Introduction: This thesis explored National Health Service (NHS) Mental Health (MH) Peer Support Workers’ (PSWs) experiences of transitioning from their own lived experiences of MH difficulties to ...supporting other people with their MH problems. Existing literature is scarce, particularly in the United Kingdom (UK). When it is available it oversimplifies the transitional process by failing to offer more than general descriptions of benefits and challenges to enacting the role. Aims: The purpose of the study was to explore how PSWs made sense of their experience of transitioning from their own lived experience of MH difficulties to providing a service to support others with their MH difficulties. Methods: Single-site ethical approval was gained to conduct the study in one NHS Trust. All PSWs within the service were approached by the Peer Support project coordinator. Semi-structured interviews were conducted with seven participants. Interviews were transcribed verbatim and analysed using an interpretative phenomenological analysis framework. Results: Analysis of transcripts yielded three superordinate themes. They were interpreted as interdependent with interrelating subordinate themes. The superordinate themes loosely reflected a time dimension of preconceptions before entering the role, actively making sense of the role in the here-and-now and future aspirations of the role. The first, fluctuating identities, detailed participants experience of a changing social self and a feeling of reconnecting, recovering and taking control. What constrained this were the difficulties with managing multiple identities. The second, PSW role, specified the understanding of what provided certainty in the role and where there was role vagueness and difficulties. Participants also detailed the complexities around boundaries and disclosures. Finally, organisational culture, outlined participants desire to change the NHS system. Supporting attitudes and barriers were described, at an individual, service, organisational and societal level. Discussion: The findings were compared to studies conducted in the areas of peer support, role transitions and identity. This research captured the complex and variable process of the transition, involving a number of inter-relating factors that impacted on an individual’s personal, interpersonal and collective identities. Participants highlighted the juxtaposition of the PSW identity being both emancipating and constraining whilst detailing the personal impact and attempted resolutions. Conclusion: The current research has clinical implications for the MH system, in that it has a role in practically supporting interprofessional working whilst addressing possible stigma attached to the PSW role. This research advocates for PSW training to be tailored to individual need, and flexible support offered throughout the process to both PSWs and the teams receiving PSWs. Finally, psychological interventions (e.g. self-narrative identity work), could help newly appointed PSWs to articulate and co-construct their identities during the transition; contextualising professional, personal and practice development. Methodological considerations are discussed, such as retrospective data collection, difficulty in recruiting a homogenous sample and the reliance on a specific transitional point. Suggestions for future research focus on the need for further longitudinal studies to better understand the enactment of the role. It may also be beneficial to explore the experiences of recipients of peer support and other professionals who work alongside PSWs.
The diets of school children have been a major cause for concern for a considerable time. There is a whole host of evidence to suggest that inadequate dieting beginning in childhood is a major ...underlying cause of ill health in later life. The link between diet and disease is now well established, as is the need to improve the health of the nation. A number of issues have been raised in recent years including the need for nutritional standards for school meals, however, not enough has been done to eradicate these problems in schools.
This research looks into one particular provision – breakfast clubs for primary school children. Research suggests that a large proportion of school children are missing out on this vital meal and the opportunity to gain a substantial proportion of the essential daily nutrients required for adequate growth and development. Breakfast clubs are intended to provide children with the opportunity to receive a nutritious breakfast at the beginning of the day.
The objective of the work was to investigate breakfast clubs and establish how they could help to overcome some of the problems associated with poor nutrition in school children. An investigation was carried out using two samples of school children, one already attending a breakfast Club and one not. Comparisons were made between the two groups to see which was providing children with the most nutritious start to the day via a series of food diaries. It was concluded that the breakfast clubs provide children with higher intakes of all the nutrients surveyed and made a significant contribution towards improving the diets of the primary school children.
Discovery's collection was originally paper documents, but with the advent of the digital age, its collection expanded. Resolving the issue of ESI has now become important in litigation. Therefore, ...this study analyzes the requirements of each domain for electronic records to be recognized as evidence. It also explained the factors that should be considered in record management. In addition, eDiscovery in the United States was selected as an advanced case to utilize records as evidence. This study investigated the Commentary on Legal Holdings: The Trigger & The Process and analyzed which functions must be considered in order for electronic records to be preserved as evidence. To this end, we analyze the functional requirements of the eDiscovery solution. Through this, necessary functional requirements are derived to help implement the system in preparation for eDiscovery. 근래까지 증거개시의 대상은 본래 종이 문서로 제한되어 왔으나, 디지털 시대로의 전환에 발맞추어 증거개시의 대상도 확대됨에 따라 현 시점에서는 전자적으로 생성된 정보에 관한 쟁점을 해결하는 것이 소송에서 중요해졌다. 따라서 본 연구에서는 전자기록이 증거로서 인정받기 위한 각 영역의 요건을 분석하고 기록관리 관점에서 고려해야 하는 요소를 설명하였다. 특히, 증거로서 전자기록을 활용되기 위한 선진 사례로, 미국의 전자증거개시제도인 eDiscovery를 선정하여 전자적 정보가 어떻게 수집, 보존되어 최종적으로 법원에 제출되는지를 살펴보았다. 특히 증거 보존 조치 지침을 조사하여 기록이 증거로서 보존되기 위해 고려되어야 하는 요건이 무엇인지 파악하였으며, 증거력이 있는 전자기록을 제출할 수 있도록 도와주는 도구인 eDiscovery 솔루션의 기능을 분석하였다. 본 연구결과를 통해 전자증거개시를 지원하는 시스템 구현 시 실질적인 도움이 될 수 있는 필수 기능요건을 도출하였다.
My dissertation consists of three chapters. My first chapter examines the degree of earnings management by IPO issuers and further investigates which financial institutions participating in the IPO ...process play a significant role in discouraging earnings manipulation. I employ a propensity score matching technique to improve on the existing approach of measuring earnings management, and also to control for potential endogeniety. After controlling for endogeniety in these two variables, the analysis shows that underwriters, but not venture capitalists are associated with a significant decrease in earnings management. My second chapter examines the extent to which accounting information quality affects equity flotation costs. As accounting information becomes less reliable, it becomes more difficult for equity investors to evaluate a firm's true performance. This increased asymmetry information between issuers and outside investors is likely to heighten investor concerns following major firm decisions, especially when a firm plans to sell new equity securities. Using a large sample of seasoned equity offerings (SEOs), I find that poor accounting quality is associated with larger expected flotation costs measured by (1) larger underwriting fees, (2) a larger negative SEO announcement effect, and (3) a higher probability of SEO withdrawals. These results are robust to adjustments for a potential sample selection bias. My third chapter examines the frequency and determinants of lockup agreements by taking into account the conflicting incentives of SEO issuers and underwriters. My empirical analysis shows that lockups are less likely to be included in underwriting agreements when there is a greater likelihood of insider selling shortly after an offering. These two insider ownership and trading characteristics appear to act as strong countervailing forces to underwriter demands for lockup agreements. Lockup frequency is also related to underwriter concerns about changing market conditions in the industry. Specifically, lockup agreements are more likely when an issuer's industry is experiencing greater return volatility.
Enhanced Recovery After Surgery: Is a Combination of Intrathecal Opioid with Rectus Sheath Catheter a Better Alternative than an Epidural in Major Gynaecological - Oncology Surgeries?158 /300 ...CharactersBackground and GoalsEnhanced Recovery After Surgery (ERAS) is increasingly used in many other surgical specialties for encouraging a more rapid postoperative recovery but has been slow to implement in gynaecological-oncology (1) . Gynaecological-oncology surgery has made significant advances in diagnostic and operative techniques, yet advances in length of stay (LOS) and postoperative activity are yet to be seen. The objective of this study was to evaluate the influence of analgesia regimes in order to tailor an ERAS protocol specifically for this cohort of patients. Traditionally this group of patients received the current accepted standard of a general anaesthesia (GA) with thoracic epidural (TEA) u2013 Group 1(2). We proposed a modified ERAS protocol with analgesic premedication, intraoperative neuroaxial block (spinal with diamorphine) alongside the GA and postoperative rectus sheath catheters (RSC) (Bbraun On Q Pain Buster), with oral analgesia u2013 Group 2. Methods This involved a combination of an audit and observational study. There was retrospective and prospective data collection, of 86 patients who had undergone surgery over the last 12 months. The goal was to compare and contrast the proposed ERAS protocol with current practice in patients with incisions below T9, with particular focus on pain scores and postoperative activity times for, both of which directly impact length of stay (3). Data was analysed using excel and all statistics were performed using Minitab 12 with a combination of two sample T test and ANOVA GLM. Results 32 retrospective 31 prospective patient records were included in the final results. Average age and surgical time for group 2 was 61 years and 169 Minutes , For group 1 58 Years and 252 Minutes. Results showed that there was statistically better pain scores for group 2, at 36 48 and 72 hours indicating an approach of a spinal + RSC is superior to GA+TEA (Figure 1). In addition there was a significant improvement in all-postoperative activities in group 2(Figure 2)There was no statistically significant difference in postoperative patient satisfaction scores, complications or nausea and vomiting between the two groups.
La presente tesis, titulada “Genes, peoples and languages in Central Africa”, examina los patrones de diversidad genética en poblaciones del oeste de Africa central, más específicamente, poblaciones ...Bantús y Pigmeas de Gabon y Camerún, dos zonas vitales para la comprensión de la expansión Bantú. Se han analizado más de 800 muestras a nivel del cromosoma Y con el fin de caracterizar genéticamente a estas poblaciones, y establecer la relación genética entre ellas. Los resultados han demostrado que la expansión Bantú homogeneizó el acervo genético de las poblaciones Bantús, eliminando la diversidad pre-Bantú, mientras que diversificó aquel de las poblaciones Pigmeas, introduciendo linajes Bantus. Además, se ha visto que el flujo de linajes paternos parece haber tenido una única dirección: de Bantus a Pigmeos. Estos resultados contrastan con aquellos obtenidos para linajes maternos (DNA mitocondrial) en estas zonas, donde se ha observado un considerable flujo genético de Pigmeos a Bantus, sugiriendo un posible sesgo sexual en la tasa de mestizaje entre poblaciones Bantus y Pigmeas. Un hallazgo interesante es la presencia de un linaje no-africano en estas poblaciones de África subsahariana.
The present thesis titled “ Genes, peoples and languages in Central Africa” examines the genetic diversity patterns in populations from west central Africa, more specifically, in Bantu and Pygmy populations from Gabon and Cameroon, two key areas in the understanding of the Bantu expansion. More than 800 samples have been analysed at the Y chromosome level in order to genetically characterise these populations and establish the genetic relationship between them. The results have shown that the Bantu expansion largely homogenised the gene pool of Bantu populations, erasing the pre-Bantu diversity, while it diversified that of Pygmy groups, introducing Bantu lineages into their gene pool. Furthermore, gene flow of paternal lineages seems to have taken place mainly in one direction; from Bantus to Pygmies. These results contrast with those found in studies of maternal (mtDNA) lineages in these areas, where considerable gene flow from Pygmy to Bantu populations have been observed, suggesting possible sex-biased admixtures rates between Bantu and Pygmy populations. An interesting finding, is the significant presence of a non-African lineage in these sub-Saharan populations.
BackgroundDuring the adolescent growth spurt, youth athletes can experience rapid changes in centre of mass, limb length and moments of inertia, with some athletes also experiencing transient changes ...in coordination, postural and neuromuscular control. These sensorimotor system changes have been proposed to increase injury risk in adolescence due to the impact on the movement patterns of sporting and non-sporting tasks.ObjectiveTo understand if maturity status impacts unilateral sporting task performance in adolescent multisport athletesDesignCohort StudySettingField based setting within sporting clubs and academiesParticipants76 male and female athletes (n = 24 pre-PHV, n = 28 circa-PHV, n= 33 post-PHV) multisport athletes participated in this studyInterventionsSingle leg squat and single leg land were analysed via qualitative assessment of single leg loading (QASLS), maturity status was determined via non-invasive maturational equation via predicted percentage of adult stature (PAH%)Main Outcome MeasureQualitative QASLS score of movement quality, maturity statusResultsSignificant interactions were identified indicating PHV group differences of unilateral task performance for both single leg squat and single leg landing. Unilateral movement task strategies had difference prevalence at different percentages of PAH%, with an observed trend in those at the higher end of PAH% using fewer movement strategies to complete unilateral tasks than those at lower PAH%. The interaction effect between sex, maturational status and unilateral task performance was non-significant suggesting that sex specific differences did not impact multisport athlete unilateral task performance as evaluated by compound QASLS score.ConclusionsThe findings of this study support an effect of maturation on unilateral task performance by multisport athletes, with different movement strategies associated with different phases of maturational status during unilateral squatting and landing tasks. This has implications and considerations for injury, its monitoring and preventions.
The extensive genetic variation in the lipooligosaccharide (LOS) core biosynthesis gene cluster has led to the development of a classification system; with 8 classes (I-VIII) for Campylobacter coli ...(C. coli) LOS region and with 23 classes (A-W) or four groups (1-4) for Campylobacter jejuni (C. jejuni) LOS region. PCR based LOS locus type identification for C. jejuni clinical isolates from a UK hospital as well as in silico LOS locus analysis for C. jejuni and C. coli genome sequences from GenBank was carried out to determine the frequencies of various LOS genotypes in C. jejuni and C. coli. Analysis of LOS gene content in 60 clinical C. jejuni isolates and 703 C. jejuni genome sequences revealed that class B (Group 1) was the most abundant LOS class in C. jejuni. The hierarchy of C. jejuni LOS group prevalence (group 1 > group 2 > group 3 > group 4) as well as the hierarchy of the frequency of C. jejuni LOS classes present within the group 1 (B > C > A > R > M > V), group 2 (H/P > O > E > W), group 3 (F > K > S) and group 4 (G > L) was identified. In silico analysis of LOS gene content in 564 C. coli genome sequences showed class III as the most abundant LOS locus type in C. coli. In silico analysis of LOS gene content also identified three novel LOS types of C. jejuni and previously unknown LOS biosynthesis genes in C. coli LOS locus types I, II, III, V and VIII. This study provides C. jejuni and C. coli LOS loci class frequencies in a smaller collection of C. jejuni clinical isolates as well as within the larger, worldwide database of C. jejuni and C. coli.
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