William Hope Hodgson's borderlands: monstrosity, other worlds, and the future at the fin de siècle.

William Hope Hodgson has generally been understood as the author of several atmospheric sea-horror stories and two powerful but flawed horror science fiction novels. There has been no substantial study analysing the historical and cultural context of his fiction or its place in the Gothic, horror, and science fiction literary traditions. Through analysing the theme of borderlands, this thesis contextualises Hodgson’s novels and short stories within these traditions and within late Victorian cultural discourse. Liminal other world realms, boundaries of corporeal monstrosity, and the imagined future of the world form key elements of Hodgson’s fiction, reflecting the currents of anxiety and optimism characterising fin-de-siècle British society. Hodgson’s early career as a sailor and his interest in body-building and physical culture colour his fiction. Fin-de-siècle discourses of evolution, entropy, spiritualism, psychical research, and the occult also influence his ideas. In The House on the Borderland (1908) and The Night Land (1912), the known world brushes against other forms of reality, exposing humanity to incomprehensible horrors. In The Ghost Pirates (1909), the sea forms a liminal region on the borderland of materiality and immateriality in which other world encounters can take place. In The Night Land and The Boats of the ‘Glen Carrig’ (1907), evolution gives rise to strange monstrous forms existing on the borderlines of species and identity. In Hodgson’s science fiction—The House on the Borderland and The Night Land—the future of the earth forms a temporal borderland of human existence shaped by fin-de-siècle fears of entropy and the heat-death of the sun. Alongside the work of other writers such as H. G. Wells and Arthur Machen, Hodgson’s four novels respond to the borderland discourses of the fin de siècle, better enabling us to understand the Gothic literature of the period as well as Hodgson’s position as a writer who offers a unique imaginative perspective on his contemporary culture.

Construct and content validity of the Greek version of the birth satisfaction scale (G-BSS).

Background: ‘Birth Satisfaction’ is a term that encompasses a woman’s evaluation of her birth experience. The term includes factors such as her appraisal of the quality of care she received, a personal assessment of how she coped, and her reconstructions of what happened on that particular day. Her accounts may be accurate or skewed, yet correspond with her reality of how events unfolded. Objective: To evaluate properties of an instrument designed to measure birth satisfaction in a Greek population of postnatal women. Study design: We assessed factor structure, internal consistency, divergent validity and known-groups discriminant validity of the 30-item Greek Birth Satisfaction Scale – Long Form (30-item G-BSS-LF) and its revised version the 10-item Greek-BSS-Revised (10-item-G-BSS-R), using survey data collected in Athens. Participants: A convenience sample of healthy Greek postnatal women (n = 162) aged 22–46 years who had delivered between 34 and 42 weeks’ gestation. Results: The 30-item-G-BSS-LF performed poorly in terms of factor structure. The short-form 10-item-G-BSS-R performed well in terms of measurement replication of the English equivalent version as a multidimensional instrument. The short-form 10-item-G-BSS-R comprises three subscales which measure distinct but correlated domains of: (1) quality of care provision (4 items), (2) women’s personal attributes (2 items), and (3) stress experienced during labour (4 items). Key conclusions: The 10-item-G-BSS-R is a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in Greek postnatal women.

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time