What is the role of the social sciences in the response to COVID-19? 4 priorities for shaping the post-pandemic world

Science has been central to informing policy in the response to COVID-19. But ensuring the successful implementation of these policies and the direction of a long-term recovery is the role of the social sciences. Dr Rachel Middlemass outlines the specific contributions that social sciences have to play in informing how we rebuild post-pandemic and the 4 priorities for researchers in ensuring that this role is realised

Mourning jewellery in England, c.1500-1800

PhD Thesis Images have been removed from electronic copy due to copyright issues. The images are included in the print version of this thesis which can be requested via the library catalogueThis thesis explores the historical importance and social function of memorial jewellery within the funerary and mourning cultures of early modern England. Mourning jewellery represented a particularly distinctive facet of mourning and funerary ritual and etiquette, and this study reveals the customary role which mourning jewellery grew to occupy, as a method for the memorialisation and commemoration of the dead, over the course of three centuries, c.1500- 1800. The thesis introduces and defines the broad parameters of the primary research, with a discussion of the source materials employed, including the creation of a database which analysed a large body of wills from Essex, Middlesex, and Surrey, as a means of understanding the place which mourning jewellery occupied within the funerary and remembrance strategies of early modern testators. Beginning with the material objects themselves, the following two chapters provide a chronological overview of the jewellery itself, looking at what kinds of pieces were actually being produced and utilised, introducing form and fashions, and detailing evolving stylistic modes, conventions, and decorative motifs. Placing these material markers within their proper social, cultural, and economic contexts offers a greater understanding of the customary function of mourning jewellery as a whole and the ways in which it was bequeathed and utilised as a means of mourning and commemorating the dead. The fourth chapter offers an insight into the types of people who were typically giving and receiving mourning jewellery, and how the processes, functions, and relationships, which lay behind these exchanges, actually worked in practice. The fifth chapter assesses the overall significance and widespread popular impact of mourning jewellery as a whole, both socially and over time, within the funerary provisions and customary remembrance strategies of testators and the bereaved. The role, significance, and import of mourning jewellery fluctuated according to its employment; it lay within an intricate web of attachments and obligations, ritual and observance, mourning and memory. The final part of the thesis ends by providing some insight into this process, looking at the ways in which mourning jewellery was used in practice and the prospective lifecycle of such objects. It also deals with thornier issues surrounding contemporary emotional responses towards death and loss, observing how mourning jewellery operated, why it was used, and whether it could provide any comfort for the bereaved.AHR

The long term implications for the future of Dental Anaesthetic Practice following the General Dental Council's Guidelines of November 1998

"The long term implicationsfor thefuture ofDental Anaesthetic Practice in Lincolnshirefollowing the General Dental Council's Guidelines ofNovember 1998."The subject of this thesis is based on the continuing requirements of patients for dental anaesthesia following the revised General Dental Council (GDC) Guidelines of November 1998.The factors to be considered in particular are issues which directly apply to referred patients for a dental general anaesthetic (DGA) namely - social class, gender, ethnicity, occupation, background education, attitude towards dental treatment and pre-operative medical history. In addition to considering the issues involved in assessing the suitability of patients for a general anaesthetic (GA) attention will be paid to the General Dental Practitioners (GDP) rationale for referring a patient for GA and whether the choice of such treatment was in any way influenced by the mindset of the patient. Issues relating to case selection will be taken into account along with the steps taken to avoid a repeat anaesthetic. The factors which motivate a GDP to offer GA, sedation or LA will be examined along with the possible reasons which guided the patient to make that decision. A look to the future will be undertaken with regard to GA and sedation services in the UK subsequent to the November 1998 guidelines with some emphasis placed on the adult use of such services.In order to assess the implications and effects of the GDC guidelines on GA services, a study of the attitudes and opinions of both referring and treating dentists was undertaken. This study also took into account the views and attitudes of patients both pre- and post-assessment.The methodology used was both qualitative and quantitative in nature involving the use of questionnaires; two questionnaires were sent to the referring and clinical dentist. The purpose of the questionnaire to the clinical dentists was to determine referral patterns post-guidelines and to monitor compliance with these, whilst the questionnaire to the treating dentists was designed to monitor attitudes regarding referrals for treatment. Likewise patients were given two questionnaires to determine whether patients referred for GA, sedation or LA were satisfied with the treatment plan and subsequent outcome.Since the Poswillo Report of 1990 there have been general recommendations to move from the position of GA towards sedation. Correspondingly part of the referring dentists questionnaire contained a section on this aspect of patient care.The results of the study are considered in detail and inferences drawn relating to the present and future provision of both GA and sedation in the UK

Drivers for change in primary care of diabetes following a protected learning time educational event: interview study of practitioners

Background: A number of protected learning time schemes have been set up in primary care across the United Kingdom but there has been little published evidence of their impact on processes of care. We undertook a qualitative study to investigate the perceptions of practitioners involved in a specific educational intervention in diabetes as part of a protected learning time scheme for primary health care teams, relating to changing processes of diabetes care in general practice. Methods: We undertook semistructured interviews of key informants from a sample of practices stratified according to the extent they had changed behaviour in prescribing of ramipril and diabetes care more generally, following a specific educational intervention in Lincolnshire, United Kingdom. Interviews sought information on facilitators and barriers to change in organisational behaviour for the care of diabetes. Results: An interprofessional protected learning time scheme event was perceived by some but not all participants as bringing about changes in processes for diabetes care. Participants cited examples of change introduced partly as a result of the educational session. This included using ACE inhibitors as first line for patients with diabetes who developed hypertension, increased use of aspirin, switching patients to glitazones, and conversion to insulin either directly or by referral to secondary care. Other reported factors for change, unrelated to the educational intervention, included financially driven performance targets, research evidence and national guidance. Facilitators for change linked to the educational session were peer support and teamworking supported by audit and comparative feedback. Conclusion: This study has shown how a protected learning time scheme, using interprofessional learning, local opinion leaders and early implementers as change agents may have influenced changes in systems of diabetes care in selected practices but also how other confounding factors played an important part in changes that occurred in practice

Handbuch der Laryngologie und Rhinologie. Lief. 13, 14, 15. (Wien: Hölder. 1897.)

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Perceptions on use of home telemonitoring in patients with long term conditions - concordance with the Health Information Technology Acceptance Model: a qualitative collective case study

BACKGROUND: Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). METHODS: An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. RESULTS: Participants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. CONCLUSIONS: HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered

Doing a Bid: The Construction of Time as Punishment

Juxtaposing the sociology of time with the sociological study of punishment, we interviewed 34 former inmates to explore their memories of how they constructed time while “doing a bid.” Prison sentences convey macro-political and social messages, but time is experienced by individuals. Our qualitative data explore important theoretical connections between the sociology of time as a lived experience and the temporality of prison where time is punishment. The interview data explores the social construction of time, and our findings demonstrate participants’ use of the language of time in three distinct ways: (a) routine time, (b) marked time, and (c) lost time

Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and primary health care professional perspectives

The problem: Insomnia is the most commonly reported psychological complaint in Britain. Although hypnotic drugs are widely used for treatment of insomnia, they are only licensed short term and adverse effects are common. Cognitive Behavioural Therapy for insomnia (CBT-I), which is effective and safe long term, is recommended first line but is not widely used nor available, in part because of the lack of trained providers. In response to this, Computerised Cognitive Behavioural Therapy (CCBT) has been advocated. Existing CCBT programmes can suffer from poor rates of uptake, adherence and completion. We aimed to investigate patients and practitioners’ views on how CCBT for insomnia (CCBT-I) could be improved by incorporating features of modern technology including social networking functions. The approach: We used a qualitative design and the theory of planned behaviour to underpin the study. Interviews and focus groups were held with adult service users and health professionals using a topic guide designed to elicit participants’ beliefs, intentions and controlling factors that might facilitate or create barriers to the uptake and adherence to CCBT-I. We explored the data using thematic analysis supported by Nvivo. Findings: We interviewed 23 health professionals and 28 patients. We identified multi-faceted issues focused on meta-themes of trust and functionality which were perceived to increase likelihood of successful uptake and adherence. Trust and confidence would be increased if CCBT-I was perceived to be evidence-based and accredited; when referral was from a trusted professional within a supervised package of care; and when online support and follow-up were provided. Interaction with other users, by integrating CCBT-I with social networking, was perceived to provide mutual support but concerns from people with sleep problems included apprehension about online ‘strangers’ and concerns from practitioners included information security. Asynchronous communication such as posting a note, commenting on a forum or adding to a thread was considered safer than engaging in real-time on-line communication. To improve functionality patients wanted mobile applications; access in short periods; self-assessment of insomnia and its causes; more personalised information on sleep; an interactive approach; and contact with other users to be moderated or overseen. Consequences: Although previous qualitative studies have looked at CCBT uptake and adherence, none have looked at insomnia exclusively or explored the feasibility, advantages and drawbacks of online communication between participants. Improving uptake and adherence to online programmes for insomnia requires attention to design features which are focused on trust and functionality. Although computerised therapies for insomnia would allow more people to access treatment, some would not be suitable for online therapies because of lack of online access or poor computer literacy. The results of the study are being used the development of a novel platform for CCBT for insomnia and other health conditions

Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and multiprofessional primary health care perspectives

Purpose: We explored patient and multiprofessional health perspectives to inform the development of a computerised cognitive behavioural therapy programme for insomnia (CCBT-I) that includes social networking. Theory: We used a qualitative design and theory of planned behaviour to underpin the analysis. Methods: Interviews and focus groups were held with service users and health professionals to elicit beliefs and intentions that might facilitate or create barriers to the uptake and adherence to CCBT-I. Findings: We interviewed 23 health professionals and 28 patients. Features designed to increase confidence in CCBT-I; engender trust in professional relationships; provide online support and improve programme functionality were perceived to increase the successful uptake and adherence. Interaction with other users via integrated social networking would provide mutual support but concerns included apprehension about online ‘strangers’ and information security. Patients wanted mobile applications; access in short periods; self-assessment; more interactive, personalised information on sleep and moderated contact with other users. Discussion: Improving uptake and adherence to online programmes for insomnia requires design features which are focused on trust and functionality. Computerised therapies for insomnia would allow access treatment for more people across geographical and heath system borders

Perceptions on use of home telemonitoring in patients with long term conditions – concordance with the Health Information Technology Acceptance Model: a qualitative collective case study

Background Health information technology (HIT) may be used to improve care for increasing numbers of older people with long term conditions (LTCs) who make high demands on health and social care services. Despite its potential benefits for reducing disease exacerbations and hospitalisations, HIT home monitoring is not always accepted by patients. Using the Health Information Technology Acceptance Model (HITAM) this qualitative study examined the usefulness of the model for understanding acceptance of HIT in older people (≥60 years) participating in a RCT for older people with Chronic Obstructive Pulmonary Disease (COPD) and associated heart diseases (CHROMED). Methods An instrumental, collective case study design was used with qualitative interviews of patients in the intervention arm of CHROMED. These were conducted at two time points, one shortly after installation of equipment and again at the end of (or withdrawal from) the study. We used Framework Analysis to examine how well the HITAM accounted for the data. Results Participants included 21 patients aged between 60–99 years and their partners or relatives where applicable. Additional concepts for the HITAM for older people included: concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’. In the technology zone, HIT self-efficacy was associated with good organisational processes and informal support; while ease of use was connected to equipment design being suitable for older people. HIT perceived usefulness was related to establishing trends in health status, detecting early signs of infection and potential to self-manage. Due to limited feedback to users opportunities to self-manage were reduced. Conclusions HITAM helped understand the likelihood that older people with LTCs would use HIT, but did not explain how this might result in improved self-management. In order to increase HIT acceptance among older people, equipment design and organisational factors need to be considered. Trial registration ClinicalTrials.gov Identifier: NCT01960907 October 9 2013 (retrospectively registered) Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED). Start date October 2012, end date March 2016. Date of enrolment of the first participant was February 2013