dependent on river/estuary type. We conclude that river and estuary re-oligotrophication effects are complex, diverse and still little known, and in some cases are equivalent to those described in shallow lakes, but the regime shift is more likely to occur in mid to high-order rivers and shallow estuaries.This work was supported by a grant from the U.S. National Science Foundation (#DBI‐1639145) to the National Socio‐Environmental Synthesis Center (Rivershift Project). The work was also financially supported by the Catalan Government through the funding grant ACCIÓ‐Eurecat (Project AquaSCI‐2022)

Ecosystem-level effects of re-oligotrophication and N:P imbalances in rivers and estuaries on a global scale

ABSTRACT: Trends and ecological consequences of phosphorus (P) decline and increasing nitrogen (N) to phosphorus (N:P) ratios in rivers and estuaries are reviewed and discussed. Results suggest that re-oligotrophication is a dominant trend in rivers and estuaries of high-income countries in the last two-three decades, while in low-income countries widespread eutrophication occurs. The decline in P is well documented in hundreds of rivers of United States and the European Union, but the biotic response of rivers and estuaries besides hytoplankton decline such as trends in phytoplankton composition, changes in primary production, ecosystem shifts, cascading effects, changes in ecosystem metabolism, etc., have not been sufficiently monitored and investigated, neither the effects of N:P imbalance. N:P imbalance has significant ecological effects that need to be further investigated. There is a growing number of cases in which phytoplankton biomass have been shown to decrease due to re-oligotrophication, but the potential regime shift from phytoplankton to macrophyte dominance described in shallow lakes has been documented only in a few rivers and estuaries yet. The main reasons why regime shifts are rarely described in rivers and estuaries are, from one hand the scarcity of data on macrophyte cover trends, and from the otherhand physical factors such as peak flows or high turbidity that could prevent a general spread of submerged macrophytes as observed in shallow lakes. Moreover, re-oligotrophication effects on rivers may be different compared to lakes (e.g., lower dominance of macrophytes) or estuaries (e.g., limitation of primary production by N instead of P) or may be dependent on river/estuary type. We conclude that river and estuary re-oligotrophication effects are complex, diverse and still little known, and in some cases are equivalent to those described in shallow lakes, but the regime shift is more likely to occur in mid to high-order rivers and shallow estuaries.This work was supported by a grant from the U.S. National Science Foundation (#DBI-1639145) to the National Socio-Environmental Synthesis Center (Rivershift Project). The work was also financially supported by the Catalan Government through the funding grant ACCIÓ-Eurecat (Project AquaSCI-2022)

Eradication of Staphylococcus aureus Biofilm Infections Using Synthetic Antimicrobial Peptides

Here, we demonstrate that antimicrobial peptides (AMPs) are an effective antibiofilm treatment when applied as catheter lock solutions (CLSs) against S. aureus biofilm infections. The activity of synthetic AMPs (Bac8c, HB43, P18, Omiganan, WMR, Ranalexin, and Polyphemusin) was measured against early and mature biofilms produced by methicillin-resistant S. aureus and methicillin-susceptible S. aureus isolates from patients with device-related infections grown under in vivo-relevant biofilm conditions. The cytotoxic and hemolytic activities of the AMPs against human cells and their immunomodulatory potential in human blood were also characterized. The D-Bac8c2,5Leu variant emerged as the most effective AMP during in vitro studies and was also highly effective in eradicating S. aureus biofilm infection when used in a CLS rat central venous catheter infection model. These data support the potential use of D-Bac8c2,5Leu, alone or in combination with other AMPs, in the treatment of S. aureus intravenous catheter infections