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Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
The mineralogy of the clay fraction was studied for soils and saprolite on two Blue Ridge Front mountain slopes. The clay fraction contained the weathering products of primary minerals in the mica gneiss and schist parent rocks. Gibbsite is most abundant in the saprolite and residual soil horizons, where only chemical weathering has been operable. In colluvial soil horizons, where both physical and chemical weathering have occurred, the clay fraction consists largely of comminuted primary phyllosilicates —muscovite, chlorite, and possibly biotite—and their weathering products: vermiculite, interstratified biotite/vermiculite (B/V), and kaolinite. The clay-size chlorite contains Fe2+ as indicated by Mössbauer spectroscopy, and is more resistant to weathering than biotite. The vermiculite and B/V, both weathering products of biotite, contain Fe3+. Vermiculite in colluvial soils and, especially, surface horizons is weakly hydroxy-interlayered. The kaolinite in the clay fraction resulted at least partly from the comminution of kaolinized biotite in coarser fractions.
The hematite content ranged from 0 to 8% of the clay fraction and strongly correlates (r =.95) with dry clay redness, as measured by the redness rating: RR = (10 - YR hue) × (chroma) ÷ (value). The hematite is largely a product of the weathering of almandine; thus, the soil redness is dependent on the amount of almandine in the parent materials and its degree of weathering in the soils. Goethite (13–22% of the clay fraction) imparts a yellow-brown hue to soils derived from almandine-free parent rocks. The release of Fe in relatively low concentrations during the weathering of Fe-bearing primary minerals, particularly biotite, appears to have promoted the formation of goethite.
The weathering products of primary biotite, chlorite, magnetite, and almandine in mica gneiss and schist in the North Carolina Blue Ridge Front were determined. Sand-size grains of biotite, the most abundant, readily weathered mineral in the parent rock, have altered to interstratified biotite/vermiculite, vermiculite, kaolinite, and gibbsite in the saprolite and soil. Fe2+-chlorite in the parent rock was relatively resistant to chemical weathering, which appears to be confined to the external surfaces of particles. Magnetite grains in the saprolite are essentially unaltered, but those in the soil contain abundant crystallographically controlled etch pits and are coated with oxidation crusts. Almandine altered to goethite, hematite, and gibbsite as the rock weathered to saprolite. Extensively weathered almandine grains were found to contain etch pits and what appeared to be oxide coatings. Apparently, a rapid release of Fe during weathering produced hematite, whereas slower release of Fe favored the formation of goethite.
In this chapter, the subjection of the Israelites in Egypt and their later liberation from oppression is examined with extracts from the Hebrew Torah, and the Greek Septuagint. The vocabulary of servitude of both Hebrew and Greek is discussed through the account of Joseph’s service and disgrace in the house of Potiphar, followed by the suffering of the Israelites, the later descendants of Jacob. The oppression inflicted by the Egyptians and their pharaoh on the Israelites in Egypt is to be seen in their forced labour in making bricks and construction work. Liberation involved leaving the country together, under the leadership of Moses. A final section examines a few further literary texts dating from the Hellenistic and Roman periods that treat related Jewish subjects.
In this chapter tomb paintings join the selection of texts (preserved on stone, papyrus, and leather) to show the role of dependence as a structural feature of pharaonic society. Foreigners were acquired through raiding and warfare, and settled in both existing and new communities. An actual trade in persons is also documented and varying aspects of the experience of such individuals is examined, as they were exploited by those who purchased them or passed them on as gifts. Changes over time in the vocabulary of dependence are discussed, as are the different types of work and production in which such dependents were involved. Non-free dependents were employed on the land, in animal herding, and in artisanal workshops, especially textiles, as well as in the home. The key economic role of Egyptian temples is a constant feature of the period.
This chapter introduces the following corpus of texts from ancient Egypt, and outlines the differing meanings ascribed to slavery and dependence from antiquity to modern times. The terms used for dependents and slaves in the various languages of the texts translated here – Egyptian (Hieroglyphic, Hieratic, Demotic, and Coptic), Greek, and Arabic – are briefly presented, and defining features of the condition of those so labelled are discussed. How and from where such persons were acquired, their life experiences, and the different forms of exploitation in which they were involved are introduced, as are forms of slave resistance and limits to the archaeological and textual evidence available, and so to what we can learn from it.
Covering late antique Egypt into the period of Arab rule, this chapter introduces documents and literary texts translated from Greek, Coptic, and Arabic. In the countryside, coloni joined slaves and dependents at work on the great estates of Byzantine Egypt, while in the cities slavery continued as before. Coptic literature from the same period introduces servitude within Christian monasteries. The writings of Shenoute and Gnostic texts regularly employ the vocabulary of slavery in a negative sense. The trade, employment, and emancipation of slaves continued. Conscripted labour is also documented. Children and adults donated to monasteries represent a new form of sacred servitude. With the Arab conquest of Egypt, war and raiding resurface as important sources of slaves. Nubia and the Near East were again key areas for their acquisition, and slaves are illustrated as active in most areas of life and integrated into the religious life of their owners’ households.
In Roman Egypt, Greek remained the language of rule but the introduction of the Roman legal system and practices resulted in changes within the bureaucracy and an increase in documentation. Declarations were now required for birth, death, taxes, and much else. There were minor changes in the vocabulary of slavery, but in terms of acquisition and use much remained unchanged. There was an active market in slaves who were primarily employed in the home. There is further evidence for slaves in labouring jobs, artisanal roles, in entertainment and sex work. Imperial slaves held some important administrative roles, and slaves might act as business agents in urban settings. Slave labour was little used in agriculture, though the balance between free and unfree changed over time. As earlier, the boundaries between these categories were sometimes blurred. There is evidence, too, for the manumission of slaves. Documents translated in this chapter illustrate the situation.