This thesis explores the barriers to accessing primary care health service provision for \nGypsies and Travellers in England. Research took place 'in two phases. The first was a \nqualitative study of Gypsies' and Travellers' cultural beliefs, attitudes, perceptions of \nand access to health care. Findings included low expectations and poor experience of \nservices, as well as many examples of communication barriers between Gypsies and \nTravellers and health staff. The second phase built on these findings, by adopting \nparticipatory action research (PAR) methods, to explore communication processes \nfrom both staff and Gypsy and Traveller perspectives. The aim was to elicit \nunderstanding with a view to exploring how barriers might be overcome. \nBoth phases ofresearch show how Gypsy and Traveller experiences of discrimination \nand racism contribute to a sense ofdevalued identity, characterised by feelings of \nshame and humiliation. Shame and attempts to ward off shame are central features of \nrelationships and encounters with health staff as personal reactions to these \nexperiences can produce mutual mistrust and poor relations between staff and the \nGypsy and Traveller patients. At the same time, health staff reactions are shaped by \npressures related to role, status and setting. By focusing on processes of coconstructed \ncommunication, I identify specific patterns of tension and mistrust. \nIn conclusion, I argue that a reflective and collaborative staff approach in primary \ncare, based on effective leadership and a shared team ethos, can provide the empathic \nfocus needed as a starting-point for trust and effective communication. I also argue \nthat acquisition of good communication skills and development of experiential \ncultural awareness, whilst essential, are insufficient to guarantee cultural competence. \nA reflexive approach, focussing on personal qualities, values, beliefs and attitudes, is \nalso essential for cultural safety. I outline the specific staff training implications of \nthese findings, in terms of ensuring culturally safe health care for Gypsies and \nTravellers.

Abstract of thesis: Gypsies and Travellers accessing primary health care: interactions with health staff and requirements for ‘culturally safe’ services

Several adaptive-optics techniques, based on the active modification of the optical properties of the laser cavity, were used to significantly reduce the time-to-full-brightness of solid-state lasers. Resonator re-configuration was achieved using a mechanical translation stage and both multi- and single-element deformable bimorph mirrors. Using these techniques the effects of thermally induced distortion in Nd:YLF and Nd:YAG lasers can be minimized and the warm-up time reduced by a factor of 3-6.

Reduction of the time-to-full-brightness in solid-state lasers using intra-cavity adaptive optics

This invention relates to a cooled deformable-mirror and its mount. A deformable mirror is provided comprising a reflective element provided on a substrate that is secured to a deformable element, wherein the substrate comprises at least one channel having a pair of ports both located around the peripheral edge of the substrate. In addition, a deformable-mirror mount and the deformable mirror described above are provided, wherein the mount has a body with a central aperture defined by a supporting surface sized and shaped to support the mirror when installed, and wherein the mount is provided with at least a pair of channels that terminate to face the ports in the mirror when the mirror is installed, the channels of the mirror and the mount being connected via flexible seals.

Deformable-mirror cooling

This thesis explores the barriers to accessing primary care health service provision for
Gypsies and Travellers in England. Research took place 'in two phases. The first was a
qualitative study of Gypsies' and Travellers' cultural beliefs, attitudes, perceptions of
and access to health care. Findings included low expectations and poor experience of
services, as well as many examples of communication barriers between Gypsies and
Travellers and health staff. The second phase built on these findings, by adopting
participatory action research (PAR) methods, to explore communication processes
from both staff and Gypsy and Traveller perspectives. The aim was to elicit
understanding with a view to exploring how barriers might be overcome.
Both phases ofresearch show how Gypsy and Traveller experiences of discrimination
and racism contribute to a sense ofdevalued identity, characterised by feelings of
shame and humiliation. Shame and attempts to ward off shame are central features of
relationships and encounters with health staff as personal reactions to these
experiences can produce mutual mistrust and poor relations between staff and the
Gypsy and Traveller patients. At the same time, health staff reactions are shaped by
pressures related to role, status and setting. By focusing on processes of coconstructed
communication, I identify specific patterns of tension and mistrust.
In conclusion, I argue that a reflective and collaborative staff approach in primary
care, based on effective leadership and a shared team ethos, can provide the empathic
focus needed as a starting-point for trust and effective communication. I also argue
that acquisition of good communication skills and development of experiential
cultural awareness, whilst essential, are insufficient to guarantee cultural competence.
A reflexive approach, focussing on personal qualities, values, beliefs and attitudes, is
also essential for cultural safety. I outline the specific staff training implications of
these findings, in terms of ensuring culturally safe health care for Gypsies and
Travellers.

Gypsies and Travellers accessing primary health care: interactions with health staff and requirements for 'culturally safe' services.

We describe a protocol for the use of a control feedback loop incorporating an iterative optimization routine for a range of time-independent adaptive optics applications. These applications are characterized by the quasi steady state of the aberrative effects (>0.1 s) and contrast, for instance, to astronomical applications where the aberrations constantly vary at frequencies above 10 Hz. For optimal performance in such time-independent applications, the control systems typically require specialized tailoring. A typical example of two different types of time-independent adaptive optics applications--an adaptive optic microscope and an adaptive optic laser platform--are detailed and compared. It is shown that implementing a number of minor, but crucial, application-specific modifications to the control system results in an improved efficiency of an already extremely successful technique for aberration compensation. We present a description of the crucial parameters to consider in a search-based adaptive optics system.

Search-based active optic systems for aberration correction in time-independent applications

A cooled copper adaptive mirror based on a double bimorph structure is proposed for the compensation of large-scale optical aberrations, including those that occur in power systems with an output up to 15 kW. The construction of the adaptive mirror is described and the results are given of calculations and of experimental studies of thermal deformations of the reflecting surface, of the response functions of the control electrodes, and of the frequency properties of the mirror. Estimates are obtained of the effectiveness of compensation of low-order optical aberrations.

http://iopscience.iop.org/article/10.1070/QE1992v022n02ABEH003369/pdf

Bimorph adaptive mirror

Cooled bimorph adaptive copper and molybdenum mirrors are proposed for the compensation of large-scale optical aberrations in laser systems with an output power up to 15 kW. An investigation is reported of the characteristics of the developed and fabricated cooled bimorph mirrors. The experimental results are compared with those obtained by computer modelling. Promising designs of bimorph adaptive mirrors are proposed and discussed.

https://iopscience.iop.org/article/10.1070/QE1994v024n07ABEH000151/pdf

Cooled bimorph adaptive mirrors for laser optics

An operator approach, described earlier, is considered. The physical meaning of the introduced parameters is established. A method is proposed for estimating the effectiveness of the operation of an adaptive mirror in any optical system when the aberrations are known.

Operator-method investigation of the effectiveness of adaptive mirrors

An operator method for estimating the effectiveness of adaptive mirrors is proposed and developed. This method yields a simple mathematical expression for the minimum residual error in the compensation of wavefront distortions. The expression makes it possible to estimate rapidly the precision of distortion compensation in the case of any adaptive mirror and any wavefront without recourse to a computer. The effectiveness of the method is demonstrated by the example of a bimorph adaptive mirror.

A G Safronov

Papers

Bimorph adaptive mirror

Cooled bimorph adaptive mirrors for laser optics

Operator-method investigation of the effectiveness of adaptive mirrors

Operator method for estimating the precision of distortion compensation by adaptive correction