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Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes, which continue to have a substantial impact on morbidity and mortality. This mixed methods thesis comprises three studies intended to address key uncertainties of improving preconception health in the UK. The first study was an umbrella review that used the GRADE framework to assess the evidence certainty of 205 unique associations for preconception exposures contained in 53 systematic reviews. I identified high- and moderate-certainty evidence that maternal preconception folate supplementation, weight, interpregnancy weight change and physical inactivity, and advanced paternal age, are associated with adverse pregnancy, birth and postpartum outcomes. The second study was a cross-sectional survey of 835 women registered with primary care in the West of England, which assessed their knowledge, attitudes and views of preconception health and intervention methods. I identified a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly among younger and nulligravid women and women with lower incomes. Intervention methods involving communication from healthcare professionals, schools, family members, and digital media were reported to be acceptable. The third study involved in-depth interviews with 20 of the cross-sectional survey participants, purposively sampled using a maximum variation approach. A framework analysis of their views on interventions to improve preconception health highlighted a multitude of factors that can enhance the acceptability and appeal of these interventions. These included enabling discretion and access, seeking consent, ensuring sensitivity, including details of the 'why', 'how' and 'how much' of preconception recommendations, and the use of visual media and personalisation. In line with national policy recommendations, a need to deliver preventive interventions ahead of first pregnancy was highlighted. This thesis contributes to the growing literature on improving preconception health. Future research should seek to develop interventions informed by the findings of this research.

The standard 12-lead ECG remains the cornerstone of immediate clinical triage In patients presenting pre-hospital or to an Emergency Department with acute ischaemic-type chest pain at rest However, this non-invasive test is well known to have poor diagnostic sensitivity for acute coronary artery occlusion. Previous research conducted at the Royal Victoria Hospital Belfast has shown the utility of extended lead systems, i.e. the body surface potential map (BSPM). in improving the diagnostic performance of the ECG in this regard. Despite advances in cardiac biomarkers, there remain a variety of high-risk populations where these biomarkers are of reduced initial diagnostic value and/or their measurement may result in an unnecessary delay to acute myocardial infarction diagnosis. The primary aim of this thesis is to evaluate the BSPM in these groups, namely those patients with: • Negative cardiac biomarkers at presentation; • ST-segment depression only on ECG at presentation; • Typically 'balanced ischaemia' on ECG, i.e. in left main coronary artery stenosis; • Ventricular Fibrillatory cardiac arrest; and • Extreme Body Mass Index.

Nuclear Reactor Pressure Vessels (RPV) are manufactured from medium strength low alloy ferritic steel, specifically selected for its high toughness and good weldability. The ability of the RPV material to resist crack growth is crucial given that it is one of the fundamental containment safety systems of nuclear power plants. For most of their lifetime, the RPV operates at sufficiently elevated temperatures to ensure the material is ductile. However, the development of ductile damage, in the form of voids, and the ability to predict ductile tearing in RPV materials using a mechanistically-based model remains difficult. The Gurson-Tvergaard-Needleman (GTN) model of ductile tearing provides one such tool for predicting ductile damage development in RPV materials. The difficulty in using the GTN model lies in the ability to calibrate the model parameters in a robust manner. The parameters are typically calibrated data, derived from fracture tests and relying on an iterative “trial and error” procedure of numerical simulations and comparison with test data until the model reproduces the experimental behaviour with sufficient accuracy. This research has addressed the development of a mechanistically-based approach to the calibration of the GTN model by developing a new understanding of the ductile fracture mechanism in RPV material through conventional metallography and 3D X-ray computed tomography to image the initiation, growth and coalescence of ductile voids. The metallographic and tomographic data were analysed in a quantitative manner to establish a direct link between the microstructural features and void evolution and the key parameters of the GTN model. This approach has established a more robust mechanistically based method for the calibration of the GTN model that will enhance the conventional iterative calibration procedure. The calibrated model was applied to predict ductile tearing behaviour in compact-tension and notched-tensile specimens. The results showed good agreement with test data and also reproduced the morphology and branching of crack extension observed in practise. Whilst these observations were due, in part, to the numerical solving procedure, they enabled new insights to be gained regarding the development of non-uniform void volume fraction distributions in tested specimensThe results from this research will strengthen the guidance provided to structural integrity engineers in industry regarding the calibration and application of ductile damage mechanics models such as the GTN model for predicting ductile initiation and growth in RPV materials.

The launch of the Sheffield Society for Constitutional Information in 1791 is recognised by historians as one of the earliest and most radical expressions of organised working class calls for parliamentary reform in England. Research for this thesis has shown that Joseph Gales, the Sheffield publisher, was active in supporting the reform movement through his newspaper the Sheffield Register, with the help of his wife Winifred, a novelist, and his assistant, the poet James Montgomery, until the flight of the Galeses to America in 1794-95. However, existing historical scholarship has not explored the archival material in depth to reveal the detailed content of their radical journalism and publishing in the key years 1791-94. There is also a pronounced gap, despite the presence of a significant archive, in the later activities of the Galeses in North America, and of Montgomery in Sheffield in 1794-97. This thesis will seek to fill this gap in historical knowledge by showing in more detail the content and depth of their radical journalism and writings, their links with national and international reformers, and how their later claims of moderation are contradicted by the newly available data. This will be achieved by exploring the letters, poems, and editorials, of the Sheffield Register, the Sheffield Iris, and the Raleigh Register newspapers, the "Recollections", letters and novels of Winifred Gales, and the poems and prose writings of James Montgomery. There will also be a consideration of their place in the rise of a middling-sort class awareness, transatlantic radicalism, the role of feminist autobiographical diaries, and the boosterist activities of the Galeses in North Carolina.

Controversy is the current state of opinion among librarians and others about the future of libraries. The proponents of the electronic library say that now that information is readily available from sources other than the library, the role of the library must be rethought. Some of the advocates of the electronic library see the elimination of the library as place. The traditional institutional approach is a variant of the electronic library position. The traditionalists realize that libraries are about more than providing information, but the path that they take will place, in the same camp as the electronic library. They also seek to reinvent the library with marketing approaches where patrons become customers. The grassroots/humanist camp argues that libraries need not strip themselves of what is valuable in the library tradition. They argue that the library can fulfill the needs of the individual and the community. They believe that libraries embody many attributes, one of which is to provide a focal point for the community. These questions are explored through the medium of a small community library in Harrisburg, Ohio. (Contains 12 references.) (Author)

This dissertation consists of three essays in health economics, each of which utilize empirical methods combined with large administrative or survey datasets to answer policy-relevant questions. Chapter 1 examines the impact of increasing the minimum legal purchase age for tobacco products on youth smoking and other substance use using data from a large survey combined with difference-in-difference methods. I find that smoking decreases significantly following the increased minimum age for 18- to 20-year-olds. I also find evidence of positive spillovers to younger individuals (14- to 17-year-olds). I find no evidence to suggest substitution to other unhealthy substances is occurring. Chapter 2 examines the impact of financial transfers from the pharmaceutical industry to cancer drug prescribing physicians. Using an event-study approach, we find that these prevalent payments increase prescribing of related drugs by approximately 4.5%. We also present evidence that this increase is being driven by newer and more expensive drugs. We do not observe improvements in physician-level patient mortality. Chapter 3 studies the sugar-sweetened beverage (SSB) tax adopted by Mauritius in 2013 on youth SSB consumption and body-mass index (BMI). Using a difference-in-difference design, we find no impact on consumption or BMI; however, when we look at boys separately, we find that they are 11% less likely to report any SSB consumption.

Schema therapy is a leading contemporary approach to treating mental illness. The therapy integrally uses self-report measures of negative schemas (“long lasting patterns of emotions, cognitions and memories”), and the negative parenting patterns that are linked to the development of these schemas. However, the negative parenting measures are insufficient, and there are no corresponding measures of positive schemas or positive parenting patterns. Study 1 focused on the development of a measure for positive schemas, the Young Positive Schema Questionnaire (YPSQ). Study 2 focused on the development of a measure for positive parenting patterns, the Positive Parenting Schema Inventory (PPSI). Finally, Study 3 empirically showed that the subscales of the Young Parenting Inventory (YPI) were not robust, and it provided a revised alternative (YPI-R2). For all three studies combined, community samples (n = 204 to 628) were collected from five countries in Asia (India, Indonesia, Malaysia, Singapore, and the Philippines) as well as the United States. The factor structure of the three instruments (the YPSQ, PPSI and YPI-R2) was stable in both Eastern and Western samples (in multigroup confirmatory factor analysis). All three scales showed prediction of mental health over and above what was possible with previous measures (incremental validity). The scales were not simply proxies for previously measured constructs (divergent validity). These scales also demonstrated significant associations with other established measures of parenting (construct validity). They also showed associations with negative schemas, well-being and ill-being (convergent validity). This thesis provides the tools needed to include a focus on positive as well as negative schemas and parenting patterns in both research and clinical practice. It also shows the benefits of so doing.

Recent research in economics and psychology has examined the childhood noncognitive skills which predict future economic success. However, there has been relatively little research on whether these skills predict future unemployment. This thesis uses data from four cohort studies (total N = 47,328) from Great Britain and the United States to examine how lifetime trajectories of unemployment are affected by childhood differences in self-control (chapter 3), conscientiousness (4), and mental health (5-6). These are some of the first studies to examine how pre-labor market measures of these psychological characteristics prospectively predict future unemployment. Chapters 3, 5 and 6 are the first studies to examine how early psychological characteristics interact with recessions to produce differential unemployment outcomes. After adjusting for cognitive ability and key sociodemographic indicators (e.g. gender, SES), all three of these psychological characteristics are found to predict future unemployment. The effects are statistically significant and economically meaningful, comparable in magnitude to the effects of intelligence. Chapter 3 shows that childhood with poor self-control were disproportionately more likely than their more self-controlled peers to become unemployed during the 1980s UK recession, and chapters 5 and 6 find a similar effect for children with high psychological distress compared to their less distressed peers during the 1980s UK recession and 2007 US recession. These studies demonstrate the value of using psychological research to examine economic outcomes. The chief policy implication is that interventions which improve childhood levels of self-control, conscientiousness and mental health may be an effective way to reduce future population unemployment levels. In the short term, remediation programs which take into account individual psychological differences may improve the efficacy of unemployment interventions, particularly during recessions when certain groups are more likely than others to become unemployed.