This report was developed to 1) examine current evidence-based research for cluttering therapy and 2) consider additional research outside of the field that may be of benefit for cluttering clients. It defines the disorder and briefly discusses its key characteristics. Treatment considerations reviewed include: slowed rate, heightened monitoring, using clear speech, using organized language, interacting with listeners, speaking naturally, and reducing excessive disfluencies. The typical approaches that have been used with clutterers as well as approaches that have been used with other disordered populations that address the key treatment considerations are discussed. / text

The aim of this thesis was to better understand how music performance anxiety can be dealt with to not negatively affect my playing when performing solo piano music by heart in concerts. Another aim was that I would feel a lot more secure and confident on those occasions and that I would be able to focus more on the interpretation and expressing my emotions after this project. The field of MPA has been studied quite a lot but not broadly within the framework of artistic research. This thesis addresses two research questions: How might physical exercises decrease my experience of music performance anxiety? How might mental training decrease my experience of music performance anxiety? The methods used were preparing for three concerts with discovered strategies, keeping a video diary from two days before the concert until the concert day, taking video recordings of the concerts and analyzing the performance videos and video diaries using open coding and observing instimulated recall sessions. I then reflected on how the strategies helped me with the anxiety. As a result of this project, I have found a lot of strategies that help me with MPA. Physical exercises that I have found helpful are e.g., yoga, Zen meditation, deep relaxation, progressive muscle relaxation, regular aerobic exercise, short physical warm-up before the concert, focusing on breathing and releasing muscular tension when practicing and performing. The mental strategies included mental practicing, positive self-talk, identifying and eliminating catastrophic thinking, reinforcing themeaning in performing, having precise goals for the concert, practicing memorization and focusing on musical values when practicing and performing.

The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine's cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals.

The thesis investigated nicotine levels and their effects on hypertensive subjects and whether aspirin could be used in the treatment of hypertension to bring about not only an anti thrombotic effect but reduce the systemic blood pressure especially in those individuals who smoke cigarettes. The study, which also audits the use of aspirin, was conducted in Kuwait and so provides an insight of hypertensive patients very rarely considered in the literature The thesis begins in Chapter One with an extensive literature review which analyses the properties and problems that nicotine causes and its ability to cause hypertensive changes along with its multitude of other events. The physiological and pathological problems caused by nicotine are reviewed on the basis of its chemistry and pharmacological properties using a worldwide perspective rather than just focus on Kuwait. The second Chapter uses extensive analysis of the literature to determine the pharmacological properties of aspirin and its use in cardiovascular disease. The pharmacokinetics and therapeutic effects are presented with emphasis to its inhibitory effects on platelet activation which is central to the development of serious cardiovascular consequences such as stroke and myocardial infarction. The third Chapter returns to consider the literature in detail and why nicotine has specific effects on the cardiovascular system in terms of receptor stimulation and how aspirin may be able to reduce nicotine¿s cardiovascular effects and concludes with the Aims and Objectives of the thesis. The fourth Chapter investigates urinary nicotine levels in smokers from cigarettes available in Kuwait to indicate the actual levels which could be achieved by smokers in this study. This established that the levels would cause pharmacological effects demonstrating also the effects of passive smoking. The number of cigarettes smoked per day has an unpredictable effect on metabolism and urinary output of nicotine. The fifth Chapter is the major investigational section of the thesis and considers if aspirin ability to reduce cardiovascular effects, may be useful in terms of diastolic blood pressure and lipid levels in the 4 blood. The effects were suggestive that aspirin did reduce the blood pressure in hypertensive subjects but was not universal and was limited to those suffering from mild - moderate hypertension. It was determined that aspirin should be sued at the earliest age possible in these patients. The sixth Chapter involved a large scale trial of the effectiveness of aspirin treatment in hypertensive patients over a one year period in Kuwait. This used ambulatory blood pressure measurements to determine the effectiveness of daytime and nightime changes in blood pressure in patients with and without aspirin treatment. The overall conclusion was a reduced relative risk of suffering cardiovascular events in mild to moderate hypertension when aspirin (75mg/day) was administered. Specifically in smokers, aspirin lowers the systolic daytime BP and diastolic nightime BP. To support this work a comprehensive audit is provided of the use of the current use of aspirin in Kuwait hospitals / Cultural Office in the Kuwait Embassy in London; Civil Service Commission of Kuwait; The Assistant Under Secretary for the Drugs and Medical Supplied Affairs

Background: The late onset of therapeutic response and a relatively large proportion of nonresponders to antidepressants remain major concerns in clinical practice. Therefore, there is a critical need for effective medication strategies that augment treatment with antidepressants. Methods: To review the available evidence on the use of lithium as an augmentation strategy to treat depressive episodes. Results: More than 30 open-label studies and 10 placebo-controlled double-blind trials have demonstrated substantial efficacy of lithium augmentation in the acute treatment of depressive episodes. Most of these studies were performed in unipolar depression and included all major classes of antidepressants, however mostly tricyclics. A meta-analysis including 10 randomized placebo-controlled trials has provided evidence that lithium augmentation has a statistically significant effect on the response rate compared to placebo with an odds ratio of 3.11, which corresponds to a number-needed-to-treat of 5. The meta-analysis revealed a mean response rate of 41.2% in the lithium group and 14.4% in the placebo group. One placebo-controlled trial in the continuation treatment phase showed that responders to acute-phase lithium augmentation should be maintained on the lithium-antidepressant combination for at least 12 months to prevent early relapses. Preliminary studies to assess genetic influences on response probability to lithium augmentation have suggested a predictive role of the –50T/C single nucleotide polymorphism of the GSK3β gene. Conclusion: Augmentation of antidepressants with lithium is currently the best-evidenced augmentation therapy in the treatment of depressed patients who do not respond to antidepressants. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: The late onset of therapeutic response and a relatively large proportion of nonresponders to antidepressants remain major concerns in clinical practice. Therefore, there is a critical need for effective medication strategies that augment treatment with antidepressants. Methods: To review the available evidence on the use of lithium as an augmentation strategy to treat depressive episodes. Results: More than 30 open-label studies and 10 placebo-controlled double-blind trials have demonstrated substantial efficacy of lithium augmentation in the acute treatment of depressive episodes. Most of these studies were performed in unipolar depression and included all major classes of antidepressants, however mostly tricyclics. A meta-analysis including 10 randomized placebo-controlled trials has provided evidence that lithium augmentation has a statistically significant effect on the response rate compared to placebo with an odds ratio of 3.11, which corresponds to a number-needed-to-treat of 5. The meta-analysis revealed a mean response rate of 41.2% in the lithium group and 14.4% in the placebo group. One placebo-controlled trial in the continuation treatment phase showed that responders to acute-phase lithium augmentation should be maintained on the lithium-antidepressant combination for at least 12 months to prevent early relapses. Preliminary studies to assess genetic influences on response probability to lithium augmentation have suggested a predictive role of the –50T/C single nucleotide polymorphism of the GSK3β gene. Conclusion: Augmentation of antidepressants with lithium is currently the best-evidenced augmentation therapy in the treatment of depressed patients who do not respond to antidepressants. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

<p>Anaerobic digestion uses a mixed, microbial community to convert organic wastes to biogas, thereby generating a clean renewable energy and reducing greenhouse gas emissions. However, few studies have quantified the relationship between waste composition and the subsequent physical and chemical changes in the digester. This Ph.D. dissertation aimed to gain new knowledge about how these differences in waste composition ultimately affect digester function. This dissertation examined three areas of digester function: (1) hydrogen sulfide production, (2) digester foaming, and (3) methane yield. </p> <p>To accomplish these aims, a variety of materials from four different large-scale field digesters were collected at different time points and from different locations within the digester systems, including influent, liquid in the middle of the digesters, effluent, and effluent after solids separation. The materials were used for biochemical methane potential (BMP) tests in 43 lab-scale lab-digester groups, each containing triplicate or duplicate digesters. The materials from field digesters and the effluents from the lab-digesters were analyzed for an extensive set of chemical and physical characteristics. The three areas of digester function were examined with the physical and chemical characteristics of the digester materials and effluents, and the BMP performances. </p> <p>Hydrogen sulfide productions in the lab-digesters ranged from non-detectable to 1.29 mL g VS^-1. Higher H₂S concentrations in the biogas were observed within the first ten days of testing. The initial Fe(II) : S ratio and OP concentrations had important influences on H₂S productions. Important parameters of digester influents related to digester foaming were the ratios of Fe(II) : S, Fe(II) : TP, and TVFA : TALK; and the concentrations of Cu. Digesters receiving mixed waste streams could be more vulnerable to foaming. The characteristics of each waste type varied significantly based on substrate and inoculum type, and digester functioning. The influent chemical characteristics of the waste significantly impacted all aspects of digester function. Using multivariate statistics and machine learning, models were developed and the prediction of digester outcomes were simulated based on the initial characteristics of the waste types. </p>