The life world of the occupational therapist : meaning and motive in an uncertain world

This thesis explores the life world of twelve occupational therapists. Interpretivist, phenomenological methodology has been employed to capture the central features of what it means to be an occupational therapist. Assumptions arising from phenomenological, social constructionist and hermeneutic theories underpin the methodology. Data gathered from nine in-depth interviews, three participant observations and personal reflection, were analysed in an attempt to understand the therapists' own view of their reality. Four global themes emerged through analysing the findings both phenomenologically and reflexively : 1. Who am I?: The fraught search for an occupational therapy identity; 2. The mission to make a difference : Enacting the therapists' craft; 3. Negotiating the boundaries : The caring-power relationship; 4. Safe haven or battleground? : Collaboration and conflict within the team. Analysis revealed that whilst the therapists' sense of professional identity is profoundly confused, these professionals are committed to holistic, person-centred values and sustained by a belief that occupational therapy promotes health-enhancing change. Therapists are challenged by caring-power relationships as they struggle to negotiate degrees of involvement and are damaged by pressures, abusive people and lack of professional recognition. Their sense of achievement when they make a difference helps them to regenerate themselves and they are 'healed' when valued in relationships with both patients/clients and team members. Throughout their various challenges, struggles and satisfactions, therapists are engaged in a search to find themselves and to cope in their uncertain world. Whilst the findings largely confirm the existing literature, they also offer some challenges. Therapists' experience has been found to be more complex (intense, ambivalent and contradictory) in practice than the literature indicates. A discussion explores the implications of the research for professional practice. The thesis also critically examines the use and value of phenomenology and reflexivity as research methods

‘Writing the Pain’: Engaging First-Person Phenomenological Accounts

One way to teach or communicate embodied-relational existential understanding is to encourage the writing and reading of first person autobiographical phenomenological accounts. After briefly reviewing the field of first person phenomenological accounts, I offer my own example – one that uses a narrative-poetic form. I share my lived experience of coping with pain and hope to show how rich poetic phenomenological prose may facilitate lived understandings in others (be they our students, clients or colleagues). I argue that first person accounts can powerfully evoke lived experience, especially where they focus on existential issues, use personal-reflexive and/or relational-dialogal forms, and draw on the arts.Indo-Pacific Journal of Phenomenology, Volume 12, Special Edition July 201

The qualitative evidence-base of relationally-orientated therapy: A critical celebration

In this article, I celebrate and critique the evidence base for relationally-orientated therapy. The central role played by the therapeutic relationship in effective therapy is now supported by an impressive evidence base, but it is mostly quantitative evidence that is privileged. This article attempts a small corrective to widen the lens by presenting 5 categories of qualitative evidence: Qualitative meta-analyses of client experiences of therapy; case studies; qualitative studies of clients’ experience; qualitative studies of therapists’ experience; and discursive studies of interactions and language use. The richness, relevance, and resonance of qualitative methodology is demonstrated by exemplar studies which highlight a special role for exploring under researched areas. However, qualitative researchers face confounding epistemological and methodological challenges in trying to capture the impossible complexity, ambivalence, variability, and ambiguity of relational therapy experiences across different cultural contexts. No methodology (qualitative, quantitative or mixed) can hope to do justice to these questions on its own and both critical reflexivity and humility are needed

Immigrants’ Experiences on Integration While Attempting to Access the Labour Market: Implications for Social Work Practice

(1) Background: The challenge of immigrants and their integration into adopted countries is a key topic for the global field of social work. However, there is a paucity of research on immigrants’ lived experiences in gaining access to the labour market. Thus, this study examines how immigrants in Norway experience integration while in the process of gaining access to the labour market. The prevalent notion of integration achieved through gainful employment narrows the concept of integration and disguises the underlying marginalization and inequalities that are derived from majority- minority dividing lines. (2) Methods: Data were collected via nine qualitative semi-structured interviews with ten immigrants (one interview was with a couple) living in Norway. Data was analysed by using Interpretative Phenomenological Analysis. (3) Results: The results showed that the participants experienced social exclusion but accepted this as an inevitable part of being an immigrant. The participants regarded the learning of Norwegian language as the key aspect to understanding social customs and forming informal relationships with native Norwegians and important for achieving integration. Freedom and equality were also regarded as issues of great importance. (4) Conclusions: The results provide the field of social work with important insights towards informing social work practices and challenging current paradigms

Bridging the Gap: Improving the relationship between social service organizations and healthcare providers

In Vermont, a significant social determinant of health is rurality. Barriers to healthcare services include distance to providers, lack of integration with social services, and failure to recognize community needs. Integration and robust collaboration between healthcare and social services can likely improve outcomes for individuals who have high utilization of both categories of services. Understanding relationships between healthcare and social services may provide an important framework for translating interventional research to rural communities to improve health equity. Project Goal: To understand barriers affecting collaboration between social service providers and community health providers in order to promote research-based improvements in health outcomes in rural populations.https://scholarworks.uvm.edu/comphp_gallery/1314/thumbnail.jp

Protein kinase B controls transcriptional programs that direct cytotoxic T cell fate but is dispensable for T cell metabolism

SummaryIn cytotoxic T cells (CTL), Akt, also known as protein kinase B, is activated by the T cell antigen receptor (TCR) and the cytokine interleukin 2 (IL-2). Akt can control cell metabolism in many cell types but whether this role is important for CTL function has not been determined. Here we have shown that Akt does not mediate IL-2- or TCR-induced cell metabolic responses; rather, this role is assumed by other Akt-related kinases. There is, however, a nonredundant role for sustained and strong activation of Akt in CTL to coordinate the TCR- and IL-2-induced transcriptional programs that control expression of key cytolytic effector molecules, adhesion molecules, and cytokine and chemokine receptors that distinguish effector versus memory and naive T cells. Akt is thus dispensable for metabolism, but the strength and duration of Akt activity dictates the CTL transcriptional program and determines CTL fate

A progress report of the IFCC Committee for Standardization of Thyroid Function Tests

BACKGROUND: The IFCC Committee for Standardization of Thyroid Function Tests aims at equivalence of laboratory test results for free thyroxine (FT4) and thyrotropin (TSH). OBJECTIVES: This report describes the phase III method comparison study with clinical samples representing a broad spectrum of thyroid disease. The objective was to expand the feasibility work and explore the impact of standardization/harmonization in the clinically relevant concentration range. METHODS: Two sets of serum samples (74 for FT4, 94 for TSH) were obtained in a clinical setting. Eight manufacturers participated in the study (with 13 FT4 and 14 TSH assays). Targets for FT4 were set by the international conventional reference measurement procedure of the IFCC; those for TSH were based on the all-procedure trimmed mean. The manufacturers recalibrated their assays against these targets. RESULTS: All FT4 assays were negatively biased in the mid- to high concentration range, with a maximum interassay discrepancy of approximately 30%. However, in the low range, the maximum deviation was approximately 90%. For TSH, interassay comparability was reasonable in the mid-concentration range, but worse in the pathophysiological ranges. Recalibration was able to eliminate the interassay differences, so that the remaining dispersion of the data was nearly entirely due to within-assay random error components. The impact of recalibration on the numerical results was particularly high for FT4. CONCLUSIONS: Standardization and harmonization of FT4 and TSH measurements is feasible from a technical point of view. Because of the impact on the numerical values, the implementation needs careful preparation with the stakeholders