A postcolonial queer analysis of aboriginal queer clients' experiences of health care services in St. John's, Newfoundland

This thesis examines the gaps between health care services aimed at Aboriginal queer individuals living in St. John’s, Newfoundland and their health care needs. I used a multi-methods research design that includes interviews and demographic surveys, unobtrusive observation and qualitative content analysis. I conducted semi-structured interviews with institutional representatives from selected health related organizations – Eastern Health, Planned Parenthood Newfoundland and Labrador, the AIDS Committee of Newfoundland and Labrador, and St. John’s Native Friendship Center; as well as a transgender activist and three people who identify as Aboriginal and queer. I conducted observational research at two public seminars on Aboriginal people and health. Finally, I carried out qualitative content analysis of organizational reports and webpages of the selected community organizations. Using a postcolonial queer framework that analyzes how Newfoundland and Labrador’s colonial history is reflected in current health care realities I argue that the lack of appropriate services and culturally insensitive delivery of services reproduce the historical marginalization of an already vulnerable group.

End-of-life care: identifying an appropriate legal framework for specialist palliative care in Ireland

This thesis argues that the legal framework in Ireland for specialist palliative care is inadequate and consequently a more appropriate legal framework must be identified. This research is guided by three central research questions. The first central research question examines the legitimacy of the distinction between specialist palliative care and euthanasia. The second central research question asks what legal framework currently exists in Ireland for specialist palliative care. The third central research question examines an alternative legal framework for specialist palliative. This thesis is composed of seven chapters. The first Chapter is an introduction to the thesis and defines the terminology and the central research questions. Chapter Two explores the development and practice of palliative care in Ireland. Chapter Three examines the distinction in criminal law between specialist palliative care practices and euthanasia. Chapter Four examines the human rights framework for specialist palliative care. Chapter Five critiques the regulatory framework in Ireland for specialist palliative care. Having gained a thorough understanding of palliative care and the related legal framework, this thesis then engages in comparative analysis of the Netherlands which is used as a source of ideas for reform in Ireland. Chapter Seven is the concluding chapter and, in it, the main findings of this thesis are summarised. The main findings being that: the distinction between specialist palliative care and euthanasia is not sufficiently supported by justifications such as a double effect or the acts and omissions distinction, there is no clear decision-making framework in Ireland for specialist palliative care, and the current legal framework lacks clarity and does not promote consistency between providers of specialist palliative care. This Chapter also proposes that detailed professional standards and guidelines are likely to be the most appropriate way to effect individual and institutional change in the provision of specialist palliative care.

Moral Masculinities: Ethical Self-fashionings of Professional Chinese Men in London

Through qualitative interviews and examination of textual sources, this essay investigates the gendered, class and cultural subjectivities of transnational, highly-educated Chinese men living and working in London. Narrative analysis of the interviews of two participants suggests that they exhibit hybrid “bricolage masculinities,” which incorporate elements from Western educational and corporate cultures, and also appropriate concepts and practices from the Confucian tradition of moral self-cultivation. A discussion of contemporary texts that support the revival of Confucian masculinities illuminates the discursive context in which the participants’ ethical self-fashionings take place. The study argues that the cosmopolitan yet culturally embedded masculinities of the participants are suggestive of how professional Chinese men, as they step onto the world stage, seek to insert themselves more advantageously into local and global power relations of gender, class and nation.

Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many

The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between the prescribing of ‘many’ drugs and ‘too many’ drugs is a significant challenge. Clinicians are tasked with ensuring that patients receive the most appropriate combinations of medications based on the best available evidence, and that medication use is optimised according to patients’ clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because of the associated medication safety risks, such as drug interactions and adverse drug events. More recently, polypharmacy has been identified as a risk factor for under-prescribing, such that patients do not receive necessary medications and this can also pose risks to patients’ safety and well-being. The negative connotations that have long been associated with the term polypharmacy could potentially be acting as a driving factor for under-prescribing, whereby clinicians are reluctant to prescribe necessary medicines for patients who are already receiving ‘many’ medicines. It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration. In this article, we outline the current perspectives on polypharmacy and make the case for adopting the term ‘appropriate polypharmacy’ in differentiating between the prescribing of ‘many’ drugs and ‘too many’ drugs. We also outline the inherent challenges in doing so and provide recommendations for future clinical practice and research.

‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people

Background: Potentially inappropriate prescribing (PIP) is common in older people in primary care, as evidenced by a significant body of quantitative research. However, relatively few qualitative studies have investigated the phenomenon of PIP and its underlying processes from the perspective of general practitioners (GPs). The aim of this paper is to explore qualitatively, GP perspectives regarding prescribing and PIP in older primary care patients.

Method: Semi-structured qualitative interviews were conducted with GPs participating in a randomised controlled trial (RCT) of an intervention to decrease PIP in older patients (≥70 years) in Ireland. Interviews were conducted with GP participants (both intervention and control) from the OPTI-SCRIPT cluster RCT as part of the trial process evaluation between January and July 2013. Interviews were conducted by one interviewer and audio recorded. Interviews were transcribed verbatim and a thematic analysis was conducted.

Results: Seventeen semi-structured interviews were conducted (13 male; 4 female). Three main, inter-related themes emerged (complex prescribing environment, paternalistic doctor-patient relationship, and relevance of PIP concept). Patient complexity (e.g. polypharmacy, multimorbidity), as well as prescriber complexity (e.g. multiple prescribers, poor communication, restricted autonomy) were all identified as factors contributing to a complex prescribing environment where PIP could occur, as was a paternalistic-doctor patient relationship. The concept of PIP was perceived to be of variable usefulness to GPs and the criteria to measure it may be at odds with the complex processes of prescribing for this patient population.

Conclusions: Several inter-related factors contributing to the occurrence of PIP were identified, some of which may be amenable to intervention. Improvement strategies focused on improved management of polypharmacy and multimorbidity, and communication across primary and secondary care could result in substantial improvements in PIP.

Culturally Sensitive Care of the Baby and Family in the NICU: a review of the literature

This oral presentation summarised the literature on cultural differences in grieving and provision of end-of-life care in the nICU

Modern Horn Playing in Beethoven: An Exploration of Period Appropriate Techniques for the Orchestral Music of Beethoven for the Modern Horn Player

Thesis (D.M.A.)--University of Washington, 2016-06

Adaptation of the MacNew quality of life questionnaire after myocardial infarction in an Iranian population

BACKGROUND: Health-related quality of life (HRQL) assessment is an important measure of the impact of a wide range of disease process on an individual. To date, no HRQL tool has been evaluated in an Iranian population with cardiovascular disorders, specifically myocardial infarction, a major cause of mortality and morbidity. The MacNew Heart Disease Health-related Quality of Life instrument is a disease-specific HRQL questionnaire with satisfactory validity and reliability when applied cross-culturally. METHOD: A Persian version of MacNew was prepared by both forward and backward translation by bilinguals after which a feasibility test was performed. Consecutive patients (n = 51) admitted to a coronary care unit with acute myocardial infarction were recruited for measurement of their HRQL with retest one month after discharge in the follow-up clinic. Principal components analysis, intra-class correlation reliability, internal consistency, and test-retest reliability were assessed. RESULTS: Trivial rates of missing data confirmed the acceptability of the tool. Principal component analysis revealed that the three domains, emotional, social and physical, performed as well as in the original studies. Internal consistency was high and comparable to other studies, ranging from 0.92 for the emotional and physical domains, to 0.94 for the social domain, and to 0.95 for the Global score. Domain means of 5, 5.3 and 4.9 for emotional, physical and social respectively indicate that our Iranian population has similar emotional and physical but worse social HRQL scores. Test-retest analysis showed significant correlation in emotional and physical domains (P < 0.05). CONCLUSION: The Persian version of the MacNew questionnaire is comparable to the English version. It has high internal consistency and reasonable reproducibility, making it an appropriate specific quality of life tool for population-based studies and clinical practice in Iran in patients who have survived an acute myocardial infraction. Further studies are needed to confirm its validity in larger populations with cardiovascular disease

THE EFFECT OF ANNEALING ON AMORPHOUS SILICON BASED SOLAR PHOTOVOLTAIC THERMAL SYSTEM (PV/T) AND APPROPRIATE GLOBAL DISPATCH STRATEGIES

Previous work has shown that high-temperature short-term spike thermal annealing of hydrogenated amorphous silicon (a-Si:H) photovoltaic thermal (PVT) systems results in higher electrical energy output. The relationship between temperature and performance of a-Si:H PVT is not simple as high temperatures during thermal annealing improves the immediate electrical performance following an anneal, but during the anneal it creates a marked drop in electrical performance. In addition, the power generation of a-Si:H PVT depends on both the environmental conditions and the Staebler-Wronski Effect kinetics. In order to improve the performance of a-Si:H PVT systems further, this paper reports on the effect of various dispatch strategies on system electrical performance. Utilizing experimental results from thermal annealing, an annealing model simulation for a-Si:Hbased PVT was developed and applied to different cities in the U.S. to investigate potential geographic effects on the dispatch optimization of the overall electrical PVT systems performance and annual electrical yield. The results showed that spike thermal annealing once per day maximized the improved electrical energy generation. In the outdoor operating condition this ideal behavior deteriorates and optimization rules are required to be implemented.

Practical, appropriate, empirically-validated guidelines for designing educational games

There has recently been a great deal of interest in the potential of computer games to function as innovative educational tools. However, there is very little evidence of games fulfilling that potential. Indeed, the process of merging the disparate goals of education and games design appears problematic, and there are currently no practical guidelines for how to do so in a coherent manner. In this paper, we describe the successful, empirically validated teaching methods developed by behavioural psychologists and point out how they are uniquely suited to take advantage of the benefits that games offer to education. We conclude by proposing some practical steps for designing educational games, based on the techniques of Applied Behaviour Analysis. It is intended that this paper can both focus educational games designers on the features of games that are genuinely useful for education, and also introduce a successful form of teaching that this audience may not yet be familiar with.

'Aedes sacrae' e 'edifici destinati all'esercizio pubblico del culto cattolico': la condizione giuridica delle chiese in Italia tra diritto canonico e ordinamento statale

Già ad uno sguardo esterno la normativa chiamata a disciplinare la condizione giuridica delle chiese cattoliche nel nostro Paese appare caratterizzata da un elevato grado di complessità: impressione che trova conferma sia con riferimento al diritto canonico, nella cui prospettiva le disposizioni appositamente dedicate ai 'loca sacra' dal Codex Iuris Canonici richiedono di essere affiancate dalle indicazioni provenienti – ai rispettivi, differenti livelli – tanto dalla Conferenza Episcopale Italiana quanto dai dicasteri della Curia romana; sia nell'ottica dell'ordinamento italiano, che agli 'edifici destinati all’esercizio pubblico del culto cattolico' riserva un'attenzione specifica, emergente nella legislazione unilaterale così come in quella pattizia. A fronte di una simile eterogeneità, sono d’altra parte note le problematiche che il tempo presente pone innanzi alle esigenze di una corretta amministrazione del patrimonio ecclesiastico – spesso pure dotato di un inestimabile valore storico-artistico –, le quali si riversano sulla preservazione stessa di tali immobili. Prendendo le mosse da questi presupposti, la trattazione si propone di effettuare una lettura sistematica delle diverse fasi in cui si articola il 'ciclo vitale' di un'ipotetica chiesa cattolica, così da ricostruire organicamente e criticamente quel quadro complessivo che permetta di formulare le soluzioni più appropriate per rispondere a questioni risalenti e sfide inedite. È quindi con questo intento che, una volta definito esattamente il concetto di chiesa-edificio, vengono ripercorsi i momenti in cui si sviluppa, anche giuridicamente, la sua esistenza: dalla pianificazione al finanziamento delle nuove costruzioni, con una speciale attenzione all'apporto che può essere offerto da parte della CEI; dagli utilizzi ammessi nel diritto canonico alle tutele garantite da parte statale; dalle misure di salvaguardia ai criteri per la loro adeguata gestione, comprendenti tanto i profili relativi alla conservazione quanto quelli riguardanti la valorizzazione; dalle implicazioni di un'eventuale riduzione a uso profano fino ai requisiti dettati per la nuova destinazione dell'immobile.