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Introduction: People living with learning disabilities (LD) are known to experience mortality disparities but the relative contribution of social, genetic, and health-related factors is not clear. Aims: The aims of this thesis were to: 1. compare differential mortality in people with and without LD; 2. compare differential life expectancy in people with and without LD; 3. quantify the impact and magnitude of sociodemographic factors, comorbidities and health needs on premature deaths; and, 4. explore primary and secondary care pathways and causes of death. Methods: The project used the Clinical Practice Research Datalink (CPRD) and linked hospital and mortality data from England in 2000-2019 to compare individuals (aged 10+ years) with and without LD (n=33,867 vs n=980,586). Parametric statistics (Poisson regression [Aims 1, 4], flexible parametric methods [Aim 2]) and propensity scores [Aim 3] were utilised. Covariates included age, gender, deprivation, severe health needs, genetic syndromes and comorbidities. Results: Consistent differential mortality disparities were observed between the LD and comparison cohorts over time. Standardised mortality ratios ranged from 2.91 ([95% CI] 2.69-3.15) to 3.06 (2.84-3.29)) and were particularly high from epilepsy and respiratory-related causes. In 2017-2019, additional years expected to live at 10 years was 57.1 (54.9-59.4) in the LD cohort compared to 72.3 (71.9-72.7) in the comparison cohort, representing a loss in life years of 21%. Severe health needs were high in the LD cohort (46.4% vs 9.7%) but did not explain all of the life expectancy disadvantages. Even in those without any of the health needs, life expectancy was still 12% lower in the LD cohort. People with LD had more primary care and hospital admissions but lower uptake of cancer screening. Methodological considerations included immortal time bias and knot placements for the flexible parametric approaches adopted. Conclusions: This thesis continues to highlight the mortality disparities that people with LD experience. Such disparities can only partially be explained by deprivation, co-occurring health needs, comorbidities and genetic syndromes. Recommendations and policy implications are discussed.

Clinical prognostic models use information about a patient's characteristics and medical history to produce a prediction. The focus of this thesis is on models for time-to-event outcomes where the interest is in producing long-term survival predictions following a diagnosis of cancer. These types of models can be very useful in clinical practice to understand a patient's likely prognosis and assess the potential benefits of different treatment options. Fitting these types of models requires patients who were diagnosed many years ago to be included in order to have sufficient long-term follow-up. However, survival outcomes in cancer have been improving. Therefore, including these patients and not taking into account these changes can lead to miscalibrated predictions that under-estimate the survival of newly diagnosed patients. Although there are established methods available for recalibrating prognostic models using more recent data in external validation studies, these methods are often not applicable at the stage of developing prognostic models. The main aim of this thesis was therefore to develop new statistical methodology to adjust for improvements in survival that could be applied when developing or updating prognostic models in order to produce and maintain well-calibrated survival predictions. The proposed method of temporal recalibration is primarily illustrated using an example of colon cancer survival but can be applied to a range of applications and model types. Since missing covariate data is often an issue, the methodology is also assessed for use with multiple imputation. The application in a competing risks setting is also considered, where temporal recalibration can easily be applied to each of the cause-specific hazard models to produce more up-to-date risk predictions.

The health care field continues to expand with an increasing need for health care professionals, however for allied health fields, this need is not being met, resulting in a shortage of professionals. This shortage is amplified in the underrepresented minority population. This issue partially stems from low enrollment into academic majors in the health sciences. To address these needs and investigate low enrollment rates, motivations of students choosing majors in the health sciences need to be understood. Motivation can be categorized as intrinsic (for the enjoyment of a decision) or extrinsic (for an outside goal). Studies have shown that students who are intrinsically motivated are more likely to choose a career in health care and have improved retention and rates of satisfaction. 188 first year students in academic majors in the health sciences were surveyed to determine their dominant motivation mechanism and their self-perceived cognitive competence. These students were, on average, more intrinsically motivated and no significant difference was found between the motivation mechanisms of underrepresented minority and non-underrepresented minority students. It was found most of the participants were influenced by a current health care professional and their major deterrent from a career in health care was the education involved. These findings provide guidance to universities to improve their recruitment methods into the health sciences. Improved recruitment can lead to improved diversity and lessened health disparities.

In this dissertation, I explore postmodern choreographic engagements of pregnant bodies in the US over the last 70 years. I discuss how choreographers negotiate identification with the look of their pregnant bodies to maintain a sense of integrity as artists and to control representations of their gender and physical abilities while pregnant. I consider the utility for pregnant artists of filmic techniques, ironic mimicry of feminine stereotypes, obstruction or re-direction of the audience’s gaze, and refusal to be recognized as any familiar type of “woman.” I study how artists reimagine and restructure rhythm, duration, and spatial locations of movement based on perceptions of their pregnant bodies. I analyze fraught collaborations between artists with divergent experiences of pregnant bodies and pregnancy needs. I problematize choreographic processes surrounding pregnancy that present pregnancy as an experience indissociable from constructions of sex and gender, and I challenge and historically contextualize ideas about the “naturalness” of pregnancy, birthing, and motherhood. Finally, I examine dances exploring radical physical transformation inspired by experiences of pregnancy, and I consider how the artists of these works use choreography to create conditions and community that support their experiences of personal metamorphoses, that allow them to have queer orientations towards pregnancy, and that help them to practice care towards themselves in ways that they deem significant and otherwise unavailable. Across chapters, the artists discussed include Anna Halprin, Trisha Brown, Twyla Tharp, Sandy Jamrog, Jane Comfort, Jody Oberfelder, Johanna Boyce, Miguel Guti�rrez, Yanira Castro, No�mie LaFrance, Hana van der Kolk, Jennie MaryTai Liu, and Meg Foley. By presenting their bodies in performance, these artists demonstrate how their experiences surrounding pregnancy intersect not only with their artform and its history but also with their personal experiences of race, gender, and sexual identification. I argue that choreography offers them tools that are alternative to medicine (or other forms of social representation) for understanding what/how pregnant bodies do and feel and what they can mean for individuals and their communities. The works within these pages invite readers to see dancing bodies and pregnant bodies in new ways and for their potential to manifest new possibilities.

Meaningful quantitative research studies require the use of instruments that have acceptable validity and reliability. The purpose of this study was to determine the reliability and validity of the Medical Terminology 350 Final Test (MT350) in a population of secondary health science students. The MT350 is an assessment instrument that measures participants’ recall of medical terminology meanings and is currently being used to assess learning in health science education. A review of literature has revealed a lack of psychometric analysis of the commonly used MT350. Past practice has suggested instruction that uses mnemonics can favorably influence medical vocabulary retention, but an absence of valid and reliable assessment instruments prevented the proper research of the practice. Archival and anonymous data from completed MT350 results was used. Participants in this study consisted of secondary health science students from Tennessee and Missouri with a total sample size of 102 students. Internal consistency was determined through reliability analysis using KR20. Content validity was established through a review by 10 content experts from the fields of health and education. The experts were asked to rate each of the 350 items on a 3-point Likert type scale (3 = essential, 2 = useful, but not essential, 1 = not necessary). It was concluded that the Medical Terminology 350 Final Test (MT350) is a reliable measure of medical terminology retention.

Health science education has been moving towards a model of Interprofessional Education in order to meet the increasing demands of Interprofessional Practice in Healthcare, which focuses on delivering high quality patient centered care. This model of Healthcare will lead to improved patient outcomes and overall efficiency of healthcare. Another integral component between effective health care practice and the education of health professional students is the development of critical thinking skills. In order for healthcare professionals to communicate effectively with their patients and their families and also with one another, as in interprofessional practice, critical thinking skills are required. Therefore, critical thinking would be necessary for interprofessional education and subsequently interprofessional practice. Critical thinking in the different health professions needs to be addressed in order for interprofessional education and practice to be effective. Critical thinking is a multi- faceted concept and is influenced by a variety of factors. However, throughout the literature on critical thinking, the influence of these factors is not consistent. The primary purpose of this study is to identify the factor(s) that influence critical thinking skills in health science professional students. A concurrent triangulation mixed methods design was used in order to collect both quantitative and qualitative data concurrently and with equal weight. The quantitative design is descriptive and cross sectional, exploratory, and experimental to gather survey data on critical thinking scores and the potential factors influencing critical thinking. The qualitative design is a one phase convergent design to obtain different but complementary data on the same topic and to validate the quantitative with the qualitative to better understand the problem. One hundred and forty students from three private Universities’ accredited BSN programs participated in this study. Study results revealed that the overall critical thinking score of undergraduate nursing students was a moderate level as measure by the Health Science Reasoning Test (HSRT). There is a significant but weak relationship between critical thinking and job shadowing experiences (p= 0.10), between critical thinking and club involvement (p=.003), and between critical thinking and athletics (p=0.035). Students involved in clubs had significantly higher overall critical thinking scores than students not involved in clubs (p= 0.002). Students involved in athletics had significantly higher critical thinking scores than students not involved in athletics (p= 0.050). Surprisingly, the stepwise regression analysis revealed only 10% of the variance in the critical thinking scores due to the involvement of clubs and healthcare experience through job shadowing. Therefore, the difference in critical thinking scores must be due to other factors not explored here, and factors not predominantly mentioned in the literature as well. The qualitative component of the study revealed that the students were involved in more teacher centered learning activities and did not have a strong understanding of what critical thinking is and its importance. This study lends support to the position that student centered learning will foster the development of critical thinking skills. The more interactive learning strategies, and opportunities for the students to form social and academic networks, the greater the development of critical thinking skills. Therefore by engaging in the active learning opportunities, the students will have the opportunity to further develop critical thinking skills by practicing and applying these skills, ultimately making them more productive, collaborative members of interprofessional education and practice.

ABSTRACT Athletic training educational program directors use a variety of admission criteria to select qualified applicants who they anticipate will succeed academically and professionally. No standard sets of admission criteria exist for identifying a student’s ability to succeed in an entry-level master’s degree athletic training program or on the Board of Certification (BOC) examination. The purpose of this retrospective study was to investigate the relationship between entry-level master’s degree athletic training student demographic and academic factors and first- attempt passing rate on the BOC examination. The research questions examined the relationship between age, gender, admission grade point average (GPA), final GPA, and BOC exam success. Data (N = 73) from 3 Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level master’s athletic training education programs were used in this study. The results of the Pearson correlation indicated a positive relationship between admission GPA and final GPA and a positive relationship between final GPA and passing the BOC examination on the first attempt. With an increased demand for athletic training professionals (Bureau of Labor Statistics, 2012) and a new focus on the program outcomes by the accrediting association (CAATE, 2013), the results of this study will assist athletic training educators in selecting and preparing students who have the greatest potential to succeed.

This study identifies and articulates the interrelationships between six key components essential for authentic learning to maximise the student-centred learning opportunities in kitchen and garden-based learning projects. Interpretative case study methodology using multiple qualitative methods for data analysis were used to direct three layers of inquiry around kitchen and garden-based learning: the context, content and characteristics of kitchen and the garden-based learning, the student learning, and the teachers’ work. Review of the literature indicated significant gaps in understanding how teachers can foster children’s interest in nature, and plan for effective authentic learning experiences in the garden. Through analysis of the literature, together with the perspectives of the Grades 4, 5 and 6 children, and their teachers, key components for authentic, contextualised learning were identified. These included: a real-world context, the opportunity for working as professionals, within a collaborative learning community, work requiring higher-order thinking, ownership of learning and authentic integrated assessment. Teachers’ pedagogy and practices are often hidden but were nevertheless significant factors affecting student outcomes. Teachers made the learning experiences more meaningful by ensuring student reflection was embedded in learning tasks. Planning and providing arenas or “safe platforms” for discursive reflection was an essential step in transforming tacit understandings to explicit knowledge enabling children to connect their personal experiences with the experiences of others. From this discourse deeper understanding of ecoliteracy emerged with one cohort, and understandings about the intricacies of collaborative teamwork with another. The focus group discussions about common experiential learning experiences had wider implications for teaching; they were a key step in making the children’s tacit understandings explicit. Examination of the staff and students’ immersive experiences within a kitchen garden learning environment, led to the development of a model of learning that provides educators with a comprehensive approach to scaffold authentic learning opportunities.

The overarching research topic for this study is the issue of effectively engaging and informing community and government decision makers about health issues that can negatively impact a community's resilience. The question guiding this study is how can formative research engage and inform community and government decision makers about the under addressed issue of youth problem gambling (YPG) in Windham County, Vermont? The study has two aims: 1) to develop a formative research conceptual framework and evaluate its effectiveness in addressing the public health issue of youth problem gambling, and 2) to use the formative research methodology to develop a better understanding of Windham County community dynamics relative to the public health issue of youth problem gambling.As defined in this study, formative research is the first stage of a health intervention initiative through which the dimensions, dynamics, stakeholders and general community awareness and understanding about a health challenge are established (Gittelsohn, J. Steckler, A. and Johnson, C. 2006; Valente, 2002). Research methods included interviews based upon snowball sampling, focus groups, journaling, relevant document review and informal conversations. Interview analysis was based upon Computer Aided Thematic Analysis (CATA) and developed within the framework provided by Greenhalgh et al's (2005) five-step qualitative research protocol. The study's conclusions, as well as informing next steps for approaching the under addressed issue of youth problem gambling in Windham County, Vermont, establish the broad applicability of formative research as a methodological approach for addressing all public health concerns whether the health risk is socio-economic, political, environmental and/or spiritual in origin.

Two isozymes of triosephosphate isomerase have been isolated to homogeneity from human placenta. Triosephosphate isomerase A and triosephosphate isomerase B were compared in terms of their chemical, and biological properties.

Histidine-rich protein from newborn rat epidermis has been further characterized. Polyacrylamide gel electrophoresis in 8 M urea demonstrated dissociation of the protein, a possible oligomeric series, and one major band with two minor bands of the, pH 5.0 precipitate. Amino acid analysis correlated well with previous analyses (except for lower levels of histidine), while the amino acids of high content increased with purification. Sedimentation coefficients and molecular weights determined by ultracentribfugation of all monomers and the residual tissue in histidine-rich protein were in agreement with estimates from gel filtration chromatography. Lower values were obtained for keratohyalin granule proteins. Isoelectric focusing indicated diisoelectric properties of the protein. A molecular model of deamidation is presented in an attempt to explain this property.

A modified ascending thin layer chromatographic technique has been developed which resolves the major phospholipid and neutral lipid classes of five common fluids and tissues. A one-half milliliter sample is extracted with n-butanol:diisopropylether (40:60 by volume, cholesteryl acetate = 100 ng/ul) for thirty minutes and the organic phase is spotted onto a thin layer chromatography plate and carried through three successive chromatographic developments. The lipids are then visualized either by charring with ammonium bisulfate or staining with phosphomolybdic acid. The use of cholesteryl acetate as an internal standard enables quantitation of the phospholipids and neutral lipid classes. This method may be a very valuable, new technique for research and clinical laboratories.

The purpose of this study was to examine the ventral prostate from Sprague-Dawley rats of the ages two, twelve, and twenty-four months to determine the extent of histological and fine structural change. The tissue was processed for routine light and electron microscopy.