The Department of Health (DH) is responsible for one of the largest estates in Europe. In this capacity, the DH produce and disseminate estates-related Standards & Guidance (S&G) to provide support to the briefing and design processes for new, and refurbishment projects in old healthcare buildings. The estate is made up of a variety of buildings, many ageing and in need of extensive refurbishment or replacement. It is therefore important to the stakeholders in the procurement and provision of healthcare environments that the DH S&G provide them with the information and data they need at the relevant time in the process to enable them to design and construct healthcare facilities that are safe and fit-for-purpose. Policy changes over the past 20 30 years have had a profound effect upon the estate. The estate was seen to be in need of modernisation, but Government lacked the extensive funding necessary to achieve anything like the extent of redevelopment required. The introduction of private sector funding to achieve this resulted in a major shift in the ownership of the estate, and latterly the regulation of the estate, both private sector and National Health Service (NHS). The NHS Constitution, introduced in 2009, was the first Government document explicitly to recognise the estate and the importance of it being fit-for-purpose. This research seeks to establish the importance of the DH S&G, and their benefits and dis-benefits to stakeholders using them, including organisations and individuals from the private and public sectors. The groups have differing roles and priorities and the research seeks to establish how these affect their requirements for S&G, how effectively the S&G meet those requirements and how they contribute to the overall provision of healthcare environments. Moreover, hospital accommodation has been proven to have an effect on the patients and staff, therefore, the provision of useful and helpful S&G could be seen to have an indirect influence on patient outcomes, and also on providing a pleasant and efficient environment for staff. The research has identified three major strands: Policy; the DH S&G themselves; and what is important to users about them and any benefits or dis-benefits incurred. Policy is viewed as the driver for the need for DH S&G. The changing political environment, amongst many other factors, affects how the S&G have been operationalized. This study of the application of DH S&G aims to establish how users view the benefits and dis-benefits and their effects on the healthcare environment. Research in the construction industry sector spans the scientific and social worlds, and the methodology is deductive research orientated, exploiting a range of data. Qualitative and quantitative data have been collected through open interviews with known experts and an on-line survey of the stakeholders using the S&G from private and public sector organisations involved with the provision of healthcare accommodation. Reference to the DH S&G and related unpublished DH documents traces their development and examines their content. The results have been mapped to the stakeholder categories (Designers, Service Users, Estates and Facilities Managers, Contractors and the DH/NHS), thus enabling comparisons to be made between each group, and between the public and private sectors. Analysis of the data identified the characteristics users found to be of importance and of benefit or dis-benefit. On balance, it was clear that the DH S&G are beneficial, but not universally. Of prime importance to its users is the DH endorsement of the S&G and its independence from commercial influences. However, the classification of the DH S&G, defined as best practice is often regarded and applied as mandatory. The content of the S&G varies in its scope, content and characteristics, being perceived as incomplete, inconsistent and out-of-date. Taking all these factors, therefore there is a danger that the DH S&G may contribute to healthcare buildings being unfit-for-purpose or out-of-date.

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Electroceramic materials research is a wide ranging field driven by device applications. For many years, the demand for new materials was addressed largely through serial processing and analysis of samples often similar in composition to those already characterised. The Functional Oxide Discovery project (FOXD) is a combinatorial materials discovery project combining high-throughput synthesis and characterisation with advanced data mining to develop novel materials. Dielectric ceramics are of interest for use in telecommunications equipment; oxygen ion conductors are examined for use in fuel cell cathodes. Both applications are subject to ever increasing industry demands and materials designs capable of meeting the stringent requirements are urgently required. The London University Search Instrument (LUSI) is a combinatorial robot employed for materials synthesis. Ceramic samples are produced automatically using an ink-jet printer which mixes and prints inks onto alumina slides. The slides are transferred to a furnace for sintering and transported to other locations for analysis. Production and analysis data are stored in the project database. The database forms a valuable resource detailing the progress of the project and forming a basis for data mining. Materials design is a two stage process. The first stage, forward prediction, is accomplished using an artificial neural network, a Baconian, inductive technique. In a second stage, the artificial neural network is inverted using a genetic algorithm. The artificial neural network prediction, stoichiometry and prediction reliability form objectives for the genetic algorithm which results in a selection of materials designs. The full potential of this approach is realised through the manufacture and characterisation of the materials. The resulting data improves the prediction algorithms, permitting iterative improvement to the designs and the discovery of completely new materials.

Digital preservation may be defined as the cumulative actions undertaken by an organisation or individual to ensure that digital content is usable across generations of information technology. As technological change occurs, the digital preservation community must detect relevant technology developments, determine their implications for preserving digital content, and develop timely and appropriate responses to take full advantage of progress and minimize obsolescence. This thesis discusses the results of an investigation of technology responsiveness for digital preservation. The research produced a technology response model that defines the roles, functions, and content component for technology responsiveness. The model built on the results of an exploration of the nature and meaning of technological change and an evaluation of existing technology responses that might be adapted for digital preservation. The development of the model followed the six-step process defined by constructive research methodology, an approach that is most commonly used in information technology research and that is extensible to digital preservation research. This thesis defines the term technology responsiveness as the ability to develop continually effective responses to ongoing technological change through iterative monitoring, assessment, and response using the technology response model for digital preservation.

The topic of this study is the War of Jenkins' Ear (1739-1744) and this thesis concentrates on the close connection between the British and Spanish gathering of intelligence and the military decisions adopted in London and Madrid during the war. The ultimate purpose of this study is to put this war in a broader context and make a contribution to understand the development of the state in eighteenth century Europe. The first part of this study analyses the structure and functioning of the several British and Spanish Intelligence Networks, i.e. diplomatic and political support to these networks, expenditures, flowing of intelligence, messengers, agents, collaborators and counter intelligence. This part consists of two chapters, as follows: (a) the British Intelligence System and (b) the Spanish Intelligence System. The second part of the study explores the connection between the gathering of intelligence and decision-making in Madrid and London. However, the study of the use of intelligence can be problematic. This is because neither on the British nor the Spanish side are there official cabinet records for this period that could directly link one process with the other. In an attempt to solve this difficulty it has been decided to study the connection through four case studies. Each of them will concentrate on one of the military expeditions that Britain and Spain carried out or planned during the war.

This thesis is concerned with the synthesis and characterisation of TiO2 based photocatalyst thin films and the assessment of their antimicrobial properties. When exposed to light of wavelength less than 380 nm TiO2 films can demonstrate self-cleaning and self-disinfecting properties. This is due to photocatalytic processes occurring on the film surface resulting in film superhydrophilicity and reactive oxygen species (ROS) production. These ROS and radicals readily oxidise organic pollutants and microbes adherent to the material surface. Consequently, TiO2 thin films are of great research interest as self-cleaning, antimicrobial coatings. TiO2 and doped TiO2 materials were prepared by a simple sol-gel route from titanium n-butoxide as the principle precursor material. Film deposition was carried out using a dip-coating technique, with substrates withdrawn from the precursor sol at a fixed speed. Deposited films were calcined to produce crystalline thin films, with excellent adherence to the substrate (glass slides). Films were characterised using a number of analytical techniques including UV-visible spectroscopy, X-ray diffraction, scanning electron microscopy, atomic force microscopy, X-ray photoelectron spectroscopy and EXAFS/XANES. Photocatalysis and film hydrophilicity were investigated using established methods. Stearic acid photodegradation, monitored by FT-IR was used to assess film photocatalysis, by monitoring the peak areas of the C-H stretching region. Relative film hydrophilicities were determined by measuring the contact angle of a sessile droplet of water. Antimicrobial properties of the films were assessed with typical examples of Gram- positive and Gram-negative organisms. Staphylococcus aureus (NCTC 6571) and Escherichia coli (NCTC 10418) were selected. Films demonstrated microbicidal activity against both organisms under 365nm UV illumination, and under illumination by a typical hospital lamp (28W 2-D fluorescent). Microbial adhesion to various substrates was also examined, using a dip-blot method. Films produced in this study demonstrate excellent potential as durable surface coatings with significant antimicrobial activity against microbes of clinical importance.

There is a need for sensitive measures of disease progression in multiple sclerosis (MS) to monitor treatment effects and understand disease evolution. MRI measures of brain atrophy have been proposed for this purpose. This thesis investigates a number of measurement techniques to assess their relative ability to monitor disease progression in clinically isolated syndromes (CIS) and early relapsing remitting MS (RRMS). Presented, is work demonstrating that measurement techniques and MR acquisitions can be optimised to give small but significant improvements in measurement sensitivity and precision, which provided greater statistical power. Direct comparison of numerous techniques demonstrated significant differences between them. Atrophy measurements from SIENA and the BBSI (registration-based techniques) were significantly more precise than segmentation and subtraction of brain volumes, although larger percentage losses were observed in grey matter fraction. Ventricular enlargement (VE) gave similar statistical power and these techniques were robust and reliable; scan-rescan measurement error was <0.01% of brain volume for BBSI and SIENA and <0.04ml for VE. Annual atrophy rates (using SIENA) were -0.78% in RRMS and -0.52% in CIS patients who progressed to MS, which were significantly greater than the rate observed in controls (-0.07%). Sample size calculations for future trials of disease-modifying treatments in RRMS, using brain atrophy as an outcome measure, are described. For SIENA, the BBSI and VE respectively, an estimated 123, 157 and 140 patients per treatment arm respectively would be required to show a 30% slowing of atrophy rate over two years. In CIS subjects brain atrophy rate was a significant prognostic factor, independent of T2 MRI lesions at baseline, for development of MS by five year follow-up. It was also the most significant MR predictor of disability in RRMS subjects. Cognitive assessment of RRMS patients at five year follow-up is described, and brain atrophy rate was a significant predictor of overall cognitive performance, and more specifically, of performance in tests of memory. The work in this thesis has identified methods for sensitively measuring progressive brain atrophy in MS. It has shown that brain atrophy changes in early MS are related to early clinical evolution, providing complementary information to clinical assessment that could be utilised to monitor disease progression.

The purpose of this thesis is to show first how the policy of the United States toward Germany developed during and after World War II: second, to describe that policy in its relation to the entrance of West Germany into the western European community.

BACKGROUND: District hospitals play an intermediary role between primary health care (PHC) clinics and community health centres; (CHC), (predominantly run by nurses) and regional hospitals, (predominantly run by specialists and doctors). However, in the absence of efficient and adequate network of PHC clinics and CHC’s, district hospitals often have to render these services. In addition, due to geographic distances between district hospitals and regional hospitals, it often has to offer specialist services such as Orthopaedics, Gynaecology, as well. This increases the burden on district hospitals. The profile of patients admitted to district hospitals have not been clearly described and this study seeks to describe and to compare trends over a two year period and factors influencing these trends, to allow for informed decisions to be made for future planning. No formal study on the trends for admissions to District hospitals have been conducted, as far as could be determined, and this study aimed to look into and describe the trends of admissions over a two year period from April 2007 to March 2009, to allow for informed decisions to be made to guide future plans. AIM: To determine the trends of adult admissions in a district hospital in Limpopo Province. METHODOLOGY: A cross-sectional study design was used for this study. A descriptive retrospective review of existing hospital records was conducted from routine information captured on the MEDICOM patient administration system and in ward and OPD/casualty registers. No intervention was done for this study. The setting was F. H. Odendaal Hospital in Modimolle, which is a district hospital situated in a rural area of the Limpopo Province. It serves a catchments population of over 103 000 people. Data was collected from 4481 admitted adult patients from which a random sample (n=800) was selected consisting of males (n=400) and females (n=400). Data on variables such as the case load (number of adult admissions during the research period), patient profile (gender, age, hospital classification and geographic location) and clinical profile (mode of admission, agnoses and associated ICD-10 code/s as well as the mode of discharge) were collected. RESULTS: This study revealed that this hospital experienced an increase number of adult admissions during the two years study period. During the same period it could reduce the length of stay, thereby improve usable bed utilisation rate. This reflected in more discharges and less death. This was probably due to availability of more experienced medical officers and the fact that outreach services has been conducted on a weekly basis by doctors and Clinical Support Services since 2008/09 financial year. The majority of the patients who were admitted over the study period were Africans residing in and around Modimolle. The majority was also classified as H1, meaning that most of the patients admitted to this hospital are capable of paying the nominal fee for services. The institution experienced an increase in the number of admission over the two years by 11.7%. The mean age was 42.5 years for adults. Of the top 5 diseases/conditions for which patients were admitted, Pneumonia, Diarrhoea and Gastroenteritis, Retrovirus infections and Diabetes Mellitus were present for both males and females. Although this disease pattern persists for a number of years, it seems as if services provided manage to reverse discharge trends as more patients were discharged home in the second year than in the first year and the mortality rate decreased by 4.5% for adults between the two years. CONCLUSION: Information obtained through this research could be extrapolated to other district hospitals for the management of services, including the management of beds. It could also serve as the basis for future research, as a reference base to students and the teaching of students.

BACKGROUND: Lehurutshe Hospital is a district hospital situated in rural North West Province of South Africa. The Hospital offers basic radiological services such as X-rays of the chest, abdomen, extremities and skull according to the norms and standards set by the National Department of Health for a level one hospital. According to 2008/2009 data from the Hospital, it is evident that the number of patients requiring radiology services is increasing. However, no systematic study has been done to determine the reasons and effects of this increasing caseload on the Radiology Unit of the Hospital. This study seeks to establish the caseload and the resources utilised for the services rendered by the Radiology Unit in Lehurutshe Hospital with specific focus on the patient profile and material and human resources utilisation. AIM: To assess the utilization of the Radiology Unit at Lehurutshe Hospital in terms of caseload, profile of patients, and resource utilization from 01 January to 31 December 2009 METHODOLOGY: This was a cross sectional study. The setting was the Radiology Unit of the Lehurutshe Hospital in Zeerust town, Ngaka Modiri Molema District in the North West Province. A retrospective record review was done and information was extracted from the Hospital information system on various variables that are relevant to the functions and resource utilization of the Radiology Unit, including caseload, profile of patients, resource utilization and workload of staff. No primary data was collected. RESULTS: The study found that more than 5000 patients were seen and radiological examinations were done during this period with a total number of public patients being significantly higher than private patients. Nearly 500 radiological examinations were done per month. The wide variation in the number of examinations done per month was probably due to seasonality, which may affect operational planning and inventory management at the Unit. Almost 50% of the radiological examinations were chest X-rays. Other examinations include X-ray of the upper and lower extremities and ultrasound examination for obstetrics and gynaecology. These examinations were done based on various clinical indications. A significant number of public patients seen at the Unit were infants, children and teenagers. The private patients were from an older age group. The majority of patient were unemployed and indigent. The material resources used in the Unit includes X-ray films, chemicals (developers and fixers) and ultrasound gel. The Unit has two radiographer and one radiographer assistant. In addition, a medical doctor read the X-rays as and when necessary. The direct costs incurred at the unit include use of material resources, maintenance of equipments (service contract) and compensation of employees. Total direct cost during the study period was R 650 803.89, most of which were incurred due to compensation of employees and maintenance of radiological equipments. Patient to staff ratio at the unit was quiet low and it shows there is spare capacity at the Unit, which could easily be used for income generation by the provision of services to private patients. CONCLUSION: This is probably the first study conducted at a radiology unit of a district hospital in South Africa. This study documented important information, which was not published before.