Avian influenza H5N1 causes occasional but serious infections in humans and efforts to produce vaccines against this strain continue. Current influenza vaccines are prophylactic and utilize the two major antigens, hemagglutinin and neuraminidase. NP is an attractive alternative antigen because it is highly conserved across all influenza strains, has been shown to increase the rate of viral clearance, and potential therapeutic vaccines would elicit cytotoxic T lymophcyte responses in an infected person. The NP antigen from H5N1 was characterized using a variety of physiochemical methods to gain insights into both the biological and physical properties of the antigen which are important from a regulatory viewpoint when considering therapeutic vaccines. Results obtained to date show that NP is relatively unstable and indicate that the conformation of the H5N1 NP antigen is highly dependent upon purification procedure, buffer conditions, pH and the presence or absence of RNA. These factors will need to be clearly defined and taken into consideration when manufacturing and regulating NP vaccine preparations.

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This is the first known occupational therapy (OT) study to examine the emergent patterns of the client-therapist working alliance during the course of a community-based OT intervention. The experiences of both the adult client and OT in each of four dyads are explored and described as they relate to the evolution of the alliance over time and the impacting contextual factors. These experiences were considered alongside the therapy outcomes. Mixed methods, including quantitative scales and interviews, were used in this multiple-case study situated within a pragmatism paradigm. Individual case and cross case analyses were conducted leading to the identification of eleven cross case themes. These findings suggest that the interpersonal relationship between a client and OT develops with the goal of becoming a safe harbour for the clients. The strengthening interpersonal bond appears to create an impetus within the client to engage in therapeutic activities. This enticed engagement results in the client’s performance of novel activity purposefully selected by the OT as bearing personal meaning for the client. The clients’ engagement often results in enhanced insight into their abilities and meaningful functional gains. This success appears to reinforce and energize both the momentum toward the collaboratively-established therapy goals, as well as provides a positive feedback mechanism into the working alliance. The OT’s training, philosophy and skill, client’s attributes, and environmental influences (both physical and social) all appear to have potential implications upon the working alliance’s development and/or the therapeutic achievements. Further research will be needed to confirm or disconfirm these findings and may include further study with variable client populations (e.g., different ages, different conditions), the role of humour in the therapeutic process, the impact of client’s degree of social isolation on the alliance, as well therapists’ disparate levels of use-of-self and the related impacts upon the alliance.

I employed classical grounded theory methodology to formulate a theory of establishing therapeutic relationships in the context of public health nursing practice. Targeting Essence: Pragmatic Variation of the Therapeutic Relationship emerged as the theoretical model that elucidates how public health nurses develop therapeutic rapport with vulnerable and potentially stigmatized clients, specifically lower income lone-parent mothers. Data sources consisted of interview transcripts and dyadic observations. Public health nurses and lower income lone-parent mothers were the primary participants. During analysis, other sources for data were sought to achieve saturation of conceptual categories and theoretical integration. Targeting Essence: Pragmatic Variation of the Therapeutic Relationship is a six-stage process that evolved from theoretical interpretive analysis of the participants general pattern of relating. Public health nurses strategically modify the therapeutic relationship during their efforts to ascertain main concerns of mothers within the constraints of contemporary practice. Lower income lone-parent mothers with heightened sensitivities enact interactional behaviours to discern the intent of public health nurses. The studys focused context elicited a nuanced explanation of the dynamic process that builds on the fundamentals of communication. Targeting Essence: Pragmatic Variation of the Therapeutic Relationship has the potential to enhance relational practice capacity, to advance nursing communication training curricula, and, ultimately, to promote maternal/child health and well-being.

Thesis (M.S.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 86-102). / vii, 102 leaves, bound ill. 29 cm

Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.

The aim of this project was to investigate a range of medicinal herbs which have radical scavenging and antioxidant activities and then apply novel mass spectrometric techniques to investigate and analyse active components responsible for their pharmaceutical actions. A sensitive electron capture negative ionization of gas chromatography-mass spectrometry (ECNI-GC-MS) method was developed to assess hydroxyl radical production, as indicated by 3.4-dihydroxyphenylacetic acid (DOPAC) production, which allows excellent evaluation of hydroxyl radical scavenging and antioxidant activity of a number of medicinal Chinese herbs. Melatonin is an effective multiple radical scavenger and antioxidant and has been used in this study for the comparison of radical scavenging activity with medicinal herbs. To analyse active compounds from herbal extracts, mass spectrometric techniques were used to separate components that suppressed hydroxyl radical production from Dimocarpus longan Lour, determine known ginsenosides from ginseng extracts as well as to identify and quantify melatonin in ten herbal extarcts. The results obtained indicated that 1) the utilization of alumina in the ECNI-GC-MS method diminished interferences from ???noise??? products in a Fenton-type reaction, which allows obtaining pure final hydroxyl radical product and this method demonstrated optimal sensitivity and reliability; 2) Aqueous extracts of all herbs analysed showed different levels of hydroxyl radical scavenging activity. Dimocarpus longan Lour, Chrysanthemum morifolium Ramat, Lonicera hypoglauca Miq, Ginkgo biloba L, Rehmannia flutinosa and Libosch Cornus officinalis Sieb all exhibited stronger inhibitory effect on hydroxyl radical production than melatonin. 3) Aqueous extract of Dimocarpus longan Lour. showed the greatest inhibitory effect on hydroxyl radical production among the other herbs tested. The active fractions of this herb eluted just after the void volume using HPLC suggesting that the active compounds responsible for radical scavenging activity are polar and water soluble. They may belong to phenol group of chemicals. 4) Herbal extracts using non-polar solvents showed no effect on hydroxyl radical production suggesting active compounds in those herbs are water soluble. 5) Different species and origins of ginseng were compared for their radical scavenging activity. Chinese fresh ginseng (Oriental ginseng) showed higher activity than Korean ginseng tablet and American ginseng. Seven known active ginsenosides were identified using HPLC-MS-MS. 6) Melatonin was found at varying concentrations in ten herbs, which may contribute to the radical scavenging activity of herbs, on the other hand, it may provide the justification of clinical use and food resources, particularly for those herbs contain high level of melatonin.

Decision support systems (DSS) are traditionally designed to optimise the outcomes of a decision. This thesis explores how DSS design can also be driven by the optimisation of the decision process leading to the decision, and how it may enhance the human uptake and use of DSS. It identifies which tasks could be simplified by decision support, and how to build DSS that are likely to be readily adopted and so improve decision outcomes. It tests the hypotheses that: (a) The analysis of specific process attributes of a given clinical decision task, as well as the information needs of its users, improves the design of DSS and enhances systems?impact and acceptance. (b) The complexity of the decision task is the key process attribute that, in conjunction with the information seeking of users, shapes the outcome of the design process. The work is applied to the domain of antibiotic prescribing in critical care. To explore the first hypothesis, the key attributes of prescribing decisions associated with specific prescribing subtasks and different decision-makers and decision contexts are identified and then analysed. Based on our findings, an information-processing model of decision support for an antibiotic-prescribing task is proposed. The second hypothesis is addressed by applying and comparing metrics for decision complexity including minimum message length, cognitive effort assessment and clinical algorithm structure analysis to the prescribing task. A framework is developed to select clinical decision tasks that may benefit from automation, by characterizing decision support as a process of complexity reduction for users, and these ideas are tested in the context of antibiotic prescribing for ventilator-associated pneumonia. The hypotheses are then tested by applying the task complexity framework to the design of a DSS for antibiotic prescribing in critical care. A web-based experiment and a clinical trial of the DSS are described, both of which study the acceptability and effectiveness of the system and verify the usefulness of the design framework. Specifically, in a before-after controlled trial, with no difference in patient mortality or severity of presentation between the two periods, the use of the DSS was associated with statistically significant improvements in patient outcomes and a reduction in antibiotic usage. The length of stay and total consumption of antibiotics decreased respectively from 7.15 to 6.22 days (P=0.02) and from 1767 to 1458 defined daily doses/1000 patient days (P=0.04). The introduction of a hand-held computer-based DSS was associated with less administration of ???broad-spectrum?antibiotics. The relative impact of the uptake of the DSS on the prescribing quality was quantified. Clinicians chose to use guidelines for one third, and pathology data or the DSS for about two thirds of cases for which they were available to assist their prescribing decisions. When used, the DSS plus pathology data improved the agreement of decisions with those of an expert panel - from 65% to 97% (P=0.002). The impact of the DSS was more significant on prescribing decisions of higher complexity. The level of decision complexity appeared to affect the choice of decision support type. Prescribing guidelines were accessed more often for lower complexity decisions, whereas the infection risk DSS plus pathology data were preferred for decisions of higher complexity. The need for measurement of the effectiveness of a DSS in improving decisions, as well as their likely rate of adoption in the clinical environment, was demonstrated. The thesis concludes with a proposal to apply the framework described to the modelling of the DSS adoption and to include task complexity and user information seeking as determinants of the design and evaluation of clinical DSS.

Errata has been inserted on p. 136 and 162. / Bibliography: p. 263-280. / xxiii, 280 p. : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Presents the results of two investigations into the characteristics of electron beams for application in radiation therapy. / Thesis (Ph.D.)--University of Adelaide, Dept. of Physics and Mathematical Physics, 1997?

Research Doctorate - Doctor of Philosophy (PhD) / Swearing is a subject largely ignored in academic circles but impossible to ignore in the health workplace. Despite its prevalence there has been little academic research into swearing, and certainly none on its impact on nursing staff. Nurses are, of all health workers, most likely to be targets of verbal aggression with up to 100% of nurses in mental health settings reporting verbal abuse. Nurses encounter swearing from patients and their carers, staff, and managers, and use swearwords in communication with each other, but there is no reference in the literature to the effects on nurses of exposure to swearing. This study set out to rectify that lack of research into swearing by answering three main questions: 1. What is the extent of swearing /verbal aggression in a health care setting? 2. What are the implications of swearing for a therapeutic encounter? 3. What is the impact of swearing on nurses? A mixed methods approach was employed. Phase one of the study explored the context of care, utilising the Overt Aggression Scale to describe the nature and extent of swearing and verbal aggression across a range of acute and long-term inpatient mental health settings. Data were derived from 9,623 reports spanning a 10-year period. The sample comprised 384 (72.1%) males and 148 (27.9%) females aged between 9.5 years and 93.3, mean age 45.6, SD=21.00 years. Most frequently reported over the 10-year period was verbal aggression; incidents involving females occurred mainly in connection with the more severe levels of verbal aggression. “Psychosis” was recorded as the main perceived cause of verbal aggression, in itself an insufficient explanation. A rising tendency to cite psychosis emerged as the level of aggression rose and, on average, 1.9 interventions were recorded for each aggressive incident. Phase two surveyed 107 nurses across three health care settings paediatrics, adult mental health, and child and adolescent mental health – by means of a questionnaire designed to elicit a combination of both qualitative and quantitative data, the Nursing Swearing Impact Questionnaire, which included three standardised instruments. The quantitative data were subjected to descriptive and inferential statistical analysis. High levels of swearing were reported, 29% of nurses being sworn at 1 to 5 times per week and 7% “continuously.” A similar incidence occurred within the nursing team, but being sworn at in anger by another staff member was rare and the major use was in jest or in conversation. The study failed to find significant differences between mental health and paediatric settings in the frequency of swearing but did find gender-based differences. High levels of distress caused by being subjected to swearing were evident, particularly when the aggressor was a relative or carer of a patient. Moreover, the respondents appeared to have only a limited range of interventions for use in dealing with the experience of being sworn at. However, what emerges strongly from the data is the extent to which swearing is culture- and context-bound, and the fact that nurses share many of the views and attitudes about swearing held by society at large. The culmination of the findings suggests that swearing is both widespread and underreported in a range of health contexts. The implications of swearing are poorly understood by nurses. These, and the magnitude of their distress in being subjected to it, render them ill-equipped to deal with the experience. The concomitant negative effects on empathy result in the nurses’ distancing themselves from the patient when confronted and implementing only a restricted range of interventions and detrimental effects on the quality of the therapeutic relationship will have negative effects on patient outcomes. Given the levels of swearing reported and its consequences on the therapeutic relationship, further research is warranted.