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Delivering Outpatient Parenteral Antimicrobial Therapy (OPAT) in a Changing National Health Service (NHS): Benefits, Risks, Challenges, and Future Prospects
Full text linkThis thesis presents a comprehensive investigation into the practice of administering intravenous antimicrobials outside inpatient settings—known as Outpatient Parenteral Antimicrobial Therapy (OPAT)—within the UK National Health Service (NHS) context. Drawing on ten published studies employing diverse methodologies, in which I served as the lead author and primary contributor, this body of work critically examines OPAT's benefits, risks, challenges, and innovations, with the overarching aim of providing evidence-based approaches for optimising service delivery.
The studies explore multiple facets of OPAT practice. A retrospective evaluation of a decade of service delivery in Sheffield demonstrated its clinical efficacy, cost-effectiveness, and patient acceptability. A cost-consequence analysis indicated that OPAT incurred approximately 39% of national average cost for equivalent inpatient care. Additional studies assessed health-related quality-of-life among OPAT recipients in Derby and identified predictors of outcomes in complex infections, such as infective endocarditis and necrotising otitis externa. Two studies reported the development and validation of a risk prediction model for unplanned hospitalisation, offering a pragmatic tool for improving patient selection.
Safety-related concerns were further addressed through a systematic review and meta-analysis on venous thromboembolism, which revealed low rates of non-catheter-related (0.2%) and catheter-related (1.1%) thrombosis in the OPAT setting, thereby informing future thromboprophylaxis recommendations. A national cross-sectional survey identified significant variation in OPAT practices and service provision, highlighting systemic challenges and opportunities for standardisation. Finally, two recent studies examined innovative approaches—telemedicine-supported OPAT and elastomeric infusion devices—demonstrating their potential to enhance accessibility and efficiency, particularly in underserved populations.
Collectively, the studies provide robust evidence that OPAT is a safe, clinically effective, and cost-efficient use of NHS resources. However, its full potential remains constrained by inconsistent implementation and geographical variation. Realising OPAT’s full benefits will require a coordinated national approach encompassing innovative delivery methods, a standardised funding framework, and comprehensive commissioning policies
Psychological flexibility and self-compassion in appearance concerns after burn injuries
Full text linkThis thesis investigated psychological flexibility and self-compassion in appearance concerns soon after burn injuries. Three studies were conducted with NHS ethics approval and pre-registration. A multi-centre prospective cohort study (n = 175) revealed that increased psychological flexibility and self-compassion during hospital admission were associated with decreased appearance concerns cross-sectionally and prospectively over six months. Psychological flexibility predicted appearance concerns over time. To gain more in-depth information, a qualitative study (n = 15) explored appearance concerns within three months of injury. Appearance concerns were influenced by the need for social acceptance and desire to conform to societal ideals and contributed to difficulties responding to appearance concerns with psychological flexibility and self-compassion. Early psychological interventions for appearance concerns were considered acceptable to many, within a therapeutic relationship. However, obstacles to engagement existed. Based on these findings, an early acceptance and commitment therapy (ACT) intervention (ProACTive) for appearance concerns after burn injuries was developed, and a mixed-methods acceptability study (n = 13) suggested that ProACTive was acceptable. Individuals valued the therapeutic relationship that ProACTive created and early support was considered important. Ratings of helpfulness were high and qualitative data suggested that ProACTive was helpful in allowing exploration and reflection on the impact of appearance changes, developing psychological flexibility and self-compassion, and preparing people for being around others. Positive affect increased and negative affect decreased. The importance of psychological flexibility and self-compassion in appearance concerns has been highlighted. Whilst further study is needed to determine its effectiveness, an acceptable early intervention (ProACTive) for appearance concerns has been developed and adopted in multiple NHS burns services
Reinforcement Learning Process Control in Powder Bed Fusion Additive Manufacturing
Full text linkPowder Bed Fusion (PBF), a prominent metal Additive Manufacturing (AM) technique, is an original technique for producing 3D parts by adding material iteratively, on a layer-by-layer basis. In PBF, a heat source melts metallic powder, layer-by-layer, enabling the creation of potentially complex parts with tailored geometries. However, despite this advantage, PBF remains challenging to analyse and understand across multiple scales due to complex, nonlinear thermal phenomena and interactions. This complexity, along with the lack of control-oriented PBF models, hinders the development of closed-loop control systems. As a result, practitioners still rely on empirical openloop settings rather than feedback, which often leads to suboptimal, inconsistent builds. Existing control attempts, based on control theory, have shown promise when applied to simplified PBF models with fixed control targets. However, as part geometries and PBF settings become more intricate, the required models may be inaccurate or even unknown for some aspects of the process, making traditional control methods challenging to design and implement. In contrast, data-driven techniques, such as Reinforcement Learning (RL), offer a more flexible alternative. RL is trained to derive optimal policies through trial-and-error interactions with the control environment, bypassing model assumptions. This flexibility, however, comes at a cost, since RL faces critical challenges: in RL training stability, marked by unpredictable training behaviour and high variance, and in constraint handling mechanisms, essential in safety-critical tasks. This thesis, presented as a coherent collection of publications, aims to bridge the gap between RL algorithms and their practical use in PBF. Specifically, this thesis focuses on addressing the RL stability and constraint challenges in the context of PBF, enabling reliability and broader adoption. The goal is to establish safe and effective RL control in real-world PBF settings, ultimately unlocking the potential of RL in critical AM applications
Tiberius
Full text linkThe first part of the thesis is a script for a pilot television series with the following logline:
A supernatural detective drama set in the North of England when the life of a promising young medical student suddenly collides with an eccentric and mysterious detective specialising in the paranormal; as the student is drawn into a tale of hauntings and magical extremism she’ll have to decide which world she truly belongs in, the rational world of science and medicine or the esoteric world of the occult which threatens to consume her.
A series bible, detailing the rest of the series, will follow.
Finally, a reflective essay will give my thoughts on some aspects and themes from the development of Tiberius
Novel Permanent Magnet Synchronous Machines with Reduced Rare-earth Magnets for Electric Vehicles
No full textThe rapid shift toward electrified transportation has driven the demand for traction motors that combine high torque density, efficiency, and reliability, while reducing dependence on rare-earth permanent magnets (REPMs). This thesis addresses these challenges through a systematic investigation of advanced machine topologies, multiphase configurations, rotor design strategies, and reliability-enhancing methodologies for electric vehicle (EV) powertrains.
The feasibility and performance potential of multiphase machines are first established through comparative analysis of three-, five-, six-, and nine-phase configurations. Results show that multiphase systems deliver 3-6% higher torque per REPM volume, inherently lower torque ripple, and up to 55% reductions in DC-link capacitance, with the dual-three-phase configuration achieving the best performance-to-cost balance.
Building on this foundation, three hybrid rotor topologies, spoke-V, spoke-delta, and spoke-II, are proposed and optimised using multi-objective evolutionary algorithms. These designs reduce NdFeB usage by up to 40% while maintaining torque output, resulting in up to 67% improvements in torque per unit rare-earth volume. Four-quadrant performance and torque decomposition analyses provide deeper insight into the distinct roles of hybrid magnet arrangements.
To improve torque quality, six rotor core shaping techniques are investigated. Asymmetrical shaping proves most effective, suppressing dominant harmonics and reducing torque ripple significantly, while partial shaping offers comparable benefits at lower computational and manufacturing costs.
Finally, robust design methodologies are developed to prevent demagnetisation in ferrite-based PM-assisted synchronous reluctance machines. A Kriging-based surrogate modelling framework accurately predicts and mitigates demagnetisation risk, enabling cost-effective, reliable alternatives to REPM-based machines.
Collectively, the contributions of this thesis provide a pathway to sustainable, high-performance, and reliable EV traction machines. By integrating multiphase operation, hybrid rotor topologies, torque ripple suppression, and demagnetisation prevention, the work establishes a comprehensive framework for next-generation electric powertrain design
Optical Coherence Tomography for Monitoring Plants’ Responses to Biotic Stressors
Full text linkThis project explores Optical Coherence Tomography (OCT) as a potential new imaging technique to detect early signs of infection in plants. OCT can be applied to deliver cross-sectional and three-dimensional images of plant’s microstructures non-invasively, in vivo, and in real-time. This puts forward a very exciting potential methodology for boosting our understanding of plant’s response to stressors, plant health, and disease management. OCT traditionally finds wide application in medical imaging, particularly in ophthalmology, to image the retina with high resolution. This research project aims to adapt this technology to the realm of botany. More specifically, the objective is to monitor the response of wheat plants when infected by septoria. In this aim, OCT provides detailed images of inner structures without affecting the plant, which enables continuous monitoring without altering the growth and development of the plant. Specifically, the study monitors the response of wheat plants infected by Septoria. This project thus corresponds to a proof-of-concept which demonstrate the detection of early signs of infection before any external signs are visible.
The principal strength of OCT lies in its ability to provide detailed internal images without damaging the plant, allowing continuous monitoring of growth and disease progression. This non-invasive capacity is crucial for pathogen detection, which in turn maximizes crop survival and minimizes chemical treatment use. In my study, OCT was benchmarked against advanced techniques such as confocal microscopy, epifluorescence microscopy, and scanning electron microscopy (SEM), alongside manual analysis using FIJI and MATLAB, confirming its reliability.
However, OCT also presents certain limitations. Compared with established imaging methods, its penetration depth in dense plant tissues is limited, which can result in blurry images. In addition, interpretation of OCT images requires specialized expertise and dedicated software to extract meaningful data. In this study, collaboration with a software company enabled the development of customized machine learning based segmentation software. This tool allows rapid, automated OCT image analysis, producing immediate quantitative results and significantly enhancing the efficiency of plant research.
The OCT analyser software, based on machine learning (ML), applies masks to the inner structure of leaves to enable gap thickness measurements and extract meaningful data. However, the current version of the software was trained on only one variety (AxC169). To improve its robustness, it will need to be trained on additional varieties. The gap thickness measurements, whether performed manually or through automated approaches, are provided in this study to ensure availability for other researchers.
Overall, the integration of OCT with ML is highly promising and has the potential to open new opportunities for agricultural application
The Politics of Counter-Terrorism: A Study of the UK Government and Media’s Framing of the Prevent Strategy
No full textThis thesis examines how public consent is cultivated for counterterrorism policies by the government and the media, using the UK’s Prevent Strategy as a case study. It explores the research question: How have the UK government and British media framed the Prevent strategy?
Integrating securitisation theory, framing theory, and the cascade model, this thesis investigates how the UK government has framed Prevent as a necessary counterterrorism measure against an existential threat, drawing from War on Terror (WoT) discourse. This framing constructs terrorism—particularly Islamist extremism—as the primary threat, reinforces an “us vs. them” binary, and positions “British values” as under attack. In this context, Muslim communities are framed as both vulnerable and potentially dangerous.
A central contribution of this thesis lies in its empirical and methodological focus. It adopts a mixed-methods approach, combining Structural Topic Modelling (STM) and Discourse Analysis (DA). STM provides a longitudinal analysis of Prevent’s media framing (2006–2023), mapping identifying dominant topics and their evolution as well as ideological and stylistic variations. DA complements this by unpacking how media frames operate discursively within broader political and cultural narratives.
The empirical findings show that British newspapers—regardless of ideological leaning or newspaper style—largely reinforce the government’s framing of Prevent. Two main narratives emerge: right-leaning tabloids emphasise Islamist threats, portraying Prevent as essential to national security; left-leaning broadsheets offer broader, more critical perspectives but rarely present fully developed counterframes. Right-leaning tabloids have steadily increased their coverage, becoming the dominant media voice on Prevent. Counterframes—particularly from NGOs—remain marginalised in mainstream media. Although coverage of far-right extremism has increased in recent years, it continues to be framed less urgently and constructed differently from Islamist threats. These insights underscore the media’s role in shaping counterterrorism discourse, with broader implications for democratic accountability, minority representation, and media responsibility
The Politics of Belonging in a British Provincial City: Postwar Urban Planning, Community Placemaking and Multicultural Heritage in York
No full textThis thesis examines how migrant and marginalised communities in York engage with both the dominant heritage narratives preserved and projected by the city, and their own diverse cultural heritage. While York is often perceived as a provincial city with a homogenous population, it has, since the post-war period, been home to a rich and diverse range of migrant and refugee communities whose histories remain largely excluded from the city’s heritage discourse.
The thesis traces how York’s civic institutions – particularly the York Civic Trust – consciously shaped the city’s identity as a centre of heritage. In the wake of industrial decline, York’s historic built environment was repurposed as a cultural asset, through June Hargreaves’s innovative approach of protecting conservation areas and framed by paternalistic Quaker ideals of urban planning towards social reform. These efforts positioned York as a leader in the heritage industry by constructing a selective, exclusionary narrative.
Against this backdrop, this thesis analyzes how post-war migrant and refugee communities experience and navigate this authorised heritage landscape. It investigates the challenges of forging belonging in a city whose spatial and symbolic architecture often marginalises non-dominant identities.
Methodologically, this research adopts an innovative, interdisciplinary approach, combining archival analysis with oral history and ethnographic fieldwork. It contributes to urban history, conservation studies, and migration research by examining the politics of heritage, the production of urban space, and the ways in which marginalised groups contest, reinterpret, and contribute to the city’s evolving cultural narrative. While grounded in York, the findings have broader implications for understanding how other British cities are similarly shaped by selective heritage narratives rooted in traditional, often exclusionary, frameworks. This study underscores the importance of recognising migrant and refugee communities as integral to the nation’s heritage discourse and calls for more inclusive practices in heritage interpretation and urban cultural policy
Reductions in alcohol consumption following participation in ‘Dry January’: an investigation of the psychological and social factors underpinning change
Full text linkDry January may help to reduce alcohol consumption and associated harms. Participation is associated with reductions in alcohol consumption six months later. Increased drink refusal self-efficacy (DRSE), belief in one’s ability to refuse alcohol, appears to mediate these reductions. Other mechanisms of change are yet to be identified. This thesis aimed to establish the psychological and social changes underlying reductions in alcohol consumption among heavy drinkers following participation in Dry January.
A mixed methods approach was used. First, a prospective observational survey study compared outcomes at six-months for ‘official’ Dry January participants (registered with access to online supports) with ‘unofficial’(unregistered) participants and people not participating (Chapter III). Alcohol consumption and relevant psychosocial constructs were measured. In Chapter IV, semi-structured interviews explored strategy use during and following Dry January. A second prospective study (Chapter V) addressed limitations of the first and incorporated findings from the interviews. Additional constructs were assessed including drinker identity and use of online supports. Finally, analysis of smartphone app data (Chapter VI) examined changes in consumption nine months post-January and investigated the impact of app engagement on these changes.
‘Official’ Dry January participation was associated with reductions in alcohol consumption six and nine months later. Greater reductions relative to people not participating suggest changes were not entirely attributable to seasonal variation in consumption. Greater reductions relative to ‘unofficial’ participants suggest access to online supports may enhance outcomes. Increased consumption following January was evident in a substantial minority of ‘official’ app users. Strategy use was dynamic and evolved post-January: minimal differences in approaches were observed between ‘official’ and ‘unofficial’ participants. Among ‘official’ participants, baseline consumption, motivation, DRSE, drinker identity, abstinence and use of strategies and the app post-January were associated with six-month consumption. Harnessing relevant psychological and social factors may help maximise the benefits of Dry January
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