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The University of Lincoln is an online archive hosting teaching and learning materials created by staff, and the full text of published research carried out by academic staff at the University

The relationship between GPs and hospital consultants and the implications for patient care : a qualitative study

Acknowledgements Clinicians assisting development of topic guide, all based in NHS Highland; Mr Angus Cain (Consultant Ear, Nose & Throat), Professor Steve Leslie (Consultant Cardiologist), Professor Ronald Macvicar (Postgraduate Dean, North of Scotland Region of NHS Education for Scotland (NES)), Dr Jerry O’Rourke (General Practice Principal), Professor Ken Walker (Consultant Colorectal surgeon). Clinicians involved in pilot of the semi-structured questionnaire; Dr Beth Macfarlane (General Practice Principal), and Dr Russell Drummond (Consultant Endocrinologist). Gillian Heron, Cairn Medical Practice who transcribed interview recordings. Funding The research was funded by both the local NHS Highland Research & Development Committee, and the “RCGP Allen & Margaret Wilson Memorial Fund.” The Chief Investigator (Dr Rod Sampson) received no personal payment for the study. No drug company is involved in this research.Peer reviewedPublisher PD

Le procès d’Oreste de Farid Paya : pour une persistance de la mémoire

Dans cet article consacré au Procès d’Oreste créé par Farid Paya et le Théâtre du Lierre, la chercheure étudie la façon dont cet auteur et metteur en scène français d’origine iranienne puise dans ce qu’Edgar Morin nomme une « Arkhe-Pensée » pour ordonner, à coups de mots, une ingénieuse allégorie de la folie. En s’interrogeant sur la représentation de la mania et de l’hybris, des termes grecs généralement traduits par « folie » et « démesure », elle montre comment l’univers dépeint par Paya se présente comme l’écho de sa propre conception musicale du théâtre, voire comme un carrefour de mémoires où texte, chorégraphies et polyphonies vocales sont des matériaux scéniques étroitement associés.In this article pertaining to the play Le procès d'Oreste (the Trial of Orestes), created by Farid Paya and the Théâtre du Lierre, the author is examining the manner in which this Iranian playwright and director draws from what Edgar Morin has called "Arkhe-Thought" ("Arkhe-Pensée") to organize through words a clever allegory of madness. By exploring the representation of mania and hybris, Greek terms which are generally translated into "madness" and "excess", she shall demonstrate how the universe as depicted by Paya can be seen as an echo of its own musical conception of the theatre, indeed as a crossroad of memories where text, choreography, and vocal polyphonies become closely linked theatrical material

Changes in Rorschach performance and clinical improvement schizophrenia

Thesis (Ph.D.)--Boston UniversityThe purpose of this study was to investigate the changes in indices of withdrawal on the Rorschach tests of hospitalized schizophrenic patients. This involved examining them when they were acutely ill and again when they were judged to be clinically improved. Two major assumptions underlie the plan of this study. The first is that the behavior and symptoms shown by the acutely ill schizophrenic patient reflects his withdrawal in three areas: interpersonal relations, the world, and the expression and control of emotion. The second assumption is that the Rorschach test has satisfactory indices for these three areas and that these indices are sensitive to changes within individuals. The concept of withdrawal as occurring in three areas is derived from different emphases in three psychiatric schools. Withdrawal from people is emphasized by the Sullivan group. Withdrawal from the environment is emphasized in the views of Meyer and Campbell. Withdrawal of and from emotion is emphasized by the Freudian school which relates this activity with centering libidinal energy on the self. One unstructured projective test which reveals the subject's attitudes and feelings toward others, his perception of the world, and the manner in which he handles his emotions is the Rorschach test. The patient's attitudes and feelings are communicated indirectly through his responses to the Rorsehach cards. In order to use this test to study the changes in withdrawal, clusters of Rorschach scores meaningfully associated with the three withdrawal areas were first isolated. Ten Rorschach indices were chosen and organized into constellations according to present theory and clinical practice. The scores reflecting the empathy, rapport, and feeling toward others experienced by the subject, and hence interpersonal relations, are the Movement and Human responses (M and H) patterned out according to their quality and with regard to the locations in which they appear, and the ratio of form-color responses to the sum of color-form and pure color responses ( FC : CF ≠ C ). The patient's perception of the world is reflected in four sets of Rorschach indices: an index of the perception of reality ( F≠% ), an index of conformity with the thinking of the group (the number of Popular responses), evidence that the world is a source of fear and danger (responses with destructive and tension-laden Content), and distortion in distance maintained by the individual between himself and the world (Rejections-Denials-Self-references). The expression and control of emotion are reflected in four sets of Rorschach indices: the ratio of intellectually determined responses to the total number of responses ( F% ), the index of the affective energy available for response to external stimuli ( 8-9-10% ), the index of emotional maturity and control ( FC : CF : C: ), and the ratio of the sum of the emotionally toned responses controlled out of respect for reality to the sum of the emotional responses where form is secondary or lacking (FC≠FY≠FV: CF ≠ C ≠ YF ≠ Y ≠ VF ≠ V ). It was predicted that clinical improvement and lessened withdrawal would be reflected in changes in the selected Rorschach indices. The changes in patterns and ratios would be in the direction of haalthier responses and better personality integration. Forty-five cooperative acutely ill schizophrenic patients between the ages of sixteen and forty were the subjects of this study. The forty-five cases were consecutive admissions selected only on the basis of diagnosis, age, and recency of onset of illness. Each patient in this study was tested both when he was acutely ill and when he left the hospital either as improved or nonimproved. Each individual was both an experimental subject and his own control since changes between first and second protocol were the data analyzed. A rating seale consisting of eleven items was devised to evaluate the clinical changes in each patient. Each patient was rated by two psychiatrists upon admission to the hospital and again upon discharge from the hospital. The second rating was made without reference to the earlier rating. The psychiatrists agreed that thirty-three of the forty-five cases showed clinical improvement during their stay in the hospital and that fourteen of these cases showed marked improvement. The remaining twelve cases showed no clinical change according to both psychiatrists. Those patients who improved and those who did not improve clinically were found to be not significantly different in respect to age, education, length of hospitalization, the kinds of therapeutic treatments given them, and the incidence of unhealthy responses on their initial tests. In the analysis of each pair of Rorschach records, a change in the direction which Rorschach theory considers to be healthy was called positive. If an index on the second protocol showed no change or changed in the direction of less healthy responses it was classified as showing an absence of positive change. The incidences of positive changes in Rorschach indices in the total group of the thirty-three improved cases were compared with the incidences of changes in the twelve nonimproved cases. A second analysis was made by comparing the incidences of Rorschach changes in those fourteen cases of the thirty-three improved cases who showed marked improvement with the incidences of changes in the twelve nonimproved cases. The specific hypotheses tested were that the clinically improved groups do not differ significantly from the nonimproved group with respect to the incidences of positive changes in each of the Rorschach indices studied. The null hypotheses could be rejected for all but three comparisons, and in two of these comparisons meaningful trends were evident in the data. StatisticaLly significant and disproportionately high incidences of multiple positive Rorschach changes occurred in the improved groups in comparison with the nonimproved group in the combined Rorschach indices. This was true for each of the three areas of withdrawal investigated: interpersonal relations (P<.O1), perception of the world (P<.001), and the expression and control of emotion (P<.02). The findings support the inference that the decrease in withdrawal which accompanies clinical improvement is related to changes in the direction of healthier responses in Rorschach retest protocols. The combined indices are more significantly related to clinical improvement than the separate indices except for the FC: CF: C ratio. This confirms Rorschach theory and practice which holds that individual scores must be combined for meaningful evaluation of a Rorschach protocol. Significant incidences of positive changes were found in the clinically improved cases in contrast with the nonimproved cases in the direction of increased interest in others (M and H; P<.04), greater warmth and empathy (FC: CF ≠ C; P<.04), increased ability to deal with stimulus material in reality terms (F≠%; P<.03), decrease in fears and tensions associated with a threatening environment (Content; P<.01), better balance between intellectual and non-intellectual drives (F%; P<.04), healthy use of affective energy (8-9-10%; P<.04), and more mature and controlled emotion (FC: CF: C; P<.01). On three of the ten indices the incidences of positive changes in the improved and nonimproved groups were not significantly different. However, trends toward significance were found on two of these indices: decrease in the total number of Rejections-Denials-Self-references and increase in the FC ≠ FY ≠ FV: CF ≠ C ≠ YF ≠ Y ≠ VF ≠ V ratio. However, separate analysis of Rejections and Denials and Self-references showed that Rejections and Denials each decreased significantly with clinical improvement (P<.03 and <.05 respectively), but the decrease in Self-references was not significant. An increase in the FC ≠ FY ≠ FV: CF ≠ C ≠ YF ≠ Y ≠ VF ≠ V ratio, indicating a greater control of emotion, was significantly associated with marked clinical improvement (P <.03) but not with undifferentiated improwment (P<.10). Changes on the tenth index, the Popular responses, were not associated with change in clinical condition. The incidences of positive Rorschach changes were relatively greater for cases showing marked clinical improvement than for cases showing undifferentiated improvement on five of the ten Rorschach indices (M and H, F≠%, F%, 8-9-10%, and the FC ≠ FY ≠ FV: CF ≠ C ≠ YF ≠ Y ≠ VF ≠ V ratio). This suggests that a small population of extreme cases may give as significant information in research as a larger more heterogeneous population. This study has shown that constellations of Rorschach indices selected on the basis of their theoretical significance can be treated experimentally, without isolating them from other scores, without ignoring qualitative features which are clinically significant, and without treating them as numerical units contrary to Rorschach usage. Changes in indices thus selected are significantly associated with changes in clinical condition. Healthier responses are found on clusters of Rorschach indices which deal with the three areas of withdrawal: interpersonal relations, attitude toward the world, and ability to handle emotions, with remission of an acute schizophrenic episode. The validity of the Rorschach test as sensitive to changes within the individual is corroborated by these data. One implication for clinical practice from this study is that this test should be given more than once in evaluating any patient. The areas in which he shows stability or disturbances would thus be delineated. Since this study has shown that Rorschach protocols are not greatly affected by familiarity with a test when there has been no clinical change, progress in therapy could be evaluated by studying changes in serial Rorschach records of one patient. This would permit evaluation of therapeutic progress within one frame of reference. The findings in this study suggest that the concept of withdrawal might be studied more intensively for its function in the genesis as well as remission in mental illness. The role of the three areas of withdrawal in the development and progress of a schizophrenic illness and the relative significance of these areas also need to be clarified

Quand l’homme et l’image se disputent le plateau : la compagnie de théâtre Les Deux Mondes et ses machinations

Depuis près d’une trentaine d’années, la scène contemporaine confronte son public à d’étranges spectacles : tantôt le dispositif scénique prend l’allure d’une installation, tantôt la représentation s’approche du happening ou de la performance, tantôt écrans et technologie de pointe montent sur les planches aux côtés de comédiens devenus chanteurs, danseurs ou acrobates. Semblable mutation, tour à tour considérée comme un effet de mode ou une idéologie représentative de la pensée de notre temps, incite bon nombre de théoriciens à se pencher sur le brouillage des frontières entre théâtre, danse, arts visuels et multimédias. À travers cette mouvance, où les tenants du « virtuel » applaudissent le renouveau des arts « vivants » alors que d’autres craignent un résultat plutôt « mortifère », on peut se demander si le théâtre d’aujourd’hui peut exister… sans acteurs. Le spectacle 2191 nuits, créé par la compagnie de théâtre Les Deux Mondes, servira ici de point d’appui au développement de cette problématique. Dans le cadre de cet article, je m’interrogerai sur le processus qui mène à la création d’un spectacle où la machine joue un rôle central et sur les transformations que celle-ci opère sur l’art de l’acteur.For more than twenty years, contemporary stage audiences have been facing strange exhibitions: sometimes the set looks more like a set-up, at other times performing borrows much to happening, or even performance art, and at times screens and leading technologies climb the stage alongside actors who are singing, dancing or doing acrobatics. Such mutation, which has in turn been considered a fashion trend, or an ideology representative of our times, encourages a number of theorists to study the blurring of the lines separating theatre, dance, visual arts and multimedia. Through this influence where adherents of "virtual reality" commend the renewal of "living" arts while others fear a "deadening" result, one can ask if theater can now exist… without actors. 2191 Nuits, a Les Deux Mondes creation, shall serve as the basis of the exposition of this problematic. Within this article, I shall reflect on the process that leads to the creation of a performance where machine takes center stage and on the transformations it works upon the actor's art

The Impact of Leadership Behaviors of Blue Ribbon Catholic School Principals on School Culture

The purpose of this study was to conduct an analysis of six successful Blue Ribbon Catholic schools to determine the relationship between principal\u27s leadership behaviors, teacher\u27s perceptions of principals and resulting school culture within six successful Blue Ribbon schools. A mixed methods approach for analysis was used through both qualitative and quantitative methods by means of principal interview data, observations, survey data, principal survey, and teacher survey. Participants in the survey included six principals and 80 teachers from elementary and high schools from rural as well as urban schools. The six schools in the study were all co-educational and ranged in size from 450 students to 1,200 students, with an average of 36 teachers per school and a 16:1 student teacher ratio.;The Bolman and Deal Four Frame Model (2008) provided the basis for the questions and surveys used to collect data concerning principal leadership, teacher\u27s perceptions of principal leadership and overall school culture. The four frame organizational theory model components are described as: the Structural Frame, which focused on goals, rules, and policies; the Human Resource Frame, which addressed roles, norms, and relationships; the Political Frame, which focused on power, self-interest and aspirations; and the Symbolic Frame, which provided a view of culture, norms and values. Constraints included deviation from normal school schedules due to significant weather-related school closures and limited time for long term classroom observation. A correlation between principal leadership and overall school culture was validated overall but there was no significant statistical difference among the values of the frames as they apply to impact on school culture

Functional analysis of signaling pathways activated by Anisomycin and Dexamethasone in two different breast cancer cell lines

While targeted therapy exists for ER-positive breast cancers, the treatment option for TNBC is conventional chemotherapy giving a poorer prognosis. It is therefore of interest to study molecular mechanisms and differences between MCF7 (ER-positive) and MDA-MB-231 (ER, PR, and HER2- negative). These cell lines are in vitro representative models for luminal A (non-aggressive) and basal-like (aggressive) breast tumors. In this study, the cell lines are stimulated with Anisomycin and Dexamethasone, and their response is observed and compared in relation to the P38 MAPK signaling pathway and GR. To achieve molecular and functional analysis of the cell lines Western Blot, proliferation assays, cell viability assays and a scratch wound assay was achieved to compare the cell lines, respectively. Anisomycin is a rapid and potent activator of p38 MAPK and inhibits proliferation in both cell lines, but the activation of the p38 MAPK signalling pathway is different as shown by the phosphorylation kinetics of the downstream targets GR (S134) and HSP27. Results also show that Dex stimulation and activation of GR in the MDA-MB-231 cells cause increased proliferation, but for MCF7 the effect of Dex with regard to proliferation was minor. Further, migration seemed to be positively affected by Dex in MCF7 and negatively affected by Dex in MDA-MB-231 cells. These findings indicate that activation of the p38 MAPK pathway in MCF7 and MDA-MB-231 cells will cause different downstream responses, among them the kinetics of the phosphorylation of GR. It will be interesting to see if these differences could be further investigated with the intention to develop targeted therapy for TNBC cells