Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

Alcohol consumption and related harm among university students in Ireland

Aim: Alcohol consumption is a leading cause of global suffering. The harms caused by alcohol to the individual, their peers and the society in which they live provokes public health concern. Elevated levels of consumption and consequences have been noted in those aged 18-29 years. University students represent a unique subsection of society within this age group. University authorities have attempted to tackle this issue throughout the past decade. However, the issue persists. Thus, the aim of this study is to contribute to the evidence base for policy and practice in relation to alcohol harm reduction among third-level students in Ireland. Methods: A mixed methods approach was employed. A systematic review of the prevalence of hazardous alcohol consumption among university students in Ireland and the United Kingdom from 2002 to 2014 was conducted. In addition, a narrative synthesis of studies of drinking types evidenced among youths in western societies was undertaken. A cross-sectional study focused on university students’ health and lifestyle behaviours with particular reference to alcohol consumption was undertaken using previously validated instruments. Undergraduate students registered to one university in Ireland were recruited using two separate modes; classroom and online. Studies investigated the impact of mode of data collection, the prevalence of hazardous alcohol consumption and resultant adverse consequences for mental health and wellbeing. In addition a study using a Q-methodology approach was undertaken to gain a deeper understanding of the cultural factors influencing current patterns of alcohol consumption. Data were analysed using IBM SPPS statistics 20, Stata 12, MPLUS and PQ Method. Results: The literature review focusing on students’ alcohol consumption found that there has been both an increase in hazardous alcohol consumption among university students and a convergence of male and female drinking patterns throughout the past decade. Updating this research, the thesis found that two-thirds of university students consume alcohol at a hazardous level, detailing the range of adverse consequences reported by university students in Ireland. Finally, the heterogeneous nature of this drinking was described in a narrative synthesis exposing six types of consumption. The succeeding chapters develop this review further by describing three typologies of consumption, two quantitative and one quali-quantilogical. The quantitative typology describes three types of drinking for men (realistic hedonist, responsible conformer and guarded drinker) and four types for women (realistic hedonist, peer-influenced, responsible conformer and guarded drinker). The quali-quantilogical approach describes four types of consumption. These are defined as the ‘guarded drinker’, the ‘calculated hedonist’, the ‘peer-influenced drinker’ and the ‘inevitable binger’. Discussion: The findings of this thesis highlight the scale of the issue and provide up-to-date estimates of alcohol consumption among university students in Ireland. Hazardous alcohol consumption is associated with a range of harms to self and harms to others in proximity to the alcohol consumer. The classification of drinkers into types signal the necessity for university management, health promotion practitioners and public health policy makers to tackle this issue using a multi-faceted approach.

"On our way": identities and representations of African women seeking asylum in Ireland

This thesis provides the first explicit Postcolonial study of asylum in the Irish context that integrates Black Feminist analyses of intersectional identity with Postcolonial Feminist theories of representation. African women seeking asylum in the Republic of Ireland were key political instruments used by the state to re-draw racial lines. The study examines how, for a group of African women “On their Way” through asylum, identity and representation work hand in hand to force identities, subaltern spaces and bodies to occupy them. Rich biographical data is gathered through mixed art and drama methods over two intensive participatory research projects conducted in a small Irish city. Data analysis critically examines the poetics (practices that signify) and politics (the powers that govern these practices) and affective economies of global and local NGO visual representations, exposing how they consume, fragment, and appropriate African women’s identities and bodies. Though hypervisible, the women themselves “cannot speak”. The women in the study reported feeling “tired” and “used”. Asking “What work are they doing as they do asylum?” the study finds that black female identities and bodies are forced to perform political, cultural, emotional and material labour on their way through this context of Irish asylum. The author argues that Postcolonial Asylum is a performative encounter that re-scripts colonial race/class/gender discourse through a humanitarian alibi to naturalize European/white supremacy, reinscribe patriarchal power and justify racialised incarceration of bodies seeking asylum in the North. This study takes an interdisciplinary approach that centralizes Black and Postcolonial Feminist theory and innovates Participatory Art-Based Action methodology. Black and Postcolonial feminisms can recognize, theorize and replenish black female political and intellectual agency. Participatory Action research, if grounded in Black feminist epistemology and ethics, can allow participants to “speak back” to what is already said about them in spaces of convivial self-representation.

High-resolution pore-water and solid-phase analyses of sediment cores GeoB6520-3 (Hydrate Hole) and GeoB6521-2 (Worm Hole) of the northern Congo Fan

The geochemical cycling of barium was investigated in sediments of pockmarks of the northern Congo Fan, characterized by surface and subsurface gas hydrates, chemosynthetic fauna, and authigenic carbonates. Two gravity cores retrieved from the so-called Hydrate Hole and Worm Hole pockmarks were examined using high-resolution pore-water and solid-phase analyses. The results indicate that, although gas hydrates in the study area are stable with respect to pressure and temperature, they are and have been subject to dissolution due to methane-undersaturated pore waters. The process significantly driving dissolution is the anaerobic oxidation of methane (AOM) above the shallowest hydrate-bearing sediment layer. It is suggested that episodic seep events temporarily increase the upward flux of methane, and induce hydrate formation close to the sediment surface. AOM establishes at a sediment depth where the upward flux of methane from the uppermost hydrate layer counterbalances the downward flux of seawater sulfate. After seepage ceases, AOM continues to consume methane at the sulfate/methane transition (SMT) above the hydrates, thereby driving the progressive dissolution of the hydrates "from above". As a result the SMT migrates downward, leaving behind enrichments of authigenic barite and carbonates that typically precipitate at this biogeochemical reaction front. Calculation of the time needed to produce the observed solid-phase barium enrichments above the present-day depths of the SMT served to track the net downward migration of the SMT and to estimate the total time of hydrate dissolution in the recovered sediments. Methane fluxes were higher, and the SMT was located closer to the sediment surface in the past at both sites. Active seepage and hydrate formation are inferred to have occurred only a few thousands of years ago at the Hydrate Hole site. By contrast, AOM-driven hydrate dissolution as a consequence of an overall net decrease in upward methane flux seems to have persisted for a considerably longer time at the Worm Hole site, amounting to a few tens of thousands of years.

EDUCATING THE PUBLIC THROUGH NEWS MEDIA: CASE STUDIES OF NEWS LITERACY IN THE NEW MEDIA LANDSCAPE

Two decades of unprecedented changes in the media landscape have increased the complexity of informing the public through news media. With significant changes to the way the news industry does business and the way news consumers access this information, a new set of skills is being proposed as essential for today’s news consumer. News literacy is the use of critical thinking skills to assess the reliability and source of the information that people consume on a daily basis, as well as fostering self-awareness of personal news consumption habits and how it can create audience bias. The purpose of this study was to examine how adults experience the news in their everyday lives and to describe the nature of the news literacy skills people employ in their daily news consumption. This study purposefully selected four adults who have completed high school, and who regularly consume news information across a number of platforms, both traditional and digital. Two of the participants, one man and one woman, were over 50 years old. One other male participant was in his 30’s and the final participant, a young woman, was in her 20’s. They all utilized both traditional and digital media on a regular basis and all had differing skill levels when using social media for information. Their news experiences were documented by in-depth interviews and the completion of seven daily news logs. In their daily logs the participants differentiated news information from other information available on-line but the interviews revealed a contradiction between their intentions and their news consumption practices. All four participants had trouble distinguishing between news and opinion pieces in the news information realm. In addition all but one seemed unaware of their personal bias and any possible effect it was having on their news consumption. Further research should explore the benefits of an adult-centered news literacy curriculum on news consumers similar to the participants, and should examine the development of audience bias and its relationship to the daily exposure people have to the torrent of information that is available to them on a daily basis.

Exploring the Shopping Imaginary: The Dreamworld of Women's Magazines

This paper focuses on the consumer imagination and, more specifically, on the imaginary shopping spaces which women's magazines create. It addresses the anticipatory, imaginary and experiential consumption which this medium invites. The paper explores how women's magazines function as ‘dreamworlds’ of shopping; and how contemporary readers consume these imaginary shopping spaces. In order to illustrate what the authors term the ‘shopping imaginary’, they draw on findings from a study of women's experiential consumption of magazines, which show the multifaceted ways around which imaginary consumption is explored and enjoyed by women. The study suggests that women's magazines, like department stores, are spaces that facilitate and celebrate just looking and browsing, and, above all, they are shopping spaces that address the power of the imagination within them. Copyright © 2005 John Wiley & Sons, Ltd.

Tourism in Albarracín and Region. Local Public Action and dynamics in recent key sustainable tourism development

Spanish tourist destinations in rural areas have been established over more than two decades of implementation of various public policy instruments (mainly tourism and rural development policies). These convey complementary objectives in theory but provoke distant results in practice. The intervention of these instruments produces in the region of Sierra de Albarracín (Teruel) two types of destination whose sustainability is committed: the historical urban site of Albarracín as a consolidated cultural tourism destination based on heritage and the Sierra as a generic and incipient destination of rural tourism. It is discussed how the deployment of the local public action causes a fragmented territory in two models of management and tourism development. Cooperation is presented as a key element for the necessary rethinking of tourism development in the region.

Turismo rural y paisaje en zonas de montaña. Propuesta metodológica para identificar sus relaciones en las Sierras Meridionales de la Provincia de Albacete

Las zonas de montaña cuentan con especificidades geográficas y socioeconómicas. En ellas, a partir del patrimonio territorial natural y cultural, se ha producido un considerable impulso del turismo rural, que ha centrado el interés en la valoración de la singularidad y variedad de los paisajes. En este caso se presta atención a las sierras meridionales de la provincia de Albacete. El trabajo se apoya en una metodología que combina el uso de encuestas de preferencias de turistas y técnicas cartográficas a partir de algunas variables del sistema turístico en el medio rural. El trabajo se inserta dentro de los paradigmas del desarrollo local y el desarrollo sostenible, aplicado a los espacios rurales y a las zonas de montaña media del sureste de Castilla-La Mancha. La hipótesis se centra en la consideración del paisaje como elemento medular del turismo rural.

Macroalgae contribute to the diet of Patella vulgata from contrasting conditions of latitude and wave exposure in the UK

Analysis of gut contents and stable isotope composition of intertidal limpets (Patella vulgata) showed a major contribution of macroalgae to their diet, along with microalgae and invertebrates. Specimens were collected in areas with limited access to attached macroalgae, suggesting a major dietary component of drift algae. Gut contents of 480 animals from 2 moderately wave-exposed and 2 sheltered rocky shores in each of 2 regions (western Scotland, 55-56°N; and southwest England, 50°N), were analysed in 2 years (n = 30 site-1 yr-1). The abundance of microalgae, macroalgae and invertebrates within the guts was quantified using categorical abundance scales. Gut content composition was compared among regions and wave exposure conditions, showing that the diet of P. vulgata changes with both wave exposure and latitude. Microalgae were most abundant in limpet gut contents in animals from southwestern sites, whilst leathery/corticated macroalgae were more prevalent and abundant in limpets from sheltered and northern sites. P. vulgata appears to have a more flexible diet than previously appreciated, and these keystone grazers consume not only microalgae, but also large quantities of macroalgae and small invertebrates. To date, limpet grazing studies have focussed on their role in controlling recruitment of macroalgae by feeding on microscopic propagules and germlings. Consumption of adult algae suggests that P. vulgata may also directly control the biomass of attached macroalgae on the shore, whilst consumption of drift algae indicates that the species may play important roles in coupling subtidal and intertidal production.

Macroalgae contribute to the diet of Patella vulgata from contrasting conditions of latitude and wave exposure in the UK

Analysis of gut contents and stable isotope composition of intertidal limpets (Patella vulgata) showed a major contribution of macroalgae to their diet, along with microalgae and invertebrates. Specimens were collected in areas with limited access to attached macroalgae, suggesting a major dietary component of drift algae. Gut contents of 480 animals from 2 moderately wave-exposed and 2 sheltered rocky shores in each of 2 regions (western Scotland, 55-56°N; and southwest England, 50°N), were analysed in 2 years (n = 30 site-1 yr-1). The abundance of microalgae, macroalgae and invertebrates within the guts was quantified using categorical abundance scales. Gut content composition was compared among regions and wave exposure conditions, showing that the diet of P. vulgata changes with both wave exposure and latitude. Microalgae were most abundant in limpet gut contents in animals from southwestern sites, whilst leathery/corticated macroalgae were more prevalent and abundant in limpets from sheltered and northern sites. P. vulgata appears to have a more flexible diet than previously appreciated, and these keystone grazers consume not only microalgae, but also large quantities of macroalgae and small invertebrates. To date, limpet grazing studies have focussed on their role in controlling recruitment of macroalgae by feeding on microscopic propagules and germlings. Consumption of adult algae suggests that P. vulgata may also directly control the biomass of attached macroalgae on the shore, whilst consumption of drift algae indicates that the species may play important roles in coupling subtidal and intertidal production.

Multifunctional anthraquinone-based sensors: UV, O2and time

An anthraquinone dye, Remazol brilliant blue R, RBBR, is used to create an indicator which can function as: (i) a UV dosimeter, (ii) an O2 indicator and (iii) a ‘Consume within’ indicator, CWI, for fresh, refrigerated foods. The dye is encapsulated in an ink containing a polymer, glycerol and a UV-activated semiconductor photocatalyst, titanium dioxide. When cast as a film, the dye is readily reduced by the TiO2 photocatalyst nanoparticles, thereby changing the colour of the film from blue to yellow, via a transitional green colour. The RBBR indicator is appropriately formulated, and covered with a film of Sellotape, which acts as an O2 barrier, so as to act as a sunburn warning indicator for people with skin type II. In the absence of the layer of Sellotape the RBBR indicator is used as an, albeit slow, sensor for measuring ambient levels of O2. Finally, by keeping the Sellotape layer, a UV-activated, yellow-coloured, RBBR indicator film is found to take ca. 42 h at 5 °C in ambient air to attain a green colour, and, on this basis, it is demonstrated as a possible CWI for refrigerated fresh foods.

Eating from the same plate? Revisiting the role of labile carbon inputs in the soil food web

An increasing number of empirical studies are challenging the central fundamentals on which the classical soil food web model is built. This model assumes that bacteria consume labile substrates twice as fast as fungi, and that mycorrhizal fungi do not decompose organic matter. Here, we build on emerging evidence that points to significant consumption of labile C by fungi, and to the ability of ectomycorrhizal fungi to decompose organic matter, to show that labile C constitutes a major and presently underrated source of C for the soil food web. We use a simple model describing the dynamics of a recalcitrant and a labile C pool and their consumption by fungi and bacteria to show that fungal and bacterial populations can coexist in a stable state with large inputs into the labile C pool and a high fungal use of labile C. We propose a new conceptual model for the bottom trophic level of the soil food web, with organic C consisting of a continuous pool rather than two or three distinct pools, and saprotrophic fungi using substantial amounts of labile C. Incorporation of these concepts will increase our understanding of soil food web dynamics and functioning under changing conditions.

National incomes and economic growth in pre-industrial Europe: insights from recent research

Pessimistic Malthusian verdicts on the capacity of pre-industrial European economies to sustain a degree of real economic growth under conditions of population growth are challenged using current reconstructions of urbanisation ratios, the real wage rates of building and agricultural labourers, and GDP per capita estimated by a range of methods. Economic growth is shown to have outpaced population growth and raised GDP per capita to in excess of $1,500 (1990 $ international at PPP) in Italy during its twelfth- and thirteenth-century commercial revolution, Holland during its fifteenth- and sixteenth-century golden age, and England during the seventeenth- and eighteenth-century runup to its industrial revolution. During each of these Smithian growth episodes expanding trade and commerce sustained significant output and employment growth in the manufacturing and service sectors. These positive developments were not necessarily reflected by trends in real wage rates for the latter were powerfully influenced by associated changes in relative factor prices and the per capita supply of labour as workers varied the length of the working year in order to consume either more leisure or more goods. The scale of the divergence between trends in real wage rates and GDP per capita nevertheless varied a great deal between countries for reasons which have yet to be adequately explained.

La visibilidad de la investigación y OrcID

[ES]La comunicación científica está experimentando en las últimas décadas enormes cambios. El uso de Internet ha revolucionado la manera en que se genera y consume la información científica, la aparición del Acceso Abierto y de herramientas derivadas de la Web 2.0, así como la persistencia del modelo tradicional de evaluación científica, muestran un panorama al investigador complejo. La carrera investigadora supone un esfuerzo y para sacarle el máximo rendimiento se ha de elegir el modo más apropiado para rentabilizar el conocimiento generado. Para ello, se esbozarán las fórmulas más idóneas para difundir la documentación científica, qué canales utilizar (A/A, revistas de impacto, redes académicas, etc.). Asimismo se tratará el nuevo identificador de la firma personal de un investigador (OrcID).

Konsumenters uppfattning och kännedom om hållbar produktion och konsumtion : Teknologiska produkter och mobiltelefoner

Sambandet mellan konsumtion och klimatförändringar blir mer tydligt och jordens naturresurser som utarmas kan enligt forskning helt tillskrivas mänskligt beteende. För att lösa denna kris behöver delvis konsumentbeteendet förändras och konsumenter behöver välja mer hållbara produkter. Den överkonsumtion som finns idag är ett stort hot mot en hållbar utveckling och svenska konsumenter är en grupp som är snabba att konsumera det nyaste på marknaden. Konsumtionen av teknologiska produkter som exempelvis mobiltelefoner, datorer och tv-apparater har ökat kraftigt under de senaste tjugo åren då dessa produkter har blivit en del av konsumentens vardag. Nya modeller av mobiltelefoner kommer ständigt ut på marknaden och mobiltelefonen är en av de teknologiska produkterna där konsumtionen har ökat kraftigt. Syftet med denna uppsats var att undersöka konsumenters uppfattning och kännedom om hållbar produktion och konsumtion av teknologiska produkter. Mobiltelefonen är den teknologiska produkt som valdes som studieobjekt. Vi valde att genomföra en kvalitativ metod med semistrukturerade intervjuer för att uppfylla syftet. Intervjuerna genomfördes med tio studenter vid olika utbildningsprogram vid Högskolan Dalarna. Resultatet visade att konsumenters generella uppfattning och kännedom om hållbar produktion och konsumtion av teknologiska produkter var låg. Det fanns en viss kännedom om hållbarhetsfrågor hos våra respondenter men ingen hade tidigare reflekterat över detta i samband med produktion och konsumtionen av teknologiska produkter. Uppfattningen hos respondenterna är i stor utsträckning att produktion och konsumtion har påverkan på den hållbara utvecklingen.