Neotyphodium endophytes (Claviceptaceae) are asexual filamentous fungi found living between the cells of many cool season forage grasses including tall fescue, meadow fescue and perennial ryegrass. They produce a range of alkaloids, including ergovaline and lolitrem B, which have been shown to be directly associated with the livestock disorders fescue toxicosis and ryegrass staggers syndrome, while others, including peramine and the lolines, have been linked to increased insect and drought resistance of the grass host. In the past decade, the Neotyphodium strains AR1, MaxQ and MaxP were selected because they did not produce the alkaloids associated with livestock disorders. Subsequently, artificial associations were established between them and commercial forage grass cultivars. The slow growth rate of Neotyphodium endophytes in vitro and the low success rate of the present methods for establishing artificial associations between endophytes and grass hosts are limiting the rate at which new novel endophytes can be incorporated into plant breeding programs and eventually commercialised. In this thesis, the type and concentration of the growth medium was shown to affect radial growth rate, colony appearance and mycelial morphology of three strains of Neotyphodium endophytes. The floret inoculation of meadow fescue with the U2 strain of N. uncinatum using several techniques involving liquid culture was attempted but was unsuccessful in creating any artificial associations. Neotyphodium endophytes are unstable in stored seed. In New Zealand, it is critical that pastures are infected with protective Neotyphodium endophytes to ensure that they will not be destroyed by exotic pests. The present methods for determining the percentage of viable endophyte infection of a seed lot are too slow for efficient use in the commercial seed industry. In this thesis, primers specific to the â-tubulin gene of N. coenophialum, N. lolii and N. uncinatum were designed and successfully used to detect these species in planta. However, using these primers to develop a method to accurately determine the viable endophyte infection rate of a seed lot using RT-qPCR was unsuccessful.

Background: Patient simulations have become a basis of training for numerous health care professions. In the field of Respiratory Therapy (RT), it has been proven to influence and motivate the students in proactively participating in learning through the use of clinical demonstrations and technology. However, there remains a limited number of studies that investigate the impact of simulation in RT. PURPOSE: The aim of this study was to determine the perceptions of RT students at an urban university on what they have learned from their patient simulation sessions. METHODS: A self-reporting descriptive survey was used. It was a modification of the Student Satisfaction and Self-confidence in Learning NLN/Laerdal Research tool. The participants included 34 undergraduate and graduate RT students from the Georgia State University. RESULTS: With a response rate of 88.2%, the majority of the RT students were satisfied with their present learning and felt supportive of simulation experience, availability and access to various learning materials and activities, simulation as their motivation, and the way instructors taught the simulation. It also revealed that self-confidence and enthusiasm in learning increased with simulation activities. Majority of RT students perceive simulation education as a helpful and effective teaching method (x̅ 3.13 SD ± 0.73). RT students perceive developing the skills and obtaining the required knowledge from simulation to perform necessary tasks in the clinical setting as the most important clinical benefit they acquire from simulation education (x̅ 3.16, SD ± 0.74). The RT students also believe it is their responsibility to learn what is needed to know from simulation activity and they agree that they know how to get help when they do not understand the concepts covered in the simulation (x̅ 3.53, SD ± .50). CONCLUSION: RT students agree that patient simulations are beneficial and effective as a supportive learning method in their learning. They also agreed that simulation activities increase their self-confidence and enthusiasm in learning, but further research and studies about simulations should be encouraged in order to determine its future importance in preparing future RT professionals in real clinical settings and clinical exploration.

Background: The social consequences of having a stroke can be severe, with social isolation a reported problem. It is little explored, however, what factors predict who will feel well supported and retain a strong social network after a stroke, nor is it well understood why friendships and other social contacts are lost. Aims: This thesis explored: 1) how social support and social network change over time following a stroke, and whether this is different for those with aphasia; 2) what factors predict perceived social support and social network six months post stroke; 3) why people lose contact with friends, and whether there are any protective factors; 4) how the changing dynamics within the family unit are perceived by the stroke survivor. Design and setting: Repeated measures cohort study. Participants were recruited from two acute stroke units and assessed at two weeks (baseline), three months and six months post stroke. A subset of participants was selected for in-depth qualitative interviews 8 – 15 months post stroke. Measures and methods: Stroke Social Network Scale; MOS Social Support Survey; General Health Questionnaire; National Institute of Health Stroke Scale; Frenchay Aphasia Screening Test; Frenchay Activities Index; and the Barthel Index. Multiple regression, ANOVA, correlation and t-tests were used as appropriate. Results: 87 participants were recruited of whom 71 were followed up at six months. At six months, 56% of participants were male, 16% had aphasia, and the average age was 69 years old. 29 participants took part in qualitative interviews. Perceived social support at six months was not significantly different from pre-morbid levels; social network, however, did significantly reduce (p = .001). Those with aphasia had comparable levels of perceived social support but significantly reduced social networks (p < .05) compared to those without aphasia. Concurrent predictors of perceived social support at six months were: a person’s social network, their marital status, and their level of psychological distress (adjusted R2 = .37). There was only one baseline predictor of social support at six months: perceived social support prior to the stroke (adjusted R2 = .43). Concurrent predictors of social network at six months were: perceived social support, ethnic background, aphasia and extended activities of daily living (adjusted R2 = .42). There were two baseline predictors: pre-morbid social network and aphasia (adjusted R2 = .60). There was a significant reduction in the Friends factor of the social network measure (p < .001). The main reasons for losing friends were: changing social desires especially a sense that many participants were ‘closing in’ on themselves; aphasia; loss of shared activities; reduced energy levels; physical disability; environmental barriers; and unhelpful responses of others. Family were generally robust members of the social network post stroke. The spouse was the main provider of all support functions. Nonetheless, beneath the apparent stability of the quantitative data there were changes in how family relationships functioned, including some distressing role shifts, for example, receiving rather than providing support. Conclusion: Contact with family and perceived social support remained stable post stroke. In contrast, a person’s social network, in particular contact with friends, was found to reduce, especially for those with aphasia. Indeed, aphasia was the only stroke-related factor at the time of the stroke that predicted social network six months later. Intervention aimed at addressing social isolation may be most effective if it takes into account the multiple reasons for friendship loss, including new language and physical disabilities, as well as changing social desires.

Domestic abuse is a public health issue with long term health and social consequences for its victims. The prevalence of domestic abuse among women seeking healthcare is higher than in the general UK population and often begins or worsens in pregnancy. Health visitors, because of their role with pregnant women and mothers are in a key position to offer both supportive interventions and to play a preventative role in domestic abuse. The aim of this research is to improve understanding of issues health visitors face when working with Pakistani mothers living with domestic abuse. The study is set in the north of Britain in an area that has experienced chain migration and settlement from the Mirpur and Faisalabad regions of Pakistan since the 1970s. Taking a qualitative approach and informed by a critical realist perspective, first-hand accounts from health visitors working in the area are used. The findings of the study confirm that domestic abuse perpetrated against some Pakistani mothers is a complex aspect of health visiting practice compounded by deep rooted cultural and social practices within many Pakistani families. The key challenge health visitors face appears to be non-disclosure of abuse by many Pakistani women and the main approach taken by health visitors in this situation is predominantly one of harm minimisation. Inconsistencies in practice were however noted. Three overarching themes were found from the analysis of the data which depict the challenges health visitors face and the endeavours they take to keep women safe. The theme of Presence depicts a range of actions linked to ‘seeing’ or ‘being with’ women and includes carrying out repeated enquiry into abuse. Role Strain describes how the health visitors express difficulty in fulfilling the various demands and expectations of the role. The term Covert Actions encompasses a range of seemingly hidden or concealed activities undertaken by health visitors in an endeavour to maintain Presence. The study provides useful insight into the forms of evidence many health visitors deem can legitimately inform their clinical interventions when working with this population group and succeeds in extending current understanding of the types of knowledge health visitors draw from to inform their decisions in this specific area of practice. It also provides awareness of the wider challenges health visitors can encounter when working more generally among collectivist and honour-based communities and raises questions about some of the philosophical assumptions usually associated with Western models of healthcare. Implications for practice are that mainstream domestic abuse interventions should be used with sensitivity to the different cultural contexts in which many Pakistani mothers live, and attempts should be made to develop appropriate interventions that derive from those contexts. This includes holistic assessment tools that are flexible enough to allow clinical judgements to be informed by the more subjective elements of evidence gathering and which take into consideration the impact of the multiple oppressions some women encounter. Recommendations for service providers are that they should take a broader view of domestic violence that recognises ‘difference’ and therefore enables health visiting interventions to be flexible and responsive to differing need. This includes considering more community-based interventions among certain population groups.

Background: Dysphagia is common after stroke, so feeding through a naso-gastric (NG) tube may be necessary. NG tubes are frequently dislodged, potentially causing feed or fluids to enter the lungs. Interventions to prevent this include taping NG tubes to the face, hand mittens and nasal bridles. Overall Aim The aim of this study was to explore the opinions of staff, patients and relatives about the maintenance of NG tube feeding for stroke patients while investigating current clinical practice. Research Design and Methods: A three-phased mixed method design was used. Phase 1 involved focus groups with multidisciplinary stroke unit staff (n=17); one-to-one interviews, with stroke patients (n=4) and relatives (n=6). Phase 2 incorporated a postal survey sent to a convenience sample (n=528) registered nurses working in the field of stroke across the UK. Phase 3 involved interviews with nurses (n=5) outside the speciality of stroke. Findings: Phase 1 highlighted many categories, including: lack of protocols; ethical and legal concerns; training to insert NG tubes; patient dignity; patient autonomy and potential harms and benefits of interventions used. There were variations in the opinions of staff, patients and relatives concerning the effectiveness and acceptability of methods for securing NG tubes. Phase 2 achieved a response rate of 59% (n=314/528); 22% (n=68/312) of nurses used hand mittens, only 11% (n=34/312) used a protocol; 56% (n=176/314) of nurses had received formal training to insert an NG feeding tube, more senior nurses had been formally trained than junior nurses (p<0.005). Acceptability and effectiveness ratings for tube securing interventions varied: 50% (n=158/312) considered hand mittens to be unacceptable. However, from a total of n=92 responses about their effectiveness, 66% (n=61/92) felt they were effective. Phase 3 produced more detailed results about fear associated with NG feeding; inconsistent approaches to training and ethical and legal issues of patient restraint. Conclusions: Overall this study demonstrates differences in opinion about what constitutes acceptable, effective and legal practice when maintaining NG feeding for stroke patients. It also suggests that the lack of consistent nurse training affects the standards of care patients receive. Furthermore, there is a need for more robust evidence to inform clinical practice. This study culminates in a model of nursing related to the insertion and maintenance of NG feeding for stroke patients.

The aims of this research study were threefold. Firstly, to explore the impact of the strategic arrangements and mechanisms to implement and support practice based learning. Secondly, to investigate the selection processes, preparation, support and evaluation of mentors. Thirdly, to explore the impact of mentorship from the viewpoint of mentors, students, managers and educational links within the clinical learning environment. The study design incorporated both quantitative and qualitative approaches involving a three phased approach engaging three regional sites. The first phase involved a quantitative approach using a survey. Phase one data arose from senior staff in Higher Education Institutions (n = 10) and the National Health Service (n = 22). The results from the survey, which focused on the strategic implementation of practice based learning and the preparation of mentors in Scotland, were used to inform phases two and three of the study. Phases two and three of the research study used a modified grounded theory approach. A range of data collection methods were used to gain information from mentors, Link Lecturers, Practice Education Facilitators, managers and students. Data collection and analysis for phases two and three occurred simultaneously and incorporated the constant comparative method of analysis. Phase two provided data from interviews with mentors across the three regional sites giving a total of 30 with ten participants in each site. Focus groups were conducted with Link Lecturers (n=17); Practice Education Facilitators (n=13); ward managers (n=21) and third year student nurses in the adult branch of the undergraduate programme (n=34). Three major categories were developed ‘Becoming a mentor to facilitate learning in practice' ‘Operationalising the facilitation of learning in practice', and ‘Quality infrastructure optimising learning in practice. From these major categories a core category emerged. The core category ‘Strategic Engagement for a Quality Learning Experience in Practice' captured the process that mentors, Link Lecturers, Practice Education Facilitators, managers and students perceived as their experience related to the clinical learning environment. A tentative theory emerged which addresses the gap between strategy and operationalisation in order to enhance the learning experience in practice. The emerging tentative theory is closing the strategic and operational gap: strategic engagement for a quality learning experience in practice. A model is provided to illustrate how to manage the interface in order to provide quality learning in practice. The study provided useful insight into learning in practice and the roles of staff within the clinical learning environment with how learning maybe more effectively managed and strengthened.

Over the past 30 years, Senior and Advanced Nurse Practitioners (SNPs/ANPs) have been introduced into the healthcare arena across the world. The international literature reports such roles have created tensions within healthcare systems (Smith 2000; Tye & Ross 2000; Scholes & Vaughan 2002). However, over the past three decades the root causes of such tensions remain still to be addressed. The literature reports the consistent entrenched reluctance to collaboratively engage with SNP/ANP roles (Cummings et al. 2003; Reay et al. 2003; Davies 2006). This led to the aims of my Constructivist Grounded Theory (CGT) study, which were to discover why there continues to be tensions surrounding Senior and Advanced Nurse Practitioner roles in healthcare, in addition to attempting to generate a substantive theory to provide a foundation in which a hypothesis could be tested across a wider arena. Arising from these aims were three research questions which were explored in three phases. The first research question, posed in phase 1, was ‘where are tensions created by Senior and Advanced Practitioner roles from a service user and healthcare team perspective?' This led to in-depth interviews taking place with service users (n=12) and members of the healthcare team (n=18). Theoretical sampling consisted of medical staff (n=9), nursing staff (n=7) and Allied Health Professionals (n=2). Data were considered saturated when no new data could be identified and the main categories with focused codes were coherent. The second research question, posed in phase 2 of my study, was ‘where do tensions remain apparent in service and what meanings and actions are attributed to them?' The method of Grounded Theory Ethnography was employed, which gave priority to interactions rather than the setting. This method consisted of a 3 stepped approach, employing participative observation and individual interviews. In total, 13 periods of observation were undertaken, which equated to 64 hours of observation within different sites. The emergent categories from this phase built upon the categories from phase 1. In phase 3 the research question posed was ‘what are the interpretations of Senior and Advanced Nurse Practitioners on interactions with the healthcare team and service users?' Six focus groups and one paired interview enabled the development of the core category “Status Games”. This subsumed the main categories from each phase and incorporated common themes and patterns across all data. This core category was further verified with five individual interviews and no new properties emerged. This core category reflected the data across all phases effectively. Interpretative theorising incorporated advanced memos across all 3 phases of my study and enabled the development of a substantive theory. Social psychological game theory and underpinning script theory, which is part of the Transactional Analysis Paradigm, provided the theoretical lens to interpret what was grounded in the data. This led to the development of two new concepts, the first was status games which incorporated game analysis and highlighted ulterior transactions which have not been previously reported in the literature. The second was the professional script concept, which it is theorised underpins status games. This is also new and has not been conceptualised in the Transactional Analysis or healthcare literature. This theoretical framework illustrated that status games which fulfil professional script are being played out with awareness. It is proposed that by recognising these concepts, this will reduce tensions with SNP/ANP roles and lead to improved patient-centred care. As Vandra (2009) reports by recognising the processes and actions of communication it is possible to bring ulterior transactions into full awareness and prevent games, thus problems with communication. This led to the development of the substantive theory in this study which is: ‘The tensions generated by SNP/ANP roles stem from playing status games to fulfil professional script which requires to be recognised and acknowledged by the healthcare team in order to change the status quo and culture'. Whilst social psychological game and script theories can provide an underpinning understanding of social games and life scripts for individuals, the status game concept which emerged from my study expands our knowledge and provides a unique understanding surrounding the impact of professional script in healthcare organisations. It is hypothesised that this script has led to status games, which is central to the tensions surrounding SNP/ANP roles.

Nicotine and stimulant medications share similar neurotransmission-related effects in the pre-frontal cortex, but it is unclear if nicotine has a similar benefit on inhibitory control. Impulsivity resulting from deficits in inhibition and sustained attention have been posited as a unifying mechanism of adult ADHD psychopathology. These deficits were quantified in the present study using Go/No-Go task accuracy and intra-individual reaction time variability (RTV). The electro-cortical P3a amplitude indexes inhibitory cognitive processes and sustained attention-related frontal cortex activation in response to infrequent NOGO stimuli. However, little work has characterized the effects of nicotine on P3a or RTV in adult ADHD. Therefore, the effects of the nicotine patch on NOGO P3a amplitude, inhibitory accuracy, and RTV were assessed in non-medicated ADHD adults (12 smokers, 12 never-smokers) in a double-blind, placebo-controlled, repeated-measures design. Nicotine patch, relative to placebo patch, significantly increased NOGO inhibitory accuracy, significantly decreased GO RTV, and significantly increased NOGO P3a peak amplitude at four frontal electrode sites. These results suggest that the nicotine reduces impulsivity in adults with ADHD. The implications of these basic findings to the clinical assessment and treatment of ADHD are discussed. Additional reports at both the basic and clinical levels are needed to confirm and extend these findings.

Patello-femoral joint syndrome (PFJS) is a common problem that is challenging to treat. The dominant theory of its aetiology is „patellar malalignment‟, in which the vastus medialis oblique (VMO) muscle is ineffective in controlling patellar position but this is based on assumption. The Q-angle, a frontal plane measure, indicates patellar position relative to the pelvis and tibia; however, there is no standardised measurement protocol and it is assumed to be a fixed value. The work reported highlights the tension between measurement rigour and clinical utility. Valid measurement of the Q-angle and VMO muscle were established using: motion analysis, magnetic resonance imaging (MRI) and ultrasound imaging, in recreationally active healthy participants, then applied in various experiments involving people with PFJS, with the following conclusions: The Q-angle: * varied over 60 seconds in relaxed standing * exhibited differences in movement patterns of the three markers which form the Q-angle between healthy and PFJS groups during the stance phase of gait * was generally at its maximum at the beginning of the stance phase of gait and at its minimum at the end * did not correlate with pronation at the sub-talar joint VMO muscle size: * linear and CSA measures of the VMO muscle correlated well * measures of VMO muscle size from ultrasound were shown to be valid when compared with MRI and were equally reliable No correlation between the Q-angle and VMO muscle size was found. These results increase our understanding of the usefulness of the Q-angle, particularly its natural variation of between 30 and 40 in static standing and its different movement pattern during gait in PFJS. It was established that ultrasound imaging provides valid measures of VMO muscle size and the relationships between its CSA and linear dimensions were characterised.

This research examines the transition from student nurse to Registered Nurse (child). Earlier studies suggest the transition always involves a period of discomfort and uncertainty. However, there is a dearth of longitudinal studies of children‟s nurses, revealing a gap in the evidence that this study aims to fill. This longitudinal study commenced in one HEI in England where the six participants were completing their undergraduate programme in child nursing. A phenomenological interpretive design was used to answer the research question: „What is the experience of making the transition from student to RN (child) like?‟ Data was collected using focused qualitative interviews at three stages: mid final year, and at 3–4 months and 12–14 months post-employment as an RN. The data was analysed using descriptive and interpretive methods. The thesis draws out the changes in the participants experience over time and suggests the transition extends beyond the first year of practice. It involves development within four overarching themes: Personal and Professional Identity, Primacy of Practice, Working with People, and Managing Newness. These key themes are present across the participants‟ experience but their importance changes over time. The transition is characterised by the visibility of being a nurse and the invisibility of being a „new‟ nurse. This study supports the findings of some earlier studies and introduces some new evidence in relation to children‟s nursing, such as responding to crises, coping with grief and the difficulties and challenges of working with parents. The main limitations are that this is a small-scale study within a specific branch of nursing, with participants drawn from one HEI and conducted by a single investigator. However, because the participants took up employment in different locations in England, the findings may have some resonance with other neophyte children‟s nurses beyond the original setting of the research. Recommendations are made for undergraduate programme providers and employers to strengthen and develop the preparation of RN (child) pre- and post-qualification, particularly in the areas of preceptorship, prioritising care and managing time, working with parents, and coping with emergencies or the death of a child