Sports participation imparts a risk of injury. By considering the risk factors involved and taking appropriate action, many injuries can be prevented, or at least their severity minimised. Among the many injuries sustained in sport ankle injury is well substantiated to be one of the most prevalent, particularly ankle sprain in football. While ankle supports are commonly used in an attempt to decrease the risk of ankle injury, there are concerns over their effect upon performance and the actual mechanism of support. Taping is a universally accepted form of ankle prophylaxis, reportedly protecting the ankle by providing joint stability and enhancing proprioceptive input. Proprioceptive training is used in rehabilitation to reduce proprioceptive deficits and is beginning to be used as a tool in prevention, again by enhancing proprioception. However, despite their widespread use, the proprioceptive effects of both taping and training are unclear for healthy subjects. An investigation was undertaken to confirm results from preceding studies in the literature, concerning the prevalence of ankle injury in football. By means of an injury survey over two football seasons, the high incidence of injury to the ankle was confirmed. This prompted exploration of the influence of taping and training by investigating the consequences of their use upon athletic performance, and their proprioceptive effect upon the ankles of healthy football players. Neither taping nor training was shown to significantly affect athletic performance, so assuaging concerns over any detriment caused by their prophylactic use. Examination of their proprioceptive effects revealed a slight increase in postural sway with taping and proprioceptive training, though this was not overall statistically significant. Significance was seen in centre of balance positioning, with taping causing the centre of balance to shift to the left and proprioceptive training to the right in single leg stance and left in double leg stance. Consideration of electromyography results revealed varying changes in muscle activity due to taping and training dependent upon the muscle examined and its action in postural stability. The conclusion is that both taping and training can be used without concern for impairment of performance but their overall effect on proprioception in the healthy player is still questionable. It may be that the sportsperson is at an optimum level of proprioception that cannot be improved. Nevertheless, knowledge of the proprioceptive level for the individual is useful for rehabilitation and there is still scope to further investigate this phenomenon, particularly in rehabilitation of the injured sportsperson. More importantly, the research paves the way for investigation into the effect of these prophylactic measures on incidence of injury. If either taping or proprioceptively training the healthy ankle can reduce the incidence of ankle injury in football, then their long-term use must be considered.

A novel osteopathic treatment has been discovered during the clinical practice of the author which alleviates many of the symptoms of chronic fatigue syndrome (CFS) known in the UK as CFS/ME. The efficacy of this manual approach was tested using two separate clinical trials. The first examined the change in the symptoms following a year of treatment. The second repeated the first study and examined the possible mechanisms of the improvement. The studies were designed to develop a greater understanding of the disorder, for which there is much scientific uncertainty regarding the cause, diagnosis and treatment. Phase 1 of the research trials included self report questionnaires to examine overall symptom change. With post-exercise fatigue being a major symptom of CFS/ME, the treatment protocol was best evaluated by determining its effects on muscle function which was analysed utilising isometric testing of the knee extensor muscles measuring the impulse torque. The second trial, which included the same self report questionnaires assessing symptom relief as in the initial trial, was divided into two parallel phases. Phase 2 primarily took the form of brain analysis using magnetic resonance imaging (MRI) to confirm if brain abnormalities seen in previous research were found in sufferers of CFS/ME. No cerebral abnormality was detected in the patient group. Central lymph scans were also carried out showing a possible trend of enlargement in CFS/ME sufferers. In the other part, phase 3, isometric tests were repeated with more accurate equipment than in phase 1. Integrated EMG and median frequency of the power spectrum were measured using surface electromyography (sEMG). Overall this study has provided strong evidence that an important component of CFS/ME involves a disturbance of lymphatic drainage of the brain and muscles. The novel osteopathic treatment developed by the author has been statistically validated in both phases of the study, emphasising the need to focus future research on the biomechanical aspectso f this disorder.

The formal management of risk was an idea in its early stages of introduction into the National Health Service when this research started. In this thesis I document the development of my thinking as an acute hospital risk manager over the last five years as I developed the Trust's risk management system. Using Action Learning as the research approach, I explored theories and concepts and tested them in the fire of real world action and reflective questioning of experiences. The definition of risk is explored in relation to health care, as are the approaches used to manage these risks. A key finding is that risk management decision making does not generally fit into either programmed or non-programmed decision making models but neither do decision makers guess. Decision makers tend to use heuristics, which are simple rules of thumb, which generally help them make the right decision with minimum mental effort. However, heuristics also tend to be applied inappropriately and can result in an organisation being exposed to unacceptable levels of serious risk. A number of key heuristics are identified and they appear to fall into two general types, B-heuristics and E-heuristics. The B-heuristics are 'basic' in form and can be summarised as a simple sentence while, E-heuristics have an 'extended' form which can be summarised as a list of related simple sentences. Knowledge of heuristics helped in the design of the Trust's risk management which has been implemented and its effectiveness tested in the field. This field testing has demonstrated that the worst effects of heuristics can be mitigated by effective soft-system design.

The concepts of ‘place’ and ‘identity’ are increasingly being used to understand the relations between people and physical environments. This research utilised ‘place’ and ‘identity’ to examine how people negotiate environmental conditions such as vibration and noise within their talk around ‘place’ and ‘identity’. For the study context, living alongside railways was chosen as an ‘ordinary’ and ‘everyday’ physical feature within residential settings and also due to potential upcoming changes to the UK rail network such as new lines and increases in rail freight traffic. Ten qualitative interviews were generated with twelve residents living alongside the West Coast Main Line (WCML) railway in the North of England. Participants were recruited from the Defra-funded study ‘NANR209: Human Response to Vibration in Residential Environments’ (Defra, 2011). Using a discursive psychological approach, railways were portrayed as an insignificant aspect of ‘place’ in relation to the wider contexts of finding somewhere to live. Through the ‘lived ideologies’ of ‘the rural idyll’ and ‘a peaceful and quiet place’ that emerged within participants’ talk, railways could be considered as ‘disruptive’. Participants drew upon interpretative repertoires of adaptation to convey railways as initially ‘disruptive’ and as something ‘you get used to’ over time. Participants positioned themselves as being immune to the ‘disruption’ in that they no longer noticed the railways presence. Living alongside railways was presented as ‘commonplace’, which enabled participants to manage their identities of place and justify their continued residence within the context of ‘disruption’. ‘Place’ and ‘identity’ offer a way to examine how people make sense of living in places of ‘disruption’. Future research on how people make sense of continued residence alongside railways, particularly the role of adaptational repertoires, could assist in policy development.

The aim of this study was to examine patients’ experiences of day surgery from a sociological perspective. Although there has been massive expansion in day surgery provision, both internationally and in the United Kingdom, there has been surprisingly little sociological research concerning this development. Within the space of three hours a patient is admitted to hospital, undergoes a general anaesthetic, followed by a significant surgical intervention and is then discharged home where responsibility for their care, which was previously performed by health service professionals, is now undertaken by the patient and their families. A study was devised to gain an understanding of the patients’ experiences within a sociological framework of analysis. One-hundred and forty-five patients and their relatives, from two different day surgery units within the United Kingdom, were recruited to the study. A qualitative framework, utilizing the grounded theory approach, enabled the researcher to gain deep insights into the patient experience. Fieldwork comprised semi-structured interviews and observation, as well as extensive use of field notes and memos. During a two-year span in the field, patients were interviewed on three occasions. The first interview took place in the pre-operative assessment clinic, where fitness for day surgery was assessed. The second and third interviews were carried out by telephone, at forty-eight hours and four weeks post-operatively. Data was simultaneously analyzed alongside data collection. Line by line analysis of the transcribed interview was undertaken whereby keywords and phrases were identified. Codes were then clustered into groups from which emerged core concepts. The core concepts which emerged from this study were: Time, the ambiguities of the Sick Role, Control, the importance of therapeutic relationships and formal communication. Recommendations include improved educational preparation for day surgery patients and their families as well as for the day surgery and community staff who are called upon to support the patient following discharge.

This research seeks to explore the nature and value of peer learning for a group of pre-registration nursing students and specifically aims to examine a group of student nurses in order to inquire whether they learn from each other and if so, how, when and where this takes place. Secondly, the work aims to discover more about the process used by those nurses while engaging in peer learning and to unearth their perceptions of and value systems ascribed to this type of learning. In this context the students engage in peer learning as they learn from and through each others’ experience. This research is set against the backdrop of recent changes within nurse education in the United Kingdom. In 1999, the Peach report made several main recommendations regarding the future of pre-registration nurse education, including the integration of knowledge and skills through balanced time in theory and practice together with the fostering of interpersonal and practice skills through experiential and problem-based learning (UKCC 1999). In this case the fellow learners are a group of pre registration student nurses enrolled on a programme leading to registration as Adult Branch nurses with a Diploma level academic qualification. The curriculum (based on the Fitness for Practice recommendations within the Peach report) convenes the group (known as a base group) together throughout the course at regular intervals, and utilizes a strategy of problem based learning as part of a range of teaching and learning strategies in order to help the students to acquire the knowledge required by a qualified nurse. It is important to differentiate peer learning from other mechanisms which involve students in learning from each other. For example, peer teaching or peer tutoring is a far more formal and instrumental strategy whereby advanced students or those further on in progression, take on a limited instructional role (Boud, Cohen and Sampson 2001). In other words, the more senior students are used to formally teach various aspects of the curriculum to more junior students.

The relationship between people and nature has long been suffering from a cultural disconnect. In truth, nature is far more readily likened to travel than it is to everyday life; synonymous, as it is, with those faraway ideals beyond the everyday reach of an urban dweller. However, urban environments are teeming with a range of plants and animals, known as urban nature, thus providing the opportunity to shed these exotic associations in favour of a far more accessible experience. In order to do so, the form of contemporary urban nature photography will be examined in this thesis, where any representational trends found to be inhibiting its development will be identified, and ultimately challenged. A combination of photographic practice and reflective analysis was used to challenge these problematic trends. Five experiments were carried out. These served to yield a set of photographs which developed alternative representations of the urban nature subject. The resulting photographs of each experiment were subjected to a means of reflection; based on Gary Rolfe’s three stage method but refocused for compatibility with photographic practice, where observations were drawn from one experiment so as to guide the direction of the following experiment. These experiments culminated in a final project: a definitive body of photographs that served to fuse the findings of each experiment into an alternative aesthetic. Identity became a critical theme underlining the representations of the urban nature subject in this thesis, for the displacement of photographic information began to instil the subject with - to some extent - otherworldly sensibilities. This process challenged the active predisposition toward naturalism in urban nature photography, and began to direct such tendencies toward a much broader aesthetic landscape; engaging with unreserved artistic ideologies so as to develop exclusive representations of the urban nature subject.

The study of stem cells has received considerable attention in forming many different tissue types, and gives hope to many patients as it provides great potential for discovering treatments and cures to many diseases such as Parkinson's disease, schizophrenia, Alzheimer's disease, cancer, spinal cord injuries and diabetes. This study was concerned with developing algorithms that analyses microscope images of stem cells harvested from the bone marrow or dental pulp of a rabbit, expanded in the laboratory at the Tissue Engineering Center in Alexandria, Egypt, and then transplanted into subcutaneous pouches of the rabbit. The research aimed to detect automatically as soon as osteogenic differentiated stem cells were ready to be implanted in the defective parts, thereby avoiding the cells becoming damaged by bacterial infection. A further requirement was that the algorithms would not use traditional (chemical) markers which eventually lead to the sample being discarded as it dies after adding the marker. A total of 36 microscopy images were obtained from seven separate experiments each lasting over 10 days, and the clinicians visually classified 18 images as showing not-ready osteogenic differentiated stem cells and the remaining images showing a variety of cells ready for implantation. The ready cells typically appeared as a colony, or spread all over the image interconnecting together to form a layer. Initially, image pre-processing and feature extraction techniques were applied to the images in order to try and identify the developing cells, and a t-test was applied to the total cell area in each image in an attempt to separate the not-ready and ready images. While there was a significant difference between not-ready images and the ready images which showed the colony shaped characteristics, there was no significant difference between not-ready images and ready images with the spreading interconnecting layer shape, and so more sophisticated classification techniques were investigated. As the differentiated stem cells are effectively texture based images, each of the 36 images were divided into quadrants to give a total of 144 images to increase the image dataset. Several sets of texture parameters were derived from the grey-scale histogram statistics, Grey-Level Co-occurrence Matrix (GLCM), and Discrete Cosine Transform (DCT) spatial frequency components of the images. Some of these parameters were used with traditional classification techniques including cross-correlation, and Euclidean distance measures to try and classify the texture relative to the first image (not-ready) in each experiment and the other images (not-ready and ready) in the experiment. The success rate using cross-correlation was 70%, and 68% for the Euclidean distance approach. Secondly, intelligent classification techniques using Artificial Neural Networks (ANN) were considered, using the various texture parameters as inputs to a feed-forward 1-hidden layer MLP using Back-propagation of Errors for training. The ANN approach gave the better results, with 77% using the grey-scale histogram statistics, 73% for GLCM, and 92% for the DCT with 70 spatial frequency components. It was observed for each of the experiments that images became classified as ready for implantation after approximately 10 days, and then remained ready for the rest of the experiment.

The debates related to the representation of the mentally ill in the media have been wide ranging over the last 20 years. Emergent representations have often been stigmatizing, claiming that the mentally ill are violent and dangerous. This study used an emergent methodological design to explore what the current representations of the mentally ill were and identify a case study from the available representations. It then examined the influence that the case study had on the thoughts and practice of experienced mental health practitioners. The study involved 8 practitioners and identified thoughts influenced by reading the case study and an academic article. Practitioner’s thoughts were captured over 3 separate interviews and by practitioners providing written reflections. At the last interview, practitioners were asked to provide comments as to what the experience of taking part in the study had meant to them. Generic themes related to risk, blame and professionalism all emerged. The study also found that practitioners were able to reflect on the influence that the material had on them, finding that only after discussing the reflections in the interviews that they became aware of some of their defensive thoughts and actions. The outcome of the study is that the media continue to present a negative representation of the mentally ill and mental health care, and that practitioner’s thoughts and actions are influenced by the media representation.

This thesis used an action learning approach to achieve two aims. Firstly to develop the authors knowledge of research and research methods and secondly to design, deliver and evaluate interprofessional education (IPE). An undergraduate IPE module was designed using the Contact Theory and delivered, in February 1999, to final year students of midwifery, nursing, occupational therapy and radiography through a problem-based learning approach. This IPE experience was evaluated in two phases. Phase one was a positivist/post-positivist evaluation and used a quasi-experimental approach. Questionnaires measured the role perception, subject and skills knowledge that one profession had regarding another profession and participants enthusiasm for IPE. Pre and post module group interviews with staff and students were also undertaken. Phase two was a 1-year follow up of students’ perceptions of their experiences on the module and used an interpretivist approach. This interview data was analysed from a phenomenological perspective. Phase one results demonstrated some statistically significant differences for some of the questionnaire items but little more than would be expected by chance. Interview and learning index data showed that students had learned about the subject knowledge of other professions with all students combined learning the most about subject knowledge for nurses. Midwifery was revealed as the profession that students had learned most about for skills knowledge. There was a statistically significant difference between professions’ enthusiasm for IPE with radiography the least enthusiastic. Phase two uncovered several themes including factors that have a detrimental effect on interprofessional working (IPW), the positive effect of the module on practice and positive and negative views of IPE. My personal leaning led me to a broader inquiring approach to research and developed my understanding of research paradigms. I gained knowledge and skills in qualitative research and improved my interviewing and analysis skills. The future of multiprofessional education is positive at both faculty and NHS levels and I conclude that there is a need for diverse forms of IPE including its delivery in the clinical context. Future research in IPE outcomes should use the qualitative paradigm.