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This work is aimed at understanding and unifying information on epidemiological modelling methods and how those methods relate to public policy addressing human health, specifically in the context of infectious disease prevention, pandemic planning, and health behaviour change. This thesis employs multiple qualitative and quantitative methods, and presents as a manuscript of several individual, data-driven projects that are combined in a narrative arc. The first chapter introduces the scope and complexity of this interdisciplinary undertaking, describing several topical intersections of importance. The second chapter begins the presentation of original data, and describes in detail two exercises in computational epidemiological modelling pertinent to pandemic influenza planning and policy, and progresses in the next chapter to present additional original data on how the confidence of the public in modelling methodology may have an effect on their planned health behaviour change as recommended in public health policy. The thesis narrative continues in the final data-driven chapter to describe how health policymakers use modelling methods and scientific evidence to inform and construct health policies for the prevention of infectious diseases, and concludes with a narrative chapter that evaluates the breadth of this data and recommends strategies for the optimal use of modelling methodologies when informing public health policy in applied public health scenarios.

Although forensic biology is a powerful tool in criminal investigations, there are a number of capability gaps; namely, the interpretation of low-level DNA mixtures, associating the DNA profile with a body fluid, and the issue of consent in sexual offences. A research strategy was developed that utilises whole genome amplification (WGA), messenger RNA and microRNA analysis, DNA profiling, and clothing damage analysis. An evaluation of a WGA technique – multiple displacement amplification - with and without a macromolecular crowding agent, indicated that this may be of use for DNA samples containing certain mixing ratios; however, for this to be truly of use, knowledge of the nature of the sample preanalysis is required, which is not feasible in a forensic environment. A SYBR Greenbased mRNA gene expression test was developed that was capable of distinguishing between saliva and blood by using relative quantitation on real-time PCR. However, the low specificity of the SYBR Green meant that a higher number of controls were required for this to work at forensic standard. A single channel simultaneous analytical test for DNA and microRNA was also developed, which meant that it could be possible to definitively identify the body fluid origin of a DNA profile. This represented a significant step forward in improving forensic biology capability. Reconstruction studies were carried out in response to a sexual assault case where consent was an issue. This study demonstrated that it was possible to cause significant damage to a bra without causing damage to the hook and eye fastening; thus, negating a hypothesis offered by the defence. A long term research strategy has been developed and significant progress has been made in improving the capability of the operational forensic biologist.

This dissertation will explore the lives, experiences and medical histories of diseased almshouse women living in late eighteenth and early nineteenth century Philadelphia. During this period Philadelphia matured from being a relatively small colonial city into a major manufacturing metropolis. Venereal disease was omnipresent in America’s major port city, and diseased residents were surrounded by a thriving medical marketplace. Historians have identified the “who and why” of prostitution, however the scope of the prostitute experience has yet to be fully explored. This dissertation will address a considerable and important gap in the historiography of prostitutes’ lives as it actually affected women. Venereal disease was an ever present threat for women engaging in prostitution, however casual, and historians have yet to illuminate the narrower aspects of the already shadowy lives of such women. Whether intentionally or by omission, historians have often denied agency to prostitutes and the diseased women associated with them, the effect of which has drained this group of sometimes assertive women of any individuality. While some women lived in circumstances and carried out activities that came to the attention of the courts, others lived more understated lives. A large proportion of the women in this study led the lives of “ordinary” women, and prostitution per se was not the only focal point of their existence. For many almshouse women their only unifying variables were disease, time and place. While prostitutes were often victims of economic adversity, they made a choice to engage in prostitution in the face of hardship and sickness. The overall aim is to consider the diseased female patient’s perspective, in an effort to illuminate how she confronted venereal infection within the context of the medical marketplace. This includes the actions she took, and how she negotiated with those in positions of authority, whose aim was sometimes -although not always- to curtail her activities. As many diseased women became more acquainted with the poor relief system of medical welfare, they were able to manipulate the lack of coherent strategy “from above”, which left room for assertive behaviour “from below”. Diseased women did not always use the almshouse as a last resort-institution as historians often have us believe. Many selected the infirmary wing as opposed to other outlets of healthcare in Philadelphia, a city that was often labelled the crucible of medicine. There is also an oft-believed notion that prostitutes and lower class women suffering from venereal disease were habitually saturated with mercury “punitive-style” as treatment for their condition. This argument does not hold for those women who were cared for in the venereal ward of the almshouse’s infirmary wing. Broadly speaking, almshouse doctors did not sanction drastic depletion and the use of mercury compounds unless deemed absolutely necessary. Many almshouse doctors adopted a different therapeutic approach as compared with that of Benjamin Rush and his followers who dominated therapy at the Pennsylvania Hospital, a voluntary institution mostly closed off to venereal women. Such medical differences reflected wider transformations in ideas of disease causation, therapeutic approaches, medical education as well as doctor-patient relationships.

A growing body of evidence now exist, which suggests that Healthcare Associated Infections (HAI) are a major cause of morbidity and mortality. There is, however, a paucity of empirical knowledge and evidence-base of the role of Facilities Management (FM) in the control of HAI. Therefore, the main aim of this research was to investigate the role of FM in the control of HAI. The focus of the study is on domestic services. The research methodology of the study employed both qualitative and quantitative approaches. Altogether, 81 interviews were carried out involving experts in the areas of FM and HAI in the National Health Service (NHS). The qualitative data collected was analysed using content analysis. The qualitative data sets were then augmented by 412 completed questionnaires. The quantitative data sets obtained were subjected to rigorous statistical analyses. The study concluded that FM has a major role to play in the control of HAI, mainly in terms of cleaning, catering, waste management and laundry and linen services. However, FM is yet to feature prominently in the ‘control of HAI agenda’ in the NHS. There is evidence and lack of clarity on the roles and clear lines of communication between the major players in the control of HAI in FM services. There is a relatively low level of integration between the clinical teams and FM teams in the control of HAI. The roles and benefits of knowledge management and performance management are yet to be fully exploited in FM services in the control of HAI. A Performance Management Framework (PMF) for the control of HAI in FM services (particularly in domestic services) have been developed, tested and validated. The study recommends, inter alia, that FM should be made integral to the core services in hospitals for effective control of HAI. A national training and education framework for FM teams should be developed in order to enable them to carry out their work to the highest standards. There is also a need to adhere to a Performance Management Framework (PMF), which allows FM services to monitor and measure the performances in the control of HAI. The research methodology employed in this study could be replicated in different countries, including developing countries. There is also scope to research the key motivational constructs associated with effective knowledge sharing between the domestics and ICT teams in the control of HAI.

During the past three or four months, May to July 1918, there has been a great pandemic of so-called influenza which, starting in Spain, has spread over the whole of Europe and even other parts of the world. It has caused considerable wastage in our own Army and those of our Allies and has, therefore, been the object of much study amongst the medical services.

This dissertation examined an implementation gap through a case study on implementing a District Health System (DHS) in the Western Cape Province of South Africa between October 2001 and April 2006. The research project explored why this implementation gap existed and what could be learnt about public policy implementation from studying this implementation gap. The main data collection methods included interviews, public and other documents and observations on the public health system in the Western Cape Province. I argue that implementation gaps could be interpreted as a signal of policy change instead of implementation failure. The key finding is that the Provincial Government of the Western Cape shifted its intentions regarding DHS implementation. The initial intention was to decentralise primary health care services to a metropolitan municipality. The decision, which was actively implemented, however centralised these services within the provincial government and started the process of the provincialisation of personal primary health care services in the Western Cape Province. This dissertation contributes to public policy implementation and public policy process literatures. It demonstrates why policy change is an alternative interpretation of implementation gaps to implementation failure and how policy change occurs during implementation. Policy change and public policy implementation are commonly two separate research themes within Public Policy Studies. The persuasion framework developed through this research project is an analytical tool that may be applied in research on implementation processes to examine whether an implementation gap is signalling policy change. The central theoretical elements in this framework that link policy change and implementation processes are the interactive effects of ideas and interests and the role of argument as a persuading factor that leads to policy change. The dissertation emphasises the role of language in public policy processes and argument and persuasion were deemed important elements in public policy processes.

This thesis summarises a selection of forty-two studies [1-42], published by the author during the period 2000-2012, investigating the conceptual basis of Insomnia Disorder, and its evaluation and treatment, principally using cognitive and behavioural interventions. The work reflects a range of research methodologies including experimental, psychometric, qualitative and population-based studies, and randomised controlled trials. Important theoretical contributions to the literature published in this period are also included and reference is made to major textbooks, position papers, and influential chapter contribution.

There is a dearth of smoking research involving young children despite the knowledge that the developmental proocess begins in early childhood. This paucity hinders the development of effective smoking prevention strategies, which need to be based on an accurate understanding of the perspectives of the target group. Therefore basic research is required, to discover where primary school children are at in their thinking about smoking before any potent anti-smoking initiatives can be devised. Such an endeavour however, is exacerbated by the lack of appropriate methods of data collection for this particular age group. The aim of this research study was to explore the perspectives that Liverpool primary schoolchildren in their early years (four to eight years of age) have about smoking by examining the beliefs, knowledge, perceptions and behavioural intentions that inform their attitudes about the habit and subsequently, to assess any changes in these factors over time. This work not only provides the understanding and insight fumdamental to the development of proactive health promotion programmes aimed at tackling the increasing prevalence of smoking among local children but also the empirical evidence needed to fill the significant gap in the existing literature on smoking as well. To achieve these aims ,a multi-method, child-centred participatory approach was used. This between-methods traingulation included questionnaires The Draw and Write Technique, semi-structured interviews and focus group interviews. For the cross-sectional study, a representative sample of primary schoolchildren in their early years from wards of varying socio-economic status participated. All were involved in the quantitative method and a subsample partook in the qualitative methods. For the longitudinal study, the same research design was used to track one birth cohort - the children from Reception for a period of three years to document any changes in perspective over time. The research findings from both studies demonstrated that the children in this investigation had considerable understanding about the nature of tobacco smoke, had as yet to take up the habit and generally expressed little intention to smoke in the future. Their perspectives were predominantly negative, very stable and relatively homogenous. They were grounded in a broad knowledge base that was primarily influenced by cognitive development and socio-cultural experiences. They acknowledged the importance of the family and perceived parents to be both preventers and promoters of the habit. The children also harboured some misconceptions, believing that the health implications from smoking were far greater for children than adults. This belief has cultivated a widespread notion that smoking is an intrinsic part of adulthood. The study findings have substantive implications for the development of proactive smoking interventions in primary schools. The results suggest that any prevention strategy devised must be implemented as early as possible in the school curriculum, that it should be developmental in nature and more than knowledge- based. A grass roots approach, one that fosters empowerment tbrough the active involvement of the children in both the development and implementation of the strategy, in collaboration with the school, the home and the community is recommended, as this work has confirmed that children in their early years can be reliable and valid participants in the research process.