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Introduction: Radiography education varies across Europe, potentially leading to variation in competency levels and patient care. This is relevant for European Union (EU) countries, given the free movement of professionals across member states. This study aimed to assess Radiotherapy (RT) education across the EU and its impact on competency, patient care, and professional mobility, focusing on TRs working in the linear accelerator (linac). Methods: An explanatory, sequential, multiphase mixed-method design was used, following philosophical principles of pragmatism. Document analyses were conducted to identify professional regulations across EU, patterns of recognition of qualifications between member states, and competencies of TRs working on the linac. These results informed the survey design investigating course characteristics and competency levels across Europe. Interviews with European stakeholders further explored the survey results, assessing the impact of education characteristics on professional mobility, competency levels, and patient care. Results: Education regulation vary considerably between member states, affecting graduates' competencies and patient care. Competency levels on the linac depend on academic level, use of international guidelines in course design, amount of RT-specific training, number of specialisms in the programme, programme duration, use of simulation, availability of academic staff with RT expertise, and teaching methods, among other non-education factors. However, when learning outcomes (competencies) are regulated, all other factors must be adjusted to achieve these objectives. In certain countries, specific course characteristics, such as low academic level and short programmes, or the lack of professional regulation, hinder the recognition of graduates' qualifications abroad. Conclusion: RT education varies considerably across Europe due to the variation in national regulation. Regulation of the learning outcomes and academic level guarantees adequate competency, irrespective of the education model used. Standardisation across Europe could harmonise care and facilitate professional mobility. Irrespective of regulations, education institutions can improve competencies by considering the factors above when designing programmes.

Background: Exercise may reduce inflammation in coronary artery disease (CAD) patients. However, the molecular mechanisms that orchestrate this cardioprotective effect are yet to be elucidated. Moreover, CAD patient participation rates in cardiac rehabilitation (CR) and long-term exercise are poor. Thus, this thesis aimed to further scientific understanding of the role of exercise in the secondary prevention of CAD by investigating these areas. In addition, the factors that influence CAD patient participation in CR and long-term exercise training were qualitatively explored. Methods: The evidence generated by randomised studies that investigated the effect of exercise on inflammatory biomarkers in CAD patients was examined by a systematic review and meta-analysis (Study 1). A pilot prospective cohort study (Study 2) was performed in post-acute myocardial infarction (AMI) patients who had been invited to a phase-III CR programme. Finally, Study 3 comprised semi-structured interviews with post-AMI patients and their significant others. Results: Study 1 demonstrated an anti-inflammatory effect of exercise in CAD patients, as indicated by a reduction in C-reactive protein, fibrinogen, and von Willebrand factor post-intervention. The outcome of Study 2 resulted in a future prospective cohort study being deemed feasible with minor amendment (recruitment strategy). Moreover, preliminary evidence for a beneficial effect of exercise on sirtuin-1 in post-AMI patients was generated. Regarding Study 3, post-AMI patients and their significant others reported that health benefits were the primary motive for participating in CR and long-term exercise, with aspects related to motivation, extrinsic influences, and CR experience underpinning the decision. Conclusion: The results of Study 1 and Study 2 further scientific understanding of the role of exercise in the secondary prevention of CAD, and offer future directions to stimulate progress in this area. Finally, the novel qualitative findings of Study 3 may inform future strategies to promote patient participation in CR and long-term exercise.

Reactive oxygen and nitrogen species (RONS) are continuously produced within the body during oxidative metabolism, and through normal immune function. When contained within a homeostatic balance, these molecules are part of a normal physiological function, and play integral signalling roles in cell growth, proliferation, and differentiation. This equilibrium is tightly regulated by a range of enzymatic and non-enzymatic antioxidants which seek to prevent detrimental reactions to biologically important macromolecules. The purpose of this thesis was twofold. Firstly, the use of various high-intensity exercise protocols was employed to investigate the effect on oxidative stress within circulating peripheral blood mononuclear cells and skeletal muscle tissue with a particular emphasis on DNA damage. Additionally, an environmental stressor was used via normobaric hypoxia to comprehensively elucidate the cell DNA damage-repair response, alongside systemic measures of oxidative stress following constant-load high-intensity exercise. Secondly, this thesis aimed to examine the efficacy of novel antioxidant supplementation on measures of exercise-induced oxidative stress; specifically, a plant-based combination of barley- and wheat-grass juice, and the mitochondrial-targeted antioxidant, Mitoquinone. Across all studies, it was confirmed that exercise of sufficient intensity (regardless of duration) provided a challenging physiological stress capable of inducing oxidative damage to DNA and lipids; likely through the generation of RONS, and concurrent reduction in antioxidant capacity. Furthermore, it was determined that peripheral blood mononuclear cells have an efficient and effective DNA damage-repair response, with maximal repair occurring within 24-hours for both single- and double-strand DNA damage; this response was marginally exacerbated in the hypoxic condition. The aforementioned modifications to DNA as a function of exercise, were concurrently aligned with systemic biomarkers of oxidative stress; including but not limited to, lipid peroxidation, lipid soluble antioxidants, and the ascorbyl free radical. With regards to plant-based antioxidant supplementation, although there was no meaningful prophylactic effect on a statistical level, a combination of barley- and wheat-grass juice did appear to provide a marginal protective effect against exercise-induced oxidative stress. On a more molecular level, mitochondrial-targeted supplementation for 21-days abrogated oxidative damage to the mitochondrial genome following high-intensity intermittent exercise; likely, through the scavenging of exercise-induced RONS, and/or secondary oxidation products of mitochondrial lipid peroxidation. The results of the studies demonstrate an increase in oxidative stress following high-intensity exercise as evidenced by an increase in DNA damage (single-strand breaks, double-strand breaks, base oxidation) across nuclear and mitochondrial genomes, and changes to other systemic measures, such as: lipid hydroperoxides, lipid soluble antioxidants, and the ascorbyl free radical. The DNA damage-repair response was exacerbated by normobaric hypoxia with single- and double-strand DNA damage returning to baseline by 48-hours and 24-hours respectively. Finally, the data also indicates a potential prophylactic effect by supplementing with a plant-based nutraceutical, and mitochondrial-targeted antioxidant; however, further research is warranted to elucidate the underlying biochemical processes.

This thesis investigated the efficacy of eye tracking technology and a digital training tool in radiographic image interpretation. A systematic review was performed to investigate the performance of reporting radiographers completing chest image interpretation following training. The quality of evidence published in this area was high. The role of image interpretation differed between studies, ranging between: image red dot abnormality highlighting, image comment and clinical reporting. A comparison of image interpretation skills of radiographers across a range of experience was completed using eye tracking technology. Reporting radiographers trained in MSK image interpretation demonstrated statistically significant accuracy rates (p≤0.001), and confidence levels (p≤0.001) and took a mean of 2.4 s longer to clinically decide on an image compared to students. Reporting radiographers also had a statistically greater accuracy rate (p≤0.001), were more confident (p≤0.001) and took longer to clinically decide (14 s on average) on an image diagnosis (p=0.02) than radiographers. Eye tracking patterns presented within heat maps, were a good reflection of group expertise and search strategies. Eye tracking metrics were indicative of participant performance and reflected the different search strategies that each group of participants adopted during their image interpretations. A digital training tool for use in chest image interpretation was created based on evidence within the literature, using expert input and two search strategies previously used in clinical practice. Images and diagrams, aiding translation of the tool content, were incorporated where possible. Improvements were seen in interpretation performance and confidence (p < 0.05). There was a decrease in FP values and increase in TN values seen in the intervention group (p<0.05). This tool therefore has the potential to be used as a training tool in chest image interpretation for reporting clinicians and healthcare professionals. This work may contribute to improving diagnosis and help reduce reporting times.

Successful management of diabetic foot pathologies is a challenge due to the influence of peripheral neuropathy, peripheral vascular disease, a susceptibility to infection and abnormal distribution of plantar pressures. The aim of the current research was to evaluate the effect of topical Phenytoin on healing in diabetic foot ulcers.