• Using Mathematical Modelling and Electrochemical Analysis to Investigate Age‐Associated Disease

  McAuley, Mark; Morgan, Amy E. (University of Chester, 2019-04-02)

  People are living longer. With this rise in life expectancy, a concomitant rise in morbidity in later life is observed; with conditions including cardiovascular disease (CVD), and cancer. However, ageing and the pathogenesis of age related disease, can be difficult to study, as the ageing process is a complex process, which affects multiple systems and mechanisms. The aim of this research was two‐fold. The first aim was to use mathematical modelling to investigate the mechanisms underpinning cholesterol metabolism, as aberrations to this system are associated with an increased risk for CVD. To better understand cholesterol from a mechanistic perspective, a curated kinetic model of whole body cholesterol metabolism, from the BioModels database, was expanded in COPASI, to produce a model with a broader range of mechanisms which underpin cholesterol metabolism. A range of time course data, and local and global parameter scans were utilised to examine the effect of cholesterol feeding, saturated fat feeding, ageing, and cholesterol ester transfer protein (CETP) genotype. These investigations revealed: the model behaved as a hypo‐responder to cholesterol feeding, the robustness of the cholesterol biosynthesis pathway, and the impact CETP can have on healthy ageing. The second aim of this work was to use electrochemical techniques to detect DNA methylation within the engrailed homeobox 1 (EN1) gene promoter, which has been implicated in cancer. Hypermethylation of this gene promoter is often observed in a diseased state. Synthetic DNA, designed to represent methylated and unmethylated variants, were adsorbed onto a gold rotating disk electrode for electrochemical analysis by 1) electrochemical impedance spectroscopy (EIS), 2) cyclic voltammetry (CV) and 3) differential pulse voltammetry (DPV). The technique was then applied to bisulphite modified and asymmetrically amplified DNA from the breast cancer cell line MCF‐7. Results indicated that electrochemical techniques could detect DNA methylation in both synthetic and cancer derived DNA, with EIS producing superiorresults. These non‐traditional techniques ofstudying age related disease were effective for the investigation of cholesterol metabolism and DNA methylation, and this work highlights how these techniques could be used to elucidate mechanisms or diagnose/monitor disease pathogenesis, to reduce morbidity in older people
• A qualitative exploration of therapists’ experience of working therapeutically pre-trial within the Crown Prosecution Service guidelines with adult clients who have reported sexual violence

  Kiyimba, Nikki; Nixon, Madelyn A. (University of Chester, 2019-01-24)

  This research is one of the first qualitative studies to explore the lived experience of therapists who were working pre-trial, within the Crown Prosecution Service guidelines with adult clients who had reported sexual assault. The aim of the study was to obtain a detailed account of the therapists’ experience in order to acquire a deeper understanding of how the participants created meaning from their practice. Interpretive Phenomenological Analysis was chosen as an appropriate approach to analyse the data gathered. Semi-structured interviews took place with six therapists. Upon analysis five super-ordinate themes emerged which were, i) the differences between pre-trial therapy and generic therapy, ii) the psychological impact of working with this client group, iii) the complexity of the work, and competency of the therapists, iv) the dilemmas and conflicts inherent in the work, and v) an expression of a loss of faith in the Criminal Justice System. These findings illustrated the complexities that therapists are faced with when working with clients’ pre-trial. A discussion is provided relating to the extensive research that has been carried out since the Crown Prosecution Service (CPS) guidelines were written in 2001 into the fallibility of memory following a traumatic incident, and the developments that have taken place in therapeutic techniques. In light of recent research and developments in therapy, it is suggested that there is potentially an argument for the need for a review and update into the current CPS guidelines into the provision of therapy for vulnerable or intimidated adults prior to trial. It is also recommended that further research is needed into whether the fallibility of memory following a traumatic incident improves after the person has undertaken an appropriate evidence-based trauma-specific treatment, and the possible need for a central register of therapists that are qualified to offer pre-trial therapy.
• Virtual and Mixed Reality Support for Activities of Daily Living

  John, Nigel; Day, Thomas W. (University of Chester, 2019-05-14)

  Rehabilitation and training are extremely important process that help people who have suffered some form of trauma to regain their ability to live independently and successfully complete activities of daily living. VR and MR have been used in rehabilitation and training, with examples in a range of areas such as physical and cognitive rehabilitation, and medical training. However, previous research has mainly used non-immersive VR such as using video games on a computer monitor or television. Immersive VR Head-Mounted Displays were first developed in 1965 but the devices were usually large, bulky and expensive. In 2016, the release of low-cost VR HMDs allowed for wider adoption of VR technology. This thesis investigates the impact of these devices in supporting activities of daily living through three novel applications: training driving skills for a powered wheelchair in both VR and MR; and using VR to help with the cognitive rehabilitation of stroke patients. Results from the acceptability study for VR in cognitive rehabilitation showed that patients would be likely to accept VR as a method of rehabilitation. However, factors such as visual issues need to be taken into consideration. The validation study for the Wheelchair-VR project showed promising results in terms of user improvement after the VR training session but the majority of the users experienced symptoms of cybersickness. Wheelchair-MR didn’t show statistically significant results in terms of improvements but did show a mean average improvement compared to the control group. The effects of cybersickness were also greatly reduced compared to VR. We conclude that VR and MR can be used in conjunction with modern games engines to develop virtual environments that can be adapted to accelerate the rehabilitation and training of patients coping with different aspects of daily life.
• Factors affecting progress of the National e-Health Strategy in the NHS in England: A Socio-technical Evaluation.

  Page, Steve; Bellamy, Lawrence; Manning, Paul; Richardson, Keith (University of Chester, 2019-03-21)

  Background: This is a formative socio-technical study of the “middle out” NHS e-health strategy in England. It began in 2015 with an objective to become “paperless at the point of care by 2020”, focussing nationally on the “electronic glue”, (interoperability), to facilitate the inter-organisational exchange digital communications of patient data and leaving the choice of EHRs to local organisations. No academic research has been published into the strategy and similar studies rarely include sample groups of suppliers or IT consultants. So this study seeks to fill both gaps in knowledge. Such strategies are prevalent across westernised developed countries and can consume large sums of government funding and local resources. In consequence, their failure can be very costly. This study seeks to mitigate that risk whilst recognising that, as they operate in highly complex environments, choosing any particular type of “bottom up”, “middle out” or “top down” strategy construct does not guarantee success. Their outcome is dependent upon the successful navigation through a mix of factors, known and unknown, across technical, human and social, organisational, macro-environmental and wider socio-political dimensions through time. Findings: The “middle out” strategy is broadly more appropriate, rather than “bottom up” or “top down”, but the target, of becoming “paperless by 2020”, is unattainable. Major cultural barriers include resistance by powerful clinicians, who can perceive such strategies as threats to the moral order and their traditional role as gatekeepers of access to patient data. Other barriers include inadequate and delayed national funding; disruption caused by government reorganisations; major premature programme re-structuring and a shift away from the original intent, resulting in the inappropriate selection of single organisation pilot sites rather than multi-organisational community wide ones to promote interoperability. New factors found include: the threats of cyber security incidents and the need for protective measures; the mismatch between strategy timescales and local procurement cycles; the quality of IT suppliers and the competing demands of similar change management programmes for scarce local NHS resources. Proposition: To reflect those findings a new socio-technical model is proposed that incorporates those additional factors as well as two further cross cutting dimensions to reflect “Lifecycle” and “Purpose”, drawing on elements of both Change Management and Technology Lifecycle Theory. “Lifecycle” reflects the “passage of time” as the evidence suggests that factors affecting progress may vary in their presence and impact over time as a strategy moves though its lifecycle. The addition of a “Purpose” dimension supports a reflection on the “why”. Some support is found for the proposal that a “middle out” strategy is more likely to facilitate progress than “bottom up” or “top down” ones. However a shift in approach is advocated. It is proposed that “middle out” e-health strategies are more likely to be successful if their “purpose” shifts away from promoting EHRs, per se, like with single organisation pilot sites, towards inter-organisational clinical and social care workflow improvement across health and social care economies. To achieve that, the focus should shift towards interoperability and cyber security programmes. Those should promote and mandate the use of national interoperability infrastructure, national systems and national standards. They should also provide national funding support to health economy wide clinical and social care workflow improvement pilots and initiatives that span those economies.
• Development and delivery of the trainee nursing associate pilot curriculum.

  Roulston, Christina; Davies, Miriam (2019-04-11)

  This article discusses the recently launched curriculum for nursing associates and the authors' involvement in the development of a medicine management module. This required recognition of the challenges in an ever-changing healthcare environment with, in this instance, limited guidance from the Nursing and Midwifery Council and associated professional organisations and with multiple stakeholders to satisfy. Curriculum development therefore required consideration of the concerns of service users and providers regarding the integration of this new, poorly understood role, its potential effect on skill mix and lack of knowledge regarding proposed regulation.

View more