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Radiotherapy has been used to treat meningiomas for decades, both in the primary setting when resection is not possible and as an adjunct to surgery in recurrent/ high grade disease. Newer radiotherapy planning and delivery techniques aim to optimise tumour control and minimise long-term toxicities. The purpose of this thesis was to explore the feasibility and potential for the use of advanced radiation planning and delivery techniques to treat meningiomas. In a prospective observational study of intensity modulated radiotherapy (IMRT) in fifty patients I demonstrated that IMRT is feasible and provided excellent dosimetric parameters. Medium term meningioma control rates were >90% in benign disease. Objective measures of toxicity were low. Visual symptoms improved in 38.5% of patients. In a pilot study of ten patients I showed that simultaneous 68Ga DOTATATE PET/MRI can be utilised in meningioma radiotherapy planning. Baseline levels of interobserver variability in target volume definition between three Observers using CT/MRI alone were very high (mean target volume conformity levels of 0.31-0.34). Levels of agreement improved only 4-5% with the addition of PET and there was negligible difference in contouring between standard PET(CT) and simultaneous PET(MRI). In a planning study of ten meningiomas I did not find a notable advantage for proton therapy (non-intensity modulated) over IMRT. The high quality of the IMRT plans left little room for improvement and range uncertainty restricted exploitation of proton dose deposition characteristics. In my review of the first six patients treated with the radionuclide 177Lutetium DOTATATE for advanced progressive meningioma, tumour growth rates were found to slow, but there was generally disease progression during treatment. In conclusion, advanced radiation techniques for meningioma treatment are feasible and can confer clinical benefit. However, advances in technology do not necessarily translate into therapeutic gains. Careful prospective evaluation is required to ensure their optimal use.

Concern over the biological effects of metal wear debris released from metal-on-metal bearing hips is high. Previous studies have suggested high 1evels of meta-I are found in patients' urine and there is an increase in bladder cancer after 10 years. This study investigates whether there is evidence of genotoxicity in patients' bladders after hip resurfacing. -Methods A cohort of 71 patients with metal-on-metal hip resurfacing two years post implant, were compared with a control group of 23 patients with no implant. Levels of cobalt, -chromium, molyb-clenum an-cl nickel were tested in blood and urine. A validated chromosomal test for the detection of bladder cancer (UroVysion) was used to detect chromosomal aneuploidy in patients' urine and buccal mucosa. Genetic mutation in bladder cancer genes p53 and FGFR3 were also screened for. Patients' urothelial cells were screened for appearances-suspicioI:Js -ofcancer. Atris-k -patient-s -wer-e -r-eferr-ed to the urology -se-rvic-es for cystoscopy. Nanoparticle tracking analysis was used to screen for nanoparticles in patients blood and urine. Results levels of cobalt and chromium were significantly raised in hip resurfacing patients' blood and urine, compared to controls. Levels of chromosomal aneuploidy were significantly raised in hip resurfaCing patients' urinary cells and -in their buccal mucosa. Fifteen h-ip resurfacing patients had -c~l/s neemed atypic-al or suspicious of bladder cancer when reviewed by a cytologist. Six of these patients had repeated atypical cytology, and one had a grade 1 transitional cell carcinoma diagnosed on cystoscopy. An additional population of nanoparticles was identified in post-operative urine. Discussion This study raises the concern of a metal induced carcinogenesis that may be occurring in the bladders of patients who have received meta1-on-metal hip resurfacing. The proposed mechanism is thattheur-othelium -is exposed to high levels -of -cobalt and chromium, which induce chromosomal aneuploidy in urothelial cells.

Creativity is a complex construct and can be studied from a number of perspectives. Despite the fact that it has been linked to successful ageing, relatively little research has directly examined the relationship between creativity and ageing in non-eminent samples. The major aim of this thesis therefore was to investigate the effects of normal adult ageing on creative activity, creative processes and creative products using a range of cognitive paradigms. A further aim was to investigate the role of potential mediating variables such as information processing speed, working memory, executive function and verbal knowledge. Across five studies, with participants aged from 17 to 82 years, age-related declines were found in a number of creative measures including self-reported frequency of participation in certain creative activities (e.g., artistic activities, photography, dancing) and self-rated creativity (study 1), several indices of divergent thinking (study 2), the number and complexity of creative mentally synthesised patterns (studies 3 and 4), and the subjectivity judged creativity of collages (study 5). In these measures, older participants (aged over 60 years) performed more poorly than younger participants (under 40 years old) or middle-aged participants (40 to 60 years old). Information processing speed and working memory appeared to explain these age-related changes; there was also evidence suggesting that executive and sensorimotor functions may account for the observed differences. However, no age differences were found in overall levels of self-reported creative activity, and participation in solitary creative activities (e.g., gardening, needlework) showed age-related increases. Taken as a whole, the current findings concur with previous research using eminent creators: higher levels of creativity are generally found in younger and/or middle-aged adults, with a decline being evident in old age. However, more work is needed to fully understand the relationship between creativity and normal adult ageing, and the cognitive mechanisms responsible.

As humanity hurtles towards the twenty first century, it is apparent that the world is becoming a smaller place. Moreover, the colonization of previous centuries has largely shown deference to a differing approach in international interaction. It would seem that consultancy offers nations the possibility of importing expertise in order to aid development without overtly incurring the domination of foreign powers. This thesis debates the veracity of such an assumption and proceeds to examine international consultancy as practised by a single professional group, namely midwives. The study is confined to consideration of those who provide a short term consultancy service. It debates whether international consultancy can rightly be considered an approach which offers the client an equal partnership or whether it remains contaminated by the spirit of western domination. The thesis explores current thinking on modernization and development and asserts that these issues are of considerable import, demanding an understanding by every midwife practising as an international consultant. This debate sets the scene for the main research question which, using a qualitative research approach, examines the characteristics of midwives who cross international boundaries in order to provide consultancy services, considering how such characteristics may impact on their effectiveness. Across the developing world, the needs within the maternity and child health services and the responsibilities of the midwife have been brought into sharper focus with the advent of the Safe Motherhood Initiative [WHO:1987]. Currently, a significant number of professionals from the industrialized West travel to Third World countries in response to requests to assist or advise on health and related issues. This thesis dissects differing perspectives of need which may occur between the Orient and the Occident and asks who responds to the expressed need for expertise, how they are selected, whether they are prepared and how they are received. Ultimately, a theory is born. This proffers that effectiveness in international consultancy is dependent on the fulfilment of certain "laws". The "laws" are derived from the discoveries made during data analysis relating to the main research question. They are also influenced by the consideration of numerous subsidiary research questions which arise during the study. The "laws" are nurtured in an extensive examination of literature scanning several professional disciplines and spanning several decades up to the present day.

The thesis outlines both the history and the historiography of the fortress and town of Louisbourg during and since the eighteenth-century, and explains the basis for its designation as a Canadian National Historic site in 1928. Emphasis has been placed on the process of research and development after the 1961 decision by the Cabinet of the Government of Canada to reconstruct a significant segment of the original fortress and town as a historical monument, outdoor museum and tourist attraction. Historical and museological research has been conducted with a view to placing the Louisbourg project into the broader context of historic site preservation and commemoration in Canada and then explaining its presentation to the public. Research, reconstruction and interpretation methodologies and their outcomes have been studied within an interdisciplinary perspective and the research philosophy and its applications have been described and analyzed in detail to document the process of research and development. The Louisbourg project has also been critically examined within the framework of policies and objectives set by Parks Canada and in terms of its contribution to the Canadian heritage field in general. With the aid of comparisons to other outdoor museums and historic sites in North America and Europe, the lessons of the Louisbourg reconstruction project as a public history model have been analyzed and highlighted.