THE CHANGING STRUCTURE OF RELATIONSHIPS BETWEEN FOREIGN AID AND LOCAL SYSTEMS

This dissertation project examines the extent to which the interaction between the international aid and the public health systems in Thailand generates change in both systems by examining the Global Fund process over the last ten years. This research uses complexity science, network theory, and organizational collaboration literatures, taking Elinor Ostrom’s institutional analysis and development framework as its theoretical foundation. The Global Fund is an action arena that bridges both the local public health action arena and the Thai foreign aid action arena. It creates structures that result in organizational interactions, program design and implementation, and program evaluations that feed back into both the local public health and foreign aid action arenas, resulting in change in both. This project uses document analysis, network analysis and interviews conducted during fieldwork in Thailand to examine how interactions between organizations change the structure of relationships, organizational roles and influence and program outcomes. It finds that the Global Fund process results in network structural and substantive changes, including changes in density, development of sub-network structures and changes in participants and program focus. Through these changes, the process engenders positive adaptation within the public health sector in Thailand, by improving human, organizational and community capacity and by reaching previously underserved populations, and positive adaptation in the foreign aid system in Thailand through the changing the roles of these organizations, adapting from agenda setters to providers of technical assistance. This study makes important contributions to the fields of complexity and systems, organizational collaboration and network theory. It finds that the bridging action arena creates and enhances relationships between organizational members, resulting in adaptation within the arenas it overlaps. The results are changes in the attributes of the community and the rules in which they operate within both systems. It also changes the material conditions of both the systems it overlaps. This study is an exploratory endeavor that seeks to expand the understanding of overlapping systems and contribute to theories surrounding this phenomenon. In the process of this research, theoretical questions emerged about the nature of these overlapping systems, about the participants within them, and about how they develop over time that will inform future research agendas

Investigation of Upper Limb Kinematics and Corticospinal Pathway Activity Early After Stroke

Abstract Reach-to-grasp is an essential part of activities of daily living (ADL’s); despite rehabilitation reach-to-grasp often impaired after a stroke contributing to disability. Upper limb rehabilitation interventions need improvement. A deeper understanding of underlying kinematic characteristics and the neural correlates of movement can be achieved through neuro-biomechanical assessment. This would provide knowledge of the interaction of the nervous and musculoskeletal system, which may contribute to development of improved targeted upper limb interventions. A systematic review and meta-analysis was conducted investigating the kinematic differences in reach-to-grasp between stroke survivors and neurologically intact adults. The results indicate stroke survivors consistently demonstrate different kinematics to neurologically intact adults during reach-to-grasp in the central and ipsilateral workspace. There was heterogeneity of the reach-to-grasp task, and included studies demonstrated unclear or high potential risk of bias. A test-retest reliability study investigated transcranial magnetic stimulation (TMS) measures of corticospinal pathway excitability in the bilateral biceps, extensor carpi radialis (ECR), and abductor pollicis brevis (APB) in neurologically intact adults. The results demonstrate variable reliability; the lower end of the confidence interval was below acceptable reliability (ICC < 0.70) for many measures. The 95% confidence intervals (CI) and 95% limits of agreement (LOA) were wide, further indicating imprecision in measurement. A test-retest reliability study investigated TMS measures of corticospinal pathway excitability in the bilateral biceps, ECR and APB in stroke survivors within three months after stroke. The results demonstrate variable reliability; and the lower end of the confidence interval was below the range of acceptable reliability (ICC < 0.70) for many measures. The 95% CI and 95% LOA were wide, further indicating imprecision in measurement. Investigations into the variability of TMS measures in sub-acute stroke survivors and neurologically intact adults; as well as specificity of TMS measurement warrant future investigations to determine the use of TMS within these populations

Production and characterization of a phage endolysin with putative antimicrobial activity against Cutibacterium acnes

Acne vulgaris (acne) is the eighth most common skin disorder worldwide. Because of the heterogeneous pathology of acne and the increasing antibiotic resistance of the causal agent (Cutibacterium acnes), novel therapeutics need to be developed to treat acne. One option is endolysins, highly conserved enzymes from bacteriophages that disrupt the bacterial cell wall. Endolysins retain bactericidal and bacteriostatic activity when applied to bacteria in vitro and are safe for topical application. We hypothesize that the endolysin (ENDL) from the P100.1 C. acnes bacteriophage will exhibit bacteriostatic activity against C. acnes in vitro. This study aims to bioinformatically characterize the P100.1 endolysin’s structure, produce and isolate the endolysin, then evaluate putative antimicrobial effects. We cloned the endolysin gene into vectors (pET11a & pBAD-GFP) for expression by Escherichia coli or as a fusion protein to green fluorescent protein (GFP). We compared the growth rates of C. acnes treated with cell lysate of cultures induced to produce the endolysin to non-treatment controls to evaluate bactericidal effects. We found \u3e88% sequence similarity between endolysins of phages targeting C. acnes, indicating high conservation and that all currently identified endolysins of phages targeting C. acnes are amidases. Expression of the recombinant proteins could only be detected for the strains containing the pBAD-GFP vector and not the pET11a vector. The antimicrobial activity of endolysin-fusion protein was inconclusive, as the impact on the growth of C. acnes over time was negligible. Therefore, more research is needed to determine whether the P100.1 endolysin or other endolysins from C. acnes phages are viable anti-bacterial therapies

Clinical perspectives on etiology, assessment, formulation and treatment of imaginary companions in adolescents with attachment trauma

This theoretical study explored the phenomenon of imaginary companions as they present within the lives of adolescents with histories of attachment trauma. The phenomenon and is origins were explored through a review of developmental, psychoanalytic and trauma research. Theoretical perspectives of narrative therapy and Winnicottian object relations were then introduced as lenses through which to conceptualize assessment and formulation of the phenomenon, with careful consideration paid to the social context within which the phenomenon emerges. These theoretical perspectives were then applied to a discussion of assessment, formulation and treatment within a specific case example, written by Proskauer, Barsh and Johnson (1980), about an Navajo adolescent male who presented for treatment with imaginary companions and a complex history of trauma. The study findings indicated that imaginary companions can be viewed as a resilient adaptive response to attachment trauma and that therapy can assist adolescents in finding a place of holding through which to address unmet developmental needs as well as to create multiple storied identities. Both theoretical approaches focused treatment on the development of the adolescent\u27s whole and true self. Areas of further research and the relevance of this study to the field of social work were both explored throughout the body of the study

A Comparison of the Pattern of Involvement of Degenerative Joint Disease Between an Agricultural and Non-Agricultural Skeletal Series

This study investigates the differences in the pattern of involvement of osteoarthritis between two groups of prehistoric American Indians who lived in a similar ecosystem and climate, separated by time and cultural activities. The purpose of this biocultural investigation was to determine if there was a difference in the patterning of the degenerative lesions in the two skeletal series and if that suite of characteristics would assist in determining possible aetiological factors and culturally determined activities. Two archaeological skeletal series were utilized, Averbuch (40DV60), of middle Tennessee, to represent an agricultural site outside the mainstream of the late Mississippian period and Indian Knoll (240H2), in Kentucky, an Archaic series. A detailed examination of the adult osseous remains was undertaken employing a sample of 196 individuals from Averbuch and 199 from Indian Knoll: observations were made bilaterally on forty-five discrete areas of the four large peripheral joints. The statistical analysis of the discrete variables as well as those of the total joints, knee, hip, shoulder, and elbow are discussed at length. A distinct difference in the pattern of involvement of degenerative joint disease was evident, the Averbuch individuals exhibited a highly statistically significant greater involvement than the Indian Knoll individuals. Averbuch exhibited evidence of an earlier onset of degenerative changes and a higher degree of severity than Indian Knoll within all joints. The degenerative changes indicate that the females of both sample populations utilized the shoulder in comparable fashion although the Averbuch women manifested evidence of more stressful behavior at all ages. Biological and social evidence of stress indicate that factors other than culturally determined physical activities existed which contributed to the generally more adversarial climate in which the Averbuch people survived. The results of this study emphasize the adverse effect which agriculture and its attendant modifications in cultural activities may have on the human species

Formulas for estimating the costs averted by sexually transmitted infection (STI) prevention programs in the United States

<p>Abstract</p> <p>Background</p> <p>Sexually transmitted infection (STI) prevention programs can mitigate the health and economic burden of STIs. A tool to estimate the economic benefits of STI programs could prove useful to STI program personnel.</p> <p>Methods</p> <p>We developed formulas that can be applied to estimate the direct medical costs and indirect costs (lost productivity) averted by STI programs in the United States. Costs and probabilities for these formulas were based primarily on published studies.</p> <p>Results</p> <p>We present a series of formulas that can be used to estimate the economic benefits of STI prevention (in 2006 US dollars), using data routinely collected by STI programs. For example, the averted sequelae costs associated with treating women for chlamydia is given as (C_w)(0.16)(0.925)(0.70)($1,995), where C_wis the number of infected women treated for chlamydia, 0.16 is the absolute reduction in the probability of pelvic inflammatory disease (PID) as a result of treatment, 0.925 is an adjustment factor to prevent double-counting of PID averted in women with both chlamydia and gonorrhea, 0.70 is an adjustment factor to account for the possibility of re-infection, and$1,995 is the average cost per case of PID, based on published sources.</p> <p>Conclusion</p> <p>The formulas developed in this study can be a useful tool for STI program personnel to generate evidence-based estimates of the economic impact of their program and can facilitate the assessment of the cost-effectiveness of their activities.</p

iPads, iBooks, Apps! What\u27s all the iFuss about?

The iVolution is here. It is iThis and iThat every way you turn. Is this just another iFad, or is it truly revolutionizing education? In a recent survey conducted by EDUCAUSE Center for Analysis and Research on undergraduates and technology, 31% of students reported owning tablet technology a 15% increase from the previous year and 76% of students reported owning smart phones. This finding was a 14% increase from the previous year. Students also reported using smart devices in class to access material, participate in activities, look up information and photograph material as learning strategies. Thomas Jefferson University is riding the iWave and taking strides to better integrate technology at all levels of medical training; leading the forefront of the iVolution, syllabi, course materials, and textbooks are now delivered in some of our courses via iPads. In the past few years, the Jefferson Health Mentors Program has embraced the use of new technologies, including Wikis, online discussion boards, Google docs, and Skype platforms to facilitate asynchronous IPE interactions. These platforms have helped to promote IPE by easing scheduling logistics and by allowing students to collaborate electronically on team-based assignments. Over the past summer, JCIPE, the Jefferson Health Mentors Program (JHMP), faculty from Jefferson Medical College and the School of Health Professions, Academic & Instructional Support & Resources (AISR) and Jeff Information Technology (IT) assembled a working group and developed yet another innovative tool to better integrate technology into our IPE efforts – the product was a new iBook, entitled “Assessing Patient Safety.

Some wildfire ignition causes pose more risk of destroying houses than others

Many houses are at risk of being destroyed by wildfires. While previous studies have improved our understanding of how, when and why houses are destroyed by wildfires, little attention has been given to how these fires started. We compiled a dataset of wildfires that destroyed houses in New South Wales and Victoria and, by comparing against wildfires where no houses were destroyed, investigated the relationship between the distribution of ignition causes for wildfires that did and did not destroy houses. Powerlines, lightning and deliberate ignitions are the main causes of wildfires that destroyed houses. Powerlines were 6 times more common in the wildfires that destroyed houses data than in the wildfires where no houses were destroyed data and lightning was 2 times more common. For deliberate-and powerline-caused wildfires, temperature, wind speed, and forest fire danger index were all significantly higher and relative humidity significantly lower (P \u3c 0.05) on the day of ignition for wildfires that destroyed houses compared with wildfires where no houses were destroyed. For all powerline-caused wildfires the first house destroyed always occurred on the day of ignition. In contrast, the first house destroyed was after the day of ignition for 78% of lightning-caused wildfires. Lightning-caused wildfires that destroyed houses were significantly larger (P \u3c 0.001) in area than human-caused wildfires that destroyed houses. Our results suggest that targeting fire prevention strategies around ignition causes, such as improving powerline safety and targeted arson reduction programmes, and reducing fire spread may decrease the number of wildfires that destroy houses

Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions:Systematic Review and Meta-Analysis

Background: Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. Aim: to identify potential; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. Methods: A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in people-with-stroke and healthy adults. Potential risk-of-bias was assessed using the Down’s and Black Tool. Synthesis was undertaken via: (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Results: Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included in the meta-analysis. Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 people-with-stroke and 429 healthy adults. The meta-analysis found, in all areas of workspace, that people-with-stroke had: greater movement times (seconds) e.g. SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g. SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; a more curved reach-path-ratio e.g. SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g. SMD 0.92 [0.32, 1.52]. In the ipsilateral and contralateral workspace, people-with-stroke exhibited: larger errors in target accuracy e.g. SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g. elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that people-with-stroke, compared with healthy adults, exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. Conclusions: This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. The differences identified and values provided are potential foci for tailored rehabilitation interventions to improve upper limb recovery after stroke