‘I don’t know what I’m doing. How about you?’: Discourse and identity in practitioners dealing with the survivors of childhood sexual abuse.

This research is based on interviews conducted with a voluntary group of health practitioners who care for the adult survivors of childhood sexual abuse in one area of Scotland. This project takes a broadly interpretive approach to the interviews, and examines the processes of sense-making apparent in the scripts of the doctors, community nurse and counsellors who comprise this voluntary Forum. Those interviewed were highly sceptical of traditional medical approaches to dealing with survivors of such abuse, and they all questioned the effectiveness of expert professional knowledge. The research highlights the role of patient disclosure as a key mechanism in the process of their treatment, which is akin to the confessional technology discussed in detail in the work of Michel Foucault. Combined with other medical technologies patient disclosure is revealed as a technique of normalization. In this particular case the experts themselves were engaged in unravelling this process in search of alternative approaches to caring for their patients, which were based on a relationship of equal partnership rather than of expert authority. This research thus begins to illustrate the processes of sense-making and identity formation which exist between professional health care workers and the victims of abuse for whom they care

Ambiguity and ambivalence: organizational change in government departments

The way in which workers and managers interpret change at work has been an important focus of interest for researchers. This interpretation may find them assimilating change as they listen to accounts from other workers experienced in the outcomes of such events. On the other hand, there may be a divergence among workers concerning the value and meaning to be ascribed to the change events. If this is the case, a culture of ambiguity may be said to exist, where the nature, degree and value of the cultural change are highly contested and remarkably unclear (McLoughlin et al;., 2005). Following Piderit (2000), this paper suggests this may explain the disparity between an individual’s expectancy of change and their response to it, and also that, individuals’ ambivalence may influence whether they accept change, adapt to it, or reject it out-of-hand, . We show how different dimensions of ambivalence in different individuals can lead not only to different responses to imposed change at work, but can also account for individuals coming to terms with the demands of change

Organizational control & the Catholic Church: a case study

This paper presents an analysis of the problem of child-abusing priests in the Catholic Church using data from the USA, UK and Ireland. The apparent scale of this issue raises crucial theoretical as well as policy issues. This paper explores various organizational explanations, linking it to traditional methods of ‘confessional control’ of organizational members. This is a novel concept which brings the issue into a wider organizational lens. Confessional control creates a series of guilt-laden identities that serve to maintain hierarchical control as well as social inclusion. Thus the process of recycling priests was part of a long-persisting pattern applied to child abuse cases. The theoretical implications of this are explored. The data consists of a series of cases across the three countries, partly drawn from a data-base of 4,000 alleged cases

FLEX

Within this project I have compiled a book length collection of poems entitled “FLEX” which explore questions of violence, inheritance and pastoral poetics. Taking place across the landscapes of Mississippi, The Dominican Republic, and contemporary Black masculinity FLEX serves to ask questions of what violences contributed to the speaker’s birth and what possibilities exist on the other side of such historical pain

In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal?

Individuals’ self administration of medication is an essential component of disease management because incorrect and incomplete medication can result in increased morbidity, mortality and healthcare costs and also spreads drug resistance. Its impact is necessarily wider than just medical and includes the cultural and managerial considerations which govern success in medical interventions. This review paper is aimed at how Nepalese cultural factors (beliefs, religious practices, customs and traditions) may affect adherence to antiretroviral (ARV) medication among people living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Results: Cultural factors (individual beliefs and perceptions) are notoriously complex concepts and shape people’s identities and influence their attitude and behaviours. The individual behaviours and beliefs about health and seeking treatment can adversely affect health care utilization and adherence to medication. These factors create a complicated and unforgiving environment for patients who are struggling to endure a chronic, life-threatening illness with life-long treatment. We cannot disregard patients’ cultural beliefs or practices in order to provide ARV treatment and their adherence because patients and clinicians come from different cultural groups. Conclusion: It is the purpose of this paper to contribute to the policy makers by exploring the pertinent cultural factors relating to the uptake of ARV treatment and its adherence

Issues and Challenges of HIV/AIDS Prevention and Treatment Programme in Nepal

This paper explores some of the key issues and challenges of government HIV/AIDS prevention and treatment programme in Nepal. Providing HIV/AIDS prevention and treatment services in Nepal is associated with a number of issues and challenges which are shaped mostly on cultural and managerial issues from grass root to policy level. Numerous efforts have been done and going on by Nepal government and non-government organization but still HIV prevention and treatment service is not able to reach all the most at risk populations because cultural issues and managerial issues are obstructing the services. The existing socio-cultural frameworks of Nepal do not provide an environment for any safe disclosure for person who is HIV infected. Thus, there is an urgent need to address those issues and challenges and strengthen the whole spectrums of health systems through collaborative approach to achieve the millennium development goals. It will be the purpose of this paper to contribute to the policy makers by exploring the pertinent issues and challenges in the HIV/AIDS programme

Rapid Steel Tooling Via Solid Freeform Fabrication

With increasing part complexity and requirements for long production runs, tooling has become an expensive process that requires long lead times to manufacture. This lengthens the amount oftime from "art to part". Rapid tooling via stereolithography (SLA), filled epoxies, etc. have been stopgap measures to produce limited prototyping runs from (10 to 500 parts). This gives poor dimensional analysis and does not allow for limited production runs of 1000+ parts. The method ofproducing prototype tooling with a powdered metal process has been developed that produces tooling with a hardness greater than 35 HRC and total shrinkage less than 0.5%. This tooling process manufactures production ready tooling that will perform extended cycle runs (100,000+). Manufacturing ofthis tooling takes 1 to 2 weeks and will compare favorably with production grade steel tooling. Originals drawn in 3D CAD can be used to prototype the master that will allow for the production ofthe rapid metal tool set. process starts with a rapid prototyped model made by whatever process is desired or a machined master. For this paper a Sander's Model Maker II® rapid prototyping machine was used to fabricate the model. After the model ofthe tool set is made, a silicone rubber negative is cast around that model. After the silicone rubber model is made, a heated slurry ofmetal powders and polymers is poured into the mold to create the green tool set. The tool set is left to cool, and then removed from the silicone rubber mold. The tool set is then debound and sintered to produce a final tool set with properties approaching hardened tool steel.Mechanical Engineerin

Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study

Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = 1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients

Barriers to and facilitators of antiretroviral therapy adherence in Nepal: a qualitative study.

Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audiotaped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural issues around ART whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients

Enforced change at work, the reconstruction of basic assumptions and its influence on attribution, self-sufficiency and the psychological contract

The theoretical underpinning of Human Resource Management assumes the existence of individual motivation, which can be manipulated or managed in a way that enables organisational objectives to be achieved with the compliance and commitment of the individual worker. However, the increasing incidence of mergers, takeovers and reengineering has imposed on the individuals caught up in it change and challenge, which leaves even those retaining their employment doubtful of the benefits of HRM proclaimed by employers. Job insecurity has been well researched by those who wish to examine how enforced change affects the survivors both within the organisation and those who move on to alternative employment elsewhere. Charting the change undergone by individuals suffering such enforced change at work has traditionally involved attempts to measure the antecedents of change and correlating it to the consequences of the change. In this way the effects of imposed change on individuals can be linked to organisational consequences like intention to leave or job satisfaction. The present research allows individuals to reflect on their own confirmed and disconfirmed expectancies following the experience of enforced change at work. It allows them to examine what assumptions they had about their employer's behaviour during enforced change and how far they have accepted or rejected the legitimacy of that behaviour. For each of them this has involved interpreting events occurring during enforced change. Such interpretation may reinforce the meaning of work and its inherent value or threaten continued belief in the value of employers' promises of employment and career development. Identifying expectancies enables the researcher to examine the different responses to questions of attribution, self-sufficiency and the traditional elements of loyalty and trust together with the individual's assessment of how he or she would respond to a repeat of such enforced change. The conclusions of the present research indicate that individuals who maintain traditional beliefs of loyalty and trust are more likely to experience alienation than those who evince an independence who seek to use working experience to gain more knowledge and skill and so increase their own employability. The future dependence of employers on traditional promises of career development and life long learning would seem to have been circumscribed by the many individuals whose experience of enforced change has convinced them they need to take ownership of their own destiny in which different employers will play but a fleeting part