The SUMA Project: Integrating Observational Data Assessment into Space and Service Design

This presentation was offered as part of the CUNY Library Assessment Conference, Reinventing Libraries: Reinventing Assessment, held at the City University of New York in June 2014

Agoraphobic Geographies : an exploration of subjectivity and socio-spatial anxiety

This thesis examines the phenomenology and significance of agoraphobia for its mostly women sufferers, principally by means of in-depth individual and group interviews. It argues that agoraphobia, typically characterised by fear and avoidance of social spaces, can be usefully conceptualised in terms of a 'crisis' in the boundaries of the embodied self. That is to say, the disorder radically problematizes the distinction individuals 'normally' experience between 'inner' self and 'outer' space, initiating a profound sense of exposure and insecurity in the face of many social situations. In response, sufferers retreat from the social sphere to the seclusion of their homes, whose walls serve to reinforce their weakened and fragile boundaries.The initial impetus behind this project stems from the fact that, while there has been no shortage of clinical research conducted on agoraphobia, it has received very little attention outside bio-medical and psychological contexts. Chapter l reviews relevant bodies of literature and highlights some of the gaps the project seeks to address. Chapter 2 offers a detailed account of the research design, and the ways in which data were generated and analysed, while chapter 3 offers reflections on what was found to be the 'processual' nature of qualitative research. In each of the five substantive chapters that remain, the thesis interweaves experiential accounts with existential problematics, and presents a general movement from concerns with theory to therapy. It also follows the unfolding development of the existential and phenomenological tradition.Chapter 4 links the more esoteric and subjectivist existentialism of Kierkegaard with experiential accounts of consumption, and chapter 5 explores the socially grounded work of Sartre in relation to sufferers' accounts of extreme discomfort in the public eye. Chapters 6 and 7 utilise the explicitly spatial, embodied, and inter-subjective account of existentialism presented by Merleau-Ponty to present first, a case study, and second, an analysis of sufferers' accounts of pregnancy. In this way the thesis ii also moves from abstract philosophical arguments about the human condition per se to a more nuanced feminist geography capable of accounting for the diversity of experiences of agoraphobia and its gendered relations to pa11icular times and places. In its final chapter, the thesis turns to an explicit discussion of treatment, and critiques the unacknowledged predominance of and reliance on masculinist Cartesian conceptions of selfhood within self-help resources, questioning what treatment based on models of embodied subjectivity more inclusive of unusual spatial relations might look like.In its conclusion, the thesis suggests that by taking account of personal narratives of agoraphobia, and of its wider social contexts and relations, a sensitive, sympathetic and fully spatialised account of the disorder more faithful to the way sufferers actually describe their experiences can be offered

Transitional care in clinical networks for young people with juvenile idiopathic arthritis: current situation and challenges

Clinical networks for paediatric and adolescent rheumatology are evolving, and their effect and role in the transition process between paediatric and adult services are unknown. We therefore explored the experiences of those involved to try and understand this further. Health professionals, young people with juvenile idiopathic arthritis and their families were recruited via five national health service paediatric and adolescent rheumatology specialist centres and networks across the UK. Seventy participants took part in focus groups and one-to-one interviews. Data was analysed using coding, memoing and mapping techniques to identify features of transitional services across the sector. Variation and inequities in transitional care exist. Although transition services in networks are evolving, development has lagged behind other areas with network establishment focusing more on access to paediatric rheumatology multidisciplinary teams. Challenges include workforce shortfalls, differences in service priorities, standards and healthcare infrastructures, and managing the legacy of historic encounters. Providing equitable high-quality clinically effective services for transition across the UK has a long way to go. There is a call from within the sector for more protected time, staff and resources to develop transition roles and services, as well as streamlining of local referral pathways between paediatric and adult healthcare services. In addition, there is a need to support professionals in developing their understanding of transitional care in clinical networks, particularly around service design, organisational change and the interpersonal skills required for collaborative working

Will “selfies” solve the identification crisis in lower socio-economic South Africans? A dental feature analysis of “selfies”

Identification in forensic odontology requires that a known characteristic of an individual’s dentition be compared with the same characteristic of the unknown decedent. In South Africa a number of factors render forensic identification of unknown individuals challenging. Many South Africans do not have access to modern dentistry, and consequently do not have ante-mortem dental records. In South Africa, 22 million people are said to own a smart phone, which accounts for close to 40% of the country's population. The aim of the study was to investigate selfies as a source of dental feature information in a government clinic catering to previously disadvantaged patients. Identifiable dental features were observed in 61 (5.6%) of the collected images (N=1098). The low number of useable selfies collected in this study could be attributed to: a lack of smiles seen in the received images. Individuals with poor dental aesthetics would commonly choose to takea selfie with a closed mouth where their teeth would not be visible. The most commonly identified dental features included: diastemas (49.2%), dental jewellery (37.7%), crowding (16.4%), difference in tooth height (16.3%), discoloured (8.2%) and missing teeth (8.2%). This studyfound that selfies cannot solve the identification crisis in lower socio-economic South Africans. Awareness of the importance of selfies in forensic identification should be increased

The British English version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the British English language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach\u2019s alpha, interscale correlations, test\u2013retest reliability, and construct validity (convergent and discriminant validity). A total of 100 JIA patients (7.0% systemic, 38.0% oligoarticular, 27.0% RF negative polyarthritis, 28% other categories) and 100 healthy children, were enrolled at the Royal Hospital for Sick Children in Glasgow. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the British English version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research

Slowing of Motor Nerve Conduction Velocity in Streptozotocin-induced Diabetic Rats is Preceded by Impaired Vasodilation in Arterioles that Overlie the Sciatic Nerve

Diabetes mellitus produces marked abnormalities in motor nerve conduction, but the mechanism is not clear. In the present study we hypothesized that in the streptozotocin (STZ)-induced diabetic rat impaired vasodilator function in arterioles that provide circulation to the region of the sciatic nerve is associated with reduced endoneural blood flow (EBF) and that these defects precede slowing of motor nerve conduction velocity, and thereby may contribute to nerve dysfunction. As early as three days after the induction of diabetes endoneural blood flow was reduced in the STZ-induced diabetic rat. Furthermore, after 1 week of diabetes acetylcholine- induced vasodilation was found to be impaired. This was accompanied by an increase in the superoxide level in arterioles that provide circulation to the region of the sciatic nerve as well as changes in the level of other markers of oxidative stress including an increase in serum levels of thiobarbituric acid reactive substances and a decrease in lens glutathione level. In contrast to the vascular related changes that occur within 1 week of diabetes, motor nerve conduction velocity and sciatic nerve Na+/k+ ATPase activity were significantly reduced following 2 and 4 weeks of diabetes, respectively. These studies demonstrate that changes in vascular function in the STZ-induced diabetic rat precede the slowing of motor nerve conduction velocity (MNCV) and are accompanied by an increase in superoxide levels in arterioles that provide circulation to the region of the sciatic nerve

The repeatability and reproducibility of four techniques for measuring horizontal heterophoria: Implications for clinical practice

PURPOSE: Convergence insufficiency, the most common binocular vision anomaly, is characterised by a receded near point of convergence and an exophoria which is at least 4 prism dioptres (Δ) larger at near than at distance. However, the repeatability of standard heterophoria measures are poorly understood. This study assessed the ability of four common heterophoria tests to detect differences of 4Δ by evaluating the inter- and intra-examiner variability of the selected techniques. METHODS: Distance and near horizontal heterophorias of 20 visually-normal adults were measured with the alternating prism cover test, von Graefe prism dissociation, Howell Card and Maddox Rod by two examiners at two separate visits using standardised instructions and techniques. We investigated inter- and intra-examiner variability using repeatability and reproducibility indices, as well as Bland-Altman analysis with acceptable limits of agreement defined as ±2Δ. RESULTS: The Howell card test had the lowest intra-examiner variability at both distance and near, as well as the best 95% limits of agreement (±1.6Δ for distance and ±3.7Δ for near). Inter-examiner reproducibility results were similar, although at near the alternating prism cover test had better repeatability (1.1Δ, 95% confidence intervals −1.1Δ to 4.0Δ) than the Howell card (1.4Δ, 95% confidence intervals −1.9Δ to 5.9Δ). CONCLUSION: The low repeatability of many standard clinical heterophoria tests limits the ability to reliably detect a 4Δ difference. The Howell Card provided the most repeatable and reproducible results indicating that this technique should be used to detect small changes in heterophoria magnitude and direction