Tissue Engineering is a rapidly evolving field of research that can change and improve the lives of many people. Successful use of bioresorbable polymers for many tissue engineering applications require typically; controlled degradation, biocompatibility (both cell and surrounding environment) and strength. Poly(c-caprolactone) (PCL) has many favourable attributes that can be utilised in tissue engineering applications. However, long uncontrollable degradation regimes and low strength in particular have limited its use for in vivo applications. The work presented here has emerged from research aimed at overcoming th.e current limitations of PCL. The degradation rate was enhanced through the use of an additive named Poly(aspartic acid-co-lactide). The results suggest that as much as 20% mass loss occurred after 7 months for the PCLIPAL blends, whereas pure PCL had zero mass loss at this time. The hydrophobic surface of PCL was made hydrophilic by the use of an atmospheric pressure glow discharge plasma. The surface became more hydrophilic at a rate which depended upon treatment time and plasma conditions. Early cell biocompatibility analysis suggests a more favourable cell response on the surface of plasma modified PCL. The strength ofPCL was optimised using a bioactive ceramic filler. The increase in mechanical performance was found to be a function of the quantity of the ceramic in the blended samples. Cooling rate effects on the structure ofPCL were investigated. The results suggest the possibility of tuning the properties ofPCL, simply by adjusting the cooling rate. It is anticipated that the outcomes from this research will promote the more frequent utilisation of PCL for in vivo applications. The results found will also help aid the development of the next generation of bioactive-bioresorbable polymers; as the processes and technologies utilised in this study can be transferred to numerous bioresorbable polymers and the design ofimplant devices.

Hospitals have always faced fundamental questions of patient safety, care, and budgetary concerns. There has been increasing recognition recently of the serious issue of medical devices management, covering the areas of procurement, training, maintenance, and governance. This issue, documented by the National Audit Office, National Patient Safety Agency, Medicines and Healthcare Products Regulatory Agency, National Health Service Litigation Authority, and World Health Organisation, impacts on healthcare costs and patient safety. It has led to new Health and Social Care Act Regulations, enforced by the Care Quality Commission. As a result of my work as a consultant in the field of medical devices management, I constructed a policy model based on my own specialist experience and knowledge. This research sought to improve that model through participatory research conducted at an NHS Hospital in London. It took the form of a case study that specifically explored the core policy areas, but this time in collaboration with participants with expertise in one or more of the four interrelated policy areas of procurement, training, maintenance, and governance. This collaboration involved researching and analysing the external demands from regulatory agencies and internal demands from the organisation, centred on procurement, budgetary, and policy issues. The action research informed changes in policy, especially around procurement, leading to improvements in practice. The challenge of keeping policy up to date, and consistent with the external regulations and internal operational demands, is discussed in the case study. The Hospital’s internal politics and culture were found to be a help when starting up the case study, but a hindrance when it came to getting agreement and approvals to change the policy content, because of multiple committees and competing interests. The overall outcome of the project was an organisationally approved best practice policy model for medical devices management within a governance framework that meets the needs of the external regulators, and the management of the organisation. More specifically it was discovered that the use, maintenance, and governance of medical equipment were all reliant on a central issue, namely procurement practice. Procurement conduct for the organisation was redefined within the Hospital policy, and is making training, maintenance, and governance easier to achieve, thereby reducing risk and cost. A major consequence is that all budget holders need to be trained in procurement itself. Moreover, it is anticipated that the model could be used at similar healthcare organisations, ultimately leading to a contribution to knowledge and practice which assists in patient safety and meeting budgets.

There exists a clinical requirement for dental implants which will enhance the speed of achievement of osseointegration, its maintenance, and biological and physical properties. Whilst commercially pure titanium remains the material of choice for implant fabrication, a promising approach to enhancing its performance is the surface incorporation of metallic ions, or alkali modification of titanium. Osteoblast behaviour adjacent to the implant is a key factor in osseointegration and it is known that the response of these cells can be modified by the surface implantation of Ca ions. This process may modify cellular behaviour via a number of physicochemical parameters, three of which were examined in this study using commercially pure titanium, into which Ca ions had been implanted: -topography, calcium ion release, and molecular adsorption. Surface topography can mediate cellular responses and may be modified by ion implantation. Laser profilometry and white light interferometry were used to measure the roughness of cp Ti surfaces implanted with either biologically active Ca or chemically inert Ar, together with the effects of nitric acid treatment, which is routinely used in implant manufacture. Ca-ion implantation may also influence cellular responses via accelerated precipitation of calcium phosphate, providing a surface with a chemical composition more similar to that of bone. This may be at least partially due to ion release from the implanted surface. Ion release into water was therefore investigated using ion chromatography and X-ray photoelectron spectroscopy (XPS). The adsorption of organic molecules (e.g. proteins and peptides) is also important in mediating cellular responses. The effects of Ca-implantation on these processes were investigated using XPS to study the surface adsorption of small model biomolecules (amino acids) from an aqueous solution. Ion implantation had little effect on surface topography, however, the implanted Ca ions were readily released into an aqueous solution and the surfaces became more receptive to the absorption of certain amino acids. It is concluded that Ca ion implantation is a potentially valuable technique for the surface enhancement of titanium dental implants.

Near-infrared spectroscopy (N1RS) has been used extensively in recent years as a non invasive tool for investigating cerebral hemodynamics and oxygenation. The technique exploits the different optical absorption of oxy-haemoglobin and deoxy-haemoglobin in the near infrared region to measure changes in their concentrations in tissue. By making multiple NIRS measurement simultaneously, optical topography (OT) provides spatial maps of the changes in haemoglobin concentration levels from specific regions of the cerebral cortex. The thesis describes several key developments in optical topography studies of functional brain activation. These include the development of a novel data analysis software to process the experimental data and a new statistical methodology for examining the spatial and temporal variance of OT data. The experimental work involved the design of a cognitive task to measure the haemodynamic response using a 24-channeI Hitachi ETG-100 OT system. Following a series of pilot studies, a study on twins with opposite handedness was conducted to study the functional changes in the parietal region of the brain. Changes in systemic variables were also investigated. A dynamic phantom with optical properties similar to those of biological tissues was developed with the use of liquid crystals to simulate spatially varying changes in haemodynamics. A new software tool was developed to provide a flexible processing approach with real time analysis of the optical signals and advanced statistical analysis. Unlike conventional statistical measures which compare a pre-defined activation and task periods, the thesis describes the incorporation of a Statistical Parametric Mapping toolbox which enables statistical inference about the spatially-resolved topographic data to be made. The use of the general linear model computes the temporal correlations between the defined model and optical signals but also corrects for the spatial correlations between neighbouring measurement points. The issues related to collecting functional activation data using optical topography are fully discussed with a view that the work presented in this thesis will extend the applicability of this technology.

Endovascular techniques have been embraced as a minimally-invasive treatment approach within different disciplines of interventional radiology and cardiology. The current practice of endovascular procedures, however, is limited by a number of factors including exposure to high doses of X-ray radiation, limited 3D imaging, and lack of contact force sensing and haptic feedback from the endovascular tools and the vascular anatomy. More recently, development of robotic platforms have aimed to improve these practices by removing the operator from the radiation source and increasing the precision and stability of catheter motion with added degrees-of-freedom. Despite their increased application and a growing research interest in this area, many such systems have been designed without considering the natural manipulation skills and ergonomic preferences of the operators. Existing studies on tool interactions and behaviour patterns of operators have been very limited, and presently there is a lack of objective and quantitative metrics for performance and skill evaluation. This research proposes a framework for automated and objective assessment of endovascular skill, by measuring catheter-tissue contact forces and operator force/motion patterns across different skill levels, relating operator tool forces to catheter dynamics and forces exerted on the vasculature, and learning the underlying force and motion patterns that are characteristic of skill. Furthermore, a novel cooperative robotic catheterization system based on 'Learning-from-Demonstration' is developed, by utilizing a learning-based approach for generating optimum motion trajectories from multiple demonstrations of a catheterization task, as well as encoding the higher-level structure of a task as a sequence of primitive motions, to enable semi-autonomous catheter navigation within a collaborative setting. The results provide important insights into improving catheter navigation in the form of assistive or semi-autonomous robotics, and motivate the design of collaborative robots that are intuitive to use, while reducing the cognitive workload of the operator.

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Personalised medicine is redefining the present and future of healthcare by increasing treatment efficacy and predicting diseases before they actually manifest. This innovative approach takes into consideration patient’s unique genes, environment, and lifestyle. An essential component is physics-based simulations, which allows the outcome of a treatment or a disease to be replicated and visualised using a computer. The main requirement to perform this type of simulation is to build patient-specific models. These models require the extraction of realistic object geometries from images, as well as the detection of diseases or deformities to improve the estimation of the material properties of the studied object. The aim of this thesis was the design of a general framework for creating patient- specific models for biomechanical simulations using a framework based on statistical shape models. The proposed methodology was tested on the construction of spine models, including vertebrae and intervertebral discs (IVD). The proposed framework is divided into three well-defined components: The paramount and first step is the extraction of the organ or anatomical structure from medical images. In the case of the spine, IVDs and vertebrae were extracted from Magnetic Resonance images (MRI) and Computed Tomography (CT), respectively. The second step is the classification of objects according to different factors, for instance, bones by its type and grade of fracture or IVDs by its degree of degeneration. This process is essential to properly model material properties, which depends on the possible pathologies of the tissue. The last component of the framework is the creation of the patient-specific model itself by combining the information from previous steps. The behaviour of the developed algorithms was tested using different datasets of spine images from both computed tomography (CT) and Magnetic resonance (MR) images from different institutions, type of population and image resolution.

Radio Frequency Identification Technology (RFID) adoption in healthcare settings has the potential to reduce errors, improve patient safety, streamline operational processes and enable the sharing of information throughout supply chains. RFID adoption in the English NHS is limited to isolated pilot studies. Firstly, this study investigates the drivers and inhibitors to RFID adoption in the English NHS from the perspective of the GS1 Healthcare User Group (HUG) tasked with coordinating adoption across private and public sectors. Secondly a conceptual model has been developed and deployed, combining two of foresight’s most popular methods; scenario planning and technology roadmapping. The model addresses the weaknesses of each foresight technique as well as capitalizing on their individual, inherent strengths. Semi structured interviews, scenario planning workshops and a technology roadmapping exercise were conducted with the members of the HUG over an 18-month period. An action research mode of enquiry was utilized with a thematic analysis approach for the identification and discussion of the drivers and inhibitors of RFID adoption. The results of the conceptual model are analysed in comparison to other similar models. There are implications for managers responsible for RFID adoption in both the NHS and its commercial partners, and for foresight practitioners. Managers can leverage the insights gained from identifying the drivers and inhibitors to RFID adoption by making efforts to influence the removal of inhibitors and supporting the continuation of the drivers. The academic contribution of this aspect of the thesis is in the field of RFID adoption in healthcare settings. Drivers and inhibitors to RFID adoption in the English NHS are compared to those found in other settings. The implication for technology foresight practitioners is a proof of concept of a model combining scenario planning and technology roadmapping using a novel process. The academic contribution to the field of technology foresight is the conceptual development of foresight model that combines two popular techniques and then a deployment of the conceptual foresight model in a healthcare setting exploring the future of RFID technology.