"Medically unexplained symptoms" or "MUS" has been constructed as a term to describe persistent physical symptoms for which no medical aetiology can be found. "MUS" account for at least 20 per cent of UK medical consultations, yet fit uneasily within a biomedical discourse where illness is legitimised by medical diagnosis. "MUS" supposedly operates as a neutral category, yet critical review of the literature problematises this so-called neutrality: it fails to be neutral whilst avoiding depicting the situation as it is. There is widespread conflict about terminology and aetiology, which results in the subjective creation of legitimacy criteria; disavowal of a psychological dimension; and patients receiving costly and ineffective treatment. This research, motivated by the need within this conflict to better understand the implications of how we talk about “MUS”, explores how practitioners are constructing “MUS”. Four semi-structured interviews with GPs and counselling psychologists were undertaken and analysed using Foucauldian Discourse Analysis. Alongside underlying biomedical discourses, discourses of separation, mindbody dualism, psychology and holism were identified. These contributed to various constructions of "MUS", including "MUS-as-choice", "MUS-as-challenge", "MUS-as-unreal", "MUS-as-placeless" and "MUS-as-untold-story". This research problematises the separation of illness into categories, the psychologisation of "MUS" and the lack of availability of an acceptable holistic discourse with which to construct illness. It emphasises the performative nature of our talk about "MUS" and the importance of discourse awareness for deepening our understanding of social and cultural influences on how we see the world and act within it. Exclusive biomedical and psychological constructions of illness displace "MUS" as legitimate illness and limit opportunities for constructive dialogue. As practitioners, we need to resist getting caught up in these frameworks. Suggestions are made for how practical disturbances of current working practices might be achieved.

Psoriasis is a chronic autoimmune skin condition that can impair psychological, social, and physical functioning. The psychological implications of psoriasis can be highly disturbing and a significant number of patients with psoriasis live with considerable and enduring psychological distress. An accumulating body of evidence suggests that Cognitive Behavioural Therapy (CBT) may be the most effective in ameliorating the psychological distress resulting from living with psoriasis. CBT has been effective in reducing the emotional distress, the quality of life impairment associated with psoriasis and as a result the clinical severity of it. The mechanisms behind these changes are not known, however. Outcome studies in CBT have shown that common factors (i.e., therapeutic relationship) and/or technical ones (i.e., CBT techniques) account for therapeutic change. The aim of this study is to identify the factors that influence the treatment process and the outcome of CBT for individuals with psoriasis and develop a model of it. This study adopted a constructivist Grounded Theory approach. In-depth semi-structured interviews were conducted with nine patients who had completed a course of CBT within the Psychodermatology Clinic of a hospital in England. From the analysis emerged the model of “Guided Therapeutic Growth” which was the core conceptual framework that subsumed the factors that influence the patients’ experiences of their therapeutic processes in CBT. These factors were: (a) “feeling engaged with the therapeutic process”; (b) “establishing a trusting therapeutic relationship”; (c) “legitimising the expression of distress associated with psoriasis”; and (d) “guided cognitive restructuring of the meanings attached to psoriasis”. The integration of these four interrelated factors forms a tentative model that was found to impact the therapeutic growth by reducing distress, alleviating emotional pain and helping individuals with psoriasis to become more self-compassionate, all of which were found to motivate and empower them to move forward and achieve positive changes in their adjustment to their psoriasis. Conversely, the absence of these factors or the presence of certain hindering conditions could compromise the therapeutic experience of CBT and jeopardise progress. In this context, the following hindering conditions were reported: (a) negative preconceived notions about homework; (b) too much or too little directiveness by the therapist; and (c) externalisation process of emotional release experienced by the patient as too revealing.

Rationale: There is accumulating evidence supporting the effectiveness of Acceptance and Commitment Therapy (ACT) in a group context for individuals with depression and/or anxiety. However, there is limited qualitative research in this area. Aim: This thesis aimed to address this gap by exploring individuals’ experiences of an ACT group for depression and/or anxiety. This may provide an insight into how individuals understand ACT processes and the mechanisms for therapeutic change within ACT. Method: Semi-structured interviews were conducted with six participants. Transcripts were analysed using Interpretative Phenomenological Analysis. Findings: Three master superordinate themes emerged; Group Dynamics; The Journey of Therapy; Usefulness of Therapy. A description of these superordinate themes and the seven related subordinate themes are discussed. The findings highlighted the benefits and challenges of ACT tools and concepts as well as the group context. Recommendations for clinical practice and future research are outlined.

Objective: Expanding the original scope of the study, which was to explore the decision-making process of pregnant women in the uptake of invasive diagnostic tests - amniocentesis and Chorionic Villus Sampling (CVS) – and taking into account the latest emergence of a Noninvasive Prenatal Testing, NIPT, the primary goal of this study was to explore factors that influence women’s decision to have an invasive, a non-invasive or no further testing at all. Design and sample: The Prenatal Decision Making Questionnaire (PDMQ) developed for the purposes of this study. Following a pilot test and factor analysis, it was distributed to a population of pregnant women (N=421) prior to them receiving their combined screening results. The total sample was divided into three sub-groups according to their risk status (low-intermediate-high) for the analysis. Results. Logistic regression analysis using the R version 3.0.3 revealed that none of the PDMQ factors had a significant impact on women’s decision to have an invasive test (CVS), whereas the following three factors had a significant impact on the decision to have a non-invasive test (NIPT): negative attitude to doctors and an internal locus of control were associated with the uptake of NIPT, whereas a negative attitude to medicine was associated with rejection of NIPT When risk status was included in the model it was found that uptake of NIPT was predicted by the presence of some level of risk for T21 or T13/T18. On the contrary, uptake of CVS was only predicted by an increased risk for T21. Conclusion(s): Women’s decision making process in prenatal diagnosis is affected by several factors with personalised risk being one of the key determinants. The findings of this study can be used by healthcare professionals in providing the appropriate support and information and facilitating an informed decision during this stage of pregnancy.

Abstract: Background: Dental hygienists can be utilized to provide care to adolescents and young adults in a school-based setting. These dental health care professionals work to improve upon public oral health through educational practices, preventative methods, and referrals. The purpose of this study was to explore the knowledge and perceptions of elementary and middle school staff with regard to the utilization of a dental hygienist in a school setting. Methods: The international review board at approved the following study. A total of eight faculty and staff members from Unicoi County Elementary School and Unicoi County Middle School completed a 14-question survey. Participants included each school’s principal, nurse, physical education/wellness teacher and science teacher or K-6. All surveys were distributed by hand to each school. Results: All eight participants saw a need for their students and would be in support of having a hygienist assigned to their school. Questions in the survey revealed that the facility believed a hygienist would be beneficial, but a full-time nurse was the major care provider in their institution. The schools that had interactions with a dental hygienist could not give the correct answer for how frequently they were coming, what services they were providing, and who was sending the dental hygienists. Discussion: The Northeast Regional Health Office supply dental hygienist for student dental health centered care and application of preventative services. However, there are only three hygienists working with the Northeast Regional Health Office to provide care for seven counties in this region.

Polymethyl methacry late-antibiotic implants for the local treatment of osteomyelitis have been used in hospitals in the U.S. since the 1970s. This treatment requires a second surgery for removal of t he depleted implant. The purpose of this study is to investigate a new biodegradable implant system based upon poly(ortho esters) (POE) which can release tobramycin sulfate (TS) over a 21-day period (the usual clinical treatment period) with simultaneous and subsequent degradation of polymer in the tissues to harmless constituents. The POE-TS disks without any excipients showed a similar drug release pattern regardless of TS loading ( 4%, 8%, 12%, w/ w) and thickness (148, 244, 433 pm): 20%-60% TS-release within the first 24 hours followed by less than 10% release during the following 20 days with less than 3% weight loss of the polymer. These formulations did not meet therapeutic requirements of either drug release or polymer degradation rate. POE d egradation is known to be acid sensitive. To achieve uniform and high TS release over 21 days, various concentrations of lactic acid (LA), sorbic acid (SA), oleic acid (OA) and palmitoleic acids (PA) were incorporated in the 244pm-disks of 8% TS. The disks with LA demonstrated a pseudo zero-order TS release. With SA, OA & PA, the TS release was multi-phasic and the rate of polymer degradation was found to be acid concentration dependent. The TS release from these disks could be attributed to burst effect, polymer erosion and diffusion. Among these formulations, disks with 0.2% LA and 0 .9% OA gave the best release rate of 2mg TS/ day/ g implant; they achieved desirable therapeutic level of TS release and POE degradation. No physical or chemical interactio ns were detected by DSC, NMR and JR. Comparisons of POE weight loss and molecular weight loss with different acid catalysts revealed extremely different kinetics of acid catalysis. Uniform distribution of the drug in the disks was concluded based on content uniformity studies. Aqueous and solid state stability of TS were found to be suitable for clinical usage.

An evaluation of vancomycin pharmacokinetics was performed in 2 phases. In phase I, a vancomycin population pharmacokinetic model was developed based on data from 126 patients using a two-compartment model. Variables tested for inclusion in the model were creatinine clearance (Crcl), age, total body weight (wt) ICU status, gender, body surface area, ideal weight and height. Variables were included at the P < _ 0. 05 level. The final population pharmacokinetic model was as follows: Cl (L/hr) = (0.025 * Crcl) * (1 + 0.0165 *age), V1 (L) = 29.5, V2 (L) = 8.17 + 0.349 * Crcl and Q (L/hr.kg) = 0. 0639 * wt. For ICU patients, V2 was larger than the non ICU patients and it was V2 (L) = 16.258 + 0.694 * Crcl. In phase II, the performance of the derived model was evaluated and compared to the Moellering, Matzke, Birt & Chandler and Rodvold Methods. Predictability of .52 vancomycin serum concentrations was assessed in 3 0 new patients. In predicting all concentration types, mean prediction error (MPE) with 95% CI for Moellering,. Matzke, Birt & Chandler, Rodvold and current methods were -0.1 (-1.6, 1.4), -0.8 (-0.7, 2. 4) , o. o ( -1.5, 1. 6) , -2. 0 ( -3. 4, -o. 5) , and 2. 1 ( o. 9, 3. 4) mg/L respectively. When considering only troughs, MPE with 95% CI were 1.8 (0.2, 3.4), 2.7 (0.9, 4.6), -1.5 (-3.5, 0.5), -1.5 (-3.2, 0.1), and 0.8 (-0.8, 2.4) mg/L respectively. MPE with 95% for the peaks were -2.5 (-5.0, 0.0), -1.6 (-4.1, 1.0), 2.0 (-0.4, 4.4), -2.5 (-5.3, 0.3) and 3.8 (1.8, 5.8) mg/L respectively. Median absolute prediction error (MABPE) , 5% and 95% quantiles for all concentration types for Moellering, Matzke, Birt & Chandler, Rodvold and current methods were 3.4 (0.2, 10.1), 4.1 (0.3, 10.9), 3.9 (0.4, 11.7), 3.1 (0.2, 13.0) and 2.3 (0.1, 9.5) mg/L respectively. MABPE, 5% and 95% quantiles for the troughs were 2. 6 ( o. 2, 9. 4) , 4. o ( o. 4, 10. 3) , 4. 1 (0.7, 10.2), 2.9 (0.2, 9.4) and 2.0 (0.1, 9.2) mg/L respectively. MABPE, 5% and 95% quantiles for the peaks were 5.0 (0.7, 11.5·), 4.2 (0.3, 10.9), 3.8 (0.4, 11.7), 4.9 (0.6, 13.0) and 5.0 (1.1, 9.5) mg/L respectively. It is recommended that the current method be used while setting initial target peak at 30 mg/L with the initial target trough at 6 mgjL. This should frequently result in serum vancomycin concentration within the therapeutic window. Individualization of therapy should then be done when the measured concentrations are available.

No description available.

Background Krüppel-like Factor 2 (KLF2) plays an important role in vessel maturation during embryonic development. In adult mice, KLF2 regulates expression of the tight junction protein occludin, which may allow KLF2 to maintain vascular integrity. Adult tamoxifen-inducible Krüppel-like Factor 4 (KLF4) knockout mice have thickened arterial intima following vascular injury. The role of KLF4, and the possible overlapping functions of KLF2 and KLF4, in the developing vasculature are not well-studied. Results Endothelial breaks are observed in a major vessel, the primary head vein (PHV), in KLF2-/-KLF4-/- embryos at E9.5. KLF2-/-KLF4-/- embryos die by E10.5, which is earlier than either single knockout. Gross hemorrhaging of multiple vessels may be the cause of death. E9.5 KLF2-/-KLF4+/- embryos do not exhibit gross hemorrhaging, but cross-sections display disruptions of the endothelial cell layer of the PHV, and these embryos generally also die by E10.5. Electron micrographs confirm that there are gaps in the PHV endothelial layer in E9.5 KLF2-/-KLF4-/- embryos, and show that the endothelial cells are abnormally bulbous compared to KLF2-/- and wild-type (WT). The amount of endothelial Nitric Oxide Synthase (eNOS) mRNA, which encodes an endothelial regulator, is reduced by 10-fold in E9.5 KLF2-/-KLF4-/- compared to KLF2-/- and WT embryos. VEGFR2, an eNOS inducer, and occludin, a tight junction protein, gene expression are also reduced in E9.5 KLF2-/-KLF4-/- compared to KLF2-/- and WT embryos. Conclusions This study begins to define the roles of KLF2 and KLF4 in the embryonic development of blood vessels. It indicates that the two genes interact to maintain an intact endothelial layer. KLF2 and KLF4 positively regulate the eNOS, VEGFR2 and occludin genes. Down-regulation of these genes in KLF2-/-KLF4-/- embryos may result in the observed loss of vascular integrity.

The present research work is a transverse and descriptive study, which had as its principal objective to determine the Food and Nutritional Situation of the communities of Villa Santa Chacoma, Hancara, Hichuraya Grande and Pan de Azucar of the Ingavi province of the department of the La Paz. The most relevant part of the study was in finding the elevated percentage of infant population that presents an elevated prevalence and different levels of malnutrition. In adults what calls the attention is the physical exhaustion and the loss of muscle tissue, this situation was seen as a consequence of poverty, food consumption, prolonged exposure to breastfeeding, complementary feeding, type of foods that those under the age of 2 eat, the lack of knowledge about nutrition, geographical location in the communities, the degree of instruction of the heads of family, sanitary conditions and above all the economic factor.