Cancer is predominately a disease of the older population and the recent changes in the cancer field, as a result of ageing, have been rapid and remarkable. Soon as many as one in two people will be diagnosed with cancer at some point in their life. Social support has been shown to have a positive effect on experiences of older people with cancer, however how social support creates a positive effect is still not clearly understood. To address this gap in knowledge, this PhD research explored older people's experiences of social support along the cancer pathway. How social support could influence firstly treatment inequality experienced by older people with cancer, and secondly the quality of life of cancer survivors, was the primary focus of the research. The complexity of the topic, that is the interplay between cancer, older people, and social support, led to integrating qualitative and quantitative methods in a mixed methods design. The first phase of the research involved analysing stories from older people who had used advocacy services to gain support. Thematic analysis methods were applied to cancer narratives to gain a better understanding of the relationship between social support and treatment decisions made by older people with cancer. An exploratory sequential design was followed and the second phase of the research was directed by the findings from the qualitative research. Bivariate and multivariate regression analysis was carried out using data from the English Longitudinal Study of Ageing to gain greater understanding of the relationship between social support and quality of life of older people living with and beyond cancer. The qualitative findings highlighted emotional support needs relating to coping and loneliness. Although advocates were able to help in practical ways it was the emotional support provided though the act of being there that had the greatest impact. Most people reported high social support and had good quality of life (although cancer survivors on average had slightly lower quality of life compared to people without cancer). However, those who reported having low support or no support reported much poorer quality of life. The relationship was similar for both cancer survivors and older people without cancer. The findings potentially reflect complex situations (such as being a carer or not in stable accommodation) that can be adversely affected by also living with cancer. Interventions that increase social support, particularly through the act of 'being there' are likely to improve quality of life for older people living with cancer.

With the expansion of online communities, extant research in multiple disciplines has attempted to investigate its adoption and use among individuals. However, the biggest challenge encountered by managers of these communities is supplying knowledge, particularly, the willingness to share knowledge among the members. It is extremely important to maintain committed members in terms of active participation. Yet their level of participation might vary based on some social, behavioral and environmental factors that eventually affect their intentions on whether to participate actively or not, in fact some users choose to discontinue participating totally in the community. Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012. The number of new cases is expected to rise by about 70% over the next 2 decades. Among men, the 5 most common sites of cancer diagnosed in 2012 were lung, prostate, colorectal, stomach, and liver cancer. According to the world cancer report, among women the 5 most common sites diagnosed were breast, colorectal, lung, cervix, and stomach cancer. For this reason, there is an ever-increasing need to establish communities to offer empathic support to patients. Though peer support groups have been known to offer adequate support to patients with cancer and are considered to be an important complement to the formal health care system, however, practical barriers such as time, mobility and geography limit their use, this is where the online communities serve an advantage, as they have the potential to overcome barriers posed by regular offline communities. To achieve its objectives, this study mainly adopts the Social cognitive theory and two components of the social influence theory. According to the SCT, user behaviour is influenced by two factors: personal cognition and environment. Social influence model postulates that individual behaviour in a community can be affected by the social environment and three factors constitute this, they are compliance, identification and internalization. The study aims to provide insights on how and why patients diagnosed with cancer (and their relatives) seek social support using the Internet and social media. In particular, we seek to understand the motivation for joining these groups and the values derived from the community for the users both active and non-active.

Foodservice is integral to safe, adequate and satisfactory food allergy management in the hospital setting. To date, research focused on objective measures of energy and protein provision, implementation and evaluation of food allergy guidelines and assessment of process failures leading to allergen exposure. There is a lack of focus on taking a person-centred approach to understanding the barriers and enablers to optimal food allergy management. A mixed methods phenomenological approach was espoused at a tertiary acute care hospital in Melbourne, Victoria. Data collection techniques included 24-hr diet recall, foodservice satisfaction questionnaires and semi-structured qualitative interviews, all delivered by an Accredited Dietitian. Statistical and thematic analysis was conducted, followed by convergence of the results from each phase of the study. Mean energy intake indicated 64% of requirements and 81% of protein requirements were met; which included external food intake to supplement the hospital diet for around half of the patients. Most patients rated their overall food service satisfaction as ‘Good’, with food quality being the lowest rated foodservice dimension. Addressing sensory, variety and communications aspects of foodservice were focus areas identified by the study patients. These included improving bland flavours and plain appearance, restricted menu choices and automated allergen interface between systems. With a person-centred care focus, the study identified new findings on the views and attitudes of patients with a food allergy on foodservice management in hospital. Within the Food and Meal Science field, the study may be seen as an initial exploratory enquiry for future research on food allergy.

There are no large-scale outcome studies of music therapy in secure hospital settings for people who have committed serious offences. These patients have a right to expect evidence-based multi-disciplinary treatment (Duggan et al. 2006); NICE (2010). Music therapy therefore should take a form which can be integrated into the treatment pathway. A single site implementation of a mixed-methods patient preference randomised controlled trial investigated the clinical effectiveness of a manualised music therapy model called Group Cognitive Analytic Music Therapy (G-CAMT). This context-specific, time limited intervention incorporates theories from Group Analysis (Foulkes 1964) and Cognitive Analytic Therapy (Ryle and Kerr 2003). The central research question was ‘Is G-CAMT feasible and effective for offenders in a secure multi-disciplinary treatment setting?’ The research process followed the Medical Research Council framework for developing and evaluating complex interventions (Campbell et al. 2000, 2007). Twenty patients were recruited; those expressing no preference were randomised to treatment or control arms. The two music therapists and the principal investigator were masked to their allocation status. Those in the treatment arm were allocated to one of two treatment groups of five, each run individually by one of the music therapists. Each group had sixteen ninety minute weekly sessions with followup at eight weeks. Treatment and control groups received standard care. The primary measure was the Person’s Relating to Others Questionnaire (Birtchnell and Evans 2004) Secondary measures were the Basic Empathy Scale (Jolliffe and Farrington 2006a), The Multi-Scale Dissociation Inventory (Briere, 2002) and an observational measure, the Chart of Interpersonal Reactions in Closed Living Environments (Blackburn and Glasgow, 1993). Quantitative data from these measures were examined for associations with qualitative data from semi-structured interviews administered to the music therapists and analyzed using Interpretative Phenomenological Analysis (Smith et.al. 2009) Findings from the results of the primary measure demonstrated statistically significant (Mann Whitney U: p<.05) reductions in favour of the treatment group compared to the control, in intrusive, restrictive and possessive behaviors and helpless or self-denigrating behaviours. There were improvements over time within the treatment group in the domains of sociability and hostility (Friedman Test :p<.04). The use of a manual was shown to help the music therapists manage the risk of violence without constraining their creativity. Two years after the end of the treatment 78% of treatment participants had moved to conditions of lower security over a mean period of 19 months compared with 66% of control subjects over a mean period of 25.5 months. The thesis concludes by situating G-CAMT amongst contemporary music therapy models.

BackgroundIndividuals from low socio-economic backgrounds have higher rates of morbidity and premature mortality from cardiovascular risk factors compared to those from more affluent backgrounds.Hearty Lives Dundee is a complex intervention which aims to address this health inequality. The intervention targets cardiovascular health checks at population groups who are likely to be at high risk, but tend not to engage with traditional services. Practitioners have tried to increase engagement with the target groups through a number of strategies. These included community and workplace-based assessments, and General Practice-run health checks supported by an outreach facility. The aim of this thesis was to explore what works at increasing patient uptake of cardiovascular health checks, for what groups, in what circumstances, and why?MethodsA Realistic Evaluation was undertaken using a mixed methods approach. Routine data was extracted from the Hearty Lives database and descriptive statistics reported on patients attending the community-based opportunistic service and the GP-based service. A total of thirty semi-structured interviews and one focus group (n=5) were conducted with patient attenders and non-attenders of community and General Practice-based health checks. Seven staff from the Hearty Lives programme were also interviewed. Thematic analysis was undertaken using Ritchie and Spencer’s Framework approach.ResultsAttenders at health checks were more likely to be female and older, regardless of the setting. Uptake varied by the number and type of invitation method. Cardiovascular risk was greater in the target population presenting opportunistically but was confounded by the older age of this group.Patient engagement relied on the interaction of a number of factors which varied according to setting; accessibility, invitation method, personal circumstances, cues to action and barriers. A continuum existed from barriers to motivators to attendance depending on the presence or absence of a cue to action, e.g. family history or symptoms. The concept of preventive health checks for cardiovascular disease was not well understood as some patients did not perceive a need to attend without symptoms. Additionally, the health check was viewed as optional by many and not treated with the same seriousness as perceived ‘compulsory’ cancer screenings.DiscussionThe complex lives of the intended target population merit a range of accessible services to reduce barriers to preventive health care. The Realistic Evaluation approach provided transferable knowledge of how to effectively engage with people from different backgrounds and care utilisation preferences, which could easily inform similar NHS services.

abstract: There has been a growing emphasis on the education of future generations of engineers who will have to tackle complex, global issues that are sociotechnical in nature. The National Science Foundation invests millions of dollars in interdisciplinary engineering education research (EER) to create an innovative and inclusive culture aimed at radical change in the engineering education system. This exploratory research sought to better understand ways of thinking to address complex educational challenges, specifically, in the context of engineering-social sciences collaborations. The mixed methods inquiry drew on the ways of thinking perspectives from sustainability education to adapt futures, values, systems, and strategic thinking to the context of EER. Using the adapted framework, nine engineer-social scientist dyads were interviewed to empirically understand conceptualizations and applications of futures, values, systems, and strategic thinking. The qualitative results informed an original survey instrument, which was distributed to a sample of 310 researchers nationwide. Valid responses (n = 111) were analyzed to uncover the number and nature of factors underlying the scales of futures, values, systems, and strategic thinking. Findings illustrate the correlated, multidimensional nature of ways of thinking. Results from the qualitative and quantitative phases were also analyzed together to make recommendations for policy, teaching, research, and future collaborations. The current research suggested that ways of thinking, while perceived as a concept in theory, can and should be used in practice. Futures, values, systems, and strategic thinking, when used in conjunction could be an important tool for researchers to frame decisions regarding engineering education problem/solution constellations. / Dissertation/Thesis / Doctoral Dissertation Learning, Literacies and Technologies 2019

La thèse interroge les transformations du capitalisme français à partir d’une technique d’acquisition de sociétés par endettement nommée Leveraged Buy­Out (LBO). Grâce au recueil de matériaux quantitatifs et qualitatifs, la thèse examine les conditions dans lesquelles les banquiers, les investisseurs et les dirigeants d’entreprise mobilisent cette « arme organisationnelle » et elle pénètre jusque dans l’entreprise pour en évaluer les effets. Le LBO révèle une transformation à la fois étendue et limitée du capitalisme français durant les dernières décennies. L’étendue du changement peut se mesurer à la croissance spectaculaire de ces opérations et à la diversité des acteurs qui participent au champ. Elles produisent de la valeur disponible qui permet aux investisseurs et aux dirigeants de constituer des fortunes considérables. Elles accélèrent le processus de destruction créatrice, le processus de rationalisation productive et recomposent le pouvoir dans l’entreprise. Mais l’arme organisationnelle a fait l’objet d’une traduction dans le langage du capitalisme français et a due être appropriée par les banquiers et les dirigeants. Le LBO est en quelque sorte auto­limité : sa mécanique comporte une fragilité intrinsèque qui peut déboucher sur des faillites d’entreprise et sur des bulles de crédit. Enfin, les plans de création de valeur peuvent manquer leur objectif car ils s’affrontent à la déstabilisation de l’ordre social d’entreprise due au changement de propriétaire et à l’incertitude sur son attitude future. Au final, le LBO tient son pouvoir paradoxal du fait qu’il contribue à faire bifurquer le capitalisme français loin du « compromis d’après­guerre » tout en conservant les aspects traditionnels de sa structure institutionnelle. / This dissertation deals with the transformations of contemporary French capitalism by analyzing the case of a take­over technique called the Leveraged Buy­Out (LBO). Based on both quantitative and qualitative materials, it examines the conditions under which investors, bankers and managers mobilize this “organizational weapon” and penetrates within companies to asses its effects. As an organizational weapon the LBO reveals both the extent and the limits of the transformation of French capitalism during the last decades. The extent of this transformation can be measured by the impressive growth of LBOs in France and the diversity of actors involved. They produce value to be captured to build enormous fortunes for shareholders and managers. They accelerate the process of creative destruction and the rationalization of production. By emphasizing the efficiency criterion of profitability, they reconfigure power relations within the firm. But change also contains significant limits. This organizational weapon had to be translated into the language of French capitalism and had to be appropriated by cautious bankers and suspicious managers. The LBO is somewhat self­limited: its mechanics contains an inherent fragility that can lead to company bankruptcies and credit bubbles. Finally, value creation plans have to survive the destabilization of the corporate order to be effective and create considerable uncertainty towards the future. In the end, the LBO derives its paradoxical power from it contributing to the bifurcation of French capitalism away from the « post­war compromise » while maintaining its underlying institutional structure.

This study explores learners’ online peer review practices during a four-week second language writing project. The project was developed at the college level, in a multi-section upper-level Spanish writing course. Using theories relevant to second language acquisition and second language writing the goals of the study were multiple: (1) to identify the types of comments students used and explore peer review in terms of the givers’ and receivers’ roles, (2) to examine students’ attitudes and self-perceptions about peer review, and (3) to develop an understanding of how students’ attitudes and self-perceptions may influence their feedback-giving procedures. The three goals were addressed using different methods of inquiry, and the findings obtained in the first phase guided the analysis that took place during the second phase. In the quantitative phase, the analyses of data sources (e.g., feedback comments given and received and students’ written drafts) show that giving feedback is a better predictor of final performance than receiving feedback. This principle of learning by reviewing is most evident when students offer feedback that identifies problems, gives a justification, or explains positive elements in the peers’ text. The qualitative phase builds on the quantitative results: it zooms in to the role of the feedback giver to further explore participants’ attitudes and perceptions towards peer review. The analyses of data sources (e.g., pre-study questionnaire, participants’ interviews and peer review simulation activity, and the teacher-researcher reflective journal) show that students do self-position themselves into a specific feedback-giving role. Moreover, the study also confirms that students’ perceptions regarding their attitudes and the comments they give to peers accurately corroborate their actual peer review performance. By combining both methods of inquiry, quantitative and qualitative methods, this study further examines the specific procedures that two case study students follow when offering feedback to a peer. In particular, the procedures for offering problem identification, suggestion, and explanation of the praise comments are analyzed in detail. The results are further interpreted through the lenses of the feedback-giving roles assumed by each of the case study students. Based on the overall findings, the study suggests broadening the notion of feedback: from a unilateral perspective in which comments are addressed from feedback givers to receivers, to a multilateral perspective in which the comments offered are meant to benefit both feedback givers and feedback receivers. The study ends with pedagogical implications for second language learning, implications for the field of second language acquisition, and perspectives for future research.

As the use of technology for personal, professional, and learning purposes increases, more and more assessments are transitioning from a traditional paper-based testing format to a computer-based one. During this transition, some assessments are being offered in both paper and computer formats in order to accommodate examinees and testing center capabilities. Scores on the paper-based test are often intended to be directly comparable to the computer-based scores, but such claims of comparability are often unsupported by research specific to that assessment. Not only should the scores be examined for differences, but the thought processes used by raters while scoring those assessments should also be studied to better understand why raters might score response modes differently. Previous comparability literature can be informative, but more contemporary, test-specific research is needed in order to completely support the direct comparability of scores. The goal of this thesis was to form a more complete understanding of why analytic scores on a writing assessment might differ, if at all, between handwritten and typed responses. A representative sample of responses to the writing composition portion of a large-scale high school equivalency assessment were used. Six trained raters analytically scored approximately six-hundred examinee responses each. Half of those responses were typed, and the other half were the transcribed handwritten duplicates. Multiple methods were used to examine why differences between response modes might exist. A MANOVA framework was applied to examine score differences between response modes, and the systematic analyses of think-alouds and interviews were used to explore differences in rater cognition. The results of these analyses indicated that response mode was of no practical significance, meaning that domain scores were not notably dependent on whether or not a response was presented as typed or handwritten. Raters, on the other hand, had a more substantial effect on scores. Comments from the think-alouds and interviews suggest that, while the scores were not affected by response mode, raters tended to consider certain aspects of typed responses differently than handwritten responses. For example, raters treated typographical errors differently from other conventional errors when scoring typed responses, but not while scoring the handwritten duplicates. Raters also indicated that they preferred scoring typed responses over handwritten ones, but felt they could overcome their personal preferences to score both response modes similarly. Empirical investigations on the comparability of scores, combined with the analysis of raters’ thought processes, helped to provide a more evidence-based answer to the question of why scores might differ between response modes. Such information could be useful for test developers when making decisions regarding what mode options to offer and how to best train raters to score such assessments. The design of this study itself could be useful for testing organizations and future research endeavors, as it could be used as a guide for exploring score differences and the human-based reasons behind them.

The goal of this study was to understand how a secondary principal uses a distributed perspective of leadership to support informal teacher leaders (ITLs) to improve classroom technology integration. Using a phenomenological lens, I employed a multi-site case study to inform the research goals. A conceptual framework based on Bandura’s (1977) social learning theory and Wenger’s (1998) communities of practice theory was used to guide the study’s methods and data collection. Data were collected in three phases. At each site, the first phase consisted of a digital survey with only closed-ended questions that was administered to all classroom teachers. The survey was analyzed using social network analysis to identify the ITLs at each school. During the second phase, individual interviews with the ITLs and the principal as well as a follow-up focus group interview with ITLs at each school were conducted. During the final phase of data collection, I observed the ITLs at work to understand how they embodied informal teacher leadership. Analyses of diverse data revealed how a principal influences the nature of informal teacher leadership in a school. Findings revealed that principals establish cultural expectations using teacher voice in leadership decisions, modeling the effective use of education technology, providing in-school and out-of-school leadership opportunities for ITLs, and establishing expectations for all teachers to assume roles of instructional leadership. It was clear in this study that although principals are not directly connected to the informal leading and learning network that occurs in a school, they indirectly influence the informal network by establishing school-wide cultural expectations for informal teacher leadership and by personally interacting with the ITLs.