Peer group supervision in a lay counselling context.

Thesis (M.A.)-University of Natal, Pietermaritzburg, 2002.Supervision is a core prerequisite for the registration and ongoing education and professional development of various levels of mental health care workers in a South African context. There is, however, a dearth of South African literature that pertains to the supervision of such workers. It would appear that the dominant form of supervision of practice is dyadic, but such supervision is resource intense. This study explores a structured model of peer group supervision (PGS model) as a possible alternative to individual supervision. As the PGS model is in a preliminary, developmental phase, this research is also an exploratory investigation. The main aim of this study was to explore how a group of experienced, voluntary lay counsellors, working under the auspices of a national, non-governmental mental health agency utilised and evaluated the PGS model. Four peer group sessions were held with the group of ten lay counsellors, in their usual site of practice. A focus group discussion was then held, followed by the participants completing a semi-structured questionnaire. The intention of this research design was that the participants' perspectives be given priority in this investigation. The concurrent collection and analysis of data was achieved by employing a qualitative, interpretive grounded theory methodology (Addison, 1989). The findings considered the way in which the group utilised the PGS model, and examined the participants' experiences. The group of lay counsellors were enthusiastic about the potential for the PGS model to offer them a forum to collaboratively discuss and assist each other with their casework. The findings were then integrated with the literature pertaining to peer group supervision, as well as ideas from a variety of sources that discuss the construction of optimal learning encounters. The findings were then discussed from a perspective of situated cognition and the notions of local knowledge and communities of practice were used to propose a deeper understanding of the experiences of the group. This research undertaking resulted in the participants making some recommendations for the adaptation of the PGS model. Further recommendations for both the application of the PGS model and for research into supervisory practice are made

Investigation of the lymphocyte function during tubulointerstitial injury in the native kidney

MD ThesisTubulointerstitial inflammation and fibrosis is frequently seen in patients with progressive renal failure, irrespective of the aetiology, and may represent a common pathway to renal failure. However, the role and function of tubulointerstitial lymphocytes in the pathogenesis of renal fibrosis is unknown. Using the wellcharacterised mouse model of unilateral ureteric obstruction (UUO) I determined the phenotype of infiltrating lymphocytes and by sequencing the complementaritydetermining region 3 (CDR3) of the variable β-chain examined whether there were clonal populations of T cells within UUO and normal kidney. There was a strong correlation between lymphocyte infiltration and tubulointerstitial expansion, α-SMA staining and collagen I deposition. A population of these infiltrating CD4+ and CD8+ lymphocytes also displayed the surface makers CD69 and CD44, and the nuclear proliferation marker Ki67. This suggests activation and proliferation of T cells in response to self-antigen recognition and the loss of immunological tolerance. Infiltrating T cells within UUO kidney demonstrated over expression of certain TRVβ gene segments in particular TRVβ3, suggesting a clonal population of lymphocytes. In normal and sham operated kidney over expression of T cells with the TRVβ13.2, 29 and 1 gene segments suggested populations of resident NKT cells expressing an invariant T cell receptor. On sequence analysis of the CDR3 region of infiltrating lymphocytes, large clonal populations of T cells were seen in individual UUO kidneys at 7 and 14 days after obstruction but not 28 days. These clonal populations in UUO kidney that were also in normal kidney had an identical amino acid motif within the CDR3 region. This suggests a population of T cells in normal kidney proliferate in response to injury. These lymphocytes could be a potential target for therapeutic interventions to prevent fibrosis in renal diseases that are not characteristically believed to be immune mediated.The Northern Kidney Research Fund

Systemic gene therapy rescues retinal dysfunction and hearing loss in a model of Norrie disease

Deafness affects 5% of the world's population, yet there is a lack of treatments to prevent hearing loss due to genetic causes. Norrie disease is a recessive X-linked disorder, caused by NDP gene mutation. It manifests as blindness at birth and progressive sensorineural hearing loss, leading to debilitating dual sensory deprivation. To develop a gene therapy, we used a Norrie disease mouse model (Ndptm1Wbrg ), which recapitulates abnormal retinal vascularisation and progressive hearing loss. We delivered human NDP cDNA by intravenous injection of adeno-associated viral vector (AAV)9 at neonatal, juvenile and young adult pathological stages and investigated its therapeutic effects on the retina and cochlea. Neonatal treatment prevented the death of the sensory cochlear hair cells and rescued cochlear disease biomarkers as demonstrated by RNAseq and physiological measurements of auditory function. Retinal vascularisation and electroretinograms were restored to normal by neonatal treatment. Delivery of NDP gene therapy after the onset of the degenerative inner ear disease also ameliorated the cochlear pathology, supporting the feasibility of a clinical treatment for progressive hearing loss in people with Norrie disease

Systemic gene therapy rescues retinal dysfunction and hearing loss in a model of Norrie disease

Deafness affects 5% of the world's population, yet there is a lack of treatments to prevent hearing loss due to genetic causes. Norrie disease is a recessive X‐linked disorder, caused by NDP gene mutation. It manifests as blindness at birth and progressive sensorineural hearing loss, leading to debilitating dual sensory deprivation. To develop a gene therapy, we used a Norrie disease mouse model (Ndp$^{tm1Wbrg}$), which recapitulates abnormal retinal vascularisation and progressive hearing loss. We delivered human NDP cDNA by intravenous injection of adeno‐associated viral vector (AAV)9 at neonatal, juvenile and young adult pathological stages and investigated its therapeutic effects on the retina and cochlea. Neonatal treatment prevented the death of the sensory cochlear hair cells and rescued cochlear disease biomarkers as demonstrated by RNAseq and physiological measurements of auditory function. Retinal vascularisation and electroretinograms were restored to normal by neonatal treatment. Delivery of NDP gene therapy after the onset of the degenerative inner ear disease also ameliorated the cochlear pathology, supporting the feasibility of a clinical treatment for progressive hearing loss in people with Norrie disease

A self-consistent, multi-variate method for the determination of gas phase rate coefficients, applied to reactions of atmospheric VOCs and the hydroxyl radical

Gas-phase rate coefficients are fundamental to understanding atmospheric chemistry, yet experimental data are not available for the oxidation reactions of many of the thousands of volatile organic compounds (VOCs) observed in the troposphere. Here a new experimental method is reported for the simultaneous study of reactions between multiple different VOCs and OH, the most important daytime atmospheric radical oxidant. This technique is based upon established relative rate concepts but has the advantage of a much higher throughput of target VOCs. By evaluating multiple VOCs in each experiment, and through measurement of the depletion in each VOC after reaction with OH, the OH + VOC reaction rate coefficients can be derived. Results from experiments conducted under controlled laboratory conditions were in good agreement with the available literature for the reaction of nineteen VOCs, prepared in synthetic gas mixtures, with OH. This approach was used to determine a rate coefficient for the reaction of OH with 2,3-dimethylpent-1-ene for the first time; k = 5.7 (±0.3) × 10–11–cm3 molecule−1 s−1. In addition, a further seven VOCs had only two, or fewer, individual OH rate coefficient measurements available in the literature. The results from this work were in good agreement with those measurements. A similar dataset, at an elevated temperature of 323 (±10) K, was used to determine new OH rate coefficients for twelve aromatic, five alkane, five alkene and three monoterpene VOC + OH reactions. In OH relative reactivity experiments that used ambient air at the University of York, a large number of different VOCs were observed, of which 23 were positively identified. 19 OH rate coefficients were derived from these ambient air samples, including ten reactions for which data was previously unavailable at the elevated reaction temperature of T = 323 (±10) K

Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers (Protocol)

This is a protocol for a Cochrane Review (Qualitative). The object ives are as follows: • To identify factors that influence referral to pulmonary rehab ilitation for COPD from the perspective of service users, thei r family/carers, and healthcare providers. • To identify factors that influence uptake of pulmonary rehabil itation for COPD (i.e. at least one attendance of an assessment or first programme session) from the perspective of service users , their family/carers, and healthcare providers. • To identify factors that influence attendance at pulmonary reha bilitation programmes for COPD from the perspective of servi ce users, their family/carers, and healthcare providers. • To develop an inductive explanatory framework for how these f actors may interact to contribute to better or poorer uptake or completion of pulmonary rehabilitation in order to guide acti ons of healthcare decision-makers to improve opportunities fo r people with COPD to benefit from pulmonary rehabilitation

The timing of auditory sensory deficits in Norrie disease has implications for therapeutic intervention

Norrie disease is caused by mutation of the NDP gene, presenting as congenital blindness followed by later onset of hearing loss. Protecting patients from hearing loss is critical for maintaining their quality of life. This study aimed to understand the onset of pathology in cochlear structure and function. By investigating patients and juvenile Ndp-mutant mice, we elucidated the sequence of onset of physiological changes (in auditory brainstem responses, distortion product otoacoustic emissions, endocochlear potential, blood-labyrinth barrier integrity) and determined the cellular, histological, and ultrastructural events leading to hearing loss. We found that cochlear vascular pathology occurs earlier than previously reported and precedes sensorineural hearing loss. The work defines a disease mechanism whereby early malformation of the cochlear microvasculature precedes loss of vessel integrity and decline of endocochlear potential, leading to hearing loss and hair cell death while sparing spiral ganglion cells. This provides essential information on events defining the optimal therapeutic window and indicates that early intervention is needed. In an era of advancing gene therapy and small-molecule technologies, this study establishes Ndp-mutant mice as a platform to test such interventions and has important implications for understanding the progression of hearing loss in Norrie disease

Improving talking therapies for autistic people

Background: Autistic people are more likely to experience common mental health conditions such as anxiety and depression. Whilst there is a substantial evidence base for psychological therapies for anxiety and depression and well established NHS Talking Therapies services, there is limited evidence on what works best for autistic people in this context. In particular, there is limited guidance on what adjustments and adaptations may work best for autistic people accessing psychological therapies services. Many autistic adults will have received a diagnosis recently and other people will be waiting for an assessment so will have added uncertainty about how what may help them to access services effectively. In this project, we aimed to understand the experience of autistic people (and those waiting for an autism assessment) when accessing Talking Therapies and improve the offer to autistic people through service redesign and training with clinicians. Methods: We used mixed methods in the project including qualitative analysis of semi-structured interviews with autistic people and clinicians in Talking Therapies services and quantitative analysis of Talking Therapies training needs and evaluation of the impact of training and service redesign. Results and Findings: We identified a number of themes from our interviews with autistic people and clinicians which has helped us to better understand the challenges to supporting autistic people in Talking Therapies. Both autistic people and clinicians reported that Talking Therapies services need significant adaptation (including clinician training) in order to meet the needs of autistic people. We designed training which clinicians reported had a positive effect. We also made changes to a Talking Therapies service to how they identified autistic people who accessed their service which led to approximately 5% of clients being identified as autistic (or having similar needs that require adaptations to therapies). Next steps: We will work to develop a large-scale research funding proposal to NIHR to build on this work and help evaluate the usefulness of these service changes particularly the impact they have upon autistic people’s experience of Talking Therapies. As part of this research and wider service development, the protocol for identifying autistic people could be tested in a wider number of Talking Therapies services and the training programme could be used in other services (following further refinement and depending on resources)

Teaching emergency and disaster management in Australia: standards for higher education providers

The need for emergency and disaster professionals with multidisciplinary knowledge and holistic understanding is widely recognised. Despite this, there is currently no international nor an Australian consensus on a set of common standards for higher education that could ensure graduates possess knowledge and skills with sufficient commonality to facilitate interoperability in all facets of disaster management cycle. Thus, this research project aimed to develop a standards and an associated conceptual framework for higher education programs in emergency and disaster management. The Generic Emergency and Disaster Management Standards (GEDMS) were developed through a mixed qualitative research approach involving a systematic literature review, mapping of current course content offered in Australia and New Zealand, focus groups of experts and consultation with policy makers, industry representatives and other relevant stakeholders. The Standards consist of three main domains: knowledge, skills and application. Governance and policy frameworks, theoretical and conceptual basis for practice, and contemporary disaster management were identified as underlying themes for the knowledge domain. Leadership, communication, and collaboration were fitted under the skills domain. The professional practice, together with critical thinking, were considered the means by which knowledge and skills are applied