This doctoral study explores what being a professional in child protection social work actually means to those working within this context. In an attempt to unravel the meaning of professional identity for social workers, I carried out an ethnography ‘at home’. But in order to create that passage of space and time between me and the discourse I currently employed, I also decided to observe the Flemish child protection system. This study has, therefore, a comparative element. My analytic focus has been drawn towards certain cultural factors which impact upon and influence the ways practitioners construct their identities. By considering where professionals are located, in the North West of England and Flanders, I wanted to explore the systems for which they work; systems embedded in unique yet diverse cultures which collectively impact on the practitioner in some shape or form. Data analysis has involved material from interviews, naturally occurring talk, electronic information (case notes, reports and emails), photographs, organisational policy and procedures. The findings demonstrate that social workers in England are firmly situated within an incongruent agency which is entrenched in a context of blame. Subsequently, a blame posture has been established which further encourages various forms of destructive discourse to emerge. Practitioners also find they are stigmatised and labelled as professional failures by both society and the agency they work for. In Flanders, however, by drawing from a discourse which evokes compassion for abusers, child protection professionals perceive themselves differently. As well as feeling confident and passionate about their practice they feel valued and revered by their agency and society. If our identity is constructed out of the discourses which are made culturally available to us then this comparative ethnography shows just how and why the practitioners from these two settings perceive their own professional identities so considerably differently.

There is a paucity of research examining the use of psychological skills and strategies within strength and conditioning, this is despite research evidencing the effectiveness of psycho-physiological interventions which would be pertinent to the objectives of the strength and conditioning practitioner. The purpose of this project was to examine the use of psychology within the strength and conditioning environment from the perspective of the strength and conditioning coaches themselves. Specifically, this project assessed the most important psychological aspects, the most frequently used skills, barriers to the use of psychology, and the psychology knowledge base for the strength and conditioning community. Finally, an experimental protocol evidenced the efficacy of employing misinformation within strength and conditioning. The project revealed that psychology was more commonly used by more experienced professionals, nevertheless there was considerable disparity in the frequency with which psychological skills and strategies were used, with particular strategies being used significantly more than others. This was consistent with subsequent in-depth phenomenological exploration which revealed that strategies to promote confidence, skill acquisition, and regulate arousal were most frequently used. It was evident that there was uncertainty between practitioners as to the role responsibilities and the ethical boundaries associated within strength and conditioning. Furthermore, a lack of understanding was identified as the largest inhibitory factor. Finally, guidelines are proposed as to what changes are required to facilitate the use of psychology within strength and conditioning. These comprise the increased use of continual professional development with workshop sessions developed by appropriately qualified psychologists. Equally the use of collaborative links with qualified psychologists was suggested as beneficial.

The main objective of the thesis was to explore how social work Approved Mental Health Professionals accomplished social work identity when seconded to Mental Health Trusts. The project has examined the identity work that the social workers engaged in as they located themselves within interprofessional interagency community mental health teams. Insights from ethnomethodology and conversation analysis have been used to examine the interview data. Following Wieder (1974), the findings chapters are presented in two parts. In the first part, the focus is on the interviews as a resource and thus there is a more traditional reporting of what the social workers talked about in the interviews. Throughout the interviews, the social workers were concerned to delineate what was ‘real’ social work. Real social work was depicted as involving autonomous work in the community with mental health service users; this is the ‘authentic realm of social work’ (Pithouse 1998 p.21). Social work identity was portrayed as intrinsic to the self with congruence between personal and professional identity and values. However, the social workers struggled to define social work. Instead of having a clearly defined role, social work was depicted as intangible; as being without clear margins and boundaries, filling in the gaps left by other professions. Notions of ‘dirty work’ (Hughes 1948) and the implications of being seconded to a Health Trust are also discussed. The analytic focus shifts in the second part to the interview as a topic, specifically to how social work identity was accomplished within the interview as interaction. Matters such as being a member, the part played by the use of humour in the interviews, and the interaction as a research interview are explored. Finally, there is an examination of how social work identity was accomplished through the telling of atrocity stories.

Modelling human gait has become an invaluable tool in a wide range of fields such as robotics and rehabilitation. With progress in computing, model complexity has advanced quickly but nevertheless, the contributions of incremental increases in model complexity are poorly understood. This thesis addresses this through a series of modelling studies. The first investigation examined the advantages and disadvantages of inverted pendulum (IP) models of walking, using a forward dynamics approach, by comparing to a normal set of experimental gait data. It was shown that the biggest failing of these models is their inability to adequately simulate double stance. The second investigation sought to highlight the effects of additional model complexities on the kinematics and kinetics, using optimisation. The additions, added one-by-one, were a knee joint, an ankle and static foot, a moving foot and a swing leg. The presence of a knee joint and an ankle moment were shown to be largely responsible for the initial peak in the vertical ground force reaction (GRF) curve. The second peak in this curve was achieved through a combination of heel rise and the presence of a swing leg. This gave mathematical evidence for the true determinants of human gait. A double support model was produced next, using a novel method to constrain both feet to the ground and calculate the GRF distribution. This was run in conjunction with the best single support model to simulate a whole gait cycle. Despite the problem of discontinuities at the transitions between double and single support, the whole gait cycle simulation had mean kinematic and mean GRF errors of less than a single standard deviation from the normal experimental data set. The final study collected gait and anthropometric data from ten subjects, which was then applied to the full gait cycle model. The model was shown to be adaptable to different people; a property that would be important for any computational model to be used in clinical assessment and diagnostics.

Introduction Intermittent claudication (IC) is a condition which affects people with peripheral arterial disease in the lower limbs and causes calf muscle pain and limping due to the lack of blood supply to the gastrocnemius muscle in particular. This limits the distance people with IC (known as claudicants) can walk before having to stop because of the pain. The accepted best treatment currently is enrolment onto supervised exercise regimes, but these provide limited improvement and do not alter their antalgic gait. This study aims to investigate the effect of specific footwear designs on gait and lower limb muscle function with the intention of identifying which features would be recommended for inclusion in footwear designed to relieve their painful symptoms by offloading the calf muscles. Method Fifteen volunteer healthy subjects, age range 20-29 years (mean 25.3 ± 2.73) undertook a series of gait laboratory trials with shoes adapted with specifically-chosen outsole features. High street shoes were adapted with the test conditions which included shoes with five different heel heights (varying from a 1.5cm to 5.5cm heels), two heel profile conditions (curved and semi curved heels), three traditional (angled) rocker soles with varying apex positions (55%, 62.5% and 70% of shoe length) and three with varying apex angles (10, 15, and 20 deg.), plus three with different forepart sole stiffness (solid, semi-flexible and flexible). The baseline shoe was taken as being one with no heel curve, a heel height of 3.5mm, an apex position of 62.5% of shoe length, and apex angle of 15 deg. and a stiff forepart to the shoe. Measurement and comparisons were taken of lower limb kinetics and kinematics (Qualysis, Sweden) plus electromyographical (EMG) activity (Noraxon USA) of medial gastrocnemius, soleus, tibialis anterior, rectus femoris and biceps femoris during walking trials where the walking speed was controlled using timing gaits. Data were analysed using Visual3D and OpenSim software to enable interpretation of EMG activity to enable calculation of lower limb muscle function during gait. Results Changes from the baseline shoe were taken as being at a level of significance of p<0.05. The most effective footwear test condition in regards to offloading of the calf muscles compared to the control shoe was that with a 4.5cm heel, a 55% of shoe length apex position, and a 20° rocker apex angle; which demonstrated significant offloading to the calf muscles. The 55% apex position had a significant offloading influence on the calf muscles whilst at the same time not significantly altering knee and hip kinematics. Conclusion This study demonstrates that a potentially useful shoe design was identified for treatment of claudicant calf pain which did not adversely affect more proximal joint kinetics and kinematics.

The human heel pad is subject to repetitive loading and plays an important role in absorbing shocks which may cause injuries. The heel pad has a composite biological structure consisting of the fat pad and the skin. The fat pad tissue is organised into a superficial micro-chamber layer and a deep macro-chamber layer. The heel pad sub-layers have different structures and properties. Hence, to understand the contribution of each layer to the heel problem, it is essential to develop a model with discrete structure. Currently, only plantar pressure measurements are used for diagnosis and treatment of the heel problems, whereas it has been shown that high internal tissue stress is an important factor. Because of complex geometry, discrete structure and nonlinear material behaviour of the heel pad, the external force applied to the heel may result in inhomogeneous internal stress condition. Therefore, the relationship between the plantar pressure and internal stress does not seem to be simple. Since there is no equipment to allow measurement of internal stress, a detailed multi-layered FE model of the heel pad can be used as a solution to predict the internal stress. The main objective of this work was to obtain the hyperelastic and viscoelastic material properties of the subject-specific heel pad sub-layers in-vivo. For this purpose, a combined methodology of finite element modeling and experimentation was developed. An anatomically detailed 3D FE model of the human heel area was developed using MR images of the right foot of a female subject. A combined ultrasound and indentation system was used to apply series of slow and rapid compression tests on the same foot. The forcestrain responses of the heel pad and its sub-layers were used as input to the FE model to estimate properties of the heel pad sub-layers using inverse FEA. The hyperelastic and viscoelastic FE models were then implemented to investigate the effects of experimental and geometrical factors on the heel pad responses. The model was also used to assess the robustness of the hyperelastic FE model when predicting the behaviour of other heels with different geometries. Finally, this model was used with Taguchi method to evaluate the effect of footwear design factors on the compressive stress in the heel pad tissue. There were some key limitations in this study. For example, the properties of the heel pad sub-layers were estimated only for a specific heel pad. Also, whilst it is preferred to use xviii automatic segmentation and solid modeling to improve repeatability of some FE processes, some parts of the modeling process were performed manually.

The knee is the joint which is most affected by osteoarthritis (OA). Knee OA is more common in older individuals and occurs more in the medial than the lateral compartment. When we stand, walk or climb stairs, our weight is transmitted through our knee joints and this is known as load which is higher in individuals with medial knee OA than healthy counterparts. Additionally, muscle weakness is a factor in medial knee OA and previous work has demonstrated increased muscle co-contraction in these patients. In this thesis we assessed the loading on the knee joint and muscle co-contraction after wearing an assistive device (a valgus knee brace) which is a common treatment in this disease. Whilst previous literature has demonstrated changes in loading with valgus knee braces during over-ground walking, no studies (to date) have assessed the effect of valgus knee braces on knee loading and muscle co-contraction during ascending and descending stairs immediately, and after a period of use. In addition, it is an un-documented opinion that knee bracing affects muscle strength and control around the knee and weakens the joint so this research also aimed to confirm or refute this theory. To accomplish the research, we performed three separate trials; a) a repeatability trial in seven patients to determine the reliability of the outcome measures for the future study; b) a clinical trial of fifteen individuals with medial knee OA would wore a valgus knee brace for a period of three months with an interim assessment at six weeks for pain and muscle strength/function; c) finally, a small pilot study of seven patients investigating combined orthotic treatments on biomechanical outcome measures. In summary the results of this thesis have demonstrated positive biomechanical and clinical outcomes when wearing a valgus knee brace for a sustained period. This was further improved biomechanically with the combination treatment with a lateral wedge insole which reduced knee loading more during stair ascent and descent, in comparison to the orthotic devices alone in the same session. Future studies to find out the effect of a combination of an off-the-shelf valgus knee brace and off-the-shelf lateral wedge insole on knee loading, clinical and radiological outcomes after a period of longer wear were indicated.

Staphylococcus aureus is a major pathogen in both hospital and community settings and it causes infections ranging from mild skin and wound infections to life-threatening systemic illness and, together with the emergence of antibiotic resistance, has been a major cause of morbidity and mortality worldwide. The stringent response, is a stress response that bacteria display to avoid death when subjected to amino-acid starvation. This phenomenon has been observed in different species among Gram positive and Gram negative bacteria but relatively few studies have observed the stress response in Staphylococcus aureus. The stringent response can be triggered by treatment with mupirocin, an antibiotic that mimics amino-acid starvation by inhibiting isoleucyl tRNA synthetase. In this project S. aureus 8325-4 was exposed to sub-inhibitory concentrations of mupirocin (0.5 MIC = 0.25µg/ml-1) to investigate the ability of this concentration to trigger the stringent response. The treatment with mupirocin was continued up to 24 h as previous studies only examined short periods of treatment. Growth was inhibited and the stringent response nucleotide ppGpp was detected 1 h after treatment which slowly decreased in concentration for up to 4 h combined with significant growth inhibition. However, ppGpp could not be detected at 12 or 24 h whereas growth resumed. In addition, the effect of sub-inhibitory concentrations of mupirocin was observed on the TSST-1 producing S. aureus clinical strain (B49). Q-PCR showed up-regulation of tst gene, codes for TSST-1, and its regulator RNAIII transcription up to 8 h of exposure relative to controls, the toxin was not detected by Reverse Passive Latex Assay. Further, RNA-seq analysis was used to observe the global transcriptional alterations caused by the stringent response in S. aureus at 1, 12 and 24 h. From the whole transcriptome profile, differentially expressed genes relative to control as well as from comparisons between treated cell time points were observed concentrating on 60 virulence genes and stress related genes that were significantly increased through stringent response status (1 h). Although ppGpp was not detected at 12 h, cells were still under the influence of the stringent response. However, cell growth had resumed by 24 h which indicates recovery after exposure to sub-lethal concentrations of mupirocin. The effect of the sub-inhibitory concentration of mupirocin on global gene expression in S. aureus is discussed in relation to global control of gene expression and clinical use. In addition, a scenario for S. aureus recovery from stringent response has been suggested here which might open doors for drug target determination in the future.

The antibacterial activities of different thin films (TiO2/CuO, Cu/SiO2 and Ag/SiO2) prepared by flame-assisted chemical vapour deposition (FACVD) and atmospheric pressure thermal (APT-FCVD) for TiO2/CuO films, were investigated against standard strains of bacteria used for disinfectant testing and against multi-antibiotic resistant bacteria that have been shown to persist in the hospital environment. These included; MRSA strains (EMRSA15 and two recent clinical isolates MRSA 1595 and MRSA 1669), extended spectrum β-lactamase (ESBL) producing Escherichia coli, a second (ESBL- 2 ) producing Escherichia coli, KPC+ (carbapenemase producing) Klebsiella pneumoniae, Stenotrophomonas maltophilia, Acinetobacter baumannii, Listeria monocytogenes, Salmonella enterica ser typhimurium, and vancomycin resistant Enterococcus faecium (VRE) . The Antimicrobial activity of the above coatings (Cu/SiO2 and Ag/SiO2) was investigated based on the BS ISO 22196:2009 and 2011 Plastics – Measurement of antibacterial activity on plastics and other porous surfaces. The activity of TiO2/CuO films was investigated based on the BS ISO 27447:2009 Test method for antibacterial activity of semiconducting photocatalytic materials. On the TiO2/CuO films, the bacteria were killed by UVA irradiation of the photocatalyst with a >5 log kill within 4-6 h except for the MRSA where a 2.3 log kill was obtained after 6 h increasing to >5 log after 24 h. There was antimicrobial activity in the dark which was enhanced by irradiation with fluorescent light. There was also activity at 5ºC under UVA but activity was lower when fluorescent light was used for illumination. The Cu/SiO2 coating showed a >5 log reduction in viability after 4 h for the disinfectant test strain (E.coli) and for some pathogenic strains include; Acinetobacter baumannii, Klebsiella pneumoniae and Stenotrophomonas maltophilia. However, their activity against the other hospital isolates was slower but still gave a >5 log reduction for extended spectrum β-lactamase producing Escherichia coli and Salmonella enterica typhimurium, and > 2.5 log reduction for vancomycin resistant Enterococcus faecium, Listeria and methicillin resistant Staphylococcus aureus within 24 h. The coating was also active at 5ºC but was slow compared to room temperature. The highest activity of copper /silica films was seen at 35ºC, but bacterial cells were also killed on the control surfaces. The Ag/SiO2 coating was also active against pathogenic bacteria; however the coating was not hard or durable as other coatings used. The activity on natural contamination in an in use test in a toilet facility was also determined for coated ceramic tiles (Cu/SiO2 and Ag/SiO2) and coated steel. The results demonstrated that the tiles were highly active for the first 4 months period and the contamination was reduced by >99.9%. However, tiles lost some of their activity after simulated ageing and washing cycles. The Cu/SiO2 coated ceramic tiles placed in Manchester Royal Infirmary also showed antimicrobial activity and no indicator organisms were detected. The coatings had a good activity against both standard test strains and clinical isolates. The coatings (copper surfaces in particular), may have applications in health care by maintaining a background antimicrobial activity between standard cleaning and disinfection regimes. They may also have applications in other areas where reduction in microbial environmental contamination is important, for example, in the food industry. However, the optimum composition for use needs to be a balance between activity and durability. Keywords: TiO2, CuO, Ag, Antimicrobial; Chemical vapour deposition; Copper; Disinfection surface; Pathogenic bacteria (hospital pathogen).

The research in this thesis investigated the independent effects of changing heel height, forefoot shoe volume and upper material stiffness on plantar pressures and comfort in ladies raised heel shoes. Plantar pressure is widely associated with comfort and foot pain including conditions such as subchondral bone microfractures, cartilage degeneration, osteoarthritis, hallux valgus, plantar calluses, metatarsalgia, morton’s neuroma, and hammer toe. Reducing peak plantar pressure at localised foot regions is therefore an aspiration of footwear manufacturers and health professionals alike. As a precursor to the primary investigations, protocols for measuring plantar pressure were investigated. Specifically, how long it takes for a participant to acclimatise to new footwear and how many steps must be measured to provide valid plantar pressure data are research design issues not thoroughly resolved by prior research. In the first study within this thesis it was found that 166 steps per foot were required to acclimatise to unfamiliar footwear. Also, that data from 30 steps should be collected to ensure sufficient data for a representative step could be accurately calculated (within error of +/-2.5%) assumed The second study investigated the effects of incremental increases in heel height and upper material stiffness on comfort and plantar pressure. It was found that an increase in heel height of 20mm was required for a significant 19% increase in plantar pressure at MTP1 in shoes which have a heel height under 55mm. A significant increase in pressure was observed with just a 10mm increase in heel height for shoes over 55mm. Similar, though smaller, effects were observed for perceived comfort in different heel heights. The third study investigated the effects of shoe volume and upper stiffness on comfort and plantar pressure. It was found that an increase in shoe volume increased the pressure at the MTP1 and reduced it at the heel. There was also a volume, the medium volume shoe, which clearly produced the significantly lowest pressure at the MT24 (275kPa medium shoe compared to 289kPa and 305 kPa in the smallest and largest volumes respectively). A significant interaction between shoe volume and material stiffness was also observed: when the material stiffness is changed the amplitude of the effect due to volume is magnified. Of the three footwear features investigated heel height has the greatest significant effect on both comfort (74% increase in overall discomfort for 35mm to 75mm heel height) and plantar pressure (33% increase at MTP1 between 35 and 75 mm heel height), followed by shoe volume then upper stiffness. There was a clear relationship between plantar pressure and comfort and the results suggest that shoes with an effective heel height over 55mm should be considered different from those with heel height less than 55mm. This serves to define a “high heeled“shoe. To ensure that set measurements could be defined investigations into the effects of heel height were completed with only one shoe size. Thus for other shoe sizes scaling may be required. The results of this thesis will improve the quality of future investigations because it has provided guidelines on the required number of steps to acclimatise to unfamiliar footwear, and the number of steps required to produce an average representative step. Also, to the benefit of researchers, the results of this thesis have highlighted the difficulty in controlling features of footwear such as the stiffness of the upper material whilst simultaneously demonstrating the importance of controlling this feature. For both shoe manufactures and research these results have shown the effect of a systematic increase in heel height which has enabled the first pressure and comfort based definition of a high heeled shoe. From this information designers will have a greater understanding of how their designs will have an effect on the plantar pressure and comfort experienced by the wearer.