In search of knowledge and understanding: working with individuals suffering from serious mental illness and their families

This research study describes a journey taken by ten health care professionals on an educational course, the English National Board for Nursing, Midwifery and Health Visiting (ENB) A28, which aimed to enable them to develop the therapeutic skills and confidence to work effectively with the families/carers of individuals suffering from a major mental illness. Their previous education and training had not equipped them to meet the clinical demands now made of them since the focus of mental health care relocated from hospital to the • community' . The course was based in a Family Intervention Service provided in an Inner London Mental Health Trust whose clinicians had developed a treatment model which they termed 'psychosocial' and combined systemic theory. expressed emotion research findings and limited behavioural methods. Grounded Theory was the chosen research method for this study as it was important to be able to access the experience and views of each student as they emerged. The students were interviewed twice, using a semi-structured interview schedule: at the beginning of the course and within three months after its completion. The questions posed at interview were informed following a pilot study of eight of the previous year's students. The students concluded that three elements in the course teaching had most contributed to achieving their aims; theory, practice and live supervision. The role of management and its influence in the clinical life of the students emerged as important. Consequently eight managers were interviewed and revealed the degree to which they supported both the students and the aims of the course. On this depended whether the Trust's clinical services would be able to maximise the benefits from its investment in this educational resource. A retrospective study by questionnaire. and subsidiary to the main investigation. is reported on in Appendices A through F. It focussed on the experience of students who had successfully completed the course during the previous years since its validation. As in the main study. the questionnaire was formulated from information given following a pilot study of eight of the previous year's student group. The aim was to ascertain the long term effects on their clinical practice. The results were analysed using a descriptive analysis technique. Although there had been changes to the original course. the findings were similar to those in the main study and showed the importance of theoretical understanding and supervised practice. Overall. the findings indicate that the respondents valued the systemic approach which was the cornerstone of the educational experience and continued to exert an influence on their practice. They gained an awareness of the extent to which social and family systems impacted on the lives of individuals during the lengthy course of major mental illness

A multi-level framework approach to improve organisational business process understanding within automotive manufacturing

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonBusiness processes are an integral part of today’s multinational corporations, allowing them to create best practice working models. Not only do business processes play an important role in defining working practices, they can also provide a basis for understanding and improvement. One key difficulty is to capture multiple aspects of a process. Capturing these allows an organisation to use these models for multiple purposes, such as learning while obtaining a high process maturity. There is not a single modelling technique that spans over multiple purposes. This research provides a critical overview of the literature of business process modelling to propose a multi-level framework (MLF). This framework aims to model a single crossfunctional process using multiple modelling techniques to address different organisational purposes and achieve a higher process maturity. Three modelling techniques were identified as appropriate to form part of such a framework: Rich Picture Diagrams (RPD), Business Process Modelling Notation (BPMN) and 4D ontologies. Design Science Research was used in three iterations to build the levels of the multi-level framework in an iterative and incremental design approach. The first two iterations used semistructured interviews to gather data, involve stakeholders and evaluate the models, whilst the third iteration proposes a method to develop and evaluate 4D ontologies. The created artefacts form the process overview (using RPD), application view (using BPMN) and semantic view (4D) levels for the final MLF of a cross-functional process. It addresses organisational purposes such as learning, process development and IT requirements, and covers maturity levels from process creation to optimisation. Involvement of stakeholders in the development and evaluation revealed high satisfaction with the provided views and increased their understanding of the process. Future work would further evaluate the overall framework and study the effects of full implementation within industry

A cross-sectional survey investigating women's information sources, behaviour, expectations, knowledge and level of satisfaction on advice received about diet and supplements before and during pregnancy

Background The reported long-term effects of poor maternal nutrition and uptake of recommended supplements before and during pregnancy was the impetus behind this study. Our objectives were to investigate and understand women’s expectations, knowledge, behaviour and information sources used regarding the use of nutrition and vitamin supplements before and during pregnancy. Methods A cross-sectional survey using a self-administered questionnaire was undertaken. A purposive sampling technique was used. Women attending the antenatal clinic at Croydon University Hospital during 2015 were invited to take part in the study. The data was analysed using descriptive statistics, paired sample T-tests and Chi-squared tests, with the level of significance set at 5% (p < 0.05). Results A total of 133 pregnant women completed the survey. Analysis of the results showed that women are currently using electronic resources (33%, n = 42) rather than healthcare professionals (19%, n = 25) as an information source before pregnancy. Women who sourced information through the internet were significantly more likely to take folic acid (p = 0.006) and vitamin D (p = 0.004) before pregnancy. Women preferred to receive information from the antenatal clinic (62%, n = 83), internet (46%, n = 61) and from mobile applications (27%, n = 36). Although women believed they had sufficient knowledge (60%, n = 80) and had received adequate advice (53%, n = 70) concerning the correct supplements to take, this was not demonstrated in their behaviour, with only a small number of women (37%, n = 49) taking a folic acid supplement before pregnancy. Women mistakenly perceived the timing of supplement advice as correct, with only a small number of women (18%, n = 23) considering the advice on supplements as too late. Conclusions Despite the small sample size, this study demonstrated that women did not receive timely and/or accurate advice to enable them to take the recommended supplements at the optimal time. Women had the misconception that they understood the correct use of pregnancy supplements. This misunderstanding may be prevented by providing women intending to become pregnant with a structured, approved electronic source of information that improves their supplements uptake

Governance and Susceptibility in Conflict Resolution: Possibilities Beyond Control

Governmentality analysis offers a nuanced critique of informal Western conflict resolution by arguing that recently emerged alternatives to adversarial court processes both govern subjects and help to constitute rather than challenge formal regulation. However, this analysis neglects possibilities for transforming governance from within conflict resolution that are suggested by Foucault's contention that there are no relations of power without resistances. To explore this lacuna, I theorise and explore the affective and interpersonal nature of governance in mediation through autoethnographic reflection upon mediation practice, and Levina's insights about the relatedness of selves. The paper argues that two qualitatively different mediator capacities - technical ability and susceptibility - operate in concert to effect liberal governance. Occasionally though, difficulties and failures in mediation practice bring these capacities into tension and reveal the limits of governance. By considering these limits in mediation with Aboriginal Australian people, I argue that the susceptibility of mediator selves contains prospects for mitigating and transforming the very operations of power occurring through conflict resolution. This suggests options for expanded critical thinking about power relations operating through informal processes, and for cultivating a susceptible sensibility to mitigate liberal governance and more ethically respond to difference through conflict resolution

Curcumin induces heme oxygenase-1 in normal human skin fibroblasts through redox signaling: relevance for anti-aging intervention

Scope: Curcumin, a component of the spice turmeric, was tested for its potential hormetic anti-aging effects as an inducer of mild stress. Methods and results: Early passage young human skin fibroblasts treated with low doses of curcumin (below 20μM) showed a time- and concentration-dependent induction of heme oxygenase-1 (HO-1), followed by compensatory increase in glutathione-S-transferase activity, GSH levels and GSH/GSSG ratio. These effects were preceded by induction of oxidative stress (increased levels of reactive oxygen species and DNA damage) and impairment of cells' GSH redox state. Curcumin also induced nuclear factor-erythroid-2-related factor 2 accumulation in the nuclei. The use of the antioxidant N-acetyl cysteine prevented the induction of HO-1 by curcumin. Pharmacological inhibition of phosphatidylinositol 3-kinase, but not other kinases, significantly prevented curcumin-induced HO-1 levels, which was corroborated by the induction of phospho-Akt levels by curcumin. Late passage senescent cells already had higher HO-1 levels, and further induction of HO-1 by curcumin was considerably impaired. The induction of stress responses by curcumin in human cells led to protective hormetic effects to further oxidant challenge. Conclusion: Curcumin induces cellular stress responses in normal human skin fibroblasts through phosphatidylinositol 3-kinase/Akt pathway and redox signaling, supporting the view that curcumin-induced hormetic stimulation of cellular antioxidant defenses can be a useful approach toward anti-aging intervention.União Europeia. Fundo Europeu de Desenvolvimento Regional (FEDER) - programa COMPETE (QREN)Fundação para a Ciência e a Tecnologia (FCT) - bolsa PTDC/QUI-BIQ/101392/2008 (NaturAge)

Biopolitics meets Terrapolitics: Political Ontologies and Governance in Settler-Colonial Australia

Crises persist in Australian Indigenous affairs because current policy approaches do not address the intersection of Indigenous and European political worlds. This paper responds to this challenge by providing a heuristic device for delineating Settler and Indigenous Australian political ontologies and considering their interaction. It first evokes Settler and Aboriginal ontologies as respectively biopolitical (focused through life) and terrapolitical (focused through land). These ideal types help to identify important differences that inform current governance challenges. The paper discusses the entwinement of these traditions as a story of biopolitical dominance wherein Aboriginal people are governed as an “included-exclusion” within the Australian political community. Despite the overall pattern of dominance, this same entwinement offers possibilities for exchange between biopolitics and terrapolitics, and hence for breaking the recurrent crises of Indigenous affairs

Diet in Pregnancy: A Review of Current Challenges and Recommendations. A British Nutrition Foundation Briefing Paper"

ABSTRACTPregnancy is a crucial period during which maternal nutrition, weight and lifestyle behaviours have a direct impact on both maternal and fetal health. This briefing paper describes dietary and lifestyle recommendations for women during the preconceptional period and throughout pregnancy, identifying specific factors that can be modified to improve health outcomes for both mother and child. It considers key areas such as nutrient intakes, supplementation, food safety and weight management, and highlights how dietary choices can help reduce the risk of common pregnancy‐related conditions. Despite widespread recognition of the importance of a healthy, balanced diet, many women in the UK fall short of recommended intakes for important nutrients, including iron, folate, iodine and vitamin D. These shortfalls are particularly evident among nutritionally vulnerable groups, such as teenagers, women from lower‐income households and those experiencing food insecurity; such groups may face barriers to accessing healthy foods and adhering to supplementation guidance. An increasing interest in plant‐based diets presents an opportunity to consider a range of dietary patterns that support both maternal health and environmental sustainability. However, such shifts must be carefully managed to ensure adequate intake of nutrients commonly found in animal products, such as vitamin B12, iron, iodine, calcium and long‐chain fatty acids. Rates of overweight and obesity among women of childbearing age remain high, reflecting trends in the general population and contributing to growing concern about maternal obesity. Maintaining a healthy weight before and during pregnancy plays a key role in supporting maternal and fetal wellbeing. Both insufficient and excessive weight gain are associated with elevated risks of complications. Excessive weight gain during pregnancy is associated with an increased risk of developing gestational diabetes, hypertensive disorders such as pre‐eclampsia, preterm birth and a greater likelihood of long‐term obesity in both mother and child. Supporting women to achieve and maintain a healthy weight in the periconceptional period and throughout pregnancy is therefore a public health priority. The antenatal period presents a unique window of opportunity to promote healthier and more sustainable eating patterns, as women are often highly motivated to improve their health and are in more regular contact with healthcare professionals at this time. Yet, research indicates that many women are unaware of dietary recommendations or receive inconsistent advice. To fully harness this opportunity, healthcare providers must be equipped with culturally appropriate, accessible and evidence‐based resources to support perinatal conversations around diet, supplementation, physical activity and body weight. Providing appropriate support during the periconceptional and early pregnancy period is essential to addressing health inequalities, improving long‐term wellbeing and positively influencing the health of future generations

Nature of the evidence base and frameworks underpinning dietary recommendations for prevention of non-communicable diseases: a position paper from the Academy of Nutrition Sciences

Abstract This Position Paper from the Academy of Nutrition Sciences is the first in a series which describe the nature of the scientific evidence and frameworks that underpin nutrition recommendations for health. This first paper focuses on evidence which underpins dietary recommendations for prevention of non-communicable diseases. It considers methodological advances made in nutritional epidemiology and frameworks used by expert groups to support objective, rigorous and transparent translation of the evidence into dietary recommendations. The flexibility of these processes allows updating of recommendations as new evidence becomes available. For CVD and some cancers, the paper has highlighted the long-term consistency of a number of recommendations. The innate challenges in this complex area of science include those relating to dietary assessment, misreporting and the confounding of dietary associations due to changes in exposures over time. A large body of experimental data is available that has the potential to support epidemiological findings, but many of the studies have not been designed to allow their extrapolation to dietary recommendations for humans. Systematic criteria that would allow objective selection of these data based on rigour and relevance to human nutrition would significantly add to the translational value of this area of nutrition science. The Academy makes three recommendations: (i) the development of methodologies and criteria for selection of relevant experimental data, (ii) further development of innovative approaches for measuring human dietary intake and reducing confounding in long-term cohort studies and (iii) retention of national nutrition surveillance programmes needed for extrapolating global research findings to UK populations.</jats:p