The concept of function in osteopathy and conventional medicine : a comparative study

This study compares and contrasts the uses of 'function' in osteopathy and in a closely related area of conventional medicine, viz., orthopaedic surgery. Function is a fundamental concept in both; but a survey of the literature, and an initial analysis of the language used by practitioners in a sample of case studies, suggests that while orthopaedic surgeons focus on local failures of physiological function (Fphys), osteopaths are concerned with such failures in the global context of the whole body (Fglob). This is closely related to individual patients' expectations in relation to their overall ability to function (Fpt). The musculo-skeletal system, with which osteopaths are expert, is shown to be particularly significant for understanding Fphys, Fpt and Fglob. These uses of function are further analysed by drawing on the philosophical literature. This is shown to focus, like orthopaedic surgeons, mainly on biological function (Fbiol which includes Fphys). In consequence, it is argued, the philosophical literature has under-emphasised the significance of context in defining functional norms. Certain authors have recognised the importance of context for the functioning of people (i. e. as Fpt); in this thesis, by contrast, context is shown to be important in defining functional norms at all levels, including the physiological/biological. In respect of the relationship between osteopathy and conventional medicine, it is concluded that Fglob (as employed more by osteopaths) involves explaining the clinical significance of local dysfunction in the broad context of patients' activities, and Fphys (as employed more by orthopaedic surgeons) involves categorising local dysfunction in terms of referential standards. The concept of agency, although not examined in detail, emerges as the key to linking the role of context in the meaning of function statements to the intentions and self-perception of patients in clinical practice. Because of the special role of the musculo-skeletal system in enacting agency, osteopathy offers particular insights into the contextual nature of function statements

Gender as an \u27Interplay of Rules\u27: Detecting Epistemic Interplay of Medical and Legal Discourse with Sex and Gender Classification in Four Editions of the Dewey Decimal Classification

When groups of people are represented in classification systems, potential exists for them to be structurally or linguistically subordinated, erased or otherwise misrepresented (Olson & Schlegl, 2001). As Bowker & Star (1999) have shown, the real-world application of classification to people can have legal, economic, medical, social, and educational consequences. The purpose of this research is to contribute to knowledge organization by showing how the epistemological stance underlying specific classificatory discourses interactively participates in the formation of concepts. The medical and legal discourses in three timeframes are examined using Foucauldian genealogical discourse analysis to investigate how their depictions of gender and epistemic foundations correspond and interplay with conceptualizations of similar concepts in four editions of the Dewey Decimal Classification. As knowledge organization research seeks solutions to manage the paradigm change from assumptions of universal knowledge to instability of knowledge, recognition of epistemological underpinnings of classification systems is necessary to understand the very real consequences of corresponding classifications of gender

The Electronic Patient Records System as Technology-in-Practice: The Impact of the Implementation of New Technology on the Routines and Structures in a Health Care Setting.

Adopting new technologies, such as electronic patient records (EPR) systems, is essential for improving inefficient practices and increasing productivity while reducing costs. However, studies show that many organizations fail to adopt technologies with demonstrable advantages. The relationship between technology and work transformation in complex organizations is poorly understood and further theoretical development is needed to advance our knowledge. This research draws on Orlikowski’s (2000) model of technology-in-practice, which suggests that the use of technology depends on how people interact with the technology and with each other over time and enact structures in social contexts. This study looks at how routines change when an EPR is implemented in a private hospital in Greece and how the technology is changed by the routines surrounding its use, aiming to explore the role of agents in implementing and using technologies in health organizations. It is conducted in two stages and is based on interpretive epistemology. Twenty-two semi-structured interviews and over twenty hours of onsite observation were conducted and analysed using a thematic approach. The findings show that the uptake of the EPR improved the performance of particular routines, the communication within the hospital, the productivity and service quality. However, in some departments different individuals introduced variations in the use of the technology and the surrounding routines. This study highlights the role of agents in implementing, using and changing a technology and refers to the technological, organizational and interpretive conditions influencing their actions. It helps researchers to understand that when a technology is integrated in complex networks, its use is less malleable than in contexts where individual actions are independent and users can shape it to fit their needs. It also emphasizes the need for designing technologies that fit the needs of end users, adequate training, strong leadership and clinician engagement in the change process

Intergenerational Interactions and the Psychological Health of Internet Users in Later Life

Intergenerational interactions have the potential to benefit older adults psychologically and remains an area warranting further investigation. The growing prevalence of internet use and intergenerational programmes has increased the opportunities for accessing intergenerational interactions in the familial and non-familial settings respectively. This thesis sought to elucidate older adults’ experiences of intergenerational interactions in both realms. Part 1 comprises a systematic review considering the impact of internet-mediated familial intergenerational contact on older adults’ psychological health. Based on the 20 included studies, the five broad areas related to remote familial intergenerational contact are: social connections and isolation, broader psychological well-being, sense of self and meaning, emotions and safety. Owing to limitations of the literature and the review, these findings are preliminary and merit further research. Part 2 comprises an empirical qualitative study exploring older internet users’ experiences of non-familial intergenerational interactions and intergenerational programmes, with a focus on their psychological well-being. Semi-structured interviews were conducted and analysed inductively in a process guided by the reflexive thematic analysis approach. Findings illustrated that participants were able to form social connections, reconnect with their younger selves, fulfil their passion for learning, contribute to others and occupy their time meaningfully through intergenerational programmes. Future research should continue to study factors influencing the usefulness of intergenerational programmes for this increasingly heterogeneous population. Part 3 comprises a critical appraisal of issues related to this research process. Reflections about conducting qualitative research and research more generally will be discussed, with an emphasis on subjectivity and practicality

Investigating Subsumption in SNOMED CT: An Exploration into Large Description Logic-Based Biomedical Terminologies

Formalisms based on one or other flavor of Description Logic (DL) are sometimes put forward as helping to ensure that terminologies and controlled vocabularies comply with sound ontological principles. The objective of this paper is to study the degree to which one DL-based biomedical terminology (SNOMED CT) does indeed comply with such principles. We defined seven ontological principles (for example: each class must have at least one parent, each class must differ from its parent) and examined the properties of SNOMED CT classes with respect to these principles. Our major results are: 31% of these classes have a single child; 27% have multiple parents; 51% do not exhibit any differentiae between the description of the parent and that of the child. The applications of this study to quality assurance for ontologies are discussed and suggestions are made for dealing with the phenomenon of multiple inheritance. The advantages and limitations of our approach are also discussed

Policing the boundaries: the writing, representation and regulation of criminology

Writing has a central role in UK higher education as a technology for, and signifier of, the learning, teaching and assessment of students. The nature and quality of student writing has also become an important issue outside the academy, particularly in the context of a globalised neo-liberal knowledge economy discourse which emphasises the importance of transferable and employability skills. Although there is a considerable body of research relating to student writing, the work that I undertook for earlier professional doctorate assignments suggested that the role of academic staff in regulating student writing was under-researched and under-theorised. The research carried out for this thesis sought to address this gap in knowledge by focussing on two central questions. Firstly, what role do academic staff play in regulating student writing? Secondly, how is this role shaped by the specific departmental, disciplinary and institutional contexts in which they are located? The research was undertaken in a criminology department in a post-1992 university in the UK. It was positioned in an academic literacies framework which conceptualises writing as a social practice, and drew on linguistic ethnographic methodologies to explore the written feedback that staff give on student writing. The written feedback encounter is where staff and student expectations about academic writing practices intersect, and is therefore a telling site for the study of educational discourses relating to knowledge and how it is represented. Data were collected from three main sources: written feedback and comments given by academic staff on 120 pieces of student work; 18 interviews with staff about academic writing; and institutional policies and procedures relating to marking, assessment and feedback. Employing a range of theoretical perspectives, including those informed by feminist and poststructuralist analysis, these texts were analysed to explore the relationship between institutional discourses, pedagogical practices and identity construction. My research showed that there was a considerable disjuncture between the institutional discourses which governed marking, assessment and feedback and the actual feedback practices of staff. Despite the strong scientific and positivist discourse that pervaded institutional documentation on assessment and feedback, some staff drew on a range of alternative pedagogical discourses and engaged in assessment practices which were more subjective and localised in nature. This gap between the institutional discourse and the situated literacy practices was mediated to some extent by the assessment coversheet and marking procedures which worked to provide an appearance of consistency and agreement to external audiences. This promoted a technical rational approach to feedback which obscured the epistemological and gatekeeping functions of feedback. The thesis concludes that the effective theorisation and teaching of student writing rests on an understanding of how academic staff construct and police the boundaries of appropriate knowledge in their discipline. This approach draws on existing academic literacies theories but argues for a more holistic model which understands academic writing as co-constructed through the practices of both students who produce the written work and the academic staff who mark it

Psychological and social aspects of bariatric surgery

This portfolio has three parts.The first is a systematic literature review, in which the psychological and social factors associated with successful weight loss after bariatric surgery are reviewed.The second part is an empirical paper, which investigates the experiences of women who have successfully lost weight following bariatric surgery, specifically with reference to changes in self-concept. Seven women were interviewed and emergent themes were analysed using interpretative phenomenological analysis. Nine subthemes were identified, clustered into three superordinate themes: (1) ‘obesity as socially unacceptable’, (2) ‘making a case for surgery’, and (3) ‘the slim self as socially acceptable’. Links to self-concept were made, and clinical implications were discussed.The third part of the portfolio comprises of the reflective statement and appendices