Background: The role of community matron (CM) was introduced to provide a single point of access to patients living with co-morbid long-term conditions who had, or were at risk of, frequent emergency admissions to hospital. CMs utilised case management as a means of managing this growing population of patients with fragile health. Since its inception, many changes in service delivery have impacted on the role. Aim: The aim was to undertake a mixed methodology study of the factors that have affected embedding of the community matron role in 3 geographical areas. Methodology: A pragmatic mixed methods approach (QUAL quan) was utilised. Settings and participants: The studies were based in health services within 2 cities and a rural area in central England. Participants for the qualitative components of the study were purposefully sampled. The sample comprised professionals: community matrons (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). Quantitative data for 212 people with long-term conditions were derived from the anonymised Patients at Risk of Rehospitalisation database (PARR data) held by area 1. Methods: Qualitative data were collected from participants using semi-structured interviews and audio diaries. For the quantitative component using PARR, some patient journeys within area 1 were explored. In addition, a sample of patients who were case managed by a CM (n=106) were matched with a set of patients who were not (n=106) and the data was examined. Findings: Participants were largely positive about the role of CM. However, difficulties with role setup had led to numerous changes which affected how the role has embedded. Additionally, this impacted understanding of the role by health care professionals, and caused practical and emotional difficulties for some CMs as they perceived the role to be eroded. The quantitative findings showed that CMs did not make a significant difference to hospital bed days used by patients on their caseload. Evaluating the role and finding an effective means of showing the work undertaken by CMs, which is often invisible, proved difficult. Conclusion: Embedding of the CM role has been affected by numerous changes in service delivery. Invisibility of community nursing rather than autonomy of the community matron role seems to be a key factor in the challenges of embedding the role. The significance of these findings is that using a mixed method approach and Liaschenko and Fisher’s adapted model may help CMs to improve the visibility of their role, and so helping the role to be less prone to the challenges of service redesign.

Recently, one of the major problems in various countries is the management of complicated organisations to cope with the increasingly competitive marketplace. This problem can be solved using Enterprise Resource Planning (ERP) systems which can offer an integrated view of the whole business process within an organisation in real-time. However, those systems have complicated workflow, are costly to be analysed to manage the whole business process in those systems. Thus, Long Running Transaction (LRTs) models have been proposed as optimal solutions, which can be used to simplify the analysis of ERP systems workflow to manage the whole organiational process and ensure that completed transactions in a business process are not processed in any other process. Practically, LRTs models have various problems, such as the rollback and check-pointing activities. This led to the use of Communication Closed Layers (CCLs) for decomposing processes into layers to be analysed easily using sequential programs. Therefore, the purpose of this work is to develop an advanced approach to implement and analyse the workflow of an organisation in order to deal with failures in Long Running Transaction (LRTs) within Enterprise Resource Planning (ERP) systems using Communication Closed Layers (CCLs). Furthermore, it aims to examine the possible enhancements for the available methodology for ERP systems based on studying the LRT suitability and applicability to model the ERP workflows and offer simple and elegant constructs for implementing those complex and expensive ERP workflow systems. The implemented model in this thesis offers a solution for two main challenges; incompatibilities that result from the application of transitional transaction processing concepts to the ERP context and the complexity of ERP workflow. The first challenge is addressed based on offering new semantics to allow modelling of concepts, such as rollbacks and check-points through various constraints, while the second is addressed through the use of the Communication Closed Layer (CCL) approach. The implemented computational reconfigurable model of an ERP workflow system in this work is able to simulate real ERP workflow systems and allows obtaining more understanding of the use of ERP system in enterprise environments. Moreover, a case study is introduced to evaluate the application of the implemented model using three scenarios. The conducted evaluation stage explores the effectiveness of executable ERP computational models and offers a simple methodology that can be used to build those systems using novel approaches. Based on comparing the current model with two previous models, it can be concluded that the new model outperforms previous models based on benefiting from their features and solving their limitations which make them inappropriate to be used in the context of ERP workflow models.

This thesis follows the research portfolio format and is carried out in part fulfilment of the academic component of the Doctorate in Clinical Psychology at the University of Edinburgh. An abstract provides an overview of the entire portfolio thesis. Chapter One contains a systematic review of published research investigating the experience of living with incurable forms of haematological malignancy. Chapter Two is an empirical study exploring adults’ experiences of living with follicular lymphoma while being maintained under the ‘watch and wait’ protocol. Both chapters are prepared for submission to the European Journal of Cancer Care, and follow their author guidelines.

Despite a general consensus concerning the relevance of supply partnerships to agility, the literature reveals disagreements and contradictions regarding their characteristics and, in particular, their duration. This is, whether partnerships in an agile strategy should be long-term (strategic partnerships) or short-term (agile partnerships). The research joins this debate by investigating the types and characteristics of supply partnerships to achieve agility. The underlying premise of the work is that the type of supply partnership is contingent on the degree of turbulence an agile strategy is designed to face. The research was carried out in the fashion industry, given the relevance of agility in this industry. Specifically, the research focused the supply partnerships developed by the footwear companies in the Macerata-Fermo district, the largest footwear district in Italy. The focus on district companies allow the comparison of several companies sharing a very similar business context, allowing a better control of external variables and increasing the internal validity of the study. The field research consisted of a preliminary survey on agility drivers and agile capabilities in the Macerata-Fermo footwear district, followed by an in-depth investigation on supply partnerships using multiple embedded cases studies. Overall six medium-large footwear companies have been analysed in their supply relationships with respect to five key supply categories. For each supply category, the buyer view of the focal firms has been complemented with a view from the supplier side. In total the fieldwork is built upon 30 interviews with 22 informants from 18 companies for a total of more than 23 hours of interviews. In all cases, except two, the key informant was owner, CEO or general manager of the company, eventually supported by another company manager. In two cases, the interviews data have been strengthened by a longitudinal analysis of purchase orders over eight years. The fieldwork highlights that agility drivers and agile capabilities impact on the footwear companies’ decision of developing agile supply partnerships. Specifically footwear companies that are under the pressure of high-turbulence agility drivers (here represented by a high collection renewal rate) and that have developed strong agile capabilities (here represented by a local supply network and a purchase orders postponement) choose agile supply partnerships with respect to supply categories that are sensitive to the fashion trends and therefore difficult to be sourced in a stable way – season after season – from the same suppliers. The main contribution to theory is related to the characteristics of supply partnerships in an agile strategy and specifically to the apparent paradox of “high-involvement & short- term” relationships (i.e. agile supply partnerships). In spite of the presence of time compression diseconomies in building up partnership and of the loss of relational (non- redeployable) benefits in closing down partnerships, scenarios of high-turbulence can give companies an incentive to look for short-term partnerships. Such finding can support a wider claim that different levels of turbulence call for different agility strategies requiring different capabilities and practices. The main contribution to practice is related to the way agile partnerships are selected, started and ended. Given that many industries are facing an increase in market turbulence, it appears that many companies – even outside the fashion industry – might have to learn how to balance high-involvement supply relationships with respect to a shorter time horizon.

This thesis is concerned with the econometric modelling of gasoline prices in US. The intention is to characterize the market process in this crucial and significant industry. Overall we have been seeking to identify a mechanism to signal and measure market failure and consequently improve market performance. Firstly we examine the time series properties of gasoline prices using the criteria for perfect arbitrage to test market efficiency from the stationarity of price proportions. This is done by considering market efficiency across in different regions of the US, by applying a range of different stationary tests. In this analysis we collected a comprehensive data set of gasoline prices for all regions of the US mainland for the longest period available. Forni (2004), outlined reasons why the analysis of price proportions may be advantageous; especially when the sample is limited. Stationarity corresponds to a broad market, it is found here that the US gasoline market is on average broad. Except for the Gulf Coast and Lower Atlantic, which may be seen as economically and/or geographically separated, market structure in the rest of the US would not appear to be a problem Next we investigate possible long-run price leadership in the US gasoline market and the inter-relatedness of price behaviour relevant to a competitive market. Following Hunter & Burke (2007) and Kurita (2008) market definition is tested. This is done on an extended regional data set to Kurita and following the analysis in Hunter and Burke on a set of company data for the US.We analysed long-run price leadership through the cointegrated vector auto-regression (VAR) to identify key characteristics of long-run structure in the gasoline market. The analysis of the system of regional prices confirms problems with the Gulf Coast and Lower Atlantic, but also based on the finding that the cointegrating rank is less than N-1 using both types of data ( regional price data and company price data) and the findings on weak exogenity it is suggested that competition across the whole of the US is further limited. We applied further tests to company data on prices and quantity data to investigate further the need to regulate for potential anomalies and to capture more directly consumer harm. The variance screening method applied to recent weekly data indicates that there is too little variation in gasoline prices and this would seem to support the cointegration study. Furthermore we applied a dynamic disequilibrium analysis to attempt to identify long-run demand and supply in the gasoline market. Finding significant variables using the Phillips-Hansen fully modified estimation of the switching regression is necessary to distinguish two long-run equations (S&D). Moreover a comparison is made with a Markov Switching Model (MSM) of prices and this suggests a similar pattern of regime to the quantity information analysed in by our disequilibrium model.

The plant communities of the Long Mynd plateau are the culmination of over 3000 years of human intervention that largely deforested the uplands, and subsequently maintained the generally treeless heath and grassland communities now extant. The capacity of these communities to respond to directional change is well known, indeed the traditional mode of heathland management, burning, depends on the regenerative capacity of the target species, generally heather (Calluna vulgaris), for its success. However, changes in post WW2 stocking practice; the loss of ponies followed by an increase in the numbers of sheep and a change to them being overwintered on the hill, led to excessive grazing and damage to the heath. This coincided with the spread over the hill by bracken (Pteridium aquilinum) and other changes in the distribution and nature of the vegetation. A sequence of vegetation surveys made by various individuals and organisations over the past 75 years or so has been analysed in an attempt to delineate spatial and temporal changes in the vegetation. This demonstrated the need for a standardised survey methodology to allow consistent monitoring. The analysis showed that bracken had been infiltrating most of the communities from its origins outside the lower limits of the Common as well as from some of the valley sides. Within the last decade, this expansion has apparently been contained in line with the current management plan for control. A survey of 730 quadrats in some 30 stands was made to characterise the variation of the vegetation on the plateau, and to relate it to some of the associated environmental factors. Classification, unconstrained ordination and ordination constrained by the abiotic environmental variables, showed that, a) the strongest trend in the vegetation distinguished water-flushed communities, b) non-wetland communities differentiate between heathland and grassland, c) this trend can be only partly be attributed to the measured abiotic environmental variables, d) the amount of pure Pteridietum [U20] is limited, although much of the heathland and grassland has bracken within it. There are indications that invasion by bracken often correlates with a loss of dominance of Calluna in favour of Deschampsia flexuosa and Vaccinium myrtillus. Difficulties in associating these trends with measured abiotic variables suggests, other factors probably management processes, are critical in driving this trend. Distribution of ‘heathland’ bryophytes was found to be associated more with the structure of their ‘host’ vascular communities rather than with abiotic factors. Finally, this investigation considers the practical implications with regard to the future encouragement of heather and the control of bracken. Cutting rather than burning appears to be the ecologically most suitable method for heather regeneration and bracken control.

This thesis covers a broad range of topics in the general area of economic growth theory and economics of technological change. It is primarily about the ultimate sources of growth and its ultimate limitations. We scrutinize the implications of several specifications of long-run growth "engines" which can be found across the theoretical literature and put forward their generalizations and extensions. At the highest level of generality, we provide a formal proof that balanced (i.e. exponential) growth requires knife-edge assumptions which cannot be satisfied by typical values of model parameters. This result implies that at least one such knife-edge assumption must be made if a given model is supposed to deliver balanced growth over the long run. Next, we deal with the issue of resource-based limits to long-run growth. We propose to promote technological progress which would improve the substitutability between non-renewable and renewable resources: if the elasticity of substitution between the two kinds of resources exceeds unity, production will not fall down to zero even after the non-renewable resources will have been completely depleted. Factor-augmenting technological progress can also be helpful, but its effects are much less pronounced and it must go on forever in order to assure sustainable production. Another question asked is whether it is plausible that R&D-based growth, fueled by steady increases in the world’s population, can be extended into indefinite time. We answer this question by introducing endogenous fertility choice, with population entering the utility functional multiplicatively, into an R&D-based semi-endogenous growth model. The next issue addressed here are the idea-based microfoundations of aggregate production functions. We discuss the correspondence between the shape of production functions, the direction of technical change, and the possibility of sustained endogenous growth. A broad class of production functions, nesting both the Cobb-Douglas and the CES function, is derived. Finally, we discuss the impact of the heterogeneity of innovations on long-run economic dynamics: we extend the semi-endogenous growth model with a distinction between radical and incremental innovations. Total R&D output is assumed to depend on technological opportunity which is depleted by incremental innovations but renewed by radical innovations. The dynamic interplay of the arrivals of the two types of innovations is shown to give rise to oscillations along the transition to the economy’s balanced growth path.

Residential outdoor education has had a significant formal and informal presence within the education system of the United Kingdom since the 1950s. However, there is little empirical research into the experiences of participants, particularly from a long-term perspective. The present study investigates the meanings, values, and impacts that participants attribute to a five-day residential experience at Ardentinny Outdoor Education Centre, near Dunoon, Scotland. Participants attended the Centre as school pupils between 13 and 16 years of age. Ardentinny Outdoor Education Centre operated as an educational facility under the auspices of the local authority between 1973 and 1996. Participants were contacted between 2007 and 2008, hence a minimum of 11 years after the Centre closed. Semi-structured questionnaires (n = 110) and interviews (n = 14) were used to generate data regarding participants’ experiences. These were analysed using a hermeneutic approach. Supplementary data were generated from archival documents and interviews (n = 29) with various stakeholders in Ardentinny Outdoor Education Centre, ranging from local authority education officers to Centre managers and instructional staff. These supplementary data contribute towards a nuanced interpretive account of participants’ experiences that has both breadth and depth. The data suggest that participants’ experiences at Ardentinny Outdoor Education Centre represented highly significant events in their school career. Principal findings relate to themes of achievement, independence and responsibility, and the development of more adult relationships. Seventy-two percent of questionnaire respondents claimed that their experience at Ardentinny Outdoor Education Centre continued to influence their adult lives. This influence was manifested in a variety of ways ranging from a love of the outdoor environment, to choices regarding use of leisure time, to employment choices. Bourdieu’s (1977, 1990b) theory of social practice, particularly the concepts of field and habitus, provides a framework to interpret participants’ expressions of the nature of their experiences and the impact those experiences did or did not have on their lives. From this perspective Ardentinny Outdoor Education Centre presented participants with a safe and authentic experience that differed sufficiently from their previous life experiences to allow for the opportunity to develop new understandings of self and the social world. These new understandings were expressed in different ways and at different times over participants’ subsequent life course.

Very Long Instruction Word (VLIW) processors are wide-issue statically scheduled processors. Instruction scheduling for these processors is performed by the compiler and is therefore a critical factor for its operation. Some VLIWs are clustered, a design that improves scalability to higher issue widths while improving energy efficiency and frequency. Their design is based on physically partitioning the shared hardware resources (e.g., register file). Such designs further increase the challenges of instruction scheduling since the compiler has the additional tasks of deciding on the placement of the instructions to the corresponding clusters and orchestrating the data movements across clusters. In this thesis we propose instruction scheduling optimizations for energy-efficient VLIW processors. Some of the techniques aim at improving the existing state-of-theart scheduling techniques, while others aim at using compiler techniques for closing the gap between lightweight hardware designs and more complex ones. Each of the proposed techniques target individual features of energy efficient VLIW architectures. Our first technique, called Aligned Scheduling, makes use of a novel scheduling heuristic for hiding memory latencies in lightweight VLIW processors without hardware load-use interlocks (Stall-On-Miss). With Aligned Scheduling, a software-only technique, a SOM processor coupled with non-blocking caches can better cope with the cache latencies and it can perform closer to the heavyweight designs. Performance is improved by up to 20% across a range of benchmarks from the Mediabench II and SPEC CINT2000 benchmark suites. The rest of the techniques target a class of VLIW processors known as clustered VLIWs, that are more scalable and more energy efficient and operate at higher frequencies than their monolithic counterparts. The second scheme (LUCAS) is an improved scheduler for clustered VLIW processors that solves the problem of the existing state-of-the-art schedulers being very susceptible to the inter-cluster communication latency. The proposed unified clustering and scheduling technique is a hybrid scheme that performs instruction by instruction switching between the two state-of-the-art clustering heuristics, leading to better scheduling than either of them. It generates better performing code compared to the state-of-the-art for a wide range of inter-cluster latency values on the Mediabench II benchmarks. The third technique (called CAeSaR) is a scheduler for clustered VLIW architectures that minimizes inter-cluster communication by local caching and reuse of already received data. Unlike dynamically scheduled processors, where this can be supported by the register renaming hardware, in VLIWs it has to be done by the code generator. The proposed instruction scheduler unifies cluster assignment, instruction scheduling and communication minimization in a single unified algorithm, solving the phase ordering issues between all three parts. The proposed scheduler shows an improvement in execution time of up to 20.3% and 13.8% on average across a range of benchmarks from the Mediabench II and SPEC CINT2000 benchmark suites. The last technique, applies to heterogeneous clustered VLIWs that support dynamic voltage and frequency scaling (DVFS) independently per cluster. In these processors there are no hardware interlocks between clusters to honor the data dependencies. Instead, the scheduler has to be aware of the DVFS decisions to guarantee correct execution. Effectively controlling DVFS, to selectively decrease the frequency of clusters with slack in their schedule, can lead to significant energy savings. The proposed technique (called UCIFF) solves the phase ordering problem between frequency selection and scheduling that is present in existing algorithms. The results show that UCIFF produces better code than the state-of-the-art and very close to the optimal across the Mediabench II benchmarks. Overall, the proposed instruction scheduling techniques lead to either better efficiency on existing designs or allow simpler lightweight designs to be competitive against ones with more complex hardware.

Medical residency is characterized by sleep deprivation, stress, and heavy workload. The impact of these pressures on physician-patient communication has not been fully explored. The aim of the current study was to investigate how contextual demands, stress, and burnout impact empathy and provision of patient-centered communication among internal medicine residents in two hospitals. The long-call shift was studied, as it is known to be particularly taxing and is a primary feature of medical residency. Assessments were obtained both prior to and at the conclusion of residents' shifts. Cognitive complexity was examined as a potential mediator of the relationship between stress and burnout, and burnout and empathy. Results revealed that there was a significant decline in physician empathy from the beginning to the end of the long-call shift and that this decline in empathy predicted less patient-centered communication from physicians. Stress, burnout, and decline in empathy were all positively associated, indicating that resident physicians who were more stressed and burned out were at increased risk for declines in empathy over the course of their shift. Cognitive complexity was not found to be a significant mediator of any associations between study variables, though it was associated with several key variables in unexpected ways. These findings highlight the importance of identifying and addressing barriers to patient-centered communication, as a number of these barriers may be routinely present in the demanding environment of medical residency.