Avoidant Personality Disorder and Social Phobia: Identification of Clinically Meaningful Differences

Background: Both avoidant personality disorder (AVPD) and social phobia (SP) feature social fears that lead to avoidant behaviour, distress and disability. The “severity continuum hypothesis” proposes that AVPD is essentially a more severe variant of SP, but a small number of studies posit the contrary, and clinical experience suggests that AVPD is a distinct disorder. Thus far AVPD is vastly under-researched compared to SP and this thesis targets this gap and investigates the extent to which AVPD is a distinct entity from SP. Methods: A literature review of the evidence for and against the severity continuum hypothesis identified factors that may differentiate AVPD and SP, in particular attachment style. Epidemiological data was interrogated to determine the prevalence and demographic correlates of AVPD with and without SP. Prospectively recruited participants were assigned to SP-only, AVPD-only or SP+AVPD groups and compared across variables of syndromic, aetiological and therapeutic interest for AVPD. A qualitative study was conducted to characterise the core lived experience features of AVPD, further informing development of a brief clinical screening measure. Results: Australian community epidemiological data confirmed international findings of a predominance of AVPD without SP. In both epidemiological and recruited samples the comorbid group separated from SP-only in the direction of greater severity, whereas AVPD-only showed a more variable relationship. Analysis of qualitative data suggested that greater emphasis would be warranted on the perceived catastrophic meaning of rejection and sense of self, and delineated cognitive-behavioural patterns worthy of further study. The brief, easily scored screening measure offers promise for use in clinical settings. Conclusions: Support is found for an alternative to the continuum hypothesis. In this, SP and AVPD share a focus on interpersonal concerns but are sufficiently distinct to justify retaining separate diagnostic categories. The brief screening tool and findings from the qualitative study add considerably to knowledge of AVPD and the insights from this thesis are likely to be of significance, informing our approach to establishing and maintaining a therapeutic alliance with this very difficult to engage patient population

A post-Keynesian perspective on the eco zone project: Liquidity premia and external financial fragility in the West African Economic and Monetary Union, Ghana and Nigeria

The paper treats the eco currency union project in West Africa and its implications for monetary policies against the backdrop of the international monetary order from a post-Keynesian perspective. The eco zone project envisions a common monetary union of the West African Economic and Monetary Union (WAEMU), i.e. the independent Western subzone of the CFA franc union, and the remaining non-CFA countries of the Economic Community of West African States (ECOWAS) with Nigeria and Ghana as the economically most important member states. The literature on the international currency hierarchy developed by Latin-American structuralists and the post-Keynesian Berlin School of thought focuses on the notion of a currency-specific liquidity premium that structurally determines the interest rate level in the corresponding currency areas. Based on this set of literature, we conduct a comparison between the liquidity premia of the Western CFA-franc, the Nigerian naira and the Ghanaian cedi to make conjectures about what implications a common ECOWAS currency union would have regarding monetary policy space. Being a non-pecuniary variable, the liquidity premium cannot be observed directly. We therefore approximate the liquidity premium by calculating differences in interest rates such as the central bank’s base rate, the coupon rate on T-bills and bonds and the interest rate spread between Eurobonds and bonds denominated in local currency. Besides, we use balance of payment data to identify external financial fragilities that might become a crucial factor for monetary policy due to an increasing financialisation in West African economies. We find that investors demand structurally higher yields on bonds originating in Ghana and Nigeria than in the CFA-franc zone. One could interpret this as the FA-franc conveying over a higher liquidity premium because it has to have lower yields rates to compensate for liquidity-differences to financial assets denominated in the US dollar or euro. However, another explanation is that expectations about the future developments of the cedi’s and naira’s exchange value by investors are more pessimistic in comparison to that of the CFA-franc. This is rooted in two major factors: Firstly, under the current arrangement, France still has leeway in monetary policy making and acts as exchange rate stabiliser by pushing for restrictive monetary policies and guaranteeing foreign exchange reserve provision. Secondly, the estimation of external financial fragility in the WAEMU, Nigeria and Ghana shows that the naira implies a greater risk of sudden devaluation compared to the Western CFA franc and the cedi due to Nigeria’s higher exposure to mobile liabilities vis-à-vis its asset endowments

A Preliminary Historical Report on Embracing Online Education in Occupational Therapy

The relevance and popularity of online occupational therapy education have been increasingly recognized. This paper describes the historical development of online occupational therapy education. Findings revealed three shifts in occupational therapy education, namely shifts in perception, in mode of instruction, and in the roles of teachers and students. The inception of online education in occupational therapy was a product of technological advancement and the demand for improved access to occupational therapy online education. The early phase of occupational therapy online education was confronted with challenges related to hesitance in the development and implementation of online programs and to negative perceptions about online education. The development and implementation of online occupational therapy programs were greatly shaped by factors such as technological tools, methods of teaching delivery, and the dynamics of teaching and learning processes. The potential of online occupational therapy education remains vast, but experts caution that quality should not be compromised

"Utforskning på 1. trinn handler mer om å etablere en kultur for utforskning, enn den faktiske utforskningen"

Gjennom dette masterprosjektet har vi undersøkt hva det vil si å jobbe utforskende i matematikkundervisningen på 1. trinn. Utforskende matematikkundervisning har de siste årene vært aktuelt innenfor forskning i matematikkdidaktikk og har fått større plass i utdanningspolitikk og i læreplaner (Artigue & Maaß, 2013, s. 797). Ved revidering av ny læreplan, var en av de største endringene at det nå er implementert kjerneelementer i de ulike fagene. Et av kjerneelementene er utforskning og problemløsning (Kunnskapsdepartementet, 2019). I tillegg blir også verbet å utforske nevnt hyppig i kompetansemålene i LK20. Maaß og Reitz-Koncebovski (2013, s. 10) beskriver utfordringer med å endre undervisningen fra den mer tradisjonelle til utforskende. Både elever og læreren må venne seg til en ny måte å lære på og å undervise på, som kan by på utfordringer i starten. Masteroppgaven tar utgangspunkt i følgende problemstilling: Hva vil det si å jobbe utforskende i matematikkundervisningen på 1. trinn? For å besvare problemstillingen har vi utført en kvalitativ studie. Vi har gjennomført observasjoner av tre utforskende undervisningsøkter i en 1. klasse. Undervisningsøktene har vi har planlagt sammen med læreren, vi har intervjuet læreren på trinnet og vi har gjennomført oppgavebaserte intervju med utvalgte elever. Dette har gitt oss et innblikk i hvordan utforskende matematikkundervisning kan se ut i 1. klasse. Gjennom forskningen vår har vi kommet frem til tre funn som kan være avgjørende for å kunne gjennomføre utforskende matematikkundervisning på 1. trinn. De tre funnene er å etablere en læringskultur for utforskning, lærerens planlegging og grep under gjennomføringen av utforskende matematikkundervisning og at elevene responderer ulikt på undervisningen avhengig av oppgavetypen. Lærerens rolle ble sentral for å kunne etablere utforskning som undervisningspraksis

Consortin, a trans-Golgi network cargo receptor for the plasma membrane targeting and recycling of connexins

Targeting of numerous transmembrane proteins to the cell surface is thought to depend on their recognition by cargo receptors that interact with the adaptor machinery for anterograde traffic at the distal end of the Golgi complex. We report here on consortin, a novel integral membrane protein that is predicted to be intrinsically disordered, i.e. that contains large segments whose native state is unstructured. We identified consortin as a binding partner of connexins, the building blocks of gap junctions. Consortin is located at the trans-Golgi network (TGN), in tubulovesicular transport organelles, and at the plasma membrane. It directly interacts with the TGN clathrin adaptors GGA1 and GGA2, and disruption of this interaction by expression of a consortin mutant lacking the acidic cluster-dileucine (DXXLL) GGA interaction motif causes an intracellular accumulation of several connexins. RNA interference-mediated silencing of consortin expression in HeLa cells blocks the cell surface targeting of these connexins, which accumulate intracellularly, whereas partial depletion and redistribution of the consortin pool slows down the intracellular degradation of gap junction plaques. Altogether, our results show that, by studying connexin trafficking, we have identified the first TGN cargo receptor for the targeting of transmembrane proteins to the plasma membrane. The identification of consortin provides in addition a potential target for therapies aimed at diseases in which connexin traffic is altered, including cardiac ischemia, peripheral neuropathies, cataracts and hearing impairment. Sequence accession numbers. GenBank: Human CNST cDNA, NM_152609; mouse Cnst cDNA, NM_14610

The 'Antiretrovirals, Sexual Transmission Risk and Attitudes' (ASTRA) study. Design, methods and participant characteristics.

Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV

Continuing the sequence?:Towards an economic evaluation of whole genome sequencing for the diagnosis of rare diseases in Scotland

Funding This research was made possible through access to the data and findings generated by Scotland’s four regional genetics centres at NHS Grampian, Lothian, Tayside and Greater Glasgow and Clyde. These four centres participated in Scotland’s involvement in the 100,000 Genomes Project. The 100,000 Genomes Project is managed by Genomics England Limited (a wholly owned company of the Department of Health) and funded by the National Institute for Health Research and NHS England. The Wellcome Trust, Cancer Research UK and the Medical Research Council have also funded research infrastructure. Acknowledgements The authors would like to thank the Scottish Genomes Partnership for their support with this work. The Scottish Genomes Partnership is funded by the Chief Scientist Office of the Scottish Government Health Directorates [SGP/1] and The Medical Research Council Whole Genome Sequencing for Health and Wealth Initiative (MC/PC/15080). We are grateful for the contributions of the funding bodies; Scottish Regional Genetics centres at NHS Lothian, Tayside, Grampian and Greater Glasgow and Clyde, clinicians and healthcare teams who contributed to the provision of data as well as the analyses and interpretation of results. We also thank Morad Ansari, Christine Bell, Martin McClatchey, Nicola Williams, Austin Diamond, Jonathan Berg, Jon Warner, Alexis Duncan, Amy Rowlatt, and Tessa Coupar for their help and advice during the SGP Project, and Michael Doherty, Florence Richards and Quinn Heppe for help with costing the standard testing pathway. We thank Professor Tim Aitman for commenting on earlier drafts of the paper. We thank all participants who took part in the valuation study. The University of Aberdeen and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit (HERU). This study would not be possible without the families, patients, clinicians, nurses, research scientists, laboratory staff, and the wider Scottish Genomes Partnership team to whom we give grateful thanks.Peer reviewedPublisher PD

Increased HIV Incidence in Men Who Have Sex with Men Despite High Levels of ART-Induced Viral Suppression: Analysis of an Extensively Documented Epidemic

Background: There is interest in expanding ART to prevent HIV transmission, but in the group with the highest levels of ART use, men-who-have-sex-with-men (MSM), numbers of new infections diagnosed each year have not decreased as ART coverage has increased for reasons which remain unclear. Methods: We analysed data on the HIV-epidemic in MSM in the UK from a range of sources using an individual-based simulation model. Model runs using parameter sets found to result in good model fit were used to infer changes in HIV-incidence and risk behaviour. Results: HIV-incidence has increased (estimated mean incidence 0.30/100 person-years 1990–1997, 0.45/100 py 1998–2010), associated with a modest (26%) rise in condomless sex. We also explored counter-factual scenarios: had ART not been introduced, but the rise in condomless sex had still occurred, then incidence 2006–2010 was 68% higher; a policy of ART initiation in all diagnosed with HIV from 2001 resulted in 32% lower incidence; had levels of HIV testing been higher (68% tested/year instead of 25%) incidence was 25% lower; a combination of higher testing and ART at diagnosis resulted in 62% lower incidence; cessation of all condom use in 2000 resulted in a 424% increase in incidence. In 2010, we estimate that undiagnosed men, the majority in primary infection, accounted for 82% of new infections. Conclusion: A rise in HIV-incidence has occurred in MSM in the UK despite an only modest increase in levels of condomless sex and high coverage of ART. ART has almost certainly exerted a limiting effect on incidence. Much higher rates of HIV testing combined with initiation of ART at diagnosis would be likely to lead to substantial reductions in HIV incidence. Increased condom use should be promoted to avoid the erosion of the benefits of ART and to prevent other serious sexually transmitted infections

Predictors of starting and stopping chemsex in men who have sex with men in England: findings from the AURAH2 prospective study

BACKGROUND: Chemsex (the use of psychoactive drugs in sexual contexts) has been associated with HIV acquisition and other STIs, so there is benefit in identifying those most likely to start chemsex to offer risk reduction interventions such as pre-exposure prophylaxis (PrEP). To date, there have been no data from a longitudinal study analysing factors most associated with starting and stopping chemsex. METHODS: The prospective cohort study, Attitudes to and Understanding Risk of Acquisition of HIV over Time (AURAH2), collected 4 monthly and annual online questionnaire data from men who have sex with men (MSM) from 2015 to 2018. We investigate the association of sociodemographic factors, sexual behaviours and drug use with starting and stopping chemsex among 622 men who completed at least one follow-up questionnaire. Poisson models with generalised estimating equations were used to produce risk ratios (RRs) accounting for multiple starting or stopping episodes from the same individual. Multivariable analysis was adjusted for age group, ethnicity, sexual identity and university education. FINDINGS: In the multivariable analysis, the under 40 age group was significantly more likely to start chemsex by the next assessment (RR 1.79, 95% CI 1.12 to 2.86). Other factors which showed significant association with starting chemsex were unemployment (RR 2.10, 95% CI 1.02 to 4.35), smoking (RR 2.49, 95% CI 1.63 to 3.79), recent condomless sex (CLS), recent STI and postexposure prophylaxis (PEP) use in the past year (RR 2.10, 95% CI 1.33 to 3.30). Age over 40 (RR 0.71, 95% CI 0.51 to 0.99), CLS, and use of PEP (RR 0.64, 95% CI 0.47 to 0.86) and PrEP (RR 0.47, 95% CI 0.29 to 0.78) were associated with lower likelihood of stopping chemsex by the next assessment. INTERPRETATION: Knowledge of these results allows us to identify men most likely to start chemsex, thus providing an opportunity for sexual health services to intervene with a package of risk mitigation measures, especially PrEP use