The Chinese group is the fastest growing ethnic group in the UK; this group is ageing fast, with the number of older Chinese doubling in 8 years. The majority of older Chinese immigrants in the UK have low education levels and limited English proficiency, and were reported to have low service use rate, lack of social support, and poor emotional status. This suggests that they may have difficult ageing experiences. This research set out to understand the UK older Chinese immigrants’ ageing experiences and coping strategies with the challenges of ageing, with a focus on the formal service use in their later life. The research adopted grounded theory as methodology, and used semi-structured interviews for data collection. The research had two phases. The first phase was exploratory using, mainly, focus groups to investigate perceptions of ageing, and for orientation to the field. Based on the contextual data provided by the phase one study, the phase two study was more focused on the support network and its influences on services use. Here individual interviews with follow-ups were used to gain in-depth understanding. Together, 58 participants, including older Chinese immigrants (n=44), family members of older Chinese (n=9), staff from organizations that work with Chinese people (n=3), and acquaintance who provided support for older Chinese (n=2), were interviewed. During phase two of the study, a group of key support providers who facilitated access to formal services for older Chinese were identified, and named as Bridge People. The outcomes of this research revealed that older Chinese immigrants used Bridge People, consisting of people from family, public sectors, Chinese community, and personal social network, to communicate with formal service providers. Older Chinese immigrants also rely on Bridge People to bridge other gaps in service delivery, such as lack of transportation, informational support, emotional support, and other cultural issues. In return, Bridge People gained trust and incurred power with older Chinese immigrants. Properties of Bridge People were identified as bilingual, bicultural, accessible, costless, and no social debt. Within the concept of Bridge People, each category provides a different combination of support, and older Chinese immigrants used this range of support in different combinations. In this study new theory and knowledge were generated about older Chinese and their key support providers. The Bridge People network model highlights the importance of interactions between Bridge People and older Chinese immigrants in accessing and using formal services. As many factors, including limited information resources, availability, role, emotional attachment, confined the performance of Bridge People, there are implications for policy makers; namely the role and importance of Bridge People should be recognized across health, social care and housing provision for older people. To promote engagement and optimise service use by older Chinese, relevant support should also be provided to Bridge People.

As the population of people in the UK, over 65, increases and the welfare system moves from a collectivist, towards a consumerist system, involving older people in their rehabilitation and care becomes more important. It is recognised that the effectiveness of practices to increase involvement varies. The reasons for this include the lack of clarity about the meaning of involvement in health care. The aims of this research were to develop a substantive theory, which explains the meaning of involvement for older people in their rehabilitation after acute illness and facilitates recommendations for health care practice development. Grounded theory was employed to collect longitudinal data from four older people, their practitioners and support staff, during the participants’ rehabilitation stay of around six weeks in an Intermediate Care unit in the UK and at home. Data were collected using recorded, semi-structured interviews and conversations, from December 2008 to November 2009 and were analysed qualitatively. The findings suggest that involvement in rehabilitation operates through an Involvement Attribute set consisting of two interdependent groups of Involvement Attributes (the psychologically-based and the action-based). Collectively, the Involvement Attributes are: the possession of a Vision, Incentive and Goals, a positive Disposition; a propensity for Cognitive Development; Goal planning, setting and achievement; and Risk Management. To be maximally involved the Involvement Attribute set has to be strong, balanced and with alignment between the two groups. Involvement in rehabilitation is also related to the type of relationships developed with the health care staff and relatives. Improvements in Involvement Attribute sets require a move away from paternalistic relationships towards the collaborative, partnerships suggested within relationship-centred care. In this way, involvement of older people in rehabilitation is: “A joint commitment within therapeutic relationships to determine and be determined in the pursuit of an Involvement Attribute set that is strong, balanced and aligned”.

Early intervention to promptly identify and treat psychosis limits the duration of untreated psychosis and improves patient outcome. Despite evidence to support efficacy, approximately 50% of young people do not take antipsychotic medication as prescribed. This research was designed to explore factors which may promote and deter teenage adherence with antipsychotic medication. Initially intended as a quantitative study, the research pragmatically shifted to a qualitative design following recruitment difficulties. Narrative inquiry and auto-photography were used to obtain stories from ten young people prescribed antipsychotic medication as a teenager. Participants collected images illustrative of their medication journey, discussing these images and their medication stories at interview. Analysis of data uncovered a metastory of a journey from darkness to brightness. In darkness, symptoms predominated bringing fear, isolation and unpredictability. As medication took effect, stories became brighter evidencing hope, happiness and productivity. Four stories linked to medication adherence emerged; namely endurance, motivation, control and resentment. Underpinning sub-stories included the endurance of resisting symptoms, taking medication long term and dealing with medication side effects. Sub-stories of motivations related to being well, being a ‘normal’ teenager and having a brighter future. Control was evident in the positive choices.

Collaboration is central in the transformation and sustainability of future healthcare with a clear place in integrated models of care, but the operationalisation of collaborative working presents challenges in practice. There is a lack of evidence about how collaboration is sustained in the delivery of healthcare, and a deficiency of studies which include patients as part of collaboration. This thesis investigates the meaning and manifestation of collaboration, including the experience of patients and professionals in practice. A social constructionist approach to grounded theory is used to investigate collaboration in an Outpatient Parenteral Antimicrobial Therapy (OPAT) service. The sample consists of staff and patients who have experience of OPAT. Interviews and focus groups are used to generate data, and grounded theory methods are used to progress the study through constant comparative analysis and theoretical sampling to a point of data saturation. Coding, categorising and techniques of situational analysis are used to analyse data and develop theory. The theory of Interactive Navigation conceptualises collaboration as a device used to navigate complex care situations and to direct collaboration with differing consequences for patients and professionals. The factors which influence collaboration are found to be a range of Situational Co-ordinates (Certainty, Uncertainty, Limits, Goals and Power) and interaction takes place through Interactive Mechanisms (Rehearsing, Coordination, Communication and Trust). The Collaboration Compass model is presented as a tool to inform understanding of Developing, Maintaining, Limiting and Disrupting collaboration. Collaboration is differentiated into four distinct areas and is revealed as a social device integral to the situation in which it takes place. This complexity requires recognition if collaborative health and social care developments are to succeed. The theory of Interactive Navigation presents a new way to view collaboration, and the Collaboration Compass offers a tool to navigate situations and map collaboration in practice.

Background: The connections between music and wellbeing are well recognised. In the current climate of economic austerity, there is a growing demand for more robust evidence of the benefits of music-based interventions to make the best use of limited arts and health resources. Aims: To explore the connections between participatory music activity and self-defined wellbeing concepts. In particular, this study seeks to identify mechanisms that connect specific types of group music activity with specific wellbeing outcomes for people with mental health issues and/or learning disabilities. Research question: What are the mechanisms that connect music and wellbeing for people in challenging circumstances? What works, for whom and in what circumstances? Design: A Realist Evaluation approach was used to identify and explore generative mechanisms in social music programmes that give rise to specific wellbeing outcomes. Two music programmes were investigated and a focus group was carried out with a third programme for validation purposes. Participant-observation and semi-structured interviews were used to identify programme theories (theories that explain outcomes), which were further developed and refined through iterative data accrual. Findings: Six programme theories were identified. Song writing and recording projects that involved both technical and artistic choices had an engaging effect, leading to outcomes of praise, hope and self-advocacy (with a corresponding sense of empowerment). Forms of musical improvisation tended to affect energy levels and consequently mood and perception, yielding both immediate effects (expressed as a sense of ‘balance’) and subsequent effects (described here as resilience). Activities involving pre-existing songs or styles (e.g. cover versions) engaged notions of identity and memory, which affected mood and increased wellbeing. Conclusion: The programme theories identified here have the potential to inform and improve music for health programmes in other contexts. Useful similarities and significant differences between service user groups were identified, enabling more specific questions to be asked of music programmes and indicating directions for future inquiry. These findings may enable similar interventions to be better tailored to their client base, making them more effective and more cost-effective.

Introduction: My ten published papers focus on two domains of the quality agenda, patient safety and patient experience, concentrating on how quality improvement can reduce the occurrence of serious consequences of patient harm and poor patient experience. Aims: My goal was to design, test and discover how to make improvements in clinical practice in four areas: sleep deprivation, infection prevention, falls prevention and pressure ulcer prevention. Literature Review: There was limited evidence of successful strategies for change to improve quality. Common quality improvement challenges were within the complex critical care environment and an urgency to act without the focus on well-designed methods. Design and Methodology: A broad range of research methods was applied to evaluate the implementation of improvement interventions in critical care. These included: observational designs to uncover understanding on patient experience, activities and processes; before and after design; stepped cluster design and longitudinal time series design, utilised to increase confidence with attributable effect from the interventions. Results: My appraisal of my ten publications showed quality varied. Process and outcome measures were used to determine the success, and I received national and local recognition for some of my work. Discussion My three main knowledge contributions were: · practical ways to help nurses assess and improve patients’ sleep · risk assessment approaches · translation and implementation of improvement methodology in critical care. I discovered four cross-cutting themes which add to quality improvement knowledge and I developed an enhanced model for improvement. The four themes are: · clinical leadership at a programme and local level · using a bundle of technical and non-technical interventions · undertaking patient risk assessment to guide interventions · the value of data measurement and feedback Conclusions & Recommendations: My work has improved patient experience and patient safety knowledge. With further testing this knowledge could greatly benefit other areas of healthcare.

In line with technological developments, there is almost no limit to collect data of high dimension in various fields including bioinformatics. In most cases, these high dimensional datasets contain many irrelevant or noisy features which need to be filtered out to find a small but biologically meaningful set of attributes. Although there have been various attempts to select predictive feature sets from high dimensional data in classification and clustering, there have only been limited attempts to do this for regression problems. Since supervised feature selection methods tend to identify noisy features in addition to discriminative variables, unsupervised feature selection methods (USFSMs) are generally regarded as more unbiased approaches. The aim of this thesis is, therefore, to provide (i) a comprehensive overview of feature selection methods for regression problems where feature selection methods are shown along with their types, references, sources, and code repositories (ii) a taxonomy of feature selection methods for regression problems to assist researchers to select appropriate feature selection methods for their research (iii) a deep learning based unsupervised feature selection framework, DFSFR (iv) a K-means based unsupervised feature selection method, KBFS. To the best of our knowledge, DFSFR is the first deep learning based method to be designed particularly for regression tasks. In addition, a hybrid USFSM, DKBFS, is proposed which combines KBFS and DFSFR to select discriminative features from very high dimensional data. The proposed frameworks are compared with the state-of-the-art USFSMs, including Multi Cluster Feature Selection (MCFS), Embedded Unsupervised Feature Selection (EUFS), Infinite Feature Selection (InFS), Spectral Regression Feature Selection (SPFS), Laplacian Score Feature Selection (LapFS), and Term Variance Feature Selection (TV) along with the entire feature sets as well as the methods used in previous studies. To evaluate the effectiveness of proposed methods, four different case studies are considered: (i) a low dimensional RV144 vaccine dataset; (ii) three different high dimensional peptide binding affinity datasets; (iii) a very high dimensional GSE44763 dataset; (iv) a very high dimensional GSE40279 dataset. Experimental results from these data sets are used to validate the effectiveness of the proposed methods. Compared to state-of-the-art feature selection methods, the proposed methods achieve improvements in prediction accuracy of as much as 9% for the RV144 Vaccine dataset, 75% for the peptide binding affinity datasets, 3% for the GSE44763 dataset, and 55% for the GSE40279 dataset.

Lignocellulose is the major component of the plant cell wall and is a sustainable source of inexpensive abundant biomass. Efficient degradation of the lignocellulosic polysaccharides, cellulose and hemicellulose, is required if the plant cell wall is to be used as a resource for renewable biofuels. Microorganisms have the ability to catalyse the degradation of such bio-material through a cascade of enzyme activities into fermentable sugars and therefore are considered to be a major resource of biocatalysts for the emerging biofuel industry. The stability of the component polysaccharides and the complexity of the plant cell wall are reflected in the diverse range of functions and substrate specificities of lignocellulosic degrading enzymes. Part of this work describes the identification of a novel GH8 endo-xylanase, OtXyn8A, from the soil bacterium, Opitutus terrae. GH8 is a family in which there is only a limited amount of data available on the xylanase substrate specificity in comparison to families GH10 and GH11 in which xylanases are well established. With this in mind, OtXyn8A is the only endo-xylanase characterised from GH8 that primarily releases xylobiose from its substrates. Synergy between O. terrae enzymes was partially investigated within this study with the identification of a gene cluster within the bacterial genome. Genes organised within this cluster encoded products required for the degradation of xylan substrates and so the associated enzymes were cloned, expressed and subsequently determined for activity. Combined activities of gene products from the cluster exhibited synergy in the hydrolysis of 4-O-methyl glucuronoxylan. While surveying the genome of O. terrae, the multiplication of genes encoding GH43 enzymes was also investigated. Genes encoding GH43 enzymes were cloned, expressed and investigated for catalytic activity. Three arabinofuranosidases from O. terrae and one from Lactobacillus brevis were characterised, including the characterisation of an exo-1,5-L-arabinofuranosidase. Furthermore, a β-xylosidase from O. terrae was characterised which exhibited dual functionality as it catalysed the release of arabinose in addition to xylose from arabino-xylooligosaccharides.

No description available.

Advances in health care have led to an increasing emphasis on family involvement in the day-to-day care of children with chronic renal disease, but if families do not become competent in this it can negatively influence the child's management. Research into the psychosocial implications of childhood chronic disease has been prolific in recent years, although relatively few studies have investigated the way that families learn about chronic disease management. However, a body of work is emerging in the human sciences around the premise that social engagement in communities of practice is a fundamental process by which people learn. Building on these lines of research this study, therefore, aimed to explore the way that children with chronic renal disease and their families learned to manage the condition, and to determine the impact of relationships between families and professionals on the learning process. Using grounded theory within a symbolic interactionist approach, data were collected and analysed in two phases (retrospective and prospective). Phase one aimed to uncover the issues that eight children and/or their parents identified as important in learning about the condition since diagnosis in the preceding four years. In phase two, a longitudinal approach (building on phase one analysis) involving six families and key professionals, allowed detailed exploration, over eighteen months, of learning events that arose following referral to a Children's Kidney Unit. A focus on learning by families as social participation in care was identified in the study. A novel, substantive theory, the social theory of learning in childhood chronic renal disease is proposed comprising three categories: the processes of assessing; interacting and synthesising. Assessing is the process by which families and professionals learn through assessing the disease course as well as each others' ability and social positioning. Interacting is the process whereby families and professionals learn through sharing knowledge, earning and maintaining trust and engaging jointly in decision making. Synthesising is the process whereby families' and professionals' learn through a new, shared understanding based on knowledge of each others' communities of practice, cultures and patterns of learning. The theory conceptualises family learning as: a two way process of interaction in developing an ongoing practice between family members and professionals; the influence of interpersonal as well as intrapersonal learning; and not only acquisition of skills but also the formation of identities in the context where the skills are learned. Three patterns of learning also emerged from the data (parallel, integrated and synthesised). These help to explain some of the differences and similarities between families' learning as they move through the chronic disease journey. This study develops and modifies Wenger's (1998) social theory of learning and Gibson's concept of participatory competence (1995) and contributes an innovative perspective to the growing body of knowledge around childhood chronic disease. Testing and further development of the theory and its use in child health is indicated.