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Correlation of anatomy and medical imaging is foundational to radiology (medicine). Experts do this well, but we have little understanding of how they learn to do so. Knowing where our novices' understanding begins in making this correlation can aid us in helping them transition to being experts. Studying how experts and novices make these correlations is challenging because of the lack of an efficient and direct way to make/observe how this task is performed. Simulation in healthcare has provided opportunities to learn about clinical conditions/treatments and acquire new skills in a safe environment that is not possible in direct patient care. Building upon this model, I developed a simulation tool that incorporates medical imaging with the physical examination to directly investigate this correlation. With this simulation tool and specifically designed clinical interview, access to thought processes and context of these thoughts were gained during specific tasks novices and experts performed while correlating the physical exam and medical imaging. The participants localized a target image within the body, assessed the correctness of a peer localization of a target image and the normality of an anatomical structure, and evaluated the safety of a biopsy approach. A mixed methods approach kept the research question central to the investigation. Experts were faster than novices when localizing a target image in the simulation, and used fewer movements. Experts approached each event from a clinical perspective drawing upon past experience, whereas novices evaluated each event in literal context. Novices often used non-anatomic cues and incorrect terminology, and experts recognized meaningful patterns not noticed by novices. Although experts and novices had differences, they demonstrate similar skills in recognizing correctness in peer assessments. I attribute this to differences in recall and recognition. Recognition is easier than recall because it bypasses the retrieval process.The cognitive differences in novices/experts provide meaningful insight in the development of educational programs that promote learning. This work indicates the importance of teaching anatomy, physical examination and imaging together. Furthermore, novices' prior knowledge/experience can aid in the recognition of related concepts within a domain. These factors should be capitalized upon when developing new curriculum. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Background: Elderly people who demonstrate memory impairment that falls short of dementia, are referred to as having amnestic Mild Cognitive Impairment (aMCI). AMCI patients have an elevated risk of developing dementia, although not all will do so. Clinical criteria for Alzheimer's Disease (AD) and aMCI do not specify how impairment of a cognitive nature should be defined. The process of differentially diagnosing these conditions can be improved, if knowledge of neuropsychological measures that best discriminate between neurodegenerative and non-neurodegenerative cognitive impairment is used to implement diagnostic criteria for aMCI and AD. Aims: We sought to 1) determine the frequency of aMCI referrals to our specialist memory clinic, 2) characterise the detailed neuropsychology of a group of patients with aMCI, 3) determine the utility in differential diagnosis and test-retest reliability of these neuropsychological measures, and 4) establish a subset of neuropsychological measures that were of prognostic utility in aMCI. Methods: The case notes of 187 consecutive referrals received by our Royal Edinburgh Hospital memory assessment service across an 18-month period were reviewed retrospectively and numbers of patients fulfilling aMCI criteria were recorded. The baseline neuropsychological performances of 46 patients with aMCI, 20 patients with very early stage AD, 20 elderly patients with depressive symptoms and 24 healthy elderly participants were compared in order to determine their usefulness in differential diagnosis. AMCI participants were followed-up across an average of 4 years. Baseline neuropsychological performances of the aMCI dementia converters and aMCI non-converters were compared. Logistic regression analysis was applied to ascertain the predictive accuracy of a combination of these. Results: One quarter of referrals received by our memory assessment service met criteria for aMCI, most of whom displayed additional neuropsychological impairments of a non-memory nature, all the while performing above the highest cut off points on even the most comprehensive dementia screening measures. A number of neuropsychological measures were highly sensitive and specific to early AD however, similar combinations of both high sensitivity and specificity to aMCI were not achieved. Forty one percent of patients presenting to our service who fulfilled criteria for aMCI, received a clinical diagnosis of dementia across an average 4-year period. Performances on a comprehensive cognitive screening measure and a measure of delayed word recognition accuracy at baseline, classified 74% of aMCI patients comprising our clinic sample in accordance with their prognostic fate. Conclusion: A significant proportion of patients presenting to specialist memory clinics display episodic and semantic memory or executive impairment that falls short of dementia and that is not detectable using traditional bedside screening measures. The vast majority of such patients (i.e. 72%) experience persisting or progressive cognitive impairment, and a significant proportion (41%) go on to receive a clinical diagnosis of dementia. The baseline neuropsychological performance of aMCI patients who do and do not develop dementia differs, and contributes over and above clinical information to the prediction of long-term diagnostic outcome. The high frequency with which aMCI is encountered in clinical practice, coupled with the minority of aMCI patients who experience resolution of their cognitive impairment, and the sensitivity and prognostic utility of several neuropsychological tasks, has implications for the clinical management of patients with aMCI.

This thesis concerns musical identities and how they affect health as young people make the transition to adulthood. The primary focus is on music listening, since this is widely reported to be a key feature of adolescents’ and young adults’ leisure time (Roe 1999; Tarrant, et al 2000). Previous studies have investigated the links between specific musical genres and problematic behaviour (Klein 1993), suicidal risk (Lacourse 2001), and emotional turmoil (Roberts 1998), however there is a lack of both longitudinal and qualitative evidence in support of these findings. A number of assumptions are made regarding ‘healthy’ and ‘unhealthy’ musical preferences although causal links between music and health are still not clear. Similarly, the extent to which musical behaviour is related to other demographic features (e.g. sex, social class, education) and whether this changes over the lifecourse have yet to be fully investigated. The principal aim of the thesis is therefore to identify how musical identities relate to health and wellbeing over the youth-adult transition. In order to meet this aim a number of objectives have been devised, these are; to trace the development of musical identities and investigate the structure of music preference; to highlight associations between musical identity and risky health behaviours; to study the relationship between musical identities and emotional wellbeing; and to address the significance of musical identities in transitions to adulthood. A dialectical methodology was adopted which synthesises quantitative and qualitative methods. The former involved statistical analysis of a large-scale longitudinal dataset (The West of Scotland Twenty-07 Study). The latter was a qualitative sub-study with 18 participants from the Twenty-07 Study, designed and analysed using Interpretative Phenomenological Analysis (IPA). Combining methods in this way allowed for philosophical pluralism in the methodological design, as well as for different aspects of the research aims to be addressed. Musical preferences were found to change over the youth-adult transition for most people, and this affected the links between musical identity and health. The overriding distinction was between participants who perceived a strong musical self-identity, and those who claimed a more limited identity. This was evidenced in both quantitative and qualitative findings. The former group were more likely to engage in risky health behaviours, but also indicated a more sophisticated use of music for therapeutic purposes. The latter group were less likely to engage in risky health behaviours, but did not tend to use music as a well-being resource like their strong-identifying peers. Strong musical identities are associated with higher levels of risky health behaviours, but this is also largely limited to a specific period of youth. Many practices associated with maintaining a strong musical identity in youth are limited by the onset of adult responsibilities, and structural identities. The emotional benefits associated with a strong musical identity, however, remain alongside adult identities. Ultimately, the associations between music listening and health are mostly influenced by strength of identity, and the current academic literature highlighting ‘problematic’ genres should be considered with this in mind. The implication of this work is that common sense assumptions about the corrosive nature of certain musical identities and youth cultures should be tempered by an acknowledgement that music tastes, associations, and identities are subject to change, often over very short periods of time.