Magister Curationis - MCur / The nursing profession is the backbone of the healthcare system glob-ally. However, due to the ongoing shortage of nurses there is a growing demand for nurses across the world. This demand puts pressure on the continued recruitment of new nursing students. The factors that influence students’ reasons for entering nursing vary and require investigation to improve recruitment practices

Magister Curationis - MCur / The nursing profession is the backbone of the healthcare system glob-ally. However, due to the ongoing shortage of nurses there is a growing demand for nurses across the world. This demand puts pressure on the continued recruitment of new nursing students. The factors that influence students’ reasons for entering nursing vary and require investigation to improve recruitment practices.

Immunological heterogeneity is the norm in most free-living vertebrate populations, creating a diverse and challenging landscape for pathogens to replicate and transmit. This dissertation work sought to determine sources of immunological heterogeneity, as well as the consequences of this heterogeneity on pathogen fitness and evolution. A major source of heterogeneity in free-living host populations is the degree of exposure to a pathogen, as well as a host's history of exposure to a pathogen, which can create variation in standing immunity. We sought to determine the role of exposure heterogeneity on host susceptibility and immunity to secondary infection, and the influence of this heterogeneity on pathogen fitness and virulence evolution in a wild bird-bacterium system. We first determined that exposure level has a significant effect on host susceptibility to infection, severity of disease and infection, as well as immunity produced to secondary infection. Subsequently, we tested whether exposure history, and the immunity formed from this previous exposure, altered the within-host fitness advantage to virulent pathogens. We determined that previous low-level repeat exposure, which wild hosts likely encounter while foraging, produces a within-host environment which greatly favors more virulent pathogens. While within-host processes are vital for understanding and interpreting the evolutionary pressures on a pathogen, the ultimate metric of pathogen fitness is transmission. We therefore tested whether exposure history altered the transmission potential of a host and whether prior host exposure selected for more virulent pathogens. The transmission potential of a host significantly decreased with previous exposure, and high levels of previous exposure selected for more virulent pathogens. While we anticipated selection to be strongest at low-levels of exposure based on our previous results, we found here that high doses of prior exposure resulted in the strongest transmission advantage to virulence. This study also provided insight into the nuanced nature of transmission, which our results indicate is determined both by the degree of within-host pathogen replication as well as host disease severity. Together, our findings underscore the importance of exposure level and exposure history in natural populations in determining susceptibility, immunity and pathogen virulence evolution. / Doctor of Philosophy / Infectious diseases disrupt and threaten all life on this planet. To better anticipate and understand why some diseases are more harmful than others, it is vital that we consider the natural variability that exists in animal populations. A major source of variation in populations that experience disease is exposure level to a pathogen, as well as the history of exposure to a pathogen, which can alter an individual’s protection against future exposures. We sought to determine the role of exposure level on the likelihood of an individual contracting an infection, their protection from future infections, and the influence this has on pathogen evolution in a wild bird-bacterium system. We determined that exposure level has a significant effect on the likelihood an individual has of becoming infected, how severe the infection became, as well as how protected they were from future infections. Subsequently, we tested whether exposure history, and the immunity formed from previous exposure, altered the ability of pathogen strains that cause different levels of harm to replicate. We determined that previous low-level exposure, which hosts likely encounter in the wild, creates a level of immunity that favors more harmful strains of the pathogen. While understanding what happens within a host is important, the ultimate metric for predicting whether more or less harmful types of pathogens will persist is the ability of each pathogen type to spread from one host to another. We therefore tested whether exposure history altered the spread potential of a host and whether previous exposure preferentially favored the spread of more harmful pathogens. The spread potential of a host was much lower if that host had previously been exposed to the pathogen, and high levels of previous exposure in hosts only allowed the more harmful pathogen types to spread. We also found that a host’s spread potential was the result of both how much pathogen they had in their body, as well as how inflamed their affected tissues were. Together, our results indicate that natural variation in prior exposure to pathogens, which is common in all animal populations, including humans, can favor more harmful pathogen types.