Background and objectives: Living with acute leukaemia can challenge patients’ physical, emotional and psychological well-being and functioning, but can be a greatly challenging experience for their families, too. Such a life-changing experience can potentially initiate or accelerate a meaning-making process that may be prolonged and demanding. Yet, there is a dearth of empirical evidence with regard to how adult patients with acute leukaemia or their family carers make sense of their illness-related experiences, and, as a consequence, clinicians still lack the knowledge necessary to tailor support to this specific population. Therefore, this qualitative study aimed to explore the processes, through which patients and family caregivers construct their meanings of acute leukaemia. Design and methods: An exploratory design was employed using serial, in-depth interviews, guided by Smith’s Interpretative Phenomenological Analysis approach. Ten adult (>18 years of age) patients with acute leukaemia and eight patient-nominated family caregivers were recruited during a 14-month period from two clinical NHS sites in Scotland. Two serial interviews were conducted with each participant, two to four weeks apart, within the first year of diagnosis or post-relapse. In total, thirty-six interviews were analysed. Results: Findings deriving from patient interviews indicated that acute leukaemia creates a state of imbalance to the person, which may initiate a search for a new equilibrium. Patients’ journeys towards making sense of their illness may involve three inter-changeable processes: decay, transformation and growth. As patients learned of their diagnosis and their treatment commenced, a sense of decay dominated their lives. ‘Feeling like being a prisoner’ and ‘living with an impaired self’ were two common emergent themes. Running in parallel, signs of transformation started to become more evident as time elapsed. Within the third making-sense process, that is to say growth, themes such as strengthened family bonds, and reprioritising values were among the most prominent. Carers’ accounts of their indirect cancer experience revealed that family members made sense of their acute leukaemia-related situation as a state of limbo that was conceptualised as a maze. After being thrust into limbo, the invisible nature of acute leukaemia created difficulties for carers to conceptualise it; however, they experienced its impact on their lives quite hastily. In order to navigate limbo, carers had to learn to steer through their social world and the unfamiliar hospital environment and eventually manage to transcend limbo by employing various coping strategies, by facilitating the cancer journey of their loved ones, and finally, by reconciling with the patient’s illness. Conclusions and future implications: Findings of this contextually and methodologically novel study highlight the complex nature of sense-making for both patients and family caregivers experiencing acute leukaemia. Additional research is warranted to further uncover the various ways in which meaning is initially constructed, negotiated, re-visited and reformed as patients and/or family carers go through the different phases of living with the illness. In any case, clinicians can rely on the findings of the present study in order to provide on-going support and guidance so that patients and carers visualise the ‘invisible’ acute leukaemia and make sense of their illness-related situation in ways that favour their short- and long-term psychosocial adjustment.

Philosophiae Doctor - PhD / Using two hydrodynamic galaxy formation simulations from the Mufasa project that I helped develop, we aim to better understand the relationship between galaxy evolution and its cold gas content commonly known as the neutral hydrogen or Hi. We first look at the environmental properties of the simulated galaxies and compare to those that are available observationally. As a proxy, we specifically quantify the so-called galactic conf ormity, which is the concordance between the properties of galaxies neighbouring the primaries, in chapter 2. We show that the Hi, the specific star formation rate (sSFR) and the colour of galaxies show galactic conformity in qualitative agreement with previous observed data, i.e. the Hi-rich primary galaxies are surrounded by Hi-richer galaxies than the Hi-poor primary galaxies, and similarly for the sSFR and the colour. We find that environment, quantified by the number of neigbouring galaxies within a fixed aperture, stellar age and molecular hydrogen (H2) also show conformity. Galactic conformity also depends on the dark matter halo mass of the primary galaxy. The galactic conformity signal from the primaries of smaller haloes is weak but extends out to several virial radii of those structures, whereas the signal is very strong for high mass haloes but lowers quickly with distances from the primaries. We also find the galactic conformity only emerges in the later half of cosmic evolution. We next quantify the gas content and star formation depletion timescales in chapter 3. We use two carefully chosen groups of simulated galaxies and find that timescales are affected by both the mass of the virialised structure of the first infall and the galaxy stellar mass at infall: the higher the halo mass or the stellar mass the shorter the timescale. The gas or Hi depletion timescale is concordant to that of the star formation quenching, indicative of direct decrease of SFR due to depletion of the extended cold gas reservoir. The neutral atomic or molecular hydrogen consumption timescale depends on the Hubble time. Galaxies tend to form stars more efficiently at lower redshift. While the halo mass of infall affects the consumption timescale of the Hi, it does not correlate with the H2. We lastly develop machine learning tools to use galaxy photometric data to predict a galaxy’s Hi mass in chapter 4, to allow predictions for Hi from much larger optical photometric surveys. The training and testing of the algorithms are done first with the simulated data from Mufasa. We show that our model performs better than previously done with ad hoc data fitting approaches. Random Forest (RF) followed by the Deep Neural Networks (DNN) perform best among the explored machine learning techniques. Extending the trained models to observed data, namely the Arecibo Legacy Fast ALFA (ALFALFA) and REsolved Spectroscopy Of a Local VolumE (RESOLVE) survey data, we show the overall performance is slightly reduced relative to the simulated testing set owing to the small inconsistency between definition of galaxy properties between simulation and observational data, and DNN perfoms the best in this case. The application of our methods is useful for galaxy-by-galaxy predictions and anticipated to correct for incompletness in the upcoming Hi deep surveys done with MeerKAT and eventually the Square Kilometre Array (SKA).

No / This paper explores the responses of 17 participants to using photo-elicitation as part of a project exploring their daily experiences of work-life balance. We explicitly asked participants about their experiences of using the method that involved taking photographs of their work-life balance experiences and interpreting these photographs through participation in semi- structured interviews. Participants took 108 photographs in total. We explore important methodological issues for researchers seeking to use these methods and explain that photograph-elicitation has much to offer management and organizational researchers. A major benefit of the method is the role of photographs as a ‘conversational technology’ in encouraging re-interpretation and reflection of experiences in a manner not always achieved when using other qualitative techniques.

The focus of this study was to better understand the state of homeless services in Western Riverside County’s unincorporated areas and cities. Though various services are available to the homeless in these areas, the distance between the appropriate services and some residential parts of the county can be vast. This study sought to obtain an understanding from the administrators of homeless services providers on the deficiencies in services across the county, striving to understand where and what type of increased services are needed. This study used a qualitative research design. Data were collected from nine homeless service administrators from around Western Riverside County using face-to-face recorded interviews. This study found that greater services to help those suffering from mental illness or those unable to afford housing were needed. This study also found that increased collaboration between agencies has been working to improve services. It is recommended that homeless agencies continue working together in collaboration to increase the effectiveness of services and to bring the needed funding which will sustain and increase the services required to end homelessness in Western Riverside County.

The War on Drugs has been a contested issue in the United States for decades. Many believe that African Americans are targeted by the government and become victims of the penal system as a result of anti-drug policies. The purpose of this ethnographic study was to explore the impact of the war on drugs on African American men, women, and young adults from their perspectives. Racial threat theory provided the framework for the study. Data were collected through interviews with and observations of 30 African American participants who had experiences directly and indirectly with the War on Drugs. Participant were recruited through purposeful and snowball sampling. Results of coding analysis by way of NVivo revealed that that many African Americans experience mental health issues (specifically depression and anxiety) due to direct and indirect consequences of drug penalties. Findings also showed that fair sentencing is needed for African Americans, and that African Americans need to come together to impact social change in their communities. Findings may be used to promote drug policy reform, rehabilitation for African American offenders and their families by addressing the mental health challenges individuals face directly and indirectly due to the drug penalties; in addition to increasing the access to these mental health resources. Furthermore, political changes for decriminalization of marijuana and commuting sentences for those penalized for the drug are apart the social changes that would lessen the impact the War on Drugs has on African Americans.

Many transitional challenges have affected female veterans after returning from serving in the war in Iraq and Afghanistan. The number of females joining the military and becoming involved in combat has increased within the past 10 years. Research exists on the transitional challenges of male veterans. However, little research exists on the reintegration challenges faced by female veterans. As these females become veterans, they are more visible in the Veterans Affairs Health Care System. Given this increase in number of female veterans, it is important to address transitional challenges experienced by females who served in Operations Enduring Freedom and Operation Iraqi Freedom (OIF/OEF) postdeployment. For female veterans, the transitional experience will impact their responses to readjustment in civilian life. Selder's transitional theory and Schlossberg theory provided the framework for this phenomenological study. Using snowball sampling, 5 female veterans who served in combat during the past 5 years were selected and interviewed about their lived experiences using an open-ended interview guide. Data from the interview responses were inductively analyzed for themes and patterns. Using NVivo11 for management of data analysis, the interview responses were transcribed, categorized, coded, and clustered, revealing 5 themes: reflection on deployment, health issues, support from family, environmental concerns, and readjustment into roles. The key findings revealed that female veterans who served in combat experienced complex challenges after reintegrating back into civilian life. The findings may contribute to positive social change by informing treatment plans and support programs for female veterans reintegrating back into civilian life.

This thesis offers an interpretation of how eight male primary school teachers experience touch between themselves and their pupils/students. Despite the positive benefits of touch and evidence suggesting that appropriate forms of touch should be encouraged, the many meanings, interpretations and reactions to touch potentially complicate the ways in which people react. The potential for touch to enhance human well-being is therefore often diminished. The taboo surrounding touch is particularly evident in the school environment where limited research has been undertaken. This study gives voice to male teachers as they share their experiences in an era when the risks associated with physical contact between teachers and pupils are increasing. Hermeneutic phenomenology was used to explore and gain deeper understanding of the meaning of touch in education through interpreting the day to day experiences of male primary school teachers in New Zealand. Narrative interviews were interpreted and described thematically. The themes: ‘being careful, cautious and visible’, ‘worrying about misinterpretation’, ‘feeling sad’ and ‘battling with boundaries’, revealed a complex array of tensions that contributed to the findings. Male primary school teachers are constantly aware of the risk they take when interacting with students. They experience tensions and conflict when deciding where and how they will touch children and whether this will be misinterpreted by others. Consideration of the ways in which people respond to this complex and sensitive subject is necessary so that male teachers feel able to use positive and appropriate forms of touch without fear of suspicion and reprisal.

Postoperative pain is a major concern to patients undergoing surgical procedures but little research has been conducted on pain management after hospital discharge for orthopaedic patients. Since pain medication is a key component of pain management, it is important to study medication usage from a patient’s perspective, for greater patient–health care provider concordance. A qualitative descriptive approach was taken to investigate the experience of 14 participants with managing pain at home immediately after total knee arthroplasty. Most participants limited their consumption and weaned themselves off prescription analgesics and used over-the-counter pain medications. The participants adapted their regimens in response to several factors and generally were content to self-manage their pain but required access to professional support. The study suggests that when developing postoperative pain management plans, health care providers may need to increase the time they spend addressing patients’ concerns and considering patients’ preferences.

Postoperative pain is a major concern to patients undergoing surgical procedures but little research has been conducted on pain management after hospital discharge for orthopaedic patients. Since pain medication is a key component of pain management, it is important to study medication usage from a patient’s perspective, for greater patient–health care provider concordance. A qualitative descriptive approach was taken to investigate the experience of 14 participants with managing pain at home immediately after total knee arthroplasty. Most participants limited their consumption and weaned themselves off prescription analgesics and used over-the-counter pain medications. The participants adapted their regimens in response to several factors and generally were content to self-manage their pain but required access to professional support. The study suggests that when developing postoperative pain management plans, health care providers may need to increase the time they spend addressing patients’ concerns and considering patients’ preferences.

Despite the ongoing initiatives of quality improvement collaboratives in healthcare which reflect various multifaceted intervention packages, clear evidence of the effectiveness of the model itself is lacking. Little is known about the true impact of the collaborative approach on improvement outcomes or how specific components are actually implemented within participating organizations. This dissertation reports on empirical qualitative research undertaken to investigate “how” healthcare providers and management describe the experience of being involved in a collaborative network for quality improvement. Using a process evaluation of a sample QI collaborative, this research reveals that frontline staff do not feel the need to conform or be identical to their peer organizations; rather they feel that by participating with them that their high level of care is finally recognized. In addition, the existing communication structure is ineffective for staff engagement and a “QI bubble” seems to exist in terms of knowledge transfer and the idea of collaboration bears out more internally in increased intra-team cooperation than externally between organizations or units. Selected theoretical perspectives from the fields of sociology and organizational behaviour are used as an analytic framework from which the author posits that based on the findings from this case study that in fact collaboratives may not actually function by any of the commonly held assumptions of legitimization, communication and collaboration. A conceptual framework for how these constructs are related in terms of QI collaborative design is proposed for future testing. With further work and on-the-ground testing of this model and relational hypotheses, this research can help the QI community develop a more functional theory of collaborative improvement and use mixed methods evaluation to better understand complex QI implementation.