For The Gambia, Our Homeland: The Diaspora, Development and Politics

This thesis aims to explore the potential of small diasporas to contribute to development and politics at ‘home’. Thereby informing inter-disciplinary thinking at the intersection of migration studies, development studies and politics. I argue that where there is a discussion of diaspora’s political engagement in the existing migration-development literature, it is either hidden behind the shield of ‘development’ or restricted to questions of violent conflict. The central claim of the thesis is that the migration-development nexus needs to address formal politics more explicitly. The Gambian diaspora are an interesting group to research because the country has not experienced violent conflict in recent years and the diaspora are making contributions to development at ‘home’. However, they are also simultaneously seeking to intervene in homeland politics, which they view as another form of development contribution. This research is a multi-sited study conducted in The Gambia, UK, and US. This thesis is based on 24 interviews with 52 participants undertaken in The Gambia with elites, students, government officials, politicians, and return migrants between February 2013 and December 2014. 49 interviews with members of the Gambian diaspora in the UK and US, and 10 interviews with heads of Gambian diaspora associations in the UK. The four research questions in this thesis address (1) development interventions, (2) political interventions, (3) the responses to these interventions from The Gambia, and (4) the relationship between development, migration and politics. The data used to address them came primarily from the interviews, participant observation, textual and visual materials acquired from newspapers, social media, archives, and secondary sources in the academic and grey literatures. Qualitative coding techniques were used for thematic data analysis. The thesis concludes that the political activities of some members of the UK and US Gambian diaspora are inhibiting the ability of the diaspora as a whole to have any ‘real’ impact on national development. This is perpetuating the distrust between the homeland government and those outside the territory. Subsequently, development contributions are mainly focused on the family scale. Whilst these political interventions have some effects at ‘home’ they are only one component in a broader set of interventions seeking to change Gambian politics (alongside diplomatic efforts, structural economic forces and human rights lobbies for example) and their impact is constrained by the limited resources and capacities of those in the diaspora. Conceptually the thesis concludes that whilst it is useful to maintain the distinction between development and politics for the purpose of organizing the analysis, in practice the two are inseparable. The case that is being made in this thesis is that politics in The Gambia is an ‘anti-development machine’, as formal political engagement is a barrier to active development in the country. Thus, paradoxically it requires diasporans who are sincerely committed to the development of The Gambia to withdraw from politics, despite simultaneously arguing that improving the political process is a part of development. Two weeks before submitting this thesis, a Presidential election occurred in The Gambia, which dramatically changed the political context of the country and its diaspora. However, given the timing, it was impossible to re-write this thesis to take account of the election, though some comments have been added to the conclusion

Archeologische verwachtingskaart uiterwaarden rivierengebied

Dit rapport betreft het project archeologische verwachtingskaart uiterwaarden rivierengebied (‘UIKAV 2014’), uitgevoerd door Deltares, Rijksuniversiteit Groningen en Universiteit Utrecht, in opdracht van Rijkswaterstaat en de Rijksdienst voor het Cultureel Erfgoed. Het rapport en de bijbehorende producten (een archeologische verwachtingskaart, met onderliggende databases, basiskaarten en documentatie op detailniveau in catalogusvorm, en verdere digitale bijlagen) bieden een overzicht van in de uiterwaarden van het Nederlandse riviergebied te verwachten archeologie. Het doel van het project was het maken van een gedetailleerde, tijd-specifieke, archeologische verwachtingskaart voor de uiterwaarden. Er zijn een aantal eisen gesteld aan dit product. Een belangrijke eis was dat de nieuwe archeologische kennis en gegevens zoals opgedaan en verzameld binnen het programma Ruimte voor de Rivier met dit product zouden worden geborgd. Daarnaast was een eis dat de kaart een transparant en reproduceerbaar product zou worden. Om die reden is een onderhoudbaar systeem opgezet (gebruik makend van de functionaliteit van Geografische Informatie Systemen, GIS), waarmee de verwachtingskaart volgens vastgelegde beslisregels gegenereerd is, volgens welke zij ook in toekomstige cycli van archeologische toetsing vernieuwd kan worden. Dit systeem betrekt landschapsgenetische en archeologische brongegevens en combineert deze automatisch tot een verwachtingskaart. Dankzij deze methodiek is lokale aanpassing naar aanleiding van nieuwe gegevens of veranderd inzicht relatief eenvoudig. Een bijkomend voordeel van het systeem is dat er verwachtingen worden uitgesproken voor zowel terrestrische (landgebonden) archeologie op en langs de oevers van de rivieren, als voor aquatische (watergebonden) archeologie langs de waterkant en begraven in de rivier. Bovendien kunnen verwachtingskaarten voor specifieke archeologische periodes gemaakt worden. In het project zijn de verwachtingskaarten voor negen opeenvolgende tijdsnedes uitgewerkt. Samen geven deze de trefkans op archeologie uit de tijd van de jager-verzamelaars (sinds het begin van het Holoceen, 9500 v. Chr.) tot en met de nieuwe tijd (WO II, 20ste eeuw). De kaarten bestrijken de uiterwaarden van de (i) Bovenrijn, Waal en Merwede van Lobith tot Gorinchem, (ii) Nederrijn en Lek van de Pannerdense Kop tot Schoonhoven, (iii) Gelderse IJssel van de IJsselkop (Westervoort) tot de IJsseldelta (Kampen) en (iv) Maas en Afgedamde Maas van Mook tot Woudrichem (en ook de Bergsche Maas). Het gebied omvat ook de door dijkverleggingen en aanleg van bypasses ontstane vergrotingen van de uiterwaarden door projecten zoals die zijn uitgevoerd binnen het programma Ruimte voor de Rivier. Alle gegevens – input en tussenproducten, berekeningsmethode en eindproducten - zijn in aanvulling op het rapport digitaal beschikbaar gesteld. Daartoe hoort ook een catalogus die per deeluiterwaard naar de gebruikte bronnen refereert en relevante informatie over geomorfologie, archeologie en landschapsouderdom samenvat. In het rapport is de totstandkoming van de kaarten uitgebreid gedocumenteerd, en worden de uiteindelijke verwachtingsbeelden beknopt besproken en vergeleken met bestaande producten. Zowel de basiskaarten (input) als de verwachtingskaarten (output) zijn primair ontsloten als GIS bestanden. Deze zijn bruikbaar voor fysisch-geografische en archeologische specialisten en geschikt voor ontsluiting via web-portalen zoals opdrachtgevers RWS (interne web-portalen) en RCE (extern portaal: http://www.archeologieinnederland.nl) deze hebben ingericht en beheren. Als snelle, laagdrempelige ingang tot het product fungeren PDF atlassen met de kaartseries in een standaardopmaak (steeds 34 bladen, schaal 1:25,000). Alle digitale producten worden zowel in de oorspronkelijke vorm (ESRI GIS shapefiles, MS-Access databases) opgeleverd, als in een vorm (PDF Atlassen) die geschikt is voor printen en analoge raadpleging van de producten (Bijlagen G tot N). De volledige dataset (volledige Digitale Bijlage) is duurzaam gedeponeerd bij DANS Data Archiving and Networked Services als dataset 57727. Web-viewer: http://www.archeologieinnederland.nl/bronnen-en-kaarten/verwachtingskaart-uiterwaarden-rivierengebied Aankonding verschijnen: http://www.mailinglijst.nl/mailings/show.aspx?mai=130118&mem=3135&a=1171800

Acceptance of new technology: a usability test of a computerized adaptive test for fatigue in rheumatoid arthritis

Background: Little is known about the acceptance and usability of computerized adaptive tests (CATs) among patients with rheumatoid arthritis (RA). The main difference between completing a CAT and a traditional questionnaire concerns item presentation. CATs only provide one item at a time on the screen, and skipping forward or backward to review and change already given answers is often not possible. Objective: The objective of this study was to examine how patients with RA experience a Web-based CAT for fatigue. Methods: In individual sessions, participants filled in the CAT while thinking aloud, and were subsequently interviewed about their experience with the new instrument. The technology acceptance model (TAM) was used to structure the results. Results: The participants were 15 patients with RA. They perceived the CAT as clear, brief, and easy to use. They were positive about answering one question per screen, the changing response options, layout, progress bar, and item number. There were 40% (6/15) of the participants that also mentioned that they experienced the completion of the CAT as useful and pleasant, and liked the adaptive test mechanism. However, some participants noted that not all items were applicable to everybody, and that the wordings of questions within the severity dimension were often similar. Conclusions: Participants perceived the “CAT Fatigue RA” as easy to use, and also its usefulness was expressed. A 2.0 version has been improved according to the participants’ comments, and is currently being used in a validation study before it will be implemented in daily clinical practice. Our results give a first indication that CAT methodology may outperform traditional questionnaires not merely on measurement precision, but also on usability and acceptance valuation

Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care

Background: poorly controlled hypertension is independently associated with mortality, cardiovascular risk and disease progression in chronic kidney disease (CKD). In the UK, CKD stage 3 is principally managed in primary care, including blood pressure (BP) management. Controlling BP is key to improving outcomes in CKD. This study aimed to investigate associations of BP control in people with CKD stage 3.Methods: 1,741 patients with CKD 3 recruited from 32 general practices for the Renal Risk in Derby Study underwent medical history, clinical assessment and biochemistry testing. BP control was assessed by three standards: National Institute for Health and Clinical Excellence (NICE), National Kidney Foundation Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were used to compare characteristics of people achieving and not achieving BP control. Univariate and multivariate logistic regression was used to identify factors associated with BP control.Results: the prevalence of hypertension was 88%. Among people with hypertension, 829/1426 (58.1%) achieved NICE BP targets, 512/1426 (35.9%) KDOQI targets and 859/1426 (60.2%) KDIGO targets. Smaller proportions of people with diabetes and/or albuminuria achieved hypertension targets. 615/1426 (43.1%) were only taking one antihypertensive agent. On multivariable analysis, BP control (NICE and KDIGO) was negatively associated with age (NICE odds ratio (OR) 0.27; 95% confidence interval (95% CI) 0.17-0.43) 70–79 compared to &lt;60), diabetes (OR 0.32; 95% CI 0.25-0.43)), and albuminuria (OR 0.56; 95% CI 0.42-0.74)). For the KDOQI target, there was also association with males (OR 0.76; 95% CI 0.60-0.96)) but not diabetes (target not diabetes specific). Older people were less likely to achieve systolic targets (NICE target OR 0.17 (95% CI 0.09,0.32) p?&lt;?0.001) and more likely to achieve diastolic targets (OR 2.35 (95% CI 1.11,4.96) p?&lt;?0.001) for people &gt;80 compared to?&lt;?60).Conclusions: suboptimal BP control was common in CKD patients with hypertension in this study, particularly those at highest risk of adverse outcomes due to diabetes and or albuminuria. This study suggests there is scope for improving BP control in people with CKD by using more antihypertensive agents in combination while considering issues of adherence and potential side effects.<br/

Translation and validation of the Dutch version of the Effective Consumer Scale (EC-17)

PURPOSE: The Effective Consumer Scale (EC-17) measures the skills of musculoskeletal patients in managing their own healthcare. The objectives of this study were to translate the EC-17 into Dutch and to further evaluate its psychometric properties. METHODS: The EC-17 was translated and cognitively pretested following cross-cultural adaptation guidelines. Two hundred and thirty-eight outpatients (52 % response rate) with osteoarthritis or fibromyalgia completed the EC-17 along with other validated measures. Three weeks later, 101 patients completed the EC-17 again. RESULTS: Confirmatory factor analysis supported the unidimensional structure of the scale. The items adequately fit the Rasch model and only one item demonstrated differential item functioning. Person reliability was high (0.92), but item difficulty levels tended to cluster around the middle of the scale, and measurement precision was highest for moderate and lower levels of skills. The scale demonstrated adequate test-retest reliability (ICC = 0.71), and correlations with other measures were largely as expected. CONCLUSION: The results supported the validity and reliability of the Dutch version of the EC-17, but suggest that the scale is best targeted at patients with relatively low levels of skills. Future studies should further examine its sensitivity to change in a clinical trial specifically aimed at improving effective consumer skills

Working mechanism of a multidimensional computerized adaptive test for fatigue in rheumatoid arthritis

Background This paper demonstrates the mechanism of a multidimensional computerized adaptive test (CAT) to measure fatigue in patients with rheumatoid arthritis (RA). A CAT can be used to precisely measure patient-reported outcomes at an individual level as items are consequentially selected based on the patient’s previous answers. The item bank of the CAT Fatigue RA has been developed from the patients’ perspective and consists of 196 items pertaining to three fatigue dimensions: severity, impact and variability of fatigue. Methods The CAT Fatigue RA was completed by fifteen patients. To test the CAT’s working mechanism, we applied the flowchart-check-method. The adaptive item selection procedure for each patient was checked by the researchers. The estimated fatigue levels and the measurement precision per dimension were illustrated with the selected items, answers and flowcharts. Results The CAT Fatigue RA selected all items in a logical sequence and those items were selected which provided the most information about the patient’s individual fatigue. Flowcharts further illustrated that the CAT reached a satisfactory measurement precision, with less than 20 items, on the dimensions severity and impact and to somewhat lesser extent also for the dimension variability. Patients’ fatigue scores varied across the three dimensions; sometimes severity scored highest, other times impact or variability. The CAT’s ability to display different fatigue experiences can improve communication in daily clinical practice, guide interventions, and facilitate research into possible predictors of fatigue. Conclusions The results indicate that the CAT Fatigue RA measures precise and comprehensive. Once it is examined in more detail in a consecutive, elaborate validation study, the CAT will be available for implementation in daily clinical practice and for research purpose

Isolated cerebellar metastasis from urothelial carcinoma:A case report of a rare phenomenon

Introduction: Although urothelial carcinoma (UC) generally is non-invasive, contrastingly in 25% of patients UC metastasizes. Isolated central nervous system (CNS) metastasis from UC without other distant metastases are considered rare. In this report we describe a patient with an isolated and solitary cerebellar metastasis from UC. Research question: In this case report we explore the value of histological analysis of CNS metastases, imaging, treatment options and survival. Material and methods: A rare case is presented of a patient diagnosed with an isolated CNS metastasis originating from UC. Through a systematic review of literature route of dissemination, current imaging and treatment options, and survival are discussed.Results: A 77-year-old male was diagnosed with a pT2N0M0 high-grade UC and treated with transurethral resection and chemoradiation therapy. Several months later, the patient presented with neurological symptoms, and radiological imaging revealed a solitary cerebellar mass. A body CT scan showed no other metastasis. After surgical resection, histology confirmed urothelial origin of the mass, matching his primary UC and the patient received post-operative stereotactic radiotherapy at the surgical site. Recurrence of the cerebellar mass occurred after 6 months for which the patient received re-resection. The patient died 5.5 months after re-resection. Discussion and conclusion: Isolated brain metastases without other distant metastases from UC are rare, so histologic confirmation of the brain metastasis is essential, particularly when the time interval between diagnosis of the UC and brain metastasis increases. Early brain CT is not recommended. PET CT may have additional value in detection of other distant metastases from UC. Despite advancements in treatments, prognosis for CNS metastasis from UC remains poor

Malignant melanoma of the stomach presenting in a woman: a case report

<p>Abstract</p> <p>Introduction</p> <p>Malignant melanoma is reported to metastasize to all organs of the human body. Although it is common for it to metastasize to the gastrointestinal tract, a melanoma located primarily in the gastric mucosa is an uncommon tumor. Gastrointestinal metastases are rarely diagnosed before death with radiological and endoscopic techniques.</p> <p>Case presentation</p> <p>In this case report the clinical course and treatment of a woman with melanoma of the stomach, without any other detectable primary lesion, is presented and discussed. A 55-year-old Turkish woman presented to our clinic with complaints of muscle pain and bone pain in the left side of her chest. During an upper gastrointestinal system endoscopy, dark cherry-colored, light elevated, round-shaped lesions were taken from her gastric fundus and from the first part of her duodenum. Biopsies from these samples were determined to be malignant melanoma by the pathologist.</p> <p>Conclusion</p> <p>Metastatic malignant melanoma cases should be examined through endoscopy for gastrointestinal metastases.</p