Search

This thesis defends naïve realism about the essential nature of perceptual experience, that is, the experiences that subjects enjoy when they hear, see, smell, taste, and touch things. It claims that the essential natures of such experiences are intrinsically constituted and relationally determined by the perceptible properties of those worldly objects with which perceiving subjects are immediately and irreducibly acquainted. In particular, this thesis defends naïve realism against the Problem of Misleading Experience which exploits the existence of misleading experiences (viz., dreams, hallucinations, and illusions) in order to show that no perceptual experience can be naïve realist in nature. Chapter 1 presents naïve realism’s metaphysical commitments and the Problem of Misleading Experience. In Chapter 2, I sketch three desirable constraints on any successful naïve realist solution: I argue that it is desirable for the Naïve Realist to (i) adopt some form of Basic Phenomenal Disjunctivism (i.e. the claim that perceptual and misleading experiences have different phenomenal natures), (ii) positively explain the phenomenal nature of misleading experience, and, (iii) tell the same fundamental story of dreams, hallucinations, and illusions. Chapter 3 introduces my own theory – Imaginative Disjunctivism (i.e. the claim that perceptual experiences have naïve realist natures whereas the natures of misleading experiences are perception-like imaginings) – that I argue has the right conceptual and empirical shape to meet these three constraints. I then put Imaginative Disjunctivism to work by showing how it can explain dreams (Chapter 4), hallucinations (Chapter 5), and illusions (Chapter 6) in a way that is compatible with naïve realism. Though there is some precedent for explaining dreams (e.g. Ichikawa 2009) and hallucinations (e.g. Allen 2014) in terms of perception-like imaginings, my account is the first to extend this treatment to illusions, and so, provides a theoretically attractive unified .theory of misleading experience.

Rationale: In recent years the overall benefit of breast screening has been a subject of debate, and one of the criticisms is excessive false-positive recalls. Arbitration by a third reader or group consensus can be integral in reducing these. Before the publication of the Public Health England arbitration guidance (August 2016), the third person arbitrator or lead of consensus meetings had to be medically qualified (radiologists, breast clinicians). How sensitive and specific the third reader should be, has never been specified, but there is considerable variation between individuals undertaking the task. This research aimed to explore the different reporting and arbitration strategies in breast screening within England to ascertain if specific systems work better in differing units, and thereby inform recommendations to standardise processes. Consideration is also given to advances in technology in this field. Method: A mixed-methods approach was used to explore the complex factors associated with decision making (reporting and arbitration) in breast screening and the effect on recall rates. The research included two national surveys, analysis of chosen performance metrics (recall rates, small cancer detection rates and Standardised Detection Ratio) for all 80 breast screening units in England (KC62data) and semi¬ structured telephone interviews, based on a pre-determined sampling frame. Interviews were undertaken to explore the opinions, experiences, perspectives and insights of reporting staff (varying professional roles). Methodological triangulation was used to evaluate complementary and divergent findings. Key findings: The survey results demonstrated variability in all aspects of reporting and arbitration practices. The reporters may be influenced by non-blind reading and arbitration, resulting in biased decision-making. The PHE guidance on arbitration has had minimal impact on the respondent units. Analysis of the KC62 data demonstrated variations in the performance parameters reviewed at the unit level, but in particular, recall rates. However, there was no difference in mean recall rates between units for the cases reviewed; the arbitration strategy; the reading type; professional role undertaking the third reader arbitration/leading consensus or programme size. Also, there were no statistically significant differences for the four-year average prevalent and incident SDR between programme sizes nor between the arbitration strategies for small cancer detection rates (prevalent and incident) or SDR (prevalent and incident). The interview results generated five main themes relating to reporting and arbitration practices: organisational factors, technology, clinician factors, teamwork factors and PHE guidance factors. Artificial Intelligence (AI) could potentially tackle some of the current challenges in breast screening, including capacity issues/workforce planning, increased efficiency, improved accuracy and advanced detection of early cancers. Further research is needed on optimising human/AI decision-making. Conclusion and further research: This thesis has resulted in several organisational and national recommendations regarding blind reading/arbitration to provide improved film reader data profiles and standardisation, and considerations surrounding alternative models of service delivery. The research has revealed the potential for future work into: 1. The design of the breast screening reporting system; 2. Selection of arbitrators and alternative methods of group decision making; and, 3. Determining cultural and organisational characteristics that may improve diagnosis and support effective teamwork.

There is growing prevalence of dementia in the UK, with up to 1 million people predicted to be living with dementia by 2025 (Prince et al. 2014). Green dementia care is a person-centred approach involving activities which enable connection to nature and promote health and wellbeing. Several benefits associated with outdoor and nature-based activities have been shown, however the UK-based and community-based research evidence is limited. Therefore, the aim of this research was to identify and evaluate the benefits associated with outdoor and nature-based activities for people living with dementia and cognitive impairment in the community in the UK, to inform green dementia care practice. This research utilised a mixed methods approach to provide a holistic perspective on the benefits of outdoor and nature-based activities on wellbeing. Study 1 involved qualitative interviews to explore the perceptions of individuals delivering outdoor and nature-based activities for people living with dementia in the UK (n=21). The findings led to the development of a model to guide the delivery of effective outdoor and nature-based activities. This was used to inform a 6-week horticultural activity intervention delivered at a community garden, and a 12-week outdoor and nature-based activity intervention delivered at an ExtraCare village. The interventions were evaluated using quantitative measures, and a range of qualitative measures including direct participant observations, reflections, and participant interviews. The results indicated the interventions provided benefits for people living with dementia in the community and in an extra care setting including positive behaviour, reminiscence and increased social interaction was shown specifically for people living with dementia. A decrease in depressive symptoms and increase in overall quality of life was reported by the participants living at the ExtraCare village. The findings highlight that such activities can be effective by providing multi-sensory stimulation, and opportunities for meaningful activity and being outdoors. Recommendations for the development and implementation of effective outdoor and nature-based activities are presented to enhance green dementia care in practice.

In the practice of new product value creation there is a creative quest that product design and development practitioners must address when existing knowledge of practice proves inadequate but the development objective remains. Design practitioners often achieve new competitive advantages as the outcome of these creative quests, and yet truly innovative and competitive products are rare, as their efforts often fall short of the original design aims. In this study, the design process of the author, a product design practitioner with over thirty years of experience, has been investigated through the examination of three case histories of successful new product development arising from his design practice. The cases were assembled by the practitioner, who is also an academic researcher, seeking an explanatory research analogue of his tacit design process. The methodology draws on the reflective practice philosophy of Donald Schön, in conjunction with grounded theory and case studies employing mixed methods, to explain how design can create new value and competitive advantage in the marketplace. The chosen cases share common successful marketplace outcomes resulting from their design and development approaches. Although qualitative in nature, this autobiographic study builds on the insights available to the researcher, and the unique access to rich quantitative evidence of the design narrative and marketing histories gained from an insider’s view of industry practice. Competitive advantage and its role in innovation in the real-world laboratory of the marketplace provide the context for researching the process of this design-focused strategy. This thesis explains the practice-design relationship in strategic new product design and development by distinguishing between existing practice and the new knowledge rivalry created through design practice, bringing focus to the new design’s ability to displace the existing solution. Whilst the primary focus of the study is on design value creation for competitive advantage in new product marketplaces, a new knowledge creation framework has emerged from this research with the potential for application by other practitioners. This strategically focused, differentiation by design based competitory action model (CAM) provides a systematic explanatory framework for practitioners seeking advantaged new knowledge creation for product design praxis, as well as an actionable framework for further academic research.