This report is part of a larger study undertaken in 1996 and 1997 for the author's doctoral dissertation. The study's purpose was to explore the experiences of male dental hygienists--focusing on their experiences before, during, and after graduation. The researcher interviewed 14 practicing male dental hygienists from east of the Mississippi River and one participant from the Midwest. Because of the length of the study, only their experiences following graduation from a dental hygiene program are discussed. Qualitative research methods were used to evaluate the information gained from the interviews, which entails analyzing interview transcripts and developing themes from the data. Four post-graduation themes emerged: participants experienced (1) no job-search difficulties, although some participants experienced minor problems with securing a position, most had little trouble in finding a job; (2) societal gender discrimination, mainly in relation to societal stereotypes about what men and women should do; (3) mixed feelings of acceptance by the profession, although most felt the profession accepting, there were some feelings of not belonging; and (4) career satisfaction, all but one of the participants felt satisfied with his career choice.

Charcot-Marie-Tooth disease (CMT) is a peripheral neuropathy presenting with distal weakness and sensory loss. This thesis examines the role that proximal activity plays in compensating for distal weakness to maintain functional walking. Comparative 3D gait analysis showed reduced range of ankle motion kinetics in people with CMT. Additionally, swing phase hip flexion increased, moments and power around the knee altered during preswing and trunk motion increased. These changes were related to the degree of distal weakness. Proximal adaptations were also observed in healthy control subjects following isolated bilateral fatigue of the plantarflexors but did not resemble those of people with CMT. The role the hip flexors play in compensating for plantarflexor weakness to maintain walking was examined in two studies. When walking on a treadmill people with CMT took an average of 48 minutes to reach level 17 on the Borg perceived exertion scale whereas matched control subjects reached level 8 while walking at the same speed and cadence. After prolonged walking the maximum voluntary contraction of the hip flexors reduced by 20% in the CMT group. Additionally, hip flexor velocity reduced during swing phase and trunk motion increased. A separate study specifically fatigued the hip flexors by 20% resulting in similar kinematic changes to the first study, plus a reduction in walking time to reach Borg level 17 in people with CMT. The effect of ankle foot orthoses (AFO) was investigated in people with CMT. A variation in the stiffness of the three splints was observed when worn with footwear. During walking all AFOs reduced footdrop during swing phase but did not reduce hip flexion. One of the more rigid devices also reduced the total ankle power generation during preswing. These studies suggest that proximal compensations are present, they maintain functional walking and may be influenced by orthotics intervention.

The words 'competence' and 'capability' are used independently by the human resource managment and the strategy communities who relate the terms to people and organisations respectively. However, the linkage between the individual and organisational level is not well documented. A better understanding of this link is important in being able to understand how organisational and individual performance may be improved but also why things sometimes go wrong. This research based case study is to identify the linkage between individual and organisation capability through an examination of patient care provided by dcotors in St George's Hospital, Tooting, London using the perspective of the resource based view of the firm. The research showed that patient care is achieved through the emergent skilful exploitation by doctors of their own capabilities, interaction with others, an their use of artefacts representing technical systems, processes, and structural influences within which the doctor operates. The role of artefacts is particularly important because continuity of patient care is dependent on information provided via artefacts rather than doctors' individual knowledge of particular patients. Doctors need not only medical knowledge but also an understanding of 'how to work the organisation'. that is how to get the organisation to do what the doctor needs for the patient. Competent action of the hospital is dependent on a series of inter-relating and inter-locking activity systems, from the doctor carrying out direct actions for a patient through the operation of departmental support systems to the overall hospital level patient care systems. Contradictions or non-copetence occurred when there was a breakdown within or between the systems. A conceptual model and diagnostic is developed that will be of use in analysing these dimensions of organisational capability.

Older people resident in care homes are amongst the most vulnerable and dependent in any society. This study aimed to explore perspectives on decision making in a care home in the United Kingdom (UK), considering the appropriateness of who made the decisions, how and under what authority. It used grounded theory methodology in a case study framework, in a single care home. Field work was conducted between December 2009 and January 2011 in an inner metropolitan area. Participants were twenty one residents, eight relatives, five registered nurses and six care workers. Data were collected using; interviews; informal conversations; observation and examination of documentation. Participants' perspectives were considered through a values based lens with emphasis on autonomy and dignity as the most dominant in policy, ethical discourse, professional and empirical literature. Findings were constructed from systemic analysis of the data. Two central phenomena were identified, resident as decision maker and others decide for resident. Decisions were categorised into three types, everyday, infrequent and advance decisions. Each group of participants viewed different decision types as most important. Staff appeared to have little knowledge of policy and law and notably, they appeared not to consider mental capacity in relation to decision making, nor did they demonstrate recognition of the ethical dilemmas they faced. All participants found it difficult to articulate values underpinning decision making. Despite staff accepting that residents were able to make decisions and had a right to do so, residents' preferences were not always respected. There was a tension between staff's desire to offer choice, the need to minimise risk and provide good care within the constraints of the organisation with a finite number of staff. If operationalised, the value of solidarity could help relieve the tension and potential dissonance experienced by actors in the care home under study and similar care home environments. Solidarity promised mutuality and reciprocity which would allow all actors to be recognised and valued, ultimately benefiting the residents' quality of life.

Volunteer mentoring (befriending and peer support) is provided across a wide range of services for people with varying health conditions. Despite such services for carers of people with dementia increasing in number, there is little evidence for the benefits they may offer. Using a pragmatic approach, this thesis investigated the impact of volunteer mentoring on carers. It also explored the processes by which volunteer mentoring works and the experiences of volunteers delivering the interventions, many of whom are former carers. A systematic review and survey of volunteer mentoring services highlighted conflicting findings surrounding the impact of the services, the perceived importance of experiential similarity of volunteers and matching carers and volunteers. However, reported outcomes from the systematic review and survey were more consistent, namely reducing emotional distress, loneliness and social isolation of carers. To explore these issues in greater depth, a sequential explanatory mixed methods design was adopted. Data were collected from carers using validated rating scales (HADS, MSPSS and the UCLA Loneliness Scale) and semi-structured interviews. Data collection from volunteers was by semi-structured interviews only. No statistically significant changes were found after the six month study period for anxiety, depression or loneliness for carers. However, significant differences in perceived social support scores were found (p = 0.042). Post-hoc analysis showed this to be between baseline and three months follow-up (p = 0.015). Of the three subscales of the MSPSS, only support from a ‘significant other’ was shown to be statistically significant between baseline and three months (p = 0.013). Qualitative findings showed volunteer mentoring to be an important source of emotional and social support for carers, which was facilitated by the volunteers’ experiential similarity. Similarly to carers, volunteers reported the importance of experiential similarity in developing bonds with carers. They discussed the importance of developing mutually beneficial relationships which leads to a two-way flow of support. Volunteers also reported satisfaction and enjoyment from their roles. Data integration showed volunteer mentoring can be a source of social support for carers. The statistically significant difference in perceived social support from a ‘significant other’ between baseline, three months follow up, was confirmed by carers taking part in the qualitative phase. They perceived that volunteer mentoring can help them be networked into other services and help them to cope better with their caring role. It is argued that volunteer mentoring is an important source of support for some carers and that the development of these types of services should be considered alongside other forms of social support. This was one of the first studies of its kind to investigate both the process of volunteer mentoring and its impact specifically on carers of people with dementia. It is concluded that without experiential similarity, carers and volunteers may not develop the level of trust necessary to form mutually beneficial relationships.

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