This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future.

It is well known that the evolution of 4G-based mobile multimedia network systems will contribute significantly to future m-health applications that require high bandwidth and fast data rates. Central to the success of such emerging applications is the compatibility of broadband networks such as mobile WiMAX (IEEE 802.16e) and RSVP A, and especially their rate adaption issues combined with the acceptable real time medical quality of service requirements. The design of effective broadband mobile healthcare systems usmg emerging WiMAX and RSxP A networks is important from the medical perspective especially in applications such as remote medical ultrasound diagnostic systems. In this thesis, we introduce a new cross layer design approach for medical video streaming over mobile WiMAX and RSVP A networks. In particular, we propose an approach based on optimising medical Quality of Service (m-QoS) in mobile WiMAX network environments described in this work. Preliminary performance analysis of the proposed cross layer algorithm has been evaluated via simulation studies. These results show that the proposed cross layer optimizer achieves improved performance compatible with the necessary medical QoS requirements and constraints for the relevant clinical application. Furthermore, this work addresses the relevant challenges of cross layer design requirements for real time rate adaptation of ultrasound video streaming in Mobile WiMAX and RSVP A networks. The comparative performance analysis of such approach is validated in two experimental m-health testbed systems for both Mobile WiMAX and RSVP A networks. The experimental results show an improved performance of Mobile WiMAX compared to the RSVP A using the same cross layer optimisation approach. Additionally, we map the medical QoS to typical WiMAX QoS parameters in order to optimise the performance of these parameters in typical m-health scenarios. Preliminary performance analysis of the proposed multiparametric scenarios is evaluated to provide essential information for future medical QoS requirements and constraints.

Osteoarthritis is common with radiographic features practically universal in at least some joints in people aged over 60 years. One of the main therapeutic interventions used in the management of osteoarthritis is the injection of corticosteroid and hyaluronan (Gossec 2006). However, there exist few studies that seek to explore possible factors that influence outcome following injection. This study examined the factors that may influence the outcomes following injection of either corticosteroid or hyaluronan in the management of osteoarthritis of the knee.

Introduction The centrality of the patient to health care has been increasingly recognised both politically and professionally. Patient-centred care has become synonymous with high-quality care and a number of studies have reinforced patient's desire for, and the positive impact of the approach. Although the concept emerged over 30 years ago, it is still not clear what it is, upon what theories it is based, or how to measure it. Whilst the concept has been explored within medicine, nursing and other allied health professions, within physiotherapy there has only been minimal discussion. The aim of this research was to explore the meaning of patient-centred care in relation to low back pain, from the perspective of musculoskeletal physiotherapists. Methods Purposive sampling was initially used to select participants. Subsequently theoretical sampling was adopted whereby analysis of the data informed the sample selection. Nine musculoskeletal physiotherapists agreed to participate in the study. They ranged in experience from five to 25 years. Individual semi- structured interviews were adopted as the method of data collection. The interviews were audio taped and then transcribed verbatim. Analysis broadly followed the Grounded Theory approach outlined by Strauss and Corbin (1990). It consisted of a process of open, axial and selective coding. Constant comparative analysis resulted in the identification with a core category and three inter-related sub-categories and the development of a substantive theory of patient-centred care.

This study explored the ways experienced mental health nurses working within a local acute mental health NHS Foundation and Teaching Hospital Trust felt about being unobtrusively observed in their everyday clinical practice. Participants were recruited from eight local units: four Community Mental Health Teams (CMHT), one Crisis Resolution Home Treatment Team (CRHT), one inpatient ward, one in-patient rehabilitation unit and an Assertive Outreach Team (AOT).

Biofilm associated infections relating to endoscopic procedures may result in asymptomatic colonisation to potentially death. An appropriate high-level disinfectant and adequate pre-cleaning steps are therefore required to prevent the risk of hospital acquired infections relating to endoscopes. OrtllO-phthalaldehyde (OPA) is an alternative high-level disinfectant to glutaraldehyde (GTA) used for the disinfection of endoscopes. The aims of this thesis were to: i) investigate the efficacy of OPA against planktonic, surface dried bacteria and bacterial biofilm ii) to develop and test a novel in-vitro sodium alginate biofilm method for the testing of OPA iii) to develop a predictive mathematical model for measuring the effect ofOPA against bacterial biofilm and iv) to investigate the effect of ill-situ re-processing steps used to re-process endoscopes colonised with bacterial biofilm. The efficacy of OPA was tested against Pseudomonas aeruginosa, Mycobacterium che/ollae and a GTA-resistant mycobacterial strain (Mycobacterium elle/ollae Epping), using a quantitative suspension test, quantitative carrier test and using bacteria grown as sedimentation biofilms. OPA (0.5 % w/v) was shown to be an effective high-level disinfectant against M.elle/ollae, M.c1le/onae (Epping) and P.aeruginosa in suspension and carrier tests. The efficacy of OPA against the three bacterial strains grown as sedimentation biofilms was however reduced, in comparison to the planktonic and surface dried cells. Bacteria grown using the novel in-vitro alginate biofilm system showed an increased resistance to OPA in comparison to the sedimentation biofilms. The novel biofilm protocol was demonstrated to be highly reproducible, simple and robust, in comparison to the sedimentation biofilm methodology. A comparison between the biofilm and planktonic outer membrane protein (OMP) profiles of P.aerugillosa cells was undertaken using I-Dimensional and 2-Dimensional SDS-PAGE. However it was not clear if the novel sodium alginate biofilms exhibited a biofilm OMP profile, although bacterial resistance to disinfection indicated a biofilm phenotype. A mathematical model was produced using extensive efficacy testing data. The predictive model was shown to be very accurate in predicting the efficacy of variable concentrations of OPA, in the presence of variable concentrations of organic load, against mycobacterial biofilm. Finally, P.aeruginosa, M.elle/onae and M.elle/ollae Epping biofilms were treated with OPA and subsequently re-incubated. Re-growth was observed for all bacterial strains. The pre-cleaning steps used in endosopce reprocessing were shown to reduce surface attached biofilm by an average of 2-3 log reductions. In addition, the adherence of bacteria to surfaces after endoscope reprocessing steps and the surface quality of polypropylene discs was investigated using scanning electron microscopy. Bacteria were observed on all surfaces even after complete reprocessing steps had been undertaken. This study further highlighted the necessity for testing the efficacy of biocides against bacterial biofilms and the value of using an organic load. The production of biofilms using the novel sodium alginate methodology in conjunction with the predictive mathematical model produced in this thesis, was shown to have the potential to represent a faster, less labour intensive method to study the efficacy of biocides, in comparison to the standard methods used currently. The importance of adequate reprocessing steps for endoscopes using appropriate biocides has also been further highlighted.

The aim of this project was to synthesise and characterise pillar[5]arenes, macrocycles comprised of 1,4-dialkoxybenzene moieties linked in the 1,5-positions by methylene bridges, and to incorporate them in a range of sensors. Pillar[5]arene-based ion-selective electrodes (ISEs) were used to detect protons, alkali metal cations and biogenic amines to investigate sensing properties resulting in the fabrication of a low pH sensor. Composite sensors incorporating 1,4-dimethoxypillar[5]arene were able to detect Na+ concentrations in the physiological range, whereas K+ concentrations were well above those encountered in vivo. The composite electrodes did not show significant differences in capacitance for biogenic amines making them suitable to detect Na+ and K+ over alkali metal ions and unaffected by the presence of biogenic amines. A novel thiolated copillar[4+1]arene was synthesised and attached to gold electrodes. It was tested against alkali metals and biogenic amines and was most selective to Li+ over other alkali metal cations. Copillar[4+1]arene-capped gold nanoparticles were synthesised and assessed for biogenic amine selectivity. Complexation occurred strongly with spermidine and spermine compared to pentylamine and putrescine. Overall, the common purpose of the research presented in this thesis was to assess the pillar[5]arene macrocycle for its selectivity of small molecules and ions, specifically alkali metals and biogenic amines of biological importance. The difference in the nature of ion selectivity by the same macrocyclic binding motif appears to be due to its arrangement and conformational freedom in the different types of electrodes. In the ISE, the crystalline macrocycle integrates with polyvinyl chloride (PVC) which makes the upper and lower rim functional groups available for complex formation. In composite sensors, the alignment of the macrocycles is very rigid making complex formation reliant on the guest fitting into the rigid macrocyclic cavity. On gold electrodes, one of the aromatic rings is involved in surface attachment with the remaining four free to change their conformations and bind guest species.

Oxygen is a requirement for almost all living organisms and adaptations to oxygen shortage are essential for surviving periods of oxygen deprivation, known as hypoxia. Cells have evolved a range of mechanisms which increase the supply of oxygen and facilitate metabolic alterations that enable the cell and the organism to maintain functionality under hypoxic conditions. Hypoxia is a hallmark of solid tumours and is associated with increased malignancy and mortality in hepatocellular carcinoma (HCC). Transarterial chemoembolisation therapy (TACE) using doxorubicin is the current standard of care for intermediate HCC, although response rates are poor. Drug eluting bead transarterial chemoembolisation (DEB-TACE) shows improved response rates over TACE. More recently, rapamycin has come under scrutiny as an effective therapy against HCC. Embolisation therapies have been shown to induce hypoxia in HCC, leading to the escape of hypoxia-adapted cancer cells from therapy. The principal transcription factor which orchestrates responses to hypoxia is hypoxia inducible factor 1 (HIF-1). Laboratory and clinical evidence support the hypothesis that HIF-1 activity contributes to cancer progression and increased mortality. Targeting HIF-1 therefore presents an opportunity for improving outcomes of cancer therapy. A hypoxic model of HCC was established, and used to characterise the responses of the cell line HepG2 to chemotherapeutic agents in both normoxic and hypoxic conditions. Firstly, the time and concentration dependent effects of doxorubicin, rapamycin and both drugs in combination on the viability of HepG2 cells cultured under both normoxic and hypoxic conditions were investigated. SDS-PAGE and Western Blotting was then used to evaluate the responses of HIF-1α, NFkB, S6K and Akt expression to doxorubicin, rapamycin and both drugs in combination in cells cultured under both normoxic and hypoxic conditions. Finally, the anti-tumour effects of doxorubicin, rapamycin and both drugs in combination were investigated in vivo using an ectopic xenograft murine model of HCC. The in vitro evidence presented in this thesis demonstrates that a concentration of doxorubicin relevant to clinical concentrations following DEB-TACE effectively inhibits the viability of both normoxic and hypoxic liver cancer cells. Also presented is in vitro evidence that low dose rapamycin inhibits the viability of both normoxic, and to a lesser extent, hypoxic liver cancer cells. The addition of low dose rapamycin to doxorubicin was consistently observed to have an additive effect on the inhibition of cell viability. Protein analysis demonstrated that low dose rapamycin inhibits the hypoxia stimulated accumulation of HIF-1α, as does high dose doxorubicin. However, inhibition of HIF-1α was attenuated when the two drugs were used in combination. Cytotoxic effects are not, therefore, wholly dependent on inhibition of HIF-1α. Inhibition of HIF-1α by each drug alone appears to be due to different mechanisms. This study also showed in vivo that combinations of doxorubicin DEB-TACE with either rapamycin DEB-TACE or oral rapamycin are more effective than either treatment alone at reducing tumour burden in a mouse model of HCC. Two clinical trials are now underway to investigate the combination of doxorubicin DEB-TACE and low dose oral rapamycin to treat HCC.

This scoping review examines the available evidence supporting accommodation use in the assessment of health professionals with disabilities in licensing contexts. While test accommodations are a protected right under antidiscrimination legislation, the peer-reviewed evidence informing their use is contested and widely dispersed. Furthermore, the ramifications of accommodation misuse are significant, including human rights violations and increased risks to patients. As such, this study addressed two research questions: 1) What is the current state of literature on accommodation use in the assessment of health professionals? and 2) What programs of research would address stakeholders’ concerns about the use of accommodations in the assessment of those professionals? Systematic searches of five prominent databases identified 15 articles for analysis. Several major themes emerged from that analysis: interpreting legislation, administration and process, relationships between education and licensure, and psychometrics and test development. Stakeholder consultation revealed that stakeholders face challenges managing accommodation requests and defining reasonable accommodations. While there is a paucity of literature on the topic overall, especially of an empirical nature, this study mapped the available evidence and laid the foundation for future studies by delineating the gaps in the scholarly literature as defined by stakeholders’ needs.

Thesis (MTech (Marketing))--Cape Peninsula University of Technology, 2005 / Although South African companies seem to make an attempt to employ more women to meet the required employment quotas, not enough is being done to allow women to grow beyond certain levels in their jobs, and it appears that women are still under-represented at top management level in corporate S.A. Despite employment-equity laws, gender inequalities regarding representative male-female ratios in corporate S.A. still appear to be prevalent at executive level. A more representative profile of male-female ratios at executive level in corporate S.A. might contribute towards a higher level of bottom-line performance for any organisation. The underlying premise is that by recognizing and utilizing their human potential to the fullest, the under-utilised available female talents and skills can contribute towards a larger skills pool within the organisation. In an attempt to assist m bridging the gap of gender inequality in corporate S.A., professional women may be branded as a valuable company asset. For females to be accepted and recognized by corporate S.A. as a brand, it is important to position them as a brand. To position a brand means emphasizing the distinctive characteristics that differentiate that brand from its competitors in a way that appeals to its target market. Identity, quality, differentiation, guaranteed consistency and clear communication to the target audience are the cornerstones of the branding process. In order for female professionals to be identified as a successful brand. these elements of the branding process need to be adhered to. What have traditionally been perceived to be inherent female qualities appear to meet the demands of contemporary management and leadership paradigms in a way that adds benefit to any leadership or management role in corporate S.A.