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<p>Emerging evidence indicates that in utero exposure to vitamin D metabolites may influence fetal and neonatal bone development. Bone accretion in prenatal and early postnatal life may impact peak bone mass achieved in early adolescence; and peak bone mass is a well-established predictor of osteoporosis risk in later life. <strong>Hypothesis</strong>: We hypothesized that offspring of mothers with higher serum vitamin D status during pregnancy will have higher whole body BMC z-score and bone size at 3 years of age, after adjustment for confounders. <strong>Methods</strong>: In a prospective, longitudinal study, 372 mothers with singleton birth were recruited during pregnancy, and maternal blood samples were obtained during the third trimester. Child bone outcome measures at 3 years of age included: whole body BMC, femoral and humeral lengths by DXA. We controlled for other relevant factors such as maternal nutrition, pre-pregnancy BMI, physical activity during pregnancy, maternal BMD, as well as the child’s nutrition at 6 months and 3 years, and the child’s physical activity. <strong>Results & Discussion</strong>: Maternal vitamin D status during pregnancy did not predict whole body BMC z-score of the child at 3 years of age. Over 92% of Canadian women in our sample were vitamin D sufficient with mean intakes of 435 IU/day from food and supplements and mean serum 25OHD of 111.2 nM. Further, data indicate a potential negative effect on offspring bone size at maternal serum 25OHD concentrations that exceed the upper limit suggested by the most recent DRI report (>125 nM), at which adverse health effects may occur. Our findings may differ from previous studies in the United Kingdom, India and Finland that found a positive relationship between maternal vitamin D status and child bone outcomes due to the high frequency of our mothers that had optimal vitamin D status. In addition, we adjusted for most of the key covariates that were not adjusted for in previous studies, which may contribute to the different findings compared to previous investigations.</p> / Master of Science (MSc)

Musculoskeletal trauma including fractures, represents a significant burden of disease for Low- and Middle-Income Countries (LMICs). Within LMICs, women possess reduced agency to make health care decisions and represent a vulnerable population. In this thesis, I aimed to characterize priority fractures among women within LMICs, and investigated whether women were delayed in hospital admission following an orthopaedic trauma. In Chapter 1, I introduce and review the existing literature on injury burden, health care deficiencies, and gender inequities within LMICs. In Chapter 2, we analyzed regional distributions of fracture burdens across 9,934 female orthopaedic trauma patients across 17 LMICs. Half of our study patients were ≥ 60 years old. We determined that the major burden of orthopaedic trauma among women within LMICs were fractures among the elderly. Fracture burden in Africa was notably different. A majority of patients were between the ages 18-59, and common fractures included tibia/fibula and femur fractures. In Chapter 3, we analyzed 26,910 orthopaedic trauma patients across 17 LMICs to determine whether women were delayed in hospital admission by >24 hours. After controlling for confounds, sex was not a significant predictor of delay. We found that instead, the severity and type of fracture influenced the delay of patient’s hospital admission. Closed fractures, falling-related injuries, pelvic, spine and hip fractures were associated with increasing delay. Irrespective of sex and region, inter-hospital referrals accounted for nearly half of the reasons patients were delayed. These two chapters highlight regional trends in orthopaedic burden sustained by women, pointing to the high frequency of fragility fractures. In addition, this thesis identifies critical gaps within LMICs’ health care systems infrastructure, demonstrating the need for improved hospital referral systems and ambulatory services. This analysis will enable policymakers, and future researchers to target interventions to address the rising global burden of injuries especially among women. / Thesis / Master of Science (MSc) / Fractures represent life-threatening injuries within Low- and Middle-Income Countries (LMICs), and globally are a top-ten leading cause of death and disability. Within LMICs, due to gender inequalities, women may be restricted from receiving hospital care following an injury. We investigated the most common types of fractures in women within LMICs and determined that women most frequently experienced fractures due to old age. We further examined whether women were delayed in reaching a hospital after sustaining a fracture, and found that sex did not significantly play a role in determining delay. Instead, injury associated factors, such as the type and severity of the fracture influenced whether a patient was delayed. In addition, transferring patients between hospitals was the most common reason for delay. As a result, policymakers in LMICs should explore strategies to treat the high burden of fractures in the elderly and improve communication between hospitals to reduce delays.

Five experiments, involving 265 subjects, were performed with the objective of extending the analysis of response probability as a determinant of the practice effect in tachistoscopic word recognition. The results showed that the response probabilities of words may be manipulated and act as a determinant of the practice effect under certain limited experimental conditions. A more powerful determinant appears to be a general skill in tachistoscopic recognition which improves as a function of the number of stimuli recognized and transfers to the recognition of different stimuli. This skill was examined in the final experiment. The overall results were discussed in terms of both response probability and a general tachistoscopic skill. / Thesis / Doctor of Philosophy (PhD)

This study showed that health equity must be achieved through education, awareness, and advocacy. A structured program must be put in place to provide accountability towards achieving health equity within organizations, communities, cites, and states. In Virginia, the Health Equity Campaign was a program put in place to provide such accountability to the citizens of Virginia. This study attempted to evaluate the Health Equity Campaign implemented by the Virginia Department of Health Office of Minority Health and Public Health Policy Division of Health Equity in order to get all Virginians to become advocates for health equity in their organizations, communities, neighborhoods. Organizational/group leaders were interviewed in addition to surveying various staff members. This study provides a detailed description of the strength of the Health Equity Campaign's ability to promote education and awareness about health equity and why many participants found it difficult to transition from motivation to advocacy. / Ph. D.

This study investigates the major factors that have restricted the flow of foreign direct investment (FDI) into the oil sector in Libya. The study focuses on the period from 2000 to 2009. This period is significant since, during this time Libya witnessed dramatic foreign and economic policy changes. The research objectives are: (1) To identify the determinants of foreign direct investment into Libya’s oil industry for the period 2000-2009; (2) To reveal the obstacles and barriers which hinder FDI in Libya’s oil industry; (3) To determine the extent that the Libyan Government FDI policy influenced FDI in Libya’s oil industry. The rationale for this thesis was driven by filling an empirical void of FDI studies on the oil industry in Libya and by the intention of providing practical insights for current and future Libyan governments. This study comprises of an analysis of the 30 multinational (MNCs) oil companies that are operating in the Libyan oil industry through questionnaire and interview data from executives employed by those MNCs, as well as data from ten Libyan senior government officials involved in the Libyan oil industry and/or FDI policies. The research has provided support for several of the determinants of FDI flows traditionally found in the literature. The survey and time series analysis further reveals that access to Libya’s proven oil and gas reserves was the singular most important determinate for influencing the MNCs to undertake FDI. Furthermore, the findings identified that Libyan government foreign policy had some impact on the MNCs decision to undertake FDI. The research findings with regards to the role played by environmental risk as a determinate of FDI, demonstrate that there is no significant relationship between overall levels of environmental risk and a country‘s performance in attracting FDI. Also, this research has identified a number of factors that are causing obstacles and challenges to the attractiveness of Libya as a location for foreign investment. It has revealed that MNCs are significantly dissatisfied by the stability of the public institutions and the lack of effective regulations in Libya.