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It is a challenge to assess the toxicity of environmental air particulate matter (PM) because PM composition is complex and variable, due to source contribution and atmospheric transformation. The goal of this study is to establish an in vitro model that can fingerprint the cytotoxic effects of airborne PM and their associated toxicity mechanisms. For this purpose, the cytotoxic effects of different reference and environmental particles on A549 human lung epithelial cells were characterized using multiple endpoint assays (cytokine release, LDH release, BrdU incorporation, cellular ATP and resazurin reduction) and proteomic analyses (2D-GE and MALDI-TOF-TOF-MS/MS). The results of this study demonstrated that proteomic analyses can distinguish the influences of different (carbon black and titanium dioxide) and similar (cristobalite and α-quartz) particles on various pathways in A549 cells (e.g., cell death and cell proliferation); and the cytotoxicity assays were capable of differentiating the phenotypic outcomes of the particles, which were complementary and supportive to pathway analyses. The ability of in vitro toxicoproteomics to differentiate the toxicity of environmental particles was tested on Ottawa urban dust (EHC-93) and its water-insoluble and soluble fractions. Findings from both cytotoxicity assays and proteomic analyses consistently indicated that the insoluble materials explained most of the toxic effects of the total PM. Interestingly, the toxic potency of EHC-93 total was not equal to the sum of its insoluble and soluble fractions, implying inter-component interactions between insoluble and soluble materials that may be reflected through synergistic or antagonistic in vitro responses. The insoluble and soluble fractions uniquely altered the expression patterns of the proteins involved in pathways such as cell death, cell proliferation and inflammation. For example, the insoluble and soluble fractions oppositely altered the expression of the proteins (e.g., TREM1, PDIA3, PKM and ENO1) involved in an inflammatory response pathway in A549 cells, and the insoluble fraction was more potent than the soluble fraction in increasing secretion of pro-inflammatory cytokines MCP-1 and IL-8 from A549 cells. In essence, in vitro toxicoproteomics is a valuable tool in relating the physicochemical characteristics of ambient air particles to their biological reactivity through understanding their mechanisms of toxicity.

The introduction of Education, Health and Care (EHC) plans proposed in the Children and Families Act 2014 has aimed to give parents and children who are going through the assessment process greater control and choice in decisions, and enhance the multi-professional collaboration between education, health services and social care. This research seeks to evaluate to what extent parents’, children and young people’s, and professionals' experiences correspond to these values at an early stage of implementation. The methodology of this thesis is based on a realistic evaluation framework informed by the work of Pawson and Tilley (1997). Realistic evaluation aims to construct a programme theory which links three distinct broad aspects of a programme: its context, mechanisms and outcomes (C-M-Os). This research employs a programme theory of how an EHC assessment is conducted and has been developed from the current literature on person-centred theory. Person-centred theory has been chosen because of its corresponding value base to the SEND reforms and the recommendation of its use in a number of government policy documents including the SEND Code of Practice (DfE, 2014). The programme theory has been used to devise questionnaires that have sought to gain professionals' experiences of the assessment process, particularly in relation to multi-agency working, and their perceptions of the person-centred nature of the assessment. In addition, five case studies have explored these issues in more depth to ascertain whether the EHC assessment process in this authority is meeting the core aims of the Children and Families Act 2014. Semi structured interviews and card sorting tasks were devised using the programme theory and conducted with a total of one child, five families and five professionals from five individual EHC assessments. This analysis goes beyond a description of the facilitating factors and barriers to person-centred support and examines how person-centred outcomes arise from specific contexts and mechanisms. Findings suggest that experiences of face-to-face multi-professional collaboration were positive within the EHC assessment group. Nevertheless, professionals expressed frustration that in some cases colleagues were not able to attend meetings due to time constraints, capacity within their services and the commissioning arrangements of their services. Parental and professional experiences of the process appear to be positive. The research demonstrates one case study where a person centred planning approach was utilised very successfully from the perspective of all involved. However, there are significant concerns raised in both phases of this study as to the way in which children and young people are provided with opportunities of contributing to their EHC assessment. The findings are relevant to the development of the EHC assessment process in the local authority (LA) in which I am employed, and will contribute to the debate about the role of educational psychologists (EPs) in evaluating this national policy.

Emergency Health Care (EHC) is an extended and multi-professional protocol designed to make communication easier in the event of a health-care emergency. Information and communication technologies (ICTs) play a vital role within EHC by coordinating emergency responses across involved departments as well as to health-care providers in the pre-hospital and hospital settings. Despite advances in ICT, there are still a variety of challenges regarding ICT usage in emergencies. To identify these challenges, a semi-structured interview was conducted with pre-hospital and hospital staff at the Emergency Departments of Vaasa Central Hospital, Finland, and Umeå University Hospital, Sweden. The findings indicate that workflow practices and the applying of medical knowledge in a pre-hospital setting is more challenging in Vaasa due to limited accessibility to the patient electronic record system. In the hospital setting, the clinical workflow and application of medical knowledge is easier in Umeå than in Vaasa as a result of there being an integrated information system in the Umeå region compared to a disintegrated system in the Vaasa region. It was discovered that the lack of a national record system in Sweden is a challenge for practitioners in the hospital setting in Umeå. In addition, badly structured information in the Finnish national record system has made collaborative activities between departments and hospitals difficult within EHC. The results reveal that the capacity of IT tools to provide on-time accessibility to patient information is fundamental for safe decision making and collaborative activities across departments and hospitals within EHC.