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Background: Coronary heart disease (CHD) remains a major cause of death and ill- health in Scotland. Coronary artery bypass grafting (CABG) aims to relieve CHD symptoms, improve quality of life and increase life expectancy in high-risk groups. Partners may positively or negatively influence patient outcome, and they too may be adversely affected by the experience of CABG. Health care is currently organised around the patient. The partner's is seen as merely assisting patient recovery. Their health and well-being is neglected despite them being at an increased risk of CHD. Research has been limited in the partner variables that have been examined. Their health needs and concerns and the influence of the patient on partner outcome have seldom been examined and the effects of CABG on the dyad. The dyad has not previously been examined as an outcome variable of interest.

This thesis analyses the twenty-four 'EU référendums' held in Western Europe since 1972 on matters associated with membership of the European Union. It does so in relation to the European Union and to a form of what is claimed to be a distinctive pattern of democratic governance emerging there. In doing so the research eschews the usual approach to analysing référendums with respect to national political systems and/or their constitutional or legal origins. In order to facilitate this task, the thesis establishes a typology of EU référendums: accession, treaty, quasi-treaty, special purpose and withdrawal référendums. These are analysed in a comparative thematic way in terms of constitutional and decision-making practices, which highlight the sources of these référendums, and in terms of participation and legitimacv. which indicate the endorsement they carry and the extent of legitimation conveyed. This forms an important part of the analysis and the main body of the thesis. EU référendums relate to the development of the European Union in the areas of enlargement, treaty reform and démocratisation. Within these parameters, these référendums are highly significant for the European Union, and particularly so in view of the inadequacies of other forms of democratic authorisation and consent. The study concludes by suggesting that a number of conventional assumptions surrounding référendums need revision, and that EU référendums have a significant impact on both the European Union itself, and on the pace and direction of integration. More importantly, the study finds that these référendums contribute cumulatively to a form of democratic governance emerging in the European Union in explicitly political/electoral areas. The argument that référendums can be understood in terms of this idea of the emergence of a democratic governance system is the primary claim to originality arising from the thesis as a whole. This form of governance restricts the development of integration to that which can be reliably passed in Danish and Irish treaty référendums which, in turn, acts as a brake on the progress of integration. In doing so it imposes on the European Union, by a very indirect means, a specific form of West European liberal democracy which is based on the explicit involvement of the people in European integration - the major political issue of contemporary Western Europe.