Due to an increase in the need for allied health professionals, there is a growing interest to assess the allied health workforce and its employment needs. This is especially true in medically underserved rural areas where there is a critical shortage of allied health professionals. A survey was sent to allied health administrators across a variety of allied health disciplines working in Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences of perceptions of strategy effectiveness among allied health disciplines, and key strategies for rural allied health recruitment. Little is known about organizational policies impacting recruitment and retention practices of allied health professionals in Tennessee hospitals. Understanding of this problem is vital to the prevention of a critical shortage of allied health professionals. Therefore, this study sought to compare rural and urban hospital in Tennessee with respect to recruitment and retention needs.

Although the recent annual growth rate in the US paramedic field has been 4%, Latino and African American men have been significantly underrepresented in the field compared to their proportion in the US population at large. This problem threatens both the quality and quantity of available emergency health care. The purpose of this study was to describe how men of color (MOC) in community college paramedical programs experienced their awareness, interest, and proactive choice of paramedicine as a course of study. Using a qualitative phenomenological approach and social cognitive career theory as a theoretical framework, I interviewed 23 MOC enrolled during one semester across three community college paramedical programs in the southwestern US: 9 Latino and 14 African American, aged 18-29 with mean age 22 years. The focus of the interviews was the participants' lived experiences at various career points, as well as the enablers and disablers they had encountered. I identified three primary themes for possible use in enhancing recruitment of MOC to the paramedic field: strategic use of new digital media, promotion of the vocation's quasi-familial characteristics, and augmentation of neighborhood-based outreach. Identified areas for further research included recruitment dynamics of female paramedics, MOC persistence issues, and MOC job satisfaction assessments.

Section A situates female clinical psychologists with children within the wider socio-historical context of working-mothers. Theoretical and empirical evidence of modernist and post-modernist approaches on the development of the working-mother identity is provided. This is followed by the literature on mothers employed in the caring profession and in psychology. The review highlights the need to further explore the relationship between social, professional and personal for female clinical psychologists with children within a socio-constructionist perspective. Section B investigates the social and professional challenges encountered by female clinical psychologists with children. Clinical psychology is an increasingly female profession, and many clinical psychologists are or will be mothers. Yet, proportionately fewer reach consultant positions (Band 8c and above) compared to their male colleagues. Existing historical professional structures, and traditional societal ideologies about motherhood and employment might be continuously negotiated within broader social positionings of working-mothers. This study aimed to explore the constructions of a sample of clinical psychologists who are mothers (CP-Ms) of their social identity. Foucauldian discourse analysis was used to explore the discourses available and drawn upon by CP-Ms to construct their professional and motherhood identity, and what were the subject positions they occupied. Ten qualified female clinical psychologists with pre-school children employed in a local NHS Trust were individually interviewed. CP-Ms’ identity was constructed as either a mother or a clinical psychologist, as being similar and different to other working-mothers. CP-Ms discoursed psychological knowledge and practices as potentially damaging their motherhood experience and their social relationships; they also discoursed motherhood and psychology as mutually enriching. Motherhood and professional identity were discoursed in opposition to one another, and yet the participants also constructed their CP-M identity as a continuous dynamic journey of reframing, of which they were agentic. This study suggests that the construction of CP-Ms’ identity is complex as it involves actively negotiating contradictions and overlaps between motherhood and clinical psychology. Further research is needed. Professional and clinical implications are discussed. Section C aims to elaborate on the research skills learnt during the research process, and on the abilities that need to be further developed. It continues with a critical appraisal of the study, before reflecting on possible clinical recommendations. Lastly, a potential new project is presented.

Angiogenesis is essential for the growth of a tumour, as it provides tumour cells with nutrients and oxygen for their survival. As the tumour expands, neovascularisation is facilitated by the release of enzymes called proteases, which degrade extracellular matrix and facilitate the metastatic spread of cancer. TNF[alpha] and IL-1[beta] are potent cytokines that share the ability to stimulate angiogenesis, hence their possible significance in metastasis has been a focus of intense research. TNF[alpha] and IL-1[beta] have been shown to regulate the activity of proteases such as MMP's and serine protease. The aim of this study was to investigate the effect of TNF[alpha] and IL-1[beta] on cathepsin B and DPP IV activity and their protein levels in HRT 18, HT 29 cells and HUVEC's. Further experiments were conducted to assess the viability of the cells upon treatment with the cytokines. In addition the potency of inhibitors Mu-Phe-Hph-FMK, for cathepsin B enzyme, and Gly-Pro-Gly-Gly, for DPP IV enzyme were assayed in the three cell lines studied. Addition of TNF[alpha] and IL-1[beta] resulted in the reduction of intracellular cathepsin B and DPP IV activity and an increase in its extracellular activity in HRT 18 and HT 29 cells, suggesting that the cytokines induced the release of the enzymes or may have inactivated intracellular enzyme while activating the latent extracellular enzyme. However, in HUVECs, both the cytokines led to an increase in intracellular as well as extracellular cathepsin B activity, possibly by activating the latent form of enzyme present within and outside the cell. With respect to DPP IV, there was an increased intracellular and extracellular activity with TNF[alpha], but with IL-1[beta], an increase in intracellular activity and a decrease in extracellular activity were observed, suggesting involvement of a different mechanism for the exopeptidase enzyme in HUVECs. The two Cytokines had a cytotoxic/cytostatic effect on all three cell lines, with prominent reduction in cell viability of HUVECs. In conclusion the varied response of intracellular and extracellular activity and protein levels of cathepsin B and DPP IV, in different cell lines suggests that TNF[alpha] and IL-1[beta] may act as important modulators of proteases in the process of angiogenesis in cancer and normal endothelial cells. Thus understanding the pleiotropic nature of these cytokines will further broaden the knowledge of involvement of these cytokines in cancer progression/cancer regression.

Accurate detection and segmentation of intracranial aneurysms plays an important role in diagnosing and reducing the incidence of subarachnoid haemorrhage (SAH) which is associated with high rates of morbidity and mortality. This research proposes a computer aided detection (CAD) and segmentation (CAS) of intracranial aneurysm in computer tomography angiography (CTA). The efficiency of the CAD/CAS system is boosted by pre-processing the input image with non-linear diffusion to smooth the CTA data while preserving the edges. A 3D region growing-based approach is used to extract the cerebral arteries followed by entropy-based search space reduction to retain the volume of the circle of Willis (CoW) and the proximal cerebral arteries where nearly all intracranial aneurysms are located, whilst eliminating the extracranial and very distal intracranial circulation. Because cerebral aneurysms vary in size we regard the problem of cerebral aneurysm detection as an intrinsically multi-scale problem and employ a multi-scale approach to all detection analysis. Shape index analysis is employed to determine potential aneurysmal regions (PARs). Hessian analysis and gradient vector field analysis which reveal 3D local shape information are used to further characterise the initial PARs. False positive reduction is then performed based on the analysis of the shape characterisations of the PARs. A ranking score is defined based on the outcomes of the shape analysis to rank the likelihood of PARs. The system allows user to navigate through the ranked PARs and select a candidate aneurysm for further analysis (CAS). The boundary of the selected aneurysm and its parent artery is delineated by using a 3D conditional morphology-based region growing approach. The output is presented to the user to be assessed for the aneurysm orientation relative to the parent vessel. A semi-automatic process is applied to detach the aneurysm from its parent artery. To have a fine segmentation of aneurysm which can be used for characterization of the aneurysm, a 3D geodesic active contour implemented in a level set framework is applied. The volume of the separated aneurysm is quantified as a typical characterization ofthe aneurysm. The system has been validated on a clinical dataset of 62 CT A scans with average 274 slices per scan (involving 17,028 CT slices) containing 70 aneurysms. Sizes of aneurysms vary between 3-16mm. 42 CTA scans have been used as a training dataset for parameter selection and 20 CTA scans have been used as a test dataset. The sensitivity of the systems for the CAD component is 97% with the average false positive of 2.24 per dataset (0.008 per slice). CAS performance was evaluated by dual visual judgment of an expert neuroradiologist and neurosurgeon. The detection and segmentation performance indicate the approach has potential in clinical applications.

This thesis addresses the theory of Socio-Technical Systems (STS) within the context of Information Systems (IS), a complicated field combining Information Technology and social shaping impacts. IS have been changing our society for some decades. From Office Automation (OA) to E-Commerce and E-government, IS are creating a new era of Mobilisation. Different industries have all been adopting Information Technology to enhance their business, from enterprises to public sectors. All these changes bring dramatic impacts for organisational behaviour and people's living, which need to be studied. According to academic literature, health informatics, being one of the important and complex fields in IS, started to employ mobile technical systems to improve healthcare service delivery for citizens at the start of the new Millennium. Comparing with other theoretical models in IS, the author argues that the Socio-Technical approach can explain comprehensively the new changes to organisations and society. Following the theories of STS, these case studies were decided by the researchers as field work in Chinese Community Healthcare Service Centres, where there are various mobile services for the citizens. Through multiple case studies, the author found that Leader Emphasis is one new social element in the field of the IS, while Participation, as another social element is essential to the context of this research project. These two social shaping elements, combining together within a model of STS, provide new decision making process, which is vital to a successful development of Mobile Health Information Systems (MHIS). The model has affected organisational behaviour, organisational structure, culture and society, following the usage of Mobile IS. Based on the result of the field work and the relevant literature of E-govemment, this research also concludes that M-govemment can be the transformation of E-govemment, as public service can be delivered efficiently by Mobile IS. A developing model is presented in this thesis.

This thesis tells the tale of a special group of healthcare 'customer service' workers called the Patient Advice Liaison Service (PALS). It looks at how their job is designed and explores the impact this has, on their wellbeing by using a mixed-method research design which includes one quantitative and one qualitative study. The starting occupational level study is based on quantitative data from 138 participants using a questionnaire that measures global wellbeing, job satisfaction and psychosocial work conditions. A high incidence of strain is reported, statistically higher than that of other customer service employees and more comparable to social workers. Psychosocial conditions at work are revealed to be dire and in need of urgent action; and yet, the same group of workers report satisfaction with their job. To further unwrap the complex lived experience of PALS workers, an individual level study was conducted. Interpretative phenomenological analysis was undertaken with nine participants. Four emergent themes affirm that when it comes to their job, others just don't really get it, especially the extent of their emotion work. Changing the NHS is compared to changing a super tanker's direction and participants confess to having had a breaking point. Nevertheless, PALS staff declare that this is a vocation and I wanna do it. Reflexive interpretations suggest that some customer service employees actually engage in rather complex work that is not easily captured by the broad 'customer service' label. For individuals engaged in this type of relational work emotion work was found to be both a source of distress and motivation. Comparisons between these healthcare workers and other public sector relational workers are made and the new discourse of expertise services is proposed. Theoretical and policy implications are discussed.

The diagnostic radiography curriculum and the process of its enactment are under researched in the United Kingdom. To date, there have been no published studies which have investigated the curriculum and the role of radiography educators from the multiple perspectives of radiography students, university radiography educators and clinical radiography educators, that is, a radiography education community. Accordingly, this study describes the perceptions and experiences of a radiography education community in relation to three research questions: 1. How does a radiography education community conceptualise the radiography knowledge and skills required of a diagnostic radiographer? 2. How does a radiography education community conceptualise the role played by university based and clinically based radiography educators in helping the radiography student acquire radiography knowledge and skills? 3. How does the community in this study compare with Lave and Wenger’s theoretical constructs of a situated learning, legitimate peripheral participation and Communities of Practice (CoP)? The epistemological foundation of the study is constructivism and the overarching methodology is a case study conducted within a single higher education institution and three of its associated clinical practice partner settings. The primary data collecting method comprised semi-structured interviews, supplemented by a critical review of germane literatures, government policy and the curriculum guidance provided by the relevant professional and statutory bodies. The theoretical framework in which the study is situated is based upon Lave and Wenger’s theories of situated learning, legitimate peripheral participation and communities of practice. The findings of the study reveal a radiography education community which is lacking any unifying pedagogic discourse. In particular, there is an absence of opportunities for cross-community working, especially in collaborative curriculum development and the process of its enactment. This is further compounded by the community’s narrow interpretation of what a curriculum should comprise. Currently there is a clear focus on knowledge content and curriculum as a product which fails to take into account praxis and the social context in which learning takes place. These findings have been summarised by a representation of the enacted curriculum as compared with the ‘ideological’ function of a radiography curriculum. Specific developments required of the curriculum include: (i) placing a greater emphasise on the vocational relevance of radiography knowledge; (ii) gaining a better understanding of tacit radiography knowledge; (iii) ensuring greater familiarity with the curriculum and (iv) enhancing the standard of clinical supervision. The radiography education community in this study evidences both convergence and divergence with Lave and Wenger’s theoretical constructs of situated learning, legitimate peripheral participation and community of practice. Within the context of radiography education the study also highlights the consequence of power relationships, the complexity of learning in and across multiple communities of practice and the importance of individual learner biographies, all of which are underdeveloped in Lave and Wenger’s theoretical discourse. These findings have been summarised in a proposed theoretical model for a radiography education community of practice. Three specific pedagogic and managerial inferences may be drawn from this study which will require staff development and consideration of how the diagnostic radiography programme is managed across the community. Firstly, context, process and praxis need to be carefully considered in the collaborative development, design and implementation of the curriculum. Secondly, the university and clinical educators need to reflect on their own learning and teaching skills by engaging more fully with pedagogy. Thirdly, communication across the radiography education community of practice must be improved.

There is a discrepancy between the life expectancy of men and women of approximately two and a half years (Taylor Nelson Sofres 2014). This suggests that women are likely to spend a period of time in the latter years of their life living alone. It is anticipated that this will lead to a unique experience of later life for women, which to date has received little attention. This study is concerned with exploring the experience of living alone for 11 women aged 70-80 years from the South East of England. A particular emphasis is placed upon the experience of being an older woman, the activities that they engage in when they are at home alone, and the environment of home as a place for occupational engagement. Influenced by interpretive phenomenology and feminist principles, this study focuses on capturing the lived experiences of the 11 women in their own images and words. To achieve this, the methods of unstructured interviews and photo-elicitation are used. The women in this study describe a predominantly positive experience of living alone in later life. They value being busy, engage in a range of meaningful activities, and maintain their independence in everyday life. They provide compelling evidence that later life is a time for self-growth and development. This appears to link to the decline in the gender related roles and occupations which are expected of them in later life. This indicates that it is essential to provide bespoke support to older women that focuses on prevention of future decline but in a way that values their ongoing abilities.

Parenting capacity assessments (PCA) have been used in the child intervention system in Canada since at least the 1970s. They are used in other Western jurisdictions including the United Kingdom, Australia, New Zealand and the United States. There is a relatively large literature that considers the ways in which these assessments might be conducted. This thesis, drawing upon the prior work of the candidate, seeks to show that, despite widespread use, the PCA is a colonial methodology that should not be used with Indigenous peoples of Canada. The PCA draws upon Eurocentric understandings of parenting, definitions of minimal or good enough parenting, definitions of family and community as well as the use of methods that have neither been developed nor normed with Indigenous peoples. Using critical theory, particularly "Red Pedagogy" which is rooted in an Indigenous lens, the PCA is deconstructed to examine applicability to Indigenous populations of Canada, and potentially other populations that do not fit a Eurocentric understanding of family and parenting. Implications for clinical practice with Indigenous peoples are drawn which may have relevance for other populations.