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The Anatomy of Policing Domestic Abuse in England and Wales: An Exploration of Outcomes
No full textThe criminal justice system goal of punishing perpetrators is not always shared by domestic abuse victim-survivors. Each year more than half of domestic abuse crimes are closed because victim-survivors no longer support police action against their abuser (outcome 16). Despite the prevalence of outcome 16s, we still do not fully understand the rationale behind victim-survivors disengagement, what they want from police, and how they define a positive outcome in their cases.Attrition from processing cases can also happen when victim-survivor goals align with those of the criminal justice system. Domestic abuse cases are more likely to be closed by a decision made by police/CPS (Crown Prosecution Service) with non-victim based evidential difficulties (outcome 15), than by a charge (ONS, 2023). When crimes are closed with outcome 15, how do victim-survivors describe and feel about the police response received and the outcome?Overall, we need a better understanding of outcomes: how victim-survivors define success, if victim-survivors comprehend the outcome – and the practical implications of it – as well as how the criminal justice system can better accommodate victim-survivor definitions of justice and success.Across three studies, using a combination of quantitative and qualitative methods, this thesis explores domestic abuse case attrition and how victim-survivors define success. The empirical analysis involves editing and analysing victim satisfaction surveys (study 1), exploring domestic abuse crime data (study 2), and the qualitative analysis of open-ended answers to an online survey and interviews with victim-survivors (study 3).The studies showcase victim-survivors’ lack of knowledge about the outcome of their case – with the outcome often not being adequately explained by police. Moreover, victim-survivors (dis)engagement was a dynamic negotiation process resulting from their circumstances, the police response received and from their cost-benefit analysis of progressing the case. The studies cast new light on domestic victim-survivors’ (dis)engagement and how police affect it
Parents' experiences of paediatric end-of-life care in the UK: A multisite qualitative study
Get PDFObjectives: Despite the marked improvement in child mortality over the last two decades, more than 7 million infants, children and young people still die worldwide every year. In the UK, four National Health Service settings care for more than 60% of the children who die each year: neonatal and paediatric intensive care units and children and teenager cancer principal treatment centres. There is limited evidence on how end-of-life care is experienced by parents and how this differs across settings. We aimed to explore parents' experiences of receiving end-of-life care for their child in these settings. Methods: A multisite qualitative study involving in-depth interviews with bereaved parents, analysed using reflexive thematic analysis. Recruitment via 14 National Health Service sites, three children's hospices and two third sector organisations across the UK. Results: 55 parents participated (37 mothers, 18 fathers), representing 44 children and young people (median age 7 years, range 0-23 years). 42 interviews were conducted. Experiences of care were highly variable. Parents' perceptions of high quality end-of-life care were highlighted within three themes: (1) building the foundations for high quality end-of-life care; (2) working together towards best decisions and care and (3) continuing care after death and into bereavement. Conclusions: Bereaved parents' experiences of care at the end of life are too inconsistent. Feeling heard is crucial; without it, there is no foundation on which adequate end-of-life care can be built. Care must be tailored to the circumstances of each family and should continue after a child's death and into bereavement
Understanding the Decision-Making Process for Haemodialysis Refusal in Oman: A Grounded Theory Approach.
Get PDFBackground: Haemodialysis (HD) is an invasive routine life-sustaining therapy for End-Stage Kidney Disease (ESKD) individuals, and it remains the common modality of Kidney Replacement Therapy (KRT). ESKD is a permanent kidney failure due to complete or nearly complete loss of kidney function and the ability to eliminate waste and excess water from the body (Griva et al., 2013). Worldwide, ESKD results in a great burden on the healthcare system and has become a major public health problem (Li et al., 2021). The decision to initiate haemodialysis is generally made by the treating nephrologist alone; however, this decision cannot be acted upon without the individual's explicit permission, as their consent is crucial to proceeding with dialysis. Professional experience and published evidence have demonstrated that a proportion of individuals living with ESKD refuse HD as a treatment option, though quantitative data on prevalence are not available.However, the decision to refuse HD is multifaceted and poorly understood, especially in Arab regions, including Oman.Aim: To explore and understand the reasons underpinning the decision to refuse haemodialysis from the individuals affected by ESKD perspective in Oman.Methodology: A qualitative study design, utilising a constructivist grounded theory approach (Charmaz, 2006), was employed to explore the research questions. The eligible participants were adults aged eighteen and above with stage five ESKD and no history of mental illness. Data collection took place in nephrology outpatient clinics and kidney dialysis units across eleven governmental hospitals under the Ministry of Health in Oman. Childress's (2019) ethical framework was applied to safeguard participant rights and uphold ethical standards throughout the study. Data were collected between October 2021 and April 2022 through in-depth, semi-structured interviews using an interview guide, with each interview lasting 30 to 60 minutes. The interviews were transcribed verbatim and translated into English. Analysis used constant comparative method, including line-by-line and axial coding, as outlined by Charmaz (2006), to enhance understanding of the social processes related to the decision to refuse haemodialysis and to facilitate categorisation.Results: Research data indicate that twenty-seven participants’ decision-making was a continuous and revisited process influenced by various factors that led to the refusal of haemodialysis. A significant knowledge gap was evident among those who declined haemodialysis, attributed to communication barriers with physicians, insufficient information about ESKD at stage five and haemodialysis, challenges in verifying information, and a tendency to selectively interpret information. Participants were also affected by the experiences of haemodialysis users, as well as input from family and peers.Fear played a critical role in the decision-making process, driven by concerns over the potential negative consequences of haemodialysis and the associated stigma. A desire for self-control was another influential factor, leading some to seek alternatives and adopt a fatalistic perspective. From the data analysis, a grounded theory of haemodialysis refusal decision-making process was developed to outline the decision-making process for individuals with ESKD who choose to refuse haemodialysis. This grounded theory consisted of five categories: self-conceptualisation, information access, influencers, fear, and self-control.The theoretical framework demonstrated how individuals balanced perceived benefits and risks, engaging in self-management, seeking second opinions, or relying on the advice of others while attempting to delay dialysis. Many participants were in a state of 'denial,' viewing themselves as healthy due to the absence of noticeable ESKD symptoms and opting to continue with oral medications. A few, however, considered kidney transplantation as an alternative option.Conclusion: Omani individuals with ESKD in this study faced various factors and behaviours that influenced their decision-making, leading them to reassess and reinforce their choice to refuse haemodialysis. Denial and fatalism were the most prominent behaviours observed. Participants exhibited a limited understanding of their condition and its complications, highlighting the need to assess the quality and method of information provided, taking into account their values, beliefs, and preferences. A personalised, patient-centred approach may be more effective than a conventional disease-oriented strategy for this population. Multidisciplinary teamwork is crucial to developing effective and ongoing education and interventions, fostering a comprehensive approach to treatment acceptance and improved health outcomes. Early pre-dialysis education and shared decision-making are vital for enabling timely interventions
Organ Donation Conversations on X and Development of the OrgReach Social Media Marketing Strategy: Social Network Analysis
Get PDFBackground: The digital landscape has become a vital platform for public health discourse, particularly concerning important topics like organ donation. With a global rise in organ transplant needs, fostering public understanding and positive attitudes toward organ donation is critical. Social media platforms, such as X, contain conversations from the public, and key stakeholders maintain an active presence on the platform. Objective: The goal is to develop insights into organ donation discussions on a popular social media platform (X) and understand the context in which users discussed organ donation advocacy. We investigate the influence of prominent profiles on X and meta-level accounts, including those seeking health information. We use credibility theory to explore the construction and impact of credibility within social media contexts in organ donation discussions. Methods: Data were retrieved from X between October 2023 and May 2024, covering a 7-month period. The study was able to retrieve a dataset with 20,124 unique users and 33,830 posts. The posts were analyzed using social network analysis and qualitative thematic analysis. NodeXL Pro was used to retrieve and analyze the data, and a network visualization was created by drawing upon the Clauset-Newman-Moore cluster algorithm and the Harel-Koren Fast Multiscale layout algorithm. Results: This analysis reveals an “elite tier” shaping the conversation, with themes reflecting existing societal sensitivities around organ donation. We demonstrate how prominent social media profiles act as information intermediaries, navigating the tension between open dialogue and negative perceptions. We use our findings, social credibility theory, and review of existing literature to develop the OrgReach Social Media Marketing Strategy for Organ Donation Awareness. The OrgReach strategy developed is based on 5 C’s (Create, Connect, Collaborate, Correct, and Curate), 2 A’s (Access and Analyse), and 3 R’s (Recognize, Respond, and Reevaluate). Conclusions: The study highlights the crucial role of analyzing social media data by drawing upon social networks and topic analysis to understand influence and network communication patterns. By doing so, the study proposes the OrgReach strategy that can feed into the marketing strategies for organ donation outreach and awareness
Volatile learning environments: Exploring the barriers to inclusion in prison education through collaborative writing
Get PDFEducation in prisons is intended to transform lives. It fulfils a major role in rehabilitation and is critical to ensuring that incarcerated people have the necessary knowledge and skills to lead meaningful, productive and economically active lives when they are released back into the community. However, there is substantial evidence that highlights the poor quality of education in prisons in the United Kingdom (UK), due to lack of ambition, narrow curricula, weaknesses in assessment and lack of attention to learners’ starting points. Our review of the literature has highlighted a lack of studies which specifically privilege the voices of prison educators and prisoners who have participated in education courses during their time in incarceration. This paper draws on our conversations between both authors to illuminate the barriers to inclusion in relation to prison education. Several issues are highlighted, including lack of consistency, volatile learning environments and lack of support for learners who are enrolled on higher education courses. We offer some tentative recommendations to advance policy and practice in prison education that are informed by the literature and international comparisons
A Novel Membrane Dehumidification Technology Using a Vacuum Mixing Condenser and a Multiphase Pump
Get PDFVacuum membrane-based air dehumidification (MAD) is potentially more efficient than refrigeration cycles. Air permeance through a membrane is inevitable, especially when there is a large pressure difference between the supply and permeate sides. Given the high specific gas volume under vacuum conditions, removing the permeating air from the dehumidifier is crucial for the stable operation of the vacuum compressor. Energy-efficient air removal techniques are still lacking, thereby hindering the development of MAD technology. This paper proposes a novel MAD approach using a vacuum mixing condenser. The cooling water directly condenses moisture from the vacuum compressor without any heat exchanger. The permeating air and water mixture in the condenser then experiences a quasi-isothermal pressurization process through a multiphase pump, enabling continuous dehumidification and air removal with low power consumption. The fundamentals of the proposed approach are illustrated, and mathematical models are built. Influences of air permeance rate, cooling water flow rate, condenser pressure, membrane area, and gravitational work are investigated. The results show that a COP of 8~12 is achievable to dehumidify air to 50%RH, 25 °C. The vacuum compressor consumes about 80% of the power. A low air permeance rate, low condenser pressure, large membrane area, and high gravitational work positively impact the COP, while the cooling water flow rate has a more complex effect. The proposed dehumidifier can use less selective membranes for higher permeability and cost-effectiveness
Improved Precision of COPD Exacerbation Detection in Night-Time Cough Monitoring
Get PDFBackground/Objectives: Targeting individuals with certain characteristics provides improved precision in many healthcare applications. An alert mechanism for COPD exacerbations has recently been validated. It has been argued that its efficacy improves considerably with stratification. This paper provides an in-depth analysis of the cough data of the stratified cohort to identify options for and the feasibility of improved precision in the alert mechanism for the intended patient group. Methods: The alert system was extended using a system complementary to the existing one to accommodate observed rapid changes in cough trends. The designed system was tested in a post hoc analysis of the data. The trend data were inspected to consider their meaningfulness for patients and caregivers. Results: While stratification was effective in reducing misses, the augmented alert system improved the sensitivity and number of early alerts for the acute exacerbation of COPD (AE-COPD). The combination of stratification and the augmented mechanism led to sensitivity of 86%, with a false alert rate in the order of 1.5 per year in the target group. The alert system is rule-based, operating on interpretable signals that may provide patients or their caregivers with better insights into the respiratory condition. Conclusions: The augmented alert system operating based on cough trends has the promise of increased precision in detecting AE-COPD in the target group. Since the design and testing of the augmented system were based on the same data, the system needs to be validated. Signals within the alert system are potentially useful for improved self-management in the target group
Five year follow up of a randomised clinical trial of endovenous laser ablation versus mechanochemical ablation for superficial venous incompetence (LAMA Trial)
Get PDFObjectiveIn this randomised clinical trial, patients treated with mechanochemical ablation (MOCA) with ambulatory phlebectomy (AP) had a lower anatomical occlusion (AO) rate at one year and no benefit in peri-procedural pain compared with endovenous laser ablation (EVLA) with AP. Early quality of life (QoL) improvements were similar. This study aimed to study comparative outcomes at five years.MethodsA total of 150 patients with unilateral, symptomatic varicose veins in association with an isolated incompetent great saphenous vein, small saphenous vein, or anterior accessory saphenous vein were equally randomised to either MOCA or EVLA with AP (NCT02627846). Outcomes at five years included AO, need for re-intervention, venous clinical severity score (VCSS), and disease specific QoL measured by the Aberdeen Varicose Vein Questionnaire (AVVQ).ResultsAt five years, 52 of 75 (69%) and 57 of 75 (76%) patients attended follow up in the EVLA and MOCA groups, respectively. Anatomical occlusion following EVLA was statistically significantly higher than after MOCA (91% vs. 47%; p< .001). The absolute risk reduction in failure of AO using EVLA rather than MOCA was 45% (95% confidence interval 29 – 60%). The rate of re-intervention was also statistically significantly lower following EVLA (8% vs. 21%; p= .033). There was no statistically significant difference between groups in median (interquartile range) VCSS (EVLA 1 [0, 3] vs. MOCA 2 [0, 4]; p= .33) and AVVQ (EVLA 3.06 [0.7, 6.4] vs. MOCA 3.63 [0.0, 8.6]; p= .79).ConclusionFive year AO following MOCA remained significantly lower than for EVLA, leading to a higher rate of re-intervention. Following these additional procedures, there was no statistically significant difference in QoL outcomes between groups
The winter movements of two fish species in a temperate lowland river
Get PDFWinter involves long periods of low water temperatures, with the activities and movements of many temperate fish species being reduced compared with summer. In very cold periods, individuals can become winter quiescent. The extent to which the activities and movements of many fish species reduce in winter is unknown, including how these decrease in relation to environmental conditions. Acoustic biotelemetry was applied here to measure the body temperatures and movements of European barbel Barbus barbus (barbel) across winter 2020/2021 and 2021/2022, and common bream Abramis brama (bream) in winter 2022/2023 in the River Severn, western Britain. Body temperatures of barbel were measured from 1.9 to 11.3 °C and bream 0.4 to 12.8 °C. The tagged fish generally remained active throughout the winters, including when water temperatures were at their lowest. The median total distance moved by bream was 106 km, which was higher than that measured in summer (103 km). Barbel moved less than bream and had total ranges that were similar in winter and summer (median range: 3.9 km in both seasons). These temperate fishes thus remained active throughout winter, did not become quiescent in the coldest periods, and their winter movements were similar to those measured in summer
