A meta-synthesis of the lived experience of adolescents with type 1 diabetes, and an empirical study of the impact of ways of coping on power of the anorexic voice

Paper 1 is a qualitative systematic review of the literature regarding adolescents lived experience of Type 1 Diabetes Mellitus (T1DM). T1DM is a chronic health condition where the bodies natural ability to produce insulin is disrupted. Without insulin, blood glucose (sugar) is not metabolised and can build up within the blood stream, which can lead to life-threatening health complications. Diabetes is described as requiring management 24/7, 365 days a year and individuals effectively act as their pancreas. They must continually monitor their blood glucose levels and administer insulin throughout the day and in response to food and drink consumption. This is a substantial burden, and for adolescents, living with T1DM can be difficult to handle. Research has shown that adolescents with T1DM have worse metabolic control, increased hospital admissions and are less likely to attend appointments as they transition to adult services. Understanding the demands faced by adolescents with T1DM is vital if healthcare services want to provide the appropriate support to improve health outcomes for young people. Whilst there has been some exploration of the experiences of children and adults with T1DM, there is a gap in the literature for adolescents. Several databases were systematically searched for qualitative papers that explored the lived experiences of adolescents with T1DM. In total 10 papers were identified for inclusion in this review, reflecting the experiences of over 200 adolescents across five different countries. Thematic synthesis was used to develop codes and themes within and across papers, which resulted in four over-arching themes: 1) Diabetes is exhausting and overwhelming, 2) Nothing is untouched by diabetes, 3) I will always be different because of diabetes and 4) Ways of coping with the burden of diabetes. Adolescents described feeling distressed and overwhelmed by the burden of diabetes and the way it impacted every aspect of their life, from school to friendships and family life. T1DM made them stand out and feel different at a time where fitting in was extremely important. In order to cope with these difficult feelings, many adolescents avoided thinking about their diabetes, or disengaged from treatment altogether. Being able to accept diabetes as part of them helped to reduce feelings of distress, but this was a process that took place over time. The findings of this systematic review highlight the importance of healthcare services looking out for and asking adolescents about diabetes distress and supporting them to find adaptive ways of coping with the burden of management. Paper 2 was concerned with exploring the impact of voice suppression on the power of the anorexic voice. The anorexic voice is a phenomenon described across eating disorders as a critical and powerful internal voice that comments on food, shape, and weight. Individuals with eating disorders have described how initially the voice starts out as encouraging and supportive, but over time it becomes more negative and hostile. What is not yet known is why the anorexic voice becomes more powerful over time. One possible mechanism is the use of metacognitive control strategies, which are ways of coping with thoughts and feelings that we experience. Some strategies, such as voice suppression, are less helpful as it actually increases the frequency of thoughts and levels of distress. Research has shown that voices perceived as malevolent are likely to be resisted and individuals with eating disorders are more likely to use control strategies like voice suppression. It may be that failure to suppress the anorexic voice leads to its increasing power over time. This research study asked a group of participants with current experience of an anorexic voice to complete a series of questionnaires regarding their beliefs about their anorexic voice and to rate topographical features of it, such as its power, volume, frequency. Then, participants were asked to either suppress or accept the experience of their anorexic voice for a short period of time and to rate their anorexic voice again. The results were interesting and showed that engaging in thinking about the anorexic voice, whether through voice suppression or acceptance, increased its power. It was also found that the anorexic voice is perceived to be both benevolent and malevolent and individuals are simultaneously willing to engage with it and try to resist it. This has implications for therapy and may explain why recovery outcomes are so poor for individuals with eating disorders

Maximizing Student Achievements: Mastering Aviation English

Flight training delays and corresponding increased costs appear to be widespread among universities with aviation programs. Students in these programs have to juggle demanding academics and flight training. Additionally, international students, for whom English is not their primary language, have the added disadvantage of learning complex aviation concepts in English. In order to maximize retention in collegiate flight programs, an experimental aviation English course has been designed to help frontload aviation vocabulary and take a proactive approach to teaching language skills that are essential in flight training

Senior Recital

List of performers and performances

Changes to inhaled corticosteroid dose when initiating combination inhaler therapy in long-acting β agonist-naive patients with asthma : a retrospective database analysis

Retrospective prescribing data were obtained from 46 general practice surgeries in NHS Scotland. Patients with asthma who were naïve to previous long-acting β agonist therapy and initiated combination inhaler therapy in 2008–2009 were classified according to the inhaled corticosteroid (ICS) dose in their combination inhaler compared with the highest dose of ICS they received before initiation. Among the 685 patients (541 (79.0%) who had been prescribed an ICS previously), those originally on low-, medium- or high-dose ICS were changed to high-dose combination therapy in 122/250 (48.8%), 94/151 (62.3%) or 85/113 (75.2%) cases in each ICS dose category, respectively. These results suggest that evaluation of appropriate high-dose ICS prescribing in general practice is needed

Doctoral Recital

List of performers and performances

Discovering the Data of Safety: Embry-Riddle’s Aviation Safety and Security Archives

The path to the sky and beyond has not been simple or obstacle-free, but dedicated dreamers have worked to overcome obstacles, learn from mishaps, and develop new technologies to achieve their goals. As the leading university for aviation and aerospace education, Embry-Riddle Aeronautical University maintains a firm commitment to the practice and study of safety. As part of this mission, the university has established the Aviation Safety and Security Archives (ASASA) which is a national treasure of aviation safety history and information

Pharmacologically Distinct Nicotinic Acetylcholine Receptors Drive Efferent-Mediated Excitation in Calyx-Bearing Vestibular Afferents

Electrical stimulation of vestibular efferent neurons rapidly excites the resting discharge of calyx/dimorphic (CD) afferents. In turtle, this excitation arises when acetylcholine (ACh), released from efferent terminals, directly depolarizes calyceal endings by activating nicotinic ACh receptors (nAChRs). Although molecular biological data from the peripheral vestibular system implicate most of the known nAChR subunits, specific information about those contributing to efferent-mediated excitation of CD afferents is lacking. We sought to identify the nAChR subunits that underlie the rapid excitation of CD afferents and whether they differ from α9α10 nAChRs on type II hair cells that drive efferent-mediated inhibition in adjacent bouton afferents. We recorded from CD and bouton afferents innervating the turtle posterior crista during electrical stimulation of vestibular efferents while applying several subtype-selective nAChR agonists and antagonists. The α9α10 nAChR antagonists, α-bungarotoxin and α-conotoxin RgIA, blocked efferent-mediated inhibition in bouton afferents while leaving efferent-mediated excitation in CD units largely intact. Conversely, 5-iodo-A-85380, sazetidine-A, varenicline, α-conotoxin MII, and bPiDDB (N,N-dodecane-1,12-diyl-bis-3-picolinium dibromide) blocked efferent-mediated excitation in CD afferents without affecting efferent-mediated inhibition in bouton afferents. This pharmacological profile suggested that calyceal nAChRs contain α6 and β2, but not α9, nAChR subunits. Selective blockade of efferent-mediated excitation in CD afferents distinguished dimorphic from calyx afferents by revealing type II hair cell input. Dimorphic afferents differed in having higher mean discharge rates and a mean efferent-mediated excitation that was smaller in amplitude yet longer in duration. Molecular biological data demonstrated the expression of α9 in turtle hair cells and α4 and β2 in associated vestibular ganglia

WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives

Loss of α-Calcitonin Gene-Related Peptide (αCGRP) Reduces Otolith Activation Timing Dynamics and Impairs Balance

Calcitonin gene-related peptide (CGRP) is a neuroactive peptide that is thought to play a role at efferent synapses in hair cell organs including the cochlea, lateral line, and semicircular canal. The deletion of CGRP in transgenic mice is associated with a significant reduction in suprathreshold cochlear nerve activity and vestibulo–ocular reflex (VOR) gain efficacy when compared to littermate controls. Here we asked whether the loss of CGRP also influences otolithic end organ function and contributes to balance impairments. Immunostaining for CGRP was absent in the otolithic end organs of αCGRP null (-/-) mice while choline acetyltransferase (ChAT) immunolabeling appeared unchanged suggesting the overall gross development of efferent innervation in otolithic organs was unaltered. Otolithic function was assessed by quantifying the thresholds, suprathreshold amplitudes, and latencies of vestibular sensory-evoked potentials (VsEPs) while general balance function was assessed using a modified rotarod assay. The loss of αCGRP in null (-/-) mice was associated with: (1) shorter VsEP latencies without a concomitant change in amplitude or thresholds, and (2) deficits in the rotarod balance assay. Our findings show that CGRP loss results in faster otolith afferent activation timing, suggesting that the CGRP component of the efferent vestibular system (EVS) also plays a role in otolithic organ dynamics, which when coupled with reduced VOR gain efficacy, impairs balance