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The Electrocardiogram (ECG) reflects the activities and the attributes of the human heart and reveals very important hidden information in its structure. The information is extracted by means of ECG signal analysis to gain insights that are very crucial in explaining and identifying various pathological conditions. The feature extraction process can be accomplished directly by an expert through, visual inspection of ECGs printed on paper or displayed on a screen. However, the complexity and the time taken for the ECG signals to be visually inspected and manually analysed means that it‟s a very tedious task thus yielding limited descriptions. In addition, a manual ECG analysis is always prone to errors: human oversights. Moreover ECG signal processing has become a prevalent and effective tool for research and clinical practices. A typical computer based ECG analysis system includes a signal preprocessing, beats detection and feature extraction stages, followed by classification. Automatic identification of arrhythmias from the ECG is one important biomedical application of pattern recognition. This thesis focuses on ECG signal processing using Independent Component Analysis (ICA), which has received increasing attention as a signal conditioning and feature extraction technique for biomedical application. Long term ECG monitoring is often required to reliably identify the arrhythmia. Motion induced artefacts are particularly common in ambulatory and Holter recordings, which are difficult to remove with conventional filters due to their similarity to the shape of ectopic xiii beats. Feature selection has always been an important step towards more accurate, reliable and speedy pattern recognition. Better feature spaces are also sought after in ECG pattern recognition applications. Two new algorithms are proposed, developed and validated in this thesis, one for removing non-trivial noises in ECGs using the ICA and the other deploys the ICA extracted features to improve recognition of arrhythmias. Firstly, independent component analysis has been studied and found effective in this PhD project to separate out motion induced artefacts in ECGs, the independent component corresponding to noise is then removed from the ECG according to kurtosis and correlation measurement. The second algorithm has been developed for ECG feature extraction, in which the independent component analysis has been used to obtain a set of features, or basis functions of the ECG signals generated hypothetically by different parts of the heart during the normal and arrhythmic cardiac cycle. ECGs are then classified based on the basis functions along with other time domain features. The selection of the appropriate feature set for classifier has been found important for better performance and quicker response. Artificial neural networks based pattern recognition engines are used to perform final classification to measure the performance of ICA extracted features and effectiveness of the ICA based artefacts reduction algorithm. The motion artefacts are effectively removed from the ECG signal which is shown by beat detection on noisy and cleaned ECG signals after ICA processing. Using the ICA extracted feature sets classification of ECG arrhythmia into eight classes with fewer independent components and very high classification accuracy is achieved.

The focus of this research study is occupational therapy students’ perceptions of employability and professionalism. Using some key principles of grounded theory, data was collected through the Ideal ***Inventory (Norton 2001), through a focus group and through seven individual interviews with final year students on a part time BSc (Hons) Occupational Therapy degree programme. The thesis maps two journeys, that of the researcher from novice to more experienced and that of the student occupational therapist from recruitment to graduation examining the trajectory of development for both. The thesis focuses on some pertinent methodological issues around researcher distance and creativity in the study; the term used for this is contamination. The work of Charmaz (2006) on constructivist grounded theory and Clarke (2005) on situational mapping in grounded theory have been used to provide reference points in my research to support the researcher’s engagement with data. It is suggested that the research is situated in the borderlands of modernist and postmodern ideas. There is a critique which focuses on theory, its value and purpose in the study and in grounded theory more generally. Analytical tools and the way in which these support understanding of the data are also debated. Relational Situational Maps (Clarke 2005) were used to engage and display data, to show assumptions about relationships between data and to highlight sites of contamination. Mapping the data in this way has assisted in the researcher to see the data differently and to engage with it more interestingly. Consideration is given to the interpretation of meaning in the data analysis, including the labelling of categories and sub- categories and the consequences of this for dissemination. A greater understanding of professionalism for occupational therapy students has been gained by undertaking the study and the importance of role models, authenticity, a prospective professional identity, personal values and the alignment of these to professional ones are discussed. Individual conceptualisations of professionalism alongside external professional regulation are also considered. Recommendations for curriculum development as a result of this study have also been identified.

Rationale: Mammography practitioners control the amount of compression force applied to the breast. There are no quantifiable recommendations for optimal compression force levels for practitioners to follow. Clients report variations in pain and discomfort when compression force is applied. Until now practitioner compression force variability has not been investigated; even though this might lead to variations in client pain and discomfort. The primary purpose of this thesis was to investigate whether practitioner compression force variability exists. Method: Three research papers investigated practitioner compression force variability: one used a cross sectional design; two used longitudinal designs, one was single centre and the other was multicentre. Three further research papers investigated important issues which might confound practitioner variability results: the first investigated compression paddle bend and distortion; the second investigated how breast thickness and compression force vary; the third evaluated practitioner ability to grade breast density, visually. The final research paper was a ‘within client’ investigation to determine how image quality varied with breast thickness and compression force. Key findings: The research firmly demonstrates that practitioner compression force variability exists. Multicentre analysis (4500 client visits) confirmed two out of three screening sites with significant practitioner variability, with the third screening site having a minimum dictate of compression force at 100N. As displayed by MLO/CC projections clients underwent a 55%/57% (site one), 66%/60% (site two) and 27%/26% (site three) change in compression force through their three screening visits. The research confirmed that the compression force received by a client was highly dependent upon the practitioner, and not the client. Within an individual clients screening pathway the research has demonstrated that clients could receive significantly different compression force levels over time. Conclusion and further research: For the first time practitioner compression force variability has been identified. Novel methods for reducing breast thickness need investigating; an example of a novel method is the use of pressure rather than force.

Cough is a common symptom of respiratory disease. Assessment of antitussives has relied mainly on animal studies and clinical trials in which recording of natural cough is difficult. This thesis describes the use of ultrasonically nebulized distilled water (UNOW) to induce cough in man. Investigation of the chemosensitivity of this response identified that extremes of pH, a chloride concentration below 75mmol/l, but not changes in osmolarity induce cough which reflects afferent rapidly adapting recep~or sensitivity in animal studies. Inhaled beta-adrenergic and anticholinergic bronchodilators, which inhibit cough in asthma, markedly reduced UNOW-induced cough in both healthy and asthmatic volunteers. Bronchoconstriction with inhaled leukotriene 04, which constricts both asthmatic and non-asthmatic airways, also caused coughing. Inhibition of bronchoconstriction either specifically or non-specifically resulted in inhibition of cough. Nedocromil sodium and the diuretic, frusemide, but not the commonly prescribed opiate, codeine, exhibited antitussive activity. Cough was also induced by inhalation of the C-fibre stimulants, capsaicin and prostaglandin E2 (PGE2), which was characterised by studies of adaptation, cross-adaptation and antitussives. UNOW and PGE2, but not capsaicin, exhibited rapid adaptation of cough. Crossadaptation, however, did not occur suggesting distinct mechanisms of cough mediation. Nedocromil inhibited capsaicin-induced cough but not PGE2-induced cough, while fenoterol did not affect either challenge. Oxitropium, which inhibited UNOW-induced cough, did not reduce cough associated with upper respiratory tract infection. Cough can be induced by a variety of inhaled stimuli. These can identify differences in response which may signal a number of pathways leading to cough. Antitussive activity may also be specific to individual challenges. This diversity in response reflects the complex neurological organisation of cough and may be related to pathological causes of cough.

This thesis presents an action research study concerned with strengthening decision-making within a councillor model of shared governance in a UK hospital trust. Shared governance seeks to flatten traditional hierarchies by empowering clinical staff to make decisions affecting policy and practice. Chapter 1 sets the scene for this exploratory case study through identification of the national and local health care context. The model of shared governance chosen for investigation is presented. An overview of the thesis is given. Chapter2 presents a literature review of shared governance framed by undertaking of a concept analysis. Existing evidence concerning shared governance and decision-making is examined. Chapter 3 considers methodology issues and justifies the selection of a qualitative approach that embraces action research as a means of promoting integration of findings into decision-making practice. Chapter4 sets out the methods used to collect data in response to the research questions. Issues around access to the research setting are discussed. Sampling decisions are made explicit and a description of the data collection process is given. Extensive use has been made of participant-observation as well as interview techniques. Chapter5 presents adetailed narrative of the approach to analysis centring on the use of basic and advanced data displays to aid qualitative data analysis. Chapter 6 details the study findings and culminates in the presentation of a conceptual model of shared governance decision-making. Chapter7 provides a substantive reflective narrative concerning my research practices and experiences throughout the action research journey, and the impact of these on my personal development. Chapter8 discusses the study findings in light of a summative review of the literature and evidence around shared governance and decision-making. Implications for practice and policy are identified along with areas for future research.

The starting point of this thesis is an examination of recent changes in public service provision of services for women who have experienced rape. I focus on the Sexual Assault Referral Centre (SARC) in Manchester, using this case to open up discussion about the 'treatment and 'management' of rape. The SARC is a joint initiative between police and Health Authority and I look at their respective interests in the centre. My central argument in the thesis is that the recent British interest in services for those who have been raped/sexually assaulted, and the consequent growth of these services, reflect a particular medical ideology of rape which in general is not helpful to women, while recognizing that individual women may benefit. I develop this thinking to argue that service provision of this kind seeks to pathologize women by treating their reactions to rape as an 'illness' which needs medical intervention to be 'cured'. Drawing upon analogous work in medical sociology I show that women who fail to fit this model are further pathologized within the medical system. I locate my argument in an examination of the national and local contexts which I seek to demonstrate provided the catalyst for changes in police handling of rape investigations. I argue that arising out of these circumstances the police have sought to establish their 'professionalism', using this as an ideological support for their practices. I look at the concept of professionalism and how it is used by police and medical personnel in their dealings with other associations which work in the field of sexual assault and victim support. This analysis covers the areas of professional attempts to incorporate the work of feminist groups but without the political analysis informed by feminism; the pressure on feminist groups to 'professionalize'; the relation between voluntary associations working in the field of crime and assault, in particular the relationship between Victim Support Schemes and Rape Crisis Centres; the policies used by Government for funding work in the field of sexual assault and other crimes. The thesis concludes with an assessment of the workings of the SARC and the irrlicat ion that I see for women's issues.

The present research aimed to assess the effects of a novel type of orthosis, the Dynamic Ankle Foot Orthosis (DAFO), on the balance and gait characteristics of hemiparetic subjects. The DAFO is a low splint with a custom-moulded insole, which is believed to support foot alignment, ankle supination-pronation and provide minimal restriction of the ankle joint flexion-extension. It was hypothesised that DAFOs improve motor behaviour after stroke involving the acquisition of standing balance (hypothesis I) and gait (hypothesis II) compared with using shoes. It was proposed that users' subjective opinions of DAFOs would support the findings of the device's ability to modify human performance such that they are beneficial when used as a part of rehabilitation management for stroke patients (hypothesis III). Twenty-two stroke subjects were randomly allocated to experimental (with DAFO and shoes-only) and control (using shoes-only) groups. Subjects followed twelve weeks of experimental trials comprising three data collections. The testing procedure was developed from preliminary work, which involved a pilot study and reliability tests. Standing balance was measured using forceplatform apparatus. The parameters investigated were: the velocity and sway index of the CoP, and F(mean), F(sd) and F(slope) of shear forces. Kinematic gait performance was assessed using a 3-D four-camera motion measurement system. The parameters studied were: the gait velocity, stride length, step length, cadence, and single stance phase, together with the minimum/maximum values of the angular displacement and velocity of the foot, shank, and thigh segments in the saggittal plane during two strides. An open questionnaire was used to evaluate subjects' opinions regarding the use of DAFOs. Overall, the quantitative studies did not identify consistent and statistically significant differences between the two experimental situations for these groups of patients. In the studies of balance, none of the parameter comparisons analysed within- and between- groups achieved statistical significance. In the studies of gait, statistically significant differences were identified for some (but not all) parameters. It is unknown whether any single or combination of balance and gait variables can be used to describe human gait entirely. On this basis, hypotheses I and II were rejected. However, these are tentative conclusions. Thus, difficulties in maintaining the stroke subject cohort number for these studies meant that the analyses probably lacked sufficient statistical power to detect small but potentially important differences in DAFO mediated actions. Furthermore, in several cases, clear differences in the magnitude of balance and gait parameters between DAFO and shoe users were apparent, and these differences were often consistent with nearer normal levels associated with use of the device (suggesting potentially beneficial influences). Thus, positive effects of the DAFO on lateral velocity of sway and variability of the spectral frequency were evident for some subjects. The gait velocity, stride length and single stance phase were also nearer normal values using DAFOs than without them. In addition, the maximum foot velocity value was improved in the middle of swing phase on the affected side, which may indicate improvement to the ankle dorsiflexion function using these devices. In contrast to the inconclusive balance and gait findings, the outcome of the questionnaire assessments was clear. The majority of subjects provided very positive feedback with regard to DAFO use. Most subjects expressed confidence in the splint, which they perceived as helpful for their walking ability in day life. Some difficulties were noticed with donning and doffing the DAFO, but the perceived benefits outweighed this consideration. These qualitative studies therefore provide the most convincing evidence to support the idea that DAFOs improve stroke patients' balance and gait, and that this type of orthosis may form a useful adjunct to rehabilitation strategies. However, as the proposals set out for this research were related, acceptance of hypothesis III requires that at least one of the preceding hypotheses be accepted. On this basis, hypothesis III was also rejected. In conclusion, although this work failed overall to demonstrate a significant effect of DAFOs on the rehabilitation of stroke patients, the anecdotal evidence obtained adds to knowledge in this field. The research identified some parameters of balance and gait, which might be influenced by the device in a beneficial manner. These parameters may be more useful to use in future investigations. The reasons for the discrepant outcomes of the quantitative and qualitative studies are unclear. However, it is suggested that there may be uncontrolled variables within either the patient group or in the DAFOs (or both) which mean that some DAFOs work better than others. It is proposed that further studies of the DAFO are warranted.

The central theme of this ethnographic study is captured in the word play in the title. It is, essentially, an analysis of the social work in social work. With a primary focus on the collegial discourse taking place between 'child care' social workers and managers in a social services department in the North West of England, I have undertaken an analysis of naturally occurring talk, interview data, formal policy and procedure, and written records of action taken (case files and minutes) and action to be taken (e.g. court reports, strategic planning documents). My analytic focus has been upon on the routines and linguistic practices through which `caseness' is accomplished. I argue that, although professional accounts are artfully produced against certain (situated) background expectancies, the 'materials' invoked in such accounts are not entirely local phenomena. That is to say, competent accounts are both locally accomplished and contingent upon available vocabularies. In a search for analytic adequacy, I have drawn particularly upon the temporal and rhetorical 'turns' in the human sciences. Using an unashamedly eclectic approach, I argue that 'imported' materials, such as bureaucratic time, remain malleable and, thus, may be invoked strategically and artfully by social workers in their (narrative) constructions of events and 'cases' and, indeed, themselves - allowing them to reference risk, deviance or normality, for example. However, the possibilities are far from infinite, and the liturgical nature of many encounters ensures that what is most remarkable about organizational life is not its instability, but its predictability.

My study is concerned not simply with the what and the how of hone care for the elderly but also with the I ask about how the domiciliary services operate: what home helps do for elderly people and how they feel about their caring role, and, what the circumstances of elderly people needing care are and how they feel about using help. But I also want to know why home help operates in this way: why home helps care in the way they do and why elderly people feel as they do about using that care? Such an approach cannot fail to take into consideration the wider ecological and structural context within which elderly people and home helps live and work. Part one of my thesis, composed of three chapters, therefore provides this backcloth. I use it to introduce the location of the study, to present a brief history and discussion of the development of domiciliary services for the elderly in Britain, and 10 describe the philosophy and policy shaping domiciliary provision within Salford Social Services Department. As I shall show, current Government economic policy is inextricably woven into the fabric of this backcloth. In Part Two, I detail the findings of my fieldwork, painting a picture of the lives of the frail and impaired elderly people using domiciliary care, and of the work of the home helps providing that care. As far as possible, I have used the interviewees' own words to explain perceptions of (in)dependence and need, of stiqma and taboo, of material and ideological motivations, and of emotional involvements and commitments. A number of writers have argued that dependency - a concept at the centre of inquiries into the care of the elderly - is a socially constructed relationship, both with respect to elderly users and female providers of care. In Part Three, I question whether and in what way the evidence supports or denies this claim. I ask what are the implications of my findings for social policy. I also justify the use of anthropological perspectives in policy-related research. Finally, I present an account of my experience as a researcher which can be approached from a number of different levels., At a'basic level, it represents an immediate account of doing fieldwork. It is also my account, as a post-graduate, of the experience of writing-up a thesis. I consider the effect of the passing of time on context and consciousness and hci this feeds into the analysis and presentation, of work. And I attempt to address concerns with the writer/reader/subject relationship which pose questions to do with communication.