Psychological factors associated with walking in patients with Peripheral Arterial Disease

Objectives This thesis aimed to explore psychological factors associated with walking behaviour in patients with Peripheral Arterial Disease, within the framework of Leventhal et al’s (1998) Common-sense Model of Self-regulation of Health and Illness. The objective was to identify psychological factors which could be modified to increase walking behaviour in these patients. Method A series of three studies were conducted to achieve these aims. The first study was an exploratory qualitative study, to explore the illness and treatment beliefs and walking behaviour of patients with intermittent claudication. The second study was a cross-sectional postal questionnaire to a cohort of patients with intermittent claudication, which tested the influence of the psychological factors identified in the qualitative study, in a larger sample. The final study was a randomised controlled trial of a brief psychological intervention designed to modify the illness and walking beliefs of patients with intermittent claudication, in order to increase walking behaviour. Results Beliefs about intermittent claudication, and beliefs about walking were both found to be associated with walking behaviour in the qualitative study. The results from the cross-sectional postal questionnaire confirmed this relationship – taken as a set, illness and walking beliefs accurately predicted adherence to minimum walking levels for 93.4% of the sample. The brief psychological intervention successfully modified illness and treatment beliefs and increased walking behaviour in patients newly diagnosed with intermittent claudication. Conclusion This thesis highlights the importance of illness and walking beliefs to the walking behaviour of patients with intermittent claudication. The thesis has added to the body of knowledge about intermittent claudication, and the findings of this thesis have implications for the treatment of patients with intermittent claudication within the health service. Theoretical and clinical implications of this research are discussed

The effect of non-inversion tillage on farmland birds, soil and surface-active invertebrates and surface seeds

This thesis investigated the effect of non-inversion tillage (NIT) compared to conventional tillage (CT) on farmland birds and their invertebrate and seed food resources. Farmland birds have suffered severe population and range declines over the last few decades. One major reason is the increased intensification of agriculture leading to a decline in the abundance and availability of food over the summer and winter months. Conventional farming systems have traditionally used a mouldboard plough (CT) to invert the soil to prepare the seedbed for crop establishment. Due to economic pressures and increasing interest in environmental and soil protection, approximately 30% of arable crops in the UK are established by NIT methods. Machinery involved in NIT generally involves the use of discs and tines. Field occupancy by farmland birds was studied on commercial farms over three winters from 2000 to 2003. In addition, the abundance of seeds and earthworms were investigated during the autumn and spring (2001 - 2003) and surface-active arthropods during March and July (2002 - 2003). The study was carried out at fourteen farms in Oxfordshire, Leicestershire and Shropshire. Experimental work examined the effect of two types of NIT and mouldboard ploughing on the movement of weed and crop seeds in the autumn of 2003. Skylarks, other granivorous passerines and game birds occupied a greater proportion of cereal fields established by non-inversion tillage than conventional mouldboard ploughing. Tillage was not significant in explaining the variation in the relative abundance of carabid beetles, staphylinid beetles or spiders trapped in March, May or July. A greater relative abundance of beetle larvae were observed in conventionally tilled fields in July in wheat fields preceded by oil seed rape. Tillage was not significant in explaining the variation in seed or earthworm abundance or weights in the autumn or spring. The cultivation experiment showed few seeds retained at the soil surface after mouldboard ploughing compared to two NIT methods

Scottish Cancer Patient Experience Survey 2015/16: Analysis of Free-text Comments

Analysis of free-text comments provided by patients as part of Scotland’s first Cancer Patient Experience Survey. The survey included seven free-text comment boxes relating to different aspects of cancer treatment, from the lead up to diagnosis, to the overall experience of cancer care. In total, 6,961 comments were made by participants

Foods the blender-way

Cover title

Cookery of the cheaper cuts of beef

Citation: Perry, Clara Jeanette. A sheet of paper. Senior thesis, Kansas State Agricultural College, 1898.Morse Department of Special CollectionsIntroduction: The subject of the cookery of the cheaper cuts of meats is one which is probably very little thought of, and much less studied. One concludes that unless he can pay a good price and secure the popular or choice cuts, that he must go without meat or limit it to a very great extent in his dietary. This conclusion is erroneous because the cheaper meats are as nutritious and often more highly flavored than some of the more expensive cuts. It is true that the most of the cheaper meats require a greater length of time for cooking. This is no factor against them in winter because as a rule the fire is kept up most of the day, and it is no waste of fuel to cook the meat a long time; even in summer there are usually several days of each week when long fires are used. Since the invention of the fireless cooker, there is no reason why every one should not own one as they are of little or no expense. With this cooker the extra cost and inconvenience of keeping up a fire on a summer day is dispensed with. If, then, we can cook cheap meat both winter and summer without extra expense for fuel, and since the meat is as nutritious and often more highly flavored, does it not pay to give a little study to the ways to prepare the cheaper cuts to take the place of high priced, but no more nutritious cuts? "Many people cannot afford to buy the expensive meats for every day use, and, having the false idea that the cheaper pieces are undesirable, they deprive themselves of much needed proteid; or if they buy meat they must lessen the cost by going without some other necessary article of diet. In either case the body is not properly nourished. A bulletin on Scientific Research, in treating the subject of errors in food economy, states that

Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review

Background: Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings. Objectives: To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings. Methods: A scoping review conducted using the Arksey and O’Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence. Findings: Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n=27) were conducted in North America (n=27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and ‘other’ factors (i.e. funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and ‘other’ factors (i.e. funding, planning for role integration). Conclusion: Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential

Solar Electric Propulsion Vehicle Demonstration to Support Future Space Exploration Missions

Human and robotic exploration beyond Low Earth Orbit (LEO) will require enabling capabilities that are efficient, affordable, and reliable. Solar Electric Propulsion (SEP) is highly advantageous because of its favorable in-space mass transfer efficiency compared to traditional chemical propulsion systems. The NASA studies have demonstrated that this advantage becomes highly significant as missions progress beyond Earth orbit. Recent studies of human exploration missions and architectures evaluated the capabilities needed to perform a variety of human exploration missions including missions to Near Earth Objects (NEOs). The studies demonstrated that SEP stages have potential to be the most cost effective solution to perform beyond LEO transfers of high mass cargoes for human missions. Recognizing that these missions require power levels more than 10X greater than current electric propulsion systems, NASA embarked upon a progressive pathway to identify critical technologies needed and a plan for an incremental demonstration mission. The NASA studies identified a 30kW class demonstration mission that can serve as a meaningful demonstration of the technologies, operational challenges, and provide the appropriate scaling and modularity required. This paper describes the planning options for a representative demonstration 30kW class SEP mission

Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker

Background: Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers (PSWs) to help veteran patients engage, however it is not known how the role influences UK veteran engagement. Aims: To gain insight into the role of peer support in UK veteran engagement with mental health and well-being services. Method: A qualitative study based on 18 semi-structured interviews with veterans, PSWs and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland. Results: Four themes of the PSW role as positive first impression, understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The PSWs’ military connection, social and well-being support and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial. Conclusions: The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision

Proteinase-activated receptors (PARs) as targets for antiplatelet therapy

Since the identification of the proteinase-activated receptor (PAR) family as mediators of serine protease activity in the 1990s, there has been tremendous progress in the elucidation of their pathophysiological roles. The development of drugs that target PARs has been the focus of many laboratories for the potential treatment of thrombosis, cancer and other inflammatory diseases. Understanding the mechanisms of PAR activation and G protein signalling pathways evoked in response to the growing list of endogenous proteases has yielded great insight into receptor regulation at the molecular level. This has led to the development of new selective modulators of PAR activity, particularly PAR1. The mixed success of targeting PARs has been best exemplified in the context of inhibiting PAR1 as a new antiplatelet therapy. The development of the competitive PAR1 antagonist, vorapaxar (Zontivity), has clearly shown the value in targeting PAR1 in acute coronary syndrome (ACS); however the severity of associated bleeding with this drug has limited its use in the clinic. Due to the efficacy of thrombin acting via PAR1, strategies to selectively inhibit specific PAR1-mediated G protein signalling pathways or to target the second thrombin platelet receptor, PAR4, are being devised. The rationale behind these alternative approaches is to bias downstream thrombin activity via PARs to allow for inhibition of pro-thrombotic pathways but maintain other pathways that may preserve haemostatic balance and improve bleeding profiles for widespread clinical use. This review summarizes the structural determinants that regulate PARs and the modulators of PAR activity developed to date