No description available.

Self-management has emerged as an approach to enhance quality of care for patients suffering from long term conditions, and to control costs of health services. So far, however, the effects of this approach as adopted by the Saudi healthcare system in the early 1990s remain unclear. Although current models define the concept of self-management, they do not provide a systematic development or an explanatory theory of how self management affects the outcomes of care. The objective of this research is to develop a framework applicable to the evaluation of self-management programmes. The evaluation model is built on patient-related intervention. The effectiveness of these interventions is determined by the levels of patient engagement and effective participation. Therefore, studying factors that influence patients‘ adherence to self-management activities is crucial to explain the outcomes of these interventions. We apply this framework to the case of diabetes mellitus, one of the most common chronic conditions in Saudi Arabia, causing huge burdens on patients and healthcare providers. A non-experimental retrospective cross-sectional survey research design has been employed to conduct this research using a self-administered questionnaire. Closed-ended questions were used to measure all study variables related to model construction. One open-ended question was used to investigate barriers to diabetes self-management. A non-probability convenient sample design was used to select diabetes centres participated in this study and a systematic approach for selecting patients in these centres. Research data were collected from five diabetes centres and clinics in the main five regions in Saudi Arabia. Quantitative data were analysed using simple, multiple and logistic regressions, whereas a directed content analysis approach was used to analyse qualitative data. The results of this study revealed that diabetes self-management improves clinical outcomes and reduces utilization of health services. The theoretical approaches underpinning self-management were based on established models from the field of health psychology. By investigating the effect of self-efficacy patients‘ beliefs, and locus of control on self-management, we found that these behavioural theories support the core assumptions of self-management. Self-efficacy was the most significant predictor of self-management followed by patient beliefs. Social support, effective communication between patients and health providers in addition to diabetes knowledge were all important factors to positively influence diabetes self-management. However a new construct, misconception of fatalism from the Islamic point of view, was found to play a negative role in diabetes management. The research model also suggests that diabetes knowledge was influenced by several factors. Education level was the most significant predictor of diabetes knowledge followed by age and diabetes education. It was also found that group education improves diabetes knowledge more than individual education. This model is a valid tool that could be used to evaluate self-management programmes in other chronic diseases. It can be used as a decision making supporting tool; to identify different components of self-management interventions, and to compare outcomes of programmes. It can also be used to group patients into different categories to facilitate providing tailored services suitable for each group. It could assist health providers to plan new interventions or to refine existing ones by allocating efforts and financial resources toward the most influential factors that affect patients‘ adherence to self-management activities.

The cellular response to radiation insult and studies have been carried out to investigate aspects of the cytoskeleton and the force response of the cell when probed by an AFM. Confirmed for the first time that there was a statistically significant difference for the PNT2 and PC3 cell lines in response to probing with the AFM tip, and that time was eliminated a possible influencing factor in the short term (1 hour) for the force response. Showed that the Hertz model is not sufficient for distances greater than 500nm due to the strain hardening effect for biological cells and that the biological cells non-linear force response becomes marked after the 500nm region. The orientation of actin was investigated and a bimodal variation was statistical significant, although the larger tendency was for a 90 degree separation there was indications that earlier theoretical work by Pollard, 2008 was present. The importance of the contact point when considering the cell lines PNT2, DU145 and PC3 and greater than 500nm indentation is shown and four different methods are tested and the most robust of these chosen as the method for the distance and cell lines involved. That being ‘line projection’ method created by the author. A method that normalises the data for AFM force curves is presented, the method minimises the contact point error at the same time and therefore provides biologists with a way to test cell lines using standard normal population tests.

Chronic myeloid leukaemia (CML) is a clonal stem cell disorder characterised by the Philadelphia chromosome. The treatment and outcomes of CML patients have improved with the introduction of tyrosine kinase inhibitors (TKI). Imatinib is associated with complete cytogenetic response (CCR) rate of 71% at 12 months, as documented by large phase 3 clinical trials. I carried out a large population study in the Merseyside, Cheshire and North Wales area, which showed a maximal CCR rate of 65% over 5 years of observation. This suggests there is a higher rate of imatinib failure in a general unselected CML population compared to large clinical studies which have strict exclusion criteria. My population study also confirmed that second generation TKIs can produce high CCR rates in imatinib intolerant/resistant patients. There are a number of mechanisms of imatinib resistance. The hOCT1 transporter has been shown to be an important predictor of response to imatinib treatment. However, it has been suggested there are other drug transporters involved in imatinib transport which may have prognostic significance. This thesis examined the role of SLCO1A2, OCTN1 and OCTN2 in the transport of TKIs. Transfected cell lines expressing high levels of the respective drug transporter were made using the AMAXA nucleofection process. The cell lines with the highest gene expression, as quantified by TaqMan PCR, were then selected and used in radioactive uptake experiments. Imatinib was confirmed to be a substrate for SLCO1A2. However, the mRNA expressions levels of SLCO1A2 did not have any prognostic correlation to outcome. A review of patient co-medication also showed inhibitors of SLCO1A2 had no effect on CCR and major molecular response (MMR) rates in imatinib treated patients. OCTN1 and OCTN2 did not transport imatinib. Nilotinib and dasatinib are not substrates for SLCO1A2, OCTN1 or OCTN2. Drug drug interactions have also been implicated in drug resistance. Imatinib and metformin are actively transported by hOCT1. It was postulated that varying concentrations of metformin could potentially affect the uptake of imatinib by competitive inhibition. A metformin concentration of 768µM was required reduce imatinib uptake by 50%. However, this concentration is much higher than therapeutic metformin levels, therefore these drugs do not interact at therapeutic concentrations. This thesis shows imatinib is an effective treatment in CML but the CCR rate is lower than in published phase 3 trials. SLCO1A2 transports imatinib but RNA levels have no prognostic significance. Imatinib and metformin do not interact at normal therapeutic concentrations.

When digital imaging and image processing methods are applied to clinical diagnostic and prognostic needs, the methods can be seen to increase human understanding and provide objective measurements. Most current clinical applications are limited to providing subjective information to healthcare professionals rather than providing objective measures. This Thesis provides detail of methods and systems that have been developed both for objective and subjective microscopy applications. A system framework is presented that provides a base for the development of microscopy imaging systems. This practical framework is based on currently available hardware and developed with standard software development tools. Image processing methods are applied to counter optical limitations of the bright field microscope, automating the system and allowing for unsupervised image capture and analysis. Current literature provides evidence that 3D visualisation has provided increased insight and application in many clinical areas. There have been recent advancements in the use of 3D visualisation for the study of soft tissue structures, but its clinical application within histology remains limited. Methods and applications have been researched and further developed which allow for the 3D reconstruction and visualisation of soft tissue structures using microtomed serial histological sections specimens. A system has been developed suitable for this need is presented giving considerations to image capture, data registration and 3D visualisation, requirements. The developed system has been used to explore and increase 3D insight on clinical samples. The area of automated objective image quantification of microscope slides presents the allure of providing objective methods replacing existing objective and subjective methods, increasing accuracy and rsducinq manual burden. One such existing objective test is DNA Image Ploidy which seeks to characterise cancer by the measurement of DNA content within individual cell nuclei, an accepted but manually burdensome method. The main novelty of the work completed lies in the development of an automated system for DNA Image Ploidy measurement, combining methods for automatic specimen focus, segmentation, parametric extraction and the implementation of an automated cell type classification system. A consideration for any clinical image processing system is the correct sampling of the tissue under study. VVhile the image capture requirements for both objective systems and subjective systems are similar there is also an important link between the 3D structures of the tissue. 3D understanding can aid in decisions regarding the sampling criteria of objective tests for as although many tests are completed in the 2D realm the clinical samples are 3D objects. Cancers such as Prostate and Breast cancer are known to be multi-focal, with areas of seeming physically, independent areas of disease within a single site. It is not possible to understand the true 3D nature of the samples using 2D micro-tomed sections in isolation from each other. The 3D systems described in this report provide a platform of the exploration of the true multi focal nature of disease soft tissue structures allowing for the sampling criteria of objective tests such as DNA Image Ploidy to be correctly set. For the Automated DNA Image Ploidy and the 3D reconstruction and visualisation systems, clinical review has been completed to test the increased insights provided. Datasets which have been reconstructed from microtomed serial sections and visualised with the developed 3D system area presented. For the automated DNA Image Ploidy system, the developed system is compared with the existing manual method to qualify the quality of data capture, operational speed and correctness of nuclei classification. Conclusions are presented for the work that has been completed and discussion given as to future areas of research that could be undertaken, extending the areas of study, increasing both clinical insight and practical application.

<p> The process of vapour fractionation during impact fusion of country rocks is discussed in relation to absolute loss and relative loss. The factors which determine the amount of vapour fractionation are considered in an equilibrium thermodynamic model. The model is tested upon the relative vapour fractionation of Rb with respect to K. Application of the model to crater studies leads to sampling concepts and the statistical validity of differences in measured compositions of melt rock and adjacent country rocks.</p> <p> The petrography and K/Rb ratios of twelve samples of melt phases in the Onaping formation, Sudbury, Ontario are presented. The data is discussed in the light of theoretical model for vapour fractionation.</p> / Thesis / Bachelor of Science (BSc)

<p> The primary purpose of this study was to date the last metamorphism of a metanorthosite near Parry Sound, Ontario, by the Rb-Sr method on the mineral phases: biotite, hornblende and plagioclase. Due to problems with the mass spectrometer, the prepared samples could not be run. </p> <p> K/Rb ratios on biotites and plagioclase give a calculated K/Rb whole rock ratio for the mafic rich bands of about 230, consistent with the main trend of igneous rocks. The plagioclase K/Rb ratio, however, is much higher, and the anorthosite body as a whole may have a much higher K/Rb ratio, consistent with oceanic tholeiites and achondritic meteorites and indicating a possible lower crustal or mantle origin. </p> / Thesis / Bachelor of Science (BSc)

No description available.

No description available.

Spider orb-webs have evolved to intercept prey, absorb and dissipate the kinetic energy from prey impact, and retain prey until a spider can subdue their catch. Orb-web structure and function engages scientists from many disciplines, including engineering, behavior, materials science, ecology, and evolution. This dissertation examines the sticky capture spiral component of an orb-web. This composite material is made of supporting fibers covered in sticky glue droplets. These threads are both adhesive and extensible, and their performance is influenced by ambient conditions. The questions I addressed are framed in an ecological context, although they also add to our understanding of materials science. The results of the first study showed that temperature increased the viscosity of glycoproteins within Argiope aurantia droplets, mediating the effect of daily humidity changes, an important environmental effect on the glue's performance. The second study demonstrates that capture spiral droplets of spiders that build webs in habitats ranging from full sun to shade and nocturnal species (Argiope aurantia, Leucauge venusta, Neoscona crucifera, Verrucosa areenata, Micrathena gracilis) is resistant to degradation after a day's worth of UVB exposure. Conversely, after the equivalent of two days of UVB exposure the glue degrades in webs built by M. gracilis that build webs in the shade and N. crucifera, a nocturnal species. The less harsh UVA has little affect on capture spiral glue function, both for species that build webs in full sun and those that build webs at night. The third study documented web asymmetry in Argiope trifasciata orb-webs and identified differences in droplet characteristics across the webs. These spiders differently allocated resources, with the bottom region of the web having twice the droplet volume as the top, and half the ratio of aqueous to glycoprotein material as the inner droplets. Additionally, during foraging times, the bottom of the web experiences higher humidity than the top, which has the potential to increase droplet toughness in this region. This study expands the understanding of web asymmetry by examining the differences in glue characteristics as an additional level of flexibility for web fine-tuning. / Ph. D.