Understanding the Patient Experience Through the Power of Film: a Mixed Method Qualitative Research Study

Background For decades film has proved to be a powerful form of communication. Whether produced as entertainment, art or documentary, films have the capacity to inform and move us. Films are a highly attractive teaching instrument and an appropriate teaching method in health education. It is a valuable tool for studying situations most transcendental to human beings such as pain, disease and death. Objectives The objectives were to determine how this helps students engage with their role as health care professionals; to determine how they view the personal experience of illness, disease, disability or death; and to determine how this may impact upon their provision of patient care. Design, Setting and Participants The project was underpinned by the film selection determined by considerate review, intensive scrutiny, contemplation and discourse by the research team. 7 films were selected, ranging from animation; foreign, documentary, biopic and Hollywood drama. Each film was shown discretely, in an acoustic lecture theatre projected onto a large screen to pre-registration student nurses (adult, child and mental health) across each year of study from different cohorts (n = 49). Method A mixed qualitative method approach consisted of audio-recorded 5-minute reactions post film screening; coded questionnaires; and focus group. Findings were drawn from the impact of the films through thematic analysis of data sets and subjective text condensation categorised as: new insights looking through patient eyes; evoking emotion in student nurses; spiritual care; going to the moves to learn about the patient experience; self discovery through films; using films to link theory to practice. Results Deeper learning through film as a powerful medium was identified in meeting the objectives of the study. Integration of film into pre registration curriculum, pedagogy, teaching and learning is recommended. Conclusion The teaching potential of film stems from the visual process linked to human emotion and experience. Its impact has the power to not only help in learning the values that underpin nursing, but also for respecting the patient experience of disease, disability, death and its reality.

The Political Economy of Information Provision in Developing Democracies

Thesis (Ph.D.)--University of Washington, 2016-07

Optimisation of digitally coded test vectors for mixed-signal components

International audience

Close encounters: international exhibitions and the material culture of the British Empire, c.1880-1940

Apparitions of empire and imperial ideologies were deeply embedded in the International Exhibition, a distinct exhibitionary paradigm that came to prominence in the mid-nineteenth century. Exhibitions were platforms for the display of objects, the movement of people, and the dissemination of ideas across and between regions of the British Empire, thereby facilitating contact between its different cultures and societies. This thesis aims to disrupt a dominant understanding of International Exhibitions, which forwards the notion that all exhibitions, irrespective of when or where they were staged, upheld a singular imperial discourse (i.e. Greenhalgh 1988, Rydell 1984). Rather, this thesis suggests International Exhibitions responded to and reflected the unique social, political and economic circumstances in which they took place, functioning as cultural environments in which pressing concerns of the day were worked through. Understood thus, the International Exhibition becomes a space for self-presentation, serving as a stage from which a multitude of interests and identities were constructed, performed and projected. This thesis looks to the visual and material culture of the International Exhibition in order to uncover this more nuanced history, and foregrounds an analysis of the intersections between practices of exhibition-making and identity-making. The primary focus is a set of exhibitions held in Glasgow in the late-1880s and early-1900s, which extends the geographic and temporal boundaries of the existing scholarship. What is more, it looks at representations of Canada at these events, another party whose involvement in the International Exhibition tradition has gone largely unnoticed. Consequently, this thesis is a thematic investigation of the links between a municipality routinely deemed the ‘Second City of the Empire’ and a Dominion settler colony, two types of geographic setting rarely brought into dialogue. It analyses three key elements of the exhibition-making process, exploring how iconographies of ‘quasi-nationhood’ were expressed through an exhibition’s planning and negotiation, its architecture and its displays. This original research framework deliberately cuts across strata that continue to define conceptions of the British Empire, and pushes beyond a conceptual model defined by metropole and colony. Through examining International Exhibitions held in Glasgow in the late-Victorian and Edwardian periods, and visions of Canada in evidence at these events, the goal is to offer a novel intervention into the existing literature concerning the cultural history of empire, one that emphasises fluidity rather than fixity and which muddles the boundaries between centre and periphery.

The development and field test of a Mealtime Interaction Clinical Observation Tool: a pilot study and clinical research portfolio

Objective: The purpose of this study was to develop and test psychometric properties of a Mealtime Interaction Clinical Observation Tool (MICOT) that could be used to facilitate assessment and behavioural intervention in childhood feeding difficulties. Methods: Thematic analysis of four focus groups with feeding and behaviour experts identified the content and structure of the MICOT. Following refinement, inter-rater reliability was tested between three healthcare professionals. Results: Six themes were identified for the MICOT, which utilises a traffic-light system to identify areas of strength and areas for intervention. Despite poor inter-rater reliability, for which a number of reasons are postulated, some correlation between psychologists’ ratings was evident. Healthcare professionals liked the tool and reported that it could have good clinical utility. Conclusion: The study provides a promising first version of a clinical observation tool that facilitates assessment and behavioural intervention in childhood feeding difficulties.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Augmented Dissent: The Affordances of ICTs for Citizen Protest (A Case Study of the Ukraine Euromaidan Protests of 2013-2014).

This dissertation research project uses the Euromaidan protests in Ukraine to inform and shape a theory of augmented dissent to help explain the complex ways in which protest participants guided by the political, social, and cultural contexts engage in dissent augmented by ICTs in a reality where both the physical and the digital are used in concert. The purpose of this research is to conceptualize the use and perception of ICTs in protest activity using the communicative affordances framework. Through a mixed-method research approach involving interviews with protest participants, as well as qualitative and thematic analysis of online content from social media pages of several key Euromaidan protest communities, the research project examines the role ICTs played in the information and media landscape during the Euromaidan protest. The findings of the online content analysis were used to inform the questions for the 59 semi-structured, open-ended interviews with Euromaidan protest participants in Ukraine and abroad. The research findings provide in-depth insights about how ICTs were used and perceived by protest participants, and their role as vehicles for information and civic media content. The study employs the theoretical framework of social media affordances to interpret the data gathered during the interviews and content analysis to better understand how digital media augmented citizens’ protest activity through affording them new possibilities for dissent, and how they made meaning of said protest activity as augmented by ICTs. The findings contribute towards shaping a theory of digitally augmented dissent that conceptualizes the complex relationship between citizens and ICTs during protest activity as an affordance-driven one, where online and offline tools and activity merge into a unified dissent space and extend or augment the possibilities for action in interesting, and sometimes unexpected ways. Such a conceptual model could inform broader theories about civic participation and digital activism in the post-Soviet world and beyond, as ICTs become an inseparable part of civic life.

Discovery of stable and variable differences in the Mycobacterium avium subsp. paratuberculosis type I, II, and III genomes by pan-genome microarray analysis

Mycobacterium avium subsp. paratuberculosis is an important animal pathogen widely disseminated in the environment that has also been associated with Crohn's disease in humans. Three M. avium subsp. paratuberculosis genomotypes are recognized, but genomic differences have not been fully described. To further investigate these potential differences, a 60-mer oligonucleotide microarray (designated the MAPAC array), based on the combined genomes of M. avium subsp. paratuberculosis (strain K-10) and Mycobacterium avium subsp. hominissuis (strain 104), was designed and validated. By use of a test panel of defined M. avium subsp. paratuberculosis strains, the MAPAC array was able to identify a set of large sequence polymorphisms (LSPs) diagnostic for each of the three major M. avium subsp. paratuberculosis types. M. avium subsp. paratuberculosis type II strains contained a smaller genomic complement than M. avium subsp. paratuberculosis type I and M. avium subsp. paratuberculosis type III genomotypes, which included a set of genomic regions also found in M. avium subsp. hominissuis 104. Specific PCRs for genes within LSPs that differentiated M. avium subsp. paratuberculosis types were devised and shown to accurately screen a panel (n = 78) of M. avium subsp. paratuberculosis strains. Analysis of insertion/deletion region INDEL12 showed deletion events causing a reduction in the complement of mycobacterial cell entry genes in M. avium subsp. paratuberculosis type II strains and significantly altering the coding of a major immunologic protein (MPT64) associated with persistence and granuloma formation. Analysis of MAPAC data also identified signal variations in several genomic regions, termed variable genomic islands (vGIs), suggestive of transient duplication/deletion events. vGIs contained significantly low GC% and were immediately flanked by insertion sequences, integrases, or short inverted repeat sequences. Quantitative PCR demonstrated that variation in vGI signals could be associated with colony growth rate and morphology.

Functional heterogeneity of medial posterior parietal cortex of macaque monkey

The posterior parietal cortex (PPC) of primates represents a remarkable platform that has evolved over time to solve some of the computational challenges that we face in the everyday life, such as sensorimotor integration, spatial attention, and motor planning. With the aim of further investigating the multifaceted functional characteristics of medial PPC, we conducted three studies to explore the visuomotor, somatic, visual, and attention-related properties of two PPC areas: V6A, a visuomotor area part of the dorsomedial visual stream, and PE, an area strongly dominated by somatomotor input, residing mainly on the exposed surface of the superior parietal lobule. In the first study, we tested the impact of visual feedback on V6A grasp-related activity during arm movements towards objects of different shapes. Our results demonstrate that V6A is modulated by both grip type and visual information during grasping preparation and execution, with a predominance of cells influenced by grip type. In the second study, we explored the influence of depth and direction information on reach-related activity of neurons in the so far largely neglected medial part of area PE. We observed a remarkable trend in medial PPC, going from the joint coding of depth and direction signals caudally, in area V6A, to a largely segregated processing of the two signals rostrally, in area PE. In the third study, we used a combined fMRI-electrophysiology experiment to investigate the neuronal mechanisms underlying covert shift of attention processes in area V6A. Our preliminary results reveal that half of the cells showed shift-selective activity when the monkey covertly shifted its attention towards the receptive field. All together these findings highlight the role of the medial PPC in integrating information coming from different sources (vision, somatosensory and motor) and emphasize the involvement of action-related regions of the dorsomedial visual stream in higher level cognitive functions.

Advanced numerical modeling of masonry vaulted structures based on BIM parametric geometry generation

Vaults are an architectural element which during construction history have been built with a great variety of different materials, shapes, and sizes. The shape of these structural elements was often dependent by the necessity to cover complex spaces, by the needed loading capacity, or by architectural aesthetics. Within this complex scenario masonry patterns generates also different effects on loading capacity, load percolation and stiffness of the structure. These effects were been extensively investigated, both with empirical observations and with modern numerical methods. While most of them focus on analyzing the load bearing capacity or the texture effect on vaulted structures, the aim of this analysis is to investigate on the effects of the variation of a single structural characteristic on the load percolation in the vault. Moreover, an additional purpose of the work is related to the coding of a parametrical model aiming at generating different masonry vaulted structures. Nevertheless, proposed script can generate different typology of vaulted structure basing on some structural characteristics, such as the span and the length to cover and the dimensions of the blocks.

Shaping the future of learning using the student voice: we’re listening but are we hearing clearly?

Student voice data is a key factor as Manchester Metropolitan University strives to continually improve institutional technology enhanced learning (TEL) infrastructure. A bi-annual Institutional Student Survey enables students to communicate their experience of learning, teaching and assessment on programmes and specific units studied. Each cycle of the survey contains approximately 40–50,000 free text comments from students pertaining to what they appreciate and what they would like to see improved. A detailed thematic analysis of this data has identified 18 themes, arranged into six categories relating to the ‘Best’ aspects of courses, and 25 themes, arranged in seven categories in relation to aspects of courses considered to be ‘in need of improvement’. This student data was then used as a basis for semi-structured interviews with staff. Anecdotally, evidence suggested that student expectations and staff expectations around TEL and the virtual learning environment (VLE) differed. On-going evaluation of this work has highlighted a disconnect. In significant instances, academic colleagues seemingly misinterpret the student voice analysis and consequently struggle to respond effectively. In response to the analysis, the learning technologist's role has been to re-interpret the analysis and redevelop TEL staff development and training activities. The changes implemented have focused on: contextualising resources in VLE; making lectures more interactive; enriching the curriculum with audio–visual resources; and setting expectations around communications.

A produção do conhecimento sobre o ensino de química nas reuniões anuais da Sociedade Brasileira de Química: uma revisão

This paper discusses the Brazilian academic production on Chemical Education. The main source of information is the annual meeting of the Brazilian Chemical Society (RASBQ) covering the period 1999-2006. All the papers presented by the Division of Chemical Education of the RASBQ were reviewed to permit a discussion about the development of the area in Brazil. This bibliographical revision comprises the following aspects: year of presentation, Brazilian region and institution of production, scholastic level encompassed by the study, the kind of academic work (or research type) and thematic focus of the study.

Isolamento compulsório de portadores de hanseníase: memória de idosos

De 1924 a 1962 o Brasil utilizou a internação compulsória de pacientes de hanseníase como controle da doença na comunidade. Com o final dessa política, muitos pacientes continuaram a viver nessas unidades. O Asilo Pirapitingui, hoje Hospital Dr. Francisco Ribeiro Arantes, é a única retaguarda asilar para internação de portadores de hanseníase por indicação social. Obtivemos o relato da história de vida de oito de seus remanescentes, que foram gravados e transcritos. A análise temática desses relatos permitiu a identificação das seguintes categorias: hanseníase; internação; vida cotidiana; a instituição; condições atuais de saúde; e permanência na instituição após a extinção da internação compulsória.

Representações sociais do trabalho: uma análise comparativa entre jovens trabalhadores e não trabalhadores

O trabalho na adolescência é justificado, dentre outros aspectos, pela necessidade econômica das famílias. Os objetivos deste estudo foram analisar o conteúdo e a estrutura da representação social do trabalho na adolescência, entre estudantes trabalhadores e não trabalhadores, entre catorze e dezoito anos; comparar as representações nos dois grupos estudados; verificar se as cognições participantes do núcleo central das representações caracterizadas se confirmam em uma segunda técnica de estudo das representações. A amostra foi composta por 724 alunos do ensino médio da rede pública de ensino da cidade de São Paulo. A coleta de dados foi realizada através da técnica de evocações livres de palavras, utilizando o termo indutor "trabalho", e da realização de 21 grupos focais. Os resultados revelam que a representação do trabalho, em ambos os grupos, foi associada a significados morais e psicossociais positivos. Do ponto de vista metodológico, a maioria dos elementos classificados como participantes do núcleo central da representação foram confirmados nos diferentes eixos temáticos da análise de conteúdo dos grupos focais.

Consequências da vasectomia: experiência de homens que se submeteram à cirurgia em Campinas (São Paulo), Brasil

OBJETIVO: Descrever a experiência de homens vasectomizados há pelo menos um ano em serviços públicos de saúde de Campinas, Estado de São Paulo. Procedimentos metodológicos: estudo descritivo com um componente qualitativo e outro quantitativo. Para a etapa qualitativa, realizaram-se 10 entrevistas semiestruturadas com homens selecionados de acordo com critérios propositais de escolaridade e número de filhos. Em seguida, foi aplicado um formulário estruturado a 202 homens, sorteados a partir da lista completa daqueles que haviam sido vasectomizados entre 1998 e 2004. Realizou-se análise temática do conteúdo das entrevistas semiestruturadas. Os dados quantitativos foram digitados e foi realizada análise descritiva. RESULTADOS: Observou-se que 97% dos homens estavam satisfeitos por terem feito a cirurgia e poucos referiram efeitos indesejados. Entre os poucos homens insatisfeitos, apenas um havia feito a reversão da cirurgia porque vivia com uma nova companheira e queria ter filhos; entre os demais a insatisfação devia-se à dor provocada pelo procedimento cirúrgico. A maioria dos entrevistados atribuiu à vasectomia mudanças para melhor sobre sua saúde, corpo, relacionamento em geral com a família e com a esposa, na vida sexual e na situação econômica. Prevaleceu a ideia de que a vasectomia só trouxera benefícios. A possibilidade de arrependimento foi mencionada pelos entrevistados como algo que não aconteceria com eles. CONCLUSÃO: Os resultados deste estudo permitiram verificar que os homens que optam pela vasectomia tendem a ver o método como fator de mudanças positivas, principalmente sobre a vida sexual e o relacionamento com a companheira e a família em geral.