Client perceptions : a useful measure of coordination of health care

Despite the many interventions and trials aimed at improving coordination of health care, there is currently no accepted measurement of coordination. My professional interests and an opportunity provided by the Care Plus (Coordinated Care) Trial in the ACT led me to consider client perceptions as a potentially appropriate measure. My research question is “can coordination of health care be usefully measured through client perceptions?” ¶ I addressed this question by developing and testing an instrument to measure perceptions of coordination called the Client Perceptions of Coordination Questionnaire (CPCQ). In the thesis I describe the processes of developing the instrument, testing it through use in several studies and considering how useful such an instrument may be for health services research. In addition to the Coordinated Care Trial, I conducted two validation studies - in a chronic pain population and a general practice sample. ¶ ..

Characterization of CONSTANS, an Arabidopsis gene that promotes flowering.

Under long day conditions Arabidopsis thaliana plants grow vegetatively for approximately two weeks before they initiate flowering while under short day conditions the vegetative period lasts around six weeks. The constans (co) mutant flowers later than wild type under long days but at approximately the same time as wild type under short days. This suggests that the CO product promotes flowering in response to long days. The CO gene was cloned previously by chromosome walking and encodes a 373 amino acid protein containing two zinc fingers suggesting that it binds DNA and is involved in regulation of gene expression. A series of mutant alleles of the CO gene was characterized and the effect of each mutation on flowering time examined. All seven co mutants are semi-dominant, with the heterozygotes having flowering times and leaf numbers intermediate between wild type and the homozygous co parent, and all differ quantitatively with respect to flowering time and leaf number. The co alleles were characterized at the molecular level and the mutations were clustered into two regions of the gene that define important domains of the predicted CO protein. Five of the mutations affect the zinc finger region near the N-terminus of the protein and the remaining two mutations affect adjacent amino acids in a basic domain near the C-terminus of the protein. Both of these domains and the individual amino acids affected by the mutations are highly conserved. Homology searches revealed a family of at least 14 closely related genes in Arabidopsis and homologues in a number of other plant species. The seven co mutations all cause in-frame changes and none were unambiguous null alleles. To investigate the effect of loss of CO function a putative null allele, co-8, was isolated after gamma-irradiation. This was characterized at the molecular level and found to contain a 1.3 kb deletion which removes approximately 1 kb of the promoter and 0.3 kb of the coding sequence at the 5’ end of the CO ORF that includes the zinc finger domain. The new co-8 mutant has an intermediate flowering time with respect to the seven previously isolated co mutants, and is also semi-dominant. A number of constructs designed to express derivatives of the CO protein were introduced into Arabidopsis to investigate whether it was possible to repress flowering by the creation of dominant negative mutations. However, with the exception of one or two small effects these did not greatly affect flowering time. A Brassica napus homologue of the CO gene was isolated. The predicted protein is 74% identical to the Arabidopsis CO protein, with the greatest conservation over the zinc fingers (91% identical) and C-terminal basic domain (94% identical). The homologue was able to complement the Arabidopsis co-2 mutation and restore wild type flowering time

John Gay's the beggar's opera: early eighteenth-century responses in the arts to cultural, sociological and political issues in London life

Differing responses in art media to these contemporary issues of London life are explored, taking John Gay's the Beggar's Opera as the focal point for discussion. Initially, a general survey is made of Gay's role as cultural, social and moral critic. Comparison with George Frederick Handel's Floridante allows Gay's work to be placed in the context of operatic responses to contemporary society, highlighting usage both of overt portrayal and indirect satire. Gay's approach to political issues is examined alongside that of Dean Swift's Gulliver's Travels enabling an estimation to be made of the effectiveness of these art media as tools of political propaganda. Similarly, responses in the field of painting are discussed in the light of representative works of James Thornhill and William Hogarth's A Harlot's Progress and A Rake's Progress. In considering all these responses it is noted that art can be interpreted at differing levels, from the sophisticated to the naive. All these art media are then placed in the context of artistic philosophy of the period, thus facilitating an objective assessment of the parallels and differences of art's responses to contemporary issues. Taking into account inherent limitations in the media, to conclude our study, Hogarth's The Beggar's Opera Scenes are compared and contrasted with Gay's prototype. The thesis highlights the trend towards realism in the arts during this period. Nevertheless, we are left with the conundrum that art, 'per se', can only 'mirror' life. It does not necessarily solve its problems. Thesis submitted in fulfilment of the requirements for the degree of Master of Arts in Music. University of Durham Department of Music 198

Quantifying the impact of infection by Batrachochytrium dendrobatidis on montane populations of Alytes obstetricans

This thesis aims to assess the population-level risk posed by Batrachochytrium dendrobatidis (Bd), a pathogen responsible for worldwide declines and extinctions, to the amphibians of a series of infected Pyrenean Lakes. The principle focus was on the common midwife toad (Alytes obstetricans), which, in parts of its range has suffered population declines and even local extinction as a result of exposure to Bd. Infection severity thresholds may play an important role in the risk of decline a population faces, but such thresholds are only useful if individual-level infection estimates are accurate. I found that widely-used data obtained via epidermal swabs are not accurate indications of the full infection burden of an individual, as assessed by a novel full-skin digest procedure I developed (Chapter Three). Swab-based infection thresholds should therefore be applied with caution. However, infection intensity in dead and moribund individuals was significantly higher than that of visually healthy individuals, suggesting that infection severity is an important predictor of mortality. Population monitoring is necessary for understanding whether long-term infection translates into changes to host population size. I used capture-mark-recapture (CMR) techniques on larval A. obstetricans and found evidence of possible disease-induced declines in two populations, but an increase in abundance in another, suggesting that the pathogen may exist in an endemic state in some host populations (Chapter Four). To assess disease-induced mortality across populations, I compared mortality rates monitored in laboratory-held individuals, to those estimated in the field (Chapter Five). This highlighted inter-site differences within my study populations and provided evidence of host persistence with low-level Bd infection. The presence of hosts in the field with low-level infection may indicate host population persistence is possible. To broaden my thesis from a single host to the amphibian community, I analysed temporal data on infection in three species within a single focal lake (Chapter Six). I show that environmental effects may affect the prevalence of infection in two sympatric species, suggesting infection is likely influenced by biotic and abiotic variables and may change over time. Overall, these data lend valuable insights into not only the individual level responses to infection, but that of the population and even begin to elucidate community level effects. These data will be useful in developing conservation policy for these, and other, Alytes populations.Open Acces

Moving home : exploring older peoples' experiences of hospital discharge

The overall aim of this research project is to investigate the impact of government policy, professional practice and social attitudes on the experiences of the older person leaving acute hospital care and returning to their own home. The project aims are summarised as below:*To develop an understanding of individuals' experiences within discharge preparation and planned support while they are preparing for home, getting home and being home. *To explore older people's experiences of co-production in the definition of needs and planning support to meet these needs. *To investigate the 'appropriateness' of the discharge package (plan or pathway) as seen by the individual once home. *To develop a model that allows a structured comparison between individual experiences and policy aims

Exploring domestic rabbit (Oryctolagus cuniculus) personality utilising behaviour coding, behaviour testing and a novel behaviour rating tool

The purpose of the study was to attempt to identify personality traits in domestic rabbits (Oryctolagus cuniculus) and to evaluate a range of tools, suitable for use in a shelter setting, that can be used to measure personality traits. A literature review highlighted limited evaluation of reliability and validity in rabbit personality research published to date. Additionally, there is a lack of clarity on what is being measured by some behaviour tests that are currently employed in animal personality research and there are limited tools available to measure domestic rabbit responses to humans. Chapter three highlights several uses of rabbit behaviour and personality data in United Kingdom (UK) shelters. Shelter staff reported uses for understanding the behaviour of an individual rabbit to support the management of the individual while at the shelter and to match the rabbit to the most suitable future home. Challenges facing shelter staff to collect behavioural data for their rabbits centred around a lack of resources, specifically time available for collecting behavioural data. An additional challenge reported by shelter staff was inaccurate information being reported by the person handing the rabbit into the shelter. To ensure any personality assessment tool could be integrated into shelter routines, the tools would need to be relatively quick to complete and should ideally include a range of data collection methods so that a full picture can be available.  In Chapter four, the results of a behaviour rating survey that was distributed to a self-selected pool of rabbit owners or those that worked with rabbits, using social media are reported. The survey was also completed by animal care technicians for rabbits taking part in direct behavioural observations, including a suite of behaviour tests and observations within the home cage. The use of an online survey enabled a large number of participants to take part. Following examination of the reliability of the data (interrater) and dimension reduction statistics, three components were retained that included 15 of the initial 47 items and accounted for 60.6% of the variance in the data (n=1,234). However, sufficient thresholds for inter-rater reliability were not achieved. As intended in the selection of survey items, the retained components accounted for intraspecific social behaviour, human-rabbit interactions (avoidance of humans) and boldness in relation to the environment. However, only the human-rabbit interaction component had sufficient distribution of scores across the sample population to consider this a personality trait. Behavioural tests are commonly used as measures of an individual animal’s personality; however, several tests have conflicting interpretations of the underlying traits that may drive behaviour in these tests. In Chapter 5, a suite of tests were used, reflecting three commonly used test paradigms for domestic rabbits; the open field test, novel object test and a new human interaction test. Five human-interaction items measured were reliable between raters and between tests and two items, location during subtest 3 where the handler was sat inside the door of the enclosure and a combined outcome score for subtest 3, 4 (stroke rabbit) and 5 (pick up rabbit) were retained to create component 2 on the final solution of the principal component analysis. From two variations of both the open field and novel object tests, two components were also derived, reflecting exploration and curiosity in rabbits. These three components were reliable between raters and between tests and accounted for 75.2% of the cumulative variance in the data. The component labelled ‘exploration’ comprising variables of activity in the open field tests were found to negatively correlate with component 2 from the behaviour rating scale, reflecting avoidance of humans. This is similar to past research in young rabbits where resistance to handling was correlated with activity in the open field. The use of behavioural observations in the home cage environment is rarely performed for personality assessment in domestic animals due to how time consuming such observations can be. As a requirement for the tools was to be able to be utilised by shelter staff, where time constraints are an important factor, home cage behavioural observations were designed to be quick to complete. Following a pilot test including three hours of observations over the day, it was possible to determine the behaviours that could be observed using video cameras positioned adjacent to or above rabbit enclosures. Additionally, this pilot test revealed that within the times of day available for testing, none were preferable over any other in terms of the range of behaviours observed in 12 rabbits. The main study therefore utilised three five-minute sampling points across the day with the refined ethogram and 30 second focal sampling. It was not possible to complete dimension reductive statistics on the sample of 16 rabbits used for this part of the study, although the behaviours observed in the relatively short time frame did represent activity patterns observed in past research. Two tools, the behaviour rating survey and suite of behaviour tests, are proposed to be retained for future examination of the utility of these tests in a shelter setting to measure rabbit behaviour and personality. These retained tests would provide information on an individual rabbit’s social behaviour (intraspecific), response to humans, boldness in relation to the environment, exploration and curiosity. Future research is recommended to determine the suitability of these tests for use in shelters, and to understand the predictive validity of these tools. That is to understand the usefulness of rabbit personality assessments to identify aspects of behaviour that are stable between different environmental contexts, such as between a shelter setting and within a home following being rehomed

The value of third sector organisations’ provision of global learning CPD in English schools

Third sector organisations have been providing continuing professional development (CPD) for teachers in the UK in the field of global learning over decades. Given the patchy provision within initial teacher training, these organisations are the main source of support for teachers in helping their pupils engage with and respond to global issues. Drawing on qualitative and quantitative data from the Global Learning Programme in England (GLP-E 2013–18), this article investigates what teachers identify as valuable from the global learning CPD they received from organisations on the programme. Teachers value the specialist expertise, both in terms of global learning knowledge and pedagogy, the relationships they develop with global learning organisations, and the willingness of these organisations to collaborate for the benefit of schools. The findings demonstrate that there is potential for a greater contribution to teachers’ global learning professional development within schools, but this requires more consistent, engagement with global learning organisations over the longer-term. To facilitate this, policymakers need to ensure a sustained funding environment both for schools and the global learning sector if teachers are to be sufficiently supported for working in an increasingly global and rapidly changing world