“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.

The Development of Entrepreneurial Drive During the University Business School Experience

This research investigates changes in entrepreneurial drive (ED) between each of the three-year levels of students at an undergraduate UK university business school in order to test this measurement construct within a European context. The research adopted a quantitative approach to determine whether the ED measurement instrument could identify differences in the students’ ED dimensions and the overall ED across the three different years of undergraduate study. The data was subjected to principle component analysis to create factor scores for the ED components and the multivariate analysis of variance tests to determine whether different year groups exhibited different levels of ED. The research found that the total ED score increased at each successive year level. In addition, the achievement motivation, proactive disposition, and self-efficacy factors (dimensions) all increased during the university experience. As such, this research confirms the value of the ED measurement instrument in assessing the development of entrepreneurial drive within a European higher education setting.

Designing for User-facing Uncertainty in Everyday Sensing and Prediction

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

Improving Patients’ Experience and Outcome of Total Joint Replacement: the RESTORE Programme

BACKGROUND: Total hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected. OBJECTIVE: To undertake a programme of research studies to work towards improving patient outcomes after THR and TKR. METHODS: We used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement. RESULTS: Systematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test. CONCLUSIONS: The RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.

Biliary duct injuries in the laparoscopic era: our experience

Aim. The main aim of our study is to evaluate the incidence, the type, the causes and the therapy of biliary duct injuries which occurred after the video laparoscopic cholecystectomies performed in our Department during the period from 1990 to 2012. Patients and methods. A retrospective analysis of 1186 VLC has been made in our Department from March 1990 to June 2012. Before the cholecystectomy all patient were evaluated with trans abdominal echography. Beyond the incidence of BDI was evaluated damaging mechanism, etiology, therapy and time of diagnosis. Results. From 1990 to 2012 a total of 9 BDIs occurred, with an incidence of 0,75%. Out of 9 patients 4 had major lesions and 5 had minor lesions; the most common BDI was Strasberg A (45%), the most common etiology was the presence of anatomical variations. In four cases the diagnosis has been intraoperative, in five cases has been postoperative. Conclusions. Our clinical experience shows that the main cause of BDI are the surgeon experience and the bile ducts anatomical variation.

Student digital experience tracker 2016: results from the pilot project

Building on funded work on the experiences of today’s digital students http://bit.ly/jiscdigistudent (2014-2015) and feedback from stakeholders, Jisc piloted a tracker tool with 24 education providers in Higher education (HE) and Further Education (FE) and skills. The aim of the tracker is to provide a snapshot of learners’ digital experiences at a training provider, college or university so that education providers can better understand this aspect of the learning experience. This survey report highlights key findings from the tracker pilot.

KANGAROO CARE: MATERNAL PERCEPTION OF THE EXPERIENCE IN THE NEONATAL INTENSIVE CARE UNIT

Objective: To investigate the maternal perception of the experience in the first phase of the Kangaroo Mother Care Method in the Neonatal Intensive Care Unit (NICU). Methods: Descriptive, exploratory and qualitative study, conducted in the period from August to October 2014, with 10 mothers of newborn preterm (NP) infants, who were admitted to the Maternity School Assis Chateaubriand (MEAC) in Fortaleza, Brazil, and had received skin-to-skin contact through the Kangaroo Care Method during hospitalization in the NICU. Data was collected by semi-structured interview, directed by guiding questions. Content analysis was used for processing the data, being established four categories: “The bond and the attachment”, “Maternal competence”, “The fear of losing the baby” and “The importance of the multidisciplinary team”. Results: The Kangaroo Care Method is a safe and pleasurable practice for mothers and relatives, in addition to providing social and psychoaffective benefits, found in the imagery of the method institutionalization and in the mothers’ experience when properly supported. The meanings of the maternal feelings of apprehension as a result of the first physical contact with the hospitalized child can be evidenced. Regarding the evaluation of its clinical practice, this method has provided better development of the newborn infant and a reduction in hospital stay. Conclusion: The study shows relevance, since the evidence of the maternal perception of this method supports its establishment as a mandatory practice in maternity hospitals, in view of the benefits to the mother and the neonate.

Reimagining the Public Library as Public Space

Once regarded as the public’s center of knowledge and information, public libraries today are challenged by the rise of mobile technology and the Internet. Information behavior of everyday library patrons have transformed to rely on instant access of information through Google search instead of the resources housed in their local libraries. The focus of public library design is shifting from storing & protecting valuable resources (books) to the experience of an active public space of learning, engaging and reading. This thesis reimagines a public library branch in East Baltimore City by evaluating the architecture of public library examples of the past and of today. By understanding the user experience of the three key elements of public library design – procession, services & flexible space - a new public library design that engages and responds to the local community can be proposed.

The Indistinct Edge: Reconnecting Experience in Nature and Architecture

This thesis explores how architectures sense of place is rooted in the natural environment. The built environment has been constructed to protect and sustain human culture from the weathering of nature. Separating experience from the natural environment removes a sense of place and belonging in the natural and reinforces architectural dominance. This separation distinguishes the natural world as an article of spectacle and gives the human experience an unnatural voyeurship to natural changes. By examining the fusion of architectural and natural edges this thesis analyzes how the human experience can reconnect with a naturalistic sense of place through architecture, blending the finite edge where architecture maintains nature, and adapting buildings to the cycles of the environment. Removing dominance of man-made spaces and replacing them with the cohabitation of the edge between built and natural forms.

Teaching Through Technology – the Experience of Bulgarian Teachers

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2016

What public experience may be - on publicity, communication and the expression of lived experiences

The idea of public experience is often invoked in different social and academic contexts. However, it seldom deserved a reflection that specifically sought to deepen its meaning from the point of view of social life. In this article we contribute to the understanding of the uniqueness of the public form of experience. We believe that one of the best ways through which we can observe the public experience is by the objectification, performance and dramatization of the culture, i.e., the “expression of lived experiences”. There is, in publicity, the possibility of simultaneous allocation of individual and collective experiences, and it is in this sense that we can see how culture influences the shaping of experience itself. Public experience is characterized by the weaving and intertwining of singular experiences that are pluralized and plural lived experiences that are singularized, in a process where individual and society interpenetrate. The relationship between experience and publicity arises from this symbolic communion contained in the systems of thought and action of societies. The decisive role of the principle of publicity to experience consists, according with the hypothesis we wish to put forward, in making available and communicating the social world of symbolic (cultural) activity. Public experience is, then, envisaged as the experience of a common world where both singular and plural definitions of the individual (taken as society) converge through lived experiences and, particularly, through their expression, which can take different symbolic forms.

Gender, class and the household economy in Scotland in the ‘Age of affluence’

From early 1950s to the early 1970s Britain is said to have experienced an ‘age of affluence’. Whilst material conditions for many households improved in these decades, this detailed examination of budget management processes shows that for many working-class households, these gains were the product of hard work and careful money management. Using oral history methodology, this thesis explores lived experiences of the household economy to illuminate these qualifications to ‘affluence’. In so doing, this thesis advances analysis which considers the relationship between the macro-level economic conditions of affluence and the everyday economic realities of households in the post-war period. The thesis examines the operation of the household economy and shows how working-class households utilised domestic labour, budgeting, paid work, credit and thrift to make ends meet, as well as to achieve ‘affluence’. Further, by exploring these areas of the household economy, this thesis shows that gendered ideology continued to preserve power and material inequalities between men and women. Although considerable change did occur, particularly involvement in the paid labour market, domestic responsibilities continued to be an important focus of women’s identities and the effective performance of these duties by women remained central to the success of the household. This thesis represents a fresh focus on how the exploration of everyday life, including the salience of ideological continuities in shaping experience, can qualify and refine our understanding of twentieth century economic and social change, and contributes to socio-historical understandings of ‘affluence’ and its intersections with the household, gender, and class.

What public experience may be - on publicity, communication and the expression of lived experiences

The idea of public experience is often invoked in different social and academic contexts. However, it seldom deserved a reflection that specifically sought to deepen its meaning from the point of view of social life. In this article we contribute to the understanding of the uniqueness of the public form of experience. We believe that one of the best ways through which we can observe the public experience is by the objectification, performance and dramatization of the culture, i.e., the “expression of lived experiences”. There is, in publicity, the possibility of simultaneous allocation of individual and collective experiences, and it is in this sense that we can see how culture influences the shaping of experience itself. Public experience is characterized by the weaving and intertwining of singular experiences that are pluralized and plural lived experiences that are singularized, in a process where individual and society interpenetrate. The relationship between experience and publicity arises from this symbolic communion contained in the systems of thought and action of societies. The decisive role of the principle of publicity to experience consists, according with the hypothesis we wish to put forward, in making available and communicating the social world of symbolic (cultural) activity. Public experience is, then, envisaged as the experience of a common world where both singular and plural definitions of the individual (taken as society) converge through lived experiences and, particularly, through their expression, which can take different symbolic forms.

The Experience of Adult Literacy as a Learning Process in the Formation of Future Educators

Learning is constructed when it is significant, therefore, promoting experiences that can make sense and joy, which constitutes a challenge in the formation of future educators. In this article, we share the considerations emanated from an investigation that gathers the experience of alphabetizing adults, carried out by college students as part of their formation. As a result, this creates a learning process that favors the respect to diversity and the value of reading and writing as the liberation of mankind. The work displays the learnings constructed, the ways of respecting diversity that emerge from the alphabetizing experience, and the value that the students give to reading and writing as a liberating way of expression.

Thyroid nodules and differentiated thyroid cancer: update on the Brazilian consensus

Thyroid nodules are frequent findings, especially when sensitive imaging methods are used. Although thyroid cancer is relatively rare, its incidence is increasing, particularly in terms of small tumors, which have an uncertain clinical relevance. Most patients with differentiated thyroid cancer exhibit satisfactory clinical outcomes when treatment is appropriate, and their mortality rate is similar to that of the overall population. However, relapse occurs in a considerable fraction of these patients, and some patients stop responding to conventional treatment and eventually die from their disease. Therefore, the challenge is how to identify the individuals who require more aggressive disease management while sparing the majority of patients from unnecessary treatments and procedures. We have updated the Brazilian Consensus that was published in 2007, emphasizing the diagnostic and therapeutic advances that the participants, representing several Brazilian university centers, consider most relevant in clinical practice. The formulation of the present guidelines was based on the participants' experience and a review of the relevant literature.