Patient-centred care positions patients as active participants, collaborators, and experts in their healthcare and healthcare relationships - a role that adults with High Functioning Autism Spectrum Disorder (HFASD) may find challenging. The purpose of this study was to better understand the perspective and experiences of adults with HFASD in healthcare and healthcare relationships. Twenty-eight North American adults with HFASD responded to four open-ended long-answer questions online, which were analyzed using constant comparison methods within the grounded theory framework. Participants’ positive and negative experiences in healthcare were determined by their interactions with healthcare professionals who were portrayed as knowledgeable and empowering allies, or unknowledgeable and overpowering adversaries. Ultimately, these findings highlight the need for more education and knowledge about HFASD among healthcare professionals, and how it impacts these adults, as well as the need to develop evidence based interventions and tools to support adults with HFASD communication in healthcare. / October 2016

The domestic sector currently accounts for approximately a third of the UK s energy use and so energy demand reduction in the domestic sector is a key part of the UK s strategy for carbon reduction. However, energy demand reduction has typically been addressed from an engineering perspective, with little consideration of the requirements of users. This PhD submission aims to identify how qualitative information about users experiences, values and practices relating to UK domestic energy demand reduction can be collected and presented effectively to an engineering audience and incorporated into engineering-focused energy research. User centred design is presented as a viable approach to understanding the context of energy use in UK homes and specifying requirements of the householders; as a way of ensuring user needs are included in this socio-technical problem space. This requires presentation of information about human behaviour in a form that is timely and appropriate to the engineering audience, who take a positivist view, preferring facts and figures to descriptions and anecdotes. A collection of nine publications, mostly peer-reviewed journal papers, by the thesis author and her co-authors is presented. Publications spanning from 2006 to 2014 illustrate a range of approaches to providing user centred information, from literature review to complex householder studies, which can provide information to enhance the engineering data and so provide additional insight and understanding. The research findings within the individual papers add to the body of knowledge on domestic energy use. In addition, the research identifies a number of roles where user centred design contributes to understanding of home energy use. From providing background and raising awareness of the presence of users within a system, to contextual understanding and the specification of user requirements, through to more sophisticated user characterisation, it is argued that user centred design can offer a significant contribution to the field. Future application of user information into engineering models, together with large scale, longitudinal studies of home energy use are proposed, building on the contributions of this thesis.

Magister Scientiae (Occupational Therapy) - MSc(OT) / Tuberculosis (TB) and multi-drug resistant (MDR) TB have been identified as one of the largest health problems in the world, and notably recognized as a big issue in democratic South Africa. Socio-demographic factors such as poverty and unemployment were identified to be major contributing factors to the epidemic. Individuals with TB reportedly have poor levels of occupational self-efficacy and found it challenging to return to work after prolonged hospitalization. The Model of Occupational Self-Efficacy (MOOSE) has been used effectively to assist individuals with traumatic Brain Injury (TBI) to return to work. Adaptation of the MOOSE was recommended for application with other syndromes associated with long hospitalization and absence from work. The aim of the study was to adapt the MOOSE for clients living with tuberculosis and to aid them in returning to work. The study was conducted through exploratory research. Semi-structured interviews were conducted with ten purposively selected key informants from private and public health facilities in the Western Cape. The data was analysed through thematic analysis from which six themes emerged. Themes One, Two and Six describe the barriers experienced by the participants when returning to work following their diagnosis of PTB or MDR-TB. Theme Three, Four and Five discussed the factors that facilitate the resumption of the worker role for the PTB and MDR-TB survivors. The findings of this study were used to inform the adaptation of the MOOSE for use with patients living with TB. Ethics clearance was obtained from the Biomedical Research Ethics Committee (BMREC) of UWC. Permission was given by the Department of Health to conduct the study on the clinical platform. All ethics principles were upheld.

Philosophiae Doctor - PhD / Introduction: The overall aim of this study was to develop a programme to facilitate quality client-centred care in Primary Health Care clinics of the rural West Coast District. Research design and -method: Both quantitative and qualitative methods were applied for this study . Phase 1, a situational analysis collected and analysed quantitative data from the perspective of clients and clinical nurse practitioners via structured questionnaires. The population included all clients 18 years and older (N=137 991) of the fixed clinics (N=25) in the five subdistricts of the West Coast District. According to the Cochran formula a sample of (n=383) should be adequate to represent the population. Non-proportional sampling was applied to estimate the number of participants per clinic. An all-inclusive sample of (n=64) clinical nurse practitioners participated in the study. Phase 2, the qualitative part of the situational analysis, applied five focus group discussions to explore and describe the managers and allied health professionals’ perceptions about quality client-centred care. A semi-structured interview schedule was compiled to guide the focus group discussions. An all-inclusive sample was utilised to include all the managers and allied health professionals of the five subdistricts (N=43). Phase 3 included the development of the programme based on the study findings and literature. Quantitative results: The analysis revealed the following quality client-centred care challenges, namely: Patient Rights (Domain 1) were not always respected and adhered to as these were characterised by: language (statistical p<0.001 and practical significant with a large effect size d=0.74); Satisfaction and Safety (statistical p<0.001 and practical significant with a medium effect size d=0.55); Referral Procedures (statistical significant p<0.001); Waiting Times (statistical p<0.001 and practical significant with a medium effect size d=0.47) and Confidentiality difficulties (statistical p<0.001 and practical significant with a medium effect size d=0.68). The Domain 2, Clinical Governance, Care and Safety showed shortcomings as highlighted by the Client and his/her Family (statistical p<0.001 and practical significant with a large effect size d=0.77). Clinical Support Services, Domain 3, revealed inadequacies regarding the continuous availability of medication (statistical significant p<0.008) and the reporting of side-effects (statistical significant p<0.001). Furthermore, Public Health Domain 4, showed that clients identified community health promotion and disease prevention events (statistical p<0.01 and practical significant with a large effect size d=0.79), and home visits by the community healthcare workers (statistical p<0.001 and practical significant with a large effect size d=1.09) as both a “problem” and a “gap”. Leadership and Corporate Governance, Domain 5 was characterised by the lack of: visible organograms (clients mean 2.40), community communication (clients mean 2.12 & clinical nurse practitioners mean 2.36), visibility of goals, values and future plans of the Western Cape Department of Health (statistical p<0.001 and practical significant with a medium effect size d=0.59) and role and function of the clinic committees (statistical significant p<0.008). Moreover, Domain 6, Operational Management was challenged by inadequate staffing levels (statistical significant p<0.003). Lastly, Domain 7: Infrastructure was characterised by the lack of drinking water in the waiting areas (clients mean 2.08 & clinical nurse practitioners mean 2.02), inadequate clinic space (clients mean 2.10 & clinical nurse practitioners 2.23); maintenance not up-to-date (statistical significant p<0.002); physical appearance of the clinic (statistically significant p<0.001) did not have a positive effect on staff morale and evacuation plans (statistical p<0.001 and practical significant with a medium effect size d=0.54) were not visible. In addition, correlations between the domains showed that the domains are not in silos, but are interdependent on another. Qualitative results The qualitative, thematic data analysis revealed various inadequacies regarding quality client-centred care. Theme One about the Patient Rights revealed that patients were not always treated with the necessary respect and dignity. Theme Two concerning Patient Care, revealed that focus group participants were well-informed on what the concept client-centred care entailed. However, patients and or clients did not always experience their care as client-centred. Theme Three about the Clinical Support Services, indicated shortages of medication and medical equipment; long waiting time for specialists and rehabilitation referral appointments. Theme Four, referring to the Public Health confirmed that health promotion and prevention activities are limited, due to various organizational factors and community healthcare workers’ activities which are limited to home-based care activities. Theme Five, Corporate Governance and Leadership matters were characterised by too many processes or “red tape” resulting in inefficient procurement processes, inadequate staffing and inactive health committees. Theme Six, Operational Management highlighted the severe pressure under which the operational managers have to work, resulting from their twofold role of being the clinic manager and at the same time operate as a clinical nurse practitioner. Theme Seven refers to Infrastructure and Facilities and is characterised by inadequate maintenance and lack of space according to the number of clients and package of care. To summarise: The situational analysis revealed 81 problems. These problems form the evidence base for the development of the programme to facilitate quality client-centred care in primary helth care clinics of the rural West Coast District.

By far the biggest injury risk faced by people with late onset dementia is a serious fall. Commercial fall detectors are available which automatically alert a call centre or carer if they detect a fall. They use accelerometers to look for the kinematics of a fall but this method is unreliable and the frequent false alarms must be cancelled by the wearer. This is inappropriate for someone with dementia. This thesis examines how a wrist-worn fall detector better suited to someone with dementia might be built. It reviews what other sensors could be used alongside accelerometers, and whether looking for the physiological effects of falling might be beneficial. It concludes that the pulse provides a source of data and describes three empirical trials to examine whether the body pose can be determined from the pulse waveform. A small convenience sample proved the viability of the concept, followed by a larger study to investigate it further, and finally a trial in people of the same age group as late onset dementia sufferers. Producing a technically better device is not sufficient, as it must also be usable by the people it is intended for. The thesis describes two qualitative studies which use carers to define, and then evaluate, a conceptual fall detector suitable for people with moderate or severe dementia which fits underneath a wrist watch. The thesis argues that wearable fall detectors should utilise physiological data to complement kinematic data. It demonstrates the practicality of a novel technique for determining body position using the pulse waveform, and finally concludes that it would be possible to build the conceptual fall detector utilising this technique.

Nitrogen-centred radicals (NCRs) are powerful reaction intermediates that allow key bonds to nitrogen to be formed. However, the generation of NCRs typically requires pre-functionalised precursors that can be difficult to access and harsh reaction conditions in the formation of the NCR itself which has limited synthetic application. In this thesis, the application of visible-light mediated photoredox catalysis towards the generation of iminyl and amidyl radicals is demonstrated and the advances to NCR chemistry this has facilitated. Initial work developed electron-poor O-aryl oximes as suitable precursors for hydroimination reactions, activated via single-electron reduction under photoredox conditions. These precursors are accessible by a simple condensation reaction with the commercially available hydroxylamine and can be purified by recrystallization. The realisation of a transition metal-free protocol was made possible by using the organic dye eosin Y as the photocatalyst. This activation mode was then extended to the generation of (carb)amidyl-radicals from easy-to-make O-aryl hydroxylamides. Similar transition metal-free photoredox reaction conditions could be applied in intramolecular hydroamidation reactions allowing the preparation of lactams and cyclic (thio)carbamates. For the first time N-Boc and N-Cbz protected amidyl-radicals were utilised despite the very high electrophilic nature of these species. Finally, one of the big challenges associated with NCR chemistry was addressed; the development of multicomponent reactions for the divergent synthesis of complex N-containing molecules. Previously developed O-aryl precursors proved unsuitable and instead a novel class of alpha-imino acid precursors were identified that can be activated via oxidation under photoredox conditions. This activation mode was also rendered transition metal-free by using the Fukuzumi photoredox catalyst. These new NCR precursors proved crucial in developing a divergent methodology that allows the synthesis of up to fifteen iminofunctionalised products from a single starting material. Moreover, this methodology could be applied to the modification of complex natural products such as immunosuppressant drug mycophenolic acid and alkaloid thebaine. One could envisage such an approach may be ideal for a drug discovery type situation where changes in functionality can greater alter drug activity.

No description available.

Unsurprisingly the National Health Service (NHS) has harnessed the prolific growth in Internet access to alleviate the increasing burden incurred due to rising healthcare costs. Healthcare interventions focus on the promotion of good behaviours; prevention of bad behaviours; provision of support for shared decision making; increasing knowledge and improving monitoring. Healthcare researchers typically rely on professional software developers in the creation of Internet interventions. Although varying in nomenclature Internet interventions typically consist of the same underlying components, such as navigation, logic and response capture. The LifeGuide Authoring Tool provides a potential solution to reduce this reliance of researchers on software developers in the creation of interventions. However the logic creation command line interface provided by LifeGuide is identified as a potential barrier for adoption, by nonprogrammers, due to their lack of experience with the strict programming style syntax it requires. Through the adoption of user-centred design techniques; early and continuous user involvement; rapid prototyping and interface design principles, a Graphical User Interface (GUI) was developed, with the potential to lower this barrier for researchers with no previous programming experience. A jigsaw metaphor was adopted in the design of the interface, utilising templates and pre-populated fields, with the aim of reducing errors and lowering the cognitive load experienced by users. A task-based evaluation compared the existing LifeGuide interface, with the new GUI, in the creation of commonly used logic. Higher results were reported over the five main usability measures: effectiveness; engagement; efficiency; ease of learning and error tolerability in favour of the GUI, in the creation of intervention logic. Continuing requests to the author to develop healthcare Internet Interventions supports the research, that there is still a heavy reliance of researchers on software developers. A further application for this approach was identified in the development of a tool to support healthcare researchers in the creation of mobile phone messaging interventions.

Mathematics has been seen to act as a ‘critical filter’ in the social, economic and professional development of individuals. The Island of Mauritius relies to a great extent on its human resource power to meet the challenges of recent technological developments, and a substantial core of mathematics is needed to prepare students for their involvements in these challenges. After an analysis of the School Certificate examination results for the past ten years in Mauritius, it was found that boys were out-performing girls in mathematics at that level. This study aimed to examine this gender difference in mathematics performance at the secondary level by exploring factors affecting mathematics teaching and learning, and by identifying and implementing strategies to enhance positive factors. The study was conducted using a mixed quantitative and qualitative methodology in three phases. A survey approach was used in the Phase One of the study to analyse the performance of selected students from seventeen schools across Mauritius in a specially designed mathematics test. The attitudes of these students were also analysed through administration of the Modified Fennema-Sherman Mathematics Attitude Scale questionnaire. In Phase Two a case study method was employed, involving selected students from four Mauritian secondary schools. After the administration of the two instruments used in Phase One to these selected students, qualitative techniques were introduced. These included classroom observations and interviews of students, teachers, parents and key informants. Data from these interviews assisted in analysing and interpreting the influence of these individuals on students, and the influence of the students’ own attitudes towards mathematics on their learning of mathematics. / The results of Phases One and Two provided further evidence that boys were outperforming girls in mathematics at the secondary level in Mauritius. It was noted that students rated teachers highly in influencing their learning of mathematics. However, the teaching methods usually employed in the mathematics classrooms were found to be teacher-centered, and it was apparent that there existed a lack of opportunity for students to be involved in their own learning. It was also determined that parents and peers played a significant role in students’ learning of mathematics. After having analysed the difficulties students encountered in their mathematical studies, a package was designed with a view to enhance the teaching and learning of the subject at the secondary level. The package was designed to promote student-centred practices, where students would be actively involved in their own learning, and to foster appropriate use of collaborative learning. It was anticipated that the package would motivate students towards learning mathematics and would enhance their conceptual understanding of the subject. The efficacy of the package was examined in Phase Three of the study when students from a number of Mauritian secondary schools engaged with the package over a period of three months. Pre- and post-tests were used to measure students’ achievement gains. The What Is Happening in This Class (WIHIC) questionnaire also was used to analyse issues related to the affective domains of the students. An overall appreciation of the approaches used in the teaching and learning package was provided by students in the form of self-reports. / The outcomes of the Third Phase demonstrated an improvement in the achievement of students in the areas of mathematics which were tested. The students’ perceptions of the classroom learning environment were also found to be positive. Through their self-reports, students demonstrated an appreciation for the package’s strategies used in motivating them to learn mathematics and in helping them gain a better understanding of the mathematical concepts introduced.

Formal approaches to software development require that we correctly describe (or specify) systems in order to prove properties about our proposed solution prior to building it. We must then follow a rigorous process to transform our specification into an implementation to ensure that the properties we have proved are retained. When we design and build the user interfaces of our systems we are similarly keen to ensure that they have certain properties before we build them. For example, do they satisfy the requirements of the user? Are they designed with known good design principles and usability considerations in mind? User-centred design approaches, which incorporate many different techniques which we may consider as informal, seek to consider these issues so that the UIs we build are designed around the needs and capabilities of real users. Both formal methods and user-centred design are important and beneficial in the development of underlying system functionality and user interfaces respectively. Given this we would like to be able to use both approaches in one integrated software development process. Their differences, however, make this a challenging objective. In this thesis we present a solution this problem by describing models and techniques which provide a bridge between the existing work of user-centred design practitioners and formal methods practitioners enabling us to incorporate (representations of) informal design artefacts into a formal software development process. We then use these models as the basis for a refinement theory for user interfaces which allows interface designers to retain their informal design methods whilst providing an underlying theory grounded in the trace refinement theory of the Microcharts language.