‘I don’t think I’d be frightened if the statins went’: a phenomenological qualitative study exploring medicines use in palliative care patients, carers and healthcare professionals

Background

Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.

How well do elderly people complete individualised quality of life measures: an exploratory study.

This research note describes and discusses a study which investigated the feasibility of using an individualised approach to measure the quality of life (QoL) of a sample of older people who were in receipt of an early hospital discharge service. Most participants (86%) were able to identify areas of their lives which were important to them, rate their level of functioning on each of these areas and rank their life areas in order of importance. However, 39% were unable to quantify the relative importance of each area of life. Indeed, the majority (57%) of participants who were over 75 years old could not complete this “weighting” or evaluative stage. The results suggest that the phenomenological approach to measuring QoL may be employed successfully with older people but that the “weighting” system used by existing individualised QoL measures needs to be refined, especially when assessing people over 75.

Teaching and cognitive outcomes in A-levels and Advanced GNVQ's: Case studies from Science and Business Studies Classrooms

The purpose of the paper is to demonstrate how a research diary methodology, designed to analyse A-level and GNVQ classrooms, can be a powerful tool for examining pedagogy and quality of learning at the level of case study. Two subject areas, science and business studies, are presented as cases. Twelve teachers and thirty-four students were studied over a four-week period in May 1997 and contrasts were drawn between lessons from three A-level physics teachers/three Advanced GNVQ science teachers and two A-level business/economics teachers/four Advanced GNVQ business teachers. Lessons were analysed within a cognitive framework which distinguishes between conceptual and procedural learning and emphasizes the importance of metacognition and epistemological beliefs. Two dimensions of lessons were identified: pedagogical activities (e.g. teacher-led explanation, teacher-led guidance on a task, question/answer sessions, group discussions, working with IT) and cognitive outcomes (e.g. structuring and memorizing facts, understanding concepts and arguments, critical thinking, problem-solving, learning core skills, identifying values). Immediately after each lesson, teachers and students (three per class) completed structured research diaries with respect to the above dimensions. Data from the diaries reveal general and unique features of the lessons. Time-ofyear effects were evident (examinations pending in May), particularly in A-level classrooms. Students in business studies classes reported a wider range of learning activities and greater variety in cognitive outcomes than did students in science classes. Science students self-rating of their ability to manage and direct their own learning was generally low. The phenomenological aspects of the classrooms were consistently linked to teachers' lesson plans and what their teaching objectives were for those particular students at that particular time of the year.

Restricted rotation dynamics and far-infrared spectra of liquid water governed by elastic interactions

A semi-phenomenological model describing wideband dielectric and far-infrared spectra of liquid water was proposed recently by the same authors [J. Mol. Struct. 606 (2002) 9], where a small dipole-moment component changing harmonically with time determines a weak absorption band (termed here the R-band) centred at the wavenumber v similar to 200 cm(-1). In the present work, a rough molecular theory of the R-band based on the concept of elastic interactions is given. Stretching and bending of hydrogen bonds cause restricted rotation (RR) of a polar water molecule in terms of a dimer comprising the H- bonded molecules. Analytical expression for the RR frequency nu(str) is derived as a function of the RR amplitude, geometrical parameters and force constants. The density g(nu(str)) of frequency distribution is shown to be centred in the R-band. The spectrum of the dipolar auto-correlation function calculated for this structural-dynamical model is found. A composite model comprising two intermolecular potentials is proposed, which yields for water a good description of the experimental wideband (from 0 to 1000 cm(- 1)) spectra of complex permittivity and of absorption coefficient. The presented interpretation of these spectra is based on a concept that water presents a two-component solution, with components differing by the types of molecular rotation. (C) 2003 Elsevier B.V. All rights reserved.

Simplified theory of wideband spectra of liquid H2O and D2O (from 0 to 1000 cm(-1)) due to reorienting polar and vibrating H-bonded water molecules

A semi-phenomenological molecular model is presented, which is capable of describing with the use of analytical formulae, the wideband dielectric(1) and far-infrared spectra of ordinary and heavy water. In the model the vector of a dipole moment is presented as a sum of two components. The absolute value of the first one is constant; the second one changes harmonically with time. The key aspect of this work is consideration of FIR spectra due to the second component. In the context of the modified hybrid model presented in the work, reorientation of the dipoles in the rectangular potential well is considered, as a result of which the librational (near 700 cm (-1)) and translational (near 200 cm (-1)) absorption bands and the microwave Debye relaxation spectrum arise. It is shown that the time-dependent part of a dipole moment contributes most to the translational band, the relevant mechanism is taken to be stretching vibration of the H-bonded molecules. Previous linear-response molecular models were unsuccessful in describing this band (in heavy water) in terms of the complex dielectric permittivity. The spatial and time scales characteristic of water are estimated. (C) 2002 Elsevier Science B.V. All rights reserved.

Analytical calculation of far infrared spectra of ice in terms of a molecular model

Wideband far infrared (FIR) spectra of complex permittivity e(p) of ice are calculated in terms of a simple analytical theory based on the method of dipolar autocorrelation functions. The molecular model represents a revision of the model recently presented for liquid water in Adv. Chem. Phys. 127 (2003) 65. A composite two-fractional model is proposed. The model is characterised by three phenomenological potential wells corresponding to the three FIR bands observed in ice. The first fraction comprises dipoles reorienting in a rather narrow and deep hat-like well; these dipoles generate the librational band centred at the frequency approximate to 880 cm(-1). The second fraction comprises elastically interacting particles; they generate two nearby bands placed around frequency 200 cm(-1). For description of one of these bands the harmonic oscillator (HO) model is used, in which translational oscillations of two charged molecules along the H-bond are considered. The other band is produced by the H-bond stretch, which governs hindered rotation of a rigid dipole. Such a motion and its dielectric response are described in terms of a new cut parabolic (CP) model applicable for any vibration amplitude. The composite hat-HO-CP model results in a smooth epsilon(nu) ice spectrum, which does not resemble the noise-like spectra of ice met in the known literature. The proposed theory satisfactorily agrees with the experimental ice spectrum measured at - 7 degrees C. The calculated longitudinal optic-transverse optic (LO-TO) splitting occurring at approximate to 250 cm(-1) qualitatively agrees with the measured data. (c) 2004 Elsevier B.V. All rights reserved.

Specific and unspecific interactions in polar fluids in view of wideband dielectric far-infrared spectra

A simple molecular analytical theory of dielectric relaxation in strongly polar fluids is considered in terms of a semi- phenomenological approach. Theoretical spectra epsilon(v), a(v) of complex permittivity and absorption coefficient are fully determined by a form of intermolecular potential well, in which a dipole reorients. In a recent publication by VI. Gaiduk, O.F. Nielsen, and T.S. Perova [J. Molliq 95 (1002) 1-25] the wideband spectra of liquid H2O and D2O were described in terms of a composite model comprising the rectangular and the cosine squared potential wells. Much better results are achieved in this work, where the rectangular well is replaced by a well with a rounded bottom termed the hat-curved well. The spectrum of the auto-correlation function (ACF) is calculated for such a potential. The proposed theory of a composite model, comprising hat-curved and parabolic wells, is applied for liquid water. This model is capable for describing the Debye relaxation region, the second relaxation region in the submillimeter wavelength range, and the far infra-red (FIR) e(v), a(v) spectra, where an intense librational band and an additional weak band are placed, respectively, near 700 cm(-1) and 200 cm(-1). The latter band reflects the features of so-called specific (viz. directly related to H-bonds) interactions and the former band reflects the features of unspecific interactions. The physical mechanisms connected with these types of interactions are discussed in terms of two relevant types of water structure (types of molecular rotation). The proposed theory is also applied to a non-associated liquid in terms of one hat-curved potential well. (C) 2004 Elsevier B.V. All rights reserved.

Boundary conditions in the simplest model of linear and second harmonic magneto-optical effects

This paper is concerned with linear and nonlinear magneto- optical effects in multilayered magnetic systems when treated by the simplest phenomenological model that allows their response to be represented in terms of electric polarization, The problem is addressed by formulating a set of boundary conditions at infinitely thin interfaces, taking into account the existence of surface polarizations. Essential details are given that describe how the formalism of distributions (generalized functions) allows these conditions to be derived directly from the differential form of Maxwell's equations. Using the same formalism we show the origin of alternative boundary conditions that exist in the literature. The boundary value problem for the wave equation is formulated, with an emphasis on the analysis of second harmonic magneto-optical effects in ferromagnetically ordered multilayers. An associated problem of conventions in setting up relationships between the nonlinear surface polarization and the fundamental electric field at the interfaces separating anisotropic layers through surface susceptibility tensors is discussed. A problem of self- consistency of the model is highlighted, relating to the existence of resealing procedures connecting the different conventions. The linear approximation with respect to magnetization is pursued, allowing rotational anisotropy of magneto-optical effects to be easily analyzed owing to the invariance of the corresponding polar and axial tensors under ordinary point groups. Required representations of the tensors are given for the groups infinitym, 4mm, mm2, and 3m, With regard to centrosymmetric multilayers, nonlinear volume polarization is also considered. A concise expression is given for its magnetic part, governed by an axial fifth-rank susceptibility tensor being invariant under the Curie group infinityinfinitym.

Experiencing Kane: an affective analysis of Sarah Kane's 'experiential' theatre in performance

The article argues for a phenomenological approach to Kane's work in performance. It notes the rise in productions of Kane's work from 2004, and focuses on productions of Crave by 11th Hour Theatre in Melbourne and Acquiesce Speck in Sydney.

The effect of flexoelectricity on the dielectric properties of inhomogeneously strained ferroelectric thin films

Recent experimental measurements of large flexoelectric coefficients in ferroelectric ceramics suggest that strain gradients can affect the polarization and permittivity behaviour of inhomogeneously strained ferroelectrics. Here we present a phenomenological model of the effect of flexoelectricity on the dielectric constant, polarization, Curie temperature (T-C), temperature of maximum dielectric constant (T-m) and temperature of the onset of reversible polarization (T-ferro) for ferroelectric thin films subject to substrate-induced epitaxial strains that are allowed to relax with thickness, and the qualitative and quantitative predictions of the model are compared with experimental results for (Ba0.5Sr0.5)TiO3 thin films on SrRuO3 electrodes. It is shown that flexoelectricity can play an important role in decreasing the maximum dielectric constant of ferroelectric thin films under inhomogeneous in-plane strain, regardless of the sign of the strain gradient.

The experience of cancer cachexia: A qualitative study of advanced cancer patients and their family members

Background
Cachexia in advanced malignancy is a debilitating syndrome which contributes to approximately two million deaths worldwide annually. In spite of advances in understanding the biomedical aspects of cancer cachexia, little attention has been paid to exploring its holistic impact on patients and those who care for them.

Objective
The aim of this paper is to describe the lived experience of cachexia from the perspective of patients with cancer and their family members.

Design
An interpretative phenomenological approach was employed.

Setting and participants
A purposive sampling strategy recruited 15 patients and 12 family members from the Regional Cancer Centre in Northern Ireland.

Method
Each participant was interviewed during 2004/2005 using an unstructured interview. All interviews were recorded and transcribed verbatim. Analysis combined a two stage approach using thematic and interpretative phenomenological analysis.

Results
Analysis generated six superordinate themes that reflected the complex dynamics of the cachexia experience. Themes were: physiological changes in appetite; visuality of cachexia; weight loss interpreted as a bad sign; response from health care professionals; conflict over food; and coping responses.

Conclusions
Findings confirmed that cancer cachexia has far reaching implications for patients and their families, extending beyond physical problems into psychological, social and emotional issues. This insight is a critical first step in the development of more responsive care for these clients.

Agitating for a design and regeneration agenda in a postconflict city: the case of Belfast

Introduction

Belfast has been a focus of academic attention for the last forty years with most interest centred on various aspects of ‘the Troubles’. Where there has been interest in the built environment, it has largely been about how the ‘security situation’ impacted directly on architecture and on the design and layout of social housing. This paper seeks to go beyond this to explore how the political- administrative culture of ‘the Troubles’ interacted with ‘normal’ market forces to shape the central area of the city, and to consider the responses of a recently formed activist group, known as the Forum for Alternative Belfast (hereafter referred to as the Forum). The paper is written by three of the directors of the Forum.1 Moreover, the empirical research presented here was undertaken by the Forum as part of a campaign to address issues relating to the design, layout and quality of Belfast’s built environment. In the longstanding tradition of participant observation working within an action-research paradigm, the participants have attempted to offer an account that is evidentially and purposefully selfcritical and reflective. It is of course recognised that while this approach offers many positive attributes, such as phenomenological access through immersion in the project, it also has the potential to bring compromise on research detachment and objectivity.2 To address the latter, the authors have attempted
to avoid polemical argument, and to support claims with primary or secondary research evidence. The authors also acknowledge that action-research has a chequered history; however, they would argue
that their approach is faithful to a concept that sees ‘research’ defined as understanding and ‘action’ defined as seeking change. The Forum’s very purpose is to seek change, but to do this requires evidence, collaboration and demonstration. And in this sense, it is a learning process for all participants, including the research activists, government officials, community organisations and students. The authors also recognise the complexity of factors that affect urban management and change, particularly in a city such as Belfast, which has had to cope with political violence for over thirty years. And they appreciate that in the context of conflict, governance is skewed to cope with political realities. Hamdi reminds us, however, that in practice there is an ‘important dialectic between top-down planning, with its formal and designed laws and structures, and bottom-up selforganizing collectivism—those “quantum and emergent systems” which Jane Jacobs argued long ago give cities their life and order.’3

Passive Intermodulation Generation on Printed Lines: Near-Field Probing and Observations

The phenomenological mechanisms of passive intermodulation (PIM) in printed lines have been explored by mapping intermodulation products generated by the two-tone traveling waves in microstrip lines. Near-field probing based upon a commercial PIM analyzer has been employed for identification of the PIM sources in printed lines. The results of extensive near-field probing provide the direct experimental evidences of cumulative growth of the intermodulation products in the matched uniform microstrip lines and reveal the fundamental role of the nonlinear scattering by the lumped nonlinear inclusions in the intermodulation production. The distributed nature of the PIM generation in microstrip lines has been conclusively demonstrated and comprehensively described in terms of the four-wave mixing process that proved to be fully consistent with the results of experimental observations of third-order PIM products on the matched and mismatched microstrip lines. © 2006 IEEE.

Viscoelastic Material Models of Polypropylene for Thermoforming Applications

Polypropylene (PP), a semi-crystalline material, is typically solid phase thermoformed at temperatures associated with crystalline melting, generally in the 150° to 160°Celsius range. In this very narrow thermoforming window the mechanical properties of the material rapidly decline with increasing temperature and these large changes in properties make Polypropylene one of the more difficult materials to process by thermoforming. Measurement of the deformation behaviour of a material under processing conditions is particularly important for accurate numerical modelling of thermoforming processes. This paper presents the findings of a study into the physical behaviour of industrial thermoforming grades of Polypropylene. Practical tests were performed using custom built materials testing machines and thermoforming equipment at Queen′s University Belfast. Numerical simulations of these processes were constructed to replicate thermoforming conditions using industry standard Finite Element Analysis software, namely ABAQUS and custom built user material model subroutines. Several variant constitutive models were used to represent the behaviour of the Polypropylene materials during processing. This included a range of phenomenological, rheological and blended constitutive models. The paper discusses approaches to modelling industrial plug-assisted thermoforming operations using Finite Element Analysis techniques and the range of material models constructed and investigated. It directly compares practical results to numerical predictions. The paper culminates discussing the learning points from using Finite Element Methods to simulate the plug-assisted thermoforming of Polypropylene, which presents complex contact, thermal, friction and material modelling challenges. The paper makes recommendations as to the relative importance of these inputs in general terms with regard to correlating to experimentally gathered data. The paper also presents recommendations as to the approaches to be taken to secure simulation predictions of improved accuracy.