Parents’ experiences during the transition from childhood to adolescence with Type 1 Diabetes: Parent-child relationships and support received during this time and clinical research portfolio

Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.

Quantification of air quality in space and time and its effects on health

The long-term adverse effects on health associated with air pollution exposure can be estimated using either cohort or spatio-temporal ecological designs. In a cohort study, the health status of a cohort of people are assessed periodically over a number of years, and then related to estimated ambient pollution concentrations in the cities in which they live. However, such cohort studies are expensive and time consuming to implement, due to the long-term follow up required for the cohort. Therefore, spatio-temporal ecological studies are also being used to estimate the long-term health effects of air pollution as they are easy to implement due to the routine availability of the required data. Spatio-temporal ecological studies estimate the health impact of air pollution by utilising geographical and temporal contrasts in air pollution and disease risk across $n$ contiguous small-areas, such as census tracts or electoral wards, for multiple time periods. The disease data are counts of the numbers of disease cases occurring in each areal unit and time period, and thus Poisson log-linear models are typically used for the analysis. The linear predictor includes pollutant concentrations and known confounders such as socio-economic deprivation. However, as the disease data typically contain residual spatial or spatio-temporal autocorrelation after the covariate effects have been accounted for, these known covariates are augmented by a set of random effects. One key problem in these studies is estimating spatially representative pollution concentrations in each areal which are typically estimated by applying Kriging to data from a sparse monitoring network, or by computing averages over modelled concentrations (grid level) from an atmospheric dispersion model. The aim of this thesis is to investigate the health effects of long-term exposure to Nitrogen Dioxide (NO2) and Particular matter (PM10) in mainland Scotland, UK. In order to have an initial impression about the air pollution health effects in mainland Scotland, chapter 3 presents a standard epidemiological study using a benchmark method. The remaining main chapters (4, 5, 6) cover the main methodological focus in this thesis which has been threefold: (i) how to better estimate pollution by developing a multivariate spatio-temporal fusion model that relates monitored and modelled pollution data over space, time and pollutant; (ii) how to simultaneously estimate the joint effects of multiple pollutants; and (iii) how to allow for the uncertainty in the estimated pollution concentrations when estimating their health effects. Specifically, chapters 4 and 5 are developed to achieve (i), while chapter 6 focuses on (ii) and (iii). In chapter 4, I propose an integrated model for estimating the long-term health effects of NO2, that fuses modelled and measured pollution data to provide improved predictions of areal level pollution concentrations and hence health effects. The air pollution fusion model proposed is a Bayesian space-time linear regression model for relating the measured concentrations to the modelled concentrations for a single pollutant, whilst allowing for additional covariate information such as site type (e.g. roadside, rural, etc) and temperature. However, it is known that some pollutants might be correlated because they may be generated by common processes or be driven by similar factors such as meteorology. The correlation between pollutants can help to predict one pollutant by borrowing strength from the others. Therefore, in chapter 5, I propose a multi-pollutant model which is a multivariate spatio-temporal fusion model that extends the single pollutant model in chapter 4, which relates monitored and modelled pollution data over space, time and pollutant to predict pollution across mainland Scotland. Considering that we are exposed to multiple pollutants simultaneously because the air we breathe contains a complex mixture of particle and gas phase pollutants, the health effects of exposure to multiple pollutants have been investigated in chapter 6. Therefore, this is a natural extension to the single pollutant health effects in chapter 4. Given NO2 and PM10 are highly correlated (multicollinearity issue) in my data, I first propose a temporally-varying linear model to regress one pollutant (e.g. NO2) against another (e.g. PM10) and then use the residuals in the disease model as well as PM10, thus investigating the health effects of exposure to both pollutants simultaneously. Another issue considered in chapter 6 is to allow for the uncertainty in the estimated pollution concentrations when estimating their health effects. There are in total four approaches being developed to adjust the exposure uncertainty. Finally, chapter 7 summarises the work contained within this thesis and discusses the implications for future research.

Towards an understanding of Pakistani undergraduates’ current attitudes towards learning and speaking English

The English language has an important place in Pakistan and in its education system, not least because of the global status of English and its role in employment. Realising the need to enhance language learning outcomes, especially at the tertiary level, the Higher Education Commission (HEC) of Pakistan has put in place some important measures to improve the quality of English language teaching practice through its English Language Teaching Reforms (ELTR) project. However, there is a complex linguistic, educational and ethnic diversity in Pakistan and that diversity, alongside the historical and current role of English in the country, makes any language teaching reform particularly challenging. I argue, in this thesis, that reform to date has largely ignored the issues of learner readiness to learn and learner perceptions of the use of English. I argue that studying learner attitudes is important if we are to understand how learners perceive the practice of learning and the use of English in their lives. This study focuses on the attitudes of undergraduate learners of English as a foreign language at two universities in the provinces of Sindh and Balochistan in Pakistan. These provinces have experienced long struggles and movements related to linguistic and ethnic rights and both educate students from all of the districts of their respective provinces. Drawing on debates around linguistic imperialism, economic necessity, and linguistic and educational diversity, I focus on learners’ perceptions about learning and speaking English, asking what their attitudes are towards learning and speaking English with particular reference to socio-psychological factors at a given time and context, including perceived threats to their culture, religion, and mother tongue. I ask how they make choices about learning and speaking English in different domains of language use and question their motivation to learn and speak English. Additionally, I explore issues of anxiety with reference to their use of English. Following a predominantly qualitative mixed methods research approach, the study employs two research tools: an adapted Likert Scale questionnaire completed by 300 students and semi-structured interviews with 20 participants from the two universities. The data were analysed through descriptive statistics and qualitative content analysis, with each set of data synthesised for interpretation. The findings suggest that, compared with the past, the majority of participants hold positive attitudes towards learning and speaking English regardless of their ethnic or linguistic backgrounds. Most of these undergraduate students do not perceive the use of English as a threat to their culture, mother tongue or religious values but, instead, they have a pragmatic and, at the same time, aspirational attitude to the learning and use of English. I present these results and conclude this thesis with reference to ways in which this small-scale study contributes to a better understanding of learner attitudes and perceptions. Acknowledging the limitations of this study, I suggest ways in which the study, enhanced and extended by further research, might have implications for practice, theory and policy in English language teaching and learning in Pakistan.