Haemophilia is an inherited condition in which circulating blood clotting factors are much reduced or absent resulting in the tendency to bleed into joint cavities where the ankle is the most commonly affected. Prophylactic replacement of clotting factors has much improved joint health in the majority of people with haemophilia however many continue to develop joint disease. Purpose. To explore the potential for non-haematological factors to influence the development of haemophilic arthropathy at the ankle. Methods. This study had two phases. Factors for investigation were determined using a Delphi process and subsequently preliminary clinical instrument testing occurred. Finally a case-control correlational study was carried out to investigate the presence of selected factors in a haemophilia cohort compared with normal volunteers. Results. Forty-two factors reached consensus from the Delphi Process of which 22 were selected for onward investigation comprising musculoskeletal, exercise, and haematological factors. In a case-control study with 90 participants, six factors successfully differentiated the Haemophilia Ankle group from the others. A further three factors separated people with haemophilia from normal volunteers representing musculoskeletal differences that cannot be attributed to arthropathy. A regression model was developed comprising: the Ankle Lunge Test, Foot and Ankle Ability Measure (FAAM), Duration of Exposure to a key sport and Subtalar joint inversion which correctly predicted 89.7% of cases with 86.7% sensitivity and 92.9% specificity. Conclusions. These results represent the first attempt to understand the interaction of factors that influence the arthropathy development. The FAAM sports subscale and Duration of Exposure to a key sport were identified as independent variables with the strongest association with haemophilic arthropathy at the ankle. Avenues for physiotherapeutic intervention have been identified with preventative screening tools and pre-habilitation programmes possible for young boys with haemophilia at risk of developing this debilitating condition.

Traumatic brain injury (TBI) is becoming more prevalent in an age of increased motorization and violence. The majority of patients are young adults previously in paid employment. Life expectancy is usually unaffected once past the acute stage of recovery. The reported statistics for successful return to work (RTW) vary from 15% to 77%. However no literature was sourced which examines or discusses the most central component of successful return to work rehabilitation for these individuals - what the individuals themselves have found to be of assistance from their experience of return to work rehabilitation in attempting to return to work. This study explored the lived experience of return to work rehabilitation from the perspective of individuals who had sustained TBI and who had actively engaged in a return to work programme as part of their rehabilitation. A phenomenological approach, with an interpretative focus was utilized to explore and obtain an enhanced understanding from data gained in semi-structured interviews conducted with ten participants. The interviews were audio-recorded. The position of the researcher was situated within the research, and a reflexive component was interwoven throughout the process. Interpretative Phenomenological Analysis (IPA) was undertaken to elicit themes to enhance my understanding. Findings formed five main themes; personal cost of lifestyle losses, impact of TBI on perceptions of RTW, factors impacting on engagement in RTW rehabilitation, participants' perceptions of assistive elements of RTW rehabilitation, impact of RTW rehabilitation on participant. Each master theme comprised a group of sub themes, discussed within the thesis. The meaning of work pre-morbidly for individuals who sustain TBI characterizes their social and familial roles and responsibilities. Upon attempting to RTW following rehabilitation the definition of work often changes in conjunction with the individual's world views and perceptions of self. Whilst RTW rehabilitation may be an important goal for the individual and his/her family, because he/she accesses rehabilitation through a community based service, other, external, factors often impact on their ability to fully engage in a RTW rehabilitation programme. Little acknowledgement of this is made by clinicians, and more flexibility and further additional one to one interventions during times of difficulty would be assistive in optimizing the chances of success for individuals. Whilst all participants in this study were able to verbalize positive experiences of the outcomes of RTW rehabilitation, none had returned to their previous employment resuming their previous roles. Thus the core message of this thesis is that the role of the occupational therapist in RTW rehabilitation needs to incorporate many elements including group rehabilitation, one to one rehabilitation and clinical liaison with work places. This can be potentially achieved through adopting Mosey's (1986) Acquisitional Frame of Reference as a working practice model. In addition, facilitated longterm peer and clinical support is required to ensure individuals maintain success in their attempts to RTW. Clinicians involved in this area of work need to work within an interdisciplinary team approach, recognise and assist with a defined grief reaction that presents in individuals when they attempt to RTW, and be flexible and accommodating in the delivery of RTW rehabilitation to patients.

This study has been undertaken in order to develop a new nanocomposite acoustic material via incorporation of multi-walled carbon nanotubes (MWCNTs) into the conventional damping material–polyvinyl acetate (PVAc). Usually MWCNTs are added into polymers to strengthen its stiffness only. Here, properties of stiffness and damping are both required for the cone/diaphragm to improve sound features of the speakers. The work provides perspectives on MWCNT covalent modification and the effect of MWCNT surface chemistry on the acoustic performance of the nanotube composites.

Age-related changes in the central nervous system (CNS) is a multi-factorial process involving subtle alterations to several subcellular systems, including a disturbance to cholinergic signalling that becomes a prominent feature in age-related neurodegenerative diseases (Giacobini, 1990). Previous work in the L. stagnalis nervous system highlighted synapse-specific alterations in subsets of neurons that are accompanied by a marked decline in feeding behaviour in chronologically aged animals (Arundell et al., 2006; Yeoman et al., 2008). To identify common elements that lead to a reduction in feeding behaviour, 2D Difference in-gel Electrophoresis (2D DIGE) analysis highlighted 49 proteins that were differentially expressed in the aged L. stagnalis CNS. Amongst them, three key protein groups involved in maintaining the cytoskeletal integrity, energy-dependent processes, and chaperones were significantly altered in the aged CBG. The expression level of cytoskeletal proteins such as tubulin and actin, putative chaperones such as 14-3-3, and kinases such as arginine kinase as well as mitochondrial proteins such as reductase were all significantly down-regulated in aged CNS (p < 0.05) and are well aligned with changes that are observed in normally aged higher vertebrates. This suggested that the alterations in functional neuronal circuits that accompany a reduction in feeding behaviour in L. stagnalis may encounter a similar set of biochemical challenges as those experienced in higher vertebrates.

The aim of the this study was to develop a moderate intensity, specific and safe homebased exercise programme and evaluate its effectiveness on fall risk factors in Portuguese people over the age of 65.

This thesis reports a phenomenological study of seven parents’ lived experience following the death of a twin in the perinatal/ neonatal period. It gives consideration to the issues important to the study. It provides a literature search to situate the study in the field of evolving bereavement theory and in the context of twin loss. A number of questions have been raised that led to the formulation of the research question (page 63). The descriptive phenomenological methodology adopted provides a framework for my ontological and epistemological positions. Through the method of analysis of the data from semi-structured interviews, the essence of the phenomenon was elicited and the fundamental structure was established.

Patients with major burns experience pathological changes which have been shown to influence the pharmacokinetics of antibiotics. Subsequently it has been demonstrated that conventional doses of some antibiotics given to patients with major burns may result in sub-therapeutic serum concentrations. The aim of this thesis was to identify antibiotics used to treat infection in critically ill patients with burns, and to develop dosage guidelines for those where data is lacking. A survey of antimicrobial use in burns centres in the UK was undertaken, leading to the identification of five antimicrobials to be studied further. Published pharmacokinetic values for gentamicin were used to develop dosage guidelines for extended dose administration. With vancomycin, current dose recommendations were reviewed for their appropriateness. Three more antimicrobials were identified where little or no pharmacokinetic data were available for patients with burns; meropenem, linezolid and colistin. A patient study was therefore set up where serum samples at steady state were collected from patients enabling the calculation of pharmacokinetic data. These were related to pharmacodynamic principles in order to propose dose recommendations.

Activated carbons possess many of the properties desirable for use as a sorbent material in extracorporeal systems. They are physically and chemically stable, may be modified in terms of porosity or surface chemistry, thus allowing a wide range of sorbent materials to be produced. One drawback of activated carbons is their inherent hydrophobicity. Unless they are used as hydrophobic matrices, the surfaces have to be modified to produce a more hydrophilic surface, to increase interaction with the biological solution of interest.

Uraemic patients demonstrate cognitive deficits, particularly in attention and memory and chronic kidney disease (CKD) is a risk factor for cognitive impairment. Memory enhancing properties of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (AlIA) have been reported in rats and mice. In humans, chronic treatment with an AlIA improved cognition in elderly hypertensive patients; ACEls improve cognition in young, hypertensive patients and acute administration of an AlIA has cognition-enhancing effects in young, healthy volunteers. The aim of this thesis was to investigate possible differential effects of ACEI and AlIA on mood and cognition in comparison to other antihypertensives in CKD patients. To rule out the possible effect of chronic disease on mood and cognition by examining neurocognitive attributes of colon cancer patients in remission, and finally to investigate the possible contribution of renin angiotensin system (RAS) gene polymorphisms to neurocognitive improvement associated with drugs targeted at the RAS.

This thesis offers possibilities for a new way of thinking about the subject of worth in relation to nursing. Its main purpose is to provide nurses with an opportunity to be reflective and reflexive about the many differing concepts of their own worth and that of the people with whom they work, thus facilitating the potential for new thinking and, in turn, new practices. The research arose from disturbances that emerged from three particular areas: 1) my own self worth evaluation; 2) client stories of being treated with a lack of worth by nurses; and 3) from hearing stories from colleagues about perceptions of self worth in relation to nursing identity. Within this study, I used Evocative Autoethnography, a reflexive methodology where the researcher and the researched are one, simultaneously aware of being both subject and researcher. I paid attention to how I experience myself as a nurse, how nursing appears to be viewed and how my idiosyncratic measures and displays of worth affect interactions with both others and myself. A process of rhizomatic conceptualisation ran alongside, through and around the autoethnographic process.providing a map of the territory and a frame of reference for the research. Within this Evocative Autoethnography the data are my thoughts, memories, reflections and reflexive thinking, 'collected' because of their evocative nature. They were analysed through a process of reflection and reflexion whereby the collection of data and the analysis of those data became an iterative cycle, the data becoming the data analysis becoming the data. The data are represented through multimedia concepts such as narrative prose, poetry and photographs. There is no conclusion to this process, only the point at which the data are no longer captured. Through undertaking the research, I discovered that my experience of self worth varied throughout the different cultures and different selves that I inhabit, and that this had an impact on the ways in which I interacted intra- and inter-personally. Through this iterative process of reflection and reflexion, I found I was sometimes able to influence my intra- and interactions in a helpful way, but sometimes my low self worth unhelpfully influenced the outcomes of my self/other encounters. Gaining insight into my constructions of self worth has provided me with opportunities for intra- and inter-actional changes with implications of more helpful practices. The intention of this research is to provide nurses, and in particular, mental health nurses, with an opportunity to be reflective and reflexive around the concepts of their own value and that of the people with whom they work. 'Hearing' others' stories or narratives is essentially an encounter, where the words of the other can resonate with us, providing us with a chance to not only respond to the words of the 'other' but also to our own responses, thus facilitating iterative 'echoing' or, in other words, 'thinking with the story'. In 'thinking with the story' nurses might discover something new about themselves and/or their practice, which in turn might bring about new ways of considering their self worth and that of others, thus leading to practices which place the value of both nurses and the people with whom they work at the centre of their interactions.