Search results for: Gaye Stephens

Authors: Sinead Impey, Damon Berry, Selma Furtado, Miriam Galvin, Loretto Grogan, Orla Hardiman, Lucy Hederman, Mark Heverin, Vincent Wade, Linda Douris, Declan O'Sullivan, Gaye Stephens

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Healthcare is a knowledge-rich environment. This knowledge, while valuable, is not always accessible outside the borders of individual clinics. This research aims to address part of this problem (at a study site) by constructing a maximal data set (knowledge artefact) for motor neurone disease (MND). This data set is proposed as an initial knowledge base for a concurrent project to develop an MND patient data platform. It represents the domain knowledge at the study site for the duration of the research (12 months). A knowledge elicitation method was also developed from the lessons learned during this process - the WICKED method. WICKED is an anagram of the words: eliciting and confirming data, information, knowledge, wisdom. But it is also a reference to the concept of wicked problems, which are complex and challenging, as is eliciting expert knowledge. The method was evaluated at a second site, and benefits and limitations were noted. Benefits include that the method provided a systematic way to manage data, information, knowledge and wisdom (DIKW) from various sources, including healthcare specialists and existing data sets. Limitations surrounded the time required and how the data set produced only represents DIKW known during the research period. Future work is underway to address these limitations.

Keywords: healthcare, knowledge acquisition, maximal data sets, action design science

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Authors: Sinead Impey, Gaye Stephens, Lucy Hederman, Declan O'Sullivan

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Continued paper use in the clinical area post-Electronic Health Record (EHR) adoption is regularly linked to hardware and software usability challenges. Although paper is used as a workaround to circumvent challenges, including limited availability of a computer, this perspective does not consider the important role paper, such as the nurses’ handover sheet, play in practice. The purpose of this study is to confirm the hypothesis that paper use post-EHR adoption continues as paper provides both a cognitive tool (that assists with workflow) and a compensation tool (to circumvent usability challenges). Distinguishing the different motivations for continued paper-use could assist future evaluations of electronic record systems. Methods: Qualitative data were collected from three clinical care environments (ICU, general ward and specialist day-care) who used an electronic record for at least 12 months. Data were collected through semi-structured interviews with 22 nurses. Data were transcribed, themes extracted using an inductive bottom-up coding approach and a thematic index constructed. Findings: All nurses interviewed continued to use paper post-EHR adoption. While two distinct motivations for paper use post-EHR adoption were confirmed by the data - paper as a cognitive tool and paper as a compensation tool - further finding was that there was an overlap between the two uses. That is, paper used as a compensation tool could also be adapted to function as a cognitive aid due to its nature (easy to access and annotate) or vice versa. Rather than present paper persistence as having two distinctive motivations, it is more useful to describe it as presenting on a continuum with compensation tool and cognitive tool at either pole. Paper as a cognitive tool referred to pages such as nurses’ handover sheet. These did not form part of the patient’s record, although information could be transcribed from one to the other. Findings suggest that although the patient record was digitised, handover sheets did not fall within this remit. These personal pages continued to be useful post-EHR adoption for capturing personal notes or patient information and so continued to be incorporated into the nurses’ work. Comparatively, the paper used as a compensation tool, such as pre-printed care plans which were stored in the patient's record, appears to have been instigated in reaction to usability challenges. In these instances, it is expected that paper use could reduce or cease when the underlying problem is addressed. There is a danger that as paper affords nurses a temporary information platform that is mobile, easy to access and annotate, its use could become embedded in clinical practice. Conclusion: Paper presents a utility to nursing, either as a cognitive or compensation tool or combination of both. By fully understanding its utility and nuances, organisations can avoid evaluating all incidences of paper use (post-EHR adoption) as arising from usability challenges. Instead, suitable remedies for paper-persistence can be targeted at the root cause.

Keywords: cognitive tool, compensation tool, electronic record, handover sheet, nurse, paper persistence

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Authors: Anna Juliet Stephens

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This research emphasises the importance of incorporating traditional ecological knowledge into Peru’s development plans, as a way to manage some of the more adverse impacts of globalisation which continue to impinge on one of the world’s most biodiverse regions. In doing so, it argues for a development strategy to be implemented in the Peruvian Amazon which prioritises local and indigenous rights, needs and perspectives.

Keywords: traditional ecological knowledge, peruvian amazon, globalisation, indigenous, development

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Authors: Sinead Impey, Gaye Stephens, Declan O’Sullivan

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Mitigating organisational knowledge loss presents challenges for knowledge managers. Expert knowledge is embodied in people and captured in ‘routines, processes, practices and norms’ as well as in the paper system. These knowledge stores have limitations in so far as they make knowledge diffusion beyond geography or over time difficult. However, technology could present a potential solution by facilitating the capture and management of expert knowledge in a codified and sharable format. Before it can be digitised, however, the knowledge of healthcare experts must be captured. Methods: As a first step in a larger project on this topic, a scoping review was conducted to identify how expert healthcare knowledge is captured digitally. The aim of the review was to identify current healthcare knowledge capture practices, identify gaps in the literature, and justify future research. The review followed a scoping review framework. From an initial 3,430 papers retrieved, 22 were deemed relevant and included in the review. Findings: Two broad approaches –direct and indirect- with themes and subthemes emerged. ‘Direct’ describes a process whereby knowledge is taken directly from subject experts. The themes identified were: ‘Researcher mediated capture’ and ‘Digital mediated capture’. The latter was further distilled into two sub-themes: ‘Captured in specified purpose platforms (SPP)’ and ‘Captured in a virtual community of practice (vCoP)’. ‘Indirect’ processes rely on extracting new knowledge using artificial intelligence techniques from previously captured data. Using this approach, the theme ‘Generated using artificial intelligence methods’ was identified. Although presented as distinct themes, some papers retrieved discuss combining more than one approach to capture knowledge. While no approach emerged as superior, two points arose from the literature. Firstly, human input was evident across themes, even with indirect approaches. Secondly, a range of challenges common among approaches was highlighted. These were (i) ‘Capturing an expert’s knowledge’- Difficulties surrounding capturing an expert’s knowledge related to identifying the ‘expert’ say from the very experienced and how to capture their tacit or difficult to articulate knowledge. (ii) ‘Confirming quality of knowledge’- Once captured, challenges noted surrounded how to validate knowledge captured and, therefore, quality. (iii) ‘Continual knowledge capture’- Once knowledge is captured, validated, and used in a system; however, the process is not complete. Healthcare is a knowledge-rich environment with new evidence emerging frequently. As such, knowledge needs to be reviewed, updated, or removed (redundancy) as appropriate. Although some methods were proposed to address this, such as plausible reasoning or case-based reasoning, conclusions could not be drawn from the papers retrieved. It was, therefore, highlighted as an area for future research. Conclusion: The results described two broad approaches – direct and indirect. Three themes were identified: ‘Researcher mediated capture (Direct)’; ‘Digital mediated capture (Direct)’ and ‘Generated using artificial intelligence methods (Indirect)’. While no single approach was deemed superior, common challenges noted among approaches were: ‘capturing an expert’s knowledge’, ‘confirming quality of knowledge’, and ‘continual knowledge capture’. However, continual knowledge capture was not fully explored in the papers retrieved and was highlighted as an important area for future research. Acknowledgments: This research is partially funded by the ADAPT Centre under the SFI Research Centres Programme (Grant 13/RC/2106) and is co-funded under the European Regional Development Fund.

Keywords: expert knowledge, healthcare, knowledge capture and knowledge management

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Authors: Danielle Kim

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This paper analyzes how conceptual metaphors in the lyrics of popular songs can be potentially detrimental by influencing the public’s perception of women. Conceptual metaphors in songs often compare women to objects (objects that are fragile and breakable or primarily of monetary value) and animals. Many common conceptual metaphors in music refer to women as less than sovereign, rational humans, implying that women should be owned, controlled, and used. These comparisons are harmful because music is so influential and has the ability to create and perpetuate stereotypes. By examining the lyrics of the popular songs: Bob Dylan’s “Just like a woman,” Robin Thicke’s “Blurred Lines” (written by Marvin Gaye), and Chris Brown’s “Fine China,” we can discern subtle ways in which misogynistic language has become so imbedded into popular culture.

Keywords: conceptual metaphors, women studies, feminism, lyrics

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Authors: Gaye Senbag

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In English language teaching, feedback is considered as one of the main components of writing instruction. Teachers put a lot of time and effort in order to provide learners with written feedback for effective language learning. At Anadolu University School of Foreign Languages (AUSFL) students are given written feedback for their each piece of writing through online platforms such as Edmodo and Turnitin, and traditional methods. However, little is known regarding how learners value and respond to teacher-provided feedback. As the perceptions of the students remarkably affect their learning, this study examines how they perceive the effectiveness of feedback provided by the teacher. Aiming to analyse it, 30 intermediate level (B1+ CEFR level) students were given a questionnaire, which includes Likert scale questions. The results will be discussed in detail.

Keywords: feedback, perceptions, writing, English Language Teaching (ELT)

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Authors: Gaye Ibrahima, Mendy Gervais, Seck Diaraf, Ouya Samuel

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In this paper, we consider the influence maximization in social networks. Here we give importance to initial diffuser called the seeds. The goal is to find efficiently a subset of k elements in the social network that will begin and maximize the information diffusion process. A new approach which treats the social network before to determine the seeds, is proposed. This treatment eliminates the information feedback toward a considered element as seed by extracting an acyclic spanning social network. At first, we propose two algorithm versions called SCG − algoritm (v1 and v2) (Spanning Connected Graphalgorithm). This algorithm takes as input data a connected social network directed or no. And finally, a generalization of the SCG − algoritm is proposed. It is called SG − algoritm (Spanning Graph-algorithm) and takes as input data any graph. These two algorithms are effective and have each one a polynomial complexity. To show the pertinence of our approach, two seeds set are determined and those given by our approach give a better results. The performances of this approach are very perceptible through the simulation carried out by the R software and the igraph package.

Keywords: acyclic spanning graph, centrality measures, information feedback, influence maximization, social network

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Authors: Ferdağ Çulhan, Emine Gaye Çontay

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Geometric thinking levels created by Van Hiele are used to determine students' progress in geometric thinking. Many studies have been conducted on geometric thinking levels and they have taken their place in teaching curricula over time. It is thought that geometric thinking levels, which have become so important in teaching, can be examined in depth. In order to make an in-depth analysis, it was decided that the most appropriate management was discourse analysis. In this study, the focus is on examining the geometric thinking levels of 8th grade students from a discursive point of view. Sfard (2008)'s "Commognitive" theory will be used to conduct discursive analysis. The "Global Van Hiele Questionnaire" created by Patkin (2014) and translated into Turkish for this research will be used in the research. The "Global Van Hiele Questionnaire" contains questions from the sub-learning domain of triangles and quadrilaterals, circles and geometric objects. It has a wider scope than many "Van Hiele Questionnaires". “Global Van Hiele Questionnaire” will be applied to 8th grade students. Then, the geometric thinking levels of the students will be determined and interviews will be held with two students from each of the 1st, 2nd and 3rd levels. The interviews will be recorded and the students' discourses will be examined. By evaluating the relations between the students' geometric thinking levels and their discourses, it will be examined how much their discourse reflects their level of thinking. In this way, it is thought that students' geometric thinking processes can be better understood.

Keywords: mathematical discourses, commognitive framework, geometric thinking levels, van hiele

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Authors: Natalie Cutler, Lorna Moxham, Moira Stephens

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Safety is a priority in mental health services, and no more so than in the acute inpatient setting. Mental health service policies and accreditation frameworks commonly approach safety from a risk reduction or elimination perspective leading to service approaches that are arguably more focused on risk than on safety. An exploration what safety means for people who have experienced admission to an acute mental health inpatient unit is currently under way in Sydney, Australia. Using a phenomenographic research approach, this study is seeking to understand the meaning of safety from the perspective of people who use, rather than those who deliver mental health services. Preliminary findings suggest that the meanings of safety for users of mental health services vary from the meanings inherent in the policies and frameworks that inform how mental health services and mental health practice are delivered. This variance has implications for the physical and environmental design of acute mental health inpatient facilities, the policies and practices, and the education and training of mental health staff in particular nurses, who comprise the majority of the mental health workforce. These variances will be presented, along with their implications for the way quality and safety in mental health services are evaluated.

Keywords: acute inpatient, mental health, nursing, phenomenography, recovery, safety

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Authors: Jennifer Stephens, Nichole Parker, Kristin Petrovic

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To gain a better understanding of how students enrolled in a Bachelor of Nursing (BN) program are educated, faculty members in the BN program at Athabasca University (AU) in Alberta, Canada, developed a 3-phase comprehensive curriculum review project. Phase one of this review centered around hiring an external curriculum expert to examine and analyze the current curriculum and to propose recommendations focused on identifying gaps as well as building on strengths towards meeting changing health care trends. Phase two incorporated extensive institutional document analysis as well as qualitative and quantitative data collection in reciprocated critical reflection and has yielded insights into valuable processes, challenges, and solutions inherent to the complexities of undertaking curriculum review and analysis. Results of our phase one and two analysis generated a quality improvement (QI) template that could benefit other nursing education programs engaged in curriculum review and analysis. The key processes, lessons, and insights, as well as future project phase three plans, will be presented for iterative discussion and role modelling for other institutions undergoing, or planning, content-based curriculum review and evaluation.

Keywords: curriculum, education, nursing, nursing faculty practice, quality improvement

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Authors: Gokul G. Kshirsagar

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Native folk theatre and folk songs have a significant influence on the origin and development of Indian cinema. Therefore, the presence of songs and music has been an integral part and special characteristics of Indian cinema which is popularly known as Bollywood. An Indian cinema without songs, either in Hindi or other regional languages, is simply unimaginable. The present paper, in the first part, attempts to explain the use and need of musical songs and also the psychology of Indian audience in this respect with reference to some of the films which give primary importance to songs. In the second part, the paper tries to situate the present study in the context by referring to the Hindi language drama film Teesari Kasam directed by Basu Bhattacharys. The film is based on the Hindi novelist Phanishwarnath Renu’s short story Teesari Kasam (Mare Gaye Gulfam) in this adapted film, the director has made use of eight songs, but these songs are the extensive versions of the songs as used in the original story. Thus, the main aim of the paper is to underscore the fact that through artistic use of the musical, the director has succeeded in transforming the central feelings conveyed in the original story. Eventually, through the present study of the film adaptation, the relevance of songs in films will be illustrated and understood.

Keywords: Bollywood, folk theatre, folk songs, film adaptation

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Authors: Stephens Oluyemi Adetunji, Nel Norma Margaret, Krogs Sozein

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There has been a shift in the role of sports from being a form of entertainment and relaxation to becoming a huge business concern and high money spinning venture. This shift has placed a greater demand on sport coaches as regards expectations for high performance from investors as well as other stake holders. The responsibility of sports coaches in ensuring high performance of sports men and women has become increasingly more demanding from both spectators and sports organisers. Coaches are leaders who should possess soft skills such as emotional intelligence aside from employing skills and drills to ensure high performance of athletes. This study is, therefore, designed to determine the emotional intelligence of sports coaches in South Africa. An assessment of the emotional intelligence of sports coaches would enable the researchers to identify those who have low emotional intelligence and to design an intervention program that could improve their emotional intelligence. This study will adopt the pragmatic world view of research using the mixed methods research design of the quantitative and qualitative approach. The non-probability sampling technique will be used to select fifty sports coaches for the quantitative study while fifteen sports coaches will be purposively selected for the qualitative study. One research question which seeks to ascertain the level of emotional intelligence of sports coaches will be raised to guide this study. In addition, two research hypotheses stating that there will be no significant difference in the level of emotional intelligence of sports coaches on the basis of gender and type of sports will be formulated and statistically analysed at 0.05 level of significance. For the quantitative study, an emotional intelligence test will be used to measure the emotional intelligence of sport coaches. Focus group interviews and open ended questions will be used to obtain the qualitative data. Quantitative data obtained will be statistically analysed using the SPSS version 22.0 while the qualitative data will be analysed using atlas ti. Based on the findings of this study, recommendations will be made.

Keywords: emotional intelligence, high performance, sports coaches, South Africa

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Authors: Gaye Demi̇rtaş Adli

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Research: It was conducted to determine the factors affecting the fear of self-injection and self-pricking of fingers of diabetic individuals.The study was conducted as a cross-sectional, relation-seeking, and descriptive study. The study was conducted on 122 patients who had just started insulin therapy. Data were obtained through The Descriptive Patient Form, The Diabetic Self-Injection, and the Fear of Testing Questionnaire Form (D-FISQ). Descriptive statistical methods used in the evaluation of data are the Mann-Whitney U test, Kruskal-Wallis H test, and the Spearman correlation. The factors affecting the scale scores were evaluated with multiple linear regression analysis. The value of P<0.05 was considered statistically significant. Study group: 56.6% of the patients are male patients. Fear of self-injection (injection), fear of self-testing (test), and total fear (total) scores of women were found to be statistically higher than men (p<0.001). Age, gender, and pain experience were important variables that affected patients' fear of injections. With a one-unit increase in age, the injection fear score decreased by 0.13 points, and the mean injection fear score of women was 2.11 points higher than that of men. It was determined that the patient's age, gender, living with whom, and blood donation history were important variables affecting the fear of self-testing. It is seen that the fear test score decreases by 0.18 points with an increase in age by one unit, and the fear test scores of women compared to men are on average 3,358 points, the fear test scores of those living alone are 4,711 points compared to those living with family members, and the fear test scores of those who do not donate blood are 2,572 compared to those who donate blood score, it was determined that those with more pain experience were 3,156 points higher on average than those with less fear of injection. As a result, it was seen that the most important factors affecting the fear of insulin injection and finger punching in individuals with diabetes were age, gender, pain experience, living with whom, and blood donation history.

Keywords: diabetes, needle phobia, fear of injection, insulin injection

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Authors: Harley Stephens

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Although fiducial marker insertion is regarded as the ‘gold standard’ in terms of image guided radiotherapy (IGRT), its application must be considered carefully as the procedure can be invasive, time-consuming, and reliant on consultant expertise. Precision of the fiducials is dependent on these markers remaining in the same location and on the prostate not changing shape during the course treatment. To facilitate the acquirement of non-ionising IGRT and intra-fractional prostate tracking, Clarity TPUS was developed as an alternative imaging system. The main benefits of Clarity TPUS are that it is non-invasive, non-ionising and cost-effective. Other studies have compared fiducials to transabdominal ultrasound, which has since been proven to not be as accurate as trans-perineal imaging, as included in this study. CBCT fiducial translations and Clarity TPUS translations for 120 images as part of the PACE-C prostate SABR trial were retrospectively evaluated by three imaging specialists. Differences were analysed using correlation and Bland-Altman plots. Inter-observer matches agreed within 3mm 88.3 % of the time in left/right direction, 86.7 % of the time in in superior/inferior direction, and 91.7% of the time in ant/post direction. They agreed within 5mm more than 98.3 % of the time in all directions. The intra-class correlation co-efficient was calculated for each direction to show agreement between imaging specialist for inter-observer variability. Each was 0.95 or above, with 1 indicating perfect reliability. Agreement between observers was slightly higher for CBCT and fiducials at 98.7% agreement within 5 mm, compared to clarity TPUS where 96.7% agreement was seen within 5mm. Clarity TPUS has the benefit of no additional dose and intra-fractional monitoring, and results show a good correlation between the different modalities. Inter-observer variability is to be considered, and further research with a larger population would be of benefit.

Keywords: oncology, prostate radiotherapy, image guided radiotherapy, IGRT

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Authors: Louise Jones, Rafael De Andrade Moral, John C. Stephens

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Background: Minerals are an essential component of correct nutrition. Conserved hay/haylage is an important component of many horse's diets. Variations in the mineral content of conserved forage should be considered when assessing dietary intake. Objectives: This study describes the levels and differences in 15 commonly analysed minerals in conserved forage fed to horses in the United Kingdom (UK), Ireland (IRL), and France (FRA). Methods: Hay (FRA n=92, IRL n=168, UK n=152) and haylage samples (UK n=287, IRL n=49) were collected during 2017-2020. Mineral analysis was undertaken using inductively coupled plasma-mass spectrometry (ICP-MS). Statistical analysis was performed using beta regression, Gaussian, or gamma models, depending on the nature of the response variable. Results: There are significant differences in the mineral content of the UK, IRL, and FRA conserved forage samples. FRA hay samples had a significantly higher (p < 0.05) levels of Sulphur (0.16 ± 0.0051 %), Calcium (0.56 ± 0.0342%), Magnesium (0.16 ± 0.0069 mg/ kg DM), Iron (194 ± 23.0 mg/kg DM), Cobalt (0.21 ± 0.0244 mg/kg DM) and Copper (4.94 ± 0.196 mg/kg DM) content compared to hay from the other two countries. UK hay samples had significantly less (p < 0.05) Selenium (0.07 ± 0.0084 mg/kg DM), whilst IRL hay samples were significantly (p < 0.05) higher in Chloride (0.9 ± 0.026mg/kg DM) compared to hay from the other two countries. IRL haylage samples were significantly (p < 0.05) higher in Phosphorus (0.26 ± 0.0102 %), Sulphur (0.17 ± 0.0052 %), Chloride (1.01 ± 0.0519 %), Calcium (0.54 ± 0.0257 %), Selenium (0.17 ± 0.0322 mg/kg DM) and Molybdenum (1.47 ± 0.137 mg/kg DM) compared to haylage from the UK. Main Limitations: Forage samples were obtained from professional yards and may not be reflective of forages fed by most horse owners. Information regarding soil type, species of grass, fertiliser treatment, harvest, or storage conditions were not included in this study. Conclusions: At a DM intake of 2% body weight, conserved forage as sampled in this study will be insufficient to meet Zinc, Iodine, and Copper NRC maintenance requirements, and Se intake will also be insufficient for horses fed the UK conserved forage. Many horses receive hay/haylage as the main component of their diet; this study highlights the need to consider forage analysis when making dietary recommendations.

Keywords: conserved forage, hay, haylage, minerals

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Authors: Stephens Oluyemi Adetunji, Nel Norma Margaret, Naidu Narainsamy

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Empathy has been identified by researchers to be a crucial factor in helping adolescents to refrain from delinquent behavior. Adolescent delinquent behavior is a social problem that has become a source of concern to parents, psychologists, educators, correctional services, researchers as well as governments of nations. Empathy is a social skill that enables an individual to understand and to share another’s emotional state. An individual with a high level of empathy will avoid any act or behavior that will affect another person negatively. The need for this study is predicated on the fact that delinquent adolescent behavior could lead to adult criminality. This, in the long run, has the potential of resulting in an increase in crime rate thereby threatening public safety. It has therefore become imperative to explore the level of empathy of delinquent adolescents who have committed crime and are awaiting trial. It is the conjecture of this study that knowledge of the empathy level of delinquent adolescents will provide an opportunity to design an intervention strategy to remediate the deficit. This study was therefore designed to determine the level of empathy of delinquent adolescents. In addition, this study provides a better understanding of factors that may prevent adolescents from developing delinquent behavior, in this case, delinquents’ empathy levels. In the case of participants who have a low level of empathy, remediation strategies to improve their empathy level would be designed. Two research questions were raised to guide this study. A mixed methods research design was employed for the study. The sample consists of fifteen male adolescents who are between 13-18 years old with a mean age of 16.5 years old. The participants are adolescents who are awaiting trial. The non-probability sampling technique was used to obtain the sample for the quantitative study while purposive sampling was used in the case of the qualitative study. A self–report questionnaire and structured interview were used to assess the level of empathy of participants. The data obtained was analysed using the simple percentages for the quantitative data and transcribing the qualitative data. The result indicates that most of the participants have low level of empathy. It is also revealed that there is a difference in the empathy level on the basis of whether they are from parents living together and those whose parents are separated. Based on the findings of this study, it is recommended that the level of empathy of participants be improved through training and emphasizing the importance of stimulating family environment for children. It is also recommended that programs such as youth mentoring and youth sheltering be established by the government of South Africa to address the menace of delinquent adolescents.

Keywords: adolescents, behavior, delinquents, empathy

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Authors: Johan Anker

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The purpose of this paper is to discuss the nature of gender construction in modern dystopian fiction, the development of this genre in Young Adult Literature and reasons for the enormous appeal on the adolescent readers. A recent award winning South African text in this genre, The Mark by Edith Bullring (2014), will be used as example while also comparing this text to international bestsellers like Divergent (Roth:2011), The Hunger Games (Collins:2008) and others. Theoretical insights from critics and academics in the field of children’s literature, like Ames, Coats, Bradford, Booker, Basu, Green-Barteet, Hintz, McAlear, McCallum, Moylan, Ostry, Ryan, Stephens and Westerfield will be referred to and their insights used as part of the analysis of The Mark. The role of relevant and recurring themes in this genre, like global concerns, environmental destruction, liberty, self-determination, social and political critique, surveillance and repression by the state or other institutions will also be referred to. The paper will shortly refer to the history and emergence of dystopian literature as genre in adult and young adult literature as part of the long tradition since the publishing of Orwell’s 1984 and Huxley’s Brave New World. Different factors appeal to adolescent readers in the modern versions of this hybrid genre for young adults: teenage protagonists who are questioning the underlying values of a flawed society like an inhuman or tyrannical government, a growing understanding of the society around them, feelings of isolation and the dynamic of relationships. This unease leads to a growing sense of the potential to act against society (rebellion), and of their role as agents in a larger community and independent decision-making abilities. This awareness also leads to a growing sense of self (identity and agency) and the development of romantic relationships. The specific modern tendency of a female protagonist as leader in the rebellion against state and state apparatus, who gains in agency and independence in this rebellion, an important part of the identification with and construction of gender, while being part of the traditional coming-of-age young adult novel will be emphasized. A comparison between the traditional themes, structures and plots of young adult literature (YAL) with adult dystopian literature and those of recent dystopian YAL will be made while the hybrid nature of this genre and the 'sense of unease' but also of hope, as an essential part of youth literature, in the closure to these novels will be discussed. Important questions about the role of the didactic nature of these texts and the political issues and the importance of the formation of agency and identity for the young adult reader, as well as identification with the protagonists in this genre, are also part of this discussion of The Mark and other YAL novels.

Keywords: agency, dystopian literature, gender construction, young adult literature

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Authors: Javad Jozaei, Rob G. Bell, Paula Blackett, Scott A. Stephens

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In the last few decades, Social Vulnerability Assessment (SVA) has been a favoured means in evaluating the susceptibility of social systems to drivers of change, including climate change and natural disasters. However, the application of SVA to inform responsive and practical strategies to deal with uncertain climate change impacts has always been challenging, and typically agencies resort back to conventional risk/vulnerability assessment. These challenges include complex nature of social vulnerability concepts which influence its applicability, complications in identifying and measuring social vulnerability determinants, the transitory social dynamics in a changing environment, and unpredictability of the scenarios of change that impacts the regime of vulnerability (including contention of when these impacts might emerge). Research suggests that the conventional quantitative approaches in SVA could not appropriately address these problems; hence, the outcomes could potentially be misleading and not fit for addressing the ongoing uncertain rise in risk. The second phase of New Zealand’s Resilience to Nature’s Challenges (RNC2) is developing a forward-looking vulnerability assessment framework and methodology that informs the decision-making and policy development in dealing with the changing coastal systems and accounts for complex dynamics of New Zealand’s coastal systems (including socio-economic, environmental and cultural). Also, RNC2 requires the new methodology to consider plausible drivers of incremental and unknowable changes, create mechanisms to enhance social and community resilience; and fits the New Zealand’s multi-layer governance system. This paper aims to analyse the conventional approaches and methodologies in SVA and offer recommendations for more responsive approaches that inform adaptive decision-making and policy development in practice. The research adopts a qualitative research design to examine different aspects of the conventional SVA processes, and the methods to achieve the research objectives include a systematic review of the literature and case study methods. We found that the conventional quantitative, reductionist and deterministic mindset in the SVA processes -with a focus the impacts of rapid stressors (i.e. tsunamis, floods)- show some deficiencies to account for complex dynamics of social-ecological systems (SES), and the uncertain, long-term impacts of incremental drivers. The paper will focus on addressing the links between resilience and vulnerability; and suggests how resilience theory and its underpinning notions such as the adaptive cycle, panarchy, and system transformability could address these issues, therefore, influence the perception of vulnerability regime and its assessment processes. In this regard, it will be argued that how a shift of paradigm from ‘specific resilience’, which focuses on adaptive capacity associated with the notion of ‘bouncing back’, to ‘general resilience’, which accounts for system transformability, regime shift, ‘bouncing forward’, can deliver more effective strategies in an era characterised by ongoing change and deep uncertainty.

Keywords: complexity, social vulnerability, resilience, transformation, uncertain risks

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Authors: Caroline Seo, Jennifer Stephens, Kirstin H. Heinrich

Abstract:

Background: Clostridiodes (formerly Clostridium) difficile infection (CDI) is an anaerobic, spore-forming bacterium with manifestations including diarrhea, pseudomembranous colitis and toxic megacolon. Despite general understanding that CDI may be associated with marked burden on patients’ health, there has been limited information available on the humanistic burden of CDI. The objective of this literature review was to summarize the published data on the humanistic burden of CDI globally, in order to better inform future research efforts and increase awareness of the patient perspective in this disease. Methods: A comprehensive literature review of the past 15 years (2002-2017) was conducted using MEDLINE, Embase and Cumulative Index of Nursing and Allied Health Literature. Additional searches were conducted from conference proceedings (2015-2017). Articles selected were studies specifically designed to examine the humanistic burden of illness associated with adult patients with CDI. Results: Of 3,325 articles or abstracts identified, 33 remained after screening and full text review. Sixty percent (60%) were published in 2016 or 2017. Data from the United States or Western Europe were most common. Data from Brazil, Canada, China and Spain also exist. Thirteen (13) studies used validated patient-reported outcomes instruments, mostly EQ-5D utility and SF-36 generic instruments. Three (3) studies used CDI-specific instruments (CDiff32, CDI-DaySyms). The burden of CDI impacts patients in multiple health-related quality of life (HRQOL) domains. SF-36 domains with the largest decrements compared to other GI diarrheal diseases (IBS-D and Crohn’s) were role physical, physical functioning, vitality, social functioning, and role emotional. Reported EQ-5D utilities for CDI ranged from 0.35-0.42 compared to 0.65 in Crohn’s and 0.72 in IBS-D. The majority of papers addressed physical functioning and mental health domains (67% for both). Across various studies patients reported weakness, lack of appetite, sleep disturbance, functional dependence, and decreased activities of daily lives due to the continuous diarrhea. Due to lack of control over this infection, CDI also impacts the psychological and emotional quality of life of the patients. Patients reported feelings of fear, anxiety, frustration, depression, and embarrassment. Additionally, the type of disease (primary vs. recurrent) may impact mental health. One study indicated that there is a decrement in SF-36 mental scores in patients with recurrent CDI, in comparison to patients with primary CDI. Other domains highlighted by these studies include pain (27%), social isolation (27%), vitality and fatigue (24%), self-care (9%), and caregiver burden (0%). Two studies addressed work productivity, with 1 of these studies reporting that CDI patients had the highest work productivity and activity impairment scores among the gastrointestinal diseases. No study specifically included caregiver self-report. However, 3 studies did provide mention of patients’ worry on how their diagnosis of CDI would impact family, caregivers, and/or friends. Conclusions: Despite being a serious public health issue there has been a paucity of research on the HRQOL among those with CDI. While progress is being made, gaps exist in understanding the burden on patients, caregivers, and families. Future research is warranted to aid understanding of the CDI patient perspective.

Keywords: burden, Clostridiodes, difficile, humanistic, infection

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