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Living with Cystic Fibrosis : Experiences of Identity and Romantic Relationships
No full textThis thesis consists of three chapters: a systematic literature review, an empirical research study, and a critical appraisal, exploring the lived experiences of people with cystic fibrosis in relation to identity and romantic relationships. The systematic literature review synthesised 34 qualitative studies to examine how individuals with cystic fibrosis construct and negotiate self-identity alongside their illness. The findings highlight identity is dynamic, shaped by negotiating a sense of normalcy and difference, social perceptions, and both positive and negative health status changes. The empirical research study used Interpretative Phenomenological Analysis to explore how seven adults with cystic fibrosis experience romantic relationships. The analysis revealed the influence of cystic fibrosis on forming and maintaining relationships, including disclosure decisions, partner choice, preferred position of cystic fibrosis in relationships and coping dynamics. Both the systematic literature review and empirical research paper present implications for clinical practice and suggestions for future research. The final chapter, a critical appraisal, integrates the findings from both papers, discusses further strengths and limitations, provides a reflective account of the research process, and offers some personal reflections
The Relationship between Role Clarity and Psychological Safety in the Healthcare Sector in Saudi Arabia : A Mixed-Methods Research Study
No full textThe aim of this thesis was to examine the relationship between role clarity and psychological safety in Saudi Arabia’s healthcare sector during the Health Sector Transformation Program (HSTP), and explored their combined influence on employee well-being. A pragmatic paradigm and concurrent mixed-methods design were adopted. The quantitative study was based on a survey of 270 healthcare employees using validated instruments, while the qualitative study involved 33 semi-structured interviews exploring employees’ experiences of clarity and safety during reform. Data were analysed through multivariate regression and mediation models for the quantitative study, and thematic analysis for the qualitative study, with integration at the interpretation stage. Quantitative findings showed that role clarity was significantly associated with psychological safety at individual, team, and organisational levels. Role clarity was also related to well-being, with team psychological safety partially mediating this association. Leadership role showed a small effect, but tenure and employment status were not significant. Qualitative findings revealed how inclusive leadership, recognition, and clear communication fostered psychological safety, while reform-related ambiguity, shifting responsibilities, and reliance on informal channels undermined it. Hierarchical and cultural dynamics influenced whose voices were heard, with lower-status staff more hesitant to speak up. The integration of findings demonstrated that role clarity is a crucial job resource that supports psychological safety and well-being, but its benefits are amplified in supportive team climates. Using the Job Demands-Resources model, Status Characteristics Theory, and the Readiness for Change framework, the study showed how organisational, relational, and contextual factors interact to shape outcomes. The thesis provides empirical evidence of the clarity-safety-well-being relationship, refines theoretical frameworks by emphasising their interactive and contingent nature, and offers context-specific insights from a reforming, non-Western healthcare system. Findings have practical implications for leadership development, role design, and communication strategies during organisational transformation
Cadmium modulates tomato root architecture and root hair responses to ABA-metabolising rhizobacteria
Get PDFExogenous cadmium (Cd) stimulates abscisic acid (ABA) accumulation in planta, enhancing Cd tolerance by maintaining growth and limiting Cd accumulation. Since rhizobacteria that metabolise ABA may compromise Cd tolerance, tomato Ailsa-Craig plants were grown in vitro with or without 80 µM CdCl2, and with or without ABA-metabolising Rhodococcus sp. P1Y and Novosphingobium sp. P6W and the Cd-tolerant, 1-aminocyclopropane-1-carboxylate (ACC) deaminase-containing Variovorax paradoxus 5 C-2 (negative control). Root colonisation of the ABA-metabolising strains was circa 50% and 2 orders of magnitude less than 5 C-2 without and with Cd respectively. While root Cd concentrations were independent of inoculation, only 5 C-2 decreased leaf Cd concentrations. P6W decreased root ABA concentrations without Cd, and leaf ABA concentrations irrespective of Cd treatment. Although P1Y didn’t affect root ABA concentrations, it decreased and increased leaf ABA concentrations with and without Cd respectively. With Cd, both ABA-metabolising strains inhibited primary root length and P1Y increased lateral root length. Without Cd, 5 C-2 increased primary root length and lateral root number, while all strains increased root hair length and density. Cd increased these root hair traits in uninoculated seedlings, with bacterial addition causing further increments. To further investigate how ABA affects root (hair) traits, the ABA-deficient flacca mutant and its wild-type (WT) were compared at varying (0-100 µM) ABA concentrations. Although WT plants tended to have longer primary roots, flacca root hair length was circa 29% longer irrespective of exogenous ABA concentration. Higher ABA concentrations decreased primary and lateral root length and lateral root number, had no effect on root hair length but increased root hair density similarly in both genotypes. That both ABA-metabolising strains increased root hair length and density of flacca suggests ABA-independent regulation of these root hair traits. Despite stimulating root hair development, the ABA-metabolizing strains didn’t enhance Cd concentrations in planta but they compromised Cd tolerance by inhibiting primary root length
Anthropogenic disturbance affects wood decomposition directly and indirectly through microclimatic and biotic drivers
Get PDFAmazonian forests play a key role in the dynamics of global ecosystem services. Human-modified forests, which already cover more than one million km2 in the region, generate still uncertain threats to the carbon cycle, such as the influence on wood decomposition rates. Understanding the factors regulating deadwood decomposition is critical for improving carbon flux predictions in tropical forests. Using a one-year standardized field experiment in easter Amazon considering 15 native tree species, this study evaluated how forest disturbance, microclimate, wood traits and decomposers activity affect wood decomposition processes. Quarterly, wood decomposition increased gradually, reaching 0.21 ± 0.29 proportional mass loss after 12 months. Wood density played a crucial role confirming it as a fundamental predictor of decay rates, with lower density woods showing higher decomposition rates. Despite the absence of significant differences in decomposition rates among forest disturbance classes, structural equation models revealed significant indirect pathways, where anthropogenic canopy openness altered microclimatic conditions which in turn suppressed decomposer activity, such as termites, a key biotic driver of decomposition. Our findings provide novel experimental evidence that forest structure and microclimate mediate the role of decomposers in carbon cycling, emphasizing the need to incorporate functional wood traits and indirect disturbance effects into carbon models to better predict ecosystem responses under increasing forest degradation and climate change
Accessing primary care following the Affordable Care Act : a qualitative study of low-income women’s experiences in urban California
Get PDFBackground The 2010 Affordable Care Act (ACA) led to Medicaid expansion, which expanded eligibility to low-income individuals below 138% of the federal poverty level in 41 states and Washington, DC. In California, over one-third of state residents are covered by Medicaid (Medi-Cal) insurance. Despite the 2014 Medicaid expansion in California, many individuals remain uninsured. Low-income women, in particular, face significant primary care access challenges due to socioeconomic status, education, and minority/disability status. This qualitative study aimed to explore the experiences of low-income women seeking and accessing primary care services following the ACA’s Medicaid expansion in California in an urban setting. Methods In-depth, semi-structured interviews were conducted with 18 women in Northern California (2021–2022). Data analysis employed Braun and Clarke’s reflexive thematic analysis using a deductive approach. Levesque’s conceptual framework of access to healthcare guided the coding and interpretation. Results The experiences of low-income women with primary care access post Medicaid expansion in an urban California setting were shaped by the complex interplay of individual demand-side factors and health system supply-side factors, and structural determinants. Levesque’s framework highlights how individual factors (self-efficacy, health literacy, social support, and affordable insurance) interact with health system factors (geographic accessibility, availability and accommodation of services, and provider-patient relationships) to shape low-income women’s experiences. However, Levesque’s framework could be strengthened by incorporating macro-level structural factors (socioeconomic, political factors, and health policies) as these profoundly influence healthcare access. Conclusions These findings provide a strong foundation for policymakers and practitioners to develop multi-level policies and interventions to address the ongoing barriers that urban low-income women encounter when accessing primary care following the ACA’s Medicaid expansion. These findings are also relevant for other U.S. states and international settings that face similar challenges stemming from healthcare inequalities, including a lack of universal healthcare
Development of a personal recovery questionnaire for older adults with bipolar : a qualitative integrated knowledge translation approach
Get PDFObjectivesTo report on the development and refinement of a questionnaire of personal recovery for use by older adults with bipolar disorder.DesignAn integrated knowledge translation approach was used to structure collaboration of individuals with clinical, research and service users. Focus groups, online meetings and online feedback were used to support information sharing.ParticipantsKnowledge users from across the UK including older adults with experience of bipolar, clinicians and academics.Primary outcome measureA final draft of the Bipolar Recovery Questionnaire for Older Adults with bipolar (BRQ-OA).ResultsFive service users and 15 stakeholders engaged with the study. The views and recommendations of the groups were integrated into the development of the BRQ-OA across four phases. Service users identified factors of personal recovery they felt had changed with ageing, including the impact of physical health and the importance of finding a purpose following changes to role. Collaboration with key stakeholders allowed for the development of a personal recovery questionnaire relevant to the experiences of older adults.ConclusionsAn integrated knowledge translation approach successfully structured engagement with key stakeholders to allow for active and meaningful engagement. Collaboration of individuals with experience of bipolar, clinicians and academics allowed for the development of the first questionnaire of personal recovery specifically adapted for older adults with bipolar. Future research is needed to validate the BRQ-OA in older adult samples so that it can be used in mental health services and intervention studies
Effects of heat source arrangements on arc behavior and keyhole stability in Laser-Arc hybrid welding of 12-mm-thick AH36 steel
No full textLaser–Arc Hybrid Welding (LAHW) critically depends on the guiding mode that sets the spatiotemporal sequence of the heat sources. Yet, how the guiding mode governs keyhole stability, the physical core of process robustness, remains poorly understood. Using AH36 high-strength steel plates of 12 mm thickness, we systematically compare Arc-Leading (A-L) and Laser-Leading (L-A) modes by combining side-view high-speed imaging (10,000 fps) with synchronous electrical measurements. We show that the two modes establish distinct bidirectional couplings between the electrically driven arc stability and the mechanically driven keyhole stability. In the A-L mode, the leading arc first forms a wide, high-temperature molten pool that buffers droplet momentum and suppresses high-frequency keyhole oscillations. After a short free-growth period (∼0.8 ms), the arc is captured and locked by the laser-formed keyhole, eliminating deflection and markedly increasing arc stiffness. In contrast, the L-A mode lacks such buffering; droplets directly impinge on the rear keyhole wall, periodically inducing partial collapses and a keyhole reconstruction period that is ≈1.8 × that of the A-L mode. Macroscopically, the A-L mode achieves a stable root at a gap of 0.6 mm, whereas the L-A mode requires 0.8 mm to suppress humping. These results reveal mode-specific feedback loops—virtuous in A-L and self-exciting in L-A—and provide a mechanistic basis for widening the robust process window in industrial LAHW
Policies, Processes, and Principles of Informed Consent in Radiotherapy for Gynaecological Cancers : A UK National Survey
Get PDFIntroduction Informed consent is a legal requirement under The Health and Social Care Act 2008 and a vital part of patient-centred care. Despite national frameworks and guidance, there is significant variability in informed consent implementation across settings. This national service evaluation aimed to assess policies, processes, and principles guiding informed consent for gynaecological radiotherapy across United Kingdom (UK) NHS departments. Methods A survey exploring processes and training, principles, and values was sent to 58 NHS radiotherapy departments. Data were obtained from 38 departments (66 % response rate), representing all UK nations. Ethical approval was obtained. Results Variation was observed in staff training, use of best-practice guidelines, and content of consent documentation. While 71 % of departments used Royal College of Radiologists (RCR) consent forms, fewer identified professional guidance indicating a potential gap in guideline familiarity. Documentation varied in the number and detail of side-effects described but alignment was observed in core ethical principles. Respondents highlighted structural challenges, notably time and staffing constraints, which limited processes and patient support. Conclusion This is the first study to provide a national overview of informed consent policies and practices in NHS radiotherapy departments for gynaecological cancers. It identifies inconsistencies in training, documentation, and guideline awareness, but highlights shared professional values. Findings support the need for national guidance, standardised consent materials, and targeted staff education to ensure equitable and fully informed patient decision-making. Implications for practice Informed consent should be treated as an ongoing, patient-centred process that extends beyond the clinician–patient interaction. All staff should be familiar with policies and procedures to support patients’ understanding of treatment and long-term impacts. Standardised materials must be tailored to individual needs to facilitate meaningful, patient-centred discussions
