This thesis investigates changes in the oscillatory dynamics in key areas of the pain matrix during different modalities of pain. Gamma oscillations were seen in the primary somatosensory cortex in response to somatic electrical stimulation at painful and non-painful intensities. The strength of the gamma oscillations was found to relate to the intensity of the stimulus. Gamma oscillations were not seen during distal oesophageal electrical stimulation or the cold pressor test. Gamma oscillations were not seen in all participants during somatic electrical stimulation, however clear evoked responses from SI were seen in everyone. During a train of electrical pulses to the median nerve and the digit, a decrease in the frequency of the gamma oscillations was seen across the duration of the train. During a train of electrical stimuli to the median nerve and the digit, gamma oscillations were seen at ~20-100ms following stimulus onset and at frequencies between 30-100Hz. This gamma response was found to have a strong evoked component. Following a single electrical pulse to the digit, gamma oscillations were seen at 100-250ms and between 60-95Hz and were not temporally coincident with the main components of the evoked response. These results suggest that gamma oscillations may have an important role in encoding different aspects of sensory stimuli within their characteristics such as strength and frequency. These findings help to elucidate how somatic stimuli are processed within the cortex which in turn may be used to understand abnormal cases of somatosensory processing.

In a series of experiments, we tested category-specific activation in normal parti¬cipants using magnetoencephalography (MEG). Our experiments explored the temporal processing of objects, as MEG characterises neural activity on the order of milliseconds. Our experiments explored object-processing, including assessing the time-course of ob¬ject naming, early differences in processing living compared with nonliving objects and processing objects at the basic compared with the domain level, and late differences in processing living compared with nonliving objects and processing objects at the basic compared with the domain level. In addition to studies using normal participants, we also utilised MEG to explore category-specific processing in a patient with a deficit for living objects. Our findings support the cascade model of object naming (Humphreys et al., 1988). In addition, our findings using normal participants demonstrate early, category-specific perceptual differences. These findings are corroborated by our patient study. In our assessment of the time-course of category-specific effects as well as a separate analysis designed to measure semantic differences between living and nonliving objects, we found support for the sensory/motor model of object naming (Martin, 1998), in addition to support for the cascade model of object naming. Thus, object processing in normal participants appears to be served by a distributed network in the brain, and there are both perceptual and semantic differences between living and nonliving objects. A separate study assessing the influence of the level at which you are asked to identify an object on processing in the brain found evidence supporting the convergence zone hypothesis (Damasio, 1989). Taken together, these findings indicate the utility of MEG in exploring the time-course of object processing, isolating early perceptual and later semantic effects within the brain.

This study examines the invention, innovation, introduction and use of a new drug therapy for coronary heart disease and hypertensio~; beta-blockade. The relationships between drug introductions and changes in medical perceptions of disease are analysed, and the development and effects of our perception of heart disease through drug treatments and diagnostic technology is described. The first section looks at the evolution of hypertension from its origin as a kidney disorder, Bright's disease, to the introduction and use of effective drugs for,its treatment. It is shown that this has been greatly influenced by the introduction of new medical teChnologies. A medical controversy over its nature is shown both to be strongly influenced by the use of new drugs, and to influence their subsequent use. The second section reviews the literature analysing drug innovation, and examines the innovation of the beta-blocking drugs, making extensive use of participant accounts. The way in which the develcpment of receptor theory, the theoretical basis of the innovation,was influenced by the innovation and use of drugs is discussed, then the innovation at ICI, the introduction into clinical use, and the production of similar drugs by other manufacturers are described. A study of the effects of these drugs is then undertaken, concentrating on therapeutic costs and benefits, and changes in medical perceptions of disease. The third section analyses the effects of other drugs on heart disease, looking at changes in mortality statistics and in medical opinions. The study concludes that linking work on drug innovation with that on drug effects is fruitful, that new drugs and diagnostic technology have greatly influenced medical perceptions of the nature and extent of heart disease, and that in hypertension, the improvement in drug treatment will soon result in much of the popUlation being defined as in need of it life-long

No description available.

There are clear indications that over the coming years, as more people live longer with life limiting illnesses an increasing amount of support for carers of service users with palliative care needs will be required. Respite care is often described in UK policy and guidance as a key need in providing this support and yet little is known about it for patients with life limiting illnesses and there is a lack of research to support its efficacy. The purpose of this research was therefore to establish whether respite care addresses the needs of palliative care service users and carers. The approach was qualitative and the methodology was interpretive. The method used was constructivist Grounded Theory. This provided high compatibility with the theoretical underpinnings which were learning from the experiences of service users and carers, embracing the principles of critical practise and learning through relational endeavour. Data collection was carried out by unstructured informal interview with three couples and two bereaved carers who had experienced hospice respite care. The participants were interviewed on two occasions and social network circle activity was undertaken as part of theoretical sampling. Findings showed that respite care is valued by palliative care service users and carers although there are some fundamental tensions in service models which limit its potential. A theory of vulnerability and resilience was developed which accommodated issues of needs and acceptance, choice and risk, loss and gains. A reframing of respite care as an empathic response within a new palliative care approach is proposed. Within this the centrality of the relationship is reinforced and the need for support over a potentially long and more uncertain illness trajectory is acknowledged. The articulation of respite care needs and the insights gained in this study have the potential to influence practice and provide a platform for innovative service development and improvement.

Poor quality and unrefreshing sleep is one of the most common symptom complaints in Chronic Fatigue Syndrome (CFS). Despite this, the links between sleep dysfunction and CFS are not well understood, and there has been an absence of good quality research into the nature of sleep problems in CFS, which also lack consistency in the data reported. However, it remains plausible that sleep problems may help to maintain and exacerbate other existing symptoms. Given the dispute in models ranging from the biological to the psychological, competing to explain symptomology, it is a critical time by which we try to understand the relationship between poor sleep, fatigue, endocrine activity and CFS, in an attempt to shortcircuit this debate. With an aim to redress this, this thesis intended to examine the role of sleep from several angles, utilizing a range of assessment methods; Study 1 addressed the lack of in depth qualitative interview studies, to understand the extent to which sleep, its management and problems, are linked to the lived experience of CFS, and how it interacts with other symptoms (chapter 3). Patient narratives demonstrated that sleep disturbances experienced were highly unpredictable and variable over time, but played a key role in symptom maintenance; Study 2 examined self-reported sleep (via sleep diaries) in CFS patients, exploring whether sleep quality and daytime napping had an impact on daytime fatigue, sleepiness and cognitive functioning (key dimensions of the illness experience) (chapter 4). The results were highly variable but indicated that afternoon-evening napping was associated with greater impairment in daytime cognitive functioning in CFS patients. It was also evident that CFS patients with longer wake time and a shorter diagnosis had more severe fatigue; Study 3 explored the possibility that sleep problems in this population are not homogeneous and revealed four sleep-specific phenotypes to exist, which are amenable to different treatment approaches. The initial cross-sectional examination of single-night polysomnography (PSG) data identified 30% of the sample had a primary sleep disorder (PSD), which underscores the need to assess for PSDs in CFS populations (chapter 5); Study 4 was conducted to address the principle aim of this thesis; to determine the feasibility of a detailed, 3-night sleep assessment protocol in a small cohort of CFS patients. By utilising iv a range of methods including ambulatory PSG and a gold-standard protocol for sampling of diurnal salivary cortisol, the study piloted the most comprehensive assessment of sleep ever attempted in a CFS population. The findings established a successful protocol that was acceptable to patients (chapter 6), a key advancement in this field where effective and thorough sleep assessment is needed. Preliminary sleep data confirmed a notable variability of sleep problems to exist. Further, the temporal stability of sleep variables was established; sleep continuity (sleep duration, wake duration, sleep efficiency) and main architectural (sleep stages) parameters were consistent across two nights of assessment (chapter 7). The results presented in this thesis indicate that disturbed sleep is a major problem for patients with CFS, albeit highly variable between and within individuals. The identification of sleep phenotypes also confirms the heterogeneity of sleep in CFS. Interestingly, light sleep and arousability was a recurring sleep characteristic in patients that was mirrored by the studies presented throughout the thesis, highlighting a potential autonomic component. This should be a consideration for forthcoming work, along with the possibility that sleep disturbances may mediate the maintenance and exacerbation of symptoms, fuelling a reciprocal cycle that keeps the condition going. The preliminary findings presented throughout this trajectory of research will help to form the systematic development of a sleep characterisation and intervention programme. With this field moving towards more patient-centred medicine and tailored treatments, by combining data from the objective and subjective sleep measures, we aim to design a definitive multicentre study, using sleep-specific interventions, amenable to the four phenotypes identified. The long-term goal is to improve treatments that will enhance symptom management, which is crucial in this condition, at least until the CFS research understands the pathogenesis of this debilitating disease.

Background: The MMSE is commonly used as a screening instrument for cognitive impairment in stroke services. However, recent research has shown that it has poor diagnostic validity for use in this patient population. The purpose of this study was to examine the validity of the ACE-R as an alternative screening measure for use in stroke. Objectives: The first objective was to determine whether the ACE-R is more accurate than the MMSE at detecting overall cognitive impairment in stroke. The second objective was to determine the accuracy of the ACE-R subscales for detecting impairments in specific cognitive domains. Methods: This study had a cross-sectional design. 40 patients were recruited from an inpatient stroke service. They were administered the ACE-R (which includes the MMSE), and a battery of more detailed neuropsychological tests, which served as the ‘gold standard’ for classification of impairment. The diagnostic validity of the ACE-R and MMSE was determined by ROC analysis. Results: Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment. No cut-scores scores could be identified which yielded test sensitivity of >80% and specificity of >60%. Levels of specificity were particularly poor. The ACE-R subscales showed a similar pattern of performance, indicating inadequate validity for the detection of impairment in specific areas of cognitive functioning. Conclusions: There was no support for the use of the MMSE or the ACE-R when screening for cognitive impairment in acute stroke. Further research should focus on the identification of an alternative measure.

Background: The MMSE is commonly used as a screening instrument for cognitive impairment in stroke services. However, recent research has shown that it has poor diagnostic validity for use in this patient population. The purpose of this study was to examine the validity of the ACE-R as an alternative screening measure for use in stroke. Objectives: The first objective was to determine whether the ACE-R is more accurate than the MMSE at detecting overall cognitive impairment in stroke. The second objective was to determine the accuracy of the ACE-R subscales for detecting impairments in specific cognitive domains. Methods: This study had a cross-sectional design. 40 patients were recruited from an inpatient stroke service. They were administered the ACE-R (which includes the MMSE), and a battery of more detailed neuropsychological tests, which served as the ‘gold standard’ for classification of impairment. The diagnostic validity of the ACE-R and MMSE was determined by ROC analysis. Results: Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment. No cut-scores scores could be identified which yielded test sensitivity of >80% and specificity of >60%. Levels of specificity were particularly poor. The ACE-R subscales showed a similar pattern of performance, indicating inadequate validity for the detection of impairment in specific areas of cognitive functioning. Conclusions: There was no support for the use of the MMSE or the ACE-R when screening for cognitive impairment in acute stroke. Further research should focus on the identification of an alternative measure.

Background Sensory sensitivity (SS) is defined as the level to which an individual is able to regulate their responses to sensory input. Children with Autistic Spectrum Disorder (ASD) have been found to display unusual and abnormal levels of SS. These variabilities in SS have been associated with poorer levels of adaptive behaviour, behavioural difficulties and emotional problems. Parental questionnaires are frequently used to assess children’s SS. However concern has been raised regarding the use of parents as the sole informant. This study aimed to assess whether parental reports of children’s SS were consistent with alternative informants’ (school staff) reports. Methods The Short Sensory Profile (SSP: Dunn, 1999) was administered to 72 pairs of parents/caregivers and school staff, to be completed for children with ASD (aged 4 to 18 years). This 38 item questionnaire highlights variations of sensory modulation and provides a total score, and 7 factor/subsection scores relating to different aspects of sensory processing (e.g. auditory filtering). This study utilised intraclass correlation coefficient (ICC) values to assess the level of agreement.

In 2011 it was estimated that in Thailand there were 498,800 stroke survivors of both sexes but most were over the age of 65. They were served by only 625 occupational therapists (OTs). Occupational therapy (OT) plays a key role in the rehabilitation service for stroke patients, in particular, by enabling stroke survivors to reengage with activities of daily living and to resume work or family tasks. OT needs to be culturally appropriate and relevant to the therapists, stroke patients and their families. The Occupational Therapy Mahidol Clinic System (OT-MCS) has been designed to be culturally relevant and is based on collaborative teamwork which can better address the needs of the stroke patients. OT-MCS was introduced in 6 regional OT clinics. This study compared perceptions of stroke clients who took part in the new approach 8 weeks before and during the rehabilitation. One hundred and twenty stroke participants were divided into 2 functional groups (slow and fast stream rehabilitation). Stroke participants (N=120) and OTs (N=60) explored the arrangement of activity items into domains for creating a new activity card sort (ACS). Sixty stroke participants (slow stream rehabilitation) and 60 OTs were surveyed to investigate the attitudes of “satisfaction” and “importance” via 40 therapeutic activities. Sixty stroke participants (fast stream rehabilitation) evaluated the levels of their activity engagement in diverse cultural-therapeutic activities. Lastly, 23 stroke participants (slow and fast stream rehabilitation) were interviewed in order to ascertain their lived experiences after the use of OT-MCS and the data were analysed using thematic analysis. The integrated analysis demonstrated strong satisfaction and engagement with OT-MCS. The use of the activity catalogue met with positive attitudes from the stroke participants and in particular the collaborative approach of OTs and participants gave meaning to the activities and a sense of self management. In addition in the fast stream rehabilitation participants reported satisfaction with the transferability of the activities to the home and external environment and their relevance to supporting family life. The OT-MCS for Thai stroke rehabilitation is a comprehensive OT service, which improves the perception of benefit in stroke clients enabling them to perform meaningful and purposeful activities based on their local and regional lifestyles. This culturally appropriate approach helps stroke clients to re-develop their life-skills. Through the use of meaningful and relevant activities which meet their specific needs, stroke clients can lead more satisfying and fulfilling lives.