This thesis follows the paper-based format and papers one and two have been prepared for submission to Attachment and Human Development and the British Journal of Clinical Psychology, respectively. The relevant submission guidelines are included in the appendices (Appendix A and B).Attachment theory (Bowlby, 1977a) has prompted a wealth of empirical research in its contribution to adult attachment patterns and subsequent psychopathology in mental health (Holmes, 2001; Wallin, 2007). More recently, attachment theory has been proposed as a suitable framework by which to inform the organisation, design and delivery of mental health services (Goodwin, 2003; Seager et al., 2007) but it is unclear what this would look like in practice. Adopting an attachment-informed service model has key implications for individual and service outcomes and the two papers presented in this thesis aim to contribute to research in this area, followed by a critical review of the research, its relevance and future implications. Paper one is a narrative overview of the literature discussing the practice implications of services adopting an attachment-informed framework, and describes how this might be conceptualised in front-line service delivery. Articles reviewed described the influence of attachment theory in predominantly inpatient, secure forensic and/or psychiatric rehabilitation services, and its application within more generic community mental health services was explored. Paper two aimed to investigate the importance of individual attachment and service attachment to client psychopathology, quality of life, service utilisation and service costs in community-based mental health services. The final section, the Critical Review, critiqued the literature review and aimed to place the research within a wider context. This section considers the findings from the research and the limitations of the study, while also highlighting important issues for services, with implications for clinical practice and future research.

The thesis investigates the processes of the formation and functioning of Water Users Associations (WUAs) which have been implemented under the policy of Participatory Irrigation Management (PIM) in Maharashtra, Western India. The thesis explores (1) how social and economic hierarchies shape the process of participation in WUAs; (2) the roles played by the State and Non-Governmental Organisations in the process of participatory development; (3) the ways in which processes of neo-liberalisation have influenced water reforms in a developing country like India. The study draws on different critiques of neo-liberalism, and it explores theories of participation to provide a holistic understanding of PIM (Participatory Irrigation Management) reforms carried out in Maharashtra. The study uses a qualitative approach, based on ethnographic fieldwork carried out over twelve months at two Water Users Associations in a village in the Nashik district of Maharashtra. The study finds that processes of participation are complex, and characterized by the vested interests of the different actors involved in the process of the formation and functioning of WUAs in the village. The WUAs have been able to provide water to many farmers in the area. However, the policy has been unable to achieve much success in terms of resolving conflicts among farmers and enhancing the participation of small landholding and marginalized farmers in the WUAs. I found that the process of neo-liberalisation does not challenge or reform traditional institutions such as caste and gender, but rather that it uses them to entrench market reforms. The implementation of WUAs' policy in the wider neo-liberal context has increased the powers of the State and NGO intervention in the formulation and implementation of WUAs policy. Processes of WUAs' formation and functioning are significant examples of the ways in which neo-liberalisation is taking shape in India, including the commodification of water, and thereby, the reproduction of existing hierarchies and power imbalances. The study contributes towards developing an understanding of the wider processes of neo-liberal governance in the water sector.

This thesis examines how constitutional reforms relating to the right to water in Bolivia have affected water provision in peri-urban Cochabamba. This multi-sited ethnography explores how the right to water has framed reforms to the Bolivian water sector, how and why the right to water has been contested in Bolivia, the impact of reforms to the water sector on peri-urban water committees and emerging challenges and opportunities for sustainable water provision in peri-urban Bolivia. It demonstrates that despite the high profile role played by Bolivia in advancing the right to water at the international and national level, in practice the right to water continues to be a fairly nebulous concept. There is a disconnect between Bolivia's international stance on the human right to water and national reforms around the right to water. This thesis contends that the right to water is a banner under which the water sector has been reformed since the election of Evo Morales in 2006. Even though the constitution states that everyone has the right to water, in practice water often continues to be provided through community providers such as drinking water committees (DWCs), largely due to the failure of municipal water provision. Reforms and policy have focussed on (re)nationalising the sector and establishing new institutions to regulate and develop diverse water providers such as peri-urban DWCs. Through detailed ethnographic examination of peri-urban Cochabamba, the thesis demonstrates that activists and community-water providers in rural and peri-urban areas have contested reforms linked to the right to water. They have contended that reforms have the potential to undermine community water systems, and furthermore, that the state has failed to guarantee basic human rights and service provision. To date, the state and non-state initiatives to enhance the sustainability of DWCs have focussed on certain elements of sustainability, specifically protecting the aquifer and enhancing institutional sustainability of DWCs. By drawing on the experience and development of one DWC, this thesis also explores further elements that present challenges and opportunities to enhance sustainable water provision in peri-urban areas, namely building equitable access, and the reconciling of local power relations.

Antimicrobials are unique drugs in that they target "infectious" or "transferable" diseases. There is considerable evidence linking increasing antimicrobial use withincreasing resistance. Resistant bacteria do not know the boundaries, either between countries or within a society between hospital and primary care. Inappropriate prescribing of antimicrobials in hospitals therefore has consequences for whole communities and problems may spread both nationally and internationally. The gathering of reliable measurements of antibiotic use in hospitals employing standardised methods is essential to building an evidence base and highlighting inconsistencies at national and international levels. In this study, after data processing, validating and record linkage, a method forelectronic conversion of drug supply data to the ATC/DDD classification and forlongitudinal analysis was established for Tayside and then for a set of Europeanhospitals. Time series analysis and interrupted time series analysis were described and used for longitudinal surveillance and interventional study of antimicrobial use. This thesis explores issues concerning the evolution and management of hospital antimicrobial use using a wide range of methods. A series of drug utilisation research studies were implemented as the basis of research methods that, in combination of previously described methods, provided novel studies. No single measure can currently capture all of the aspects of hospital antibiotic use. However, a combination of detailed, point prevalence data from individual patients with longitudinal analysis of total consumption can provide meaningful data for comparison between hospitals and for analysis of the relationship between use and outcome. Additionally, there is a need to apply standard processes and novel methods to produce more meaningful surveillances. Longitudinal and point prevalence surveillances together with an explanation ofvariations in hospital characteristics are used to produce a set of coherent measurements of hospital antimicrobial use. Administrative data for longitudinal surveys requires continuous quality control.Whereas drug utilisation researchers and clinicians should target a set of indicators for interventional studies, large studies at national or international level need central data processing by country to identify targets for evaluation and for interventional studies. Support from experts in other fields is needed to address any shortcomings that may be experienced during continuous antibiotic drug utilisation monitoring at national and international levels.

Innovation programmes require organisations to transfer both technology and knowledge to the diverse actors who operate within innovation eco-systems. The changing relationship between science and society has witnessed the growth of public private partnerships (PPP) to create new knowledge, while also triggering the emergence of a new role for universities as catalysts for innovation. This brings many challenges, stemming from the inherent nature of knowledge and the complex interactions involved with inter-disciplinary knowledge transfer. Concurrently, these public-funded programmes come under increasing scrutiny to demonstrate greater societal and economic impact as a return on research investment. Knowledge generated within the UK low carbon energy innovation system has the potential to facilitate the achievement of national emission targets. However, while knowledge may be successfully created, there is no guarantee that it will be disseminated and utilised in a way that contributes to the achievement of knowledge-related objectives. Current literature concentrates on the micro level inhibitors and enablers of knowledge transfer; however, a gap in empirical work which investigates system level knowledge interactions is evident. Research and practical application in this field has historically centred on technology transfer whilst under-emphasising the crucial role of knowledge within this complex, socio-technical innovation system. The overall aim of this qualitative study is to achieve a better understanding of the influences of knowledge transfer across a defined innovation system. This is achieved through the perceptions of participants via two case studies; one in a PPP and one in a University. Semi-structured interviews were conducted with twenty-eight participants, along with document analysis and participant observation at workshops, to investigate the participant perceptions. A three tier (macro-, meso- and micro-level) data analysis approach was adopted to reflect the systems level interactions. The study found that knowledge transfer is often perceived as the dissemination of information via explicit forms of knowledge, which may or may not be used by stakeholders to achieve innovation objectives. The main barriers to stakeholders utilising knowledge included: accessibility to knowledge; fit-for-purpose knowledge; stakeholder motivation/ability to use the knowledge; and viewing knowledge as an object. While there is an emerging impact agenda in academia, cultural and normative influences direct researchers towards traditional academic outputs (e.g. publications). Knowledge utilisation by stakeholders was found to be maximised through relational, stakeholder driven models, which view knowledge as a process. Knowledge utilisation was context specific, and, due to complex system influences, was never guaranteed to occur. Although planning for knowledge utilisation was undertaken at both the PPP and the University, implementing and measuring results was found to be difficult due to dynamic system influences such as understanding stakeholder motivations, resourcing constraints and complexity in the desired project outcomes. This makes adaptability and responsiveness important qualities for knowledge producers, while also necessitating specific skill sets. Based on this work, a set of principles were developed which should guide more effective utilisation of knowledge and promote more impactful research outcomes.

L’arrivée de la traduction automatique (TA) bouleverse les pratiques dans l’industrie de la traduction et soulève par le fait même des questions sur l’utilité et l’utilisation de cette technologie. Puisque de nombreuses études ont déjà porté sur son utilisation dans un contexte où elle est imposée aux traducteurs, nous avons choisi d’adopter la perspective toute particulière des traducteurs pour examiner son utilité et son utilisation volontaire dans l’environnement de traduction (ET). Notre recherche visait à répondre à trois grandes questions : les traducteurs utilisent-ils la TA dans leurs pratiques? Les traducteurs croient-ils que les données de sortie sont utiles et utilisables? Les traducteurs utilisent-ils concrètement ces données de sortie dans le processus de traduction? Pour répondre à ces questions, nous avons d’abord diffusé un sondage à grande échelle afin de mesurer l’utilisation de la TA en tant qu’outil, de recueillir des données sur le profil des répondants et d’évaluer leur perception d’utilité par rapport aux données de sortie et aux divers types de phénomènes que nous avions identifiés au préalable avec l’aide de deux traducteurs professionnels. Ensuite, nous avons réalisé une expérience avec d’autres traducteurs professionnels où nous leur avons demandé de procéder à la traduction de courts segments et avons examiné s’ils utilisaient ou non ces données de sortie pour produire leur traduction. Notre analyse était fondée sur le principe que, dans un contexte d’utilisation volontaire, l’utilisation d’une donnée de sortie permet d’induire une perception d’utilité et d’examiner, par le fait même, l’utilité de la TA. Dans l’ensemble, nous avons trouvé que la TA n’est habituellement pas utilisée de façon volontaire, que les perceptions des traducteurs sont peu favorables à une telle utilisation, que la perception des traducteurs quant à l’utilité des données de sortie est aussi plutôt négative, mais que les données de sortie semblent être beaucoup plus utiles et utilisables que ce que ne pourraient le croire les traducteurs, car ils les ont généralement utilisées dans le processus de traduction. Nous avons aussi examiné les facteurs déterminants de l’utilité et de l’utilisation de la TA et des données de sortie.

Étant donné l’investissement économique que représente le développement de produits innovants ainsi que leur faible taux de succès auprès du grand public, anticiper ce succès est devenu essentiel pour les industriels. Par conséquent, un cadre d’analyse centré sur l’expérience utilisateur met en avant l’émotion des individus comme critère déterminant pour prédire l’utilisation future d’un produit. Néanmoins, malgré les avantages des modèles issus de ce cadre d’analyse, ils apparaissent également comme étant limités du point de vue des prédictions qu’ils permettent de réaliser. Parallèlement, d’autres modèles issus de la théorie des intentions ont cherché à identifier les prédicteurs de l’intention comportementale des individus à utiliser pour la première fois ces produits ou bien ceux de l’intention comportementale des individus à les utiliser de nouveau. Ces modèles, comme le Technology Acceptance Model, l’Unified Theory of Acceptance and Use of Technology et le Consumer Acceptance of Technology, mettent en lien les attitudes envers les caractéristiques des produits et ces intentions d’utilisation. Cependant, ils posent également quelques problèmes vis-à-vis de leurs manières de prendre en compte l’émotion des individus.Pour répondre à la problématique de l’étude de l’émotion suscitée par des produits, nous proposons d’adopter le Component Process Model. Selon ce modèle l’émotion est le résultat de modifications internes et externes qui peuvent être regroupées en cinq composantes : la composante cognitive, la composante motivationnelle, la composante subjective, la composante expressive et la composante physiologique. Nous proposons d’utiliser ce modèle pour étudier spécifiquement l’influence de l’innovation des produits sur les émotions. Ainsi dans nos Études 1 et 2, nous monterons d’une part qu’il est possible d’analyser l’émotion suscitée par des produits avant même leur utilisation d’après trois des cinq composantes et d’autre part que ces émotions ne sont pas influencées par des caractéristiques propres aux individus. Ensuite dans nos Études 3 et 4, nous testerons expérimentalement ces composantes en comparant les émotions suscitées par les toutes premières utilisations de produits dits « innovants » avec l’utilisation de produits dits « communs ». Les résultats de ces études confirmeront l’intérêt qu’a l’utilisation du Component Process Model dans l’étude des émotions suscitées par des produits et plus particulièrement par des produits innovants. / Given the sizable economic investment of innovative products’ development, anticipating their success has become essential for companies. Therefore, a descriptive framework centered on user experience – also called UX – highlights individuals’ emotions as a criterion to predict the future use of products. Nevertheless, despite the pros of the models derived from this framework, they also have limits regarding the predictions they allow to make. Meanwhile, other psychological models aim to identify predictors of individuals’ behavioral intention to use these products for the first time or to use them again. These models – such as the Technology Acceptance Model, the Unified Theory of Acceptance and Use of Technologies or the Consumer Acceptance of Technology – enable to foresee individuals’ attitudes towards product characteristics and their intention to use them. However, they are also problematic regarding their way to take users’ emotions into account.To address the problem of the study of emotions triggered by products, we propose to adapt the Component Process Model. In this model emotions are the result of internal and external changes that can be categorized into five components: the cognitive component, the motivational component, the subjective component, the expressive component and the physiological component. We suggest using this model to specifically study the influence of a product’s innovational impact on emotions. Thus, in Studies 1 and 2 we show; firstly that it is possible to analyze the emotion elicited by products before their uses from three of the five components and secondly, that these emotions are not influenced by individuals’ personality and context. Then, in Studies 3 and 4, we experimentally test these components by comparing the emotions triggered by the first uses of so-called “innovative” products compared to the uses of products known as being “traditional”. The results of these studies confirm the advantage of using the Component Process Model to analyze emotions triggered by products and, more particularly, by innovative products.

This thesis describes a series of three experiments designed to estimate the nutritional cost of the immune response to the gastrointestinal nematodes Trichostrongylus colubriformis and Teladorsagia circumcincta in sheep. For each experiment, animals were allocated hierarchically by liveweight into one of four groups that were either infected (group IF), similarly infected and concurrently immuno-suppressed with weekly intramuscular injections of 1.3mg kg liveweight (LW)-1 of methylprednisolone acetate (group ISIF), immuno-suppressed only (group IS) or remained as controls (group C). Body composition of all animals was estimated using x-ray computer tomography prior to infection and at the conclusion of each study with bodyweight and faecal nematode egg counts (FEC; eggs gram-1 of fresh faeces (epg)) measured along with blood samples taken for the determination of levels of serum proteins, phosphate and antibodies. In the first trial (Chapter 3), the nutritional cost of both the acquisition and maintenance of immunity to gastro-intestinal nematodes was investigated using immunologically naive 5-month-old lambs and immunologically competent 17-month-old ewes during infection with 2,000 and 4,000 L3 infective T. colubriformis larvae d-1, respectively (80 L3 T. colubriformis larvae kgLW-1 d-1). Profiles of FEC and comparative worm burdens at slaughter indicated an effective immune response was maintained in IF ewes and developed in IF lambs while successfully suppressed in both ISIF lambs and ISIF ewes and was confirmed by serum antibody titres. The typical reduction in voluntary feed intake as a consequence of infection was observed in IF lambs (0.30, p&lt0.001) but not in IF ewes, ISIF lambs or ISIF ewes, and appeared to be associated with L3 IgA. Gross efficiency of use of metabolizable energy (ME) for net energy (NE) deposition was reduced by 0.20 in lambs during acquisition of immunity and by 0.16 in ewes maintaining an established immunity. Infection in immuno-suppressed animals reduced efficiency by 0.05 and 0.15 for lambs and ewes. These findings allowed the hypothesis that the reduction in feed intake and nutrient utilization in young parasitized sheep is caused by physiological signalling associated with the acquisition phase of the host immune response to infection, rather than simply the damage caused by the parasite per se. The second trial (Chapter 4) investigated the influence of metabolizable protein (MP) supply on the metabolic disturbances associated with the acquisition phase of the immune response during infection with 2,000 L3 T. colubriformis d-1. Groups of lambs were offered either a low protein (L; 62g MP kgDM-1) or high protein diet (H; 95g MP kgDM-1). Patterns of total daily egg excretion indicated that an effective immune response was developed in HIF, but not LIF, HISIF nor LISF and was confirmed by comparative worm burdens. The proportionate reduction in feed intake in immunologically normal animals was reduced through the provision of additional protein, being 0.12 in HIF and 0.23 in LIF. Regardless of diet, infection did not cause a reduction in feed intake in immuno-suppressed animals (p&gt0.05). Infection proportionately reduced the gross efficiency of ME utilization in immunologically normal animals by 0.23 in HIF (p=0.09) and by 0.51 in LIF (p=0.01), but not in immuno-suppressed animals. Immuno-suppression did not suppress serum L3 IgA levels in seven of the eight HISIF and four of the eight LISIF animals. Furthermore, only four out of the eight immunologically normal animals from both the HIF and LIF groups displayed an L3 IgA response. Consequently, regardless of immuno-suppression treatment, animals were termed as IgA responders (HR or LR) or non-responders (HN or LN). Feed intake was proportionately reduced from day 22 by 0.15 in HR (p=0.03) and by 0.32 in LR (p=0.01), but was not significantly reduced in HN or LN. Gross efficiency of ME utilization was significantly reduced for LN animals only, being proportionately 0.59 (p&lt0.01). These findings allowed the conclusion that additional MP reduced the consequence of immunological signalling that was displayed in reduced feed intake and in nutrient utilization, both of which appeared to be associated with an IgA response. It is hypothesized that the lessening of nutritional disturbance observed in high protein and immuno-suppressed animals could be a consequence of altered physiological signalling during the immunological cascade. The third trial (Chapter 5) utilized lambs infected with the abomasal parasite T. circumcincta to explore the possibility that the reduction in feed intake and nutrient utilization is a universal phenomenon of the acquisition phase of the immune response to nematode parasites inhabiting different organs along the gastrointestinal tract. In addition, immunological changes at the site of parasite infestation in the abomasal mucosa were measured from serial biopsy tissue samples taken from a further twelve animals that were surgically fitted with an abomasal cannula and either infected (CIF) or concurrently infected and immuno-suppressed as described previously (CISIF). The development of immunity in IF animals was accompanied by a 0.17 proportional decrease in feed intake between days 15 to 28 of infection (p&lt0.05) and a 0.20 proportional reduction in nutrient utilization (p=0.07), none of which were observed in ISIF animals. While FEC and worm burdens indicated successful immuno-suppression in ISIF animals, both serum IgA and total antibody production were not reduced. The development of immunity in CIF was reflected in an increase in both mast cells and globule leukocytes in serial abomasal tissue biopsies, both of which were reduced in CISIF (p&lt0.01 for both). In serial biopsy tissue, immuno-suppression did prevent a rise in tissue IgA that was apparent in CIF animals (p&lt0.01) although these changes were not reflected in serum IgA levels. It appears that the alleviation of the reduction in feed intake and nutrient utilization in young lambs through the use of corticosteroid induced immuno-suppression may be a universal phenomenon for both intestinal and abomasal parasites, but the association with and/or role of IgA during infection with T. circumcincta is unclear. In summary, the reduction in feed intake and nutrient utilization in sheep during infection with both the abomasal nematode T. circumcincta and the small intestine nematode T. colubriformis appears to be associated with a component(s) of the acquisition phase of the host immune response, rather than, as conventionally assumed, the direct mechanical damage of the parasite per se. It is hypothesised that the nutritional disturbance as a consequence of infection in young lambs may be the result of pro-inflammatory cytokines involved in immunological signalling that may also be associated with the production of IgA, the effects of which can be reduced through the provision of adequate MP. These studies provide evidence that the immune response to gastrointestinal parasites is nutritionally costly to the animal and have implications for application of manipulations that are intended to promote the development of a strong immune reaction in high producing animals.

Tonsillectomy, adenoidectomy and myringotomy are the most common surgical procedures undergone by children. Medical opinion regarding the appropriateness of these procedures remains contentious, and considerable resources have been expended in the formulation and distribution of relevant practice guidelines. The impact of this surgery on the child, community and private and public health resources is considerable, yet there has been little examination of surgery rates and trends, or of the characteristics of children who undergo surgery. This thesis addressed five major questions regarding this surgery in New South Wales, Australia. The first three related to population rates: the level of surgery among NSW children, comparability with international rates, trends over time and the effect of guidelines. Comprehensive hospital data between 1981 and 1999 were analysed. Major findings were a higher myringotomy rate in NSW than reported internationally, the short-term effect of guidelines, and a major shift towards children having surgery at a younger age. The remaining questions asked whether children who had surgery differed from other children in their use of health services prior to surgery, and if so, whether their utilization reverted to the norm following surgery. Matched records of a population cohort of 6239 NSW children, born during January 1990, were extracted from Health Insurance Commission data, and their claims for medical services followed retrospectively from birth to 8 years. Children who had privately funded surgery were found to use more medical services than other children, and, most unexpectedly, this did not change following surgery. The results suggest potential non-clinical factors influencing this excess utilization. This is the first population study to examine health service utilisation by these children and it has identified an important new risk factor for surgery.

PROBLEM INVESTIGATED: Methodological issues and policy implications arising from the application of interrupted time series (ITS) analyses to assess the impact of Pharmaceutical Benefit Scheme (PBS) subsidisation policies on drug utilisation in Australia. PROCEDURES FOLLOWED: A critical review of methodological issues relating to the application and analysis of ITS designs was undertaken. This included an examination of drug utilisation data sources in Australia. The PBS policies examined were: (i) the introduction of copayments in 1990; (ii) the introduction of re-supply limits in 1994 and (iii) the introduction of a form of reference pricing in 1998. Monthly aggregate drug utilisation data was obtained from the Australian Department of Health and Ageing. Segmented regression analyses incorporating autocorrelated errors were implemented and statistical diagnostics applied to ensure correct ITS model specification. Alternative seasonal modelling approaches were compared. RESULTS OBTAINED: The copayment ITS evaluation found that while these copayments produced a reduction in the utilisation of essential and discretionary medications, this effect was stronger for discretionary drugs. An unintended policy effect was a large anticipatory increase in drug utilisation during the month prior to the copayments. Repatriation PBS data was also utilised due to the limited number of pre-intervention data points in the Community series. The re-supply limit ITS evaluation found that the 20-day rule markedly reduced the size of the seasonal increase during the month of December. However, logistic regression analyses showed that the size of this reduction attenuated over time, highlighting the need to consider alternative analysis strategies when applying a ITS approach. The reference pricing ITS evaluation found that this policy had achieved its drug utilisation objectives for H2RAs and ACE Inhibitors. However with regard to CCBs, no increase in the utilisation of benchmark priced drug was apparent, which probably reflected clinical concerns at the time about the safety of these drugs. MAJOR CONCLUSIONS: Well implemented ITS analyses provide a valuable tool for evaluating the impact of PBS subsidisation policy change on drug utilisation in Australia. As with any methodology, however, different design and data integrity issues will affect the quality of information provided.