Disclosure in lesbian, gay and bisexual cancer care: towards a salutogenic healthcare environment

open access articleBackground: The literature on sexual orientation disclosure is arguably one of the most developed in the field of lesbian, gay and bisexual (LGB) people in healthcare in English speaking countries however, relatively little research has been conducted into disclosure in cancer care. Studies have been mainly undertaken in primary care where distinct circumstances pertain and where the benefits of disclosure include obtaining appropriate health information, treatment advice and avoiding misdiagnosis. Methods: We conducted an in-depth qualitative study primarily recruiting patients through oncology care in hospital settings and through LGB community cancer support groups. Data were gathered through semi-structured interviews with 30 LGB patients with different cancer types. Results: Data were analysed using thematic analysis and interpreted and interrogated through salutogenesis theory which offers a useful lens through which to consider the health promoting effects of sexual orientation disclosure in cancer care. We present three themes as part of the analysis: Authenticity as a driver for disclosure in cancer care, Partners as a (potential) salutogenic resource and Creating safe, healing environments conducive to disclosure. The findings are reported and discussed in relation to three inter-related concepts from current salutogenesis theorising including a sense of coherence, generalised resistance resources and healing environments which can facilitate sexual orientation disclosure. Conclusion: Our findings enable a more nuanced approach to understanding disclosure in this context. This study contributes to the literature through its articulation of the salutogenic potential of disclosure (if responded to appropriately) for LGB patients as individuals, in relationship to their partners or carers and the role of creating a visible healing-oriented optimal environment to promote quality of life and recovery

DEVELOPMENT OF CULTURE AND TOXICITY TESTING METHODS FOR THE FRESHWATER COPEPOD BRYOCAMPTUS ZSCHOKKEI

The aim of this thesis was to evaluate the use of a meiofaunal copepod as a test species for assessing the developmental and reproductive effects of toxicants relevant to freshwater ecosystems. The harpacticoid copepod Bryocamptus zschokkei was chosen as a candidate test species as it possesses several attributes (widespread distribution, small size and fast development times) that are considered pre-requisites for toxicity test organisms, and has previously been shown to be a sensitive component of the stream community to contaminant exposure. Prior to conducting toxicity tests with B. zschokkei, studies were performed to evaluate the effects of water hardness and food quality on the development and reproduction of this copepod. These data were then used to define optimal culture conditions. Bryocamptus zschokkei was insensitive to water hardness at <150 mg 1ˉ¹ (as CaCO3), reflecting its range of tolerance in the field and suggesting the potential for toxicity testing across a range of hardness levels. Food quality affected development and reproduction: beech leaves (Fagus sylvatica L.), conditioned for 2 weeks supported optimal overall development to adult and reproduction of B. zschokkei and were chosen for use in subsequent culturing and testing regimes. Development and reproduction assays for assessing the effects of environmental parameters on B. zschokkei were combined to produce the first full life-cycle toxicity test for a freshwater copepod. This life-cycle test was relatively quick (6 weeks at 20°C) and is highly reproducible. The effects of three reference chemicals, the trace metal zinc, the pesticide lindane, and the moulting hormone 20-hydroxyecdysone (20-HE), were measured using this toxicity test. There was no effect of 20-HE (0-269 µg 1ˉ¹) on the life cycle of B, zschokkei. Bryocamptus zschokkei was, however, relatively sensitive to zinc and lindane compared with other freshwater crustaceans although sensitivity depended on the chemical and the duration of exposure. A model of ‘equiproportional development' was used to aid interpretation of the mechanism of toxicity of lindane, which was found to act by significantly prolonging the development time to adult. Reproductive endpoints (numbers of eggs and nauplii per female) were the most sensitive measure of zinc and lindane exposure, with lowest observed effect concentrations (LOEC) of 0.48 mg Zn 1ˉ¹ and 32 fig lindane 1ˉ¹, respectively. An increase in abortion frequency, observed for these contaminants, may have potential as a biomarker of stress for this copepod. In conclusion, it is proposed that toxicity tests with B. zschokkei should be included in contaminant assessment procedures for freshwater systems as they would increase the choice and ecological relevance of current testing regimes.Brixham Environmental Laboratory, AstraZeneca UK Limite

Procedural Justice, Identity, Reciprocity and Behaviour: The Importance of Fairness for Employee Behaviour in Emergency Services

This thesis examines the relationship between procedural justice and positive employee behaviour, and is comprised of two studies. Study 1 draws upon social identity theory and social exchange theory, and examines the two as competing routes for explaining the relationship between procedural justice and work engagement. Data from 347 employees suggests that organisational pride and perceived organisational support are found to be mediators of this relationship. Drawing upon self-concept theory, Study 2 investigates employee collective self-concept as an important mediator for the relationship between procedural justice and ethical voice behaviour. Data from 239 employees and their co-workers suggests that procedural justice is positively related to ethical voice behaviour, and that employee collective self-concept fully mediates this relationship. Individual self-concept and relational self-concept were controlled for in the mediation model, and the results show that individual self- and relational self-concept were not found to mediate the relationship between procedural justice or ethical voice behaviour

Place Bonding in Children's Hospice Care- a qualitative study

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background Limited knowledge exists of parents’ perceptions and experiences of children’s hospices and how these contribute to the varied access and uptake of services. Aim This study aimed to explore parents’ perspectives and experiences of a hospice, to understand the barriers and/or facilitators to accessing a hospice, and what characteristics parents wanted from hospice provision. Methods A two-phase qualitative study underpinned by a constructivist grounded theory methodology was employed. Phase 1 used focus groups to collect data from parents of children already accessing the hospice (n=24). Phase 2 used in-depth semi-structured interviews with parents of children who did not use the hospice (n=7) and with parents who had previous experience of using a hospice (n=7). Results A grounded theory of place bonding was developed which illustrates the cognitive journey taken by parents of children with life-limiting conditions considering/receiving hospice care for their child. Conclusions Finding a place where they belonged and felt at ‘home’ made the decision to accept help in caring for their child with a life-limiting condition more acceptable. The theory of place bonding offers children’s hospices a new perspective from which to view how parents access, accept and build relationships at the hospice

Student nurses' experience of learning to care for older people in enriched environments : a constructivist inquiry.

The unpopularity of gerontological nursing is well established and, although numerous studies have sought explanations for this, few have explored how work with older people can be promoted as a more fulfilling and challenging career choice. Underpinned by a constructivist methodology, this thesis provides new insights into how the experiences of student nurses during their training influence their predisposition to work with older people. Using a two stage approach, data were collected from longitudinal focus group interviews with student nurses from four schools of nursing over a period of eighteen months, together with case studies in seven clinical placement areas where students had identified a positive experience of learning to care for older people. The study was part of a larger national investigation funded by the English National Board for Nursing, Midwifery and Health Visiting. Data analysis revealed that a positive experience of work with older people in a range of settings was key to determining whether gerontological nursing was seen as an interesting and exciting career option. Both 'impoverished' and 'enriched' environments of care were identified and analysed in terms of the 'Senses Framework' (Nolan et al 2001a). 'Enriched' environments ensured that students, staff and patients/carers each in their various ways experienced a sense of security, belonging, continuity, purpose, achievement and significance. The longitudinal nature of data collection also indicated that these senses varied in importance as students' experiences unfolded, and a number of foci for students' efforts emerged. These were: self as focus; course as focus; professional care as focus; patient as focus; and person as focus. Findings suggest that only in the most enriched environments will students have a vision of care that has the person as its focus. Based on the interdependency implicit in the data, the thesis concludes by arguing that future policy, practice and education in gerontological nursing should be informed by relationship-centred care, as opposed to person-centred care

A proposed framework for the development of urban agriculture in South African cities

While climate change and rapid urbanisation are impacting our cities and existing infrastructure, population growth and resource scarcity are placing unprecedented pressure on our food systems. In light of such challenges and the Sustainable Development Goals, resilient solutions are being sought to move both urban development and food production towards a more sustainable future. In this context, Urban Agriculture (UA) has been identified as a possible mechanism to complement rural food production with many associated social, economic and environmental benefits for urban communities. Some of these benefits include increased food system resilience, better urban environmental management, circular and productive reuse of urban wastes, employment opportunities, reduced food miles and the promotion of social inclusivity. Through a sustainable food system lens and underpinned by Resilience Theory, this research study sets out to investigate and explore the considerations for UA development. The research study reviews UA literature to identify and analyse the common challenges which act as barriers to implementation, as well as the current or potential opportunities which could be leveraged to drive UA development. The insights gained from literature on UA and UA development frameworks; and the data gathered from qualitative interviews with experts working in UA-related fields in South Africa (SA), were used to build a conceptual framework for UA development in SA. The conceptual framework developed is intended to be used as a guide for local municipalities, urban planners, urban farmers, urban communities and UA support organisations in their approach to developing UA initiatives. The findings from this research study reveal that UA development in SA involves numerous actors at both provincial and municipal levels; and within private institutions, businesses, universities, farmer organisations and society. The findings also reveal that UA currently occurs at many levels in SA, with each level drawing a particular range of participants due to the various social, economic and/or environmental features of the initiative. Along with challenges associated with land access, the lack of UA-related knowledge, the threat of theft, vandalism and soil contamination (to name a few); a lack of understanding of how agriculture can fit into urban spaces was found to be a major obstacle. The findings suggest that this lack of understanding has led to an under-realisation of the full potential of UA in South African towns and cities; and an inability to incentivise and optimise the development of UA. Considering the findings derived from the investigation, the study proposes five major considerations for UA development in SA, all of which are unpacked in the conceptual framework. The study concludes by making recommendations for UA decision-makers and UA organisations to consider for future developments

The challenge of conducting qualitative research to understand the factors that influence equity in medical education: A scoping review

Introduction There are national and international concerns about equity in basic and postgraduate medical education, especially about differential rates of access and attainment across groups of learners. Qualitative research has been increasingly used to understand the factors that influence equity but there are potential limitations to this understanding related to how the research has been conducted. The aim of the scoping review was to identify how qualitative research exploring the factors that influence equity in basic and postgraduate medical education has been conducted. The intention was to inform future research. Methods The electronic databases British Education Index, Campbell Library, CINAHL, Cochrane Library, EMBASE, ERIC, Google Scholar, Health Management Information Consortium (HMIC), MEDLINE, PsycINFO, Web of Science and medical education journals were searched to identify relevant published articles between 2008 and April 2019. Results Among 19,523 articles identified from the literature search, 72 full text articles were included in the review. Most studies had a focus on only one background characteristic and only two studies had a strengths-based focus on individuals. Recommendations for change was at the ‘policy level’ in ten studies and four studies had learner recommendations for change. No studies with a participatory approach were identified. Conclusion The approach to conducting previous qualitative research appears to limit greater understanding of the complexity of factors that influence equity. In response to this challenge, we recommend that future research widen the focus to consider the experiences and strengths of individual learners in addition to those identified by background characteristics. Future qualitative research is recommended to have a broad focus on both the ‘policy level’ and ‘local level’, especially from multiple perspectives. We also recommend greater collaboration of participants with researchers throughout the research process.</p

Gravity, capillary and dilational wave mode resonance at a visco-elastic two-fluid interface

Thesis (Sc. D.)--Massachusetts Institute of Technology, Dept. of Civil and Environmental Engineering, 2005.Includes bibliographical references (p. 222-226).(cont.) space corresponding to experimental conditions to thereby interpret the experimental results. We tested this method on noisy simulated data sets and then applied it to published experimental data sets. We designed an experimental set-up to measure wave number, spatial damping coefficient, and wave slope data for a 3-10 hertz frequency range of transverse and longitudinal waves in a clean enclosed flume. We used kimball-mounted lasers whose beams passed through optical glass in the tank and lid to capture transverse wave motion. The experimental conditions included waves traveling on fatty acid monolayers on aqueous solutions and also waves traveling on a visco-elastic fluid at a variety of temperatures. In addition to the wave data we obtained, we also measured in-situ surface tension. Analyzing the experimental data, we demonstrated the effects of modulation of one wave mode on another. We obtained the rheological parameters for these experimental systems by the inverse method. We used the inverse method to construct the dispersion relation solution space corresponding to the experimental conditions. We used the diagnostic tools for root classification, spatial stability together with a graphical representation of the dispersion relation solution space to understand the physics underlying our experiments. We demonstrated resonance phenomena experimentally with the wave data from the visco-elastic fluid and confirmed this resonance numerically: gravity-capillary resonance near 4.2 hertz ...This thesis is a study of first order resonance between gravity, capillary and dilational wave modes. Gravity, capillary and dilational waves, occurring at a visco-elastic interface between two fluids, are different modes described by a single linear dispersion relation. Gravity and capillary modes arise due to the restoring forces of surface tension and gravity and result in oscillatory motions transverse to the surface. The dilational, or Marangoni, modes arise due to the elastic nature of the interface and result in longitudinal motion along the interface. The visco-elasticity of the interface may be due to the interfacial nature of the two fluids or it may be due to the presence of a monolayer of surfactant, such as a film on the ocean surface. This visco-elasticity affects the interfacial stress balance and is accounted for in the dispersion relation via interfacial heological parameters. We described resonance as coalescence of the roots of the dispersion relation in complex frequency and wave number space. We used this description to explain numerical and experimental resonance phenomena noted in previous studies. We classified some of the roots of the dispersion relation as primarily gravity, capillary or dilational modes. We numerically determined the dependence on interfacial rheology of root coalescence (resonance) and the boundaries of spatial stability of the modes. We used these diagnostic tools to characterize the conditions for both gravity-capillary and capillary-dilational modal resonances. We developed an inverse method from which interfacial rheological parameters can be determined from experimental measurements of wave number, frequency and spatial damping coefficient. We used this tool to construct the dispersion relation solutionby Susan Jayne Brown.Sc.D