Prevention of Major Amputation secondary to Diabetes-related Foot Disease

Incidence of amputation secondary to diabetic foot disease is unacceptably high, especially as up to 80% of these amputations are deemed preventable through optimal management and education. Tackling complications and reducing amputation rates requires a holistic approach identifying issues at a person, system and population level. Investing in preventive strategies is cost effective and avoids the burden of extremely costly reactive interventions. The overarching aim of this thesis was to understand the previously undocumented burden of diabetes-related amputation and the associated risk factors for amputation within Wales. The thesis investigated amputation rates and mortality in the Welsh population with and without diabetes over the last decade for both major and minor amputations using a repository of medical data of all Welsh residents. The thesis also examined risk factors for amputation at a person, health board and population level using different methodologies to quantify specific risks. This included root cause analysis to assess care provision and questionnaires to understand patient’s knowledge and behaviours. The thesis identified variance from gold standards of care for diabetic foot disease and most amputations in the root cause analysis were determined potentially preventable. However, it identified simple behavioural and educational measures and areas for implementation of risk reduction strategies within our health board. Despite the population with diabetes representing only 7% of the total Welsh population, they accounted for over 50% of the incident amputations performed. Only a minor reduction in rate of amputation was seen over time and there was marked variance in rates between health boards. Mortality following major amputation was high with a mortality rate of 61.9% at 5 years in the total population and 67% in the population with diabetes. By highlighting variance and current trends in care the thesis provides the grounds for the implementation of interventions to reduce amputation rates

A Case Study Exploring the Motivating Factors and Needs That Influence Older Adult Learners’ Decisions to Enroll and Persist in One University System of Georgia eMajor Collaborative Program

This qualitative case study seeks to examine older adult learners\u27 views toward technology use and their motivation, needs, and experiences while enrolled in the eMajor online Organizational Leadership bachelor\u27s degree program offered by the University System of Georgia (USG). The research will investigate what motivates students to enroll in and advance through a degree program and their present technological competencies in relation to online learning management systems. The case study will also strive to identify the demands of older adult learners and the influence online learning has on their drive for program completion. Qualitative data were collected from twelve older adult learners, 45 years of age and older, from one eMajor collaborative program at three partner University System of Georgia institutions through semistructured virtual interviews. The four themes that emerged from the interviews, program, degree, instructor influence, technology, online learning, and needs and experiences helped answer the guiding research questions. The study\u27s results revealed how older adult learners perceive the use of technology in higher education to increase academic achievement, learning comprehension, and course tasks. The current study sought to further assist higher education administrators and leaders understand older adult learners\u27 needs and motivators and how to better support these learners in an online environmen

Inflectional morphology and compounding in English : a single route, associative memory based account

Native English speakers include irregular plurals in English compounds (e. g., mice chaser) more frequently than regular plurals (e. g., *rats chaser) (Gordon, 1985). This dissociation in inflectional morphology has been argued to stem from an internal and innate morphological constraint as it is thought that the input to which English speaking children are exposed is insufficient to signal that regular plurals are prohibited in compounds but irregulars might be allowed (Marcus, Brinkmann, Clahsen, Weise & Pinker, 1995). In addition, this dissociation in English compounds has been invoked to support the idea that regular and irregular morphology are mediated by separate cognitive systems (Pinker, 1999). It is argued in this thesis however, that the constraint on English compounds can be derived from the general frequencies and patterns in which the two types of plural (regular and irregular) and the possessive morpheme occur in the input. In English both plurality (on regular nouns) and possession are denoted by a [-s] morpheme. It is argued that the constraint on the use of plurals in English compounds occurs because of competition between these two identical morphemes. Regular plurals are excluded before a second noun because the pattern -noun-[-sJ morpheme- noun- is reserved for marking possession in English. Irregular plurals do not end in the [-s] morpheme and as such do not compete with the possessive marker and consequently may be optionally included in compounds. Interestingly, plurals are allowed in compounds in other languages where this competitive relationship does not exist (e. g. Dutch (Schreuder, Neijt, van der Weide & Baayen, 1998) and French (Murphy, 2000). As well as not being in competition with the possessive structure irregular plurals also occur relatively infrequently in the input compared to regular plurals. This imbalance between the frequency of regular and irregular plurals in compounds also affects the way the two types of plural are treated in compounds. Thus there is no need for an innate mechanism to explain the treatment of plurals in English compounds. There is enough evidence available in the input to constrain the formation of compound words in English

Reworking: Transforming a Textile Mill

This project examines the adaptive reuse of a disused nineteenth century textile mill building in Gilbertville, Massachusetts. While the original form and structure of the building type was conducive to maximum production of goods, contemporary uses require different forms. Although other mills in New England have been reused for housing, museums, or professional offices, my goal was to propose a program that related to the building’s original function as a place where people worked. Because the unemployment rate is rising in Massachusetts in 2010, I propose that the mill be reused as a training center where people learn green building techniques that they can use in their jobs. The form of this project is guided by environmental responses to the annual and daily solar paths. Primary among these responses is the conversion of the broad, south-facing masonry wall to a trombe wall system. Similarly, a south-facing light scoop is used on the north side to provide light and heat; shading devices are used throughout the building to prevent overheating

The Cost of Quality Out-of-School-Time Programs, Executive Summary

Funders and program planners need a clear understanding of the costs of quality afterschool or summer programs to make sound investments. With support from The Wallace Foundation, P/PV partnered with The Finance Project to embark on one of the largest and most rigorous out-of-school-time (OST) cost studies to date, collecting detailed data from 111 programs that varied dramatically in their focus, content, location, staffing, management and hours of operation.This executive summary highlights the full report's key findings, summarizes variations in program costs and provides recommendations for policymakers and funders who seek to build and sustain quality OST programs for children and youth in their communities.In addition, a companion online cost calculator that provides stakeholders with estimates for various program options is available atwww.wallacefoundation.org/cost-of-quality

The Cost of Quality Out-of-School-Time Programs

Funders and program planners want to know: What does it cost to operate a high-quality after-school or summer program? This study answers that question, discovering that there is no "right" number. Cost varies substantially, depending on the characteristics of the participants, the goals of the program, who operates it and where it is located. Based on detailed cost data collected from 111 out-of-school-time programs in six cities, this report, along with an online calculator (www.wallacefoundation.org/cost-of-quality), provides cost averages and ranges for many common types of programs

Elections using Open Primaries lead to more autonomy being granted for committees in State Legislatures

State legislatures vary considerably in their organization, especially in the scope of leadership powers and the degree of autonomy given to legislative committees. Since the members themselves often have power over how their own legislative bodies are organized, political scientists have a keen interest in understanding why members choose to give committees greater autonomy in decision-making. Tanya Bagashka and Jennifer Hayes Clark argue the decision to grant more autonomy to committees is influenced by the type of electoral system (open versus closed primaries) from which legislators are elected

Female candidates are more likely to use Twitter to discuss policy issues and to ‘go negative’ in their campaign.

In the 2016 presidential primaries, both female candidates, Hillary Clinton and Carly Fiorina, have made extensive use of Twitter to reach out to female voters. In new research, using data gathered during the 2012 election, Heather Evans and Jennifer Hayes Clark look at how female candidates make use of Twitter. They find that women are much more likely to ‘go negative’ on Twitter, and to use Twitter to discuss policy issues, especially those that affect women the most