Cancer is one of the leading causes of death in the world (only second to heart disease in developed countries). It is a multifactorial disease that is characterised by the unregulated growth of the atypical forms of the body’s own cells and intrusion and spread of these cells from the primary site to other areas in the body. It is rare for cancer to cause death by the functional failure of the primary organ affected and the clinical consequences of cancer are indirect relating to the bulk of the tumour or the invasion of tissues both local and distant.

The repair of peripheral nerve lesions presents a common clinical challenge, with those injured suffering from an array of debilitating symptoms and sensory or motor handicaps. The current method of repairing peripheral nerve lesions involves the use of nerve autografts or artificial nerve repair conduits to bridge the gap between the two ends of the damaged nerve. However, results from the use of these techniques rarely produce full functional recovery. Several studies have shown that carbon nanotubes (CNTs) can be used as a successful substrate for the growth and guidance of neurons. These data suggest CNTs could be used as a neural tissue scaffold that may be incorporated into the lumen of existing nerve repair conduits to enhance axonal guidance at the nanoscale. Despite the substantial interest in the use of CNTs as a biomaterial in neurobiology, very little is understood about the interactions of CNT’s with neurons. The aim of this research project is to 1) provide an assessment of CNT biocompatibility with cells of the peripheral nervous system and 2) assess the ability of a CNT substrate to support neurite outgrowth.

BACKGROUND: Problem Based Learning (PBL) facilitators have sometimes sought to motivate learners to ‘talk more’ in order to ‘learn more’ but there has been little work to differentiate through differences evident in their speech behaviour during PBL discussions and to identify which differences are associated with successful learning. Corpus analysis is a useful tool for probing students’ speech in PBL, providing a quantitative basis for examining student talk. AIMS AND OBJECTIVES: The aim of this study was to create a speech corpus of at least 100,000 words, which identifies each individual student’s contribution to a PBL discussion of the same case at the same time within six randomly selected, gender-balanced PBL groups. The study then uses corpus analysis to explore the nature of the speech of individuals and their performance in learning. A statistical analysis was designed to triangulate findings through measuring and analysing underlying factors thought to influence the speech behaviour of individual learners, such as gender and personality type and to identify correlations with educational attainment. METHODS: Wmatrix3 was used to identify significant differences in frequency, parts of speech and semantic category usage from verbatim transcripts of the same three session cycle of PBL. SPSS analyses identified significant differences between learners’ speech behaviour, personality type, gender and attainment in the first year. RESULTS: Multiple and simple linear regression analysis demonstrates significant correlation to a moderate degree between certain data points. In summary, the calmer, more conscientious, lower openness to experience learner, with a high GAMSAT score, achieved significantly higher MCQ scores at the end of year one. Introverted students spoke less frequently, but with longer utterances. Male students spoke significantly more frequently than female students. More emotionally reactive (neurotic) students achieved significantly lower scores on knowledge tests at the close of year one and their talk focussed their own performance. Corpus analysis demonstrated statistically significant differences between personality, gender, high and low test performers. Lower performers frequently dwelt on ‘what’ and ‘why’ and more general technical terminology. Higher performers used ‘when’ and ‘how’ and highly specific technical vocabulary more frequently. CONCLUSION: This study demonstrates that corpus analysis of PBL transcripts provides rich evidence of significant differences in individual speech behaviour whilst learning through discussion. The results broadly replicate well-established findings about gender communication styles and personality difference. This suggests that there may be a utilitarian case for enhancing the approach of PBL facilitators and learners to individual differences without resorting to the overgeneralisations of stereotyping. For example, male and female learners often demonstrate different communication strategies, which may potentially limit the breadth of their future clinical communication skills. Facilitators and learners may use this awareness to explicitly encourage both male and female learners to adopt the full range of communication behaviours. It is important for facilitators to model best practice in their own communication in the initial sessions. By making such language patterns evident, it becomes possible to ensure that PBL groups become more skilled in initiating spontaneous contributions from introvert and female learners, in encouraging longer contributions from extraverts, more factual statements from female students and more varied types of speech from male learners. Learners who identify themselves as emotionally reactive (neurotic or volatile) could productively seek to moderate unproductive anxiety from an early stage through adopting excellent study habits and attitudes, particularly with respect to assessments.

Background For epidemiological research purposes structured data provide identifiable and immediate access to the information that has been recorded, however, many quantitative recordings in electronic medical records are unstructured. This means researchers have to manually identify and extract information of interest. This is costly in terms of time and money and with access to larger amounts of electronically stored data this approach is becoming increasingly impractical. Method Two programmatic methods were developed to extract and classify numeric quantities and identify attributes from unstructured dosage instructions and clinical comments from The Health Improvement Network (THIN) database. Both methods are based on frequently occurring patterns of recording from which models were formed. Dosage instructions: Automated coding was achieved through the interpretation of a representative set of language phrases with identifiable traits. The dosage data table was automatically recoded and assessed for accuracy and coverage of a daily dosage value, then assessed in the context of 146 commonly prescribed medications. Clinical comments: Automated coding was achieved through the identification of a representative set of text and/or Read code qualifications. The model was initially trained on THIN data for a wide range of numeric health indicators, then tested for generalizability using comments from an alternative source and assessed for accuracy, sensitivity, and specificity using a subset of 12 commonly recorded health indicators. Results Dosage instructions: The coverage of a daily dosage value within the dosage data table was increased from 42.1% to 84.8% coverage with an accuracy of 84.6%. For the 146 medications assessed, on a per-unique-instruction basis, the coverage was 79.7% on average with an accuracy of 95.4%. On an all-recorded-instructions basis the weighted coverage was 65.9% on average with an accuracy of 99.3%. Clinical comments: For all 12 of the health indicators assessed the automated extraction achieved a specificity of >98% and an accuracy of >99%. The sensitivity was >96% for 8 of the indicators and between 52-88% for the other indicators. Conclusion Dosage instructions: The automated coding has improved the quantitative and qualitative summary for dosage instructions within THIN resulting in a substantial increase in the quantity of data available for pharmaco-epidemiological research. Clinical comments: The sensitivity of the extraction method is dependent on the consistency of recording patterns, which in turn was dependent on the ability to identify the differing patterns of qualification during training.

Thesis Aim: Boundary violations are committed when a professional crosses the emotional, physical, spiritual or sexual limits of another, thus disrupting the relationship between staff and clients. This thesis explores this issue in the context of healthcare and forensic settings. It identifies boundary violation risk and protective factors for staff working with forensic healthcare patients. The thesis also investigates reasons why staff under-report and may not whistleblow their concerns in these areas. Methods: A mixed method approach was used to explore multiple elements of this topic. A systematic review was used to identify risk factors associated with staff committing boundary violations in healthcare and forensic settings. This was then expanded, through a regression, to specifically look at risk and protective factors in the forensic healthcare settings. A thematic analysis was carried out to explore staff’s perceptions of whistleblowing and boundary violating behaviours. A case study and several psychometrics (including the Exploitation Index) were also used to investigate this topic in more depth and assess the impact that boundary violating can have on the patients involved. Findings: The setting and environment were shown, through the systematic review, to be key when exploring this topic, as they not only impact on the definition of boundary violating along with what factors protect or put staff at risk of boundary violating. The regression identified risk factors, including staff feeling they had no one to turn to and working alone with patients. There were also factors which protected staff from committing boundary violations, such as having good social support and receiving training about boundaries. The thematic analysis found that people did not raise concerns of colleagues’ boundary violating due to concerns about anonymity, feeling that nothing would be done, and feeling that personally intervening (not management) would be a more effective method. Conclusions: It is of great importance to explore this topic and develop a greater understanding of boundary violations, as the impact of and harm caused by this behaviour are wide ranging. This thesis can aid the identification of professionals at risk, and create strategies to prevent or manage this destructive behaviour. These findings can also help create a more open and honest arena for concerns about boundaries to be raised and managed.

No description available.

No description available.

No description available.

No description available.

No description available.