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Introduction: Following reductions in bacterial meningitis which occurred in the UK due to the implementation of vaccine programmes, contemporary knowledge was needed about the current aetiology of childhood meningitis in the context of historical changes in epidemiology, how to reliably distinguish bacterial and aseptic meningitis at presentation to hospital, and outcomes particularly following viral meningitis. Methods: Annual hospital admission rates were analysed for bacterial and viral meningitis in children <15 years in England from the 1960s to 2011. Data from a prospective cohort study performed across 31 UK hospital sites from 2012-2016, recruiting children <16 years with confirmed or suspected meningitis was used to investigate current aetiology, clinical and laboratory features, clinical decision models to distinguish bacterial and aseptic meningitis, short term outcomes at 3 months post-discharge and health-related quality of life until 18 months post-discharge. A study of enteroviral (EV) PCR from non-CSF sites in a subset of participants with suspected or confirmed viral meningitis was also performed. Results: Hospital admissions datasets demonstrated a reduction in bacterial meningitis of different aetiologies after the introduction of different vaccines, a reduction in viral meningitis admissions in children >1 year since the 1980s, but a recent increase in viral meningitis admissions in infants. Of 2754 prospectively recruited children with suspected meningitis, 892 had meningitis, of which 80.7% (720/892) were aseptic, 34.2% (305/892) were caused by enteroviruses and 31.3% (280/892) had no identified aetiology. Following analyses of clinical and laboratory features of meningitis of different aetiologies, a pre-existing bacterial meningitis score was assessed, and a new clinical decision model was developed to distinguish aseptic from bacterial meningitis at hospital presentation. In a subset of children, EV-PCR performed on non-CSF samples demonstrated that in EV meningitis all available stool samples were EV-PCR+, and 35% of children with aseptic meningitis of unknown aetiology had a stool EV-PCR+ result. Analysis of short term outcomes and health related quality of life indicated that although sequelae and lower quality of life scores occurred most often following bacterial meningitis, for enteroviral meningitis parental concern about sequalae and limited lower quality of life scores were reported compared with a control group. Conclusion: These data could inform priorities for prevention and improve the care of children with meningitis.

When Turkey became a candidate of the EU in 1999 it had been a problematic applicant for forty years due to residual unpopularity with several member states for cultural, economic, security and normative reasons. However, the Helsinki European Council heralded a change of fortunes for Ankara and by 2005 accession negotiations had opened. This happened in spite of Turkey remaining an unpopular candidate with some member states. Moreover, since 2005, Turkey s standing within the EU has returned to a position akin to its pre-1999 stasis. This thesis thus asks: why did Turkey make such progress between 1999 and 2004/5? What was the specific configuration of structures, processes and actions that enabled that to happen then but not before or after? The thesis approaches this puzzle using a stretched eclectic version of Historical Institutionalism which can incorporate the effects of both structure and agency. In this way it can include the influence of wider structural factors, such as CEEC enlargement, Cyprus and ESDP as well as the agency of Turkey s advocates within the EU. It is a detailed qualitative process-tracing study which uses semi-structured interviews and documentary evidence to make a case for a given explanation. It concludes that a path dependent process, influenced by both structure and agency, can be traced from the Helsinki European Council to that in Brussels five years later which rhetorically entrapped the member states into agreeing to open accession negotiations in spite of Turkey s underlying unpopularity. By adopting this framework for analysis, the thesis makes a contribution to the literature on the Turkey-EU accession process by viewing the time period as a whole and taking a temporal rather than a snapshot approach. In so doing it is possible to explain why and how Turkey was able to make such progress between 1999 and 2004. It is also valuable in the study of present Turkey-EU relations as the ultimate conclusion has to be that there was a unique window of opportunity for both Turkey and the EU during this time and the window may now have closed.