Background: Suicide prevention strategies recognise the need to address suicide in high-risk groups, such as people with psychiatric illness. People with bipolar disorder are known to be at particularly high risk of suicide and self-harm, with around half of people diagnosed with bipolar disorder making at least one suicide attempt during their lifetime. It is important that clinicians can identify who is most at risk among people with bipolar disorder so that interventions that meet the needs of this high risk group can be implemented. Method: A multiple-methods approach was used to explore suicidal behaviour in bipolar disorder. Descriptive analysis, case-control methods, and survival analysis were used on data held by The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCI), and the Manchester Self-Harm (MaSH) Project, to identify characteristics and risk factors associated with suicide in bipolar disorder. Semi-structure interviews were carried out with people who had a range of experiences of suicidal behaviour in bipolar disorder, and these data were analysed using Thematic Analysis to add context and depth to the quantitative results. Results: Suicidal behaviours were common in people with bipolar disorder, accounting for around 10% of all psychiatric suicide deaths in England; this rate was fairly stable over time. Characteristics associated with suicidal behaviour in bipolar disorder included; being aged 45 to 64 years old, experiencing negative life events, comorbid alcohol use, multiple inpatient admissions; there was a particularly strong association with a history of self-harm. It is clinically important that people with bipolar disorder were often seen by services in the 24 hours before they died. This both emphasises the weaknesses in current risk assessment, and highlights the potential for successful intervention if risk can be determined more accurately. Key issues identified in the interview study included being able to access care rapidly during time periods when risk was elevated, the importance of obtaining a correct diagnosis of bipolar disorder, and the potential benefits of including family in the care of people with bipolar disorder. Conclusion: Suicidal behaviours are common in people with bipolar disorder. People with bipolar disorder who die by suicide tend to have several markers that may indicate a more severe (e.g. multiple inpatient admission, history of self-harm) and complex course of illness (e.g. comorbid alcohol use, personality disorder). Diagnosis-specific risk assessment is needed to better identify risk of suicide in an illness that is often characterised by fluctuating mood states. Family involvement in care may aid detection of increased suicide risk.

abstract: This study examines teacher educators' understandings of hope related to teacher education. The study provides a previously unforeseen perspective on teacher educators' hope or lack of hope, and gives insight into that hope's foundation and maintenance. I have designed and implemented a rigorous multi-method study, beginning with developing and conducting a nationwide on-line survey with 625 participants. From a pool of 326 participants expressing interest in participating in interviews, I interviewed 23 teacher educators selected from a randomized and purposive sample. Finally, 25 participants took part in a writing prompt sent in lieu of an interview. Findings reflect that teacher educators' "hope" is a construct, a mixture of abstract ideas, emotions, dispositions, attitudes, that is hard to conceptualize or measure, but appears to be a very relevant and influential and hope for teacher educators takes place on a continuum from bystander to actualizing. The results of this study serve as a way to encourage educators to be more explicit about hope and discourses about teaching. It raises awareness about "false senses" of hope, which arise from narratives of redemption, paving the way for a conception of hope grounded in a strong understanding of the multiplicities of teaching, and how things "are." This conception of hope has the potential to foster discussions and actions of what education can be, rather than dwelling in the rhetoric of what education is not. Further, this research has the potential to open up spaces to discuss both the importance of and how to begin to think about incorporating hope into curricula through critical pedagogy and pedagogies of hope. / Dissertation/Thesis / Ph.D. Curriculum and Instruction 2011

Livability, sustainability, and accessibility in urban public space are growing concerns in urban research and policy agendas. The professional field, however, lacks perspectives for public space qualities. Academic research about women and girls’ involvement in the re-design of public spaces is scarce. The Swedish suburb of Fittja in Botkyrka municipality is characterized by modernism and functionalism and at the beginning of a large refurbishment process. In 2018, think tank Global Utmaning initiated #UrbanGirlsMovement Botkyrka with the purpose of improving the public spaces of Fittja together with multiple stakeholders, particularly girls and young women from Fittja. In this case study, multiple methods and concepts from feminist urban geography and public space research are applied to examine how livability is illustrated and understood by girls and in which ways these learnings can inform urban public space policies. The results highlight ways to discharge patriarchal structures in public space using a compact and multifunctional urban form, accessible to all citizens through a variety of unprogrammed activity options, vibrant hangspace and green beautification. A feminist approach to urban livability shows the importance of understanding the diversity of perspectives to livability in public space, and that these perspectives matter for how we understand planning principles.

The core essence of a marketing transaction is the exchange of value between two parties. Quite often, the exchange of value describes a customer purchasing a product from a company. When purchasing products, the exchange of value can often fail due to product defects or customer dissatisfaction. When the marketing exchange fails, customers often desire an avenue for recourse to right the exchange imbalance. Accepting and quickly processing product returns represents a strategic tool companies can leverage to maintain healthy relationships with customers, despite an exchange failure. Effectively managing product returns also benefits companies financially, by reducing inventory levels, costs, and the risk of product obsolescence. Despite providing both relationship management and financial benefits, numerous companies struggle to manage product returns effectively. In a time when companies are facing a growing number of product returns due to omni-channel retailing and online shopping, implementing an effective system to manage product returns has become a vital strategic tool necessary to maintain competitiveness. First, the current research answers the question of why do companies struggle with product returns? by identifying the important components of an effective product returns system. Informed by complex adaptive systems theory and based on a qualitative, grounded theory analysis, the current research finds that the hidden complex nature of managing product returns prevents numerous companies from implementing an effective system to mange returns. Managing product returns requires five important components (firm capabilities, employees, the returns management information system, organizational climate, and the customer service boundary), which interact with each other multiple times to process a product return. After identifying the important components and interactions within a product returns system, Essay I integrates the information together to form a substantive theory of the complexity of product returns management. The substantive theory implies that companies looking to improve their management of product returns need to understand and invest in multiple components within the product returns system. Second, the current research answers the question of how do the employees, returns management information system, and climate for creativity components of a product returns system relate to a firm’s flexibility, adaptability, and performance? To answer this research question, this dissertation empirically evaluates the role these three components play in shaping a firm’s flexibility, adaptability, subjective performance and relationship quality by analyzing data collected through an online survey with 102 US managers with experience in product returns. The empirical analysis indicates that employee decision-making resources show a statistically significant negative relationship with firm adaptability, while the firm’s climate for creativity and flexibility show a statistically significant positive relationship with firm adaptability. Firm adaptability shows statistically significant positive relationships with subjective performance and relationship quality. Firm adaptability acts as a partial or full mediator in all of these relationships. The combined findings of Essay I and Essay II point to the importance of product returns as a strategic relationship management tool. Firms that can effectively manage product returns give employees more flexibility to respond to problems, are better able to make structural changes, have higher subjective performance ratings, and better quality relationships with customers.

Background: Changing service demands require United Kingdom ambulance services to redefine their role and response strategies, in order to reduce unnecessary Emergency Department attendances. Treat and Refer guidelines have been developed with this aim in mind. However, these guidelines have been developed in the absence of reliable evidence or guiding mid-range theory. This has resulted in inconsistencies in clinical practice. One condition frequently included in Treat and Refer guidelines is hypoglycaemia. Therefore this thesis aimed to investigate prehospital hypoglycaemic emergencies in order to develop an evidence base for future interventions and guideline development. Research approach: A pragmatic and inductive applied health services research approach was employed. Multiple methods were used in a sequential explanatory design. Three linked studies were undertaken with the results of previous studies informing the development of the next. Study one: A scoping review of prehospital treatment of hypoglycaemic events. Aims: i) To describe the demographics of the patient population requiring ambulance service assistance for hypoglycaemic emergencies; ii) To determine the extent to which post-hypoglycaemic patients with diabetes, who are prescribed oral hypoglycaemic agents (OHA), experience repeat hypoglycaemic events (RHE) after being treated in the prehospital environment. Methods: A scoping literature review was conducted using an overlapping retrieval strategy that included both published and unpublished literature. Findings: Twenty-three papers and other relevant material were included. Hypoglycaemia related ambulance calls account for 1.3% to 5.2% of ambulance calls internationally. Transportation rates varied between studies (25%-73%). Repeat hypoglycaemic emergencies are experienced by 2-7% of patients within 48 hours. There was insufficient detail to determine any relationship between repeat events and OHA. The low quality of included papers means that the results should be cautiously interpreted. The safety of leaving patients on OHA at home post hypoglycaemic emergency is unknown. Consequently patients taking OHAs who experience a hypoglycaemic emergency should be transported to hospital for observation. There was a lack of knowledge about the Scottish demographics of the patient population. Study two: A retrospective cross-sectional observational study of diabetes related emergency calls. Aims: To investigate i) the patient demographics and characteristics of hypoglycaemia related emergency calls; ii) the incidence of repeat hypoglycaemic events; and iii) the factors associated with emergency calls that result in individuals being left at home. Methods: A retrospective observational cross-sectional study conducted using Medical Priority Dispatch System® call data from West of Scotland Ambulance Control Centre over a 12 month period. Data were extracted on age, gender, dispatch code, time of call, deprivation category, and immediate outcome (home or hospital). Multiple regression analysis was used to determine predictors of remaining at home. Findings: 1319 calls for hypoglycaemia were received. Patient demographics were similar to the scoping review findings. Most patients remained at home (N = 916 vs N = 380; p < .001). RHE’s were experience by 3.1% within 48 hours, and 10.6% within two weeks. The most significant independent predictor for patients remaining at home was a prior call to the ambulance service (OR of 2.4 [95%CI 1.5 to 3.7]). Patients’ reasons for remaining at home and the causes of subsequent severe events are unknown. It is likely that non-clinical factors may explain some of this behaviour. Study 3: Investigating patients’ experiences of prehospital hypoglycaemic care. Aim: To investigate the experiences of patients who are attended by ambulance clinicians for a hypoglycaemic emergency. Methods: In-depth interviews with adults with diabetes who had recently experienced a hypoglycaemic emergency treated by ambulance clinicians. Participants were recruited from Greater Glasgow and Clyde and Lanarkshire Health Board areas. Data were analysed using Framework Analysis. Findings: Twenty six patients were interviewed. Three key themes were developed. Firstly, an explanation for help seeking behaviour; patients’ impaired awareness of hypoglycaemia as well as the inability of friends and relatives to cope can contribute to an ambulance call-out. Secondly, the perceptions of ambulance service care; patients felt the service provided was good; however ambulance clinicians’ advice was inconsistent. Thirdly, the influences on uptake of follow-up care; patient preferences for follow-up care were influenced by previous experiences of home, hospital and primary care. Post-hoc analysis identified three psychological theories that may explain these findings and provide a useful basis for intervention development: Common Sense Model (Leventhal et al, 1998); Health Belief Model (Rosenstock, 1966); Ley’s cognitive hypothesis model of communication (Ley and Llewelyn, 1995; 1981). Conclusion: Most people treated for severe hypoglycaemia by ambulance clinicians remain at home and do not follow-up their care. A few experience repeat hypoglycaemic emergencies. Key causal, but modifiable factors, contributing to this include:- impaired awareness of hypoglycaemia; inconsistent delivery of ambulance clinician referral advice; and patients’ perceptions of the costs and benefits of follow-up care. Ambulance services cannot address all these factors in isolation. The studies in this thesis have generated an evidence base and identified plausible candidate theories. This will support the future development of novel interventions to improve severe hypoglycaemic emergency follow-up.

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