Autonomy and Higher Education: Insight into the Autonomy System in the Commonwealth of Virginia

Institutions of Higher Education (IHEs) have wrangled with state governmental agencies for decades about the role the government should assume in overseeing campus operations. IHEs continue to argue that government intrusion impedes efficient IHE operation. Government agencies counter that IHEs are provided tax dollars to complete the job of educating the states’ citizens and that IHEs must abide by the rules and regulations set by the state. However, over the last two decades, state funding for IHEs is at an all-time low; yet governments still dictate how IHEs operate. With decreased state funding, IHEs sought to replace those funds by focusing on external funding sources such as tuitions. These issues strain the relationship between IHEs and state governments resulting in IHEs calling for more autonomy in campus operations. In 2005, the Commonwealth of Virginia passed the Restructured Higher Education Financial and Administrative Operations Act, known as the Restructuring Act. This legislation created a unique autonomy system in Virginia that provided IHEs an opportunity to obtain substantial autonomy over their affairs. This dissertation reports results of research seeking to better understand the autonomy system in Virginia. This study examined pre-autonomy Virginia Commonwealth University (VCU) (2006-2008) and post-Autonomy III VCU (2009-2015). Post-Autonomy III VCU has complete autonomy over its finances and operations and are not under the authority of the Commonwealth of Virginia. This study sought to determine if postAutonomy III VCU had higher minority enrollment percentages, smaller administrative and management staff percentages, and higher axillary revenue percentages. Also, this research reviewed minority enrollment percentages, administrative and management staffing percentages, and auxiliary revenue percentages to determine if autonomy status influenced Virginia Commonwealth University’s minority enrollment percentages, administrative and staffing percentages, and auxiliary revenue percentages compared to non-autonomous comparative IHEs in Virginia. The Delta Cost Project Database (DCPD) was created in 2007 to make the Integrated Postsecondary Education Data System (IPEDS) more usable for longitudinal research (American Institutes of Research, 2017). In 2012, the American Institutes for Research (AIR) assumed responsibility for the database while the National Center for Educational Statistics (NCES) maintained the database. The data stored in the DCPD spans from 1987-2015 (AIR, 2017). The DCPD provides data on 184 public IHEs in the United States (AIR, 2017). The DCPD database also includes data related to enrollment and administrative expenditures, as well as auxiliary expenditures. The research conducted within this dissertation yielded promising results. PostAutonomy III VCU possessed a more diverse enrollment and employed less administrative and management staff. Further, VCU created a higher percentage of revenue for auxiliary enterprises and possessed a higher percentage of minority enrollment than non-autonomous IHEs in Virginia. This research was designed to gain a better understanding of the autonomy system in Virginia. The results indicate that a relationship exists between autonomy and how IHEs operate. Further research on autonomy in higher education is needed to determine how autonomy impacts efficiency. However, to date, little research exists related to this topic in the United States. This study contributes to our understanding of and raises future research question about the relationship between institutional autonomy and multiple institutional outcome

Screening for Park Access during a Primary Care Social Determinants Screen.

While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks.MethodsWe conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses were conducted to explore associations between lack of access to parks and sociodemographic variables. We also explored the extent to which access to parks competed with other needs.ResultsThe survey was completed by 890 caregivers; 151 (17%) identified "access to green spaces/parks/playgrounds" as an unmet need, compared to 397 (45%) who endorsed "running out of food before you had money or food stamps to buy more". Being at or below the poverty line doubled the odds ( Odds ratio 1.96, 95% CI 1.16-3.31) of lacking access to a park (reference group: above the poverty line), and lacking a high school degree nearly doubled the odds. Thirty-three of the 151 (22%) caregivers who identified access to parks as an unmet need prioritized it as one of three top unmet needs. Families who faced competing needs of housing, food, and employment insecurity were less likely to prioritize park access (p < 0.001).ConclusionClinical interventions to increase park access would benefit from an understanding of the social and economic adversity faced by patients

Impfkämpfe: Was können wir aus der kalifornischen Erfahrung mit der Pflichtimpfung der Schulkinder Lernen?

The almost universal administration of childhood immunisations has been associated with logarithmic drops in the incidence of a number of diseases in the United States and worldwide. In the United States, mandatory school immunisation laws have in particular been instrumental in achieving the high levels of coverage needed to sustain herd immunity. However, concerns about vaccine safety led to the passing of the National Childhood Vaccine Injury Act of 1986, which uses a no-fault system compensation system for people found to be injured by certain vaccines. The measles vaccine is highly effective, and outbreaks of measles are usually the consequence of failure to vaccinate. A high-profile outbreak of measles at a southern California amusement park in 2014 led the state of California to further restrict the ability of children to attend school if they are not immunized because of their family’s beliefs. Immunisation requirements are but one of many legal mandates designed for public health protection, from mandatory fluoridation of drinking water to quarantine and isolation for communicable diseases. We conclude that school immunisation requirements help governments fulfil their duty to protect and promote public health.Gotovo univerzalna imunizacija djece povezana je s logaritamskim opadanjem broja zaraza kako u Sjedinjenim Državama tako i svijetu. U Sjedinjenim Državama, zakon o obveznom cijepljenju školske djece pokazao se posebno korisnim za postizanje visokog stupnja zaštite potrebne za održavanje imunosti zajednice. Međutim, zabrinutosti oko sigurnosti cjepiva dovele su do donošenja National Childhood Vaccine Injury Act (Nacionalni zakon o štetnosti dječjeg cjepiva) iz 1986., prema kojem se kroz „no-fault sustav“ (bez obzira tko je kriv) kompenziraju oštećeni određenim cjepivima. Cjepivo protiv ospica iznimno je učinkovito, a pojave ospica najčešće su povezane s neprimanjem cjepiva. Zbog poznatog slučaja pojave ospica u kalifornijskom zabavnom parku 2014., savezna država Kalifornija dodatno je ograničila mogućnost pohađanja škole djece koja nisu cijepljena zbog obiteljskih uvjerenja. Obvezno cijepljenje predstavlja samo jednu od odredbi kojima je cilj zaštita javnog zdravlja, a ,eđu kojima su i obvezna fluoridacija pitke vode i karantena i izolacija zbog prenosivih bolesti. Zaključujemo da obvezno cijepljenje školske djece pomaže vladama u ispunjenju njihove dužnosti u zaštiti i unaprjeđenju javnog zdravstva.Eine fast universelle Immunisierung der Kinder ist, sowie in den USA als auch in der übrigen Welt, mit einer logarithmischen Abnahme der Ansteckungsfälle verbunden. In den USA hat sich das Gesetz über die Pflichtimpfung von Schulkindern als besonders nützlich zum Erreichen einer hohen Stufe des für Erhalten der Immunität der Gemeinschaft nötigen Schutzes erwiesen. Allerdings haben die Bedenken über die Impfsicherheit zum Erlassen des Nationalen Kindheits-Impfstoff-Verletzungsgesetz aus dem Jahr 1986 (National Childhood Vaccine Injury Act) geführt, wonach durch ein „No-Fault-System“ (ungeachtet dessen, wer die Schuld trägt) die durch bestimmte Impfstoffe Betroffenen entschädigt werden. Der Masernimpfstoff ist außerordentlich effizient und die Masernfälle sind meistens mit der Nichtimpfung verbunden. Wegen des bekannten Falls des Masernausbruchs im kalifornischen Vergnügungspark 2014 hat der Bundesstaat Kalifornien zusätzlich den Schulbesuch von Kindern beschränkt, die aus Familienüberzeugung nicht geimpft wurden. Die Pflichtimpfung ist nur eine von Bestimmungen, deren Ziel der Schutz der öffentlichen Gesundheit ist, dazu gehören noch die obligatorische Trinkwasserfluoridierung, Quarantäne und und Isolation wegen übertragbaren Krankheiten. Wir kommen zum Schluß, dass die Pflichtimpfung von Schulkindern den Regierungen hilft, ihre Pflichten im Rahmen des Schutzes und der Förderung der öffentlichen Gesundheit zu erfüllen

The Epidemiology of HIV and AIDS in the World

The worldwide epidemic of HIV continues to expand in many regions of the world, particularly in southern Africa, South and Southeast Asia, East Asia and Eastern Europe and Central Asia. Estimates are that at the end of 2005 there were 38.6 million persons living with HIV infection and that 4.1 million new infections and 2.8 million deaths from HIV occurred during the year. Regionally different patterns predominate from generalized heterosexual epidemics in sub-Saharan Africa and parts of the Caribbean to mixes of epidemics in which transmission among injection drug users, their sexual partners, commercial sex workers and their partners intersect. Multilateral and bilateral antiretroviral access campaigns, such as the World Health Organization’s 3 x 5 initiative, have resulted in broader access to live-saving therapy for infected persons in low- and middle-income countries, but several million infected people who are clinically eligible for antiretroviral therapy remain untreated. The public health challenge worldwide is to keep the uninfected and to treat and care for those who have already been infected

Toxicity-related antiretroviral drug treatment modifications in individuals starting therapy: a cohort analysis of time patterns, sex, and other risk factors.

BackgroundModifications to combination antiretroviral drug therapy (CART) regimens can occur for a number of reasons, including adverse drug effects. We investigated the frequency of and reasons for antiretroviral drug modifications (ADM) during the first 3 years after initiation of CART, in a closed cohort of CART-naïve adult patients who started treatment in the period 1998-2007 in Croatia.Material and methodsWe calculated differential toxicity rates by the Poisson method. In multivariable analysis, we used a discrete-time regression model for repeated events for the outcome of modification due to drug toxicity.ResultsOf 321 patients who started CART, median age was 40 years, 19% were women, baseline CD4 was <200 cells/mm3 in 71%, and viral load was ≥100 000 copies/mL in 69%. Overall, 220 (68.5%) patients had an ADM; 124 (56%) of these had ≥1 ADM for toxicity reasons. Only 12.7% of individuals starting CART in the period 1998-2002 and 39.4% in the period 2003-2007 remained on the same regimen after 3 years. The following toxicities caused ADM most often: lipoatrophy (22%), gastrointestinal symptoms (20%), and neuropathy (18%). Only 5% of drug changes were due to virologic failure. Female sex (hazard ratio [HR], 2.42 95%; confidence intervals, 1.39-4.24) and older age (HR, 1.42 per every 10 years) were associated with toxicity-related ADM in the first 3 months of a particular CART regimen, but after 3 months of CART they were not.ConclusionsLess toxic and better-tolerated HIV treatment options should be available and used more frequently in Croatia

Gestational dating by metabolic profile at birth: a California cohort study.

BackgroundAccurate gestational dating is a critical component of obstetric and newborn care. In the absence of early ultrasound, many clinicians rely on less accurate measures, such as last menstrual period or symphysis-fundal height during pregnancy, or Dubowitz scoring or the Ballard (or New Ballard) method at birth. These measures often underestimate or overestimate gestational age and can lead to misclassification of babies as born preterm, which has both short- and long-term clinical care and public health implications.ObjectiveWe sought to evaluate whether metabolic markers in newborns measured as part of routine screening for treatable inborn errors of metabolism can be used to develop a population-level metabolic gestational dating algorithm that is robust despite intrauterine growth restriction and can be used when fetal ultrasound dating is not available. We focused specifically on the ability of these markers to differentiate preterm births (PTBs) (<37 weeks) from term births and to assign a specific gestational age in the PTB group.Study designWe evaluated a cohort of 729,503 singleton newborns with a California birth in 2005 through 2011 who had routine newborn metabolic screening and fetal ultrasound dating at 11-20 weeks' gestation. Using training and testing subsets (divided in a ratio of 3:1) we evaluated the association among PTB, target newborn characteristics, acylcarnitines, amino acids, thyroid-stimulating hormone, 17-hydroxyprogesterone, and galactose-1-phosphate-uridyl-transferase. We used multivariate backward stepwise regression to test for associations and linear discriminate analyses to create a linear function for PTB and to assign a specific week of gestation. We used sensitivity, specificity, and positive predictive value to evaluate the performance of linear functions.ResultsAlong with birthweight and infant age at test, we included 35 of the 51 metabolic markers measured in the final multivariate model comparing PTBs and term births. Using a linear discriminate analyses-derived linear function, we were able to sort PTBs and term births accurately with sensitivities and specificities of ≥95% in both the training and testing subsets. Assignment of a specific week of gestation in those identified as PTBs resulted in the correct assignment of week ±2 weeks in 89.8% of all newborns in the training and 91.7% of those in the testing subset. When PTB rates were modeled using the metabolic dating algorithm compared to fetal ultrasound, PTB rates were 7.15% vs 6.11% in the training subset and 7.31% vs 6.25% in the testing subset.ConclusionWhen considered in combination with birthweight and hours of age at test, metabolic profile evaluated within 8 days of birth appears to be a useful measure of PTB and, among those born preterm, of specific week of gestation ±2 weeks. Dating by metabolic profile may be useful in instances where there is no fetal ultrasound due to lack of availability or late entry into care

Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey.

IntroductionAt the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.MethodsBetween October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.ResultsOverall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.DiscussionThis report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary

Challenges to generating political prioritization for adolescent sexual and reproductive health in Kenya: A qualitative study.

BackgroundDespite the high burden of adverse adolescent sexual and reproductive health (SRH) outcomes, it has remained a low political priority in Kenya. We examined factors that have shaped the lack of current political prioritization of adolescent SRH service provision.MethodsWe used the Shiffman and Smith policy framework consisting of four categories-actor power, ideas, political contexts, and issue characteristics-to analyse factors that have shaped political prioritization of adolescent SRH. We undertook semi-structured interviews with 14 members of adolescent SRH networks between February and April 2019 at the national level and conducted thematic analysis of the interviews.FindingsSeveral factors hinder the attainment of political priority for adolescent SRH in Kenya. On actor power, the adolescent SRH community was diverse and united in adoption of international norms and policies, but lacked policy entrepreneurs to provide strong leadership, and policy windows were often missed. Regarding ideas, community members lacked consensus on a cohesive public positioning of the problem. On issue characteristics, the perception of adolescents as lacking political power made politicians reluctant to act on the existing data on the severity of adolescent SRH. There was also a lack of consensus on the nature of interventions to be implemented. Pertaining to political contexts, sectoral funding by donors and government treasury brought about tension within the different government ministries resulting in siloed approaches, lack of coordination and overall inefficiency. However, the SRH community has several strengths that augur well for future political support. These include the diverse multi-sectoral background of its members, commitment to improving adolescent SRH, and the potential to link with other health priorities such as maternal health and HIV/AIDS.ConclusionIn order to increase political attention to adolescent SRH in Kenya, there is an urgent need for policy actors to: 1) create a more cohesive community of advocates across sectors, 2) develop a clearer public positioning of adolescent SRH, 3) agree on a set of precise approaches that will resonate with the political system, and 4) identify and nurture policy entrepreneurs to facilitate the coupling of adolescent SRH with potential solutions when windows of opportunity arise

A systemic gene silencing method suitable for high throughput, reverse genetic analyses of gene function in fern gametophytes

BACKGROUND: Ceratopteris richardii is a useful experimental system for studying gametophyte development and sexual reproduction in plants. However, few tools for cloning mutant genes or disrupting gene function exist for this species. The feasibility of systemic gene silencing as a reverse genetics tool was examined in this study. RESULTS: Several DNA constructs targeting a Ceratopteris protoporphyrin IX magnesium chelatase (CrChlI) gene that is required for chlorophyll biosynthesis were each introduced into young gametophytes by biolistic delivery. Their transient expression in individual cells resulted in a colorless cell phenotype that affected most cells of the mature gametophyte, including the meristem and gametangia. The colorless phenotype was associated with a 7-fold decrease in the abundance of the endogenous transcript. While a construct designed to promote the transient expression of a CrChlI double stranded, potentially hairpin-forming RNA was found to be the most efficient in systemically silencing the endogenous gene, a plasmid containing the CrChlI cDNA insert alone was sufficient to induce silencing. Bombarded, colorless hermaphroditic gametophytes produced colorless embryos following self-fertilization, demonstrating that the silencing signal could be transmitted through gametogenesis and fertilization. Bombardment of young gametophytes with constructs targeting the Ceratopteris filamentous temperature sensitive (CrFtsZ) and uroporphyrin dehydrogenase (CrUrod) genes also produced the expected mutant phenotypes. CONCLUSION: A method that induces the systemic silencing of target genes in the Ceratopteris gametophyte is described. It provides a simple, inexpensive and rapid means to test the functions of genes involved in gametophyte development, especially those involved in cellular processes common to all plants

MathBrush: An Experimental Pen-Based Math System

It is widely believed that mathematics will be one of the major applications for Tablet PCs and other pen-based devices. In this paper we discuss many of the issues that make doing mathematics on such pen-based devices a hard task. We give a preliminary description of an experimental system, currently named MathBrush, for working with mathematics using pen-based devices. The system allows a user to enter mathematical expressions with a pen and to then do mathematical computation using a computer algebra system. The system provides a simple and easy way for users to verify the correctness of their handwritten expressions and, if needed, to correct any errors in recognition. Choosing mathematical operations is done making use of context menus, both with input and output expressions