Dissertations / Theses on the topic 'Clinical Sciences not elsewhere classified'

In radiotherapy, the treatment is typically pursued by irradiating the patient with high energy x-ray beams conformed to the shape of the tumour from multiple directions. Rather than administering the total dose in one session, the dose is often delivered in twenty to thirty sessions. For each session several settings must be reproduced precisely (treatment setup). These settings include machine setup, such as energy, direction, size and shape of the radiation beams as well as patient setup, such as position and orientation of the patient relative to the beams. An inaccurate setup may result in not only recurrence of the tumour but also medical complications. The aim of the project is to develop a novel image processing system to enable fast and accurate evaluation of patient setup errors in radiotherapy by automatic detection and alignment of anatomical features in images acquired during treatment simulation and treatment delivery. By combining various image processing and mathematical techniques, the thesis presents the successful development of an effective approach which includes detection and separation of collimation features for establishment of image correspondence, region based image alignment based on local mutual information, and application of the least-squares method for exhaustive validation to reject outliers and for estimation of global optimum alignment. A complete software tool was developed and clinical validation was performed using both phantom and real radiotherapy images. For the former, the alignment accuracy is shown to be within 0.06 cm for translation and 1.14 degrees for rotation. More significantly, the translation is within the ±0.1 cm machine setup tolerance and the setup rotation can vary between ±1 degree. For the latter, the alignment was consistently found to be similar or better than those based on manual methods. Therefore, a good basis is formed for consistent, fast and reliable evaluation of patient setup errors in radiotherapy.

This thesis describes the work carried out on the development of a novel digit actuator system with tactile perception feedback to a user and demonstrated as a master-slave system. For the tactile surface of the digit, contrasting sensor elements of resistive strain gauges and optical fibre Bragg grating sensors were evaluated. A distributive tactile sensing system consisting of optimised neural networking schemes was developed, resulting in taxonomy of artificial touch. The device is suitable for use in minimal invasive surgical (MIS) procedures as a steerable tip and a digit constructed wholly from polymers makes it suitable for use in Magnetic Resonance Imaging (MRI) environments enabling active monitoring of the patient during a procedure. To provide a realistic template of the work the research responded to the needs of two contrasting procedures: palpation of the prostate and endotracheal intubation in anaesthesia where the application of touch sense can significantly assist navigation. The performance of the approach was demonstrated with an experimental digit constructed for use in the laboratory in phantom trials. The phantom unit was developed to resemble facets of the clinical applications and digit system is able to evaluate reactive force distributions acting over the surface of the digit as well as different descriptions of contact and motion relative to the surface of the lumen. Completing control of the digit is via an instrumented glove, such that the digit actuates in sympathy with finger gesture and tactile information feedback is achieved by a combination of the tactile and visual means.

In today’s world, antimicrobial resistance is one of the biggest global health issues that mankind is facing. This most effective way to ensure a wound does not become infected is through cleanliness and continued disinfection of the wound site. There is a lack of new antimicrobial drugs coming to the market due to economical and clinical reasons, this is evident in Lord O’Neill’s 2016 report and is addressed by Professor Dame Sally Davies in Parliament, (“We have reached a critical point and must act now on a global scale to slow down antimicrobial resistance”2). Prescription drugs have led to this epidemic that was highlighted by O’Neill. The latest report (2016) by O’Neill states, it is critical to improve sanitation and hygiene, refrain from overusing antibiotics in agriculture and the environment as well as introducing rapid diagnostics and vaccines3. This is leading to the need for photodynamic antimicrobial chemotherapy (PACT) that involves the use of a reactive oxygen species (ROS), photosensitiser, and light to cause microbial death. PACT is a treatment for resistant and non-resistant pathogens that is included in the treatment of multidrug resistant infections. The approach is to use novel antimicrobial drugs topically, avoiding systemic photo-toxicity, thus leading itself towards topical infection control. Herein, we report the development of a range of novel photosensitisers based on the second generation photodynamic therapeutic dyes (PDT) that are based on the tricyclic isoalloxazine structure of riboflavin, vitamin B2. Photosensitisers were synthesised using similar strategies to the isoalloxazine for a number of reasons: e.g. photoactivity and capability of degradation. In order to investigate which photosensitisers gave the highest reactive oxygen yield, functional group changes were made on the N-phenyl ring by substituting a range of electron withdrawing/donating substituents at different positions (ortho, meta, para). The free amide moiety was used to attach the photosensitiser to a solid support that would act as proof of principal of a photosensitiser attached to a bandage. These dyes show a phototherapeutic response via a Type I and II mechanism upon illumination by light of a selected wavelength. The mechanisms produce highly toxic oxygen-species, such as radical production via Type I pathway and singlet oxygen generation by Type II, thus causing terminal damage to microbes in a short time period. The synthesised photosensitisers are illuminated using blue light (440 - 490 nm) and white light in order to monitor and compare the singlet oxygen and radical yields generated as they absorb approximately at 440 nm, thus blue light being ideal for irradiation. The outstanding singlet oxygen result generated by compound 12c of 172% and a radical production by 11c of 227% show promising generators of cytotoxic species, resulting in microbial death. The synthesised photosensitisers have been tested against two opportunistic microbes (Gram positive and Gram negative bacteria; Staphylococcus aureus (S. aureus), and Escherichia coli (E.coli). They have proven to be problematic from its presence within the healthcare system especially when found on surgical site infections. From the statistics generated for the National Health Service (NHS) in the UK we can see that 52.4 % of S. aureus, and 43.1 % E.coli originates within the hospital environment. Antimicrobial activity was observed for several compounds under different light regimes on and off the solid support. As a result, the best observed MIC value of 0.25 mM/mL was achieved for S. aureus in darkness and in blue light without the polymer support. Additionally, when these compounds were linked to a polymer support (mimicking a bandage), antimicrobial activity was retained when irradiated using blue light at 1.0 mM/mL. These results show potential towards the next generation of antimicrobial disinfection agents. In time, these compounds could be integrated into the healthcare system for use as a new generation of self- cleaning bandages towards post-operative wound disinfection rather than employing front line antimicrobials. This is a moot subject under review in parliament and former UK prime minister has highlighted the concern. In a statement recently released, he states “If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine" – David Cameron, UK Prime Minister2.

Project investigates the design requirements of a computer based drug dosing system suitable for use by general physicians.. One area of medicine in which knowledge-based systems may improve day to day patient care is in the design of initial dosing regimens and dosage adjustment of certain drugs whose plasma levels correlate with their toxicity and/or efficacy. Since the general clinician is responsible for the appropriate administration of many of these drugs, a way must be found to enable these clinicians to rapidly detrmine the appropriate dose or dosage adjustment required to achieve the desired plasma concentration and thus the desired clinical effect. To obtain the best results, a good knowledge of pharrnacokinetic principles is required as well as the facility to apply these principles easily and safely. In this study, the intention was to construct a knowledge-based system for the design of drug dosing regimens and to investigate issues relating to the design of such a system which will affect its' utility in general medicine. A multidisciplinary approach to the problem was adopted. A combination of standard pharmacokinetic modelling and artificial intelligence techniques was used to design a system suitable for use by the general physician. The approach was informed by ethnography with the design incorporating features seen as desirable by prospective users and a knowledge base with facts and rules related to the safe and effective use of the system. In addition, a more general method of pharmacokinetic parameter estimation than that employed in most current pharmacokinetic systems was investigated. In the clinical environment, there are a number of sources of error which may invalidate pharmacokinetic calculations. The most important of these being those associated with the incorrect preparation of doses and the recording of incorrect times of dosing and specimen collection. It was observed that current pharmacokinetic systems do not address these sources of error directly. A more general Bayesian approach which might be extended to incorporate these 'external' errors would be appropriate. The method investigated in the report is a Bayesian formulation of the Kalman filter. It was applied to the one and two compartment linear models and to the one compartment nonlinear model. These models being sufficient to cover the majority of drugs of interest in the general hospital setting. Kalman filtering is a general method for handling state-space models which gives optimal estimates of the current state of a dynamic system. It is commonly encountered in the field of control engineering but is also used in the analysis of time series. The method was shown to be adaptable in principle to pharmacokinetic parameter estimation and it is theoretically extendable to incorporate the external sources of error described above. The positive initial results presented in the report form the basis for ongoing research into the possible extension of the system and a formal assessment of user acceptance.

The core principles of the Queensland Ambulance Service (QAS) that are founded on improving the health and well-being of all persons have remained relatively stable since 1892. This is despite changes in organisational structure, policies, protocols and procedures employed by operational paramedics. The primary scope of QAS operations is focused on the pre-hospital aspects of the health care continuum and has seen changes over time, with particularly rapid changes in the last two years to the content and nature of paramedic clinical practice. Timely and appropriate pain management in the pre-hospital environment is paramount to effective patient care. It is readily identified as a priority within the paramedic profession. Numerous studies have identified many factors that hinder the delivery of adequate pain management to patients with pain. A comprehensive review of the literature related to prehospital pain management, education and barriers to pain management has been conducted. This thesis has attempted to identify if educational programs improved knowledge and changed clinical behaviour, specifically patient care interventions and patient health outcomes. This information is valuable to those who develop clinical standards and education for ambulance services. As a result, this information could be used to help design programs that better meet the educational needs of paramedics and ultimately the needs of their patients and the community. The literature did not sufficiently identify the influences on clinical behaviour other than knowledge, so from this outcome it was identified that future studies must examine a theoretical model that can be used to assess paramedics’ intention to administer morphine to patients experiencing pain. The Theory of Planned Behaviour (TPB) was identified as an effective model for analyzing paramedic behavioural intention; it was recognised that this theory might help to identify and better understand the constructs of attitudes, social norms and behavioural control beliefs that influence paramedics’ intention to administer opioids to patients with pain. The purpose of this study was to analyse the ability of the direct measures of the Theory of Planned Behaviour (TPB) Model to mediate factors influencing ambulance paramedics’ intention to administer Morphine to patients with pain. Participants of this study were Advanced Care and Intensive Care Paramedics who were deemed competent in Morphine administration through the education division of the Queensland Ambulance Service. Data were collected by means of a questionnaire that used the constructs of the TPB, including subjective norm, perceived behavioural control and attitude. While participants reported strong intentions to administer Morphine they also reported negative attitudes towards the behaviour (morphine administration). The constructs of the TPB explained 26 per cent of the variance in intention to administer Morphine with subjective norm being the strongest significant predictor. The findings related to specific attitudes and normative pressures provide an understanding into paramedic’s pain management behaviour. This research may be the first step to identify if concepts taught in the classroom are being transferred to the clinical setting. Potential findings that may be identified in this study could be used to improve organisational awareness of factors that contribute to the future education and professional development of QAS Paramedics.

Parkinson disease(PD) is a degenerative neurological disorder that impacts a great number of individuals in the United States and often results in significant changes to speech and voice, as well as increased reliance on informal caregivers. Relevant literature has shown that caring for a person with PD can have a negative impact on caregivers but has not explored the relationship between perceived impact of life events or relationship satisfaction and caregiver quality of life(CGQOL), or the impact that therapy delivery paradigm can have on these psychosocial factors and on caregivers of people with PD. The current study examined the psychosocial factors associated with caring for someone who has PD and the effect of therapy delivery paradigm on these factors through regression and mediation analyses. Results indicated that caregiver burden, caregiver depression, and perceived impact of life events (PILES), were significantly associated with CGQOL post-treatment, but quality of life pre-treatment and treatment modality were not significant. Although no evidence of mediation was found in this study, change in PILES scores from pre-to post-treatment was significantly associated with caregivers’ ratings of patient self-efficacy for communication post-treatment, while caregiver burden pre-treatment and self-efficacy for people with disabilities pre-treatment were significantly associated with caregivers’ rating of self-efficacy for people with disabilities post-treatment. Collectively, results from this study suggest that focusing on the psychosocial impact of caregiving is an integral part of the treatment process for any provider working with people with PD. Ensuring that caregivers receive the support and education needed to effectively manage the psychosocial factors associated with caregiving will lead to higher quality of care for the patient, as well as better patient outcomes in therapy, and in their daily lives.

Total knee arthroplasty (TKA) has proven successful in treating symptomatic arthritis of the knee. Since its development, many and varied outcome measures have been developed to assess outcome. None have been accepted as the universal standard, although some are widely used. Many measures have no data regarding validity, reliability or responsiveness. There is little guidance or consensus in the literature as to which should be used in clinical practice, research or audit. In addition, there is limited research assessing the relationship between subjective clinical outcome scores, patient perceived reports and objective measures such as the timed up and go test (TUG), knee laxity and muscle strength. Establishing relationships between self report and objective measures may aid clinicians in developing more appropriate interventions. Twenty four patients underwent unilateral TKA and were assessed a mean of 27.5 (SD 11.7) months after surgery. Assessment included four patient reported scores (Knee Outcomes and Osteoarthritis Score, Oxford Knee Score, American Knee Society Score and Short Form 12) and three objective outcome scores (knee laxity, quadriceps muscle strength and timed up and go test (TUG). Significant (<0.05) correlations were demonstrated between the four patient reported scores (r=0.410- 0.786) except the MCS portion of the SF12 (r=0.286-0.483). The TUG was the only objective outcome measure to demonstrate a statistically significant (p=0.0001-0.005) correlation with subjective knee outcome scores (OKS, KOOS and 4 items of the KOOS) (r=--0.557 to -0.770). A patient's ability to walk at a certain pace is correlated with patient satisfaction after TKA. There were no 4 observed correlations between knee laxity or quadriceps muscle strength with the four subjective knee scores. Therefore for a comprehensive assessment of outcome after TKA, use of a combination of objective and subjective outcome measures is recommended, as they measure different aspects of outcome.

The hypothesis underlying this research is that hand activity produces changes in the tissues of the hand which are reflected in the various functions of those tissues. Understanding the effect of hand activity upon hand function would allow occupational therapists to assess the efficacy of therapeutic interventions upon a clients ability to perform hand activity without damage to the tissues of the hand. Such information could assist in the design of safe and sustainable work tasks. The first step towards understanding how activity affects the hand is to measure its effects. The aim of this research is to determine which instruments can measure the effects of activity upon the hand.

An increasing number of individuals with physical disabilities or mental disorders are incorporating specially trained service dogs as an assistance aid to improve functionality. In addition to the tasks that service dogs are rained for, studies also suggest that service dogs may benefit psychosocial health and wellbeing. However, current knowledge on these potential benefits is limited by methodological weaknesses without multi-method assessment. There remains a need for empirical and replicable quantification the psychosocial outcomes of service dog assistance and companionship.

The objective of Chapters 1-3 was to summarize, evaluate, and quantify the effects of service dogs on psychosocial health among individuals with physical disabilities. Chapter 1 conducted a systematic literature review of N=24 articles describing the effects of guide, hearing, mobility, and medical service dogs on standardized measures of psychosocial functioning. Chapters 2 and 3 conducted an empirical investigation using quantitative and qualitative methods to quantify the psychosocial effects of mobility and medical service dogs among N=154 individuals with physical disabilities. Results identified specific psychological, social, and emotional benefits that are associated with having an assistance dog or service dog among diverse populations with physical disabilities or chronic conditions.

The objective of Chapters 4-6 was to quantify the role of psychiatric service dogs for post-9/11 military veterans with PTSD. Chapter 4 quantified the perceived importance, frequency of use, and therapeutic value of service dog behaviors for N=216 military veterans with PTSD. Chapters 5 and 6 then quantified the effects that PTSD service dogs on psychosocial outcomes and physiological indicators of functioning, respectively, among a sample of N=141 military veterans with PTSD. Results identified therapeutic components, tangible psychosocial benefits, and potential physiological mechanisms of psychiatric service dogs for military veterans with PTSD.

Overall, this research combined quantitative, qualitative, and physiological measurement to describe outcomes of service dog pairings in two different at-risk populations. Results provide non-causational evidence of psychosocial benefits from service dogs for individuals with physical disabilities or mental disorders. Findings provide a basis for further large-scale research to disentangle active components of the assistance dog-human partnership and identify potential mediating variables of effects.

This study explored longitudinal change in executive function (EF) and episodic memory (EM) related to multimorbidity, number of chronic conditions, change in chronic conditions overtime in a nationally representative sample of young, middle-aged,and older adults. Participants were from the second (2004-2006) and third (2013-2015) waves of the Survey of Midlife Development in the United States (MIDUS; N=2,532). Participants completed telephone interviews and questionnaires providing information on demographics and chronic conditions. The Brief Test of Adult Cognition by Telephone (BTACT) assessedcognitive function. The BTACT includes measures of EM (ex. word list recall) and EF (ex. digits backward, category fluency, etc.).Overall, only change in chronic conditions was associated with EF decline in the whole sample. In young adults multimorbidity and number of chronic conditions was significantly associated with both EF and EM decline, whereas only change in number of chronic conditions was significantly associated with EF decline in middle aged adults.Future research is needed to assess a broader range of chronic conditions to determine their overall burden on EF and EM over time.

Methods for the preparation of concentrates of factor VIII, factor IX, high purity factor IX, Cl esterase inhibitor, specific immunoglobulin and platelet factor XIII are described. These procedures were developed or modified with the aim of integration into an automated process that would allow sequential recovery of all the clinically significant trace proteins from a single plasma pool. Concomitant recovery of important proteins such as transferrin, alpha-1-antitrypsin and platelet-derived growth factor was considered. A high-purity factor VIII concentrate heat-treated at 80°C for 96 h was prepared by a process that incorporated heparin fractionation. This method was shown to be suitable for assimilation into an existing regional blood processing laboratory. Several ion-exchange procedures for the recovery of factor IX were evaluated and higher purification of a factor IX concentrate was achieved on a new cellulose-based chromatographic medium. A chromatographic procedure for the preparation of a heat-treated high-purity Cl esterase inhibitor concentrate was described and the performance of a new cellulose-based desalting medium was evaluated in comparison with ultrafiltration. A heat-treated specific immunoglobulin concentrate was prepared from side-stream fractions of an automated chromatographic process for the production of albumin concentrate, and a pilot study for the fractionation of outdated platelet concentrates was carried out with the aim preparing components of potential therapeutic value. See summary flow diagrams of fractionation processes included with references in the back of this thesis.

In our first study, we explored the barriers to complying with iron supplement recommendations using focus groups. We recruited adults, ages 18-75 years, who have had bariatric surgery at least two months previously to participate in one of four 90-minute focus groups. Participants filled out a survey asking for information on demographics and supplement use, and a facilitator asked a set of pre-determined questions to each group. Responses were written, recorded, transcribed using TranscribeMe (San Francisco CA), and analyzed using NVivo (QSR International Pty Ltd, Doncaster, Victoria). The focus groups contained nineteen participants, five of which had sleeve gastrectomy (SG) and fourteen had Roux-en-Y gastric bypass (RYGB). The average age of the participants was 49.3 ± 9.4 years, and they had undergone surgery 3.9 ± 3.6 years previously. The key factors that influenced participants’ adherence to supplement guidelines were cost, tolerability, and palatability of the supplement, level of knowledge and support from healthcare providers, and convenience of the supplementation regime.

The second study was a prospective observational study to determine the bioavailability of ASP compared to FS. Iron deficient RYGB patients ages 18-65 years, who had surgery at least 6 months previously, participated in 8-hour iron absorption tests. Participants received a low-iron breakfast with 65 mg ASP (N=7) or FS (N=3). We assessed serum iron every 30 minutes for 8 hours following the supplementation using a colorimetric assay (South Bend Medical Foundation, South Bend, IN). In participants administered FS, serum iron increased 96.0 ± 27.2 µg/dL compared to baseline, whereas with ASP, serum iron increased 5.8 ± 4.7 µg/dL compared to baseline (P = 0.02). These data indicate that ASP is not as bioavailable as FS in RYGB patients.

This inquiry examined coaching as an approach for supporting and professionally developing clinical nurse leaders within their roles. An explanatory sequential mixed methods design was considered appropriate for this study consisting of a quantitative phase at the outset, followed by a qualitative phase.

Cinical facilitation is an independent and autonomous role where the clinical facilitators rarely have an opportunity to observe other facilitators in their role. The purpose of this study was to identify the meaning of the lived experence of clinical facilitation for clinical factors.

"The research documented in this thesis explored the way registered nurses currently working in regional Queensland health environments have learnt about legal issues and it describes their experiences of applying legal theory in the clinical environment. Further the study explored if there is a clinical culture, that is the beliefs and attitudes held about the law in practice, that are transmitted to colleagues and student nurses and what effects this might have. Thirty (30) registered nurses were interviewed for this study ..."--Abstract.

Nurses provide leadership at various levels throughout healthcare organisations as Directors of Nursing, Chief Nursing Officers, as well as clinical leaders at a unit level. Existing research into nursing leadership has mainly focussed on transformational and transactional forms of leadership, which has been at the expense of exploring more contemporary forms of leadership. Furthermore there is limited research into the experiences of leadership from registered nurses working in the clinical settings. This research explored the extent and appropriateness of four forms of leadership namely transactional, transformational, distributed and hybrid leadership as it applies in to clinical nursing.

Point of care (POC) diagnosis is essential in personalized treatment to obtain effective clinical outcomes when the patient is on site. And Mass spectrometry (MS) system promotes the applications of rapid sampling ionization, which could be a tool for fast disease determination. In this thesis, a miniature MS system was firstly developed for POC tissue analysis. Lipid profile in rat organs were demonstrated. By coupling with online Paternò–Büchi (PB) reaction, fast determination of lipid C=C bond location isomers was realized. The system was applied to quantitatively analyze the change of lipid C=C location isomers between mouse normal and cancerous samples. The intensity ratio of fatty acid 18:1 (D9) and 18:1 (D11) in wild type breast tissue was calculated to be 2.881, while the ratio in tumor breast tissue was 0.667. The direct sampling-based miniature MS system is potential for POC analysis of lipid profiles and lipid biomarkers discovery.

Secondly, an integration of paper-capillary spray and MS make it possible to analyze dried blood samples instantly in clinical laboratory and hospital. Quantitation of ratio between deuterate Phenylalanine and deuterate Tyrosine was achieved by using paper spray and paper-capillary spray MS directly, without any pretreatment of blood samples. Furthermore, these methods could generate calibration curves which enable the calculation of Phenylalanine concentration in whole human blood within 60 seconds. This disposable design is a promising application for point-of-care (POC) PKU analysis in newborn screening.

At last, an increased in free fatty acids (FFAs) of cereals was observed during storage, and a simple and direct rice quality assessment was performed using nanoESI (Nano-Electrospray Ionization) mass spectrometry method. Six fatty acids including palmitic, oleic, and linoleic acids were compared between different rice species, growth regions and harvest years. 2D and 3D linear discriminant analysis (LDA) methods were deployed and a good sample separation was achieved. This direct sampling method of extracting FAs from rice surface combined with MS is suitable for industrial use in rapid identification for large number of samples.

Poor workplace relations are an issue of concern in many workplaces and this phenomenon is not restricted to the nursing profession. The issue of workplace violence in nursing is well documented and there are an increasing number of studies which have investigated the notion of horizontal violence amongst graduate nurses. The impact that poor workplace relations has on the development of a professional identity by nursing students in the off-campus clinical setting is significant in light of the current global shortage of nurses. There is a dearth of knowledge in understanding how Australian undergraduate nursing students experience the off-campus clinical setting and subsequently develop a professional identity as a nurse. Therefore the aim of this study was to discover and describe the phenomena in order to develop a substantive theory that explains the experiences of the under-graduate nursing students in a regional setting. Constructivist grounded theory methods were utilised in the conduct of the study. A sample of 29 participants was recruited permitting the formulation of a substantive theory regarding the development of a professional identity in nursing students. This substantive theory contributes knowledge relevant to the undergraduate nursing students, nurse educators, nursing workforce planners, and the tertiary educational institutions offering nursing. This is achieved through discovering, describing and explaining the phenomenon of anxiety which the nursing students experience as a result of the interrelationship and interactions of tradition bearing, staff and student performance. These interactions intersect to form expectations of where the student fits within the hierarchy of the facility and the nursing profession in general. An understanding of the issues associated with tradition bearing, staff performance, and student performance and the impact that the interaction of these conditions has upon the students developing professional identity as a nurse is necessary to allow for the implementation of corrective strategies.

This thesis explores the fluorescence properties of tooth-coloured dental restorative materials, and how these can be used to identify the presence of restorations. It includes studies of how fluorescence is affected by moisture and by exposure to high temperatures. These results have forensic and clinical applications in dentistry.

The poultry industry has rapidly grown in the last few years with a focus in improving growth and productivity of broiler chickens, with performance assessed on measures such as feed conversion ratio, body weight gain and good immunity. The incorporation of antibiotics and feed additives in poultry diets, have been implemented for years to ensure the maintenance of poultry health with a focus on the control and reduction of zoonotic pathogens. In the last few years, however, key issues surrounding the antimicrobial resistance of antibiotics have urged for alternative supplementations. Nanoparticles (NPs) of silver and other metals have been heavily used in the poultry industry to improve the growth and performance of birds. Whilst successful, metal NPs exhibited higher toxicity at the higher surface to volume ratio, especially with the use of silver. This study proposes the use of NPs of essential metals and natural compounds to safely deliver nutrients, resulting in positive impacts on health and productivity with little to no toxic effects. Selenium is an essential mineral, required for the proper functioning of the immunity and is an important element in the first cell line of defence in the body. The work described in this thesis explores the ability of selenium NPs to improve the health and growth of broiler chickens by modulating their gut microbiome and metabolome, without the toxic effects observed with silver. Selenium NPs were synthesised using a simple chemical reduction method and a full characterisation was performed, assessing the physicochemical properties of the NP. Selenium NPs were then compared in an animal trial against two commonly used selenium additives in the poultry industry, sodium selenite (inorganic selenium) and selenomethionine (organic selenium). The performance of the birds was assessed based on body weight gain, the gut microbial composition and metabolite production. The toxicity of NPs was further investigated by quantifying selenium concentration in various tissues, along with a detailed histopathological assessment. Results show selenium NPs completely altered the gut microbial ecology at high concentration, with a strong correlation observed between Faecalibacterium prausnitzii abundance and increasing concentration of selenium NPs. Selenium NPs additionally increased villus height/crypt ratio associated with enhanced absorption in the small intestine and an overall increase of healthy colonic metabolites. Finally, an in vitro study demonstrated the ability of selenium NPs to reduce emerging pathogenic Enterococcus cecorum species. This thesis demonstrates the prospective ability of selenium NPs as alternatives to antibiotics and bulk supplementation, resulting in an improvement of health and performance of broiler chickens in the poultry industry.

Dual degree nurse midwives graduate with a broader scope of practice which is welcomed and valued across a wide variety of health care settings. Transition to practice experiences for these beginning health practitioners reflect the breadth of their practice capabilities and are directly dependent on their roles and responsibilities as a nurse and a midwife, the support available to them and organisational expectations for autonomous practice. While literature exists that examines the transition to practice experiences of nurses and midwives, no literature was located for this study that explored the transition to practice experiences of dual degree graduate nurse midwives. As a result, the aim of this research project was to describe the transition to practice experiences of Bachelor of Nursing/Bachelor of Midwifery graduates working in a variety of health care settings across Australia as beginning health care practitioners. Face to face interviews were undertaken using a Husserlian Descriptive Phenomenological approach. Twenty-three graduate double degree nurse midwives employed as both nurses and midwives in a variety of health care settings across Australia described their transition to practice experiences. Four core themes emerged: A need to feel safe; A need to feel a sense of valued belonging; The path to exhaustion and work-life imbalance; and The daunting world of autonomous practice. Recommendations from this study include the need for graduates who are transitioning into more than one discipline to be acknowledged for their expanded scope of practice and be supported accordingly. This support needs to be context specific, holistic and include rostering and shift-work expectations that enable a satisfactory work-life balance.

The problem of sediment transport and sedimentation in estuaries is examined in relation to the Boyne Estuary situated on the Central Queensland Coast. Bottom material characteristics are examined and the most appropriate formulae for prediction of sediment transport are identified.. Estuaries are natural resources that play an important role in the economic and social development of nations. They offer habitat for fish, sites for harbours, industries, and recreational activities. Sediment transport into estuaries, and the subsequent shoaling of estuaries are important estuarine processes that impact upon the physical condition (shape, depth etc) of the estuary, and therefore the uses to which the estuary can be put. As such, estuaries represent important and complex engineering problems. The sediment transport aspect of these estuarine processes is examined in this thesis with a view to quantifying the sediment transport rate in the Boyne Estuary on the Central Queensland coast of Australia. The estuary was characterised into five distinct zones using the particle size distribution of the bottom materiaL A null point, at which the velocity of the river current is effectively balanced by the velocity of the incoming tidal and coastal current was identified in one of the five zones. Analyses of the sediment transport rate were carried out using the depth of flow, mean velocity of flow, bottom roughness and characteristics of the bottom material ofthe Boyne Estuary. Sediment transport formulae reported in the literature are reviewed for this purpose with six formulae, namely, the Ackers-White formula, the Engelund-Hansen formula, the Inglis-Lacey formula, the Van Rijn formula, the Ranga Raju formula, and the Zanke formula, being selected for detailed study. Three of the six formulae (the Van Rijn formula, the Ranga Raju formula, and the Zanke formula) predict the components of the total sediment transport, namely, the bed load transport, and suspended load transport separately. The other three formulae predict the total sediment transport without any detail on the components. Wash load transport is not considered in any of the formulae. The Van Rijn formula was selected as the reference sediment transport formula and three other sediment transport formulae, namely, the Ackers-White, the Engelund-Hansen, and the Inglis-Lacey, that predict close results with the reference formula were found to be suitable for the evaluation of sedimenttransport rate in the Boyne Estuary.

The behaviour of waste biomass materials, specifically bagasse* and sawdust, in deep fluidized beds was investigated. The bagasse used was dry (less than 1% moisture by mass). Sawdust was from mixed eucalyptus hardwoods with moisture contents up to 25% by mass. A series of cold flow visualisation tests were completed in a bed of 190mm diameter using graded river sand of surface mean particle diameters of 180 and 490 microns. Bagasse was added to the bed in various quantities and the ingestion and mixing phenomena observed. The influence of distributor design, cones, and draft tubes on mixing rates were investigated for use in the combustor design. Combustion Tests using Sawdust and Bagasse were completed in a Combustor of 489mm diameter with graded river sands of surface mean particle diameters of 300,490 and 530 microns. Various configurations were tested including a shallow bed of depth 130mm, deep beds of depths up to 460mm, a Reverse Circulation Bed, and Modified Spouted Beds of depths up to 740mm. Fuel feeding systems included above bed chutes, an ingestor tube, a direct bed wall screw feeder, and a pressurised screw feeder fitted to the air supply of a Modified Spouted Bed. Bagasse was not successfully fed through the screw feeder systems used. Sawdust, which has similar fluidized bed combustion characteristics to bagasse, was used in screw feeders to indicate the possible results that could be obtained from bagasse using below bed feed systems. Configurations utilising direct below bed surface screw feed, Ingestor tube feed, and pressurised screw feed to the fluidizing air were all successful in increasing the percentage of combustion occurring below the bed surface. The best results were obtained from pre-mixed air and fuel particles entering the modified spouted bed giving combustion efficiencies of up to 60% comparable to coal. Higher efficiencies would be possible with further optimisation of the design. The results of the investigation open several avenues of development including partial gasification/combustion systems and further development of the ingestor tube, reverse circulation bed and modified spouted bed concepts. The problems encountered with the combustion of lightweight, particulate biomass fuels are now reduced to finding practical methods of fuel feeding and rate control. *Bagasse is the cellulose residue from sugar cane stalks which remains after crushing.It is particulate, fibrous, tangled and irregular in size, length and aspect ratio.

Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.
Thesis (PhD)--University of South Australia, 2009

The research presented here analyses and compares textual narratives generated within policy, scholarly and popular media to discern how the sexuality or intimacy needs of people categorised as ‘learning disabled’ have been historically and more recently managed in Australia and the United Kingdom. The research uses a modified critical discourse analytical approach which, in order to clarify the distinct role of power in the construction of discourses of sexuality, is mediated by the more recent ideas of progressive phronesis offered by Flyvbjerg (1998a; 2001). The analysis identifies three broad stages in the historical development of the discourses about the sexuality of learning disabled people. The first phase was prior to the 1800s, when these people were labelled non-derogatorily as ‘idiots’, and perceived as childlike, innocent and asexual. The second stage was in the 1800s when, with the emergence of scientific rationality and medicalisation, so-called idiots became medicalised and categorised as ‘feeble-minded’ or ‘moral imbeciles’. This thesis demonstrates that, during this period, an emphasis on sexual self-denial, anxieties about venereal disease and non-procreative erotic pleasure helped to inform discourses of eugenics and learning disabled people became perceived as a sexual threat to the society. This underpinned policies of sexual control through institutionalisation, gender segregation and sterilisation. The third period in the development of discourses relating to the sexuality of learning disabled people paralleled the ‘sexual revolution’ of the late- 1900s and the move towards deinstitutionalisation and human rights. This analysis shows that, although the principle of ‘sexual freedom’ was ostensibly incorporated in modern policy discourse, the sexuality of learning disabled people continues to be influenced by significant barriers of sexual intolerance, demonstrated by continuing practices of sexual segregation, sterilisation, criminal labelling and imprisonment. The analysis indicates that a discourse of sexuality, which has legitimised the control and management of learning disabled people in varying forms since the Enlightenment, continues to be encountered in policy and popular narratives. Robust sexuality awareness and education programs for carers of these people, and society in general, are necessary so that intimacy and/or sexual desires are accepted as a normal need for all human beings.