NGOs, Development, and Dependency: A Case Study of Save the Children in Malawi

Senior Project submitted to The Division of Social Studies of Bard College

Untangling the oxidative cost of reproduction: An analysis in wild banded mongooses

The cost of reproduction plays a central role in evolutionary theory, but the identity of the underlying mechanisms remains a puzzle. Oxidative stress has been hypothesized to be a proximate mechanism that may explain the cost of reproduction. We examine three pathways by which oxidative stress could shape reproduction. The “oxidative cost” hypothesis proposes that reproductive effort generates oxidative stress, while the “oxidative constraint” and “oxidative shielding” hypotheses suggest that mothers mitigate such costs through reducing reproductive effort or by pre‐emptively decreasing damage levels, respectively. We tested these three mechanisms using data from a long‐term food provisioning experiment on wild female banded mongooses (Mungos mungo). Our results show that maternal supplementation did not influence oxidative stress levels, or the production and survival of offspring. However, we found that two of the oxidative mechanisms co‐occur during reproduction. There was evidence of an oxidative challenge associated with reproduction that mothers attempted to mitigate by reducing damage levels during breeding. This mitigation is likely to be of crucial importance, as long‐term offspring survival was negatively impacted by maternal oxidative stress. This study demonstrates the value of longitudinal studies of wild animals in order to highlight the interconnected oxidative mechanisms that shape the cost of reproduction

NRF2 Rewires Cellular Metabolism to Support the Antioxidant Response

The transcription factor (nuclear factor-erythroid 2 p45-related factor 2, NRF2) is a master regulator of the cellular response to oxidative insults. While antioxidant response enzymes are well-characterized transcriptional targets of NRF2, it is recently becoming clear that NRF2 also supports cellular detoxification through metabolic rewiring to support the antioxidant systems. In this chapter, we discuss the regulation of NRF2 and how NRF2 activation promotes the antioxidant defense of cells. Furthermore, we discuss how reactive oxygen species influence cellular metabolism and how this affects antioxidant function. We also discuss how NRF2 reprograms cellular metabolism to support the antioxidant response and how this functions to funnel metabolic intermediates into antioxidant pathways. This chapter concludes by exploring how these factors may contribute to both normal physiology and disease

Conexión venosa anómala total infracardiaca infradiafragmática; reporte de un caso

ResumenIntroducciónLa conexión venosa anómala es una de las malformaciones cardiacas congénitas menos usuales en la práctica clínica. Se presenta un reporte de caso de una paciente con disnea persistente desde el nacimiento, en quien se documentó drenaje venoso anómalo total infracardiaco-infradiafragmático tipo portal, se realizó reparación quirúrgica con evolución postoperatoria satisfactoria.Presentación de casoRecién nacido a término, de sexo femenino, que ingresó a las 40h de nacida por síndrome de dificultad respiratoria persistente. Se realizó ecocardiograma transtorácico que evidenció drenaje venoso anómalo total infracardiaco con comunicación interauricular amplia. Ante los hallazgos clínicos y radiográficos encontrados en la paciente se realiza corrección quirúrgica con buena evolución clínica, con lo cual se dio egreso hospitalario.ConclusiónAun cuando el drenaje venoso anómalo es una de las cardiopatías congénitas menos frecuentes, es importante tenerla presente dentro de los diagnósticos diferenciales en la disnea persistente del recién nacido; su diagnóstico oportuno es clave para la supervivencia, siendo el manejo quirúrgico oportuno en centros especializados la única forma de manejo. La ecocardiografía es el estándar de oro para el diagnóstico de la enfermedad. Otros medios imagenológicos, como la tomografía de tórax, ayudan a descartar compromiso del parénquima pulmonar.AbstractIntroductionAnomalous infracardiac infradiaphragmatic pulmonary venous connection is one of the less common congenital cardiac malformations in clinical practice. A case report is presented on a patient with persistent dyspnoea from birth in whom echocardiographic findings suggested a pulmonary venous drainage to the portal. A surgical repair was performed with satisfactory postoperative course.Case presentationA 40 hour-old female newborn presented with persistent respiratory distress syndrome. The transthoracic echocardiogram showed total anomalous venous drainage with wide atrial septal defect. Following the clinical and radiological findings a surgical correction was performed on the patient, with good clinical outcome after which she was dischargedConclusionEven though it is rare, it is important to keep this condition in mind as early diagnosis is key to patient survival because of the surgical management being the only way of treatment. Echocardiography is the reference method for the diagnosis, but other imaging techniques, such as the chest computerised tomography, can help rule out diseases involving the lung parenchyma

Health care disparities for incarcerated adults after a suicide attempt

OBJECTIVE: Incarcerated adults have high rates of fatal and nonfatal suicidal behaviors. Suicide prevention recommendations stress the need for the provision of health care for incarcerated adults after suicide attempts, yet prison policies and practices often focus instead on punitive responses to suicidal behaviors. Existing research is limited regarding factors that predict the provision of health care to incarcerated adults post-suicide attempt. The current study examined individual, incident, and institutional factors as predictors of health care to incarcerated adults post-suicide attempt. METHOD: We used data from critical incidents reports for suicide attempts (NÂ =Â 495) to conduct mixed-effects logistical regression models. RESULTS: Staff responded to suicide attempts by placing incarcerated adults under direct observation (with no care) or in segregation at odds two and three times higher than of providing health care, particularly in prisons for men. Race was a significant factor; incidents involving Black men were less likely than incidents involving white men to include staff requesting health care, and incidents involving Black women were less likely than incidents involving white women to include requesting and providing health care. CONCLUSIONS: This study's findings highlight factors predicting health care responses to suicide attempts and the need to address and prevent health care disparities in prisons

Endotracheal Intubation: The Role of Sterility

Background: There is a paucity of data regarding whether sterile handling of endotracheal tubes (ETTs) impacts the incidence and prevalence of pneumonia in the emergency, urgent, or elective clinical scenarios. Intensive care units employ infection control and reduction schemes to reduce pneumonia rates. Methods: A MEDLINE search of the English-language literature for the last 30 years was performed using the keywords “endotracheal intubation,” “intubation,” “pneumonia,” “sinusitis,” “tracheobronchitis,” “nosocomial infection,” and “infection.” Data were limited to those papers addressing the role of sterile handling or passage of ETTs, infection with antibiotic-resistant micro-organisms, antibiotic prophylaxis, and the role of virulence determinants in supporting invasive infection. Also, a convenience sample of a single author's patients requiring tracheal intubation was undertaken. Data were acquired on tube handling, success of insertion, and subsequent occurrence of pneumonia. Results: Virtually no data exist on the impact of sterile ETT handling, but unsterile manipulation of the ETT prior to insertion is common (112 of 154 intubation events). Within the limited patient sample, no conclusions may be drawn regarding the impact of unsterile handling on pneumonia rates, although sinusitis after nasotracheal intubation clearly increases the incidence of pneumonia. Biofilm generation as a facilitator of bacterial colonization of artificial airway surfaces is a ubiquitous virulence determinant that is not ameliorated by antibiotic administration. Conclusions: Unsterile ETT handling and insertion techniques are not clearly associated with pneumonia induction, but physiologically sound approaches that retard biofilm production may decrease pneumonia rates.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63193/1/sur.2006.054.pd

Inclusive teaching circles : mechanisms for creating welcoming classrooms.

This essay examines the Inclusive Teaching Circle (ITC) as a mechanism for faculty development in creating instructional tools that embrace an inclusive pedagogy reflecting diversity, cultural competence and social justice. We describe one group’s year-long participation in an ITC at a large, metropolitan research university in the south. Next, we share several members’ strategies for promoting more inclusive and equitable learning for students in our classrooms. Finally, we consider the implications of ITCs for its group participants and the professorate at large

Holly Springs, Wake County : a community assessment including secondary data analysis and qualitative data collection

Community Diagnosis. Community diagnosis is a process that is conducted to provide a comprehensive assessment of the strengths and needs of a particular community. This assessment analyzes the ability of the community to identify its available resources to respond to conditions and situations that affect the general health and wellness of its residents. A team of first-year Master’s students in the Department of Health Behavior and Health Education of the School of Public Health at the University of North Carolina at Chapel Hill performs this diagnosis as part of a two-semester course requirement. The team collects data from written documents (quantitative or secondary data), personal interviews (qualitative or primary data), and interaction with residents at various community gatherings. Topics of investigation include any information that illuminates how living in the community affects the physical health, prosperity, and outlook of those who reside there. The compiled data are returned to the community so that it may better direct any efforts it wishes to make in reacting to challenges that it faces both now and in the future. The present community diagnosis was conducted in the town of Holly Springs, North Carolina. Team members Kim Brown, Adam Buchanan, Gina Febbraro, Yalonda Lewis, and Ana Validzic collected and analyzed data from September 1998 to March 1999. Residents responded to the assessment findings in a Town Meeting held at the end of this period. Methodology. Sources of information include population and economic reports, statistics provided by government agencies, town and local documents, newspapers, and personal interviews with Holly Springs community members and service providers. In particular, secondary data were gathered during the fall semester from the 1990 U.S. Census, a special 1998 Census of Holly Springs, the North Carolina State Center for Health Statistics, Wake County Health Department, Wake County Human Services, Holly Springs Human Services, and Holly Springs Town Hall. When compared with statistics for Wake County and for North Carolina, these Holly Springs data give a numerical picture of the overall health status of the town. Primary data were collected in a series of interviews conducted with eighteen community members and twelve local service providers during the fall and spring semesters. These interviews sought to add personal insight to the secondary data already compiled. The open-ended questions of the interviews were devised to elicit the individual stories and perspectives of those living in, or providing services for, Holly Springs. Questions to community members covered such topics as the assets and needs of the town, change and growth, the different populations within Holly Springs and how these groups interact, and the health of the community. Service providers were interviewed regarding particular groups who use their services, barriers to providing or receiving the service, and the strengths and needs of the community. Potential interviewees were referred by community leaders, other interviewees and through informal discussions with community members. The community assessment team intentionally tried to interview residents who would represent the rich diversity of Holly Springs. Two team members were present at each interview to conduct the interview and take notes. The interviews were audiotaped for future reference in identifying salient themes from the interviews. The information gained from the quantitative and qualitative assessments was presented to the community at a Town Meeting on March 18, 1999. This meeting gave community members the opportunity to digest and discuss the major themes that had been identified throughout the community diagnosis process. The presence of a few service providers at the meeting also fostered discussion on how these organizations can better serve the residents of Holly Springs. Limitations. Realizing the limitations involved in this community diagnosis process helps one understand the data in a more accurate context. One major limitation of the quantitative data collection is that the special census conducted in June 1998 does not cover the full scope of information included in the 1990 U.S. Census. Thus, much of the data that was drawn from the 1990 census may no longer give an true picture of life in Holly Springs. Given the dramatic growth in Holly Springs and Wake County since 1990, extra care should be taken when drawing conclusions from these data. Many of the morbidity and mortality health statistics were collected for the zip code 27540, which includes Holly Springs and a portion of the surrounding area. This represents another quantitative data limitation, as these data may have been influenced by those living outside the Holly Springs town limits. Thus, the information may not give a completely valid representation of the salient health problems of the town. The selection of interview candidates is a decided limitation of the qualitative data collection process. The referral method used to identify these candidates kept the sample from being a random representation of the community. Although care was taken to interview residents from all major groups living in Holly Springs, this convenience sampling method tended to lead residents to refer those with similar experiences and views. Thus, some of the themes identified as important by interviewees may not be considered so by residents from groups that the team was unable to contact. This non-representative referral method is in part a product of the relatively short amount of time allotted for data collection due to academic process. Conducting the data collection over a longer time period without the requirements of an academic process would allow investigators to spend more time in the community, thus giving a more accurate portrayal of the essence of life in Holly Springs and decreasing the potential for selection bias presented here. Still, there is much to be gained from examining the available findings. Quantitative Findings. Growth was the predominant theme present in both secondary and primary data. What was a quiet, rural, primarily poor community throughout the late 1800s and most of the twentieth century has undergone incredible expansion in the last decade. The explosion has been primarily residential, as the town has grown from 920 persons in 1990 to 6,658 persons in June 1998 (U.S. Census Bureau, 1990 & 1998). This 723% population increase has also been accompanied by a dramatic shift in the racial composition of the community. Whereas the 1990 Census showed a town that was made up of 76% African Americans and 24% Whites (U.S. Census Bureau, 1990), the 1998 Census demonstrated a marked demographic change. Currently, Holly Springs is approximately 74% White, 22% African American, 2.4% Latino, 1.2% Asian/Pacific Islander, and 0.4% Native American (U.S. Census Bureau, 1998). Additionally, many of the individuals moving into the town are younger families. These demographic changes highlight the importance of involving the long-term residents as the town evolves to meet the specific needs of its newer, younger residents. Further examination of the secondary data reveals that the town of Holly Springs is already working to respond to the various needs associated with its continued growth. The establishment of a police and fire department in 1992 and 1995, respectively, has resulted in quicker response times to emergency calls and a substantial decrease in the occurrence of severe crimes. Holly Springs Human Services now offers a variety of programs aimed at addressing the health and social needs of the town. County officials hope to avert some of the traffic that tends to bottleneck on NC Highway 55 into Holly Springs by building a bypass around Holly Springs and widening the road north of the town. Still, while there are efforts to plan accordingly for the continued growth of Holly Springs, some unrealized services and controversial conditions deserve special attention. There is currently no medical doctor within town limits. Additionally, transportation to county health care facilities is not always available to many residents. Other noted concerns include the building of the proposed South Wake Sanitary Landfill on the northwestern town border and the storage of spent fuel rods at the Shearon Harris Nuclear Plant south of Holly Springs. Furthermore, some town officials believe that the town’s current water and sewer systems may be inadequate to accommodate additional growth. Thus, the secondary data reveal directions for future work to continue to address the changing needs of the Holly Springs community. Qualitative Findings. There is a sense of excitement about the future of Holly Springs that pervades the personal interviews. Residents suggested numerous issues that should receive priority in the next few years in Holly Springs. Many mention the maintenance of the small-town feel of the community as important. Some of these individuals refer to plans for a major overhaul and rebuilding of the downtown area as a means of perpetuating this feeling. Many residents feel that building a middle and high school solely for Holly Springs’ youth would also contribute to this small-town nature. Residents list many other wishes and concerns for their community during the primary data collection. The recreational, educational, and mentoring needs of adolescent youth are discussed frequently. Some service providers and community members note that substance abuse is a problem, especially among young people. Discussions during the Town Meeting reveal a variety of community resources that the youth could draw on to help them reach their potential. In addition to youth needs, many residents mention the demand for a physician or clinic in town. Some residents also show concern for the elderly and low-income populations of Holly Springs. Access to services is the primary issue noted for these populations. Just as with the youth development, residents are quick to recognize existing community organizations that are working to improve the wellness of the elderly and low-income community members. Conclusions. Holly Springs is described by many residents as a great place to live. Both the quantitative and qualitative data support this assertion. The town has already shown promise in responding to the various needs raised due to the tremendous growth it has undergone over the last few years. New and greater challenges will surely arise as the town grows and becomes more diverse. Tapping into the resources, assets, and experiences of the native residents as well as the newcomers will help strengthen the entire town in addressing these challenges. Residents are aware of many areas on which they would like to focus energy for improvement. Service providers within Holly Springs and Wake County express a willingness to work with the community to strengthen and maintain the social, environmental, and personal health of the residents of the town. Together, these groups are in the enviable position of being able to direct the future of their community.Master of Public Healt

Understanding determinants of acute stroke thrombolysis using the tailored implementation for chronic diseases framework: a qualitative study

Abstract Background The Tailored Implementation in Chronic Disease (TICD) framework is a comprehensive framework describing the determinants of implementation success that has been used extensively in primary care settings. We explored the utility of the TICD to identify determinants of practice in an acute setting, namely guideline concordant acute stroke thrombolysis in a low-resourced, predominately minority serving, large, Emergency Department (ED). Methods Through workshops and expert review, we developed an interview guide informed by the TICD framework. We then conducted semi-structured interviews with data collected through written transcripts, audio transcripts or interviewer notes based on participant availability. Three independent coders then performed a content analysis using template analysis, but open to new determinants that arose from the data, into the TICD framework. Results We performed a total of 15 semi-structured interviews with ED acute stroke providers including medical technicians, nurses, and physicians. We found that guideline factors, individual health professional factors, and patient factors domains were barriers to guideline concordant acute stroke thrombolysis. The domain professional interactions was a facilitator to treatment. We identified three determinants, healthcare professional burnout, health care professional turnover and surrogate decision making, that are not part of the TICD framework. Conclusions Most determinants of acute stroke thrombolysis are included within the TICD framework. Inclusion of healthcare professional burnout, healthcare professional turnover and surrogate decision making may assist in expanding the TICD to time-sensitive ED conditions. Further work is needed to confirm this finding and to establish whether the TICD is applicable for use in non-time sensitive ED conditions. Interventions that address guideline, individual health professional and patient factors may improve guideline concordant acute stroke thrombolysis.https://deepblue.lib.umich.edu/bitstream/2027.42/148315/1/12913_2019_Article_4012.pd