This study aimed to explore the experiences of midwives who were also homeopaths as they attempted to straddle the different philosophical and practice paradigms they encountered in each domain. It also explored the implications of their experience on their practice. Over recent decades the National Health Service (NHS) has moved towards a scientific-bureaucratic perspective, in which the emphasis is on the use of evidence-based frameworks. It has been argued that this development has moved the focus in healthcare away from ‘caring’. In parallel, there has been an increase in the demand for complementary and alternative medicines in the United Kingdom (UK), and elsewhere. In responding to this call a number of midwives have taken up training opportunities in massage, aromatherapy, hypnotherapy, acupuncture and homeopathy, amongst others. There are no studies however, that have examined the impact of training as a homeopath on midwives and their practice. After a comprehensive analysis of existing literature, this study used an interpretive hermeneutic framework to explore the experience of midwives who trained as homeopaths. In-depth interviews were conducted with seven midwife homeopaths. The findings were analysed using three different lenses. The first of these conceptualised and explored the midwives narratives as personal and professional metamorphoses, as they changed from midwife to homeopath or midwife homeopath. Secondly, the data were framed using a Heideggerian lens, which illuminated a process of transformation into being authentic practitioners. This demonstrates how authenticity allowed the participants to (re) engage with, and further value the therapeutic relationship as a fundamental element of their clinical practice. The final lens explored the impact engendered of being authentic on the therapeutic relationship that developed between midwife homeopath and the women in their care. The conclusion was drawn that the therapeutic relationship developed by an authentic practitioner via a homeopathic consultation is transferable to other healthcare practitioners, and offers a challenge to practice based in notions of scientism and bureaucracy. Further exploration of these phenomenon’s could help to deliver on the drive to deliver compassionate personalised care across the NHS as a whole.

Made available in DSpace on 2014-06-12T23:00:15Z (GMT). No. of bitstreams: 2 arquivo8509_1.pdf: 624683 bytes, checksum: 3bb183e86aacbaf66ac07943ca0139d3 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2003 / Desde a introdução das primeiras limas confeccionadas em liga de níquel-titânio na endodontia, diversos instrumentos manuais e rotatórios foram integrados ao arsenal endodôntico com a promessa de se realizar uma instrumentação rápida e segura do sistema de canais radiculares. No presente trabalho foram utilizados 50 molares inferiores humanos, com processo de rizogênese completa, obtidos no banco de dentes do Curso de Pós-Graduação em Odontologia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, com o objetivo de avaliar, através de tomadas radiográficas de dupla exposição, as alterações morfológicas produzidas pelo preparo biomecânico no terço apical dos canais radiculares mésio-vestibulares, tendo como instrumento apical final (IAF), uma lima com diâmetro da ponta (D0) igual a 0,25 milímetros. Para se observar a ocorrência da manutenção da patência original do canal foi realizada sobreposição da imagem radiográfica do instrumento apical inicial (IAI), Lima K 10# e o IAF. Foram utilizadas as limas manuais de aço inoxidável Flexofile® (Dentsply/Maillefer, Ballaigues, Swiss), e Tipo K® (Dyna, Burges, France). As limas de níquel-titânio, Nitiflex® (Dentsply/Maillefer, Ballaigues, Swiss) e os sistemas rotatórios Protaper® e Profile® .04/.06(Dentsply/Maillefer, Ballaigues, Swiss). A avaliação das imagens radiográficas, foi realizada por três examinadores independentes e previamente calibrados. Os resultados obtidos permitiram concluir que os melhores instrumentos em ordem decrescente foram: Flexofile®, Protaper®, Nitiflex®, Profile® e a lima Tipo K

The apparent success of homeopathy is often attributed to a collaborative, holistic and empathic consultation and to the practitioner patient relationship. However most research into the homeopathic consultation has focussed on patients’ experiences although the practitioner is a crucial component of the therapeutic context and may have an important part to play in optimising health outcomes in homeopathy. Therefore the aim of this research was to gain an in depth understanding of homeopathic practitioners’ perceptions and experiences of the consultation. An additional aim was to generate a theoretical model to explain the processes that underpin the homeopathic consultation. A qualitative approach was taken using constructivist grounded theory methodology employing a process of two phases of data collection. Medical and non medical homeopaths were sampled from the registers of the Faculty of Homeopathy and the Society of Homeopaths. Phase 1 involved face to face in-depth interviews with homeopaths. From these interviews a theoretical model of the homeopathic consultation was developed. Phase 2 of data collection involved observations of homeopathic consultations and the use of solicited practitioner reflective diaries in order to confirm, refute or enlarge on the model which developed from phase 1. The emergent theoretical model entitled “a theoretical model of a UK classical homeopathic consultation” describes how homeopaths view and enact the consultation process. The findings indicate that the consultation consists of processes which are interlinked and dependent on each other. I have labelled these processes exploring the journey together, finding the level, responding therapeutically and understanding self. Central to these processes is the core category which I have labelled connecting. This study has highlighted that the whole process of the homeopathic consultation is important and aspects that are unique to homeopathy such as the process of identifying and matching the homeopathic remedy cannot be separated from the rest of the consultation and must be considered as part of the whole process. Additionally the ritualistic and symbolic aspects of the consultation that are embedded in this process are of paramount importance and provide meaning, highlighting the power of the consultation to promote beneficial effects for the patient. This research has implications for all stakeholders and signals many future avenues for research.

Homoeopathic practitioners in the United Kingdom can be divided into two groups,those with medical qualifications and those without, professional homoeopaths. This study examines these two groups to discover how they practise homoeopathy and why. Also examined are any tensions that may exist, both between the two groups and within the groups. Collecting qualitative and quantitative data using questionnaires and interviews, a randomly selected sample of homoeopaths was studied. All subjects were members of either the Faculty of Homoeopathy or the Society of Homoeopaths. The study starts by examining the development of homoeopathy over its almost 200 year history. Following this section data regarding the practice of homoeopathy and the opinions of homoeopaths on this practice are discussed. The homoeopath's opinions regarding their opposite numbers are also discussed, that is professional homoeopath's opinions of medically qualified homoeopaths and vice versa. The data highlighted a number of tensions that exist between medically qualified homoeopaths and professional homoeopaths. Medically qualified homoeopaths questioned the wisdom of allowing non-medically qualified people to practice homoeopathy and the professional homoeopaths questioned the validity of the homoeopathic methods used by medically qualified homoeopaths. Tensions within professional homoeopathy were also identified between pro and anti professionalisation and registration subgroups. Another tension identified was between those professional homoeopaths who claim to use the original, 'classical' formulation of homoeopathy and those using a more eclectic therapeutic regime with changes to the original method incorporated into their practices. Finally, the utility of the concept of heresy when describing both medically qualified homoeopaths and professional homoeopaths in the United Kingdom was addressed. Although the labelling of heretics is properly reserved for those members of the orthodoxy, not for researchers, a small number of homoeopaths were identified as holding potentially heretical ideas. On the whole the medically qualified homoeopaths and the majority of professional homoeopaths could not be regarded as heretics or dissenters in any way. In the light of the tensions that were identified, and the policies being promoted by the professional bodies, the conclusion examines the possible future of homoeopathy in the United Kingdom in the first years of the new millennium. A thoroughly modernist medicine in a possibly postmodern era.

Class of 2013 Abstract / Specific Aims: The purpose of the study is to describe the reasons for medication disposals at Take-Back-Rx events and make inferences regarding medication adherence. Methods: Participants at Take-Back-Rx were invited to complete a survey that collected information on the participants current medical conditions, associated medications, unwanted medications, and demographic information. Main Results: The majority of participants were non-Hispanic White (89.2%) on Medicare (87.8%) with at least some college education (72.1%). The mean number of reasons listed for disposal was 2.25 and the majority of medications were expired (70%) or the dose/agent changed (47%). Conclusion: This study effectively described the reasons for medication disposals at Take-Back Rx events, but applicability to further patient populations may be limited due to shortcomings of the instrument.

The subject of this thesis is the lived experience of training in non-orthodox health care professions1 or CAM (complementary and alternative medicine) as it is commonly known. The thesis focuses both on the nature of the knowledge and skills acquired during training (knowledge of the body) and the changing embodiment of the students (embodying knowledge). It is based on ethnographic research, conducted over one academic year, at two case-study sites: the anonymized Colleges of Homeopathy and Osteopathy. The data presented in this thesis offers four distinct contributions. Methodologically, it offers insights into the embodied experience of conducting sociological research and the deep impact that this experience has on the researcher, further supporting the argument that reflexivity is a vital component of valid and reliable research. Empirically, it contributes to our understanding of an under-researched area, the ?Tactice of CAM therapies generally, and the training of practitioners particularly. Theoretically, the explicit focus of both the participants in the study .and myself, as researcher, on 'bodies' makes it a worthwhile topic of study to contribute to the growing discipline of embodied sociology. Finally, from a social policy perspective, the explosion of interest in CAM in recent years, and particularly the growing pressure on practitioners to regulate their professions, makes research into the nature of professional knowledge and practice very timely. The thesis concludes that it is of critical importance to consider embodiment in any understanding of healthcare knowledge or practice. In particular, an embodied sociological perspective permits recognition of the depth and nature of the knowledge and skills that healthcare practitioners learn to deploy on a day-to-day basis.

La méthode solide-liquide en milieu alliage fondu à base de lithium a permis ces dernières années la synthèse de plusieurs composés d'intercalation du graphite (CIG) insérés à coeur au sein des systèmes graphite-lithium-alcalino-terreux. Dans le cadre de cette thèse, cette méthode de synthèse a été étendue aux systèmes graphite-lithium-lanthanoïde, avec une difficulté supplémentaire qui est la méconnaissance des diagrammes de phases binaires lithium-lanthanoïde dont les données sont capitales pour déterminer les domaines de température et de composition chimique des alliages susceptibles de conduire à des CIG. L'immersion de plaquettes de pyrographite dans certains alliages lithium-europium judicieusement choisis a mené à un composé binaire EuC6 ainsi qu'à un composé ternaire graphite-lithium-europium de premier stade.La cinétique de formation de EuC6 a été suivie par diffraction des rayons X ex situ afin de comprendre les différentes étapes de la réaction et d'identifier les phases intermédiaires menant au composé final thermodynamiquement stable. Ce mécanisme révèle un processus réactionnel plus « coopératif » que celui menant au composé CaC6 et a été décrit par une succession d'étapes contribuant à l'insertion à coeur de l'europium.La composition élémentaire du composé ternaire a été déterminée grâce à une analyse par faisceau d'ions qui a permis de doser simultanément les trois éléments lithium, carbone et europium. Le résultat de cette analyse a conduit à la formule chimique Li0,25Eu1,95C6. EuC6 a également été étudié par microsonde nucléaire, le rapport atomique C/Eu de 6 a ainsi notamment pu être confirmé.Des études structurales ont été menées pour les composés binaires et ternaires. D'une part, il a été possible d'effectuer la résolution structurale complète du binaire EuC6, qui cristallise dans une maille hexagonale de groupe d'espace P63/mmc. D'autre part pour le ternaire Li0,25Eu1,95C6, la séquence d'empilement poly-couche selon l'axe c du feuillet inséré a été modélisée, par combinaison des données structurales avec les informations issues de l'analyse par faisceau d'ions.Les composés d'intercalation du graphite sont des solides de basse dimensionnalité qui se prêtent idéalement à l'étude des relations structure-propriétés. Ainsi dans le système graphite-lithium-calcium, le caractère supraconducteur des composés CaC6 et Li3Ca2C6 a été étudié par spectroscopie de spin de muon ([mu]SR). Pour le système graphite-lithium-europium, des mesures magnétiques réalisées préalablement à ce travail ont été poursuivies et complétées par des analyses [mu]SR (pour Li0,25Eu1,95C6 et EuC6) ainsi que par spectrométrie Mössbauer de 151Eu (pour Li0,25Eu1,95C6) à basse température. / The molten alloy solid-liquid method containing lithium has recently enabled the synthesis of several bulk graphite intercalation compounds (GICs) in graphite-lithium-alkaline earth metal systems. As part of this thesis, this synthesis method was extended to graphite-lithium-lanthanide systems, with an additional difficulty which is the lack of knowledge of lithium-lanthanide binary phase diagrams whose data are crucial for determining the temperature range and chemical composition of alloys that may lead to GICs.The immersion of pyrographite platelets in some europium-lithium alloys wisely chosen led to a binary EuC6 compound as well as a graphite-lithium-europium first stage ternary compound.Kinetics study of EuC6 compound was followed by ex situ X-ray diffraction in order to understand the different reaction steps and identify intermediate phases leading to the thermodynamically stable final compound. This mechanism revealed a reaction process more "cooperative" than that leading to CaC6 binary compound and was described by a succession of steps that contribute to the bulk insertion of europium.The elementary composition of the ternary compound was determined by ions beam analysis allowing the simultaneous quantification of the three elements lithium, carbon and europium. The refinement of these analyses led to the chemical formula Li0,25Eu1,95C6 for the ternary compound. EuC6 has also been studied by nuclear microprobe analysis, and especially the C/Eu atomic ratio equal to 6 has been confirmed.Structural studies have been undertaken for binary and ternary compounds. On one hand, it was possible to fully resolve the three-dimensional structure of the binary EuC6, which crystallizes in a hexagonal unit cell with P63/mmc space group. On the other hand, the c axis stacking sequence of the poly-layered intercalated sheet of the ternary compound was modeled by combining structural data with information from the ions beam analysis. The graphite intercalation compounds are low-dimensional solids that are ideal for the study of structure-properties relations. Thus in graphite-lithium-calcium system, superconducting character has been studied for CaC6 and Li3Ca2C6 compounds by muons spin spectroscopy ([mu]SR). For the graphite-lithium-europium system, previous magnetic measurements have been continued and supplemented by [mu]SR analysis (for Li0,25Eu1,95C6 and EuC6) and by low temperature 151Eu Mössbauer spectroscopy (for Li0,25Eu1,95C6).

The aim of this study was compared two measurement methods of dentin in wear risk of mandibular molars. The distal dentin thickness wall of the mesial canals, at 2 mm of ten molar furcation, was measured before and after the cervical preparation with CPDrill ® through the Cone Beam Tomography (apparent image) and through the Stereomicroscope (real image) in order to verify if the first provided trusted values, even though an examination by image. After analysis in Image Tool computer program, the results were subjected to statistical analysis of Mann-Whitney. The result of this study showed that there was no statistical difference between the values obtained (p ˃ 0.5) in Stereomicroscope and Cone Beam computed tomography. Within the methodology of this study was possible to conclude that the Cone Beam Tomography (Imaging examination) allows to evaluate the dentin wear as similar as real values. / O objetivo deste estudo foi comparar dois métodos de aferição do desgaste dentinário na zona de risco de molares inferiores. A espessura dentinária da parede distal dos canais mesiais, a 2 mm da furca de dez molares inferiores, foi mensurada antes e após o preparo cervical com a broca CPDrill®, por meio da Tomografia Cone Beam (imagem aparente) e por meio de Estereomicroscópio (imagem real) com a finalidade de verificar se o primeiro fornecia valores fidedignos, mesmo sendo um exame por imagem. Após análise no programa de computador Image Tool,os resultados foram submetidos à análise estatística de Mann-Whitney. O resultado deste estudo mostrou que não houve diferença estatística entre os valores obtidos (p˃ 0,5) no Estereomicroscópio e na Tomografia Computadorizada Cone Beam. Dentro da metodologia deste estudo foi possível concluir que a Tomografia Cone Beam (exame por imagem) permite avaliar o desgaste dentinário com valores similares aos valores reais.

Les connaissances des propriétés des fluides hydrothermaux, c'est-à-dire des solutions aqueuses à haute température (T) et haute pression (P), sont essentielles dans les domaines des sciences de la terre, chimie prébiotique, industrie nucléaire ou encore des sciences environnementales. Près du point critique (Pc, Tc) et dans les conditions pseudocritiques (i.e. à la densité critique au dessus de la Tc-Pc), les propriétés des fluides changent de manière radicale. Ces modifications ont lieu à différentes échelles: à l’échelle macroscopique (changements de densité et de compressibilité), à l’échelle mésoscopique (processus d’agglomération entre les différentes clusters) et enfin à l’échelle moléculaire (organisation local entre les atomes et les molécules, par exemple les liaisons hydrogène, H).Cette étude est centrée sur les effets de la solvatation aqueuse de différents électrolytes en fonction de la température, pression et concentration. L'étude expérimentale a été conduite par les mesures d’Absorption X, technique de choix pour mesurer d'une part l'évolution de la densité du fluide et d'autre part sonder l'environnement atomique local autour des solutés. Cette étude a été faite sur l'eau pure et sur différentes solutions salines à différentes pressions (jusqu'à ~1.3Pc) et à température variable (jusqu'à ~2Tc), pour passer du domaine liquide au domaine supercritique, dans une cellule permettant de découpler totalement l’effet de la pression et de la température.Nous avons obtenu des preuves expérimentales du déplacement du point critique et de l'isochore et de leur dépendance en fonction de la concentration en sel pour NaCl (0,3, 0,5 et 1,0 moles NaCl par kilogramme d'eau). Nous avons également observé une anomalie de densité dans la région supercritique (SC) et l'apparition d'une séparation des phases liquide-vapeur pour certaines solutions aqueuses. L'augmentation de la densité relative dans cette zone critique est plus prononcée pour Cs>Rb>K>Na>Li pour les bromures et les chlorures. Le changement structural dans cette région a été suivi par spectroscopie XANES haute résolution au seuil K du brome pour différents bromures d'alcalin. L'interprétation des spectres XANES indiquent clairement un changement drastique dans la structure locale du fluide au moment de l'apparition de cette anomalie pouvant être interprétée par l'apparition des paires ioniques.Ces nouvelles observations sont a relier au changement structurale du solvant et principalement à l'évolution de son pouvoir de solvatation lié à l'évolution des liaisons hydrogène à hautes T-P. / Knowledge of the properties of hydrothermal fluids, i.e. aqueous solutions at high temperature (T) and high pressure (P), are essential in the fields of earth sciences, prebiotic chemistry, nuclear industry and environmental sciences. Near the critical point (Pc, Tc) and under the pseudocritic conditions (i.e. at the critical density at T-P above Tc-Pc), the fluid properties change radically. These changes take place at different scales: the macroscopic scale (density and compressibility changes), the mesoscopic scale (agglomeration process between different clusters) and finally, the molecular scale (local organization of atoms and molecules, for example hydrogen bonds, H).This study focuses on the solvation effects in different electrolytes as a function of temperature, pressure and concentration. The experimental study was carried out by X-ray absorption measurements, the technique suitable for probing both fluid density evolution and local atomic environment around the solutes. This study was carried out on pure water and salt solutions at different pressures (up to ~ 1.3Pc) and temperatures (up to ~ 2Tc), to pass from the liquid to the supercritical domain, using a cell permitting to completely decouple the effects of pressure and temperature.We have obtained experimental proofs of the displacement of the critical point and the isochore and their dependence on the salt concentration in the case of NaCl (0.3, 0.5 and 1.0 moles NaCl per kilogram of water). We have also observed a density anomaly in the supercritical region (SC) and the appearance of liquid-vapor phase separation for some aqueous solutions. The relative density increase in the critical zone is more pronounced for Cs>Rb>K>Na>Li for bromides and chlorides. The structural change in this region was followed by high-resolution XANES spectroscopy at the K-threshold of bromine for various alkali bromide. The interpretation of the XANES spectra clearly indicates a drastic changes in the fluid structure related to this anomaly, which can be interpreted by the appearance of ionic pairs.These new observations are in link with water structure and solvation properties evaluation and consequently with hydrogen bonding changes under high T-P.

Background & Aim: Osteoarthritis (OA) sufferers frequently turn to complementary and alternative medicine (CAM), of which the most common are acupuncture and homeopathy, to improve manageability of their condition. However, there is little extant evidence of effectiveness for these treatments for OA, particularly for homeopathy. One criticism of homeopathic studies is that treatment protocols do not reflect true homeopathy. The nature of true homeopathy is not documented in extant literature. In the current study a mixed methods approach was used to investigate the use of homeopathy for osteoarthritis using a survey, conducted with a parallel acupuncture survey for comparison, follow up interviews with homeopaths and a patient-centred study in a homeopathic department offering treatment on the NHS, in order to inform future studies. Method: The current study involved three phases; (1) A descriptive survey conducted on n=362 medical and non-medical homeopaths and acupuncturists, was used to , investigate practice of the therapies (2) Follow up interview of n=28 of the homeopathic practitioners. (3) A patient-centred study of n=11 patients with OA receiving homeopathy in the primary care setting. Results: (1) Most commonly encountered conditions were chronic diseases. Medical and non-medical acupuncturists practised very different forms of acupuncture particularly in terms of diagnostic techniques used and theoretical underpinning. Homeopathic practitioners used individualised treatments, abiding by classical homeopathy. Differences between medical and non-medical homeopaths included time spent in the consultation (p= 0.01), strength of confidence in homeopathy for asthma (p=0.01), musculo-skeletal (p=0.046) and acute conditions (p=0.01)., and confidence in conventional medicine (p=0.01). There was a belief amongst acupuncturists and homeopaths that the treatments may work on electrodynamic fields in the body. (2) A similar approach was taken by participants during a detailed initial consultation. However, irrespective of medical status, varied approaches were used to identify the remedy, potency, and remedy f6mi, and the source of remedy also varied. Main themes regarding the modus operandi of homeopathy included stimulation of self healing mechanisms and identifying in detail events at the point where the initial health imbalance occurred. Identification of this point together with the patient was considered a potential trigger for the healing process to begin, adding a particular importance to the role of the consultation. (3) OA patients in the primary care setting identified pain or stiffness as the most common primary complaint., with an emotional factor such as anxiety and limitations caused by their condition as a secondary complaint. A desire to reduce their medication or to improve the manageability of their condition was a common theme for interest in receiving homeopathy, with access to NHS homeopathic treatment and perceived safety of receiving treatment from medical doctors being important factors. Following 6 months of' homeopathic treatment, most participants reported an improvement in the manageability of their condition. This, however was not supported by results from VAS pain, VAS stiffness, MYCAW scores or SF36 subscore, or salivary concentration of substance P results which were not found to be significant. Few correlations were found between outcome measures. Substance P level was strongly correlated with the functional limitations sub-score of the SF36 (p=0.01), indicating a potential role for this biochemical measure in future studies. Conclusion: Findings from the current study can inform future studies on how to enhance the evidence base for homeopathic and acupuncture treatment, and inform the integration debate. Future advances in the understanding of subtle processes in the body, the placebo response, and the nature of cure may add to our understanding of' CAM treatments. However, it is likely that in order to advance the evidence base on the effectiveness of homeopathy for OA, more effective tools that are sensitive to changes in biopsychosocial dimensions of health will be necessary. Future research on combination therapies is also warranted.