• 'Death Drive': A Literature-based Heuristic Study of the Influence of the Freudian Death Drive on 21st Century Counselling and Psychotherapy Literature

      Bains, Maninder (University of Chester, 2011-01)
      The theory of death drive has been controversial from the very start. It has been identified as a myth that had been out of favour in modern psychotherapy and counselling. Such is the dynamism of this ‘dead subject’ that it has been infused with life from 1920 to 2011; as this study will show sometimes by its adherents other times by its dissidents. Through this heuristically informed literature-based research, I endeavour to show the impact of the death drive on the present psychotherapy and counselling literature. Within much of the literature the death drive is perceived as a destructive or daemonic force, only achieving quiescence and Nirvana through addiction. Three emerging themes of Aggression, Quiescence and Narcissism have been further elaborated in chapters 4, 5 and 6. Written from a psychodynamic perspective, with keeping in mind its roots in psychoanalysis, this study concludes that like the phenomenon of death in life, the death drive is also inescapable in counselling and psychotherapy. By not getting mentioned in training and with covert references in literature its ‘unconscious pressure’ is difficult to ignore.
    • Determinants of anthropometric measurement use amongst dieticians

      Almiron-Roig, Eva; Mash, Laura E. (University of Chester, 2010-11)
      Background: Nutritional assessment, including the measurement and interpretation of anthropometric data, is a pivotal part of the dietitian’s role. However, the extent to which dietitians use anthropometry in their day-to-day activities is poorly documented. Anecdotal evidence suggests that this is below ideal levels. Attitudes and perceived barriers towards the use of anthropometry may further differ by work setting and patient group (e.g. between acute and community-based dietitians). In order to evaluate factors influencing the use of anthropometry amongst dietitians, sensitive, validated tools are needed. Visual analogue scales (VAS) are easily used and interpreted, but have not been validated for assessing confidence levels, in particular when taking body measurements. Aims: This study investigated the use of, and barriers/attitudes towards taking anthropometric measurements amongst dietitians using a cross-sectional survey. For this, a new type of confidence scale (VAS-based) was validated against two other commonly used scales (the Likert and the general-labelled magnitude scale, gLMS). Design and procedure: A pre-piloted questionnaire including confidence scales and attitudinal scales was sent to all NHS dietitians in the North West of England between March-April 2010. The pilot sample (n=32) rated their perceived confidence at taking various anthropometric measures using VAS, Likert and gLMS scales on 2 separate occasions, with scale order randomised. Results: ANOVA and Bland-Altman plot tests indicated VAS to be as sensitive and as reproducible as Likert; VAS also had greater level of agreement with Likert than gLMS, therefore VAS were chosen for the final questionnaire. Of the 397 questionnaires posted, 213 (54%) were returned. Highest confidence ratings were for BMI, height and weight, and lowest for BodPod and head circumference measurements. Average confidence scores across all measurements were lower for community dietitians compared with acute dietitians (mean + SEM scores for community: 54.21 + 14.78 mm; vs. acute: 60.27 + 12.11 mm; p<0.05). The majority of anthropometric measures were reported to be taken on an infrequent basis (‘Never’/’Less than monthly’). Height, weight and BMI were the most commonly used. Significantly more acute than community dietitians used ‘estimated’ (50% vs. 11.3%) and ‘recalled’ weight (50% vs. 11.4%) on a daily basis. The most common barriers against taking measurements were ‘Not appropriate for patient’, ‘Lack of equipment’ and ‘Time/work load constraints’. Significantly more acute responders reported ‘Time’ (81.4%, α=0.003) and ‘Confidence’ (75.5%, α=0.05) to be barriers to anthropometry use. Beyond half of the sample (61%) would attend future training, primarily to increase confidence and competency. Conclusions: Regardless of the importance/reported benefits of anthropometry, it is performed to a very limited degree by dietitians in the North West and is often limited to estimates, BMI, heights and weights. There are numerous barriers to anthropometry use for acute and community dietitians, namely time, equipment and confidence. It may therefore be unrealistic to expect many anthropometric measures to be taken and training should be adapted to reflect the reality of practice. This study also supports the use of VAS scales when assessing dietitians’ confidence at taking anthropometric measurements as a sensitive and reliable tool compared to the more widely used, however less sensitive, Likert scales.
    • Determinants of participation in cardiac rehabilitation phase IV

      Fallows, Stephen; Mansley, Jennifer C. (University of Chester, 2008-09)
      Reducing the wide spread incidences of coronary heart disease (CHD) is a clinical challenge for the public sectors within the NHS in the UK. The current study aimed to highlight the key barriers that affected participation within exercise based provisions of cardiac rehabilitation (CR). The study concentrated on the two exercise based phase (CR phase III and phase IV) and targeted those who had completed CR phase III. Information on patients who had completed the CR phase III within the previous year were sent a questionnaire to collect information on the patients’ actions after completing the CR phase III exercise based class. 35 (64.8%) males and 19 (35.2%) females returned questionnaires indicating their activity levels following a cardiac event and/or procedure. The results showed that from the patients that responded, 11 (20.4%) were currently attending the CR phase IV exercise based class, 7 (13.0%) has previously attended the Cr phase IV class and 36 (66.7%)had not attended the Cr phase IV exercise based class. The results were analysed using SPSS (version-16.0) for frequencies between the answers given. The results showed that despite the barriers expressed by the participants who did not participate in the community based phase IV exercise class, the service could be enhanced to encourage more to utilise the services provisions. As CHD is becoming more prevalent in younger adults, many of the participants who responded to the questionnaire stated that they had resumed employment and no longer had the time to participate in CR services. Despite this finding many acknowledged the importance of remaining active and living a healthier lifestyle in the aim of reducing further risk factors associated with CHD.
    • Developing professional judgement in the legal profession: the use of the Professional Education and Training Programme (PEAT 2) in selected Scottish law firms

      Westwood, Fiona (University of Chester, 2015-06)
      The objective of this research is to evaluate the effectiveness of the development of professional judgement during the two year work-based pre-admission training period (PEAT 2) required of Scottish solicitors so as to identify a model that allows them to respond to the changes the UK legal services sector is experiencing. The methodology adopted throughout reflects an emphasis on researching knowledge in the context of its application (Flyvbjerg 2001). Professional judgement is described as the ‘heart of professional practice’ (Fish and Coles 1998) and is therefore selected to provide a holistic method of evaluation. The UK legal profession is fragmenting in its response to market pressures, including the introduction of external regulation and ‘alternative business structures’ under the Legal Services Act 2007 and increased globalisation, specialisation and commoditisation. It is therefore important to identify the traditional method used by Scottish solicitors to develop their judgement as there is a risk that what was previously implicit and assumed in this ‘community of practice’ (Wenger 1998) becomes dissipated. As a result, the relevance and application of judgement is considered in the context of professional practice and solicitors in particular. The effect of external influences are interpreted, including in relation to the job of a solicitor, the future development of judgement and implications for legal education. The research method adopted enables confidential data to be obtained about the development of professional judgement and the PEAT 2 processes through completion of semi-structured interviews with a number of Scottish law firms, the Law Society of Scotland and related regulatory organisations, supplemented with Scottish trainee focus groups and comparative data from illustrative law firms and regulators in England and Wales. This allows 10 detailed case studies of law firms to be developed and analysed using Eraut’s (2007) model of early career learning and Fuller and Unwin’s (2003) model of expansive and restrictive apprenticeships as well as providing commentary from experienced solicitors and regulatory sources on the development of professional judgement. This allows 10 detailed case studies of law firms to be developed and analysed using Eraut’s (2007) model of early career learning and Fuller and Unwin’s (2003) model of expansive and restrictive apprenticeships as well as providing commentary from experienced solicitors and regulatory sources on the development of professional judgement. This data enables an analysis of the effectiveness of the current Scottish pre-admission training processes and the identification of methods used to develop the judgement of novices. Findings indicate that elements of the formal requirements of PEAT 2 are limiting the experiential and reflective learning of trainees and, in the wider context of work-based learning, that professional judgement is developed through exposure to reflective practice in a ‘community’ that provides an expansive apprenticeship and establishes parameters of acceptable choices. Recommendations include adjustments to pre-admission legal training and the introduction of a specialist qualification, accredited by the Law Society of Scotland.
    • The development of a ten year skills strategy, within the high value added manufacturing sector, in Wales and the north west of England using partnership management, as a strategic enabler: A qualitative study at Chester Business School

      Martin, Andrew F. (University of Chester, 2008-05)
      This study aims to develop research in considering models to understand contemporary thinking on developing long term strategic direction and strategic relationship management. In addition it intends to investigate the current approach to strategic direction through relationship management, within the developing High Value Added Manufacturing Sector Strategy. The research will then draw conclusions and make recommendations for incorporating strategic direction, and relationship management into the High Value Added Manufacturing Sector strategy in Wales and North West England.
    • Developmental validation of a forensic profiling system for black rhinoceros (Diceros bicornis) and extraction of nuclear DNA from historic rhinoceros horns

      Dicks, Kara L. (University of Chester, 2014-11)
      Demand for rhinoceros horn in the late 20th century led to the population decline of black rhinoceros (Diceros bicornis) by more than 96 %, and the species remains critically endangered. Trade in rhinoceros and their products is prohibited under CITES legislation. Despite this, there has been a recent increase in rhinoceros horn demand for use in traditional Asian medicine (TAM) to treat a range of illnesses including cancer, childhood fevers and as a hangover cure. Consequently, the value of rhinoceros horn in illegal trade has risen dramatically, alongside a dramatic increase in poaching. Large numbers of horns exist in historic collections, and since 2011 there has been numerous thefts in both rhinoceros range states and throughout Europe. Wildlife DNA forensic analysis can be used to individually identify rhinoceros horn, matching a seized horn to a crime scene. This can provide valuable evidence in criminal proceedings. This study therefore aimed to validate a profiling system that could be used for D. bicornis horns and to determine an optimal DNA extraction method for historic horns. A developmental validation of a marker panel consisting of 15 short tandem repeat (STR) and one sexing locus was carried out to determine its reliability and efficacy in singleplex reactions. The markers were not found to deviate from patterns of Mendelian inheritance, and species specificity studies found that only two loci (WR7C and ZF1) amplified human and dog DNA. Alleles could be scored at DNA concentrations of less than 1 ng/μL for all loci except WR7C. The marker panel was found to be highly reproducible with a maximum d-value of 0.545, mean heterozygous balance of 1.30 and stutter ratio of 0.35. The marker panel was also robust to reductions in annealing temperature (TA) and increasing cycle number (up to 43 cycles), although increasing TA reduced amplification success. The markers were then combined into two multiplexes and allele frequency data was generated for 52 D. bicornis michaeli, and two markers (BlRh37D and IR12) were rejected for violating assumptions of Hardy-Weinberg equilibrium and linkage equilibrium. The average probability of identity (PIave) ranged between 1.06 x 10-11 and 1.16 x 10-7 with varying levels of relatedness and population structure. The marker panel was determined suitable for use in forensic casework analysis under the defined conditions, and limitations were described. Previous studies have shown that nuclear DNA (nDNA) can be extracted from modern horns, but how effective those methods would be on historic horns was unknown. Optimisation of a number of aspects of the extraction method was carried out, including sample preparation, chemical breakdown with dithiothreitol (DTT), mass of starting material and extraction kit. Mechanical breakdown of rhinoceros horn material using a mixer mill was determined unnecessary, whilst the addition of DTT was found to improve digestion. Irrespective of extraction kit, 20 mg of horn material yielded sufficient quality and quantity nDNA for forensic profiling. Qiagen extraction kits using the QIAamp Mini columns were found to yield superior DNA quantity compared with QIAamp MinElute columns. Whilst KingFisher Cell and Tissue DNA Kits yielded equivalent extract quantity, mitochondrial DNA contamination between samples was detected. The Qiagen method using QIAamp MinElute columns was therefore considered the most robust extraction method for historic rhinoceros horns. This work describes the conditions and limitations of a forensic profiling system for D. bicornis and an effective extraction methodology for historic rhinoceros horns. This enables this marker panel to be used with confidence in forensic casework analysis of both modern and historic horns.
    • Did Paul accept the Apostolic Decree

      Simmonds, Issac (University of Chester, 2017-09)
      The relationship between the so-called Apostolic Decree (Acts 15:20, 29) and the apostle Paul has puzzled many scholars. Following F. C. Baur, many have maintained that there is at the heart of early Christianity a divide between Jewish (Petrine) and Gentile (Pauline) Christianity. On this view, Paul could never really have consented to - or even been present at - the apostolic council and agreed to the decree which established a minimum set of requirements for Gentile believers. This dissertation shall provide an in-depth exegesis of the Apostolic Council in Acts 15, placing in within the context of Second-Temple Judaism and the Book of Acts. Along these lines I shall suggest that there are three core issues when it comes relationship between the account of Apostolic Decree (Acts 15:20, 29) and the Apostle Paul. Ultimately, I shall argue that the divide between Jewish (Petrine) and Gentile (Pauline) Christianity has been overstated and derives from a misunderstanding of the Apostle Paul.
    • Difference between low cadence-high resistance and high cadence low resistance in relation to muscle breakdown in cyclists

      Stanley, Robert (University of Chester, 2015-09)
      Training at different cadences provides a different training stimulus (Brisswalter et al, 2000) which can be metabolic adaptations or skeletal muscle hypertrophy. Studies have considered the role of cadence in metabolic efficiency and/or participants perceptions of effort (Coyle et al, 1991. Cangley et al, 2009) however there is little literature measuring the efficiency of cadence in relation to muscle breakdown. This may be due to it being difficult to measure muscle breakdown in a noninvasive manner and without conducting a muscle biopsy. Creatine Kinase can be used as a marker of increased muscle breakdown and it is measured using a finger prick blood sample however this indirect method of measuring muscle breakdown is not as reliable and discrepancies in the results can occur as a result of differing response rates between participants or other health issues causing an increase in creatine kinase levels (Brancaccio et al, 2007). Coaches and athletes often use high intensity interval training as a method of improving metabolic efficiency (Laursen et al. 2005) however there is little research into the effects of high intensity interval training for skeletal muscle hypertrophy and strength training in cyclists. This literature review will form the basis for a research project that will consider the effects of differing cadences on muscle breakdown during a high intensity interval training protocol. This research hopes to provide recommendations for coaches and well trained cyclists to improve the training that they conduct to have the desired training stimulus they hope to achieve whether that be increasing muscle breakdown to cause hypertrophy and increase strength or increase adenosine triphosphate production by improving metabolic efficiency. By considering the existing literature surrounding cadence, this review hopes to provide potential reasoning for the results of the proceeding research project. The method’s for how best to conduct the research shall also be reviewed along with a discussion about the use of high intensity interval training protocol’s for well trained cyclists.
    • Differences in outcomes between type 2 diabetes and non-type 2 diabetes patients in a local specialist weight management service

      Taylor, Iona (University of Chester, 2014)
      ‘Diabesity’, the comorbid occurrence of type 2 diabetes (T2DM) with obesity, is increasing rapidly in the UK, and becoming more prevalent in younger age groups. The onset of diabetes increases risk of macro- and microvascular complications, reduced life expectancy, and decreased economic productivity and quality of life. It is also expensive to manage, through medication costs, monitoring, and management of complications. Management of obesity can improve diabetes control, but weight loss is often slower than in those without diabetes. This is often made more challenging over time, with disease progression increasing the number of medications required for glycaemic control. Dietary methods for weight loss in diabesity have been explored; restricting energy intake and regular support appears to be of more importance to success than macronutrient balance, although long-term effectiveness is unclear. However, bariatric surgery is the only current treatment option offering both the possibility of diabetes remission as well as substantial long-term weight loss. Specialist diabesity services, supported by a multidisciplinary team to manage outcomes for obesity and diabetes concurrently, have been piloted. However, these services are not commonly available at local level. It is unclear whether the existing obesity management service provision is adequately supporting weight loss for those with comorbid type 2 diabetes.
    • Digital marketing and young consumers: A framework for effective digital marketing communications

      Maheshwari, Vish; Morris, Bethan (University of Chester, 2019-01-22)
      Children in contemporary society are an important and lucrative consumer segment (Haryanto, Moutinho, & Coelho, 2016). They have both individual spending power, and significant influence over the purchase decisions of their parents and carers (Calvert, 2008). Brands have recognised the business benefits of engaging with consumers at an early age in order to develop profitable lifelong consumer relationships (Hamelin, Gbadamosi, & Peters, 2018) Developments in online communications, especially since the emergence of Web 2.0, has enabled businesses to build a presence in an interactive and co-creative online environment (Ryan, 2014). In the UK, consumer use of interactive technologies is pervasive. Smartphone penetration in the UK in 2016 was 81 per cent (Deloitte, 2016). The Consumerisation of ICT is particularly visible in children, born since 2000 who have grown up in the interactive era of Web 2.0 (Carter, Bennett Thatcher, Applefield, & McAlpine, 2011). 99 per cent of UK families have internet access in their home (ONS, 2016) and 83 per cent of 5 to 15 year olds have access to a mobile ICT device in their household. It is estimated that one third of all online users are below the age of 18 (Livingstone, Carr, & Byrne, 2016). Young consumers therefore have access multiple channels for communication and engagement with peers, family, and businesses. At a time when children have become proficient navigators of the online marketplace there is a real importance for marketers to understand how to communicate effectively with this segment (Thiachon, 2017). Children have been recognised as a distinguishable consumer segment since the mid-twentieth century. The study of children’s consumer socialisation emerged during the 1970s (Roedder John, 1999). In the years following, academic understanding of consumer socialisation has influenced government policy in areas of public health and child welfare, as well as influencing the self-regulation of marketing and advertising practice (Jordan, 2008). The body of existing research is predominantly focused on these areas rather than how marketers can effectively communicate with young consumers. Studies that do focus on marketing communications have done so by examining practices in relation to brand loyalty and trust (Haryanto, Manuela, & Moutinho, 2015 ; Haryanto, Moutinho, & Arnaldo, 2016). Although they provide recommendations that highlight the importance of these concepts in developing communications with young consumers, they do not identify the types of approaches to employ in order to achieve these relationships with consumers. As public policy concerns provided the impetus for research in this area, it is unsurprising that there is a concentration of research investigating the influence of marketing communications on young consumers within the context of public health. Children in this context are positioned passive and vulnerable members of society (Haefner, 1975; Roedder John, 1999; Calvert, 2008; Sramová & Pavelka, 2017). Although this approach is valid and provides valuable insights, academic understanding of young consumers would be limited if research was generated only from this perspective. This study will aim to address this gap in understanding, acknowledging that children have expanded their roles within the family as purchase influencers and independent purchase decision makers. The research will examine current Digital Marketing Communication (DMC) practices employed by brands whose products are aimed at young consumers. For the purposes of providing research focus, children are defined as individuals aged 17 and under.
    • Do graduated compression garments improve field-hockey skill performance and repeated sprint ability following an intermittent endurance test?

      Heath, Jonathan (University of Chester, 2008-09)
      Introduction: Compression garments have long been shown to promote physiological benefits both within the medical profession and also within the sporting arena. Team sports such as field-hockey, football and rugby are characterised by high intensity intermittent exercise, also requiring a significant contribution of motor skill performance and cognitive function. To date there is paucity in the research regarding graduated compression garments and their effects on field-hockey skill performance. Method: 14 male field-hockey players (24 ± 4 years), National League North standard, attended on five separate occasions: two familiarisation sessions and three test sessions. During testing sessions participants wore one of three clothing combinations, Control (polo shirt and shorts), Placebo and Graduated compression garments (Skins™). Placebo and Graduated compression garments were worn underneath the control clothing condition and consisted of a long sleeve top, shorts and socks. The order in which clothing conditions were tested was randomized. Testing consisted of 15 minutes rest followed by a 15 minute warm up. Participants then performed a field-hockey skill test, a repeated sprint ability test and an intermittent endurance test. Following the intermittent endurance test the field-hockey skill test and sprint test were repeated. Followed by 20 minutes recovery. Heart rates were monitored constantly throughout the test. Blood lactate, core temperature and subjective whole thermal ratings, clothing sweating sensation, clothing comfort sensations and Ratings of Perceived Exertion (RPE), were monitored after each test component. Results: Field-hockey skill results were not significantly different between clothing conditions (p = 0.800 and p = 0.822 for pre and post intermittent endurance respectively). Repeated sprint ability fatigue times showed no significant difference between clothing conditions pre intermittent endurance test (p = 0.607). Post intermittent endurance fatigue time was significantly different between control and placebo (p = 0.005), but not significant between control and graduated compression garments and between placebo and graduated compression garments (p = 0.073 and p = 0.753 respectively). Intermittent endurance results were significant (p = 0.002) between control and graduated compression garments (1699.92 ± 120.19m and 1767.71 ± 140.45m respectively), and between placebo and graduated compression garments (1682 ± 155.48m and 1767.71 ± 140.45m respectively). Heart rate, blood lactate and core temperature between clothing conditions were not significant (p = 0.510; p = 0.893; p = 0.502 respectively). Subjective whole thermal sensations were not significant (p = 0.784). Clothing sweating sensations were significant for graduated compression garments at field-hockey skill test post intermittent endurance (p = 0.015) compared to control, sprint test post intermittent endurance (p = 0.001) compared to control, and also during recovery (p = 0.0014) compared to placebo. Clothing comfort sensations were significantly improved for graduated compression garments (p = 0.012). RPE scores were not significant (p = 0.444). Conclusion: Graduated compression garments do not improve field-hockey skill performance and repeated sprint ability either before or after an intermittent endurance test. They do however significantly improve intermittent endurance running, and may help to maintain skill and sprint performance at levels comparable to clothing conditions performing significantly less in an intermittent endurance test. Graduated compression garments also have significant effects on subjective clothing sweating sensations and also clothing comfort sensations.
    • Do psychological factors influence magistrates' behaviour towards mentally disordered defendants?: An empirical study

      Whittington, Richard; Dawson, Lindsey-Jane (University of Liverpool (Chester College of Higher Education), 1996-07)
      The aim of this study was to assess magistrates' knowledge of, and attitudes relating to, mentally disordered defendants / offenders and the effects upon 'disposal' [decision making]. Method: A combined quantitative and qualitative empirical study supported by a literature review was chosen. The research instrument used was a questionnaire distributed to a combined local and national sample of magistrates. The knowledge, attitudes and decisions of the whole sample were analysed and comparisons made according to gender, professional experience and length of service. No effort was made to control the three ' grouping' variables gender, professional experience and length of service. The possible influence of these three 'grouping' variables were considered and analysed. The significance of the 'grouping' variables upon knowledge and attitude were statistically analysed using the Mann Whitney U-test, Kruskal Wallis Test and chi-square test. Qualitative data was used to support the statistical analysis. Results: The level of magistrates' knowledge of the procedure for disposal of mentally disordered defendants/offenders was low. Professional experience did not indicate improved knowledge. Magistrates 'knowledge of other agencies' responsibilities and policies with regard to the mentally disordered defendant were demonstrated to be seriously deficient. Magistrates were shown to have negative attitudes towards mental disorder but a more positive attitude towards the history of mental disorder when considering the disposal of defendants/offenders. Female magistrates and longer serving magistrates were significantly inclined to a more positive attitude towards mentally disordered defendants, giving greater weight to the issue of mental disorder. Magistrates showed variable estimates of the importance of mental disorder in criminal behaviour. Magistrates find facilities and options for the handling and 'disposal' of the mentally disordered in the Magistrates' Court extremely deficient,limited and frustrating. Conclusion: The research has shown that there is in general, poor knowledge and understanding of the main issues associated with mentally disordered defendants/offenders. The study has also demonstrated that these deficiencies adversely affect magistrates' decision making 'disposal', in respect of mentally disordered defendants/offenders. The study has shown that in order to reduce the number of mentally disordered remanded to prison and thus adhere to policy outlined in Home Office circulars 66/90 and 12/95, it is necessary to take steps to improve the knowledge and understanding of the issues related to the mentally disordered defendant/mentally disordered offender for all magistrates.
    • Do UK based weight management programmes cause weight loss maintenance in adults? A systematic review

      Jawadwala, Rehana; Moore, Alison (University of Chester, 2012-10-08)
      The aim of this dissertation was to examine whether UK based weight management programmes promote weight loss maintenance (follow up of 12 months to assess effectiveness of intervention in weight loss) in adults through the process of a systematic review. The World Health Organisation (WHO) has described obesity as a "global epidemic". Weight management comprises two phases; weight loss and weight loss maintenance. The latter phase is the true goal for obesity and the most difficult element of weight management to achieve. However much less is know about this as compared with the weight loss phase. There is little purpose in committing time and money to reducing obesity if the weight is regained. This is counter-productive and weight loss maintenance is essential to combat the obesity epidemic. Searches were made for relevant information from a variety of scientific online databases and journals,. Seven articles met the inclusion criteria and were analysed in the review. All studies incorporated a multi-component (diet, exercise, behaviur modification) intervention approach. All control and internvetion groups reported weight loss at 12 months when compared with baseline. All groups recieved an intervention. One study reported a significant difference (P<0.05) between groups. Four studies reported on at least one component (diet, physical activity, behaviour modification) however there was not enough information to conclude whether they complied with national guidelines (NICE CG43 and SIGN 115). High attrition rates and loss to follow up are problematic for each study except one. Analysis on an intention to treat basis was common however this is problematic and there are alternative methods which may be more suitable for dealing with missing data.
    • Does a community based heart failure disease management programme improve quality of life, knowledge and self-care of participants?: A service evaluation

      Buckley, John P.; Baron, Clare E. (University of ChesterBurnley Borough Council, 2011-09-30)
      Heart failure also has poor clinical outcomes with around 40% of people dying within one year of initial diagnosis. Heart failure patients have a five-year survival rate of just 58% compared to 93% in the age- and gender-matched general population. It has long been identified that education and improving self-care behaviour is an important aspect of managing heart failure to aid in reducing costs to the economy as well as, more importantly for patients, improving quality of life. The aim of this service evaluation is to assess the impact of the Living Well with Heart Failure Programme on participants in terms of knowledge, quality of life and self-care behaviour. 21 participants (14 males, 67 yrs ±13, 7 females, 72 yrs ± 9) with diagnosed heart failure took part in a pilot six week disease management programme consisting of education, social interaction and relaxation practice facilitated by a community cardiac rehabilitation practitioner. Participants' quality of life was assessed via the Minnesota Living with Heart Failure questionnaire and self-care behaviour was measured via the Self-Care of Heart Failure Index at week one and week six along with a knowledge questionnaire. Paired t tests were conducted on the overall sample with further analysis being carried out on genders, NYHA classifications and age groups both within and between groups. There was a significant improvement in quality of life of 12% (p=0.005) and participant knowledge improved by 100% (p=0.005). Self-care behaviour also significantly improved - maintenance 70% (p=0.005), management 66% (p=0.005) and confidence 63% (p=0.005). Whilst all groups showed significant improvements in quality of life, knowledge and self-care behaviour, no significant differences were found between them. Statistically significant improvements in quality of life, knowledge and self-care behaviour were seen in the participants of the Living Well Programme. The design of this programme of not only educating participants but also encouraging self-care behaviours with continued support and motivation would seem to be key in promoting behaviour change which in turn improve well being. On the basis of the evidence provided in this service evaluation local primary care trust should look to commission the Living Well Programme across East Lancashire allowing all heart failure patients in the area the opportunity to empower themselves to improve their health and well being.
    • Does a particular sporting background provide an advantage to an athlete entering the sport of triathlon?

      Fallows, Stephen; Mooney, Orla G. (University of Chester, 2008-09-30)
      The goal of this dissertation is to establish what sporting background do age group triathletes come to the sport of triathlon from and if a particular sporting background results in faster finishing times. It will also examine the impact of training hours, periodisation and strength training on finishing times. The research in this study is questionnaire based and 401 completed surveys from triathletes of both sexes across 26 countries and ranging in age from 16-19 years to 70-74 years. In all statistical comparison tests, a significant value indicates p<0.05 unless a Bonferroni adjustment was required. For the purposes of data analysis, the data was been broken up into four categories, i.e. Male and Female Sprint distance triathletes and Male and Female Olympic Distance triathletes and these were subdivided into “High Performer” and “Regular” triathletes. Athletes from a swimming background had the lowest mean finishing time in three data groups, and statistically significant differences in two data groups but in no case was there a statistically significant difference between athletes from a swimming background and those from a running background. Training hours proved to be very significant with “High Performers” having a significantly higher volume of weekly training than their “Regular” counterparts. Triathletes had a very high awareness of the concept of periodisation with statistical differences in finishing times between those who employed periodisation, those who did not and those who were unaware of the concept, in three of the four groups. There was some evidence that early learning was advantageous but only to the extent of becoming involved in sport; specialization at a young age did not appear to be a criterion for success at age group level in the sprint and Olympic distance triathlons.
    • Does calorie information on menu labeling affect consumer food and beverage purchases?

      McDermott, Clara (University of Chester, 2014-09)
      The increase in diet related diseases is considered to be primarily caused by a changing environment that encourages poor dietary habits and a sedentary lifestyle (Swinburn, Caterson, Seidell & James, 2004) . Research by Ng et al . (2014) has found that the number of obese and overweight people worldwide has increased from 857 million in 1980 to 2.1 billion in 2013. Bowman and Vinyard (2004) make the point that frequent consumption of fast food, in particular , is associated with poorer diet quality and risk of obesity for both children and adults. This literature review examines studies both in favour of calories being posted on menus in restaurants that argue that the implementation of this will have a positive effect on the obesity crisis and those that argue that its implementation will have a limited effect. This review looks at various studies that argue that the policy is likely only to affect certain population segments or socio economic groups.
    • Does diet play a role in the alleviation of rheumatoid arthritis symptoms?

      Fallows, Stephen; Lee, Claire E. (University of Chester, 2007-10)
      This systematic review of scientific literature was undertaken to investigate the possibility of a role for diet in the alleviation of rheumatoid arthritis (RA) symptoms, with an objective of highlighting specific nutrients and/or certain food groups and diets that may impact upon the symptoms of RA. Studies displaying conflicting evidence (i.e. show diets that have no effect on RA symptom alleviation) were also reviewed. A comprehensive literature search to identify relevant papers was carried out with the use of criteria, in an attempt to identify as many studies as possible, but also to minimise selection bias for those that were found. Electronic databases, library catalogues and internet search engines played key parts in paper identification. A total of 31 papers were identified after meeting selection criteria and summaries and critical appraisals were compiled for comparison. Some studies show that fish oil supplementation displayed the greatest benefits through a reduction in the number of tender joints and morning stiffness. One paper offers a dosage figure for improvement in clinical symptoms as 40mg/kg body weight/day of oil containing n-3 fatty acids (FAs) combined with <10g/day of dietary (n-6) FAs. Periods of fasting with a vegetarian diet promotes a reduction in RA symptoms. Several studies identify Gammalinolenic Acid as capable of decreasing pro-inflammatory products of Arachidonic Acid. Similarly, elemental diets and foods devoid of allergens may benefit RA activity parameters, however improvements in RA symptoms seen in response to elemental diets are not sustained on individualised diets. Many researchers recognised the influence of a Mediterranean diet, rich in anti-oxidant containing vegetables, n-3 FAs and a lower ratio of n-6 to n-3 FAs as sources of inflammation reduction. Vitamin E treatment was shown to provide a small analgesic property compared to placebo, the mechanism of which and identification of additional vitamins and food sources with such potential require further study. Further work is required on establishing most beneficial supplement dosage, duration and length of treatment interval. Knowledge of correlations of food allergies in RA sufferers to immune responses compared to food antigens in the fluid of blood and joints would be useful.
    • Does empathy and adult attachment affect the stigma placed on individuals with mental health conditions?

      Bramwell, Ros; Rattu, Tracey-Anne (University of Chester, 2017)
      Current research suggests that mental health stigma can lead to discrimination, social disadvantages, self-stigma, and a lack of help seeking. Adult attachment styles are proposed to influence an individual’s empathy levels, which can decrease mental health stigma. This study is a replication study of Webb et al, (2016) with slight differences in methodology. It investigated if adult attachment and empathy levels affected the stigma placed on individuals with mental health disorders. The hypotheses were as follows; (1) a schizophrenia vignette would produce more stigma than homelessness, (2) participants with greater empathy levels would have lower levels of stigma, regardless of vignette type, (3), adult attachment would moderate the relationship between empathy and stigma, and the secure adult attachment style would produce decreased levels of stigma and greater empathy. Participants (N=80) empathy was measured via an Empathy quotient-short Form (Wakabayashi et al, 2006) and adult attachment styles via a Relationship Questionnaire (Bartholomew & Horowitz, 1991). Participants read a vignette describing and agitated man in a library, described as either homeless or schizophrenic. They then rated 11 stigma statements. 2x2 ANOVA results found partial support for hypothesis 1,as the main effect of status on stigma was significant, F (1, 75) = 6.11, p <.02, and the interaction between vignette and status on stigma levels was also significant, F (1, 75) =4.10, p <.05. Students stigmatised schizophrenia less than the general population. Correlation analysis concluded that empathy was significantly related to stigma (.43** (77)) supporting hypothesis 2, and regression analysis showed a significant main effect for empathy on stigma at step 1 (β= -.43, t=3.77, p< .001) and step 2 (β=-1.00, t= -1.87, p< .07). Regression results lack support hypothesis 3 as the total amount of variance for stigma did not increase significantly when interactive terms for empathy and adult attachment style were added (R²=.24, ΔR²= .04, ΔF (5.34) = .52, p = .03. Suggesting the interaction between empathy and adult attachment style does not predict stigma. Overall empathy related to stigma within this study. Future research should determine if empathy training techniques can reduce mental health stigma. A larger sample size is needed to gain more individuals from the four attachment styles to determine their effects on stigma more effectively. Another key finding was that stigma tendencies differed between student and non-student (general population) participants. Future research should investigate if training interventions and prior knowledge are beneficial for the reduction of stigma.
    • Does maternal early pregnancy underweight influence neonatal birth outcome? A retrospective study in Liverpool

      Fallows, Stephen; Ralph, Sabra H. H. (University of Chester, 2009-09)
      The neonatal period is a sensitive indicator of a population’s health with birth weight acknowledged as the most important factor affecting the newborn. Both ends of the birth weight spectrum predispose to increased risk of subsequent obesity and/or disease. There is considerable research into neonatal consequences of maternal overweight/obesity but less into maternal underweight. This study used BMI groups to consider whether maternal early pregnancy underweight influences neonatal birth outcome, particularly birth weight, and whether such associations vary according to the degree of underweight. This retrospective study used Statistical Package for the Social Sciences (SPSS) to analyse anonymised data, from a three year period, for 23,664 women booking-in for care at Liverpool Women’s Hospital. Following data recoding, study participants were placed into BMI bands with underweight being separated into <18.5kg/m2 and 18.6-19.9kg/m2; the X2 test investigated potential associations (p=<0.05) between early pregnancy BMI, particularly underweight, and neonatal outcomes. Data were unavailable for 5.7% of the sample group. Incidence of maternal underweight (9.2% mean) decreased over the data period; the majority (6.3%) of the underweight women were in the 18.6-19.9kg/m2 group. Of the total births, 7.5% were low birth weight; such infants were more likely to be delivered to mothers in the underweight groups (p=0.00). Other adverse neonatal outcomes (Gestational Age, foetal growth, neonatal intensive care requirement) were also associated with maternal underweight. The risk of adverse neonatal outcomes was inversely associated with degree of maternal underweight. Cross-tabulations performed between variables other than maternal underweight indicated a variety of associations, underlining the multi-factorial nature of birth outcome. This study indicates that maternal early pregnancy underweight is associated with adverse neonatal outcomes with risk influenced by the degree of underweight. Recommendations are made for further research to adjust for confounding factors and extend the observations.
    • Does performance during the ISWT truly reflect changes in physiological function?

      Innes, Geraldine (University of Chester, 2009-09)
      This aim of this dissertation is to evaluate whether changes in performance i.e. maximum distance walked (MDW) in the ISWT truly reflect improvements in physiological fitness in patients who have undergone a 3 month course of cardiac rehabilitation. (CR) A retrospective analysis of 184 patients was carried out and data was collected from an ISWT before and after CR. A Wilcoxan Signed Rank test was used to analyse the variables of heart rate (HR), RPE, MDW and walking speed index (WSI) for all participants. The inclusion of a WSI, looking at peak HR in relation to speed of walking, was used to determine if there was a significant decline in HR at increasing workloads post CR. This was used to signify if a true physiological change in fitness had occurred. There was a 27% mean increase (p=0.0005) in MDW for all participants post CR. Peak HR increased an average 7% (p=0.0005) and RPE significantly increased from 12 to 13 (p=0.0005). WSI indicated an 8% average (p=0.0005) increase in physiological fitness, based on HR, in all participants. In Men MDW increased significantly from 440metres to 555 metres (26%), peak HR increased by an average 6% (p=0.0005), RPE from12.6 to 13.6 (p=0.0005) and WSI by 7% (p=0.0005). In women mean distance achieved rose 30% from 303metres to 393metres (p=0.0005), peak HR by 6bpm (p=0.001), RPE rose from 11.8 to 12.4, which was not significant (p=0.131) and WSI showed an average increase of 9%. This study showed that 8% of a 27% increase in walking performance following a CR programme could be attributed to a true physiological (fitness) adaptation. In circumstances where a practice walk is not always carried out, the addition of HR in relation to a given walking speed should be used to assess and quantify the true physiological change related to a programme of exercise based CR.