Celebrations are pervasive. At a personal level they include birthdays, funerals, weddings, get-togethers, award ceremonies, and parties organised for any number of reasons. At a community level they include faith-based services, public holidays, commemorations and community festivals. These are just a selection. I argue that there is a need to better understand what role celebrations can play to improve health and wellbeing and not just for individuals but for communities. In this thesis I examine the experiences, context, processes and politics of celebrations and how they contribute to both personal and collective health and wellbeing. Of course, some celebrations make a more meaningful contribution than others. And it is the nature of that difference I seek to understand. The two leading research questions I address are: • How do celebrations contribute to personal and collective health and wellbeing? • What is ‘healthy’ celebration practice? There are three sections in this thesis. In the first I describe and discuss the Australian context of celebration activities. I also explore definitions of celebrations. I consider celebrations to be an active process made up of both play and ritual. Celebrations seek to focus people’s attention, and intention, in a positive way. The resulting celebratory act(s) are a cultural expression of what a particular individual or community values. There are a diversity of celebration forms and practices - open, spontaneous, planned and formal. Each celebration is influenced by, and influences, the context in which it occurs. I will be focusing on celebrations occurring within a community context. A community may be a family, an organization, local community, shared interest group or a whole of society grouping. In the second section of the thesis I analyse the relationship of celebrations to various dimensions of health and wellbeing. These dimensions include: social connectedness, identity, transitions and lifespan development, and community capacity. A major part of my fieldwork was undertaken in Victoria where I studied 20 community celebrations. The community celebrations I examined in varying degrees, did positively contribute to personal and collective wellbeing. They did so because they included positive and personally meaningful activities. They explored identity. Celebrations played a role in supporting transitions leading to ongoing healthy development. They provided opportunities for learning; not just knowledge but allowed values to be explored and skills and resources to be gained. They brought people together to interact and fostered a sense of belonging. Celebrations that were health enhancing valued diversity but also explored what unites people. My research confirmed that celebrations can foster our connections; to ourselves, others, the earth, time and the spiritual. They can build relationships between individuals, groups and organizations. They can be spaces that allow for personal and collective healing. But the degree to which these positive dimensions can be achieved depends on the nature or quality of the celebration practice. And it is the practice of planning and facilitating celebrations that is the focus of the third section of the thesis. Some celebration practices are health enhancing while others are not. Celebrations can be an opportunity to explore not just ourselves but our communities and how they oppress particular individuals and groups. Many contemporary celebrations do not feel authentic or resonate with people. They often remain at the surface and focus on passive forms of entertainment and the consumption of goods. Deeper engagement can be facilitated through more participatory and creative activities such as dance, playing music, story -making and -telling and ritual; particularly when engaged in with conscious intention. Celebrations at the individual level can be a positive, affirming experience that is personally meaningful and enables people to move towards their potential. At a collective level they build relationships between the individual, groups and places. They highlight the interconnectedness between all things. And as such they are an integral part of community life. I conclude by presenting an analytical framework to help understand the nature of celebration practice that is less or more likely to facilitate health and wellbeing. I try to adopt the viewpoint of a practitioner interested in the health and wellbeing of individuals and communities. I anticipate this knowledge will stimulate discussion particularly within the health and community sector about how celebration practice can be integrated into the work of health professionals and community workers.

Cough is a common symptom of respiratory disease. Assessment of antitussives has relied mainly on animal studies and clinical trials in which recording of natural cough is difficult. This thesis describes the use of ultrasonically nebulized distilled water (UNOW) to induce cough in man. Investigation of the chemosensitivity of this response identified that extremes of pH, a chloride concentration below 75mmol/l, but not changes in osmolarity induce cough which reflects afferent rapidly adapting recep~or sensitivity in animal studies. Inhaled beta-adrenergic and anticholinergic bronchodilators, which inhibit cough in asthma, markedly reduced UNOW-induced cough in both healthy and asthmatic volunteers. Bronchoconstriction with inhaled leukotriene 04, which constricts both asthmatic and non-asthmatic airways, also caused coughing. Inhibition of bronchoconstriction either specifically or non-specifically resulted in inhibition of cough. Nedocromil sodium and the diuretic, frusemide, but not the commonly prescribed opiate, codeine, exhibited antitussive activity. Cough was also induced by inhalation of the C-fibre stimulants, capsaicin and prostaglandin E2 (PGE2), which was characterised by studies of adaptation, cross-adaptation and antitussives. UNOW and PGE2, but not capsaicin, exhibited rapid adaptation of cough. Crossadaptation, however, did not occur suggesting distinct mechanisms of cough mediation. Nedocromil inhibited capsaicin-induced cough but not PGE2-induced cough, while fenoterol did not affect either challenge. Oxitropium, which inhibited UNOW-induced cough, did not reduce cough associated with upper respiratory tract infection. Cough can be induced by a variety of inhaled stimuli. These can identify differences in response which may signal a number of pathways leading to cough. Antitussive activity may also be specific to individual challenges. This diversity in response reflects the complex neurological organisation of cough and may be related to pathological causes of cough.

Cognitive deficits have been shown to be responsible for the onset and maintenance of depression, while psychological resources are known to enhance psychological wellbeing. The present study aimed to understand the mechanism of depression by integrating both perspectives. Partial support was found for the hypothesis that participants with higher levels of negative attentional bias tended to engage in more brooding rumination, which in turn predicted more depressive symptoms. On the other hand, partial support was found for the hypothesis that participants with higher levels of cautiousness or vitality tended to engage in less negative attentional bias and brooding rumination, which in turn predicted less depressive symptoms. Implications for clinical practice and research were discussed in detail. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

This thesis presents an action research study concerned with strengthening decision-making within a councillor model of shared governance in a UK hospital trust. Shared governance seeks to flatten traditional hierarchies by empowering clinical staff to make decisions affecting policy and practice. Chapter 1 sets the scene for this exploratory case study through identification of the national and local health care context. The model of shared governance chosen for investigation is presented. An overview of the thesis is given. Chapter2 presents a literature review of shared governance framed by undertaking of a concept analysis. Existing evidence concerning shared governance and decision-making is examined. Chapter 3 considers methodology issues and justifies the selection of a qualitative approach that embraces action research as a means of promoting integration of findings into decision-making practice. Chapter4 sets out the methods used to collect data in response to the research questions. Issues around access to the research setting are discussed. Sampling decisions are made explicit and a description of the data collection process is given. Extensive use has been made of participant-observation as well as interview techniques. Chapter5 presents adetailed narrative of the approach to analysis centring on the use of basic and advanced data displays to aid qualitative data analysis. Chapter 6 details the study findings and culminates in the presentation of a conceptual model of shared governance decision-making. Chapter7 provides a substantive reflective narrative concerning my research practices and experiences throughout the action research journey, and the impact of these on my personal development. Chapter8 discusses the study findings in light of a summative review of the literature and evidence around shared governance and decision-making. Implications for practice and policy are identified along with areas for future research.

The starting point of this thesis is an examination of recent changes in public service provision of services for women who have experienced rape. I focus on the Sexual Assault Referral Centre (SARC) in Manchester, using this case to open up discussion about the 'treatment and 'management' of rape. The SARC is a joint initiative between police and Health Authority and I look at their respective interests in the centre. My central argument in the thesis is that the recent British interest in services for those who have been raped/sexually assaulted, and the consequent growth of these services, reflect a particular medical ideology of rape which in general is not helpful to women, while recognizing that individual women may benefit. I develop this thinking to argue that service provision of this kind seeks to pathologize women by treating their reactions to rape as an 'illness' which needs medical intervention to be 'cured'. Drawing upon analogous work in medical sociology I show that women who fail to fit this model are further pathologized within the medical system. I locate my argument in an examination of the national and local contexts which I seek to demonstrate provided the catalyst for changes in police handling of rape investigations. I argue that arising out of these circumstances the police have sought to establish their 'professionalism', using this as an ideological support for their practices. I look at the concept of professionalism and how it is used by police and medical personnel in their dealings with other associations which work in the field of sexual assault and victim support. This analysis covers the areas of professional attempts to incorporate the work of feminist groups but without the political analysis informed by feminism; the pressure on feminist groups to 'professionalize'; the relation between voluntary associations working in the field of crime and assault, in particular the relationship between Victim Support Schemes and Rape Crisis Centres; the policies used by Government for funding work in the field of sexual assault and other crimes. The thesis concludes with an assessment of the workings of the SARC and the irrlicat ion that I see for women's issues.

The present research aimed to assess the effects of a novel type of orthosis, the Dynamic Ankle Foot Orthosis (DAFO), on the balance and gait characteristics of hemiparetic subjects. The DAFO is a low splint with a custom-moulded insole, which is believed to support foot alignment, ankle supination-pronation and provide minimal restriction of the ankle joint flexion-extension. It was hypothesised that DAFOs improve motor behaviour after stroke involving the acquisition of standing balance (hypothesis I) and gait (hypothesis II) compared with using shoes. It was proposed that users' subjective opinions of DAFOs would support the findings of the device's ability to modify human performance such that they are beneficial when used as a part of rehabilitation management for stroke patients (hypothesis III). Twenty-two stroke subjects were randomly allocated to experimental (with DAFO and shoes-only) and control (using shoes-only) groups. Subjects followed twelve weeks of experimental trials comprising three data collections. The testing procedure was developed from preliminary work, which involved a pilot study and reliability tests. Standing balance was measured using forceplatform apparatus. The parameters investigated were: the velocity and sway index of the CoP, and F(mean), F(sd) and F(slope) of shear forces. Kinematic gait performance was assessed using a 3-D four-camera motion measurement system. The parameters studied were: the gait velocity, stride length, step length, cadence, and single stance phase, together with the minimum/maximum values of the angular displacement and velocity of the foot, shank, and thigh segments in the saggittal plane during two strides. An open questionnaire was used to evaluate subjects' opinions regarding the use of DAFOs. Overall, the quantitative studies did not identify consistent and statistically significant differences between the two experimental situations for these groups of patients. In the studies of balance, none of the parameter comparisons analysed within- and between- groups achieved statistical significance. In the studies of gait, statistically significant differences were identified for some (but not all) parameters. It is unknown whether any single or combination of balance and gait variables can be used to describe human gait entirely. On this basis, hypotheses I and II were rejected. However, these are tentative conclusions. Thus, difficulties in maintaining the stroke subject cohort number for these studies meant that the analyses probably lacked sufficient statistical power to detect small but potentially important differences in DAFO mediated actions. Furthermore, in several cases, clear differences in the magnitude of balance and gait parameters between DAFO and shoe users were apparent, and these differences were often consistent with nearer normal levels associated with use of the device (suggesting potentially beneficial influences). Thus, positive effects of the DAFO on lateral velocity of sway and variability of the spectral frequency were evident for some subjects. The gait velocity, stride length and single stance phase were also nearer normal values using DAFOs than without them. In addition, the maximum foot velocity value was improved in the middle of swing phase on the affected side, which may indicate improvement to the ankle dorsiflexion function using these devices. In contrast to the inconclusive balance and gait findings, the outcome of the questionnaire assessments was clear. The majority of subjects provided very positive feedback with regard to DAFO use. Most subjects expressed confidence in the splint, which they perceived as helpful for their walking ability in day life. Some difficulties were noticed with donning and doffing the DAFO, but the perceived benefits outweighed this consideration. These qualitative studies therefore provide the most convincing evidence to support the idea that DAFOs improve stroke patients' balance and gait, and that this type of orthosis may form a useful adjunct to rehabilitation strategies. However, as the proposals set out for this research were related, acceptance of hypothesis III requires that at least one of the preceding hypotheses be accepted. On this basis, hypothesis III was also rejected. In conclusion, although this work failed overall to demonstrate a significant effect of DAFOs on the rehabilitation of stroke patients, the anecdotal evidence obtained adds to knowledge in this field. The research identified some parameters of balance and gait, which might be influenced by the device in a beneficial manner. These parameters may be more useful to use in future investigations. The reasons for the discrepant outcomes of the quantitative and qualitative studies are unclear. However, it is suggested that there may be uncontrolled variables within either the patient group or in the DAFOs (or both) which mean that some DAFOs work better than others. It is proposed that further studies of the DAFO are warranted.

The central theme of this ethnographic study is captured in the word play in the title. It is, essentially, an analysis of the social work in social work. With a primary focus on the collegial discourse taking place between 'child care' social workers and managers in a social services department in the North West of England, I have undertaken an analysis of naturally occurring talk, interview data, formal policy and procedure, and written records of action taken (case files and minutes) and action to be taken (e.g. court reports, strategic planning documents). My analytic focus has been upon on the routines and linguistic practices through which `caseness' is accomplished. I argue that, although professional accounts are artfully produced against certain (situated) background expectancies, the 'materials' invoked in such accounts are not entirely local phenomena. That is to say, competent accounts are both locally accomplished and contingent upon available vocabularies. In a search for analytic adequacy, I have drawn particularly upon the temporal and rhetorical 'turns' in the human sciences. Using an unashamedly eclectic approach, I argue that 'imported' materials, such as bureaucratic time, remain malleable and, thus, may be invoked strategically and artfully by social workers in their (narrative) constructions of events and 'cases' and, indeed, themselves - allowing them to reference risk, deviance or normality, for example. However, the possibilities are far from infinite, and the liturgical nature of many encounters ensures that what is most remarkable about organizational life is not its instability, but its predictability.

My study is concerned not simply with the what and the how of hone care for the elderly but also with the I ask about how the domiciliary services operate: what home helps do for elderly people and how they feel about their caring role, and, what the circumstances of elderly people needing care are and how they feel about using help. But I also want to know why home help operates in this way: why home helps care in the way they do and why elderly people feel as they do about using that care? Such an approach cannot fail to take into consideration the wider ecological and structural context within which elderly people and home helps live and work. Part one of my thesis, composed of three chapters, therefore provides this backcloth. I use it to introduce the location of the study, to present a brief history and discussion of the development of domiciliary services for the elderly in Britain, and 10 describe the philosophy and policy shaping domiciliary provision within Salford Social Services Department. As I shall show, current Government economic policy is inextricably woven into the fabric of this backcloth. In Part Two, I detail the findings of my fieldwork, painting a picture of the lives of the frail and impaired elderly people using domiciliary care, and of the work of the home helps providing that care. As far as possible, I have used the interviewees' own words to explain perceptions of (in)dependence and need, of stiqma and taboo, of material and ideological motivations, and of emotional involvements and commitments. A number of writers have argued that dependency - a concept at the centre of inquiries into the care of the elderly - is a socially constructed relationship, both with respect to elderly users and female providers of care. In Part Three, I question whether and in what way the evidence supports or denies this claim. I ask what are the implications of my findings for social policy. I also justify the use of anthropological perspectives in policy-related research. Finally, I present an account of my experience as a researcher which can be approached from a number of different levels., At a'basic level, it represents an immediate account of doing fieldwork. It is also my account, as a post-graduate, of the experience of writing-up a thesis. I consider the effect of the passing of time on context and consciousness and hci this feeds into the analysis and presentation, of work. And I attempt to address concerns with the writer/reader/subject relationship which pose questions to do with communication.

Celebrations are pervasive. At a personal level they include birthdays, funerals, weddings, get-togethers, award ceremonies, and parties organised for any number of reasons. At a community level they include faith-based services, public holidays, commemorations and community festivals. These are just a selection. I argue that there is a need to better understand what role celebrations can play to improve health and wellbeing and not just for individuals but for communities. In this thesis I examine the experiences, context, processes and politics of celebrations and how they contribute to both personal and collective health and wellbeing. Of course, some celebrations make a more meaningful contribution than others. And it is the nature of that difference I seek to understand. The two leading research questions I address are: • How do celebrations contribute to personal and collective health and wellbeing? • What is ‘healthy’ celebration practice? There are three sections in this thesis. In the first I describe and discuss the Australian context of celebration activities. I also explore definitions of celebrations. I consider celebrations to be an active process made up of both play and ritual. Celebrations seek to focus people’s attention, and intention, in a positive way. The resulting celebratory act(s) are a cultural expression of what a particular individual or community values. There are a diversity of celebration forms and practices - open, spontaneous, planned and formal. Each celebration is influenced by, and influences, the context in which it occurs. I will be focusing on celebrations occurring within a community context. A community may be a family, an organization, local community, shared interest group or a whole of society grouping. In the second section of the thesis I analyse the relationship of celebrations to various dimensions of health and wellbeing. These dimensions include: social connectedness, identity, transitions and lifespan development, and community capacity. A major part of my fieldwork was undertaken in Victoria where I studied 20 community celebrations. The community celebrations I examined in varying degrees, did positively contribute to personal and collective wellbeing. They did so because they included positive and personally meaningful activities. They explored identity. Celebrations played a role in supporting transitions leading to ongoing healthy development. They provided opportunities for learning; not just knowledge but allowed values to be explored and skills and resources to be gained. They brought people together to interact and fostered a sense of belonging. Celebrations that were health enhancing valued diversity but also explored what unites people. My research confirmed that celebrations can foster our connections; to ourselves, others, the earth, time and the spiritual. They can build relationships between individuals, groups and organizations. They can be spaces that allow for personal and collective healing. But the degree to which these positive dimensions can be achieved depends on the nature or quality of the celebration practice. And it is the practice of planning and facilitating celebrations that is the focus of the third section of the thesis. Some celebration practices are health enhancing while others are not. Celebrations can be an opportunity to explore not just ourselves but our communities and how they oppress particular individuals and groups. Many contemporary celebrations do not feel authentic or resonate with people. They often remain at the surface and focus on passive forms of entertainment and the consumption of goods. Deeper engagement can be facilitated through more participatory and creative activities such as dance, playing music, story -making and -telling and ritual; particularly when engaged in with conscious intention. Celebrations at the individual level can be a positive, affirming experience that is personally meaningful and enables people to move towards their potential. At a collective level they build relationships between the individual, groups and places. They highlight the interconnectedness between all things. And as such they are an integral part of community life. I conclude by presenting an analytical framework to help understand the nature of celebration practice that is less or more likely to facilitate health and wellbeing. I try to adopt the viewpoint of a practitioner interested in the health and wellbeing of individuals and communities. I anticipate this knowledge will stimulate discussion particularly within the health and community sector about how celebration practice can be integrated into the work of health professionals and community workers.

Doctor of Philosophy (PhD) / The alarming rates of ill-health and social disadvantage amongst Australian Indigenous peoples has continued despite improved understanding of the determinants behind these conditions. There appears to be an urgent need to review and re-orientate health and social programs, from a deficit-focused to a strengths-based model, whereby a community’s capacity and resilience is enhanced utilising, and building on, existing strengths and resources. The current study set out to investigate the meaning and role of resilience in the wellbeing of Indigenous Australians. The aim of the study was to examine resilience within an Indigenous context, its potential role in strengthening the Indigenous response to adversity, and the prospective ways in which this may be used in initiatives aimed at boosting health and wellbeing in Indigenous communities. The study involved qualitative in-depth interviews and focus groups within the Indigenous Yaegl community of north-eastern New South Wales. This was achieved through extensive consultation with the community, and a strong commitment to upholding cultural sensitivities and ethical considerations. The data was analysed using a phenomenological framework, involving objective and in-depth thematic analysis, with specific focus on the relationships within the data and their associations with the research questions posed. The study indicates the resilience of the Yaegl community, involving individual, family and community level resilience, involves interdependent protective factors and support structures. The experience of hardship itself, and the ability to employ positive adaptational/coping skills and recruit a variety of protective resources are key to the development of resilience throughout the life continuum. The study demonstrates the importance of these mechanisms not only at the individual level, but also in the resilience of family units and the community. This appears particularly important within the Indigenous context where these levels of functioning are interdependently connected. The study has implications for health and social practitioners looking to broaden their understanding of the Indigenous experience, to one that acknowledges the many existing strengths and protective factors present in Indigenous communities. Practitioners and program developers would benefit from utilising this holistic model of resilience, in which individual, family and community based protective factors play important roles in the prevention of risk and the development of resilience. Programs incorporating this understanding are expected to be more effective in both service delivery and outcomes, because all levels of functioning would be viewed and addressed as interdependent elements in the development of resilience and response to adversity.