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Two clinical trials investigating the effect of modulating two dietary components, tea containing polyphenols and vitamin D aimed at improving non-haem iron absorption and iron status recovery, were carried out in a cohort of healthy and iron deficient UK women, respectively. Tea has been shown to be a potent inhibitor of non-haem iron absorption but it remains unclear whether the timing of tea consumption relative to a meal influences iron bioavailability, with limited published evidence, especially in human trials. The aim of the first study was to investigate the effect of tea consumption on non-haem iron absorption and to assess the effect of time interval of tea consumption on non-haem iron absorption relative to an iron-containing meal, in a cohort of healthy female participants using a stable iron isotope (57Fe).

This thesis aimed to assess the feasibility of conducting a randomised controlled trial (RCT) into the use of Korean Hand Acupuncture (KHA) for pregnancy related pelvic girdle pain (PPGP). Despite PPGP developing in approximately 20% of all pregnant women, there are currently very few studies that have investigated interventional strategies, with a dearth of UK based studies. Of extant interventions investigated to date, acupuncture has shown some promising findings, although the effects of KHA on PPGP remain unclear. In line with the MRC framework for complex interventions, any potential treatment should be subjected to feasibility testing prior to a definitive RCT. This three phase feasibility study followed a mixed methods paradigm. Phase 1 was a comparative study of 20 non pregnant women, measuring the belief that there had been a needle inserted into the skin, between a penetrating KHA (pKHA) group and a non-penetrating KHA (npKHA) group. Between group analysis found that at initial assessment (p=0.07) and one week post intervention (p=0.643), believability was similar. Qualitative comments were analysed through content analysis, and provided insight into what factors influenced their belief score, such as ‘acupuncture noises’. The study findings helped to develop the intervention protocol in Phase 3. This study was the first to investigate the believability of a non penetrating form of KHA. Phase 2 recruited eight PPGP sufferers and adopted a qualitative approach, using semistructured interviews to gain an understanding of how PPGP affected them. Data was subjected to thematic analysis and produced four themes: The reality of PPGP; Support mechanisms most important in PPGP; Vulnerability and; Knowledge is power. Findings indicated PPGP is a problem that is biopsychosocial, and one which is represented via the Pelvic Girdle Questionnaire (PGQ). It demonstrated that information provision was considered as important to the participants within this study as it is to sufferers outside of the UK, and that they valued health care professional advice and support. This is the first UK based study to investigate women’s experience of PPGP, the first piece of qualitative work with the lead author and interviewer being male, the first to provide a level of validity to PGQ use within the UK and the first to adopt a pragmatic philosophy. Phase 3 was a mixed methods feasibility study, assessing the acceptability and practicality of conducting a definitive RCT on KHA for PPGP. A two armed study consisting of six sessions in either a standard physiotherapy plus pKHA or a standard physiotherapy plus npKHA group. The study recruited 59 women, 40 of whom completed all six sessions. Acceptability and practicality was confirmed through content analysis of the qualitative data produced by the participants, in particular those in the pKHA group who stated they would seek out the treatment again. Further acceptability was noted as all adverse events experienced were minor and transient, and that the retention of women to the study was greater than normally expected from the study population. In addition, trends noted in NRS at present (p=0.002) and PGQ (p=0.041) at the final data point indicated that pKHA may have additional benefits over npKHA for PPGP. The original contributions from Phase 3 are that it is the first study to be conducted using KHA for a pregnancy related condition in the English language and the first study to adopt a mixed methods approach within the UK for an acupuncture study within pregnancy. Finally, it is the first study written in English that has compared pKHA to npKHA for any condition.

The aim of the research was to examine the ways in which occupational therapists construct meaning in their professional lives and, in doing so, shed light on the wider dialogue of the meaning of occupation. A secondary aim was to provide a framework to assist occupational therapists to unravel, articulate and position themselves within the meaning of their work. Hermeneutic phenomenology was chosen as a research approach to enable particpants to examine their own actions and for the insider researcher to be visible via hermeneutic reflection.

Errors during radiotherapy treatment can cause severe, and potentially fatal, patient harm. The final check immediately prior to treatment delivery, whereby two radiographers ensure that the dose about to be delivered corresponds with the prescription, is the last defence against error. The aim of this research was to increase understanding of this final treatment check and factors affecting error detection, in order to improve the safety of radiotherapy treatment delivery. The research adopted a mixed methods approach, combining qualitative and experimental studies to investigate the interaction of factors affecting accuracy during the final treatment checks. The qualitative interviews and task analysis pointed to difficulties maintaining attention and variation in how these checks are conducted. The interface used to conduct the final treatment check was also recognised to have usability issues. The laboratory-based experimental studies results indicated that a structured form of double checking, called challenge-response, is most effective at error detection, when compared to single or unstructured double checking. Furthermore, it was found that alternating the roles of challenger and responder, and the order parameters are checked in, significantly increases accuracy during repeated treatment checks. The original contribution of this research was a detailed investigation of a previously understudied aspect of radiotherapy treatment. The results informed the design of an original, evidence and theoretical based two-person checking protocol for use during the final treatment check. Qualitative evaluation indicates that it would be well received as a standardised method of treatment checking. Furthermore, an alternative interface design has been proposed, specifically for use during the final treatment check. This was comparatively tested against the most frequently used software package within the UK and found to have a significant positive impact upon user’s accuracy. An additional output is a series of practice based recommendations to improve accuracy during repeated treatment checking. This research has concluded that implementation of the practice recommendations, checking protocol and interface design should help maintain radiographers’ attention during repeated final treatment checks, thereby preventing errors passing undetected. Future research into the radiotherapy interface design and implementation of the standardised final treatment check protocol have been identified.

The corpus of literature about disabled therapists within physiotherapy omits one important factor: the experiences of disabled physiotherapy students. Therefore, this research aimed to fill this gap by exploring the integration of disabled students into the physiotherapy profession. This participatory research sought to investigate the phenomenon from multiple perspectives to incorporate the voice of disabled students, an analysis of the policies which regulate the profession, and the opinions of representatives from the Chartered Society of Physiotherapy and the Health and Care Professions Council. In stage one of the project ten disabled physiotherapy students were recruited. These students completed narrative interviews and Kawa drawings to document their experiences. Stage two explored the available information for prospective disabled students by conducting an internet survey. Finally in stage three, the policies of the Health and Care Professions Council and Chartered Society of Physiotherapy were examined for ableist language and then two representatives from each organisation were interviewed about the integration of disabled students. The data collected were analysed by critical narrative analysis with the student participants contributing to the generation of categories and themes. Further analysis was conducted using Bourdieu’s Theory of Practice and the SEAwall model of discrimination. My research has identified two paradoxes that affect the integration of disabled students. Firstly, the paradox of the perfect physiotherapist, applied via a narrow physiotherapy corporeal standard, which particularly limits access for people with physical impairments. Secondly, the paradox of supporting students whilst maintaining qualification standards. Again this limits access for disabled students, particularly when fitness to practise standards are applied during the admission process. These competing imperatives create a dilemma for disabled students around disclosing their disability status. This dilemma will only be solved by reducing discrimination at all levels of the system. However, in order to achieve this change, disabled physiotherapists and students will need to adopt a more affirmative orientation to disability to act as facilitators of change within the profession.

Background: Radiotherapy is used in the treatment of over 50% of cancer patients and bar surgery, is the most effective cancer intervention. However, in the clinic secondary malignancies have been observed following radiotherapy and in vitro increased cell migration and invasion have been seen following radiation. The Src/FAK signalling pathway is known to play an important role in the metastatic phenotype through its involvement in cell adhesion, migration and invasion and we have previously demonstrated that radiotherapy can activate this pathway along with the phosphoinositide 3-kinase (PI3K) pathway, also associated with tumour metastases and an aggressive phenotype. Using pharmacological inhibitors, we have investigated combination approaches to evaluate whether Src and PI3K targeting is beneficial in a radiotherapy context, especially focusing on metastatic phenotype. We wished to relate pathway activation to cellular phenotype and increase understanding of the metastatic cascade, the processes involved and the signalling pathways taking the lead. Method: Using thyroid carcinoma cell lines FTC133 and 8505c the effects of Src inhibition using AZD0530, FAK inhibition using FAKi and PI3K inhibition using GDC-0941 were studied. The effects of radiotherapy alone, and in combination with the above inhibitors, were also studied. In vitro MTT, apoptosis and clonogenic assays were used to assess cell proliferation and cell survival and scratch assays, cell adhesion and cell spreading assays were used to assess the effects of the drugs on metastatic characteristics. In vivo tumour growth, survival and ex vivo clonogenics were used to measure the effects of AZD0530 and GDC-0941. Western blotting, immunofluorescence and immunohistochemistry was used to observe the effects on pathway activation and protein localisation. Results: Src and FAK inhibition reduced metastatic characteristics of thyroid carcinoma cell lines in vitro such as cell spreading and migration. FAK inhibition showed a greater effect on cell survival by MTT, clonogenic and apoptosis. In the thyroid carcinoma cell lines radiotherapy enhanced the metastatic phenotype. This was seen by enhanced activation of the Src and PI3K pathways, increased migration and invasion in vitro and enhanced tumour metastasis in vivo. By combining Src inhibition with radiation a reduction in metastatic characteristics was observed and by combining PI3K inhibition with radiotherapy radiosensitivity could be improved. With the triple combination of Src and PI3K inhibition with radiotherapy a significant reduction in cell survival was demonstrated in vitro compared to radiation alone and either inhibitor combined with radiation, with a corresponding significant reduction in tumour growth being observed in vivo. With the combination of Src and PI3K inhibition significant reductions in metastatic characteristics were also observed both in vitro and in vivo seen by a reduction in cell migration and tumour metastasis. Finally combined inhibition of the Src and PI3K pathway reduced the radiation enhanced activation of several pathways in vivo including Src and PI3K.Conclusions: Together these results suggest that the Src and PI3K pathways play a role in radiation enhanced metastatic characteristics in thyroid carcinoma and through combined inhibition of the pathway the negative effects of radiation, enhanced migration and invasion, can be inhibited and the cells can be made more radiosensitive. Full characterisation of the pathways involved in radiation induced motility and radioresistance will provide further rationale for combination therapies and provide potential for application of these therapies in the clinic.

The respiratory system is highly compromised after a tetraplegic spinal cord injury due to paralysis of the major breathing muscles. As a result mechanical ventilation is often required and respiratory complications are a major cause of rehospitilisation, morbidity, and early mortality. Functional electrical stimulation (FES) applied acutely to the abdominal wall muscles in synchrony with a patient's volitional exhalation has been shown to improve breathing volumes and the ability to cough in spontaneously breathing tetraplegic patients. It has also been used acutely to improve breathing volumes in otherwise mechanically ventilated patients. The effect of using abdominal FES (AFES) chronically on AFES-assisted and unassisted respiratory function is currently unknown. To support clinical adoption of AFES practical systems are required. Systems that synchronise AFES with exhalation automatically have been developed but they have relied on invasive respiratory sensors. In the first clinical study of this thesis twelve tetraplegic patients who could breathe spontaneously completed a three week AFES training programme in addition to a one week pre-training control period and a three week post-training follow up period. The results showed a significant increase in \ac{afes}-assisted forced vital capacity (FVC), and unassisted FVC, peak expiratory flow (PEF), and cough peak flow (CPF) throughout the training period. AFES-assisted PEF and CPF tended to increase over the same period, but the increase was not significant. The difference between unassisted and AFES-assisted measures did not change. Overall, there were limited changes in the outcome measures during the control and follow up periods, which suggests that the changes in outcome measures observed during the training period were a response to training. In the second clinical study daily sessions of AFES-breathing were combined with the standard of care during the process of weaning a single tetraplegic patient from mechanical ventilation. The results showed that the approach was feasible: AFES acutely increased the duration of ventilator free breathing at the start of the weaning process and daily ventilator free breathing improved considerably during two four-week long periods of daily AFES-assisted breathing. In the final study breathing data was recorded from ten healthy volunteers using a spirometer (the current standard), a nasal thermocouple, and piezoelectric belts wrapped around the chest and abdomen. An algorithm was written for each of the sensors so that they could be used to trigger stimulation during quiet breathing. The thermocouple system, followed by the chest belt system, were shown to be the most suitable replacement sensors for the spirometer. The results of this thesis suggest three different applications of AFES in tetraplegia: a neurorehabilitation device that can be used to improve unassisted respiratory function in spontaneously breathing tetraplegics; a neuroprosthesis device that could be used to assist spontaneously breathing tetraplegics in times of respiratory distress, e.g. during recovery from respiratory infection; and as a method of weaning tetraplegic patients from mechanical ventilation. The realisation of these applications will be assisted by the non-invasive respiratory sensor algorithms developed in this thesis. Collectively these results have demonstrated the feasibility of several new areas of future research, which could ultimately be of great benefit to the health of patients with tetraplegia.

Internet-based therapies are growing in number and popularity and cover a diverse range of practices for both individuals and groups. In concordance with the hyperpersonal theory and online disinhibition effect, people more readily disclose personal information when conducted via the internet. Due to technological constraints and social interactions, a non-standard language developed and has widely been termed “netspeak” (Crystal, 2006). Emotional words are processed differently to non-emotional words. Further, people do not connect with abbreviations on the same emotional level as they do when the words are written in full. Three studies were conducted: the first focused on assessing if a short emotionally evocative mini-biography had an emotional impact on participants. This material was then used in a second study which was a mass-testing of 62 young people on whether netspeak can change the impact on mood. The study used 3 conditions whereby participants re-wrote the mini-biography into either full English, using Netspeak or in their own words. A new vignette was created from the Netspeak condition to use as material for a third study. This final study was conducted via email into how much a psychological therapist understood what had been written in the Netspeak vignette. No differences were seen from re-writing an emotional biography in netspeak to English. Although psychological therapists demonstrated some understanding of the netspeak vignette, there was evidence of misinterpretation, presumption and misunderstanding suggesting that there may be some barrier to communication in internet therapy. The clinical implications of this research suggest that psychological therapists need to reflect on their practice in order to be aware of the level of assumption that can be made during therapy.

This qualitative study aims to explore the parents’ or other family members’ experiences in participating in music therapy sessions with their children with special needs. This aim leads to three research questions which were; 1) Can music therapy help to achieve aims set out for individual children with special needs and their parents or other family members 2) What are the functions of music therapy in nurturing communication between the parents or other family members and their children? and 3) How can the music therapist develop ways in which parents or other family members can use music to help their children? Six children who are attending the Special Education Centre, region 9 in Thailand, aged four to twelve years old with their family members who are their primary carers, participated in 24 music therapy sessions. Each session was videoed and the video recordings were discussed every two weeks with the carers. The carers were interviewed three times by the research assistants. Interpretative Phenomenological Analysis was employ to evaluate data collected from interviews. Furthermore, there were two home visits, one after a month when the 24th session was finished and another visit was two months after the 24th session was finished. From the interview analysis, there are 28 themes under five categories namely: 1) The carers’ expectations of the music therapy 2) The carers’ experience of seeing their children in the music therapy sessions 3) The carers’ experiences of seeing themselves in the sessions 4) The carers’ experiences of reviewing the video recordings from the music therapy sessions and 5) The carers’ experiences of using music at home. It can be summarised that music therapy made a positive impact on the children and their carers. The finding highlighted how the music therapy enhanced the social and communication skills of the children. Moreover, involving the carers in the sessions enabled the carers to have positive experiences with their children and these experiences led the carers to see and interact with their children differently. The findings suggest the ways to work with the carers in a therapeutic process and how to encourage the carers to use music at home with their children.