Background - UK healthcare has adopted various improvement strategies from business including using satisfaction surveys. However, the way patients form and express judgements of quality care can be more complex than customer purchases. Research in adult patient satisfaction has found capturing patient opinion challenging; however, adult service- user views continue to underpin quality care guidance across healthcare. Development of knowledge to include parental views of quality care is important to inform future guidance specific to children’s services. Methods - This study aimed to examine how parents determined the quality of care provided when their child was hospitalised, factors influencing perceptions of care and whether these judgements changed over time. Using a grounded theory approach, data were collected through a series of in-depth interviews (22) with nine parents following their child’s hospitalisation. Findings - The substantive grounded theory - Parenting in an alien hospital world: on guard and on behalf offers new perspectives on the complex psychosocial processes underlying parents’ quality judgements. When their child was hospitalised parents landed in an ‘alien’ world but continued to try 'to parent' (protect and advocate) their child. Parents' experiences were characterised by landing; moving from being' new parents' to 'old hands'; searching for and judging the 'clues' and facing dilemmas of how best to respond to professionals. Parents were found to use an escalating level of signals to prompt health professionals to respond to their queries and concerns Parents' personal lens altered through their transitional journey and this, together with their perception of professionals' power impacted on their chosen responses to professionals and their quality judgements. Parents held two views of care quality: ‘at the time’ and a final ‘on balance’ view. The final view recognised their own heightened emotions and reflected their current transition. Conclusions - Ultimately parents judge hospital care as high quality when they perceived health professionals acted as their allies in their parenting roles as protectors and advocates for their child in the alien hospital world. Health professionals could improve parents' experiences and quality judgements of care by early recognition and response to their 'signalling' and by explicitly acting as parental allies.

This research was an idiographic investigation of the first-hand accounts of mature undergraduate students with depression. Participants were drawn from one Institution of Higher Education in Ireland. The number of mature students entering Higher Education in Ireland is increasing annually. The number of individuals with a diagnosis of depression is increasing also. To date, very little research has examined the experiences of mature undergraduate students with depression, in the Irish context. The focus was on undergraduate studies as the research aimed to examine an individual's first experiences of Higher Education. As the study aimed to provide a description of an individual's experiences of studying with depression, the participants had a current diagnosis of depression and were taking antidepressant medication. It is routine in Ireland to prescribe antidepressants for mild depression (e.g. HSE, 2016). Data were collected via in-depth semi-structured interviews with eight students aged between twenty-six and fifty years. Data were examined using Interpretative Phenomenological Analysis (Smith et al, 2010), which is an approach that facilitates a hermeneutic phenomenological enquiry into the unique lived experience, as well as convergences among participants. Based on the analysis of the material, the students' experiences were organised into three main themes: Journey through Academia with Depression; Managing Depression; and Altered Self. These themes indicated that the experience could be characterised as a journey through academia, with the journey getting increasingly more difficult as students entered their third and fourth years of a four-year undergraduate degree. Findings revealed that individuals had a complicated relationship with medication, and that they sought other ways in which to manage their depression. They also revealed the changes to their sense of self that they expressed as taking place during their academic journey. Individuals' accounts communicated the stigma around depression, the distinct dynamic among mature undergraduate students in relation to why they have come back into education, the difficulties in engaging in group work for individuals who experience depression, feeling isolated or disconnected, the challenges of receiving feedback on academic work, and a self-critical voice. The extent of suffering articulated by the participants leaves no uncertainty about the gravity of depression and the implications for their academic experience. Findings, which have implication for counselling psychologists working with mature students in HE, are discussed.

Analytical survey of the above ground evidence has been undertaken on twelve areas of prehistoric fields in southern Britain. In all cases at least two phases were noted, one directly overlying the other; in ten of these areas the earlier phase comprised an extensive rectilinear grid and the later smaller areas of aggregated fields. The earlier field systems could be externally bounded and left little land unenclosed for open grazing and timber production, movement was only allowed along high ridges. It is suggested that the earliest of these fields date to the beginning of the 2nd millennium, on both sides of the Channel, where they were regarded as symbolic of status within a period of visible ostentatious possessions. The majority were created in the middle centuries of that period, possibly as a reaction to perceived land pressure. No settlements could be identified as coeval with these fields. The later fields represent a major contraction of enclosed land and their design is more suited to stock, rather than arable, production. Larger areas around the fields were marked by linear ditch systems or by cross ridge dykes. Settlements were frequently, and presumably deliberately, placed over the boundaries of the earlier fields, possibly in an act of incorporation; these settlements tend to date to the two centuries on either side of 1000BC, and it is likely, though not certain, that the later fields were contemporary with these settlements. The production of stock as evidence of wealth led to feasting, as exemplified by midden sites, and to a raiding culture within which aggression is more likely, but warfare not proven. The point is made that, with no structure visible at excavation across lynchets, analytical survey is the best method of recording phase differences. Also, given the lack of below ground evidence these sites, though widespread, are a diminishing resource and protection of the best examples is highly desirable.

No description available.

The opioid epidemic is a public health crisis. How the crisis developed, how to mitigate its effects, and how to prevent it from spreading is less transparent. The practice of pain management poses a myriad of ethical challenges. The following essay will examine ethical dilemmas that arise during the decision-making process with regards to pain management in the context of addiction after a brief history of pain management and discussion of the corresponding legal and medical regulations.

Rates of obesity and the associated comorbidities continue to increase for women in the United States. Despite information available, efforts at weight loss are often unsuccessful because women lack integral knowledge of how to approach the various components essential for weight loss. This doctoral project was created to address the practice question of whether obesity can be reduced through a step-wise weight loss program that identifies essential elements to reduce weight in menopausal age women. Guided by the information-motivation-behavioral skills model, this project led 17 volunteer participants from a Northwest, Florida primary care clinic through 6 weeks of protocols supplemented with Facebook interactions. A pretest/posttest comparison showed increased knowledge regarding weight loss and increased self-efficacy as measured by the PANSE scale. All participants had some decrease in weight and an average of a drop in systolic blood pressure of 4 mmHg. This supports the use of a nurse-lead structured education and support model for improved weight loss in women. This project can lead to positive social change with the ability to assist women with obesity and hypertensive disorders, thus reducing morbidity and mortality as well as improving quality of life.

There is increasing evidence that stroke survivors benefit from the provision of intensive, task-specific therapy in the rehabilitation of motor function. Providing such therapy to a number of stroke survivors in a group setting (know as circuit class therapy) has been proposed as an alternative model of physiotherapy service delivery within the inpatient rehabilitation setting. This study investigated the effectiveness and feasibility of circuit class therapy, as compared to the standard practice of one-to-one therapy sessions, within a representative sample of stroke survivors receiving inpatient rehabilitation.

Exchange is at the core of public space. Whether trading products or sharing information, exchange between people produces social interactions and spatialized hubs of activity. Without exchange public spaces fail. Today, the Internet threatens older methods of spatialized exchange as people communicate through email, pay bills electronically, and shop online. These despatialized forms of exchange are having a damaging impact on previously functioning public spaces such as the post office and retail stores. Distribution centers, meanwhile, are thriving as product exchange points but they remain completely invisible and inaccessible to the customer. With the United States Postal Service in rapid decline, once monumental buildings will soon be abandoned. Taking advantage of the existing infrastructure of post offices, I am proposing a centrally located public distribution center; giving online companies a physical presence in the city, monumentalizing the currently despatialized market, and reintroducing the public to the exchange process.

Thesis (M.S.)--University of Cincinnati, 2009. / Advisor: Keith King. Title from electronic thesis title page (viewed Feb. 22, 2010). Includes abstract. Keywords: college students; physical activity; benefits; barriers; cues. Includes bibliographical references.

One of the most important distinguishing marks of the Christian faith is that it is a revealed religion. The Christian faith professes that God has graciously and with authority revealed himself to his creatures. Therefore, the doctrine of Scripture, specifically biblical, is an issue of central importance in any theological formulation that is distinctly Christian. Despite the centrality of biblical authority in the system of Christian faith, there is perhaps no other doctrine under greater reproach. In light of the increased criticism of the doctrine of Scripture, Christians have adopted various theologies of revelation in order to explain what the biblical text is, how it relates to God, and how it functions authoritatively. And yet many of these proposals fail to take advantage of the resources provided by the communicative categories of the rich Christian trinitarian tradition. Specifically, very few evangelical proposals related to biblical authority consider how the specific modes of subsistence related God the Father (unbegottenenss), God the Son (eternal begottenenss), and God the Holy Spirit (procession) contribute to a Christian understanding of divine authorship. This dissertation is an exercise in dogmatic and exegetical theology that gives an account of the relationship between biblical authority and trinitarian communicative activity. This dissertation will argue that the Bible is authoritative because it has God the Father as its source, God the Son as the content and mediator of the Father's speech, and God the Spirit as the efficacious power who speaks the Word that he receives from the Father and Son. Therefore, Scripture is authoritative because God the Father, God the Son, and God the Spirit all speak, with one voice, an authoritative Word.