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This thesis explored both parent and staff experiences of the implementation of parenting programmes using qualitative methodologies. The thesis consists of three papers: 1) a systematic literature review, 2) an empirical study and 3) a critical reflection of the research process. The systematic review (Paper 1) is a qualitative metasynthesis of parent's perceptions and experiences of parenting programmes. Twenty-six studies were included, spanning 17 years of parenting research in seven different countries and involving 822 parents. A thematic synthesis derived three main themes and nine subthemes: 1) a family's journey (prior to the parenting programme, outcomes and post-intervention), 2) aspects perceived to be important or valuable (group leader or facilitator, programme content and delivery and value of the group) and 3) challenges or difficulties (barriers to engagement or attendance, programme content and suggestions for improvement). Outcomes of parenting programmes included changes in the parent, alongside changes in the child and family more widely. The utility of parenting programmes as a means of early intervention were emphasised. In light of these findings, recommendations are made to improve provision of accessible, clinically and cost-effective interventions for parents striving to meet the challenges of their caregiving role. The empirical paper (Paper 2) explored staff implementation of a self-directed parenting intervention for parents with mental health difficulties. Triple P self-help workbooks were provided to existing front-line staff. Data were collected regarding workbook uptake and use. Semi-structured interviews with twelve practitioners explored their perspectives and experiences of implementation. Thematic analysis of interview data revealed practitioner concerns, views of the intervention and implementation issues. Whilst uptake and utilisation were varied, practitioners who did use the work reported positive outcomes. Findings were considered in relation to existing literature to make recommendations for overcoming barriers to implementation and facilitating a family-focused approach to meet the needs of parents with mental health difficulties and their children. Paper 3 provides a critical appraisal of the research process. The strengths and limitations of the work, the challenges faced and its contribution to this field of research are considered. The researchers' personal reflections on the process are offered.

Background: From personal experience, plus a brief overview of literature, the researcher surmised that the potentially traumatic impact on patients of losing their analyst to terminal illness/sudden death had received scant attention from the psychoanalytic community. Listening directly to patients (as opposed to analysts) had been particularly overlooked. Literature Review: This initial hypothesis was confirmed/refined by this Review: it was felt that focusing on the account that patients gave of their experience would be the most appropriate means of eliciting information. Knowledge that would assist the psychoanalytic community to most effectively ensure the wellbeing of future patients. Methodology: Interpretative Phenomenological Analysis (IPA) seemed to most appropriately meet the aims of this research. 14 semi-structured interviews were conducted, allowing the flexibility in questioning that is an inherent characteristic of IPA. For consistency collecting, transcribing and analysing of data were undertaken by the researcher. Accepted ethical procedures were followed. Findings and Discussion: Five Superordinate Themes emerged based on 21 Major Themes – Changes in Analysis before Termination; Aftercare in Relation to Outcomes; The Inherent Nature of Analysis inc. Requirements of Analytic Training; Emotional/Psychic Effects; Experience Utilised. Within these 5 Superordinate Themes issues/dilemmas were identified that were detrimentally affecting, in some cases seriously, patients’ wellbeing. The majority of these issues had been identified, in some form, over the past 50 years but not adequately acknowledged/acted upon. Some new issues emerged, including problems that are occurring in the interface between formal executors and sick analysts. Suggestions were given that might be helpful for the profession to take forward. Conclusions: The researcher has separated out the variables that appear to affect the outcome for patients into those that are largely ‘fixed’ as opposed to those that are ‘more malleable’ and urges the psychoanalytic community to act speedily on the latter.

Photo-activatable platinum(IV) diazido complexes with the general formula of trans,trans,trans-[Pt(N3)2(OH)(X)(py)(am1)] (X is a hydroxide or carboxylate and am1 is an aliphatic/aromatic amine) show dark-stability under physiological conditions but can induce a photo-cytotoxic effect in cancer cells after irradiation with UVA, blue and/or green light. These platinum(IV) diazido complexes can platinate DNA and induce different lesions that are distinctly different from those generated by the anticancer drug cis-platin. Through the use of EPR, multinuclear NMR, and UV-visible absorption spectroscopy, as well as mass spectrometry and some cell studies, this thesis aims to investigate the pathways of photochemical decomposition and in particular the release of azidyl ligands and their subsequent involvement in photo-cytotoxicity. Firstly, the irradiation of trans,trans,trans-[Pt(N3)2(OH)2(py)2] (40, py = pyridine) with blue light in the presence of the spin trap 5,5-dimethyl-1-pyrroline-N-oxide (DMPO) led to the detection of a characteristic quartet-of-triplets EPR spectrum, assigned to the azidyl radical adduct, DMPO-14N3. Irradiation of 15N-40, led to the detection of a quartet-of-doublets EPR spectrum as assigned to the DMPO-15N3 spin adduct. This confirmed that the ●N3 radicals arose from the platinum(IV)- bound azide. The DMPO-N3 spin adduct was also detected from the photoirradiation of trans,trans,trans-[Pt(N3)2(OH)2(MA)(py)] (44, MA = methylamine) with blue light. A greater yield in the DMPO-N3 spin adduct was formed in PBS/D2O. This effect was attributed to the Brownian motion of the ●N3 radicals. Interestingly, photoirradiation in the cell culture medium-, RPMI-1640 led to a reduction in the DMPO-N3 spin adduct. This reduction was accredited to the variety of components present in the cell culture medium which could behave as radical quenchers. Alternative nitrone spin traps, -4-pyridyl-1-oxide-N-tert-butylnitrone (4-POBN) and 5-diethoxyphosphoryl-5-methyl-1-pyrroline-N-oxide (DEPMPO) also led to the trapping of the azidyl radicals from irradiated 40, forming the 4-POBN-N3 (triplet-of-quartets) and DEPMPO-N3 (octet-of-triplets) spin adducts EPR spectra, respectively. DEPMPO was the most efficient azidyl radical trap; with the DEPMPO-N3 spin adduct possessing the longest lifetime in aqueous media. Extending the wavelength of activation to green light (517 nm), also led to the detection of DMPO-N3 from the photo-irradiation of 40 in RPMI-1640, trans,trans,trans-[Pt(N3)2(OH)(SAD)(py)2] (56,SAD=succinate), trans,trans,trans-[Pt(N3)2(OH)(ethyl-methyl-SAD)(py)2] (57) and trans,trans,trans-[Pt(N3)2(OH)(N-MI)(py)2] (58, N-MI = N-methylisatoate) in H2O/DMF. The DEPMPO-N3 was also detected from the gamma-ray irradiation of 40, which appears to be the first report of the activation of a platinum(IV) diazido anticancer complex with gamma-rays, a procedure which might be useful of clinical use. The azidyl radicals generated from irradiated 40 were unreactive towards both glycine and L-tyrosine. However, in the presence of L-tryptophan the azidyl radicals were quenched. Detection of free azide by 14N NMR spectroscopy confirmed that this quenching mechanism proceeded through a one-electron transfer pathway. The photo-cytotoxicity of 40 was supressed in the presence of low doses of L-tryptophan in A2780 ovarian cancer cells. From this study, it was deduced that the photo-cytotoxicity of 40 is comprised of both an acute (radical) and chronic (DNA platination) based mechanisms. Additionally, certain cancers have reported on the depleted serum levels of L-tryptophan, in particular ovarian cancer cells. This suggests the extent of the photo-cytotoxicity of 40 can be controlled in the presence of L-tryptophan. Photo-irradiation of 40 in the presence of melatonin, an analogue of L-tryptophan was also performed. Despite, the structural similarity between L-tryptophan and melatonin, the presence of the 5-methoxy substituent present in melatonin induced an alternative photo-decomposition pathway of 40. Photo-irradiation of 40 in the presence of melatonin with blue light also led to the detection of the quartet EPR spectrum assigned to the hydroxyl radical adduct, DMPO-OH. Through multinuclear NMR and mass spectrometry the quenching of both the azidyl and hydroxyl radicals by melatonin was determined. Additionally, mass spectrometry also detected a mass adduct attributed to a platinum(II)-melatonin complex. This dual antioxidant and metal-binding ability of melatonin was attributed to the observed photo-protective effect in A2780 ovarian cancer cells. Melatonin regulates circadian rhythms with a maximum concentration during dark hours. Consequently, treatment of antineoplastic tissue with 40 during the hours of melatonin production may be ineffective. Platinum accumulation and absorption has been suggested to be mediated by organic cation transporters (OCTs), in particular OCT2. Irradiation of 40 was monitored in the presence of cimetidine, an OCT2 inhibitor. A new strong absorption band at ca. 354 nm was assigned to an SPtII LMCT band. High resolution mass spectroscopy identified a mass adduct assigned to a novel platinum(II)-cimetidine species. The loss of coordinated pyridine from irradiated 40 as detected by 1H NMR spectroscopy and the quenching of the azidyl radical by cimetidine were correlated with the observed photo-protective effect in HaCaT keratinocytes cells.

This project explored two main areas: the assessment of apraxia and the intervention effectiveness in rehabilitation of the apraxic condition. This was achieved through a group study and a series of single case designs. Three experimental groups were used to investigate clinical tests and the kinematics ofmovement~ apraxic (n=17) and non-apraxic (n=13) left hemisphere damaged patients, and normal control subjects (n=ll). Using computergraphic techniques, the data provided evidence of disruption to the temporalspatial aspects of movement in apraxic people, which was not related to modality of testing, though some normal kinematic profiles were found within the apraxic group. Clinical assessments used to identify apraxia showed no relationship one with another which suggested each was identifying different aspects, or sub-types of a heterogeneous condition. Some tests were found to have low internal consistency, though inter-rater reliability through the observer-judgment process was high. A test devised for identifying agnosia was shown to relate to possible cognitive-perceptual processes or intact vision-to-action routes in the apraxic movement output. Dissociations found between clinical assessments for apraxia and kinematics of movement were explained in relation to different compensatory movement strategies employed by the apraxic patients, and/or as evidence for possible 'sub-types' of the apraxic condition. Analysis also suggested that different task demands might determine compensatory movement strategies and produce altered movement kinematics. This group study was followed by a series of single cases, two of which charted the 'natural history' process in recovery of apraxia using task performance and kinematic analysis as outcome measures. Evidence for spontaneous recovery over a six week period was shown in one case. Four single case ABA design investigations were then carried out on individuals with ideomotor and ideational apraxia to determine the effectiveness of intervention strategies. Specific sensory stimulation protocols were evaluated with no convincing evidence for effectiveness of the intervention, though both natural recovery improvements and learning effects were seen in the outcome measures. Variability of performance was a feature of all cases studied and could be considered a feature of the apraxic condition. Task break-down strategies were also evaluated in functional activities and demonstrated some effectiveness in a case of ideomotor apraxia, though a case with an ideational component indicated a more intractable condition. The strategy was not seen to generalise to other unpracticed tasks. In conclusion, the associations and dissociations found between movement kinematics and the clinical assessment tests for apraxia suggested the presence of 'sub-types' within the blanket diagnosis of the condition. Identification of such sub-types might be facilitated by the development of the agnosia test newly devised for this project. Finally, research into intervention effectiveness in apraxia calls for further investigation to determine what procedures might be used with different sub-types of the condition.