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Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series
Get PDFFrom Wiley via Jisc Publications RouterHistory: received 2020-01-23, rev-recd 2020-07-27, pub-electronic 2020-09-10, pub-print 2021-06Article version: VoRPublication status: PublishedAbstract: Objectives: Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). Design: Case series. Methods: A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6‐month intervention window. Participants were assessed four times over a 12‐month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental‐health and recovery measures. Results: Sixteen participants engaged in the intervention and were included in last‐observation‐carried‐forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post‐traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. Conclusions: The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. Practitioner points: Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation
The Potential of Incremental Forming Techniques for Aerospace Applications
Get PDFIncremental sheet metal forming (ISF) processes are part of a set of non-classical techniques that allow producing low-batches, customized and/or specific geometries for advanced engineering applications, such as aerospace, automotive and biomedical parts. Combined or not with other joining processes and additive manufacturing techniques, ISF processes permit rapid prototyping frameworks, and can be included in the class of smart manufacturing processes.
This chapter discusses the fundamentals of ISF technology, key attributes, future challenges and presents few examples related to the use of incremental forming for the development of complex parts as specifically found in aerospace applications such as aerofoils. The use of incremental forming to produce customized designs and to perform quick try-outs of ready-to-use parts contributes to decrease the time to market, decrease tooling cost and increase part design freedom
Water friction in nanofluidic channels made from two-dimensional crystals.
Get PDFFrom Europe PMC via Jisc Publications RouterHistory: ppub 2021-05-01, epub 2021-05-25Publication status: PublishedFunder: European Research Council; Grant(s): 852674Membrane-based applications such as osmotic power generation, desalination and molecular separation would benefit from decreasing water friction in nanoscale channels. However, mechanisms that allow fast water flows are not fully understood yet. Here we report angstrom-scale capillaries made from atomically flat crystals and study the effect of confining walls' material on water friction. A massive difference is observed between channels made from isostructural graphite and hexagonal boron nitride, which is attributed to different electrostatic and chemical interactions at the solid-liquid interface. Using precision microgravimetry and ion streaming measurements, we evaluate the slip length, a measure of water friction, and investigate its possible links with electrical conductivity, wettability, surface charge and polarity of the confining walls. We also show that water friction can be controlled using hybrid capillaries with different slip lengths at opposing walls. The reported advances extend nanofluidics' toolkit for designing smart membranes and mimicking manifold machinery of biological channels
Understanding acceptability in the context of text messages to encourage medication adherence in people with type 2 diabetes
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: received 2021-01-29, accepted 2021-05-11, registration 2021-06-22, pub-electronic 2021-06-28, online 2021-06-28, collection 2021-12Publication status: PublishedAbstract: Background: Acceptability is recognised as a key concept in the development of health interventions, but there has been a lack of consensus about how acceptability should be conceptualised. The theoretical framework of acceptability (TFA) provides a potential tool for understanding acceptability. It has been proposed that acceptability measured before use of an intervention (anticipated acceptability) may differ from measures taken during and after use (experienced acceptability), but thus far this distinction has not been tested for a specific intervention. This paper 1) directly compares ratings of anticipated and experienced acceptability of a text message-based intervention, 2) explores the applicability of the TFA in a technology-based intervention, and 3) uses these findings to inform suggestions for measuring acceptability over the lifespan of technology-based health interventions. Methods: Data were obtained from a quantitative online survey assessing anticipated acceptability of the proposed text messages (n = 59) and a 12-week proof-of-concept mixed methods study assessing experienced acceptability while receiving the text messages (n = 48). Both quantitative ratings by return text message, and qualitative data from participant interviews were collected during the proof-of-concept study. Results: The quantitative analysis showed anticipated and experienced acceptability were significantly positively correlated (rs > .4). The qualitative analysis identified four of the seven constructs of the TFA as themes (burden, intervention coherence, affective attitude and perceived effectiveness). An additional two themes were identified as having an important impact on the TFA constructs (perceptions of appropriateness and participants’ role). Three suggestions are given related to the importance of appropriateness, what may affect ratings of acceptability and what to consider when measuring acceptability. Conclusions: The high correlation between anticipated and experienced acceptability was a surprising finding and could indicate that, in some cases, acceptability of an intervention can be gauged adequately from an anticipated acceptability study, prior to an expensive pilot or feasibility study. Directly exploring perceptions of appropriateness and understanding whether the acceptability described by participants is related to the intervention or the research - and is for themselves or others - is important in interpreting the results and using them to further develop interventions and predict future use
Shifting attention between modalities: Revisiting the modality-shift effect in autism
Get PDFFrom Springer Nature via Jisc Publications RouterHistory: accepted 2021-03-14, registration 2021-03-16, online 2021-04-30, pub-electronic 2021-04-30, pub-print 2021-08Publication status: PublishedAbstract: Selective attention to a sensory modality has been observed experimentally in studies of the modality-shift effect – a relative performance benefit for targets preceded by a target in the same modality, compared to a different modality. Differences in selective attention are commonly observed in autism and we investigated whether exogenous (automatic) shift costs between modalities are increased. Autistic adults and neurotypical controls made speeded discrimination responses to simple visual, tactile and auditory targets. Shift costs were observed for each target modality in participant response times and were largest for auditory targets, reflective of fast responses on auditory repeat trials. Critically, shift costs were similar between the groups. However, integrating speed and accuracy data using drift-diffusion modelling revealed that shift costs in drift rates (reflecting the quality of information extracted from the stimulus) were reduced for autistic participants compared with neurotypicals. It may be that, unlike neurotypicals, there is little difference between attention within and between sensory modalities for autistic people. This finding also highlights the benefit of combining reaction time and accuracy data using decision models to better characterise selective attention in autism
Assessing Fracture Toughness and Impact Strength of PMMA Reinforced with Nano-Particles and Fibre as Advanced Denture Base Materials
Get PDFFrom MDPI via Jisc Publications RouterHistory: accepted 2021-07-20, pub-electronic 2021-07-24Publication status: PublishedStatement of Problem: Polymethyl methacrylate (PMMA) denture resins commonly fracture as a result of the denture being dropped or when in use due to heavy occlusal forces. Purpose: To investigate the effects of E-glass fibre, ZrO2 and TiO2 nanoparticles at different concentrations on the fracture toughness and impact strength of PMMA denture base. Materials and Methods: To evaluate fracture toughness (dimensions: 40 × 8 × 4 mm3; n = 10/group) and impact strength (dimensions: 80 × 10 × 4 mm3; n = 12/group), 286 rectangular tested specimens were prepared and divided into four groups. Group C consisted of the PMMA specimens without any filler (control group), while the specimens in the remaining three groups varied according to the concentration of three filler materials by weight of PMMA resin: 1.5%, 3%, 5%, and 7%. Three-point bending and Charpy impact tests were conducted to measure the fracture toughness and impact strength respectively. Scanning Electron Microscope (SEM) was utilised to examine the fractured surfaces of the specimens after the fracture toughness test. One-way analysis of variance (ANOVA) followed by Tukey post-hoc tests were employed to analyse the results at a p ≤ 0.05 significance level. Results: Fracture toughness of groups with 1.5 and 3 wt.% ZrO2, 1.5 wt.% TiO2, and all E-glass fibre concentrations were significantly higher (p 0.05) than the control group. The samples reinforced with 3 wt.% ZrO2 exhibited the highest fracture toughness. Those reinforced with a 3 wt.%, 5 wt.%, and 7 wt.% of E-glass fibres had a significantly (p 0.05) higher impact strength than the specimens in the control group. The heat-cured PMMA modified with either ZrO2 or TiO2 nanoparticles did not exhibit a statistically significant difference in impact strength (p > 0.05) in comparison to the control group. Conclusions: 1.5 wt.%, 3 wt.% of ZrO2; 1.5 wt.% ratios of TiO2; and 1.5 wt.%, 3 wt.%, 5 wt.%, and 7 wt.% of E-glass fibre can effectively enhance the fracture toughness of PMMA. The inclusion of E-glass fibres does significantly improve impact strength, while ZrO2 or TiO2 nanoparticles did not
Patient preferences and priorities for haemophilia gene therapy in the US: A discrete choice experiment
Get PDFGene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments.
Aim: We conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes.
Methods: We surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity.
Results: A total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%).
Conclusion: People with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and differences can inform clinical and health policy decisions to improve health equity for people with haemophilia
Non-Exhaust Vehicle Emissions of Particulate Matter and VOC from Road Traffic: A Review
Get PDFAs exhaust emissions of particles and volatile organic compounds (VOC) from road vehicles have progressively come under greater control, non-exhaust emissions have become an increasing proportion of the total emissions, and in many countries now exceed exhaust emissions. Non-exhaust particle emissions arise from abrasion of the brakes and tyres and wear of the road surface, as well as from resuspension of road dusts. The national emissions, particle size distributions and chemical composition of each of these sources is reviewed. Most estimates of airborne concentrations derive from the use of chemical tracers of specific emissions; the tracers and airborne concentrations estimated from their use are considered. Particle size distributions have been measured both in the laboratory and in field studies, and generally show particles to be in both the coarse (PM2.5-10) and fine (PM2.5) fractions, with a larger proportion in the former. The introduction of battery electric vehicles is concluded to have only a small effect on overall road traffic particle emissions. Approaches to numerical modelling of non-exhaust particles in the atmosphere are reviewed. Abatement measures include engineering controls, especially for brake wear, improved materials (e.g. for tyre wear) and road surface cleaning and dust suppressants for resuspension. Emissions from solvents in screen wash and de-icers now dominate VOC emissions from traffic in the UK, and exhibit a very different composition to exhaust VOC emissions. Likely future trends in non-exhaust particle emissions are described
Dietary vitamin D consumption, sunlight exposure, sunscreen use and parental knowledge of vitamin D sources in a cohort of children aged 1–6 years in North West England
Get PDFThis article has been accepted for publication and will appear in a revised form, subsequent to peer review and/or editorial input by Cambridge University Press, in Proceedings of the Nutrition Society published by Cambridge University Press. Copyright The Authors 2015.Hospital admission for children with rickets in England has dramatically increased, from <1 child per 100,000 in the early 1990's to 4·78 (4·58–4·99) per 100 000 between 2007 and 2011( 1 ). The re-emergence of rickets thus suggests poor vitamin D status( 2 ). Additionally, there has been a plethora of publications associating low vitamin D status with many adverse health outcomes other than the classical role of vitamin D in the development, maintenance and function of a healthy skeleton( 3 ). Vitamin D is a fat lipophilic steroid pro hormone obtained from few foods in the diet. However, the majority (90–95%) of vitamin D is synthesised from exposure of bare skin to sunlight( 4 ), and casual sunlight exposure has been considered adequate for the majority of the population. Consequently, there is no reference nutrient intake (RNI) for ages 4–65 yrs( 5 ). With modern indoor lifestyles, cautious sun screen usage and changes in food habits, sunlight exposure may no longer be sufficient to maintain adequate vitamin D status. To avoid vitamin D deficiency, supplementation and fortification may need to play a more prominent role in everyday lives( 6 ).
The aim of the present study was to investigate vitamin D dietary intake in children, parents’ knowledge of vitamin D sources, children's outdoor habits and sun screen application practices. A retrospective, cross sectional study approach was utilised. Parents of children (n = 42) aged between 1 and 6 yrs completed a semi-validated food frequency questionnaire, a sources of vitamin D knowledge questionnaire, and a sunlight exposure and sunscreen use questionnaire, in Adlington, N.W. England (latitude 55oN) during May 2013.
Children's mean (±SD) dietary vitamin D intake was 4·4 ± 2·5 μg/d, significantly lower than 7μg/d (P = < 0·001, for comparison 7μg/d, the RNI for ages 3 months-4 yrs was used). As expected, children taking supplements had a significantly higher mean (±SD) vitamin D intake (8·49 ± 1·78 μg/d) compared to those that did not supplement (3·34 ± 1·23 μg/d, P < 0·001). The greatest contribution to dietary vitamin D intake from food was from butter and spreads (0·028μg/d), followed by cakes, biscuits & scones (0·023μg/d). Parents' knowledge of food sources was poor, with a mean (±SD) incorrect response of 76% ±11·2. Contrastingly, 93% correctly identified sunlight exposure as a potential source of vitamin D. Eighty nine percent of participants played outdoors daily for 1 hour or more, 81% used sunscreen with an SPF ≥30 and only 2% rarely applied sunscreen.
This study revealed that children's diet in the NW England is lacking sufficient vitamin D content, in line with larger surveys( 7 , 8 ). Parents' knowledge regarding vitamin D dietary sources was poor but 93% of parents knew that sunlight was the non-dietary source of vitamin D. Outdoor play indicated sufficient exposure time to produce endogenous vitamin D but sunscreen usage may have potentially diminished epidermal UVB exposures.
Further research is needed using biomarkers to confirm vitamin D insufficiency, and public health strategies should be implemented to promote existing recommendations regarding supplementation and consumption of vitamin D rich foods. Additionally, guidelines for safe sun exposure and sunscreen use are required
Impact Assessment of Holiday Provision in Cheshire West and Chester, Halton and Wirral – Summer 2020: Assessment of Provision and Coordination under Covid19
No full textThis report is an evaluation of the activities undertaken by Edsential and Partners during the summer of 2020. Edsential and its consortium were one of ten providers awarded funding by the Department of Education to coordinate activities and food provision in England, receiving £1.8 million of the £9 million allocated for 2020. Compared to the summer of 2019, the area of the provision under the care of Edsential has significantly increased, including Cheshire West and Chester, Wirral and Halton. The provision was organised through Partnership Boards created for each local area, and this report not only provides an impact assessment of the holiday food and activity provision, but also an evaluation of the partnerships and their functioning. The context of the provision has been affected by the Covid19 pandemic, and as such, researchers have also analysed how Covid19 has affected families, particularly during lockdown restriction periods, and the provision of activities.This report is an evaluation of the activities undertaken by Edsential and Partners during the summer of 2020. Edsential and its consortium were one of ten providers awarded funding by the Department of Education to coordinate activities and food provision in England, receiving £1.8 million of the £9 million allocated for 2020. Compared to the summer of 2019, the area of the provision under the care of Edsential has significantly increased, including Cheshire West and Chester, Wirral and Halton. The provision was organised through Partnership Boards created for each local area, and this report not only provides an impact assessment of the holiday food and activity provision, but also an evaluation of the partnerships and their functioning. The context of the provision has been affected by the Covid19 pandemic, and as such, researchers have also analysed how Covid19 has affected families, particularly during lockdown restriction periods, and the provision of activities
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