3,582 research outputs found
Experience, evidence and what counts in UK music therapy – an arts-based autoethnographic study
The field of music therapy is not bland: therapists train because of deep belief in the dignity of people and the power of music; participants begin therapy because something significantly challenging is present in their lives; fundraisers share stories which are painful, life affirming, uncomfortable; receptionists juggle quiet spaces with loud spaces with stimulation without sensory triggers; carers listen, absorb, give and give some more, often beyond the limits of their energy. And pulse and meter and melody and dynamics and bodies and voices and wood and skin and metal are the raw materials.However, it might be argued that the search for evidence in music therapy has led to something akin to a parallel reality, - one in which measured, analytical reporting of certain aspects of the work is shared, often in official documents. The vital, sensory, embodied, relational experience which is music making, and which lies at the heart of the therapy is rendered in careful and dispassionate text. There are good reasons for this, and for the steady growth of ‘evidence-based practice’, which lie in the history of the profession and its search for validation. Yet the evidence which is shared in these texts has tended to become increasingly disconnected from many features of the musical therapeutic encounter that music therapists value.In this study, conceived from a critical realist perspective, I ask ‘what is experience in music therapy’, ‘what is evidence in music therapy’, ‘are evidence and experience in fact the same thing, or could they be’? I look at my own experiences, and evidencing of these experiences, gained across 24 years of working as a music therapist. In so doing, I find I cannot maintain a single role or persona. Unexpectedly, in the course of this reflexive exploration, four Roles arrive noisily and will not go away (Music Therapist, Researcher, Musician and Carer). They debate, argue and probe at the heart of what counts, and at the cultures of music therapy which systematise and perpetuate what counts. They consider the turn to evidence-based practice in music therapy and ask ‘what is the evidence of’, and ‘does this make sense to insiders, outsiders, either, both’?This multivocal, dialogical approach allows me to adopt the different positions taken by each of the four Roles as they ask ‘does this make sense to me’, and to advocate for culture change in both music therapy and academia. It resonates with the focus of this research – experience, evidence and what counts in music therapy, and invites various different methodological approaches - autoethnography, arts-based research, phenomenology, and Aesthetic Critical Realism which is introduced to the field of music therapy for the first time. A complex web of different kinds of experience and evidence emerges through poems, stories, vignettes, images and mobile making and results in a concept of four phases of experience, leads to defined categories of different kinds of experience, and to the proposition that in music therapy, experience is evidence of personhood.The thesis is relational: those engaging with it are part of the network of experiences in the field of music therapy, because I conceptualise this field as including all musical, logistical, contractual, academic, public and informal encounters of all stakeholders, from participants to next-door neighbours. Because you are engaging with this thesis, I regard you as a Collaborator, but it is not necessary for you to be familiar with the field. Thank you for your involvement
A clinical decision support system for detecting and mitigating potentially inappropriate medications
Background: Medication errors are a leading cause of preventable harm to patients. In older adults, the impact of ageing on the therapeutic effectiveness and safety of drugs is a significant concern, especially for those over 65. Consequently, certain medications called Potentially Inappropriate Medications (PIMs) can be dangerous in the elderly and should be avoided. Tackling PIMs by health professionals and patients can be time-consuming and error-prone, as the criteria underlying the definition of PIMs are complex and subject to frequent updates. Moreover, the criteria are not available in a representation that health systems can interpret and reason with directly.
Objectives: This thesis aims to demonstrate the feasibility of using an ontology/rule-based approach in a clinical knowledge base to identify potentially inappropriate medication(PIM). In addition, how constraint solvers can be used effectively to suggest alternative medications and administration schedules to solve or minimise PIM undesirable side effects.
Methodology: To address these objectives, we propose a novel integrated approach using formal rules to represent the PIMs criteria and inference engines to perform the reasoning presented in the context of a Clinical Decision Support System (CDSS). The approach aims to detect, solve, or minimise undesirable side-effects of PIMs through an ontology (knowledge base) and inference engines incorporating multiple reasoning approaches.
Contributions: The main contribution lies in the framework to formalise PIMs, including the steps required to define guideline requisites to create inference rules to detect and propose alternative drugs to inappropriate medications. No formalisation of the selected guideline (Beers Criteria) can be found in the literature, and hence, this thesis provides a novel ontology for it. Moreover, our process of minimising undesirable side effects offers a novel approach that enhances and optimises the drug rescheduling process, providing a more accurate way to minimise the effect of drug interactions in clinical practice
Women in the public sphere in Egypt : 2011–2014
Through interviews, many documents and secondary data, this dissertation investigates how fifty-four women activists participated in the public sphere in Egypt from the outbreak of the 2011 uprising to the re-emergence of the authoritarian regime in 2014. The women activists studied in the dissertation took part in various counter-publics of social movements, opposition political parties, and civic engagement. Their aim was to influence the political scene at large by participating as women and as citizens in ways that placed their demands within the broader context of the national revolutionary discourse. At the same time, they increased their visibility through participation in the face of various constraints, including the patriarchal order and masculine norms at the family, community, and societal levels while challenging the regime’s repression.The findings of the dissertation emphasise ‘participation’ as encompassing collectivity – which here refers to the process of accessing the public sphere – and visibility – which refers to the content of this participation thereafter. The findings give us a new perspective on how women pushed gender boundaries in different contexts in the public sphere and how they developed a new agency through which they employed different strategies to overcome their exclusion and marginalisation. The findings show how they consciously resisted acting and being portrayed as agents of a liberal/secular Western discourse or submitting to cultural nationalists and Islamists who regard them as victims of an anticolonial nationalist discourse
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Towards a Global System of Innovation: the Role of Donors in Immunisation for International Development
This research examines what role donors play with respect to innovation in immunisation for international development. It uses as its conceptual framework the global innovation system (GIS) model to examine the principal donors within the sector. Because the empirical data is in-depth, contextualised, and qualitative, the research design adopted is that of a multiple case-study of donor organisations, using triangulated, mixed-methods qualitative data collection. The examined cases are UNICEF, the Bill and Melinda Gates Foundation, and Gavi, the Vaccine Alliance.
Knowledge gaps in the existing literature related to how these donors engage actors and institutions across different spatial levels for innovation; to how donors’ manifold power relations affect this; and to how donor structure and capabilities determine their particular roles in innovation.
The research finds strong evidence of an emerging GIS in immunisation for international development. This consists of a global sub-system and a set of sub-systems at the national level, each representing a country receiving development assistance in immunisation. Donors perform four principal roles within this GIS. Firstly, they provide, maintain and extend structural elements of the GIS, especially its networks and linkages between sub-systems. Secondly, donors generate and utilise resources of financial investment, market access and innovation legitimacy for the valuation of innovation. Thirdly, donors coordinate to ensure complementarity in the activities they and other actors provide, which enables effective distributed agency across the GIS. Fourthly, donors navigate the rules, norms and presumptions of the GIS on behalf of partnerships of actors, variously complying, co-opting or contesting them.
The relationship is shown between each of these principal roles and the system’s spatial levels, inter-actor power relations and donors’ structure and capabilities. This offers new, detailed understanding to close significantly the previously-identified knowledge gaps
NEMISA Digital Skills Conference (Colloquium) 2023
The purpose of the colloquium and events centred around the central role that data plays
today as a desirable commodity that must become an important part of massifying digital
skilling efforts. Governments amass even more critical data that, if leveraged, could
change the way public services are delivered, and even change the social and economic
fortunes of any country. Therefore, smart governments and organisations increasingly
require data skills to gain insights and foresight, to secure themselves, and for improved
decision making and efficiency. However, data skills are scarce, and even more
challenging is the inconsistency of the associated training programs with most curated for
the Science, Technology, Engineering, and Mathematics (STEM) disciplines.
Nonetheless, the interdisciplinary yet agnostic nature of data means that there is
opportunity to expand data skills into the non-STEM disciplines as well.College of Engineering, Science and Technolog
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Design for Accessible Collaborative Engagement: Making online synchronous collaborative learning more accessible for students with sensory impairments.
This thesis looks at the accessibility of collaborative learning and the barriers to engagement experienced by blind/visually impaired (BVI) students and deaf/hard of hearing (DHH) students. It focuses specifically on online synchronous collaborative learning after establishing that this format presented the greatest barriers, and that these student groups were not engaging.
Taking a design-based research (DBR) approach, five studies were undertaken to identify these barriers and determine potential interventions. The product of the research, a result of collaborative design by the participants in the study, is a framework for accessible collaborative engagement represented in the form of an interactive website model, the Model for Accessible Collaborative Engagement (MACE).
The studies involved representatives of all stakeholders in the collaborative learning process at the institution (the Open University): students, tutors, modules teams, academics, support staff, and the student union Disabled Students Group. These studies took the form of an online survey of 327 students, 10 interviews with staff and students, 6 staff workshops and a collaborative design focus group. With significant representation of the target groups (BVI and DHH) in all studies, and taking an iterative approach to the design, evaluation and construction of the framework model, the studies established that barriers existed in four main categories covering different themes:
1. Communications: aural, visual, screen reading and navigation, text and captioning, lip reading and non-verbal communications, interpretation and third-party communications, mode control, and synchronisation.
2. Emotional and Social Factors: familiarisation, support networks, self-advocacy, opting out, cognitive load, and stress and anxiety.
3. Provisioning and Technical Factors: dissemination, speed and pacing of sessions, staff training, participation control, group size, technical provisioning, and recordings.
4. Activity and Session Design: Volume of materials, advance materials, accessible materials, accessible activities, and session formats.
Interventions were designed that could reduce the barriers in each of these categories and themes by adjustments and changes from both the student and institutional standpoints. MACE is designed to be utilised by both students and staff to provide guidance and suggestions on how to identify and acknowledge these barriers and implement interventions to reduce them.
This research represents an original and essential contribution to the field of investigation. As well as informing future research inquiry, the model can be used by all participants and stakeholders in online collaborative learning to help reduce barriers for BVI and DHH students and improve inclusivity in synchronous online events
T Follicular Helper cell dynamics in response to vaccination
High quality long lived humoral immune responses require significant help from T follicular helper (Tfh) cells located within the germinal centres (GC) of lymph nodes (LN). Cognate interactions established between Tfh cells and GC B cells regulates somatic hypermutation and affinity maturation, determining the quality of antibodies produced. However, the anatomically protected location of Tfh cells, within the LN, poses a significant logistical and ethical obstacle to in vivo interrogation in humans. This study utilised the fine needle biopsy (FNB) technique to directly probe the GCs of human axillary LNs pre- and post- seasonal influenza vaccination, with the aim to interrogate the commitment of CD4+ T cells to the Tfh cell lineage.
In this study, peripheral blood and draining and contralateral LN FNBs were collected prior to and 5 days post vaccination. Ex vivo phenotyping of LN FNB samples revealed significant expansion of GC Tfh cells was restricted to draining LNs. This early expansion of GC Tfh cells was characterised by an increase in highly activated, motile, and proliferating cells, measured by CD38, ICOS and Ki67 expression. Further, although no significant increase in the absolute number of Pre Tfh cells was observed, there was an increase in CD38+ICOS+ Pre-Tfh cells post vaccination, implicating this population in the immune response and highlighting the changes in cellular profile.
Characterisation of cellular subsets by traditional flow cytometry techniques is limited by the number of parameters available on the instrument. Therefore, we leveraged Smart-Seq2 single cell RNA-sequencing (scRNA-seq) to further examine the heterogeneity within GC Tfh and Pre-Tfh cells. In 3 participants, we identified 7 functionally distinct clusters of cells based on differentially expressed (DE) genes. A proliferating cluster and a motile cluster were observed in all participants. The proliferating cluster exhibited an activated, proinflammatory gene signature and was enriched for Tfh differentiation gene pathways, whereas the motile cluster was enriched for pathways involved in cellular migration and motility, critical for rapid reorganisation of GCs to support dynamic interactions and cellular reactivation.
To explore functional flexibility and plasticity of LN GC Tfh and Pre-Tfh, we integrated scRNAseq post vaccination data from 5 participants. Based on DE genes, we identified 5 distinct clusters; Resting, Activated migrating, B cell interacting Tfh, Proliferating and Cytotoxic. Trajectory analysis using inferred pseudotime revealed the transition of cells through activation states and the gain/loss of different CD4+ T cell lineage attributes and effector functions. Using the T cell receptor as a natural cellular barcode, we were able to identify divergent differentiation into different fate lineages from a common precursor cell.
Overall, the work presented in this thesis is the first to quantify the selective activation of GC Tfh and Pre-Tfh and provides exciting and promising initial evidence of the functional heterogeneity and plastic potential with the Tfh lineage in vivo in human axillary LNs in response to vaccination, that could be leveraged to develop more effective vaccines
Analytical validation of innovative magneto-inertial outcomes: a controlled environment study.
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