An Applied Study Examining Inclusion Models in an All-Girls Rhode Island Catholic High School

The purpose of this applied study was to seek to solve the problem of a lack of comprehensive special education programming in an all-girls, Catholic school in Rhode Island, that addresses the students’ academic, social, and emotional needs, and to design a proposal of recommendations, using a multi-method approach. Particular attention was given to the merits of peer mentoring as an effective inclusion strategy. The central research question was “How can the problem of lack of comprehensive special education programs for girls be solved at St. Teresa’s Catholic School in Rhode Island?” Data were collected using both quantitative and qualitative approaches, including interviews with teachers and administrators at St. Teresa’s Catholic School; a survey of teachers and administrators at St. Teresa’s Catholic School; and a document review from Sacred Heart Academy’s Options Program, which included IEP, demographic, and curriculum data and testimonials from program stakeholders. Data were analyzed for codes and themes, from which the solution to solve the problem of a lack of comprehensive special education programming at St. Teresa’s Catholic School was derived. Results indicated the creation of an Options Program for girls in Rhode Island is a solution to the lack of comprehensive special education programming in Catholic secondary schools. A secondary solution is the creation of an advocacy group which supports the creation and expansion of special education programs

Investigating the role of proteostasis pathways in regulating the intracellular inclusion formation of firefly luciferase: a model system to study protein aggregation in cells

The maintenance of cellular protein homeostasis, or proteostasis, is dependent upon a complex network of molecular chaperones, degradation machinery and other regulatory factors, which together act to keep the proteome soluble and functional. Disturbances to proteostasis can lead to protein aggregation and inclusion formation, processes associated with a variety of neurodegenerative disorders. The heat shock proteins (Hsps) are a superfamily of molecular chaperones that are dramatically upregulated in response to cellular stress. The Hsps can bind aggregation-prone proteins and either refold or traffic them for degradation. One class of Hsps, the DNAJBs, act as co-factors of the Hsp70 machine and have been previously identified as potent suppressors of disease-related protein aggregation. This has raised the potential of targeting DNAJB chaperone action in the context of protein aggregation associated with disease. In the work described in this thesis, a destabilised isoform of the protein firefly luciferase (R188Q/R261Q Fluc; FlucDM) was overexpressed in cells to assess how components of the proteostasis machinery engage with aggregation-prone proteins to prevent them from forming intracellular inclusions

Towards therapeutic understanding through dreams, art and poetry

Examines the intuitive value of art therapists' dreams, art and poetry, as opportunities for gaining insight into possible client dynamics and the therapeutic relationship. Reviews ideas proposed by Joanne Kielo

BIRTH IN A BROKEN HEALTH SYSTEM; HOW ABUSE, NEGLECT, POVERTY AND DISRESPECT UNDERMINE INTRAPARTUM CARE IN MOROGORO REGION, TANZANIA

Despite decades of policies, declarations and interventions, in 2013 more than 289,000 women died from causes related to pregnancy and childbirth, and most of those deaths occurred in Sub-Saharan Africa. Tanzania, which is situated on the east coast of Africa, bears a disproportionately high burden of maternal deaths; it is among ten countries that account for a majority of the world’s maternal deaths. Rates of skilled attendance at birth have remained low (below 52%) for more than 20 years among Tanzanian women. This dissertation sought to explore how women, their partners and relevant community members describe the decisions and experiences related to birth in Morogoro Region, Tanzania. The study drew upon quantitative methods (including a household survey) and qualitative methods (including in-depth interviews). The study found that disrespectful care – feeling neglected, scorned, discriminated against or charged arbitrary fines or fees – permeated respondent accounts of childbirth, and compelled many families to minimize their exposure to the formal health system (detailed in Chapter 5). These experiences undermined respondents’ faith in the health system and shaped decisions that placed mother-baby pairs in danger. Respondents described delaying departure from home to facilities, which in some cases led to births en route (detailed in Chapter 6). They also described departing facilities dangerously early after delivery (detailed in Chapter 7). In conclusion, this study found that disrespectful care has become a normalized yet understudied component of the careseeking experience in Morogoro Region. In presenting not only the dynamics of disrespect but also the nexus between disrespect and careseeking at and around the intrapartum period, we add to a limited but expanding body of literature examining disrespectful care, and the ways in which it undermines efforts to promote careseeking for delivery

Energy use, growth and survival of coral reef snapper larvae reared at elevated temperatures

The success of individuals during the pelagic larval phase is critical to maintaining healthy and viable populations of coral reef fishes; however, it is also the most environmentally sensitive and energetically demanding life stage. Climate change is increasing the frequency and intensity of marine heatwaves, which could have significant effects on the development and survival of larval coral reef fishes. However, little is known about how the larvae of pelagic-spawning coral reef fishes will be affected due to the difficulty of spawning and rearing these species in captivity. In this study, we tested how elevated temperatures, similar to those occurring during a marine heatwave, affected the yolk utilization, growth, and survival of larval, Lutjanus carponotatus, a common mesopredatory fish on Indo-west Pacific coral reefs. Eggs and larvae were reared at a current-day average summer temperature (28.5 °C) and two elevated temperatures (30 °C and 31.5 °C) until 14 d post-hatch (dph). Larvae in the elevated temperatures depleted their yolk reserves 39% faster than at the control temperature. The standard length of larvae was 55% (30 °C) and 92% (31.5 °C) longer in the elevated temperature treatments than the control temperature at 14 dph. Conversely, survival of larvae was 54% (30 °C) and 68% (31.5 °C) lower at elevated temperatures compared with the control temperature. This study provides new insights as to how the early life stages of coral reef fishes could be affected by ocean warming and marine heatwaves, with implications for their population dynamics

Elevated CO₂ and food ration affect growth but not the size-based hierarchy of a reef fish

Under projected levels of ocean acidification, shifts in energetic demands and food availability could interact to effect the growth and development of marine organisms. Changes to individual growth rates could then flow on to influence emergent properties of social groups, particularly in species that form size-based hierarchies. To test the potential interactive effects of (1) food availability, (2) elevated CO₂ during juvenile development, and (3) parental experience of elevated CO₂ on the growth, condition and size-based hierarchy of juvenile fish, we reared orange clownfish (Amphiprion percula) for 50 days post-hatching in a fully orthogonal design. Development in elevated CO₂ reduced standard length and weight of juveniles, by 9% and 11% respectively, compared to ambient. Development under low food availability reduced length and weight of juveniles by 7% and 15% respectively, compared to high food. Parental exposure to elevated CO₂ restored the length of juveniles to that of controls, but it did not restore weight, resulting in juveniles from elevated CO₂ parents exhibiting 33% lower body condition when reared in elevated CO₂. The body size ratios (relative size of a fish from the rank above) within juvenile groups were not affected by any treatment, suggesting relative robustness of group-level structure despite alterations in individual size and condition. This study demonstrates that both food availability and elevated CO₂ can influence the physical attributes of juvenile reef fish, but these changes may not disrupt the emergent group structure of this social species, at least amongst juveniles

Facilitators and barriers to the implementation of a Mobile Health Wallet for pregnancy-related health care: A qualitative study of stakeholders’ perceptions in Madagascar

Financial barriers are a major obstacle to accessing maternal health care services in low-resource settings. In Madagascar, less than half of live births are attended by skilled health staff. Although mobile money-based savings and payment systems are often used to pay for a variety of services, including health care, data on the implications of a dedicated mobile money wallet restricted to health-related spending during pregnancy–a mobile health wallet (MHW)–are not well understood. In cooperation with the Madagascan Ministry of Health, this study aims to elicit the perceptions, experiences, and recommendations of key stakeholders in relation to a MHW amid a pilot study in 31 state-funded health care facilities. We conducted a two-stage qualitative study using semi-structured in-depth interviews with stakeholders (N = 21) representing the following groups: community representatives, health care providers, health officials and representatives from phone provider companies. Interviews were conducted in Atsimondrano and Renivohitra districts, between November and December of 2017. Data was coded thematically using inductive and deductive approaches, and found to align with a social ecological model. Key facilitators for successful implementation of the MHW, include (i) close collaboration with existing communal structures and (ii) creation of an incentive scheme to reward pregnant women to save. Key barriers to the application of the MHW in the study zone include (i) disruption of informal benefits for health care providers related to the current cash-based payment system, (ii) low mobile phone ownership, (iii) illiteracy among the target population, and (iv) failure of the MHW to overcome essential access barriers towards institutional health care services such as fear of unpredictable expenses. The MHW was perceived as a potential solution to reduce disparities in access to maternal health care. To ensure success of the MHW, direct demand-side and provider-side financial incentives merit consideration

Autonomy dimensions and care seeking for delivery in Zambia; the prevailing importance of cluster-level measurement.

It is widely held that decisions whether or when to attend health facilities for childbirth are not only influenced by risk awareness and household wealth, but also by factors such as autonomy or a woman's ability to act upon her own preferences. How autonomy should be constructed and measured - namely, as an individual or cluster-level variable - has been less examined. We drew on household survey data from Zambia to study the effect of several autonomy dimensions (financial, relationship, freedom of movement, health care seeking and violence) on place of delivery for 3200 births across 203 rural clusters (villages). In multilevel logistic regression, two autonomy dimensions (relationship and health care seeking) were strongly associated with facility delivery when measured at the cluster level (OR 1.27 and 1.57, respectively), though not at the individual level. This suggests that power relations and gender norms at the community level may override an individual woman's autonomy, and cluster-level measurement may prove critical to understanding the interplay between autonomy and care seeking in this and similar contexts

Intended and unintended effects: community perspectives on a performance-based financing programme in Malawi.

Background: Several performance-based financing (PBF) evaluations have been undertaken in low-income countries, yet few have examined community perspectives of care amid PBF programme implementation. We assessed community members' perspectives of Support for Service Delivery Integration - Performance-Based Incentives ('SSDI-PBI'), a PBF intervention in Malawi, and explored some of the unintended effects that emerged amid implementation. Methods: We conducted 30 focus group discussions: 17 with community leaders and 13 with mothers within catchment areas of SSDI-PBI implementing facilities. We analysed data using the framework approach. Results: Community leaders and women had mixed impressions regarding the effect of SSDI-PBI on service delivery in facilities. They highlighted several improvements (including improved dialogue between staff and community, and cleaner, better-equipped facilities with enhanced privacy), but also persisting challenges (including inadequate and overworked staff, overcrowded facilities and long distances to facilities) related to services in SSDI-PBI-implementing facilities. Further, respondents described how four targeted service indicators related to maternal risk factor management, antenatal care (ANC) in the first trimester, skilled birth attendance and couple's HIV testing sparked unintended negative effects as experienced by women and communities. The unintended effects included women returning home for delivery, women feeling uncertain about their pregnancy status, women feeling betrayed or frustrated by the quality of care provided and partnerless women being denied ANC. Conclusion: PBF programmes such as SSDI-PBI may improve some aspects of service delivery. However, to achieve system improvement, not only should necessary tools (such as medicines, equipment and human resources) be in place, but also programme priorities must be congruent with cultural expectations. Finally, facilities must be better supported to expect and then address increases in client load and heightened expectations in relation to services