Eccentric biased muscular contractions, when compared to concentric and isometric muscle actions have a number of benefits, which include greater hypertrophy, increased strength and a reduced metabolic cost at any given intensity. The literature has reported the benefits of eccentric contractions in a variety of populations, which include exercisers, athletes, geriatric and chronically diseased communities. However, eccentric contractions can result in temporary exercise-induced muscle damage (EIMD) that reduces function and causes soreness. Consequently, a number of interventions, such as post-exercise therapies and prior exercise have been used in an attempt to attenuate the negative effects of this muscle action. Therefore, the purpose of this thesis is to provide novel data to expand the existing body of knowledge and investigate a cryotherapeutic intervention that may attenuate the symptoms of exercise-induced muscle damage. Furthermore, this work examines the adaptation to prior exercise (the repeated bout effect) in the ipsilateral and contralateral limbs to provide additional novel data to elucidate the possible mechanisms responsible for adaptation. Study 1: The aims of the first study were to investigate the effects of repeated applications of ice massage on the markers of muscle damage using a within-subject, cross-over design and to examine the effects on muscle function during static and dynamic contractions. The results suggest that ice massage does not reduce any of the signs or symptoms of EIMD after high intensity eccentric exercise, nor does it return the function of static or dynamic muscle actions following a damaging bout of exercise. Study 2: The aims of this investigation were firstly, to determine the reliability of functional testing and the associated surface EMG signal on five consecutive days, and secondly to elucidate the reliability and precision of other dependent measures commonly used in the assessment of muscle damage following a bout of eccentric contractions. All variables displayed good reliability and therefore may be appropriate to examine longitudinal changes as a result of a damaging protocol. Study 3: The purpose of this investigation was to examine the magnitude of the repeated bout effect (RBE) from high and low volume maximal eccentric exercise followed by a high volume bout of maximal eccentric exercise after full recovery from the initial bout (two weeks later). There were no differences in dependent variables between groups in the repeated bout, indicating that the magnitude of the RBE is similar following initial low and high volume bouts of maximal eccentric exercise, which was attributable, at least in part, to changes in electromyographic frequency content. The initial high volume bout did however result in greater EIMD than the initial low volume bout; in addition, the magnitude of change from the initial bout was more profound after high volume exercise. Study 4: The aims of this investigation were to elucidate the existence of a contralateral RBE in the upper limb and to compare the magnitude of change to an ipsilateral model, which had been previously been established in Study 3. Significant differences in some variables provide evidence that a repeated bout effect is evident in the contralateral limb after a single bout of eccentric exercise. This adaptation appears to be mediated by neural mechanisms, as there is no direct stimulus for change from the initial bout to the contralateral homologous muscle group. The magnitude of change between contralateral and ipsilateral models was different for some variables suggesting that the RBE is not as profound in contralateral homologous muscle as in the ipsilateral model. These investigations provide additional novel data on interventions used to combat the negative effects of eccentric contractions and temporary EIMD. In particular, Study 4 has shown that adaptation occurs in the contralateral homologous muscle group, which has implications for a variety of populations and also for future research study design. Further investigations are warranted to elucidate the exact mechanisms responsible for the repeated bout effect.

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Arthritis is a growing aging and public health concern in Canada and elsewhere. As with many other chronic health conditions, arthritis occurs more often and has a higher impact on functioning for people who have lower incomes or live in an impoverished environment. There is a large body of research that supports a gradient between socioeconomic status and health and between area level poverty and decreased quality of life. Although this relationship is widely acknowledged, less is known about the influence of broader social conditions at the neighbourhood level on health outcomes. By examining quality of life from the theoretical framework of poverty as a fundamental cause of differences in health (Link & Phelan, 1995) and Bourdieu’s (1984) theory of habitus, I provide an analysis of the direct impact of material and social deprivation on health related quality of life (HRQoL), as well as the impact considering the influence of age, body weight, physical functioning, gender, and coexisting health conditions. I also examine interaction effects between neighbourhood deprivation and individual characteristics. An explanatory three-level multilevel model supported a relationship between individual factors as well as deprivation at the neighbourhood level on quality of life. The impact of neighbourhood deprivation was more pronounced for mental health related life quality, with a history of another health condition making the largest contribution to the model. Physical HRQoL was impacted by gender in interaction with material deprivation and body mass index in interaction with social deprivation. I discuss implications for practice, service delivery, and policy and make suggestions for further research. / May 2016

Thesis (Ed.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

ABSTRACT Introduction The advent of potent anti-retroviral agents for HIV treatment has resulted in marked decrease in deaths. Health workers now have to ensure that their patient’s physical, social, and psychological well-being is optimized. This study used a validated tool to measure Health Related Quality of Life concepts amongst HIV patients in a public treatment program. The main objective of this research was to establish factors that are associated with poor quality of life of these patients with the purpose of using this information as a basis for determining who would require individualized medical care and attention. Materials and methods The study is set at Bontleng Clinic in Gaborone, Botswana. The study questionnaire consisted of two parts: part one for collecting data on sociodemographic, illness and treatment related factors, and part two was the Medical Outcomes Study – Short Form tool used to obtain data on quality of life concepts. Two groups of participants were interviewed: ART-Naïve (n=90) and ARTExperienced (n=110). The study protocol had ethical approval from both the University of the Witwatersrand, Johannesburg and the Ministry of Health in Botswana. iv Results A smaller proportion of ART-experienced participants reported various disease symptoms as compared to those participants who were ART-naïve. Statistically significant differences were noted for: weight loss (25% vs 77%), diarrhoea (3% vs 11%), cough (19% vs 39%), and night sweats (24% vs 43%) for ART experienced and ART Naïve patients respectively. CD4 counts and HB levels were also significantly higher in patients on HAART. The overall QoL summary score was significantly higher (better) in the ART-experienced (mean score 53 out of 100) compared to the ART-naïve group (mean score 47 out of 100). Therefore being on ART favoured a higher QoL score. However, changes in the three laboratory indices of CD4 count, Hb level, and viral load had no statistical significant association with HRQoL scores. Multiple regression identified only five factors as being associated with better QoL scores. These factors were to do with the absence of the following disease symptoms: weight loss, diarrhoea, night sweats, and feet pains; as well as absence of recent hospitalisation. Discussion The study patients do respond well to HAART with significant improvements in all dimensions of QoL. This is in keeping with findings from other populations. In assessing these patients at the initiation of HAART, and at subsequent visits, one must take into account any history of recent hospital admission, history of weight loss, and most importantly presence/absence of various disease symptoms. Conclusions and recommendations Symptoms, regardless of the underlying cause: be it due to HIV disease itself or drug side effects; greatly impact patients’ quality of life. Efforts should be made to include the assessment of symptoms in the continuum of care of HIV patients. The introduction of newer potent anti-retroviral agents with fewer side effects should also favour the beneficial impact of HAART.

Sweden is aiming for a sustainable development through achieving the Sustainable Development Goals by 2030. To do so, new mobility habits among Sweden’s inhabitants must be realized; public transport and car sharing have to be prioritised over private car ownership in which people travel alone. As the Swedish government aims to meet these needs, the commercialisation of autonomous vehicles is awaited along with digitalisation. Digitalisation cross-bread with a roll out of self driving cars is by some expected to boost the roll out of Mobility as a Service in the shape of a door to door solution within transportation. This can potentially create a decline of today’s ride sharing services, largely made up by the mass transit-system and ride-pooling. The use of mass transit systems and large pooled rides has the biggest potential to reduce congestion and CO2-emissions or energy use per traveller, provided the passengers are going in the same direction. As a self driving door to door solution can cause shifts in the demand for transportation, this study aims to understand the pathway needed to make ride sharing the preferred choice of motorised transportation among travellers in urban areas in Sweden by 2030 – in the light of the potential Self Driving door to door roll out, as well as the achievement of the SDGs. To meet the aim, the transition theory Multi-Level Perspective and Strategic Niche Management is used, together with semi-structures interviews with central stakeholders of ride sharing. The result shows that mobilisation processes through communication, envisioning and education are needed, together with innovation promoting sustainable behaviours, such as digital means for a faster democratic process. With regards to innovation processes, the result shows that the use of interdisciplinarity and promotion of perspectives deriving from the humanities within in learning and envisioning practices in Sweden are needed. Both within the Swedish educational system, but also at conferences. The results also show a need for economic schemes and steering policies for the promotion of ride sharing.

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Biogas is renewable and carbon neutral, which makes it an excellent environmentally friendly alternative to the use of fossil fuels. Biogas production in agriculture is based on the use of manure and residual waste, which results in less greenhouse gas emissions to the atmosphere. Biogas production, together with other environmental initiatives, can contribute to achieving several of the Swedish environmental goals. Today, the farm-based biogas production in Halland County is still under development and although there is a great potential in agriculture, it is far from being used. It is also important to find out whether the conditions for agricultural-based biogas production have changed and to find out what difficulties there are to eliminate and what can be done to get more farmers to invest in biogas. The method used to answer the question is based on interviews with ten farmers, review of scientific literature, reports and statistics. The result shows that the conditions for biogas production in agriculture have improved, but there are some obstacles that should be remedied. In order to develop and create a stable and sustainable farm-based biogas production, it is necessary that the permit process is simplified and that it creates demand and a stable market for biogas. Furthermore, active efforts are required from politicians and municipalities as well as a dialogue between various biogas actors, farmers and authorities, to develop a sustainable and long-term farm-based biogas production.

Tourism is the fastest growing sector in the world. It represents 10% of the global GDP and generates one in 11 jobs. Nature tourism has become increasingly popular in the last few decades and it is predicted to keep increasing. Wildlife watching has initially been welcomed by conservation and environmental organisations as a conservation tool. However, we now know that these activities can have severe consequences for the environment and for the local communities. In this thesis, I have provided advice on the governance approaches and management tools that can be used to facilitate sustainable outcomes of nature tourism socioecological systems. First, I used semi-quantitative models to investigate nature tourism systems' dynamics under perturbations and the properties that confer resilience to the system, as well as leading to sustainable outcomes. Then, after validating the use of social media data to quantify nature tourism activities in Scotland, I used it to identify the major drivers of intensity of nature tourism on a national scale. I then obtained a global picture of nature tourism and its role in helping countries to achieve the UN Sustainable Development Goals. In the end, I designed an individual-based model to test how different tourists' phenotypes influence the sustainability of a nature tourism destination and whether any governance regime could be effective in maintaining sustainable socioeconomic and ecological dynamics. This work will be useful to inform management of local, national and global scale governance of nature tourism. Caution is needed when promoting the expansion of a country's tourism sector before determining how to manage it sustainably. Scotland has already developed some of the governance institutions that could contribute to sustainable governance of nature tourism. What is needed now is designing flexible rules and institutions that will be able to adapt to future changes.