Using non-participant observation to uncover mechanisms: insights from a realist evaluation

This article outlines how a realist evaluation of dementia care in hospitals used non-participant observation to support the refinement and testing of mechanisms likely to lead to the use of person-centred care. We found that comments and explanations of their actions from hospital staff during observation periods provided insights into the reasoning that generated their actions for care in real time. This informed subsequent data collection and analysis. Two worked examples of mechanisms first identified during non-participant observation demonstrate (1) how they were uncovered, and (2) how this informed research activities for theory refinement. Early, iterative engagement with the analytic process, primarily involving reflection and debate with the research team, maximised the potential of observation data to support surfacing underlying mechanisms, linking them to specific contexts and outcomes.Peer reviewedFinal Accepted Versio

Geometry and Topology of Escape II: Homotopic Lobe Dynamics

We continue our study of the fractal structure of escape-time plots for chaotic maps. In the preceding paper, we showed that the escape-time plot contains regular sequences of successive escape segments, called epistrophes, which converge geometrically upon each endpoint of every escape segment. In the present paper, we use topological techniques to: (1) show that there exists a minimal required set of escape segments within the escape-time plot; (2) develop an algorithm which computes this minimal set; (3) show that the minimal set eventually displays a recursive structure governed by an ``Epistrophe Start Rule'': a new epistrophe is spawned Delta = D+1 iterates after the segment to which it converges, where D is the minimum delay time of the complex.Comment: 13 pages, 8 figures, to appear in Chaos, second of two paper

Financial aggregation of risks for MSMEs in developing economies: a conceptual framework of financial aggregation and microinsurance effects

Business vulnerability is a function of the extent of risks faced and the ability of the business to adapt to adverse changes in circumstances. Financial Aggregation arises out of the link between economic interactions at the micro level and their macro based risks Microbusinesses in developing countries are often highly vulnerable to a range of risks including natural disasters, corruption, poor weather conditions and illness. This vulnerability creates a need for insurance but ability to take out appropriate insurance is frequently limited by financial resources, availability of insurance policies and information on these policies and financial education levels. On the supply side, microinsurers are faced with high marketing and administrative costs and the microinsurance market is further distorted by information asymmetries, adverse selection and moral hazards. This limits interest in the microinsurance market from commercial providers, with microinsurance frequently being available through non-profit agents. This paper investigates the relationship between vulnerability, risk appetite of microbusinesses and their propensity to insure. In building a conceptual framework, we explore the factors that impact financial aggregation and the uptake of microinsurance. We observe additionally that improved financial education and more effective information may help to increase the extent and quality of microinsurance

Sleep Baby Sleep Waltz

Woman sitting on bench holding baby with house in backgroundhttps://scholarsjunction.msstate.edu/cht-sheet-music/11299/thumbnail.jp

Sleep, Baby , Sleep

Woman holding baby outside home in mountains looking down path at man walking toward homehttps://scholarsjunction.msstate.edu/cht-sheet-music/11298/thumbnail.jp

Health Counseling for the Overweigh Adolescent Girl

This study was undertaken for the purpose of seeing how a health counseling program for overweight adolescent girls could be developed in a secondary high school setting. Initially, the study developed out of an awareness and concern for the problem of obesity among teenage girls, especially those in a secondary school. To provide a strong background for the use in both planning and executing a health counseling program, the study reviewed the health literature dealing especially with several topics: a. The prevalence of obesity. b. The relationship of obesity to mental and physical health. c. The influence of food faddisms and quackery on obesity. d. The etiology of obesity including hereditary, endocrine, metabolic, environmental and psychological factors. In addition, the study involved a survey of school nurse-teacher health counseling programs in schools within the administrative area established for health programs by the New York State Department of Education. To provide information about the general social and communal context of the adolescent girls to be included in the health counseling program, the study drew on the summary of community characteristics provided by an eleven. member North Shore High School Faculty Committee in preparation for the school\u27s evaluation by the Middle States Association of Colleges and Secondary Schools. From the information about the problem of obesity and the scarcity of school health counseling programs, the school nurse-teacher with the cooperation of members of the Physical Education, Home Economics, and Guidance Departments as well as the Psychological and Medical Services, devised a six-month pilot health counseling program. The program included a careful selection of sateen overweight girls who were twenty or more pounds over their desired weight according to the Baldwin-Wood standardized Weight-Height-Age Table. Weekly individual counseling sessions followed by monthly group meetings were established. A physical exercise program came about as an outgrowth of the monthly group meetings. Nutritional education, retraining of eating habits, stimulation of diverse interest and encouragement of physical activity formed the nucleus of the counseling sessions. The primary focus centered around appearance and dress with the basic aim to establish good nutritional habits and a healthy, wholesome pattern of daily living. Social reinforcement and supportive reassurance were paramount in the relationship between the health counselor and counselee. The results of the six-month pilot study showed an overall weight loss of 22 pounds among the sixteen counseled girls as contrasted to a weight increase of 76 pounds among the sixteen uncounseled group. An improvement in personal appearance, attitudinal realism about the weight problem, along with self-acceptance, were changes evident with the counseled group. The results of this pilot study have implications both within the high school and beyond. The program developed in the pilot study is continuing in the high school. Programs based upon the design offered in this study could be extended throughout the community starting in the elementary schools and reaching out into the community health agencies. The study shows that a thoroughly informed school nurse-teacher by means of detailed planning and program execution is in a strategic position to offer her expertise in assisting the student with a weight problem. If additional studies beyond this pilot study bear out the results of this study, then adeqt.1ately prepared health counseling programs can serve as one means of prevention and control of the problem of overweight among the high school students

Geometry and Topology of Escape I: Epistrophes

We consider a dynamical system given by an area-preserving map on a two-dimensional phase plane and consider a one-dimensional line of initial conditions within this plane. We record the number of iterates it takes a trajectory to escape from a bounded region of the plane as a function along the line of initial conditions, forming an ``escape-time plot''. For a chaotic system, this plot is in general not a smooth function, but rather has many singularities at which the escape time is infinite; these singularities form a complicated fractal set. In this article we prove the existence of regular repeated sequences, called ``epistrophes'', which occur at all levels of resolution within the escape-time plot. (The word ``epistrophe'' comes from rhetoric and means ``a repeated ending following a variable beginning''.) The epistrophes give the escape-time plot a certain self-similarity, called ``epistrophic'' self-similarity, which need not imply either strict or asymptotic self-similarity.Comment: 15 pages, 9 figures, to appear in Chaos, first of two paper