Constructing Personal and Couple Narratives in Late Stage Cancer: A Narrative Analysis

An increasing number of people with terminal cancer are being cared for at home, often by their partner. This study explores the identity, experiences and relationships of people caring for their partner at the end of life and how they construct their experience through personal and couple narratives. It draws upon dialogical approaches to narrative analysis to focus on caring partners and the care relationship. Six participants were recruited for the study. Two methods of data collection are used: narrative interviews and journals. Following individual case analysis, two methods of cross-narrative analysis are used: an analysis of narrative themes and an identification of narrative types. The key findings can be summarised as follows. First, in the period since their partner's terminal prognosis, participants sustained and reconstructed self and couple relationship narratives. These narratives aided the construction of meaning and coherence at a time of major biographical disruption: the anticipated loss of a partner. Second, the study highlights the complexity of spoken and unspoken narratives in terminal cancer and how these relate to individual and couple identities. Third, a typology of archetypal narratives based upon the data is identified. The blow-by-blow narratives illustrate how participants sought to construct coherence and meaning in the illness story, while champion and resilience narratives demonstrate how participants utilised positive self and relational narratives to manage a time of biographical disruption. The study highlights how this narrative approach can enhance understanding of the experiences and identities of people caring for a terminally ill partner.

My Ideal School: A Personal Construct Psychology Approach to Understanding the School Constructs of Children Described as Anxious

This research explores the school constructs of children described as anxious. Little research exists that looks at understanding children’s school-related anxiety through the lens of Personal Construct Psychology (PCP). This qualitative research design includes semi-structured interviews that followed a PCP theoretical framework. The interviews were carried out with five children aged between 7 and 11, who attended state schools in Malta, and who were experiencing school-related anxiety. Participants were asked to comment and produce drawings about the kind of school they would like to attend (their ideal school), and the kind of school they would not like to attend. The children’s constructs were organised according to whether they related to adults in school, their peers, the school and classroom environment, and the participants themselves in each of these two imaginary schools. Participants were also asked to think of how the school they currently attend can become more like their ideal school. Findings indicate the importance of relationships between teachers and pupils, relationships amongst pupils themselves, a positive learning environment within the classroom and the belongingness to a common value system and school ethos to which anxious children can relate. This research aims to shed light on the responsibility of professionals working with children with school-related anxiety to look beyond within-child factors and understand possible stressors in the child’s environment as potentially contributing to heightening their anxiety.

Images of Africa and the resilience of ignorance

Images about Africa in the northern hemisphere are generally negative and pessimistic. In spite of instant global communication, why have these images persisted till date? This contribution shall revisit these perceptions and the images embodying them to unearth the motivations and rationale. The central argument, based on some narratives and experiences, is that ignorance feeds these images and stereotypes. Furthermore, positionality of non-African experts and some groups of African scholars and activists contribute to this culture of ignorance and paternalism. The contribution shall end with an ethical evaluation of the persistence of the images and the extent of moral responsibility of the authors and carriers of the racist stereotypes embedded in the images. (DIPF/Orig.)

The Welsh Marches: Resilient Farmers? Exploring Farmers' Resilience to Extreme Weather Events in the Recent Past

In the 21st century climate change will cause a significant increase in the frequency and intensity of extreme weather events across Europe. Investigating farmers’ resilience to extreme weather events in the past can be used to establish the inherent level of resilience farmers’ will have to respond to comparable events in the future. The Welsh Marches has experienced a range of extreme weather events including: heatwaves, flooding; prolonged rainfall; and heavy snowfall. To identify the resilience of farmers in the Marches farmers’ apparent vulnerabilities, coping capacity, social capital and adaptive capacity that have been exposed in past events are discussed. Rural isolation is identified as an exacerbating factor of farming vulnerability. Yet, this is also an apparent source of resilience as farmers are found to rely on high social capital to assist each other in emergency and challenging situations during extreme weather events. The paper concludes by indicating that more localised studies are required, situated within unique farming cultures. This will enable a more complete picture of farmers’ resilience across Europe to be established.

The Role of Perceived Social Support, Resilience, and Depression on Communicative Participation in Head and Neck Cancer Survivors

Thesis (Master's)--University of Washington, 2016-08

Assessing the resilience of water supply systems in Oman

Water systems in the Sultanate of Oman are inevitably exposed to varied threats and hazards due to both natural and man-made hazards. Natural disasters, especially tropical cyclone Gonu in 2007, cause immense damage to water supply systems in Oman. At the same time water loss from leaks is a major operational problem. This research developed an integrated approach to identify and rank the risks to the water sources, transmission pipelines and distribution networks in Oman and suggests appropriate mitigation measures. The system resilience was evaluated and an emergency response plan for the water supplies developed. The methodology involved mining the data held by the water supply utility for risk and resilience determination and operational data to support calculations of non-revenue water. Risk factors were identified, ranked and scored at a stakeholder workshop and the operational information required was principally gathered from interviews. Finally, an emergency response plan was developed by evaluating the risk and resilience factors. The risk analysis and assessment used a Coarse Risk Analysis (CRA) approach and risk scores were generated using a simple risk matrix based on WHO recommendations. The likelihoods and consequences of a wide range of hazardous events were identified through a key workshop and subsequent questionnaires. The thesis proposes a method of translating the detailed risk evaluations into resilience scores through a methodology used in transportation networks. A water audit indicated that the percentage of NRW in Oman is greater than 35% which is similar to other Gulf countries but high internationally. The principal strategy for managing NRW used in the research was the AWWA water audit method which includes free to use software and was found to be easy to apply in Oman. The research showed that risks to the main desalination processes can be controlled but the risk due to feed water quality might remain high even after implementing mitigation measures because the intake is close to an oil port with a significant risk of oil contamination and algal blooms. The most severe risks to transmission mains were found to be associated with pipe rather than pump failure. The systems in Oman were found to be moderately resilient, the resilience of desalination plants reasonably high but the transmission mains and pumping stations are very vulnerable. The integrated strategy developed in this study has a wide applicability, particularly in the Gulf area, which may have risks from exceptional events and will be experiencing NRW. Other developing countries may also experience such risks but with different magnitudes and the risk evaluation tables could provide a useful format for further work.

“PROSPERING BECAUSE THAT’S ITS HISTORY”: BLACK RESILIENCE AND HONORS DEVELOPMENT IN HIGHER EDUCATION: MORGAN STATE UNIVERSITY AND THE STATE OF MARYLAND, 1867-1988

This study explores the origins and development of honors education at a Historically Black College and University (HBCU), Morgan State University, within the context of the Maryland higher education system. During the last decades, public and private institutions have invested in honors experiences for their high-ability students. These programs have become recruitment magnets while also raising institutional academic profiles, justifying additional campus resources. The history of higher education reveals simultaneous narratives such as the tension of post-desegregated Black colleges facing uncertain futures; and the progress of the rise and popularity of collegiate honors programs. Both accounts contribute to tracing seemingly parallel histories in higher education that speaks to the development of honors education at HBCUs. While the extant literature on honors development at Historically White Institutions (HWIs) of higher education has gradually emerged, our understanding of activity at HBCUs is spotty at best. One connection of these two phenomena is the development of honors programs at HBCUs. Using Morgan State University, I examine the role and purpose of honors education at a public HBCU through archival materials and oral histories. Major unexpected findings that constructed this historical narrative beyond its original scope were the impact of the 1935/6 Murray v Pearson, the first higher education desegregation case. Other emerging themes were Morgan’s decades-long efforts to resist state control of its governance, Maryland’s misuse of Morrill Act funds, and the border state’s resistance to desegregation. Also, the broader histories of Black education, racism, and Black citizenship from Dred Scott and Plessy, the 1863 Emancipation Proclamation to Brown, inform this study. As themes are threaded together, Critical Race Theory provides the framework for understanding the emerging themes. In the immediate wake of the post-desegregation era, HBCUs had to address future challenges such as purpose and mission. Competing with HWIs for high-achieving Black students was one of the unanticipated consequences of the Brown decision. Often marginalized from higher education research literature, this study will broaden the research repository of honors education by documenting HBCU contributions despite a challenging landscape.

A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Dynamic Coculture of a Prevascularized Engineered Bone Construct

The generation of functional, vascularized tissues is a key challenge for the field of tissue engineering. Before clinical implantations of tissue engineered bone constructs can succeed, in vitro fabrication needs to address limitations in large-scale tissue development, including controlled osteogenesis and an inadequate vasculature network to prevent necrosis of large constructs. The tubular perfusion system (TPS) bioreactor is an effective culturing method to augment osteogenic differentiation and maintain viability of human mesenchymal stem cell (hMSC)-seeded scaffolds while they are developed in vitro. To further enhance this process, we developed a novel osteogenic growth factors delivery system for dynamically cultured hMSCs using microparticles encapsulated in three-dimensional alginate scaffolds. In light of this increased differentiation, we characterized the endogenous cytokine distribution throughout the TPS bioreactor. An advantageous effect in the ‘outlet’ portion of the uniaxial growth chamber was discovered due to the system’s downstream circulation and the unique modular aspect of the scaffolds. This unique trait allowed us to carefully tune the differentiation behavior of specific cell populations. We applied the knowledge gained from the growth profile of the TPS bioreactor to culture a high-volume bone composite in a 3D-printed femur mold. This resulted in a tissue engineered bone construct with a volume of 200cm3, a 20-fold increase over previously reported sizes. We demonstrated high viability of the cultured cells throughout the culture period as well as early signs of osteogenic differentiation. Taking one step closer toward a viable implant and minimize tissue necrosis after implantation, we designed a composite construct by coculturing endothelial cells (ECs) and differentiating hMSCs, encouraging prevascularization and anastomosis of the graft with the host vasculature. We discovered the necessity of cell to cell proximity between the two cell types as well as preference for the natural cell binding capabilities of hydrogels like collagen. Notably, the results suggested increased osteogenic and angiogenic potential of the encapsulated cells when dynamically cultured in the TPS bioreactor, suggesting a synergistic effect between coculture and applied shear stress. This work highlights the feasibility of fabricating a high-volume, prevascularized tissue engineered bone construct for the regeneration of a critical size defect.

Urban Retrofit and Resilience: The challenge of Energy Efficiency and Vulnerability

Urban retrofit is becoming increasingly established as one of the most effective solutions to contain the energy consumption of the existing building stock, to reduce vulnerability to natural and man-made risk and generally improve the quality of built space. However, the planning of retrofit interventions at urban scale should take account of the actual feasibility of measures lest they remain only on paper. This contribution supplies an overview of the many issues related to the subject of urban regeneration, proposing a procedure to identify practical interventions to minimize costs and maximize benefits, in terms of energy efficiency, an increase in resilience and improvement in the quality of the building stock. This procedure was applied to a case study of a neighborhood in the city of Naples, a high-density urban area which is particularly vulnerable to volcanic and seismic risk, and to risks due to climate change.

Adaptability, Transformation and Complex Changes in Namibia and Tanzania: Resilience and Innovation System Development in Local Communities

This thesis is a research about the recent complex spatial changes in Namibia and Tanzania and local communities’ capacity to cope with, adapt to and transform the unpredictability engaged to these processes. I scrutinise the concept of resilience and its potential application to explaining the development of local communities in Southern Africa when facing various social, economic and environmental changes. My research is based on three distinct but overlapping research questions: what are the main spatial changes and their impact on the study areas in Namibia and Tanzania? What are the adaptation, transformation and resilience processes of the studied local communities in Namibia and Tanzania? How are innovation systems developed, and what is their impact on the resilience of the studied local communities in Namibia and Tanzania? I use four ethnographic case studies concerning environmental change, global tourism and innovation system development in Namibia and Tanzania, as well as mixed-methodological approaches, to study these issues. The results of my empirical investigation demonstrate that the spatial changes in the localities within Namibia and Tanzania are unique, loose assemblages, a result of the complex, multisided, relational and evolutional development of human and non-human elements that do not necessarily have linear causalities. Several changes co-exist and are interconnected though uncertain and unstructured and, together with the multiple stressors related to poverty, have made communities more vulnerable to different changes. The communities’ adaptation and transformation measures have been mostly reactive, based on contingency and post hoc learning. Despite various anticipation techniques, coping measures, adaptive learning and self-organisation processes occurring in the localities, the local communities are constrained by their uneven power relationships within the larger assemblages. Thus, communities’ own opportunities to increase their resilience are limited without changing the relations in these multiform entities. Therefore, larger cooperation models are needed, like an innovation system, based on the interactions of different actors to foster cooperation, which require collaboration among and input from a diverse set of stakeholders to combine different sources of knowledge, innovation and learning. Accordingly, both Namibia and Tanzania are developing an innovation system as their key policy to foster transformation towards knowledge-based societies. Finally, the development of an innovation system needs novel bottom-up approaches to increase the resilience of local communities and embed it into local communities. Therefore, innovation policies in Namibia have emphasised the role of indigenous knowledge, and Tanzania has established the Living Lab network.

Resilience and Urban Risk Management

International audience

The Fourth Attempt to Construct a Politics of Welfare Obligations

Since the 1980s there have been three main attempts to ground citizenship upon the principles of duty, obligation and responsibility: conservative, communitarian and Third Way. Each of these are reviewed below. The principal task of this article, though, is to examine the emergence of a fourth attempt which, by relating duty to equality through the principle of reciprocity, represents a synthesis of traditional social democracy with the new politics of obligation. Our focus will be upon The Civic Minimum by Stuart White since this is arguably the most cogent expression of duty-based egalitarianism to have emerged in recent years. Key words: citizenship, equality, reciprocity, Basic Income

Regenerative Aquaculture: Designing for Resilience of the Chesapeake Tidewater

The Chesapeake Bay is out of balance. As the effects of decades of overharvesting, overdevelopment, and pollution have taken their toll, tidewater communities are confronted with a loss of culture, livelihood, and the environment in which they live. This thesis seeks to reframe the problem of regeneration of community and environment, through the use of resilient design. Resilient design is the process of designing for an uncertain at risk future. Through resilient design, architecture and aquaculture can be combined with food culture to foster stewardship of place. This thesis will explore interconnectedness of tidewater food culture, the waterman culture, aquaculture, and regenerative design in an effort to generate a holistic solution. The final product will consist of a methodology of planning for resilience at a framework scale, and will also propose an architectural solution that combines educational facilities with commercial aquaculture, to foster stewardship and regeneration in the Chesapeake Tidewater.