The aim of this project was to synthesise and characterise pillar[5]arenes, macrocycles comprised of 1,4-dialkoxybenzene moieties linked in the 1,5-positions by methylene bridges, and to incorporate them in a range of sensors. Pillar[5]arene-based ion-selective electrodes (ISEs) were used to detect protons, alkali metal cations and biogenic amines to investigate sensing properties resulting in the fabrication of a low pH sensor. Composite sensors incorporating 1,4-dimethoxypillar[5]arene were able to detect Na+ concentrations in the physiological range, whereas K+ concentrations were well above those encountered in vivo. The composite electrodes did not show significant differences in capacitance for biogenic amines making them suitable to detect Na+ and K+ over alkali metal ions and unaffected by the presence of biogenic amines. A novel thiolated copillar[4+1]arene was synthesised and attached to gold electrodes. It was tested against alkali metals and biogenic amines and was most selective to Li+ over other alkali metal cations. Copillar[4+1]arene-capped gold nanoparticles were synthesised and assessed for biogenic amine selectivity. Complexation occurred strongly with spermidine and spermine compared to pentylamine and putrescine. Overall, the common purpose of the research presented in this thesis was to assess the pillar[5]arene macrocycle for its selectivity of small molecules and ions, specifically alkali metals and biogenic amines of biological importance. The difference in the nature of ion selectivity by the same macrocyclic binding motif appears to be due to its arrangement and conformational freedom in the different types of electrodes. In the ISE, the crystalline macrocycle integrates with polyvinyl chloride (PVC) which makes the upper and lower rim functional groups available for complex formation. In composite sensors, the alignment of the macrocycles is very rigid making complex formation reliant on the guest fitting into the rigid macrocyclic cavity. On gold electrodes, one of the aromatic rings is involved in surface attachment with the remaining four free to change their conformations and bind guest species.

Oxygen is a requirement for almost all living organisms and adaptations to oxygen shortage are essential for surviving periods of oxygen deprivation, known as hypoxia. Cells have evolved a range of mechanisms which increase the supply of oxygen and facilitate metabolic alterations that enable the cell and the organism to maintain functionality under hypoxic conditions. Hypoxia is a hallmark of solid tumours and is associated with increased malignancy and mortality in hepatocellular carcinoma (HCC). Transarterial chemoembolisation therapy (TACE) using doxorubicin is the current standard of care for intermediate HCC, although response rates are poor. Drug eluting bead transarterial chemoembolisation (DEB-TACE) shows improved response rates over TACE. More recently, rapamycin has come under scrutiny as an effective therapy against HCC. Embolisation therapies have been shown to induce hypoxia in HCC, leading to the escape of hypoxia-adapted cancer cells from therapy. The principal transcription factor which orchestrates responses to hypoxia is hypoxia inducible factor 1 (HIF-1). Laboratory and clinical evidence support the hypothesis that HIF-1 activity contributes to cancer progression and increased mortality. Targeting HIF-1 therefore presents an opportunity for improving outcomes of cancer therapy. A hypoxic model of HCC was established, and used to characterise the responses of the cell line HepG2 to chemotherapeutic agents in both normoxic and hypoxic conditions. Firstly, the time and concentration dependent effects of doxorubicin, rapamycin and both drugs in combination on the viability of HepG2 cells cultured under both normoxic and hypoxic conditions were investigated. SDS-PAGE and Western Blotting was then used to evaluate the responses of HIF-1α, NFkB, S6K and Akt expression to doxorubicin, rapamycin and both drugs in combination in cells cultured under both normoxic and hypoxic conditions. Finally, the anti-tumour effects of doxorubicin, rapamycin and both drugs in combination were investigated in vivo using an ectopic xenograft murine model of HCC. The in vitro evidence presented in this thesis demonstrates that a concentration of doxorubicin relevant to clinical concentrations following DEB-TACE effectively inhibits the viability of both normoxic and hypoxic liver cancer cells. Also presented is in vitro evidence that low dose rapamycin inhibits the viability of both normoxic, and to a lesser extent, hypoxic liver cancer cells. The addition of low dose rapamycin to doxorubicin was consistently observed to have an additive effect on the inhibition of cell viability. Protein analysis demonstrated that low dose rapamycin inhibits the hypoxia stimulated accumulation of HIF-1α, as does high dose doxorubicin. However, inhibition of HIF-1α was attenuated when the two drugs were used in combination. Cytotoxic effects are not, therefore, wholly dependent on inhibition of HIF-1α. Inhibition of HIF-1α by each drug alone appears to be due to different mechanisms. This study also showed in vivo that combinations of doxorubicin DEB-TACE with either rapamycin DEB-TACE or oral rapamycin are more effective than either treatment alone at reducing tumour burden in a mouse model of HCC. Two clinical trials are now underway to investigate the combination of doxorubicin DEB-TACE and low dose oral rapamycin to treat HCC.

This scoping review examines the available evidence supporting accommodation use in the assessment of health professionals with disabilities in licensing contexts. While test accommodations are a protected right under antidiscrimination legislation, the peer-reviewed evidence informing their use is contested and widely dispersed. Furthermore, the ramifications of accommodation misuse are significant, including human rights violations and increased risks to patients. As such, this study addressed two research questions: 1) What is the current state of literature on accommodation use in the assessment of health professionals? and 2) What programs of research would address stakeholders’ concerns about the use of accommodations in the assessment of those professionals? Systematic searches of five prominent databases identified 15 articles for analysis. Several major themes emerged from that analysis: interpreting legislation, administration and process, relationships between education and licensure, and psychometrics and test development. Stakeholder consultation revealed that stakeholders face challenges managing accommodation requests and defining reasonable accommodations. While there is a paucity of literature on the topic overall, especially of an empirical nature, this study mapped the available evidence and laid the foundation for future studies by delineating the gaps in the scholarly literature as defined by stakeholders’ needs.

Identifying how policy proposals are selected by policy-makers is an important question for scholars. This thesis evaluates the use of discourse and the role of actors in the exchange of ideas to support interprofessional collaboration (IPC) among Ontario’s regulatory colleges. A variation of discourse analysis was developed, based on the seven areas of reality that are constructed by language, to evaluate the interactions between state and policy actors. I argue that actors did not appear to engage in meaningful discourse because the state established the parameters of the consultative processes, which suggests the expert consultative processes were tools to legitimize the policy process for Bill 179. The state appears to have increasingly greater control of both the content and context of policy- making in this field. Further evaluation of the interactions between health professional organizations and the state is needed to better understand the importance of discourse in the health policy process.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Anatomy Academy (AA) is a service-learning program in which pre- and current health professional students (Mentors) work in pairs to teach anatomy, physiology, and nutrition to children in the community. The purpose of this study was to investigate the short- and long-term Mentor outcomes in personal, social, civic, academic, and professional domains. Former Mentors were invited to complete a survey of Likert-style and free response questions evaluating the perceived impact of their AA experience on: teaching skills, personal and interpersonal development, civic engagement, and academic and professional development. Follow-up interviews with a subset of survey respondents were performed. The survey was completed by 219 Mentors and 17 survey respondents were interviewed. Over 50% of former Mentors reported moderate or major impact of AA participation on elements of personal and interpersonal development (e.g., selfesteem [57.6%], altruism [67.9%], communication skills [60.1%], and ability to work with others [72.6%]) and community service participation (54.2%) that endures in the years after the program. Mentors who worked with low-income or Special needs populations reported unique impacts in personal, interpersonal, and civic domains. A majority of former Mentors agreed that AA participation helped them learn practical skills (76.3%) and factual knowledge (65.4%) relevant to the their careers, with several current health professionals reported that they regularly employ teaching and interpersonal skills learned while Mentors in their roles as physicians, nurses, or physician’s assistants. A majority of former Mentors reported that AA validated their choice to either pursue a healthcare career or not (59.7%), increased their confidence in performing professional tasks (64.7%), and helped shape their professional identity (58.9%). These results indicate that a health education-based service-learning program offers undergraduate, graduate, and professional students interested in or actively pursuing a healthcare career benefits across personal, interpersonal, civic, and professional domains that support their academic progress and preparation for professional practice. This study contributes much-needed evidence of the long-term student outcomes of service-learning to the literature, with a particular focus on how the pedagogy can supplement the education and professional development of pre- and current health professional students.

Leadership in the health sector continues to be recognized as a key factor in improving healthcare and is considered part of professional competence in health professions. In dietetics, the Integrated Competencies of Dietetic Education and Practice, a document which informs dietetic education and professional development in Canada, was recently revised to include leadership as part of a new competency domain. But with limited research on dietetic leadership, it is challenging to develop and assess leadership skills in dietetic trainees and dietitians. My thesis addresses this gap by exploring how leadership is currently developed and used in practice through a three-phase qualitative design. The theoretical framework and conceptual model was pulled from complexity theory, leadership theory as well as feminist theory. The LEADS in a Caring Environment framework was used as the specific leadership framework. It is recognized as a comprehensive model for leadership in healthcare designed to embody the key skills, behaviours, abilities, and knowledge required to lead in all sectors and types of organizations. A multi-phase qualitative study was conducted, which included documentary analysis, one-on-one interviews with dietitians, and focus group interviews with dietetic educators. The methodology aligned with complexity science where interactions within and between the individual, micro-, meso-, and macro- levels were considered throughout the study. Furthermore, issues related to gender and other forms of diversity as crosscutting influences were considered. To inform this research, an expert committee comprised of dietitians from different practice areas was involved. Phase I included a documentary analysis of program documents and one focus group with dietetic educators to elaborate on their programs. In Phase II, using a multi-case study methodology, dietitians’ leadership skills development and use in practice were identified. Finally, Phase III focused on determining actions and implications of my research findings from Phases I and II through three focus groups with dietetic educators. The findings showed that dietitians tend to describe leadership in relation to having a formal management role. My study found that leadership skills have not been explicitly taught through dietetic education, but some are developed through transferrable skills that can be useful in leadership. The findings also demonstrated that dietitians use leadership skills in a variety of ways and contexts throughout their careers. All four cohorts provided personal examples of their leadership skills in practice that aligned with each of the LEADS domains and most of the capabilities. This might suggest that although dietitians were not formally taught leadership skills through their dietetic education, there is evidence that they possess and use leadership in their different practice areas throughout the career trajectory. This research furthers the scholarship on leadership development in dietetics and considers the complexities of leadership in a highly gendered system.

There is strong evidence that certain neurophysiological processes link action and observation (Higuchi et al., 2012), which supports the idea that learning a motor skill is enhanced via skill observation (Hayes et al., 2010). Skill learning through observation is optimized when the observation includes a combination of expert and novice models (Rohbanfard and Proteau, 2011). The purported advantage lies in the two types of models’ dissimilar ability (Andrieux & Proteau, 2013). The novice model is characterized by larger margins of error that manifest as variable attempts. Increased variability has been shown to be beneficial in physical practice (Moxley, 1979). The purpose of the first study was to examine the observation of novice variability effect to explore whether it is Schmidt’s (1975) generalized motor programs or schema parameterization representations that is acquired when observing modeled performances. Participants engaged in an observational period in which they observed a criterion model with no variability, a model demonstrating absolute timing variability, a model demonstrating relative timing variability, or a model demonstrating variability in both relative and absolute timing. The results indicate that variability in relative timing information contributes to observational learning, which suggests that generalized motor programs are acquired through observation but not schematic parameterizations. The purpose of the second study was to apply the Rohbanfard and Proteau (2011) paradigm in the medical education context by exploring the impact of video-based observational practice on the clinical learning. First year medical students learned a common surgical skill by observing expert demonstrations of the skill, novice demonstrations, or demonstrations by both an expert and novice model. The study demonstrated a robust effect of observational learning in that all groups improved over time regardless of the type of model they observed. Both studies highlight that an expert model may be the most beneficial when engaging in observational practice. / Thesis / Master of Science (MSc)

Yes / Consultant radiographer numbers remain low despite the ongoing capacity challenges in diagnostic imaging. This is compounded by the limited evidence of how such roles can positively impact on service delivery, particularly in relation to their leadership expectations. Aims: To examine the activities undertaken by consultant radiographers; evidence the impact of the roles, and consider whether the roles encompass the four domains of consultant practice. Method: Six consultant radiographers employed in a single NHS Trust completed an activity diary over a period of 7 days. Interval sampling every 15 minutes enabled the collection of a large volume of complex data. Findings: All consultants worked beyond their contacted hours. The documented activities demonstrate the breadth of the roles and confirmed that the participants were undertaking all four core functions of consultant practice. Conclusion: The impact of the roles stretched beyond the local department and organisation to the health system and wider profession.

Thesis (MPhil)-- Stellenbosch University, 2013. / Introduction: The close interrelation between the processes of learning, assessment and feedback has been recognized and supported extensively in the educational field for many decades. The benefits of the feedback as a strong tool for facilitating learning have been corroborated by learning theories and educational research. The introduction of Problem- Based Learning (PBL) approaches to higher education programmes, especially in medical training, is a worldwide trend. The PBL approach to learning brings new perspectives to the specific characteristics and values of feedback on learning and the quality of learning and thus, more especially to the role of the tutor as learning facilitator. Purpose: To explore the medical students’ perception of the role and utility of the verbal feedback provided by the tutor to students during the PBL tutorial sessions; and the students’ perceptions on how to improve the effectiveness of the feedback. Methodology: This study used a qualitative and interpretive methodological approach. The qualitative data collection tool used was the focus group discussion. The study was conducted at the Walter Sisulu University in the Eastern Cape province of South Africa, where the faculty of Health Sciences has implemented the PBL approach for training. The research targeted the students in the third year of the MBChB program. Results: Students’ perceptions on the role of the tutorial feedback suggested that they strongly acknowledge its value: they see it as a tool for improving their learning skills and also as an enhancer of their learning motivation and regulation. The students also perceived it as instrumental in the modelling of programme-specific professional skills which would be required in their future medical practice. Students’ expectations from PBL-tutors feedback are quite high and comprehensive regarding both the kind and the nature of the feedback. Students perceived that the imperfections in the feedback received during tutorial sessions were a source of emotional discomfort and a hindrance to their learning success. The students’ need for clear, timely and regular provision of feedback, based on specific learning outcomes, was also highlighted. The participants’ recommendations for improving the efficient use of feedback included the regularization of the feedback practices across the different tutors and an increase in the allotted time for self-directed learning in their schedule. Conclusions: The results of this study support the need for a socio-constructive learning environment to ensure successful learning in PBL. Among other conditions, the harmonious provision of balanced, supportive and motivating feedback is a complement for the establishment of a learning environment conducive to learning. Similarly, students highlighted the need for highly skilled PBL-trained tutors, to enable them to self-monitor and self-regulate their learning, and ensure learning success via the facilitation and feedback. Higher Education Institutions using PBL training must identify and address factors limiting the effectiveness of the feedback and the overall quality of learning such as increased staff workload, increased demand for resources and modularization of courses. Recommendations: Higher education institutions using PBL training should address the need for training of tutors in the different aspects and practices of the feedback in the specific settings of the small group tutorial. External factors interfering with the effective use of tutors’ feedback should also be considered to minimize their negative impact on students’ learning. A regular process of curriculum enquiry is required to ensure the constructivist alignment of the different curricular components and overall design as a condition for the successful implementation of PBL.