The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^

Impact of consciousness raising and social liberation on readiness to engage in regular physical activity among adults in Magnolia Park/Lawndale-Wayside, Houston, TX

According to the transtheoretical model, consciousness raising and social liberation are processes used to help individuals progress through the stages of change for a given behavior. This study assessed the impact of these two processes on readiness to engage in regular physical activity among a convenience sample of 35 adults in the Magnolia Park/Lawndale-Wayside area of Houston, TX. The duration of the study was approximately 4 weeks. All pre/post-test data were collected via self-administered surveys available in English or Spanish. Baseline data were used to determine the culturally relevant content of a one-dose intervention consisting of a presentation and dissemination of educational materials as well as a list of local physical activity opportunities. Although the intervention did not improve progression through the stages of change, significant increases were evident among 5 out of 6 processes of change. Based on these results and qualitative data, this study recommended that the Houston Parks and Recreation Department incorporate cultural competency into the design and publication of materials and revise the schedule of available programs (i.e.: increase the number of walking programs) in order to reflect the physical activity preferences of Magnolia Park/Lawndale-Wayside residents.^

The impact of parent acculturation on parental fruit and vegetable intake, child fruit and vegetable intake, and child perceived access and availability to fruits and vegetables in the home environment

The purpose of this thesis was to investigate the association between parent acculturation and parental fruit and vegetable intake, child fruit and vegetable intake, and child access and availability to fruits and vegetables. Secondary data analysis was performed on a convenience sample of low-income Hispanic-identifying parents (n = 177) and children from a baseline survey from the Sprouting Healthy Kids intervention. T tests were used to examine the association between parent acculturation status (acculturated or non-acculturated) and fruit intake, vegetable intake and combined fruit and vegetable intake of both the parent and the child. T tests were also used to determine the relationship between parent acculturation and child access and availability to fruits, vegetables, and combined fruits and vegetables. Statistical significance was set at a p level of 0.05. The mean FVI for the parents and children were 3.41 servings and 2.96 servings, respectively. Statistical significance was found for the relationships between parent acculturation and parent fruit intake and parent acculturation and child fruit access. Lower acculturation of the parent was significantly related to higher fruit intake. Counter to the hypothesis, higher acculturation was found to be associated with greater access to fruits for the child. These findings suggest the necessity for not only culturally specific nutrition interventions, but the need for interventions to target behaviors for specific levels of acculturation within a culture. ^

The Effect of Proximity, Explicitness, and Representation of Basic Science Information on Student Clinical Problem-Solving

Problem: Medical and veterinary students memorize facts but then have difficulty applying those facts in clinical problem solving. Cognitive engineering research suggests that the inability of medical and veterinary students to infer concepts from facts may be due in part to specific features of how information is represented and organized in educational materials. First, physical separation of pieces of information may increase the cognitive load on the student. Second, information that is necessary but not explicitly stated may also contribute to the student’s cognitive load. Finally, the types of representations – textual or graphical – may also support or hinder the student’s learning process. This may explain why students have difficulty applying biomedical facts in clinical problem solving. Purpose: To test the hypothesis that three specific aspects of expository text – the patial distance between the facts needed to infer a rule, the explicitness of information, and the format of representation – affected the ability of students to solve clinical problems. Setting: The study was conducted in the parasitology laboratory of a college of veterinary medicine in Texas. Sample: The study subjects were a convenience sample consisting of 132 second-year veterinary students who matriculated in 2007. The age of this class upon admission ranged from 20-52, and the gender makeup of this class consisted of approximately 75% females and 25% males. Results: No statistically significant difference in student ability to solve clinical problems was found when relevant facts were placed in proximity, nor when an explicit rule was stated. Further, no statistically significant difference in student ability to solve clinical problems was found when students were given different representations of material, including tables and concept maps. Findings: The findings from this study indicate that the three properties investigated – proximity, explicitness, and representation – had no statistically significant effect on student learning as it relates to clinical problem-solving ability. However, ad hoc observations as well as findings from other researchers suggest that the subjects were probably using rote learning techniques such as memorization, and therefore were not attempting to infer relationships from the factual material in the interventions, unless they were specifically prompted to look for patterns. A serendipitous finding unrelated to the study hypothesis was that those subjects who correctly answered questions regarding functional (non-morphologic) properties, such as mode of transmission and intermediate host, at the family taxonomic level were significantly more likely to correctly answer clinical case scenarios than were subjects who did not correctly answer questions regarding functional properties. These findings suggest a strong relationship (p < .001) between well-organized knowledge of taxonomic functional properties and clinical problem solving ability. Recommendations: Further study should be undertaken investigating the relationship between knowledge of functional taxonomic properties and clinical problem solving ability. In addition, the effect of prompting students to look for patterns in instructional material, followed by the effect of factors that affect cognitive load such as proximity, explicitness, and representation, should be explored.

Retrospective analysis of Methicillin-Resistant Staphylococcus Aureus (MRSA) skin and Soft-Tissue Infections (SSTI) in a university hospital emergency department (ED)

Study Objective: Identify the most frequent risk factors of Community Acquired-MRSA (CA-MRSA) Skin and Soft-tissue Infections (SSTIs) using a case series of patients and characterize them by age, race/ethnicity, gender, abscess location, druguse and intravenous drug-user (IVDU), underlying medical conditions, homelessness, treatment resistance, sepsis, those whose last healthcare visit was within the last 12 months, and describe the susceptibility pattern from this central Texas population that have come into the University Medical Center Brackenridge (UMCB) Emergency Department (ED). ^ Methods: This study was a retrospective case-series medical record review involving a convenience sample of patients in 2007 from an urban public hospital's ED in Texas that had a SSTI that tested positive for MRSA. All positive MRSA cultures underwent susceptibility testing to determine antibiotic resistance. The demographic and clinical variables that were independently associated with MRSA were determined by univariate and multivariate analysis using logistic regression to calculate odds ratios (OR), 95% confidence intervals, and significance (p≤ 0.05). ^ Results: In 2007, there were 857 positive MRSA cultures. The demographics were: males 60% and females 40%, with the average age of 36.2 (std. dev. =13) the study population consisted of non-Hispanic white (42%), Hispanics (38%), and non-Hispanic black (18.8%). Possible risk factors addressed included using recreational drugs (not including IVDU) (27%) homelessness (13%), diabetes status (12.6%) or having an infectious disease, and IVDU (10%). The most frequent abscess location was the leg (26.6%), followed by the arm and torso (both 13.7%). Eighty-three percent of patients had one prominent susceptibility pattern that had a susceptibility rate for the following antibiotics: trimethoprim/sulfamethoxazole (TMP-SMX) and vancomycin had 100%, gentamicin 99%, clindamycin 96%, tetracycline 96%, and erythromycin 56%. ^ Conclusion: The ED is becoming an important area for disease transmission between the sterile hospital environment and the outside environment. As always, it is important to further research in the ED in an effort to better understand MRSA transmission and antibiotic resistance, as well as to keep surveillance for the introduction of new opportunistic pathogens into the population. ^

President Chain Store Corporation's Hsu Chong-Jen: A Case Study of a Salaried Manager in Taiwan

Salaried managers have been increasing in top management of many Taiwanese companies. Why and how have their roles become more important? In order to answer these questions, it is necessary to examine the complicated relationships between salaried managers and the founders' families who appoint them to top-management positions. This paper examines the case of Hsu Chung-Jen, the president of President Chain Store Corporation. PCSC operates Taiwan's 7-ELEVENs, the largest convenience store chain on the island. He may be regarded as the most advanced salaried manager in Taiwan today.

Poverty Analysis of Ethiopian Females in the Amhara Region: Utilizing BMI as an Indicator of Poverty

This paper analyzes poverty-affected females in the Amhara region of Ethiopia. As the measurement of poverty, the paper uses body mass index (BMI) because it is one of the effective tools for measuring individual poverty level. The results of the BMI analysis show that the most poverty-affected female group is the female household heads in urban areas. The results, however, should be treated carefully considering the different social and economic structure of urban and rural areas, and the interdependent relationship between these two areas. In rural areas, access to land is the biggest issue affecting the BMI, while in urban areas, the occupation of husbands or partners is more important. These differences by area do not mean that there is no intersection between the urban and rural female groups because the majority of females in urban areas migrated from rural areas to urban areas due to various reasons such as divorce, marriage, and job opportunities.

Chapter 2 On the usage of the measurements of geographical concentration and specialization with areal data

Measures have been developed to understand tendencies in the distribution of economic activity. The merits of these measures are in the convenience of data collection and processing. In this interim report, investigating the property of such measures to determine the geographical spread of economic activities, we summarize the merits and limitations of measures, and make clear that we must apply caution in their usage. As a first trial to access areal data, this project focus on administrative areas, not on point data and input-output data. Firm level data is not within the scope of this article. The rest of this article is organized as follows. In Section 2, we touch on the the limitations and problems associated with the measures and areal data. Specific measures are introduced in Section 3, and applied in Section 4. The conclusion summarizes the findings and discusses future work.

Marriage as women's old age insurance : evidence from migration and land inheritance practices in rural Tanzania

In a traditional system of exogamous and patrilocal marriage prevalent in much of Sub-Saharan Africa, when she marries, a rural woman typically leaves her kin to reside with her husband living outside her natal village. Since a village that allows a widow to inherit her late husband's land can provide her with old age security, single females living outside the village are more likely to marry into the village. Using a natural experimental setting, provided by the longitudinal household panel data drawn from rural Tanzania for the period from 1991 to 2004, during which several villages that initially banned a widow's land inheritance removed this discrimination, this study provides evidence in support of this view, whereby altering a customary land inheritance rules in a village in favor of widows increased the probability of males marrying in that village. This finding suggests that providing rural women with old age protection (e.g., insurance, livelihood protection) has remarkable spatial and temporal welfare effects by influencing their decision to marry.

Marriage, dowry, and women's status in rural Punjab, Pakistan

Dowry is a common custom observed in South Asian countries. It has been a target of an opposition movement because it is assumed to be a root cause of women's mistreatment, for example, in the form of sex-selective abortion, girls' malnutrition, female infanticide, and domestic homicide called "dowry murder." Despite its alleged evil consequences and the legal ban or restrictions on it, the custom has been extended, and recently, the dowry amount seems to be increasing. However, there is little empirical evidence of dowry's effects. This study empirically investigates the effects of dowry on women's status in rural Pakistan. We conducted a unique survey in rural Punjab, Pakistan, to explore the marriage practices there and to answer the research question. Results show that a higher dowry amount enhances women’s status in the marital household. This implies that an outright ban on dowries does not necessarily improve women's welfare at this time.

Better than nothing? : dowry in the absence of the legal protection of women's inheritance rights

The practice of dowry is often thought to be the root cause of the unequal treatment of women in India. For women without inheritance rights, however, dowry may function as their only source of protection. Using a nationwide dataset and exploiting a natural experimental situation, this study explores the effects of dowry on women's empowerment in India, a society where women do not have inheritance rights. In such a society, dowry seems to enhance women's status in the marital household. The effects reverse when women have equal inheritance rights as their brothers. Empirical analysis suggests that the outright ban on dowry that ignores the context may not necessarily benefit women.

Dangerous unions : mapping human smuggling and human trafficking in international marriage through Japan's legal response

This working paper explores human smuggling and human trafficking through international marriage. It focuses on Japan's criminal justice response, while examining the major stakeholders involved in this activity. The paper focuses on the time period from 2008-2013. International marriages, particularly commercially brokered arrangements, have rapidly increased throughout East and Southeast Asia, with more women from less developed countries moving to richer destinations. The increasing prevalence of brokered marriages, and the overall numbers of marriage migrants, provides cover for criminal organizations to smuggle labor migrants on false marriages, and to send some migrants into what are clearly human trafficking situations.

Desing and Validation of a Light Inference System to Support Embedded Context Reasoning

Embedded context management in resource-constrained devices (e.g. mobile phones, autonomous sensors or smart objects) imposes special requirements in terms of lightness for data modelling and reasoning. In this paper, we explore the state-of-the-art on data representation and reasoning tools for embedded mobile reasoning and propose a light inference system (LIS) aiming at simplifying embedded inference processes offering a set of functionalities to avoid redundancy in context management operations. The system is part of a service-oriented mobile software framework, conceived to facilitate the creation of context-aware applications—it decouples sensor data acquisition and context processing from the application logic. LIS, composed of several modules, encapsulates existing lightweight tools for ontology data management and rule-based reasoning, and it is ready to run on Java-enabled handheld devices. Data management and reasoning processes are designed to handle a general ontology that enables communication among framework components. Both the applications running on top of the framework and the framework components themselves can configure the rule and query sets in order to retrieve the information they need from LIS. In order to test LIS features in a real application scenario, an ‘Activity Monitor’ has been designed and implemented: a personal health-persuasive application that provides feedback on the user’s lifestyle, combining data from physical and virtual sensors. In this case of use, LIS is used to timely evaluate the user’s activity level, to decide on the convenience of triggering notifications and to determine the best interface or channel to deliver these context-aware alerts.d

A methodology for granularity-based control of parallelism in logic programs

Several types of parallelism can be exploited in logic programs while preserving correctness and efficiency, i.e. ensuring that the parallel execution obtains the same results as the sequential one and the amount of work performed is not greater. However, such results do not take into account a number of overheads which appear in practice, such as process creation and scheduling, which can induce a slow-down, or, at least, limit speedup, if they are not controlled in some way. This paper describes a methodology whereby the granularity of parallel tasks, i.e. the work available under them, is efficiently estimated and used to limit parallelism so that the effect of such overheads is controlled. The run-time overhead associated with the approach is usually quite small, since as much work is done at compile time as possible. Also,a number of run-time optimizations are proposed. Moreover, a static analysis of the overhead associated with the granularity control process is performed in order to decide its convenience. The performance improvements resulting from the incorporation of grain size control are shown to be quite good, specially for systems with medium to large parallel execution overheads.

Towards granularity based control of parallelism in logic programs

Several types of parallelism can be exploited in logic programs while preserving correctness and efficiency, i.e. ensuring that the parallel execution obtains the same results as the sequential one and the amount of work performed is not greater. However, such results do not take into account a number of overheads which appear in practice, such as process creation and scheduling, which can induce a slow-down, or, at least, limit speedup, if they are not controlled in some way. This paper describes a methodology whereby the granularity of parallel tasks, i.e. the work available under them, is efficiently estimated and used to limit parallelism so that the effect of such overheads is controlled. The run-time overhead associated with the approach is usually quite small, since as much work is done at compile time as possible. Also, a number of run-time optimizations are proposed. Moreover, a static analysis of the overhead associated with the granularity control process is performed in order to decide its convenience. The performance improvements resulting from the incorporation of grain size control are shown to be quite good, specially for systems with médium to large parallel execution overheads.