Effect of Wealth on Health Care Seeking Behavior And Out of Pocket Health Expenditure in Malawi

Thesis (Master's)--University of Washington, 2016-06

Using Social Worlds Theory to Explore Influences on Community Nurses’ Experiences of Providing Out of Hours Paediatric Palliative Care

Abstract Background: Paediatric oncology palliative care in the community is rare and nationally there is a lack of standardisation of out of hours nursing service provision. Objectives: This paper seeks to explore influences on the experiences of paediatric nurses providing out of hours palliative care within the family home to children with cancer. The study used social worlds theory to aid identification and demonstration of the findings. Methods: Twelve community-based palliative cases were purposively selected from children with cancer treated at one regional centre. Tape-recorded interviews were undertaken with 54 health professionals (general practitioners, community nurses and allied health professionals) involved in providing their palliative care and five facilitated case discussions completed. Data analysis followed a grounded theory approach; chronological comparative data analysis identifying generated themes. Social worlds theory was used as a framework to examine the data. Results: Nurses’ experiences are shaped by their social world and those of the nursing team,child and family and the inter-professional team providing the care. The lack of a formalised service, sub-optimal inter-professional working and impact of social worlds influence the experience of the nurse. Conclusions: Social worlds theory provided a new perspective in understanding these experiences based within a paediatric palliative care setting, knowledge that can be used to inform service provision.

Large-scale Roll Out of Online Prospective Measurement of Mood Symptoms in Affective Disorders

Background and Aims: True Colours is an online prospective mood-monitoring system developed at the University of Oxford to assist local patients and clinicians with monitoring course of illness in bipolar disorder. We report our initial experiences of using True Colours for research purposes in the Bipolar Disorder Research Network (BDRN; www.bdrn.org), a large research network of individuals with mood disorders spread throughout the UK. Methods: After initial piloting to ensure the practicality/acceptability of using True Colours within BDRN, we invited all BDRN participants (n = 7000) to participate in weekly True Colours ratings via three postal invitations sent over an 8-month period. Results: Following the three postal invitations, 915 individuals have so far expressed an interest in joining True Colours, and, of these, 662 (72.3%) have registered. 32 of those who registered for True Colours (5%) have so far asked to leave the system. Positive feedback from participants has focused around the ease of use and convenience of True Colours and potential clinical utility of the graphical representation of weekly mood scores. Conclusions: We have demonstrated that large-scale prospective mood monitoring for research purposes using a contemporary online approach is feasible. Challenges have included: (i) variation in participants’ technological ability; (ii) management of requests for clinical advice based on mood scores within a research setting; and, (iii) resources required to provide access and on-going support for participants using True Colours. We continue to expand recruitment to True Colours within BDRN, and plan to trial email invitations in the next phase of recruitment.

School Mobility for Children in Out-of-Home Placement: Incidence, Educational Outcomes, and Tools for Mitigation

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

Taking the 'physical' out of physical education

The impacts of environmental and anthropogenic stressors on largemouth bass: an integration of field and laboratory studies

Several environmental stressors can impact the physiology and survival of fishes. Fish experience natural fluctuations in temperature and dissolved oxygen, but variations in these parameters due to anthropogenic sources are typically greater in magnitude and duration. Changes in temperature and oxygen of anthropogenic origins may therefore have larger negative impacts on fish than those occurring during natural events. Physiological parameters are sensitive indicators of the impacts of stressors by providing insight into the manner in which fish are disturbed by the stressor. Fish may display cumulative physiological responses to successive stressors, but the concept of synergy among multiple thermal stressors is poorly understood. Further, some fish species can be subjected to competitive angling events, which expose fish to an array of additional stressors that can increase mortality. The impacts of these events may change over seasons as fish display seasonal changes in behavior and physiology. Latitudinal origin may also affect the physiological response and mortality of fish exposed to common environmental stressors as individual populations are adapted to local environmental conditions. This thesis focuses on addressing these potential impacts on physiological parameters and mortality of largemouth bass (Micropterus salmoides) and provides implications for management and conservation. Largemouth bass were relatively robust to abrupt changes in temperature and oxygen, but were perturbed from physiological homeostasis during large (12°C) temperature shocks and low (< 4 mg O2/L) levels of dissolved oxygen. Cumulative physiological impacts of multiple cold shocks were only slightly greater than the disturbances sustained during a single cold shock, suggesting largemouth bass are able to tolerate successive thermal stressors. Largemouth bass exhibited seasonal changes in physiological parameters but the responses of fish to angling tournaments were relatively similar across seasons when compared with seasonal controls. Mortality was low during angling tournaments held during four seasons and no apparent seasonal trends were observed. Lastly, largemouth bass from two latitudinally separated populations exhibited differences in their physiological responses to acute cold stressors and overwinter mortality, characterized by greater mortality and physiological disturbances of southern fish than northern fish. Knowledge gained from this study can be used to make management and conservation decisions regarding a host of environmental factors and provides insight into the mechanisms by which fish species can persist over large latitudinal ranges.

Falling Out of the Sky

“Falling Out of the Sky” is a collection of poems, both formal and free verse, that explores an intimate familial landscape. In particular, these poems raise the question of what it means to be human through examinations of family mythology and its changes as bodies and memories become unreliable with time.

Which way out of poverty? the human capital versus human capabilities approaches

La pobreza es un problema mundial que afecta a personas de diferentes maneras. El propósito de este artículo es explorar dos teorías principales que abordan la pobreza y la posibilidad de su superación, que son los enfoques de capital humano y de capacidades humanas. El enfoque del capital humano se centra exclusivamente en la faceta económica de la pobreza; en esta perspectiva, la pobreza se define como la falta de dinero y puede abordarse mediante el aumento de los ingresos financieros de las personas que viven en la pobreza. El enfoque de las capacidades humanas ve la pobreza como un problema multidimensional que va más allá de la economía para áreas como la salud, la educación y la libertad. Este enfoque se orienta hacia el cambio social y ayudar a las personas en situación de pobreza para descubrir y desarrollar su potencial. El autor considera que las capacidades humanas abarcan con mayor precisión el alcance de la pobreza y las personas afectadas por el mismo, aunque debido a su amplia gama ha sido difícil diseñar e implementar políticas eficaces que aborden todas las facetas de la pobreza.

Rare sex or out of reach equilibrium? The dynamics of F-IS in partially clonal organisms

Background: Partially clonal organisms are very common in nature, yet the influence of partial asexuality on the temporal dynamics of genetic diversity remains poorly understood. Mathematical models accounting for clonality predict deviations only for extremely rare sex and only towards mean inbreeding coefficient (F-IS) over bar < 0. Yet in partially clonal species, both F-IS < 0 and F-IS > 0 are frequently observed also in populations where there is evidence for a significant amount of sexual reproduction. Here, we studied the joint effects of partial clonality, mutation and genetic drift with a state-and-time discrete Markov chain model to describe the dynamics of F-IS over time under increasing rates of clonality. Results: Results of the mathematical model and simulations show that partial clonality slows down the asymptotic convergence to F-IS = 0. Thus, although clonality alone does not lead to departures from Hardy-Weinberg expectations once reached the final equilibrium state, both negative and positive F-IS values can arise transiently even at intermediate rates of clonality. More importantly, such "transient" departures from Hardy Weinberg proportions may last long as clonality tunes up the temporal variation of F-IS and reduces its rate of change over time, leading to a hyperbolic increase of the maximal time needed to reach the final mean (F-IS,F-infinity) over bar value expected at equilibrium. Conclusion: Our results argue for a dynamical interpretation of F-IS in clonal populations. Negative values cannot be interpreted as unequivocal evidence for extremely scarce sex but also as intermediate rates of clonality in finite populations. Complementary observations (e.g. frequency distribution of multiloci genotypes, population history) or time series data may help to discriminate between different possible conclusions on the extent of clonality when mean (F-IS) over bar values deviating from zero and/or a large variation of F-IS over loci are observed.

Keeping the Germans out of the straits: The five ottoman dreadnought thesis reconsidered

This article contests Sean McMeekin’s claims concerning Russian culpability for the First World War. McMeekin maintains that Ottoman rearmament, particularly the purchase of several battleships released onto the global arms market by South American states, threatened to create a situation where the Russian Black Sea Fleet would be outclassed by its Ottoman opposite number. Rather than waiting for this to happen, the tsarist regime chose to go to war. Yet, contrary to McMeekin’s claims, the Ottoman naval expansion never assumed threatening dimensions because the Porte was unable to purchase battleships from Chile or Argentina. As a result, it provided no incentive for Russia to go to war in 1914.

Methane seep carbonates yield clumped isotope signatures out of equilibrium with formation temperatures

Methane cold seep systems typically exhibit extensive buildups of authigenic carbonate minerals, resulting from local increases in alkalinity driven by methane oxidation. Here, we demonstrate that modern seep authigenic carbonates exhibit anomalously low clumped isotope values (Delta(47)), as much as similar to 0.2 parts per thousand lower than expected values. In modern seeps, this range of disequilibrium translates into apparent temperatures that are always warmer than ambient temperatures, by up to 50 degrees C. We examine various mechanisms that may induce disequilibrium behaviour in modern seep carbonates, and suggest that the observed values result from several factors including kinetic isotopic effects during methane oxidation, mixing of inorganic carbon pools, pH effects and rapid precipitation. Ancient seep carbonates studied here also exhibit potential disequilibrium signals. Ultimately, these findings indicate the predominance of disequilibrium clumped isotope behaviour in modern cold seep carbonates that must be considered when characterizing environmental conditions in both modern and ancient cold seep settings.

Risk perception and correlates of alcohol use among out-of-school youth in motor parks in Lagos State, Nigeria

Background and Aim: The prevalence of alcohol use has increased globally. Out-of-school youth are a vulnerable group who might have missed opportunities for learning healthy behaviours in a formal school environment. The purpose of this study was to determine the risk perception, pattern of use, and correlates of alcohol use among out-of-school youth in Lagos, Nigeria. Methods: A cross-sectional study was conducted among 380 out-of-school youth in motor parks in Lagos State, Nigeria, using interviewer administered questionnaires. Results: The lifetime prevalence of alcohol use was 61.1%, while 55.5% were current drinkers. Beer (57.3%) was the most consumed type of alcohol, followed by distilled spirits (29.8%). Using the CAGE scoring system, more than half (57.8%) of the current drinkers had a drinking problem. Almost three quarters (70.1%) had experienced at least one episode of alcohol intoxication within the past month. A considerable number of current drinkers (63.5%) desired to reduce their alcohol intake or stop drinking, while 45.5% had made unsuccessful attempts to do so within the past year. Only 28.9% had received assistance to quit or reduce their drinking and of these less than half (39.3%) received assistance from a professional or healthcare worker. Males were more likely to be current drinkers and to have experienced episodes of alcohol intoxication. Parental and peer drinking were associated with alcohol use but not with intoxication. Conclusions: It is important to design specific programmes to reduce alcohol use among out-of-school youth in these settings.

Effect of oxygen on the electrical characteristics of field effect transistors formed from electrochemically deposited films of poly(3-methylthiophene)

Field effect devices have been formed in which the active layer is a thin film of poly(3-methylthiophene) grown electrochemically onto preformed source and drain electrodes. Although a field effect is present after electrochemical undoping, stable device characteristics with a high modulation ratio are obtained only after vacuum annealing at an elevated temperature, and only then if the devices are held in vacuo. The polymer is shown to be p type and the devices operate in accumulation only. The hole mobility in devices thermally annealed under vacuum is around 10 -3 cm 2 V -1 s -1. On exposure to ambient laboratory air, the device conductance increases by several orders of magnitude. This increase may be reversed by subjecting the device to a further high-temperature anneal under vacuum. Subsidiary experiments show that these effects are caused by the reversible doping of the polymer by gaseous oxygen.

Effect of oxygen on the electrical characteristics of field effect transistors formed from electrochemically deposited films of poly(3-methylthiophene)

Field effect devices have been formed in which the active layer is a thin film of poly(3-methylthiophene) grown electrochemically onto preformed source and drain electrodes. Although a field effect is present after electrochemical undoping, stable device characteristics with a high modulation ratio are obtained only after vacuum annealing at an elevated temperature, and only then if the devices are held in vacuo. The polymer is shown to be p type and the devices operate in accumulation only. The hole mobility in devices thermally annealed under vacuum is around 10 -3 cm 2 V -1 s -1. On exposure to ambient laboratory air, the device conductance increases by several orders of magnitude. This increase may be reversed by subjecting the device to a further high-temperature anneal under vacuum. Subsidiary experiments show that these effects are caused by the reversible doping of the polymer by gaseous oxygen.