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Background: People using forensic mental health services often have complex difficulties and the impact of these on carers is an area requiring further investigation. Little is known about the experiences of caregiving in the context of forensic mental health services. Aims: This study aimed to investigate the experiences of caregiving from the perspective of mothers of patients receiving forensic mental health services, specifically how they have made sense of their experiences, roles and relationships Methods: The study was designed following the principles of Interpretative Phenomenological Analysis (IPA). Five mothers provided their informed consent to participate in semi-structured interviews exploring their experiences of caregiving in a forensic context. Interviews were transcribed and analysed in line with IPA methodology. Results: Four superordinate themes emerged from the data: 1) The process of coming to terms with what happened 2) Evolving relationships 3) Negotiating the conflict between vulnerability and threat 4) The emotional realities of being a mother. Applications: Participants’ accounts provided valuable insights into the complex nature of caregiving within a forensic context but also highlighted implications for clinical practice, service provision and future research.

This thesis explored whether patients in high security hospitals are more ‘Complex Cases’ or more ‘Difficult Cases’ than their counterparts in lower security settings. Herein, case complexity is associated with co-morbid diagnoses or clinical needs, whilst case difficulty refers to challenging, violent and aggressive behaviour. A systematic literature review examined institutional violence and aggression in different security settings within healthcare and prison environments. No clear differences were found in frequency of incidents between the security levels, and a suggestion that the severity of incidents were greatest in lower security had limited generalisability. The results were confounded by data incompatibility, meaning that it could not be concluded that higher security sites house the more ‘Difficult Cases’. An empirical research study examined differences in clinical complexity between personality disordered (PD) patients living in high and medium security units (MSUs). Statistical differences were found on several clinical and forensic variables between settings, including age at first conviction, and difficulties with affective instability, paranoia and depression (assessed with the Personality Assessment Inventory; PAI). This led to the development of a Model of a Complex Case of PD. The results suggested that higher security sites do treat a greater number of ‘Complex Cases’ of PD. Interestingly, they were also found to house a greater number of physically violent patients than the MSUs, ie. more ‘Difficult Cases’. A case study examined a high security PD patient, ‘Andrew’. His assessment, formulation and violence relapse prevention treatment were presented and discussed. It was identified that on admission Andrew was a match to the Model of a Complex Case of PD, and that a lowering of his PAI score profile over time reflected his treatment gains and lessening of his clinical difficulties. When preparing to transition to an MSU, Andrew could no longer be classified as complex, according to the Model. Finally a critique of the PAI psychometric was presented. The tool was assessed for reliability and validity as a measure of clinical psychopathologies, interaction styles and treatment needs, and was praised for its utility with PD patients. The findings from the thesis chapters were reviewed, and the application of the Model of a Complex Case of PD was also discussed. It was concluded that the high security hospital currently provides treatment services to more ‘Complex Cases’ of PD and more ‘Difficult Cases’ than the investigated medium security counterparts. Please note that Chapter 3, which details a confidential patient case study, has been redacted.

In the study a novel method for synthesis of a dark magnetic flake powder for detecting latent fingerprint has been developed. Even though, flake powders ,of aluminium, brass and highly reflective magnetic iron flake are already in use in crime scenes , it is highly desirable to develop a suitable darker variety of magnetic flake powder for print development on light background surfaces. In order to achieve rapid production of dark metal flakes, a new high energy prototype vibratory mill has been designed, manufactured and develo ed. The design concepts were developed following a comprehensive review of the various commercially available milling devices and undertaking some initial experimentation. The mechanical milling process which results in changing the particle morphology of starting atomised iron powder to flaky shaped powder was investigated in terms of different milling phases like micro forging, fracture and agglomeration. The effect of milling process parameters on the flake quality was investigated. It was shown that the amount of stearic acid content, ball packing fraction and weight loading were important parameters in determining the final flake qualities. The quality of latent fingerprint development with the dark flake powder was investigated. Some of the flake powders produced excellent ridge quality details with good adherence quality on a range of background surfaces. The present study has been able to establish the relationship between the visual characteristics ( dark) and adherence property of the flake fingerprint powder with respect to the particle dimensions and surface characteristics of the flakes. It was also found that finer flakes are darker in colour and the low weight percentage of stearic acid has produced the best adherence quality for the dark flake powder. Some unique relationship between the flake dimensions with the nature of the print deposit was also established as it was found that slightly coarser flakes are suitable for heavy print deposit whereas finer flakes are more sensitive to aged prints. Further, the role of process variables in influencing the milling process were established such that optimum conditions by vibration milling can be determined to obtain dark flakes of desired quality. While the weight loading significantly influenced the milling behaviour of the powder, the role of stearic acid as an additive was found to influence the surface quality of flakes, besides restricting particle welding. Increasing the pre determined theoretical ball size does not result in faster milling, but increasing the ball packing fraction from 50% to 70% has proved to be more effective. Some relation with the oxidising behaviour of the powder with vibration milling has also been established. Moreover, the study has demonstrated that high energy milling by a vibration mill can be utilised for consistent production of a novel dark magnetic flake powder.

Die Studie befasst sich mit der Untersuchung verschiedener Risikofaktoren auf ihren Zusammenhang mit der Entstehung der Invasiven Aspergillose bei Patienten nach HSCT. Diese Faktoren sind: Verabreichen einer GvHD-Prophylaxe, Gabe einer An-timykotischen Prophylaxe, bereits bestehende Vorerkrankungen, das noch nicht voll-ständig wiederhergestellte hämatologische System und die Durchführung der Stamm-zelltransplantation mit einer haploidenten Spende. Die Daten von 72 Patienten wurden retrospektiv aus den Krankenakten erfasst. 33 von ihnen hatten eine haploidente Stammzellspende empfangen, bei der also nur die Hälfte der HLA-Merkmale mit denen des Empfängers übereinstimmten. Die anderen 39 Pati-enten erhielten eine identische Spende von einem Geschwister, bei der demzufolge die HLA-Merkmale mit denen des Empfängers komplett übereinstimmten. Mit Hilfe dieser Daten wurde die Verabreichung von Prophylaxen nachvollzogen, die Vorerkrankungen erfasst und kategorisiert, Zellzahlen und andere Blutwerte zu bestimmten Tagen zu-sammengetragen und notiert, ob die Diagnose IA nach den neuen EORTC Kriterien vorlag. Im Anschluss führte man verschiedene statistische Testverfahren zum Nachweis eines signifikanten Zusammenhangs mit der Entstehung der IA durch. In der vorliegenden Arbeit konnte zwar nicht nachgewiesen werden, dass ein Zusam-menhang zwischen der Gabe der GvHD-Prophylaxe und der Entstehung der IA besteht, allerdings bleibt die Vermutung weiterhin bestehen und sollte durch künftige Studien untermauert werden. Gleiches gilt für die Antimykotische Prophylaxe, die Vorerkran-kungen und die haploidente allogene Stammzellspende. Auch der Einfluss der Wieder-herstellung des hämatologischen Systems auf die Entstehung der IA brachte -entgegen der Erwartungen- kein eindeutig signifikantes Ergebnis, mit Ausnahme einiger verein-zelter Werte bei verschiedenen Zellarten. Es bietet sich folglich auch hierbei ein mögli-cher Ansatz für künftige Studien. Es gingen jedoch auch signifikante Ergebnisse aus der vorliegenden Untersuchung hervor. So konnte gezeigt werden, dass es einen Zusam-menhang zwischen der Wiederherstellung des hämatologischen Systems (in Bezug auf die Thrombozyten) und der Art der Spende gibt. Letztlich sollte dies aber durch detail-lierte Untersuchungen untermauert werden. / The study cannot prove that Graft-versus-Host Disease Prophylaxis, underlying diseases or type of transplantation (haploidentical versus fully matched stem cell transplantation) are risk factors for Invasive Aspergillosis. There neither can be found any correlation between the recovery of the hematopoietic system and the appearance of Invasive Aspergillosis, nor between the recovery of the hematopoietic system and the type of transplantation. But the study shows that antimycotic prophylaxis counts not as a risk factor for Invasive Aspergilloses. Because of little number of patients participating in this study, advanced surveys should confirm our results.

Hintergrund vorliegender Arbeit ist, dass mehrere Studien eine erhöhte Suizidrate bei Krebspatienten im Vergleich zur Allgemeinbevölkerung gezeigt haben. Zu suizidalen Gedanken und Handlungen (Suizidalität) bei Krebspatienten und ihren Risikofaktoren gibt es jedoch nur wenige Studien. Ziel der Arbeit war, die Prävalenz von Suizidgedanken bei Krebspatienten festzustellen, und einen Zusammenhang zwischen Suizidalität und den Faktoren Geschlecht, Depressivität, Angst, Distress, Schmerzen, der Inanspruchnahme psychosozialer Unterstützungsangebote sowie bestimmten Tumorlokalisationen zu untersuchen. Die Tumorlokalisationen wurden zwischen Lokalisationen mit erhöhtem vs. nicht erhöhtem Stigmatisierungspotential bzw. Lokalisationen mit besonders negativer vs. nicht besonders negativer Prognose unterschieden. Im Rahmen einer multizentrischen, deutschlandweiten Querschnittstudie wurden Krebspatienten mithilfe des Patient Health Questionnaire (PHQ) hinsichtlich ihrer Suizidalität und verschiedenen Korrelaten mithilfe validierter Messinstrumente untersucht. In vorliegender Arbeit wurden die Daten der im Studienzentrum Würzburg rekrutierten Patienten ausgewertet. Eine Stichprobe von 770 Krebspatienten wurde ambulant (25,7%), stationär (43,4%) und in der Rehabilitation (30,9%) rekrutiert. Alle Patienten waren zwischen 18 und 75 Jahre alt, 52,9% waren weiblich. Das Durchschnittsalter der Befragten lag bei 57,2 Jahren. Die häufigsten Tumorlokalisationen waren die der Brustdrüse (26,4%), der Verdauungsorgane (26,7%) und die der männlichen Genitalorgane (10,0%). Suizidalität wurde bestimmt, indem das Item 9 aus dem PHQ-9„Gedanken, dass Sie lieber tot wären oder sich Leid zufügen möchten“ mit den Antwortmöglichkeiten „überhaupt nicht“, „an einzelnen Tagen“, „an der Hälfte der Tage“ oder „an beinahe jedem Tag“ verwendet wurde. In vorliegender Arbeit wurde ein Patient als suizidal eingestuft, wenn er im PHQ-9 bei Item 9 zur Suizidalität 1= „an einzelnen Tagen“, 2= „an der Hälfte der Tage“ oder 3= „an beinahe jedem Tag“ angegeben hat. Die Prävalenzrate von Suizidalität bei Krebspatienten liegt bei 14,2%. Die Faktoren Distress, Inanspruchnahme psychosozialer Unterstützung und Depressivität besitzen für Suizidalität eine unabhängige Vorhersagekraft. Ein univariater Zusammenhang mit Suizidalität wird für die Faktoren Geschlecht, Angst, Schmerz und Karnofsky-Status (körperliche Funktionsfähigkeit) festgestellt. Einer Adjustierung für andere Risikofaktoren hält dieser jedoch nicht stand. Die Faktoren Alter, Stigmatisierungspotential von Tumoren und negative Prognose von Tumoren hängen univariat nicht signifikant mit Suizidalität zusammen. Schlussfolgerung dieser Arbeit ist, dass auf mögliche Suizidalität bei Krebspatienten im Klinikalltag besonders geachtet werden muss und weitere Studien zur validen Erfassung von Suizidalität notwendig sind. / Background the present study is that several studies have shown an increased rate of suicide in cancer patients compared with the general population . However, there are few studies about suicidal thoughts and actions ( suicidality ) in patients with cancer and their risk factors Aim of this study was to determine the prevalence of suicidal ideation in patients with cancer , and to investigate a relationship between suicidality and the factors gender , depression , anxiety , distress , pain , the use of psychosocial support offerings and specific tumor sites . The tumor sites were between locations with increased vs. not increased stigmatization or potential locations with particularly negative vs. not particularly negative prognosis differed . As part of a multicenter , Germany-wide cross-sectional study of cancer patients were examined using the Patient Health Questionnaire ( PHQ ) in terms of their suicidality and various correlates using validated instruments . In the present study , the data of the recruited at the study center Würzburg patients were evaluated . A sample of 770 cancer patients were recruited outpatients ( 25.7% ) , stationary ( 43.4% ) and in rehabilitation ( 30.9% ) . All patients from 18 to 75 years of age , 52.9 % were female . The average age of respondents was 57.2 years . The most frequent tumor sites were the breast ( 26.4% ) , digestive system ( 26.7% ) and that of the male genital organs ( 10.0 % ) . Suicidality was determined by the item 9 of the PHQ - 9 " thoughts that you would be better off dead or wish to inflict suffering " with the possible answers "not at all " , " on some days " " to half the days " or " was used on almost every day " . In this work , a patient was classified as suicidal , if he has 1 = specified in the PHQ - 9 in Item 9 for suicidality " on some days " , 2 = " on half the days " or 3 = " at almost every day " . The prevalence rate of suicidal behavior in patients with cancer is 14.2% . The factors Distress , use psychosocial support and depression have an independent predictive power for suicidality . A univariate associated with suicidality is found for the factors sex , fear, pain and Karnofsky status ( physical functioning ) . However, an adjustment for other risk factors holding this was not . The factors of age , stigmatization potential of tumors and negative prognosis of tumors depend univariate not significantly associated with suicidal behavior together . Conclusion of this work is that of possible suicidal behavior in cancer patients in clinical practice requires particular attention and further studies on the valid detection of suicidal behavior are needed .