A study of the role of the medical social worker in the treatment of fifteen patients with rheumatoid arthritis referred to the social worker on the Home Medical Service at the Massachusetts Memorial Hospital during 1950-1952.

Thesis (M.S.)--Boston University N.B.: Page 46. No copy 2

Spoiled for choice? An applicant-centred approach to understanding UCAS decision making

Despite the consistent rise in the number of young people entering university, statistics show that class-based disparity in progression continues. Those from advantaged families are over-represented at prestigious institutions to which the less-advantaged rarely apply. A gap in the literature on progression concerns the application process itself: how do young people choose the universities for their UCAS form? Using card-sort tasks within an interview format, six cohorts of Year 13 students (56 in total), described the decision-making stages that underpinned their university choices. Some had researched, longlisted and shortlisted. Others applied only to their local universities. Significant differences in knowledge and understanding were often cohort-specific. As the educational environment became more HE-oriented, students’ ability to use and evaluate resources increased. However, within-cohort variation demonstrated the power of personal motivation to expand or restrict the choice of universities. The conceptual framework drew on two theorists. Bronfenbrenner’s Bioecological Model explores how person-process-context interactions determine developmental outcomes, whilst recognising that less-advantaged families lack capacity to manipulate social environments. Simon’s Behavioural Model of human decision-making acknowledges the need to simplify complex tasks, suggesting UCAS applicants may be satisficing, rather than optimising. Both models recognise knowledge and ‘know-how’ as determinants of behaviour. A synthesis of the two suggested that having a strong knowledge structure at the start of the process was linked to ‘cold’ reasoning and a macro-focussed approach to decision-making. A weak knowledge structure was linked to ‘hot’ reasoning and a micro-focussed approach reliant on family or friends. Pragmatising emerged as an effective decision-making style. The ‘curricular’ approach to UCAS information, advice and guidance in the independent school produced discriminating, well-informed decision-makers. The state sector, ‘opt-in’ model left some students unaware of key resources, even the UCAS website. Providing adequate support for all UCAS applicants might be a step towards achieving parity in progression

Glutamate release mechanisms from megakaryocytes

Cardiovascular disease (CVD) is one of the main causes of death in western society. Platelet activation, thrombus formation and plaque rupture are all central events in the pathogenesis of acute coronary syndromes, therefore therapies targeted at controlling platelet numbers and aggregation are likely to be beneficial in the treatment of CVD. Megakaryocytes (MKs) which are the precursors to platelets are an ideal target for these therapies, however the intrinsic factors that regulate the production and shedding of platelet precursors are poorly understood. Recent studies identified that MKs express functional NMDA-type glutamate receptors similar to those found in the CNS and that antagonism of these receptors prevents normal MK differentiation and platelet function. This thesis investigates glutamate signalling within MKs further, focusing on the glutamate release capability of MK cells and the mechanisms involved. Using molecular and cellular techniques it was demonstrated that MK cells expressed numerous regulatory proteins required for vesicular glutamate release, including core SNARE proteins, VAMP, SNAP-23 and syntaxin; specific glutamate-loading vesicle proteins, VGLUTI and VGLUT2; and glutamate transporters, EAATI and EAAT2. Active vesicle recycling was observed in MK cells using a fluorescent reporter and an enzyme-linked fluorimetric assay confirmed that MK cells constitutively released glutamate and that glutamate release levels increased significantly following MK differentiation. Transient transfection of the human cell line MEG-Ol with tetanus toxin, which disables vesicle recycling, induced a 30% decrease (P<O.OOI) in released glutamate compared to empty vector controls. In contrast, over-expressing VGLUTI caused a 41% increase (P<O.OO1) in glutamate release activity of MEG-O1 cells compared to controls. These data demonstrate that MK cells regulate glutamate exocytosis through specific vesicular proteins, indicating that glutamate signalling may be a potential target for CVD therapies. Also the observations that MKs both release and recycle glutamate indicates an important role for glutamate signalling from these cells in autocrine and paracrine interactions within the bone marrow microenvironment

“Tell Me More About Your Child’s Sleep”: A Qualitative Investigation Of Sleep Problems In Children With ADHD

Objective: To investigate parental experiences and perceptions of sleep problems in their children with Attention Deficit Hyperactivity Disorder (ADHD), the perceived impacts of sleep problems and coping strategies deployed by parents.Methods: Semi-structured interviews with twenty-six parents of pre- adolescent children with a diagnosis of ADHD, followed by thematic analysis of the interview transcripts.Results: Three themes were generated from the data: Children’s Sleep Difficulties; Impacts of Children’s Sleep; and Improving Children’s Sleep. Sleep initiation problems in children with ADHD were commonly reported by parents, were perceived to be linked in a bidirectional manner with executive and emotional problems, and were reported as being disruptive to parental sleep. Some parents reported that their children’s sleep problems were the initial prompt that lead to a diagnosis of ADHD. Parents reported utilizing a range of coping strategies to mitigate sleep problems, such as controlling the bedroom sensory environment and using emotional “wind down” as part of the bedtime routine. Some parents endorsed a beneficial effect of melatonin on their children’s sleep.Conclusions: Sleep problems in children with ADHD were perceived as important issues by parents. Equipping parents with evidence-based strate-gies for the management of their children’s sleep may lead to benefits for the children, parents and wider household

The Development of a Pain Medication Management Protocol

Implementation of an organization-wide pain management policy incorporates a multifaceted team approach that could lead to improved patient outcomes. The absence of a standardized opioid prescribing policy within a healthcare organization has led to individual departments adopting their own guidelines. Management of an individual patient’s pain medication is often met with reluctance from providers when a patient is transferred from another department leaving the patient with inadequate care

‘You don't take things too seriously or un‐seriously’: Beyond recovery to liminal and liminoid possibility in a community arts and mental health project

Recent years have seen a renewed interest in integrating creative activities into statutory mental health practice in high-income countries. In this article, we offer an exploratory analysis of an arts project delivered within UK mental health services, Creativity for Enablement and Wellbeing (CREW). Drawing on data collected for a process evaluation of the project, we suggest that conceptualising CREW as liminal and liminoid provides a helpful way to articulate the processes, atmospheres, relationships, and practices of the project. Through this theoretical lens, we identify CREW as a mode of engagement comprising looseness, possibility and collectivity, all brought together through a unique community event, the showcase. We explore CREW's mode of engagement through three themes: ‘carving out a liminal space’, ‘looseness and experimentation,’ and ‘from liminal to liminoid’. Implications for service delivery are discussed, focussing on how CREW managed to create a transformative space of liminoid possibility rather than a recovery journey delineated by service-defined imperatives

What are the information needs of people with dementia and their family caregivers when they are admitted to a mental health ward and do current ward patient information leaflets meet their needs?

Introduction: An admission to a mental health ward is an uncertain and unexpected part of a person’s journey with dementia and consequently, families require information about what to expect and how to prepare. This study aimed to establish the information needs of people with dementia and their families at the point of admission to a mental health ward and to collate existing ward information leaflets to explore if they meet these information needs. Methods: This research was in two parts, (1) a qualitative study using focus groups, one with people with dementia and family carers with lived experience of such an admission (n=6) and another with Admiral Nurses (n=6) to explore information needs at the point of admission. (2) Each NHS mental health trust (n=67) was asked to provide a copy of their ward information shared at admission. A total of 30 leaflets were received from 15 NHS trusts, after removing duplicates 22 were included. A content analysis was conducted to evaluate to what extent leaflets met the information needs identified from focus groups. Results:Two main categories ‘honest, accurate and up to date information’ and ‘who is the information for’ and four subcategories were derived from focus group data. Participants felt that people with dementia and families were likely to have different information needs. Material for people with dementia needed to be in an accessible format. Information should cover the aim of the admission, a timeline of what to expect and details about how families will be involved in care. Practical information about what to pack and ward facilities was valued. Participants spoke about the need to consider the tone of the information given people are likely to be distressed. The information leaflets reviewed did not meet the information needs identified by focus group participants. Conclusions: People with dementia and family carers have different information needs at the point of admission to a mental health ward. Information provided to people with dementia needs to be in an accessible format with content relevant to these needs. Wards should aim to co-create information to ensure they meet people’s information need

Multimedia Informed Consent Tool for a Low Literacy African Research Population: Development and Pilot-Testing.

BACKGROUND: International guidelines recommend the use of appropriate informed consent procedures in low literacy research settings because written information is not known to guarantee comprehension of study information. OBJECTIVES: This study developed and evaluated a multimedia informed consent tool for people with low literacy in an area where a malaria treatment trial was being planned in The Gambia. METHODS: We developed the informed consent document of the malaria treatment trial into a multimedia tool integrating video, animations and audio narrations in three major Gambian languages. Acceptability and ease of use of the multimedia tool were assessed using quantitative and qualitative methods. In two separate visits, the participants' comprehension of the study information was measured by using a validated digitised audio questionnaire. RESULTS: The majority of participants (70%) reported that the multimedia tool was clear and easy to understand. Participants had high scores on the domains of adverse events/risk, voluntary participation, study procedures while lowest scores were recorded on the question items on randomisation. The differences in mean scores for participants' 'recall' and 'understanding' between first and second visits were statistically significant (F (1,41)=25.38, p<0.00001 and (F (1, 41) = 31.61, p<0.00001 respectively. CONCLUSIONS: Our locally developed multimedia tool was acceptable and easy to administer among low literacy participants in The Gambia. It also proved to be effective in delivering and sustaining comprehension of study information across a diverse group of participants. Additional research is needed to compare the tool to the traditional consent interview, both in The Gambia and in other sub-Saharan settings

Apoptosis and schizophrenia: a pilot study based on dermal fibroblast cell lines

Introduction: The aim of this study was to investigate whether there is an increased susceptibility to apoptosis in cultured fibroblasts from patients with schizophrenia

Peripheral Innate Immune Activation Correlates With Disease Severity in GRN Haploinsufficiency.

Objective: To investigate associations between peripheral innate immune activation and frontotemporal lobar degeneration (FTLD) in progranulin gene (GRN) haploinsufficiency. Methods: In this cross-sectional study, ELISA was used to measure six markers of innate immunity (sCD163, CCL18, LBP, sCD14, IL-18, and CRP) in plasma from 30 GRN mutation carriers (17 asymptomatic, 13 symptomatic) and 29 controls. Voxel based morphometry was used to model associations between marker levels and brain atrophy in mutation carriers relative to controls. Linear regression was used to model relationships between plasma marker levels with mean frontal white matter integrity [fractional anisotropy (FA)] and the FTLD modified Clinical Dementia Rating Scale sum of boxes score (FTLD-CDR SB). Results: Plasma sCD163 was higher in symptomatic GRN carriers [mean 321 ng/ml (SD 125)] compared to controls [mean 248 ng/ml (SD 58); p &lt; 0.05]. Plasma CCL18 was higher in symptomatic GRN carriers [mean 56.9 pg/ml (SD 19)] compared to controls [mean 40.5 pg/ml (SD 14); p &lt; 0.05]. Elevation of plasma LBP was associated with white matter atrophy in the right frontal pole and left inferior frontal gyrus (p FWE corrected &lt;0.05) in all mutation carriers relative to controls. Plasma LBP levels inversely correlated with bilateral frontal white matter FA (R2 = 0.59, p = 0.009) in mutation carriers. Elevation in plasma was positively correlated with CDR-FTLD SB (b = 2.27 CDR units/μg LBP/ml plasma, R2 = 0.76, p = 0.003) in symptomatic carriers. Conclusion: FTLD-GRN is associated with elevations in peripheral biomarkers of macrophage-mediated innate immunity, including sCD163 and CCL18. Clinical disease severity and white matter integrity are correlated with blood LBP, suggesting a role for peripheral immune activation in FTLD-GRN