Background: South Asian communities are increasing in the UK and there is a significant growth of this population from the 2001 and 2011 Censuses. In Brent and Leicester more than 30% of the population are from a South Asian background. South Asian men make a significant proportion of this population (Office for National Statistics (2012)). In general men’s health is under-researched and there is little research that focuses on the health of men from ethnic minorities in the UK. The sexual health of men is well researched particularly in the field of Human Immunodeficiency Virus (HIV) but this largely focuses on men who have sex with men and there is little UK research that examines the issues surrounding the sexual health of men in the South Asian community. This thesis focuses on producing a better understanding of South Asian men’s perspectives on sexual health through participatory research and dialogue. Methods: A South Asian men’s participatory action research group (PAR) was established to collectively explore South Asian men’s sexual health in Brent; followed by ten semi-structured and five in-depth one-to-one interviews with South Asian men in Leicester. The data from the three phases was thematically analysed using a qualitative descriptive method and key themes identified in relation to the perspectives of South Asian men towards sexual health. . Findings: This study uncovered deep seated cultural and religious issues that are important for those working in the field of men’s sexual health to understand. The themes emerging from the data highlighted that talking about sexual health carries connotations of stigma and shame that are largely associated with non-acceptance 4 of homosexuality and what South Asian communities consider to be western or ‘white’ liberal culture. Generational differences and the strong influence of first generation immigrants and religious leaders emphasised the theme of shame and stigma. Misconceptions about what is meant by sexual health were evident, with participants focusing on infection and promiscuity rather than health and suggesting that culturally sensitive information was lacking. Themes focused on how services could be more accessible and culturally acceptable also focused on the need to ‘be private and discreet’ and to some degree ‘hidden’ to prevent stigma and shame. Conclusion: South Asian men’s sexual health cannot be understood without understanding the wider local South Asian community which encompasses religious and cultural influences which impact South Asian men’s perspectives on sexual health. These perspectives have been shaped by cultural and geographic origins, patterns of migration, religious and family expectations, generational and marital status. These issues result in a lack of engagement amongst South Asian men and sexual health services. The findings of this study suggest that services should target South Asian men at an individual, cultural community and service level to build trust and provide services that are accessible and culturally acceptable. There is also a need to create greater understanding about the nature of sexual health and align it with men’s health issues more generally. Establishing forums and creating information sources that facilitate open discussion among men in South Asian communities to de-stigmatise sexual health would also assist in reducing stigma.

manifestation of PE in mothers who later develop the complication; histamine receptors H1 and H2, and DAO messages are expressed in juxtapositions at the foeto-maternal interface, Histidine Decarboxylase (HDC) HDC activity is elevated in PE placentae; and while elevated histamine upregulates the proteins for Th1-like cytokines, it also down-regulates DAO message expression after prolonged exposure in the placenta. The findings further show that lipopolysaccharides and pro-inflammatory cytokines including IL-10 and INF-g increase histamine production in the placenta; and the histamine has a positive feedback loop regulatory relation with the proinflammatory cytokines. Furthermore, the validation of Elevated Histamine Model (EHM), an in vitro model designed for studying histamine effect in placenta showed that placental micro explants (∼50 mg) in long-term culture (explants that have undergone syncytiotrophoblast regeneration) at the liquid-gas interface in 8% oxygen is an optimum culture condition to study effects of histamine in the placenta. EHM produced RNA with quality akin to time zero pre-culture explants. The works also led to the identifications of a core set of significant genes that are consistently expressed in both normal (NP) in PE placentae but at varying levels, and a further subset of significant genes expressed consistently only in PE placentae (PE specific genes). Comparison of EHM significant genes with the PE specific genes confirmed the presence of 270 consistently expressed genes that appear to underpin the effects of elevated histamine in the placenta with implications for PE pathogenesis. Further analyses of these EHM genes in PE placentae showed that the natural process by which pre-eclampsia develops is affected by the amount of histamine in the maternal blood and placenta, and the natural process by which pre-eclampsia develops is indirectly affected by histamine via covariate functional groups regulated by specific histamine regulated PE placental genes. 5 Conclusion: Histamine receptor genes are expressed at the foeto-maternal interface; DAO genes are expressed in the placenta; HDC activity levels are increased in PE placentae; there is cross-talk between histamine, DAO and cytokines in the placenta; elevated histamine regulated the expression of specific genes in the placenta and these genes are abnormally expressed in PE placentae; the functions of the histamine regulated genes also identified in PE placentae are involved in tissue morphology and possibly poor placentation, metabolic defects, endothelial dysfunction, inflammation, immunologic response, angiogenic and anti-angiogenic response in PE placentae. Therefore it is reasonable to conclude that the elevated histamine observed in PE would have pathophysiological roles in PE and early detection leading to effective control of maternal blood histamine levels has survival values and it’s thus recommended.

Mycobacterium Ulcerans (also known as Buruli Ulcer) is a rare skin disease which is prevalent in rural communities in the developing world mostly in Africa. Even though the mortality rate is low morbidity and consequent disabilities which affect the quality of life of sufferers is very high. If the disease is reported early treatment is available but many people receive help late in the disease process. Many reasons have been given in the literature why people receive treatment late. The aim of this study was to explore the experiences of people living with Buruli ulcer in a rural district in central Ghana in order to understand their diagnosis and support needs. The study was qualitative in design and used Glaser‟s version of grounded theory. It consisted of semi-structured and unstructured interviews, participant observation, conversation with opinion leaders, traditional healers, people living with Buruli ulcer (who were not part of the study) and a focus group interview with six health care professionals. The Dermatology Life Quality Index (DLQI) tool was also used to determine the quality of life of people living with Buruli ulcer in the study area. Three principal categories of Delayed treatment, Quality of life as a mirage and Seeking to be myself and a Basic Social Psychological Problem (BSPP) of Reliving the trauma of my ulcer were derived. These led to an encompassing core category of My needs matter. The theory explains the needs of people living with Buruli ulcer and that this followed a three stage process whereby Delayed diagnosis was the cause of the BSPP, Quality of life as a mirage the consequences and Seeking to be myself as the strategies required to deal with the BSPP of Reliving the trauma of my ulcer. How to deal with the consequences of this disease and the approaches to dealing with the needs of this vulnerable group have also been explored. The outcome of this thesis and its contribution to knowledge is a theory which explains the needs of people in the early stages of and living with Buruli ulcer and why their needs matter.

A selective agar medium was developed for the isolation of Clostridium bifermentans. The formulation of the C. bifermentans selective agar (CBSA) was a modification of C. botulinum isolation agar (CBI) medium. The modifications included: a) change of the base medium to promote growth of C. bifermentans, b) increase of antimicrobial concentrations to improve selectivity and, c) lowering of the egg yolk concentration to lower the cost. The CBSA medium contains cycloserine (375 µg/ml), sulfamethoxazole (114 µg/ml) and, trimethoprim (6 µg /ml) as selective inhibitory agents. Quantitation of C. bifermentans strains on CBSA yielded counts comparable to those obtained on egg yolk agar control plates. The increased concentration of the selective agents in CBSA suppressed the growth of the lecithinase producing C perfringens, C. sordellii and other fecal organisms tested. Isolation of C. bifermentans from 20 seeded fecal specimens was readily achieved. The CBSA medium permits quantitative recovery of lecithinase positive colonies of C. bifermentans from human feces and can be used for large scale screening of various clinical specimens.

Roles organize occupational behavior. They influence time use, performance, manner, style, and content of interaction with others. It is assumed that knowledge of occupational role performance in the general population of Iceland will enable occupational therapists to be more effective in enabling a client's role performance. The purpose of this study was to add to the Icelandic occupational therapists' knowledge base about role performance among the Icelandic population. A random sample of 149 Icelandic subjects, with an age range of 18 to 75 years, was surveyed about the frequency, value, and change in value of role performance in ten occupational roles over time. Results indicated that the most frequently performed roles were: worker, family member, home maintainer, caregiver, and friend. The most valued roles were family member, worker, caregiver, friend, and student. Significant differences were found between various demographic variables and the frequency and value of occupational role performance.

<p>With the increase in diabetes prevalence and the resultant greater demand for diabetes services, together with fewer resources to pay for them, diabetes has become a multi-billion dollar economic burden the world over. Electronic personal health records (ePHRs) have been positioned as transformational agents that facilitate productive interactions between patients and their healthcare providers, and support self-management of chronic diseases such as diabetes. In keeping with a patient -centred model of care, healthcare services such as ePHRs that incorporate patients' preferences and level of activation are being sought to increase and sustain patients' utility of these services. This study examines patients' preferences for the attributes of an ePHR service that supports diabetes self-management. It also explores factors that might influence their preferences. Conjoint analysis, one of the most widely used approaches to predict consumer preferences was chosen for this study. Specifically, adaptive choice-based conjoint analysis was used to identify the attributes of a winning ePHR service framework. Using Sawtooth Software's suite of interviewing products, a webbased survey was developed comprising six ePHR service attributes. Hierarchical Bayes estimations were used to quantify patient preferences while latent class analysis was used to segment the sample. Additional statistical analyses were conducted to identify any significant relationships between patient characteristics and their preferences. A stratified sample of 150 patients with Type 1, Type 2, and Prediabetes were unwavering in their preference for an internet-based ePHR service supplied by a physician or specialist. They also preferred to exchange their health information with their physician or nurse, once a month, at no cost. Monthly service fees were considered the most important ePHR service attribute. These results were applied in market simulations and sensitivity analyses to uncover the more complex effects of the ePHR attributes on the overall utility of the service. Exchanging health information every two to three months as opposed to once a month, and offering an ePHR service in the form of a monitoring device as opposed to an internet-based application, may be viable options. Selling an ePHR service directly to patients via a commercial supplier had negative impact on the utility of the service. This research also indicated that it would be prudent to take patients' ages and perceived health status into consideration when developing and marketing an ePHR service. Surprisingly, patients' level of activation for self-management did not appear to playa major role in influencing their preferences for the attributes of the ePHR service framework identified in the study.</p> / Master of Science (MS)

<p>This study sought to explore the meaning of spirituality to individuals living with schizophrenia. Gadamer's philosophy of understanding underpinned this hermeneutic inquiry. The study took place in a community-based psychosocial rehabilitation program in an urban Canadian setting. The sample included 7 English-speaking men and women, ages 25 to 49, who had not been hospitalized for six months or more. Methods involved hermeneutic analysis of verbatim transcripts of open-ended individual interviews. Four major themes were identified: the fractured self: the meaning of a "spiritual holocaust"; the vortex: the meaning of a subverted spirituality; the emergent self: the meaning of spiritual cohesion; and the nurtured self: the meaning of spiritual practices. Findings demonstrated the high value ascribed to spirituality in the lives of participants, regardless of whether they had a religious affiliation. Spirituality was seen as the fundamental connecting force that maintains the integrity of the self against the fragmenting effects of the illness. Participants felt this connectedness could be profoundly challenged as spirituality interacts with delusions. Nevertheless, spiritual connections within the individuals' life stories, with their community and with God provided the stability that helped them develop a robust sense of self while living with the illness. Implications for practice include the need to courageously support consumers in their spiritual meaning- making. Research recommendations encourage replication of this study in a more diverse population in terms of religious affiliation and an exploration of the spiritual meaning of music and art to persons with major mental illness.</p> / Master of Science (MSc)

<p>Extinction to Double Simultaneous Stimulation (EDSS) is a perceptual disorder which occurs with varying frequency following lateralized brain lesions, predominantly in the rifht parietal lobe. Correlated with impaired functional recovery of hemiplegic patients, the phenomenon is characterized by faulty or non-recognition of stimuli on the side of opposite to that of the damaged cerebral hemisphere where these stimuli are presented simultaneously with stimuli on the ipsilesional side. Yet the phenomenon cannot be explained by a simple sensory deficiency since a patient who manifests the syndrome correctly identifies the same stimuli on unilateral presentation. EDSS is considered a (milder) sanifestation of the 'neglect' syndrome, that is, the tendency to neglect the contralesional half of the body and space following brain damage. Although known for a full century, the psychoshysiologic mechanisms underlying the syndromes of EDSS and 'neglect' are still poorly understood and many hypotheses remain speculative. Investigation of an underlying mechanism seems essential for the development of treatment strategies aimed at ameliorating the syndrome and thereby conceivably enhancing the rehabilitation potential of this patient group. Although the unilateral neglect of stimuli may involve different sensory modalities, the present study focuses on somatosensory stimuli. The purpose of the present study was two-fold: first, to test two prevailing theories which account for the syndrome of EDSS in hemiplegic patients, and to distinguish between the respective hypotheses; second, to investigate hemispheric asymmetries in the perception of somatosensory stimuli prior to brain injury as a possible basis for the development of unilateral hemineglect after brain lesions. The postulated mechanisms underlying EDSS, stimulus properties and the hemispace in which the stimuli occur, were therefore tested in both a clinical as well as a neurologically intact population. The research questions were addressed in two parts of the study: in study A, electrical stimuli at perception threshold, systematically varied with respect to duration and the hemispace in which they were delivered, were presented to 68 subjects free of neurological disease (34 males, 34 females). The subjects; report of perceived stimuli was recorded and errors of detection were analyzed. In study B, a similar procedure was performed on 19 hemiplegic patients manifesting EDSS. The results indication that both sensory characteristics and attentional factors influence perception. The findings of study A suggest that: 1. The hemispace in which stimuli are presented play a significant role in their perception. 2. A left hemispace advantage appears to be pre-eminent in females. 3. The right hemisphere may be a better 'watchkeeper' for stimuli directed to the left hemisphere that the left hemisphere is for stimuli directed to the right hemisphere. In hemiplegic patients (study B), neither of the two tested theories could account by itself, under the experimental conditions of the present study, for the syndrome of 'extinction'. Based on the present findings, EDSS is viewed as a deficiency in neurointegrative functioning altering the physiological processing of stimuli.</p> / Doctor of Philosophy (PhD)

<p>The factors regulating the uterus in the maintenance of pregnancy and the onset of labor are two important and unresolved problems in uterine physiology. At term, specialized cell-to-cell contacts, gap junctions, appear between the uterine smooth muscle cells. These structures are thought to allow direct passage of ions and small molecules between cells thus their formation between uterine smooth muscle cells at term may promote propagation of electrical activity and development of contractile synchrony in the uterine wall, necessary for expulsions of the fetus(es). The objective of this thesis was to examine the possible functional role of gap junction formation in the myometrium at parturition. The hypothesis that gap junction formation results improved electrical excitation (which give an indirect measure of cell-to-cell electrical coupling_ in the myometrium before (i.e. at preterm) and after (i.e. at delivery) in situ gap junction formation. Some of the tissues used for these experiments were examined by thin section electron microscopy for the presence of gap junctions. Spontaneous burst discharges propagated other the entire recording distance of 15mm in the longitudinal axis of the myometrium at both preterm and at parturition. Burst activity at both times showed some of the characteristics of a system of coupled relaxation oscillators. However, individual spikes within the bursts propagated further with higher velocity in this axis at parturition as compared to at preterm. In the transverse axis of the myometrium, both bursts and individual spikes within bursts propagated over longer distances at parturition than before. Propagation in this axis at parturition appeared to require an intact or undamaged circular muscle layer. Analysis of the propagation of spikes evoked by electrical stimulation confirmed that spike propagation was improved (e.g. higher velocity and long distance spread) in both the longitudinal and transverse axes of the myometrium at parturition. Electron microscopy studies confirmed that gap junctions were present in large numbers between uterine smooth muscle cells during parturition and were absent or present in very small numbers at preterm. Thus, improved propagation of electrical discharges was associated with an increase in gap junction contact between myometrial cells. These results are consistent with the hypothesis that gap junction formation at the term results in improved electrical coupling of the uterine smooth muscle cells.</p> / Doctor of Philosophy (PhD)

<p>The synovial membrane (SM) is a specialized tissue which lines the joint capsule surrounding the interface between bone and cartilage. The intimal layer of the SM, a 1 to 2 cell thick layer of myeloid and mesenchymally-derived cells, has generally been characterized as the population of cells responsible for the secretion of synovial fluid (SF) and with maintaining structural stability within the capsule of diarthrodial joints.</p> <p>In pathological states, the SM is transformed into an aggressive tissue inundated by inflammatory cells and their soluble mediators. The intimal layer of the SM and its resident cells, Type A and Type B synoviocytes, undergo an alteration in phenotype during disease, particularly chronic joint inflammation. These synoviocytes expand in number and activity and have been demonstrated to be involved in part with the arthritic lesions associated with inflammatory joint disease. The purpose of this thesis is to illustrate that the human synovial fibroblast (HSF or Type B synoviocyte) is a dynamic cell both responding to and influencing its local environment. More specifically, it is documented that HSF activity is significantly affected by a host of locally produced soluble mediators released during arthritic diseases. In addition, HSF are shown to respond to their environment by possessing the capability to alter the activity of other inflammatory cells which are present in the joint milieu. We also show that the pathological state of the originating SM is significant in determining the response and activity of HSF. That is, HSF-derived from normal SM respond to some stimuli differently than do HSF derived from SM originating from diseased joints.</p> / Doctor of Philosophy (PhD)