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The influence of political economy on nurses' post-registration development in the English NHS
Get PDFRegistered nurses are the largest safety-critical profession in healthcare, and their post-registration development is essential for staff retention and high-quality patient care and safety. Despite this, nurses’ post-registration is limited, fragmented, and lacking in transparency. With an increasing national drive and focus in policy on enhancing patient care, safety, quality, and staff retention, exploring why nurses’ post-registration development is underdeveloped is essential for securing the future prospects of the health service.
This thesis is grounded in the sociology of the professions, focusing on considering nurses' market shelter strengthening through the lens of political economy. The theoretical core of this PhD uses Light’s (1991, 1995, 2010) countervailing powers framework to consider the relationship between the state and the nursing profession. Consequently, the research question was: ‘Why has nursing in England not established a stronger market shelter through post-registration development and career frameworks, despite post-Fordist reforms?’. To enable the exploration of the research question, a qualitative research project was utilised, using a multi-method, multi-level research design incorporating NHS policy document analysis (n49) from 1989-2020, followed by semi-structured interviews over three levels. Macro (n9): individuals in national-level organisations that are influenced by or influence policy. Meso (n11): organisational leads, such as Chief Nurses. Micro (n27): registered nurses working in education, management, research and clinical areas.
The findings are presented in a chapter for each level of analysis. The policy document analysis highlights the role of clinical governance and the ‘Agenda for Change’ NHS workforce policy, workforce planning and data and the instability of healthcare governance and policy. The macro analysis considers the challenges with Agenda for Change, data and government, and the short termism and instability of politics and policy. The meso analysis considers the role of organisational governance, networks and partnership working and clinical governance and data. Finally, the micro analysis considers training and development as a ‘luxury’ item, the role of middle management and the overall impact of the lack of post-registration development on nurses.
The research question is answered through three core themes from the overall analysis, which are threaded throughout the different levels: first, the instability of healthcare policy; second, the lack of appropriate data and economic analysis; and finally, the juridification of practice. The overall implication from the analysis frames nurses’ post-registration development as a ‘wicked problem’.
The potential future research from this thesis includes exploring the view of healthcare as a safety-critical industry and implications for workforce development, system-wide considerations of labour economics and workforce planning, and finally the ‘situated wickedness’ of clinical governance in relation to nursing workforce policy and management.
Theoretically, this thesis provides an enhanced consideration of the state-profession relationship, including state actors and multi-level and multi-centric governance. Furthermore, it provides insight into the importance of stability in state projects, a focus on the economic within the ‘market’ and the increasing role of state-mandated legal mechanisms on professional practice. Critically, this PhD provides the development of a greater practice-theory perspective on professional development. Conceptually, this PhD indicates the importance and the role of workforce planning in relation to workforce development. Furthermore, how the healthcare industry is viewed as service or safety is explicitly linked to workforce development. Adjoining this is a greater emphasis on the role of data and economics, including how data is used to help a profession negotiate with various levels of power within a system
Robust Quantification of Cerebrovascular Reactivity using Magnetic Resonance Imaging and Hypercapnic Challenges
Get PDFPseudocontinuous Arterial Spin Labelling (pCASL) magnetic resonance imaging (MRI) can quantify tissue cerebral blood flow (CBF) in the brain, providing a potential clinical biomarker of brain health. A cerebrovascular reactivity (CVR) response can be induced by increasing blood flow via a vasoactive stimulus, e.g. inhaling carbon dioxide during hypercapnic challenges. The overall aim of this thesis was to validate robust measures of CVR using MRI. Multiple investigations examined blood flow changes, magnetic field effects, pharmacological interventions, and advanced CVR analysis methods.
Findings demonstrated that pCASL blood flow measurements showed significant parameter dependent variations during hypercapnic challenges, with notable regional CBF variation. Magnetic field investigations revealed modest B_0 changes during hyperventilation and optimal B_1 field characteristics at the V3 vertebral artery segment.
A pharmacological intervention study examined the effects of anti-hypertensive medication during hypercapnic challenges. This was to alter the blood pressure and see what affect it had on CVR. While these interventions induced expected heart rate changes, they did not significantly alter blood pressure or carotid artery blood flow, suggesting robust compensatory mechanisms in healthy individuals.
Advanced CVR measurement techniques were explored using multiple post labelling delay "enhanced" ASL (eASL) and blood oxygen level dependent (BOLD) MRI, with a novel semi-automated gas delivery box. The eASL data showed a substantial CVR response (~60\% increase in CBF, ~22 s decrease in arterial transit time) during hypercapnia, which was a larger change than recent studies. The dynamically modelled BOLD (dCVR) analysis of the haemodynamic response function showed a 3.2\% increase in magnitude. However, the processing was computationally intensive.
A study into the comparison of eASL, sinusoidal modelled BOLD CVR (sinCVR), and dCVR analyses showed no correlation between eASL and BOLD-based magnitude measures. There was a weak correlation between eASL and sinCVR timing metrics. sinCVR and dCVR magnitude were strongly positively correlated, whilst their timing metrics were weakly negatively correlated. This suggested the relationship between the different methods and physiology would require further investigation.
In conclusion, recent developments in acquisition and analysis of functional MRI were combined to resolve issues regarding CVR quantification. The intended impact was to improve the robustness of CVR results for diagnosis and prognosis of patients with cerebrovascular diseases
Evaluation of synthetic and bio-based additives as oxidation stability enhancers in palm biodiesel
Get PDFStudy on the antioxidants’ efficiency on biodiesel becomes crucial as the research for greener fuel continues. Set against this background, this thesis aims to evaluate the effects of synthetic and bio-based additives in palm biodiesel through a comprehensive assessment of fuel stability properties, oxidation kinetics and thermodynamics of doped fuels, and long-term storage stability. Synthetic additives were found to be more effective compared to their bio-based counterparts in terms of oxidation stability index (OSI), however, butylated hydroxyanisole (BHA) and tert-butyl hydroquinone (TBHQ) showed contradictory OSI results from Rancimat and PetroOXY test methods. Similar findings were observed in the long-term storage study which highlighted that TBHQ was the best additive followed by BHA and α-T being inefficient in long term storage of palm biodiesel. In addition, kinetics modelling utilising regression analyses coupled with error functions for doped palm biodiesels determined that BHA, BHT, TBHQ, and α-T adhered to the first order kinetic model judging from the high R and R2 values and low χ2 values obtained. The increase in Ea for DPOME showed that the performance of all additives was great, while positive ΔH‡, negative ΔS‡ and positive ΔG‡ values suggested that all oxidation reactions were endothermic, non-spontaneous and endergonic. The gas chromatography-mass spectrometry (GC-MS) analyses revealed that 3-octyl-oxiraneoctanoic acid ME, and 17-octadecynoic acid ME were the major oxidation products of palm biodiesel. ANN models were also developed to predict fuel stability properties, and the accuracy of the models was in the order of Rancimat IP > PetroOXY IP > kinematic viscosity > acid value > iodine value. Developed models highlighted the potential of ANN in reducing cost and time needed for analysis. Comprehensive evaluation of additives in palm biodiesel were carried out
Print and performativity: courtly literature during the Union of the Crowns
No full textCourtly literature remains the subject of much scholarly debate. Anglo-Scottish courtly literature at the turn of the seventeenth century is further complicated by the Union of the Crowns. Scottish writers seeking to achieve or maintain access to the court had to consider removal to England, whilst English writers were required to navigate a new monarchy with quite different cultural expectations. This thesis examines how writers used literature and circulation to achieve or establish position in this changing political landscape.
The fields of book history and seventeenth century literary studies have been enjoying greater academic attention in recent years. This thesis responds to existing scholarship by combining these principles in case studies that establish texts as courtly performances, expanding on Stephen Greenblatt’s model of self-fashioning. These case studies demonstrate the varied types of engagement with print and courtly literary culture, considering both the content and circulation of texts to understand their performativity in a court context. They focus primarily on Scottish writers, albeit with some English inclusions, including James VI, William Alexander, Alexander Montgomerie, Fulke Greville, William Drummond, Robert Allyne, John Burel and Robert Ayton. Each case study consists of textual analysis exploring the shared vocabulary of courtly writing in the period and any (in)consistencies in imagery or trends that illustrate a commonality in courtly performativity. They also establish circulation and readership, through examinations of the textual lives and afterlives of each text, considering how, where, when and by whom each was printed. Each case study develops a broader understanding within the thesis of the text as a performance of Jacobean court culture.
With these studies, this thesis firstly establishes the parameters of courtly literary culture in the years immediately preceding and following the Union of the Crowns by defining courtliness by proximity and access to the monarch. Consequently, the thesis demonstrates layers of courtly performativity: firstly, that of the monarch; secondly, courtiers; and thirdly, writers seeking courtly patronage. The thesis secondly studies how texts can either perform the existing courtliness of their writers, or perform the writer’s capacity for position or patronage. It establishes how the monarch disseminated literature in print as a performance of monarchical authority. It also establishes traditions of addressing the court or, more specifically, the monarch, considering both the genre and the content of circulated texts to understand how writers sought monarchical or courtly advancement or patronage. It addresses the content of advice-to-princes material and occasional verse, alongside the circulation and audience, to understand how writers exhibited their capability to act in a courtly context in the content of their texts. Furthermore, book history demonstrates how writers engaged with print culture, or not, to undertake such performances, and how this choice was impacted by courtly access. In turn, this thesis examines the impact of print on writers and texts in their lives and afterlives. It particularly considers whether, by circulating in print, texts could lose their performativity with a readership beyond the court
A qualitative exploration of how SENCos construct the term ‘acquired brain injury’ and associated support in UK primary schools: A Reflexive Thematic Analysis.
Get PDFAcquired brain injury (ABI) is a term used to describe a neurological injury that occurs to the brain after birth (Howe & Ball, 2013). In the UK, there are reports of up to 40,000 new cases of childhood ABI per year (Dunford et al., 2020). The impact of ABI on children has been linked to physical, cognitive, social and emotional needs (Wilkinson et al., 2017; Saly et al., 2023); highlighting the importance of providing appropriate and timely support in schools (Crowe et al., 2021). Current literature suggests that school professionals are often unaware of ABI and its impact (Ernst et al., 2017) and acknowledge their own gaps in knowledge relating to ABI (Chleboun et al., 2021), including frequent misconceptions (Bennett et al., 2022). However, there is limited research into how ABI and any associated support is constructed by school professionals, especially by Special Educational Needs Coordinators (SENCos), who often work closely with children with ABI (Linden et al., 2013). The current study aims to provide a novel insight into how SENCos in UK primary schools construct the term ‘acquired brain injury’ and any associated support for children with ABI.
This study used semi-structured interviews and espoused itself to Reflexive Thematic Analysis (RTA) to gather and analyse data to explore SENCo constructions of ABI, based on a social constructionist positioning (Pilgrim, 2019). Six participants from mainstream UK primary schools participated in this study, who were all actively supporting children with special educational needs in a SENCo role for more than one academic year. Data was analysed using Braun & Clarke’s (2006 & 2021) six stages of RTA. A critically oriented analysis of the data interpreted that SENCos constructed ABI as complex in need, complex to support, easily misconceived, and requires a high level of support and significant growth in their role as a SENCo. Implications of these findings suggest that there is a need for increased awareness and knowledge of ABI through professional development and research, as well as multidisciplinary working. This research hopes to contribute to the limited literature on ABI in education from a SENCo’s perspective and highlights the need for systemic change to support inclusive and informed practice to support children and young people with ABI
On the emergence of physics beyond the Standard Model from right-handed neutrinos
Get PDFSakharov's induced gravity is a semiclassical mechanism where classical spacetime dynamics emerge from quantised matter fields. In this thesis, we find the Lagrangian terms from Sakharov's induced gravity where the matter fields are exclusively right-handed neutrinos. The right-handed neutrino induced terms consist of two main types: gravitational and fermionic. Our key result from the gravitational piece is a Newton constant that is consistent with observation, whence it is possible for the Einstein-Hilbert action to be an emergent consequence of right-handed neutrinos alone. We also obtain a cosmological constant and gravitational couplings of curvature-squared order, but these are incompatible with existing bounds and can be discarded. The fermionic piece leads to a seesaw mechanism, which gives active (left-handed) and sterile (right-handed) neutrino masses. The active neutrino masses turn out to be consistent with experimental data, but this comes at the expense of naturalness and staying within the perturbative coupling domain. The sterile neutrino masses lead to a potential neutrino dark matter candidate. Hence, we observe that right-handed neutrino induced gravity accounts for the combination of realistic spacetime dynamics, neutrino masses and a dark matter candidate, which is unaccounted for by the Standard Model. The right-handed neutrino induced Einstein-Hilbert term in particular further motivates right-handed neutrino existence.
In the non-commutative formulation of geometry due to Connes, coordinates under multiplication do not commute. A simple matrix model within Connes' non-commutative geometry is considered. It is observed that the full action of this model is emergent in a manner akin to Sakharov's induced gravity. In the model, this induced gravity perspective provides further explanation for a non-commutative geometry principle which is a stronger version of diffeomorphism-invariance at the level of the action. The findings are restricted to our model and constitute work in progress. It is hoped that non-commutative geometry will gain more understanding due to the induced gravity perspective
The influence of the Lutheran and Calvinist attitudes on Protestant liturgical music within sixteenth-century France
Get PDFThis thesis explores how liturgical music developed from the standard Roman Catholic liturgy to the Calvinist and Lutheran settings in France during the sixteenth century. It examines Martin Luther's exegetical approach towards music and embrace of art and music within worship, this combined with singing in the vernacular shows how Luther exemplifies the Normative Principle. This thesis also explores John Calvin's unyielding and stringent teachings and approach to liturgical music. It is this approach that resulted in congregational singing and Calvinist Monody which exemplify the Regulative Principle. Despite both theologians representing different approaches to liturgical music their impact on the Huguenots cannot be underestimated. It cannot be said whether the Normative or Regulative Principle had a greater influence across Europe throughout the centuries
Effects of dietary nitrate and vitamin C supplementation on blood pressure and vascular health in humans.
No full textEndothelial dysfunction (ED) and elevated blood pressure are key risk factors for cardiovascular disease, characterized by reduced nitric oxide (NO) bioavailability. Co-administration of vitamin C and inorganic nitrate (NO3¯) may reduce oxidative stress, boost the conversion of nitrite (NO₂⁻) into NO and elicit positive vascular effects.
Systematic review and meta-analysis of 20 randomized controlled trials (890 participants) demonstrated that vitamin C supplementation significantly reduced systolic blood pressure, with greater effects in populations with type 2 diabetes (-4.6 mmHg) and essential hypertension (-3.2 mmHg). Cross-sectional analysis of the InChianti cohort (920 older participants) showed initial inverse correlations between dietary NO3¯ and blood pressure, and vitamin C with systolic blood pressure only, all becoming non-significant after adjustment for confounding factors. No significant interaction was observed between NO3¯ and vitamin C on blood pressure. Analysis of vascular biomarkers revealed that dietary NO3¯ intake maintained significant negative associations with reduced C-reactive protein (CRP) and symmetric dimethylarginine (SDMA) levels even after adjustment for confounders. Vitamin C intake was positively associated with increased homoarginine levels. The only significant interaction effect between dietary NO−3 and vitamin C was observed for L-arginine concentrations.
In the experimental study on young healthy participants, combined supplementation of dietary NO3¯ (6 mmol) and vitamin C (1000 mg) for three days significantly reduced home systolic blood pressure, while no significant changes were observed with NO3¯ alone. The subsequent randomized crossover trial in overweight/obese middle-aged adults showed no significant changes in blood pressure across interventions but demonstrated that co-supplementation significantly improved flow-mediated dilation (FMD) and increased NO₂⁻ bioavailability compared to NO3¯ supplementation alone.
In conclusion, age, adiposity and metabolic status appear to influence the blood pressure and vascular responses to dietary NO3¯ and vitamin C co-supplementation. While blood pressure responses varied across studies, consistent enhancement of NO₂⁻ bioavailability and improved endothelial function with combined supplementation suggests potential therapeutic applications. These findings highlight the importance of considering individual anthropometric and physiological factors in designing nutritional interventions for cardiovascular health
The Randwick Wap: community, identity, and folk custom from the early-eighteenth to late-twentieth century
No full textThis thesis examines the historical practice, interruption, memorialisation, and revival of the Randwick Wap, a local folk custom in Gloucestershire, from its earliest known documentation in 1703 to the end of the twentieth century. Through close analysis of archival, textual, visual, and oral sources, the study examines how the Wap was shaped by both internal community dynamics and external perceptions, including moralistic and folkloric interpretations. By focusing on the Wap as a long-running and intermittently dormant tradition, this research offers a detailed case study through which to explore broader questions about the role of folk custom in community identity, historical memory, and cultural change. It highlights the evolving meanings attached to the custom, from a site of political expression and communal catharsis to a nostalgic symbol of Merrie England and rural identity. This thesis shows how traditions are constructed, adapted, and reimagined in response to shifting social and cultural contexts. The revival of the Wap in the 1970s is analysed not as a straightforward reinstatement, but as a creative act of cultural negotiation that balanced historical memory with contemporary values. Particular attention is paid to the role of individual agency, especially the influence of key figures, and local community members, in recording, interpreting, and reviving the custom.
This research argues that even highly local customs cannot be understood as isolated practices. Instead, they function within a dynamic traffic between local experience and national narratives, revealing the complex ways in which folklore is both shaped by and contributes to wider cultural and political formations. Voices of participants are here studied, considering how emotion, memory, and nostalgia operate within tradition-making processes. In doing so, the thesis contributes to interdisciplinary debates in folklore studies, cultural history, and heritage studies, and offers a model for how close studies of local traditions can reveal the layered relationships between memory, identity, and performance over time. It argues that the Wap’s enduring relevance lies in its function as a dynamic and negotiated expression of community identity, one that invites reflection on the fluidity of tradition and the power of local agency in shaping cultural heritage
How can we use narrative hospitality to understand rights?
No full textThe largely structural or legal‐functional accounts of rights that legal philosophers such as Dworkin, Feinberg, and Rawls developed are short on explanatory power, asking what content needs adding to the notion of rights to make it more complete? An operative theoretical framework for rights would aid rights discourse, thus this research suggests that framing rights as narratives of hospitality provides a more complete conception. Communication technologies are the lens used to explore this conception of rights.
Rights within society have normatively been viewed through public, private, and human rights perspectives, with rights as a mediated concept underpinning each. The aim of this thesis was to gain an understanding of how narrative hospitality can be used to understand rights examining why that mediation needs accounting for. Rights as a holistic concept were investigated using legal philosophical approaches to find the essence of what a right is, framing rights as requests for hospitality to alleviate personal suffering. The ends of this research provide an approach enabling examination of philosophical concepts of rights within a technological framing. I provide a wide-ranging examination about the concept of rights, establishing how narrative hospitality is essential to understanding rights
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