This study analyses the data from medical records from a former tuberculous sanatorium for children at Stannington, Morpeth, Northumberland. It focuses on the demographic profile of the sanatorium and also examines the changes in therapy that occurred between 1937 and 1953. The objective of the study was to understand the patterning of tuberculosis in the sanatorium by considering the differences between male and female patients, ages affected, and the socio-economic backgrounds of patients from a sample of patient records taken from pre- and post-antibiotic eras, pre- and post-Second World War, and pre- and post-NHS years. 1,897 patient records were utilized in this study, all held at the Northumberland Record Office at Morpeth. This study was followed in accordance to the limitations given by the Medical Ethics Committee which was to ensure that patient confidentiality would be maintained. A limited database is included with this reasearch, but a complete database will be held in the future at the Northumberland Health Authority, in Morpeth. Overall more females than males were admitted to the sanatorium and all patients from various types of tuberculosis. The majority of the children (over 60%) were suffering from pulmonary tuberculosis, but there were a large number also suffering from tuberculosis of the bones and joints (230 cases or 12%). Most of the children came from poor backgrounds and originated from the Newcastle and Gateshead areas. The introduction of chemotherapy, the end of the Second World War and the implementation of the NHS did not have a great effect on who was being treated at the sanatorium. In conclusion these records hold a wealth of information that may help build an epidemiological model of tuberculosis in the North-East of England. Future work on the records is suggested and limitations of the research outlined.

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Relatively little is known about the strategies that people use when monitoring and interpreting (criminal) events observed in CCTV footage. Four studies reported in this thesis used a change blindness task to explore: (a) whether instructions and/or event type influence where people attend to during CCTV observation; (b) how factors such as task instructions and central and marginal information influence fixation behaviour during CCTV observation; (c) the effect of change detection on memory recall during CCTV observation; and (d) whether verbalisation, attentional set and/or repeated viewing improve change detection and memory recall rates for CCTV footage. In Experiment one, we found that change detectors fixated on the changing target directly before the change more so than non-detectors. We replicated this finding in Experiment two and additionally found that change detectors, more so than non-detectors, produced significantly more and longer fixations on the change target during the change. The findings from Experiments one and two demonstrated that observers were drawn to a criminal event, more so than a non-criminal event, and that this was especially the case for central rather than marginal events in the footage. We found no evidence that instructions significantly affected gaze behaviour. In Experiment three, we found that change detectors recalled more accurate detail from the CCTV footage compared to the non-detectors, but only once the severity of the crime had increased. Experiment four found improved rates of change detection during CCTV observation when participants were able to repeatedly view the footage. Verbalisation (thinking aloud) however made no difference in terms of change detection and the accuracy of memory recall. These findings may help to inform training courses aimed at instructing people how to optimally attend to CCTV footage.

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This thesis provides a broad and diverse investigation into the field of psychological treatment for child molesters. A range of methods including a systematic review, a single case study and a primary phenomenological investigation were used to explore issues in the field. Following an introduction in Chapter 1, Chapter 2 reviews the effectiveness of psychological treatment for reducing recidivism in child molesters. The results indicate that recidivism among treated and untreated child molesters is yet to consistently and clearly differ and that the treatment outcome literature is obstructed by weak studies using suboptimal scientific designs. In Chapter 3 the aetiology of a child molester’s offending is formulated using the Pathways Model of child abuse (Ward & Siegert, 2002). Treatment sessions addressing areas of criminogenic need are outlined and the impact of the sessions is determined using systems of clinical change on psychometric measures. The results indicate improvements in some of the targeted areas however these were not sufficient to indicate clinically significant changes on both systems used. Chapter 4 explores the lived experience of a sexual preference for children in a sample of five child molesters using the principles of Interpretive Phenomenological Analysis. Four themes were identified. (1) It Creates a Battle for Me, (2) I’m Always Going to Have These Thoughts, (3) There’s No Help Out There and (4) My Interest in Children is More Than Just Sexual. The results have implications for clinical practice and are discussed in the context of directions for further research. Chapter 5 evaluates the Sex with Children scale (Marshall, 1995) which was used as an assessment measure in Chapter 3. Finally, Chapter 6 provides a discussion and close to the thesis drawing together the implications of the research.

Surface (S) gene mutations are clinically important in both hepatitis B VIruS (HBV) prevention and diagnosis. Several HBV vaccination progr~es in endemic countries have revealed their influence on failure of immunisation. Furthermore, sera harboring these variants can escape serological detection, but, remain detectable by HBV-DNA testing. According to these findings, the current work can be divided into two main parts. In the first, the impact of vaccination on the prevalence of S gene variants and, interestingly, how to use HBsAg variability as a marker of human population history, were studied. In the second, the influence of S gene variants on diagnostic failure, and also how to standardise and evaluate these variants in a novel tag system were investigated. Initially (Chapter 3.1), four methods of DNA extraction have been compared to enable quick and efficient human genomic and viral DNA extraction from clotted blood. Two of these, a phenol based in-house method and Tripure isolation reagent (Roche), only achieved a low DNA yield. In contrast, QIAamp blood kit (Qiagen) and High Pure Viral Nucleic Acid kit (Roche Diagnostics) were equally efficient and sensitive. The prevalence rate of hepatitis B in the south Pacific is amongst the highest in the world. Regional immunisation programmes were introduced in four Pacific islands in 1995: Vanuatu and Fiji in Melanesia, Tonga in Polynesia and Kiribati in Micronesia (Chapter 3.2). To assess the efficacy of these programmes, sera from infants and their mothers were tested. Following immunisation there was a dramatic fall in the seroprevalence of surface antigen, especially in Fiji to 0.7% of children. However, in Vanuatu and Tonga it was 3.0% and 3.8% respectively, and occurred mostly in babies of HBeAg positive mothers denoting the importance of this mode of transmission. On the other hand, the 3.8% HBsAg prevalence in Kiribati among children of non-carrier mothers indicated that most of these infections were horizontally transmitted. This relative failure to provide satisfactory protection could reflect poor health services or insufficient neutralisation. Moreover, although the opportunity for the emergence of vaccine escape variants in these populations was high due to the presence of a considerable amount of the virus with apparently incomplete protection, there were no "a" determinant variants discovered, suggesting that these variants are relatively insignificant in this population. Some other variants were noted, but the functional significance of these remains to be determined. Geographic distribution of HBV genotypes is thought to reflect aspects of human population history. Hepatitis B virus surface antigen (HBsAg) variation from the four Pacific island locations has been analysed (Chapter 3.3). Samples were collected from unvaccinated children and adults and tested for HBsAg. At least 20 HBsAg positives from each island were amplified by PCR and sequenced. HBV isolates from C and D genotypes were identified, Genotype C predominated in Vanuatu, Fiji and Tonga while D was the dominant genotype in Kiribati. The diversity of the C genotype sample was significantly greater than that of D, consistent with a longer history of HBV infection in those islands. Strong geographic identity was evident in all populations except Tonga and Fiji, which were statistically indistinguishable. Analysis of HBV sequences from other locations will be required to fully interpret these data. HBsAg negativity does not exclude hepatitis B viraemia and HBsAg variants can be responsible for such diagnostic failures. In Chapter 3.4, we cloned 13 different HBsAg variants. Variant protein then produced in a mammalian expression system and tested using seven commercial HBsAg diagnostic assays. Of 12 variants analysed, 6 samples displayed similar reactivity to the standard HBsAg sequence in most of the assays but 6 samples, containing various mutations throughout the entire major hydrophilic region (MHR), showed reduced reactivity. Loss of cysteine at aa124 in one sample was found to influence the secretion as well as the reactivity of HBsAg in the expression system. Finally, not all assays were equally able to detect HBsAg variants implying that, to attain an acceptable level of sensitivity, the antibody repertoire of the current assays should be extended. Reduced reactivity might be due to antigenic changes or reduced particle production. To investigate the reason(s) for non-detection, supernatants derived from in-vitro expression of cloned HBsAg variants were used. We have developed an antibody capture system, using a non-HBV epitope, to standardize the amount of in-vitro expressed HBsAg protein (Chapter 3.5). Three tag systems were assessed. The successful one, influenza HA-tag, was inserted into the HBV S gene of control samples and 12 diagnostically important variants within different backbone subtypes: one aywl, four ayw2, two ayw3, and five adw2. The amount of in-vitro expressed HBsAg was then equalised in an ELISA that recognises the tag. Subsequently, the immunoreactivity of each variant was compared using three commercial HBsAg assays. We were then able to precisely attribute the diagnostic failure of the investigated variants to antigenic non-recognition and! or poor secretion of HBsAg protein. In found that single tag epitopes of up to 15 aa could be inserted at either end of HBsAg protein without affecting HBsAg reactivity. However, insertion at both ends led to a major impact on HBsAg conformation. Differentiation of second episodes of HBsAg positivity as reinfection or reactivation is a matter of debate. 5 patients who had a serological picture suggesting a second hepatitis B virus episode were studied compared to a control group of two patients who were HBsAg positive throughout with fluctuating HBeAg status. We suggest molecular criteria to distinguish between these two possibilities: number of nucleotide substitutions; number of amino acid substitutions; situation of aa changes; phylogenetic relatedness, co-incidence of mutation with immune or antiviral therapy; and genotype/ subtype shifts (Chapter 3.6). Interestingly, S gene variants were found in all 5 cases with unusual serology but in neither of the controls. Abnormal serology was therefore accompanied in all patients by rare sequences.

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