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The overall aim of this research is to explore the experiences of newly qualified occupational therapy staff, with reference to professional identity and the role of the preceptorship year in developing this. Using a phenomenological methodology, based on the work of Van Manen (1990), seven newly qualified staff were interviewed using a grand tour question. The subsequent transcripts were analysed using thematic analysis that included a priori coding, as well as codes that emerged from a detailed reading of the data. The findings and recommendations are presented as answers to the two research questions which are: How do newly qualified staff, who have recently been through preceptorship, experience the preceptorship process? In what ways is the preceptorship process perceived as having any influence on the development of professional identity? The findings indicate that preceptorship is perceived to be important in the development of professional identity as part of a continuum, and that the preceptorship period offers an unrivalled time of reflexivity and growth and puts a large emphasis on role modelling. Recommendations include action points specifically developed for the Trust where the research was conducted. They may be useful for other organisations who are providing preceptorship programmes. These recommendations include choice and training for the preceptors. The recommendations also highlight that professional identity is the responsibility of every individual member of the profession.

The world’s population is increasing; whilst this implies improvement in health, for older people itmay also imply more years spent in ill-health. A developing body of literature supports the role that remaining active and engaged in meaningful occupations can play in the maintenance of health and wellbeing at all ages. An understanding of how this can be supported is of importance. Whilst widowhood is a common experience; in older age it may be complicated by challenges resulting from increased age. The focus of this study was the experience of engaging in occupations by older people during the first year after spousal bereavement. A scoping review of the literature indicates the body of literature relating to occupation and bereavement to be small; n relation to older people this largely focuses on the development of skills to manage everyday occupations. This study adopted a hermeneutic phenomenological approach to explore the lived experience for widowed, older people as they re-engaged in occupations and routines during the first year after the death of their spouse. Nineteen older widowed people were recruited with the help of the bereavement support teams at two hospices. The study took a longitudinal approach and participants were interviewed twice. The first interview took place approximately three months after they were widowed; the second at thirteen months. A superordinate theme was identified, recovering occupation; this was underpinned by three sub-themes: retreating to the familiar; taking stock; and revising occupation. The study offers insight into the role played by occupation for the participants; and illustrates the challenges experienced and strategies adopted to facilitate engagement. The role of continuing bonds in this process is illustrated with evidence suggesting a novel form of occupational bond was developed. Implications for policy, health and social care practice; and the occupational therapy profession are considered.

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Acupuncture is potentially an effective treatment for common conditions of pregnancy and labour pain with midwives being well placed to offer it. The aims of this study were to explore the experiences of pregnant women receiving acupuncture treatment from midwives, to provide insight into their perceptions of effect including the influence and value of the midwife on this experience. The lack of qualitative evidence has provided the rationale for this study. Within a phenomenological methodology an 'Interpretative Phenomenological Analysis' (IPA) approach was adopted, with 10 women attending the Salford Midwifery Acupuncture Service (SMAS) being recruited to this study. Data was collected via semi-structured interviews and the IPA analysis identified five main themes; justification of choice, relief & relaxation, trust & understanding, regaining self, discovering and sharing a secret. The women were happy to access acupuncture if recommended by a health professional; they gained pain relief and improved function, with more ability to care for their children and to continue working. They were grateful for the opportunity to access acupuncture, finding it enjoyable and reporting intense emotional and physical sensations. It offered prolonged effect, improving sleep and wellbeing, and it correlated well with purported neurophysiological mechanisms. Responses seemed more intense than in previous reports, possibly due to their pregnant state or heightened affective component. A midwife-acupuncturist was advantageous having knowledge and understanding of pregnancy, with ‘understanding’ being more important than professional background. The women felt optimistic and empowered to make plans for birth and parenthood and were wishing to share their experiences with others. The ‘lay network’ was an important factor within the women’s choice to access acupuncture. These findings indicate acupuncture is an acceptable treatment which can provide relief, improved wellbeing and support normality. Midwives could offer acupuncture as an adjunct to their role to facilitate individualised reflexive practice.

This research aims to provide a more detailed understanding of transnational professional education. In doing so it develops current critical perspectives of physiotherapy, focussing on issues of internationalisation. The impetus for the research was my concern for the relevance of a Masters’ degree for Indian physiotherapists studying at an English university when their future working lives lie in India. I interviewed six Indian students during the dissertation phase of their study. The research methodology is formed using a bricolage approach, one that synthesises aspects of phenomenological (Wertz, 2011) and constructivist grounded theory (Charmaz, 2014). Since becoming a professional is synonymous with developing an ‘identity’, I interpret participant professional identification constructions and working cultures in different national contexts using a theoretical perspective drawn from Holland et al., (2001). This provides an ethnographic understanding of participants’ cultural practices and illuminates the cultured worlds of both physiotherapy practice and its teaching in the course as well as their agency within different national contexts. I show professional work to be suffused with meanings and reveal the interplay of cultural and symbolic capital between patient and physiotherapist (Bourdieu 1986). Different professional, cultural practices can be seen to hold similar meanings and the centrality of the engagement between patient and therapist is exposed. Wider practice contexts (structural, social and political issues) shape the power relations concomitant to physiotherapy, and thereby strongly influence its practice in different locations. I also expose a hegemonic discourse within course teaching, expressed in participants’ narratives of rejection of previous Indian practice, notwithstanding their recognition of the limitations within an Indian context of the practice taught. Critical race theory suggests this forms an example of an oppressive pedagogy (Ladson-Billings and Tate IV, 1995). Although participants describe an increase in self-confidence from studying abroad, paradoxically, I argue that some loss of confidence is likely to result from these unintentional positionings. Further I contend that part of the ethical responsibility of teaching is that it is respectful of different perspectives (Carroll and Ryan 2007). This is particularly important when working with international students, where the student’s home context may be difficult for tutors to comprehend.

Accurate radiotherapy delivery is required for curing cancer. Historical radiotherapy accuracy studies at Leeds (1983-1991) are discussed in context of when radiographers were not involved in practice design. The seminal research was unique in being led by a radiographer practitioner, and in prospectively studying the accuracy of different techniques within one department. The viability of alignment of treatment beams with marks painted on a patient's skin varied daily, and, using film I showed that the alignment of treatment on anatomy varied. I then led 6 sequential studies with collaborating oncologists. Unique outcomes were in identifying the origins of treatment inaccuracies, implementing and evidencing changes in multi-disciplinary practice, thus improving accuracy and reproducibility generally and achieving accuracy for the pelvis to within current norms. Innovations included: discontinuation of painted skin marks and developing whole-body patient positioning using lasers, tattoos, and standardised supports; unification of set-up conditions through planning and treatment; planning normal tissue margins round target tissue to allow for inaccuracies (1985); improved manual shielding methods, changed equipment usage, its quality assurance and design; influenced the development of portal imaging and image analysis. Consequences and current implications. The research, still cited internationally, contributed to clinical management of lymphoma, and critically underpins contemporary practice. It led to my becoming the first radiographer invited into multi-disciplinary collaborative work, to advise in the first multi-centre clinical trials to consider treatment delivery accuracy, contribute to books written from within other disciplines and inform guidelines for good practice so helping to improve practices, with recent publications. I thus led my profession into research activity. Later work included development of a national staffing formula for radiotherapy Centres, and contributing to the evidence-base for improved National radiotherapy resourcing. I recently researched and developed a textbook (second edition) on quality in treatment delivery.

The physics of protons makes them well-suited to conformal radiotherapy due to the well-known Bragg peak effect. From a proton’s inherent stopping power, uncertainty effects can cause a small amount of dose to overflow to an organ at risk (OAR). Previous models for calculating normal tissue complication probabilities (NTCPs) relied on the equivalent uniform dose model (EUD), in which the organ was split into 1/3, 2/3 or whole organ irradiation. However, the problem of dealing with volumes < 1/3 of the total volume renders this EUD based approach no longer applicable. In this work the case for an experimental data-based replacement at low volumes is investigated. Lung fibrosis is investigated as an NTCP effect typically arising from dose overflow from tumour irradiation at the spinal base. Considering a 3D geometrical model of the lungs, irradiations are modelled with variable parameters of dose overflow. To calculate NTCPs without the EUD model, experimental data is used from the quantitative analysis of normal tissue effects in the clinic (QUANTEC) data. Additional side projects are also investigated, introduced and explained at various points. A typical radiotherapy course for the patient of 30×2Gy per fraction is simulated. A range of geometry of the target volume and irradiation types is investigated. Investigations with X-rays found the majority of the data point ratios (ratio of EUD values found from calculation based and data based methods) at ∼20% within unity showing a relatively close agreement. The ratios have not systematically preferred one particular type of predictive method. No Vx metric was found to consistently outperform another. In certain cases there is a good agreement and not in other cases which can be found predicted in the literature. The overall results leads to conclusion that there is no reason to discount the use of the data based predictive method particularly, as a low volume replacement predictive method.

The high uncertainty in the Relative Biological Effectiveness (RBE) values of particle therapy beams, which are used in combination with the quantity absorbed dose in radiotherapy, together with the increase in the number of particle therapy centres worldwide necessitate a better understating of the biological effect of such modalities. The present novel study is part of performance testing and development of a microcalorimeter based on Superconducting QUantum Interference Devices (SQUIDs). Unlike other microdosimetric detectors that are used for investigating the energy distribution, this detector provides a direct measurement of energy deposition at the micrometer scale, that can be used to improve our understanding of biological effects in particle therapy application, radiation protection and environmental dosimetry. Temperature rises of less than 1 μK are detectable and when combined with the low specific heat capacity of the absorber at cryogenic temperature, extremely high energy deposition sensitivity of approximately 0.4 eV can be achieved. The detector consists of three layers: a Tissue Equivalent (TE) absorber, a SuperConducting (SC) absorber and a silicon substrate. Ideally all energy would be deposited in the TE absorber and the heat rise in the SC layer would arise due to heat conduction from the TE layer. However, in practice direct particle absorption occurs in all three layers and must be corrected for. To investigate the thermal behavior within the detector, and quantify any possible correction, particle tracks were simulated employing Geant4 (v9.6) Monte Carlo simulations. The track information was then passed to the COMSOL Multiphysics (Finite Element Method) software. The 3D heat transfer within each layer was then evaluated in a time-dependent model. For a statistically reliable outcome, the simulations had to be repeated for a large number of particles. An automated system has been developed that couples Geant4 Monte Carlo output to COMSOL for determining the expected distribution of proton tracks and their thermal contribution within the detector. The percentage heat contribution from the TE absorber into the SC absorber was determined for mono-energetic proton pencil beams of 3.8, 10, 62 and 230 MeV. The corrected energy distribution is compared to the ideal energy distribution, exhibiting good agreement.

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