BACKGROUND: Problem Based Learning (PBL) facilitators have sometimes sought to motivate learners to ‘talk more’ in order to ‘learn more’ but there has been little work to differentiate through differences evident in their speech behaviour during PBL discussions and to identify which differences are associated with successful learning. Corpus analysis is a useful tool for probing students’ speech in PBL, providing a quantitative basis for examining student talk. AIMS AND OBJECTIVES: The aim of this study was to create a speech corpus of at least 100,000 words, which identifies each individual student’s contribution to a PBL discussion of the same case at the same time within six randomly selected, gender-balanced PBL groups. The study then uses corpus analysis to explore the nature of the speech of individuals and their performance in learning. A statistical analysis was designed to triangulate findings through measuring and analysing underlying factors thought to influence the speech behaviour of individual learners, such as gender and personality type and to identify correlations with educational attainment. METHODS: Wmatrix3 was used to identify significant differences in frequency, parts of speech and semantic category usage from verbatim transcripts of the same three session cycle of PBL. SPSS analyses identified significant differences between learners’ speech behaviour, personality type, gender and attainment in the first year. RESULTS: Multiple and simple linear regression analysis demonstrates significant correlation to a moderate degree between certain data points. In summary, the calmer, more conscientious, lower openness to experience learner, with a high GAMSAT score, achieved significantly higher MCQ scores at the end of year one. Introverted students spoke less frequently, but with longer utterances. Male students spoke significantly more frequently than female students. More emotionally reactive (neurotic) students achieved significantly lower scores on knowledge tests at the close of year one and their talk focussed their own performance. Corpus analysis demonstrated statistically significant differences between personality, gender, high and low test performers. Lower performers frequently dwelt on ‘what’ and ‘why’ and more general technical terminology. Higher performers used ‘when’ and ‘how’ and highly specific technical vocabulary more frequently. CONCLUSION: This study demonstrates that corpus analysis of PBL transcripts provides rich evidence of significant differences in individual speech behaviour whilst learning through discussion. The results broadly replicate well-established findings about gender communication styles and personality difference. This suggests that there may be a utilitarian case for enhancing the approach of PBL facilitators and learners to individual differences without resorting to the overgeneralisations of stereotyping. For example, male and female learners often demonstrate different communication strategies, which may potentially limit the breadth of their future clinical communication skills. Facilitators and learners may use this awareness to explicitly encourage both male and female learners to adopt the full range of communication behaviours. It is important for facilitators to model best practice in their own communication in the initial sessions. By making such language patterns evident, it becomes possible to ensure that PBL groups become more skilled in initiating spontaneous contributions from introvert and female learners, in encouraging longer contributions from extraverts, more factual statements from female students and more varied types of speech from male learners. Learners who identify themselves as emotionally reactive (neurotic or volatile) could productively seek to moderate unproductive anxiety from an early stage through adopting excellent study habits and attitudes, particularly with respect to assessments.

Background For epidemiological research purposes structured data provide identifiable and immediate access to the information that has been recorded, however, many quantitative recordings in electronic medical records are unstructured. This means researchers have to manually identify and extract information of interest. This is costly in terms of time and money and with access to larger amounts of electronically stored data this approach is becoming increasingly impractical. Method Two programmatic methods were developed to extract and classify numeric quantities and identify attributes from unstructured dosage instructions and clinical comments from The Health Improvement Network (THIN) database. Both methods are based on frequently occurring patterns of recording from which models were formed. Dosage instructions: Automated coding was achieved through the interpretation of a representative set of language phrases with identifiable traits. The dosage data table was automatically recoded and assessed for accuracy and coverage of a daily dosage value, then assessed in the context of 146 commonly prescribed medications. Clinical comments: Automated coding was achieved through the identification of a representative set of text and/or Read code qualifications. The model was initially trained on THIN data for a wide range of numeric health indicators, then tested for generalizability using comments from an alternative source and assessed for accuracy, sensitivity, and specificity using a subset of 12 commonly recorded health indicators. Results Dosage instructions: The coverage of a daily dosage value within the dosage data table was increased from 42.1% to 84.8% coverage with an accuracy of 84.6%. For the 146 medications assessed, on a per-unique-instruction basis, the coverage was 79.7% on average with an accuracy of 95.4%. On an all-recorded-instructions basis the weighted coverage was 65.9% on average with an accuracy of 99.3%. Clinical comments: For all 12 of the health indicators assessed the automated extraction achieved a specificity of >98% and an accuracy of >99%. The sensitivity was >96% for 8 of the indicators and between 52-88% for the other indicators. Conclusion Dosage instructions: The automated coding has improved the quantitative and qualitative summary for dosage instructions within THIN resulting in a substantial increase in the quantity of data available for pharmaco-epidemiological research. Clinical comments: The sensitivity of the extraction method is dependent on the consistency of recording patterns, which in turn was dependent on the ability to identify the differing patterns of qualification during training.

Thesis Aim: Boundary violations are committed when a professional crosses the emotional, physical, spiritual or sexual limits of another, thus disrupting the relationship between staff and clients. This thesis explores this issue in the context of healthcare and forensic settings. It identifies boundary violation risk and protective factors for staff working with forensic healthcare patients. The thesis also investigates reasons why staff under-report and may not whistleblow their concerns in these areas. Methods: A mixed method approach was used to explore multiple elements of this topic. A systematic review was used to identify risk factors associated with staff committing boundary violations in healthcare and forensic settings. This was then expanded, through a regression, to specifically look at risk and protective factors in the forensic healthcare settings. A thematic analysis was carried out to explore staff’s perceptions of whistleblowing and boundary violating behaviours. A case study and several psychometrics (including the Exploitation Index) were also used to investigate this topic in more depth and assess the impact that boundary violating can have on the patients involved. Findings: The setting and environment were shown, through the systematic review, to be key when exploring this topic, as they not only impact on the definition of boundary violating along with what factors protect or put staff at risk of boundary violating. The regression identified risk factors, including staff feeling they had no one to turn to and working alone with patients. There were also factors which protected staff from committing boundary violations, such as having good social support and receiving training about boundaries. The thematic analysis found that people did not raise concerns of colleagues’ boundary violating due to concerns about anonymity, feeling that nothing would be done, and feeling that personally intervening (not management) would be a more effective method. Conclusions: It is of great importance to explore this topic and develop a greater understanding of boundary violations, as the impact of and harm caused by this behaviour are wide ranging. This thesis can aid the identification of professionals at risk, and create strategies to prevent or manage this destructive behaviour. These findings can also help create a more open and honest arena for concerns about boundaries to be raised and managed.

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.

Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Since the SPICES (S: student centred; P: problem-based learning; I: integration; C: community based/hospital based; E: electives; and S: systematic apprenticeship based) model of medical curriculum was proposed by Harden, most medical schools worldwide have introduced curriculum changes toward a paradigm shift in teaching and learning. Walter Sisulu University (WSU) introduced such changes in 1992 when problem-based learning (PBL) was implemented in the medical school. This research assignment examines the level of horizontal integration within the WSU Bachelor of Medicine and Bachelor of Surgery (MBChB III) programme. The purpose of the study was to determine the students’ and tutors’ perceptions of integration in the curriculum. A cross-sectional descriptive survey was designed and piloted in 2009 and the questionnaire was then administered to MBChB III students who agreed to form part of the study. The tutors’ opinions on integration were also explored. A questionnaire on integration using a five-point Likert scale, was administered to both the students (12 questions) and the tutors (six questions). Six open-ended questions on integration were added to the students’ instrument and one to the tutors’ instrument, for qualitative analysis and to assist in triangulation. In addition, semi-structured interviews were conducted with the tutors individually. As a result of the survey, it seemed that all the students were “satisfied” or “very satisfied” with the level of integration of content and learning. All the tutors were aware of the need for integration, but some were not familiar with how the learning environment could be modified to enhance students’ approach to integration. MBChB III students at WSU highly valued the integration of learning and teaching during tutorials. Thirty-three per cent of the tutors, though, believed that integration increased their workload. All the tutors thought that integration facilitated students’ learning skills and promoted student engagement, learning and interaction with faculty. / AFRIKAANSE OPSOMMING: Sedert Harden die SPICES-model as mediese kurrikulum voorgestel het, het die meeste mediese skole in die wêreld kurrikulumveranderings ingevoer as ʼn paradigmaskuif in onderrig en leer. (S – studentgesentreerde; P – problemgebaseerde leer; I – integrasie; C – gemeenskaps-/hospitaalgebaseer; E– keusevakke; en S – gebaseer op sistematiese vakleerlingskap.) Die Walter Sisulu-universiteit (WSU) het in 1992 sulke veranderings aangebring toe probleemgebaseerde leer (PBL) in die mediese skool geïmplementeer is. Hierdie navorsingswerkstuk ondersoek die mate van integrasie in die Baccalaureus in Geneeskunde-program en Baccalaureus in Chirurgie-program (MBChB III) aan die WSU verder as die PBL-tutoriale kan vorder. Die doel van die studie was om te bepaal wat studente en studieleiers se persepsies oor die integrasie van die kurrikulum is. ʼn Beskrywende deursnee-opname is in 2009 opgestel en ’n loodsstudie is gedoen. Die opname is weer gebruik met MBChB III-studente wat ingestem het om aan die studie deel te neem. Studieleiers se menings oor integrasie is ook ondersoek. ʼn Vraelys oor integrasie volgens 'n vyfpunt Likert-skaal, is aan die studente (12 vrae) sowel as die studieleiers (ses vrae) gestel. Ses oop vrae oor integrasie is by die studente se instrument gevoeg en een by die vraelys vir die studieleiers ter wille van kwalitatiewe ontleding en triangulasie. Daarbenewens is ʼn semigestruktureerde onderhoud met elke studieleier individueel gevoer. Na afloop van die toepassing en ontleding van die opname was al die studente “tevrede” of “baie tevrede” met die vlak van integrasie van leer, met begrip en met die vlak van integrasie van inhoud. Al die studieleiers was bewus van die behoefte aan integrasie, maar sommige was nie vertroud met hoe die leeromgewing aangepas kan word om die studente se benadering tot integrasie te bevorder nie. MBChB III-studente aan die WSU het 'n hoë waarde geheg aan die integrasie van leer en onderrig tydens tutoriale. Drie-en-dertig persent van die studieleiers het egter geglo dat integrasie hulle werkslading verhoog. Al die studieleiers was van mening dat integrasie die studente se leervaardighede fasiliteer en die studente se deelname, leer en interaksie met akademiese personeel bevorder.

Service learning is a pedagogy designed to teach democratic skills to prepare students to become civically engaged members of society. One of the challenges in the field of service learning is to demonstrate the effectiveness of this pedagogy. Common methodological problems include small sample sizes, difficulty differentiating correlation from causation, self-selection bias, and use of primarily qualitative and experiential outcome measures. The literature review failed to reveal any quantitative scales designed for the health professions. The purpose of this study was to develop and test a quantitative scale to measure service learning outcomes among health professions students, before and after an academic service learning activity. Phase 1 of the study, the development phase, involved an extensive review of the literature to develop the conceptual framework and identify the operational indicators to be measured. Items were adapted from existing scales that were consistent with the personal and social responsibility dimensions and found to possess at least minimally acceptable reliability and validity. Items were adapted to add the health professions perspective which resulted in the preliminary twenty-two item scale, divided into four subscales: Civic Responsibility, Self-Efficacy Toward Service, Civic Participation, and Social Justice Attitudes. Psychometric testing of this preliminary PSR Scale was done in 3 studies. Study 1 involved evaluation of content validity with subject matter experts utilizing a Content Validity Index. The scale was modified based on the results of the CVI and recommendations of the subject matter experts. The S-CVI/Ave for the entire scale was .84 suggesting content validity of the PSR Scale. Study 2 utilized principal components analysis of the subscales to validate the dimensions and operational indicators. Data was constrained to four factors which accounted for 60.56% of the total variance. Items with factor loadings less than 0.4 were deleted. Cronbach’s alpha coefficient was calculated for internal consistency. Based on these results, the scale was further revised by deleting items that decreased the Cronbach’s alpha. This resulted in a 16 item scale, containing four subscales, each with four items. The Cronbach’s alpha for the entire revised scale PSR Scale was .94. Study 3 involved testing the final 16 item version for sensitivity. Wilcoxon signed rank analysis revealed statistically significant changes pre and post service learning activity in the Civic Participation Subscale. Civic Participation Subscale items that were significant included “volunteering time to support my community”, “being involved in programs and activities that improve my community”, and “being involved in activities that improve the health of my community”. These findings suggest that participation in a service learning activity can increase civic participation. Psychometric testing of the Personal and Social Responsibility Scale (PSR) support preliminary validity, reliability and sensitivity of the instrument and the premise, consistent with prior research that changes in civic participation can occur as a result of service learning. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

This thesis describes some models that attempt to forecast the number of occupied beds due to emergency admissions each day in an acute general hospital. Hospital bed managers have two conflicting demands: they must not only ensure that at all times they have sufficient empty beds to cope with possible emergency admissions but they must fill as many empty beds as possible with people on the waiting list. This model is important as it could help balance these two conflicting demands. The research is based on data from a district general and a postgraduate teaching hospital in South East London. Several tests indicate that emergency bed occupancy may have a nonlinear underlying data generating process. Therefore, both linear models and nonlinear models have been fitted to the data. At horizons up to 14 days, it was found that there was no statistically significant difference in the errors from the linear and nonlinear models. However at the 35 day forecast horizon the linear model gives the best forecast and tests indicate errors from this model are within 4% of mean occupancy. It is noted that a Markov Switching model gave very good forecasts of up to 4 days into the future. A search of the literature found no previous research that tested emergency bed occupancy for nonlinearities. The thesis ends with a gravity model to predict the change in number of Accident and Emergency (A&E) attendances following the relocation of an A&E Department in South East London.