Approximately 41,000 young people, under the age of 18, are bereaved of a parent each year within the U.K. (Child Bereavement Network, 2014; Winston’s Wish, 2016), and a significant number of these deaths will have been preceded by a period of terminal illness (TI). Adolescents are considered to be particularly susceptible to negative psychosocial outcomes when a parent is unwell (Grabiak, Bender & Puskar, 2007), yet adolescents as a group are less likely to access mental-health services (Reardon, Harvey, Baranowska, O’Brien, Smith & Creswell, 2017). Thus, whilst adolescents of terminally ill (TI) parents may present a vulnerable group, they may also be difficult to engage and subsequently support (Bremner, 2000). There has also been little consideration of how adolescents experience parental terminal illness (PTI), particularly considering their perceptions and experiences of support during this period. This study qualitatively explores the experiences of six individuals who had a parent diagnosed with a TI during late adolescence. Their experiences are explored in terms of their understanding, processing and adjustment to their parent’s TI, both as an individual, and in the context of their wider family and social setting. Their experiences and perceptions of support are additionally explored; considering the role of supportive individuals, services and interventions. Interpretative Phenomenological Analysis was employed to analyse participant data. Participants were individuals who had a parent diagnosed with a terminal illness aged 16-18. Four superordinate themes emerged from the data: 1) ‘Changing family dynamics’ 2) ‘grappling with adolescence and adjustment to loss’ 3) ‘Barriers to feeling/being supported’ 4) ‘Living with the consequences’. Participants relate the profound impact that PTI during adolescence has had and continues to have on their lives. Whilst there are prominent threads of difficulty and distress, elements of positive change and growth are also highlighted. Implications are discussed in terms of service provision and design, including therapeutic recommendations for counselling psychologists and other professionals working with this group.

Over 55,000 new breast cancer cases are diagnosed each year and the figures are rising. Most studies show that women want to get back to ‘normal’ and describe how returning to work helps to achieve this. For some, there are wider health implications which may affect their mobility or return to work (RTW). Disabilities are sometimes hidden, for example fatigue and emotional stress may result in a loss of confidence and work ability. Few studies focus on how the structural relations of organizations impact women’s decisions to RTW after treatment. This study contributes to our knowledge and understanding of how employers view disability, how work place adjustments are made and the support that women are offered on their RTW. This study explores the process of return or non-return to work after breast cancer diagnosis and treatment. It examines the relationship between the personal narratives of women with breast cancer and discourses around workplace discipline and practice. It records women’s attitudes towards work, their career aspirations and how support networks played a part in influencing their return or non-return to work. It illustrates how women’s embodied experiences are not only about immediate experiences located in a specific context i.e. the breast cancer diagnosis but also how the body intersects with culture: how it is marked by categories of gender, age, class, ethnicity, and (dis)ability and is subject to regulation and control. Interviews were conducted with sixteen breast cancer respondents and HR directors from five major employers based in the South West of England. The cases in this research show that women’s safe return to work is limited due to employers’ lack of understanding of their working [dis]ability with few or no adjustments in place to accommodate their needs. Breast Cancer patients consider a RTW allows them to move on from their cancer diagnosis but struggle to overcome the barriers in the process of returning. Whilst some women struggled to retain their jobs, others changed career paths or retired early due to ill-health continuing long after diagnosis.

Diabetes is an endocrine disease characterised by a chronic increase in blood sugar levels caused by a deficiency of insulin production, which leads to type 1 diabetes, or by a loss of tissue response to insulin, which leads to type 2 diabetes. The disease leads to disruption of metabolism, vascular damage and damage to the nervous system, as well as damage to other organs and systems. Type 2 diabetes is becoming more common throughout the world, due to poor nutrition and lifestyle, and genetic background. Efforts have accordingly been increased towards developing and refining treatments as well as to addressing the underlying causes of the disease. Many parts of the world have a documented history of the use of plants to treat diabetes, and these can be an attractive, local, alternative to expensive pharmaceutical medicines. Accordingly there is an increasing interest in identifying new phytochemicals with proven pharmacological effects on diabetes. The tree Moringa peregrina is commonly found throughout the Middle East and the oil from its seeds has been used for thousands of years. Other members of the Moringa family have recorded anti-diabetic family and Moringa peregrina was chosen for investigation in this work with the aim of characterising anti-diabetic activity from its leaves. Six extracts were prepared using solvents water, methanol, butanol, ethyl acetate, chloroform and hexane, based on standard extraction techniques. The study was designed to assess the effect of these six extracts on the uptake of glucose in a human hepatoma cell line (HepG2) using a well-studied fluorescent derivative of glucose, 2-2-[N-(7-nitrobenz-2-oxa-1, 3-diazol-4-yl) amino glucose (2-NBDG). The cells can take up 2-NBDG instead of glucose via glucose transporters and its uptake is indicative of the capacity of cells to take up glucose, i.e. of the number of active glucose transporters on the cell surface. The results revealed that the extracts prepared with ethyl acetate and chloroform increased glucose uptake significantly more than the other extracts. Moreover the effects of the extracts were rapid, with a one hour treatment producing a similar stimulation to a 24 hour treatment. These data were confirmed in a second method of investigation of the hypoglycaemic effect of the extracts, by measuring consumption of glucose from cell culture medium. A preliminary assessment of the effect of active extracts on expression of the main glucose transporter of HepG2 cells, GLUT1, by western blotting indicated no large changes in expression. Dietary phytoestrogens have been shown to play a beneficial role in obesity and diabetes, so the second part of this study investigated the effect of phytoestrogens on glucose uptake. Three phytoestrogens (daidzein, formonontein and genestin, which are naturally occurring isoflavones) were chosen. HepG2 cells showed a significant increase in glucose uptake after treatment with phytoestrogens compared to the control. In an attempt to identify the active phytochemicals that could account for the observed effects, extensive purification and characterisation of components from the ethyl acetate fraction was undertaken. Seven components were identified: (1) OEthyl 4-[(α-L-rhamnosyloxy)benzyl] thiocarbamate (E), (2) O-Butyl 4-[(α-Lrhamnosyloxy)benzyl] thiocarbamate (E), (3) 4-(α-L-Rhamnosyloxy)benzyl isothiocyanate, (4) ȕ-Sitosterol, (5) Daucosterol, (6) γ’-methyl-quercetin-3-Orutinoside (also known as isorhamnetin-3-O-rutinoside), (7) Rutin. In a final analysis an attempt was made to assess the effect of a representative set of three out of the seven components on basic metabolic activity of HepG2 cells using a Seahorse XF-24 analyser. The three components chosen were O-ethyl 4-[(α-L-rhamnosyloxy) benzyl] thiocarbamate (E), ȕ-sitosterol from the phytosterols family and Rutin. Real-time monitoring of cell metabolism by a Seahorse XF-24 auto analyser after two hours incubation with the three chosen compounds revealed that maximal respiration, non-mitochondrial respiration and spare respiratory capacity have trended towards an increase with ȕ-sitosterol and3-O-ethyl 4-[(α-Lrhamnosyloxy) benzyl] thiocarbamate (E) treatments compared to control. As no similar trends were observed in ATP production, the increased maximal respiration could increase metabolic activity at higher concentrations of glucose and account, in part for the effects observed on glucose consumption.

Background: Low desire for sex is a common problem in the lives of women. It features in Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013) as Female Sexual Interest/Arousal Disorder (FSI/AD) and often causes distress where there is a desire discrepancy in a relationship. A literature search revealed that very little research has been undertaken on couple aspects of the problem. This is a qualitative study of heterosexual couples where the woman experiences low desire and incorporates a feminist critique, a counselling psychology perspective and an emphasis on tying the findings to therapeutic techniques. Due to paucity of research this study provides original insight and contributes to practical work with couples. Aim: The research aims were to explore couples’ narratives of low sexual desire and to connect these findings to potential application in the practice of counselling psychology or allied professions. Method: The study employed a qualitative design using semi-structured interviews from four participant couples, which were analysed using Langdridge’s 2007 Critical Narrative Analysis. Results: Six main themes were uncovered including couple’s experiences of blame and problematic communication patterns. Men’s themes included entitlement, doubt and conflation of love and sex. Prevalent women’s themes were anxiety over abnormality and seeking causes of low desire. The concept of identity was explored with men adopting a role of victim while the women occupied a role of self-sacrifice. Use of a feminist critique found evidence of pathologisation of normal sexual variation and man-centred views about sexuality. Ways of addressing these findings in a therapeutic arena were explored. For example, the benefits of a systemic approach, normalisation of experience and the importance of arriving at a shared narrative of problems and potential solutions in therapy were underlined. Counselling psychology’s emphasis on reflexive practice and a pluralistic approach were proposed as being advantageous for couples presenting with this problem.

Family therapy is not well utilised outside Western culture. The lack of literature exploring fathers' experience of family therapy is an issue that crosses many Eastern cultures. Literature has illustrated the importance of fathers in family therapy, but does not address cultural difference. As an Indian therapist, in an Indian family, with an Indian father the researcher investigated this issue from an Indian perspective. Consequently providing insight into Indian fathers' experiences of family therapy and advancing existing literature, helping counselling psychologists working with this client group to better understand and engage them, therefore helping the process of family therapy and development of services. Interpretative phenomenological analysis was used to explore Indian fathers' subjective reports of meaning in relation to family therapy. Four Indian fathers, aged 38-64 years old, who had completed family therapy, were recruited from an organisation working with Indian families from a city in England. Four super-ordinate themes emerged: "Indian fathers and their family", "east versus west", "the therapist" and "what is therapy?" Two findings emerged from the analysis; Indian fathers found family therapy to be a foreign notion, which proved to be a valuable experience and they found it useful to be matched to their therapist. The study highlights the need for counselling psychology training to allocate more sessions on working cross culturally, which needs to be mirrored in CPD. Understanding Indian fathers' experience can help improve services and increase their engagement, and a community psychology approach is proposed to address this wider issue within the Indian community. The findings from this study help build the foundations for future qualitative research exploring Indian families and family therapy, such as investigating Indian fathers’ experience of family therapy with a non-Indian therapist, which would help provide insight on whether the therapists’ ethnicity has an impact on experience.

Both MVs and exosomes are isolated by similar methodologies such as differential centrifugation of cell culture supernatant (S/N), filtration, floating on chemical gradients or using antibody labelled magnetic beads. Hence, the isolation techniques, commonly in use, provide low levels of purification and therefore require improvements and an in-depth analysis of observed results. This research has established a protocol for isolation of these vesicles and a means to identify them using known markers and their respective properties. The isolation techniques used and developed in this research include differential centrifugation, sucrose gradient centrifugation, and filtration. MVs and exosomes were later identified and distinguished according to their relative ability to bind FITC and PE conjugated annexin V, anti-LAMP1, anti-CD63 and anti-CD11b antibodies using flow cytometry. Protein gels were run with MVs and exosome samples isolated by different techniques to identify some distinct proteins in MVs/exosomes that may be uniquely present on one or either and hence that could be used as a marker to distinguish MVs from exosomes. To prevent exosomal contamination of MV preparations, in a further improvement of the newly developed reverse filtration technique, gentle disruption of exosome aggregates by gentle water sonication was used and measurements of plasma MV levels made from a population of healthy donors. This found plasma MV levels to range between 0.51 and 2.82 x 105 MVs/ml. The MVs were characterised as phosphatidylserine-positive and ≥0.2 μm in diameter. Most of the variables looked at in this study including freezing at -20ºC, gender and subject age did not alter MV absolute counts significantly. For the first time the effect of fasting on MV levels has been studied. Fasting individuals had a wider spread and appeared to have higher MV levels (2.8x105-5.8x105 MVs/ml). This could be defined as the normal baseline fasting reference range, which is almost 3-fold higher compared to the non-fasting group reference range (0.9-1.5x105) MVs/ml. These results suggest that when analysing total MVs, further investigations should use fasting subjects, as for quantification of other fasting analytes. Prospective markers of (monocyte-derived) MVs, IL-1α, RANTES, G-CSF, CCL-1 and IL-17E are proposed for further investigation. MVs were shown to inhibit phagocytosis of apoptotic bodies more effectively than exosomes. With a view to understanding likely pathways being stimulated during MV release, and to also shortlist possible pharmacological reagents capable of being used to therapeutically inhibit Y27632, calpeptin and methyl-β cyclodextrin were shown to inhibit MV release. MV release from K562 cells was inhibited by Y27632 and calpeptin but less effectively by chlorpromazine or methyl-β-cyclodextrin, MV release from THP-1 acute monocytic leukaemia cells was greater than from peripheral blood monocytes which were in turn shown to express more phosphotidylserine than on exosomes. With a view to using MVs as drug delivery vehicles, THP-1 MVs were found to fuse/hemifuse to K562 erythroleukaemia cells, but not at 4°C or if the MV surface was blocked with annexin V. β-Gly (10 μM) (as well as MVs carrying β-Gly [β-Gly MVs]) was found to inhibit proliferation at least 3-fold compared to untreated control. β-Gly and β-Gly MVs increased the doubling time but neither induced apoptosis of K562 cells (unlike MVs from apoptotic cells). Finally, β-Gly increased the percentage of cells in G0/G1 whilst decreasing the cells in G2/M and appears to induce erythroid differentiation as seen by the increase in the percentage of benzidine-stained cells.

Background: Breastfeeding rates continue to remain low in the UK even though a number of initiatives have been delivered in an attempt to increase them. Evidence suggests a large proportion of mothers now perceive breastfeeding as the best feeding practice for their baby and many wish to do so, but are unable to for a number of reasons including issues around breastfeeding in public. This study set out to explore lived experience of breastfeeding in public to better inform our understanding. Methods: A qualitative approach was chosen using semi-structured interviews to facilitative an in-depth exploration of mothers’ experiences of public breastfeeding. Women aged 31 to 40 years old who had experience of breastfeeding in public within London were interviewed and narratives analysed using Interpretative Phenomenological Analysis. Results: Two themes emerged from the data: “Societal attitudes as ostracising” and “Becoming a nursing mother”. It was evident these mothers experienced a strong transference from a British society generally disapproving and feeling uncomfortable with breastfeeding. Consequently implicit expectations are placed on them to conceal the behaviour either by covering their breast or breastfeeding in discrete locations including feeding rooms. Transitioning from a woman to a mother is a significant life stage and being able to breastfeed successfully appeared to be an important aspect of motherhood for these mothers. Their determination to breastfeed exceeded the challenges they faced in public with their confidence enhancing with time. Findings are considered in light of current social attitudes and the importance of normalising views about breastfeeding in society in order to improve health outcomes.

Certain amino acids, notably L-glutamate and L-aspartate, are believed to fulfil a role as excitatory neurotransmitters in the mammalian Central Nervous System (CNS). Investigation has revealed the presence of three, and possibly a fourth, type of receptor for such neurotransmitters. These receptors have been named after the most potent and selective agonist of each; thus they are usually referred to as N-methyl-D-aspartate (A1), quisqualate (A2), kainate (A3) and 2-amino, 4-phosphono butyric acid (A4); the designations in brackets being that of the nomenclature of Fagg and Foster.

As women’s roles in society have changed and they have had more freedom to pursue other life-goals, decisions about having children are frequently delayed. Consequently, some women find themselves in their late thirties and undecided about motherhood in the face of the relentless ticking of the biological clock. This research explores women’s experiences of being undecided about motherhood between the ages of 35 and 40 when fertility levels begin to decline sharply. Interpretive Phenomenological Analysis (IPA) was used to analyse semi-structured interviews with five participants. Three major findings were identified. The first was that being at an age where fertility is decreasing and finding oneself undecided about the pursuit of motherhood resulted in feelings of panic and fears regarding the future for some participants. This was influenced by the second major finding – that of societal discourses impacting on the participant’s experience. The third finding was the changing sense of identity and emotional impact experienced by participants in the face of their uncertainty. This suggests a multi-faceted experience which encompasses the intertwining of biological, social and psychological factors. These findings are discussed alongside existing literature in the field to suggest how Counselling Psychologists may support and empower women who are experiencing this stage of their lives as a challenging time.

Background/Aims: According to the United Kingdom (UK) census statistics (ONS, 2011), Islam represents the second largest religion after Christianity, and the largest group of Muslims in the UK has a Pakistani heritage. Analysis of the existing research suggests that Pakistani Muslim men with psychological difficulties under-utilise mental health services in the UK. Several studies (mainly quantitative in nature) have reported that CBT can be an appropriate treatment for Pakistani Muslims, but some authors argue that there are fundamental philosophical conflicts between Islam and CBT. However, there has been no research to date on how CBT is actually experienced by Pakistani Muslim men, and the needs of this under-represented group remain unexplored. In response to this dearth of research, particularly in Counselling Psychology, this study investigated the experiences of Pakistani men who had completed CBT treatment within the last 18 months. Design/Method: Verbatim accounts of semi-structured interviews were analysed employing Interpretative Phenomenological Analysis. The participants were six Second-Generation Pakistani Muslim men (SGPMM) aged between 20 and 43 who had received individual CBT. Findings: In the process of analysis three superordinate themes were generated: ‘Pre-CBT difficulties’ (which refers to the thoughts, feelings and challenges that the participants had encountered prior to CBT), ‘the process of CBT for Muslim men’ (which discusses what CBT means and how helpful and/or unhelpful the participants found CBT), ‘the interaction between CBT and Islam (which explores the significance of religion, and how CBT and Islam complement and/or clash with each other). Conclusions: The participants emphasised the difficulties and concerns that SGPMM can encounter in therapy as a result of religious and cultural pressures: namely in adhering to collectivist and individualist values, in meeting family and community expectations, and in reconciling differing aspects of Islam and CBT. It is therefore suggested that training programmes and practitioners should consider developing more targeted interventions to better address this group of clients’ religious and cultural needs.