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Objective: The systematic review aimed to evaluate the effectiveness of cultural adaptations to psychosocial interventions conducted within the United Kingdom. The empirical study aimed to explore the psychosocial experiences of young refugees and their families resettling in Edinburgh. Additionally, it sought to gather information on the experiences of staff and volunteers from organisations working with refugee/ asylum-seeking families. A triangulation of these three groups aimed to provide rich insight into the resettlement process and provide opportunities for meaningful change. Methods: For the review, eleven databases were searched to identify studies examining psychosocial interventions for refugee young people and families. Cultural adaptations were also identified within these studies to examine their effectiveness at supporting refugee families. For the empirical study, interviews and focus groups were conducted across the three participant groups; refugee young people, refugee mothers and staff members. Refugee participants were asked questions about the positive and negative aspects of resettling in Edinburgh, whilst staff participants discussed the rewards and challenges when working with refugee populations. Results: For the systematic review, eleven studies met eligibility criteria. These studies used a number of methodological designs, psychosocial interventions and cultural adaptations to engage and support refugee families. The identified studies reported that participants found the culturally adapted interventions helpful. During the empirical study, four themes emerged across all three participant groups; Trust & Safety, Connection & Disconnect, Meeting Needs and Identity. Three other themes emerged specific to different participant groups; Loss & Longing for both refugee groups, and Unknown & Uncertainty and Vocational Discord for the staff participant group. Discussion: Studies in the systematic review have provided support for the use of cultural adaptations, however there were no measures taken to identify the effectiveness of different components of treatment. The empirical study identified clinical implications and recommendations for service change. Both parts of this project emphasise the need for further research within a refugee/ asylum-seeker population, with particular emphasis on building trusting relationships and recognising cultural strengths and coping strategies.

The main focus of this thesis is examination of the role of the VWF-ADAMTS13 axis in acute ischaemic brain injury. Acute ischaemic stroke and transient ischaemic attack (TIA) are associated with raised von Willebrand factor (VWF) and decreased ADAMTS13 activity but association with outcome has not been studied. We prospectively explored VWF antigen (VWF:Ag) and activity (VWF:Act) levels and ADAMTS13 in 308 adults with acute ischaemic stroke (n=103), TIA (n=80), haemorrhagic stroke (n=16) or controls (n=109), with serial samples taken from presentation until after 6 weeks (median follow up 188 days). Severity was assessed at presentation and at follow up using the National Institutes of Health Stroke Score (NIHSS) and modified Rankin scale (mRS). We demonstrate resolution of VWF:Ag-ADAMTS13Ac ratio in convalescence in ischaemic stroke (IS, 2.42 to 1.66; p=0.008; TIA, 1.89 to 0.65; p=<0.0001). A raised VWFAg/ ADAMTS13 ratio at presentation of acute IS or TIA was associated with increased mortality, including when adjusted for age. Thrombolysis resulted in prompt reduction of the VWF:Ag- ADAMTS13Ac ratio. Therapeutic targets to VWF and ADAMTS13 activity merit further investigation. In conjunction with this, we studied the pharmacokinetics of ADAMTS13 activity in plasma of 6 patients with congenital thrombotic thrombocytopenic purpura (TTP) receiving regular infusions. There was variability in ADAMTS13 half-life, suggesting analysis of inter-individual clearance is necessary for future optimisation of treatment, particularly in the era of recombinant ADAMTS13. Haematological laboratory investigations in patients under 60 years of age presenting to the hyperacute stroke unit (HASU) were retrospectively reviewed, examining 609 stroke and TIA patients over a 31-month period. We examined the haematocrit and platelet count, and potential for primary haematological cause such as myeloproliferative disease (MPD) or TTP. One quarter of the cohort merited further follow up. Thrombophilia testing has now altered so that triple antiphospholipid antibody testing is performed rather than heritable risk factors for venous thrombosis. The work overlaps between clinical haematology, stroke medicine and laboratory haemostasis; with promise for future investigation and therapy in diseases with pathogenesis common to all.