Dissertations / Theses on the topic 'University of Liverpool'

Across higher education (HE) institutions in the United Kingdom (UK), the lower grades achieved by a large proportion of students from socio-economically disadvantaged backgrounds represents one of the main entry barriers to these students. However, though students’ trajectories into university are heavily dependent on their school qualifications, these alone are limited as predictors of academic potential. The current thesis explores how these inequalities play out at the University of Liverpool (UoL), looking also at the period prior to admission as educational inequalities reflect the long-term negative effects of childhood disadvantage. Aim: To investigate socio-economic inequalities in relation to participation and attainment at the UoL. Methods: A traditional sequential mixed methods design is followed, where quantitative studies 1 and 2 were carried out prior to qualitative study 3. These studies are combined using a pragmatic approach. Two retrospective cohort studies investigate associations between the educational and socio-demographic background characteristics of students on Introduction: Socio-economic inequalities in participation and attainment are ubiquitous three year-programmes (study 1) and the medical programme (study 2) with participation and attainment at the UoL. Underpinned by phenomenology, qualitative study 3 investigates the challenges faced by thirteen socio-economically disadvantaged students throughout their educational trajectories from primary school to the UoL. Results: Studies 1 and 2 depict the on-going socio-economic differences in participation at the UoL. Regarding attainment, in both studies, entry grades were positively associated with final attainment. Most entry-level differences narrowed or disappeared at university in both studies though the variables sex, ethnicity, and school type predicted significant differences in final attainment. As such, privately educated students performed less well than comprehensive school students at university in both studies. In Study 3, two main themes were derived from the data: ‘identity’ and ‘engagement’. These themes emerged across narratives in the types of disruption, barriers and instability that were discussed by individuals and in the ways that they attempted to cope and/or adapt to disadvantage. Conclusions: The findings of the quantitative studies suggest that educational attainment at school is a good, albeit imperfect, predictor of academic attainment at university. These findings support the use of contextual background information, alongside school grades in university admissions processes as a means of refining the selection of students. In turn, individuals' narratives expose a more complex picture of what it means to be disadvantaged, depicting the factors that may affect students' trajectories to HE prior to the point of admissions. Hence, combining quantitative and qualitative studies provides a more nuanced evaluation of 'disadvantage' highlighting various mechanisms that may drive differences in the educational outcomes of socio-economically disadvantaged students. Findings advocate for further evidence using mixed methods to help address these inequalities and widen participation at universities fairly.

This research explored the factors perceived to be influential for members of staff at the University of Liverpool (UoL) to adopt and implement educational technologies. The research was based in practice and the UoL examined as a case study. The theoretical framework was based upon innovation research and informed by Rogers’ (2003) Diffusion of Innovations (DOI), and Ely’s (1999) eight conditions of implementation. Semi-structured interviews were conducted with sixteen members of staff. Thematic analysis of the interview transcripts complemented an analysis of relevant UoL documentation. I did not find evidence for five categories of adopters as defined in the DOI. Instead I proposed three categories: Enthusiasts, Pragmatists and Risk Aversives. These categories were not perceived to be static but varied as a result of contextual and individual factors. Participants’ perceptions of drivers and rationales were examined using Hannan’s (2005) concept of drivers for directed, guided and individual innovations. Directed institutional drivers were generally perceived to be lacking, though some faculty, school or departmental drivers were reported. Guided drivers were not reported. However, participants perceived certain general institutional activities to be drivers. I defined these as indirect drivers. Several individual drivers were reported including a perception of benefit, general interest and career benefit. Factors perceived to enable participants to utilise educational technologies effectively were split between the support available from central services and informal developments within faculties, schools and departments. The availability of accessible colleagues, or near peers, was reported as one of the most influential factors. My findings were contrasted with the innovation-decision process of Rogers’ (2003) DOI and Ely’s (1999) eight implementation conditions. A new model focused upon the importance of context was proposed. There are implications for how the UoL supports the adoption and implementation of educational technologies. Recommendations are made and areas for further research are identified.

In the last ten years there have been many changes to health care delivery, and higher education in preparing students for professional practice. Occupational therapy has had to meet these demands by being more challenging and evaluative of the care they deliver. One way this has been addressed is through the inclusion of reflective thinking and reflective practice into the undergraduate curriculum of occupational therapy. This research looks at how reflective practice has been developed within the Course curriculum of Occupational Therapy at The University of Liverpool with the aims of investigating and establishing - • How the notion of reflective practice has been incorporated into the curriculum overtime • How students' perceptions of reflective practice have changed over time • How the changes in curriculum design are related to the values students place on reflection and reflective practice. The methodology uses a case study design involving document analysis. Three sources of data were gathered from: Public Records, Private Papers of students and Biographical teaching notes of staff. Findings: Several factors have emerged that have implications for future practice both in occupational therapy and other health science professions. When reflection is not explicitly taught and/or where reflection is only considered as a discrete part of a curriculum, students are unable to incorporate reflection into their daily practice. Students' capacity to develop reflective skills leads to students acquiring reflective abilities at differing levels and therefore curriculum design needs to provide practical ways in which students can enrich their reflective practice competencies. To be reflective a number of cognitive skills need to be taught and developed in order for reflection to be effective. Students also need to be taught how reflection works in practice and how their personal reflective abilities impact on the benefit to clients.Recommendations It is suggested that future curriculum design should embrace a model of education which encourages opportunities for 'learners' to develop their capacities which are fundamental to competent reflective practice and the acquisition of knowledge that should proceed interactively with reflecting about real practical situations. One possible consideration would be to identify early on in the course the students' reflective thinking, using a scheme for assessing students' writing and then employ a . variety of teaching strategies that bring together the material used and found in the progress of this study. Tutors need to be mindful that the teaching of reflection does not necessarily require changes in what is taught but instead more emphasis is needed on how to incorporate thinking skills into a repertoire of knowledge. Tutors also need to make more explicit the links reflection has with the skills of problem solving and clinical reasoning so that students can learn to "reflect effectively and practice reflectively" (Burton, 2000).

The late Victorian and Edwardian period saw ritual become increasingly important in political life. Towns and cities were involved in conscious efforts to construct and project attractive images of themselves. These images were intended to encourage a sense of civic patriotism. Ceremonies, honorific titles, public events and civic architecture were essays in the invention of tradition. However, historians have applied the concept of the invention of tradition unevenly. Previous research has dwelt on the construction of images. Perceptions of official images and responses to them have been overlooked. This thesis employs a model which recognises images as processes with foundaitons in human relationships. It evaluates images in terms of intentionality, power, context and participation. The participative dimension is of particular importance, because images aimed to instil a sense of civic patriotism which would encourage citizens to make emotional and financial investments in their communities. Liverpool attained the status of a city in 1880. The civic ideology of the city was dominated by images of commerce and by notions of Imperial duty and public service which celebrated commercial virtues. Many aspects of urban life were shaped by civic image. This study does not confine itself to public events and pageantry, instead it explores such spheres as municipal art policy, Liverpool's public health record, the attempts to extend the city boundaries, civic hagiography, the foundation of the University, women and the ideal of citizenship and the influence of football on civic identity to demonstrate the importance of images in the city's social, political and institutional history. The purpose of the thesis is three-fold: to suggest that civic image opens new perspectives on Liverpudlian history, to discover why there were more conscious attempts to construct civic image and to restore participation to the study of civic image by unravelling the connections between image and patriotism.

The General Medical Council (GMC) is the UK's independent regulator of doctors, ensuring that proper standards in the practice of medicine are maintained to safeguard the public. The GMC sets and accredits the undergraduate medical curriculum in the UK as detailed in the Tomorrow's Doctors documentation. This specifies the standards of professional behaviour to be delivered as part of the undergraduate medical curriculum. Tomorrow's Doctors (GMC, 2009) places emphasis on the use of formative and summative feedback, with students' knowledge, skills and professional behaviours being assessed as part of their learning experience. Peer assessment has emerged as an effective mechanism for delivering feedback on professional behaviours (Schonrock-Adema et aI, 2007). However, clear guidance from the GMC on how to incorporate peer feedback on professional behaviours in the undergraduate medical curriculum is absent. This thesis will examine different ways that peer feedback on professional behaviours can be incorporated within the existing curriculum at the University of Liverpool with reference to the latest GMC guidance and the views of staff and students. The research used a social constructionist approach informed by action research theory (Carr and Kemmis, 1997). This sociological approach aimed to produce recommendations for curriculum change that were relevant and achievable. The interpretation and analysis of data is presented to highlight how peer feedback on professional behaviours is and can be incorporated into the undergraduate medical curriculum at Liverpool, other medical schools regulated by the GMC, and related medical and health care courses. The study population consisted of two undergraduate medical student cohort groups in their second year of study (2007/8, 2009/10), contemporary Problem Based Learning (PBL) and communication skills tutors. A mixed methods research methodology was employed using qualitative and quantitative methods in the form of interviews, online surveys and Problem Based Learning (PBL) evaluation data to elucidate the mechanisms that exist in relation to peer feedback on professional behaviours. The thesis demonstrates what students and staff think of peer feedback generally, and how this would fit into the delivery of PBL with reference to current GMC guidance. Recommendations are made for how peer feedback could fit into the Liverpool - and other - undergraduate medical curriculums. By examining the same material from different viewpoints, the research has produced a set of methodological triangulated qualitative data to provide detailed information about the peer feedback of professional behaviours. Tutors and students expressed some concerns about the delivery and use of peer feedback on professional behaviour but did appreciate the value of these comments for reflective learning. The results suggest a formative model of peer feedback on professional behaviours supported by training for students and tutors would be the most effective way to implement this aspect of curriculum change. This model should link to the communication elements of the MBChB course explicitly referring to outcomes of GMC guidance.

This thesis examines the origins and development of the Loan Collection at the Institute of Archaeology (I of A) from 1904 to 1930, at the University of Liverpool. It presents primary material collected from various archives in order to establish how the Loan Collection was assembled, how it developed, and how it changed over the time period under consideration here. As part of this study, a short history of the I of A is presented in order to contextualize the Loan Collection. Points of connection with other university collections are identified and explored in order to help explain the methods used to acquire the artifacts in the Institute's collection. Equally, this work discusses how financial issues that affected the Institute of Archaeology had an impact upon the Loan Collection. Further, this historiography outlines an attempt that was made to takeover the Institute of Archaeology and its Loan Collection in 1906. The thesis shows that this incident required the Institute to define its relationship with the University, besides the collection that it housed. It is also seen that this attempt at a takeover brought into question what the Institute referred to as a 'Museum' between 1904 and 1906. Similarly, this thesis explores a later proposal in 1910 that endeavored to create an alliance between the I of A and the city of Liverpool's Public Museum. Both this latter attempt and the incident that occurred in 1906 are reviewed here as a means of aiding in defining and further contextualizing the Loan Collection. The argument put forward in this thesis is that the Loan Collection held by the Institute of Archaeology was not a museum, and that the way in which the collection was created and assembled over the years under study never provided the space for it to become one.

Bis es im 19. Jahrhundert in die globale Peripherie abgedrängt wurde, war China selbst Zentrum eines ostasiatischen Weltsystems. Seither versucht das „Reich der Mitte“ die frühere Zentrumsposition innerhalb des modernen Weltsystems wiederzuerlangen. Hochschulbildung, ein ausländischer Import des späten 19. Jahrhunderts, dient der Modernisierung des Landes und spielt eine wichtige Rolle im Nationswerdungsprozess des Landes. In der jüngsten Vergangenheit fanden Veränderungen enormen Ausmaßes im chinesischen Hochschulsystem statt. Offizielle Forschungs- und Innovationsdaten deuten auf einen raschen Aufschluss Chinas an die Leistungen westlicher Industrienationen hin. Gemäß der Zielvorgaben der Entscheidungsträger in der Bildungspolitik hat die VR China nicht nur einen Aufholkurs, sondern einen Überholkurs eingeschlagen. China ist nicht mehr nur das wichtigste Herkunftsland für international mobile Studierende, sondern es will auch zu einem der wichtigsten Gastländer werden. Neue Stipendienprogramme (incoming wie outgoing) und Programme zur Rückgewinnung chinesischer Talente aus dem Ausland wurden eingerichtet. Zahlreiche internationale Kooperationsprogramme bieten „ausländische Bildung” innerhalb chinesischer Grenzen als Bereicherung des nationalen Bildungsangebots an. Gleichzeitig strebt China zunehmend danach eigene nationale Bildungsangebote am Weltbildungsmarkt zu etablieren. Die vorliegende Arbeit stellt einen Beitrag zur Positionsbestimmung Chinas im globalen Kontext dar. Zu diesem Zweck wurden statistische Daten durch Aussagen aus semi-strukturierten narrativen Interviews mit Akademikern und Entscheidungsträgern der chinesischen Hochschulbildung ergänzt. Die meisten befragten Experten arbeiten an einer von drei strukturell sehr unterschiedlichen chinesischen Hochschule, die dieser Arbeit als Fallbeispiele dienen. Bei den Fallbeispielen handelt es sich um die Tsinghua-Universität, die Qiqihar-Universität und die Xi’an Jiaotong Liverpool University.
China used to be a core country within an East-Asian world-system but was forced into periphery status during the 19th century. Ever since China strives to regain its former core position within the modern world-system. University education, a foreign import of the late 19th century, has become an important tool for China’s endeavor for modernization and nation building. In recent years the Chinese higher education landscape was subject to gigantic changes. Official research and innovation data seem to indicate a rapid affiliation with the achievements of western industrialized nations. Following the agenda of decision-makers in educational policy in the People’s Republic, the suggested course of action would be to overtake, not just to catch up: By 2020 technology imports should sink to under 30 per cent; in the same year China would like to receive a half million international students and thus become not only the most important sending country for international students, but also an important host country. New scholarship programs (incoming and outgoing) as well as programs to recover Chinese talent from abroad, were established. A multitude of international cooperation programs have been created to provide “foreign education“ within Chinese borders to further enrich the Chinese landscape of higher education. At the same time China also urges to establish its own brand of higher education abroad. This dissertation represents a contribution to determine the position of Chinese higher education within its global context. Statistical data is completed by semi-structured narrative interviews with academics and decision makers in Chinese higher education. Most interviewees are working at one of three structurally quite different institutions of higher education in China that serve as case studies in the thesis: Tsinghua University, Qiqihar University and Xi’an Jiaotong Liverpool University.

The aim of this research is to understand the socio-economic development of a metropolitan region in Sydney through an analysis of regional innovative activity. South West Sydney, a major growth region within Sydney, includes the Local Government Areas (LGAs) of Liverpool, Campbelltown, Camden and Wollondilly. This region has absorbed 25% of Sydney’s population growth in the period from 1991-2001. Although South West Sydney has experienced rapid population growth, this has not been matched by associated employment growth. In some sectors such as business services employment growth has been minimal in the previous decade, this is particularly the case in Liverpool, the regional centre of South West Sydney. Population growth is estimated to continue at the current rate (in excess of 5% per annum) for at least the next fifteen years. In this environment, local government authorities in the region are seeking ways in which to develop the regional economy of South West Sydney and increase the amount of sustainable employment commensurably with current population and labour force increases. The role of innovative activity has a central place in economic development. This thesis uses a ‘systems of innovation’ (SI) approach to examine innovative activity in the South West Sydney region. SI understands innovation as a socially embedded process of transforming ideas and knowledge into novel products, processes and services through the processes of learning and searching. The approach recognises that innovative activity is determined by various actors (firms and institutions) and the interactivity between these actors and the cumulative base of knowledge in which they operate. The Regional Innovations Systems (RIS) framework develops from an acknowledgement that innovation is primarily a geographically bounded phenomenon. The RIS approach sees that specific local resources are important in determining and encouraging the innovative activities carried out by local firms and hence, the competitiveness of these areas. The RIS literature provides two fields of understanding of what constitutes a regional innovation system. The first takes the global examples of highly innovative regions such as Silicon Valley and Route 128 in the United States of America (Saxenian 1994), South West England (Cooke and Morgan 1998), Baden Wurttemberg in Germany (Cooke 2001; Braczyk, Cooke et al. 2004), Northern Italy (Piore and Sabel 1984) and in Australia, the North Ryde corridor (Searle and Pritchard 2005). These regions represent ‘ideal’ or ‘star’ RIS, with highly specialised and networked clusters of firms, many forms of supporting regional infrastructure, and high levels of interactivity. The second and emerging field understands RIS to be in existence in all regions and individual RIS are identified on a scale from weak to strong (Wiig and Wood 1995; Cooke and Morgan 1998; Cooke 2001). This second stream includes the analysis of regions seeking to encourage innovative activity by using the RIS approach to examine their local resources and connectedness. It seeks to determine how not only local resources but also their connectedness could be enhanced to increase firm competitiveness. The innovation systems represented in the ����ideal���� regions are largely a world away from what is available and what is necessary in the encouragement of RIS in most other regions. However, the conceptual framework for examining and interpreting RIS is derived from the analysis of these ‘ideal’ regions. This framework does not provide for measurement and effective interpretation of a range of activities that may be present in less exceptional regions. This research contributes to this endeavour by providing a method that allows for interpretation of a wider range of innovation activities through the analysis of knowledge intensive services activities (KISA). The focus on knowledge gathering, particularly through the KISA analysis, provides an examination of the relationship between innovation, learning and knowledge, much more so than more traditional measures of innovative activity e.g. patents and research and development (RandD) expenditure. KISA analysis is an emerging field of innovation research. KISA are closely linked to firm innovative activity (OECD 2006) and through an analysis of regional KISA usage, an understanding of innovation and knowledge activities within the region can be constructed. This analysis applies equally across various regions and provides an opportunity to guide regional economic development policy intervention at the local government level in South West Sydney.

There is an increase in the prevalence of obesity among people with schizophrenia thought to be due in part to the weight enhancing side-effects of medications commonly used to treat the symptoms of schizophrenia. Despite the deleterious health effects associated with obesity and its impact on quality of life and medication compliance, little is known about body composition and energy expenditure in this clinical group. The primary purpose of this thesis was to enhance understanding of body composition and energy expenditure, particularly resting energy expenditure in men with schizophrenia who take atypical antipsychotic medications. Unique to this investigation is the evaluation of clinical tools used to predict body composition and energy expenditure against reference methodologies in men with schizophrenia. Further, given the known links between obesity and physical activity, an additional but less comprehensive component of the thesis was a consideration of total and activity energy expenditure in addition to the interaction between psychiatric symptoms, side-effects of antipsychotic medications and physical activity also occurred as part of this thesis. Collectively, the goals of this thesis were addressed through a series of studies – the first two studies were related to the measurement and characteristics of body composition in men with schizophrenia, while the third and fourth studies were related to the measurement and characteristics of resting energy expenditure in men with schizophrenia. The fifth and sixth studies the utilised doubly labelled water technique to quantify activity and total energy expenditure in a small group of men with schizophrenia and explored the use of accelerometry in this cohort. The final study briefly considered the impact of psychiatric symptoms and self-reported medication side-effects on objectively measured physical activity. In the first study, thirty-one male adults previously diagnosed with schizophrenia and sixteen healthy male controls were recruited. Estimates of body composition derived from an anthropometry-based equation and from bioelectric impedance analysis (BIA) using deuterium dilution as the reference methodology to determine total body water were compared. The study also determined the validity of equations commonly used to predict body composition from BIA in the men with schizophrenia. A further aim was to determine the superiority of either BIA or body mass index (BMI) as an indicator of obesity in this cohort. The inclusion of the control group, closely matched for age, body size and body composition demonstrated that there was no difference in the ability of body composition prediction methods to distinguish between fat and fat-free mass (FFM) in controls and men with schizophrenia when both groups had similar body composition. However this study indicated that an anthropometry-based equation previously used in people with schizophrenia was a poor predictor of body composition in this cohort, as evidenced by wide limits of agreement (25%) and systematic variation of the bias. In comparison, the best predictor of percentage body fat (%BF) in this group was gained when impedance values were used to predict percentage body fat via the equation published by Lukaski et al (1986). Although percentage body fat was underpredicted using the Lukaski et al. (1986) equation, the mean magnitude was relatively small (1.3%), with the limits of agreement approximately 13%. Linear regression analysis revealed that %BF predicted using the Lukaski et al. (1986) equation explained 25% more of the variance in percentage body fat than BMI. Further, this study also indicated that BIA was more sensitive than BMI in distinguishing between overweight and obesity in this cohort of men with schizophrenia. Because of the almost exclusive use of BMI as an indicator of obesity in people with schizophrenia, the level of excess body fat may be in excess of that previously indicated. The second study extended the examination of body composition in men with schizophrenia. In this study, the thirty-one participants with schizophrenia (age, 34.2 ± 5.7 years; BMI, 30.2 ± 5.7 kg/m2) were individually matched with sedentary controls by age, weight and BMI. Deuterium dilution was used to distinguish between FFM and fat mass. The previous study had indicated that while BIA was a suitable group measure for obesity, on an individual level the technique lacked the precision required for investigating body composition in men with schizophrenia. Waist circumference was used as an indicator of body fat distribution. The findings of this study indicated that in comparison with healthy sedentary controls of similar body size and age, men with schizophrenia had higher levels of body fat which was more centrally distributed. Percentage body fat was on average 4% higher and waist circumference, on average 5 cm greater in men with schizophrenia than the sedentary controls of the same age and BMI. Further, this study indicates that the use of BMI to predict body fat in men with schizophrenia will result in greater bias than when it is used to predict body fat in other sedentary men. Commonly used regression equations to predict energy requirements at rest are based on the relationships between weight and resting energy expenditure (REE) and in such equations, weight acts as a surrogate measure of FFM. The objectives of study three were to measure REE in a small group of men with schizophrenia who were taking the antipsychotic medication clozapine and to determine whether REE can be predicted with sufficient accuracy to substitute for the measurement of REE in the clinical and/or research settings. Body composition was determined using deuterium dilution and REE was measured using a Deltatrac Metabolic Cart via a ventilated hood. The male participants, (aged 28.0 ± 6.7 yrs, BMI 29.8 ± 6.8 kg/m2) were weight stable at the time of the study and had been taking clozapine for 20.5 ± 12.8 months, with doses of 450 ± 140 mg/day. Of the six prediction equations evaluated, the equation of Mifflin et al. (1990) with no systematic bias, the lowest bias and the lowest limits of agreement proved to be the most suitable equation to predict REE in this cohort. The overestimation of REE can be corrected for by deducting 160 kcal/day from the predicted REE value when using the Mifflin et al. (1990) equations. However, the magnitude of the error associated with the prediction of REE for an individual is 370 kcal/day. The findings of this study indicate that REE cannot be predicted with sufficient individual accuracy in men with schizophrenia, therefore it was necessary to measure rather than predict REE in subsequent studies. In the fourth study, indirect calorimetry (Deltatrac Metabolic Cart via ventilated hood) and deuterium dilution were used to accurately determine REE, respiratory quotient (RQ) and FFM in 31 men with schizophrenia and healthy sedentary controls individually matched for age and BMI. Data from this study indicated that gross REE was lower in men with schizophrenia than in healthy sedentary controls of a similar age and body size. However, there was no difference between the groups in REE when REE was adjusted for FFM using the mathematically correct method (analysis of covariance with FFM as the covariate). There was however a statistically and clinically significant difference in resting, fasted RQ between men with schizophrenia and controls, suggesting that RQ rather than REE may be an important correlate worthy of further investigation in men with schizophrenia who take antipsychotic medications. Studies five and six involved the application of the doubly labelled water (DLW) technique to accurately determine total energy expenditure (TEE) and activity energy expenditure (AEE) in a small group of men with schizophrenia who had been taking the atypical antipsychotic medication clozapine. The participants were those who took part in study three. The purpose of these studies was to assess the validity of a commercially available tri-axial accelerometer (RT3) for predicting free-living AEE and to investigate TEE and AEE in men with schizophrenia. There was poor agreement between AEE measured using DLW and AEE predicted using the RT3. However, using the RT3 to measure inactivity explained over two-thirds of the variance in AEE. This study found that the relationship between current AEE per kilogram of body weight and change from baseline weight in men taking clozapine was strong although not significant. The sedentary nature of the group of participants in this study was reflected in physical activity levels, (PAL, 1.39 ± 0.27), AEE (435 ±352 kcal/day) and TEE (2511 ± 606 kcal/day) that fell well short of values recommended by WHO (2000) for optimal health and to prevent weight gain. Given the increasing recognition of the importance of sedentary behaviour to weight gain in the general community, further examination of the unique contributing factors such as medication side effects and symptoms of mental illness to activity levels in this clinical group is warranted. The final study used accelerometry (RT3) to objectively measure activity in a group of 31 men with schizophrenia who had been taking atypical antipsychotic medications for more than four months. The purpose of this study was to explore the relationships between psychiatric symptomatology, side-effects of medication and physical activity. Accelerometry output was analysed to provide a measure of inactivity and moderate intensity activity (MIA). The well-validated and reliable standardised clinical interview, the Positive and Negative Syndrome Scale (PANSS) was used as a measure of psychiatric symptoms. Perceived side-effects of medication were assessed using the Liverpool University Neuroleptic Rating Side-Effects Scale (LUNSER). Surprisingly, there was no relationship reported between any measures of negative symptoms and physical inactivity. However, self-reported measures of medication side-effects relating to fatigue, sleepiness during the day and extrapyramidal symptoms explained 40% of the variance in inactivity. This study found significant relationships between some negative symptoms and moderate intensity activity. Despite the expectation that as symptoms of mental illness reduce, inactivity may diminish and moderate intensity activity will increase, it may not be surprising that in practice this is an overly simplistic view. It may be that measures of social functioning and possibly therefore cognition may be better predictors of physical activity than psychiatric symptomatology per se.

There is an increase in the prevalence of obesity among people with schizophrenia thought to be due in part to the weight enhancing side-effects of medications commonly used to treat the symptoms of schizophrenia. Despite the deleterious health effects associated with obesity and its impact on quality of life and medication compliance, little is known about body composition and energy expenditure in this clinical group. The primary purpose of this thesis was to enhance understanding of body composition and energy expenditure, particularly resting energy expenditure in men with schizophrenia who take atypical antipsychotic medications. Unique to this investigation is the evaluation of clinical tools used to predict body composition and energy expenditure against reference methodologies in men with schizophrenia. Further, given the known links between obesity and physical activity, an additional but less comprehensive component of the thesis was a consideration of total and activity energy expenditure in addition to the interaction between psychiatric symptoms, side-effects of antipsychotic medications and physical activity also occurred as part of this thesis. Collectively, the goals of this thesis were addressed through a series of studies – the first two studies were related to the measurement and characteristics of body composition in men with schizophrenia, while the third and fourth studies were related to the measurement and characteristics of resting energy expenditure in men with schizophrenia. The fifth and sixth studies the utilised doubly labelled water technique to quantify activity and total energy expenditure in a small group of men with schizophrenia and explored the use of accelerometry in this cohort. The final study briefly considered the impact of psychiatric symptoms and self-reported medication side-effects on objectively measured physical activity. In the first study, thirty-one male adults previously diagnosed with schizophrenia and sixteen healthy male controls were recruited. Estimates of body composition derived from an anthropometry-based equation and from bioelectric impedance analysis (BIA) using deuterium dilution as the reference methodology to determine total body water were compared. The study also determined the validity of equations commonly used to predict body composition from BIA in the men with schizophrenia. A further aim was to determine the superiority of either BIA or body mass index (BMI) as an indicator of obesity in this cohort. The inclusion of the control group, closely matched for age, body size and body composition demonstrated that there was no difference in the ability of body composition prediction methods to distinguish between fat and fat-free mass (FFM) in controls and men with schizophrenia when both groups had similar body composition. However this study indicated that an anthropometry-based equation previously used in people with schizophrenia was a poor predictor of body composition in this cohort, as evidenced by wide limits of agreement (25%) and systematic variation of the bias. In comparison, the best predictor of percentage body fat (%BF) in this group was gained when impedance values were used to predict percentage body fat via the equation published by Lukaski et al (1986). Although percentage body fat was underpredicted using the Lukaski et al. (1986) equation, the mean magnitude was relatively small (1.3%), with the limits of agreement approximately 13%. Linear regression analysis revealed that %BF predicted using the Lukaski et al. (1986) equation explained 25% more of the variance in percentage body fat than BMI. Further, this study also indicated that BIA was more sensitive than BMI in distinguishing between overweight and obesity in this cohort of men with schizophrenia. Because of the almost exclusive use of BMI as an indicator of obesity in people with schizophrenia, the level of excess body fat may be in excess of that previously indicated. The second study extended the examination of body composition in men with schizophrenia. In this study, the thirty-one participants with schizophrenia (age, 34.2 ± 5.7 years; BMI, 30.2 ± 5.7 kg/m2) were individually matched with sedentary controls by age, weight and BMI. Deuterium dilution was used to distinguish between FFM and fat mass. The previous study had indicated that while BIA was a suitable group measure for obesity, on an individual level the technique lacked the precision required for investigating body composition in men with schizophrenia. Waist circumference was used as an indicator of body fat distribution. The findings of this study indicated that in comparison with healthy sedentary controls of similar body size and age, men with schizophrenia had higher levels of body fat which was more centrally distributed. Percentage body fat was on average 4% higher and waist circumference, on average 5 cm greater in men with schizophrenia than the sedentary controls of the same age and BMI. Further, this study indicates that the use of BMI to predict body fat in men with schizophrenia will result in greater bias than when it is used to predict body fat in other sedentary men. Commonly used regression equations to predict energy requirements at rest are based on the relationships between weight and resting energy expenditure (REE) and in such equations, weight acts as a surrogate measure of FFM. The objectives of study three were to measure REE in a small group of men with schizophrenia who were taking the antipsychotic medication clozapine and to determine whether REE can be predicted with sufficient accuracy to substitute for the measurement of REE in the clinical and/or research settings. Body composition was determined using deuterium dilution and REE was measured using a Deltatrac Metabolic Cart via a ventilated hood. The male participants, (aged 28.0 ± 6.7 yrs, BMI 29.8 ± 6.8 kg/m2) were weight stable at the time of the study and had been taking clozapine for 20.5 ± 12.8 months, with doses of 450 ± 140 mg/day. Of the six prediction equations evaluated, the equation of Mifflin et al. (1990) with no systematic bias, the lowest bias and the lowest limits of agreement proved to be the most suitable equation to predict REE in this cohort. The overestimation of REE can be corrected for by deducting 160 kcal/day from the predicted REE value when using the Mifflin et al. (1990) equations. However, the magnitude of the error associated with the prediction of REE for an individual is 370 kcal/day. The findings of this study indicate that REE cannot be predicted with sufficient individual accuracy in men with schizophrenia, therefore it was necessary to measure rather than predict REE in subsequent studies. In the fourth study, indirect calorimetry (Deltatrac Metabolic Cart via ventilated hood) and deuterium dilution were used to accurately determine REE, respiratory quotient (RQ) and FFM in 31 men with schizophrenia and healthy sedentary controls individually matched for age and BMI. Data from this study indicated that gross REE was lower in men with schizophrenia than in healthy sedentary controls of a similar age and body size. However, there was no difference between the groups in REE when REE was adjusted for FFM using the mathematically correct method (analysis of covariance with FFM as the covariate). There was however a statistically and clinically significant difference in resting, fasted RQ between men with schizophrenia and controls, suggesting that RQ rather than REE may be an important correlate worthy of further investigation in men with schizophrenia who take antipsychotic medications. Studies five and six involved the application of the doubly labelled water (DLW) technique to accurately determine total energy expenditure (TEE) and activity energy expenditure (AEE) in a small group of men with schizophrenia who had been taking the atypical antipsychotic medication clozapine. The participants were those who took part in study three. The purpose of these studies was to assess the validity of a commercially available tri-axial accelerometer (RT3) for predicting free-living AEE and to investigate TEE and AEE in men with schizophrenia. There was poor agreement between AEE measured using DLW and AEE predicted using the RT3. However, using the RT3 to measure inactivity explained over two-thirds of the variance in AEE. This study found that the relationship between current AEE per kilogram of body weight and change from baseline weight in men taking clozapine was strong although not significant. The sedentary nature of the group of participants in this study was reflected in physical activity levels, (PAL, 1.39 ± 0.27), AEE (435 ±352 kcal/day) and TEE (2511 ± 606 kcal/day) that fell well short of values recommended by WHO (2000) for optimal health and to prevent weight gain. Given the increasing recognition of the importance of sedentary behaviour to weight gain in the general community, further examination of the unique contributing factors such as medication side effects and symptoms of mental illness to activity levels in this clinical group is warranted. The final study used accelerometry (RT3) to objectively measure activity in a group of 31 men with schizophrenia who had been taking atypical antipsychotic medications for more than four months. The purpose of this study was to explore the relationships between psychiatric symptomatology, side-effects of medication and physical activity. Accelerometry output was analysed to provide a measure of inactivity and moderate intensity activity (MIA). The well-validated and reliable standardised clinical interview, the Positive and Negative Syndrome Scale (PANSS) was used as a measure of psychiatric symptoms. Perceived side-effects of medication were assessed using the Liverpool University Neuroleptic Rating Side-Effects Scale (LUNSER). Surprisingly, there was no relationship reported between any measures of negative symptoms and physical inactivity. However, self-reported measures of medication side-effects relating to fatigue, sleepiness during the day and extrapyramidal symptoms explained 40% of the variance in inactivity. This study found significant relationships between some negative symptoms and moderate intensity activity. Despite the expectation that as symptoms of mental illness reduce, inactivity may diminish and moderate intensity activity will increase, it may not be surprising that in practice this is an overly simplistic view. It may be that measures of social functioning and possibly therefore cognition may be better predictors of physical activity than psychiatric symptomatology per se.