Do specific adaptations need to be made to IAPT interventions to make them more accessible to patients with a learning disability?

Background: There is a growing interest in how people with intellectual disabilities (ID) experience psychotherapy, and the extent to which mainstream psychotherapies may need to be adapted for people with ID. However, it is currently unclear whether models of the therapeutic alliance, largely developed based on the experiences of clinicians and mainstream populations, effectively describe the experiences of people with ID. The empirical basis upon which to base decisions regarding therapeutic adaptation for people with ID likewise remains nascent. Methods: A qualitative meta-synthesis using a best-fit framework analysis examined how the therapeutic alliance is experienced by people with ID. The review specifically examined whether Bordin’s model (1979) of the therapeutic alliance accurately fits the experiences of people with ID. An empirical study was also conducted to examine which factors predict recovery for people with ID accessing NHS Talking Therapies (NHSTT), (previously Improving Access to Psychological Therapies – IAPT) and whether these factors are similar or dissimilar to those which predict recovery for people from the mainstream population. Results: Twenty studies met the inclusion criteria for the qualitative meta-synthesis. All studies were conducted in the United Kingdom (UK). The analysis found broad areas of agreement between Bordin’s model (1979) and how people with ID experience the therapeutic alliance, though people with ID assigned more importance to interpersonal aspects of therapeutic processes. In the empirical study, data from 250 participants were included across two matched groups of ID (n = 125) and non-ID (n=125) participants who had accessed NHSTT services since 2013. Results suggest that the total number of sessions and disagreement on discharge were associated with recovery outcomes for both groups. Results also suggest that baseline GAD-7 score, social deprivation, referral duration and wait to second treatment were additionally associated with outcomes for people with ID. Conclusions: The systematic review suggests that people with ID assign greater importance to the interpersonal aspects of psychotherapy. The primary importance of interpersonal factors is not necessarily reflected in Bordin’s model (1979). Further research is also needed to determine whether Bordin’s model, which is predicated upon the concept of individual responsibility, can be applied as a “best fit” to people whose lives are more likely to be characterised by impaired abilities to make autonomous decisions, reduced quantity and quality of interpersonal connections, and reduced opportunities across personal, social and professional domains. The empirical study found that the factors which predict recovery for people from the general population accessing IAPT also predict recovery for people with ID. However, there appear to be factors which additionally predict recovery for people with ID. Further research is required to determine whether these findings can be replicated across a larger sample

Bostonia: The Boston University Alumni Magazine. Volume 19

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Vascular collagen type-IV in hypertension and cerebral small vessel disease

Cerebral small vessel disease (SVD) is common in older people and causes lacunar stroke and vascular cognitive impairment. Risk factors include old age, hypertension and variants in the genes encoding collagen alpha-1(IV) and alpha-2(IV), here termed collagen-IV, which are core components of the basement membrane. We tested the hypothesis that increased vascular collagen-IV associates with clinical hypertension and with SVD in older persons and with chronic hypertension in young and aged primates and genetically hypertensive rats. We quantified vascular collagen-IV immunolabeling in small arteries in a cohort of older persons with minimal Alzheimer's pathology (N=52; 21F/31M, age 82.8±6.95 years). We also studied archive tissue from young (age range 6.2-8.3 years) and older (17.0-22.7 years) primates ( ) and compared chronically hypertensive animals (18 months aortic stenosis) with normotensives. We also compared genetically hypertensive and normotensive rats (aged 10-12 months). Collagen-IV immunolabeling in cerebral small arteries of older persons was negatively associated with radiological SVD severity (ρ: -0.427, =0.005) but was not related to history of hypertension. General linear models confirmed the negative association of lower collagen-IV with radiological SVD ( <0.017), including age as a covariate and either clinical hypertension ( <0.030) or neuropathological SVD diagnosis ( <0.022) as fixed factors. Reduced vascular collagen-IV was accompanied by accumulation of fibrillar collagens (types I and III) as indicated by immunogold electron microscopy. In young and aged primates, brain collagen-IV was elevated in older normotensive relative to young normotensive animals ( =0.029) but was not associated with hypertension. Genetically hypertensive rats did not differ from normotensive rats in terms of arterial collagen-IV. Our cross-species data provide novel insight into sporadic SVD pathogenesis, supporting insufficient (rather than excessive) arterial collagen-IV in SVD, accompanied by matrix remodeling with elevated fibrillar collagen deposition. They also indicate that hypertension, a major risk factor for SVD, does not act by causing accumulation of brain vascular collagen-IV

Global Pyrogeography: the Current and Future Distribution of Wildfire

Climate change is expected to alter the geographic distribution of wildfire, a complex abiotic process that responds to a variety of spatial and environmental gradients. How future climate change may alter global wildfire activity, however, is still largely unknown. As a first step to quantifying potential change in global wildfire, we present a multivariate quantification of environmental drivers for the observed, current distribution of vegetation fires using statistical models of the relationship between fire activity and resources to burn, climate conditions, human influence, and lightning flash rates at a coarse spatiotemporal resolution (100 km, over one decade). We then demonstrate how these statistical models can be used to project future changes in global fire patterns, highlighting regional hotspots of change in fire probabilities under future climate conditions as simulated by a global climate model. Based on current conditions, our results illustrate how the availability of resources to burn and climate conditions conducive to combustion jointly determine why some parts of the world are fire-prone and others are fire-free. In contrast to any expectation that global warming should necessarily result in more fire, we find that regional increases in fire probabilities may be counter-balanced by decreases at other locations, due to the interplay of temperature and precipitation variables. Despite this net balance, our models predict substantial invasion and retreat of fire across large portions of the globe. These changes could have important effects on terrestrial ecosystems since alteration in fire activity may occur quite rapidly, generating ever more complex environmental challenges for species dispersing and adjusting to new climate conditions. Our findings highlight the potential for widespread impacts of climate change on wildfire, suggesting severely altered fire regimes and the need for more explicit inclusion of fire in research on global vegetation-climate change dynamics and conservation planning

Vulnerability of power distribution utility poles to tsunami bore impacts

Recent events have demonstrated that power distribution networks located in low-lying coastal areas are susceptible to damage from tsunami. Utility poles are a critical component of distribution networks as they support overhead power lines. Damage to the poles could therefore compromise the electricity supply to emergency facilities as well as to homes and businesses over large areas. This work quantifies the component-level tsunami vulnerability of common power distribution line utility poles, considering hydrodynamic wave-impact loading effects but neglecting debris impact and scour effects. First, a series of scaled flume experiments were used to identify the relationship between the tsunami wave properties and hydrodynamic loading histories. Next, nonlinear numerical distribution line utility pole models were validated using the experimental data and extended to account for soil-structure interaction effects. Finally, the loading histories from the flume tests were scaled and used in the numerical models to perform an incremental dynamic tsunami analysis on varying pole geometries and loading orientations at prototype scale. The results from this work provide valuable insight into the response of power distribution poles subjected to tsunami attack. This includes validating idealised approaches to determine the expected failure mode(s) based on pole embedment depths and soil properties and providing probabilistic tools capable of estimating damage based on expected tsunami inundation depths

Solution NMR analyses of the C-type carbohydrate recognition domain of DC-SIGNR protein reveal different binding modes for HIV-derived oligosaccharides and smaller glycan fragments

Background: DC-SIGNR, a C-type lectin which promotes infection of pathogens such as HIV, is a promising drug target. Results: Carbohydrate recognition domain of DC-SIGNR is highly dynamic, displaying unique binding modes for individual glycans. Conclusion: More complex, disease-associated glycans have different binding modes than smaller glycans previously studied. Significance: Understanding ligand-binding properties and solution dynamics of DC-SIGNR will facilitate therapeutic desig

Profiling health-care accreditation organizations : an international survey

Objective. To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Design. Web-based questionnaire survey. Participants. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. Main Outcome Measure(s). External relationships, scope and activity public information. Results. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. Conclusions. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.10 page(s