Innovation and research have been key features throughout the sixty years the UK has publicly funded a National Health Service. Over the last thirty years, in planning health service reforms, successive Governments have drawn on the values of the private sector, where innovation is considered an imperative If firms are to survive in the global market place. Consequently, the innovation imperative is now at the heart of UK health policy.

Massage, as a complementary therapy is no longer controversial in many settings, such as palliative care. Within the field of haematological oncology however, there is still major concern regarding its safety. The aims of this study were firstly to show that massage with and without essential oils can be given to isolated haematology patients safely and that physiological and psychological benefits are evident following such therapy. Secondly to demonstrate that such benefits are manifest following single sessions of massage.

The use of street drugs and/or alcohol combined with mental health problems is referred to as dual diagnosis within mental health and substance misuse services. The aim of this research study was two-fold. Firstly, to discover what people considered helpful in terms of support or intervention that could then be developed into information materials. And secondly, to develop an explanatory theory that added to the subjects’ wider understanding. A grounded theory methodology was employed to elicit the personal experiences of participants which in turn would ensure that the production of information materials and the development of theory remain rooted in the data. Twenty-six unstructured conversational interviews and 9 focus groups were conducted. Two carers, 6 practitioners and 18 service users were interviewed. The focus group participants were all service users, just under half of whom participated in interviews also, the remainder were new to the study; all took place in mental health and substance misuse treatment settings. In total 41 people, 34 of whom were service users, participated. Including repeat participants, 51 separate voices or contributions were made. Data incidents and happenings (n = 977) were analysed using open, axial and selective coding procedures overlaid by constant comparison. Twelve categories sharing properties and dimensions relating to helpful advice, intervention or behaviour emerged. The theme of helpfulness was a key concept and emerged as the major category subsequently entitled Help. The theory related to help developed. It challenged dual diagnosis convention by identifying people with a dual diagnosis as positively seeking, for themselves or others, recovery or alleviation of substance or mental health related problems. They did this from within a harm reduction or damage limitation paradigm. The examples of help related incidents (from which the help theory emerged) were collated and formed the content of dual diagnosis information materials.

The time dimension is a unique and powerful dimension in every enterprise data. In dynamic application such as financial and medical applications representing data as it changes overtime is a common problem. There are diverse applications that require tracing the changes of contents of a data element as time passes. The ability to reason about time and temporal relation is fundamental to almost any intelligent entity that needs to make a decision. Temporal reasoning is a tool to enhance other types of reasoning. Many reasoning tasks such as planning, understanding or diagnosis have an aspect of time. Time-oriented data mining, or knowledge discovery in time-oriented databases, refers to the extraction of implicit knowledge, temporal relations, or other patterns not explicitly stored in time-oriented databases. This research investigates and contributes to the accommodation of temporal semantics within the domain of data mining. It uses the outcome to discover knowledge from medical data where the history of data is very important and discovery of patterns of data over time is crucial.

National policies (DoH, 2008; 2011) propose a clear role for GPs in responding to the increase in childhood obesity, despite a limited evidence base which would secure such an emphasis. Previous research has indicated multiple barriers to the engagement of GPs in this clinical activity due to the sensitivities of the subject, low levels of role competence and confidence and limited access to specialist services. Using interpretive phenomenological analysis, this study explored how GPs made sense of their experiences of identifying and managing childhood obesity in order to provide a unique insight into these professional behaviours. Retrospective semi-structured interviews were carried out with ten GPs,who had been in practice for over 25 years. Four themes emerged. The first ‘understanding the family’ demonstrated how the GPs utilised their knowledge of the family’s health beliefs, motivations, skills, and wider socio economic factors to compile a unique understanding of the family which framed their responses to the obese child. The second ‘flexibility and responsiveness’ explored how this complex knowledge of the family was used to negotiate and address the different physical and emotional needs of the child. The third theme ‘professional and individual dilemmas’ explored areas of professional uncertainty, the identification of perceived legitimate role boundaries and the personal belief systems of the GPs regarding childhood obesity. The final theme ‘organisational challenges’ highlighted how time pressures, competing priorities, and structural constraints challenged their abilities to provide effective responses. An extended explanatory insight is provided by exploring the GPs’ dominant epistemological framework which resulted in the identification of 4 role types, using Laws et al., (2009) theoretical framework. The role types are considered in relation to the GPs’ professional identities and their contextual responses to the child and family. The research concludes with practical recommendations for service improvement at the practitioner, commissioner and national policy level.

Globally, accidental chemical poisonings account for the deaths of more than 35,000 children below the age of 15 annually. Chemical poisonings also cause many more children to endure disease and disability. A new Globally Harmonised System for Classification and Labelling was being introduced through the United Nations at the time of the study. This replaces the many disparate systems in use around the world. The aim of this study was to identify more productive methods for teaching home chemical safety interventions to primary school children aged 7 to 11 years old in order to increase their knowledge uptake and increase the retention of this knowledge. The new GHS hazard labelling system was applied to this. The focal concept was the knowledge gained and knowledge retained with the variety of influences that affect the outcomes of learning. A Delphi survey was employed to elicit consensus of expert opinion of the design of the educational intervention. The design of the study was based on a non-equivalent groups, pre-test, post-test, follow-up test structure. The quantitative part of this study demonstrated a larger gain in knowledge by the test school than by the control school from pre-test to post-test, but it is not clear whether this was due to the intervention or to regression. However, retention of knowledge gained was far superior for the test school and was the result of the intervention. Children’s misconceptions regarding the new hazard symbols were also elicited in the study, clarifying the task set for adults in teaching home chemical safety and mitigating the effect of cognitive dissonance. Rather than any individual teaching method being superior to others, a blend of teaching styles and learning activities was the most effective. Children’s capacity and resources for preventing injury are increased by strengthening their knowledge using comprehensive approaches.

The assessment of the acromiohumeral distance (AHD) is an essential part of the clinical shoulder joint examination. Changes of normal AHD occur frequently in individuals with subacromial impingement syndrome (SAIS). Real time ultrasound scanning (RTUS) is a useful imaging technique. It allows for the assessment of distances between the humeral head and scapular landmarks, such as the acromion and the humeral head in several shoulder positions. This thesis investigates the within-day and between-day reliability of both RTUS in measuring the AHD and the Palpation Meter (PALM) while measuring the scapular position and motion in healthy individuals. Intra-class correlation, standard error of measurement and the smallest detectable difference values were used to determine the intra-tester within-day and intra-tester between-days reliability of both RTUS and PALM devices. A paired t-test was used to determine the differences between the dominant shoulder versus non-dominant shoulder in two positions; neutral and 60 degrees of passive abduction for the AHD by using RTUS and by using the PALM. A paired t-test was used to determine the differences between the dominant shoulder and the non-dominant shoulder at resting position, 60 degrees of passive abduction and full elevation. Both RTUS and PALM were found to be reliable and precise when measuring AHD and scapular position. Moreover, a correlation analysis was used to determine whether there was a relationship between the AHD and the scapular upward rotation angle (SURA) measurements in 35 healthy volunteers. A moderate correlation between AHD and SURA during 60 degrees of passive abduction was noted. The case study of five patients who suffered from SAIS was evaluated in comparison to normative data for both AHD measurements by using RTUS and the scapular position measurements by using the PALM to detect the sensitivity of these tools in the presence of pathology. The injured arm demonstrated smaller AHD and SURA during 60 degrees of abduction tasks. The last phase assessed the effect of modifying the scapular position on the AHD and SURA by using taping, and the effect of the muscle stimulation on AHD. The findings from this intervention programme did show position effects on AHD in healthy individuals, yet its effect should be evaluated in patients who suffered from SAIS.

Oxidised bases in DNA are removed by a number of DNA glycosylases in the first step of base excision repair. These include 8-oxoguanine DNA glycosylase (OGG1), endonuclease III-like 1 (NTH1) and the Nei-like proteins, NEIL1, NEIL2 and NEIL3. While NEIL1 and NEIL2 are relatively well characterized, the function of NEIL3 is still not fully understood. Although all three proteins show homology to the Escherichia coli Fpg/Nei family, NEIL3 is the largest member with an extended C-terminal domain and contains a valine instead of the highly conserved proline residue at amino acid position two. While it has been reported that recombinant murine NEIL3 shows DNA glycosylase and AP lyase activities in vitro, its biological role remains unclear. Therefore, to gain an insight into the function of NEIL3 in vivo, the full-length human NEIL3 cDNA has been expressed in Saccharomyces cerevisae as a prelude to undertake a yeast 2-hybrid screen to determine specific protein-protein interactions. To date, cDNA library screenings for potential hNEIL3 interactors have been completed and clones expressing potential interactors have been isolated, sequenced and analysed. This data, along with the results of other confirmatory experiments are presented in this thesis. Furthermore, clones of Pichia pastoris harbouring an expression cassette with full-length human NEIL3 or mouse NEIL1 or truncated versions of hNEIL3 with amino acid length 1-394 and 1-502 cDNA have been generated in preparation for its overexpression in a eukaryotic system. It is envisaged that the expression of 6XHis tagged hNEIL3 in P. pastoris will enable the purification of hNEIL3 protein that can be used in enzyme assays and for further in vitro investigations of putative protein interactions discovered by yeast two-hybrid (Y2H) screen.

Background In Saudi Arabia, more than 2 million people complain of asthma: 13% being aged 6-10 years. This makes asthma one of the most common illnesses among children in Saudi Arabia. Little has been explored about children’s ability to learn more about their own asthma in Saudi Arabia. Aims The study was designed to assess the impact of a school-based, nurse-delivered asthma health education programme on asthmatic children's knowledge and attitude towards asthma, quality of life, anxiety level, and school absenteeism. Methods A quasi-experimental, non-equivalent group, pre-test post-test design was used. The education programme was developed from existing evidence. The Paediatric Asthma Quality of Life Questionnaire, Spence Anxiety Tool, Asthma Knowledge Questionnaire, and Asthma Attitude Questionnaire were employed for data collection in 2013. Intervention (n=130) and control (n=98) groups were drawn from 10 schools in Ha’il region, Saudi Arabia. Both descriptive and inferential statistics were used to examine differences between groups. Results The level of asthma knowledge was increased significantly more in the intervention group than in the control group (F=26.5746, DF 2, p<0.001). Attitude toward asthma was not changed by the intervention (F=0.0490, DF 2, p=0.9522). In the accumulative score, there was a statistically significant difference in the anxiety score between the three phases of intervention group (F=3.7599, DF 2, p=0.0242) but no statistically significant difference between pre-test and either post-test (p>0.05). Anxiety scores had reverted to those at pre-test at post-test II. Regarding quality of life, the intervention group scored higher in total quality of life scores compared to the control group (F=87.6534, DF 2, p<0.001). Finally, school absenteeism also reduced significantly after delivering the programme (F=2.98, DF 2, p=0.003). Conclusion The asthma education programme impacted positively on students' knowledge, anxiety, quality of life, and school attendance. However, asthma education did not change attitudes towards the condition. The results emphasise the benefits of provision of health education directly to children. Asthma education should be integrated into the Saudi national child health programme.

Self-care, capability in performing certain activity in maintaining well-being in daily life, is regarded important especially among people with long-term condition such as diabetes. Locus of control and religion are regarded as important factors in influencing such particular activity in day to day basis. Indeed, among Javanese people the lingering culture cannot be separated from religion, influencing how they perceive any factors that might play into role in managing any ill-health condition. Utilizing a mixed methods study design, with the deployment of two screening tools for further semi-structured interviews (the Summary of Diabetes Self-care Activity and the Muslim Piety questionnaires), this study was aimed to explore further into the perceptions and experiences of Javanese Muslim with diabetes in utilizing religion with embedded cultural aspects, in managing their daily self-care activity. Subsequent to this, the study sought further into barriers and opportunities in performing self-care. A convenient sample of 100 participants has filled the questionnaires, and 24 participants from various gender and age groups were purposively collected to gain a richer perspective for further interviews. The study identified the moderate self-care practices as a separate notion, instead of an integrated and comprehensive concept. The study has also found that the act of surrendering or nerimo ing pandum among Javanese people, as a representation of external locus of control, is paramount in maintaining self-care. The state of surrendering has been shown in the belief in Allah as the determinative factor in managing self-care, and in how they were surrendering to the lacking of adequate access to healthcare services. Social support can be served as a hindrance in self-care, as well as supporting factor. The later notion has been shown in the role of Pengajian, a social religious activity, and Persadia, a peer support group, which have been performing more of a social hub in supporting not only in enhancing capability, but also psychological support. The role of external locus of control and the lack of healthcare access have been served as an opportunity in conducting an individualized approach in educating the Javanese Muslim in enhancing the capability and capacity in self-caring themselves, with collaborative work between the healthcare professional and the Muslim cleric.