Psychological Impact of Testing Positive for Human Papillomavirus at Cervical Cancer Screening

In the UK and elsewhere, cervical cancer screening has changed to incorporate primary human papillomavirus (HPV) testing. This means all women who attend screening are told whether they test positive or negative for high-risk HPV. Testing positive for HPV has been associated with elevated anxiety and distress; and can also carry a negative label due to its sexually transmitted nature. Prior to this PhD, there had been no major studies assessing the psychological impact of routine HPV primary screening, or the impact of testing HPV-positive with normal cytology, a result unique to these screening methods. Four studies were conducted: 1) mixed-method systematic review to synthesise emotional response to testing HPV-positive at cervical cancer screening (33 studies); 2) cross-sectional survey comparing anxiety and distress between different test result groups at routine HPV primary screening (n=1127); 3) cross-sectional survey exploring distinct illness representation profiles and anxiety in women testing HPV-positive with normal cytology (n=646); and 4) comparative qualitative interview study to explore reasons for variations in anxiety in women testing HPV-positive with normal cytology (n=30). Overall, testing HPV-positive at cervical screening was sometimes associated with adverse emotional, cognitive, behavioural, and physiological sequelae. These impacts appeared to differentially affect subgroups of the population in terms of intensity, duration, and clinical significance. For women testing HPV-positive with normal cytology, maladaptive illness representations may partially account for clinically significant anxiety. Highly anxious women primarily expressed fear of developing cervical cancer and had concerns about potential relationship infidelity and fertility issues. Cognitive Behavioural Theory and Leventhal’s Common-Sense Model of Self-Regulation were used to formulate overarching findings, providing a preliminary theoretical literature in an otherwise atheoretical domain. The findings of this PhD begin to develop an evidence-base for specific messages which could be used by policymakers in routine patient communication materials, to alleviate unnecessary anxiety at HPV primary screening

so much apparent nothing

This document contains reflections on motivations behind selected works leading up to and including my thesis exhibition so much apparent nothing. Through journal excerpts and analysis of my own psychology, I attempt to put into words my thoughts concurrent to my making, indirect as they may be. The following text shares my personal conflicts and ideologies surrounding art-making, the permanence of objects, and the acceptance of an identity in flux

Effects of Smoking vs. Nicotine Replacement Therapy During Pregnancy on Childhood Health Outcomes: An Integrative Literature Review

PICOT: In pregnant women does the use of nicotine replacement therapy compared to smoking during pregnancy reduce the risk of future childhood health concerns? Methods: A search was conducted on healthcare literature databases (Alt HealthWatch, AMED, CINAHL, and Medline).The initial search yielded 940 results related to the topic. Initial review narrowed the search to 25 articles. Articles were excluded if published before 2008. After reviewing the full articles and evaluating effectiveness of the studies, 12 studies met the criteria. These 12 articles focused on the effects of smoking and childhood outcomes, NRT, and success of NRT. Findings: The articles concluded that NRT may aid in positive health outcomes since it excludes the risk factors associated with carbon monoxide and other carcinogens found in cigarettes. The NRT still delivers significant levels of nicotine exposure to the fetus and leads to pregnancy complications ending in low birth weight and preterm birth. Recommendations: Further studies should be conducted on the effects of nicotine and NRT especially on birth outcomes and future childhood health concerns

Review of best management practices for aquatic vegetation control in stormwater ponds, wetlands, and lakes

Auckland Council (AC) is responsible for the development and operation of a stormwater network across the region to avert risks to citizens and the environment. Within this stormwater network, aquatic vegetation (including plants, unicellular and filamentous algae) can have both a positive and negative role in stormwater management and water quality treatment. The situations where management is needed to control aquatic vegetation are not always clear, and an inability to identify effective, feasible and economical control options may constrain management initiatives. AC (Infrastructure and Technical Services, Stormwater) commissioned this technical report to provide information for decision- making on aquatic vegetation management with in stormwater systems that are likely to experience vegetation-related issues. Information was collated from a comprehensive literature review, augmented by knowledge held by the authors. This review identified a wide range of management practices that could be potentially employed. It also demonstrated complexities and uncertainties relating to these options that makes the identification of a best management practice difficult. Hence, the focus of this report was to enable users to screen for potential options, and use reference material provided on each option to confirm the best practice to employ for each situation. The report identifies factors to define whether there is an aquatic vegetation problem (Section 3.0), and emphasises the need for agreed management goals for control (e.g. reduction, mitigation, containment, eradication). Resources to screen which management option(s) to employ are provided (Section 4.0), relating to the target aquatic vegetation, likely applicability of options to the system being managed, indicative cost, and ease of implementation. Initial screening allows users to shortlist potential control options for further reference (Section 5.0). Thirty-five control options are described (Section 5.0) in sufficient detail to consider applicability to individual sites and species. These options are grouped under categories of biological, chemical or physical control. Biological control options involve the use of organisms to predate, infect or control vegetation growth (e.g. classical biological control) or manipulate conditions to control algal growth (e.g. pest fish removal, microbial products). Chemical control options involve the use of pesticides and chemicals (e.g. glyphosate, diquat), or the use of flocculants and nutrient inactivation products that are used to reduce nutrient loading, thereby decreasing algal growth. Physical control options involve removing vegetation or algal biomass (e.g. mechanical or manual harvesting), or setting up barriers to their growth (e.g. shading, bottom lining, sediment capping). Preventative management options are usually the most cost effective, and these are also briefly described (Section 6.0). For example, the use of hygiene or quarantine protocols can reduce weed introductions or spread. Catchment- based practices to reduce sediment and nutrient sources to stormwater are likely to assist in the avoidance of algal and possibly aquatic plant problems. Nutrient removal may be a co-benefit where harvesting of submerged weed biomass is undertaken in stormwater systems. It should also be considered that removal of substantial amounts of submerged vegetation may result in a sudden and difficult-to-reverse s witch to a turbid, phytoplankton dominated state. Another possible solution is the conversion of systems that experience aquatic vegetation issues, to systems that are less likely to experience issues. The focus of this report is on systems that receive significant stormwater inputs, i.e. constructed bodies, including ponds, amenity lakes, wetlands, and highly-modified receiving bodies. However, some information will have application to other natural water bodies

Epidural Hematoma Following Cervical Spine Surgery.

STUDY DESIGN: A multicentered retrospective case series. OBJECTIVE: To determine the incidence and circumstances surrounding the development of a symptomatic postoperative epidural hematoma in the cervical spine. METHODS: Patients who underwent cervical spine surgery between January 1, 2005, and December 31, 2011, at 23 institutions were reviewed, and all patients who developed an epidural hematoma were identified. RESULTS: A total of 16 582 cervical spine surgeries were identified, and 15 patients developed a postoperative epidural hematoma, for a total incidence of 0.090%. Substantial variation between institutions was noted, with 11 sites reporting no epidural hematomas, and 1 site reporting an incidence of 0.76%. All patients initially presented with a neurologic deficit. Nine patients had complete resolution of the neurologic deficit after hematoma evacuation; however 2 of the 3 patients (66%) who had a delay in the diagnosis of the epidural hematoma had residual neurologic deficits compared to only 4 of the 12 patients (33%) who had no delay in the diagnosis or treatment (P = .53). Additionally, the patients who experienced a postoperative epidural hematoma did not experience any significant improvement in health-related quality-of-life metrics as a result of the index procedure at final follow-up evaluation. CONCLUSION: This is the largest series to date to analyze the incidence of an epidural hematoma following cervical spine surgery, and this study suggest that an epidural hematoma occurs in approximately 1 out of 1000 cervical spine surgeries. Prompt diagnosis and treatment may improve the chance of making a complete neurologic recovery, but patients who develop this complication do not show improvements in the health-related quality-of-life measurements

Covid-19 public health road map: Eating behaviour

This roadmap aims to support health officials to consider changes to eating behaviour that may have occurred during the Covid-19 pandemic and to use psychologically-informed behaviour change approaches to optimise health improvement and mitigate negative eating patterns. It will focus on eating a balanced diet, as opposed to eating behaviours related to disordered eating. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pd

Covid-19 public health road map: Sedentary behaviour

This roadmap aims to support health officials to consider changes to sedentary behaviour that may have occurred during the Covid-19 pandemic and to use psychologically informed behaviour change approaches to optimise health improvement and mitigate an increase in time spent sitting or lying down. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdfFinal Published versio

Covid-19 public health road map: Physical activity

This roadmap aims to support health officials to consider changes to physical activity that may have occurred during the Covid-19 pandemic and to use psychologically-informed behaviour change approaches to optimise health improvement and mitigate a reduction in activity levels. This guidance should be used alongside the Achieving Behaviour Change (ABC) guide {1} for local government and partners, and the Improving People’s Health behavioural and social science strategy {2} {1}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/875385/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf {2}https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/744672/Improving_Peoples_Health_Behavioural_Strategy.pdfFinal Published versio

Mechanistically-guided materials chemistry: synthesis of new ternary nitrides, CaZrN2_2 and CaHfN2_2

Recent computational studies have predicted many new ternary nitrides, revealing synthetic opportunities in this underexplored phase space. However, synthesizing new ternary nitrides is difficult, in part because intermediate and product phases often have high cohesive energies that inhibit diffusion. Here, we report the synthesis of two new phases, calcium zirconium nitride (CaZrN$_2$) and calcium hafnium nitride (CaHfN$_2$), by solid state metathesis reactions between Ca$_3$N$_2$ and $M$Cl$_4$ ($M$ = Zr, Hf). Although the reaction nominally proceeds to the target phases in a 1:1 ratio of the precursors via Ca$_3$N$_2$ + $M$Cl$_4$ $\rightarrow$ Ca$M$N$_2$ + 2 CaCl$_2$, reactions prepared this way result in Ca-poor materials (Ca$_xM_{2-x}$N$_2$, $x<1$). A small excess of Ca$_3$N$_2$ (ca. 20 mol\%) is needed to yield stoichiometric Ca$M$N$_2$, as confirmed by high-resolution synchrotron powder X-ray diffraction. In situ synchrotron X-ray diffraction studies reveal that nominally stoichiometric reactions produce Zr$^{3+}$ intermediates early in the reaction pathway, and the excess Ca$_3$N$_2$ is needed to reoxidize Zr$^{3+}$ intermediates back to the Zr$^{4+}$ oxidation state of CaZrN$_2$. Analysis of computationally-derived chemical potential diagrams rationalizes this synthetic approach and its contrast from the synthesis of MgZrN$_2$. These findings additionally highlight the utility of in situ diffraction studies and computational thermochemistry to provide mechanistic guidance for synthesis