Together for Tomorrow: Improving Title I Education through Intersectoral and Governmental Collaboration

The Obama administration created the Office of Faith-Based and Neighborhood Partnerships and related Centers throughout federal agencies. Their aim is to help cultivate relationships between the interfaith community and government in communities around the United States. One such effort, Together for Tomorrow, seeks to facilitate partnerships to strategically deploy volunteers to lift up schools and students in low-income communities. The partnership involves federal offices, national service through AmeriCorps VISTA, local government agencies, nonprofit organizations, and faith organizations—a “multi-flavored wedding cake.” This article reports on the theoretical and observed enactment of the first-in-the-nation pilot project of Together for Tomorrow, suggests lessons, and advances propositions for how to structure intergovernmental and cross-sector partnerships to achieve social outcomes and community transformation

Theoretical foundations of operational research

The conclusions of both Parts One and Two complement and reinforce each other. After outlining the ideals of OR, I set out in Part One to find and scrutinize the philosophical foundations upon which some leading operations researchers have claimed that these ideals could be implemented. In chapters 2, 3, and 4 I argue that adopting (respectively) the positivist, conventionalist and/or idealist philosophies as the theoretical foundations upon which to build an adequate theory of inquiry for the purposes of OR would force it to abandon its ideals. These philosophies are interpreted as attempts on the part of academic operational researchers to stave-off the open-ended ambiguity and anarchy of inquiry which an unqualified interpretation of OR's ideals could engender. These attempts to give substance to the ideals of OR all exert a strong bias against raising questions about the nature of the subject-matter with which OR deals, and it in largely on these grounds that they are rejected in chapter 5 because of the implications which this has for the ideals of OR. One conclusion of Part One is that OR needs protection from such philosophies, and that a realist-type alternative at least provides this. I conclude by raising the doubt whether philosophy can provide much more to OR. The other major conclusion is that OR needs to understand its subject-matter before it can reasonably hope to implement its ideals. Given the general bias which we find in Part One against seriously considering the subject-matter of OR, we enter Part Two with some trepidation. Notwithstanding the philosophical bias against it, it is clear that OR must have a conception of the nature of its subject-matter. However, OR's ideals can just as easily be lost by inadequate attention to this task. In Part Two the biases discovered in Part One come home to roost. The first attempt to provide the ideals of OR with a substance on the basis of which its ideals can be implemented in an objective fray turns out to be just that, i.e., metaphysical 'substance' in the guise of a theory of management. We see in chapter 6 that to the extent to which this theory moves beyond merely asserting that management would 'take care' of OR's need for an objective basis, it presupposes a social theory which would show how social systems by their nature (if properly constructed) embody this objectivity. This move is foreshadowed in chapter 3 where we see Kuhn (who is taken as an exemplar of conventionalist philosophy) finally resorting to this device to prop up his conventionalism, against the growing weight of subjectivity under which it threatened to sag into the jaws of positivism. The social theory on which such claims rest is given detailed consideration in. chapter 7. In chapter 7 I give serious consideration to the possibility that OR's social theory, if it has one at all, will be developed in reaction to what it sees as the "problem of order", because this problem can be seen as but another way of stating its ideals in a specifically social way. Stating OR ideals in this way orients them directly to at least one aspect of the question of the nature of OR's subject-matter. We see that by employing, Durkheim's account of and solution to the social problem of order as a basis for comparison with OR (first as a homomorphism. and later as an isomorphism) that we are able to gain quite a firm grip on OR's social theory (and, hence, its grasp of its subject-matter). We see that this theory, although providing a justification for OR's theory of management (especially in its modern form), it is itself inadequate. The basis of the inadequacy, most fundamentally, is that the theory in question presupposes the very thing, that should be in question, namely, the nature of the social collective. I conclude with a specific illustration of the impact of this theory on the ideal of OR by analysing the inadequate treatment of power and conflict which it allows

Shortfall in stroke care: A study of ischaemic stroke care practices in a South African metropole

Background. In recent years there have been significant advances in the management of stroke. In particular, reperfusion therapies have been shown to confer significant benefit, with the possibility of reversing ischaemic stroke or reducing disability when administered to suitable patients. However, these therapies also carry significant risk, including death. The South African (SA) and other international guidelines for stroke care provide recommendations to optimise benefit and reduce risk of these novel treatments. Failure to adhere to recommended guidelines can lead to increased preventable morbidity and mortality in such patients.Objectives. To describe the acute and post-acute ischaemic stroke services offered to patients in level 1, 2 and 3 hospitals in the Cape Metro Health District, determine levels of adherence to the SA stroke guideline, and identify barriers to optimal stroke patient care.Methods. This study in five level 1, one level 2 and two level 3 public hospitals involved semi-structured interviewer-administered questionnaires and reviews of ischaemic stroke patient discharge summaries, hospital staffing, stroke protocols, diagnostic investigations available and stroke education for patients and their caregivers. The findings were then compared with recommendations in the national guideline.Results. Twenty-eight participants (18 doctors, 10 nurses) from the general medical wards, stroke units and emergency units of eight hospitals were invited to participate in interviews. Most level 1 and 2 hospitals experienced difficulties transferring patients to higher levels of care. There was also limited access to stroke management protocols, inadequate stroke education among health professionals, pre- and in-hospital delays in patients receiving medical attention, and limited access to diagnostic investigations. As only a total of 12 stroke unit beds were available at the two level 3 hospitals, the majority of ischaemic stroke patients were admitted to the general medical wards of level 1, 2 and 3 hospitals. The level of care at all these facilities was not homogeneous.Conclusions. The two stroke units at the level 3 hospitals adhered most closely to the recommended SA stroke guideline. Elsewhere, ischaemic stroke care varied widely across general medical wards at all hospital levels. Adherence to the guideline was influenced by factors such as limited access to diagnostic investigations, patient delays in receiving medical attention, and shortages of staff. Monitoring systems for continuous evaluation of the quality of acute and post-acute stroke services are needed. The shortfall in compliance with recommended stroke treatment guidelines could lead to worse outcomes and exposure to litigation

Inherited polyglutamine spinocerebellar ataxias in South Africa

Objective. To determine the frequency and distribution ofpolyglutamine spinocerebellar ataxias (SCAs) from referrals over a24-year period to the National Health Laboratory Service (NHLS)in South Africa (SA).Methods. Paper-based clinical reports in the University ofCape Town laboratory and the NHLS electronic patient recorddatabase spanning a 24-year period were mined for informationregarding the molecular diagnosis, ethnicity and CAG repeatlength for individuals referred for molecular genetic testing for thepolyglutamine SCAs.Results. SCA1 and 7 are the most frequent types of polyglutamineSCA in the SA patient population, followed by SCA2, 3 and 6.SCA1 is the most common type in the coloured, white and Indianpopulations, whereas the majority of indigenous black Africanpatients are affected with SCA7 and 2. Of individuals tested, 22%were found to be positive for one of the polyglutamine SCAs.Conclusion. Although trends in the frequency and distributionof the polyglutamine SCAs in SA have not changed significantlysince our previous study in 2003, they differ remarkably from thosereported elsewhere, and reflect the unique genetic and demographicbackground of SA. The provision of accurate and complete patientinformation and family history is crucial to the diagnostic process,to enable comprehensive epidemiological studies and assist indeveloping therapeutic and patient management strategies

Stroke outcomes in a socio-economically disadvantaged urban community

Aims. To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. Methods. Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. Results. The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. Conclusion. Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes

There\u27s More to Young Adult Unemployment Than Mental Health: What Else to Look For [English and Spanish versions]

A Spanish translation of this publication is available to download under Additional Files below. High unemployment among young adults with serious mental health conditions (SMHCs) should not only be attributed to their mental health conditions. Research should take an intersectional approach where, in addition to looking at mental health condition factors, other indicators of social and demographic inequalities are also taken into account

Registration of amiloride in South Africa: Cutting the Gordian knot

Amiloride is an antagonist of the renal tubular epithelial sodium channel (ENaC). As such, it is a diuretic that is both potassium and magnesium sparing. It is used for the treatment of potassium depletion and hypertension, and is the specific therapy for hypertension due to overactivity of the ENaC (Liddle syndrome and several additional genetic causes of the Liddle phenotype - low renin and low aldosterone). It is listed as a World Health Organization essential drug, but has never been registered in South Africa (SA) and can therefore only be prescribed under a Section 21 application to the SA Health Products Regulatory Authority (SAHPRA) on a case-by-case basis. In SA, \u3e50% of patients treated for hypertension are not controlled. In the USA, the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study reported that African Americans are more likely to be diagnosed with hypertension, more likely to be treated, more likely to be treated intensively, and less likely to achieve blood pressure (BP) control. Although the reasons are complex, studies show that 10 - 20% of blacks may carry the Liddle phenotype. Observational data and a controlled clinical trial done in three African countries have shown that these patients respond to amiloride and not to conventional guideline-based antihypertensive treatment. The former is likely to result in a significant reduction in cardiovascular, stroke and kidney morbidity and mortality, because of improved BP control. Amiloride is very unlikely to ever be registered in SA, as it was first developed \u3e50 years ago, and SAHPRA regulations prevent widespread prescription of this essential drug. This is a classic Gordian knot that requires a novel approach from authorities to sever the knot and improve the health of many South Africans