Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis

Objectives: To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods: Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results: Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion: Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable

Transcutaneous electrical nerve stimulation for cancer pain in adults.

Background Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown. Objectives The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED and PEDRO databases (11/04/08). Selection criteria Only randomised controlled trials (RCTS) investigating the use of TENS for the management of cancer-related pain in adults were included. Data collection and analysis The search strategy identified 37 possible published studies which were divided between two pairs of review authors that decided on study selection. A study eligibility form was used to screen each abstract and where study eligibility could not be determined from the abstract, the full paper was obtained and assessed by one pair of review authors. A standardised data extraction sheet was used to collect information on the studies and the quality of the studies was assessed independently by two review authors using the validated five-point Oxford Quality Scale. Final scores were discussed and agreed between all four review authors. The small sample sizes and differences in patient study populations of the two included studies prevented meta-analysis. Main results Only two RCTs met the eligibility criteria (64 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Authors' conclusions The results of this systematic review are inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults

Removing Barriers to Certification: Enhancing the Path for Caribbean Teachers in Florida\u27s Grades K-8

This dissertation explores the multifaceted challenges faced by Caribbean teachers seeking certification in Grades K-8 within the state of Florida, with a primary focus on identifying and mitigating barriers to the certification process. Caribbean educators bring diverse perspectives, pedagogical expertise, and cultural richness to the American education system, making their integration as certified teachers in Florida classrooms an asset. The research delves into the complex dynamics affecting the certification process, encompassing qualitative and quantitative surveys questions. A descriptive research study approach is employed to elucidate the systemic barriers encountered by Caribbean teachers, as well as to uncover potential solutions to streamline the certification journey. Key findings from the research reveal a constellation of obstacles, including stringent credential evaluation processes, misalignment of prior teaching experiences, linguistic and cultural challenges, and a lack of comprehensive support structures. These barriers impede the progress of qualified Caribbean educators, hindering their access to Florida\u27s teaching workforce. This dissertation advocates for the implementation of tailored interventions to alleviate these barriers. Proposed strategies encompass the development of culturally responsive teacher preparation programs, mentorship initiatives, and the establishment of clear pathways for Caribbean teachers to navigate the certification system. Moreover, recommendations are made for the cultivation of an inclusive and culturally diverse educational environment that embraces the unique contributions of Caribbean educators. The implications of this research extend beyond the immediate context of Florida, resonating with educational policymakers, administrators, and stakeholders across the United States grappling with the imperative of diversifying the teaching profession. By fostering inclusivity and removing barriers, this dissertation underscores the importance of harnessing the expertise and cultural richness that Caribbean teachers bring to Grades K-8 education, thus enriching the learning experiences of students and fostering a more globally aware and equitable educational landscape

Sacral Kingship: Aragorn as the Rightful and Sacrificial King in \u3ci\u3eThe Lord of the Rings\u3c/i\u3e

Consideration of Aragorn’s mythical role as rightful and sacrificial king in The Lord of the Rings. Using studies of the structure and function of kingship in folklore and mythology, presents instances of self-sacrifice in Aragorn’s story to show how he exemplifies ancient patterns of regenerative sacrifice

How young people find out about their family history of Huntington's disease

Family communication about adult-onset hereditary illness can be problematic, leaving some relatives inadequately informed or ignorant of their risk. Although studies have explored the barriers and facilitators in family communication about genetic risk, questions remain about when, what, how and indeed whether to tell relatives. The process of disclosure is also dependent upon the way in which genetic information is realized and understood by recipients, but research here is limited. Our paper explores young people’s experiences of finding out about a family history of the hereditary disorder Huntington’s disease (HD). In-depth interviews explored how and when young people found out, their reactions to different communication styles and any impact on family relations. We recruited young people through the North of Scotland regional genetics clinic and the Scottish Huntington’s Association (SHA). Thirtythree young people (aged 9–28) were interviewed. A qualitative analysis was undertaken which revealed four types of disclosure experiences: (1) having always been told, (2) gradually told, (3) HD was kept a secret, or (4) HD as a new diagnosis. In particular, the timing and style of disclosure from relatives, and one’s stage of awareness, were fundamental in structuring participants’ accounts. This article focuses on questions of when, how and indeed whether to tell children, and sits within a broader set of research and practice issues about what professionals and families (should) tell children about parental illness and genetic risk.Wellcome Trust’s Programme in Biomedical Ethic

Carbon 'hot-spots' in global supply chains : an inter-regional input-output analysis

Input-Output (IO) frameworks have been extensively used to study anthropogenic CO2 emissions within single economies or globally. This is usually done through the calculation of headline figures like the Production and Consumption Accounting Principles (PAP and CAP), which in turn leads to a lack of transparency on the structure of emissions and limits the information available on the drivers of those emissions. To overcome these limitations, we decompose the standard Environmental Inter-Regional Input-Output (EIRIO) headline calculations, drawing on the OECD Inter-Country IO tables. We show how this facilitates consideration of downstream demands driving the production and associated CO2 emissions at specific industrial ‘hot-spots’ outside the borders of individual regions/territories under study. The results for a UK study reveal how domestic final demand can drive the generation of emissions outside the UK’s territorial boundaries (despite the fact that the majority of emissions are generated within its borders). The combined Chinese ‘Electricity, Gas and Water Supply’ sector is identified as a major direct emitter of CO2 in the global supply chain of other industries (including UK-based ones) serving UK final demands. Furthermore, the UK ‘Health and Social Work’ sector is revealed to have the second largest CO2 footprint driven by UK final demand, amongst all production sectors in all countries. However, it is found to have numerous CO2 ‘hot-spots’ in its international upstream supply chain, highlighting the impact of UK’s ‘Health and Social Work’ sector on generation of emissions in the UK’s trading partners

Challenges of researching showering routines: From the individual to the socio-material

In the UK, water supplies are under pressure from climate, population and lifestyle change. Showering is the largest component of domestic water consumption. Young adults are high water-users at a transitional life-stage, when practices are dynamic, and habits shaped. This paper presents the methodology, early findings and reflections on challenges of working with different data types and scales, to explore real-world water-saving through a mixed-methods approach, focusing on showering patterns of first year university students in campus accommodation at the University of the West of England, Bristol, UK. Combining household meter, logged water-fixture micro-component, personal-use questionnaire, user diary and stakeholder focus group data with the Scottish Government Individual-Social-Material model, typical showering demand reduction interventions were evaluated and insights into alternative interventions were generated. Results indicate Estates’ routine equipment maintenance and database management affect data quality and consistency. Despite these issues a profile of daily student water use was derived (equivalent to 114 L per person per day) but with high variability between different households (from 83 to 151 L per person per day). Average shower durations (self-reported 10–12 min) were higher than reported UK norms, although frequency was similar to the UK daily shower norm. Average measured shower volumes (51 L in one house) were not excessive, indicating shower fixtures provided a contribution to water saving

Expression Profiles of Exosomal MicroRNAs from HEV- and HCV-Infected Blood Donors and Patients:A Pilot Study

Exosomes seem to play an important role in hepatits C virus (HCV) and hepatitis E virus (HEV) infection by shielding their cargo from the host immune responses, with microRNAs being key exosomal components. Little is known about their involvement in a mixed HCV/HEV infection or at the early stages of infection, such as in asymptomatic blood donors (BDs). To obtain preliminary data, we have compared the exosomal microRNA expression profiles in four each of HCV RNA-positive, HEV RNA-positive and negative blood donors and four patients, one of whom was a rare patient with HCV/HEV co-infection. Exosomes were purified from sera by a combination of a precipitation and density gradient centrifugation and exosomal microRNA was analysed using Taqman array cards. Out of 33 deregulated miRNAs, miR-885-5p and miR-365 were upregulated in HCV BDs, miR-627-5p was downregulated in HCV BD and miR-221 was downregulated in HCV patients and BDs. In HEV infection, miR-526b appeared specifically downregulated. Six miRNAs (miR-628-3p, miR-194, miR-151-3p, miR-512-3p, miR-335 and miR-590) indicated a potential involvement in both infections. First time preliminary data on pre- and post-antiviral treatment exosomal microRNA profiles of the HEV/HCV co-infected patient revealed a pool of 77 upregulated and 43 downregulated miRNAs to be further investigated for their potential roles in these viral infections

Mixed-monolayer glyconanoparticles for the detection of cholera toxin by surface enhanced raman spectroscopy

The same interactions that a pathogen uses for establishment in a host can be exploited in its detection. The carbohydrates comprising the intestinal cell surface GM1-ganglioside, are targeted by vibrio cholerae via the lectin, cholera toxin, to initiate infection. We report on the preparation of mixed-monolayer, carbohydrate-coated silver nanoparticles (glyconanoparticles) for the sensitive (56 ng/mL), low volume detection of cholera toxin B-subunit (CTB) in synthetic freshwater samples and in 5 minutes by surface enhanced Raman spectroscopy (SERS). The detection limit falls within the recommended detection range and matches WHO approved test limits. PEGylated galactose and sialic acid are added in a specific ratio to coat the particles in GM1-ganglioside mimics for interaction with CTB and display a synergic effect greater than either glycan alone. This demonstrates the first use of a mixed-monolayer glyconanoparticle which mimics the GM1 ligand, allowing selective interaction with CTB

Strategic Planning: Plan-to-Plan Final Report

In January 2007, a group of USD graduate students in Nonprofit Leadership and Management, selected a San Diego museum for their applied project. The USD team\u27s purpose was to collect data that would be useful to the museum in its strategic planning process and to provide the client with two products: a Plan-to-Plan and this final report.https://digital.sandiego.edu/npi-bpl-strategicplanning/1003/thumbnail.jp