Spirituality is a phenomenon integral to health and wellbeing and a fundamental element of nursing care. Nonetheless, empirical evidence suggests that spirituality is a frequently ignored aspect of care provision. While there is evidence that examines the relevance of providing spiritual care to service users, minimal research has been undertaken that examines the spiritual needs of pre registration nursing students. This study used a Glaserian grounded theory design to explore and explain pre registration nursing students’ personal understanding of their own spirituality and the relationship between experiences in clinical practice and spiritual awareness. Participants comprised seven pre-registration nursing students undertaking a three-year educational programme. Data was collected between 2008 and 2013 through two focus groups, twelve one-to-one interviews and theoretical sampling of a variety of literature and media, including artefacts created by the participants. The findings identified that pre-registration nursing students’ awareness of spirituality can be explained in three main Basic Social Processes [BSPs]: struggling, safeguarding and seeking. When their spirit was at risk of becoming broken by negative experiences in clinical practice, then their hope to carry on was at risk and struggling, safeguarding and seeking were evident. These three concepts are integral to the theory that emerged from the findings: a theory of carrying hope that explains participants’ resolve between clinical experiences and spiritual awareness. This study highlights that the challenges associated with spiritual awareness may impact on attrition from pre-registration nursing programmes. If students’ spiritual needs and awareness are not adequately nurtured and supported there are implications linked to the aspiration of nursing to recapture the 6Cs (DH 2012). Recommendations from this study include the identification of role models in clinical practice and the implementation of a model of pastoral care for tutors supporting pre-registration nursing students. Further research is required to examine how role modelling and pastoral care can enhance spiritual awareness in pre registration nursing students. While this study focused on nursing, implications for other vocational professions are identified.

Objective tests of motor function suitable for older people in epidemiological studies and community settings are lacking. The current study aimed to establish non-invasive biomarkers using conventional and novel tests that do not rely entirely on volition, and identify suitable analysis techniques for complex data. It was hypothesised that novel technologies would improve the discriminant validity of motor function testing. In 138 self-reported healthy males and females (65 young, mean age±SD = 25.7±4.8 years; 73 older, 74.9±5.9 years), nine tests (25 parameters) included: hand grip and quadriceps strength; respiratory muscle strength (peak flow); thigh composition (ultrasound imaging); muscle mechanical properties (Myoton technology); upper limb kinematics (Motor Task Manager); timed up and go; stair climbing; balance. Three questionnaires and one mobility assessment were administered including the health related quality of life (SF36). Four experiments tested hypotheses regarding the influence of recording conditions on mechanical properties to validate the novel MyotonPRO device. Reliability of all tests was confirmed and, as expected, data indicated reduced function with ageing (all p<0.05), with the majority showing gender differences. Some mechanical properties were significantly influenced by testing site, muscle length, contractile status and prior activity. Seven of the 25 parameters (5novel) had high discriminant ability for classifying healthy adults into age/gender groups analysed by linear discriminant function using a stepwise approach. Novel technologies, notably mechanical properties of muscle and thigh composition (relative contribution of muscle and subcutaneous fat on ultrasound scans), improved classification accuracy (from 75% to 89%) when combined with conventional tests, supporting the hypothesis and providing potential screening tools independent of participant effort. High discriminant ability (73 to 80%) was also found for classification based on functional measures. This research has advanced the approach to functional assessment and analysis by producing a comprehensive battery of non-invasive biomarkers with high discriminant ability for indicating musculoskeletal health, providing reference data for comparison with clinical populations. The most sensitive novel biomarkers did not require volition, highlighting potential powerful tests for vulnerable older people with pain or cognitive impairment.

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Stroke affects the ability of the trunk muscles to maintain an upright posture and maintain the base of support during static and dynamic postural adjustments. The trunk is considered an important postural stabilizer which enables the dissociation of the upper extremity from the trunk for function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. The association between trunk control and recovery of upper extremity function in stroke patients is not known currently. The cross-sectional studies (Phase 1A and Phase 1B studies) investigated the relationship between trunk control and upper extremity function in 45 subacute stroke and 25 chronic stroke participants, and 34 age- and sex-matched healthy controls. Trunk control and upper extremity function were assessed using the Trunk Impairment Scale (TIS) and Streamlined Wolf Motor Function Test (SWMFT) respectively. The participants performed SWMFT tasks, with and without an external trunk support in random order. Kinematic data were captured with the Vicon motion capture system in the Phase 1A study with chronic stroke participants and healthy controls. With trunk support, there was statistically significant improvement in trunk control (TIS) of subacute and chronic stroke participants; improvement in SWMFT performance time (SWMFT-Time) of the upper extremity of the stroke participants and the healthy controls; and improvement in SWMFT-Functional Ability Scale (SWMFT-FAS) in stroke participants. There was also statistically significant improvement in movement smoothness and elbow extension of the affected upper extremity of chronic stroke participants. The findings suggest that stabilization of the trunk enables an improved ability to use the upper extremity for functional activities. Significant strong associations were found between trunk control and upper extremity impairment (Fugl-Meyer score, FMA) and upper extremity function (SWMFT-Time and SWMFT-FAS). The longitudinal study (Phase 2 study) examined the recovery pattern of trunk control and upper extremity impairment and function in 45 subacute stroke participants in the first 6 months following stroke. The results further confirmed the findings of the cross-sectional studies (Phase 1A and Phase 1B studies) about the strong association between trunk control and upper extremity in the first 6 months post stroke. The rate of change of the recovery curves of trunk control and upper extremity impairment was found to be similar over time. As TIS scores improved over time, both the upper extremity impairment (FMA) and upper extremity function (SWMFT-Time and SWMFTFAS) improved almost in parallel with the TIS increase. The results imply that trunk control has an association with the recovery of the upper extremity. This PhD work has deepened our understanding about trunk control and upper extremity in people with stroke and provided valuable insights for rehabilitation professionals and researchers. The findings will assist therapists to design comprehensive programmes for rehabilitation of trunk control and upper extremity at different stages of stroke recovery; and aid in the prognostication of trunk and upper extremity recovery post stroke and therefore, will have an impact on clinical practice.

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Human lung cytidylyltransferase was found associated with both 'soluble' (S100) and membrane-rich particulate (P100) fractions of Tris-buffered saline homogenates. S100 enzyme activities in 15 - 16 week fetal and adult human lungs represented a constant proportion of overall recovery, (66.8 4.8% vs 66.1 7.5%, means standard error). A lack of support for the regulatory translocation of human lung cytidylyltransferase at these extremes of development was unable to rule out a transient change in distribution near term. Rat lung P100 enzyme increased from 31% to 40% between d18 gestation and term, d22, but a concomitant increase in total. S100 cytidylyltransferase, measured in the presence of the lipid activator PG, questioned the physiological significance of the apparent translocation. Cytidylyltransferase from human and rat lung S100 were resolved into a high molecular weight H form (> 106 daltons) and a lower molecular weight L form (~200,000 daltons). Incubation of S100 at 37oC for 2 hours yielded insoluble, protein-rich aggregates which were strongly associated with rat H form cytidylyltransferase, while less strongly with the human H form. The principal 43,000 dalton, protein in these aggregates was identified as a cytoplasmic actin on the basis of its properties, amino acid composition and western blot analysis. The association of H form cytidylyltransferase with cytoskeletal F-actin containing fractions in vitro was disrupted by the detergent CHAPS, which was also able to release a portion of P100 enzyme. Separation of human S100 H and L form enzyme, by gel filtration or ultracentrifugation, revealed the presence of latent cytidylyltransferase, often as high as 3 fold, which questioned activity determinations in fresh S100. Within the framework of an emerging concept of a highly ordered aqueous cytoplasm, the incorporation of these results suggested that a portion of human lung cytidylyltransferase might by cytoskeletally bound in vivo, as has been described for many enzymes or enzyme systems. The use of conventional purification techniques, including affinity chromatography, with a view to testing these ideas in defined systems, met with little success. Low yields or highly unstable enzyme characterised many individual steps, especially where cytidylyltransferase was separated from F-actin enriched fractions. A number of triazine dyes screened as pseudoaffinity ligands revealed a rapid inhibition with Procion Green H-4G and a partial protection with MgCTP. Sepharose CL4B-immobilised Green H-4G bound cytidylyltransferase, but MgCTP was unable to effect elution. Increasing ionic strength eluted some activity but also inhibited enzyme irreversibly, while CHAPS at 1% released a maximum of only 18% bound enzyme and SDS PAGE revealed a relatively non-specific binding. The use of dye-affinity matrix offered the potential of a useful purification step with partially purified enzyme if suitable elution conditions could be devised.

Research to date has suggested that fatty acids (FAs) may affect the immune system, through their (and those of their metabolites) effects on membranes, mediators, and gene expression. However, despite the research carried out, there still exist gaps of knowledge where further research is required. In addition, programming by diet in pregnancy may affect the immune system, due to stress and/or structural and functional changes to immune cells, but whether this effect is long-lasting is uncertain. In order to address some of these gaps in knowledge, experiments were conducted to examine the effects of dietary FAs on immune outcomes in rodent models of clinical relevance and the effect of maternal protein restriction on immune outcomes in two later generations. The first experiment investigated the effect of diets differing in FA composition on the recall response in a mouse model of influenza vaccination. A diet rich in salmon oil resulted in enhanced ear swelling (measured after 48 hours) compared with diets rich in linseed oil, sunflower oil or beef tallow, suggesting that long chain n-3 FAs increase the TH1 response. The different effects of salmon oil compared with the other diets appears to relate to the lower n-6 fatty acid status that occurs with salmon oil feeding. The second experiment investigated the effect of diets differing in FA composition in a mouse model of allergic sensitisation (to ovalbumin). There was reduced immediate hypersensitivity to ovalbumin in mice fed a diet rich in salmon oil and increased immediate hypersensitivity in mice fed a diet rich in beef tallow, but there was no effect of diet on airway responsiveness to ovalbumin. Beef tallow feeding also raised IgE in blood and elevated IL-4 production by anti-CD3 stimulated splenocytes. The salmon oil did not affect IgE or cytokine profiles. The results suggest that the n-3 FAs found in salmon oil decrease TH2-mediated responses to an allergen and that such responses are increased by a diet rich in saturated FAs. The third experiment examined the effect of diets differing in FA composition fed during rat pregnancy on the abundance of different immune cells in blood and lymphoid organs of the offspring at weaning and beyond. The FA profile of the dams at the end of lactation reflected dietary intake in pregnancy, but no changes were found in immune cell abundance of offspring. The fourth experiment examined the effect of diets rich in a- linolenic acid (ALA, a short chain n-3 FA) or linoleic acid (LA, a short chain n-6 FA) in mouse pregnancy on allergic sensitisation to ovalbumin in the offspring. Diets were given during pregnancy alone, in both gestation and lactation, or during lactation alone, and compared to a low-fat control. The ALA-rich diet in gestation and lactation and the LArich diet in gestation reduced ear swelling in the offspring. Despite these differences, there were no effects on lung function or immune markers. The fifth experiment investigated the effect of protein restriction in rat pregnancy on the immune system of the offspring over two generations. No differences were seen between groups in the F1 generation. Protein restriction reduced TH and B-cell abundance in the spleen and thymus of F2 males. In conclusion, dietary fatty acids can alter immune responses, and there may be an effect of FAs in pregnancy on the immune response in the offspring but such effects may not be long lasting. Protein restriction during pregnancy, which is stress inducing, appears to have an effect on immune cell abundance that is manifested at the second generation of offspring

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Parkinson’s is a common, progressive, neurodegenerative movement disorder of the central nervous system, presenting with particular impairment of the motor system. Despite a growing body of literature recommending the use of dance for the treatment and management of Parkinson’s, the exact impact and effect on turning ability has not been investigated. In addition, the experience of those teaching dance has also received little attention. The purpose of this research study was to explore the experience of teaching ballroom and Latin American dance classes for people with Parkinson’s (PwP) from a qualitative perspective alongside the main aim of investigating effects on turning in PwP from a quantitative perspective. Qualitatively, three dance teachers were approached to participate in semi-structured interviews before and after teaching dance classes for PwP over one year. A thematic analysis was undertaken using a framework approach, informed by the principles of Interpretative Phenomenological Analysis. Two dance teachers participated, with analysis generating four themes: 1) the role of adaptation, 2) the context and 3) practical application of the class and 4) how achievement was measured and the impact of the teacher. Quantitatively, twenty-four PwP were randomly allocated to receive either twenty, one-hour dancing classes over 10-weeks (n=12), or usual care (n=12). Using 3-dimensional movement analysis before and after the intervention period, measures of latency and horizontal movement of the eyes, head, thorax, shoulders, pelvis and feet, centre of mass displacement, and the total time of a 180 degree on-the-spot turn were taken alongside clinical measures. Statistical analysis (4-way ANOVA) demonstrated a significant four-way interaction for head latency (p=0.008), with mean values showing longer latency in the usual care. Similar trends were also shown in pelvis latency (p=0.077), first (p=0.063) and second (p=0.081) foot latency, with mean values suggesting longer pelvis latency and slower foot movement in the usual care group, although all results were affected by prediction and preference of turn direction. Significant between-group differences were also found for pelvis rotation (p=0.036), with the usual care group showing greater rotation. No differences were found in the centre of mass displacement, turn time or clinical measures. As a result of interpretation the main findings suggest a tighter coupling and greater co-ordination of all segments following dance. In conclusion, teachers’ expectations and experiences suggest a multidimensional impact of dance for PwP with importance of socialisation, increased confidence, level of achievement and participation, knowledge of which will support the development of dance classes for PwP. Specifically, body segments (head, pelvis and feet) appear more coordinated in time and sequence following dance in PwP, suggesting a more ‘en bloc’ turning pattern with greater inter-segmental coordination. However, this is influenced by direction of turn preference and prediction, with further research required to comment on the clinical implications.