The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Understanding changes in mobility & subsistence from terminal Pleistocene to Late Holocene in the highlands of New Guinea through intensity of lithic reduction, changing site types, and paleoclimate

Thesis (Ph.D.)--University of Washington, 2016-08

A Theoretical and Synthetic Investigation of New Donors for Organic Electro-Optic Chromophores: Understanding the Effects of Structure and Substituents on Donor Strength

Thesis (Ph.D.)--University of Washington, 2016-08

The Meanings of New Money: Social Constructions of Value in the Rise of Digital Currencies

Thesis (Ph.D.)--University of Washington, 2016-07

How task format affects cognitive performance: a memory test with two species of New World monkeys

In cognitive tests, animals are often given a choice between two options and obtain a reward if they choose correctly. We investigated whether task format affects subjects' performance in a physical cognition test. In experiment 1, a two-choice memory test, 15 marmosets, Callithrix jacchus, had to remember the location of a food reward over time delays of increasing duration. We predicted that their performance would decline with increasing delay, but this was not found. One possible explanation was that the subjects were not sufficiently motivated to choose correctly when presented with only two options because in each trial they had a 50% chance of being rewarded. In experiment 2, we explored this possibility by testing eight naïve marmosets and seven squirrel monkeys, Saimiri sciureus, with both the traditional two-choice and a new nine-choice version of the memory test that increased the cost of a wrong choice. We found that task format affected the monkeys' performance. When choosing between nine options, both species performed better and their performance declined as delays became longer. Our results suggest that the two-choice format compromises the assessment of physical cognition, at least in memory tests with these New World monkeys, whereas providing more options, which decreases the probability of obtaining a reward when making a random guess, improves both performance and measurement validity of memory. Our findings suggest that two-choice tasks should be used with caution in comparisons within and across species because they are prone to motivational biases.

The role of new information and communication technologies (ICTs) in information and communication in science. A conceptual framework and empirical study

Problem This dissertation presents a literature-based framework for communication in science (with the elements partners, purposes, message, and channel), which it then applies in and amends through an empirical study of how geoscientists use two social computing technologies (SCTs), blogging and Twitter (both general use and tweeting from conferences). How are these technologies used and what value do scientists derive from them? Method The empirical part used a two-pronged qualitative study, using (1) purposive samples of ~400 blog posts and ~1000 tweets and (2) a purposive sample of 8 geoscientist interviews. Blog posts, tweets, and interviews were coded using the framework, adding new codes as needed. The results were aggregated into 8 geoscientist case studies, and general patterns were derived through cross-case analysis. Results A detailed picture of how geoscientists use blogs and twitter emerged, including a number of new functions not served by traditional channels. Some highlights: Geoscientists use SCTs for communication among themselves as well as with the public. Blogs serve persuasion and personal knowledge management; Twitter often amplifies the signal of traditional communications such as journal articles. Blogs include tutorials for peers, reviews of basic science concepts, and book reviews. Twitter includes links to readings, requests for assistance, and discussions of politics and religion. Twitter at conferences provides live coverage of sessions. Conclusions Both blogs and Twitter are routine parts of scientists' communication toolbox, blogs for in-depth, well-prepared essays, Twitter for faster and broader interactions. Both have important roles in supporting community building, mentoring, and learning and teaching. The Framework of Communication in Science was a useful tool in studying these two SCTs in this domain. The results should encourage science administrators to facilitate SCT use of scientists in their organization and information providers to search SCT documents as an important source of information.

Predominant learning styles among pharmacy students at the Federal University of Paraná, Brazil

Background: Learning styles are cognitive, emotional, and physiological traits, as well as indicators of how learners perceive, interact, and respond to their learning environments. According to Honey-Mumford, learning styles are classified as active, reflexive, theoretical, and pragmatic. Objective: The purpose of this study was to identify the predominant learning styles among pharmacy students at the Federal University of Paraná, Brazil. Methods: An observational, cross-sectional, and descriptive study was conducted using the Honey-Alonso Learning Style Questionnaire. Students in the Bachelor of Pharmacy program were invited to participate in this study. The questionnaire comprised 80 randomized questions, 20 for each of the four learning styles. The maximum possible score was 20 points for each learning style, and cumulative scores indicated the predominant learning styles among the participants. Honey-Mumford (1986) proposed five preference levels for each style (very low, low, moderate, high, and very high), called a general interpretation scale, to avoid student identification with one learning style and ignoring the characteristics of the other styles. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0. Results: This study included 297 students (70% of all pharmacy students at the time) with a median age of 21 years old. Women comprised 77.1% of participants. The predominant style among pharmacy students at the Federal University of Paraná was the pragmatist, with a median of 14 (high preference). The pragmatist style prevails in people who are able to discover techniques related to their daily learning because such people are curious to discover new strategies and attempt to verify whether the strategies are efficient and valid. Because these people are direct and objective in their actions, pragmatists prefer to focus on practical issues that are validated and on problem situations. There was no statistically significant difference between genders with regard to learning styles. Conclusion: The pragmatist style is the prevailing style among pharmacy students at the Federal University of Paraná. Although students may have a learning preference that preference is not the only manner in which students can learn, neither their preference is the only manner in which students can be taught. Awareness of students’ learning styles can be used to adapt the methodology used by teachers to render the teaching-learning process effective and long lasting. The content taught to students should be presented in different manners because varying teaching methods can develop learning skills in students.

The analysis and detection of new psychoactive substances in biological matrices

New psychoactive substances (NPSs) have appeared on the recreational drug market at an unprecedented rate in recent years. Many are not new drugs but failed products of the pharmaceutical industry. The speed and variety of drugs entering the market poses a new complex challenge for the forensic toxicology community. The detection of these substances in biological matrices can be difficult as the exact compounds of interest may not be known. Many NPS are sold under the same brand name and therefore users themselves may not know what substances they have ingested. The majority of analytical methods for the detection of NPSs tend to focus on a specific class of compounds rather than a wide variety. In response to this, a robust and sensitive method was developed for the analysis of various NPS by solid phase extraction (SPE) with gas chromatography mass spectrometry (GCMS). Sample preparation and derivatisation were optimised testing a range of SPE cartridges and derivatising agents, as well as derivatisation incubation time and temperature. The final gas chromatography mass spectrometry method was validated in accordance with SWGTOX 2013 guidelines over a wide concentration range for both blood and urine for 23 and 25 analytes respectively. This included the validation of 8 NBOMe compounds in blood and 10 NBOMe compounds in urine. This GC-MS method was then applied to 8 authentic samples with concentrations compared to those originally identified by NMS laboratories. The rapid influx of NPSs has resulted in the re-analysis of samples and thus, the stability of these substances is crucial information. The stability of mephedrone was investigated, examining the effect that storage temperatures and preservatives had on analyte stability daily for 1 week and then weekly for 10 weeks. Several laboratories identified NPSs use through the cross-reactivity of these substances with existing screening protocols such as ELISA. The application of Immunalysis ketamine, methamphetamine and amphetamine ELISA kits for the detection of NPS was evaluated. The aim of this work was to determine if any cross-reactivity from NPS substances was observed, and to determine whether these existing kits would identify NPS use within biological samples. The cross- reactivity of methoxetamine, 3-MeO-PCE and 3-MeO-PCP for different commercially point of care test (POCT) was also assessed for urine. One of the newest groups of compounds to appear on the NPS market is the NBOMe series. These drugs pose a serious threat to public health due to their high potency, with fatalities already reported in the literature. These compounds are falsely marketed as LSD which increases the chance of adverse effects due to the potency differences between these 2 substances. A liquid chromatography tandem mass spectrometry (LC-MS/MS) method was validated in accordance with SWGTOX 2013 guidelines for the detection for 25B, 25C and 25I-NBOMe in urine and hair. Long-Evans rats were administered 25B-, 25C- and 25I-NBOMe at doses ranging from 30-300 µg/kg over a period of 10 days. Tail flick tests were then carried out on the rats in order to determine whether any analgesic effects were observed as a result of dosing. Rats were also shaved prior to their first dose and reshaved after the 10-day period. Hair was separated by colour (black and white) and analysed using the validated LC-MS/MS method, assessing the impact hair colour has on the incorporation of these drugs. Urine was collected from the rats, analysed using the validated LC-MS/MS method and screened for potential metabolites using both LC-MS/MS and quadrupole time of flight (QToF) instrumentation.

Identification and Characterization of New Small Molecule Inhibitors of Picornavirus Replication

The Picornaviridae family consists of positive-strand RNA viruses that are the causative agents of a variety of diseases in humans and animals. Few drugs targeting picornaviruses are available, making the discovery of new antivirals a high priority. Here, we identified and characterized three compounds from a library of kinase inhibitors that block replication of poliovirus, coxsackievirus B3, and encephalomyocarditis virus. The antiviral effect of these compounds is not likely related to their known cellular targets because other inhibitors targeting the same pathways did not inhibit viral replication. Using an in vitro translation-replication system, we showed that these drugs inhibit different stages of the poliovirus life cycle. A4(1) inhibited the formation of a functional replication complex, while E5(1) and E7(2) affected replication after the replication complex had formed. A4(1) demonstrated partial protection from paralysis in a murine model of poliomyelitis. Poliovirus resistant to E7(2) had a single mutation in the 3A protein. This mutation was previously found to confer resistance to enviroxime-like compounds, which target either PI4KIIIβ (major enviroxime-like compounds) or OSBP (minor enviroxime-like compounds), cellular factors involved in lipid metabolism and shown to be important for replication of diverse positive-strand RNA viruses. We classified E7(2) as a minor enviroxime-like compound, because the localization of OSBP changed in the presence of this inhibitor. Interestingly, both E7(2) and major enviroxime-like compound GW5074 interfered with the viral polyprotein processing. Multiple attempts to isolate resistant mutants in the presence of A4(1) or E5(1) were unsuccessful, showing that effective broad-spectrum antivirals could be developed on the basis of these compounds. Studies with these compounds shed light on pathways shared by diverse picornaviruses that could be potential targets for the development of broad-spectrum antiviral drugs.

Perceptions of New Principal Mentoring Programs in a Large Urban School District

The principalship has changed significantly over the past 20 years. Today’s principals must be effective instructional leaders, managers of large facilities, and experts at analyzing data to successfully meet the accountability demands of high-stakes testing, along with state, and federal mandates. The primary purpose of this quantitative study was to examine how 43 first- and second-year sitting school principals perceived their mentoring experiences and the degree to which a principal mentoring program—offered by their large urban school district—was effective in building their leadership capacity. A second purpose of this inquiry was to understand these principals’ perceptions of the most beneficial aspects of the mentoring program. The study used quantitative data gathered via an online questionnaire distributed during Fall 2015. The results indicated that respondents perceived that the components of the large urban school-mentoring program were generally effective in training principal mentees to become highly-effective school leaders. This study enriches the literature on mentoring by providing the voices of first and second year school leaders to add depth to the characteristics of successful mentoring programs.

Development of new analytical procedures of isotope geochemistry by mass spectrometry. Application to the study of high-pressure metamorphic rocks from the Iberian Massif

319 p.

Bioequivalence evaluation of new microparticulate capsule and marketed tablet dosage forms of lornoxicam in healthy volunteers

Purpose: To compare oral bioavailability and pharmacokinetic parameters of different lornoxicam formulations and to assess similarity in plasma level profiles by statistical techniques. Methods: An open-label, two-period crossover trial was followed in 24 healthy Pakistani volunteers (22 males, 2 females). Each participant received a single dose of lornoxicam controlled release (CR) microparticles and two doses (morning and evening) of conventional lornoxicam immediate release (IR) tablet formulation. The microparticles were prepared by spray drying method. The formulations were administered again in an alternate manner after a washout period of one week. Pharmacokinetic parameters were determined by Kinetica 4.0 software using plasma concentration-time data. Moreover, data were statistically analyzed at 90 % confidence interval (CI) and Schuirmann’s two one-sided t-test procedure. Results: Peak plasma concentration (Cmax) was 20.2 % lower for CR formulation compared to IR formulation (270.90 ng/ml vs 339.44 ng/ml, respectively) while time taken to attain Cmax (tmax) was 5.25 and 2.08 h, respectively. Area under the plasma drug level versus time (AUC) curve was comparable for both CR and IR formulations. The 90 % confidence interval (CI) values computed for Cmax, AUC0-24, and AUC0-∞ , after log transformation, were 87.21, 108.51 and 102.74 %, respectively, and were within predefined bioequivalence range (80 - 125 %). Conclusion: The findings suggest that CR formulation of lornoxicam did not change the overall pharmacokinetic properties of lornoxicam in terms of extent and rate of lornoxicam absorption.

Resistance performances: (Re)constructing spaces of resistance and contention in the 2010-2011 University of Puerto Rico student movement

On the night of April 20, 2010, a group of students from the University of Puerto Rico (UPR), Río Piedras campus, met to organize an indefinite strike that quickly broadened into a defense of accessible public higher education of excellence as a fundamental right and not a privilege. Although the history of student activism in the UPR can be traced back to the early 1900s, the 2010-2011 strike will be remembered for the student activists’ use of new media technologies as resources that rapidly prompted and aided the numerous protests. ^ This activist research entailed a critical ethnography and a critical discourse analysis (CDA) of traditional and alternative media coverage and treatment during the 2010 -2011 UPR student strike. I examined the use of the 2010-2011 UPR student activists’ resistance performances in constructing local, corporeal, and virtual spaces of resistance and contention during their movement. In particular, I analyzed the different tactics and strategies of resistance or repertoire of collective actions that student activists used (e.g. new media technologies) to frame their collective identities via alternative news media’s (re)presentation of the strike, while juxtaposing the university administration’s counter-resistance performances in counter-framing the student activists’ collective identity via traditional news media representations of the strike. I illustrated how both traditional and alternative media (re)presentations of student activism developed, maintained, and/or modified students activists’ collective identities. ^ As such, the UPR student activism’s success should not be measured by the sum of demands granted, but by the sense of community achieved and the establishment of networks that continue to create resistance and change. These networks add to the debate surrounding Internet activism and its impact on student activism. Ultimately, the results of this study highlight the important role student movements have had in challenging different types of government policies and raising awareness of the importance of an accessible public higher education of excellence.^

Synthesis of new non-fullerene acceptors based on indacenodithiophene core for organic solar cells

Due to the low cost, lightness and flexibility, Polymer Solar Cell (PSC) technology is considered one of the most promising energy technologies. In the past decades, PSCs using fullerenes or fullerene derivatives as the electron acceptors have made great progress with best power conversion efficiency (PCE) reaching 11%. However, fullerene type electron acceptors have several drawbacks such as complicated synthesis, a low light absorption coefficient and poor tuning in energy levels, which prevent the further development of fullerene-based PSCs. Hence the need to have a new class of electron acceptors as an alternative to conventional fullerene compounds. Non-fullerene acceptors (NFAs) have developed rapidly in the last years and the maximum PCEs have exceeded 14% for single-junction cells and 17% for double-junction tandem cells. By combining an electron-donating backbone, generally with several fused rings with electron-withdrawing units, we can simply construct NFA of the acceptor–donor–acceptor type (A–D–A). Versatile molecular structures have been developed using methods such as acceptor motif engineering and donor motif engineering. However, there are only a few electron-donating backbones that have been proved to be successful. Therefore, it is still necessary to develop promising building blocks to further enrich the structural diversity. An indacenodithiophene (IDT) unit with just five fused rings has a sufficiently rigid coplanar structure, which has been regarded as one of the promising electron-rich units to design high-performance A–D–A NFAs. In this work, performed at the King Abdullah University of Science and Technology in Saudi Arabia, a new nine-cyclic building block (TBIDT) with a two benzothiophene unit was synthesized and used for designing new non-fullerene electron acceptors.

Imported Malaria In A Non-endemic Area: The Experience Of The University Of Campinas Hospital In The Brazilian Southeast.

Although malaria in Brazil almost exclusively occurs within the boundaries of the Amazon Region, some concerns are raised regarding imported malaria to non-endemic areas of the country, notably increased incidence of complications due to delayed diagnoses. However, although imported malaria in Brazil represents a major health problem, only a few studies have addressed this subject. A retrospective case series is presented in which 263 medical charts were analysed to investigate the clinical and epidemiological characterization of malaria cases that were diagnosed and treated at Hospital & Clinics, State University of Campinas between 1998 and 2011. Amongst all medical charts analysed, 224 patients had a parasitological confirmed diagnosis of malaria. Plasmodium vivax and Plasmodium falciparum were responsible for 67% and 30% of the infections, respectively. The majority of patients were male (83%) of a productive age (median, 37 years old). Importantly, severe complications did not differ significantly between P. vivax (14 cases, 9%) and P. falciparum (7 cases, 10%) infections. Severe malaria cases were frequent among imported cases in Brazil outside of the Amazon area. The findings reinforce the idea that P. vivax infections in Brazil are not benign, regardless the endemicity of the area studied. Moreover, as the hospital is located in a privileged site, it could be used for future studies of malaria relapses and primaquine resistance mechanisms. Finally, based on the volume of cases treated and the secondary complications, referral malaria services are needed in the non-endemic areas of Brazil for a rapid and efficient and treatment.