Hospital admissions for patients close to the end of life are considered ‘inappropriate’ in contemporary English health policy. Hospitals are supposedly unable to offer a ‘good’ death for patients, and dying there is thought to contradict patient choice, since patients are assumed to want to die at home. However, almost half of all deaths in England in 2015 occurred in hospital, and of these, nearly a third died within three days of admission. This thesis seeks to explore why these admissions are considered to be a problem and how they occur. Through a systematic review of UK literature I found that it cannot be stated that most patients want to die at home, because of the extent of missing data (preferences not asked, expressed, reported or absent). This finding challenges the justification that admissions are inappropriate because they contravene patient choice. Similarly inconclusive evidence about the undesirability, cost, and lack of need for patients to be in hospital were also found in a review of policy. Together with analysis of historical trends in hospital and hospice provision, it is apparent that attitudes towards end-of-life admissions reflect existing tensions about the role of hospital as an acute provider, and as a place of death. An analysis of interviews conducted with healthcare staff and next-of-kin involved in the admission of patients (case-patients) who died shortly after being admitted to Meadowbridge, a large English hospital explored these tensions further. I found that whilst hospital was not recognised as a place where ‘good’ deaths typically occurred, it was acknowledged as an emergency place of care. In this context, patients without obvious need for hospital care were nevertheless admitted to the hospital and the environment was subsequently recognised to offer distinct benefits. The need for emergency care reflected the difficulties of providing end-of-life care in the community. For dying to occur appropriately, home had to be adapted and care organised by healthcare staff. Both tasks were complicated by the unpredictability of dying, and family carers helped to absorb much of the uncertainty and support patients to die at home. Ambulance staff became involved when patients had care needs that exceeded care quickly and easily available in the community. When called to the case-patients, ambulance staff instituted familiar practices in transferring them to hospital. Hospital was recognised as a default place of care because ambulance staff struggled to facilitate alternative care and lacked sufficient professional authority to keep patients at home. The admissions of the case-patients represent the best attempts of staff to navigate the tangled practices of end-of-life care. These practices are the result of the actions of the staff, which in turn both constrained and enabled their action in providing care to patients. The term ‘inappropriate’ to describe admissions does not encompass these attempts, and moreover, devalued the significant care provided by healthcare staff in the community and hospital.

Submitted by Daniela Kubudi Glasman (dkubudi@gmail.com) on 2014-06-23T17:18:45Z No. of bitstreams: 1 tese_DanielaKubudi_final.pdf: 1329488 bytes, checksum: 78a5e9b2527544313ec47b6425dbeb07 (MD5) / Approved for entry into archive by BRUNA BARROS (bruna.barros@fgv.br) on 2014-10-27T16:31:57Z (GMT) No. of bitstreams: 1 tese_DanielaKubudi_final.pdf: 1329488 bytes, checksum: 78a5e9b2527544313ec47b6425dbeb07 (MD5) / Approved for entry into archive by Marcia Bacha (marcia.bacha@fgv.br) on 2014-11-13T13:38:37Z (GMT) No. of bitstreams: 1 tese_DanielaKubudi_final.pdf: 1329488 bytes, checksum: 78a5e9b2527544313ec47b6425dbeb07 (MD5) / Made available in DSpace on 2014-11-13T13:39:30Z (GMT). No. of bitstreams: 1 tese_DanielaKubudi_final.pdf: 1329488 bytes, checksum: 78a5e9b2527544313ec47b6425dbeb07 (MD5) Previous issue date: 2013-02-25 / This thesis consists of three works that analyses the term structure of interest rates using different datasets and models. Chapter 1 proposes a parametric interest rate model that allows for segmentation and local shocks in the term structure. Adopting U.S. Treasury data, two versions of this segmented model are implemented. Based on a sequence of 142 forecasting experiments, the proposed models are compared to established benchrnarks and find that they outperform in out-of-sample forecasting results, specially for short-term maturities and for the 12-month horizon forecast. Chapter 2 adds no-arbitrage restrictions when estimating a dynamic gaussian polynomial term structure model for the Brazilian interest rate market. This article propose an important approximation of the time series of term structure risk factors, that allows to extract the risk premium embedded in interest rate zero coupon instruments without having to run a fui! optimization of a dynamic model. This methodology has the advantage to be easily implemented and provides a good approximation for the term structure risk premia that can be used in many applications. Chapter 3 models the joint dynamic of nominal and real yields using an affine macro-finance no-arbitrage term structure model in order to decompose the break even inflation rates into inflation risk premiums and inflation expectations in the US market. The Yields-Only and the Macro version of this model are implemented and the estimated inflation risk premiums obtained are small and quite stable during the sample period, but have differences when comparing the two versions of the model. / Esta tese é composta de três artigos que analisam a estrutura a termo das taxas de juros usando diferentes bases de dados e modelos. O capítulo 1 propõe um modelo paramétrico de taxas de juros que permite a segmentação e choques locais na estrutura a termo. Adotando dados do tesouro americano, duas versões desse modelo segmentado são implementadas. Baseado em uma sequência de 142 experimentos de previsão, os modelos propostos são comparados à benchmarks e concluí-se que eles performam melhor nos resultados das previsões fora da amostra, especialmente para as maturidades curtas e para o horizonte de previsão de 12 meses. O capítulo 2 acrescenta restrições de não arbitragem ao estimar um modelo polinomial gaussiano dinâmico de estrutura a termo para o mercado de taxas de juros brasileiro. Esse artigo propõe uma importante aproximação para a série temporal dos fatores de risco da estrutura a termo, que permite a extração do prêmio de risco das taxas de juros sem a necessidade de otimização de um modelo dinâmico completo. Essa metodologia tem a vantagem de ser facilmente implementada e obtém uma boa aproximação para o prêmio de risco da estrutura a termo, que pode ser usada em diferentes aplicações. O capítulo 3 modela a dinâmica conjunta das taxas nominais e reais usando um modelo afim de não arbitagem com variáveis macroeconômicas para a estrutura a termo, afim de decompor a diferença entre as taxas nominais e reais em prêmio de risco de inflação e expectativa de inflação no mercado americano. Uma versão sem variáveis macroeconômicas e uma versão com essas variáveis são implementadas e os prêmios de risco de inflação obtidos são pequenos e estáveis no período analisado, porém possuem diferenças na comparação dos dois modelos analisados.

This qualitative action research was activated at the junction between three sites of operation of modern power: the site of the woman in the family, religious and cultural power discourses and the professional discourses of therapy. Using an action research design for this study focused the research on reaping benefits in real terms for the research participants. The researcher applied a postStructuralist, feminist and narrative approach to the phenomenon of failed personhood as manifested in the lives of two White Afrikaans women. Narrative therapy methodologiElS, steeped in a religious studies ethic were valuable guides on the therapy-as-research journeys, ensuring the exposure and deconstruction of dominant cultural and religious power discourses. In the course of the therapeutic and research journeys, various narrative therapy methodologies were used with positive effect on the life world of the participants. These methodologies included the externalisation of problems and the discovery of unique outcomes that constitute alternative, preferred life stories that contradict problem-saturated life stories of failed personhood. The research participants engaged in individual and communal conversations, relanguaging their self-narratives and religious narratives as part of the coconstruction of their preferred identities of moral agency and hope. Support networks were created for the research participants, Mara and Grace, to strengthen their new self- and religious narratives and to dislodge the power of the normative cultural and religious discourses of rugged individualism. In one instance, the researcher incorporated the healing power of South African bush veld, by inviting a group of women on a series of expeditions into the wilderness as part of Mara's journey. fn Grace's narrative, we utilised the modern technologies of the internet to connect her with a virtual response team and the Anti-Anorexia/Anti-Bulimia League. Storytelling and reflecting conversations formed the basis of the therapy-asresearch processes. The research participants extended therapy conversations beyond the therapy room, by actively participating in their therapy-as-research journeys. In line with narrative approaches, the researcher encouraged them to honour their skills and knowledges on their journeys: Mara extended her therapy by making resistance quilts while Grace assimilated her art, poetry and resistance writing into her healing process. / Religious Studies and Arabic / D. Litt. et Phil. (Religious Studies)

Corporate culture is believed to be integral to organisational success and sustainability. This research study was conducted according to a humanistic, positive psychology and an open systems paradigm in order to examine the theoretical relationship between organisational culture and organisational commitment. The quantitative measuring instruments used for data collection were the Harrison and Stokes organisational culture questionnaire (OCQ) and Allen and Meyer’s organisational commitment scale (OCS). The empirical study involved respondents from a selected IT company in the KwaZulu-Natal region. This study revealed that there was no significant relationship between organisational culture and organisational commitment. However, there was a difference between the existing and preferred power culture as well as the existing and preferred role culture dimensions. The main recommendation for this study is that the selected IT company should set stretch targets with a focus on common vision, purpose and company values, with a strong emphasis on creating meaningful rewards for top performers at both individual and team level. / Industrial and Organisational Psychology / M. Com. (Industrial and Organisational Psychology)

A trama de magmas graníticos alojados na crosta intermediária e superior pode-se originar pela ação de forças de corpo (ascensionais, convectivas) e/ou tectônicas. Diferentes mecanismos podem concorrer para a formação de tramas, embora a interação entre a deformação magmática e a tectônica regional seja um dos mecanismos fundamentais, notadamente nos granitos alojados em faixas orogênicas. No Domínio Apiaí da Faixa Ribeira (SP - PR), os batólitos graníticos alongados têm sido historicamente classificados como sintectônicos, ou seja, colocados durante o desenvolvimento de um arco magmático continental neoproterozóico. Os plútons menores, de forma circular a ovalada, geralmente discordantes e com típica coloração avermelhada, são considerados pós-tectônicos ou alojados após a colisão continental entre os diferentes blocos litosféricos que formaram a Faixa Ribeira. Essa classificação esquemática tem sido baseada em geoquímica e geocronologia dos granitos. Este trabalho identificou e mapeou a trama interna dos plútons sin-tectônicos (Ribeirão Branco) e pós-tectônicos (Capão Bonito e Sguário) utilizando a anisotropia de suscetibilidade magnética (ASM), de forma a inserí-los propriamente nos modelos de classificação tectônica, cujas premissas básicas são de natureza estrutural. Os granitos porfiríticos (Ribeirão Branco e Itaóca) possuem uma elevada suscetibilidade magnética (k 10-2 SI), a qual é menor (k 5 x 10-3 SI) nos granitos vermelhos (Capão Bonito e Sguário). A suscetibilidade dos granitos porfiríticos é proveniente de óxidos ferromagnéticos, notadamente magnetita pobre em Ti, que encontra-se frequentemente associada com titanita, biotita e anfibólio. Nos granitos vermelhos a suscetibilidade é gerada por magnetita, variavelmente oxidada (maghemita) e Ti-hematita (hemo-ilmenita), havendo também significativa contribuição da fração paramagnética (biotita cloritizada) à suscetibilidade total nas rochas, quando k < 10-3 SI. O grau de anisotropia magnética (P) tanto nos granitos porfiríticos como nos vermelhos é variável, porém tipicamente maior nos porfiríticos (P = 1,14, dp. 0,08), se comparado aos vermelhos (P = 1,07, dp. 0,05). A maior anisotropia de suscetibilidade no plúton Ribeirão Branco é atribuída a uma incipiente foliação detectada em vários setores do granito, que contrasta com a microestrutura aparentemente isótropa dos granitos vermelhos. O estudo da trama de silicatos no granito porfirítico Itaóca e no granito Capão Bonito mostrou que os eixos principais de anisotropia de suscetibilidade magnética e da orientação preferencial de forma (OPF) de feldspato e de biotita, são correspondentes, porém, comumente oblíquos. Essa obliquidade entre eixos é atribuída às características físicas próprias (forma, tamanho e anisotropia) dos minerais marcadores da trama. O estudo combinado da ASM e da OPF revelou ainda que P tende a crescer com a intensidade da orientação preferencial de silicatos, o que permitiu identificar os domínios de maior deformação magmática e correlacioná-los com a estrutura regional. A trama magnética do granito Ribeirão Branco organiza-se em coerência com uma tectônica regional transcorrente sinistral. Na margem ocidental deste granito, contudo, a orientação da trama é diferente do restante do maciço, tendo sido aparentemente afetada pela intrusão do granito Sguário. A trama magnética do Ribeirão Branco contrasta com a do plúton Itaóca, este último exibindo um padrão concêntrico que antecedeu ao desenvolvimento da deformação transcorrente regional. Zircões do Itaóca forneceram uma idade U-Pb (SHRIMP) concordante de 623 ± 10 Ma, atribuída à cristalização deste plúton. Dados da literatura indicam que o granito Capão Bonito é aproximadamente 15 Ma mais jovem que os batólitos de granito porfirítico. O Capão Bonito, entretanto, apresenta uma trama muito bem organizada, típica de intrusões sin-tectônicas, destacando-se excelente alinhamento da lineação magnética. No granito Sguário, o arranjo da trama é tipicamente helicoidal e, junto com a estrutura do Capão Bonito, podem ter sido organizadas em resposta a uma deformação transcorrente E-W destral. Este evento tardio estaria associado à reativação da zona de cisalhamento Ribeira, que afetou a borda sul do granito Itaóca e que contém uma componente extensional. A deformação transtensiva E-W, que favoreceu a injeção dos granitos vermelhos no Domínio Apiaí, sucederia a um evento tectonomagmático principal, que teria sido responsável pela colocação e deformação dos batólitos de granito porfirítico. A intrusão dos grandes corpos graníticos ocorreu em torno de 615 Ma e foi relacionada à convergência crustal e estiramento subparalelo à Faixa Ribeira, com a deformação localizada notadamente nas estruturas transcorrentes de direção NE-SW. / The fabric of granitic magmas emplaced in the middle and upper crustal levels can be caused by the stress action during the ascension and convection of plutons and/or tectonic strain. Several mechanisms can contribute for the previous thing, nevertheless the interaction between the distortions and tectonic is the domineering one, principally in granites located in orogenic belts. In the Apiaí domain of the Ribeira belt (SP-PR) the elongated granitic batholiths have been historically classified like syn-tectonic and them was emplaced during the development of a neoproterozoic continental magmatic arch. Small Plutons with subcircular to oval forms generally discordant with regard to the disposition of the regional structures and that in turn possess feldspars of reddish typical colour, had been considered pos-tectonic, and therefore, emplaced after the collision that joined the different litho-tectonic units that constitute the Ribeira orogenic belt. This schematic classification of these granites relicts on geochemistry and geochronology data. In this study was identified and recorded in map the internal fabric of the syn-tectonic Ribeirão Branco granite and of the pos-tectonic Capão Bonito and Sguário granites using the anisotropy of magnetic susceptibility (AMS) with the aim of inserting them appropriately in the models of tectonic classification whose basic premises are of structural nature. The porphyritic Ribeirão Branco and Itaóca granites have a high magnetic susceptibility (k = 10-2 SI), which is minor than (k = 5 x 10-3 SI) in the red granites (Capão Bonito, Sguário). In the first ones the poor Ti magnetite is the main source of susceptibility, commonly associated to titanite, biotite and amphibole. In the red granites, the susceptibility is provided by magnetite variability rusty (maghemite) and Ti - hematite (hemo-ilmenite), in addition to the significant contribution of biotite altered by hydrothermal processes. The grade of anisotropy rise (P) in the porphyritic granites (P = 1,14 SD. 0,08) and this is bigger than in the red ones (P = 1,07, SD. 0,05). In the Ribeirão Branco pluton, the high value of P is attributed to an incipient foliation detected in several sectors, which contrasts with the microstructure seemingly isotropic of the red granites. The study of the fabrics of silicates in the porphyritic granites Ribeirão Branco and Itaóca revealed that the orientations of the main axes of AMS and of shape preferred orientation (SPO) of feldspar and mafic silicates (biotite + amphibole) are congruent, nevertheless some obliquities occur. Those obliquities are attributed to the influence of the proper characteristics (form, size, anisotropy) of the marker minerals of the respective sub fabrics. In the same way, the above-mentioned study of silicates fabric demonstrated that P tends to grow up with the intensity of the SPO of silicates, which allowed to identify domains with major magmatic distortion into de granitic bodies and to correlate them with the regional structure. In general, the magnetic fabric of the Ribeirão Branco granite is organized coherently with the tectonic regional sinestral strike-slip shear zones; nevertheless, in the western sector the orientation of the magnetic fabric was likely modified by the accommodation of the Sguário granite. In the Itaóca granite, the organization of the magnetic fabric is different if compared with fabrics of the previous pluton. In Itaóca granite was recorded a fabric with a concentric organization in 623 ± 10Ma. (MSWD 0,31), according to the concordant U-Pb (SHRIMP) age in zircons obtained for the crystallization of the granite, that seems to be occurred before the strain related with the activation of the regional strike-slip shear zones. Geochronology data of the literature indicates that the Capão Bonito granite is approximately 15 Ma. younger than the batholiths of porphyritic granite. The Capão Bonito granite has an organized fabric typical of syn-tectonic intrusions that has an excellent alignment of the magnetic lineation. In the granite Sguário, the fabric has a spiral organization, in the same way as recorded in Capão Bonito, like response to a strain associated with to a small strike-slip shear zone with W-E direction. This event would be related to the reactivation of the Ribeira strike-slip shear zone, which affected the south sector of the Itaóca granite, with the participation of an extensional component. The W-E transtensive deformation that favoured the injection of the red granites in the Apiaí Domain likely was subsequent to a main tetonomagmatic event and this should have been the responsible by the emplacement and strain in the porphyritic granites. The intrusion of the big granitic bodies ~ 615 Ma. and could be it related to the convergence between crustal blocks and to the consequent stretching sub parallel of the Ribeira belt, in which the distortion was located remarkably in the strike-slip shear zones with NE-SW direction.

In South Africa the death of a significant caregiver is a haunting possibility. Violence, crime, road accidents, HIV/AIDS, cancer, diabetes and substance abuse are household words that describe some of the causes of "untimely deaths" of parents who still have young, school-going children. These children carry their bereavement with them to school. The challenge of standing with them lies not only with their caregivers, but also with staff and children in our school community. In co-authoring conversations with children in our school who have experienced bereavement and loss, this qualitative study used research as co-search to uncover children's preferred knowledges and spiritualities about coping, hope, care and communities of concern. This study used therapy-as-research and participatory action research-as-therapy in what developed into a network of caring communities for the participants, caregivers and therapist. / Philosophy, Practical and Systematic Theology / M. Th. (Pastoral Therapy)

Thèse de doctorat présenté en vue de l'obtention du doctorat en psychologie - recherche intervention, option neuropsychologie clinique (Ph.D) / Les traumatismes craniocérébraux (TCC) peuvent entraîner de lourdes conséquences physiques, cognitives, émotionnelles et comportementales. Parmi celles-ci, l’agitation est très fréquente et se caractérise par une hyperactivité motrice, une désorientation, des problèmes d'attention, une labilité émotionnelle, une désinhibition et de l’agressivité. Elle interfère avec le rétablissement et les processus de réadaptation, mais il n'existe pas à ce jour de consensus sur son traitement, outre la contention physique ou la prise de médicaments, qui peuvent respectivement causer des blessures ou entraver la récupération. De récentes données suggèrent que les interventions musicales peuvent réduire l’agitation chez les patients TCC mais la capacité des patients TCC à percevoir et traiter la musique pendant la phase aiguë post-blessure n'a pas été établie. Le premier article de cette thèse visait à évaluer la perception musicale chez les patients TCC hospitalisés en phase aiguë. Dans la présente étude, 42 patients ayant subi un TCC ont été comparés à un groupe témoin. Tous les participants ont complété les tests de Scale et Rhythm de la Montreal Battery of Evaluation of Amusia pour mesurer la perception musicale, et le test d’empan numérique pour mesurer la mémoire verbale à court terme. Comparativement au groupe témoin, les patients TCC ont obtenu des performances significativement inférieures; 43% d'entre eux présentaient des déficits de traitement de la hauteur et 40% des déficits de traitement du rythme. Les patients présentant des lésions à l'hémisphère droit ont obtenu des résultats plus faibles que ceux présentant des lésions à l'hémisphère gauche. Les déficits de traitement de la hauteur et du rythme coexistaient dans 31% des cas, ce qui suggère l'existence de réseaux neuronaux partiellement dissociables. Le deuxième article est une revue non systématique dont l’objectif était de caractériser l'agitation et son traitement. Plusieurs types d’interventions comportementales, dont les interventions musicales, ont été explorées dans cette revue. Les limites méthodologiques ont été discutées et des recommandations ont été faites pour une approche plus systématique de la recherche utilisant des études de cas et de séries de cas chez les patients agités. Le troisième article est une étude pilote de phase II dans laquelle sont inclus des patients ayant subi un TCC modéré à sévère (n = 3) ou un accident vasculaire cérébral de l'artère cérébrale moyenne (n = 1). Ils ont été exposés à leurs musiques préférées, de la musique classique relaxante et un extrait sonore non musical (cascade) pendant la phase aiguë de récupération. Les comportements d’agitation ont été évalués à l'aide de l'Échelle d’Agitation (Agitated Behaviour Scale), de mesures actigraphiques et d’une observation qualitative. Les résultats indiquent que l’agitation a diminué lors de l’écoute de la musique classique relaxante et la cascade. L’agitation est restée stable lors de la musique préférée, mais certains patients ont exprimé des émotions positives ou présenté un comportement plus organisé, comme taper du pied ou chanter. Compte tenu des importantes limites méthodologiques dans ce champ d’études, la présente étude a permis d’explorer la faisabilité et l’effet d’une intervention musicale, ce qui permettra de guider les études futures. / Traumatic brain injury (TBI) has serious physical, cognitive, emotional, and behavioural consequences. Agitation is highly prevalent among patients with TBI, and is characterized by motor hyperactivity, disorientation, attention problems, emotional lability, disinhibition, and aggression. It often results in decreased engagement in rehabilitative treatment, and poorer functional outcomes. There is no consensus on the treatment for agitation. Most often, it is managed with medication and physical restraints, which may cause injury or impede cognitive recovery. Few studies examine novel non-pharmacological interventions for agitation in TBI patients. However, recent evidence suggests that music interventions may decrease agitated behavior in TBI patients. The ability of TBI patients to perceive and process music during the acute phase has not been established, though it may influence the efficacy of preferred music interventions. The first article of this thesis evaluated music perception in acutely hospitalized TBI patients. Music perception deficits have been identified in populations with acquired brain injury due to epilepsy, stroke, and after aneurysmal clipping. However, few studies have evaluated deficits following TBI, resulting in an underdiagnosis in this population. Forty-two patients completed the Scale and Rhythm tests of the Montreal Battery for the Evaluation of Amusia to measure music perception, and Digit Span Forward to measure verbal short-term memory. TBI patients were more often impaired than controls, with 43% demonstrating pitch processing deficits, and 40% demonstrating rhythm processing deficits. Patients with right hemisphere damage performed more poorly than those with left hemisphere damage. Pitch and rhythm deficits co-occurred 31% of the time, suggesting partly dissociable neural networks. Results are discussed in the context of current research and clinical implications. The second article was a non-systematic review in which we characterized agitation and its treatment. We explored behavioural interventions, including music interventions, occupational therapy, the Intervention Contingencies Awareness Relationship behavioural model, operant contingency management, and general therapeutic activities. The methodological limitations were discussed and recommendations made for a more systematic approach to research using case and case series studies in agitated patients. The third article was a phase-II development-of-concept pilot study in which four patients with moderate to severe TBI (n = 3), and middle cerebral artery stroke: (n = 1) were exposed to preferred music, relaxing classical music, and a nonmusical control (waterfall) during the acute phase of recovery. Agitated behaviours were assessed using the Agitated Behavior Scale, actigraphy, and qualitative observation. Agitated behaviour decreased during relaxing classical music, and waterfall. It remained stable in the preferred music condition. However, certain patients expressed positive emotions and organized behaviour such as tapping or singing along. Given important methodological limitations in current studies, a phase-II study allowed for the evaluation of outcomes and the practicality of delivering music listening interventions, which may guide future studies.

Estimating others characteristics from facial cues plays an important role in our everyday lives. People usually agree in these estimates well and many of these estimates correlate. Majority studies consider one or few character- istics only and their respondents usually are in narrow ranges of ages. This study is partly based on rating of 13 characteristics of 80 men's and women's faces by respondents of various ages. These data were originally collected within yet unpublished study of Jaroslav Flegr, Amy E. Blum and Šebastian Kroupa. In this study I most strikingly found out that: i) older respondents of both genders rates photos of women as more attractive, ii) respondents spend more time by rating faces considered by themselves as more attractive or nice, iii) men rate people with different eye color as more attractive and women rate others with the same eye color as nicer, iv) preferences computed by two methods do not differ much. 1