Lay sense-making and knowledge of biotechnology : Its functionality and its limitations.

This thesis examines lay sense-making of biotechnological items, its functionality and its limitations, which, it is claimed, may have implications for biotechnological developments and how they are received. The theoretical approach taken to lay sense-making drew on social representations theory as an explanatory framework. This informed the aim to collect data on verbal and visual representation, and categorisation, of biotechnological items. Data was collected in three studies, through multiple sorting tasks and in-depth interviews with lay individuals in the UK, and field observation of mobilisation events and protests in the US. Methods used to analyse the data were multidimensional scalogram analysis, smallest space analysis, content analysis and thematic content analysis with data display. Representation and categorisation captured in the studies points to lay sense-making and knowledge of biotechnological items having a number of functions beyond understanding, and limitations beyond any scientific and technical knowledge-deficits of the kind suggested in ongoing surveys. Findings are supportive of previously reported findings suggesting that lay knowledge is complementary to scientific, regulatory and commercial knowledge sets. It is argued that limitations of and constraints on lay sense-making of biotechnological items are related to its rich functionality and its complementarity. Findings also suggest that lay engagement with and sense-making of biotechnology can be empowering for those involved, allowing lay people to take ownership of a concept and topic such as biotechnology that might very well affect areas of their lives. On the other hand, it is suggested that as lay people become more engaged with biotechnology, their agendas may also become more engaged, suggesting in turn that biotechnology may be progressively less likely to be judged on its own merits, or that developments may be increasingly stalled by negotiation of competing interests

Parents’ experiences of neonatal care in England

With the greater need for specialist neonatal care in England over the last decade, increased attention has been given to developing and implementing quality measures to ensure that babies and their families receive the highest quality care. Patient experience is recognised as a key measure of quality, therefore it is essential to assess parents’ experiences of neonatal services to understand how these can be improved. In this paper we detail findings from the second large scale survey of parents’ experiences of neonatal care carried out in England in 2014, focusing on results that highlight aspects of family-centred care: information sharing; communication; support; and involvement. The results reveal great variations between individual units, as well as highlight key areas in which units could improve to provide family-centred care. This includes parents being able to speak to their doctor more, as well as receiving important information to understand their baby’s condition, and about support services available. Positively, many parents felt they were able to visit their baby as much as they wanted and were involved in their day-to-day care, which are fundamental to parents forming a bond with their baby. The survey is a rich data source that provides neonatal units in England with results that allow them to focus improvement efforts on what matters most to those using their services. It also enables neonatal units to evaluate how they are performing on key standards of care, supporting them in striving for clinical best practice

Parents’ Experiences of Communication in neonatal care (PEC): a neonatal survey refined for real-time parent feedback

Objective Assessing parent experiences of neonatal services can help improve quality of care; however, there is no formally evaluated UK instrument available to assess this prospectively. Our objective was to refine an existing retrospective survey for ‘real-time’ feedback. Methods Co-led by a parent representative, we recruited a convenience sample of parents of infants in a London tertiary neonatal unit. Our steering group selected questions from the existing retrospective 61-question Picker survey (2014), added and revised questions assessing communication and parent involvement. We established face validity, ensuring questions adequately captured the topic, conducted parent cognitive interviews to evaluate parental understanding of questions,and adapted the survey in three revision cycles. We evaluated survey performance. Results The revised Parents’ Experiences of Communication in Neonatal Care (PEC) survey contains 28 questions (10 new) focusing on communication and parent involvement. We cognitively interviewed six parents, and 67 parents completed 197 PEC surveys in the survey performance evaluation. Missing entries exceeded 5% for nine questions; we removed one and format-adjusted the rest as they had performed well during cognitive testing. There was strong inter-item correlation between two question pairs; however, all were retained as they individually assessed important concepts. Conclusion Revised from the original 61-question Picker survey, the 28-question PEC survey is the first UK instrument formally evaluated to assess parent experience while infants are still receiving neonatal care. Developed with parents, it focuses on communication and parent involvement, enabling continuous assessment and iterative improvement of family-centred interventions in neonatal care

Site amplification in the Kathmandu Valley during the 2015 M7.6 Gorkha, Nepal earthquake

The 25th April 2015 M7.6 Gorkha earthquake caused significant damage to buildings and infrastructure in both Kathmandu and surrounding areas as well as triggering numerous, large landslides. This resulted in the loss of approximately 8600 lives. In order to learn how the impact of such events can be reduced on communities both in Nepal and elsewhere, the Earthquake Engineering Field Investigation Team (EEFIT) reconnaissance mission was undertaken, aiming to look at damage patterns within the country. Passive, microtremor recordings in severely damaged areas of the Kathmandu Valley, as well as at the main seismic recording station in Kathmandu (USGS station KATNP) are used to determined preliminary shear wave velocity (Vs) profiles for each site. These profiles are converted into spectral acceleration using the input motion of the Gorkha earthquake. The results are limited, but show clear site amplification within the Siddhitol Region. The resulting ground motions exceed the design levels from the Nepalese Building Codes, indicating the need for site-specific hazard analysis and for revision of the building code to address the effect of site amplificatio

Neural effects of cannabinoid CB1 neutral antagonist tetrahydrocannabivarin (THCv) on food reward and aversion in healthy volunteers

Disturbances in the regulation of reward and aversion in the brain may underlie disorders such as obesity and eating disorders. We previously showed that the cannabis receptor subtype (CB1) inverse agonist rimonabant, an antiobesity drug withdrawn due to depressogenic side effects, diminished neural reward responses yet increased aversive responses (Horder et al., 2010). Unlike rimonabant, tetrahydrocannabivarin is a neutral CB1 receptor antagonist (Pertwee, 2005) and may therefore produce different modulations of the neural reward system. We hypothesized that tetrahydrocannabivarin would, unlike rimonabant, leave intact neural reward responses but augment aversive responses. Methods: We used a within-subject, double-blind design. Twenty healthy volunteers received a single dose of tetrahydrocannabivarin (10mg) and placebo in randomized order on 2 separate occasions. We measured the neural response to rewarding (sight and/or flavor of chocolate) and aversive stimuli (picture of moldy strawberries and/or a less pleasant strawberry taste) using functional magnetic resonance imaging. Volunteers rated pleasantness, intensity, and wanting for each stimulus. Results: There were no significant differences between groups in subjective ratings. However, tetrahydrocannabivarin increased responses to chocolate stimuli in the midbrain, anterior cingulate cortex, caudate, and putamen. Tetrahydrocannabivarin also increased responses to aversive stimuli in the amygdala, insula, mid orbitofrontal cortex, caudate, and putamen. Conclusions: Our findings are the first to show that treatment with the CB1 neutral antagonist tetrahydrocannabivarin increases neural responding to rewarding and aversive stimuli. This effect profile suggests therapeutic activity in obesity, perhaps with a lowered risk of depressive side effects. Keywords: reward, THCv, obesity, fMRI, cannabinoi

Serotonin controlling feeding and satiety

Serotonin has been implicated in the control of satiety for almost four decades. Historically, the insight that the appetite suppressant effect of fenfluramine is linked to serotonin has stimulated interest in and research into the role of this neurotransmitter in satiety. Various rodent models, including transgenic models, have been developed to identify the involved 5-HT receptor subtypes. This approach also required the availability of receptor ligands of different selectivity, and behavioural techniques had to be developed simultaneously which allow differentiating between unspecific pharmacological effects of these ligands and ‘true’ satiation and satiety. Currently, 5-HT1B, 5-HT2C and 5-HT6 receptors have been identified to mediate serotonergic satiety in different ways. The recently approved anti-obesity drug lorcaserin is a 5-HT2C receptor agonist. In brain, both hypothalamic (arcuate nucleus, paraventricular nucleus) and extrahypothalamic sites (parabrachial nucleus, nucleus of the solitary tract) have been identified to mediate the serotonergic control of satiety. Serotonin interacts within the hypothalamus with endogenous orexigenic (Neuropeptide Y/Agouti related protein) and anorectic (α-melanocyte stimulating hormone) peptides. In the nucleus of the solitary tract serotonin integrates peripheral satiety signals. Here, the 5-HT3, but possibly also the 5-HT2C receptor play a role. It has been found that 5-HT acts in concert with such peripheral signals as cholecystokinin and leptin. Despite the recent advances of our knowledge, many of the complex interactions between 5-HT and other satiety factors are not fully understood yet. Further progress in research will also advance the development of new serotonergic anti-obesity drugs