Mixed Methods Evaluation of a Novel Clinical Pathway for People with Co-occurring Eating Disorders and Autism

This thesis aims to evaluate a novel clinical pathway for people with cooccurring eating disorders (ED) and autism – the Pathway for Eating disorders and Autism developed from Clinical Experience (the PEACE Pathway) – implemented at the South London and Maudsley (SLaM) NHS Foundation Trust ED service. A systematic review was first conducted to identify existing treatment adaptations for autistic people with ED, which concluded that the PEACE Pathway was the only treatment adaptation pathway for this comorbidity that has been described in publications. A second review was then conducted to investigate the impact of autism on ED clinical outcomes. While autism does not directly impact weight-related outcomes and eating pathology, it was linked with more severe comorbid symptoms such as depression and anxiety in patients with ED, and was associated with longer hospitalisations and increased use of intensive treatment. To explore these links in real clinical setting and to gain an understanding of patients’ presentation at the SLaM ED service – where PEACE was developed and implemented – a cluster analysis was carried out using patients’ self-reported clinical measures and found a patient group with more severe presentation than others; the same group also had higher average weight, more severe eating pathology, higher anxiety and depression, and more autistic characteristics. Clinical challenges associated with supporting autism and ED were then synthesised from PEACE case studies and clinical notes. Common challenges included autism-related communication, sensory, emotion and eating difficulties, cognitive rigidity, other comorbid complications, and issues with autism screening and maintaining treatment boundaries. In order to support patients’ sensory difficulties, PEACE developed the sensory wellbeing workshop, which was evaluated next. Both in-person and online formats of the workshop produced significant improvement in patients’ sensory wellbeing with no difference between the two formats. Lastly, outcomes of the PEACE pathway were evaluated clinically and economically using service audit data, and qualitatively through clinician interviews. Overall, the PEACE Pathway has increased autism awareness and met patients’ needs through an individualised approach without compromising ED treatment outcomes, while reducing the length of hospitalisation for autistic patients to bring cost-savings to the service.<br/

Re-examining The Two-Step Flow of information in the age of digital media: The case of the 2012 presidential election in the United States

An online questionnaire was administered to a sample of 233 young adults qualified to vote in the 2012 U.S. presidential election. The findings show that respondents depended more on the traditional media and interpersonal sources to be aware of, form attitudes toward, and decide on political candidates and issues. The relationships of source use at the three stages point to a general flow of information quite different from that outlined in the two-step flow hypotheses. At the awareness stage, the findings indicate that people tended to choose between the traditional media and social networking sites as their main sources of information about the presidential election. Users of both sources also refer to interpersonal sources, indicating a complementary relationship. Thus, the interpersonal sources tended to supplement, but not replace, traditional and social media use. At the stage in which voters were forming their attitude about the candidates and their platforms, all three source categories were utilized, suggesting a symbiotic type of relationship among them. At the point when voters are trying to solidify their voting choice, the correlations show the traditional and social media competing for audience attention, supplemented by interpersonal sources. Voters used interpersonal sources across the three stages, suggesting their utility as political information conduits even in the digital age. In other words, the study failed to detect any evidence that the social media were replacing or substituting for interpersonal contacts--and the traditional media--as the main sources of presidential election information

Breaking The Silence: Extending Theory To Address The Underutilization Of Mental Health Services Among Chinese Immigrants In The United States

Mental health services underutilization has been a prevalent issue in Chinese immigrant community in the United States. Using a nation wide survey of 445 Chinese immigrants in November 2017, this study investigates the effects of cognitive barriers (i.e., acculturation levels) and affective obstacles (i.e., mental illness stigma) on Chinese immigrants’ perceptual, attitudinal, and behavioral responses toward mental health services, by combining situational theory of problem solving and the theory of planned behavior. This study also examines the effects of mainstream and ethnic media use on acculturation and perceived stigma. Findings provide empirical support for the combined model, showing that all the cognitive and affective factors can predict Chinese immigrants’ communicative action and behaviors regarding mental health services utilization. In addition, this study found that acculturation (cognitive barriers) is an effective predictor of individuals’ ability to recognize the problem, connection to the problem, subjective norms regarding the problem, and their perceived behavioral control over the problem. On the other hand, mental illness stigma (affective barriers) can predict individuals’ constraint recognition, attitudes, and perceived behavioral control over the issue. Practical implications are discussed for health public relations practitioners and communicators to better identify publics, propose strategic messages, and implement communication campaigns to improve Chinese immigrants’ mental health services utilization rates

A Model for Mapping Interactivity in Learning Experiences

This research is situated at the intersection of technology, education, and design. A design methodology was applied to examine the issues relating to interactivity within these disciplines. The result of this research is a working definition of interactivity aesthetics that can be used across multiple disciplines, and a model of interactivity as a practical means of evaluating the interactivity in any given learning experience

Heat transfer analysis of an integrated double skin façade and phase change material blind system

In this study, the heat transfer in an integrated double skin facade (DSF) and phase change material (PCM) blind system has been theoretically analysed. Both heat transfer and airflow models with CFD methods have been developed for the integrated DSF and PCM blind system. Data from an existing typical DSF building have been obtained in order to define input parameters for the simulation exercise and validate the numerical models. The temperature and velocity fields in DSF with the PCM blind system has been predicted under overheating scenario using the ANSYS Workbench FLUENT software and been compared with case of conventional aluminium blind system. This study has shown that the integrated PCM blind system was able to reduce the average air temperature and outlet temperature of the DSF while improving the convective heat transfer between the cavity air and the blades. Compared with the aluminium blind, the PCM blind can absorb large amount of excessive heat in the cavity. Overall the integrated PCM blind system has the potential to be used as an effective thermal management device for minimising the overheating effect in DSFs