Using implementation intentions to reduce self-harm

Implementation intentions (IMPs) are IF-THEN plans that require people to specify critical situations (e.g., situations that tempt a behaviour, such as self-harm) and link those situations with goal-directed responses (e.g., coping strategies). This research tested the effectiveness of an intervention technique (a volitional help sheet) designed to encourage the formation of IMPs to avoid self-harm thoughts and behaviour in the wider community. Chapter 1 discusses the prevalence and detrimental impact of self-harm behaviour and thoughts, and existing interventions. Chapter 2 introduces the concept of IMPs and reviews evidence suggesting that IMP interventions are likely to reduce self-harm. Potential motivational, volitional, and cognitive moderators of IMPs are also considered. Following a consideration of key methodological issues relating to the design of the present research (chapter 3), study 1 is presented in chapter 4. Study 1 showed that an IMP intervention reduced self-harm behaviour in the critical situations specified in participants’ plans. In line with expectations, this effect was observed only when individuals were motivated to reduce self-harm and experienced high levels of self-harm and suicide-related mental imagery. No effects were observed on other measured outcomes: self-harm in unspecified critical situations, suicidality, anxiety, and depression. Exposure to self-harm by friends and family did not moderate the effects of the intervention on any outcome measure. Study 2 (chapter 5) showed that the IMP intervention reduced self-harm thoughts in the participants’ specified critical situations. Consistent with study 1, this effect was observed only when individuals were motivated to stop thinking about self-harm. No effects of the intervention were largely observed on other outcome measures. Cognitive abilities (attention, and prospective and retrospective memory) did not moderate the effects of the intervention on self-harm thoughts, suicidality, anxiety or depression. However, there was evidence that they moderated the effects of the intervention on self-harm behaviour. Chapter 6 presents a pilot study for a clinical trial to test the effects of IMPs, and the moderators investigated in this thesis, on patients admitted to hospital for self-harm. A reflection on the pilot’s methods and results is presented with a view to a future, full-scale clinical trial. The overall findings across the three studies are discussed in chapter 7. Implications for practice and future research are presented.Implementation intentions (IMPs) are IF-THEN plans that require people to specify critical situations (e.g., situations that tempt a behaviour, such as self-harm) and link those situations with goal-directed responses (e.g., coping strategies). This research tested the effectiveness of an intervention technique (a volitional help sheet) designed to encourage the formation of IMPs to avoid self-harm thoughts and behaviour in the wider community. Chapter 1 discusses the prevalence and detrimental impact of self-harm behaviour and thoughts, and existing interventions. Chapter 2 introduces the concept of IMPs and reviews evidence suggesting that IMP interventions are likely to reduce self-harm. Potential motivational, volitional, and cognitive moderators of IMPs are also considered. Following a consideration of key methodological issues relating to the design of the present research (chapter 3), study 1 is presented in chapter 4. Study 1 showed that an IMP intervention reduced self-harm behaviour in the critical situations specified in participants’ plans. In line with expectations, this effect was observed only when individuals were motivated to reduce self-harm and experienced high levels of self-harm and suicide-related mental imagery. No effects were observed on other measured outcomes: self-harm in unspecified critical situations, suicidality, anxiety, and depression. Exposure to self-harm by friends and family did not moderate the effects of the intervention on any outcome measure. Study 2 (chapter 5) showed that the IMP intervention reduced self-harm thoughts in the participants’ specified critical situations. Consistent with study 1, this effect was observed only when individuals were motivated to stop thinking about self-harm. No effects of the intervention were largely observed on other outcome measures. Cognitive abilities (attention, and prospective and retrospective memory) did not moderate the effects of the intervention on self-harm thoughts, suicidality, anxiety or depression. However, there was evidence that they moderated the effects of the intervention on self-harm behaviour. Chapter 6 presents a pilot study for a clinical trial to test the effects of IMPs, and the moderators investigated in this thesis, on patients admitted to hospital for self-harm. A reflection on the pilot’s methods and results is presented with a view to a future, full-scale clinical trial. The overall findings across the three studies are discussed in chapter 7. Implications for practice and future research are presented

Evaluation of The UN Mine Action Programme in Nepal

This evaluation looks at the UN Mine Action Programme in Nepal, which comprised two distinct but complementary components: one managed by the UN Mine Action Service (UNMAS) and the other by the United Nations Children\u27s Fund (UNICEF). The aims of the evaluation were to: assess the efficacy of the UN Mine Action Programme in Nepal identify strengths and weaknesses in the relationships, structures, capacity development and processes that have been established make recommendations for improving the efficiency and effectiveness of similar programme

Executive Summary: Evaluation of the MacArthur Foundation's Human Rights and International Justice Grantmaking in Nigeria 2000-2012

The MacArthur Foundation commissioned Itad to conduct an evaluation of the Foundation's Human Rights and International Justice (HRIJ) grant?making program in Nigeria between 2000 and 2012. During this period, the Foundation supported 102 HRIJ projects with an end?date in 2000 or later, for a total grant amount of US$23,945,010. The projects broadly fell within the following thematic categories:- Accountability of democratic institutions, including the police- Justice: legal and judicial reform, including international justice standards - Protection and promotion of human rightsThe evaluation was commissioned to seek answers to the following questions: - Approach and strategy: o What has changed in the wider Nigerian HRIJ landscape in Nigeria since 2000? o What was the Foundation's HRIJ grantmaking strategy in Nigeria over this time? o How has the Foundation responded to change in the wider environment? o How has the implementation of grants contributed to strategic aims? - Impact: o What have been the main results of the Foundation's investments? o What was the Foundation's primary contribution to Nigeria HRIJ issues? o What lessons can be drawn for future HRIJ grantmaking in Nigeria

Evidence that implementation intentions reduce drivers' use of mobile phones while driving

Implementation intentions are IF-THEN plans that have the potential to reduce mobile phone use while driving and thus contribute towards the prevention of road traffic crashes. We tested whether an intervention, designed to promote the formation of implementation intentions, could reduce drivers’ use of mobile phones. A randomized controlled design was used. The participants (N = 136) were randomised to an implementation or a control condition. Self-report questionnaires were administered to all participants at both pre- and one-month post-intervention to measure the use of mobile phones while driving, goal intentions and the theoretically derived motivational pre-cursors of goal intentions (attitudes, subjective norm and perceived behavioural control). Immediately following the pre-intervention questionnaire, the participants in the implementation intention condition (n = 67) were given a volitional help sheet, which asked them to form implementation intentions by specifying target driving situations that tempted them the most to use a mobile phone and linking them with goal-directed responses that could be used to resist the temptation. The participants in the control condition (n = 69) were asked to specify target situations that tempted them the most to use a mobile phone while driving and to generally try to avoid using a mobile phone in those situations. One-month post-intervention, the participants in the implementation intention condition reported using a mobile phone less often while driving in their specified target driving situations than did the participants in the control condition. As expected, no differences were found between the conditions in the reported frequency of mobile phone use in unspecified driving situations, goal intentions or any motivational pre-cursor of goal intentions. The implementation intention intervention that was tested in this study is a potentially effective tool for reducing mobile phone use while driving in target driving situations where behaviour-change is most needed

Evidence that implementation intentions reduce self-harm in the community

Objectives: Implementation intentions are 'IF‐THEN' plans that encourage goal‐intended behaviour. This study was designed to test whether an intervention encouraging the formation of implementation intentions can reduce self‐harm in the community. Design: A randomized controlled design was used. Methods: At pre‐intervention, outcome variables (self‐harm in both specified and unspecified critical situations and suicidality) and potential moderators of implementation intentions (goal intention, mental imagery, and exposure to self‐harm) were measured using self‐report questionnaires. The participants (N = 469, aged 18–66 years, 86.4% female, 6.8% male and 6.7% other) were then randomized to either an experimental (implementation intention) or control task. At three‐months post‐intervention, self‐report questionnaires were used again to measure the outcome variables. Results: There were no overall differences between the conditions at post‐intervention. However, goal intention and mental imagery, but not exposure to self‐harm, moderated the effects of condition on self‐harm in specified critical situations. At high (mean + 1SD) levels of both goal intention and mental imagery, the experimental condition reported self‐harming less frequently in the situations specified in their implementation intentions. Conclusions: Implementation intentions therefore represent a useful intervention for reducing self‐harm in specified critical situations for people in the community who wish to avoid self‐harm and those who frequently experience self‐harm and suicide related mental imagery

Moult cycle specific differential gene expression profiling of the crab Portunus pelagicus

Background: Crustacean moulting is a complex process involving many regulatory pathways. A holistic approach to examine differential gene expression profiles of transcripts relevant to the moulting process, across all moult cycle stages, was used in this study. Custom cDNA microarrays were constructed for Portunus pelagicus. The printed arrays contained 5000 transcripts derived from both the whole organism, and from individual organs such as the brain, eyestalk, mandibular organ and Y-organ from all moult cycle stages.Results: A total of 556 clones were sequenced from the cDNA libraries used to construct the arrays. These cDNAs represented 175 singletons and 62 contigs, resulting in 237 unique putative genes. The gene sequences were classified into the following biological functions: cuticular proteins associated with arthropod exoskeletons, farnesoic acid O-methyltransferase (FaMeT), proteins belonging to the hemocyanin gene family, lectins, proteins relevant to lipid metabolism, mitochondrial proteins, muscle related proteins, phenoloxidase activators and ribosomal proteins. Moult cycle-related differential expression patterns were observed for many transcripts. Of particular interest were those relating to the formation and hardening of the exoskeleton, and genes associated with cell respiration and energy metabolism.Conclusions: The expression data presented here provide a chronological depiction of the molecular events associated with the biological changes that occur during the crustacean moult cycle. Tracing the temporal expression patterns of a large variety of transcripts involved in the moult cycle of P. pelagicus can provide a greater understanding of gene function, interaction, and regulation of both known and new genes with respect to the moulting process

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Comprehensive Rare Variant Analysis via Whole-Genome Sequencing to Determine the Molecular Pathology of Inherited Retinal Disease

Inherited retinal disease is a common cause of visual impairment and represents a highly heterogeneous group of conditions. Here, we present findings from a cohort of 722 individuals with inherited retinal disease, who have had whole-genome sequencing (n = 605), whole-exome sequencing (n = 72), or both (n = 45) performed, as part of the NIHR-BioResource Rare Diseases research study. We identified pathogenic variants (single-nucleotide variants, indels, or structural variants) for 404/722 (56%) individuals. Whole-genome sequencing gives unprecedented power to detect three categories of pathogenic variants in particular: structural variants, variants in GC-rich regions, which have significantly improved coverage compared to whole-exome sequencing, and variants in non-coding regulatory regions. In addition to previously reported pathogenic regulatory variants, we have identified a previously unreported pathogenic intronic variant in $\textit{CHM}$ in two males with choroideremia. We have also identified 19 genes not previously known to be associated with inherited retinal disease, which harbor biallelic predicted protein-truncating variants in unsolved cases. Whole-genome sequencing is an increasingly important comprehensive method with which to investigate the genetic causes of inherited retinal disease.This work was supported by The National Institute for Health Research England (NIHR) for the NIHR BioResource – Rare Diseases project (grant number RG65966). The Moorfields Eye Hospital cohort of patients and clinical and imaging data were ascertained and collected with the support of grants from the National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, National Health Service Foundation Trust, and UCL Institute of Ophthalmology, Moorfields Eye Hospital Special Trustees, Moorfields Eye Charity, the Foundation Fighting Blindness (USA), and Retinitis Pigmentosa Fighting Blindness. M.M. is a recipient of an FFB Career Development Award. E.M. is supported by UCLH/UCL NIHR Biomedical Research Centre. F.L.R. and D.G. are supported by Cambridge NIHR Biomedical Research Centre

Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes.

Multiple primary tumors (MPTs) affect a substantial proportion of cancer survivors and can result from various causes, including inherited predisposition. Currently, germline genetic testing of MPT-affected individuals for variants in cancer-predisposition genes (CPGs) is mostly targeted by tumor type. We ascertained pre-assessed MPT individuals (with at least two primary tumors by age 60 years or at least three by 70 years) from genetics centers and performed whole-genome sequencing (WGS) on 460 individuals from 440 families. Despite previous negative genetic assessment and molecular investigations, pathogenic variants in moderate- and high-risk CPGs were detected in 67/440 (15.2%) probands. WGS detected variants that would not be (or were not) detected by targeted resequencing strategies, including low-frequency structural variants (6/440 [1.4%] probands). In most individuals with a germline variant assessed as pathogenic or likely pathogenic (P/LP), at least one of their tumor types was characteristic of variants in the relevant CPG. However, in 29 probands (42.2% of those with a P/LP variant), the tumor phenotype appeared discordant. The frequency of individuals with truncating or splice-site CPG variants and at least one discordant tumor type was significantly higher than in a control population (χ2 = 43.642; p ≤ 0.0001). 2/67 (3%) probands with P/LP variants had evidence of multiple inherited neoplasia allele syndrome (MINAS) with deleterious variants in two CPGs. Together with variant detection rates from a previous series of similarly ascertained MPT-affected individuals, the present results suggest that first-line comprehensive CPG analysis in an MPT cohort referred to clinical genetics services would detect a deleterious variant in about a third of individuals.JW is supported by a Cancer Research UK Cambridge Cancer Centre Clinical Research Training Fellowship. Funding for the NIHR BioResource – Rare diseases project was provided by the National Institute for Health Research (NIHR, grant number RG65966). ERM acknowledges support from the European Research Council (Advanced Researcher Award), NIHR (Senior Investigator Award and Cambridge NIHR Biomedical Research Centre), Cancer Research UK Cambridge Cancer Centre and Medical Research Council Infrastructure Award. The University of Cambridge has received salary support in respect of EM from the NHS in the East of England through the Clinical Academic Reserve. The views expressed are those of the authors and not necessarily those of the NHS or Department of Health. DGE is an NIHR Senior Investigator and is supported by the all Manchester NIHR Biomedical Research Centre