Patient exposure monitoring and radiation qualities in two-dimensional digital x-ray imaging

The methods for estimating patient exposure in x-ray imaging are based on the measurement of radiation incident on the patient. In digital imaging, the useful dose range of the detector is large and excessive doses may remain undetected. Therefore, real-time monitoring of radiation exposure is important. According to international recommendations, the measurement uncertainty should be lower than 7% (confidence level 95%). The kerma-area product (KAP) is a measurement quantity used for monitoring patient exposure to radiation. A field KAP meter is typically attached to an x-ray device, and it is important to recognize the effect of this measurement geometry on the response of the meter. In a tandem calibration method, introduced in this study, a field KAP meter is used in its clinical position and calibration is performed with a reference KAP meter. This method provides a practical way to calibrate field KAP meters. However, the reference KAP meters require comprehensive calibration. In the calibration laboratory it is recommended to use standard radiation qualities. These qualities do not entirely correspond to the large range of clinical radiation qualities. In this work, the energy dependence of the response of different KAP meter types was examined. According to our findings, the recommended accuracy in KAP measurements is difficult to achieve with conventional KAP meters because of their strong energy dependence. The energy dependence of the response of a novel large KAP meter was found out to be much lower than with a conventional KAP meter. The accuracy of the tandem method can be improved by using this meter type as a reference meter. A KAP meter cannot be used to determine the radiation exposure of patients in mammography, in which part of the radiation beam is always aimed directly at the detector without attenuation produced by the tissue. This work assessed whether pixel values from this detector area could be used to monitor the radiation beam incident on the patient. The results were congruent with the tube output calculation, which is the method generally used for this purpose. The recommended accuracy can be achieved with the studied method. New optimization of radiation qualities and dose level is needed when other detector types are introduced. In this work, the optimal selections were examined with one direct digital detector type. For this device, the use of radiation qualities with higher energies was recommended and appropriate image quality was achieved by increasing the low dose level of the system.

Emotional experience in psychotherapeutic interaction : Conversation analytical study on cognitive psychotherapy

The dissertation examines how emotional experiences are oriented to in the details of psychotherapeutic interaction. The data (57 audio recorded sessions) come from one therapist-patient dyad in cognitive psychotherapy. Conversation analysis is used as method. The dissertation consists of 4 original articles and a summary. The analyses explicate the therapist s practices of responding to the patient s affective expressions. Different types of affiliating responses are identified. It is shown that the affiliating responses are combined with, or build grounds for, more interpretive and challenging actions. The study also includes a case study of a session with strong misalignment between the therapist s and patient s orientations, showing how this misalignment is managed by the therapist. Moreover, through a longitudinal analysis of the transformation of a sequence type, the study suggests that therapeutic change processes can be located to sequential relations of actions. The practices found in this study are compared to earlier research on everyday talk and on medical encounters. It is suggested that in psychotherapeutic interaction, the generic norms of interaction considering affiliation and epistemic access, are modified for the purposes of therapeutic work. The study also shows that the practices of responding to emotional experience in psychotherapy can deviate from the everyday practices of affiliation. The results of the study are also discussed in terms of concepts arising from clinical theory. These include empathy, validation of emotion, therapeutic alliance, interpretation, challenging beliefs, and therapeutic change. The therapist s approach described in this study involves practical integration of different clinical theories. In general terms, the study suggests that in the details of interaction, psychotherapy recurrently performs a dual task of empathy and challenging in relation to the patient s ways of describing their experiences. Methodologically, the study discusses the problem of identifying actions in conversation analysis of psychotherapy and emotional interaction, and the possibility to apply conversation analysis in the study of therapeutic change.

What should I think; How should I feel? : The balancing of personal experiences and social norms in the outgroup attitude formation of youth

The present study focused on the associations between the personal experiences of intergroup contact, perceived social norms and the outgroup attitudes of Finnish majority and Russian-speaking minority youth living in Finland. The theoretical background of the study was derived from Allport s (1954) theory of intergroup contact (i.e., the contact hypothesis), social psychological research on normative influences on outgroup attitudes (e.g., Rutland, 2004; Stangor and Leary, 2006) and developmental psychological research on the formation of explicit (deliberate) and implicit (automatically activated) outgroup attitudes in adolescence (e.g., Barrett, 2007; Killen, McGlothlin and Henning, 2008). The main objective of the study was to shed light on the role of perceived social norms in the formation of outgroup attitudes among adolescents. First, the study showed that perceived normative pressure to hold positive attitudes towards immigrants regulated the relationship between the explicit and implicit expression of outgroup attitudes among majority youth. Second, perceived social norms concerning outgroup attitudes (i.e., the perceived outgroup attitudes of parents and peers) affected the relationship between intergroup contact and explicit outgroup attitudes depending on gender and group status. Positive social norms seem to be especially important for majority boys, who need both pleasant contact experiences and normative support to develop outgroup attitudes that are as positive as girls attitudes. The role of social norms is accentuated also among minority youth, who, contrary to majority youth with their more powerful and independent status position, need to reflect upon their attitudes and experiences of negative intergroup encounters in relation to the experiences and attitudes of their ingroup members. Third, the results are indicative of the independent effects of social norms and intergroup anxiety on outgroup attitudes: the effect of perceived social norms on the outgroup attitudes of youth seems to be at least as strong as the effect of intergroup anxiety. Finally, it was shown that youth evaluate intergroup contact from the viewpoint of their ingroup and society as a whole, not just based on their own experiences. In conclusion, the outgroup attitudes of youth are formed in a close relationship with their social environment. On the basis of this study, the importance of perceived social norms for research on intergroup contact effects among youth cannot be overlooked. Positive normative influences have the potential to break the strong link between rare and/or negative personal contact experiences and negative outgroup attitudes, and norms also influence the relationship between implicit and explicit attitude expression.

Jatropha cultivation in southern India: assessing farmers' experiences

Together with 106 farmers who started growing Jatropha (Jatropha curcas L.) in 20042006, this research sought to increase the knowledge around the real-life experience of Jatropha farming in the southern India states of Tamil Nadu and Andhra Pradesh. Launched as an alternative for diesel in India, Jatropha has been promoted as a non-edible plant that could grow on poor soils, yield oil-rich seeds for production of bio-diesel, and not compete directly with food production. Through interviews with the farmers, information was gathered regarding their socio-economic situation, the implementation and performance of their Jatropha plantations, and their reasons for continuing or discontinuing Jatropha cultivation. Results reveal that 82% of the farmers had substituted former cropland for their Jatropha cultivation. By 2010, 85% (n = 90) of the farmers who cultivated Jatropha in 2004 had stopped. Cultivating the crop did not give the economic returns the farmers anticipated, mainly due to a lack of information about the crop and its maintenance during cultivation and due to water scarcity. A majority of the farmers irrigated and applied fertilizer, and even pesticides. Many problems experienced by the farmers were due to limited knowledge about cultivating Jatropha caused by poor planning and implementation of the national Jatropha program. Extension services, subsidies, and other support were not provided as promised. The farmers who continued cultivation had means of income other than Jatropha and held hopes of a future Jatropha market. The lack of market structures, such as purchase agreements and buyers, as well as a low retail price for the seeds, were frequently stated as barriers to Jatropha cultivation. For Jatropha biodiesel to perform well, efforts are needed to improve yield levels and stability through genetic improvements and drought tolerance, as well as agriculture extension services to support adoption of the crop. Government programs will -probably be more effective if implementing biodiesel production is conjoined with stimulating the demand for Jatropha biodiesel. To avoid food-biofuel competition, additional measures may be needed such as land-use restrictions for Jatropha producers and taxes on biofuels or biofuel feedstocks to improve the competitiveness of the food sector compared to the bioenergy sector. (c) 2012 Society of Chemical Industry and John Wiley & Sons, Ltd

The What? and How? of education and training for information professionals in a changing world: some experiences from Wales, Slovakia and the Asia-Pacific region

Tedd, L.A. (2003). The What? and How? of education and training for information professionals in a changing world: some experiences from Wales, Slovakia and the Asia-Pacific region. Journal of Information Science, 29(1), 79-86.

Experiences of the foster care process in the Republic of Ireland: retrospective accounts from biological children of foster carers

This thesis examines the experiences of the biological children of foster carers. In particular it explores their experiences in relation to inclusion, consultation and decision-making. The study also examines the support and training needs of birth children in foster families. Using a qualitative methodology in-depth, semi-structured interviews were conducted with fifteen birth children of foster carers aged between 18 and 30 years. The research findings show that for the majority of birth children, fostering was overall a positive experience which helped them develop into individuals who were caring and nonjudgemental. However, from the data collected in this study, it is clear that fostering also brings a range of challenges for birth children in foster families, such as managing feelings of loss, grief, jealousy and guilt when foster children leave. Birth children are reluctant to discuss these issues with their parents and often did not approach fostering social workers as they did not have a meaningful relationship in order to discuss their concerns. The findings also demonstrate that birth children undertake a lot of emotional work in supporting their parents, birth siblings and foster siblings. Despite the important role played by birth children in the fostering process, this contribution often goes unrecognised and unacknowledged by fostering professionals and agencies with birth children not included or consulted about foster care decisions that affect them. It is argued here that birth children are viewed by foster care professionals and agencies from a deficit based perspective. However, this study contends that it is not just foster parents who are involved in the foster care process, but the entire foster family. The findings of this study show that birth children are competent social actors capable of making valuable contributions to foster care decisions that affect their lives and that of their family.

Emergency Department Efficiency in an Academic Hospital: A Simulation Study

Gemstone Team HOPE (Hospital Optimal Productivity Enterprise)

Evaluation of extended training for general practice in Northern Ireland: qualitative study.

Objective To evaluate participants' perceptions of the impact on them of an additional six months' training beyond the standard 12 month general practice vocational training scheme. Design Qualitative study using focus groups. Setting General practice vocational training in Northern Ireland. Participants 13 general practitioner registrars, six of whom participated in the additional six months' training, and four trainers involved in the additional six months' training. Main outcome measures: Participants' views about their experiences in 18 month and 12 month courses. Results Participants reported that the 12 month course was generally positive but was too pressurised and focused on examinations, and also that it had a negative impact on self care. The nature of the learning and assessment was reported to have left participants feeling averse to further continuing education and lacking in confidence. In contrast, the extended six month component was reported to have restimulated learning by focusing more on patient care and promoting self directed learning. It developed confidence, promoted teamwork, and gave experience of two practice contexts, and was reported as valuable by both ex-registrars and trainers. However, both the 12 and 18 month courses left participants feeling underprepared for practice management and self care. Conclusions 12 months' training in general practice does not provide doctors with the necessary competencies and confidence to enter independent practice. The extended period was reported to promote greater professional development, critical evaluation skills, and orientation to lifelong learning but does not fill all the gaps.

Carrying religion into a secularising Europe: Montserratian migrants' experiences of global processes in British methodism

Migrants to Europe often perceive themselves as entering a secular society that threatens their religious identities and practices. Whilst some sociological models present their responses in terms of cultural defence, ethnographic analysis reveals a more complex picture of interaction with local contexts. This essay draws upon ethnographic research to explore a relatively neglected situation in migration studies, namely the interactions between distinct migration cohorts - in this case, from the Caribbean island of Montserrat, as examined through their experiences in London Methodist churches. It employs the ideas of Weber and Bourdieu to view these migrants as 'religious carriers', as collective and individual embodiments of religious dispositions and of those socio-cultural processes through which their religion is reproduced. Whilst the strategies of the cohort migrating after the Second World War were restricted through their marginalised social status and experience of racism, the recent cohort of evacuees fleeing volcanic eruptions has had greater scope for strategies which combat secularisation and fading Methodist identity.

Keeping it real! Enhancing realism in standardised patient OSCE stations

Background: Objective structured clinical examinations (OSCEs) are a
commonly used method of assessing clinical competency in healthcare education. They can providean opportunity to observe candidates interacting with patients.
There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter arti?cial and removed from actual clinical practice.
Context: Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated
and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable
within an OSCE framework.
Innovation: This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an
OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in
combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.
Implications: By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less
aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE

A need to belong?: The prevalence of experiences of belonging and exclusion in school among minority ethnic children living in the 'White hinterlands'

Based on a survey of 711 children in Northern Ireland, this paper explores a range of aspects of experiences of belonging and exclusion in relation to school among three main minority ethnic groups: Irish Traveller, Chinese/Asian and European Migrant children. The study examines variations between each group and how they compare to the White settled population. The findings indicate that all three groups experience lower levels of belonging and higher levels of exclusion compared to their White, settled Northern Irish peers. The experiences of Irish Traveller children were the most negative. The article adds to the dearth of data on minority ethnic children living in mainly white regions in the UK and Ireland. It argues for the need to move beyond achievement gaps in assessing minority ethnic children’s differential experiences in education and highlights the potential of belongingness as a concept for the further study of differential patterns of need and processes of inclusion.

Getting In and Getting On? The Experiences of Young People with Visual Impairments and Hearing Impairments in Third-Level Education

Young disabled people continue to be under-represented throughout further and higher education settings. Drawing on Pierre Bourdieu’s social theory of habitus, capital and field, this paper explores the practices of domination and oppression that have made it difficult for young people with visual impairments and hearing impairments to participate in third-level education on the same basis as non-disabled people. Twenty young people with hearing impairments and visual impairments were interviewed about their educational experiences. In addition, 31 interviews were conducted with third-level education providers, policy-makers and non-governmental organisations. This article has two aims: firstly, to critically examine the experiences of young people with hearing impairments and visual impairments in accessing and engaging with support provisions in further and higher education settings; and secondly, to identify and explore the diversity of ways in which these young people have managed and responded to the practices they have encountered. This article emphasises the journey from ability to dis-ability that young people with hearing and visual impairments experience in their quest for educational achievement. The ambiguities of “inclusion”, “widening participation” and “support” are highlighted and critiqued for their extensive failure to challenge taken-for-granted discourses.