Pulmonary embolism (PE) is an obstruction within the pulmonary arterial tree and in the majority of cases arises from a thrombosis that has travelled to the lungs via the venous system. Pulmonary embolism (PE) is a fatal condition which affects all age groups and is the third most common cause of death in the US. Computed tomographic angiography (CTA) imaging has recently emerged as an accurate method in the diagnosis of pulmonary embolism. Each CTA scan contains hundreds of CT images, so the accuracy and efficiency of interpreting such a large image data set is complicated due to various PE look-alikes and human factors such as attention span and eye fatigue. Moreover, manual reading and interpreting a large number of slices is time consuming and it is difficult to find all the pulmonary embolisms (PE) in a data set. Consequently, it is highly desirable to have a computer aided detection (CAD) system to assist radiologists in detecting and characterizing emboli in an accurate, efficient and reproducible manner. A computer aided detection (CAD) system for detection of pulmonary embolism is proposed in CTA images. Our approach is performed in three stages: firstly the pulmonary artery tree is extracted in the region of the lung and heart in order to reduce the search area (PE occurs inside the pulmonary artery) and aims to reduce the false detection rate. The pulmonary artery is separated from the surrounding organs by analyzing the second derivative of the Hessian matrix and then a hybrid method based on region growing and a new customized level set is used to extract the pulmonary artery (PA). In the level set implementation algorithm, a new stopping criterion is applied, a consideration often neglected in many level set implementations. In the second stage, pulmonary embolism candidates are detected inside the segmented pulmonary artery, by an analysis of three dimensional features inside the segmented artery. PE detection in the pulmonary artery is implemented using five detectors. Each detector responds to different properties of PE. In the third stage, filtering is used to exclude false positive detections associated with the partial volume effect on the artery boundary, flow void, lymphoid tissue, noise and motion artifacts. Soft tissue between the bronchial wall and the pulmonary artery is a common cause of false positive detection in CAD systems. A new feature, based on location is used to reduce false positives caused by soft tissue. The method was tested on 55 data scans (20 training data scans and 35 additional data scans for evaluation containing a total of 195 emboli). The system provided a segmentation of the PA up to the 6th division, which includes the sub-segmental level. Resulting performance gave 94% detection sensitivity with an average 4.1 false positive detections per scan. We demonstrated that the proposed CAD system can improve the performance of a radiologist, detecting 19 (11 %) extra PE which were not annotated by the radiologist.

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.

Coronary artery disease is one of the most pernicious diseases around the world and early identification of vascular disease can help to reduce morbidity and mortality. Assessment of the degree of vascular obstruction, or stenosis, is critical for classifying the risks of the future vascular events. Automatic detection and quantification of stenosis are important in assessing coronary artery disease from medical imagery, especially for disease progression. Important factors affecting the reproducability and robustness of accuarate quantification arise from the partial volume effect and other noise sources. The main goal of this study is to present a fully automatic approach for detection and quantification of the stenosis in the coronary arteries. The proposed approach begins by building a 3D reconstruction of the coronary arterial system and then making accurate measurement of the vessel diameter from a robust estimate of the vessel cross-section. The proposed algorithm models the partial volume effect using a Markovian fuzzy clustering method in the process of accurate quantification of the degree of stenosis. To evaluate the accuracy and reproducibility of the measurement, the method was applied to a vascular phantom that was scanned using different protocols. The algorithm was applied to 20 CTA patient datasets containing a total of 85 stenoses, which were all successfully detected, with an average false positive rate of 0.7 per scan.

Police custody is an area of scholarly research that has previously been overlooked. Whilst the research and literature regarding this topic begins to grow, there still remains a wide variety of aspects to be considered. Chapter One presents a general introduction to the topic. Chapter Two presents a literature review following a systematic approach regarding the healthcare needs of those detained in police custody. The findings revealed that there is a considerable presence of mental health, substance misuse, and physical health care needs amongst police custody detainees. Chapter Three presents a critique of an impulsivity measure, the Barratt Impulsiveness Scale (BIS-11). The concluding remarks reported that further research is essential in examining the psychometric properties amongst forensic populations. The indications regarding reliability and validity are supportive, although further evidence considering the effectiveness of this tool for decision-making would be beneficial. Chapter Four, an empirical study, examined the prevalence of impulsivity, self-harm, and situational aggression amongst detainees. In addition, the predictive validity of one of the National Strategy for Police Information Systems (NSPIS) risk assessment was reviewed. This study identified that impulsivity traits are highly prevalent amongst detainees (for the non-planning impulsiveness subtrait); for self-harmers, their function of this behaviour was identified as ‘self-punishment’; and 40% engaged in some form of aggressive behaviour throughout their detention. The NSPIS risk assessment has significant predictive value, although with the additional of one Dynamic Appraisal of Situational Aggression (DASA) assessment and the BIS-11 total score, the predictability increases by 21%. A single case study in Chapter Five considers the effectiveness of Dialectical Behaviour Therapy (DBT)-informed skills training in the community. This individual displayed borderline personality disorder traits and exhibited self-harming behaviours. The difficulties associated with working with such a client group have been discussed. In Chapter Six, a discussion concludes the thesis.

This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future.

It is well known that the evolution of 4G-based mobile multimedia network systems will contribute significantly to future m-health applications that require high bandwidth and fast data rates. Central to the success of such emerging applications is the compatibility of broadband networks such as mobile WiMAX (IEEE 802.16e) and RSVP A, and especially their rate adaption issues combined with the acceptable real time medical quality of service requirements. The design of effective broadband mobile healthcare systems usmg emerging WiMAX and RSxP A networks is important from the medical perspective especially in applications such as remote medical ultrasound diagnostic systems. In this thesis, we introduce a new cross layer design approach for medical video streaming over mobile WiMAX and RSVP A networks. In particular, we propose an approach based on optimising medical Quality of Service (m-QoS) in mobile WiMAX network environments described in this work. Preliminary performance analysis of the proposed cross layer algorithm has been evaluated via simulation studies. These results show that the proposed cross layer optimizer achieves improved performance compatible with the necessary medical QoS requirements and constraints for the relevant clinical application. Furthermore, this work addresses the relevant challenges of cross layer design requirements for real time rate adaptation of ultrasound video streaming in Mobile WiMAX and RSVP A networks. The comparative performance analysis of such approach is validated in two experimental m-health testbed systems for both Mobile WiMAX and RSVP A networks. The experimental results show an improved performance of Mobile WiMAX compared to the RSVP A using the same cross layer optimisation approach. Additionally, we map the medical QoS to typical WiMAX QoS parameters in order to optimise the performance of these parameters in typical m-health scenarios. Preliminary performance analysis of the proposed multiparametric scenarios is evaluated to provide essential information for future medical QoS requirements and constraints.

Osteoarthritis is common with radiographic features practically universal in at least some joints in people aged over 60 years. One of the main therapeutic interventions used in the management of osteoarthritis is the injection of corticosteroid and hyaluronan (Gossec 2006). However, there exist few studies that seek to explore possible factors that influence outcome following injection. This study examined the factors that may influence the outcomes following injection of either corticosteroid or hyaluronan in the management of osteoarthritis of the knee.

Introduction The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care has become synonymous with high-quality care and a number of studies have reinforced patient's desire for, and the positive impact of the approach. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it. Whilst the concept has been explored within medicine, nursing and other allied health professions, within physiotherapy there has only been minimal discussion. The aim of this research was to explore the meaning of patient-centred care in relation to low back pain, from the perspective of musculoskeletal physiotherapists. Methods Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. They ranged in experience from five to 25 years. Individual semi- structured interviews were adopted as the method of data collection. The interviews were audio taped and then transcribed verbatim. Analysis broadly followed the Grounded Theory approach outlined by Strauss and Corbin (1990). It consisted of a process of open, axial and selective coding. Constant comparative analysis resulted in the identification with a core category and three inter-related sub-categories and the development of a substantive theory of patient-centred care.

This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).

Biofilm associated infections relating to endoscopic procedures may result in asymptomatic colonisation to potentially death. An appropriate high-level disinfectant and adequate pre-cleaning steps are therefore required to prevent the risk of hospital acquired infections relating to endoscopes. OrtllO-phthalaldehyde (OPA) is an alternative high-level disinfectant to glutaraldehyde (GTA) used for the disinfection of endoscopes. The aims of this thesis were to: i) investigate the efficacy of OPA against planktonic, surface dried bacteria and bacterial biofilm ii) to develop and test a novel in-vitro sodium alginate biofilm method for the testing of OPA iii) to develop a predictive mathematical model for measuring the effect ofOPA against bacterial biofilm and iv) to investigate the effect of ill-situ re-processing steps used to re-process endoscopes colonised with bacterial biofilm. The efficacy of OPA was tested against Pseudomonas aeruginosa, Mycobacterium che/ollae and a GTA-resistant mycobacterial strain (Mycobacterium elle/ollae Epping), using a quantitative suspension test, quantitative carrier test and using bacteria grown as sedimentation biofilms. OPA (0.5 % w/v) was shown to be an effective high-level disinfectant against M.elle/ollae, M.c1le/onae (Epping) and P.aeruginosa in suspension and carrier tests. The efficacy of OPA against the three bacterial strains grown as sedimentation biofilms was however reduced, in comparison to the planktonic and surface dried cells. Bacteria grown using the novel in-vitro alginate biofilm system showed an increased resistance to OPA in comparison to the sedimentation biofilms. The novel biofilm protocol was demonstrated to be highly reproducible, simple and robust, in comparison to the sedimentation biofilm methodology. A comparison between the biofilm and planktonic outer membrane protein (OMP) profiles of P.aerugillosa cells was undertaken using I-Dimensional and 2-Dimensional SDS-PAGE. However it was not clear if the novel sodium alginate biofilms exhibited a biofilm OMP profile, although bacterial resistance to disinfection indicated a biofilm phenotype. A mathematical model was produced using extensive efficacy testing data. The predictive model was shown to be very accurate in predicting the efficacy of variable concentrations of OPA, in the presence of variable concentrations of organic load, against mycobacterial biofilm. Finally, P.aeruginosa, M.elle/onae and M.elle/ollae Epping biofilms were treated with OPA and subsequently re-incubated. Re-growth was observed for all bacterial strains. The pre-cleaning steps used in endosopce reprocessing were shown to reduce surface attached biofilm by an average of 2-3 log reductions. In addition, the adherence of bacteria to surfaces after endoscope reprocessing steps and the surface quality of polypropylene discs was investigated using scanning electron microscopy. Bacteria were observed on all surfaces even after complete reprocessing steps had been undertaken. This study further highlighted the necessity for testing the efficacy of biocides against bacterial biofilms and the value of using an organic load. The production of biofilms using the novel sodium alginate methodology in conjunction with the predictive mathematical model produced in this thesis, was shown to have the potential to represent a faster, less labour intensive method to study the efficacy of biocides, in comparison to the standard methods used currently. The importance of adequate reprocessing steps for endoscopes using appropriate biocides has also been further highlighted.