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Background: Improving care for people living with dementia when they are admitted to hospital is a national priority. Interventions have been designed and implemented to support staff to improve how they provide care to patients with dementia. However, there is limited understanding of how these interventions work in practice and what the outcomes are for patients and their family carers. Objective: To develop, test, and refine a theory-driven explanation of what supports hospital staff to provide dementia-friendly care and with what outcomes for people living with dementia and their carers. Method: A two-phase study design employing realist methodology. Phase one was a realist review which combined evidence from stakeholder interviews and literature searches. Phase two used realist evaluation to analyse data collected from two NHS Hospital Trusts in the East of England to test the theory developed in phase one. Findings: Initial scoping in the realist review identified three candidate theories which structured the literature searches and analysis. Six related context-mechanism-outcome configurations were identified and collectively made the initial programme theory. The review found that single strategies, such as dementia awareness training, would not on their own change how staff provide care for patients with dementia. An important context was for staff to understand behaviour as a form of communication. Organisational endorsement for dementia care and clarity in staff roles was important for staff to recognise dementia care as a legitimate part of their work. The realist evaluation refined the programme theory. While the study sites had applied resources for patients with dementia differently, there were crosscutting themes which demonstrated how key mechanisms and contexts influenced staff actions and patient outcomes. When staff were allocated time to spend with patients and drew on their knowledge of the patient with dementia and dementia care skills, staff could provide care in ways that reassured patients and recognised their personhood. However, accepted organisational and social norms for care practices influenced whether staff considered providing skilled dementia care was an important contribution to the work on the ward. This impacted on how staff prioritised their work, which influenced whether they recognised and addressed patient needs such as pain or hunger, made attempts to reduce distress, and if patients and carers considered they were listened to. Organisational focuses, such as risk management, influenced how patient need was defined and how staffing resources were allocated. Staff commitment to continuing in dementia care was influenced by whether or not they valued dementia care as skilled work. Discussion: Single strategies, such as the use of dementia awareness training, will not on their own improve the outcomes for patients with dementia when they are admitted to hospitals. In addition, attention needs to be paid to the role of senior managers and their knowledge of dementia to support staff to provide care in ways that recognise the needs of the person. The way dementia care is valued within an organisation has implications for how resources are organised and how staff consider their role in providing dementia care. Evidence from observations demonstrated that when staff are supported to provide good dementia care, patients experienced positive outcomes in terms of their needs being addressed and reducing distress. Dementia care needs to be recognised as skilled work by the staff and the organisation.

This thesis explores the importance of tolerating and facilitating uncertainty as it is recognised by British Independent and Kfeinian psychoanalysis and contemporary British magic realist fiction. In Part I, I offer some theoretical investigations, arguing that postmodem and some psychoanalytic discourses, namely Lacanian psychostructuralism, remarkably fail to address the challenges facing subjects in late- twentieth, early twenty-first century consumer culture. In their inability to tolerate paradoxes and uncertainty, these discourses objectify the subject, through processes of depersonalisation, derealisation and desubjectification. To redress these problems, I offer the work of British psychoanalysts, specifically, that of D. W. Winnicott and Melanie Klein and her followers. These perspectives, I argue, better serve the contemporary subject by recognising the importance of paradox and helping develop facilitating environments for the realisation of creative experience. In Part II, I examine how the play of paradox is fostered in contemporary British magic realist fiction. Specifically, I look at how these narrative strategies attempt to move away from the vicissitudes of internal and external, certainty and uncertainty, reason and unreason, to negotiate a Winnicottian third, potential space. The conceptualisation of such a space, I believe, offers a place from which we can begin to dialogue, to draw ourselves out of the oppositional dialectics that have plagued the bourgeois subject. I believe that in the novels of writers such as Jeanette Winterson, Joanne Harris, John Fowles, John Murray and, most especially, Angela Carter, we can find alternatives to bourgeois conceptions of reason and rationality, alternatives that are not based on the paranoid-schizoid, primitive processes and depersonalisation necessitated by the Enlightenment and capitalism but instead upon, in Kleinian terms, depressive ambivalence and the recognition of whole-objects.

This thesis, presented as a theoretical contribution to the discipline of International Relations, describes the intellectual origins of the idea of the territorial state. The idea of the territorial state has a privileged place in International Relations for it is an integral element of Realism, the discipline's dominant intellectual tradition. Realism assumes that the primary actors in the modern international system are states, as identified by their exercise of sovereignty over a delimited space or territory. In Realist history, the territorial state and the modern territorial international order emerged together, twin products of seventeenth century political theory and practice, as signified by political settlement of the Peace of Westphalia in 1648. This thesis challenges the Realist narrative of the idea of the territorial state on two counts: methodologically and historically. First, it rejects the view that it is possible to account for the idea of the territorial state exclusively in terms of political practice and knowledge. It argues that the Realist idea of the territorial state needs to be understood as one expression of a much broader and more complex matrix of narratives - social, political, philosophical and cultural - about man's capacity to know, represent and order the spaces of modernity. Second, the thesis rejects the Realist history that dates the emergence of the territorial state to the seventeenth century. An alternative chronology is put forward that dates the origins of the idea of the territorial state to fifteenth and sixteenth century Renaissance Italy. The thesis argues that the first signs of the idea of the territorial state can be identified in various Renaissance spatial discourses: political, cosmological, artistic and cartographic. These spatial discourses and the practices they led to established the templates for thinking about and representing space in modernity, including those underlying the articulation of the idea of the modern territorial state.

PURPOSE. This thesis considers the best way to address the challenges faced by educators, institutions and funding bodies trying to not only develop and implement educational technology successfully but tackle the challenge of understanding and evidencing what works (and what does not) and why. The aim of the research was to find and validate an evaluation method that provided usable and useful evidence. APPROACH. A range of evaluations were undertaken to elicit the strengths and weaknesses of different approaches, augmented by drawing upon the experiences and outcomes published by others. An analysis of the issues was made and significance of the problem established. The problem being premature timing, unsuitable models, rapid change, complex implementation chains, inconsistent terminology, ideology and marketisation. A tailored realist evaluation framework was proposed as an alternative method and it was tested to evaluate an institutional lecture capture (LC) initiative. FINDINGS. The theory-driven realist approach provided a level of abstraction that helped gather evidence about wider influences and theories of potential future impact of the LC programme and its linked policy. It proved valuable in generating real and practical recommendations for the institution, including what more could be done to improve uptake and support embedding in teaching and learning, from practice, policy and technological points of view. It identified some unanticipated disadvantages of LC as well determining how and when it was most effective. PRACTICAL IMPLICATIONS. A Realist Evaluation of Technology Initiative (RETI) framework has been produced as tool to aid the rapid adoption of the approach. Recommendations for future research and seven guiding principles have been proposed to encourage the formation of a community of realist evaluative researchers in educational technology. ORIGINALITY/VALUE. The rigorous application of a tailored realist evaluation framework (RETI) for educational technology (including the development of two Domain Reference Models) is the primary contribution to new knowledge. This research is significance because it has potential to enable the synthesis of evaluation findings within the sector. This will enable an evidence-base of what works, for whom, in which contexts and why, ultimately benefiting policy-makers and practitioners to support better informed decision making and investment in education.

After World War II the United States, faced with the new Soviet threat of Communism, instituted the foreign policy known as “containment” in order to mitigate the threat to Western European states of Soviet expansionism. After the fall of Communism in the USSR in 1991 that policy was deemed, at once, a success and an anachronism. The power vacuum that the subsequent abandonment of that policy created was most notable in the Islamic states that had served as proxies in the Cold War against Communism. Both the backdrop of containment as well as the withdrawal of that policy served to lay the foundation for the rise of Islamic fundamentalism throughout the Muslim world as a function of American hegemony after 1991.

Yes / This article recounts our experience of eliciting, cataloguing and prioritizing conjectured Context-Mechanism-Outcome configurations at the outset of a realist evaluation, to provide new insight into how Context-Mechanism-Outcome configurations can be generated and theorized. Our construction of Context-Mechanism-Outcome configurations centred on how, why and in what circumstances teamwork was impacted by robotic surgery, rather than how and why this technology improved surgical outcomes as intended. We found that, as well as offering resources, robotic surgery took away resources from the theatre team, by physically reconfiguring the operating theatre and redistributing the surgical task load, essentially changing the context in which teamwork was performed. We constructed Context-Mechanism-Outcome configurations that explain how teamwork mechanisms were both constrained by the contextual changes, and triggered in the new context through the use of informal strategies. We conclude by reflecting on our application of realist evaluation to understand the potential impacts of robotic surgery on teamwork.

No / Falls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England. Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. / This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal.

Classifications are useful and efficient. We group things into kinds to facilitate the acquisition and transmission of important, often tacit, information about a particular entity qua member of some kind. Whilst it is universally acknowledged that classifications are useful, some scientific classifications (e.g. chemical elements) are held to higher epistemic standards than folk classifications (e.g. bugs). Scientific classifications in terms of 'natural kinds' are considered to be more reliable and successful because they are highly projectible and support law-like and inductive generalisations. What counts as a natural kind is, however, controversial: according to essentialists (e.g. Putnam, Kripke, Ellis) natural kinds are mind-independent and possess essential characteristics; according to promiscuous realists (e.g. Dupre ) there are 'countless legitimate, objectively grounded ways of classifying objects in the world'; and according to scientific realists (e.g. Boyd, Psillos) natural kinds are grounded in the 'causal structure of the world'. More specifically, realism about kinds can be understood as a commitment to the existence of natural divisions (kinds) in the world that we come to know as a result of mature scientific investigation into the nature of such kinds. Realism about natural kinds is supported and articulated in terms of three main arguments, metaphysical, semantical, and epistemological. In the first part of my thesis I offer a sustained and systematic investigation of these three main arguments, with their respective promises and prospects for the viability of realism about kinds and I find them wanting, whilst in the second part of the thesis I pursue an unexplored line of inquiry regarding natural kinds and propose a mild realism about natural kinds via the ontology of real patterns.

<p>Den franske kunstneren Eugène Carrière virket i 1800-tallets slutt og har hovedsakelig blitt omtalt og definert som del av den symbolistiske retningen både i hans samtid og i ettertiden. I litteraturen jeg har studert, omhandlende symbolismen og dens virkende aktører,omtales Carrière gjennomgående nokså generelt og mer eller mindre med lignende beskrivelser av hans kunst: Hans bilders motiv utgikk til størst del fra familielivet og moderskapet, inspirert av hans hustru og deres barn på en måte som samtidig kunne koples til drømmene. Fra den tidlige perioden av hans kunstnerskap fantes det i større grad innflytelser fra det naturalistiske maleriet, men hans stil utvikledes deretter til en mer personlig og beveget seg dermed mer vekk fra den direkte avbildningen og mot hva som altså omtales som symbolistisk. Hans teknikk var dog nokså unik i hans fargebruk som var minimert til hovedsakelig brune og gråe toner påført i tynne, synlige penselstrøk, men for øvrig opplevdes hans verk som mindre utfordrende og heller nokså sentimentale, og sees som en mulig grunn</p><p>til at han til dels har blitt ”bortglemt” gjennom historien, noe Pierre-Louis Mathieus</p><p>introduksjon til avsnittet om Eugène Carrière i boken The Symbolist Generation kan vise på: ”A fairly neglected artist today, owing perhaps to the repetitive and somewhat old-fashioned sentimentality of his favorite subjects”. Uti fra dette resonnementet kan dermed Carrière oppfattes som en middelmådig, allmenndaglig kunstner i sin tid uten det mest banebrytende kunstnerskap. Er det kun slik man har ønsket å omhandle ham? Gir hans motiv og hans</p><p>teknikk kun muligheten til denne tolkningen eller finnes det flere muligheter? Dette er hva jeg ønsker å ta rede på i denne uppsatsen.</p><p>Gjennom inngående billedanalyser av utvalgte verk ønsker jeg å belyse andre aspekter,</p><p>som genus og hvordan bildene eventuelt kan si noe om de sosiale omstendigheter i tiden, men videre også gjennom vår persepsjon utforske bildenes innhold avskilt fra den øvrige virkelighet og se hvilket inntrykk de kan gi av Carrière som del av såkalte fin de siecle og den pågående utvikling i modernismens retning mot det autonome maleri.</p><p>Jeg har valgt å ta for meg tre verk som hver og ett vil bli beskrevet, analysert</p><p>formalistisk og gitt mulige tolkninger: Alphonse Daudet et sa fille 1891 (Musée d’Orsay), Aprés le bain 1887 (Musée d’Orsay) og Le Théatre de Belleville 1886-1895 (Le Musée Rodin). Jeg mener dette er tre verk som på ulike måter kan vise på sider av Carrières kunst der fokuset kan legges et annet sted enn kun hos hans bruk av sin egen familie som modeller, noe som til dels ellers kan se ut til å ha vært en gjennomgående generell oppfatning.</p>