Echinococcus granulosus is a canid cestode species that causes hydatid disease or cystic echinococcosis (CE) in domestic animals or humans. Echinococcus equinus formerly recognised as the ‘horse strain’ (E.granulosus genotype G4) is not known to be zoonotic and predominantly involves equines as its intermediate host. The domestic dog is the main definitive host for both species, which are also both endemic in the UK but data is lacking especially for E.equinus. An E.equinus-specific PCR assay was designed to amplify a 299bp product within the ND2 gene and expressed 100% specificity against a panel of 14 other cestode species and showed detection sensitivity up to 48.8pg (approx. 6 eggs). Horse hydatid cyst isolates (n = 54) were obtained from 14 infected horse livers collected from an abattoir in Nantwich, Cheshire and hydatid cyst tissue was amplified using the ND2 PCR primers to confirm the presence of E.equinus and used to experimentally infect dogs in Tunisia from which serial post-infection faecal samples were collected for coproanalysis, and indicated Echinococcus coproantigen and E.equinus DNA was present in faeces by 7 and 10 days post infection, respectively. Canine echinococcosis due to E.granulosus appears to have re-emerged in South Powys (Wales) and in order to determine the prevalence of canine echinococcosis a coproantigen survey was undertaken. The Welsh Assembly Government also funded a 2 year hydatid disease eradication campaign (2008-10) as a preventative public health measure and faecal samples were tested from farm dogs in the control area. In addition 8 foxhound packs (5 from Wales and 3 from England) were sampled and screened for echinococcosis infection using an Echinococcus genus-specific coproantigen ELISA that was optimised against a panel of known Echinococcus and control faecal samples. Farm dogs and foxhounds were also screened using two coproPCR assays (predominantly E.granulosus G1 or E.equinus G4 specific). In the Welsh farm dog study, 609 dog faecal samples were collected at baseline (pre-treatment) of which 10.8% (66/609) were found to be coproantigen positive, 5.1% (31/609) were G1 E.granulosus coproPCR positive, and 1.8% (12/609) were E.equinus ND2 coproPCR positive. A total of 742 farm dog samples were tested after 3 quarterly deworming treatments and showed a coproantigen decrease to 0.7% (5/742). One year after the last dosing round 4.2% (45/1076) of farm dogs were found to be coproantigen positive; of these only 123 were tested with the G1 primers of which 15.4% (19/123) were positive for E.granulosus DNA. Of 8 foxhound packs screened by the Echinococcus genus specific coproantigen ELISA and by the two coproPCR tests (E.granulosus, E.equinus) 3 of the 4 Welsh hunts had copropositive dogs (hunt prevalence 30.9%, 9.7%, 61.2%) and 2 of the 3 English hunts (hunt prevalence 17.5%, 44.5%). Hounds in 6 of the 8 hunts were coproPCR positive for E.granulosus DNA and 2 of the 8 hunts were positive for E.equinus coproDNA. Additional foxhound data was collected in the form of a survey questionnaire to hunt staff which suggested that there may be a link between increased Echinococcus coproantigen prevalence and inadequate worming protocols and unsafe feeding practices. The study showed that canine echinococcosis due to E.granulosus and E.equinus occurred in farm dogs and foxhounds in Wales and England and that an intervention programme in mid-Wales reduced canine echinococcosis in farm dogs after four dosing rounds, but coproprevalence increased by 12 months after cessation of dosing. The data are discussed with reference to potential human infection, risk factors and optimal intervention approaches. The study showed that the distribution of canine echinococcosis in farm dogs and foxhounds was not homogenous and also confirms the continued presence of both E.granulosus and E.equinus in foxhounds in England and Wales.

This thesis presents a programme of nine key published works, as well as twelve published supporting works focusing on two areas. Firstly, an investigation of how non-technical skills education in healthcare can be used to enhance outcomes for patients. Secondly, an exploration of how evidence synthesis be used as a tool to direct educational innovation and, in this context, enhance patient safety. Non-technical skills are the interpersonal, communication, team working and decision making skills that support safe patient care. Existing theory was applied to build new conceptual frameworks to understand how non-technical skill learning occurs. Educational innovations were developed, allowing outcomes for patients to be enhanced and the theory to be refined. Ultimately, this has led to the proposal of the SECTORS model, combining three key elements: The generic knowledge and skills in core areas that contribute to and support learning in non-technical skills (Systems and technology use, Error awareness, Communication, Team working), a situated cognition approach to formal and experiential learning that develops these skills (Observation and simulation) and developments in analytical skills that can integrate these and support decision making (Risk assessment and situational awareness). SECTORS can support curricula design, educational innovation and design of assessments. SECTORS will support future scholarly research, allowing the field to move from theory generation to theory testing and refinement. Additionally, synthesis of educational evidence to support the development of this new knowledge has been employed. Building on existing guidance and in response to calls for more theoretical generation in primary educational research, a complete method for health education evidence synthesis has been developed and applied. This method allows clarification of educational questions through generation of conceptual frameworks and new theory within a systematic framework that employs qualitative synthesis techniques such as thematic generation and meta-ethnography, representing a significant contribution to the field.

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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.