• Is there agreement on the pathogenesis / pathophysiology of exercise induced asthma?

      Caulfield, Una (University of Chester, 2009)
      Purpose: Exercise Induced Asthma was formally proposed as a concept to the medical profession in 1966. However up to 1990 two different hypotheses were being put forward to explain the mechanism involved. Methods: A literature search of Pubmed, Google Scholar, Ovid and The Cochrane Library was conducted in May 2009 using a combination of controlled vocabulary and truncated text words to capture relevant articles. All relevant randomised controlled trials, case control studies and case series were included in the review. Results: The initial search identified 2361citations. Following the removal of duplicates and the application of selection criteria, a total of 36 articles were included in this review. Two scales were used to assess the data the Jadad Scale and The Scottish Intercollegiate Guidelines Network Grading Review Group guidelines known as SIGN Criteria. Discussion: Within the studies reviewed a particular issue encountered was the definition of EIA itself. Thirteen of the studies gave no definition, ten used FEV1≥10%, seven used FEV1≥15%, four used FEV1≥20% with the remaining two studies using FEV1≥12% and FEV1≥7%. Accordingly pooling of the data for analysis was only possible under the broader headings of the two original hypothesis and two new categories Inflammatory Causative Factors and Emerging Science. Studies into Inflammatory Causative Factors had by far the highest number of studies (15) and participants – with 497 in total. The participants in the McFadden and Emerging Science studies were almost equal at about 180 participants each. While a total of only 63 subjects participated in the Anderson hypothesis studies While the current balance of evidence clearly suggests a more probable relationship with inflammation for asthmatics with EIA. Clearly further work is required to explore the pathogenesis of EIA in non asthmatics. Conclusions: While a number of possible mechanisms involved in the pathogenesis of EIA were evaluated it would still appear that the studies reviewed do not allow any firm conclusions to be drawn. However the evidence appears to be currently weighted in favour of inflammatory causative factors as the basis for EIA.
    • Issues, response and support needs of parents if their child had self-harmed, from a parents and professionals perspective

      Heath, Hannah; Ruck, Samantha (University of Chester, 2018)
      Self-harm for young people has been considered to be a significant health concern (Byrne et al., 2008) and is understood to be typical amongst young people (Hawton et al., 2002). Parents experience an array of overwhelming emotions on finding out about their child’s self-harm (Raphael et al., 2006). To date, little attention has been paid to exploring the understanding and experiences of parents whose children have not self-harmed or looking at the role of mental health (MH) professionals supporting parents from the professional view point. The aim of this research was to understand from both a parents and professionals perspective, what the perceived issues for parents are if their child self-harmed; how would/do parents respond to self-harm; and what support needs do the parents have. A multiple qualitative perspectives design was used. Seven parents were interviewed, alongside two focus groups and one interview with six Mental Health (MH) Professionals and were analysed with Thematic Analysis (Braun & Clarke, 2006). The results indicated that parents had a perceived lack of knowledge about self-harm and available support services. How parents respond to a child’s self-harm is influenced by their lack of understanding, how they find out and their natural desire to protect their child. Education about self-harm, strategies for parents and peer support group were identified as key mechanisms for professionals to provide support to parents. Parents and professionals both highlighted the lack of knowledge parents have about self-harm and their desire for support to help their child. There is a future research need to explore the processes which parents follow to seek information and help regarding self-harm and the impact of parent peer support in both community and clinical settings.
    • An Italian Affair: the impact of Italy on the woman traveller in George Eliot’s Middlemarch and Henry James’s The Portrait of a Lady

      Wynne, Deborah; Walker, Naomi (University of Chester, 2015)
      The aim of this dissertation is to examine the impact of Italy on the woman traveller, primarily through an analysis of the ways they are presented in George Eliot’s Middlemarch and Henry James’s The Portrait of a Lady. The dissertation will examine the travel writings, journals and letters of George Eliot and Henry James in order to gain an insight into their own perceptions of the country. The travel writings of Victorian women travellers will also be discussed. The investigation is split into three chapters. The first chapter analyses the time spent by George Eliot and Henry James in Italy and their thoughts and experiences of the country and how this impacted on their novels. It will be discussed whether the style of their writing in their journals, letters and essays is different to their novels. The second chapter focuses mainly on the two heroines of the novels, Dorothea Brooke and Isabel Archer, and examines the effect that Italy had on them. This chapter will also look briefly at other women characters in The Portrait of a Lady, and in other novels and novellas by Henry James, and how Italy affected their lives and situations. The third chapter studies the travel writings of Victorian women who visited Italy. This chapter also reflects on how tourism to Italy enabled Victorian women to re-imagine their own reality at home. The conclusion will briefly discuss two novels by E. M. Forster to analyse how the depiction of the woman traveller to Italy had changed by the early twentieth century.
    • It’s the singer, not the song: A critical investigation into perceptions of the benefits of singing in daily life

      Hall, Louise E. C. (University of Chester, 2014-12)
      The purpose of this study is to consider how people feel about singing, particularly but not exclusively if they do not identify themselves specifically as singers. Any benefits of singing that were perceived or experienced by a group of adults are described, and consideration is given to whether measurement or monitoring of these benefits is necessary or helpful. The review of literature is based on answering the following key questions: Why is singing important? Where is singing situated culturally in contemporary British society? Does this have any bearing on how adults feel about singing both individually and chorally, as part of a group? Consideration is given to the evidence supporting a range of claimed benefits of singing and the location of singing in a postmodern, neo-liberal culture is discussed. Finally, the results of a small-scale ethnographic survey and focus group session are detailed and interrogated. This investigation concludes that singing is perceived by many as being of social, cultural and emotional significance which may have wider implications for health and education policy. Implications for further research include creating research models which might interrogate further the emotional impact of singing and how that impacts on other activities.
    • Keeping up with technology – The development of a tablet-based multimedia education programme for women with a history of gestational diabetes: a formative evaluation

      Jacobs, Helen (University of Chester, 2015-12)
      BACKGROUND A history of gestational diabetes significantly increases the risk of progression to type 2 diabetes (T2DM). Lifestyle intervention is an effective technique for delaying or preventing the onset of T2DM in this population and represents a unique opportunity for the primary prevention of type 2 diabetes. Following gestational diabetes, women face significant barriers to engaging in education and achieving health behaviour change. A multimedia patient education programme could overcome the barriers and be an effective method of reaching this population. OBJECTIVE The aim of the programme was to support women with a recent history of gestational diabetes to make lifestyle changes with the view to reduce the risk of type 2 diabetes in the future. This stage of the project aimed to evaluate the relevance, usability, content and appearance of the programme and also to identify any issues with the programme prior to proceeding to clinical trial. METHODS The multimedia education programme was developed using a five stage system development method: identification of user requirements, system design, system development, system evaluation and system application. Experts and patient representatives assessed the relevance, usability, content and appearance through a formative evaluation. RESULTS The multimedia education programme ‘Keeping Healthy after Gestational Diabetes’ contained seven modules: introduction, health, diet, lifestyle, baby health, living post GDM and warning signs. The formative evaluation by 22 experts and 20 patient representatives has provided valuable direction for the on-going development of the programme and suggest that the programme is relevant, easy to use, interesting and visually appealing. CONCLUSION Findings suggest that users found the programme relevant, easy to use, interesting and visually appealing; suggesting that this may be a feasible and acceptable mode of education.
    • Knowing and complying: Patient awareness of aspirin use for secondary prevention of stroke and transient ischaemic attack

      Hogard, Elaine; Little, Victoria (University of Liverpool (University College Chester)Arrow Park Hospital, 2005-11)
      The aim of this study was to gain understanding into compliance behaviour with aspirin as prescribed for secondary prevention of stroke. The study used a convenience sample of 20 patients who had been admitted to a NHS Trust following a subsequent stroke or transient ischaemic attack. Semi-structured interviews were used to explore the use of aspirin at the time of admission. Patient perception of personal risk and risk factors for stroke were explored. Where appropriate, responses were checked against health care records for comparison. The findings suggested that the majority of patients were compliant with aspirin, however deficiencies in current practice were identified. Patients lacked awareness of their risk factors and their risk of having a further stroke. They were also unaware why they were taking aspirin. Strategies that assisted compliance behaviour and reasons for non-compliance were identified.
    • Knowledge and attitudes of obesity in university students

      Fallows, Stephen; Morris, Mike; Giglia, Melissa (University of Chester, 2012-09)
      This paper reviews the literature which has measured individual’s knowledge on the health risks associated with obesity, and individual’s attitudes towards obese persons. This review primarily focuses on studies that recruited students, health care professionals, and the general population. The inclusion criteria was: students, health care professionals, general population, studies that used the Obesity Risk Knowledge (ORK-10) scale, studies that used the Attitudes Towards Obese Persons (ATOP) scale, and any other validated questionnaire which measured obesity risk knowledge (ORK), and attitudes towards obese persons. Results revealed high obesity risk knowledge among health care professionals, primarily dieticians and general practitioners, and low obesity risk knowledge amongst the general population. Negative attitudes towards obese persons were prevalent in most studies, and were evident in students, health care professionals and the general population. The variables gender and BMI yielded conflicting results among the selected studies. Education is needed to increase obesity risk knowledge among a number of health care professionals and the general population, this will aid preventative techniques towards overweight and obesity. In addition, educational tools to raise awareness and reduce weight related bias and stigma need to be implemented in employment and educational settings, amongst the general population and health care professionals.
    • The landscape, heritage and society of St Michael's churchyard, Shotwick

      Gaunt, Peter; Greatorex Roskilly, Vanessa J. (University of Liverpool (University of Chester), 2005-10)
      This dissertation examines the history and heritage of St Michael's Churchyard in the Wirral parish of Shotwick. It explores in particular the effect topographical features and historical events have had on the churchyard's development. Stylistic variations in memorials are analysed to identify chronological trends. The lifestyle of churchyard occupants is also discussed, with the spotlight focusing specifically on the Whaley, Roberts and Maddock families; parish curates; and RAF pilots killed in the final months of the Second World War. Information has chiefly been derived from memorials recorded during numerous visits to the churchyard itself, and from primary and secondary sources held by Cheshire and Chester Archives and Local Studies, in particular maps, parish registers and their transcripts, churchwarden's accounts, wills, reports of coroner's inquests, school log¬books, tithe apportionments, charters and church correspondence. Relevant information has been extracted from Cheshire County Council's Sites and Monuments Record, and material held by the War Graves Commission and the RAF Museum at Hendon has also contributed to the exposition. Data from all these sources has been collated and analysed to extrapolate parochial trends, and much supporting material discussed in the body of the dissertation is included in the Appendices as verification.
    • Language dependent business process outsourcing: A study of delivery methods

      Webb, Paul; Lynchelaun, Neil (University of Chester, 2009-08)
      Shared services operations are popular operating models delivering non-core activities to their parent companies following several common principles of consolidation, standardisation and leverage of resource, continuously improving best practice and advanced technology across client businesses on a competitive basis charging for services proportionate to their use. Business process outsource providers are held to the same expectations, whilst primarily driving cost competitiveness through wage arbitrage. The low cost locations are experiencing economic growth. Particularly for European language dependent transaction processing, the prospect for further wage arbitrage benefits from new locations is limited. This study investigates how BPO providers might sustain competitiveness, constrained by language dependent wage arbitrage, through new delivery models.
    • Lifestyle behaviours associated with type 2 diabetes risk in Australian construction workers

      Markwell, Katherine; Botley, Sian (University of Chester, 2018-08-31)
      Type 2 diabetes mellitus (T2DM) is a global problem with many unfavourable consequences. Obesity is the single largest predictor of T2DM. Additional modifiable risk factors include lifestyle behaviours such as poor diet and physical inactivity have also been identified to be key determinants of the disease, and are therefore key in delaying or preventing progression, as proven by many systematic reviews. The incidence of T2DM is increasing, despite efforts to reverse this trend, so barriers need to be identified and solutions proposed to aid individuals to achieve positive lifestyle behaviours. Habitual lifestyle behaviours can be determined by occupation and particular work stresses. The construction industry is a large working population in Australia whose health outcomes have not been fully explored in relation to T2DM risk. It is unknown if specific unfavourable lifestyle behaviours are adopted within this population which increase the risk of progression of this disease. This review will discuss the associated risk factors and how they can be modified to prevent progression of T2DM. A rationale will be proposed for further investigation of T2DM and its potential specific risk factors within the Australian construction industry.
    • Linear fractional order differential equations and their solution

      Blank, L.; Simpson, A. Charles (University of Liverpool (Chester College of Higher Education)Chester College of Higher Education, 1996-03)
      Chapters 1, 2, 3, and 4 provide background material. Chapter 5 describes new results on the behaviour of solutions to (0.0.0).
    • Liverpool City Council's inclusion strategy for pupils with special educational needs

      Gleave, Karen (University of Chester, 2008-08)
      One of the key tenets of the present Government’s education policy for pupils with special educational needs (SEN) has been that of inclusion, i.e. that wherever possible and appropriate, pupils with SEN should attend local mainstream schools with appropriate support. Another important facet of Central Government policy over the last decade has been the increased emphasis on accountability in the public sector. One of the consequences of this trend has been the emergence of stakeholder theory as an important factor in determining the success of public sector organisations in meeting their objectives. This dissertation has reviewed the past and present literature relating both to stakeholder theory and to the debate around inclusion from the standpoint of three principal stakeholder groups: schools, children and young people, and parents and carers. The purpose of this was to give a context to Liverpool’s position vis a vis its stakeholders and to evaluate the likelihood of the success of Liverpool’s Inclusion strategy for pupils with SEN. The research examined the views of Liverpool’s key stakeholders towards inclusion in general and to Liverpool’s strategy in particular using a multi-method approach through the use of questionnaires, focus groups and case study. Results obtained from the data analysis indicate a wide range of views and standpoints on the part of stakeholders and reveal some positive aspects to Liverpool’s Inclusion strategy. They also point to a number of significant challenges which form the basis of some recommendations for the local authority to consider in order to ensure the success of its future strategy.
    • Liverpool City Council's performance management framework: An evaluation of its impact on customer-focused results

      Heath, Jan (University College Chester, 2004-08)
      Following the emergence of New Public Management, and the increased focus on performance management by the current UK government through initiatives such as the Local Government Modernisation Agenda, Best Value and Comprehensive Performance Assessment, local authorities have come under increasing pressure to improve their performance management systems. Within this context Liverpool City Council, with a history of poorly performing services and the highest Council Tax in the country, introduced its Comprehensive Performance Management Framework in 2000 to deliver performance improvement and embed a performance culture across the organisation. Since then, the Council has transformed services and overturned its image as a failing authority. This study evaluates the impact of the Council's Corporate Performance Management Framework on customer-focused results through analysis of quantitative and qualitative data and considers the potential negative consequences of performance management systems within the UK public sector with reference to other research. The research also identifies the role of control and accountability within public sector performance management regimes and considers whether it is possible to implement performance management systems based on private sector practices that are able to fulfil a dual role of both accountability and performance improvement.
    • Liverpool's approaches to tackling the educational attainment gap between mainstream pupils and looked after children (LAC)

      Stockton, Jim; Maher, Michael J. (University of ChesterLiverpool City Council, 2010-06)
      In October 2006 the Government Green Paper; 'Care Matters: Transforming the lives of Children and Young People in Care', outlined its proposals for the creation of Virtual Schools for Looked after Children (LAC) by setting out a radical package of proposals for transforming the lives of Children in Care (CiC). They noted the educational attainment gap between CiC and the wider school population was widening, leading to poorer life chances and much bleaker futures for children that had been looked after. The concept of the Virtual School (VS) has provoked much interest in England and Europe. The initial successes of the pilot LA(s) has meant that the programme is to be rolled out nationwide, albeit to claims that the Government's efforts are once again directed at symptoms rather than causes. However one thing is evident, and that is the political will to do the right thing. This dissertation examines the approaches to tackling the educational attainment gap between LAC and their mainstream peers. It investigates the deeper theoretical relationships required to tackle a holistic approach in developing a clearer strategy to assist the main driver as a concept of the VS. Liverpool's performance will be measured against its closest geographical, demographic and statistical neighbours. In conclusion recommendations will be offered to enhance the life chances for the future LAC of Liverpool.
    • Living with a very low fat diet

      Ellahi, Basma; Whitfield-Brown, Louisa M. (University of Chester, 2008-03)
      Aims: This study investigated compliance with the very low fat diet used by some clinics in the UK to treat severe hypertriglyceridemia and the patients’ experience of the diet. Methodology: Eight adults with severe hypertriglyceridemia attending the Lipid Clinic at Manchester Royal Infirmary, Manchester, UK took part in the study. Compliance with the therapeutic diet was assessed by analysis of telephone based diet histories and diet diaries using dietary assessment software. The patients’ experience of the diet was investigated using telephone based semi-structured qualitative interviews and analysed using thematic analysis. Main findings: The diet histories revealed the mean percentage energy contribution from fat was 22.5%. This is significantly higher than the target of 15% prescribed by the very low fat diet. The qualitative interviews revealed that patients considered complete compliance difficult. The patients understood the health benefits of the diet. Their level of adherence was affected by their perception of vulnerability to the health consequences of non-adherence. Barriers to adherence included lack of accessible nutritional information, increased patient burden, lack of appropriate food choices, other peoples’ ignorance with regard to the diet, lack of flavour and variety in the diet, a desire to broaden the palate, cost, social pressure to conform and negative experiences with dietitians. Enablers to compliance included nutritional awareness, desire to maintain good health, building on their nutritional knowledge base, behaviour and lifestyle modification, developing a routine, the support of family and friends and supportive eating environments. Conclusions: Compliance with the very low fat diet could be improved through extensive education on labelling, eating during special occasions such as Christmas, birthdays and eating out of home. Dietetic professionals need to work with food retailers and outlets to promote clear disclosure of the nutritional content of food to facilitate adherence to therapeutic diets.
    • Living with Multiple Sclerosis – exploring the effects of physical activity on quality of life

      Kennedy, Lynne; McGregor, Linda J. (University of Chester, 2017-08-31)
      Objective: To examine the effect of exercise on quality of life and investigate the perceived barriers to exercise participation. Methods: A qualitative study using semi-structured one-to-one interviews on 12 participants with multiple sclerosis. Results: Five qualitative themes were identified: environmental, personal, knowledge, quality of life, and taking control. Participants felt that discussing the benefits of physical activity engagement with a health professional and addressing problems such as transport would be helpful strategies for exercise engagement. All participants perceived that physical activity helped with quality of life. Conclusions: These findings indicate that exercise therapy is beneficial to quality of life and that physical activity should be promoted by the neurologist at diagnosis.
    • Longterm effects of preoperative carbohydrate loading for colorectal surgery

      Almiron-Roig, Eva; Commane, Daniel; Beadman, Claire (University of Chester, 2011-02)
      Recent changes in preoperative fasting guidelines have resulted in the development of preoperative carbohydrate drinks. Almost all research to date has examined the immediate/early postoperative metabolic and physiological effects, concluding beneficial clinical outcomes post surgery. The aim of this study was to test the hypothesis that preoperative carbohydrate loading results in longer term improvements in wellbeing, sustained return of postoperative physical function and better retention of muscle mass and nutritional status at a later (and potentially more clinically relevant) stage in the postoperative recovery period. This double-blinded placebo controlled randomised control trial took place at Salford Royal NHS Foundation Trust between 1st April 2008 and 31st January 2010. 10 males and 4 females, with a median age of 65.5 years, were included in the study and these were all listed for potentially curative colorectal cancer surgery. Each participant was assessed preoperatively, daily throughout their hospital admission and then at 30 days post surgery. Assessments included anthropometric measurements, analysis of dietary intake, physical activity and an evaluation of pain and well-being. The results showed that carbohydrate loading had no significant effects on anthropometric, dietary, physical or well-being parameters. However it was seen that pain scores in those patients who received carbohydrate loading were significantly lower (p=0.017) 30 days post surgery than those who received the placebo drinks. The trial was a pilot study and has shown that further research is needed to determine whether carbohydrate loading may have long-term clinical benefits.
    • Long‐term outcomes of cardiovascular rehabilitation: One year follow‐up concerning quality of life, physical activity and psychological state of health – a pilot study

      Buckley, John P.; Fallows, Stephen; Morris, Mike; Ilina, Viktoriia (University of Chester, 2014-10)
      Cardiovascular rehabilitation is known to be beneficial in short‐term and long‐term disease management and enhancing physical and psychological well‐being: the majority of recent evidence outlines that comprehensive cardiac rehabilitation has positive short term improvements in physical fitness, quality of life and psychological status, however, there is less data regarding similar long‐term outcomes of the programme. A recent systematic review highlighted the efficacy of exercise‐based cardiac rehabilitation towards reduction in mortality (medium to longer term studies) and in hospital admissions (short‐term studies). Further research should focus on evaluation of comprehensive programmes as far as quality of life, social and psychological status are less explored in research literature, compared to mortality and morbidity levels. Special considerations are advised to contribute into monitoring and management of anxiety and depression levels which may alter patients` quality of life and general health state. Lastly, the analysis of prolonged rehabilitation outcomes should be in a high priority, according to confirmation of continuous 12 months improvement in physical activity, depression and anxiety reduction after rehabilitation. Consequently, the future studies are recommended to investigate whether participants of cardiac rehabilitation services maintain the physical and psychological benefits, at one year, following programme and, consequently, to reveal effectiveness of these services.
    • “Looking from the outside in” – Emotional and cognitive reactions of sport, non-sport and ex-sport playing adults to initiation practices

      Lafferty, Moira E.; Gately, Joseph (University of Chester, 2017-09)
      Research examining hazing and the motives behind the events have received significant focus over recent years. While research has enhanced the understanding and provided interesting insight of hazing events, it has been done exclusively with those directly involved in the events. However, to date, research is yet to examine the perceptions from the wider general public and understand their opinions of hazing. The present study was an exploration in order to gain understanding of the general public’s emotional and cognitive response to modern day hazing events in the United Kingdom. Sixty-Seven participants of a mixed general public population completed quantitative and qualitative questions based on their experiences of watching hazing videos. Following each video, participants completed a self-report measure of arousal and I-PANAS-SF. In addition, participants were then required to answer 3 short qualitative questions on their perceptions of the videos viewed. Results of quantitative measures revealed that participant’s self-reported arousal and I-PANAS-SF scores were significantly effect by hazing videos. In addition, results of qualitative questioning revealed that participants provided a mixture of responses regarding hazing. In general, participants were accepting of events that involved no physical harm however, were also quick to highlight their disapproval of events where they perceived issues of hierarchy and power. While participants noted issues of hierarchy, participants generally, neglected any aspect of psychological harm that may occur following involvement in hazing events.
    • Lowering dietary carbohydrates to manage obesity and related disease: A systematic review and theoretical framework

      Fallows, Stephen; Verma, Radhika (University of Chester, 2012-09)
      This study aimed to evaluate the lowering of carbohydrates from conventionally recommended levels of ->55% of energy intake as a valid and safe treatment option for managing obesity and related disease. The study was a qualitative systematic review of fourteen randomized controlled studies, each with at least one study arm that lowered intake of carbohydrates to either ketogenic levels (->50g/) (Atkins type diet) or non-ketogenic levels including Zone type diets (>50g/d to 40-45% of energy intake). Low carbohydrate diets have generally implied increased protein intake to around 30% of energy intake. Outcomes evaluated included weight and fat loss; dyslipidemia; blood sugar control; hypertension; nutritional adequacy; hunger and satiety; adherence and safety. A synthesis of process, results and implications was used towards generating a theoretical weight maangement framework. In the short to medium term of up to six months both the ketogenic and non-ketogenic lowering of carbohydrates within the context of a calorie reduction of 300-750 kcal/day generated clinically meaningful weight loss results of 5-10% Lower-carbohydrates diet plans generated similar or better results for most of the main outcomes examined as comparted with conventional higher-carbohydrate/low-fat diet alternatives. Longer-term studies were few in number but weight loss results were in the range of 2-6% with no significant diet difference noted. Potential impact of ketogenic diets on dyslipidemia, renal and bone health needs further evaluation. When lowering carbohydrates or calories, nutritional adequacy may require maangement with the use of supplementation. Lowering carbohydrates may provide an important and useful strategy to achieve a regular daily caloriee deficit, generate clinically meaningful weight loss and improve related metabolic health markers. Recommended weight management protocols may be individualised based on a theoretical model that considers individual health risks and genetics, dietary preferences, carbohydrate sensitivity and is geared towards improved adherence.