Complex PTSD, interpersonal trauma and relational consequences: Findings from a treatment-receiving Northern Irish sample

Background:
The relationship between PTSD and complex PTSD remains unclear. As well as further addressing this issue, the current study aimed to assess the degree to which DESNOS (complex PTSD) was related to interpersonal trauma and had relational consequences.

Methods:
Eighty one treatment-receiving participants with a history of exposure to the ‘Troubles’ in Northern Ireland, were assessed on various forms of interpersonal trauma, including exposure to the Troubles, and measures of interpersonal and community connectedness.

Results:
DESNOS symptom severity was related to childhood sexual abuse and perceived psychological impact of Troubles-related exposure. A lifetime diagnosis of DESNOS was related to childhood Troubles-related experiences, while a current diagnosis of DESNOS was associated with childhood emotional neglect. PTSD avoidance predicted current DESNOS diagnosis and severity. Feeling emotionally disconnected from family and friends (i.e., interpersonal disconnectedness) was related to all three indices of DESNOS (i.e., lifetime diagnosis, current diagnosis and current symptom severity).

Limitations:
Sample characteristics (i.e., treatment-receiving) and size may limit the generalizability of findings.

Conclusions:
Complex PTSD is associated with PTSD but when present should be considered a superordinate diagnosis.

Roles for the subiculum in spatial information processing, memory, motivation and the temporal control of behaviour

The subiculum is in a pivotal position governing the output of the hippocampal formation. Despite this, it is a rather under-explored and sometimes ignored structure. Here, we discuss recent data indicating that the subiculum participates in a wide range of neurocognitive functions and processes. Some of the functions of subiculum are relatively well-known-these include providing a relatively coarse representation of space and participating in, and supporting certain aspects of, memory (particularly in the dynamic bridging of temporal intervals). The subiculum also participates in a wide variety of other neurocognitive functions too. however. Much less well-known are roles for the subiculum, and particularly the ventral subiculum, in the response to fear, stress and anxiety, and in the generation of motivated behaviour (particularly the behaviour that underlies drug addiction and the response to reward). There is an emerging suggestion that the subiculum participates in the temporal control of behaviour. It is notable that these latter findings have emerged from a consideration of instrumental behaviour using operant techniques; it may well be the case that the use of the watermaze or similar spatial tasks to assess subicular function (on the presumption that its functions are very similar to the hippocampus proper) has obscured rather than revealed neurocognitive functions of subiculum. The anatomy of subiculum suggests it participates in a rather subtle fashion in a very broad range of functions, rather than in a relatively more isolated fashion in a narrower range of functions, as might be the case for

Testing a social ecological model for relations between political violence and child adjustment in Northern Ireland

Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family, and child psychological processes in child adjustment, supporting study of interrelations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M = 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures or community discord, family relations, and children's regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members' reports of current sectarian antisocial behavior and nonsectarian antisocial behavior. Interparental conflict and parental monitoring and children's emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children's adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world.

Exploring and comparing the experience and coping behaviour of men and women with colorectal cancer at diagnosis and during surgery

Aim. This paper is a report of a study exploring and comparing the experience of men and women with colorectal cancer at diagnosis and during surgery.

Background. Men have higher incidence and mortality rates for nearly all cancers and frequently use health behaviours that reflect their masculinity. There has been minimal investigation into the influence of gender on the experience of a ‘shared’ cancer.

Methods. From November 2006 to November 2008, a qualitative study was conducted involving 38 individuals (24 men, 14 women) with colorectal cancer. Data were generated using semi-structured interviews at four time points over an 18-month period. This paper reports the participants’ experience at diagnosis and during surgery (time point 1) with the purpose of examining the impact of gender on this experience.

Findings. In general, men appeared more accepting of their diagnosis. The majority of females seemed more emotional and more affected by the physical side effects. However, there was variation in both gender groups, with some men and women portraying both ‘masculine’ and ‘feminine’ traits. There was also individual variation in relation to context.

Conclusions. It appears that many men may have been experiencing side effects and/or psychological distress that they were reluctant to discuss, particularly as some men portrayed typical ‘masculine’ traits in public, but felt able to open up in private. Nurses should not make assumptions based on the traditional view of masculinity, and should determine how each man wants to deal with their diagnosis and not presume that all men need to ‘open up’ about their illness.

Defining the molecular basis for the first potent and selective orthosteric agonists of the FFA2 free fatty acid receptor

FFA2 is a G protein-coupled receptor that responds to short chain fatty acids (SCFAs) and has generated interest as a therapeutic target for metabolic and inflammatory conditions. However, definition of its functions has been slowed by a dearth of selective ligands that can distinguish it from the closely related FFA3. At present, the only selective ligands described for FFA2 suffer from either poor potency, altered signaling due to allosteric modes of action, or a lack of function at non-human orthologs of the receptor. To address the need for novel selective ligands, we synthesized two compounds potentially having FFA2 activity and examined the molecular basis of their function. These compounds were confirmed to be potent and selective FFA2 agonists that interact with the orthosteric binding site. A combination of ligand structure-activity relationship, pharmacological analysis, homology modeling, species ortholog comparisons and mutagenesis studies were then employed to define the molecular basis of selectivity and function of these ligands. From this, we identified key residues within both extracellular loop 2 (ECL2) and the transmembrane domain (TM) regions of FFA2 critical for ligand function. One of these ligands was active with reasonable potency at rodent orthologs of FFA2 and demonstrated the role of FFA2 in the regulation of lipolysis in murine 3T3-L1 adipocytes. Together, these findings describe the first potent and selective FFA2 orthosteric agonists and demonstrate key aspects of ligand interaction within the orthosteric binding site of FFA2 that will be invaluable in future ligand development at this receptor.

Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

Evaluation of a Final Year Work-shadowing Attachment

The transition from medical student to junior doctor is well recognised to be a difficult and stressful period. To ease this transition, most UK universities have a work-shadowing period (WSP), during which students can learn practical skills needed for forthcoming employment. The aim of this study was to evaluate the WSP at Queen's University Belfast, and gain the views of both students and Foundation Programme Supervisors and Directors (FPSDs). The study utilised both qualitative (focus groups) and quantitative (questionnaires) approaches. The FPSDs completed a specific questionnaire designed for this study, while the students completed the university's internal quality assurance questionnaire. Twenty-eight of the 37 (76%) FPSDs and 106 / 196 (54%) students completed the questionnaires. Focus groups were conducted with up to 10 students in each group in both a regional centre and a district general hospital at the start and the end of the WSP as well as 8 weeks into working life. The transcripts of the focus groups were analysed and themes identified. A number of deficiencies with the current WSP were identified, including concerns about the use of log books, the timing of the attachment and relatively low levels of supervision provided by senior hospital staff members. As a result, students felt unprepared for commencing work, with particular mention given to medical emergencies, prescribing, and the emotional aspects of the job. A number of recommendations are made, including the need for more senior input to ensure better student attendance, participation and clinical interaction. Furthermore, students should be offered additional supervised responsibility for delivery of patient care and more experiential learning with respect to drug prescribing and administration. The study also suggests that more needs to be done to help ease the emotional and psychological stresses of the early FY1 period. These issues have been resolved to a large extent with the introduction of the new final year Student Assistantship module in the academic year 2010-2011. © The Ulster Medical Society, 2012.

A Social–Ecological, Process-Oriented Perspective on Political Violence and Child Development

Youth's risk for adjustment problems amid political violence is well documented, but outcomes vary widely, with many children functioning well. Accordingly, researchers are seeking to identify the mechanisms and conditions that contribute to children's adjustment, with an interest in understanding effects on children in terms of changes in the social contexts in which they live and the psychological processes engaged by these social ecologies. In this article, we look at the importance of studying many levels of the social ecology and of differentiating the effects of exposure to contexts of political versus nonpolitical violence, and we address theories about explanatory processes. We review research pertinent to these themes, including a six-wave longitudinal study on political violence and children in Northern Ireland.

Mathematics background of engineering students in Northern Ireland and Finland

The Organisation for Economic Co-operation and Development investigated numeracy proficiency among adults of working age in 23 countries across the world. Finland had the highest mean numeracy proficiency for people in the 16 – 24 age group while Northern Ireland’s score was below the mean for all the countries. An international collaboration has been undertaken to investigate the prevalence of mathematics within the secondary education systems in Northern Ireland and Finland, to highlight particular issues associated with transition into university and consider whether aspects of the Finnish experience are applicable elsewhere. In both Northern Ireland and Finland, at age 16, about half of school students continue into upper secondary level following their compulsory education. The upper secondary curriculum in Northern Ireland involves a focus on three subjects while Finnish students study a very wide range of subjects with about two-thirds of the courses being compulsory. The number of compulsory courses in maths is proportionally large; this means that all upper secondary pupils in Finland (about 55% of the population) follow a curriculum which has a formal maths content of 8%, at the very minimum. In contrast, recent data have indicated that only about 13% of Northern Ireland school leavers studied mathematics in upper secondary school. The compulsory courses of the advanced maths syllabus in Finland are largely composed of pure maths with a small amount of statistics but no mechanics. They lack some topics (for example, in advanced calculus and numerical methods for integration) which are core in Northern Ireland. This is not surprising given the much broader curriculum within upper secondary education in Finland. In both countries, there is a wide variation in the mathematical skills of school leavers. However, given the prevalence of maths within upper secondary education in Finland, it is to be expected that young adults in that country demonstrate high numeracy proficiency.

Session organiser/chair: Architecture, Infrastructure and the Making of Modern Ireland

‘A free Ireland would drain the bogs, would harness the rivers, would plant the wastes, would nationalise the railways and the waterways, would improve agriculture, would protect fisheries, would foster industries, would promote commerce, and beautify the cities …’ (Padraig Pearse, ‘From a Hermitage’, 1913)

Somewhat unusually in his often romantic writings Padraig Pearse – poet, pedagogue and revolutionary – chose to describe the future of an independent Ireland in terms of infrastructure and technological processes. Terence Brown’s locating of this excerpt at the beginning his seminal work Ireland: A Social and Cultural History 1922-2002 highlights the simultaneous and interlinking construction of both a new physical and cultural landscape for an independent modern nation. Lacking any significant industrial complex, the construction of new infrastructures in Ireland was seen throughout the 20th century as a key element in the building of the new State, just as the adoption of an international style modernism in architecture was perceived as a way to escape the colonial past. For Paul N. Edwards modernity and infrastructure are intimately connected.

‘infrastructures simultaneously shape and are shaped – in other words, co-construct – the condition of modernity. By linking macro, meso, and micro scales of time, space and social organisation, they form the stable foundation of modern social worlds’ (2003: 186).
Simultaneously omnipresent and invisible – infra means beneath – Edwards also points out that infrastructure tends only to become apparent when it is either new or broken. Interpreting the meso scale as being that of the building, this session calls for papers that critically and analytically investigate aspects of the architectures of infrastructure in 20th-century Ireland. Like the territory they explore these papers may range across scales to oscillate between a concern for the artefact and its physical landscape, and the larger, often hidden systems and networks that co-define this architecture.

Psychosocial interventions to improve quality of life and emotional wellbeing in newly diagnosed cancer patients

Title
Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients.

Background
Despite clear guidelines recommending the provision of emotional support for cancer patients, we do not know how best to address psychological distress in this group.

Aim
To assess the effects of psychosocial interventions to improve quality of life (QoL) and general psychological distress newly diagnosed cancer patients.

Methods
We searched electronic sources for RCTs of psychosocial interventions or ‘talking therapies’ with individual newly diagnosed cancer patients. Only trials measuring QoL and general psychological distress were included. Meta-analyses examined subgroups by outcome measurement, mode of delivery and discipline of trained helper.

Results
Thirty trials met the criteria. No significant effects were observed for QoL at 6-months (SMD 0.11; 95% CI -0.00 to 0.22) except when using cancer-specific measures (SMD 0.16; 95% CI 0.02 to 0.30). Sub-group analyses revealed that psycho-educational, nurse-delivered interventions improved QoL (SMD 0.23; 95% CI 0.04 to 0.43). General psychological distress as assessed by ‘mood measures’ improved (SMD - 0.81; 95% CI -1.44 to -0.18), but heterogeneity was a factor.

Discussion and conclusion
Psychosocial interventions vary in format and content, raising concerns about heterogeneity, despite appearing to have a beneficial impact on cancer-specific QoL and mood. Future research should concentrate on screening for emotional support needs and identifying common elements within interventions that are of value. Authors should carefully select outcome measures that are appropriately sensitive to change.

Distributed Sounding Art – Practices in Distributing Sound (eds. Barry Truax, Marcel Cobussen and Vincent Meelberg)

This chapter examines distributed sounding art by focusing on three key aspects that we consider essentially tied to the notion of distribution: assignment, transport and sharing. These aspects aid us in navigating through a number of nodes in a history of sounding art practices where sound becomes assigned, transported and shared between places and people. Sound or data become distributed, and in the process of distribution, meanings become assigned and altered through differing socio-cultural contexts of places and people. We have selected several works, commencing in the 1960’s as we consider this period as having produced some of the seminal works that address distribution.
We draw on works by composers, performers and sound artists and thus present a history of sounding art, which is amongst the many histories of sounding art in the 20th and 21st century.

Psychosocial interventions to improve quality of life and emotional wellbeing in newly diagnosed cancer patients

Title
Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients.

Background
Despite clear guidelines recommending the provision of emotional support for cancer patients, we do not know how best to address psychological distress in this group.

Aim
To assess the effects of psychosocial interventions to improve quality of life (QoL) and general psychological distress newly diagnosed cancer patients.

Methods
We searched electronic sources for RCTs of psychosocial interventions or ‘talking therapies’ with individual newly diagnosed cancer patients. Only trials measuring QoL and general psychological distress were included. Meta-analyses examined subgroups by outcome measurement, mode of delivery and discipline of trained helper.

Results
Thirty trials met the criteria. No significant effects were observed for QoL at 6-months (SMD 0.11; 95% CI -0.00 to 0.22) except when using cancer-specific measures (SMD 0.16; 95% CI 0.02 to 0.30). Sub-group analyses revealed that psycho-educational, nurse-delivered interventions improved QoL (SMD 0.23; 95% CI 0.04 to 0.43). General psychological distress as assessed by ‘mood measures’ improved (SMD - 0.81; 95% CI -1.44 to -0.18), but heterogeneity was a factor.

Discussion and conclusion
Psychosocial interventions vary in format and content, raising concerns about heterogeneity, despite appearing to have a beneficial impact on cancer-specific QoL and mood. Future research should concentrate on screening for emotional support needs and identifying common elements within interventions that are of value. Authors should carefully select outcome measures that are appropriately sensitive to change.