For individuals diagnosed with a glioma, survival rates have shown little improvement over the last 40 years due to the heterogeneity of tumours and the difficulty of specifically targeting the tumour whilst sparing surrounding healthy tissue. Altered gene methylation is often seen in glioma cells, but methylating agents such as folate, may reverse aberrant methylation. Folate treatment has shown a beneficial effect, reducing risk of certain cancers (colorectal, breast, squamous cell carcinoma) but other studies have shown detrimental results whereby proliferation of cancer increased (mammary, prostate). The aim of this thesis was to investigate the opposing roles of folate in glioma. The glioma cell lines 1321N1, U87 MG and non-cancerous glial SVGp12 cells were used for analysis. Cells were grown in folate deficient, folic or folinic acid supplemented media and compared to standard cell culture media. Cell viability, cell cycle and apoptosis analysis along with methylation status and protein expression of the genes of interest; PTEN, FOLR1, RFC, PCFT, and MTHFR were analysed to determine differences between cell lines following treatment. The investigation showed that folic and folinic acid behaved differently depending on concentration used and the cell lines treated. Folic acid at 5 µg/ml significantly increased cell viability and protein expression levels in the U87 MG and SVGp12 cell lines, whilst the folinic acid (35 µg/ml) resulted in significant decreased cell viability, increased apoptotic activity and down regulation of the folate transporters in the 1321N1, U87 MG and SVGp12 cell lines. Folate treatment did not significantly alter cell cycle phase. Altered methylation of genes specific for folate metabolism and transport did not explain the cytotoxic effects of folate in cell lines. In conclusion, the work presented here signifies that folinic acid rather than folic acid would be more suitable for glioma treatment. The effect of folinic acid treatment on glioma had not been previously studied, and the knowledge obtained here regarding the effects of folic and folinic acid treatment on folate transporter expression in glioma has advanced understanding.

The physiotherapist-patient interaction is the medium through which physiotherapy is practiced. However, to date little physiotherapy research literature reports on physiotherapists' interactive behaviours in clinical practice. The objectives of this study were to explore, interpret and describe experienced cardiorespiratory physiotherapists' understandings of their interactive behaviours when treating chronically breathless patients and to make recommendations for practice. The study is located in the interpretive research paradigm. It has adopted a hermeneutic phenomenological approach underpinned by a relativist ontological stance and Gadamerian philosophy (1975/2004). Five experienced cardiorespiratory physiotherapists' were video recorded in a natural treatment setting with a chronically breathless patient. Data were generated through a video-cued recall and reflection, and a follow-up interview with each physiotherapist. Three themes were derived from the physiotherapists' accounts: 'Creating a facilitative space', 'Accessing and attending to your world' and 'Sharing my world'. These were considered to be key dimensions of physiotherapists' understandings of their interactive behaviours. The concept of 'Merging Worlds - facilitating the journey to a shared understanding and purpose, and safe achievement of purpose' draws together these key dimensions and represents the nature of the interactional behaviours of experienced physiotherapists when managing chronically breathless patients. The challenge of explicating tacit practice knowledge was observed during the process of data generation. This issue was considered alongside the thematic interpretation and the concept of 'Merging Worlds' to inform the development of a new model of physiotherapy practice: Mindful, Reciprocal Interaction. A series of questions to facilitate explication of, and critical reflection on interactive behaviours were developed for use by physiotherapists to enhance their interactive behaviours during encounters with patients. The findings of this study provide new knowledge for physiotherapy practice.

Low back pain is a common health problem in all societies. It affects between 60% and 85% of adults at some time in their lives and is associated with individual suffering and substantial economic and societal costs. Non-specific acute and chronic low back pain account for about 90% of low back pain and its sufferers complain of somatic symptoms without clear specific cause. A number of studies have shown that cultural and psychosocial factors can be important in the prediction of both low back pain experience and disability. This study aims to investigate the prevalence of low back pain and the socio-cultural influences on physiotherapy management of non-specific low back pain in the Gaza Strip, with a view to developing new strategies for future physiotherapy practice.

Introduction The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care has become synonymous with high-quality care and a number of studies have reinforced patient's desire for, and the positive impact of the approach. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it. Whilst the concept has been explored within medicine, nursing and other allied health professions, within physiotherapy there has only been minimal discussion. The aim of this research was to explore the meaning of patient-centred care in relation to low back pain, from the perspective of musculoskeletal physiotherapists. Methods Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. They ranged in experience from five to 25 years. Individual semi- structured interviews were adopted as the method of data collection. The interviews were audio taped and then transcribed verbatim. Analysis broadly followed the Grounded Theory approach outlined by Strauss and Corbin (1990). It consisted of a process of open, axial and selective coding. Constant comparative analysis resulted in the identification with a core category and three inter-related sub-categories and the development of a substantive theory of patient-centred care.