A silent pandemic, chronic, non-healing wounds are a major cause of morbidity, with treatment and management representing significant health burdens. The opportunistic pathogens Staphylococcus aureus and Pseudomonas aeruginosa are the most common species isolated from chronic wounds. Polydimethylsiloxane (PDMS), a biocompatible and, inexpensive to fabricate polymer, can undergo various modifications. The ability of the produced polymers to attract S. aureus and P. aeruginosa, either from the planktonic state, or while sessile in biofilms on ex vivo skin, was investigated using flat (FL) or patterned (PT) PDMS with or without 1% or 10% triclosan Patterned PDMS + 10% triclosan (PT 10%) attracted significantly more live S. aureus and P. aeruginosa, as determined using Colony Forming Unit (CFU) analysis (*p<0.01), Scanning Electron Microscopy (SEM) (*p<0.01) and Confocal Scanning Laser Microscopy (CSLM) (*p<0.01). The released triclosan was not cytotoxic against either bacteria or primary cultures of human dermal fibroblasts using Water Soluble Tetrazolium Salts (WST-1) assay. High performance liquid chromatography analysis highlights low level of triclosan release from the PDMS. Bacterial infection in co-culture using the Boyden chamber assay increased fibroblast viability in the presence of PDMS (*p<0.05). PT 10% demonstrated superior biofilm transfer from epidermis (*p<0.05), in comparison to all other analysed polymers. In summary, the unique topography of PDMS combined with triclosan attracted bacteria most efficiently. This promising data suggests potential for engineering a patterned polymer to physically transfer biofilms from wounds, and importantly lacks bactericidal properties which is vital in the quest to combat antimicrobial resistance.

Evaluation using mouse subcutaneous tumour models is a key process in cancer drug development. Tumour material is implanted subcutaneously and tumour growth measured using callipers. However this methodology can have poor reproducibility and accuracy due to observer variation. Furthermore the physical pressure of using callipers can distress the mouse and lead to tumour damage. Non-invasive digital tumour imaging would reduce handling stresses and allow volume determination without physical contact. This thesis focusses on capturing 2D digital images of subcutaneous tumours, then using image processing and machine learning methods to determine 3D volume. The biggest challenge faced was lack of differentiation between tumour and surrounding skin, rendering tumour boundary identification difficult. Whilst image processing methods such as colour segmentation and edge detection were unsuccessful, machine learning proved more successful. Three convolutional neural networks, VGG-Face, VGG-19 and VGG-16 models were evaluated, with VGG-Face producing the best results. Using the layer FC7 before RELU activation for extraction in the VGC-Face model, a tumour recognition rate of 98.86% was achieved. This was increased to 100% through a semi-automatic step with detection repeated on cropped versions of negatively classified images. Finally, volume was determined through extracting image features using the VGG-Face model and conducting partial least squares regression (error of 0.1). This work has successfully demonstrated that with computational methods the volume of subcutaneous tumours can be evaluated through non-invasive digital imaging without need to have contact with the tumour itself, thus offering refinement benefits to the mice as well as eliminating observer bias.

Background With an expected increase of seven to eight-fold in the UK in the number of people from a Black Asian Minority Ethnic (BAME) heritage living with dementia, there will be a similar increase in the number of family carers. Whilst policy and research have discussed issues pertaining to awareness and access issues for minoritised ethnic communities, there remains an under-representation of these communities in services. A lack of understanding on the part of service providers as to how services could meet the needs of these carers, together with a mistrust of services, leads to bias and misconceptions about dementia care amongst South Asian families. Added to this, migrant communities are now well established in the UK, yet little is understood about the factors impacting on care and coping in the face of discrimination and prejudice. This adds to the complexities of caring for older relatives living with dementia. Aims The aim of this doctorate was to develop an understanding of how South Asian families cope with caring transitions connected with the care needs of advancing dementia. Emotional and physical coping strategies require some elements of individual capability but also some external elements, such as information, support and access to services. This research set out to identify what, and how, it influenced South Asian family carers’ ability to cope, especially in the light of a lack of culturally appropriate services. I set out to explore these influences, as they are especially salient in the cultural context. The research explored how South Asian carers coped with transitions in dementia care whilst taking into consideration factors such family dynamics, cultural perspectives, values (including faith) and service provision. Design and methods I undertook two studies, both using a phenomenological methodology, underpinned by a social constructivist approach. The first study gathered retrospective accounts from former carers to identify key transitions in their experience of providing dementia care, and to identify factors to explore in a subsequent longitudinal study. It included in-depth semi-structured interviews with former carers from 5 families. The interviews were transcribed and then analysed using thematic analysis to identify key themes. These themes influenced the second study, where I interviewed carers from 7 South Asian families, who were actively caring for a relative living with advanced dementia. Four interviews took place bi-monthly with each family over a period of six months. Results Analysis identified a number of themes, which influence South Asian family carers’ ability to cope with the care needs of a relative living with advanced dementia. Study one identified five key themes, which were: stigma from family and community, access to information, appropriateness of services, expectations regarding caregiving, and attitudes arising from faith and religion regarding care provision. Family carers identified the transitioning aspects of South Asian communities themselves and how these influenced the adapting nature of culture, values and social norms in society. These include the changing nature and constructs associated with care and caregiving as care needs increase or become complicated, in relation to what is acceptable as care needs increase or become complicated. Study two incorporated findings of study one. Themes from the analysis identified some general factors, such as changing attitudes to cultural influences, faith-based impacts, carers’ own ability to cope with caring, coping as a family, gender-based influences, services and stigma as factors that impacted their coping experiences. Conclusion This PhD raised some interesting aspects relating to coping with care that included the value of nuanced approaches to understanding the needs of the family carers and their frustrations with barriers to accessing services that were associated with faith, gender and cultural expectations or obligations. There was a clear difference between the views of older South Asian family carers, who held more traditional values to providing care, and younger British-born carers, who saw their faith and values as not opposing their ability and desire to seek external sources of support, community or statutory services. The research therefore moves forward the previous discourse mainly restricted to awareness and attitudes. It moves it towards practical recommendations that can help support services to be more open-minded and tackle their own biases. Encouraging this, whilst taking into consideration aspects such as family-centred approaches or faith-based influences in supporting carers to better cope with the demands of caring for a relative with advancing dementia.

The pandemic produced by the COVID-19 virus has resulted in an estimated 6.4 million deaths worldwide and a rise in unemployment rates, notably in the UK. Healthcare monitoring systems encounter several obstacles when regulating and anticipating epidemics. The study aims to present the AF-HIDOP model, an artificial neural network Fast Fourier Transform hybrid technique, for the early identification and prediction of the risk of Covid-19 spreading within a specific time and region. The model consists of the following five stages: 1) Data collection and preprocessing from reliable sources; 2) Optimal machine learning algorithm selection, with the Random Forest tree (RF) classifier achieving 94.4% accuracy; 3) Dimensionality reduction utilising principal components analysis (PCA) to optimise the impact of the data volume; 4) Predicting case numbers utilising an artificial neural network model, with 52% accuracy; 5) Enhancing accuracy by incorporating Fast Fourier Transform (FFT) feature extraction and ANN, resulting in 91% accuracy for multi-level spread risk classification. The AF-HIDOP model provides prediction accuracy ranging from moderate to high, addressing issues in healthcare-based datasets and costs of computing, and may have potential uses in monitoring and managing infectious disease epidemics.

Research emphasises the importance of the mother-infant relationship for infants’ well-being. To benefit interventions, the current research, using a critical realist lens, investigates an area that research has neglected, which is the subjective experience of the mother-infant relationship, including experiences of moments of connection. Bourdieu’s ‘thinking tools’ enables exploration of mechanisms that may affect the mother-infant relationship. How the study’s results can inform health visiting practice is considered. Six mothers were interviewed, four of whom participated in a video of their mother-infant interaction. Two focus groups, each with six health visitors, discussed their practice in the context of supporting the mother-infant relationship. Interpretative phenomenological analysis and thematic analysis were employed. This research indicated a high arousal state, referred to as Vigilantia, was experienced by mothers and infants. Vigilantia appeared to support mothers’ drive to make sense of their young infants but also seemed associated with mothers’ reliance on a discourse of the ‘traditional baby’, which stressed instrumental care and omitted the relational infant. The mothers found it difficult to make sense of the “bizarre” relational connection they felt for their infants. Health visitors described obstacles to supporting the mother-infant relationship associated with their service’s design and their role. Health visitors also seemed to identify with some mothers and in doing so could overlook the infants. Neoliberal values discount the relational and these values affect the experience of the mother-infant relationship. Ideas for improving practice are suggested, as well as acknowledgment of the need for social structural changes.

Background- Diagnostic radiography is an established method of investigating child safeguarding concerns. The role of the radiographer in identifying signs that represent safeguarding concerns and acting as a conduit between the patient and other professionals is less well understood. Aims- To evaluate the role of the radiographer in child safeguarding. Establish the contributory factors that influence that role and identify the measures that can be taken to maximise the contribution that could be made to protect patients. Methods- A multimethod approach of two studies (KAP survey and semi-structured interviews) was implemented sequentially to permit the second study to be influenced by the results of the first. Results - An inconsistent knowledge base in terms of child safeguarding exists. A positive attitude towards the profession’s role was identified and an inference that the profession does contribute to the escalation process, albeit only exceptionally. Conclusion- Those in the earlier stages of their career are most in need of recognising suspicious appearances. Radiographic appearances are commensurate with the modality utilised and needs accounting for within education. Contemporary practice makes assessment of more abstract appearances of child safeguarding concerns challenging. The systems of escalating concerns are known, and the profession is willing and able to contribute. Recommendations- Educational focus on the recognition of pathognomonic signs of abuse and aetiology to permit recognition of occasions when injury and clinical history disagree. Education should also include child safeguarding concerns commensurate with the modality utilised and as part of image reporting. Further research is needed to promote the role of the profession and to evaluate the impact of technological advancement on the profession’s capability to contribute effectively.

This thesis investigates global fight against terrorism in North West Pakistan and Afghanistan from a 21st century perspective in 2018. It focuses on local attitudes towards the War on Terror and their interplay with geo-strategic, regional, international and Pakistan’s domestic landscapes. In doing so, it questions the efficacy of existing academic and policy approaches towards achieving sustainable peace in North West Pakistan in particular and South Asia in general. It also evaluates the impact of regional rivalries especially in between Pakistan and India on the achievement of US foreign policy interests. Part-1 reviews existing literature on terrorism especially in post 9/11 setting. It examines the international discord of agreeing on a single definition of terrorism and its ramifications. It sequentially focuses on character of security in North West Pakistan and neighbouring Afghanistan since colonial times. It also identifies various traditional, religious and societal angles of Pashtun tribes; which always inspired them to fight against external powers. Part-2 combines academic investigations with empirical evidence. The results are correlated with current discussions on modern terrorism, geopolitical pulls and regional rivalries to create a holistic picture. It identifies local attitudes and regional rivalries as major impediments towards achievement of sustainable peace. Research findings indicated that predominant Western academic debates on the conflict were foreign policy inspired with little local and veteran input. By adapting a pragmatic approach the terrorism challenge can be addressed and the region can contribute towards the continuation of ‘Rules Based Order’ within the current phase of Great Power Rivalry.

The success of small and medium enterprises (SMEs) is critical to Europe’s economic health, however, our understanding of SME strategic behaviour is predominantly based on large enterprise theory. This study uses the Miles and Snow (1978) typology to examine the strategic behaviour of 150 UK SMEs. It also investigates whether strategy type, environment adaptation and organisational performance can be predicted by several contingency factors: organisation size, age, industry type, and management style. The findings confirm that the typology is not well suited for categorising SMEs; organisations that rarely develop through all three domains of the adaptive cycle to be sufficiently eligible for categorisation by one of the four pure archetypes. However, similar patterns of strategic behaviour were observed for certain dimensions, largely independent of the industry type or size of the SME, suggesting that an optimal configuration of mixed strategies may exist. Furthermore, Reactors, or those with mixed strategies, were found to perform similarly as Analysers and better than Defenders. The study also found that by fitting nominal logistic regression models to organisation age and size data, it was possible to predict strategic behaviour and environment adaptation, and to a lesser degree, financial performance. Surprisingly, the industry type and management style data were observed to exert minimal influence on the outcome variables. Finally, this research provides important insight relating to the validity concerns of the Miles and Snow typology and categorisation method employed, and demonstrates how these can be avoided.

Chrysin is a flavonoid that can be used as a medication for asthma and chronic obstructive pulmonary disease due to its anti-inflammatory activities. However, no studies have investigated the effectiveness of an inhaled formulation of chrysin on its own or in combination with corticosteroids. Therefore, this study aimed to assess the aerosol performance of chrysin formulations as well as the performance of combined formulations of chrysin and budesonide. Dry powder inhaler formulations were used first, where chrysin was processed using three different techniques, namely ball-milling, sonocrystallisation, and spray drying, to obtain a suitable particle size for inhalation. The highest fine particle fraction was 27% when the sonocrystallised samples were used. As the lung deposition was relatively low, budesonide was not added to the formulations. Next, liquid formulations of chrysin and budesonide were prepared in two concentrations using limonene and oleic acid as the oil phase. In a comparison of low and high drug concentrations of the formulations, the FPF of the formulations prepared with limonene ranged from 45% to 53.3% and from 49.3% to 53.9% for chrysin and budesonide, respectively; by contrast, the FPF of the formulations prepared with oleic acid oil ranged from 41% to 50.4% and from 46% to 53.3% for chrysin and budesonide, respectively. A genotoxicity study confirmed the safety of these combined formulations, and an anti-inflammatory study confirmed the potential for chrysin to be used with budesonide in a combined formulation; thus, chrysin’s anti-inflammatory efficacy can be improved and the required inhaled dose can be reduced.