Seven Vermont school districts participated in a five year professional development program sponsored jointly by the National Science Foundation and the United States Department of Education from 2002-2007. Using a robust mixed methods evaluation, teachers and students demonstrate pronounced organizational and academic growth. Analysis of data from focus groups held with teachers over the course of the period from fall 2004-spring 2006 provides strong supporting evidence for the growth. The purpose of this dissertation is to reanalyze the focus group data to document institutional and longitudinal change at the first person level. With focus groups as the unit of analysis, themes rising from the anonymous participants‟ I statements form the substance for this review. By revisiting an extensive pre-existing data set with a different method of analysis, this work expands on what is known about how teachers process change on the ground level. The findings reveal how complex individual feelings about one‟s experiences serve to describe degrees of institutional as well as personal change. New thematic coding confirms the original findings of the program evaluation. More importantly, the findings provide new details and understandings about organizational change and growth previously unobserved in the aggregate reports. By way of a methodological contribution, the research findings suggest and demonstrate an alternative approach to the analysis of focus group data in the aggregate.

In 1998, 12 students, aged 11-12 years, were identified by primary schools in a socially disadvantaged area of New Zealand as being at risk of negative life outcomes, as a consequence of known adversities in their lives. The students were interviewed, as were their parents and teachers, and they also completed learning assessments and measures of personal and social concerns. The purpose of these evaluations was to identify risk and protective factors in the young people’s lives, and to make estimations of personal resilience. In 2008, nine of the original study participants, who were now aged 21-22 years and in emerging adulthood, were located and were interviewed again. The assessments addressed the participant’s current circumstances, and what had happened for them over the last ten years. The interviews also asked the participants to reflect about 12 resilience dimensions that have been identified in the literature (Masten & Coatsworth, 1998) and whether they considered that they were personally resilient. The recent interview data were analysed using interpretative phenomenological analysis (Smith & Osborn, 2008). The individual analyses show a rich diversity of life paths and, as well, three sets of themes were identified across the case studies; and they are personal relationships, contexts of development (schooling and education, culture, religion, and jobs and careers), and personhood and identity. A resilience model was derived from the integration of the data from the first and second assessments with contemporary resilience studies and theorising. The central idea of the model is that resilient functioning is determined by the nature and quality of relationships within, and across, developmental settings. As a corollary, it is hypothesised that interpersonal relationships influence individual executive functioning, and emotional regulation in particular; and that these cognitive and affective capacities can translate into goal seeking and other constructive actions. The explanation of the resilience model leads onto recommendations for further research on relationships that enhance personal functioning. There are also suggestions for social policy that follow from the exposition, and some guidelines for professional practice with children and families.

In 1998, 12 students, aged 11-12 years, were identified by primary schools in a socially disadvantaged area of New Zealand as being at risk of negative life outcomes, as a consequence of known adversities in their lives. The students were interviewed, as were their parents and teachers, and they also completed learning assessments and measures of personal and social concerns. The purpose of these evaluations was to identify risk and protective factors in the young people’s lives, and to make estimations of personal resilience. In 2008, nine of the original study participants, who were now aged 21-22 years and in emerging adulthood, were located and were interviewed again. The assessments addressed the participant’s current circumstances, and what had happened for them over the last ten years. The interviews also asked the participants to reflect about 12 resilience dimensions that have been identified in the literature (Masten & Coatsworth, 1998) and whether they considered that they were personally resilient. The recent interview data were analysed using interpretative phenomenological analysis (Smith & Osborn, 2008). The individual analyses show a rich diversity of life paths and, as well, three sets of themes were identified across the case studies; and they are personal relationships, contexts of development (schooling and education, culture, religion, and jobs and careers), and personhood and identity. A resilience model was derived from the integration of the data from the first and second assessments with contemporary resilience studies and theorising. The central idea of the model is that resilient functioning is determined by the nature and quality of relationships within, and across, developmental settings. As a corollary, it is hypothesised that interpersonal relationships influence individual executive functioning, and emotional regulation in particular; and that these cognitive and affective capacities can translate into goal seeking and other constructive actions. The explanation of the resilience model leads onto recommendations for further research on relationships that enhance personal functioning. There are also suggestions for social policy that follow from the exposition, and some guidelines for professional practice with children and families.

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Introduction The present study explored the nature of the semantic deterioration normally displayed in the course of Alzheimer’s disease (AD). The aim was to disentangle the extent to which semantic memory problems in patients with AD are best characterized as loss of semantic knowledge rather than difficulties in accessing semantic knowledge. Method A longitudinal approach was applied. The same semantic tests as well as same items were used across three test occasions a year apart. Twelve Alzheimer patients and 20 matched control subjects, out of a total of 25 cases in each group, remained at the final test occasion. Results and Conclusions Alzheimer patients were impaired in all the semantic tasks as compared to the matched comparison group. A progressing deterioration was evident during the study period. Our findings suggest that semantic impairment is mainly due to loss of information rather than problems in accessing semantic information.

Dogslife is the first large-scale, longitudinal cohort study of canine lifestyle, morphology and health. The project involves recruiting the owners of UK-based, Kennel Club registered Labrador Retrievers and asking them to submit data about their dogs via an online questionnaire repeatedly as the dogs age. In this thesis, I have analysed Dogslife data regarding the lifestyle, morphology and health of Labrador Retrievers up to four years of age. A validation study was initially undertaken in order to understand the quality of the Dogslife data because this would underlie all future investigations. Owners were visited and veterinary records scrutinised. It was determined that Dogslife illness reports were subject to recall decay and that minor changes would improve the usability of the questionnaire. Accelerometers were subsequently sent to a subset of the cohort and aspects of the Dogslife exercise questionnaire were found to be correlated to accelerometer readings indicative of sedentary, light and moderate to vigorous exercise. Overall, Dogslife dogs were exercised for over two hours each day with the time spent being dominated by time off lead and on other activities. Dogs in England spent less time exercising than those in Scotland and Wales and dogs in family households spent less time exercising than those in single adult households or households comprising more than one adult. Despite being pedigree animals, the males in the cohort were 2-3cm taller than the breed standard. On average, the females met the breed standard but there was wide variation for both sexes. Working dogs in the cohort were over 2kg lighter than household pets and chocolate coloured dogs were 1.4kg heavier than their black and yellow counterparts. Dogs in multi-dog households were 0.5kg lighter than those in households with no other dog. Heavier dogs spent less time fetching, chasing and retrieving and on other exercise. Over 6,000 signs of illness were reported to Dogslife in the first three and half years and approximately half of them did not involve a veterinary visit. Reported signs were dominated by vomiting and diarrhoea, both of which peaked when the dogs were between 3-6 months of age. For the first time, rates of diarrhoea were shown to be positively associated with human population density in the UK. Limber tail was found to be associated with swimming in the cohort and working dogs were more likely to develop the condition than pets. Genetic analyses identified regions of interest that might predispose the dogs to limber tail on chromosomes 6 and 30. Data from the Dogslife project provide a unique resource for investigating the epidemiology of Labrador Retrievers. This thesis creates a platform for all such future investigations.

Longitudinal studies rely on data collected at several occasions from a set of selected individuals. The purpose of these studies is to use a regression-type model to express a response variable as a function of explanatory variables, or covariates. In this thesis, we use marginal models for the analysis of such data, which, coupled with the method of estimating equations, provide estimators of the main regression parameter. When some of the responses are missing or there is error in the recorded covariates, the original estimating equation may be biased. We use techniques available in the literature to modify it and regain the unbiasedness property. We prove the asymptotic normality of the regression estimator obtained under these more realistic circumstances, and provide theoretical and numerical examples to illustrate this approach.

Background: The burden of non-communicable diseases including cardiovascular diseases such as heart failure in Africa is rising rapidly, and they are now recognised as a significant cause of morbidity and mortality in the continent. Heart failure causes significant multidimensional impact (physical, social, psychological and spiritual), even with the advent of medicines that offer mortality benefit. Comprehensive care for heart failure must include palliative care that addresses multidimensional needs in line with patient-centered care. However, most research on heart failure in Africa has not explored these multidimensional needs from the patients’ perspective, and palliative care is still seen as being for those with cancer and HIV/AIDS. Aims: To understand the multidimensional experiences, needs, and use of services by patients with heart failure during their disease trajectory. To understand health care professionals’ perceptions of patients’ needs, the care required and the availability of services for patients with advanced heart failure in Uganda. Methods: A total of 48 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer, 8 with bereaved carers), were conducted with 21 patients with stage 3 or 4 heart failure being treated in Mulago Hospital and some of their family carers. Patient interviews were followed by the administration of the African Palliative Care Association African Palliative Outcome Scale supplemented with the broader symptom assessment tool the POS-S. Patients were interviewed during the time of hospitalisation when the researcher first made contact with them, and were followed up monthly by phone. Longitudinal interviews were conducted at 3 and 6 months after the first interview if their clinical condition remained stable, and earlier if there were major concerns or changes in their multidimensional experiences. Eight single interviews were conducted with health professionals (5 doctors, 2 nurses and 1 social worker) involved in the care of the patients. All interviews were audio recorded, and those of the health professionals transcribed verbatim, those of the patients were first translated to English and transcribed and all were exported into QSR Nvivo software version 10 for analysis. Principles from Charmaz’s grounded theory (line by line coding, focused coding, constant comparison and theoretical coding) were employed for analysis. Findings: The patients’ experience was that of learning to live with the unknown in a life dominated by symptoms despite, and because of, treatments. The impact of the various symptoms limited physical performance leading to multiple losses. Presence of a high level of health illiteracy, lack of information on their illness coupled with a high reliance on local cultural beliefs to make health decisions, led to the following: delayed recognition of illness and seeking of care; inappropriate self- care and poor adherence to medications; poor understanding of illness and its prognosis; unrealistic expectations of treatment; and inappropriate choices of where to seek care. Patients were often faced with health system challenges that contributed to late diagnosis and exacerbated the problem of poor adherence to treatment because of lack of medicines and lack of information. The illness impact was also observed in the social, psychological and spiritual domains of patients’ lives causing anxiety and worry, isolation, rejection and stigma, spiritual pain and spiritual growth. Patients expressed the need for normal functioning, information, to be in control and to be facilitated to cope and adapt to the unknown. Patients employed different mechanisms of coping and adaptation, with hope being central in coping as they tried to live with the unknown. Patients suggested changes to the health system and in the conduct of health professionals to improve future care. Health professionals were able to recognise the multidimensional impact of the illness on the patients, but the details of the concerns tended to differ for the patients and health professionals. Health professionals’ proposals on improving care tended to emphasise interventions that would improve physical care as opposed to the other dimensions. Conclusion: This is the first qualitative longitudinal research in Uganda that has explored the experiences of patients with advanced heart failure to gain an understanding of their needs and concerns from their perspective over the course of their illness. Many concerns such as a lack of information, challenges with coping, the symptom experience and its impact on function and the psychological, social and spiritual aspects of their lives are enduring in literature. However, this study also identified other concerns less common in the literature that could have led to a unique illness experience. These included: health system challenges; the impact of culture; beliefs and poverty; and a high level of health illiteracy.

Background: Across North America, smoking prevalence is highest among young adults (YAs). Understanding the cessation behaviours of YAs is critical given their higher smoking rates; however, there is a paucity of prospective studies on YA cessation from a population-based sample of smokers. Objectives: This study characterizes younger and older adult smokers as well as identifies the rate of making a quit attempt (QA) and smoking cessation among a representative sample of younger and older adult smokers. Guided by the Social Cognitive Theory (SCT), this study also examines the interpersonal predictors of moving toward smoking cessation among YAs. Methods: Self-report data on 592 YA and 2777 older adult smokers were compiled from the Ontario Tobacco Survey baseline and six-month follow-up interviews. Smoking cessation behaviour was measured as an ordinal variable: made no attempt to quit, made a QA that lasted for less than 30 days, and successfully quit for 30 days or longer. Design-based analyses examined the characteristics of young and older adult smokers. Making a QA and smoking cessation during a six-month follow-up period were modeled according to the SCT constructs while accounting for the complex study design. Results: Young adult smokers were more likely to be men with lower levels of addiction but greater self-efficacy and an intention to quit than their older counterparts. While YA smokers were more likely to make a QA than their older counterparts (25% vs. 17%, respectively), they were no more likely to succeed (14% vs. 10%, respectively). Having an intention to quit smoking and having made two or more lifetime number of QAs predicted making a QA; the use of smoking cessation aids or resources and having knowledge that stop smoking medications make quitting a lot easier also contributed to making an attempt to quit. Self-efficacy, use of smoking cessation aids or resources and having someone to support one‘s QA were positive predictors of quitting whereas having high levels of addiction was a negative predictor of cessation. Conclusions: Young and older adults are distinct types of smokers with different personal and smoking characteristics. Different factors predicted making a QA and smoking cessation among YAs. Smoking cessation interventions for YAs should provide social support and skills to build and maintain self-efficacy to quit. It is critical to ensure YA smokers have effective smoking cessation aids and services that are easily accessible and appropriate for this population. Future research is needed to understand long-term smoking cessation and relapse in this vulnerable population.