Edward I in Scotland: 1296-1305

This thesis sets out to investigate the activities of Edward I and his officials in Scotland during the period from the conquest of 1296 up until the settlement of September/October 1305. To this end, the administration established by the English king in 1296 is discussed to provide a starting-point from which to assess the events of the following decade. Following the renewal of the war in 1297, the investigation centres primarily on the activities of the English garrisons in Scotland in order to establish where, and to what extent, Edward could describe himself as ruler of Scotland. The campaigns of 1297, 1298, 1300, 1301 and 1303-4 form a necessary part of that investigation as the English sought to expand and consolidate their hold in south-west Scotland particularly. As a complement to the above, the administration of Scotland outwith English control - for which there is very little direct evidence - is also considered, as is the role of the fleet, vital to the survival of Edward's garrisons. The role of these garrisons - which defined the limit and extent of the English administration - is of such importance that an account is then given of the history of each castle held for Edward, however briefly. The final section of the thesis describes Edward's second settlement of Scotland. Between the submission of the Guardian in February 1304 and the ordinances of September 1305, the king devoted much time and energy to his Scottish subjects: a large number of disputes resulting from the war, largely concerned with lands and property, required to be decided and a new administrative system palatable both to Edward and the Scottish nobility to be worked out. This activity thus reflects the problems of the previous decade and the lessons learned from them

Recovery as a troublesome concept: A phenomenographic study of mental health nursing students’ learning experiences

The notion of recovery is central to mental health nursing practice, yet little is known about the ways in which nursing students understand it. This study explores the variation in how recovery is experienced by nursing students and the troublesome nature of their learning journeys as they engage with the concept. Contemporary understanding of recovery has moved beyond the idea of ‘cure’ and is concerned with the person building a meaningful and satisfying life. This challenges the traditional thinking and practices of mental health professionals. There is evidence to suggest that in some areas nurses still rely on out-dated authoritative models of care; however, there is little literature exploring how the concept is understood by nursing students. As today’s student nurses represent the future nursing workforce, it is important that their educational experiences support the knowledge development required to embrace this contemporary practice. Phenomenography and the threshold concept framework provide the research design. Semi-structured interviews were carried out with 13 pre-registration students at one UK University. Following phenomenographic analysis four qualitatively distinct categories of description, or ways of understanding recovery, were identified; Recovery as Clinical Improvement, Recovery as Making Progress, Recovery as Managing to Live Well, and Recovery as Learning to Live Differently. The threshold concept framework was utilised in considering the variation in how students’ progress (or otherwise) in their understanding of recovery in considering the obstacles to learning that students encounter. Four categories were identified; Troublesome Knowledge, Troublesome Learning Environments, Troublesome Practice, and Troublesome Relationships. Understanding the dimensions of variation in student understanding and the obstacles to learning they might face provides important insights for future teaching. Findings here identify recovery as posing particular challenges for students requiring educators to consider a range of strategies to support transformational learning

Taking the learning beyond the individual:how reflection informs change in practice

OBJECTIVES: The purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice. METHODS: A small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed. RESULTS: The results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful information and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice. CONCLUSIONS: The significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme

Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom

Background: Children with maltreatment associated psychiatric problems are at increased risk of developing behavioural or mental health disorders. Dyadic Developmental Psychotherapy (DDP) was proposed as treatment for children with maltreatment histories in the USA, however, being new to the UK little is known of its effectiveness or cost-effectiveness. As part of an exploratory study, this paper explores the feasibility of undertaking economic analysis of DDP in the UK. Methods: Feasibility for economic analysis was determined by ensuring such analysis could meet key criteria for economic evaluation. Phone interviews were conducted with professionals (therapists trained and accredited or in the process of becoming accredited DDP practitioners). Three models were developed to represent alternative methods of DDP service delivery. Once appropriate comparators were determined, economic scenarios were constructed. Cost analyses were undertaken from a societal perspective. Finally, appropriate outcome measurement was explored through clinical opinion, literature and further discussions with clinical experts. Results: Three DDP models were constructed: DDP Full-Basic, DDP Home-Based and DDP Long-Term. Two potential comparator interventions were identified and defined as Consultation with Carers and Individual Psychotherapy. Costs of intervention completion per case were estimated to be: £6,700 (DDP Full-Basic), £7,100 (Consultations with Carers), £7,200 (DDP Home-Based), £11,400 (Individual Psychotherapy) and £14,500 (DDP Long-Term). None of the models of service delivery were found to currently measure effectiveness consistently. The Strengths and Difficulties Questionnaire (SDQ) was deemed an appropriate primary outcome measure, however, it does not cover all disorders DDP intends to treat and the SDQ is not a direct measure of health gain. Inclusion of quality of life measurement is required for comprehensive economic analysis. Conclusions: Economic analysis of DDP in the UK is feasible if vital next steps are taken to measure intervention outcomes consistently, ideally with a quality of life measurement. An economic analysis using the models constructed could determine the potential cost-effectiveness of DDP in the UK and identify the most efficient mode of service delivery

The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy

Background: Maltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT. Methods: Qualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design. Results: DDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a ‘gold standard’ Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical. The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning. Conclusions: An RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field

Pulmonary rehabilitation: uptake and completion profile of patients with COPD

This document is the Accepted Manuscript version of a Published Work that appeared in final form in International Journal of Therapy and Rehabilitation copyright © 2017 MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see http://www.magonlinelibrary.com/doi/abs/10.12968/ijtr.2017.24.9.385.Background: Pulmonary rehabilitation (PR) is effective in the management of chronic obstructive pulmonary disease (COPD) patients. 33% of patients referred for PR do not start the programme. Aim: To examine the relationship between participation in outpatient PR and baseline measures of disease severity and psychosocial variables in COPD patients. Methods: In an observational study and prior to their first outpatient PR appointment, COPD patients completed outcome measures of depression (Brief Assessment Depression Card), social support (Duke Social Support Index), multidimensional health locus of control (MHLC) and COPD severity (Medical Research Council dyspnea score). Data on attendance at the PR appointments were obtained from the PR register. Results: Fifty-one patients (mean age 77.2 year, male= 20), completed the study. Results indicate that in a patient, the presence of depression has a moderate, but statistically significant association (p=0.02) with the uptake of PR. There was no significant correlation between uptake status and any of the domains of MHLC, DSSI or MRC (p>0.005). Conclusion: Patients with COPD and depression are less likely to take up a referral to PR compared to those without depression. None of social support, HLC and COPD severity has a relationship with the uptake or completion of outpatient PR.Peer reviewedFinal Accepted Versio

The screams all sound the same : the music of Of Monsters and Men and the Icelandic imaginary as geographical discourse

Over the last two decades, a substantial body of geographical research has emerged examining the mutually generative relations between music, space, place, landscape, identity and locality. This work has revealed the complex ways in which specific geographical identities and imaginaries can be reinforced and created through differences in sound, through lyrics, and through the acts and meanings of making music. Yet, these identities and imaginaries can also perform important economic functions, representing geographical discourses that musicians can employ to develop distinctiveness to make themselves marketable, particularly in the context of a heavily-saturated contemporary global music market. In this paper, we examine this with specific relation to the Icelandic band, Of Monsters and Men. We provide an account of how references to landscape and folklore in the band’s music, lyrics and imagery represent not only expressions of intimate connections with local landscape, cultural identity and lived experience, but also embody awareness of a pre-existing Icelandic imaginary. The use of folk music instruments, cultural references and motifs, we argue, acts to legitimise the band’s use of this imaginary. Further, we highlight explicit attempts to brand Icelandic music under a single ‘label’ as representative of the way in which this Icelandic imaginary comes to represent a powerful, if potentially homogenising, geographical discourse to mark out Icelandic music in a crowded global music market

Randomisation before consent : avoiding delay to time-critical intervention and ensuring informed consent

Peer reviewedPostprin

Avá-Guarani

Carta da Survival Internacional solicitando que a Itaipu atenda as reivindicações dos Avá-Guarani sobre o reassentamento da comunidade em um território adequado a sua organização cultural e espacial. Conforme o documento é o mínimo que a Usina poderá fazer para compensar todo o sofrimento a que os índios foram submetidos ao longo dos treze anos e garantir o direito deles a posse a terra.Comissão Estadual da VerdadeBom