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Objective: The thesis had two objectives. The first was to examine the effectiveness of self-compassion-focused and mindfulness-based interventions in improving the emotional wellbeing of mental health professionals. A systematic review aimed to provide a comprehensive and updated critical examination of the available literature. The second objective was to examine the relationships between carer burden, self-compassion, emotional intelligence, depression and anxiety in family caregivers of individuals with a diagnosis of diagnosis. The empirical study also aimed to identify any potential protective mechanisms of self-compassion and emotional intelligence on the impact of carer burden. Method: To address the first research objective, electronic databases were systematically searched to identify appropriate studies and a quality assessment was undertaken. An independent reviewer assessed the quality of seven papers. To address the second research objective, a cross-sectional study was conducted and participants (N =164) completed five online questionnaires examining carer burden, depression, anxiety, emotional intelligence and self-compassion. Results: In the systematic review, 22 studies comprising 1015 participants met the eligibility criteria to be included in the review. Quality appraisal highlighted several limitations in the studies. There was relatively strong evidence for the effectiveness of both self-compassion and mindfulness-based therapies on multiple measures of emotional wellbeing. There was mixed evidence for the sustained benefits when using longer-term follow-up periods. In the empirical project, higher carer burden was associated with and predicted lower levels of depression and anxiety in family carers of individuals with dementia. Higher self-compassion and emotional intelligence were also associated and predicted lower levels of depression and anxiety. Self-compassion and emotional intelligence did not moderate the relationships between carer burden and depression and anxiety. Conclusions: The findings of the review suggest evidence that self-compassion-focused and mindfulness-based interventions are effective in improving emotional wellbeing in mental health professionals, although methodological weaknesses need to be taken into consideration. Further research is required to establish the evidence base on this topic, in particular longitudinal studies. The empirical study provided evidence that self-compassion and emotional intelligence can predict mental health symptoms in a sample of participants experiencing high levels of carer burden. This suggest that individual differences are important to consider when evaluating resilience in this population. Additional research is required to better understand the interactions between these variables in family caregivers. Note: The overall aim of this thesis was to examine emotional wellbeing in both professionals who work in mental health settings and in informal family caregivers. Due to the increasing amount of research into the constructs of self-compassion and emotional intelligence, the empirical study examined these factors, and their relationships with depression, anxiety and carer burden in a sample of family caregivers of individuals with a diagnosis of dementia. Due to the limited number of research studies examining these factors in family carergivers, a systematic review was not warranted. As such, the systematic review aimed to highlight the needs of ‘professional carers’ by examining the effectiveness of self-compassion and mindfulness-based in mental health professionals. Overall, the thesis aims to further the research into self-compassion, mindfulness and emotional intelligence, emotional wellbeing in both family and professional caregivers.

There is strong and consistent epidemiological evidence that short sleep duration is associated with increased risk of obesity from early childhood. Childhood obesity and inadequate sleep have negative consequences for health and well-being, and the ability to target both of these public health concerns with a novel obesity intervention involving sleep extension is appealing; yet little is known about the mechanisms linking short sleep with obesity. In adults, hormonal mechanisms have been proposed; in young children, behavioural mechanisms and parenting are likely to be involved. Furthermore, the wider social and cultural determinants of short sleep and obesity should be incorporated into sleep-obesity research. This study aimed to explore some aspects of the sleep-obesity link in preschool children, using an exploratory design with a mixture of quantitative and qualitative methods, and applying an evolutionary medicine perspective. Participants were 109 3-year-old children and their parents in Stockton-on-Tees. Children’s sleep (validated by actigraphy), food intake and activity over 4 days/5 nights were assessed by parental diary report, and body composition was measured. Parents’ attitudes were explored using semi-structured interviews. Combined daytime and nighttime sleep duration was associated with central fat. Alternate parenting strategies were identified, based on regulation and consistency (routine-led), or child-governance and lack of regulation (routine-free). Building on the trends identified and the literature reviewed, I propose two hypotheses to explain the short sleep-obesity link in young children: the Behavioural Mechanisms Hypothesis (dietary and activity behaviours mediate or confound the association), and the Parental Confounding Hypothesis (parenting strategies, which vary with SES, impact on both children’s sleep duration and obesity risk). Parenting impacts children’s health by either limiting or facilitating discordance between children’s experiences in evolutionarily novel environments, and their biological make-up. I conclude that sleep-based obesity interventions should consider the wider context of children’s behaviours, particularly strategies of parenting.

This two-phase, qualitative research study explores the empowerment of nursing students in clinical practice. The first phase utilises the Critical Incident Technique (CIT) and the second is underpinned by hermeneutic phenomenology. Although there is a great deal of literature in nursing regarding power and empowerment, most of it focuses on the empowerment of patients and registered nurses, rather than nursing students. Moreover, there are no studies that explore empowerment of nursing students from a phenomenological perspective and similarly, there are no studies that have used CIT to explore empowerment of nursing students in clinical practice. Thus, the aim of the study is to address these omissions and make a contribution to nursing knowledge. The aim of Phase One of the research was to illuminate the empowering and disempowering critical incidents experienced by nursing students in clinical practice and to capture their experiences at different stages of the curriculum. To achieve this, a CIT study was designed that utilised an anonymous, written form of CIT with 1st, 2nd and 3rd year nursing students from the UK. From the findings, a model of nursing student empowerment was proposed. This phase of the research also comprised of a cross-cultural CIT study that compared and contrasted the empowerment of nursing students in the UK and Japan. Despite very different contexts, the study found striking similarities in the experiences of empowerment among students from the two countries. The Phase One CIT studies provided the springboard for inquiry in the second phase of the research. This study which was underpinned by hermeneutic phenomenology, aimed to illuminate the essential themes of nursing student empowerment. Thirteen, first-year nursing students were recruited to a longitudinal study and annual, semi-structured interviews captured their trajectory from 1st to 3rd year of the programme. Focus group interviews with a cross-sectional sample of students were then used to clarify and check emerging themes. The essential themes were highlighted as 'knowledge' and 'confidence' . The study culminated with the development of a visual representation to capture the complexity of the phenomenon which shows the multiplicity of influences on students' empowerment. From this, a number of recommendations are made that might serve to promote the empowerment of nursing students in clinical practice.

Responses to vasoactive peptides are mediated by the action of two receptors, bradykinin B1 (BKB1) and bradykinin B2 (BKB2), which belong to the superfamily of G-protein coupled receptors. A role for inducible BKB1 receptors in pathophysiology has been demonstrated using pharmacological studies in a number of models of tissue injury and in response to specific inducing agents. This study describes the cloning of the rat BKB1 receptor gene and investigation of the molecular mechanisms involved in the inducible receptor expression. The first part of this thesis describes the isolation and characterisation of genomic and cDNA clones for the rat BKB1 receptor. This has allowed detailed analysis of the receptor protein coding sequence and determination of the BKB1 receptor genomic structure. Primer extension analysis and RACE studies have been used to identify the transcription initiation sites and the 3' cDNA ends and provide evidence for alternative splicing of the BKB1 receptor transcript. Furthermore, using the rat BKB1 receptor as a species-specific probe Northern blot analysis has established a distinct expression profile for the receptor mRNA in rat tissues and cultured cell lines. BKB1 receptor expression has been examined by Northern blot analysis in JTC-19 cells following the addition of a number of inducing agents. The increase in BKB1 receptor mRNA levels following the addition of the pro-inflammatory cytokine, IL-1β, and the bacterial endotoxin, LPS, were found to result from an increase in transcription with no change in mRNA stability. Examination of the effects of specifc inhibitors show that multiple signal transduction pathways, including PI 3-kinase activation and NF-κB-dependent and independent pathways are involved in the IL-1β and LPS-mediated BKB1 receptor transcriptional activation. Reporter gene constructs and electromobility shift assays have been used to delineate important elements involved in the transcriptional regulation of the BKB1 receptor gene.

Tetrahydrobiopterin (BH4) is a limiting cofactor for nitric oxide synthase (NOS) catalysed conversion of L-arginine to nitric oxide and citrulline. Content of BH4 in mammalian cells is regulated at many levels, but most important is de novo biosynthesis from GTP. GTP cyclohydrolase (GTPCH) is the rate-limiting enzyme for the de novo synthesis of BH4. While various immunostimulants, hormones and growth factors have been reported to increase GTPCH mRNA levels and intracellular biopterin (BH4 degradation product), it is not known whether these factors act at the level of GTPCH gene transcription. To test this I utilised 1, 3 and 6 kb 5'upstream GTPCH gene sequence in a secreted alkaline phosphatase reporter vector (SEAP). These constructs were stably transfected in PC-12 cells and rat aortic smooth muscle cells, and the cells were treated with various immunostimulants and growth factors in order to determine whether these factors could enhance GTPCH gene transcription. Intracellular biopterin levels were also measured to confirm that the upregulation of the SEAP-reporter correlated with a rise in biopterin. Our investigations conclude that transcriptional regulation of the GTPCH gene is indeed a major site for control of intracellular BH4 levels. In further experiments, we have characterised the binding of [3H]BH4 to endothelial NOS (eNOS) and examined influences of the substrate, arginine, on the BH4 binding. In addition we selected tetrahydropterins (that support NOS catalysis) and dihydropterins (that are catalytically incompetent) to determine the extent to which modifications of BH4 alter pterin binding affinity to eNOS. Dihydropterins are unable to support NOS catalysis. Studies showed for the first time that dihydropterins, but not tetrahydropterins, support superoxide generation by eNOS. We also have determined that eNOS may be able to produce NO in the absence of BH4 cofactor from the reaction intermediate hydroxyarginine. We have characterised this reaction and are able to provide a plausible mechanism for the NOx generation from eNOS in the absence of BH4 cofactor.

The investigation of renal pathophysiology and toxicology has traditionally been advanced by the development of increasingly defined and refined in vitro preparations. This study has sought to develop and evaluate various methods of producing pure samples of renal proximal tubules (PTs) from the Fischer rat. The introduction summarised the most common in vitro preparations together with the parameters used to monitor viability - particularly with regard to toxic events. The most prevalent isolation methods have involved the use of collagenase to produce dissociation of the cortex. However, the present study has shown that even the mildest collagenase treatment caused significant structural damage which resulted in a longevity of only 3hr in suspension. An alternative mechanical isolation technique has been developed in this study that consists of perfusion loading the renal glomeruli with Fe304 followed by disruption of the cortex by homogenisation and sequential sieving. The glomeruli are removed magnetically and the PTs then harvested by a 64μM sieve. PTs isolated in this way showed a vastly superior structural preservation over their collagenase isolated counterparts; also oxygen consumption and enzyme leakage measurements showed a longevity in excess of 6hr when incubated in a very basic medium. Attempts were then made to measure the cytosolic calcium levels in both mechanical and collagenase isolated PTs using the fluorescent calcium indicator Fura. However results were inconclusive due to significant binding of the Fura to the external PT surfaces. In conclusion, PTs prepared by the present mechanical isolation technique exhibit superior preservation and longevity compared with even the mildest collagenase isolation technique and hence appear to offer potential advantages over collagenase isolation as an in vitro renal system.

The protection of minority shareholders within the realm of corporate governance constitutes an ongoing challenge facing modern company law. This thesis critically analyses the statutes in the protection of minority shareholders in England and Wales and Nigeria, the reason been both jurisdictions operate the common law system, and Nigeria been a former colony of the British empire despite the similarities in the different statutes in the protection of minority shareholders, the question which arises is it effective in the protection of minority shareholders, this is worthy of discuss. It is important to note that at the start of the research, the Companies and Allied Matters Act 2004 (CAMA) was in operation in Nigeria upon completion it was repealed and replaced by the CAMA 2020 which came into force on the 7th of August 2020, the relevant sections under focus are s.303 -308 under the CAMA 2004 now s.346-352 of the CAMA 2020 which highlights the procedure for commencing a derivative action and s.310-312 of the CAMA 2004 now s.353-357 of the CAMA 2020 which provides relief on the grounds of unfairly prejudicial and oppressive conduct. The CAMA 2020 has brought about key changes for instance, an improvement under s.346 of the CAMA 2020 enables an applicant to apply for leave to the courts to bring an action on behalf of a company or a subsidiary, this development is absent under the s.303 of the 2004 which allowed leave to bring an action on behalf of a company excluding its subsidiaries. This is a breakthrough in holding majority shareholders accountable for their actions. Considering this development, the relevance of the 2020 Act will come into focus in a comparative analysis of the CAMA 2004 and 2020 and the Companies Act 2006 in England and Wales in chapter 6 and 7. Alternatively, the remedy of derivative claim and unfair prejudice petition have been codified under s.260 and s.994 of the Companies Act 2006 in England and Wales (CA 2006). In analyzing both jurisdictions, the Nigerian jurisdiction differs from England and Wales in several ways. For instance, while corporate ownership in the United Kingdom consists mainly of diffused ownership between widely dispersed public shareholders in public limited companies, and privately owned shares in private limited companies, in contrast ownership in Nigeria is concentrated predominantly in individuals, families and the government. Despite the differences, both countries share similarities in the substance of their codes (the Nigeria Securities and Exchange Commission (SEC) Code 2011 and the United Kingdom 2016 Financial Reporting Code (FRC)), and most importantly their reliance on efficient market-based governance mechanisms to enforce corporate governance by applying a system of disclosure of roles of non-executives to attain greater transparency between the company and its members. The core question to be addressed in this thesis is: to what extent are minority shareholders' rights effectively protected against breach by majority shareholders? This comparative study focuses on the remedy of derivate claim/action and unfair prejudice petition in both jurisdictions in order to address this question; to demonstrate the current state of minority shareholder protection in England and Wales, and Nigeria, respectively; and to make suggestions as to the realistic achievement of greater protection, based on the findings of the comparative analysis. Adopting a doctrinal comparative analysis of these claims/actions in the respective jurisdictions, this thesis argues that the statutory provisions in England and Wales are more progressive in the protection of minority shareholders than the Nigerian legal provisions. The key reason is the relative ease of instituting both remedies in a suit, in addition with the option of an exit strategy which is usually present in a shareholders' agreements. There is a greater chance of success for a minority shareholder to get justice which usually entails the majority purchasing his or her shares at a fair value. Whereas, in Nigeria, evidence reveals minority shareholders in most circumstances are at the mercy of the majority shareholders they are left with little or no remedy due to the literal interpretation of the majority rule in Foss v Harbottle by the courts, which set the precedent in any action in which a wrong is alleged to have been done to a company, the proper claimant is the company itself. This poor situation is further compounded by slow judicial processes and legal enforcement. The thesis recognizes that despite the Nigerian jurisdiction has specific provisions for the protection of minority shareholders under CAMA 2004 now 2020, unfortunately it is not effective in its application. As a result, it is suggested legal reform is required by amending relevant sections under the CAMA Act 2004 now 2020. Alternatively, this may entail the adoption of a partial legal transplant of key provisions under the Companies Act 2006 in England and Wales to supplement existing statutes in Nigeria to bridge the gap in the protection and enforcement of minority shareholders rights when necessary. However, it is recognized that the adoption of a partial legal transplant would not necessarily be without significant challenges as a result the advantages and disadvantages of this approach will be critically analyzed to ascertain if it is an appropriate mechanism for reforming and modernizing Nigerian corporate law, over 60 years after it attained independence. In view of the foregoing observations, the thesis nevertheless concludes with a series of recommendations for change which acts as a blueprint for future revision of corporate law statutes in Nigeria by the Houses of Assembly in order to improve minority shareholder protection in Nigeria. As such this thesis is relevant to policy holders and legislators in this field, and could contribute to amending policy, legislation and practice in the future.

The first section is a systematised review exploring the concept of graduateness in United Kingdom (UK) nursing. This contains an additional tier of the method, a concept analysis of graduateness, using a modified version of Walker and Avant’s concept analysis model (1995) and from this, a model of graduateness in UK nursing is constructed. The empirical phase articulates with the first using compassion, selected from the graduateness model. Critical discourse analysis is used to examine compassion and the nature of associated learning via literary and focus group analyses in nursing and social work to provide novel insights into the relationships and influence of compassion in the two fields.

Background: Care of premature infants is challenging for health care professionals. When the preterm infant is separated from its mother the parent-child interaction is impeded. In the last few decades, there has been increasing interest in the effectiveness of massage as an intervention to counter the negative physiological, clinical and behavioral consequences of prematurity and the neonatal intensive care unit environment. Aims: To establish the effectiveness of moderate pressure massage from evidence in the literature and to then explore the cultural, organisational and contextual factors that may act as facilitators and/or barriers for its future implementation in Lebanon. Methods: This thesis utilizes a two-step approach. Two literature reviews were undertaken to establish recent evidence on moderate pressure massage. A qualitative exploratory investigation was adopted as no articles were found that elucidated the contextual barriers and facilitators for massage implementation in the neonatal intensive care unit. The normalization process theory was used as a sensitizing framework to understand implementation issues and address the observed difficulties in implementing new interventions in clinical settings. This study was also concerned with context and culture as moderate pressure massage is not practiced in the Lebanese neonatal intensive care units. A purposive sample of Lebanese health care professionals and parents were recruited from three university hospitals with data generated through focus group discussions and observational notes. Framework analysis was used for the analysis and interpretation of the findings. The study drew on the principles and practice of ethnographic approaches. Findings: The findings from the two literature reviews only revealed randomized control trials that observed mostly the short-term physiological and psychological effects of moderate pressure massage. There were no studies that examined the organizational and contextual issues that need to be understood before any trial could be designed in the neonatal intensive care unit setting. The evidence from this review suggested there is a need to explore the views of health care professionals and parents on the practice of massage in the neonatal intensive care units to provide insight into the subsequent design of an intervention study that would be culturally sensitive, appropriate, and acceptable in practice. The findings from the qualitative study then revealed that despite the participants’ interest in implementing massage intervention, parents’ participation in the neonatal intensive care unit is almost absent except for breastfeeding. Participants in both groups, parents and health care professionals, highlighted the parents’ fear and anxiety. In general, nurses are in charge and parents are passive observers. Transportation difficulties, unavailability of helpful staff, and fear were reported as major barriers to parent-implemented infant moderate pressure massage; health care professionals highlighted staff attitude and resistance, workload and time constraints. Communication, gradual implementation, encouragement and support were identified by parents as potential facilitators. In comparison, having extra staff and a protocol for teaching nurses, training parents and openness to innovation were the main potential facilitators of implementation identified by health care professionals. Conclusion: This study helped to reveal the potential challenges of applying such a complex intervention as moderate pressure massage by the parents in the neonatal intensive care unit. Adopting infant massage in the Lebanese neonatal intensive care unit without preparation of health care professionals and parents would be premature. Good communication between parents and health care providers is a key element to facilitate early bonding and parent-infant interaction. Missing the opportunity to involve parents in neonatal intensive care unit care puts the family in a difficult situation to adapt to the new challenges after discharge. The findings of this study will advance current knowledge in understanding the factors that determine applicability, acceptability and feasibility of massage implementation in the neonatal intensive care unit setting. It will also assist and inform the design of future randomized control trials. The noramalization process theory was a valuable lens to guide the process of inquiry and to make sense of the emergent findings from this exploratory qualitative study.

The majority of reports of imported malaria in Europe come from the UK, France, Germany and Italy. Most of those affected are of African origin visiting friends and relatives (VFRs). There is little understanding of the factors that enhance and constrain effective malaria prevention practices in this group. Two studies were undertaken to investigate this. An epidemiological analysis of 13813 reports made in the UK between 2001 and 2008 showed that 58% lived in London, where 83% of infections were caused by Plasmodiumfalciparum. The rate per 100000 offalciparum infections in the capital in 2008 in those categorised as of "Black African" ethnicity was 131.0 (CI: 120.0-142.1), compared to 0.3 (CI: 0.2-0.5) amongst the "White British". To investigate factors influencing the behaviours of VFRs, semi-structured interviews were undertaken with African VFRs resident in the UK visiting Nigeria and Ghana (n = 20), malaria patients (n= 6), practice nurses (n= 10), GPs (n = 10), community pharmacists (n= 7) and hospital consultants (n= 3). Factors influencing the use of mosquito avoidance methods included knowledge about the local environment, a perceived inevitability of contracting malaria, and a desire to use methods common amongst host families. Chemoprophylaxis use was influenced by perceptions of susceptibility, by previous experiences of malaria, perceptions of the seriousness of malaria, and peer pressure. Relevant structural factors included the cost of chemoprophylaxis and difficulties in accessing health advice. This research showed that in managing malaria, VFRs choose pragmatically between two parallel social and environmental contexts and the structural constraints associated with each. A novel conceptual framework shows the complex manner in which these interact, and may be appropriate in different countries and also in future research investigating other travel-related diseases in migrants. Practical recommendations for research priorities within the UK imported malaria context are made.

The effect of social, political, and economic context on treatment seeking and the effective case management of malaria is widely recognised. In refugee settings, the whole balance of society has been upset and both intra and inter- household relationships have been extensively disrupted. Many refugees undergo trauma, which may affect their perceptions of health and ill health. This study, investigated the factors influencing effective case management of malaria in the Kakuma refugee camp using a variety of data collection methods including: indepth interviews, focus group discussions, observations of clinical management and a parasite prevalence survey. The refugees and the providers of health care in Kakuma perceived that the burden of malaria was high, but the parasitological data were of insufficient quality to confirm these perceptions. Clinical management and parasitological diagnosis of malaria were insufficient and affected by: inadequately qualified and poorly motivated staff, budgetary, logistical and security constraints. Awareness of the symptoms of malaria among the refugees were relatively high, but treatment seeking was affected by the insufficient quality of malaria management, the context of the refugee camp setting, and the experiences suffered in becoming a refugee. In particular, the loss of a sense of agency and the on-going problems of nutritional and physical security influenced the refugees' motivation to seek treatment. The establishment of community health committees could provide a mechanism to address some of these contextual issues by: strengthening the relationships among the refugees health care providers and camp management; providing the refugees with a greater sense of agency; helping in the support and motivation of the health staff and providing a forum for the development of appropriate disease management programmes. This study underlines that understanding the setting and circumstances of becoming and remaining a refugee is essential to developing effective disease management strategies for refugees.