Introduction: Epidemiological studies have indicated that 5-38% of influenza like illnesses (ILI) develop into severe disease due to, among others, factors such as; underlying chronic diseases, age, pregnancy, and viral mutations. There are suggestions that dual or multiple virus infections may affect disease severity. This study investigated the association between co-infection between influenza A viruses and other respiratory viruses and disease severity. Methodology: Datum for samples from North West England tested between January 2007 and June 2012 was analysed for patterns of co-infection between influenza A viruses and ten respiratory viruses. Risk of hospitalization to a general ward ICU or death in single versus mixed infections was assessed using multiple logistic regression models. Results: One or more viruses were identified in 37.8% (11,715/30,975) of samples, of which 10.4% (1,214) were mixed infections and 89.6% (10,501) were single infections. Among patients with influenza A(H1N1)pdm09, co-infections occurred in 4.7% (137⁄2,879) vs. 6.5% (59⁄902) in those with seasonal influenza A virus infection. In general, patients with mixed respiratory virus infections had a higher risk of admission to a general ward (OR: 1.43, 95% CI: 1.2 – 1.7, p = <0.0001) than those with a single infection. Co-infection between seasonal influenza A viruses and influenza B virus was associated with a significant increase in the risk of admission to ICU/ death (OR: 22.0, 95% CI: 2.21 – 219.8 p = 0.008). RSV/seasonal influenza A viruses co-infection also associated with increased risk but this was not statistically significant. For the pandemic influenza A(H1N1)pdm09 virus, RSV and AdV co-infection increased risk of hospitalization to a general ward, whereas Flu B increased risk of admission to ICU/ death, but none of these were statistically significant. Considering only single infections, RSV and hPIV1-3 increased risk of admission to a general ward (OR: 1.49, 95% CI: 1.28 – 1.73, p = <0.0001 and OR: 1.34, 95% CI: 1.003 – 1.8, p = 0.05) and admission to ICU/ death (OR: 1.5, 95% CI: 1.20 – 2.0, p = <0.0001 and OR: 1.60, 95% CI: 1.02 – 2.40, p = 0.04). Conclusion: Co-infection is a significant predictor of disease outcome; there is insufficient public health data on this subject as not all samples sent for investigation of respiratory virus infection are tested for all respiratory viruses. Integration of testing for respiratory viruses’ co-infections into routine clinical practice and R&D on integrated drugs and vaccines for influenza A&B, RSV, and AdV, and development of multi-target diagnostic tests is encouraged.

Le but de cette recherche est d’évaluer l’importance du paysage culturel dans la résilience des communautés urbaines post-catastrophes. Ce travail se concentre sur le quartier du Lower Ninth Ward dans la ville de La Nouvelle-Orléans (États-Unis) après le passage de l’ouragan Katrina en 2005. Les catastrophes naturelles prennent une envergure et causent des dommages considérables lorsqu’elles touchent des villes. La reconstruction post -désastre est donc très dispendieuse pour les villes et les gouvernements, d’autant que certaines régions sont dévastées au point qu’elles doivent être reconstruites au complet. Cependant, le coût le plus lourd à assumer reste celui en vies humaines et si rebâtir les éléments concrets d’une ville est une tâche difficile à entreprendre, reconstruire une communauté est considérablement plus complexe. Dans le but de comprendre une telle démarche, cette recherche se concentre sur les éléments intangibles, comme l’attachement au lieu et les réseaux sociaux, dont une communauté a besoin pour se reconstituer de façon durable et résiliente. Le concept de résilience est très contesté dans la littérature et plusieurs chercheurs se sont essayés à le mesurer. Cette recherche adopte une perspective critique sur le concept et le revisite d’un point de vue holistique pour mettre en lumière sa complexité. Cette démarche permet de remettre en question l’importance de mesurer un concept finalement en perpétuelle redéfinition dans le temps et selon les échelles géographiques. De plus, en établissant une relation entre résilience et paysage culturel, il a été possible de mieux comprendre la complexité de la résilience. Touchant à plusieurs disciplines (architecture de paysage, urbanisme et sociologie), cette recherche utilise une méthodologie qui reflète son aspect multidisciplinaire : les méthodes mixtes. Ces dernières permettent la collecte de données quantitatives et qualitatives qui produisent une vue globale de la situation post-Katrina à travers le regroupement de recensions statistiques, d’observations de terrain et d’articles de journaux. Parallèlement, des entretiens ont été réalisés avec des résidents du quartier ainsi qu’avec des professionnels pour mieux comprendre les différents points de vue. Cette méthodologie a permis de produire des résultats au niveau du cas d’étude autant qu’au niveau théorique. La recherche valide l’importance de prendre en compte le paysage culturel dans les situations post-catastrophes, (en particulier) dans la mesure où il s’agit d’un élément souvent négligé par les urbanistes et les acteurs locaux. En effet, les éléments constitutifs du paysage culturel tels que l’attachement au lieu et les réseaux sociaux, participent d’un sentiment d'appartenance (« home ») et d’une volonté, pour les résidents, de reconstruire leurs habitations, leur communauté ainsi que leur quartier. Toutefois, il faut reconnaître que ces éléments ne suffisent pas à retrouver ce qu’ils ont perdu. Ainsi, l’étude du paysage culturel permet non seulement de mieux comprendre la complexité de la résilience, mais démontre également que cette dernière est une construction sociale. / The purpose of this research is to determine the importance of using the cultural landscape in evaluating the resilience of an urban community after the occurrence of a natural disaster. The focus is on the neighborhood of the Lower Ninth Ward after Hurricane Katrina in 2005 in the city of New Orleans. Natural disasters are gaining significance and magnitude when they hit cities, which are becoming more and more populated over the years. The damage these disasters cause is colossal. It is very costly for cities to undergo major disasters and sometimes, large sections of cities need to be entirely rebuilt. The costliest price is the human life, and as history marks it, too many lives have perished due to disasters. While rebuilding is a challenging task, yet feasible, rebuilding a community is not as tangible as rebuilding the infrastructure. This research focuses on the many intangible aspects, like place attachment and social networks, a community needs to rebuild itself in a sound and resilient way. The concept of resilience is very contested in the literature and many have attempted to measure it. This research takes a step back and scrutinizes the concept of resilience from a holistic perspective, which highlights its complexity. This leads to questioning the importance of measuring the concept, especially that it changes with time and with the different scales of geography. In addition, a relationship between the cultural landscape and resilience is established, which allows for a better understanding of this complexity. Taking a little from multiple disciplines (Landscape Architecture, Urban Planning, and Sociology), this research resorts to a methodology that reflects its multidisciplinary aspect. The methodology is the mixed methods research design, which allows the collection of quantitative and qualitative data. The focus is to gather census data, newspaper articles, and observations to give a general perspective on the post-Katrina situation. Interviews are collected from residents and from professionals so as to tackle the research from different angles. This allows reaching results at the case study level as well as the theoretical level. This research validates the importance of using the cultural landscape in post-disaster situations as planners and government officials overlook it. Some of the elements that constitute it like place attachment and social networks motivate people to return to their original neighbourhoods and rebuild their homes and community. These elements, however, cannot by themselves give people back what they lost in the disaster. By relating the cultural landscape to the concept of resilience, it implies that resilience is a social construction.

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<p>The term magical realism traces back to the German art critic Franz Roh, who in the early twentieth century applied it to (visual) art expressing the wondrousness of life. However, this definition has been eclipsed over time. Reorienting critical attention back to magical realism as the art of portraying wonder and wondering, I explore the magical realist novels of contemporary African American and Asian American women writers. Specifically, I examine Toni Morrison’s <em>Paradise</em> (1997), Jesmyn Ward’s <em>Sing, Unburied, Sing</em> (2017), Karen Tei Yamashita’s <em>Through the Arc of the Rain Forest</em> (1990), and Ruth Ozeki’s <em>A Tale for the Time Being</em> (2013). In wonder, all frames of reference at hand suddenly become inadequate. Simultaneously, the subject’s interest is heightened. As such, the act/experience of wondering may lead to humility and respect, the two attitudes at the base of any ethically flourishing life—a life that flourishes <em>with</em> others. For this reason, the Asian American woman writer and peace activist Maxine Hong Kingston espoused wondering. Affiliated with groups marginalized within the US, like Kingston my writers also promote wonder. I examine how these writers, through compelling use of both content and form, guide their readers toward a particular kind of wondering: wondering with an awareness of how the act/experience might lead to ethical flourishing.</p>

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BACKGROUND: Clinical facilities are essential components not only for health care delivery systems but also for health care education programs. The clinical learning environment is important in training the future workforce in healthcare. Respiratory therapy education programs face several issues with the need to prepare a proper learning environment in different clinical settings. PURPOSE: The purpose of this study was to determine the perceptions of respiratory therapy students on the learning environment of clinical facilities affiliated with a respiratory therapy program at an urban state university. METHODS: This study used an exploratory research design to evaluate the essential aspects of a clinical learning environment in respiratory therapy education. A self-reporting survey was utilized to gather data from 34 respiratory therapy students regarding their perception about the effectiveness of clinical facilities in respiratory therapy education. The researcher utilized The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale that was developed by Sarrikoski et al. (2008). The CLES+T evaluation scale was adapted and modified after a written agreement from the author. The survey included three main domains, which are the clinical learning environment (18 items), the supervision relationship (15 items), and the role of clinical instructors (9 items). Thirty-two students participated in the survey with a response rate of 94.1%. RESULTS: Responses included two groups of students: the second year undergraduate (68.8%) and graduate students (31.3%), with 75% being female participants. The results obtained from the study indicated that both graduate and undergraduate respiratory therapy students gave high mean scores to the learning environment of the clinical facilities, supervisory relationship and the roles of clinical instructors. A statistically significant data was obtained pertaining to the difference of perceptions regarding the multi-dimensional learning between the graduate and undergraduate students. The graduate students evaluated that “the learning situation are multi-dimensional” more than the undergraduate students (p = 0.03). Findings of this study showed that female students had higher ratings than male students in all evaluations of clinical facilities. However, only one dimension of leadership style stating that “the effort of individual employees was appreciated” was statistically significant (p=0.03). The results stating, the presence of a significant percentage of the students with lack of successful private supervision and high percentage of failed supervisory relationship, are in contrast with the fact that clinical learning plays a vital role in the respiratory therapy education. It is also contrasting that majority of the students experienced team supervision, which is against the philosophy and principles of individualization. CONCLUSION: Since respiratory therapy is a practice-based profession, it is essential to integrate clinical education to respiratory care education. Gender and education level may impact students’ perceptions about the learning environment of clinical facilities. This study provides information about areas for improvement in clinical facilities affiliated with a respiratory care education program at an urban university.

There are many factors that contributed to the proliferation of visual codes, metaphors and references to the gendered gaze in women's fiction of the late-eighteenth and early-nineteenth centuries. This thesis argues that the visual details in women's novels published between 1778 and 1815 are more significant than scholars have previously acknowledged. My analysis of the oeuvres of Jane Austen, Ann Radcliffe, Maria Edgeworth and Fanny Burney shows that visuality — the nexus between the verbal and visual communication — provided them with a language within language capable of circumventing the cultural strictures on female expression in a way that allowed for concealed resistance. It conveyed the actual ways in which women ‘should' see and appear in a society in which the reputation was image-based. My analysis journeys through physiognomic, psychological, theatrical and codified forms of visuality to highlight the multiplicity of its functions. I engage with scholarly critiques drawn from literature, art, optics, psychology, philosophy and anthropology to assert visuality's multidisciplinary influences and diplomatic potential. I show that in fiction and in actuality, women had to negotiate four scopic forces that determined their ‘looks' and manners of looking: the impartial spectator, the male gaze, the public eye and the disenfranchised female gaze. In a society dominated by ‘frustrated utterance,' penetrating gazes and the perpetual threat of misinterpretation, women novelists used references to the visible and the invisible to comment on emotions, socio-economic conditions and patriarchal abuses. This thesis thus offers new insights into verbal economy by reassessing expression and perception from an unconventional point-of-view.

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This thesis is a work of Christian theology. Its purpose is twofold: firstly to develop an adequate understanding of reconciliation at the level of peoples and nations; and secondly to make a practical contribution to resolving the problems in Australia for the welfare of all the peoples, and of the land itself. The history of the relationships between the Indigenous and non-Indigenous peoples in Australia has left many problems, and no matter what the non-Indigenous people try to do, the Indigenous peoples of Australia continue to experience themselves as being in a state of siege. Trying to understand what is happening, and what can be done to resolve the problems for the peoples of Australia and the land, have been the implicit drivers for the theological development in this thesis. This thesis argues that the present generation in any trans-generational dispute is likely to continue to sin in ways that are shaped by the sins of the past, which explains why Indigenous peoples in Australia find themselves in a stage of siege, even when the non-Indigenous peoples are trying to pursue policies which they believe are for the welfare of all. The only way to resolve this is for the peoples of Australia to seek reconciliation. In particular, the non-Indigenous peoples need to repent, both of their own sins, and the sins of their forebears. Reconciliation processes have become part of the international political landscape. However, there are real concerns about the justice of pursuing reconciliation. An important part of the theological development of this thesis is therefore to show that pursuing reconciliation establishes justice. It is shown that the nature of justice, and of repentance, can only be established by pursuing reconciliation. Reconciliation is possible because God has made it possible, and is working in the world to bring reconciliation. Because land is an essential part of Indigenous identity in Australia, the history of land in court cases and legislation in Australia over the past half century forms an important case study in this work. It is shown that, although there was significant repentance within the non-Indigenous legal system in Australia, the degree of repentance available through that legal system is inherently limited, and so a more radical approach is needed in order to seek reconciliation in Australia. A final chapter considers what the non-Indigenous people of Australia need to do in order to repent.

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