Working at the intersection of medical sociology and the psychology of health, language and communication, in this PhD I use thematic analysis (TA) and conversation analysis (CA) to provide an insight into various aspects of doctor-patient communication that may be considered, or are constructed as, challenging and/or delicate for either the patient, doctor or both at a Gender Identity Clinic (GIC) in the UK. This project involves the secondary analysis of two existing data-sets: (i) 21 recorded telephone interviews between my PhD supervisor and transsexual patients who attended the GIC; (ii) 156 transcribed audio-recordings and 38 video-recordings (total = 194) of psychiatrist-patient consultations in the GIC. The first original research paper uses TA to investigate the views and experiences of transsexual patients regarding their communication with psychiatrists at the GIC. An important finding was that patients actually appreciated being challenged in this setting, subsequently the implications of this are considered with regards to the achievability and desirability of patient centred communication. The second research paper uses CA to consider how patients overtly challenge psychiatrists in the GIC in ways that have not been shown in conversation analytic research on medical interactions to date. Analysis of the data corpus revealed that there were three common ways in which patients challenged psychiatrists at the GIC, which are (1) by problematising their questions; (2) by disagreeing with statements that are made regarding their treatment; (3) and by initiating complaints. The findings of this study are considered in relation to the implications that they have for clinicians and for the persistence and desirability of asymmetry in clinical interaction in light of the current debates surrounding the concept of patient-centeredness. The final research paper also uses CA, in this instance to study how the topic of weight, which is often constructed and orientated towards as delicate in talk-in-interaction, is occasioned and discussed by psychiatrists and patients at the GIC. Whereas previous CA research on this topic has focused on how this is constructed by speakers as a moral issue, this paper is concerned with focusing on how psychiatrists (1) establish with patients that their weight is an issue, (2) encourage patients to lose weight by informing them that this is their responsibility and (3) offer advice on the behavior changes associated with weight loss. The results of this paper are discussed with regards to the implications that they have for clinicians who discuss the potentially delicate topic of weight with patients in a number of different settings. This project contributes towards the growing debates regarding the achievability and desirability of patient centred communication and the persistence of asymmetry in clinical interaction. It also contributes to medical conversation analytic literature to date on asymmetry and talk about weight in clinical interactions.

Process plants come with a wide variety of engineering challenges. Each process has uniqueoperating conditions that require careful operation and maintenance programs to keep the process equipment in a condition that is safe for operation. A pilot-scale plant was built in Luleå to demonstrate the possibility of carbon dioxide removal from blast furnace gas usingthe Sorption Enhanced Water Gas Shift (SEWGS) technology. One of the challenges facingthe SEWGS pilot plant was the lack of a maintenance plan which was the motivation for this thesis. The aim of this thesis was to create a maintenance plan for the SEWGS pilot plant. Studying the process conditions of the pilot plant was the starting point since an understanding of the unique operating conditions was necessary for creating a maintenance plan for the pilot plant’s equipment. The Reliability-centered maintenance (RCM) method was chosen to create the maintenance plan. The study began with determining the objectives and contents of the analysis. The next step was a functional failure analysis in the form of a Failure Mode and Effect Criticality Analysis (FMECA) covering all the equipment in the plant. Afterwards the failure consequences were assessed based on a criticality assessment matrix to determine which equipment necessitate the performance of maintenance activities. The maintenance plan was created based upon the criticality of the equipment and the selected maintenance activities were based on the recommendations of manufacturers. The failure analysis found that the blast furnace gas compressor is the most critical for the process. The boiler and superheater have been found to be highly critical due to the dangerous safety consequences of their failure. In addition, all pressure safety valves have been found to be highly critical due to the hidden nature of their failure. The maintenance plan addresses these critical items and other less critical items while some non-critical items have been removed from the plan due to the negligible consequences of their failure.

L'étude du champ électromagnétique autour des étoiles à neutrons est l'une des méthodes vitales pour comprendre la physique des pulsars. Alors que la plupart des publications utilisent l'hypothèse d'un champ électromagnétique dipolaire centré standard, des études récentes se sont concentrées sur l'inclusion de composantes de champ multipolaire plus élevées et ont présenté une image plus générale pour les pulsars dans lesquels le moment du dipôle magnétique est décalé du centre de l'étoile. Ce travail discute des conséquences d'un dipôle magnétique rotatif excentré dans le vide en montrant diverses caractéristiques des lignes de champ magnétique et de l'émission de pulsar. Une étude à large bande du spectre du rayonnement pulsar est également présentée par la création de cartes des différentes régions d'émission des pulsars distinguées sur la base de leur fréquence dans le but principal de rechercher l'évolution du profil d'impulsion avec la fréquence. La thèse présente tous les résultats ci-dessus accompagnés des discussions nécessaires pour comprendre les modèles théoriques utilisés et les détails des méthodes numériques appliquées. / Studying the electromagnetic field around neutron stars is one of the vital methods to understand the physics of the pulsars. While major literature uses assumption of a standard centred dipolar electromagnetic field, recent studies have focused on including higher multipolar field components and have presented a more generalized picture for pulsars in which the magnetic dipole moment is shifted off from the centre of the star. This work discusses the consequences of an off centred rotating magnetic dipole in vacuum by showing various characteristic features of magnetic field lines and pulsar emission. A broadband spectrum study of pulsar radiation is also laid out by creating maps of different emission regions of pulsars distinguished on the basis of their frequency with the main aim of looking for the evolution of the pulse profile with frequency. The thesis presents all the above results accompanied by the necessary discussions to understand the theoretical models used and the details of the numerical methods applied.

This research embraces an eco-systemic perspective of human behaviour (Bronfenbrenner, 1979) and uses participatory action research methodology to explore with young people, and those 'immersed in the system' (Carr & Kemmis, 1986) of education, their views and school experiences, to facilitate increased participation, empowerment and professional collaboration to support future school transitions. This study has been carried out in the South-West of England (inner-city and suburban areas), involving young people and their families, schools, alternative placement providers and multi-agency professionals. The following research aims were addressed: 1) To improve our understanding of the views and perspective of young people who have experienced school exclusion. 2) To explore multiple stakeholder perspectives of using a person-centred planning (PCP) approach to support school transition/re-integration and the perceived ‘supports' and 'barriers’ to implementation. 3) To explore the use of PCP in supporting positive outcomes for young people, 'post transition/re-integration' to mainstream school. 4) To consider the implications for future practice and research. This was a two part study, consisting of two research papers. The participants in paper one of the study were young people (N=12) identified by their settings as having experienced prior school exclusion, with an impending transition (or re-integration) to mainstream education. Paper one explored young people’s perspective to better understand the supports and barriers that have impacted upon their educational journeys, what they attribute as causes for their school exclusion and what they believe will help them in their future. A person-centred planning approach informed the data gathering process (Smull, Sanderson, Sweeney, Skelhorn, George & Bourne, 2005) and semi-structured interviews were analysed using thematic analysis based on Braun and Clarke’s (2006) framework. The individual interviews explored 'with' each young person, their views and perspective, and contributed towards the 'preparing to plan' stage of Person Centred Planning (PCP) being implemented in paper two. Paper two explored the use of Person Centred Planning (PCP) in supporting young people (N=6) in their school transition/re-integration to mainstream education. This involved young people from study one and a range of stakeholders including their family, friends, school/placement staff and multi-agency professionals. This focussed on exploring multiple stakeholder experiences of the ‘supports' and 'barriers’ of using a PCP approach in 'real life' practice. It also explored perceptions of the impact and efficacy of the approach over time in supporting young people across key outcome areas, 'post' transition/re-integration. Findings from paper one indicated young people's capacity to express themselves clearly and reflect meaningfully upon their educational journeys. Each young person made their own decision as to how they would participate and contribute their views and how the information would be used. Key findings indicated a range of perceived 'supports' and 'barriers' that young people identified as having impacted upon them. These encompassed the systems of school, family and community and, consistent with existing research, highlighted the significance of positive and caring relationships, access to help and support and experiencing a sense of belonging (Lown, 2005; Mainwaring & Hallam, 2010; O'Connor, Hodkinson, Burton & Torstensson, 2011).Young people's causal attributions referred to negative teacher relationships, peer bullying, rejection and perceived injustice. A distinct finding from this study referred to young people's sense of isolation when they felt that help was being denied at a time when they were experiencing negativity across the contexts of family, school and community. Young people referred to not feeling understood and supported and reflected upon this impacting on their behaviour in school. Findings also indicated that whole school behavioural systems posed a barrier to young people being able to access the help and support of key adults they had identified and to their inclusion in the wider school community. Findings from paper two indicated positive support from all stakeholder groups that PCP enabled the young person to be fully involved in their transition planning, facilitating a positive ethos that embraced equality and collaboration. Exploration of stakeholder views highlighted some negative reflections on the use of PCP, particularly in relation to its 'time consuming' nature and a range of key factors were identified as supportive and/or obstructive to implementing PCP in practice. When exploring perceptions of impact and efficacy over time, there were clear indications of positive development for each young person across key outcome areas. The majority of positive reflections were consistent across stakeholders groups and related to increased school attendance, improved emotional understanding, social interaction and academic progress. All individual targets were reviewed 'post transition/re-integration' and were deemed to have 'met' or 'exceeded' the expected levels. Furthermore, there have been clear references to changes made at a systems and environmental level that have underpinned these positive changes and emphasised the role that others play as ‘agents of change’ (Fielding, 2001). These findings have been assimilated and the implications for educational psychology practice and research considered.

The interest in the complex relationship between the behaviour of users and the design of interactive system has been significantly increased as the digital technology has advanced. This has led to usability becoming one of the key elements in user-centred interaction design. Systems need to be designed in a usable way; efficient, use-enhancing, flexible and learnable and the design should also meet the user’s needs and aspirations. This thesis aimed to develop a more usable prototype of the Maintenance Ground Support System (MGSS), using prototyping and a user-centred design approach. The prototype was developed using an adaptation on the evolutionary software development process that consisted of four iterative steps. The prototypes were created, tested and evaluated with surrogate and end-users. The design of the prototype is based on a customizable and simple dashboard application that supports multiple user needs and requirements, in a familiar environment where the user can feel confident and be in control. Based on usability testing, the prototype was concluded to be more efficient, understandable as well as easier to use than the existing system.

Older Norwegian adults with an intellectual disability are today more integrated into society than earlier generations. Some represent the last of the generation that experienced and can talk about childhoods in central institutions and about living under the World War II Nazi regime. The closure of Norwegian institutions, which took place in the1990s, was based on social valuation theories. The post-closure situation for people with intellectual disabilities, their staff and local authorities was very different form what they had experienced previously, local authorities being responsible for providing person-centred services. This thesis examines whether life story work represents an effective approach to the person-centred support of older adults with an intellectual disability, through examining the impact of this work on services users (‘storytellers’) and their life story work supporters (‘interlocutors’). ‘The life story model of identity’ developed primarily by the American psychologist and professor Dan P. McAdams, is a major contribution to the thinking of this study. The model emphasises the importance of service providers’ understanding and knowledge of their service users’ life stories. A combination of critical realism and interpretative phenomenology analysis is advanced as a suitable joint philosophical framework for investigating the impact life story work has on both storytellers with intellectual disabilities (aged 45+) and on the interlocutors they personally chose from their staff group. The Delphi technique was used in a preparatory phase of interviews of six experienced life story workers from three different countries. A Participatory Action Research (PAR) approach was used to prepare the intervention, to develop the LSW programme and for pre- and post-interviews. 38 participants from day centres and residential settings in Norway took part in the study. The results indicate that even staff who had known storytellers for a long time learned new and valuable information. They came into possession of a better understanding of the service users’ behaviour and the interlocutors’ attitudes to service users were changed by the experience of carry out life story work with them. The interlocutors stated that they considered life story work to be ‘important’ in today’s services. The storytellers experienced increased feelings of safety and greater awareness of their abilities, life span (roots) and of themselves as a person (identity and personal development). They expressed pride in their life story work and appreciated the time they had spent talking and working alone with their interlocutors. Storytellers and interlocutors both said that life story work had brought them closer together and the love and appreciation they had for each other was a clear result of the time they had spent together. The eight week programme was, however, also challenging for the interlocutors who had problems finding the opportunity to conduct two hours work a week without interruption from other contextual influences.

The study explored instructors' conceptions of teaching and their teaching practices in four Ethiopian universities in the light of the existing calls for the employment of student-centred approach to teaching in higher education in Ethiopia. The study was grounded on the assumption that instructors are unlikely to adopt student-centred approach to teaching unless their conceptions of teaching are developed and/or unless the teaching environment is supportive. To address the objective of the study, data were collected using a mixed methods research design using a sequential exploratory strategy. Based on this strategy, data were obtained first qualitatively from 20 instructors through interviews and classroom observations and then quantitatively from 160 instructors and 170 students through questionnaires. The data from the interviews and the classroom observations were analysed qualitatively using a phenomenographic approach and content analysis respectively whereas the data from the questionnaires were analysed statistically using SPSS. From this, frequencies, mean scores and percentages were computed in order to summarise and interpret responses. In addition, independent samples test and one-way ANOVA were applied to examine the differences in conceptions of and approaches to teaching among instructors. Furthermore, Pearson correlation coefficient was applied to examine the relationship between instructors‟ conceptions of teaching and their teaching practices. From the results, it was found that instructors‟ conceptions of teaching in the four universities incline towards the student-centred conception of teaching though there were also instructors whose conceptions of teaching were the traditional teacher-centred. Regarding teaching practices, although the instructors claimed that their teaching practices were student-centred, the results of the study appear to suggest that meaningful instructional practices were still under the influence of the traditional conception of teaching. In addition, numerous factors were found to be impeding the proper implementation of student-centred instruction including the background of the students, the instructors‟ obsession with lecturing and lack of enabling environment. Based on the findings, teaching improvement programs that develop instructors‟ conceptions of teaching were suggested. Furthermore, a supportive environment that enables instructors to translate their changed conceptions of teaching into their teaching practices was recommended. Finally, recommendations for further studies were provided. / Curriculum and Instructional Studies / D. Ed. (Curriculum Studies)

The study investigated how the child centred approach is applied in teaching Natural Science (NS) in Johannesburg East schools. Most attention was paid on which teaching methods were used and how they were used to teach NS. Data was collected from 5 randomly selected schools in Johannesburg East through observations of Natural Science teachers teaching, and focus group discussion with them. Data presentation and analysis revealed that NS teachers who participated in the study used a limited range of child centred teaching methods. They only used experiments, class activities, as well as question and answer method. Literature review revealed that there are numerous child centred teaching methods that NS teachers can use. Some of these methods are brainstorming, discussions, games, group/pair work, field trips, case studies and assignments, using Information and Communication Technology (ICT), debates and facilitation. The majority of teachers still used the out-dated lecture method contrary to the Curriculum Assessment Policy Statement (CAPS) 2012 documents that call for an end in the use of traditional teaching methods such as the lecture method. The study also revealed that there are certain challenges and factors that inhibit the implementation of the child centred approach in NS. These challenges among others include the teacher centred curriculum which dictates the pace and content to the child, lack of adequate NS resources, big volumes of learners in classes, different abilities, talents, interests and skills possessed by learners, learners’ lack of discipline, as well as shortage of qualified NS teachers. All these were seen as inhibiting factors in the implementation of the child centred approach in NS. The study among other recommendations recommended that, in order for the child centred approach to be implemented successfully the Ministry of Basic Education should develop a child centred curriculum that does not dictate the pace to the child. The Ministry as well should come up with a specific or customised child centred approach model that is relevant to NS as a subject, in-service all NS teachers and empower them with the child centred teaching methods, principles and strategies, capacitate all schools with all necessary resources such as qualified NS teachers as well as relevant chemicals, materials, apparatus and information and communication technology infrastructure designated for NS. / Science and Technology Education / M. Ed. (Natural Science Education)

The thesis presented consists of two parts: a theory and the empirical part. The theory is introduced with a brief survey of the history of the patient centred care followed with current trends in nursing. It is followed with the three key areas determining nursing care. The first one consists of the objective factors - the health care system. The second area is formed by the factors associated with the practical implementation of nursing. The third area is devoted to the role of the patient and his surroundings. Objective of the thesis: The mapping of the factors influencing patient-oriented care by the nursing staff and management in various health care institutions. Research group The research group consisted of 11 female respondents state-registered nurses, aged from 24 to 58 years of age. The respondents varied in their position, level of education, and specialization, and they worked in various health-care institutions. Among them, there were 6 registered nurses, 4 ward nurses, and 1 head nurse. The willingness to cooperate and the saturation of responses were principal in forming the research team in question. The way adopted for achieving of the objective A qualitative research method has been chosen to achieve the goal. The phenomenological focus of the work has led to the selection of the method. The data were collected using semi-structured interviews. The findings were further categorized and confronted with the source material to answer the research questions. Results The research confirms the nursing care is a complex phenomenon. The recently-adopted health care legislation shows a shift from the paternalistic concept of care on behalf of the right of the patient to self-determination. On the other hand, however, the principle of solidarity the basis of the health care system in the Czech Republic retains some paternalismus, and that can negatively affects the relationship of the patient to the nursing staff in some cases. The respondents are in agreement as to the notion of PCC but a single one respondent knows its concept. The possibility of putting the PCC in practice is hampered by a wide range of factors. According to the respondents, the major obstacle is the undernumerousness of the nursing staff, resulting in the omnipresent time stress. The excessive red-tape demands have been seen as the almost equally important factor, together with the lack of continuity of care, but also the fast-and-loose approach of some nurses. The evaluation of the cooperation between staff nurses at the bed and the nurses in senior positions differed. Staff nurses see the problem in cooperation with their superiors, lacking appreciation of their work. Management, i.e. head nurses and ward nurses are often seen as systemic obstacles. The research investigation also shows insufficient cooperation with the patient's family. Permanent changes in the nursing education concept are seen as a hindrance to the problem solution. Regretfully, the actual approach of a nurse often slides down from a vocation to a mere employment. Conclusion The problems identified in the healthcare system indicate a wide range of factors influencing the relations between the nursing staff and patients. Multidimensional patient care concepts and examples from our healthcare system illustrate how clinical, structural, and interpersonal factors can interact in the relations between nursing staff and patient. The PCC concept should enable any health-care provider to set ways to improvement the care rendered and to motivate the caring staff to adopting it.

Philosophiae Doctor - PhD / Diabetes is a chronic, metabolic disease that requires lifelong medical management, health education and self-management. According to a World Health Organisation report, there is a global increase in the prevalence of diabetes and even more so in the low-and middle-income countries, specifically Nigeria, which has the highest number of people with diabetes in the African region of the World Health Organisation. As a global issue, the positive health outcomes of diabetes are tied to health education and self-management of the disease and using the health resources of nations. However, in the context of limited resources in Nigeria, there is a need for improvement of health education in self-management of Type 2 diabetes. Health education that is provided in some Nigerian health facilities is reported to be unstructured, without patients’ active participation, not tailored to the needs and the interests of the patients and limited collaboration between multi-disciplinary professionals. In this context, the aim of the study was to develop a structured health education programme for self-management of patients with Type 2 diabetes, to facilitate the quality of the lives of these patients .An adapted intervention mapping framework provided a structured process for development of an evidenced based programme. A mixed method approach was followed. In the first phase of the study an exploratory descriptive qualitative research design was followed. A purposive sampling approach was used in selecting (i) participants, who were patients with Type 2 diabetes and (ii) health-care professionals working in two health-care institutions in Benin City, Edo State, Nigeria. In phase 1, Step1 of the research was a situation analysis, which consisted of conducting 30 semi-structured interviews with patients; observation of nurses providing health education; and five focus group discussions with health-care professionals (nurses, dieticians and social workers). Qualitative data analysis was accomplished through using Tesch’s (1990) steps of analysis to identify themes and categories. The situation analysis revealed, firstly, that there was a lack in the knowledge and self-management of Type 2 diabetes among patients. Secondly, that the health-care professionals acknowledged their collective role in health education and were burdened with the patients who were non-adherent to self-management. The result also revealed the necessity to change from a traditional teaching method to a structured educational process that is patient-centred. The second phase of the research was the stage of developing the educational programme through collaboration with the stakeholders (health-care professionals and patients with Type 2 diabetes) using the findings from the data-analysis of the first phase supported with literature. In phase 2, Step 2 was to develop matrices from the data analysis in Phase 1 for the programme. Step 3 added theory-based intervention methods and practical applications to the preliminary program and in Step 4 the programme was described. This was followed in Step 5 by preparing health-care professionals for offering the programme to patients and implementing and evaluating the programme. The evaluation of the programme was by means of a quantitative pilot study in which a pre-post-test in a quasi-experiment was conducted with 28 patients and qualitative interviews after the program and post intervention interviews with the participants. The evaluation showed that the program was effective in meeting its objectives. In Step 6 a plan for the adoption, implementation, sustainability and evaluation of future implementations was developed.