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The spread of HIV and AIDS is a serious and increasing global problem with the sharing of contaminated injection equipment a primary cause of HIV infection in the developed world. Mathematical models of disease transmission allow us to assess the impact of different epidemiological and behavioural assumptions on the long term behaviour of disease. Initially a simple deterministic model is examined which allows intravenous drug users to progress through three different infectious stages after initial infection with HIV and prior to the development of AIDS. This model is then developed to also allow contaminated injection equipment to exist in three different states of infectivity. The resulting model contains a number of parameters, which while potentially important, are extremely difficult to estimate. In response to this, several special cases are examined which represent intuitive upper and lower bounds for the spread of disease. In each case an equilibrium and stability analysis is presented. Later these special cases, together with a generalisation of them, are compared with a well established single stage infectivity model to ascertain whether the inclusion of variable infectivity increases the predicted spread of disease. We find that the impact of variable infectivity depends on a number of factors and can lead to either an increase or decrease in the prevalence of disease. Testing drug users for the presence of HIV has been proposed as a method of reducing the incidence of HIV. Using the previously discussed upper and lower bound variable infectivity models, we examine the effect of testing addicts for HIV using a number of different infectivity assumptions. We find that under certain conditions HIV testing can be an effective control strategy against the future spread of HIV. This is followed by a short discussion of sensitivity analysis of these models. While predominantly discussing deterministic models we conclude with a brief discussion of stochastic models and demonstrate the behaviour of these models using simulation.

Background. Influenza and pneumococcal vaccinations are important therapies supported by national and international guidelines for preventing morbidity and mortality from respiratory illnesses in high-risk groups. The responsibility for delivering these vaccinations in the United Kingdom lies with primary care. Little is known about how rates of influenza and pneumococcal vaccination can be increased in high-risk groups in primary care. Aim. To research methods of improving rates of influenza and pneumococcal vaccination in high-risk groups in primary care. Objectives. To investigate the impact of educational interventions for primary care teams on influenza and pneumococcal vaccination rates in high-risk groups. Method. The research had the following components: a. Literature search examining current practice and policy in relation to influenza and pneumococcal vaccination and studies undertaken to improve performance, both in general and specifically in relation to improving adult vaccination rates. b. Pilot study of targeting influenza and pneumococcal vaccination to high-risk groups in a single general practice. c. Effect of audit and feedback with an information pack to primary care teams on influenza and pneumococcal vaccination in primary care: before-and-after multipractice study. d. Effect of audit and feedback with an information pack to primary care teams, as part of a clinical governance programme, on influenza and pneumococcal vaccination in a primary care trust: before-and-after multipractice study. e. Randomised controlled study of an educational outreach intervention partly nested within primary care trust study with audit, feedback and information (passive dissemination of guidelines and recommendations) directed at primary health care teams compared with audit feedback and information alone using multifaceted interventions to increase influenza and pneumococcal vaccine uptake in high-risk groups in primary care. Results. The studies demonstrated significant improvements in influenza and pneumococcal vaccination rate in high-risk groups in primary care, showed the levels of improvement that could be expected from these types of intervention and described how primary care teams responded to direct and indirect educational interventions supported by measurement of performance. Conclusions. Education to multiprofessional teams is an important method for diffusion of innovations in the highly professionalised organisations of primary care and general practice. Educators need to understand the complex nature of primary care organisations and teams, when and how education for teams is likely to be successful, the barriers to implementation of new ideas and how to address these. Education when applied appropriately can have important effects in improving health care. This is more likely to occur when careful assessments are made around the nature of the evidence, clear outcomes are sought and measured and the healthcare intervention is understood from the perspective of the patient, the healthcare team and other stakeholders.

Background: The application of Positive Behavioural Support (PBS) has been widespread across educational and learning disability settings, typically in supporting individuals who exhibit challenging behaviour. Following espousal in various national policy and guidance, PBS is now being applied in the area of secure forensic adult mental health. To date, very little is known about the application of PBS in this area. This study aims to understand how staff within a secure forensic adult mental health setting perceive the application of PBS. Method: Using semi-structured interviews, 11 multi-disciplinary staff members were interviewed regarding their perceptions of PBS. The data was collected and subject to a qualitative thematic analysis. Results: Five themes were identified from the data relating to staff perceptions of PBS, these were: 'The functions', 'Appraising a new approach', 'Collaborative challenges', 'Staff variables' and 'Organisational issues'. Conclusion: PBS translates to a forensic mental health setting and is generally appraised positively by staff. There are however a number of issues that are perceived to impact the delivery of PBS, many of these are consistent with existing PBS literature, however a number arise from the unique nature of providing an approach underpinned by social role valorisation in a context of containment and disempowerment.

Forensic entomology relies on accurate identification of forensically important blowflies to species level, preceded by ageing the Calliphorid specimens present on a cadaver to determine the post-mortem interval (PMI). The task of identifying blowflies based on morphologial criteria can be challenging due to complex keys, limited diagnostic features in the immature stages and poor preservation of entomological samples. Therefore, the larvae will mostly be reared to adult flies to confirm identification, which is a time consuming process. This thesis presents work examining the cuticular hydrocarbon (CHC) profiles of three forensically important blowfly species in the UK, Lucilia sericata, Calliphora vicina and Calliphora vomitoria with two main aims to this study. Firstly to establish if CHC analysis could be used to determine whether the three species yield characteristic profiles, allowing for identification to be achieved. The second aim was to examine the hydrocarbon profiles over time to determine if chemical changes occurred at certain points in time, giving an indication of age. The CHCs were extracted from all life stages (empty egg cases, larvae, pupae, empty puparial cases and adult flies) and analysed using gas chromatography – mass spectrometry (GC-MS) and Direct-analysis-in-Real-Time MS (DART-MS). Statistical interpretation was applied in the form of principal component analysis (PCA) and preliminary Artificial Neural Networks (ANN). Results showed species-specific characteristics within the chromatograms in all life stages, meaning distinctions can be made between the three species, even in 1st instar larvae. Significant chemical changes were observed within the hydrocarbon profiles over time, hence accurate ageing could be established for larvae, empty puparial cases and adult flies. Early results show great potential to utilise this technique and to develop it into a highly useful identification and ageing tool.

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This thesis explores the value of including protective factors in the violence risk assessment and risk management processes of forensic mental health services. More specifically it investigates whether assessment of protective factors improves predictive accuracy of violence risk assessment tools, and discusses the implications for clinical practice. The impact on patient motivation to change is also considered. A critique is presented of the Historical Clinical Risk-20 Version 3 (HCR-20V3; Douglas, Hart, Webster, & Belfrage, 2013), one of the most popular and widely used violence risk assessment tools. Despite its popularity and good measurable properties, the HCR-20V3 does not include an assessment of protective factors. A systematic review examined research investigating the predictive accuracy of the three violence risk assessment tools recommended for use in forensic mental health services in the National Health Service: HCR-20V3, the Structured Assessment of Protective Factors (SAPROF; de Vogel, de Ruiter, Bourman, & de Vries Robbé, 2012), and the Short Term Assessment of Risk and Treatability (START; Webster, Martin, Brink, Nicolls, & Desmarais, 2004). The SAPROF had superior predictive accuracy of absence of violence compared to the other measures; however, limited reliability and validity evidence was found for its use in English forensic inpatient settings. An empirical research project conducted a prospective validation study of the SAPROF, also reporting on the reliability and validity of the measure across a number of domains, and in relation to the HCR-20V3 and START. The SAPROF demonstrated better absence of violence risk predictive abilities than the HCR-20V3 and the START (presence of violence risk); combined use of the SAPROF and HCR-20V3 significantly increased predictive accuracy of presence of violence risk. Finally, a single case study explores the impact of collaborative risk assessment and management training on a patient’s motivation to engage in treatment and interventions to manage risk. Collaborative risk assessment had a positive impact on motivation; however it was not reliably or clinically significant. This thesis provides positive research evidence for the inclusion of protective factors in the violence risk assessment and management process.

The impact of delusional thinking on the violent behaviour of individuals with psychiatric diagnoses has been explored using a variety of investigative methods. The notion that delusions play a role in an individual’s violent offending has been broadly upheld within the work of this thesis. The nature or function of delusions in this process appears to be affected by a range of mediating and moderating factors. The complexity of these was illustrated during the conduction of a case study. Advances in the understanding of mental disorder as a continuum, alongside the developments of risk assessment and management approaches, seem to provide the potential for an optimum vantage point to formulate the true role of delusions in the cognitive process. Future research should avoid utilising the overarching themes of psychiatric diagnoses or sets of symptoms to explore violence and should focus on considering the functions of individual symptoms or characteristics, as many of these overlap with other clinical and nonclinical populations.

In dieser Studie wurden n=137 Patienten untersucht, die mit einer akuten thorakalen Aortendissektion in der Universitätsklinik für Herz- und Thoraxchirurgie Würzburg notfallmäßig behandelt worden sind. Hierbei wollten wir überprüfen, ob die Wetterparametern wie Lufttemperatur, Luftdruck, Bewölkung, Windgeschwindigkeit, Niederschlagshöhe und Sonnenscheindauer mit der Inzidenz von akuten thorakalen Aortendissektion korreliert ist. Durch statistischen Analysen konnte keine Signifikanz belegt werden. / In this study were 137 patients examined, who were treated with acute thoracic aortic dissection in the University Clinic for Cardio Thoracic Surgery Würzburg. Aim of this study was to analyze whether the weather parameters such as air temperature, air pressure, cloud cover, wind speed, precipitation height and sunshine duration have an influence on the incidence of acute thoracic aortic dissection. No correlation regarding weather parameters and onset of aortic dissection was find.

Die vorliegende Arbeit dient der Zielsetzung, Patienten, die an chronisch dysfunktionellem Schmerz leiden mittels eines kurzen 3-Fragen-Screeners im Rahmen einer routinemäßigen zahnärztlichen Untersuchung zu erkennen und eine ggf. notwendige weiterführende Diagnostik, die zu einer möglichst erfolgreichen Therapie führt, einzuleiten. Es konnte eine signifikante Korrelation zwischen den Ergebnissen des PEG und den Ergebnissen des GCPS V.1 und GCPS V.2 gezeigt werden. Darüber hinaus konnte belegt werden, dass chronisch dysfunktioneller Schmerz signifikant mit Depressivität korreliert. Diese Ergebnisse unterstreichen, dass ein Patient, der an chronisch dysfunktionellem Schmerz leidet, interdisziplinär behandelt werden sollte. / The aim of the present work is to identify patients suffering from chronic dysfunctional pain by means of a short 3-question screener as part of a routine dental examination and to initiate any necessary further diagnostics that lead to the most successful therapy possible. A significant correlation could be shown between the results of the PEG and the results of the GCPS V.1 and GCPS V.2. In addition, it could be shown that chronic dysfunctional pain correlates significantly with depression. These results underscore that a patient suffering from chronic dysfunctional pain should receive interdisciplinary treatment.