Violent behaviour can be seen all over the world and across time; it is also intrinsically linked to culture. As such, the analysis of skeletal material presents excellent physical evidence of violent occurrences within communities. The current thesis looks to understand the possible presence of fracture patterns and interpersonal violence in London during the 18th and 19th centuries by analysing the fracture patterns observed on six skeletal collections from the geographical area and characterised by various social and economic contexts. The contextualisation of each burial ground proved to be imperative to the research. The statistical results revealed that grouping collections together based on their socioeconomic status does not describe nor explain the fracture patterns seen in the collections considering that some did not emulate the characterisation implemented upon them by the media or City officials at the time. It also was found that the patrilineal society and the subsequent sexual division of labour had a profound effect on the results especially when comparing the prevalence of fractures between men and women. Therefore, this thesis provides a comprehensive overview of fracture patterns and the presence of interpersonal violence in regards to the different lifestyles and socioeconomic contexts found in London during the 18th and 19th centuries and how such behaviour affected the individuals’ daily lives.

A novel approach which has potential to improve quality of patient care on general hospital wards is proposed. Patient care is a labour-intensive task that requires high input of human resources. A Remote Patient Monitoring (RPM) system is proposed which can go some way towards improving patient monitoring on general hospital wards. In this system vital signs are gathered from patients and sent to a control unit for centralized monitoring. The RPM system can complement the role of nurses in monitoring patients’ vital signs. They will be able to focus on holistic needs of patients thereby providing better personal care. Wireless network technologies, ZigBee and Wi-Fi, are utilized for transmission of vital signs in the proposed RPM system. They provide flexibility and mobility to patients. A prototype system for RPM is designed and simulated. The results illustrated the capability, suitability and limitation of the chosen technology.

Occupational loading is a significant risk factor for back pain and vertebral joint disease. Although biomechanical principles predict that spinal loading is affected by body proportion, particularly with differences in upper to lower body measurements, these differences have not previously been investigated in anthropometrical studies. This research is innovative as it aims to provide a functional explanation for vertebral pathology through the use of biomechanical models and the study of biometric data from documented skeletal samples. Particular emphasis is placed on occupation and occupational health in the 18th and 19th Century silk weaving community. Appendicular and axial measurements were recorded along with the presence and severity of vertebral osteophytes. Ratio variables were created in order to investigate the biomechanical models. The frequency of vertebral osteophytosis was determined in relation to sex and age-at-death. Statistical analyses were performed with regards to age-at-death and both vertebral osteophytosis and the metric measurements, as well as between sex and the metric variables. The association between vertebral osteophytes and the metric variables was also analysed. A significant interaction was observed between age-at-death and both vertebral osteophytes and the metric measurements, which was subsequently controlled for in the statistical analyses. In males, vertebral osteophytes in the lower thoracic and lumbar spine were associated with greater skeletal measurements, while those in the cervical and mid thoracic region were related to smaller dimensions. In females, osteophytes were for the most part associated with larger measurements. The analyses of the ratio variables showed that vertebral osteophytes were significantly associated with larger upper to lower body dimensions in males. The skeletal measurement results suggest that there was either an ergonomic constraint in the working environment, possibly as a result of equipment size and/or operation, or a propensity towards specific occupations being linked to body size, which is supported by contemporary accounts. The ratio variable results substantiate the predictions of the biomechanical models that a greater upper to lower body size ratio is associated with increased spinal loading.

This research investigates on the use of digital photoelasticityin biomedical sensing applications with a particular emphasis on assessment of diabetic foot ulceration. One of the main causes of foot ulceration in diabetic patients is excessive pressure at the sole of the foot, which involves vertical as well as shear forces. Precise role of these forces in predisposing the foot to ulceration is not very well understood, however, a general consensus is that the combined effect of vertical and shear forces is much more harmful than the vertical force alone. Whilst the vertical force can be measured relatively easily,it is difficult to decouple the shear force from the combined force,which is considered to be of more clinical relevance in assessment of diabetic foot ulceration. The major impediment in achieving this objective is lack of suitable shear force measuring devices and limitation of the existing systems that can simulate the actual conditions of foot loading. In this research a photoelastic material has been used to develop a prototype-sensing device, which develops coloured fringes due to foot loading. Intelligent image processing techniques have been employed to analyse and obtain relevant load information from these fringes. The research surveys the existing sensing devices that are commonly used in diabetic foot clinics. It highlights the need for a new sensor design that can be used for pressure-induced pathologies. To meet these requirements and develop a sensor based on the principle of photoelasticity, conventional techniques of RGB photoelasticity and Phase-shifting methods have been fully investigated. This led to identify suitable optical elements for the system design and applicability of these techniques for the intended application. This resulted in devising an experimental set up that can provide coloured image of foot per se actual conditions of foot loading. However, the conventional technique of stress analysis cannot be directly applied in the present case, since the photoelastic effect is induced due to the material deformation as opposed to the usual component loading in photoelastic experiments with coatings. Also, in the current application the applied load has to be estimated from the fringe patterns (i.e. inverse problem) under varying environmental conditions with different loading situations for each subject. As it is difficult to develop analytical models under these conditions and the related inverse might have infinite number of solutions, the use of neural networks has been proposed to overcome these complexities. The network has been trained with direct image data which provides input load information under controlled experimental conditions of vertical as well as shear forces. The prototype sensor also provides qualitative whole-field data of the actual foot loading, which can be used for quick differentiation of foot with or without callus. This may also find use in haptics, pattern recognition and other biomedical sensing applications such as pressure sore assessment for disabled subjects or patients with numbness. With further enhancement in image processing technique this can be developed into a clinically viable system capable of providing complete foot analysis from early stage detection to prevention of ulceration.

Stroke causes impairment of the sensory and motor systems; this can lead to difficulties in walking and participation in society. For effective rehabilitation it is important to measure the essential characteristics of impairment and associate these with the nature of disability. Efficient gait requires a complex interplay of muscles. Surface electromyography(sEMG) can be used to measure muscle activity and to observe disruption to this interplay after stroke. Yet, classification of this disruption in stroke patients has not been achieved. It is hypothesised that features identified from the sEMG signal can be used to classify underlying impairments. A clinically viable gait analysis system has been developed, integrating an in-house wireless sEMG system synchronised with bilateral video and inertial orientation sensors. Signal processing techniques have been extended and implemented, appropriate for use with sEMG. These techniques have focussed on frequency domain features using wavelet analysis and muscle activation patterns using principal component analysis. The system has been used to measure gait from stroke patients and un-impaired subjects. Characteristic patterns of activity from the ankle musculature were defined using principal component analysis of the linear envelope. Patients with common patterns of tibialis anterior activity did not necessarily share common patterns of gastrocnemius or soleus activity. Patients with similar linear envelope patterns did not always present with the same kinematic profiles. The relationship between observable impairments, kinematics and sEMG is seen to be complex and there is therefore a need for a multidimensional view of gait data in relation to stroke impairment. The analysis of instantaneous mean frequency and time-frequency has revealed additional periods of activity not obvious in the linear or raw signal representation. Furthermore, characteristic calf activity was identified that may relate to abnormal reflex activity. This has provided additional information with which to group characteristic muscle activity. An evaluation of the co-activation of gastrocnemius and tibialis anterior muscles using a sub-band filtering technique revealed three groups; those with distinct co-activation, those with little co-activation and those with continuous activity in the antagonistic pair across the stride. Signal features have been identified in sEMG recordings from stroke patients whilst walking extending current signal processing techniques. Common features of the sEMG and movement have been grouped creating a decision matrix. These results have contributed to the field of clinical measurement and diagnosis because interpretation of this decision matrix is related to underlying impairment. This has provided a framework from which subsequent studies can classify characteristic patterns of impairment within the stroke population; and thus assist in the provision of rehabilitative interventions.

Methadone is increasingly involved in drug overdose cases and the molecular actions of the drug in vivo are largely unknown requiring elucidation. This study set out to examine the relationship between methadone toxicity and CYP2B6 and mu (μ) opioid receptor (OPRM1) single nucleotide polymorphisms (SNPs). Using SNP genotyping, the association between OPRM1 A118G and CYP2B6 T750C, G516T, and A785G variations and post-mortem methadone concentrations were investigated. The allele frequencies of OPRM1 and CYP2B6 variants were then studied in a control population of live non-methadone using subjects, to determine the prevalence and distribution of specific variations in post-mortem and living subjects. Further in vitro study was conducted to assist in interpreting the association between OPRM1 and CYP2B6 variations and individual susceptibility to methadone. Cloning strategies were designed for the studies of promoter activities affected by the T750C promoter SNP on CYP2B6 expression, and the role of the OPRM1 A118G variation for receptor internalisation following methadone treatment was investigated. A significant association was identified between high post-mortem methadone concentrations and G561T and A785G (CYP2B6*6) variations reflecting poor methadone metabolism. Furthermore, the OPRM1 A118G SNP significantly correlated with higher post-mortem methadone concentrations and the in vitro analysis of A118G indicated that this could be due to a reduction in receptor internalisation in 118 AG subjects. The findings from the research contribute to pre-determining, in part, individual susceptibility to methadone accumulation and toxicity. Specific screening to identify CYP2B6*6 and OPRM1 A118G carriers prior to addiction treatment could therefore be valuable as part of a cost-effective risk management strategy. Furthermore, CYP2B6*6 and A118G could be used to interpret toxicology results identifying subjects with poor metabolism.

Background: Back pain is a common disorder, affecting up to 2 in 3 of the adult population, with the general practitioners (GPs) being the first point of contact for help. Bio-psychosocial management of back pain has been shown to be problematic. Meeting patients‟ expectations is alleged to play a vital role in concordance, adherence and satisfaction with the given treatment; a more potent aspect, however, could be a state of matched patient-GP expectations, which could have an influential effect on the process and outcome of the medical consultation. This aspect, however, has not been fully investigated in the literature and further research is needed to discern the potential importance of this matching on different aspects of the consultation. Methods: The main aim of the study was to investigate the matching of patient-GP expectations related to the back pain consultation in primary care by means of (1) developing a structured questionnaire that can measure this matching; (2) using the tool to measure the matching of patient-GP expectations; and (3) exploring the perceived importance of such matched expectations on different aspects of the consultation. Using a mixed methods sequential nested design, 11 GPs and 57 back pain patients (from 11 general practices in the South of England) completed the Expectations Questionnaire (EQ) that measured the matching of their expectations. Telephone interviews were then used for exploring the perceived importance of this matching. The study tested the hypothesis that the matching of patients‟ and GPs‟ expectations was perceived as an important attribute for a successful back pain consultation in primary care, from the patients‟ and GPs‟ perspectives. Results: The study showed that the EQ can be used as a valid and reliable tool for measuring the matching of patient-GP expectations. The results showed that patients and GPs had mismatched expectations regarding one third of the EQ items. These were mainly related to the psychosocial aspect of the management. The data suggested a trend within the back pain consultations, where patients were less likely to express their expectations and the GPs were less likely to enquire about any unmet expectations at the end of the visit, which could render many expectations unaddressed and unmet. Thematic data analysis revealed several emerging themes with regard to the importance of matched expectations, namely, enhanced communication, trust, empathy, satisfaction and adherence, and have identified different or lack of agendas, time, caseload, cultural and language variations and continuity of care as possible barriers to this matching. Conclusion: The study revealed several convergences, but also identified a significant mismatch between patients‟ and GPs‟ expectations. Matched expectations were perceived as a significant indicator of the quality of the back pain consultation. Considering the many challenges and difficulties in managing back pain in general practice, a state of matched patient-GP expectations has the potential for improving the overall consultation experience, in terms of both the process and the outcome.

This study aims to explore recovery in AN from the perspective of individuals who have experience of it and examine if there are implications for practice. A Grounded Theory methodology was used and semi structured interviews employed to collect the data. The sample consisted of 12 individuals who had experience of AN, either as currently ill or self-defined as recovered from AN. All interviews were recorded and transcribed and the constant comparison method employed to analyse the data. The findings show that recovery for the person involves the successful integration of the four major dimensions of recovery; deciding to recover, sustaining recovering, doing the necessary tasks and building a life without AN. Each of these dimensions represents a series of tasks, which the person must complete, to varying degrees, if they are to recover. The grounded theory that emerged makes explicit that recovery from AN is conditional on the individuals' decision to recover and to take an active part in making it happen. Integrating the four dimensions is a spiralling process where the change in one is dependant on and is influenced by change in the others. They have to improve their physical condition or no recovery is possible because of the effects of starvation. They must tackle the issues that contributed to the AN and take on new roles if they are to move away from the AN identity. They must reconnect with others, asking for and accepting their help because recovery is not achieved alone. If they invest the substantial physical and emotional energy needed to sustain their recovery then they are transformed. They explore and build a life separate from the AN through the integration of the four dimensions. As a result the limited identity of AN is replaced by a more complex identity where individuals are stronger, more connected with others and in control of their lives. This study supports greater attention to the role of self-development tasks and models of treatment that promote autonomy in the person.

This investigation set out to explore the changes affecting the role of the hospital nurse from the perspectives of nurses and doctors working on, and patients receiving treatment in, hospital wards. The aim was to examine their perceptions through qualitative methodology using the systematic method of grounded theory. Initially, eighteen nurses were interviewed, and through theoretical sampling, these were followed by interviews with seven doctors and then eight patients. All the nurses had been registered for a minimum of one year, and included general and specialist nurses. The doctors ranged from the newly qualified juniors to senior doctors with between fifteen and thirty years' experience, and worked in assorted specialties. The patients varied both in age and previous hospital experience, and these variations in all the groups provided both similarity and diversity of findings. The data were collected and analysed separately for each group. Four constructs emerged from the nurses: providing a service, drifting away from the patients, being ambitious and getting on and making choices. Four constructs emerged from the doctors: working together, retaining nursing, challenging medical power and defining the boundaries, and three from the patients' data: the changing healthcare environment, building relationships and responding to patients' needs. The findings of each group were then compared to examine their similarities and differences and to provide a framework for the evolving theory. The results demonstrate that the perceptions of each group are subject to both internal and external influences affecting the health care context. Thus, the role of the hospital nurse is perceived as remaining the same in some areas, such as a need to retain the caring role for patients, whilst in others progressing towards technological change and overlapping with the roles of doctors. It is perceived as undergoing metamorphosis and changing as a consequence of external political pressure, societal influences and nurses own developing knowledge; at the same time the role retains traditional elements, where nurses build a therapeutic relationship with patients and respond to their needs. Thus, depending on the perceptions of specific factors affecting the health care context, these influences generate metamorphosis or stasis in the role of the hospital nurse.

Diabetic retinopathy is the single largest cause of sight loss and blindness in 18 to 65 year olds. Screening programs for the estimated one to six per- cent of the diabetic population have been demonstrated to be cost and sight saving, howeverthere are insufficient screening resources. Automatic screen-ing systems may help solve this resource short fall. This thesis reports on research into an aspect of automatic grading of diabetic retinopathy; namely the identification of the retinal blood vessels in fundus photographs. It de-velops two vessels segmentation strategies and assess their accuracies. A literature review of retinal vascular segmentation found few results, and indicated a need for further development. The two methods for vessel segmentation were investigated in this thesis are based on mathematical morphology and neural networks. Both methodologies are verified on independently labeled data from two institutions and results are presented that characterisethe trade off betweenthe ability to identify vesseland non-vessels data. These results are based on thirty five images with their retinal vessels labeled. Of these images over half had significant pathology and or image acquisition artifacts. The morphological segmentation used ten images from one dataset for development. The remaining images of this dataset and the entire set of 20 images from the seconddataset were then used to prospectively verify generaliastion. For the neural approach, the imageswere pooled and 26 randomly chosenimageswere usedin training whilst 9 were reserved for prospective validation. Assuming equal importance, or cost, for vessel and non-vessel classifications, the following results were obtained; using mathematical morphology 84% correct classification of vascular and non-vascular pixels was obtained in the first dataset. This increased to 89% correct for the second dataset. Using the pooled data the neural approach achieved 88% correct identification accuracy. The spread of accuracies observed varied. It was highest in the small initial dataset with 16 and 10 percent standard deviation in vascular and non-vascular cases respectively. The lowest variability was observed in the neural classification, with a standard deviation of 5% for both accuracies. The less tangible outcomes of the research raises the issueof the selection and subsequent distribution of the patterns for neural network training. Unfortunately this indication would require further labeling of precisely those cases that were felt to be the most difficult. I.e. the small vessels and border conditions between pathology and the retina. The more concrete, evidence based conclusions,characterise both the neural and the morphological methods over a range of operating points. Many of these operating points are comparable to the few results presented in the literature. The advantage of the author's approach lies in the neural method's consistent as well as accurate vascular classification.