'Every pregnant woman needs a midwife'--the experiences of HIV affected women in maternity care

TITLE: 'Every pregnant woman needs a midwife'-the experiences of HIV affected women in Northern Ireland.

OBJECTIVE: to explore HIV positive women's experiences of pregnancy and maternity care, with a focus on their interactions with midwives.

DESIGN: a prospective qualitative study.

SETTING: regional HIV unit in Northern Ireland.

PARTICIPANTS: 22 interviews were conducted with 10 women at different stages of their reproductive trajectories.

FINDINGS: the pervasive presence of HIV related stigma threatened the women's experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care.

KEY CONCLUSIONS: pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman's sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing 'balanced care' could meet all of the woman and child's medical needs, whilst also emphasising the normalcy of pregnancy.

Boys' underachievement, educational aspirations and constructions of locality

Over recent years the moral panic that has surrounded 'boys' underachievement' has tended to encourage crude and essentialist comparisons between all boys and all girls and to eclipse the continuing and more profound effects on educational achievement exerted by social class and 'race'/ethnicity. While there are differences in educational achievement between working class boys and girls, these differences are relatively minor when comparing the overall achievement levels of working class children with those from higher, professional social class backgrounds. This paper argues that a need exists therefore for researchers to fully contextualise the gender differences that exist in educational achievement within the over-riding contexts provided by social class and 'race'/ethnicity. The paper provides an example of how this can be done through a case study of 11-year-old children from a Catholic, working class area in Belfast. The paper shows how the children's general educational aspirations are significantly mediated by their experiences of the local area in which they live. However, the way in which the children come to experience and construct a sense of locality differs between the boys and girls and this, it is argued, helps to explain the more positive educational aspirations held by some of the girls compared to the boys. The paper concludes by considering the relevance of locality for understanding its effects on educational aspirations among other working class and/or minority ethnic communities.

Transcending Boundaries of Creativity: Active learning in the Design Studio

This essay investigates the changing dynamics of interaction and paradigm of communication in the design studio. It analyses the process of practical implementation of interactive tools in architectural education which placed the
diversity of students’ cultural experiences, contextual awareness and individual interests as crucial resource for design innovation and inquiry. Building on Brian Lawson’s thesis on creativity in design thinking, this research project undertook
comprehensive investigation of students’ satisfaction of their roles in the studio and the room for liberal thought they are given to elaborate on genuine approach to architectural matters. The cyclical development of interactive learning strategy is explored through two different settings: first, it analyses architectural students’ position as passive/active in the studio, considering their relationships with tutors’ ideals; second, it reports on empirical strategy of students-led workshops at British schools of architecture, during which students have taken the lead of their creative design agenda. The practical implementation of interactive learning tools proved influential in helping students to personalize their design direction and to build a sense of confidence and independence.

Authenticity, Identity and Sustainability in Post-war Iraq: Reshaping the Urban Form of Erbil City

Issues of authenticity and identity are particularly significant in cities where social and cultural change is shaping active transformation of its urban fabric and structure in the post-war condition. In search of sustainable future, Iraqi cities are stretched between the two ends of the spectrum, authentic quarters with its traditional fabric and modern districts with their global sense of living. This paper interrogates the reciprocal influences, distinct qualities and sustainable performance of both authentic and modern quarters of Erbil, the
capital of the Iraqi province of Kurdistan, as factors in shaping sustainable urban forms for Iraqi cities. In doing so, the paper, firstly, seeks to highlight the urban identity as an effective factor in relation to sustainable urban form. Secondly, the city of Erbil in Iraq has been chosen as a field study, due to its regional, social, political and historical role in the region. Thirdly, the study emphasises the dynamic activities and performance of residential projects according to rational sustainable criteria. The research concludes that urban identity and the sense of place in traditional and historical places should inform design strategies in order to achieve a more sustainable urban context.

Breaking the Intimate Screen: Pre-Recording, Special Effects and the Aesthetics of Early British Television

The technological constraints of early British television encouraged drama productions which emphasised the immediate, the enclosed and the close-up, an approach which Jason Jacobs described in the title of his seminal study as 'the intimate screen'. While Jacobs' book showed that this conception of early British television drama was only part of the reality, he did not focus on the role that special effects played in expanding the scope of the early television screen. This article will focus upon this role, showing that special effects were not only of use in expanding the temporal and spatial scope of television, but were also considered to be of interest to the audience as a way of exploring the new medium, receiving coverage in the popular press. These effects included pre-recorded film inserts, pre-recorded narration, multiple sets, model work and animation, combined with the live studio performances. Drawing upon archival research into television production files and scripts as well as audience responses and periodical coverage of television at the time of broadcast, this article will focus on telefantasy. This genre offered particular opportunities for utilising effects in ways that seemed appropriate for the experimentation with the form of television and for the drama narratives. This period also saw a variety of shifts within television as the BBC sought to determine a specific identity and understand the possibilities for the new medium.
This research also incorporates the BBC's own research and internal dialogue concerning audiences and how their tastes should best be met, at a time when the television audience was not only growing in terms of number but was also expanding geographically and socially beyond the moneyed Londoners who could afford the first television sets and were within range of the Alexandra Palace transmissions. The primary case study for this article will be the 1949 production of H.G.Wells’ The Time Machine, which incorporated pre-recorded audio and film inserts, which expanded the narrative out of the live studio performance both temporally and spatially, with the effects work receiving coverage in the popular magazine Illustrated. Other productions considered will be the 1938 and 1948 productions of RUR, the 1948 production of Blithe Spirit, and the 1950 adaptation of The Strange Case of Dr Jekyll and Mr Hyde. Despite the focus on telefantasy, this article will also include examples from other genres, both dramatic and factual, showing how the BBC's response to the changing television audience was to restrict drama to a more 'realistic' aesthetic and to move experimentation with televisual form to non-drama productions such as variety performances.

England, Neo-Latin, and the Continental Journey: Linguistic and Textual Itineraries

This chapter examines the ramifications of continental travel and associated epistolary communication for English poets of the period. It argues that recourse to neo-Latin, the universal language of diplomacy, served not only to establish a sense of shared space—linguistic, cultural, generic—between England and the continent, but also to signal self-conscious differences (climatic, geographical, historical, political) between England and her continental peers. Through an investigation of a range of ‘performances’ on stages that were ‘academic’, poetic, autobiographical, and epistolographic, it assesses the central role of neo-Latin as a language that underwent a series of textual itineraries. These ‘itineraries’ manifest themselves in a number of ways. Neo-Latin as a shared linguistic medium can facilitate, and quite uniquely so, intertextual engagement with the classics, but now ancient Rome, its language, its mythology, its hierarchy of genres, are viewed through a seventeenth-century lens and appropriated by poets in both England and Italy to describe contemporary events, whether personal, or political. Close examination of the neo-Latin poetry of Milton and Marvell reveals, it is argued, a self-fashioning coloured by such textual itineraries and interchanges. The absorption and replication of continental literary and linguistic methodologies (the academic debate; the etymological play of Marinism; the hybridity of neo-Latin and Italian voices) reveal in short a linguistic and textual reciprocity that gave birth to something very new.

The incentives of a resource owner: Evidence from a private oyster fishery

European flat oyster Ostrea edulis fisheries were once abundant around the UK coastline. The sole remaining productive O. edulis fishery in Scotland is in Loch Ryan. This fishery has been privately owned and managed by a single family since 1701. Economic theory predicts that ownership, whether public or private, is a necessary condition for rational fishery management. In this paper, a series of four leases and a licence are examined, covering an 85-year period over the 20th and 21st century, to examine whether the management of the Loch Ryan fishery conforms to the expected norms of rational management. The leases show that, over this period, the owners appear more willing to expend resources on regulating tenant behaviour, supporting the conclusion that successive generations of owners developed an evolving sense of what "rational management" might require. The results of this study could inform the management of other fisheries - both public and private - by emphasising the importance of learning from experience.

Late effects of cancer and cancer treatment-the perspective of the patient

PURPOSE: Understanding the experience of late effects from the perspective of cancer survivors is essential to inform patient-centred care. This study investigated the nature and onset of late effects experienced by survivors and the manner in which late effects have affected their lives.

METHODS: Sixteen purposively selected cancer survivors participated in a qualitative interview study. The data were analysed inductively using a narrative schema in order to derive the main themes that characterised patients' accounts of late effects.

RESULTS: Individual survivors tended to experience more than one late effect spanning a range of physical and psychological effects. Late effects impacted on relationships, working life, finances and the ability to undertake daily activities. Survivors reported experiencing psychological late effects from around the end of treatment whereas the onset of physical effects occurred later during the post-treatment period. Late effects were managed using formal health services, informal social support and use of 'wellbeing strategies'. Survivors engaged in a process of searching for reasons for experiencing late effects and struggled to make sense of their situation. In particular, a process of 'peer-patient comparison' was used by survivors to help them make sense of, or cope with, their late effects. There appeared to be an association between personal disposition and adaptation and adjustment to the impact of late effects.

CONCLUSIONS: Cancer survivors identified potential components for supported self-management or intervention programmes, as well as important considerations in terms of peer comparisons, personal disposition and making sense of experienced late effects.

'Talk to me': a mixed methods study on preferred physician behaviours during end-of-life communication from the patient perspective

Background
Despite the recognized importance of end-of-life (EOL) communication between patients and physicians, the extent and quality of such communication is lacking.

Objective
We sought to understand patient perspectives on physician behaviours during EOL communication.

Design
In this mixed methods study, we conducted quantitative and qualitative strands and then merged data sets during a mixed methods analysis phase. In the quantitative strand, we used the quality of communication tool (QOC) to measure physician behaviours that predict global rating of satisfaction in EOL communication skills, while in the qualitative strand we conducted semi-structured interviews. During the mixed methods analysis, we compared and contrasted qualitative and quantitative data.

Setting and Participants
Seriously ill inpatients at three tertiary care hospitals in Canada.

Results
We found convergence between qualitative and quantitative strands: patients desire candid information from their physician and a sense of familiarity. The quantitative results (n = 132) suggest a paucity of certain EOL communication behaviours in this seriously ill population with a limited prognosis. The qualitative findings (n = 16) suggest that at times, physicians did not engage in EOL communication despite patient readiness, while sometimes this may represent an appropriate deferral after assessment of a patient's lack of readiness.

Conclusions
Avoidance of certain EOL topics may not always be a failure if it is a result of an assessment of lack of patient readiness. This has implications for future tool development: a measure could be built in to assess whether physician behaviours align with patient readiness.

Mental illness or mental distress; stigma and concealment in University students - a discussion paper

This discussion paper addresses the issue of mental distress, sometimes mis- perceived or misinterpreted as mental illness. The
focus is on positive psychology. Reflecting in part on a UK-based study with younger University students studying to health
related degrees, nursing, midwifery and medicine (N = 12), many of the students were apparently suffering dis-stress with
disordered eating at least in part being used as a coping mechanism. However notwithstanding that they were at the end of
their first year studies in health, a significant number of the students interpreted their approach to eating as a mental illness.
Consequently, many within the study felt stigmatised and were reluctant to acknowledge certainly to the University health care
authorities that there was an issue; perceiving both academic and career/professional consequences of mental health labelling. The
paper approaches the issue of mental health from a health promoting perspective, reflecting against the theory of salutogenesis
and its focus within the three dimensions of comprehensibility, manageability and meaningfulness as an approach to building
resilience and managing stressors to better facilitate a sense of coherence. Complex manifestations of distress and poor coping
mechanisms can in some cases be misinterpreted or miss perceived as mental illness. Promoting mental health and reducing the
stigma of mental illness or the misperception of mental distress as mental illness, would need to be addressed in order to more
effectively outreach certainly to younger University students who might be at risk. The focus should be on how better to promote
their sense of coherence.

Care Leavers’ Experiences of Transition and Turning Points: Findings from a Biographical Narrative Study

This paper reports on the findings of a PhD research project that set out to explore how young people leaving out of home care experienced and made sense of their transition to adulthood. Using the Biographical Narrative Interpretative Method, in-depth accounts were collected and analysed for eight care leavers. The data suggest that in addition to care leavers living their lives as a series of biographical events, their ‘care career’, they also experience changes in the way they make sense of their lives which form a ‘subjective pathway’. Influenced by the literature on resilience, the research had anticipated that ‘turning point’ events would play a significant role in the young people’s subjective pathways. But the findings show a more gradual, phased shifting of subjectivity. It is suggested that legislation, policy, services and care practices need to facilitate this more drawn out ‘subjective pathway’. Attachment, resilience and humanistic social psychology are proposed as useful theoretical underpinnings for that work

Participatory Sonic Arts: towards a socially engaged art of sound in the everyday (The Som da Maré Project)

Participatory and socially engaged art practices have, for a couple of decades, emerged a myriad of aesthetic and methodological strategies across different media. These are artistic practices that have a primary interest in participation, affecting social dynamics, dialogue and at times political activism. Nato Thompson in “Living Form: Socially Engaged Art from 1991-2011” surveys these
practices, which range from theatre to urban planning, visual art to healthcare. Linked to notions such as relational aesthetics (Bourriaud, 1998), community art and public art, socially engaged art often focuses on the development of a sense of ownership by the part of participants. If an artist is working truly collaboratively with participants and addressing the reality of a particular community, the long-term effect of a project lies in the process of engagement as well as in the artwork itself. Projects by New York based artist Pablo Helguera, for example, use different media to engage with social inequalities through participative action while rejecting the notion of art for art sake.

“Socially engaged art functions by attaching itself to subjects and problems that normally belong to other disciplines, moving them temporarily into a space of ambiguity. It is this temporary snatching away of subjects into the realm of art-making that brings new insights to a particular problem or condition and in turn makes it visible to other disciplines.” (Helguera, 2011)

Socially engaged practices develop the notion of artwork about or by a community, to work of a community. In this chapter we address how socially engaged, participatory approaches can form a context for the sonic arts, arguably less explored than practices such as theatre and performance art. The use of sound is clearly present in a wide range of socially engaged work (e.g. Helguera’s “Aelia Media” enabling a nomadic radio station in Bologna or Maria Andueza “Immigrant Sounds – Res(on)Art (Stockholm)” exploring ways of sonically resonating a city, or Sue MacCauley’s “The Housing Project” addressing ways of representing the views of urban dwellers on public scape through sound art. It is nevertheless rare to encounter projects which take our experience of sound in the everyday as a trigger for community social engagement in a participatory context.
We address concepts and methodologies behind the project Som da Maré, a participatory sonic arts project in the favelas of Maré, Rio de Janeiro.

Speaking Out Online:The Benefits and Risks of Speaking About Sexual Violence for Young People

Speaking out about sexual violence has been a fundamental part of feminist politics since the 1970s. The practice of narrating experiences of violence, either publicly or to friends and family aims to combat the culture of silence and stigmatisation that surrounds sexual violence while also helping individuals to gain a sense of empowerment and connect with other survivors. However, speaking out also contains inherent risks, especially for young people. Survivors may meet with stigmatising or disbelieving responses, and they may lose control over who knows their story and the way in which it is told and retold.
These risks and benefits are altered, and potentially exacerbated, in an online environment. While social media may increase survivors’ ability to contact and connect with others with similar experiences it also makes it harder to control when and how their story is shared. The disjuncture between online and offline environments may also increase feelings of stigmatisation and isolation.
There is a need to explore the specific risks and benefits of speaking out online given both young people’s extensive use of social media for social interactions and the increasing tendency for support and educational services targeted at young people to make use of social media and online environments. This paper draws on literature and some preliminary research to consider both risks and benefits of speaking out online and to open a conversation about the creation of supportive spaces and mechanisms for young people to speak about sexual violence in online environments.

Commemoration in the United Kingdom: A multitude of memories

In the United Kingdom (UK) the centenary commemoration of the First World War has been driven by a combination of central government direction (and funding) with a multitude of local and community initiatives, with a particular focus on 4 August 2014; 1 July 2016 (the beginning of the Battle of the Somme) and 11 November 2018. ‘National’ ceremonies on these dates have been and will be supplemented with projects commemorating micro-stories and government-funded opportunities for schoolchildren to visit Great War battlefields, the latter clearly aimed to reinforce a contemporary sense of civic and national obligation and service. This article explores the problematic nature of this approach, together with the issues raised by the multi-national nature of the UK state itself.