• Front line fatigue or capacity building - what's really going on? A case study of Liverpool City Council front line services

      Scanlon, Tom; Aspinall, Dyane (University of ChesterLiverpool City Council, 2005-05)
      Liverpool City Council has undergone a huge transformation, perhaps most notably in its front line services. Many of the staff working within the new functionally centralised environments has been exposed to a prolonged period of transformational and ongoing transactional change. This study has attempted to analyse the effects such a change journey has on individuals, looking particularly at the notion of capacity building and change fatigue. The case study utilised interviews with Managers and staff focus groups which were supplemented by surveys of 60 staff within Liverpool City Councils front line services, i.e. Call Centre and One- Stop Shops. The data confirmed that staff within these environments have undergone a unique change journey over the last four years and found that exposure to extensive and prolonged change does increase an individual capacity to undertake further changes in the future. The extent of the presence of capacity building within individuals was found to be similar in both Call Centre and One- Stop Shops. The evidence also suggests the presence of change fatigue within both working environments and particularly so within the One- Stop Shops where more change fatigue was found to be present. The findings from this research suggest that staff within these working environments would benefit from greater involvement in setting the pace of the change, more effective communication about future change and require greater support from managers as the cumulative effects of change builds to a critical point. This case study is largely theoretical with some application in practise.
    • The function of the multidisciplinary team meeting for head and neck cancer: A qualitative analysis

      Perry, Catherine; Arya, Arvind K. (University of Liverpool (University of Chester), 2007-10)
      Multidisciplinary team meetings (MDMs) have been shown to be beneficial in the management of patients with cancer. Government recommendations introduced in 2002 suggested that more meetings were needed to take place to optimize cancer care in the UK. Head and neck cancer is a typically heterogeneous disease, and the input of a multidisciplinary team was considered to be vital in order to manage patients properly. This study was aimed at exploring the working of such MDMs through a series of interviews with healthcare professionals who regularly attended them. A large tertiary referral centre for head and neck cancer was the setting of the study. A total of 12 interviews were undertaken. Themes emerged from the data suggesting that there were benefits and problems with the MDM. There were benefits to team working, communication, information gathering, patient care, planning and decision reassurance. The problems identified included time constraints, excessive radiological workload, cost implications and loss of nurse led meetings. There was little contribution by certain allied heath professionals (AHPs) who found the atmosphere generated by medical staff combative. There was little time available to discuss non-medical issues. Patient care was not affected because social issues were discussed at a clinic following on from the MDM. Some Consultants questioned the ability of the MDM to come up with suitable treatment plans for patients, and preferred to make decisions in the clinic. The study's findings could help improve the working of the MDM in head and neck cancer. The issues of non-contribution should be addressed as should time and financial resources. A different set up of the MDM may be beneficial or by having an addition MDM per week. Further studies are needed to fully explore these issues, and to implement changes to improve head and neck cancer services in the UK.
    • General public's attitudes towards people who self-harm: Perceived dangerousness and desired social distance

      Hochard, Kevin D.; Ellis, Jacob (University of Chester, 2017-09)
      Public attitudes towards self-harm are critically important, yet relatively unexplored. They can moderate or further exacerbate social and emotional difficulties that instigated initial self-harming episodes and considerably influence help-seeking behaviour. Participants from the general public (N = 109) answered a repeated measures self-report questionnaire that assessed desired social distance and perceived dangerousness towards individuals depicted in eight hypothetical vignettes, which varied between gender (male, female), presence of self-harm (no, yes) and self-harm intent (without suicidal intent, suicidal intent, ambivalent intent). Regarding desired social distance, evidence was identified to suggest that people who engage in self-harm without suicidal intent are perceived more negatively than individuals who do not have a history of self-harm (p < .001, d = 1.55). Numerous factors were identified to further adversely affect desired social distance from individuals who engage in self-harming behaviour. Males tended to have more negative attitudes towards people who self-harmed (p = .015, d = .48) and both genders displayed more negative attitudes towards male self-harmers (p < .001, d = .55). Both males (p = .004, d = .57) and females (p < .001, d = 1.31) who indicated suicidal intent received more negative responses than those who self-harmed without suicidal intent. Overall, perceptions of dangerousness were positively correlated with desired social distance (r = .36, p = < .001), however, gender and intent-specific attitudes contributed conflicting evidence to this relationship. These findings provide foundations for research into public attitudes towards individuals who self-harm, which could potentially inform public awareness campaigns.
    • Genii of the Moors: Exploring the Imaginary and Imaginative Spaces in the Brontës juvenilia’s geographical fantasy worlds of Glass Town, Angria and Gondal, and its domestic resurgence in Charlotte Brontë’s Jane Eyre

      Pickett, Danielle J. (University of Chester, 2017)
      The story of the Reverend Patrick Brontë’s gift of twelve wooden soldiers to his twelve-year-old son Branwell in June 1829 is a much repeated one among scholars of the Brontë juvenilia. Renamed affectionately The Twelves, the toy soldiers provided the catalyst for the Young Men’s plays that grew into the Glass Town, Angria and Gondol sagas, and would continue to fuel the four youngest Brontë siblings’ imagination for the next twenty years. And yet, despite this early education of authorship and world play, Elizabeth Gaskell in The Life of Charlotte Brontë gave little attention to the ‘wild weird writing’ of her subject’s formative years,1 instead enshrining Charlotte in a domestic home ‘of the most dainty order, [and] the most exquisite cleanliness’.2 Resorting to same superlatives that she does in her treatment of the juvenilia, Christine Alexander’s assertion that ‘Nineteenth-century biographers…generally gave no more than a cursory glance at an author’s juvenilia, if indeed they acknowledged it at all’ fails to account for Gaskell’s censorship, and implies a more deliberate motive for the (dis)use of her language.3 This study locates Gaskell’s uneasiness in the conflict between Charlotte the writer, and Charlotte the woman. Accepted as her writing was in adulthood, it is Charlotte’s juvenilia and the imaginary worlds of Glass Town and Angria she created in childhood but continued well into adulthood, that disrupts the demarcation between what was acceptable as a professional woman author, and what was not. If the nature of the freedom of play in childhood is meant to be temporary, the transgressive nature of the Brontës’ was that it was not. For Charlotte, prolonged immersion in her fantasy world began to affect her reality, and it is the conflict between reality and her imaginary world that is evident in Jane Eyre, which this study examines as a full-length version of her last contribution to her juvenilia and read as ‘A [Final] Farwell to Angria’.
    • Giving a Voice, Healing Trauma: Exploring the Usefulness of Art Therapy with Refugee Children

      Lovell, Andy; Lowndes; Akthar, Zahra (University of Chester, 2017-10)
      Children who seek refuge to the United Kingdom have experienced a journey witnessing many traumatic events, separation and losses. These experiences can have a profound effect on a child’s well-being and resettlement in the host country. Art therapy is an avenue which can help these children to heal their trauma, and explore the feelings and changes that arise with becoming a refugee. This research set in an interpretive paradigm, informed by hermeneutic phenomenology explores the usefulness of art therapy with refugee children. It aims to investigate this enquiry through the lens of art therapists to gain insights from lived experiences and stories. Three semi-structured interviews were conducted, which were explored and analysed through using thematic analysis, which discovered five key themes these were identified as: (1) Giving Voice, (2) Rebuilding Trust, Opening Wounds, (3) Sharing Stories, Healing Pain, (4) Exploring Identity, Discovering New- Self, and (5) Understanding Art Therapy. Upon reflection, the four initial findings merged together highlighting the two key usefulness of art therapy, these were established as: (a) providing refugee children with a safe space to heal and discover new-self, and (b) giving refugee children a voice to express, and share their stories. Despite the last theme (understanding art therapy) being established as a limitation, this created an area for future research to help inform art therapy practice. From the findings discovered, it was concluded that art therapy is a useful form of psychotherapy for refugee children. Art therapy provides these children with a safe space to heal, and gives them a voice to express and be heard.
    • A gluten-free diet as a normal way of life: Adherence to gluten-free diet among people with coeliac disease and the role of specialist follow up

      Ford, David; Pender, Fred; Fallows, Stephen; Britcut, Elizabeth K. (University of Liverpool (University of Chester)Wirral University Teaching Hospital NHS Foundation Trust, 2009-08)
      Strict adherence to a gluten-free diet is the only known treatment for coeliac disease and is believed to reduce the risk of serious complications such as malignancy. Regular follow up has been associated with better dietary adherence in this group. This thesis examines adherence to a gluten-free diet among people with coeliac disease with a particular emphasis on specialist follow up. The research presented in the thesis comprises a qualitative study, conducted using a grounded theory method, and a questionnaire study. The questionnaire focussed particularly on specialist follow up and aimed to compare people who attended follow up with those who had defaulted. Data for the qualitative study was collected by means of semi-structured interviews. Thirty interviews were carried out. Interview transcripts were analysed and the findings used to develop a model of dietary adherence. The experience of coeliac disease and of implementing a gluten-free diet was seen to be a social one. At the centre of the model was the concept of dietary adherence as the incorporation of the gluten-free diet into normal life. The model illustrates the factors which were found to facilitate or inhibit the adoption of a strict gluten-free diet as part of normal life. Findings from the qualitative study were used to inform a postal questionnaire. Three hundred and four questionnaires were distributed and 214 returned giving a response rate of 70%. A higher response rate (78%) was obtained from regular clinic attenders than non-attenders (43%). Non-attenders (n=29) were less likely than attenders (n=185) to report their needs had been met at their out-patient appointments. This suggests that a service which better meets the needs of this group may result in better attendance and this may in turn improve dietary adherence and possibly influence long term health. This research suggests a number of ways in which health professionals may better support people with coeliac disease. These include understanding the social aspects of coeliac disease, providing practical and factual information that is useful to the individual and allowing adequate time for patients to discuss their concerns.
    • Group Algebras and Their Applications

      Gildea, Joe; O'Neill, Harrison T. (University of Chester, 2017-10-09)
      Let RG be the group ring of the group G and the ring R. If R is a field, we usually refer to RG as a group algebra. We initially describe the unit group of the group algebra F2 kD8 where F2 k is a Galois Field of 2k elements and D8 is the dihedral group of order 8. We then describe the unitary unit group of F2 kD8. Furthermore, we show the connection between unitary units in group rings and self-dual codes. Finally, we construct certain self-dual codes from the unitary units of the group algebra F2 kD8.
    • Has the introduction to homogenous business management structures improved flexibility in Liverpool City Council?

      Webb, Paul; Malloy, Bill (University of ChesterLiverpool City Council, 2010-06)
      May 2010 saw the emergence of a hung parliament from the general elections. The public had exercised their right to vote and made their decision. It is now the duty of the elected members of parliament to form a government that will govern in the interest of the country. With a mountainous financial burden hanging over the nation, it has never been more important for public sector organisations to deliver value for money and maximise performance. All political parties have indicated that there will be cuts in the public sector and have recognised that the public sector will have to shrink, yet still deliver essential services. This will involve a reshaping of the public sector, with fewer staff delivering services. It will require a more business oriented approach to service delivery with economies of scale and efficiency drives. It will require structural changes with multi-skilled staff delivering a more flexible approach to service delivery. Such a change has already taken place within Liverpool City Council. The old council service structures have been replaced with new business unit structures. But has the introduction of business units changed the way we work? Has it improved services? Has it improved the flexibility? In this study we shall consider the flexibility issue. We shall develop a flexibility measurement model and put the new structure to the test.
    • HbA1c, weight, quality of life and hypoglycaemia awareness after a structured education programme teaching carbohydrate counting and insulin dose adjustment

      Almiron-Roig, Eva; Ellis-Gowland, Julie (University of Chester, 2010-11)
      Objective - The primary aim was to assess the effects of Aintree Hospital’s ‘4-Step’ programme which teaches carbohydrate counting and insulin dose adjustment to patients with Type 1 diabetes, on HbA1c, Weight, Quality of life and Hypoglycaemia awareness. A secondary aim was to compare the effects of group education and one to one clinics in HbA1c, Weight, Quality of life and Hypoglycaemia awareness. Methods -All parameters were measured at baseline and four months later. HbA1c is measured by blood test, Quality of Life using the Problem Areas in Diabetes questionnaire and Hypoglycaemia Awareness using the ‘Symptom Awareness of Hypoglycaemia’ questionnaire. A convenience sampling technique was used whereby patient data was collected over a 6 month period from all patients who fit the criteria. Those excluded were patients with patients receiving nutritional support and those undertaking weight management programmes, those undergoing chemo/radiotherapy and those on renal dialysis. Fifty two sets of patient data were collected in total. All patients underwent either group or one-to-one clinic sessions. The programme was of four weeks duration and patients were followed up for repeat measurements three months after the programme. Where populations fit a normal ’Gaussian’ distribution parametric paired t-tests were chosen for statistical analysis. Where the population was found to be skewed, non- parametric Wilcoxon tests were used. Results - Following the programme overall HbA1c levels improved by 0.29% (p=0.008) with greater improvements occurring in those undertaking joint clinics (p=0.037) than groups (p=0.111). There was an overall weight loss of 0.5kg which did not reach statistical significance (p=0.100). However weight loss was greater in those attending group education (p=0.04) compared to those attending clinics (p=0.438). Quality of life scores improved by 11% overall (p=0.000) with group education being slightly more effective in achieving improvements (p=0.000) than group education (p=0.001). There was no change in symptoms of Hypoglycaemia awareness in the population as a whole (p=0.052) although as with HbA1c, those undergoing individual education had great improvements (p=0.046) compared to those in groups (p=0.409). Conclusions - The study has served to demonstrate the effectiveness of Aintree’s ‘4-Step’ programme in achieving key improvements in clinical and non-clinical aspects of patients’ diabetes care. While the improvement in HbA1c is beneficial, it is unclear whether this is sustained over time. Longer term follow-up and refresher education at intervals may increase the likelihood of sustained clinical benefits. Whilst weight loss was shown to be minimal, the study importantly demonstrates that the ‘4-Step’ programme does not lead to weight gain, an important finding when offering a programme enabling greater food freedom. Quality of Life improvements were highly significant with impressive improvements. However, future studies would benefit from including a more detailed analysis of the Quality of Life questionnaire. Whilst highlighting aspects which are most favourably influenced by the programme, this would also enable targeting of those aspects which demonstrate lower levels of satisfaction for future service provision. Hypoglycaemia Awareness did not improve, possibly due to the short study duration. Future evaluations may be better placed to measure frequency of hypoglycaemia for a more accurate assessment of the impact of the ‘4-Step’ programme on hypoglycaemic events.
    • A 'head’ of their time: The influence of phrenology on nineteenth-century literature

      Keep, Gemma A. (University of Chester, 2014)
      This dissertation assesses the impact of phrenology on nineteenth-century literature. It specifically focuses on texts by Mary Ann Evans, Charlotte Brontë, Florence Nightingale and Charlotte Perkins Gilman. In the introduction, the popularity of phrenology will be established followed by the key phrenological principles which are mainly sourced from George Combe’s The Constitution of Man. The introduction focuses on providing context and evidence to demonstrate the applicability of this argument. In particular, this dissertation looks at women who used phrenology positively as evidence for their innate intellectual faculties. Chapter one analyses Mary Ann Evans’s Middlemarch through a phrenological lens, assessing how phrenology influenced her characterisation and views on patriarchal society. This chapter has a specific focus on Dorothea and her perceptions of her position as a woman and the idea that an active life and knowledge are masculine privileges. Chapter two demonstrates the influence of phrenology on Charlotte Brontë’s The Professor and Villette, focusing on the differences between the two protagonists and the influence of the gender assumptions in nineteenth-century society. Chapter three uses Andrew Combe’s Observations on Mental Derangement, Florence Nightingale’s ‘Cassandra’ and Charlotte Perkins Gilman’s ‘The Yellow Wallpaper’ to demonstrate how phrenology highlighted the impact of passivity on women’s mental health. All chapters begin by establishing each author’s awareness of phrenology to provide context and creditability for the argument which follows in each chapter.
    • Health beliefs and behaviours amongst women at high risk of breast cancer: An in-depth interview study

      Barlow, Cheryl (University of Chester, 2009-10)
      Aims: This study aims to explore the health beliefs and the reasons for these beliefs amongst BRCA mutation carriers. Design: This study used a qualitative research design through one to one interviews. A semi structured interview guide was developed around the phenomenon being investigated. Data collection was through audio recordings of interviews. Tapes were transcribed verbatim. Transcriptions were coded for emerging themes using Framework Analysis. Elements of Discourse Analysis were also applied. Subjects: 20 women either BRCA1 or BRCA2 mutation carriers, affected or unaffected by breast cancer, or at a 50% risk of being a BRCA carrier. Findings: Genetic factors are perceived to be the strongest element when assessing breast cancer risk. Secondary factors quoted included a wide variety of other causes, environment, stress, diet, exercise and smoking. Participants were aware of their raised breast cancer risk. The majority of the group had made changes to their behaviour. The perceived benefits of these changes were, improved outcome if they did develop breast cancer in the future, positive effects on general health and ensuring that they had done whatever they could to reduce possible causes. Belief that a behaviour was a risk factor in the development of breast cancer was not always correlated with changes in that behaviour. Some individuals did not believe particular behaviours were risk factors yet still made changes to those behaviours. The majority of the group were willing to join future lifestyle based trials but were generally reluctant to be involved in drug based investigations. Conclusions: Despite the wide spread belief that their breast cancer risk was largely predetermined by genetic factors the group displayed strong motivation to find other ways to exercise control over their breast cancer risk and the possible outcome if breast cancer did occur. If clear causal links between behaviour and breast cancer occurrence can be proven for this specific population group, it may be expected that the group’s strong motivation to affect some control over their increased breast cancer risk would lead them to engage in this protective behaviour.
    • A heuristic study into spirituality in the counselling relationship

      Swinton, Valda; Kirk, Noel (University of Chester, 2011-10)
      Through a qualitative heuristic study (Moustakas (1990), four counsellors who identified with their spirituality, were interviewed to explore spirituality within the therapeutic relationship. Through reflexive processes, the experience of the author remained visible within the research, integrating personal and professional experience with that of the research participants. The literature review suggests that psychotherapeutic change both affects, and is affected by spiritual concerns. Transcripts of semi-structured interviews produced the data needed for analysis. The data was analysed and interpreted using Moustakas’ (1990) process. The research identifies three distinct themes, Connection, Transcendence/Mystical, and Definition. The growth of spiritual interest within the general population, and within psychotherapy, suggest that there is a need for counsellors to incorporate spirituality into the therapeutic relationship. Further research suggestions would be, to extend the theory and practice of psychotherapy by exploring the spiritual dimension of human development.
    • A Heuristic Study of Counsellors’ Understanding and Experience of the Nature of Shame and the Impact of Shame on Therapeutic Contact.

      Mintz, Rita; Carr, Antoinette (University of Chester, 2016-06)
      The aim of this qualitative heuristic research study was to provide insight into the lived experience of shame and the impact of shame on the therapeutic relationship. The experience of the researcher is found within the study, integrating her own experience with the personal accounts of the participants and the literature on shame. Semi-structured interviews were conducted using four experienced, qualified therapists who were grounded in their understanding of shame. A latent thematic analysis was used to analyse the data. As this was a heuristic study the researcher also kept a reflective journal throughout the process. The following five themes emerged: understanding of shame; physiology of shame; socially constructed aspects of shame, impact of shame and shame and therapy. Shame was found to be innately felt by humans with specific physical characteristics including blushing, downcast eyes and feeling small. The content of what is perceived as shameful can be culturally, gender and experientially specific. Shame is established as an intrinsic part of society in establishing norms and boundaries. However, excess of shame is indicated as a factor in P. T. S. D., mental health problems, social isolation and violence against self or others. In this study silence, negative self-talk and resistance were found to be both characteristic behaviour developed as defence against further shaming and combined with support, compassion and connection factors in reparative growth. There is potential for shame to cause a rupture in the therapeutic relationship. However, where shame is worked with in therapy it can be a source of therapeutic growth. Counsellor awareness of shame processes, self-regulation and self-care were indicated as important for working with shame to ensure modelling a grounded presence for the client. All four participants work on shame had influenced their choice of therapy as a career. However, none of the participants had received any training about shame during their initial training. The findings emphasised the need for including working with personal shame in both professional development and counselling training courses. This research supports previous research and provides opportunities for further research.
    • A heuristic study of the impact on the therapeutic relationship of counsellors who have chosen to experience a significant amount of contemplative silence in their lives

      Mintz, Rita; Humphreys, Marjorie R. (University of Liverpool (University College Chester), 2006-10)
      A heuristic investigation was undertaken in which four counsellors who live with a significant amount of chosen contemplative silence in their lives were interviewed in order to explore the impact, if any, that their way of life had on the therapeutic relationship. The in depth, open ended interviews took the form of the narrative enquiry. As the ‘bricoleur’ my analysis was based on an emergent design utilizing heuristic methodology. The literature search which revealed a paucity of previous material demonstrates that silence in the lives of counsellors enhances their way of being with clients, making them more self aware and able to relate at a deeper level. The interviews discovered that whilst there were a number of benefits to the counsellor, there were also some difficulties to address. The benefits were an increased self-awareness, relational depth, mindfulness and acceptance. The difficulties raised were that the subject of contemplation or meditation is a difficult area to verbalize, there is a reticence to be transparent about it, and that there are occasions when the fact that the counsellor has access to something that is not understood by the client this may impair the counselling relationship. Findings are presented in the form of individual depictions of each of the four co-researchers, a composite depiction and a creative synthesis. Further research would be beneficial to explore this phenomenon in more depth.
    • High intensity interval training, the best HIIT FITT: Literature review, systematic review and comparative analysis

      Fallows, Stephen; Morris, Mike; O'Loughlin, Nicola (University of Chester, 2016-09)
      Background - High-intensity interval training (HIIT) may be a viable approach to improving the health of the general population. The objective of this literature review was to investigate the current research available on HIIT, examining its evolution, and health benefits as well as the barriers that exist to this type of training. Conclusions - HIIT is a feasible and time-efficient approach for improving overall health indicators in the general adult population.
    • High-intensity intervals versus continuous endurance for weight loss and fitness enhancement

      Barbara, Gianluca (University of Chester, 2015-09)
      The aim of this paper was to provide a broad review of the already established evidence detailing the efficacy of high-intensity interval training (HIIT) in weight loss, body compositions and fitness. In doing so, a clearer picture would be formed on the importance of HIIT in health, longevity and the reduction of chronic disease. A comparison was made with continuous endurance exercise (CET) which is an already established form of exercise in the regard of the stipulated outcomes. A search was conducted using specific keywords and using the databases Google, EBSCO, SPORTDiscus, MEDLINE and the University of Chester portal, which gave access to supplementary articles which were deemed important for this research. A literature review was then conducted whereby established evidence of HIIT was highlighted in the form of a review (Section 3) and rationale for the research project was given in relation to the formulation of the chosen research question (Section 4).
    • Histomorphometric Analysis of Structural and Bone Remodeling Parameters in the Underloaded Ovine Calcaneus

      Power, Jon; Hughes, Stephen F.; Lister, Max (University of Chester, 2018-07-24)
      Osteoporosis is a disease that affects over three million people in the UK (NHS, 2016), and is categorized by a reduced bone mass leading to decreased bone strength and increased fragility. Clinical features of osteoporotic fractures include increased morbidity (physical impairment, reduced quality of life, pain), greater risk of new fractures and increased mortality (Geusens, 2008). During the lifetime of a typical human, bones are their strongest whilst a person is in their early-mid 20’s. As one ages bone loss begins to occur around the age of 35. One important causal factor leading to osteoporosis is lack of weight-bearing physical activity, which might impact the elderly human population at sites such as the femoral neck resulting in fragility fractures. Around 70,000-75,000 hip fractures occur in the UK each year, additionally every year an increase in incident rates has been observed partly due to an aging population (NHS, 2016). The relationship between a decreased mechanical load and resulting in reduced bone mass is well established. The structural and cellular consequences of mechanical underloading within a temporal animal model are yet to be fully explored. The objective of the current study was to determine the temporal structural changes occurring due to the influence of mechanical under-loading (experienced at day 0/baseline, week 4 and week 16) within an ovine skeletal model. Additionally, this experimental system provided insight into the cellular activity (in terms of bone remodeling) associated with a reduced mechanical loading environment. Within this model by week 16 of mechanical under-loading, an increase in cortical porosity (4%, p=0.017) within the dorsal region and reduced cortical thickness (19.7%, p=0.025) across all combined regions (as well as a regional decrease of 15% and 23% within the medial and ventral regions respectively) was observed. These changes indicating a reduction in bone mass were accompanied by increased cortical remodeling medially (58%;p=0.028) as evidenced by an increase in the proportion (%) of canals undergoing bone formation within that anatomical region. These data demonstrate a reduction in bone mass and increased bone remodeling associated with reduced mechanical load within this skeletal site. Additionally, the data presented here of decreased mechanical load appear to support the observed bone loss and elevated remodeling occurring within the osteoporotic human femoral neck. This investigation,therefore, validates the underloaded ovine calcaneus as a suitable experimental model to investigate the possible pathological events associated with disuse osteoporosis.
    • Home visit v telephone follow up in phase II cardiac rehabilitation following myocardial infarction: Effects on anxiety, depression, attendance at Phase III and visits to A&E or readmission

      Fallows, Stephen; McPaul, Janet (University of ChesterSt Heilier Hospital, Surrey, 2007-09)
      The effect of two interventions, telephone call and home visit, in Phase II cardiac rehabilitation were examined. Twenty-five patients were recruited during Phase I following myocardial infarction, twenty-one males and four females aged 33-87 (mean 67.2, SD13.9) years who were grouped as older (males >70, females >75) or younger. The study used a prospective independent groups design with random assignment to receiving a telephone call (usual treatment) or home visit in Phase II. Repeat measurements of anxiety and depression were conducted in Phase I and at the end of Phase III using the Hospital Anxiety and Depression Scale and attendance at Phase III, visits to A&E or readmission with cardiac symptoms were recorded. Results were analysed using SPSS (version 14) and median anxiety and depression scores for subgroups consisting of older and younger attenders and non-attenders of Phase III. After Phase III there were no significant differences in anxiety (p=0.615) or depression (p=0.085) scores although there was a trend towards lower scores for telephone call recipients. There was no significant difference between the intervention groups (p=0.513) or age groups (p=0.275) for attendance at Phase III although there was a trend towards younger and telephone call groups attending. There were no significant differences between attenders and non-attenders for anxiety after Phase III (p=0.937) but there was a marginal difference for depression (p=0.057) with lower scores for attenders. No patients were readmitted or attended A&E with cardiac symptoms during the study period. The study found that within subgroups attendance at Phase III appeared to be the factor that most affected anxiety and depression regardless of intervention or age group but the numbers in each subgroup were small and therefore these results had to be treated with caution.
    • Horse racing in nineteenth-century literature

      Heaton, Sarah; Wise, Jamie (University of Chester, 2013)
      The popularity of nineteenth-century horse racing is firmly established. Throughout the century it provided entertainment, amusement and employment across all the classes. Most scholarship focuses on horse racing in terms of leisure and the negotiation of class values, noting the shift from the sport as a predominantly aristocratic playground in the early part of the nineteenth century, to the commercialised arena of entertainment it became towards the end of the Victorian era. What is unexplored by both historical and literary critics however is the representation of horse racing in nineteenth-century literature. This dissertation attempts to fill that void. The carnival values of the racecourse, horse racing’s shift towards commercialism, concepts of class defined leisure and the sports inevitable association with gambling are all scrutinised with reference to both the historical context of horse racing and their inclusion in nineteenth-century fiction. George Moore’s Esther Waters, Émile Zola’s Nana and Charles Dickens’s Nicholas Nickleby, The Old Curiosity Shop and ‘The Lazy Tour of Two Idle Apprentices’ are all closely analysed in terms of their representation of the racecourse carnival, racecourse space and infrastructure and working-class gambling. The aim of this dissertation is ultimately to provide an in depth reading of the few significant representations of horse racing in nineteenth-century literature and to shed light on why the popularity of the sport across the nineteenth century is not replicated by meaningful inclusion within the literature of the day.
    • How art therapists view the effects of and importance of various materials used in art therapy: An exploratory study using IPA

      Mason-Whitehead, Elizabeth; Johnson, Amy (University of Chester, 2013-03)
      I sought to understand the effects and implications of certain materials in art therapy. I was struck by the lack of research on this topic in contrast to the high volume of theory. I began to question the beliefs that art therapists had here. I aimed to ‘Explore ways in which art therapists view the effects and importance of various materials in art therapy’. I conducted semi-structured interviews with two art therapists, one male and one female. The interviews were analysed using IPA. Seven superordinate themes were identified; three of these were further investigated: ‘Reflecting upon art therapy research’, ‘The blurred role of the art therapist’ and ‘The importance of what is being communicated by use and selection of art materials’. The results validated the importance of research on materials; highlighted many ways in which clients may communicate with art materials and demonstrated the breadth of art therapists differing views on their role in relation to materials. The four themes not further investigated were: ‘The core box of materials’; ‘Striking a balance when providing materials to clients’, ‘The art therapists own preferences towards materials and implications of this’ and ‘Associations and benefits of particular art materials’. A wealth of rich information came to light; however this concluding research served mainly to identify the many avenues in which future research is necessary.