'They did not have a word': the parental quest to locate a 'true sex' for their intersex children

Given the paucity of research in this area, the primary aim of this study was to explore how parents of infants with unclear sex at birth made sense of 'intersex'. Qualitative methods were, used (semi-structured interviews, interpretative phenomenological analysis) with 10 parents to generate pertinent themes and provide ideas for further research. Our analysis highlights the fundamental shock engendered by the uncertain sex status of children, and documents parental struggles to negotiate a coherent sex identity for their children. Findings are discussed in light of the rigid two-sex system which pervades medicine and everyday life, and we argue that greater understanding of the complexity of sex and gender is required in order to facilitate better service provision and, ultimately, greater informed consent and parental participation regarding decisions about their children's status.

Mothers' attributions following their child's diagnosis of autistic spectrum disorder: exploring links with maternal levels of stress, depression and expectations about their child's future

Although the impact of autism spectrum disorders (ASDs) on the family is well recognized, the way mothers attempt to make sense of the diagnosis is largely unexplored. However, in other disabilities, attributions have been shown to predict a variety of outcomes including maternal wellbeing and engagement in treatment. Using Weiner's (198S) three-dimensional model, 16 mothers were interviewed to examine the nature and impact of their beliefs about their child's ASD using semi-structured interviews and measures of depression, parenting stress and expectations for their child's future. The findings suggested that mothers made a diverse and complex range of attributions that were consistent with Weiner's dimensions of locus of cause, stability and controllability. The nature of their attributions reflected particular difficulties associated with ASDs, such as uncertainties regarding cause and prognosis. Taking account of mothers' search for meaning will better enable professionals to support families following diagnosis.

A qualitative exploration of the underlying causes of preventable drug-related morbidity in primary care, resulting in hospitalisation

This study has explored the underlying causes of preventable drug-related admissions to hospital, from primary care through semi-structured interviews and review of patients’ medical records. Analysis of the data has revealed that communication failures between different groups of healthcare professionals and between healthcare professionals and patients contribute to preventable drug-related admissions, as do knowledge gaps about medication in both healthcare professionals and patients. In addition, working conditions for community pharmacists severely limit their ability to effectively act as a safety barrier to patients receiving inappropriate medication. Limitations include heavy workloads, lack of access to patients’ clinical information, poor relationships with general practitioners and time restrictions. The results of this study represent an important addition to our understanding of the contribution of human error as an underlying cause of preventable drug-related morbidity, and the factors which contribute to errors occurring in the primary healthcare setting.

An experimental approach to project risk identification and prioritization

One of the aims of a broad ethnographic study into how the apportionment of risk influences pricing levels of contactors was to ascertain the significant risks affecting contractors in Ghana, and their impact on prices. To do this, in the context of contractors, the difference between expected and realized return on a project is the key dependent variable examined using documentary analyses and semi-structured interviews. Most work in this has focused on identifying and prioritising risks using relative importance indices generated from the analysis of questionnaire survey responses. However, this approach may be argued to constitute perceptions rather than direct measures of the project risk. Here, instead, project risk is investigated by examining two measures of the same quantity; one ‘before’ and one ‘after’ construction of a project has taken place. Risks events are identified by ascertaining the independent variables causing deviations between expected and actual rates of return. Risk impact is then measured by ascertaining additions or reductions to expected costs due to the occurrence of risk events. So far, data from eight substantially complete building projects indicates that consultants’ inefficiency, payment delays, subcontractor-related problems and changes in macroeconomic factors are significant risks affecting contractors in Ghana.

Understanding UK construction professional services exports: definitions and characteristics

Services are very important to the UK balance of trade; a surplus has been recorded for trade in services every year since 1966. Construction professional services exports (CPS), which cover architecture, engineering and surveying (AES), have also increased, contributing over £3bn to the UK trade balance in 2007. The changing environment of construction professional services exports complicates the validity of the characteristics and definitions of services as described in the research literature and official export statistics. Through semi-structured interviews undertaken with large consulting engineers and a round-table discussion with industry and government representatives, the research found that the impact of globalisation and the changes in the construction business environment, such as increasing foreign ownership and changing forms of procurement, are not fully reflected in the official statistics. There have also been rapid changes in technology, procurement and methods of delivery which have impacted exporting AES firms and a more appropriate set of characteristics is needed to better reflect the project-specific and knowledge-intensive nature of AES firms.

Working together? Parent and local authority views on the process of obtaining appropriate educational provision for children with autism spectrum disorders

Background: There is general agreement across all interested parties that a process of working together is the best way to determine which school or educational setting is right for an individual child with autism spectrum disorder. In the UK, families and local authorities both desire a constructive working relationship and see this as the best means by which to reach an agreement to determine where a child should be educated. It has been shown in published works 1 1. Batten and colleagues (Make schools make sense. Autism and education: the reality for families today; London: The National Autistic Society, 2006). View all notes that a constructive working relationship is not always achieved. Purpose: This small-scale study aims to explore the views of both parents and local authorities, focussing on how both parties perceive and experience the process of determining educational provision for children with autism spectrum disorders (ASD) within an English context. Sample, design and method: Parental opinion was gathered through the use of a questionnaire with closed and open responses. The questionnaire was distributed to two national charities, two local charities and 16 specialist schools, which offered the questionnaire to parents of children with ASD, resulting in an opportunity sample of 738 returned surveys. The views of local authority personnel from five local authorities were gathered through the use of semi-structured interviews. Data analyses included quantitative analysis of the closed response questionnaire items, and theme-based qualitative analysis of the open responses and interviews with local authority personnel. Results: In the majority of cases, parents in the survey obtained their first choice placement for their child. Despite this positive outcome, survey data indicated that parents found the process bureaucratic, stressful and time consuming. Parents tended to perceive alternative placement suggestions as financially motivated rather than in the best interests of the child. Interviews with local authority personnel showed an awareness of these concerns and the complex considerations involved in determining what is best for an individual child. Conclusions: This small-scale study highlights the need for more effective communication between parents of children with ASDs and local authority personnel at all stages of the process

Innovation in facilities management: from trajectories to ownership

Purpose – Innovation in facilities management (FM) is a complex process as FM is a diverse discipline. This paper aims to use innovation trajectories to explore this complex process through the introduction of a technology innovation in two FM services of security and workspace management. It also aims to consider the discourse of individuals within their trajectory to understand their positions toward the innovation. Design/methodology/approach – A two-year case study was conducted and it was based in an in-house FM department that was part of a financial institution. The specific methods used for the paper were semi-structured interviews with key participants of the project. Critical discourse analysis was used to examine the data. Findings – Individuals who were involved in introducing the technology to the FM department were both internal and external to FM as innovation in FM does not happen in isolation to the organisation. Innovation trajectories were often intertwined or occurred simultaneously during the process of a project which sometimes resulted in conflict. Tensions within the discourse of ownership of the project were particularly apparent as this discourse had a power dimension in driving the project through to implementation. Research limitations/implications – The research is limited by being a single case study so it is not possible to generalise findings but the findings may have resonances with other organisations. Originality/value – The paper presents an original idea about how to understand innovation processes in FM services.

Water reuse for irrigation in Jordan: perceptions of water quality among farmers

The reuse of treated wastewater (reclaimed water) for irrigation is a valuable strategy to maximise available water resources, but the often marginal quality of the water can present agricultural challenges. Semi-structured interviews were held with Jordanian farmers to explore how they perceive the quality of reclaimed water. Of the 11 farmers interviewed who irrigate with reclaimed water directly near treatment plants, 10 described reclaimed water either positively or neutrally. In contrast, 27 of the 39 farmers who use reclaimed water indirectly, after it is blended with fresh water, viewed the resource negatively, although 23 of the indirect reuse farmers also recognised the nutrient benefits. Farmer perception of reclaimed water may be a function of its quality, but consideration should also be given to farmers’ capacity to manage the agricultural challenges associated with reclaimed water (salinity, irrigation system damage, marketing of produce), their actual and perceived capacity to control where and when reclaimed water is used, and their capacity to influence the quality of the water delivered to the farm.

Provider diversity in the English NHS: a study of recent developments in four local health economies

Objectives: The overall objective of the research was to assess the impact of provider diversity on quality and innovation in the English NHS. The aims were to map the extent of diverse provider activity, identify the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organisations within the NHS, and the factors that affect the entry and growth of new private and TSOs. Methods: Case studies of four Local Health Economies (LHEs). Data included: semi-structured interviews with 48 managerial and clinical staff from NHS organizations and providers from the private and Third Sector; some documentary evidence; a focus group with service users; and routine data from the Care Quality Commission and Companies House. Data collection was mainly between November 2008 and November 2009. Results: Involvement of diverse providers in the NHS is limited. Commissioners’ local strategies influence degrees of diversity. Barriers to the entry for TSOs include lack of economies of scale in the bidding process. Private providers have greater concern to improve patient pathways and patient experience, whereas TSOs deliver quality improvements by using a more holistic approach and a greater degree of community involvement. Entry of new providers drives NHS Trusts to respond by making improvements. Information sharing diminishes as competition intensifies. Conclusions: There is scope to increase the participation of diverse providers in the NHS, but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.

Dimensionalising on- and off-line brands' composite equity

This paper approaches the subject of brand equity measurement on and offline. The existing body of research knowledge on brand equity measurement has derived from classical contexts; however, the majority of today's brands prosper simultaneously online and offline. Since branding on the Web needs to address the unique characteristics of computer-mediated environments, it was posited that classical measures of brand equity were inadequate for this category of brands. Aaker's guidelines for building a brand equity measurement system were thus followed and his brand equity ten was employed as a point of departure. The main challenge was complementing traditional measures of brand equity with new measures pertinent to the Web. Following 16 semi-structured interviews with experts, ten additional measures were identified.

Coping with linguistic challenges in UK higher education: the use of strategies by Chinese research students

The present study sets out to examine the strategies used by Chinese learners in a predominantly naturalistic environment and how such learner strategy use relates to their proficiency in the second language. Data were collected from four Chinese research students in the UK using semi-structured interviews. Their proficiency in English was assessed with an oral interview and a listening test. The main findings from this study are that the learners used a wide range of strategies overall, including metacognitive, cognitive, social/affective and compensation strategies. The majority of the commonly reported strategies were metacognitive strategies, suggesting that the learners were self-directed and attempting to manage their own learning in an informal context. They also showed idiosyncrasies in their use of learner strategies. Attempts to explain the learners’ strategy use in relation to their levels of proficiency in English and contextual factors, as well as several other factors, are offered. Implications for target-country institutions in terms of the provision of support to Chinese students are discussed.

Motivation in second language acquisition in Chinese research students in the UK

The present study sets out to examine motivation to learn English by Chinese research students in an informal setting. Data were collected, using semi-structured interviews, from four research students at two points in time during their first year in the UK. The main findings are: they believed that learning English was important; their main goal orientations were instrumental and extrinsic; they set learning goals and persisted to attain them; they valued their current learning environment in general and saw it as supportive of their goals; they held both positive and negative attitudes towards the British, which had differential effects on their motivation; their self-perceived support seemed to have a positive impact on their motivation and the development of self-confidence; they tended to attribute their success to stable causes such as the environment and failure to unstable but controllable causes such as effort. It is concluded that qualitative data of this kind may complement insights from quantitative research. Implications for target country institutions in the provision of support are discussed.

Reflective practice among MATESOL graduates in the UAE: theoretical construct or ongoing benefit?

Many teacher training programs, including the MATESOL program at the American University of Sharjah (AUS) in United Arab Emirates, encourage their trainees to reflect on their practice. However, whether or not reflection becomes a part of the trainees’ practice once they leave these programs is a thought-provoking question, which formed the core of the current study. The study was qualitative in nature, using interviewing as its method of data collection. The researcher conducted semi-structured interviews with four AUS MATESOL program graduates, and investigated their perceptions of and engagement with reflective practice. The findings of the study indicate that the participants have generally developed an understanding of and appreciation for reflection and reflective practice, are aware of its values, and use different forms of reflection in order to reflect on their practice. However, some of them hold some uncertainties and misconceptions about reflective practice and its different aspects.

The Huntington's Disease health-related Quality of Life questionnaire (HDQoL): a disease-specific measure of health-related quality of life

Hocaoglu MB, Gaffan EA, Ho AK. The Huntington's disease health-related quality of life questionnaire: a disease-specific measure of health-related quality of life. Huntington's disease (HD) is a genetic neurodegenerative disorder characterized by motor, cognitive and psychiatric disturbances, and yet there is no disease-specific patient-reported health-related quality of life outcome measure for patients. Our aim was to develop and validate such an instrument, i.e. the Huntington's Disease health-related Quality of Life questionnaire (HDQoL), to capture the true impact of living with this disease. Semi-structured interviews were conducted with the full spectrum of people living with HD, to form a pool of items, which were then examined in a larger sample prior to data-driven item reduction. We provide the statistical basis for the extraction of three different sets of scales from the HDQoL, and present validation and psychometric data on these scales using a sample of 152 participants living with HD. These new patient-derived scales provide promising patient-reported outcome measures for HD.

Understanding the barriers to real estate investment in developing economies

Baum (2008a) related the number of real estate funds investing in developing economies to simple economic and demographic variables, and showed that, while the popularity of markets was explained by population and GDP per capita, some countries receive more or less investment than the model predicted. Why is this? In this paper we undertake a literature review to identify the barriers which inhibit international real estate investment. We test our initial findings by questioning property investment professionals through semi-structured interviews. By doing this we were able to verify our list of barriers, identify those barriers which are most likely to affect real estate investors, and to indicate whether there are any real estate-specific variables that create barriers which have not received any academic attention. We show that distortions in international capital flows may be explained by a combination of these formal and informal barriers.