School of Health Sciences

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An investigation of motor control for speech in phonologically delayed children, normally developing children and adults.
(Queen Margaret University, 1992) Waters, D. M.
Difficulty with phonological acquisition in children is currently widely regarded as a linguistic/cognitive disability but, since speech is a motor as well as a linguistic activity, speech motor control abilities must have a bearing on acquisition of the speech sound system. On the basis of previous studies, measures of speech rate and temporal variability are regarded as indices of level of speech motor control ability. Evidence was sought concerning the possibility that slow maturation of speech motor control abilities may underlie phonological delay in children. Speech timing characteristics were compared in 12 adult speakers (Group A), 12 normal preschool children (Group N, aged 3;8 years -4;10 years, mean age 4;3 years) and 12 age-matched phenologically delayed children {Group P). Measurements were made of phrase and segment durations and temporal variability in multiple tokens of an experimental phrase. The phonological structure of the speech data was also analysed and a measure of speech rate {in segments/second) was derived. The N Group were found to exhibit slower speech rates, generally longer mean phrase and segment durations and higher levels of temporal variability than the A Group. The P Group exhibited significantly slower speech rates than the N Group and there was a trend towards longer phrase and segment durations in the P Group data. With one marginal exception, no significant differences were found between the two child groups on measures of temporal variability. The weight of evidence indicated that speech motor control was less mature in the P Group than in the N Group. The findings lend some support to the view that differences in speech motor maturity may be implicated in phonological acquisition differences. Some implications for the design of therapy procedures are explored. The importance of analysing and taking account of the phonological form of speech data in investigations of speech rate is highlighted.
Spiritual aspects of nursing: a descriptive study of nurses' perceptions.
(Queen Margaret University, 1992) Waugh, L. A.
This descriptive, exploratory study examines nurses' perceptions of spiritual care. Having reviewed the literature it became apparent that the spiritual dimension can influence health, well-being and quality of life. Moreover, the nursing literature considers spiritual care part of the nurse's role, however, guidelines for its practice are absent. Research on spiritual care, particularly of British origin, is very much in its infance and nothing is known about how British nurses perceive their role in this. A conceptual framework for giving spiritual care using the Nursing Process is, therefore, offered by the researcher, although this still requires testing. The study, believed to be the first of its kind in Britain, ascertain how nurses, working in care of the elderly hospitals in Scotland, perceived spiritual need and spiritual care and professed to have given this care in practice. This was achieved by distributing a purpose designed postal questionnaire to the population of nurses (n=1170) in 1991. A response rate of 67.8% (n=793) was achieved, 58.5% (n=685) of questionnaires being usable. In addition, factors which appeared to influence the spiritual care nurses were identified. Initially clues to possible factors were obtained by conducting a certain statistical analysis using nurses' responses in the questionnaires. Further exploration of factors influencing spiritual care took place through interviewing a sample (n=12) of nurses. Findings revealed that nurses in the larger sample (n=685) seemed able to identify patients' spiritual needs and evaluate the care given, mainly through using non-verbal / indirect verbal cues displayed by patients. Nurses were, however, less willing / able to personally respond to these needs. Whereas for some nurses their reluctance to respond to patients' spiritual needs may have been due to their disclaim of responsibility for spiritual care, for others it seemed to be due to feelings of inadequacy. Charge nurses claiming religious affiliation and working on varied wards in certain geographical locations were most likely to have claimed to have identified patients' spiritual needs. However, it seemed, from the limited sample interviewed, that personal characteristics of the nurse were perhaps more important than the forementioned factors in determining the spiritual care given. Furthermore, factors relating to other professionals, the ward environment and the patient appeared to influence the way in which spiritual care was given to patients. The limitations of the study are acknowledged and the implications of the findings discussed. Given the descriptive nature of the study its prescriptive function is limited which highlights the need for further research in this important area of patient care.
Single-route and dual-route approaches to reading aloud difficulties associated with dysphasia.
(Queen Margaret University, 1999) Mack, S. K.
The study of reading aloud is currently informed by two main types of theory: modular dual-route and connectionist single-route. One difference between then theories is the type of word classification system which they favour. Dual-route theory employs the regular-irregular dichotomy of classification, whereas single-route considers body neighbourhoods to be a more informative approach. This thesis explores the reading aloud performance of a group of people with dysphasia from the two theoretical standpoints by employing a specifically prepared set of real and pseudoword stimuli. As well as being classified according to regularity and body neighbourhood, all the real word stimuli were controlled for frequency. The pseudowords were divided into two groups, common pseudowords and pseudohomophones, and classified according to body neighbourhood. There were two main phases to the study. In the first phase, the stimuli were piloted and the response time performances of a group of people with dysphasia and a group of matcehd control people were compared. In the second phase, a series of tasks was developed to investigate which means of word classification best explained the visual lexical decision and reading aloud performance of people with dysphasia. The influence of word knowledge was also considered. The data was analysed both quantitatively and qualitatively. The quantitative analysis of the number of errors made indicated that classification of items by body neighbourhood and frequency provided the more comprehensive explanation of the data. Investigation of the types of errors that were made did not find a significant relationship between word type and error type, but again the results indicated that the influence of frequency and body neighbourhood was stronger than that of regularity. The findings are discussed both in terms of their implications for the two theories of reading aloud and their relevance to clinical practice.
Consumer use of the nutritional label on food packages: a cognitive task analysis
(Queen Margaret University, Edinburgh, 2000) Higginson, Catherine Susan
An instrumental study of alveolar to velar assimilation in slow and fast speech using EPG and EMA techniques.
(Queen Margaret University, 2000) Ellis, Lucy A.
This thesis evaluates the widely-held notion that place assimilation is (i) more frequent at faster rates of speech and (ii) a gradual phonetic process. The latter view is based on previous small-scale EPG studies which showed evidence of partial alveolar assimilations lacking complete stop closure on the alveolar ridge but with a residual tongue body gesture. For the present study, EPG data from 10 speakers were collected. Two experimental sequences, /n#k/ and /ŋ#k/, embedded in meaningful sentences, were produced by subjects 10 times each in a slow/careful style and 10 times each in a fast/casual style. The first sequence captures the potential site of assimilation and the second is a lexical velar-velar sequence with which cases of complete assimilation can be compared. The results showed that, overall, assimilation was more frequent in fast speech than in careful speech, although timing analysis revealed that assimilation is not the automatic consequence of rate-induced changes in intergestural timing of /n#k/. In fast speech, six of the ten speakers showed relatively consistent assimilatory preferences: they either produced only complete assimilations or they never assimilated. However, four speakers showed considerable intra-speaker variability. Two of the four produced either full alveolars or complete assimilations in the manner of a categorical opposition (complete assimilations were indistinguishable from control /ŋ#k/ sequences). The other two speakers produced a continuum of forms that could be ranked from full alveolars to complete assimilations via partial assimilations. Using the same stimuli, a follow-up combined EPG/EMA study was carried out, the purpose of which was to look for reduced coronal gestures undetectable in tongue-palate contact-only data. Two 'categorical' assimilators were re-recorded and these gestures were not found. This supports the interpretation that for some speakers assimilation is determined at a higher level through the application of a cognitive rule, while for others variation is 'computed on-line' during speech production itself. Current phonological models of assimilation are found to be unable to capture both gradient effects and more radical feature-sized substitutions under a single framework.
The nature and use of knowledge by district nurses in decision making relating to first assessment visits.
(Queen Margaret University, 2000) Kennedy, C M.
District nurses are the largest group of community nurses in the United Kingdom and an important aspect of their role is the responsibility to assess the health needs of patients at home. To date there has been limited exploration of the knowledge or decision-making underpinning needs assessment in district nursing practice. The aim of this study was to explore knowledge in use by district nurses at the first assessment visit and the relationship of this knowledge to the decisions they make. The inherent difficulties in exploring the knowledge and decision making of experienced district nurses demanded a systematic and interpretative research approach where the impact of the context could be examined. An ethnographic approach was adopted for the study as the focus on perspectives and activities in the natural setting and the substantial reliance on observation of real examples provided a starting point for this study. Eleven district nurses were accompanied on a first assessment visit. Each district nurse was interviewed twice, immediately following the observed visit and then approximately one year later when preliminary data analysis had been undertaken. This approach to the study revealed a breadth and depth of community nursing knowledge that seemed to incorporate an amalgam of theoretical (knowing that) knowledge with practice based (knowing how) knowledge. The study findings depict the range and scope of the knowledge in use by district nurses and challenge the utility of theoretical models which remove knowledge from the context in which it is used and applied. The most striking findings relate to the influence of the context in which the DN/patient interaction takes place and the reflexive character of the assessment process. In particular, the study illuminates the ways in which DNs utilise a range of cues throughout the assessment process. The information search in assessment is often 'paced' to cope with the uncertainty that exists in many of the complex, multifaceted situations encountered by the DN. Understanding assessment as a paced process was linked to making the best judgement at the time of the first visit. A model of district nurse assessment, which seeks to illuminate the process of assessment, is presented. In particular, this model seeks to highlight the reflexive nature of the assessment process. A typology of district nursing knowledge, which conceptualises six dimensions of practice based knowing in district nursing practice, is also presented. Strategies for decision making are revealed through the application of Carroll and Johnson's (1990) theoretical framework. Recommendations are given for future research and the educational and professional context in which DN practice exists. It is suggested that further research should take cognisance of the ongoing nature of assessment in the community setting. A study conducted over a longer period of time, exploring further the impact of the context on the assessment process, seems particularly important. Given the paced approach to needs assessment and the ongoing nature of assessment identified by the study participants, it is suggested that the qualified DN should be contributing to needs assessment on a continuing basis. This recommendation is counter to recent trends in the skill/grade mix in the DN team which emphasise the need to reduce rather than increase the numbers of qualified DNs. Additionally, given the emphasis on family care by the DNs in this study, it is recommended that DNs should record and examine this important area of their work, so that this aspect of the DN role is identified and acknowledged. Finally, the importance of experiential learning depicted by the participants in this study suggests that work-based and problem-based learning approaches may be the most appropriate way in which to teach DN students about assessment. The findings are therefore important for the education of current and future DNs. This study contributes to the knowledge of assessment practice by increasing understanding of the ways DNs work in relation to the first assessment visit. The model of assessment illuminates the process of assessment and the typology aims to provide a conceptualisation of knowledge in use. Furthermore, the ways in which DNs make decisions is revealed. Therefore, the study findings can inform the education of present and future DNs to the potential benefit of patients and their carers.
Alleviating psychosocial suffering: an analysis of approaches to coping with war-related distress in Angola.
(Queen Margaret University, 2001) Eyber, Carola
This study investigates the role that the notions of trauma and culture play in relation to the alleviation of distress within an war-affected population. It analyses how local, cultural conceptions of distress and those held by psychological service providers relate to one another, and how they contribute to improving the well-being of the displaced. Fieldwork was conducted with urban and rural displaced populations in the south-eastern province of Huila in Angola. Ethnographic, psychometric and participatory methods were used to examine issues of health, illness and distress amongst the displaced. Local idioms of distress in the form of pensamentos, mutima, madness and high and low blood pressure are common ways of expressing suffering related to war. The different explanatory models held about these illnesses and the various resources available in the popular, folk and professionals sectors of the health care system were explored. The religious and spiritual domains were found to be influential in the treatment of distress-related illnesses. The psychological services available in the war-displaced communities were examined in terms of their common theoretical and practical elements. These were then analysed in relation to the conceptualisations held by local populations, and points of similarity and difference were noted. Specifically, the conceptualisation of suffering as trauma and the cultural misunderstandings that arise as a result of this, and the representation of the displaced as traumatised and therefore dependent and passive people, are discussed. A particular subgroup in the community, the adolescents, was identified and participatory methods were employed to investigate the strategies and resources this group uses for coping with war-related distress. The youths predominantly make use of distraction, conselho, religious and cultural resources. The application of a PTSD scale, the EARAT, suggests that 71% of the adolescents had symptoms of trauma consistent with a diagnosis of PTSD. It is argued that for the vast majority such a conceptualisation does not reflect the adolescents' abilities to function on social, vocational, educational and physical levels. The implications of these findings for research and practice in the field of psychosocial work are discussed.
Communication in young people with intellectual impairments: the influence of partnership.
(Queen Margaret University, 2002) Walton, A. P.
Adults with intellectual impairments experience frequent communication breakdown in their everyday interactions. This can result from impairment of the linguistic skills required for effective communication and/or difficulties dealing with non-verbal information. Problems also exist, however, in the way that some non-impaired speakers, such as care providers, approach these communicative episodes. This thesis investigates communication in young adults with intellectual impairments with three different communication partners. These were a care provider, a student and a peer with intellectual impairments. Student partners were previously unknown to the main participants and not experienced in communicating with people with intellectual impairments. Communication structure and process are investigated according to the number of words and turns used to complete a co-operative problem-solving task and the types of conversational acts used by speakers and listeners. Non-verbal communication is investigated through the use of one non-verbal signal, gaze, during the task dialogues. An interactionist approach is taken to communication, where outcome or success is viewed as a product of the collaborative efforts of speakers and listeners. Communication is seen as multi-modal and involving the exchange of information via the verbal and non-verbal channels. The results show that when both parties were intellectually impaired performance was poorest. More surprisingly, dyads including a student partner communicated more effectively and efficiently than where the partner was a carer. One reason for this may be that carers used more complex, open questions to introduce new information into the task, and these were distracting rather than useful. Overusing open questions may be problematic for this population and less effective at establishing shared understanding than where listeners check their own interpretation of previous messages, a strategy preferred by student partners. Non-verbal signals can help to ease constraints on communication by providing interlocutors with feedback information on the levels of mutual understanding.
An investigation of physical activity, influences on participation and psychological well-being in female undergraduates.
(Queen Margaret University, 2002) Bulley, C. J.
Recent health surveys have found that many young women do not participate in sufficient physical activity to produce health benefits. Consequently, they are at risk of developing cardiovascular disease, diabetes and osteoporosis in later life. The transition between secondary and higher education is associated with particular risks in relation to declining activity participation. There is clearly a need to explore the aetiology and impact of activity behaviour change in this context. A literature review identified several gaps relating to the validity of physical activity measurement, mental health benefits associated with participation and factors influencing changes in activity choices over time. Three studies were designed to address these issues in a female undergraduate population at Queen Margaret University College in Edinburgh. A theory is proposed to explain relationships between many of the variables explored. Study One aimed to validate the Scottish Physical Activity Questionnaire (SPAQ) against an estimate of time in moderate and vigorous activity derived from heart rate monitoring data. Women were monitored for three days of the seven-day recall period (N=23). Self-report and heart rate estimates of time in activity differed significantly (t test: p=0.008) and correlated poorly (r=0.03). The questionnaire was modified as a result of analysis and testing was repeated in a sample of 21 women. Modified SPAQ for students and heart rate estimates of time in activity did not differ significantly (p=0.119) and demonstrated improved correlations (r=0.59). Stage of Behaviour Change classifications also demonstrated hierarchical agreement with subjective and heart rate estimates of time in activity. Study Two aimed to establish baseline levels of exercise and moderate lifestyle physical activity in female undergraduates and to explore associations with psychological well-being over time. A large longitudinal survey was carried out using the modified SPAQ for students and psychometric measurement tools. The first survey time-point occurred at the start of the academic year and according to Stage of Behaviour Change classification 51% of participants were not active enough to achieve health benefits (n=425). The second survey was carried out two months later. Significant correlations were found between self-esteem scores and Stage of Behaviour Change classification in relation to moderate lifestyle PA (r=0.29), but not vigorous exercise. The low response to survey two (n=89) necessitated a change in methodology, implemented in the final study. Study Three aimed to explore changes in activity over the first academic year, influences on activity-related decisions and the effects of these choices on psychological well-being. Sixteen participants from the previous study sample were interviewed in a qualitative study design. Content analysis indicated that individuals frequently decreased their activity participation on entry to higher education, but some re-incorporated activity into their lifestyles over subsequent months. Many influences on activity patterns were discussed, including the negative impact of transition periods such as the summer vacation. Data analysis led to the development of the Narrative Integration Theory, which describes motivation to participate in physical activity as being influenced by the immediate affective reaction to the experience. This is reciprocally related to interacting personal, cultural, environmental and social influences and their integration into a sense of identity. Positive experiences are required to alter negative perceptions and to build feelings of competence in relation to activity participation. This thesis provides further understanding of the challenges to activity behaviour experienced by female students. Decisions relating to uptake of activity and continued participation are frequently made with conscious processing and reflect complex issues relating to personal identity and self-evaluations.
Unfolding tragedies: the impact of a mother's death on her kin and community. An ethnography from Southern Malawi.
(Queen Margaret University, 2003) Putter, C.
In examining the specific impact of a mother's death on her surviving family and community, the thesis highlights the social devastation resulting from such an event. Crucially, it argues that the increased frequency of maternal death associated with the HIV/AIDS epidemic, and the associated increase in numbers of orphaned children, have the potential to provoke full-scale destruction of traditional kinship structures and coping mechanisms. The study contributes to a gendered study of death and the resultant coping mechanisms as well as emphasizing the importance of sibling bonds in Malawian kinship. Furthermore, it provides an analysis of the current trends relating to orphan care, and suggests how these goals could be improved within the specific cultural context. The findings are based on 14 months of in situ fieldwork, during which time a totla of 78 interviews were conducted with 66 individuals, 46 of whom are case studies. Further interviews were conducted with hospital personnel, workers with orphans, and teachers, i.e. those in positions to provide social commentary. Nudist N4 software was used for data management of the interview transcripts and fieldnotes, and facilitated access to the coded data as analysis proceeded. An historical understanding of Malawi's cultural context is outlined in the introductory chapter and the entire discussion is grounded within this context. More detailed anthropological data is provided in the chapter on kinship, which emphasizes the importance of maternal kin in looking after orphans subsequent to a mother's death. Chapters on HIV and death outline how communities are besieged by illnesses surrounding HIV-infection, and how the increased death rates associated with HIV have undermined the traditional bereavement processes, and, hence, the associated coping mechanisms. The thesis concludes with a discussion of the kinds of orphan care currently available in Malawi, followed by recommendations on how the needs of orphans could better be met by development initiatives that are more suited to working with community-based organizations.
The acute and long-term effects of 3,4- methylenedioxymethamphetamine (MDMA; 'ecstasy') upon cerebral and cerebrovascular serotonergic processes.
(Queen Margaret University, 2004) Ferrington, Linda
The amphetamine derivative 3,4,-methylenedioxymethamphetamine (MDMA; Ecstasy) is a recreational drug of abuse, particularly popular among young people with whom it has formed a well-established sub-culture. MDMA is popular for its euphoria-inducing and mild stimulant properties and its popularity continues to rise despite a number of well-publicised cases of MDMA-associated fatalities and evidence of MDMA-induced acute toxicity. MDMA is known to produce an acute efflux of serotonin (5-HT) release in the brains of experimental animals, in which a marked behavioural response is also demonstrated. In the long-term MDMA causes specific neurotoxic damage to serotonergic nerve terminals, a phenomenon which is not demonstrated in other neurotransmitters. MDMA use has been associated with long-term adverse effects on both psychological and physiological health and this may represent a major public health problem given the 2 million people who use the drug in the UK alone. However, there is a perceived imbalance between the relative number of those who use MDMA and the serious adverse effects of the drug and it is possible that these may occur in a more susceptible sub-population of users. This thesis involves in vivo work using the Dark Agouti (DA) rat strain which is known to be more susceptible to MDMA and which may therefore provide an insight in this more susceptible sub-population of human MDMA users. The data presented in this thesis demonstrate that a single exposure to MDMA (15mg.kg-1) has a significal effect upon local cerebral glucose utilisation (LCMRglu) and local cerebral blood flow (LCBF) in DA rats both acutely and in the longer-term. This work demonstrates that this single dose of MDMA is neurotoxic to serotonergic neurons, inducing up to 80% depletion of serotonergic nerve terminals 6 weeks later. Furthermore, data generated from pharmacological challenges upon animals treated with MDMA 6 weeks earlier demonstrates the existence of compensatory mechanisms which act to normalise LCMRglu and LCBF, despite the persistence of serotonergic depletion. Thus this thesis extends the currently available information regarding acute and long-term effects of MDMA in a vulnerable sub-population of users and also proposes potential theories for the mechanisms of action by which pharmacological compensation for these long-term effects of MDMA-induced neurotoxicity may occur. In addition this thesis examines the effects of previous exposure to MDMA upon physiological challenges that might realistically be encountered by human users of the drug. The nature of MDMA-induced neurotoxicity suggests that human users of MDMA may suffer from untreatable chronic psychosis, and this thesis lends support to the view that currently available first line anti-depressant therapies may not be useful in the treatment of this sub-section of the population.
The pain of rheumatoid arthritis: the different perspectives of patient and rheumatologist.
(Queen Margaret University, 2005) Howden, Stella
The chronic pain associated with rheumatoid arthritis (RA) is identified by patients as a priority for treatment and is said to shape their illness experience. However, review of the literature reveals that little is known about patients' perspectives on pain in RA, with even less being known about how rheumatologists, the clinical experts in patient care, perceive this phenomenon. Increasing knowledge and understanding of patients' and rheumatologists' perspectives on pain can be used to try to influence their action/inactions as well as helping to identify patients' specific concerns and unmet needs. The aims of this study were: To describe patients' and rheumatologists' perspectives on the meaning of pain in RA; To explore how these pain meanings are constructed; and To consider the implications of these constructions for pain management. This interpretive, qualitative study used semi-structured interviews to generate accounts related to respondents' perspectives on pain in RA. Purposive sampling was used to select a heterogeneous group of patients with RA (n=29) and rheumatologists (n=16). Thematic analysis was used inductively to generate findings using a cumulative, constant comparative technique (Strauss and Corbin, 1998). Both patients and rheumatologists presented multiple pain meanings but generally viewed pain as an expected symptom of the disease, both being resigned to the belief that most patients would have some degree of daily pain. Additionally, both groups considered the pain experience to have a pervasive, negative impact on life, potentially threatening the patient's concept of 'self'. In contrast, patients' and rheumatologists' pain meanings regarding clinical topics were not similar. Patients' views of medical responsibility were narrowly difined, rooted in western biomedical conceptions of pain and were influenced by experiences of clinical interactions. Accordingly, patients viewed the rheumatologist to be responsible only for 'legitimate' pain i.e. pain associated with the body and disease processes. Rheumatologists, on the other hand, presented a more comprehensive understanding of pain by incorporating psychological and social theories along with an associated 'ideal' model of care (reflecting a biopsychosocial approach). Consequently, they identified eclectic roles/responsibilities for themselves in patient management. However, rheumatologists viewed this 'ideal' as difficult to attain in the context of their experiences of clinical work where multiple constraints were perceived to exist, such as difficulties in deciphering pain, the perception of limited resources (e.g. time) and organisational barriers. In light of this, their role was often reduced to focusing simply on disease management, thus displacing the 'ideals' of patient-centred care and perpetuating the dominant biomedical discourse of pain in the clinical context. This thesis adds to the body of knowledge about patients' perspectives on pain when they live with a chronically painful condition and patient barriers to reporting pain. New findings are presented regarding the medical experts' conceptions of pain; in particular, those related to complex clinical work. The findings also identify areas of unmet need regarding patients' knowledge of pain, pain management and of the roles and responsibilities of healthcare professionals. Suggestions are made for further work in the areas of investigating patient barriers to reporting pain; exploring patient perspectives on self-management and using alternative research methods to complement and develop the findings from this study.
Rhetoric or reality? Cross-sector policy and practice at the UK Government Department for International Development (DFID) in the UK and Nepal: an exploration of reproductive health and women's education linkages
(Queen Margaret University, 2005) Bovill, Catherine
Within the international development community, global agreement around a poverty elimination target and the Millenium Development Goals (MDGs) has led to renewed emphasis on partnership and cross-sectoral approaches. Similarly the UK Government aims to ensure policies are coherent in an increasingly complex global arena and has called for joined-up working. In response to both of these influences, the UK Government Department for International Development (DFID) stresses partnership, joining-up and cross-sectoral approaches within departmental documents. This research explores cross-sector policy and practice at DFID in the UK and Nepal and focuses particularly on cross-sectoral relationships between reproductive health and women's education. The research employs a social constructionist epistemology and utilises Critical Inquiry and Feminist theories, elements of grounded theory and narrative analysis methodologies, informing the use of numerous data collection methods. These methods include literature searches, document analysis, semi-structured interviews (incorporating Participatory Learning and Action techniques), informal meetings and critical reflection. Data was gathered in the UK and Nepal from DFID staff, Nepali Government staff, DFID-funded project staff, external development consultants and other stakeholders. A 'cross-sector continuum model' is presented to facilitate understanding of the different definitions and possible levels of cross-sectoral engagement. Examples of cross-sector policy and practice are presented and discussed. Key factors facilitation cross-sector policy and practice are also identified. The greatest levels of cross-sectoral engagement were found at project-level in Nepal, although the DFID offices had also made some significant efforts to improve cross-sectoral approaches. Poor knowledge and selective use of the reproductive health and women's education research, however, exposed a gap between research and policy. In addition, the reality of cross-sector policy and practice often did not match the rhetoric within DFID's documents. According to respondents, DFID faces some substantial challenges that contribute to these research-to-policy and policy-to-implementation gaps. Despite the increased calls for cross-sectorality, there is little evidence of the benefits of cross-sector policy and practice, suggesting the need for research clarifying the added value of cross-sectoral approaches. Finally, the lack of agreement over cross-sector definitions, the lack of operational guidance and DFID's strong emphasis on outcomes all suggest the need for a reorientation of focus towards cross-sectoral processes. Based on these findings and conclusions, recommendations are made for DFID and other organisations wishing to pursue cross-sectoral approaches.
An evaluation of the impact of introducing a breakfast club on nutritional status and cognitive function in lower social class primary school children
(Queen Margaret University, 2005) Mehrotra, S.
Breakfast has been shown to increase the supply of glucose to the brain which improves short-term memory. On waking hepatic glycogenolysis is the major buffer against short-term (12-18 hrs) fasting. The higher ratio of brain weight to liver weight in the child (1.4 - 1.6 versus 0.73 for the adult) and the 50% greater metabolic rate per unit brain weight in the child, places a greater demand on the child's glycogenic stores during a short fast as compared to the adult. Few school breakfast studies have examined the effect of different breakfasts on cognitive performance. This study investigated the nutritional differences of a habitual breakfast consumed at hom (NBC) and breakfast served at a breakfast club in (BC) school and the effect of these breakfasts on cognitive performance. Subjects were primary school children aged 7-11 years old in Scotland. When baseline cognitive performance scores were compared to scored at data collections 2,3 and 4 there were more significantly pronounced improvements for the NBC group than the BC group (p < 0.001). There were significantly greater numbers of children eating a cooked breakfast in the BC group and significantly higher numbers of children eating a cereal breakfast in the NBC group. As a result breakfasts of the BC group were higher in fat (MUFA and PUFA) (p < 0.01) and lower in percentage energy from carbohydrate than the NBC group. Positive correlations existed between percentage energy from carbohydrate and percentage energy from starch and cognitive test performance (p < 0.01). This suggests that a breakfast higher in % energy from carbohydrate such as a cereal breakfast benefits short-term memory, by supplying the brain with readily available supply of glucose it's primary and preferred fuel. This results of this research provide evidence for the requirement of guidelines to ensure that breakfasts served at school will both assist learning in morning lessons and be in-line with healthy eating recommendations.
Skill acquisition in people with chronic upper limb spasticity after stroke
(Queen Margaret University, 2006) Van Wijck, F M J.
Background After a stroke, a considerable proportion of people experience upper limb (UL) impairments, which may affect their activities of daily living. Focal spasticity is common, for which botulinum toxin-type A (BTX-A) is used increasingly. However, published randomised controlled trials have not used valid outcome measures to assess the effects of BTX-A on spasticity and have hardly explored its impact on UL function. The primary aim of this thesis was to investigate whether task-specific UL practice in the form of an evidence-based, functional skill acquisition programme, administered after BTX-A, would have any differential effects on upper limb spasticity or functional UL activity in people more than six months after stroke. The prerequisites were to: 1) clarify the definition of spasticity, 2) pilot a novel biomechanical spasticity measurement device, 3) standardise the assessment of arm function, 4) systematically review the literature on the effects of BTX-A and 5) compile an evidence- and theory-based skill acquisition programme. Methods Design: randomised controlled feasibility study with four repeated measures and a blinded assessor. Fourteen participants (time after stroke: range 1.4 -11.0 years) gave informed consent and were randomised into either the experimental group (EG: BTX-A plus skill acquisition) or the placebo control group (CG: BTX-A plus inflatable arm splint). Outcome measures were: Action Research Arm Test, Canadian Occupational Performance Measure, grip force of the affected hand, Stroke Impact Scale, EMG of the elbow flexors, biomechanically measured resistance to passive movement and Ashworth scale. Outcomes were assessed at baseline and weeks 4, 7 and 13 following BTX-A injection. Differences in change between the two groups were analysed using the Mann-Whitney U-test. Applying the Bonferroni correction for three repeated measures yielded a critical p-value of 0.017. Results At baseline, there were no significant differences between the two groups in any of the dependent variables. Compared to the CG, the EG improved in self-reported hand function between baseline and week 4 (median change 25%, range 0 to 30% vs. CG: median change 0%, range -10 to 0%; p=0.04). The EG also improved in arm function between baseline and week 7 (median ARA T change 4 points, range 1 to 8 points vs. CG: median change -1 point, range -3 to 0 points; p=0.003) as well as in self-reported ADL between baseline and week 13 (median change 11.3%, range 5 to 20% vs. CG: median change 0%, range -2.5 to 5%; p=0.02). Only the differential improvement in ARAT by the EG reached statistical significance. There were no significant differences between the two groups in any of the other outcome measures. Although the programme was perceived as intensive, most participants in the experimental group had found the intervention to be enjoyable. Conclusion The main finding of this study was that people with severe and chronic upper limb spasticity may still improve in functional activity involving their affected arm, using a combination of BTX-A and a functional skill acquisition programme - without exacerbating spasticity. BTX-A alone did not improve upper limb activity in this study. Implications for clinical practice and research were discussed.
The development of a system to measure the effects of plantar foot pressure on the microcirculation of the foot
(Queen Margaret University, 2006) Santos, Derek
An investigation into the effects of plantar foot pressure on the microcirculation of healthy subjects and patients with Rheumatoid Arthritis was carried out. In the light of no equipment available to carry out this study a new system was developed. A shoe device was built with a combined pressure/skin blood flow transducer embedded in a three-tier piston mechanism in the heel so that plantar foot pressure could be applied/removed and quantified. The skin blood flow transducer made contact with the skin and was able to collect data about the microcirculatory state of the skin. The first system developed consisted of the laser Doppler Fluxmeter (Moor Instruments Ltd., UK) used to collect skin blood flow information and incorporating a strain gauge (Kyowa Electronic Instruments Co. Ltd., Japan) to quantify plantar foot pressure applied to the centre of the heel. This system was visually/sound synchronised and due to the time delay error it was modified. For the final system developed, the strain gauge was replaced with a custom-made Novel capacitative transducer (Novel, Germany) to quantify pressure. This allowed for the pressure system to be electronically synchronised in real time with the laser Doppler fluxmeter using an electronic synchronisation box. A number of studies were carried out to validate the systems. The developed systems were used to: (a) investigate the effects of the venoarteriolar response in healthy subjects with regards to the effects of plantar foot pressure on skin blood flow. The study concluded that subject positioning (that is, supine or semi-weight bearing) has an effect on how the microcirculation of the skin reacts to applied pressure. Thus, studies investigating the effects of external pressure on skin blood flow must have their subjects in a position that is related to what is being studies; (b) investigate the effects of plantar foot pressure on skin blood flow in patients with Rheumatoid Arthritis. A healthy control group was compared with a cohort of patients with Rheumatoid Arthritis with no evidence of vasculitis. The study concluded that there were no significant differences between both groups. A number of articles have been published from this thesis (see Appendix 14).
Language interaction in the bilingual acquisition of sound structure: a longitudinal study of vowel quality, duration and vocal effort in pre-school children speaking Scottish English and Russian.
(Queen Margaret University, 2006) Gordeeva, Olga
This PhD thesis contributes new empirical knowledge to the question of what paths bilingual acquisition of sound structure can take in early simultaneous bilinguals. The issues of language differentiation and interaction are considered in their relationship to language input, crosslinguistic structure and longitudinal effects. Two Russian-Scottish English subjects aged between 3;4 and 4;5 were recorded longitudinally. Russian was spoken in their families, and Scottish English in the community (Edinburgh, UK). The family environments were similar, but one subject had received substantially more input in Russian than the other one. We addressed the detail of their production of prominent syllable-nuclear vowels in Scottish English and in Russian with regard to their vowel quality, duration and vocal effort. Language differentiation and interaction patterns were derived by accounting for the language mode, and by statistical comparison of the crosslinguistic structures to the speech of monolingual peers (n=7) and adults (n=14). Subjects' bilingual results revealed both substantial language differentiation and systematic language interaction patterns. The extent of language differentiation and directionality of interaction depended on the amount of language exposure. Its directionality did not necessarily depend on the markedness of the crosslinguistic structures, and could be bi-directional for the same properties. Longitudinally, language differentiation increased, while interaction reduced. The amount of reduction depended on both language input and the structural complexity of the languages with segmental tense/lax contract and complex postvocalic vowel duration conditioning showing more persistent language interaction effects. The results confirmed the importance of language input. We showed that in bilingual phonological development language interaction should be considered as a normal but non-obligatory process. Besides, some structurally complex processes potentially explainable by 'markedness' (applied to isolated segments) could rather be explained by lexical and phonotactic factors.
An inquiry into the relationship between the visual arts and psychotherapy in post revolutionary Cuba
(Queen Margaret University College, 2006-03) Hills de Zárate, Margaret
This thesis focuses on the relationship between the visual arts and psychotherapy in post Revolutionary Cuba. The material on which it is based was collected over a fourteen month period and three visits to Cuba between April 1999 and August 2001. The study opens with the presentation of two brief histories, that of Cuban Art and Art Education and that of Cuban Mental Health Care. In this context the Revolution is taken as a useful reference point in terms of thinking about change and historical developments in both fields. Naturalistic Inquiry and Grounded Theory respectively were used to collect and analyse the data presented. These approaches allowed the researcher the degree of flexibility necessary to undertake research in a potentially delicate situation full of unknowns and to be able to modify and develop the course of inquiry as new evidence emerged. The main descriptive themes emerging from an analysis of the data pertain to the relationship between artists and mental health care professionals. These are (1) therapeutic work undertaken by artists, (2) artists working collaboratively with mental health professionals and (3) psychologists working with art as a therapy. The story which emerges pertains to a series of largely unrecorded histories spanning a forty year period. It begins with the work of Antonia Eiriz, who emerges as a key figure in the early development of art as a therapy and concludes with the work of the psychologist, Aurora García Morey, who takes centre stage in its continued development. This snapshot of Cuban art therapy is specific and unique and demonstrates the development of a very particular Cuban practice. However an analysis of the analytic themes which emerge from the data suggests that certain concepts such as responsiveness and pragmatism resound within a wider picture. These themes are discussed in chapters 7 and 8 with reference to the wider international context and specifically to the development of the profession in the United Kingdom. In my conclusions I suggest that these themes may be applicable to other areas of research and practice outwith and beyond Cuba and that while the concept of art therapy cannot be narrowly defined when it is applied to understanding practices in other, social, economic and cultural contexts, there are common factors which can be identified.
An Investigation into the Ability of Adults with Post-Stroke Aphasia to Learn New Vocabulary
(Queen Margaret University, Edinburgh, 2006-05-31) McGrane, Helen
Recent studies have established that adults with post-stroke aphasia can learn to establish connections between familiar words and abstract images, and nonwords with familiar objects. What has not been investigated was whether adults with aphasia could learn non-words with abstract images/ novel meanings i.e. new vocabulary. The main objective of this study was to investigate whether adults with post-stroke aphasia could learn 'novel' word forms with 'novel' word meanings, despite phonological and/or semantic impairment. Specific research questions included: Can post-stroke adults with aphasia learn new vocabulary? If so, what factors affect their capacity to learn? Is it possible to predict which individuals will learn most successfully? The methodology was developed using preliminary studies both with adults of normal language and cognitive functioning and post-stroke non-aphasic and aphasic adults. It incorporated learning theory and a cognitive neuropsychological model of language. A range of assessments was used to facilitate the capture of new learning. 'New learning' was measured not only in terms of the accurate production of the new stimuli but also the recognition and knowledge of the word forms and meanings of this new vocabulary. In the main investigation twenty novel word forms with 20 novel meanings were taught to 12 aphasic adults (< 65 years), over a four day period, using an errorless learning paradigm. Immediate recall of these newly learnt representations was investigated as well as delayed recall. Quantitative and qualitative results from a case series of 12 participants are presented and discussed. Despite semantic and phonological difficulties, all but three participants demonstrated substantial learning of the new vocabulary. The participants' range of learning ability (from both immediate and delayed recall data) was analysed in relation to severity of aphasia, cognitive factors (including attention, memory and executive function), as well as variables such as age, months post-stroke and number of years in education. With an intensive training period, these participants with aphasia demonstrate varying degrees of ability for new learning. Possible influencing factors and implications for speech and language therapy rehabilitation are discussed.
Chronic Patellofemoral Pain Syndrome: A randomised controlled trial based on the international classification of functioning, disability and health
(Queen Margaret University Colege, 2006-08) Syme, Grant