This thesis is part of a journey that has encompassed a lifetime love of horses. It evolved from horses being a childhood passion, and led to working with horses together with young people with various disadvantages and difficulties in a therapeutic and educational capacity. The PhD research study followed as an attempt to articulate and share some of the experiences of ‘The Yard’, the therapeutic horsemanship (TH) programme on which this thesis is based. Through a personal belief and understanding that contact with horses could be therapeutic in a number of ways I found myself in the fortunate position to be able to incorporate TH in my work as a social worker for a foster care company. Whilst initially this was limited to young people who were in foster placements with this particular company, the TH programme expanded through interest from outside agencies to include young people referred from youth offending and other organisations. The young people who attended the TH programme, named ‘The Yard’ for the purpose of this study, were generally considered to be ‘at-risk’ within the social work and allied professions due to their circumstances and histories. Substantial research within the literature concerned with risk and resilience claims there is a high likelihood of negative life outcomes as a result of experiencing adverse childhood experiences (Masten, Best, & Garmezy, 1990; Rutter, 1985). It cannot be claimed that this thesis is completely impartial or objective; on the contrary it is a deeply personal and reflexive account of my experiences alongside seven of the young people who attended The Yard and participated in the study. I can only hope that through the many hundreds of hours of the meticulous process that has made up this practitioner-researcher ethnography, that I have provided some kind of useful contribution to the knowledge base of TH. In any case, at the very least, it has certainly been a hugely worthwhile endeavour in terms of gaining invaluable insight into my own practice, together with associated personal and professional growth.

This research was concerned with the experimental and theoretical investigation of the spray issued from a pressurised metered-dose inhaler (pMDI) and has been motivated by the urgent need to find suitable replacements to the environmentally destructive Cf'Csbased propellants currently used and to extend the working knowledge of the device. The majority of the experimental work was conducted using phase-Doppler anemometry (PDA), a single particle light scattering technique which provides the simultaneous measurement of drop size, velocity and concentration, yielding the most detailed temporal and spatial analysis of the pMDI spray to date. The PDA analysis was complemented by a visual investigation of the near-orifice flow field in an attempt to obtain information on the primary atomization process. The theoretical investigation of the pMDI spray consisted of constructing a model of the fluid flow through the pMDI during a single actuation that was based on a quasi-steadystate separated flow analysis and included a qualitative and quantitative description of the primary atomization process. The construction of a model of the resultant spray was based on the solution of the multiphase transport equations using computational fluid dynamics (eFD) techniques, with the theoretical results being validated against the experimental data. The spray issued from a pMDI was found to be an unsteady, transient, threedimensional, multiphase fluid flow, generally characterised by high initial drop velocities with steep axial velocity radial gradients, small drop sizes, high levels of turbulence and a mean spray cone angle of approximately eleven degrees. The visualisation of the near-orifice flow field suggested that flash evaporation was the primary atomization mechanism, producing a finely pre-atomized spray. The pMDI spray was affected by attitude, it having been observed that the patternation of the spray was biased in the downward direction and this was a consequence of the asymmetric geometry of the actuator nozzle. The results predicted at the near-orifice measurement locations by the theoretical spray model suggested that the theoretical actuator flow model successfully simulated the fluid flow through the pMDI and the primary atomization process during a single actuation for a placebo hydrofluoroalkane formulation. However, the resultsproduced by the theoretical spray model could only be considered as preliminary until further numerical analysis is conducted.

The aim of this work is to study the effect of removing the flattening filter (FF) from the head of a linear accelerator (linac) on photon beam dosimetric properties and treatment outcomes with emphasis on photoneutron production. An Intensive Monte Carlo (MC) study was carried out for this purpose using two MC codes: FLUKA and BEAMnrx/DOSXYZnrc. These codes were used to model the head of Varian Clinac and/or TrueBeam linacs with and without a FF. For the Varian Clinac, several aspects of the FF removal were addressed. These include: first, study of the dosimetric characteristics of the 15 MV unflattened beam such as dose rate, percentage depth dose on the central axis, beam profile, out-of-field dose, surface dose and neutron contamination. Second, the neutron fluence in treatment rooms housing flattening filter free (FFF) linacs at different energies. Third, the quality of megavolt age cone beam computed tomography (MVCBCT) images by using the 6FFF photon beam with a copper target. Fourth, the feasibility of using the 15FFF beam in intensity modulated radiotherapy (IMRT) for prostate cancer with regard to planning target volume (PTV) coverage, organs at risk sparing (OAR) and neutron dose to the patient was studied. Finally, the dosimetric effect of combining two FFF beams and investigating its practicality was studied. For the Varian TrueBeam, the dosimetric properties of 6 and 10 MV photon beams with and without a FF were calculated using the second version of Varian TrueBeam phase-spade files and compared with measurements. In addition, four volumetric modulated radiotherapy (VMAT) plans of a prostate cancer case for these photon beams were modelled using MC techniques for comparison. Results obtained showed that the 15FFF photon beam of the Varian Clinac has a dose rate 4.86±0.09% times higher than the flattened one and the average out-of-field dose from the edge of the field to the edge of the phantom was reduced by 44.0±0.5%.The neutron fiuence and neutron dose equivalent at the isocentre were also reduced by 77±3%. However, the photon surface dose of the unfiattened beam increased by 13.0±0.3%. Moreover, a significant drop-off in neutron fiuence at different locations inside the treatment room was found when the FF was · removed. For example: the neutron fiuence at the isocentre decreased by 54.0±4.2%, 76.0±1.4% and 75.0±0.8% for 10, 15 and 18 MV, respectively. This would decrease the neutron dose to patient and medical staff as well as reduce the shielding cost of the treatment room. A reduction was observed in the mean energy of the photon spectrum and an increase is obtained in the low energy photon ratio when the 6FFF beam with the copper target was used leading to an improvement in the quality of MVCBCT images. The local contrast in the MVCBCT images when two cylindrical bones with a 2 cm diameter were placed inside a water phantom with a 5 cm thickness was improved by 31.0±1.3% when the copper target was used. The 15FFF did not provide sufficient coverage to the PTV because the modelled 15FFF plan was not optimised as the hospital treatment planning system did not have the 15FFF data required for the optimising process. However, the calculated neutron dose from a full step and shoot IMRT plan on a water phantom decreased significantly with the use of the 15FFF. Combining the 6 and 15FFF beams provided better sparing of the rectum and bladder and less surface dose. This technique could improve the current IMRT treatments. The calculated dosimetric properties using new TrueBeam phase-space files agreed with measured data. Results of out-of-field dose were found to decrease by 30.4±0.6% and 44.8±0.8% for the unfiattened 6 and 10 MV beams, respectively, compared to the flattened beams. The homogeneity index (HI) within the PTV for 6 and 10 photon beams with and without FF plans were found to be 0.08, 0.07, 0.09, and 0.11, respectively. The volume receiving 70 Gy within the bladder were 11.9% ,11.3%, 11.0% and 4.7%, respectively. The VMAT plan treated with the conventional 10 MV beam provided the lowest HI, while the VMAT plan treated with the 10FFF beam provided the highest OAR sparing. All VMAT plans were found to be acceptable clinically. From all results obtained, it can be concluded that the unflattened beam can lead to better treatment outcomes and could provide a step forward towards optimum photon radiotherapy. -

Radiotherapy has been used for decades in the treatment of cancer however; the efficacy of radiotherapy is limited by the damage it causes to normal tissue. High Z materials have previously been used as contrast agents in imaging due to their favourable mass attenuation coefficients in comparison to tissue. Gold, a high Z material, has the potential to significantly enhance radiation dose deposited in by physically scattering the energy from the radiation beam. Various publications have demonstrated the potential for gold nanoparticles in enhancing cell death with radiation and calculations predict dose enhancements of two fold or greater. A comparison of various gold nanoparticles showed 1.9 nm Aurovist™ to be the most effective at enhancing cell death in the presence of radiation showing radiosensitisation in MDA-MB-231, DU14S and T98G cancer cell lines not in AGO-1S22, a normal fibroblast cell line. The type of cell death induced is cell line dependent and DNA damage is induced upon exposure to gold nanoparticles alone which is further amplified with radiation. Further investigation observed oxidative stress including ROS production, mitochondrial depolarisation and mitochondrial oxidation as biological responses to gold nanoparticle exposure. Treatment with the ROS scavenger, N-acetyl-cysteine, and gold nanoparticies revealed mitochondrial oxidation as a key event in gold nanoparticle radiosensitisation. Protein disulphide isomerase, an enzyme present on the cell surface, was shown to have a significant role in the cellular effects observed upon gold nanoparticle treatment and radiosensitisation.

Links between music and emotional state have been posited for many years, dating back to Aristotle, and periodically taken up by musicians, musicologists, philosophers and most recently neuroscientists. Mounting evidence suggests that music is used by many as a form of mood regulation and there is a long history of music as therapy, usually realised as performance or group work, with more recent studies showing links between music listening and positive healthcare outcomes. In addition to interest in the relationship between music and emotion, there ha.s been a recent upsurge in research into emotion as a channel for technological and creative interaction with music, multimedia artworks, computers and new digital instruments. It is exploring this aspect of emotion-based interaction that provides the motivation for this thesis, a desire to utilise emotion (and the physiological characteristics associated with affect) as an interaction channel. In order to achieve this, further exploration of the associations between emotion, physiology and music is necessary. As context for my own work, this thesis initially presents an overview of the dominant theories relating to emotions, and in particular their interaction with music and the mechanisms and audio features by which music may induce emotion. An overview and critique of artworks utilising signifiers of affective state is also presented before detailing my own artistic contributions as co-creator of artworks utilising physiological correlates of emotion. An overview of a large-scale public experiment (Emotion In Motion) designed to explore and deepen knowledge of some these issues is presented, along with an analysis of the data collected. This analysis found relationships between specific musical features such as tempo, mode and dynamic range and participant experiences of factors relating to emotions such as valence, arousal and engagement.

There is a mass of common lore about the reasons people garden and the benefits they derive from gardening but little academic study into the topic. The literature has tended to take a snapshot look at gardening with little consideration of the patterning to people's experience across their lives. This study takes a life course perspective and investigates ways in which people's relationship to their garden, and the meanings they ascribe to gardening, vary at different ages and stages. It considers the links between these meanings and the well-being of the gardeners. The study is qualitative and draws on interviews with 25 gardeners in the UK, aged between 25 and 94 years. A small sample of autobiographical garden writing is also used as a data source. The study is influenced by phenomenological, biographical, narrative, and grounded theory approaches. Thematic analysis builds on narrative methods and on case by case comparison. The analysis indicates that most of the meanings associated with gardening emerged in childhood and include 'escape', 'fun and pleasure', 'aesthetic appreciation', 'care and responsibility', 'control', and 'connections'. Across the life course these meanings continue to be available to gardeners but are brought to the fore at different times and under influences which may lie within the individual or in broader social or historical forces. Life events were experienced as times for greater urgency to garden, and provide a lens through which the 'goods' of gardening can be brought into stark relief. At such times gardening is seen to support identity maintenance and offers strategies and resources for coping with major life changes. It is argued that gardening, because it evokes meanings which encompass emotional, psychological, social, spiritual and physical elements, is particularly well placed to support people at such times.

This thesis attempts to answer a number of questions regarding falls in older adults, both in terms of the assessment of individuals experiencing falls and their physiotherapy based rehabilitation. Firstly, an audit (Chapter 2) of a commonly used falls risk assessment tool (the Physiological Profile Assessment: PPA) was performed to determine the variability of component measures in differing age groups and to assess its clinical validity. A novel multi-task directed stepping test was designed and piloted to investigate changes in volitional directed stepping when performing complex spatial tasks (Chapter 3). Changes in prioritisation of postural tasks with older age were identified in healthy older adults compared to a healthy young cohort. A case control trial was performed to compare vestibular function in older adult fallers and age matched healthy individuals (Chapter 4). Both groups were compared to age matched patients with known peripheral vestibular dysfunction across a range of physical and questionnaire measures. It was identified that fallers have significantly higher proportions of vestibular dysfunction than age matched healthy older adults. A 2 arm RCT was performed to investigate the beneficial effects of a customised multi-sensory balance home exercise rehabilitation programme (vs. stretching) (Chapter 5). Older adult falters undertook an 8 week Otago programme combined with either a Multi-sensory or Stretching home exercise programme. Multi-sensory rehabilitation provided significant within group and larger between group changes in FGA scores and PPA falls risk. This study identifies the beneficial effects of multi-sensory rehabilitation in older adult fallers, when combined with the Otago exercise programme.

The thesis examines the healing and ritual practices of traditional healers (known as rezadeiras) in a semi-arid interior region of the State of Pernambuco in the Northeast of Brazil, know as the Sertão. The thesis commences by introducing the field, the research methods employed and ethnological approach, and then proceeds to examine the historical origins of rezadeiras' practices and rituals in the Christianity of colonial Brazil, African and native magic and medicine and the cult of Catimbó (which assimilates native and Afro-Brazilian elements). The more recent influence on rezadeiras' practices and rituals of Popular Catholicism is also referred to. The way in which someone becomes a rezadeira is detailed, alongside an account of each of the rezadeiras who were the principal informants for the thesis. Examples of illnesses and issues treated by rezadeiras are given (for example, depression and romantic problems), and the perceived causes of those illnesses and problems (such as, for instance, in quebranto, which is magical concept explained in greater detail in the thesis), and examples of consultations and treatment of clients by rezadeiras are given. The most important ritual practices employed by rezadeiras - reza (or prayer) and responso (a local form of antiphon or antiphonary) - in treating their clients, and the medicinal herbs, healing baths and medicinal teas prepared by rezadeiras for use in their treatments are also discussed. A concluding section seeks to place rezadeiras in a more analytical context, by looking at the ways in which rezadeiras' clients embody illness, the role of metaphor in concepts of illness in the Sertão and the effectiveness of the reza.

No description available.

The education of healthcare professions students in the effective management of people experiencing neurological conditions is essential. If physiotherapy students’ are experiencing neurophobia, the fear of neurology (Jozefowicz 1994: 328) it is important to understand the underlying reasons, to inform future teaching practice. The purpose of this research was to explore physiotherapy students’ perceptions of neurology and their experiences of learning neurological physiotherapy in one UK Higher Education Institution (HEI). This mixed methods case study was conducted with all pre-registration physiotherapy students on the BSc and MSc programmes at the participating institution. The research consisted of an initial survey questionnaire to all students, followed by observations of neurology teaching sessions and interviews with students from each of the 3 BSc and 2 MSc year groups. The data was analysed using thematic analysis. The results suggested that students’ perceptions of neurology and neurological disability were set long before they commenced on the programme and these preconceptions impacted on subsequent learning experiences. The students in the study unanimously felt that learning neurology was difficult. There were also concerns expressed about the pressure of an inherent perception of the high importance of the physiotherapist’s role in the rehabilitation of neurological patients, with the outcome of treatment having a life-changing effect on patients and their families. The students’ experiences of learning neurological physiotherapy was challenged by difficulties conceptualising new neurological knowledge, learning a new approach to patient treatment, and the complexities of performing neurological physiotherapy clinical reasoning. This learning was also influenced by the methods of teaching taking into account the informal and non-formal learning along with the formal, and most significantly the lack of experiential learning with patients during the university based teaching. The implications from this research can inform changes to the pedagogy within neurological physiotherapy and the wider programme content.