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AN ABSTRACT OF THE DISSERTATION OFKimberly Noel Turner, for the Doctor of Philosophy degree in Political Science, presented on June 9, 2021, at Southern Illinois University Carbondale. TITLE: EDUCATION BULGES AND MASS PROTEST: HOW HIGHER EDUCATION INFLUENCES PROTEST ONSET AND OUTCOMESMAJOR PROFESSOR: Dr. Stephen BloomCan trends in higher education attainment explain protest onset and outcomes? Beneficial state development indicators, such as education attainment, may produce detrimental employment outcomes. Nonviolent protests spread throughout the developing world throughout the 2010s, often in countries previously immune to public agitation. At the forefront of these protests were well-educated professionals, often doctors and lawyers. Why did these protests emerge? Why did middle-class groups initiate and lead these protests? How successful were these protests? The education bulge theory provides a framework for explaining the onset and outcomes of nonviolent mass protests in repressive countries. The education bulge theory captures the formation of skilled labor grievance and the spillover that influence the emergence of nonviolent, large and diverse protests. Chapter Two details the education bulge theory. Education bulges occur when a country undergoes sharp increases in university enrollments exceeding global averages. As university graduates increases, so does the supply of skilled labor. An increasing percentage of the population is then impacted when demand for skilled labor wanes, i.e. skills downgrading. Skills downgrading worsens the relative position of university graduates to other educational attainment groups, increasing tertiary unemployment and underemployment. Skilled labor compensates by downshifting, seeking out and competing for positions within the semi-skilled job market. This increased competition for semi-skilled positions pushes other educational groups down and out of the labor market. The global forces of labor polarization, education bulges, and skills downgrading are examined for their roles in inducing downshifting behavior. The fomentation of grievance amongst skilled labor is detailed, as well as the spillover effects for semi and unskilled labor. Flattening supplies of knowledge-intensive positions within the private sector along with public sector hiring reductions in the post-recession period exacerbates the decline of skilled labor’s relative position. Chapter Three examines objective measures of skilled labor’s relative position to other education attainment groups. Alongside theories of economic development and inequality, the education bulge theory is tested for its relationship to protest onset. Governmental expenditures on education, relative unemployment amongst primary, secondary and tertiary education attainment groups, and average wage growth are evaluated for their relationship with education bulges and protest onset. Bivariate and multivariate regression analysis indicate that skills downgrading is significantly increases the odds of protests emerging in highly repressive countries. Under an education bulge, additional governmental spending on tertiary education is positively correlated to protest onset. Do education bulges contribute to the overall successfulness of protests? In Chapter Four, I develop a new cost-benefit approach to measuring protest success. Canonical binary measurement of protest success fails to capture the relative concessions demonstrators might extract from their regimes. I develop a 21-point scale capturing the dimensions of gains protests might achieve (in the form of regime concessions) and the costs they pay for those concessions (in the form of state reprisals). Using Mokken scale analysis, country success scores pinpoint a protest’s position along a unidimensional continuum of abject failure to transformative changes in the body politic is developed. My measure offers an improved method of capturing regime behavior in the form of ‘ignoring’ and active repression. My measure also captures instances where protests may be misclassified as failures and features a stronger correlation for crowd age diversity. However, the success scores and binary measures often share directionality and strength for key causal factors. Thus, I cannot claim a definitive victory for my measure. However, unlike binary measures, my measure is able to offer more accurate confidence intervals for interactive relationships evaluated in Chapter Five. Chapter Five evaluates the relationship between political contexts and protest features. Entrenched leadership and repressive state structures are traditional deterrents to protest success. Education bulges, leadership tenure, and state repressiveness are evaluated for their influence on protest successfulness. Education bulges are found to increase overall protest successfulness. Education bulges are also found to increase crowd size and crowd diversity. Interactive relationships between education bulges, crowd size, and class diversity are examined. Class diversity and education bulges are individual have a positive and significant influence upon protest success. Education bulges are found to moderate class diversity, shifting class diversity’s effect on protest success from positive to negative. Regime concessions and protest successfulness are also influenced by external factors, such as sanctions, defections, and audience sympathy. External actors are more likely to apply reputational, material or defection costs against regimes when protests occur within education bulges and feature class diversity. These costs act as mediators of regime responsiveness. Under a mediated moderation model, the direct and indirect effect of education bulges, crowd size, class diversity, and regime costs are evaluated for their effect on protest successfulness. Education bulges increase reputational costs for regimes while class diversity increases material costs. Crowd size increased both material costs and defections. Education bulge contexts producing diverse and large crowds are more successful than non-education bulge protests. This study offers an examination of the role of higher education attainment upon the emergence and successfulness of nonviolent mass protests in authoritarian states from 2005-2013. Despite data limitations, robust findings indicate that education bulges increase the odds of a stable repressive regime experiencing protest onset and protest success. Failure of central governments to ensure commiserate employment for their growing pools of skilled labor increases grievance, crowd sizes and diversity, and punitive action against governments seeking to repress demonstrators.

Outcomes are critical for informing evidence-based, shared decision-making about health supports for children. These outcomes should be important and meaningful to all interested parties, particularly to children and their families, and should be included within research and practice. The work in the present manuscript represents three studies that 1) investigated how service outcomes were being used in school-based, speech-language therapy 2) explored what service outcomes were meaningful and important according to interested parties, and 3) identified a set of core service outcomes using the aggregate input of the interested parties to guide future research and practice. In the first study, I analyzed interview transcripts from 24 senior, school-based speech-language therapists and clinical managers to explore how clinicians working in schools determined the impact of their services. I identified seven outcomes and common facilitators and barriers to the meaningful use of outcomes to determine service impact through this qualitative analysis. In the second study, I interviewed 14 school-based speech-language therapists, teachers, and family members of children receiving supports. I asked participants to speak to the outcomes or impacts of these services they thought were most important or valuable. I identified six outcomes using both qualitative and quantitative analysis techniques. In the third study, I combined the perspectives of these three groups of interested parties into a single set of core outcomes for school-based, speech-language services. The result is a suggested set of impacts to include in research and practice. Including these core outcomes in research will improve the relevance of clinic-external evidence (research studies), providing more pertinent information to shared decision making about speech-language supports in schools. Their inclusion in clinical practice with strengthen clinic-internal evidence (data about specific programs or services) about the appropriateness of supports in context, and will assist the development of local, contextualized evidence for speech-language services. / Dissertation / Doctor of Philosophy (PhD) / School-based speech-language services provide important social and academic supports to children throughout their school years. To better understand if these services are achieving meaningful results for children and families, we wanted to know what people think is a meaningful result. In our first study, we asked speech-language therapists working in schools how they knew they were achieving meaningful results from their work. In our second study, we discussed what results were most important with family members, teachers, and speech-language therapists. Finally, in our third study, we combined all perspectives into a single list of most important service results to guide future research and quality improvement work. Together, these three studies provide important information on what results we want to achieve, which include important results for students, teachers and families, and the school system. The most important result was providing a holistic approach to support children, their families, and school communities.

The Mississippi State Department of Education (MDE) adopted a state assessment in 2014 to measure early literacy skills for incoming kindergarten students (Mississippi Joint Legislature Committee on Performance Evaluation and Expenditure Review [PEER], 2015). The purpose of this study was to determine the effects of early childhood education (ECE) programs in a selected school district in the state. A quantitative research design was used to conduct the study. Specifically, this study sought to determine if there were differences in the mean scores on the Star Early Literacy baseline assessment for students who attended an ECE program and those who did not. In addition, this study sought to determine if there were differences in the mean scores on the Star Early Literacy baseline assessment for four literacy classifications (early emergent reader, late emergent reader, transitional reader, and probable reader), as well as differences for gender, race, and socioeconomic status (SES) among students who attended an ECE program and those who did not. Lastly, the study determined if there were significant differences in the mean scores on the Star Reading and Star Math end-of-year (EOY) assessments as well as differences by gender, race, and SES for students who attended an ECE program and those who did not. Existing data included Star Early Literacy baseline scores, Star Early Literacy four literacy classifications, Star Reading EOY scores and Star Math EOY scores, gender, race, and SES. The results of the study showed that students who participated in an ECE program scored statistically higher on all student academic outcomes when compared to students who did not participate in an ECE program. The results showed there were no statistically significant differences in the mean scores based on gender, race, or SES for student academic outcomes when comparing students who did and did not participate in an ECE program.

Indiana University-Purdue University Indianapolis (IUPUI) / Anatomy Academy (AA) is a service-learning program in which pre- and current health professional students (Mentors) work in pairs to teach anatomy, physiology, and nutrition to children in the community. The purpose of this study was to investigate the short- and long-term Mentor outcomes in personal, social, civic, academic, and professional domains. Former Mentors were invited to complete a survey of Likert-style and free response questions evaluating the perceived impact of their AA experience on: teaching skills, personal and interpersonal development, civic engagement, and academic and professional development. Follow-up interviews with a subset of survey respondents were performed. The survey was completed by 219 Mentors and 17 survey respondents were interviewed. Over 50% of former Mentors reported moderate or major impact of AA participation on elements of personal and interpersonal development (e.g., selfesteem [57.6%], altruism [67.9%], communication skills [60.1%], and ability to work with others [72.6%]) and community service participation (54.2%) that endures in the years after the program. Mentors who worked with low-income or Special needs populations reported unique impacts in personal, interpersonal, and civic domains. A majority of former Mentors agreed that AA participation helped them learn practical skills (76.3%) and factual knowledge (65.4%) relevant to the their careers, with several current health professionals reported that they regularly employ teaching and interpersonal skills learned while Mentors in their roles as physicians, nurses, or physician’s assistants. A majority of former Mentors reported that AA validated their choice to either pursue a healthcare career or not (59.7%), increased their confidence in performing professional tasks (64.7%), and helped shape their professional identity (58.9%). These results indicate that a health education-based service-learning program offers undergraduate, graduate, and professional students interested in or actively pursuing a healthcare career benefits across personal, interpersonal, civic, and professional domains that support their academic progress and preparation for professional practice. This study contributes much-needed evidence of the long-term student outcomes of service-learning to the literature, with a particular focus on how the pedagogy can supplement the education and professional development of pre- and current health professional students.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital cardiac defect with a global annual incidence of 40,000 cases. Advances in surgery and perioperative care led to improvements in perioperative mortality and, thus, a growing number of survivors. TOF survivors often suffer from complications related to a failing right ventricle. Follow-up studies evaluating TOF repair strategies suggest an association between the type of surgical repair strategy and late right ventricular health. However, surgical practices remain unchanged and led by institution-level biases. The body of evidence addressing outcomes based on TOF surgical repair strategy is weak and controversies persists on the management of these patients.  This thesis comprises 6 chapters that form the foundation of a multi-centre research program on outcomes after TOF surgical repair. The program uses various methodologies to generate evidence with a vision to change surgical practices.  Chapter 1 is an introduction providing background on TOF and contemporary areas of controversy.  Chapter 2 presents the results of a retrospective analysis evaluating the use of early echocardiogram parameters in predicting late cardiac magnetic resonance imaging evaluation of the right ventricle.  Chapter 3 presents the results of a retrospective cohort exploring the association between TOF repair strategy and development of right bundle branch block.  Chapter 4 presents the results of a multinational survey aiming to explore contemporary biases in TOF surgical repair strategy selection.  Chapter 5 presents the background, rationale, design and baseline cohort characteristics of the Tetralogy of Fallot for Life (TOF LIFE) study. The study is a multi-centre inception cohort study with a follow-up period of 2 years.  Finally, Chapter 6 discusses the conclusion, limitations, and future implications of this research program. / Thesis / Doctor of Science (PhD)

Patient-reported outcomes (PROs) produce meaningful information about patient-perceived health status reported directly by patients. Routine collection of PROs data is particularly important in chronic conditions, such as heart failure (HF). Major cardiovascular societies and regulatory agencies encouraged PRO inclusion in randomized controlled trials (RCTs), but PROs remain underutilized as a key outcome in these studies. In this systematic review, we aimed to evaluate temporal trends and explore trial characteristics associated with PRO inclusion in HF RCTs published in high-impact medical journals. We also assessed the quality of PRO reporting against the Consolidated Standards of Reporting Trials PRO extension. We found that over half of HF RCTs included a PRO. The proportion of RCTs with PROs increased significantly since 2000. A number of RCT characteristics such as multicentre; medium-sized (n = 51-250 participants); trials coordinated in Central and South America; and that tested health services, devices or surgery, exercise and rehabilitation interventions were independently associated with higher odds of PRO inclusion. The quality of PRO reporting was modest, with better reporting in RCTs with PROs a primary or co-primary endpoint. Consistent PRO inclusion and high-quality reporting are necessary to increase the utility of these findings by patients, clinicians, and health care policy makers. / Thesis / Master of Science (MSc)