Psychophysiological responses to visceral and somatic pain in functional chest pain identify clinically relevant pain clusters

Background: Despite chronic pain being a feature of functional chest pain (FCP) its experience is variable. The factors responsible for this variability remain unresolved. We aimed to address these knowledge gaps, hypothesizing that the psychophysiological profiles of FCP patients will be distinct from healthy subjects. Methods: 20 Rome III defined FCP patients (nine males, mean age 38.7 years, range 28-59 years) and 20 healthy age-, sex-, and ethnicity-matched controls (nine males, mean 38.2 years, range 24-49) had anxiety, depression, and personality traits measured. Subjects had sympathetic and parasympathetic nervous system parameters measured at baseline and continuously thereafter. Subjects received standardized somatic (nail bed pressure) and visceral (esophageal balloon distension) stimuli to pain tolerance. Venous blood was sampled for cortisol at baseline, post somatic pain and post visceral pain. Key Results: Patients had higher neuroticism, state and trait anxiety, and depression scores but lower extroversion scores vs controls (all p < 0.005). Patients tolerated less somatic (p < 0.0001) and visceral stimulus (p = 0.009) and had a higher cortisol at baseline, and following pain (all p < 0.001). At baseline, patients had a higher sympathetic tone (p = 0.04), whereas in response to pain they increased their parasympathetic tone (p ≤ 0.008). The amalgamating the data, we identified two psychophysiologically distinct 'pain clusters'. Patients were overrepresented in the cluster characterized by high neuroticism, trait anxiety, baseline cortisol, pain hypersensitivity, and parasympathetic response to pain (all p < 0.03). Conclusions & Inferences: In future, such delineations in FCP populations may facilitate individualization of treatment based on psychophysiological profiling. © 2013 John Wiley & Sons Ltd.

Managing enterprise resource planning and multi-organisational enterprise governance:a new contingency framework for the enterprisation of operations

This research has been undertaken to determine how successful multi-organisational enterprise strategy is reliant on the correct type of Enterprise Resource Planning (ERP) information systems being used. However there appears to be a dearth of research as regards strategic alignment between ERP systems development and multi-organisational enterprise governance as guidelines and frameworks to assist practitioners in making decision for multi-organisational collaboration supported by different types of ERP systems are still missing from theoretical and empirical perspectives. This calls for this research which investigates ERP systems development and emerging practices in the management of multi-organisational enterprises (i.e. parts of companies working with parts of other companies to deliver complex product-service systems) and identify how different ERP systems fit into different multi-organisational enterprise structures, in order to achieve sustainable competitive success. An empirical inductive study was conducted using the Grounded Theory-based methodological approach based on successful manufacturing and service companies in the UK and China. This involved an initial pre-study literature review, data collection via 48 semi-structured interviews with 8 companies delivering complex products and services across organisational boundaries whilst adopting ERP systems to support their collaborative business strategies – 4 cases cover printing, semiconductor manufacturing, and parcel distribution industries in the UK and 4 cases cover crane manufacturing, concrete production, and banking industries in China in order to form a set of 29 tentative propositions that have been validated via a questionnaire receiving 116 responses from 16 companies. The research has resulted in the consolidation of the validated propositions into a novel concept referred to as the ‘Dynamic Enterprise Reference Grid for ERP’ (DERG-ERP) which draws from multiple theoretical perspectives. The core of the DERG-ERP concept is a contingency management framework which indicates that different multi-organisational enterprise paradigms and the supporting ERP information systems are not the result of different strategies, but are best considered part of a strategic continuum with the same overall business purpose of multi-organisational cooperation. At different times and circumstances in a partnership lifecycle firms may prefer particular multi-organisational enterprise structures and the use of different types of ERP systems to satisfy business requirements. Thus the DERG-ERP concept helps decision makers in selecting, managing and co-developing the most appropriate multi-organistional enterprise strategy and its corresponding ERP systems by drawing on core competence, expected competitiveness, and information systems strategic capabilities as the main contingency factors. Specifically, this research suggests that traditional ERP(I) systems are associated with Vertically Integrated Enterprise (VIE); whilst ERPIIsystems can be correlated to Extended Enterprise (EE) requirements and ERPIII systems can best support the operations of Virtual Enterprise (VE). The contribution of this thesis is threefold. Firstly, this work contributes to a gap in the extant literature about the best fit between ERP system types and multi-organisational enterprise structure types; and proposes a new contingency framework – the DERG-ERP, which can be used to explain how and why enterprise managers need to change and adapt their ERP information systems in response to changing business and operational requirements. Secondly, with respect to a priori theoretical models, the new DERG-ERP has furthered multi-organisational enterprise management thinking by incorporating information system strategy, rather than purely focusing on strategy, structural, and operational aspects of enterprise design and management. Simultaneously, the DERG-ERP makes theoretical contributions to the current IS Strategy Formulation Model which does not explicitly address multi-organisational enterprise governance. Thirdly, this research clarifies and emphasises the new concept and ideas of future ERP systems (referred to as ERPIII) that are inadequately covered in the extant literature. The novel DERG-ERP concept and its elements have also been applied to 8 empirical cases to serve as a practical guide for ERP vendors, information systems management, and operations managers hoping to grow and sustain their competitive advantage with respect to effective enterprise strategy, enterprise structures, and ERP systems use; referred to in this thesis as the “enterprisation of operations”.

The influence of eating psychopathology on autobiographical memory specificity and social problem-solving

The primary aim was to examine to influence of subclinical disordered eating on autobiographical memory specificity (AMS) and social problem solving (SPS). A further aim was to establish if AMS mediated the relationship between eating psychopathology and SPS. A non-clinical sample of 52 females completed the autobiographical memory test (AMT), where they were asked to retrieve specific memories of events from their past in response to cue words, and the means-end problem-solving task (MEPS), where they were asked to generate means of solving a series of social problems. Participants also completed the Eating Disorders Inventory (EDI) and Hospital Anxiety and Depression Scale. After controlling for mood, high scores on the EDI subscales, particularly Drive-for-Thinness, were associated with the retrieval of fewer specific and a greater proportion of categorical memories on the AMT and with the generation of fewer and less effective means on the MEPS. Memory specificity fully mediated the relationship between eating psychopathology and SPS. These findings have implications for individuals exhibiting high levels of disordered eating, as poor AMS and SPS are likely to impact negatively on their psychological wellbeing and everyday social functioning and could represent a risk factor for the development of clinically significant eating disorders.

Brief report:effects of sensory sensitivity and intolerance of uncertainty on anxiety in mothers of children with autism spectrum disorder

This study examined the relations between anxiety and individual characteristics of sensory sensitivity (SS) and intolerance of uncertainty (IU) in mothers of children with ASD. The mothers of 50 children completed the Hospital Anxiety and Depression Scale, the Highly Sensitive Person Scale and the IU Scale. Anxiety was associated with both SS and IU and IU was also associated with SS. Mediation analyses showed direct effects between anxiety and both IU and SS but a significant indirect effect was found only in the model in which IU mediated between SS. This is the first study to characterize the nature of the IU and SS interrelation in predicting levels of anxiety.

‘Everything’s from the inside out with PCOS’:exploring women’s experiences of living with Polycystic Ovary Syndrome (PCOS) and co-morbidities through Skype™ interviews

Polycystic ovary syndrome is an endocrine disorder affecting 1 in 10 women. Women with polycystic ovary syndrome can experience co-morbidities, including depressive symptoms. This research explores the experience of living with polycystic ovary syndrome and co-morbidities. Totally, 10 participants with polycystic ovary syndrome took part in Skype™ interviews and analysed using thematic analysis. Four themes emerged from the data: change (to life plans and changing nature of condition); support (healthcare professionals, education and relationships); co-morbidities (living with other conditions and depression, self-harm and suicidal ideation) and identity (feminine identity and us and them). The findings highlight the need for screening of women with polycystic ovary syndrome for depressive disorders.

The influence of alexithymia and mood on eating psychopathology in a non-clinical female sample

It has been demonstrated that clinical and subclinical disor- dered eating are associated with elevated levels of depression and the personality trait alexithymia (ALX). ALX means literally lack of words for emotion and is associated with a difficulty identifying and describing feelings, and with an externally oriented cognitive style. The aim of the current study was to examine the inter-relationships between mood and ALX in accounting for variations in non-clinical eating psychopathology. 124 females were assessed on the 20- item Toronto Alexithymia Scale (TAS-20), the Hospital Anxiety and Depression Scale (HADS) and the Eating Disorders Inventory (EDI). Results revealed that EDI scores were positively associated with scores on the TAS-20 and with scores on the depression and anxi- ety subscales of the HADS. A series of stepwise multiple regressions revealed that depression and ALX accounted for 53% of the variance in total EDI scores and 40% of the variance in scores on the drive- for-thinness subscale of the EDI. Scores on the bulimia and body dissatisfaction subscales were predicted by the mood scores only. In conclusion, ALX and mood may contribute, alone and in combi- nation, to the development of some forms of disordered eating.

The influence of alexithymia and mood on eating psychopathology in a non-clinical female sample

It has been demonstrated that clinical and subclinical disor- dered eating are associated with elevated levels of depression and the personality trait alexithymia (ALX). ALX means literally lack of words for emotion and is associated with a difficulty identifying and describing feelings, and with an externally oriented cognitive style. The aim of the current study was to examine the inter-relationships between mood and ALX in accounting for variations in non-clinical eating psychopathology. 124 females were assessed on the 20- item Toronto Alexithymia Scale (TAS-20), the Hospital Anxiety and Depression Scale (HADS) and the Eating Disorders Inventory (EDI). Results revealed that EDI scores were positively associated with scores on the TAS-20 and with scores on the depression and anxi- ety subscales of the HADS. A series of stepwise multiple regressions revealed that depression and ALX accounted for 53% of the variance in total EDI scores and 40% of the variance in scores on the drive- for-thinness subscale of the EDI. Scores on the bulimia and body dissatisfaction subscales were predicted by the mood scores only. In conclusion, ALX and mood may contribute, alone and in combi- nation, to the development of some forms of disordered eating.

Medical conditions and depressive, anxiety, and somatic symptoms in older adults with and without generalized anxiety disorder

OBJECTIVE: The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxiety disorder (GAD). METHOD: A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated. MEASUREMENTS: The measurements used for this study include: Brief Symptom Inventory-18, Mini International Neuropsychiatric Interview, and the Anxiety Disorders Interview Schedule. RESULTS: Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD. CONCLUSION: These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.

The effect of ward design on the well-being of post-operative patients

Changes in the design of hospital wards have usually been determined by architects and members of the nursing and medical professions; the views and preferences of patients have seldom been sought directly. The Hospital Anxiety and Depression scale and the Disturbance Due to Hospital Noise questionnaire were administered to 64 female patients on bay and Nightingale wards together with a questionnaire designed for this study. Perceptions of social and physical factors of ward design were examined, and their relationship to psychological well-being and sleep patterns. The results show that the bay ward seemed to offer a more favourable environment for patients but some of the disadvantages of bay wards are balanced by better staffing levels and better and more modern facilities. Visibility to nurses was lower on the bay ward. The Nightingale ward was perceived as significantly noisier than the bay ward and noise levels were significantly correlated to anxiety scores. Paradoxically the increase in noise levels appeared to improve the perceived level of privacy on the Nightingale ward. Seventy-five per cent of patients were found to prefer the bay ward design, and since neither design appears to have major disadvantages their continued introduction should be encouraged. However, recommendations are made concerning the optimizing of patients' well-being within the bay ward setting.

Software engineering techniques for the development of systems of systems

This paper investigates how existing software engineering techniques can be employed, adapted and integrated for the development of systems of systems. Starting from existing system-of-systems (SoS) studies, we identify computing paradigms and techniques that have the potential to help address the challenges associated with SoS development, and propose an SoS development framework that combines these techniques in a novel way. This framework addresses the development of a class of IT systems of systems characterised by high variability in the types of interactions between their component systems, and by relatively small numbers of such interactions. We describe how the framework supports the dynamic, automated generation of the system interfaces required to achieve these interactions, and present a case study illustrating the development of a data-centre SoS using the new framework.

Intentional forgetting in depressed states

The aim of this thesis was to extend previous research on intentional forgetting in depressed states. The first experiment used the think/no-think paradigm, and found that although dysphoric individuals were significantly worse at suppressing emotional (positive and negative) words than non-dysphoric individuals, both groups were unsuccessful at direct thought suppression. However, there was no effect of rumination on dysphoric individuals' ability to intentionally forget material. Furthermore, there was also no group differences in attentional measures of Stroop and IDEO. The second experiment involved modifying the TNT task, by including the use of substitute words in the suppression phase, in order to determine whether recalling substitute words during suppression would increase the level of forgetting. The findings from the study revealed that both dysphoric and non-dysphoric individuals were successful at intentionally forgetting neutral words using a thought substitution strategy. However, both groups were impaired at suppressing words in the direct thought substitution condition. The third experiment investigated the influence of thought substitution on intentional forgetting of emotional words in dysphoria. The study replicated experiment two, but used emotional (i.e. positive and depression-relevant) words instead of neutral words. The study found that dysphoric individuals were still impaired in their ability to suppress emotional material. Furthermore, dysphoric individuals were recalling significantly more depression­ relevant respond and previously-suppressed words. The fourth experiment examined the role of executive control in intentional forgetting. In the study, dysphoric and non­ dysphoric participants were categorised as having good or poor executive control based on their scores on the operation span with words task (OSPAN). The study found that non-dysphoric individuals with good control demonstrated successful suppression. However, dysphoric individuals with good control were unsuccessful at suppression. The fifth experiment investigated whether experimentally induced changes in mood state would alter an individual's ability to intentionally forget emotional material. Non-dysphoric healthy participants were given a positive or negative autobiographical memory and music mood induction. They completed two modified think/no-think tasks, one prior to the mood induction and one after the mood induction. The study found that transient negative mood state impaired intentional forgetting of depression-relevant material. Summary: Taken together, the findings suggest that individuals in a depressed mood are impaired in their ability to intentionally forget emotional material, even with the use of a thought substitution strategy. Furthermore, the findings implicate poor executive control and negative mood state in impaired intentional forgetting. An important theme emerging from the findings was the role of an inhibitory mechanism in intentional forgetting. The findings reported in this thesis suggest that thought substitution involves engaging an inhibitory control mechanism that contributes to successful intentional forgetting. The findings have clear implications on depressed individuals everyday functioning, and suggest that even with the presence of effective distraction, dysphoric indivduals are imapired in their ability to suppress emotional material. Furthermore, it is suggested that impaired intentional forgetting of emotional material may contribute to the maintenance of depressed mood, and could potentially worsen ongoing depression.

Self-esteem moderates affective reactions to briefly presented emotional faces

According to the sociometer hypothesis individuals with low self-esteem experience increased negative affect in response to negative social stimuli, even when these stimuli are not perceived consciously. Using an affective priming paradigm, the present study examined whether trait self-esteem would moderate mood following briefly presented facial expressions. Results from 43 undergraduates revealed that, after controlling for baseline mood, anxiety and depression, the degree of negative affect experienced by the participants following exposure to expressions of anger and disgust varied as a function of their self-esteem. Implications for individuals with low-self esteem and our understanding of the link between self-esteem and negative affect are discussed.

An Exploration of parametric software cost estimating models for Jackson Systems Development

Most parametric software cost estimation models used today evolved in the late 70's and early 80's. At that time, the dominant software development techniques being used were the early 'structured methods'. Since then, several new systems development paradigms and methods have emerged, one being Jackson Systems Development (JSD). As current cost estimating methods do not take account of these developments, their non-universality means they cannot provide adequate estimates of effort and hence cost. In order to address these shortcomings two new estimation methods have been developed for JSD projects. One of these methods JSD-FPA, is a top-down estimating method, based on the existing MKII function point method. The other method, JSD-COCOMO, is a sizing technique which sizes a project, in terms of lines of code, from the process structure diagrams and thus provides an input to the traditional COCOMO method.The JSD-FPA method allows JSD projects in both the real-time and scientific application areas to be costed, as well as the commercial information systems applications to which FPA is usually applied. The method is based upon a three-dimensional view of a system specification as opposed to the largely data-oriented view traditionally used by FPA. The method uses counts of various attributes of a JSD specification to develop a metric which provides an indication of the size of the system to be developed. This size metric is then transformed into an estimate of effort by calculating past project productivity and utilising this figure to predict the effort and hence cost of a future project. The effort estimates produced were validated by comparing them against the effort figures for six actual projects.The JSD-COCOMO method uses counts of the levels in a process structure chart as the input to an empirically derived model which transforms them into an estimate of delivered source code instructions.

Tetrahydrobiopterin Metabolism

Tetrahydrobiopterin is the cofactor for the hydroxylation of phenylalanine, tyrosine and tryptophan and is therefore essential for the production of monoamine neurotransmitters. Neopterin, a biosynthetic precusor of tetrahydrobiopterin, and biopterin appear in urine. In normal subjects the urinary neopterin to biopterin ratio has been found to be about 1.00. In patients suffering from Alzheimer's disease, Down's syndrome and depression the urinary neopterin to biopterin ratio has been found to be elevated. In some Alzheimer's and depressed patients the increased urinary neopterin to biopterin ratio is proportional to the severity of the disease. Folates were found not to increase tetrahydrobiopterin biosynthesis in the rat as previously thought. Methotrexate was found to reduce liver biopterin levels and increas_ urinary biopterin levels in the rat. Methotrexate also reduced brain pterin levels but had no influence on liver pterin. Urinary isoxanthopterin, found in some patients, was found to be derived from biopterin and neopterin in the rat. Isoxanthopterin is proposed as an indicator of the levels of tetrahydrobiopterin turnover.

Mechanism of induction of muscle protein loss by hyperglycaemia

Treatment of murine myotubes with high glucose concentrations (10 and 25 mM) stimulated protein degradation through the ubiquitin–proteasome pathway, and also caused activation (autophosphorylation) of PKR (double-stranded-RNA-dependent protein kinase) and eIF2a (eukaryotic initiation factor 2a). Phosphorylation of PKR and eIF2a was also seen in the gastrocnemius muscle of diabetic ob/ob mice. High glucose levels also inhibited protein synthesis. The effect of glucose on protein synthesis and degradation was not seen in myotubes transfected with a catalytically inactive variant (PKR?6). High glucose also induced an increased activity of both caspase-3 and -8, which led to activation of PKR, since this was completely attenuated by the specific caspase inhibitors. Activation of PKR also led to activation of p38MAPK (mitogen activated protein kinase), leading to ROS (reactive oxygen species) formation, since this was attenuated by the specific p38MAPK inhibitor SB203580. ROS formation was important in protein degradation, since it was completely attenuated by the antioxidant butylated hydroxytoluene. These results suggest that high glucose induces muscle atrophy through the caspase-3/-8 induced activation of PKR, leading to phosphorylation of eIF2a and depression of protein synthesis, together with PKR-mediated ROS production, through p38MAPK and increased protein degradation.