Thermoresponsive hydrogels containing gold nanoparticles (AuNPs) were explored for their potential use as colorimetric sensors. The shrinking and swelling behaviour of thermoresponsive polymers cross-linked by AuNPs induces a colour change around the LeST. Formulation of the AuNPs cross-linked thermoresponsive polymer in an agarose gel allows naked eye visualisation of the colour change, overcoming the opaque appearance of the AuNPs cross-linked thermoresponsive polymer alone above the LeST. A thermoresponsive polymer, PPEGMA was prepared using a bifunctional RAFT agent, cross-linked with AuNP and subsequently dispersed in an agarose hydrogel. Upon raising the temperature above the LeST, the thermoresponsive hydrogel construct underwent a colour change from red to blue, due to the AuNPs moving closer together as a result of the shrunken state of the polymer. This colour change was reversible as the temperature was cycled above and below the LeST. Similar data was achieved using another thermoresponsive polymer, PNIPAM. The thermoresponsive hydrogel constructs were characterised by NMR; UV-Vis absorption to measure LeST transition and TEM to establish AuNPs distribution. The proof-of-principle colorimetric sensing approach was extended by modifying the thermoresponsive polymer to include pendant boronic acid group. In the presence of a target (fructose), the hydrogel construct underwent a colour change from blue to red, due to swelling of the polymer below the LeST induced by fructose binding to the boronic acid groups present in the polymer. The colorimetric sensor was also modified for detection of an enzyme, elastase. A synthetic peptide (Pro-Ala-Ala-Ala-Ala) was conjugated to a PNIPAM polymer and the response to the enzyme was observed by the colour change from red to blue, due to the shrinking of the polymer when the peptide was cleaved by elastase. This colorimetric sensor has the potential to be applied in a rapid, cost-effective, and simplified test kit for biomedical applications

As the first systematic and in-depth study in any language on the subject, this thesis makes original contributions by unravelling the relationship between Chinese healthcare state governance, health law and medical practitioners, and casting a spotlight on the ethically problematic medical practices raised by cases of SARS and others. More specifically, this thesis examines the role of state governance and regulation in China’s healthcare system and their impact on professional practices and ethics. The thesis addresses the issues from a social-legal perspective. It provides evidence from an integration of historical, empirical and theoretical approaches to explore the role of Chinese medics in their relations with healthcare state governance and law. It explores the character of power relations and the consequences of imbalance of power in these relations. Diagrammatic models are used throughout this work to illustrate the findings from the above approaches and to represent the changing nature of the author’s thinking about the dynamics at work in the relationships under scrutiny. The basic principle advocated in this thesis is that the effective formation and delivery of healthcare is facilitated by ethically-based systems of policy, rules and regulation. More particularly, it is argued that the roles of medical professionalism and patient control are central to good governance of healthcare in China. Set within this context, the thesis has three main goals. First, it aims to contribute to the development of theories about the relationship between the medical profession and the Communist state of China, examining the relatively powerless position of medical professionals in China as demonstrated by both historical and original empirical evidence generated by the research undertaken for this thesis. Secondly, the thesis examines the nature and extent of de-professionalisation among Chinese medical professionals. More particularly, it considers the consequences of challenges to Chinese medics’ professional autonomy which have occurred as a result of the Chinese healthcare power structure. Ultimately, it is argued that a re-structured model which places Chinese medical practitioners in a more professional and responsible role is urgently required.

Organisational development claims to improve an organisation’s functioning through enhancing its members’ performance. OD achieves this through deploying talk and text to trigger ideational change and so produce new sense-making and behaviours in organisational members. This thesis makes this explicit through a realist evaluation of three cases of OD practice. OD literature highlights inconsistent outcomes, failure to produce transformational change and an absence of studies exploring the means by which interventions actually succeed or fail to produce change. Although the influence of context is regarded as a source of explanation for these shortcomings, OD has not resolved the issue of how to theorise and integrate it into practice. This thesis addresses these shortcomings through the proposal of an alternative theory of change upon which the field’s theory and practice could be based. Neo-Durkheimian institutional theory articulates an inter-relationship between ideation and institution. It points to ways of developing culturally-specific OD practice. It provides an explanation for the need for different interventions for transformational and transactional change, and for the success of OD interventions within different cultural forms. NDIT’s potential contribution to a richer understanding and explanation of OD is highlighted through an NDIT-driven realist evaluation of three OD cases.

The objective of this thesis was to identify statistical issues that are commonly associated with evaluations of services for older people with a view to establishing the most appropriate methods of addressing them. This goal was achieved in two stages. In the first stage, a comprehensive literature review of studies that have reported such evaluations on populations of older people in the UK was conducted. The second stage involved demonstrating approaches for dealing with these issues on a dataset drawn from largest evaluation of intermediate care done and published in the UK to date. The approaches were adapted from the studies reported in the literature review and where appropriate, from other sources. This thesis identified a number of statistical issues including those associated with distributional characteristics of variables, missing data and the need to predict utility outcome measures from non-utility ones. Robust approaches of dealing with these problems were demonstrated. The results obtained underlined the importance of avoiding erroneous results and conclusions by applying methods with a sound theoretical background.

Dans le contexte français des formations en soins infirmiers, cette thèse propose de concevoir le soin comme un processus de médiation et d’échange de significations entre les acteurs concernés, notamment soignés et soignants. Les processus communicationnels identifiés ici mettent en jeu des valeurs, des représentations et des positionnements identitaires qui concourent à l’élaboration et à l’expression d’une professionnalité soignante. Le corpus de cette recherche est organisé à partir d’images médiatiques, d’activités de soin, de récits relatifs à des situations professionnelles, d’un récit de vie et d’une monographie. Ces cinq sources de données permettent une approche compréhensive des formes communicationnelles mobilisées dans le contexte du soin, des effets de sens relatifs aux pratiques observées ainsi que des logiques d’intervention et de relation des personnels soignants. Le concept de corps-monde est proposé comme modèle intégrateur des rencontres et des distances relationnelles co-construites par les acteurs du soin. Enfin, pour répondre aux questionnements d’ordre stratégique auxquels se trouvent confrontées les organisations de santé dans le cadre des nouvelles pratiques de soin et des évolutions de la formation infirmière, la notion centrale de soin-communicant est installée afin de définir le soin comme un système complexe d’échanges signifiants. Ce concept tente de formaliser les espaces de médiation propres à la construction d’une professionnalité soignante pertinente et cohérente au regard des nouveaux enjeux de la formation en soins infirmiers. / In the french context of nursing care teaching, this thesis aims at conceiving nursing as a process of mediation and communication notably between especially patients and care givers. The identified communication process involving values, self-identification and representation help to build up and express the caring professionalism. The background documents are organized from 5 types of data which are media focuses, caring acts, professional situation reports, life stories and monographs. These data allow the comprehension of the communication items which are used in the health care context, also the effects of the observed practice meanings and finally the care giver way of acting and relating. The carers build medical encounter and distance relationships. This is presented as the “world-body” concept. As part of the new care exercises and the nurse teaching evolution, the health care organizations are faced with strategic questionings. In order to answer those interrogations, the central concept of “communicating-care” is developed. This leads to define the care act as a meaningful and complex interaction system. This concept tries to formalize mediation areas which are specific to the building of a relevant and coherent caring professionalism as regards with looking at the new challenges in nurse care teaching.

Cette recherche vise à étudier les processus de transformation du « sale boulot » en « bel ouvrage » et ce en privilégiant la problématique de la reconnaissance de soi au travail, entendue comme résultant d’une tension entre les « usages de soi ». La division morale du travail à l'hôpital ordonne les tâches, mais aussi les métiers autour d’une répartition clivant les activités au service de la vie et les activités au service de l’épuration des traces de la mort. L’ investigation part de la notion de « sale boulot » et analyse les traces de cette division morale et psychologique du travail, ici celles qui se réfèrent à des activités de confrontation à la mort.Le cadre théorique retenu articule l’éclairage anthropologique et historique du traitement de la mort dans la société et dans l’hôpital, le concept de négatif psychosocial comme analyseur de la hiérarchisation morale du travail et la reconnaissance de soi, discutée par les théories de la clinique du travail. Ici, l’activité est l’unité d’analyse fondamentale et le collectif de travail est conceptualisé comme espace transitionnel où les usages de soi sont dialectalisés. Les activités analysées et comparées sont les Interruptions Médicales de Grossesse (IMG) et les Interruptions Volontaires de Grossesse (IVG) dans une unité de gynécologie ainsi que celles d’accompagnement de la fin de vie en équipe mobile de soins palliatifs. La méthodologie s’inscrit dans la tradition de la recherche action et s’appuie sur l’observation-participante et la conduite d’entretiens semi-structurés auprès de soignants et de leur encadrement. Les résultats de cette recherche sont présentés selon trois axes : la hiérarchisation morale des unités, des professionnels et des activités est articulée aux stratégies défensives collectives, aux idéologies de métier: elles contribuent à la définition et à la délégation du « sale boulot » dans l’organisation du travail. Le deuxième axe présente les différentes configurations groupales en fonction de la sollicitation d’affects archaïques dans les activités, liant ou déliant les collectifs de travail. Des stratégies de dégagement ont été identifiées : elles ouvrent la voie à la construction des trames symboliques qui permettent de domestiquer les résonances fantasmatiques de la confrontation avec « l’objet » de travail, la mort et ses équivalents symboliques, la maladie, la vieillesse, la déficience, la perte, le manque ... La capacité d’instituer de nouvelles normes et de se reconnaître dans son travail puise dans des configurations collectives fondées sur des règles partagées. Dans les cas de défaillances du collectif de travail, le recours aux ressources trans-individuelles permet de subvertir le négatif en travail estimable : elles renvoient au travail de civilisation, dans ses différentes dimensions. / This research aimed at studying the process of transformation of “dirty work” into “commendable work”. This was done by highlighting self-recognition at work, understood as the result of self-agency tensions. Work moral division at the hospital organizes tasks as well as careers through the separation of life-preserving related activities from death-reminiscence related ones. The research focuses on the notion of “dirty work” and analyzes, through death-related activities, work’s moral and psychological division.The theoretical framework used articulates anthropological and historical views on how modern society and thereby, the hospital deals with death; intertwining theories derived from “work’s clinical psychology” with the concept of psychosocial negative, analyzer of both work’s moral hierarchy and self-recognition. Herein, activity is the fundamental unit of analysis and the “collective work arrangements” are conceptualized as transitional space for the emergence of self-agency dialectics. The activities analyzed and compared are medical termination of pregnancy, abortion at the gynecological unit and accompanying the dying at the palliative care mobile team. The method subscribes to the action-research tradition, whereby participant-observation and semi-structured interviews with healthcare workers as well as chief-nurses were used. The results of this research are presented under three main axes: Firstly, the moral hierarchization of the medical units, of the professions and of the activities is articulated to the collective defense strategies as well as to professional ideology, which contribute to the definition and to the banishment of “dirty work”, thus structuring the organization of work itself. Secondly, the different group configurations are a function of archaic affects emerging from dealing with death-related activities. These may involve, but also encumber healthcare professionals, thus disorganizing the “collective work arrangements”. Strategies to disengage were identified: they open up to symbolic resources which allow restraining fantasmatic resonance induced by the confrontation of the object of their work, i.e. death, and its symbolic equivalents, disease, old-age, deficiency, loss… Moreover, the capacity to institute new norms and to recognize oneself while working has its bearing on collective configuration founded upon shared norms. Finally, should “collective work arrangements” fail to be created, trans-individual resources are called upon to subvert negative into estimable work, based on the different dimensions of “Civilization work”.

La régulation médicale est une sous-discipline de la Médecine d'Urgence. La tâche du médecin régulateur s'apparente à la gestion d'un environnement dynamique à risque. SimulPhone© est un nouveau type d'outil permettant de simuler un appel. L'objet de ce travail est de construire un outil d'apprentissage par simulation à partir des données de l’ingénierie cognitive. A partir de scénarios de simulation, nous avons conduit cinq expériences. La première expérience permet d'étudier la faisabilité et de déterminer les axes d'analyse. La deuxième étude teste la validité et la fidélité du simulateur. Nous avons ensuite établi un score de performance cognitive. La troisième expérience détermine un sous-groupe d'experts grâce au score précédent. Leur comportement est analysé pour chaque scénario afin d'établir un guide pédagogique. La quatrième expérience étudie l'impact de la dominance sur le raisonnement et la décision. La dernière expérience analyse les apprentissages au cours d'une journée de simulation. Les résultats des expériences retrouvent (1) un réalisme important du simulateur. Nous avons démontré (2) la validité, la fidélité intra et inter-observateur du simulateur. Ces résultats ne sont pas modifiés par la profession du participant. Dans la troisième expérience, la sous-population d'experts nous permet de construire un guide pédagogique. Dans l'arrêt cardiorespiratoire, nous avons observé une limitation de la charge cognitive de l'appelant pour lui faire réaliser un massage cardiaque par téléphone. Nous avons démontré (4) l'impact des informations paraverbales sur la décision des régulateurs. Enfin, au cours d'une journée de formation (5), nous avons observé une réactivation des connaissances antérieures. / Emergency Medical Call Center is a part of Emergency Medicine. Emergency Medical Dispatching Physician (EMDP) deals with a critical dynamic environment. SimulPhone© is a novel simulator for call center. The aim of this work is to build a training simulation tool from the cognitive engineering. With simulation scenarios, we conducted five experiments. For the first one, we tested the feasibility and determined the fields of analysis. The second study tested the validity and reliability of the simulator. We then established a cognitive performance score. The third experiment determined a subgroup with experts with the previous score. Their behaviors were analyzed for each scenario in order to establish an educational guide. The fourth experiment studied the impact of dominance on the reasoning and decision. The last one analysed the learning experience during a simulation day. Our results found (1) a significant realism of the simulator. We have demonstrated (2) the validity, reliability, intra and inter-observer simulator. These results are not affected by the profession of the participants. In the third experiment, the subgroup of experts allowed us to build an educational guide. In cardiac arrest, we observed a cognitive underload from subject to the caller in order to realise a telephone cardiopulmonary resuscitation. We have demonstrated (4) the impact of paraverbal informations on the decision of EMDP. At least, during a training session (5), we observed previous knowledge awakening.

L’Évaluation d’Impact sur la Santé (EIS) est un instrument de support à la décision, pour juger une politique quant aux effets potentiels sur la santé et leur distribution (équité). C’est encore souvent une approche qualitative.L’objectif principal est de montrer l’utilité de méthodologies statistiques quantitatives multivariées pour enrichir la pratique d’EIS, améliorant la compréhension des résultats par des professionnels non-statisticiens.Les futures réformes des systèmes de santé déplacent le centre d’évaluation des services de santé des fournisseurs aux citoyens (besoins, préférences, équité d’accès aux gains de santé), exploitant big data associant information de soins aux données sociales, économiques et de déterminants de santé. Des méthodologies statistiques et d’évaluation innovantes sont nécessaires à cette transformation.Les méthodes de data mining et data science, souvent complexes, peuvent gérer des résultats graphiques compréhensibles pour amplifier l’usage d’EIS, qui deviendrait ainsi un outil précieux d’évaluation de politiques publiques pour amener les citoyens au centre de la prise de décision. / Health Impact Assessment (HIA) is a decision-making support tool to judge a policy as to its potential effects and its distribution on a population’s health (equity). It’s still very often a qualitative approach.The main aim here is to show the usefulness of applying quantified multivariate statistical methodologies to enrich HIA practice, while making the decision-making process easier, by issuing understandable outputs even for non-statisticians.The future of healthcare reforms shifts the center of evaluation of health systems from providers to people’s individual needs and preferences, reducing health inequities in access and health outcomes, using big data linking information from providers to social and economic health determinants. Innovative statistical and assessment methodologies are needed to make this transformation.Data mining and data science methods, however complex, may lead to graphical outputs simple to understand by decision makers. HIA is thus a valuable tool to assure public policies are indeed evaluated while considering health determinants and equity and bringing citizens to the center of the decision-making process. / A Avaliação de Impacte na Saúde (AIS) é um instrumento de suporte à decisão para julgar política quanto aos seus efeitos potenciais e à sua distribuição na saúde de uma população (equidade). É geralmente ainda uma abordagem qualitativa.O principal objetivo é mostrar a utilidade das metodologias estatísticas quantitativas e multivariadas para enriquecer a prática de AIS, melhorando a compreensão dos resultados por profissionais não-estatísticos.As futuras reformas dos sistemas de saúde deslocam o centro da avaliação dos serviços de saúde dos prestadores para as necessidades e preferências dos cidadãos, reduzindo iniquidades no acesso à saúde e ganhos em saúde, usando big data que associam informação de prestadores a dados sociais e económicos de determinantes de saúde. São necessárias metodologias estatísticas e de avaliação inovadoras para esta transformação.Métodos de data mining e data science, mesmo complexos, podem gerar resultados gráficos compreensíveis para os decisores. A AIS é assim uma ferramenta valiosa para avaliar políticas públicas considerando determinantes de saúde, equidade e trazendo os cidadãos para o centro da tomada de decisão.