“Considering there’s supposedly nothing wrong with me, it’s not a life”: Women’s Narratives of Distress, Visiting Herbalists, and Being Well in the 21st Century

Distress can have a profoundly negative impact on the well-being of women (who are the main receivers of treatment for distress). Distress also poses a huge financial problem for the United Kingdom, the cost of which is predicted to reach over £26bn by 2026. A growing body of research has shown that various medicinal plants have potential to treat different aspects of distress. However, there is little research investigating the patient experience of western herbal practice (WHP), and none investigating women’s experiences of WHP for distress. In response, this longitudinal study utilised interviews with twenty-six women who were visiting herbalists for distress across the south-east of The United Kingdom to elicit their stories of distress, as well as their experiences of WHP. The narratives were analysed from a constructionist standpoint, using inductive thematic analysis. The participants’ narratives highlighted the profound impact of everyday distress, whilst feelings associated with distress (anxiety, low mood, isolation, shame and guilt) were frequently communicated via the use of metaphors. These negative feelings, often combined with unsuccessful biomedical encounters, frequently led to the women feeling desperate when first visiting a herbalist. The participants’ experiences of WHP showed that an accessible practitioner and good therapeutic relationship combined with flexible herbal treatment, allowed women with diverse stories of distress to overcome feelings of desperation. Ongoing support allowed the women to feel like they had a safety net as they journeyed from a place of distress, back into the wider world. These findings were supported by more unusual negative accounts, which showed how the herbal therapeutic process could be unsuccessful if elements were missing. This research is of significance as it helps to deepen our understanding of women’s experiences of distress – particularly perceptions of stigma which surround feelings of shame (linked to an inability to cope) and guilt (linked to the perceived impact of distress on others). The research also has relevance for WHP, as it highlights which positive aspects of WHP are of particular importance to women patients who are living with distress.

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, Jokinen M, Kemp B, Kurinczuk JJ, Lewis G, Lindquist A, Locock L, Nair M, Patel N, Quigley M, Ridge D, Rivero-Arias O, Sellers S, Shah A on behalf of the UKNeS coapplicant group. Background Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision. Objectives To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts. Methods Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group. Setting Maternity units in all four countries of the UK. Participants Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity. Main outcome measures The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches. Results Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services. Limitations This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded. Conclusions Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Something to show for it: the place of mementoes in women’s oral histories of work

Workplace memorabilia, regarded here as artifacts and mementoes kept from workplaces and stored in homes, is varied, including; tools of a trade, ephemeral leaflets and pamphlets, union mementoes, uniforms and badges, long service awards, gifts from colleagues, and photographs both formal and informal. These objects can symbolize many years of work-life history and the corollary of this, their absence, perhaps the need to forget the drudgery of ‘the daily grind’. The materiality of an object saved or taken from the workplace often prompts reminiscence (Bornat, 2001) but can also, in itself and its method of display, represent and express key identities, work processes and traditions. Using examples from a three year ESRC funded project on work and identity this paper focuses on the women who participated in the study and investigates what is kept or not, whether the ways in which work memorabilia is displayed or stored is gendered, and how this might illuminate gendered social relations in the workplace and gendered work identities.

Supporting the learning and networking experiences of doctoral students

This study explores the impact of a Graduate Virtual Research Environment (GVRE) on the learning and networking experiences of research students. The GVRE was established to support and enhance research skills and employability training across a university. It provides an extensive range of resources including video reflections based on the experiences of students and staff; GVRE members are encouraged to comment and engage in discussions on these resources. Our work is framed using social theories of learning and the role of communities in the support and development of research students. In particular, we are interested in exploring the challenges involved in developing communities and networks for students whose main focus is their individual research. The GVRE was made available to over 600 students and in this research we explore its impact on the experiences of research students. In particular, we investigate four questions: (a) what impact does the students use of the GVRE have on the development of their research skills; (b) what impact does membership of the GVRE have on the networks and communities of research students; (c) how do research students view the relationships between their research skills training programme, their individual research and the GVRE; and (d) how do research students currently use social media. We use an interpretivist approach and our data sources include site statistics, responses to a questionnaire and also feedback from a focus group. Our findings indicate that networking remains an issue and students suggested approaches to facilitating this using the GVRE: (1) A clearer pathway from skills need identification to skills acquisition; (2) Rewards for activities around networking - possibly through credit on the training scheme; (3) Activities that would involve research directly. Feedback on the GVRE indicated that it is valued by research students as it facilitates the development of their research skills. In terms of marketing the GVRE to research students important factors identified were: the ease of access to the site, the overview it gives of the PhD process; and the value of the site to students around the defining moments of their studies when the students felt they needed additional advice and guidance.

E-learners’ experiences of time

This paper explores the experiences of e-learners participating in continuing professional development programmes in three UK universities. Data was collected using questionnaires, discussion group postings and informal telephone interviews. These were analysed using two approaches to content analysis: a coding scheme and metaphors. Findings indicated that: e-learners reconstruct their approaches to time management at an early stage in their programme; the e-learners developed different time management strategies (planned, opportunistic, planned/opportunistic); and metaphors illustrated their underlying experiences of time. These provide the basis of recommendations for e-tutors. Finally, the paper explores methodological issues and outlines some implications for practice.

Comfort, confidence and confidentiality: the experiences of two e-learners

This paper is based on the authors’ experiences as e-learners on a MEd in Collaborative Networked Learning during 2000-2002. Although this course was delivered completely online, a strong sense of community developed early and continued as a key theme throughout the two years of the course. Our paper examines how this sense of community was facilitated and maintained, based on narrative analysis of our learning journals and personal recollections.

Exploring the intangible impacts of cultural events on the creative sector: Experiences from the Cultural Olympiad programmes of Torino 2006 and London 2012

This paper engages with the debates around the Olympic legacy by exploring the qualitative, intangible impacts of the Cultural Olympiad programme on local small creative firms in Torino, Italy and London, UK. The research objectives are achieved through a qualitative study of local small creative firms’ perceptions of the impacts of the Olympic Games’ cultural programme on their activities. To achieve this, Torino 2006 and London 2012 are used as case studies. The findings of this exploratory study show that cultural events can impact the creative sector. They do this by providing opportunities for mutual learning and access to initiatives that may generate ideas and new skills, as well as contributing to the development of a creative field. The study also explores the weaknesses and missed opportunities linked to the Cultural Olympiad programme, as perceived by creative practitioners. These include the lack of information and failure to engage smaller businesses. Based on qualitative analysis and discussion, recommendations for future organizers and further research are provided.

Business Models for Cloud Computing: Experiences from Developing Modeling & Simulation as a Service Applications in Industry

The potential of cloud computing is gaining significant interest in Modeling & Simulation (M&S). The underlying concept of using computing power as a utility is very attractive to users that can access state-of-the-art hardware and software without capital investment. Moreover, the cloud computing characteristics of rapid elasticity and the ability to scale up or down according to workload make it very attractive to numerous applications including M&S. Research and development work typically focuses on the implementation of cloud-based systems supporting M&S as a Service (MSaaS). Such systems are typically composed of a supply chain of technology services. How is the payment collected from the end-user and distributed to the stakeholders in the supply chain? We discuss the business aspects of developing a cloud platform for various M&S applications. Business models from the perspectives of the stakeholders involved in providing and using MSaaS and cloud computing are investigated and presented.

Probation staff experiences of managing suicidal and self-harming service users.

The current study sought to explore the impact of suicidal behaviours on probation staff, in relation to their experiences of working with probation service users who have carried out suicide, attempted suicide or self-harm. Thirteen in-depth interviews were carried out with probation staff who had direct contact with probation service users in one probation area, and had varying degrees of experience of managing suicidal or self-injurious service users. These were analysed using thematic analysis and five themes were identified. Findings indicate that staff felt that suicide and self-harm by service users are serious issues which need to be recognized and dealt with in an effective yet compassionate manner. Not attending the suicide prevention training, or lack of experience, were perceived as restricting their ability to know how to deal with these individuals, and offer support. Furthermore, staff were emotionally affected by these incidents and it is recommended that they should continue to be provided with access to appropriate support services after an incident.

Accessibility instruments for planning practice: A review of European experiences

Although a large body of literature has been produced on the theoretical definitions and measurements of accessibility, the extent to which such indicators are used in planning practice is less clear. This research explores the gap between theory and application by seeking to understand what the new wave of accessibility instruments (AIs) prepared for spatial and transport planning practice purports to offer the users of AIs. Starting from the question of how urban and transport planners are designing AIs, the article analyzes and describes the AIs developed over the last decade (mainly in Europe), offering a structured overview and a clear categorization of how accessibility measures can be applied. The paper identifies AI characteristics, and considers their usability, based on AI developer perceptions.