This is the thesis (critical appraisal) component of a PhD by Published Works. The overall submission was a portfolio of ten published papers supported by a critical appraisal focusing on two key areas: an exploration of the roles that Health Information Professionals (HIPs) can play within evidence based practice (EBP) and an exploration of the effectiveness and impact of the traditional supportive role played by HIPs within EBP. The published papers are listed and referenced within this document but not contained within it. The majority are available elsewhere within the University of Salford Institutional Repository. Drawing on a model developed from the library literature, the thesis highlights a wide range of supportive and active roles that HIPs can potentially play within EBP. This model is informed and illuminated by the studies within the portfolio that demonstrate how the author has fulfilled a wide range of these roles in practice, and identified a new role within systematic reviews in health and social care. This demonstrates that HIPs can transfer their skills outside their traditional library and information practice domain, thus extending their role and offering a range of professional opportunities. Using a varied range of research methodologies, the thesis also explores the effectiveness and impact of the contribution made by HIPs when using traditional skills to support EBP. Two models are used to illustrate the outcomes to which HIPs contribute. These include improving search skills and providing evidence which can, over the longer term, contribute to policy making and patient care. At present the weight of the evidence presented to support these links is weak. Methodological issues and future research that needs to be addressed to improve the strength of the evidence base are therefore highlighted and discussed.

Bakgrund: Bröstcancer är den vanligaste cancersjukdom bland kvinnor i Sverige och i världen. Mellan 15 och 20 kvinnor insjuknar varje dag. Att få beskedet bröstcancer skapar förde flesta förvirring, ångest och chock såväl hos den som är sjuk som hos de som står den drabbade kvinnan nära. De förändringar som uppstår i samband med sjukdomen och de olika behandlingarna har stor inverkan på kvinnornas självkänsla och upplevelse av hälsa. Syftet: Syftet med den här uppsatsen är att beskriva kvinnors upplevelse av att leva med bröstcancer. Metod: Kvalitativ metod har används för att få en djupare förståelse i människors upplevelse och erfarenheter. Två själbiografiska böcker valdes ut för analys. Resultat: I resultatet redovisas ett tema; Kvinnors upplevelse av att leva med sjukdomen bröstcancer och fyra kategorier; Att få besked, att få behandling, efter diagnos och uppleva stöd, samt niounderkategorier; tankar och känslor kring beskedet, förnekande av sjukdom, oro och rädsla,ångest och lidande, fysiska förändringar, psykiska förändringar, av familjen, omgivningen ochandra i samma situation samt sjukvårdpersonalen. Resultatet beskriver bland annat kvinnornas känslomässiga upplevelse samt vad det innebär att leva med bröstcancer. Slutsats: För att en bröstcancer patient ska få den ultimata omvårdnaden så är det av stor betydelse att ta vara påpatientens individuella upplevelse och behov. / Background: Breast cancer is the most common type of cancer among women not only in Sweden but worldwide. Somewhere between 15 to 20 women are diagnosed with this type of cancer each day. Being told that you have breast cancer usually results in confusion, anxiety and shock for the one who is ill as well as for those closely related to the affected women. Symptoms of the sickness and side effects of the various treatments have a major impact on women's self-esteem and health experience. Purpose: The purpose of this paper is to describe women's experience of living with breast cancer. Method: Qualitative methodology is used to understand and penetrate deeper into people's perception and experience of the disease. Two autobiographical books were selected to analyze. Results: The result is presented in one theme; Women’s experience of living with the sickness breast cancer and four categories;Receiving the diagnose, getting treatment, after the diagnose and to experience support, as well as nine sub-categories, thoughts and feelings about diagnose, denial of illness, anxiety and fear, anguish and suffering, physical changes, mental changes, the family, surroundings and others in the same situation and finally medical personnel. The results describe among other things women's emotional experience and what it means to live with breast cancer. Conclusions: For a breast cancer patient to receive the best possible care, it is of the greatest importance to be aware of the patient's individual experience and needs.

The University of Salford has developed a program in order to improve the control of lower limb orthotics thus improving the ability of paraplegics to walk. Although the system is greatly needed for rehabilitation it is hoped that the final system would enable paraplegics to walk in the community. The present project, which is based on previous designs such as the R. G. O (Reciprocating Gait Orthbsis), strives to add external power at the hips of the R. G. O. The constructed prototype is made of a mechanical skeleton with each leg driven by a brushless motor and a lead screw. The main purpose of this project is to design a control system to control the motion of the legs. The first step in achieving this task was to model the various components of the system separately and then derive a model using system identification that will describe the behaviour of the whole system. The starting point was a mechanical device with two motors mounted one at either hip. A full mathematical analysis of the system is carried out. Once a mathematical model is derived for the RG. O with the two motors it can be used to carry out real time simulations using MATLAB. Once the model is derived it must be validated to make sure it is actually a mathematical representation of the system. The identified model is usually very accurate as it is based on the actual system performance. Then real time simulations of the theoretical and the identified model are compared. If the theoretical model behaves in the same way as the identified model then it is validated and may be used for further work. The models derived using system identification were validated and gave a good comparison when compared to real data. A pole placement controller was designed and tested based on these models. The controller performance was tested with the orthosis unloaded, loaded with artificial loads (a plaster leg weighing 10 Kg). The controller managed to follow the pre-set trajectory reasonably well. The orthosis was then tested with a volunteer in it. Again the performance was very encouraging. The fmal Project will be P. C driven System with the possibility of using NiCAD Batteries as the power source. The main tools, which will be used in order to carry out simulations and comparisons of theoretical and practical results, are MATLAB. The software used was C.

The findings of this multi-site study emphasise the importance of Organisational Culture for integrating clinical information systems into intensive care units. A novel model, the Iterative Systems Integration Model, has two principle components, these being Organisational Culture and the Actual Usefulness of the clinical information system. The model is derived from empirical data collected in four intensive care sites in England and Denmark, with one site being used to validate the model. The model highlights clinical information systems as directly affecting the work processes of the sites investigated, which in turn affect the Organisational Culture and Actual Usefulness of the clinical information system used, and these features affect clinical information system integration. This forms an iterative process of change as clinical information systems are introduced and integrated. Intensive care units are complex organisations, with complex needs and work processes. The impact of clinical information systems on these work processes is investigated in this thesis using Role Activity Diagrams. These diagrams are analysed to show that although clinical work processes are consistent at each site, the information processes differ. Intensive care information processes are found to have the potential to be much simplified with the introduction of seamless clinical information systems. Qualitative data collectio n methods were deployed, i. e., observations, interviews, and shadowing of clinical staff, together with a questionnaire at each site for further validation. Data were analysed using grounded theory to extract salient variables, which informed the development of the model. These factors were indicative of the Organisational Culture of the sites investigated and the Actual Useftilness of the clinical information systems being used. It was posited that clinical information systems that reconcile expectations of both hospital management and clinical staff - and that have the potential to adapt to their organisational environment - have a greater chance of surviving in complex environments such as intensive care. Despite decades of Health Infon-flatics, no such systems exist in their entirety; this research shows that 'ancient problems' of clinical information systems integration are still prevalent, and presents the Iterative Systems Integration Model, the application of which may assist with the integration of clinical information systems in intensive care.

Echinococcus granulosus is a cestode species responsible for human cystic echinococcosis (CE). The domestic dog is the primary definitive host for the transmission of E. granulosus infection to domestic livestock intermediate hosts and to humans. In order to determine the prevalence and risk factors for canine echinococcosis, epidemiological studies were conducted in known endemic localities in three different countries i.e. Libya, Kenya and Wales. Stray dogs were subject to direct examination of the small intestine at necropsy. Owned dogs (total n=1659) were screened for E. granulosus infection using a genus specific coproantigen ELISA test that was restandardised against 75 dog necropsy results, and exhibited 100% sensitivity and 98% specificity. Analysis of risk factors for canine echinococcosis associated with Echinococcus coproantigen positive results was evaluated based on dog-owner questionnaires. In Libya, the overall infection of E. granulosus in autopsied dogs was 25.8%, and an overall coproantigen prevalence of 21.6% was obtained for owned dogs (n= 334). Risk factors (p<0.05) for a coproantigen positive owned dog in Libya were, dog age (≤5 years), non-restraint of dogs, dogs fed on offal, sheepdog class, owners that did not de-worm their dogs, and dogs owned by farmers who admitted to frequent slaughter of livestock. Dog sex was not a significant risk factor for a positive coproantigen ELISA in dogs from all study areas. Worm burdens in necropsied dogs in Libya ranged from 29 to 2900 (mean 1064) and were positively correlated to coproantigen ELISA OD values (r= 0.76), but negatively associated with dog age (r= -0.64). Canine echinococcosis in Libya measured by locality varied, with Alkhums (Leptis-Magna) district having the highest coproantigen prevalence at 38.7% (p=0.001), followed by Azahwia district with 19.2%. Tripoli district had the lowest coproprevalence where 17.5% of dogs were copro-positive. In Tripoli an abattoir survey for livestock CE was also undertaken and is reported. In northern Kenya, post-mortem examination of the small intestines of 17 dogs from Turkana, revealed 29.4% harboured E. granulosus infection, with a mean worm burden of 1570 adults. Overall 26% (42/161) of Turkana dogs were copro-positive, with the highest copro-prevalence identified in dogs from Lokichoggio division. Younger dogs (≤5 years), free-roaming dogs, dogs fed on offal, and dogs of owners that practiced home slaughter of livestock and that had no knowledge about echinococcosis, appeared to have a significantly higher risk of being coproantigen positive (p<0.05). In mid-Wales a list of 321 sheep farms were selected at random, from which 1164 farm-dogs were screened using rectal faecal samples tested for Echinococcus coproantigens, and owners questioned using a modified dog-owner questionnaire. Furthermore, the potential impact of the 2001 footand- mouth disease (FMD) epidemic, on the prevalence of E. granulosus in farm dogs was assessed. An overall coproantigen positive rate of 8.0% was recorded on 22% of farms surveyed, which compared to a rate of 3.4% obtained in the same region in 1993. There was no significant difference in copro-positive prevalence between FMD affected properties and those that were unaffected. Significant risk factors for a positive farm dog in Wales were associated with allowing dogs to roam free, and infrequent deworming (>4month intervals) of dogs. The data are discussed in relation to a previous pilot hydatid control program in that area of Wales (1983-89) and the potential for increase in transmission to humans. Identification of risk factors associated with canine echinococcosis appear to be similar in all three communities studied and help to demonstrate practices that may be amenable to change as part of hydatid control programmes.

This thesis presents a methodology for soundscape research, utilising consumer mobile and internet technologies. This has been used to gather objective environmental data, as well as subjective data from participants in-situ. A total of 323 untrained members of the public have submitted soundscape recordings from around the world. For the first time, participant choice has been factored into soundscape research, where members of the public decide which sound environments are investigated. Human relationships with their sound environments have been investigated, with a number of findings corresponding with those of other studies utilising entirely different methodologies. In addition, a number of new findings have been made to contribute to the field. The two extracted subjective principal components of ’Appreciation’ and ’Dynamics’ has shown a solid validation of the project’s methodology, due to their similarities with a number of other studies utilising different techniques of data retrieval. The distinctive groupings of the different soundscape types within this factor space defined by the extracted components reveals the perceptual differences between the soundscape categories: urban, rural, urban public space and urban park. The activity a person is involved in while making their submission has shown to be influential in soundscape appraisal, with relaxation and recreation situations resulting in increased soundscape appreciation. The reasons behind a soundscape submission have revealed significant differences in subjective response. The positive interpretation of the term soundscape has resulted in a majority of positive reasons for participation. Soundscapes that arise from a participant’s daily routine are generally less appreciated than soundscapes containing a particular sound source focus. The highest levels of appreciation were observed in soundscapes whose focus is on a specific activity that the participant is involved in. The interest that a participant has on their soundscape is seen to result in raised levels of appreciation.

Health and Wellbeing Boards (HWBs) are new local government (LG) sub-committees tasked with assessing local health and social care needs, and developing strategies for promoting integration and tackling health inequalities; yet they have no statutory authority to compel action. This research explored how they approached tackling health inequalities, focussing on the role of environmental health (EH), the LG public health occupation, in the pre-shadow and shadow stages and as they went live in April 2013. Four case study sites (based around individual HWBs) were purposively sampled to ensure that a variety of HWBs were included, including unitary and two-tier authorities and urban, suburban and rural areas. Data collection at each case study site included semi-structured interviews, observation of HWB meetings, and documentary analysis and extended for 18 months from early 2012. In addition, EH practitioners and managers were interviewed from each of the English regions to provide a wider context. The data was analysed thematically both inductively and deductively using Atlas.ti. and conclusions drawn. HWBs were varied in their structures, practices and intentions and some changed considerably during the research, as would be expected at a time of new policy development and implementation. There was evident commitment and enthusiasm from HWB members to improve the health of local populations. However it is unclear what ‘success’ will be or how it will be measured and attributed to the work of the HWB, and there were some tensions between the various parties involved. There was an espoused commitment to the principles of Marmot, in particular to children, however much of the focus during HWB meetings was on integrating health and social care. Taking action on many of the social determinants of health is outside the core sphere of HWB control, however they did not generally appear to be utilising some of the readily available tools, such as EH work to improve local living and working conditions. EH was found to be largely ‘invisible’ within its own public health community and does not have a tradition of evidence based practice needed to secure funding in the new system. This, along with the decline of the regulatory role, has led to a period of reflection and adaptation. The research findings are linked by the policy approaches of ‘doodle’ and localism, including the shrinking of the state, and in particular the retreat of statutory and regulatory roles and the introduction of overt political values in policy making; shifting the focus to relationships, partnership-building, integration and the impact of individuals. The contexts in which the research has taken place, both at local and national levels, including financial austerity, major health restructuring, and high national and local expectations are all significant factors which have shaped the findings.

The psychosocial implications of chronic illnesses (CIs) are an apparent issue as exemplified through the extensive literature put forth on the matter. However, the primary focus of this literature is typically the aging population, and researchers have given less consideration to the experiences of youth. At this point in their life, young adults are already experiencing self-discovery, pursuing anticipated milestones, and defining one’s worth/purpose, therefore, being diagnosed and living with a CI only complicates these matters. Investigating how CIs impact young adults’ mental health (MH) is imperative when trying to understand the various intersecting forces that influence one’s ability to achieve optimal health and well being. This research explores the psychosocial effect of receiving a CI diagnosis using a qualitative, interpretive phenomenological approach ( Van Menen’s viewpoint) in which 12 semi-structured interviews were conducted with university students. Interviews were recorded and transcribed for thematic analysis. Findings indicate that the onset of CIs among young adults adds/perpetuates various types of psychosocial distress, ultimately impacting one’s MH based on their exposure towards such stressors and ability to cope. Irrespective of individualized experiences, all participants unilaterally echoed the need for MH support post diagnosis. Such a finding warrants evaluation of the existing treatment and management of CIs, suggesting that interventions ought to be more holistically designed to include greater MH support. / Thesis / Master of Science (MSc)

An individual’s health is influenced by more than just the health care system, but also in large part by the social determinants of health. People exist within broader social, cultural, and ecological systems which influence their health outcomes through the social determinants of health. This doctoral dissertation examines social, cultural, and ecological systems to understand several factors that support and hinder community health and wellbeing to inform future policy. This dissertation incorporates a mix of methodological approaches across four interrelated research studies to better understand direct and indirect factors influencing community health and wellbeing. In doing so, this thesis is divided into four research chapters. Study 1 consists of a community-based research project that examines how food security, cultural continuity, and community health and wellbeing are connected through the sharing of harvested country food in Chesterfield Inlet, Nunavut, Canada. Based on this understanding we can demonstrate how climate change and increased shipping along the inlet affects the community as a result of changes in marine mammals and harvesting activities. Study 2 presents a logistic regression that models how cultural continuity variables impact self-rated health for participants living in Inuit Nunangat in Canada. This model uses the Arctic Supplement questions of the Aboriginal Peoples Survey to compare measures of cultural continuity to traditional measures based on government services. This study demonstrates an important link between cultural continuity and self-rated health for Inuit living in Inuit Nunangat. iv Study 3 contains a case study of different implementation successes and challenges of Locally Managed Marine Areas globally. These cases are used to understand how community member involvement as stakeholders in marine resource decision-making not only aligns with existing local and Indigenous ways of management, but also can enhance biodiversity as well as local livelihoods. Finally, Study 4 uses ontology engineering methods to represent the results from the first three studies. This study demonstrates how this novel method can be used to illustrate the interconnectedness of results from different disciplines using diverse data sources and through the creation of different scenarios. Taken together, these studies provide timely insights regarding the ways policy can support or hinder efforts to improve community health and wellbeing and adapt to climate changes. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to develop a better understanding of how social, cultural, and ecological systems impact community health and wellbeing in various contexts. Findings indicate climate and shipping changes impact Chesterfield Inlet, Nunavut through the relationship between food security, cultural continuity, and community health and wellbeing. Relatedly, harvesting activities, access to country food, satisfaction in Inuit governance, and community involvement all increase the probability that an Inuk living in the Arctic has good or great self-rated health. Additionally, Locally Managed Marine Areas, an approach to marine resources management that includes community members as key stakeholders, not only aligns with existing local and Indigenous management practices, but can also support biodiversity and increased catch of various species. Finally, by representing these research results in a single model called an ontology, we can make educated guesses about how these different studies are interconnected. The insights gained from this work can be adopted by decision- makers to create supports for and remove barriers to improved community health and wellbeing and community efforts to adapt to changes.

The thesis looks firstly at creativity and the creative process, approaching the subject from a whole range of different viewpoints, such as the psychological, philosophical, biographical and anthropological angles. Following from this there is an exploration of the ways in which creativity way be awakened and unfolded. Special attention is given to the conditions and situations that are likely to encourage creative development and to the blocks and difficulties that inhibit its expression. Particular reference is made, on the one hand, to art education and to the art, leisure, and teaching student, and on the other hand, to art therapy and the psychiatric patient. The themes of the individual and the community are explored in a complementary way in the final two chapters. The thesis emphasizes the viewpoint of the student and the patient, but since these people do not exist in a vacuum, this involves looking also at the teacher, the therapist and society. With reference to the psychiatric field, other specific questions arise, for example: How may creative opportunities assist the healing process? What are the reciprocal influences of art and mental illness? Throughout the thesis the term 'art' is used in the visual sense, but references are made to creativity in other fields where parallel conclusions apply. The emphasis has been placed on the adult, but the subject of 'Creativity and the Teaching Student' involves some references to child art and 'Creativity and the Community' involves all ages.