The trajectory to diagnosis with pulmonary arterial hypertension: a qualitative study

Objectives To investigate the patient's experience of the trajectory to receiving a diagnosis of pulmonary arterial hypertension (PAH) and inform the provision of care for this patient group. Design Qualitative study using in-depth one-to-one interviews and pictorial representations. Data were analysed using thematic analysis. Setting Participants were interviewed in their own homes across England. Participants 30 patients with a diagnosis of pulmonary hypertension (18 participants were women, mean age 56 and range 26-80 02years and time since diagnosis ranged from a few months to more than 12 02years) participated. Results All participants, regardless of the time since diagnosis, vividly described the process from manifestation of symptoms to receiving a confirmed diagnosis. The authors present data using three major themes: (i) making sense of symptoms, (ii) process of elimination and (iii) being diagnosed with PAH. Making sense of symptoms represented an early period of perseverance 14people tried to carry-on as usual despite 18unexplained breathlessness 19. As time progressed, this period was punctuated by critical events that triggered seeking medical advice. Once medical contact had been made, patients described a period of 18elimination 19 and convoluted contact with the medical profession. Dyspnoea misdiagnosis was a key factor that delayed the PAH diagnosis. Diagnosis disclosure by some medical professionals was also viewed as lacking empathy. More positive experiences were relayed when the medical team disclosing the diagnosis acknowledged previous limitations. Conclusions A lack of awareness of this illness from both the sufferer themselves and the medical profession emerged as a central theme and led to prolonged periods of being misdiagnosed. The application of a diagnostic pathway for unexplained dyspnoea that alerts practitioners to rare conditions could expedite the process of correct diagnosis

Performance, Embodiment, and Nervous Sympathy in Maria Edgeworth’s Harrington

In eighteenth-century moral philosophy sympathy underwrites sociality by ascribing authentic reality to others. Critics have discussed how this sympathy can, however, backfire by misleading reason. It might also intensify into invasive obsession. What remains understudied, though, is sympathy’s physiological dimension. Physicians in the period posit a form of nervous communication that operates intra- and intersubjectively, bypassing consciousness and—problematically—moral will. Maria Edgeworth’s novel Harrington (1817) brings these different forms of sympathy into productive conflict. Her story of a reformed anti-Semite turns on modes of nervous imagination (or affect) that fail to align with emotion. Hence, affects such as anxiety and disgust generate (and haunt) love and desire. Sensibility in the novel becomes “morbid”: instead of resolving questions of identity and reality, excessive, embodied feeling sponsors a play of simulation woven together at the level of nervous anatomy

Herne Bay 1830-1880 a failed seaside resort?

This thesis sets out to examine Herne Bay’s success or otherwise as a seaside resort in the period during the nineteenth century, with a specific focus on the period from 1830 until around 1880. The significance of these dates centres upon the involvement of speculators and the building of the first deep sea pier that opened in 1832 closely followed by the passing of an Improvement Act in 1833. The effect of the 1833 Act was to provide a form of governance over the town’s affairs with varying effectiveness until this was reformed in the early 1880s as a result of provisions contained within the Public Health Act 1875. This time period also includes important transport developments that had a significant effect upon the town

Composing darkness”: Romantic Prophecy and the Phenomenology of History

In contrast to the Greek concept of prophecy as a form of prediction, Romantic prophecy rehabilitates a version of Hebrew prophecy that involves a more ambivalent relationship to history and time. That is, while the rise of prophecy in Romanticism might—like the rise of historiography more broadly—seem to organize and contain political and epistemological revolution, closer examination reveals that, in fact, this very attempt at hyper-organization becomes necessary only because of a deep and pervasive sense of historical discontinuity. Hence, while prophecy might aim to ameliorate disorder, in fact it draws attention to and exacerbates this same disorder. This uncertainty stems from a new sense of time as a detotalizing and structurally ironic phenomenon. Hence, chapter one looks at Immanuel Kant’s ironic, non-predictive form of prophecy— what he calls the Sign of History—as an example of how prophecy becomes the infinite absolute negativity of history or the counter-science that displaces natural history through a history of nature. Chapter two considers William Wordsworth’s claims to special poetic election and his attempt to absorb trauma into historical and subjective Bildung. It turns out that while Wordsworth seems to invite what Georges Bataille calls a general economy of expenditure, in fact he restricts this energy in an effort to profit from prophecy. Chapter three looks at Percy Shelley’s play, Hellas, for how the synthesizing figures of prophecy—metaphor, memory, and history itself—are inverted and displaced by the Wandering Jew. Chapter four, on William Blake’s Milton, re-conceptualizes the preface as a mode of ambivalent prophecy and reads Milton’s ostensibly totalizing form in light of the absolute preface’s workelessness. Finally, chapter five uses Ernst Bloch’s concept of exodus to organize readings of Caroline Lamb’s Glenarvon and Mary Shelley’s Valperga and The Last Man in terms of how female prophecy, specifically, displaces forms of history that remain disabling for marginalized subjects. These works all do this through some version of double negation that inaugurates a negative dialectic, negating the present in an effort to open the future to a new concept of the future

A Stitch Between

Over the past year, the exhibition, A Stitch Between, has developed into a meditation on relationships with the self and others. This project includes a series of three portraits and a grouping of felt objects. These were created through a variety of processes, including printing, drawing, painting, and sewing. This formal combination mirrors the complexity of relationships surrounding sexuality and reproductive health that is the undercurrent of the work. Utilizing fiber’s associations with femininity and its ties to feminine resistance, A Stitch Between examines moments that are sites for growth and celebration

Doctor of Philosophy

dissertationThe U.S. finishes in the bottom fifth of industrialized nations in math achievement, based on the Program for International Student Assessment (PISA) scores. The National Assessment of Educational Progress (NAEP) classifies almost 10% of U.S. students as low achieving, and students with disabilities score particularly poorly on such assessments. Experts describe U.S. students as lacking conceptual understanding and requiring remedial instruction in math. When implemented across multiple grade and ability levels, math instruction incorporating a concrete-representational-abstract (CRA) sequence has increased math achievement. Writing To Learn Math (WTLM) is a strategy proven through research to improve students’ conceptual understanding through writing. CRA and WTLM have similar cognitive foundations, yet no studies have evaluated a combination of CRA and WTLM. Combining CRA and WTLM has the potential to address the challenges of adjusting to the national Common Core standards and assessments, which include improving conceptual understanding and writing across all content areas. This unique combination of interventions could offer promising results for effective curriculum development and remedial instruction. This study included three ninth-grade students from a suburban school who are below state proficiency levels in math, and employed a single-subject across-participants design to investigate the following research questions: (1) What is the effect of implementing a concrete-representational-abstract (CRA) instructional sequence incorporating writing to learn math strategies on students with disabilities’ proficiency in solving rate of change problems, and (2) Do students with disabilities find WTLM math and a CRA instructional sequence to be socially acceptable? Results indicated that the CRA + Writing intervention may be effective in improving students’ with disabilities understanding of rate of change. All 3 students improved their scores on the math items of the rate of change probes, and maintained these improvements on maintenance assessments administered between 1 and 7 weeks following the completion of the intervention. Two of the 3 students also displayed moderate improvements in their scores on the writing items of the rate of change probes. The findings of this study provide multiple implications for both research and practice, as well as several directions for future research

The Limits of Foreign Aid Diplomacy: How Bureaucratic Design Shapes Aid Distribution

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113691/1/isqu12191-sup-0001-appendixS1.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/113691/2/isqu12191.pd

The Journalist-Source Privilege in Quebec Civil Law: Globe and Mail v. Canada (Attorney General)

This paper analyzes the recognition of the journalist-source privilege in legal proceedings in Quebec, namely, in the context of the examination of witnesses aiming at identifying a journalist’s secret source. It first presents an overview of the state of the law in foreign jurisdictions and the n proceeds with the analysis of the development of a journalist-source privilege in Canada and Quebec, up to the Supreme Court of Canada’s recent decision in Globe and Mail v. Canada (Attorney General). The Supreme Court of Canada developed a clear analytical framework for recognizing journalist-source privilege on a case-by-case basis. Before ordering a journalist to answer questions likely to reveal the identity of a confidential source, the courts must perform the four-pronged analysis developed by the Supreme Court of Canada, inspired by the common law “Wigmore Doctrine”. The analysis of the Supreme Court confirmed the mixed nature of Quebec’s civil procedure and evidence law, and established an analytical framework to determine in which circumstances journalist-source privilege will be recognized, meanwhile reaffirming the essential role played by the media in the preservation of democracy

Improving Access to General Education via Co-Teaching in Secondary Mathematics Classrooms: An Evaluation of Utah\u27s Professional Development Initiative

Co-teaching may be a promising strategy to improve inclusive secondary mathematics education in rural schools. Professional development (PD) aids in special and general education teachers\u27 co-teaching implementation, yet little empirical research examines how to effectively train and support co-teachers. In this study we describe one U.S. state\u27s PD model for secondary mathematics co-teaching, evaluate outcomes of the PD on co-teachers\u27 behaviors and beliefs, and examine the impact of co-teaching on students\u27 mathematics achievement. We examined data from observations, surveys, and students\u27 pre/post assessments across nine classes within seven U.S. school districts, including three rural school districts, over 3 years. We report data from a total of 19 teachers and 281 students in sixth through ninth grades. The PD participants implemented effective co-teaching strategies and reported positive viewpoints toward co-teaching. Additionally, students with and without disabilities improved their mathematics scores. We present key findings for rural schools to guide future implementation and research