This study aims to investigate the physical properties of particles and their implications for source apportionment and health human exposure studies. A wide range of particle number size distribution (PNSD) measurements was conducted in selected environments using state-of-the-art high time resolution instruments. It is found that PNSD varied in different environments, depending on emission sources and atmospheric processes. A mass balance model was used to predict the penetration, infiltration factors, deposition and loss rates of indoor particles. The loss rates of indoor particles, which are mainly subject to deposition, coagulation and evaporation, were found to be a function of particle size and time. Moreover, HTDMA measurements were performed to study the hygroscopic properties of particles in outdoor and indoor environments, and from five major indoor sources. The particles emitted from indoor sources were mostly hydrophobic. An enhanced lung deposition model based on the ICRP and MPPD models was developed to predict the deposition fraction of particles in the human respiratory tract, with consideration of their hygroscopicity. Furthermore, a combination of lung deposition models and the PMF technique was applied to identify which sources are mostly responsible for deposited particles in the different regions of lung.

A significant number of patients requiring adoptive T-cell therapy (ATCT) need to resort to third party donors; we aimed to find ways to optimise ATCT from third party donors in EBV-associated diseases. Firstly, we evaluated the T-cell response to 29 EBV-restricted peptides in a cohort of 100 healthy donors. For each peptide we found at least one high-responding donor. Also, we compared the efficacy of different separation techniques. These results support the setting up of a registry of third party donors, to provide fresh EBV-specific T cells for ATCT. Secondly, we investigated the mechanisms generating T memory stem cells (T_SCM), which are considered most suitable for ATCT. We demonstrated that homeostatic cytokines revert recently differentiated CD8⁺ memory T cells from cord blood (CB) to cells with a T_N-like phenotype (T_Nrev) and T_SCM-like characteristics. Finally, we compared phenotype and function of CD8⁺ T cells from peripheral blood and CB, after transduction of an EBV-specific TCR. Transduction efficiency, growth kinetics and cytolytic activity were comparable. However, TCR-transduced CB T cells showed less differentiated phenotype, increased multi-cytokine expression, and lacked expression of the senescence marker CD57. These data suggest that survival of engineered T cells in vivo is likely to be improved by using cells from CB.

The first paper is a literature review which examines how women with a learning disability experience breast and cervical cancer screening, as well as how these procedures can be made more acceptable and accessible to them. Fifteen papers are reviewed and critically appraised. Learning disabled women tend to feel anxious at the prospect of these screening tests although for some, it is said to facilitate a feeling of connectedness to a ‘sisterhood’. The presentation of a DVD may be more worthwhile than lengthy classroom interventions in increasing preparedness for screening in this population. Simple adjustments, such as having accessible information, have been shown to make the process of screening more acceptable. Researchers are encouraged to use creative outcome measures which are not knowledge based when conducting research with individuals who have learning disabilities. The second paper is an empirical study which explores what women with a learning disability think makes a good mother. Eight women with a learning disability were recruited and interviewed on a one-to-one basis. Interpretative Phenomenological Analysis is used to analyse the resulting data into themes. The women spoke about the variety of skills needed to make a good mother, including an ability to show love and provide sensitive discipline. Many themes mirror principles of Attachment Theory, including an appreciation of reciprocity within a mother-child relationship. Some of the women interviewed feel mothers with a learning disability are stigmatised and are frustrated by this. An unexpected theme around bereavement frequently arose and is also included.

Hospital acquired infections is a modern day reality which plagues health care system around the world. Infections are the cause of 37,000 deaths and a 20 billion euro expense in EU annually. Despite the attention that such infections receive in scientific literature, very few viable solutions have been put forward and implemented. This study systematically developed, characterised and optimized novel long-lasting antibacterial surface coatings for use in medical devices, surgical instruments and hospital equipment. The reactive magnetron-sputtering deposition technique was successfully employed to combine the high mechanical performance of the nitrogen AISI 316 S-phase coating and the antibacterial efficacy of the elements silver and copper. Various configurations including homogeneous monolayers and layered multilayers were investigated for the first time in literature. It was found that substitutional silver and copper atoms can reside within the S-phase lattice while the good corrosion and wear resistance of S-phase are maintained by carefully controlling deposition parameters. Silver was observed to significantly increase the nitrogen uptake up to a previously unreported level of 50at% which has been termed 'ultra-saturation'. Copper based multilayers were found to have a 100% bacteria elimination rate, while silver monolayers also exhibited a good antibacterial efficacy against Staphylococcus aureus.

This thesis focuses on three different parts: (1) An analyses of dietary consumption, diet diversity and risk of developing bladder cancer within a case-control study in China. This study showed that higher diet diversity, particularly a diet varied in fruit may reduce the risk of developing bladder cancer. In addition, there was a positive association between the consumption of red meat, organ meat, leafy vegetables, bulb vegetables or preserved vegetables may increase the risk of bladder cancer. The consumption of citrus fruits, stone fruits, vine fruits, flower vegetables, fresh fish, potatoes and dairy products may decrease the risk of developing bladder cancer. (2) A dose-response meta-analysis on the association between total fluid consumption and bladder cancer was conducted. The results of this study suggest a non-linear relationship between total fluid intake and bladder cancer risk in men. Also, the findings indicates that low to moderate fluid consumption was not associated with an increased risk of developing bladder cancer; although fluid consumption exceeding 8 cups per day might increase the risk of developing bladder cancer. (3) A pooled analysis on fluid consumption and risk of developing bladder cancer using individual patient data from the Bladder Cancer Epidemiology and Nutritional Determinant consortium. The results suggest that excess consumption of coffee per day may increase the risk of developing bladder cancer in men.

China is facing epidemic of cardiovascular disease propelled by obesity, hypertension, dyslipidaemia, and hyperglycaemia. Epidemiological studies are continuing to show an increase in the prevalence of the aforementioned cardiovascular disease risk factors in the Chinese and studies are yet to shown signs of abating. Diet is able to affect the cardiovascular function by influencing the risk factors but very little is known about the diets of the Chinese. This thesis identified three dietary patterns (Non-nut and Non-cruciferous Vegetable, High Protein-High Fat, Omnivorous) using principal component factor analysis and examined the cross-sectional relationships with hyperglycaemia, hypertension, and metabolic syndrome in 20,146 middle-aged and older Chinese adults. The Non-nut and Non-cruciferous Vegetable diet was adversely associated with hyperglycaemia and the metabolic syndrome but showed no association with hypertension. The High Protein-High Fat diet was associated with reduced risk of hyperglycaemia and hypertension but exhibited no relationship with the metabolic syndrome. The Omnivorous diet was inversely associated with hyperglycaemia and the metabolic syndrome but demonstrated an adverse association with hypertension. In addition, the thesis developed a conceptual model and highlighted the putative mechanisms mediating the relationships between the High Protein-High Fat diet and cardiovascular disease risk factors using the structural equation model.

Patient chronic illness and disability impacts the health of family members and household members who experience psychological distress and care burden. These impacts, known as ‘health spillovers’, are typically ignored in economic evaluations, despite being relevant to ensuring maximum health benefits from scarce resources. This thesis explores methods for including health spillovers in economic evaluation. Three empirical studies were carried out. The first study generated evidence supporting the validity of the EQ-5D-5L and SF-6D for measuring health spillovers. The second study examined the health spillover from a behavioural intervention on related household members’ outcomes. Further trials are warranted which measure household member outcomes for patient health interventions. The third study demonstrated and applied a methodology which could be used to include health spillovers in a cost-utility analysis. The general conclusion is that family member costs/outcomes should be systematically accounted for in extra-welfarist economic evaluations, and though there remains uncertainty about the best way to achieve this, the findings from this thesis show that this is possible and advance the methods forward.

Rates of suicide amongst young people with a first episode of psychosis are significantly higher than those of the general population. Psychological theory demonstrates that protective and moderating factors that buffer risk against suicidality are important for understanding why people think about, attempt and are successful at killing themselves. A literature review was conducted to identify the factors that reduce the risk of suicidality specific to people experiencing psychosis. Positive self­ appraisals, social support, daily activities, coping, negative symptoms of psychosis, and low IQ were found to protect against suicide amongst people with psychosis. An empirical study was then conducted to investigate whether the moderators (i.e. thwarted belongingness, perceived burdensomeness and acquired capability) outlined in the Interpersonal-Psychological Theory can distinguish between young people with a first episode of psychosis who think about suicide and those who attempt suicide (N=45) using self-report measures. The concepts of the Interpersonal­ Psychological Theory appear to resonate with the experience of psychosis, regardless of suicidality. This may explain why this study was unable to distinguish between those who just think about suicide and those who attempt in a psychosis population. Future research could assess specific features of psychosis and their influence on suicidality.

Background: Several studies have documented differences between individuals from different ethnic groups in terms of the way in which medications are viewed. These views can potentially impact on medication adherence. However, comparisons of adherence between rheumatoid arthritis (RA) patients from other minority ethnic groups and South Asians have not been reported. Method: Two studies were undertaken in patients with RA: a quantitative survey (180 patients) to investigate the relation between demographic, diseases related and psychological variables and a qualitative study explored the reasons for poor adherence to medications used in RA. Results: The quantitative survey undertaken for this thesis demonstrated that South Asian RA patients exhibited more negative beliefs about medicines and lower levels of adherence to RA medicines than did their White British counterparts and were more dissatisfied with the information they received about their medicines. Results from the interviews showed that four interlinking themes influenced adherence in both South Asian and White British ethnic groups. Conclusion: This thesis has demonstrated that some beliefs about medicines and illness perceptions differ between the South Asian and White British ethnic groups; these beliefs and perceptions are important in understanding differences in adherence between these two groups.

Background: Overweight and obesity are major health problems globally, particularly in men. Some group-based interventions for men, such as Football Fans in Training (FFIT), a gender-sensitised weight management and healthy living programme for overweight or obese men, have proven successful in helping men initiate and achieve weight loss. However, there is still a need to understand how men's attempts to make changes to health practices are influenced by their social context. This study explored how men's attempts to change their dietary practices and physical activity to lose weight and maintain weight loss were influenced by, and influenced, their cohabiting female partners within the context of FFIT. Method: Separate interviews were conducted with 20 men and their cohabiting female partners 3-12 months after men had completed FFIT. Their experiences around men's participation in FFIT and subsequent attempts to change dietary practices and physical activity were explored. Data were thematically analysed, guided by Self-Determination, Social Support, Interdependence, and Gender theories. Results: All partners in this study were supportive of men's autonomous decisions to join FFIT. Each partner displayed varied levels of involvement in the process of men's attempts to make changes to dietary practices and physical activity. Men's success or failure in making and maintaining changes, and/or achieving weight loss, was described as resulting from their resoluteness for the changes, responsiveness to FFIT and reliance on/receptiveness to the partner's involvement and support. Men's participation in FFIT also positively influenced the partners' dietary practices and physical activity, as well as couples' relationships despite some tensions and conflicts arising during this process. Conclusion: Cohabiting couples' close relationships provide a supportive context for overweight or obese men to initiate the pursuit of weight loss, and maintain healthy dietary practices and physical activity. This study also highlights the mechanisms by which partners influence men's changes to dietary practices and physical activity following a weight loss intervention, and how they too are influenced in this process. It thus helps explain how varying behaviour change outcomes can occur within an intervention. This study highlights the importance, and the bidirectional nature, of health behaviour change in the cohabiting couples' context.