Fitness to Practise (FtP) is an emerging area of interest within the health and social care field due to the increasing high profile cases relating to professionalism and conduct of practitioners. Research has ‘yet to catch up’ with the emerging interest and the current body of evidence predominately consists of literature reviews and descriptive or discursive papers which examine the process and functionality of FtP panels. Currently no research has attempted to examine the decisions made or indeed how these decisions were arrived at within the following health and social care professions, Nursing, Paramedic Practice and Social work. Professional regulation for each of these professional groups is established through regulatory bodies. The regulation and determination of FtP of students on leading to registration is the role of the Higher Education Institution (HEI) and is less uniform in its approach. This may lead to disparity and the potential risk of inconsistency, unfair and unjust decisions for students. Aim: In order to gain a greater understanding FtP and professional conduct, this research study aimed to examine the decision-making process involved in ‘FtP’ panels for undergraduate health and social care students, comparing the decision-making process of students, lay person and practitioners (both experienced and inexperienced). This study explored the factors that influence the decision-making processes including experience and skills. Methods: Three simulated ‘FtP’ case studies were created and filmed to examine the decision-making process that takes place in panels for undergraduate nursing/paramedic/social work students. These were informed by real life cases and expertise of professionals within each of the professional groups. Actors were recruited for each of the case studies and the simulations were filmed. Debriefing of the simulation was conducted with the actors and the data collected was analysed using thematic analysis. The case studies were then examined and deconstructed by four focus groups for each case (twelve in total) with degrees of experience, lay people and students. This deconstruction also included an evaluation of the simulation and its potential use in the field of FtP. The data collected was analysed using thematic analysis and key emergent themes were identified. Findings: The findings highlighted two key areas. Firstly, the importance of those involved in panels, 'the people involved in FtP panel' and secondly the ‘decisions that were made during the panels’. These findings suggest that there are a number of identified roles within FtP. The influence of these roles is measured not by the role but the execution of the role and personalities are more influential than identified roles. There is a further suggestion that experience of FtP panels can influence decision-making processes and can make for lengthy yet robust decision-making and that when systematic approaches to decision-making are employed that there is clearer understanding of decisions it leads to more effective decision-making processes. Conclusion: Understanding student FtP decision-making and the influential factors involved in that process will inform HEIs in the overall management of FtP and consequently promote consistency and fairness in decision-making. This will be achieved by recognising the influential factors on the processes of FtP and considering these when FtP are conducted. It should prompt attention to the approaches adopted by individuals during FtP and the need for a more uniformed approach to FtP not dissimilar to that of the regulatory bodies approach. Implications: Recognising that personalities as well as identified roles are influential in the decision-making is important to consider when HEIs reflect panel composition. It is also essential to consider the experience and the skill when selecting panel members for FtP.

Chapter one is a literature review of the experiences of carers from Black and ethnic minority communities caring for someone with dementia in the United Kingdom. Critical analysis of eight articles revealed that carers viewed symptoms of dementia as a normal process of ageing. Furthermore, the carers perceived their role as an extension of an existing responsibility to provide care and support for their family member. The literature review highlighted the majority of carers being female and stigma of a family member having a mental health issue still influenced carers’ willingness to engage in formal health services. Chapter two is an exploration of the experiences that staff within alcohol services have had whilst providing support to relatives of alcohol dependent individuals from the Sikh community. Ten staff members were recruited to take part in semi-structured interviews. Thematic analysis was conducted on the derived data, eliciting a number of themes illustrating the nature of familial support provided for someone who is alcohol dependent, the pro-social attitude towards alcohol held by Sikh family members, a lack of understanding regarding addiction and the confidential nature of alcohol services. This article provided evidence of inter-generational differences between Sikh family member’s knowledge of addiction and the expectation of alcohol services. Lastly, the present study identified variations in how alcohol services target and tailor their services in specific ways to meet the needs of Sikh family members of someone with alcohol dependence. Chapter three is a reflective article on the process of conducting the empirical research. The article addressed reasons why the lead researcher conducted research in this area and considers the effects of participant experiences of working with Sikh family members of someone with alcohol dependence. This chapter also discusses the lead researcher’s relationship with participants and how the research process impacted on the lead researcher’s personal life.

Background Physical activity in children with intellectual disabilities is a neglected area of study, which is most apparent in relation to physical activity measurement research. Although objective measures, specifically accelerometers, are widely used in research involving children with intellectual disabilities, existing research is based on measurement methods and data interpretation techniques generalised from typically developing children. However, due to physiological and biomechanical differences between these populations, questions have been raised in the existing literature on the validity of generalising data interpretation techniques from typically developing children to children with intellectual disabilities. Therefore, there is a need to conduct population-specific measurement research for children with intellectual disabilities and develop valid methods to interpret accelerometer data, which will increase our understanding of physical activity in this population. Methods Study 1: A systematic review was initially conducted to increase the knowledge base on how accelerometers were used within existing physical activity research involving children with intellectual disabilities and to identify important areas for future research. A systematic search strategy was used to identify relevant articles which used accelerometry-based monitors to quantify activity levels in ambulatory children with intellectual disabilities. Based on best practice guidelines, a novel form was developed to extract data based on 17 research components of accelerometer use. Accelerometer use in relation to best practice guidelines was calculated using percentage scores on a study-by-study and component-by-component basis. Study 2: To investigate the effect of data interpretation methods on the estimation of physical activity intensity in children with intellectual disabilities, a secondary data analysis was conducted. Nine existing sets of child-specific ActiGraph intensity cut points were applied to accelerometer data collected from 10 children with intellectual disabilities during an activity session. Four one-way repeated measures ANOVAs were used to examine differences in estimated time spent in sedentary, moderate, vigorous, and moderate to vigorous intensity activity. Post-hoc pairwise comparisons with Bonferroni adjustments were additionally used to identify where significant differences occurred. Study 3: The feasibility on a laboratory-based calibration protocol developed for typically developing children was investigated in children with intellectual disabilities. Specifically, the feasibility of activities, measurements, and recruitment was investigated. Five children with intellectual disabilities and five typically developing children participated in 14 treadmill-based and free-living activities. In addition, resting energy expenditure was measured and a treadmill-based graded exercise test was used to assess cardiorespiratory fitness. Breath-by-breath respiratory gas exchange and accelerometry were continually measured during all activities. Feasibility was assessed using observations, activity completion rates, and respiratory data. Study 4: Thirty-six children with intellectual disabilities participated in a semi-structured school-based physical activity session to calibrate accelerometry for the estimation of physical activity intensity. Participants wore a hip-mounted ActiGraph wGT3X+ accelerometer, with direct observation (SOFIT) used as the criterion measure. Receiver operating characteristic curve analyses were conducted to determine the optimal accelerometer cut points for sedentary, moderate, and vigorous intensity physical activity. Study 5: To cross-validate the calibrated cut points and compare classification accuracy with existing cut points developed in typically developing children, a sub-sample of 14 children with intellectual disabilities who participated in the school-based sessions, as described in Study 4, were included in this study. To examine the validity, classification agreement was investigated between the criterion measure of SOFIT and each set of cut points using sensitivity, specificity, total agreement, and Cohen’s kappa scores. Results Study 1: Ten full text articles were included in this review. The percentage of review criteria met ranged from 12%−47%. Various methods of accelerometer use were reported, with most use decisions not based on population-specific research. A lack of measurement research, specifically the calibration/validation of accelerometers for children with intellectual disabilities, is limiting the ability of researchers to make appropriate and valid accelerometer use decisions. Study 2: The choice of cut points had significant and clinically meaningful effects on the estimation of physical activity intensity and sedentary behaviour. For the 71-minute session, estimations for time spent in each intensity between cut points ranged from: sedentary = 9.50 (± 4.97) to 31.90 (± 6.77) minutes; moderate = 8.10 (± 4.07) to 40.40 (± 5.74) minutes; vigorous = 0.00 (± .00) to 17.40 (± 6.54) minutes; and moderate to vigorous = 8.80 (± 4.64) to 46.50 (± 6.02) minutes. Study 3: All typically developing participants and one participant with intellectual disabilities completed the protocol. No participant met the maximal criteria for the graded exercise test or attained a steady state during the resting measurements. Limitations were identified with the usability of respiratory gas exchange equipment and the validity of measurements. The school-based recruitment strategy was not effective, with a participation rate of 6%. Therefore, a laboratory-based calibration protocol was not feasible for children with intellectual disabilities. Study 4: The optimal vertical axis cut points (cpm) were ≤ 507 (sedentary), 1008−2300 (moderate), and ≥ 2301 (vigorous). Sensitivity scores ranged from 81−88%, specificity 81−85%, and AUC .87−.94. The optimal vector magnitude cut points (cpm) were ≤ 1863 (sedentary), ≥ 2610 (moderate) and ≥ 4215 (vigorous). Sensitivity scores ranged from 80−86%, specificity 77−82%, and AUC .86−.92. Therefore, the vertical axis cut points provide a higher level of accuracy in comparison to the vector magnitude cut points. Study 5: Substantial to excellent classification agreement was found for the calibrated cut points. The calibrated sedentary cut point (ĸ =.66) provided comparable classification agreement with existing cut points (ĸ =.55−.67). However, the existing moderate and vigorous cut points demonstrated low sensitivity (0.33−33.33% and 1.33−53.00%, respectively) and disproportionately high specificity (75.44−.98.12% and 94.61−100.00%, respectively), indicating that cut points developed in typically developing children are too high to accurately classify physical activity intensity in children with intellectual disabilities. Conclusions The studies reported in this thesis are the first to calibrate and validate accelerometry for the estimation of physical activity intensity in children with intellectual disabilities. In comparison with typically developing children, children with intellectual disabilities require lower cut points for the classification of moderate and vigorous intensity activity. Therefore, generalising existing cut points to children with intellectual disabilities will underestimate physical activity and introduce systematic measurement error, which could be a contributing factor to the low levels of physical activity reported for children with intellectual disabilities in previous research.

This research is concerned with patient dignity in nursing. It proposes the introduction of the concept of Perceptual Adjustment Level (PAL) in order to resolve the problem of the definition of patient dignity and its maintenance within nursing care. The aims of the study are to identify how patients and nurses perceive patient dignity, to investigate the extent to which patient dignity is maintained and to identify nursing care activities in maintaining patient dignity. The implications of the findings of this study for nursing education and the development of policy on clinical practice are also examined. The literature review revealed a paucity of research on patient dignity. There was no clear definition of dignity that could be understood by both nurses and patients during their day to day interaction. Little was known of the maintenance of patient dignity and its influencing factors. A qualitative methodology utilising a phenomenological approach was used. A total of 102 patients and 94 nurses from medical and surgical wards in three hospitals within the United Kingdom were interviewed using semi-structured interview techniques. Although neither patients nor nurses specifically defined patient dignity, they came up with similar categories in terms of how they perceived patient dignity: privacy, respect, communication, the need for information, involvement in care, independence, patients' choice, form of address, decency and confidentiality. Control was only mentioned by patients. Although there was congruence between how the patients and nurses described patient dignity, it emerged that nurses tended to operate on different levels from how patients perceived the maintenance of their dignity. While nurses utilised primarily their own perception of dignity to maintain patient dignity, it was discovered that hospitalised patients went through a process of adjustment of their notion of dignity and came to a level they could accept. As a result a new concept termed Perceptual Adjustment Level (PAL) is proposed. Patients felt dignified if events matched with this level. This research has, therefore, proposed a tentative definition of patient dignity as the fulfilment of patients' expectations or needs in terms of values within each patient's perceptual adjustment level taking into account the hospital environment. The need for assessing patients to discover their perceptual adjustment level has been highlighted. A number of patients were satisfied with how their dignity was maintained but a significant number were not. Ways of improving the maintenance of patient dignity have also been proposed. In order to maintain patient dignity, nurses should consider six questions: "what?" signifies the needs of dignity which should be met. "Why?" highlights the importance of full explanations of the purpose of tasks carried out on patients, and whether it matters to the patient. "Who?" relates to who is going to perform the task on her or him? "Where?" considers whether privacy will be ensured when the tasks will be done and "how?" sensitively the tasks will be done? It is also important to make the patient aware "when?" tasks will be carried out. The main factors that influenced the maintenance of patient dignity are revealed and implications for nursing practice, management, education and research are discussed.

This thesis presents an instrumental case study of a National Health Service (NHS) mental healthcare trust in relation to race related equality policy in the delivery of secondary mental healthcare in England. The study takes a constructionist ontological position, and an interpretivist epistemology. Semi-structured interviews were conducted with the 20 participants working at three different levels of the organisation. These include strategic leaders: Chief Executive Officer, Operational Director, Director of Nursing Quality and Patient Experiences, Director of Learning and Development, Head of Human Resources, Equality and Diversity Lead; service level middle managers: General Manager, Modern Matron, Team leader, Manager of the Recovery College; and frontline practitioners: clinical directors, psychiatrist, occupational therapist, staff nurses, community psychiatrist nurse, Recovery College instructor, all working in an adult mental healthcare setting of the organisation. Narrative interviews were also conducted with eight members of the Pakistani community living in the local service area to gain their perspectives on mental illnesses and mental health services. The study was conducted because national race equality policy expects NHS mental healthcare organisations to change their culture and deliver equitable, culturally appropriate and satisfactory mental health services to all members of society, including those who identify themselves as ‘BME’ groups. However, there is evidence in the policy and research literature of inequalities in mental healthcare experienced by service users who identify themselves as being from ‘BME’ groups in England. This study, therefore, explores how a NHS mental healthcare Trust is trying to bring about cultural changes in order to meet the expectations of policy as well as meeting the needs of service users of ethnic background. For example, on the organisational side, the study explored vision and strategy as well as interventions for bringing about organisational change and the views of the participants on this change. The views from the members of the Pakistani ethnic group highlight how mental illnesses are perceived and responded to within this ethnic group. Data obtained from the staff group were analysed using a thematic framework approach. Resultant themes include: interpretation of racial equality policy in the organisation; organisational vision and strategy for change; and the challenges, barriers and facilitators to achieving the stated vision on racial equality in the service provision, especially for people of Pakistani ethnic group. The analysis benefited from the organisational development literature in analysing the data. Data obtained from the members of the Pakistani community were analysed using a thematic narrative approach. This data reflected ways in which mental health/illness is perceived and responded to within this group including: the social identity claims that people of Pakistani ethnicity make when perceiving and responding to mental illnesses; the extent to which they associate themselves with western and/or eastern models of mental illnesses; and their identification as an ethnic group with diverse and multiple social identities. Social identity literature is used to analyse and interpret this data. The relationship between the organisational data and the ethnic group data is discussed, and a way forward is suggested for bringing about the expected cultural change to the organisation in order to meet the mental health needs of ‘BME’ groups in England. The instrumental organisational case study, along with perspectives of the service users, have served to underline the challenges for the organisation on a day-to-day basis as they attempt to meet the expectations of policy, as well as the views and expectations of people of Pakistani ethnicity.

No description available.

Generally, most of the in vitro tests used in neurotoxicology are limited to transformed cell lines which are derived from rodent or human. For an in vitro test to have high rate of predictability of neurotoxicity and teratogenicity it should undergo the important processes of embryological development, such as cell proliferation, cell migration, and differentiation. Human neural stem cells have been proposed for this purpose, which have the ability to divide, differentiate, and migrate. In this study, it was found that double coating of laminin with either poly D lysine or poly L lysine was most suitable for growing human neural stem cells rather than coating with a single extracellular molecule. Several chemicals and drugs were then chosen to assess the utility of neural stem cells as an assay for neurotoxicity: methyl mercury and lead acetate; four anti-epileptics drugs (sodium valproate, phenytoin, carbamazepine, and phenobarbitone); anti-oxidants (folic acid and melatonin). These anti-oxidants were tested alone and when added to sodium valproate and to phenytoin (which are well known in their teratogenicity), and other drugs (lithium, diazepam, and amitriptyline), which are weak teratogens. To assess the effects of these molecules on human neural stem cells cell survival, total cellular protein, neuronal process length, neurosphere sizes, migration distance, Glial Fibrillary Acidic Protein, and tubulin III protein expression were measured. The study shows that methyl mercury caused significant reduction in most of the end points from the dose of 1µM and it led to significant increase in Glial Fibrillary Acidic Protein expression (which is a sign of reactive gliosis). Lead acetate led to a significant reduction in cell migration 48hours after treatment with 10µM. In the case of the anti-epileptics, sodium valproate appeared to reduce neurosphere size significantly from the dose of 500µM and decrease migration distance significantly 48hours after treatment with 1000µM. Moreover, phenytoin treatment resulted in significant reduction in neurosphere sizes from the dose of 25µM and reduced cell migration significantly from the dose of 50µM. However, the other anti-epileptics (carbamazepine and phenobarbitone) revealed their effect only at high doses which are above their therapeutic range. On the other hand, adding the anti-oxidants (Folic acid or Melatonin) to sodium valproate or phenytoin had to some extent beneficial effects, by making their toxic effect appear at doses which were higher than when used alone. Regarding the other drugs (lithium, diazepam, and amitriptyline), it seems that their toxic effect appeared only at doses which are higher than the therapeutic range. Therefore, it can be concluded that human neural stem cells are a sensitive model in detecting the neurotoxicity of methyl mercury and lead acetate at low doses and can predict the neurotoxicity of sodium valproate and phenytoin at their therapeutic doses.

The aim of this research has been the examination of the long term psychological consequences of admission to the Intensive Care Unit (ICU) for critical illness. The major objectives were first, psychometric assessment at specified intervals post-discharge, using the General Health Questionnaire, Rosenberg Self Esteem scale, and the Impact of Event Scale, and secondly identification of ICU related variables which influence psychological wellbeing and recovery. The design was prospective and used survey methods. Seventy-two patients were recruited from the ICU at St James's University Hospital in Leeds. Data were collected at six weeks, six months and twelve months post-discharge. The initial analysis produced evidence of discrimination between subgroups, in particular age, length of stay in ICU, admission severity, indication for admission, communication, pre-existence of cancer, and the use of muscle relaxant drugs. Further analysis by way of a logistic regression identified four factors which may have predictive properties - age, admission severity, trauma and pre-existence of cancer. Patients from younger age groups reported more post traumatic stress symptoms than older patients; patients with pre-existing cancer also reported fewer post traumatic stress symptoms. Patients admitted following trauma reported poorer psychological outcome. Admission severity was negatively associated with psychological dysfunction, with those who were sickest on admission reporting fewer problems. Symptoms of post traumatic stress disorder were found in a number of patients; at final follow-up 27% of the surviving sample had medium levels, and 27% high levels of post traumatic stress symptoms. ICU patients form a fragile group to study and sample attrition was considerable. Nevertheless the findings are of interest to this developing research area and suggestions are made regarding their utilisation.

Radium contamination in the lakes near uranium mines and its intake by fish and other aquatic species are of great concern in environmental radiation protection. As an alternative technique to Liquid Scintillation Counting, we present a gamma-ray spectrometric method for low level 226Ra analysis, particularly in live fish. The HyperPure Ge and a 4π NaI(Tl) array were employed as gamma-ray spectrometers. The 226Ra spectra for each spectrometer were collected in order to compare their analytical performance. From the HPGe 226Ra spectra, a detection limit of 6.81 Bq with 99% confidence was determined for an hour counting with the three strongest peaks combined. For the 4π NaI(Tl) 226Ra spectra, in order to optimize the spectral analysis, a method applied to nine different energy regions was attempted and it turned out that the detection limit is best when the total integral count subtracted by the corresponding background is used. The detection limit of the 4π NaI(Tl) was 0.99 Bq with 99% confidence for one hour counting. A benchmark simulation for point source position dependence on relative peak efficiency showed a good agreement with the experimental data. To extend 226Ra analysis to volumetric aqueous samples, MCNP Monte Carlo simulations showed that for three cylindrical volume sources, as the simulated volume source size increased from 60 ml to 125 ml to 250 ml, the full-energy peak efficiency in the energy range of interest for 226Ra decreased by approximately 3% for each size increase, due to attenuation in the source volume. A method has been proposed in order to demonstrate this technique for a live fish, whereby a fish injected with 226Ra would be kept in its own special aquarium and its gamma-ray spectrum collected. / Thesis / Master of Science (MSc)

The quantity and variety of product information available online today has increased significantly in recent years. This situation has exacerbated user information overload perceptions and made it difficult for online shoppers to choose between various online products and services. This is especially true for older adults, who typically have limitations in cognitive abilities due to the natural aging process and, as such, may perceive additional difficulties processing large amounts of information online. In response, Recommendation Agents (RAs) have become popular as decision support tools for online consumers in general, and older adults in particular. However, in the information systems literature, there is a lack of understanding regarding the design of RAs to suit the needs of different segments of the population, including older adults. Grounded in the theory of planned behaviour, and the “aging and IS adoption” literatures, this study investigates the impact of cognitive age and RA comprehensiveness on user perceptions towards the complexity of the input and output stages of an RA, and their subsequent impact on the antecedents of a user’s intention to utilize the RA for online shopping. This experimental study finds that: (i) an individual’s cognitive age significantly increases perceived RA input and output complexity perceptions; (ii) higher levels of RA comprehensiveness increases a user’s RA input and output complexity perceptions significantly; (iii) RA output complexity plays a more critical role than RA input complexity in shaping user perceptions of the overall complexity of an RA; and, (iv) increased levels of RA comprehensiveness increases individual perceptions of RA usefulness. Additionally, and as expected, cognitive age moderates the relationship between RA comprehensiveness and input/output complexity such that the effect is stronger for older adults. Surprisingly, however, cognitive age also moderates the relationship between RA comprehensiveness and perceived RA usefulness such that it is stronger for older adults. Theoretically, this study helps us to better understand how different levels of RA comprehensiveness, in terms of both the input and output stages of the RA operation, impact the intention of users of different cognitive ages to use online RAs. For practitioners, the results highlight the importance of customizing the design of RAs, in both their input and output stages, for consumers with different cognitive ages. / Thesis / Doctor of Philosophy (PhD)