Doctor-Patient Knowledge Transfer: Innovative Technologies and Policy Implications

The aim of this study was to empirically investigate the barriers in doctor-patient communication and knowledge transfer and the role of innovative technologies in overcoming these barriers. We applied qualitative research methods. Our results show that patients extensively use information sources, primarily the Internet before the visits. Patients regularly apply a self-diagnosis regarding their diseases. This implies several risks as many of them are not able to properly interpret the found information and at the same time the information might not be reliable. To overcome these risks efforts are required within the fields of technology developments for making web sites more reliable and improvement of the health culture of patients, as well. Our research identified the most significant barriers of doctor-patient communication including limited time, the patients’ distress, inadequate health culture and prior knowledge, as well as poor communication skills of some clinicians. Technology might help clinicians to use their limited time more effectively. In the long term, innovative technology solutions might take over some tasks of the health care personnel if they provide reliable health information adapted to the patient’s health, emotional and psychosocial status. Barriers of access to the new technology should be identified and addressed otherwise it would increase the already existing knowledge gap between patients and doctors.

How do partnerships lead to a competitive advantage? Applying the resource based view to nascent social ventures

This dissertation is one of the earliest to systematically apply and empirically test the resource-based view (RBV) in the context of nascent social ventures in a large scale study. Social ventures are entrepreneurial ventures organized as nonprofit, for-profit, or hybrid organizations whose primary purpose is to address unmet social needs and create social value. Nascent social ventures face resource gaps and engage in partnerships or alliances as one means to access external resources. These partnerships with different sectors facilitate social venture innovative and earned income strategies, and assist in the development of adequate heterogeneous resource conditions that impact competitive advantage. Competitive advantage in the context of nascent social ventures is achieved through the creation of value and the achievement of venture development activities and launching. The relationships between partnerships, heterogeneous resource conditions, strategies, and competitive advantage are analyzed in the context of nascent social ventures that participated in business plan competitions. A content analysis of 179 social venture business plans and an exploratory follow-up survey of 72 of these ventures are used to analyze these relationships using regression, ANOVA, correlations, t-tests, and non-parametric statistics. The findings suggest a significant positive relationship between competitive advantage and partnership diversity, heterogeneous resource conditions, social innovation, and earned income. Social capital is the type of resource most significantly related to competitive advantage. Founder previous start-up experience, client location, and business plan completeness are also found to be significant in the relationship between partnership diversity and competitive advantage. Finally the findings suggest that hybrid social ventures create a greater competitive advantage than nonprofit or for-profit social ventures. Consequently, this dissertation not only provides academics further insight into the factors that impact nascent social value creation, venture development, and ability to launch, but also offers practitioners guidance on how best to organize certain processes to create a competitive advantage. As a result more insight is gained into the nascent social venture creation process and how these ventures can have a greater impact on society.

Risks to Hospitality Firms in the International Arena

Much potential for growth in hospitality firms exists in foreign countries, but expansion abroad typicality bears additional risks that could be detrimental to the operations. The authors explore those risks, currency exchange risk, and country risk, and offer practical techniques to access, manage, control, and reduce them. Deriving benefits from global opportunities requires effective management of these areas

Women-led community development organizations (CDOs) in Miami-Dade County: A model of community development efforts impacting the economic security of women

Recent studies on the economic status of women in Miami-Dade County (MDC) reveal an alarming rate of economic insecurity and significant obstacles for women to achieve economic security. Consistent barriers to women's economic security affect not only the health and wellbeing of women and their families, but also economic prospects for the community. A key study reveals in Miami-Dade County, "Thirty-nine percent of single female-headed families with at least one child are living at or below the federal poverty level" and "over half of working women do not earn adequate income to cover their basic necessities" (Brion 2009, 1). Moreover, conventional measures of poverty do not adequately capture women's struggles to support themselves and their families, nor do they document the numbers of women seeking basic self-sufficiency. Even though there is lack of accurate data on women in the county, which is a critical problem, there is also a dearth of social science research on existing efforts to enhance women's economic security in Miami-Dade County. My research contributes to closing the information gap by examining the characteristics and strategies of women-led community development organizations (CDOs) in MDC, working to address women's economic insecurity. The research is informed by a framework developed by Marilyn Gittell, who pioneered an approach to study women-led CDOs in the United States. On the basis of research in nine U.S. cities, she concluded that women-led groups increased community participation and "by creating community networks and civic action, they represent a model for community development efforts" (Gittell, et al. 2000, 123). My study documents the strategies and networks of women-led CDOs in MDC that prioritize women's economic security. Their strategies are especially important during these times of economic recession and government reductions in funding towards social services. The focus of the research is women-led CDOs that work to improve social services access, economic opportunity, civic participation and capacity, and women's rights. Although many women-led CDOs prioritize building social infrastructures that promote change, inequalities in economic and political status for women without economic security remain a challenge (Young 2004). My research supports previous studies by Gittell, et al., finding that women-led CDOs in Miami-Dade County have key characteristics of a model of community development efforts that use networking and collaboration to strengthen their broad, integrated approach. The resulting community partnerships, coupled with participation by constituents in the development process, build a foundation to influence policy decisions for social change. In addition, my findings show that women-led CDOs in Miami-Dade County have a major focus on alleviating poverty and economic insecurity, particularly that of women. Finally, it was found that a majority of the five organizations network transnationally, using lessons learned to inform their work of expanding the agency of their constituents and placing the economic empowerment of women as central in the process of family and community development.

A Fuzzy Preprocessing Module for Optimizing the Access Network Selection in Wireless Networks

A heterogeneous wireless network is characterized by the presence of different wireless access technologies that coexist in an overlay fashion. These wireless access technologies usually differ in terms of their operating parameters. On the other hand, Mobile Stations (MSs) in a heterogeneous wireless network are equipped with multiple interfaces to access different types of services from these wireless access technologies. The ultimate goal of these heterogeneous wireless networks is to provide global connectivity with efficient ubiquitous computing to these MSs based on the Always Best Connected (ABC) principle. This is where the need for intelligent and efficient Vertical Handoffs (VHOs) between wireless technologies in a heterogeneous environment becomes apparent. This paper presents the design and implementation of a fuzzy multicriteria based Vertical Handoff Necessity Estimation (VHONE) scheme that determines the proper time for VHO, while considering the continuity and quality of the currently utilized service, and the end-users' satisfaction.

The science of citizen science

Biodiversity citizen science projects are growing in number, size, and scope, and are gaining recognition as valuable data sources that build public engagement. Yet publication rates indicate that citizen science is still infrequently used as a primary tool for conservation research and the causes of this apparent disconnect have not been quantitatively evaluated. To uncover the barriers to the use of citizen science as a research tool, we surveyed professional biodiversity scientists (n = 423) and citizen science project managers (n = 125). We conducted three analyses using non-parametric recursive modeling (random forest), using questions that addressed: scientists' perceptions and preferences regarding citizen science, scientists' requirements for their own data, and the actual practices of citizen science projects. For all three analyses we identified the most important factors that influence the probability of publication using citizen science data. Four general barriers emerged: a narrow awareness among scientists of citizen science projects that match their needs; the fact that not all biodiversity science is well-suited for citizen science; inconsistency in data quality across citizen science projects; and bias among scientists for certain data sources (institutions and ages/education levels of data collectors). Notably, we find limited evidence to suggest a relationship between citizen science projects that satisfy scientists' biases and data quality or probability of publication. These results illuminate the need for greater visibility of citizen science practices with respect to the requirements of biodiversity science and show that addressing bias among scientists could improve application of citizen science in conservation.

A articulação entre a estratégia saúde da família e o Centro de Atenção Psicossocial: análise de experiência em município do Nordeste brasileiro

The antimanicomial psychiatric reform is a process that seeks to deconstruct the exclusionary logic caused by hospitalizations, providing strategies for social reintegration of individuals. In this sense, the primary care through the Family Health Strategy - FHS comes progressively becoming strategic space in mental health interventions, configured as a field of practice and production of new modes of care. In this perspective, there has been a process of implementing this proposal in the Areia Branca City/RN, through the articulation of Psychosocial Care Network and the Family Health Strategy / ESF. However, this process has not been able to bring changes in practices. From the view that the relationship between mental health and primary care is a challenge currently being faced, that improving the care provided and the expansion of the access to services with guaranteed continuity of care depend on the effectiveness of this joint, established themselves as research objective: To investigate how is the relationship between the FHS team and CAPS team in care mental health in the town of Areia Branca - RN from the speeches of professionals. And if you had specific purposes: 1) Know the demand in existing mental health in the town of White Sand - RN served by FHS; 2) Identify limits and difficulties in the relationship between the ESF teams and CAPS; 3) Identify potential for linkages between ESF teams and CAPS for the establishment of local RAPS. This was a descriptive, exploratory study with a qualitative methodological design, whose subjects were professionals from the Family Health Strategy, professionals Psychosocial Care Center and responsible for the conduct / management of mental health in the municipality. The research tools used informal observations, semistructured interviews and focus groups were used. The data obtained were analyzed for the content analysis of Bardin, allowing discuss the relevance of the theoretical framework with data obtained through observation and interpretation of the relationship between the Family Health Strategy and the network of Psychosocial Care in Areia Branca-RN. On the one hand, there was strong demand for mental health arising from users and their families and / or caregivers. On the other, it was verified that although there is some progress with regard to perceptions of mental health, there are still practical, historical and contextually rooted, which act as barriers to effective response to this demand in view of deinstitutionalization. In this sense, it is considered important to emphasize that the teams of the Family Health Strategy should be trained to ensure the health practice with integrity and incorporating the mental health network in the municipality. This training must occur through continuing health education.

(Table 3) Age determination of sediment cores from the SW Pacific Ocean

Eight- to ten-point depth profiles (from 1200 to 4800 m water depth) of oxygen and carbon isotopic values derived from benthic foraminifera, averaged over selected times in the past 160 ka, are presented. The data are from 10 sediment cores off eastern New Zealand, mainly North Chatham Rise. This lies under the Deep Western Boundary Current in the Southwest Pacific and is the main point of entry for several water masses into the Pacific Ocean. The benthic isotopic profiles are related to the structure of water masses at present and inferred for the past. These have retained a constant structure of Lower Circumpolar Deep Water-Upper Circumpolar Deep Water/North Pacific Deep Water-Antarctic Intermediate Water with no apparent changes in the depths of water mass boundaries between glacial and interglacial states. Sortable silt particle size data for four cores are also examined to show that the vigour of the inflow to the Pacific, while variable, appears to have remained fairly constant on average. Among the lowest Last Glacial Maximum values of benthic d13C in the world ocean (-1.03 per mil based on Cibicidoides wüllerstorfi) occurs here at ~2200 m. Comparable values occur in the Atlantic sector of the Southern Ocean, while those from the rest of the Pacific are distinctly higher, confirming that the Southern Ocean was the source for the unventilated/nutrient-enriched water seen here. Oxygen and carbon isotopic data are compatible with a glacial cold deep water mass of high salinity, but lower nutrient content (or better ventilated), below ~3500 m depth. This contrasts with the South Atlantic where unventilated/nutrient-enriched water extends all the way to the sea bed. Comparison with previous studies also suggests that the deeper reaches of the Antarctic Circumpolar Current below ~3500 m are not homogeneous all around the Southern Ocean, with the Kerguelen Plateau and/or the Macquarie-Balleny Ridges posing barriers to the eastward spread of the deepest low-d13C water out of the South Atlantic in glacials. These barriers, combined with inferred high density of bottom waters, restricted inter-basin exchange and allow three glacial domains dominated by bottom waters from Weddell Sea, Adelie Coast and Ross Sea to be defined. We suggest that the Ross Sea was the main source of the deep water entering the Pacific below ~3500 m.

Photocatalytic activities of tin(IV) oxide surface-modified titanium(IV) dioxide show a strong sensitivity to the TiO 2 crystal form

Surface modification of rutile TiO2 with extremely small SnO2 clusters gives rise to a great increase in its UV light activity for degradation of model organic water pollutants, while the effect is much smaller for anatase TiO2. This crystal form sensitivity is rationalized in terms of the difference in the electronic modification of TiO2 through the interfacial Sn−O−Ti bonds. The increase in the density of states near the conduction band minimum of rutile by hybridization with the SnO2 cluster levels intensifies the light absorption, but this is not seen with modified anatase. The electronic transition from the valence band to the conduction band causes the bulk-to-surface interfacial electron transfer to enhance charge separation. Further, electrons relaxed to the conduction minimum are smoothly transferred to O2 due to the action of the SnO2 species as an electron transfer promoter.

Design of Antibacterial Prochelators to Target Drug-Resistant Bacteria

Transition metals such as iron and copper are valued in biology for their redox activities because they are able to access various oxidation states. However, these transition metals are also implicated in a number of human disease states and play a role in bacterial infections. The ability to manipulate and monitor metal ions has vast implications on the fields of biology and human health. As such, the research described here covers two related goals: to manipulate metals in specific biological circumstances and to visualize this disturbance in cellular metal homeostasis.

Antibiotic resistance necessitates the development of drugs that exploit new mechanisms of action such as the disruption of metal homeostasis. In order to manipulate metals at the site of bacterial infection, two prochelators were developed around a β-lactam core such that the active chelator is released in the presence of bacteria that produce the resistance-causing β-lactamase enzyme. Both prochelators display enhanced activity toward resistant bacteria compared to clinical antibiotics.

Fluorescent sensors are a powerful tool for detecting small concentrations of biological analytes. Two analogs of a ratiometric fluorescent sensor were designed and synthesized to monitor cellular concentrations of copper and iron. These sensors were found to operate as designed in vitro; however the fluorescence intensity necessary for quantification of cellular metal pools has not yet been achieved.

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

Men's knowledge and attitudes about cervical cancer screening in Kenya.

BACKGROUND: A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women's utilization of screening and treatment. METHODS: We administered an oral survey to 110 men in Western Kenya about their knowledge and attitudes regarding cervical cancer and cervical cancer screening. Men who had female partners eligible for cervical cancer screening were recruited from government health facilities where screening was offered free of charge. RESULTS: Specific knowledge about cervical cancer risk factors, prevention, and treatment was low. Only half of the men perceived their partners to be at risk for cervical cancer, and many reported that a positive screen would be emotionally upsetting. Nevertheless, all participants said they would encourage their partners to get screened. CONCLUSIONS: Future interventions should tailor cervical cancer educational opportunities towards men. Further research is needed among both men and couples to better understand barriers to male support for screening and treatment and to determine how to best involve men in cervical cancer prevention efforts.

Food Swamps, Obesity & Health Zoning Restrictions on Fast Food Restaurants

Protecting public health is the most legitimate use of zoning, and yet there is minimal progress in applying it to the obesity problem. Zoning could potentially be used to address both unhealthy and healthy food retailers, but lack of evidence regarding the impact of zoning and public opinion on zoning changes are barriers to implementing zoning restrictions on fast food on a larger scale. My dissertation addresses these gaps in our understanding of health zoning as a policy option for altering built, food environments.

Chapter 1 examines the relationship between food swamps and obesity and whether spatial mapping might be useful in identifying priority geographic areas for zoning interventions. I employ an instrumental variables (IV) strategy to correct for the endogeneity problems associated with food environments, namely that individuals may self-select into certain neighborhoods and may consider food availability in their decision process. I utilize highway exits as a source of exogenous variation .Using secondary data from the USDA Food Environment Atlas, ordinary least squares (OLS) and IV regression models were employed to analyze cross-sectional associations between local food environments and the prevalence of obesity. I find even after controlling for food desert effects, food swamps have a positive, statistically significant effect on adult obesity rates.

Chapter 2 applies theories of message framing and prospect theory to the emerging discussion around health zoning policies targeting food environments and to explore public opinion toward a list of potential zoning restrictions on fast-food restaurants (beyond moratoriums on new establishments). In order to explore causality, I employ an online survey experiment manipulating exposure to vignettes with different message frames about health zoning restrictions with two national samples of adult Americans age 18 and over (N1=2,768 and N2=3,236). The second sample oversamples Black Americans (N=1,000) and individuals with high school as their highest level of education. Respondents were randomly assigned to one of six conditions where they were primed with different message frames about the benefits of zoning restrictions on fast food retailers. Participants were then asked to indicate their support for six zoning policies on a Likert scale. Subjects also answered questions about their food store access, eating behaviors, health status and perceptions of food stores by type.

I find that a message frame about Nutrition and increasing Equity in the food system was particularly effective at increasing support for health zoning policies targeting fast food outlets across policy categories (Conditional, Youth-related, Performance and Incentive) and across racial groups. This finding is consistent with an influential environmental justice scholar’s description of “injustice frames” as effective in mobilizing supporters around environmental issues (Taylor 2000). I extend this rationale to food environment obesity prevention efforts and identify Nutrition combined with Equity frames as an arguably universal campaign strategy for bolstering public support of zoning restrictions on fast food retailers.

Bridging my findings from both Chapters 1 and 2, using food swamps as a spatial metaphor may work to identify priority areas for policy intervention, but only if there is an equitable distribution of resources and mobilization efforts to improve consumer food environments. If the structural forces which ration access to land-use planning persist (arguably including the media as gatekeepers to information and producers of message frames) disparities in obesity are likely to widen.

Chemoenzymatic routes to enantiopure hydroxytetrahydrofurans: muscarine and its analogues

Muscarine was identified as an active principle of the poisonous mushroom Amanita muscaria over 170 years ago and has been identified as an agonist of acetylcholine. The synthesis of all stereoisomers of muscarine have been accomplished at this stage by chemical methods and the biological activity of these compounds tested. A number of synthetic routes to enantiomerically pure muscarine and its analogues have been published. In this work, we are focussed on the use of a novel biotransformation strategy to access these compounds. Asymmetric synthesis involves targeting a synthetic pathway leading to one enantiomer of a compound and biocatalysis is one strategy used in asymmetric synthesis. Chapter 1 consists of a review of the relevant literature pertaining to the synthesis and stereoselective transformations of 3-hydroxytetrahydrofuranss. A review of synthetic routes to these compounds is presented, with a particular focus on routes to the natural product muscarine and its analogues. Chapter 2 discusses the preparative routes to the 3-hydroxytetrahydrofurans via 3(2H)- furanones. Steps amongst which include Rh(II) mediate cyclisation and kinetic resolution via baker’s yeast mediated carbonyl reduction, resulting in enantioenriched 3- hydroxytetrahydrofuran derivatives. Finally, application of this methodology to the preparation of all four enantiomers of an analogue of desmethylmuscarine and the synthesis of epimuscarine is described. Chapter 3 consists of a detailed experimental section outlining the synthetic procedures employed.

Telescoped approach to aryl hydroxymethylation in the synthesis of a key pharmaceutical intermediate

An efficient synthetic approach leading to introduction of the hydroxymethyl group to an aryl moiety via combination of the Bouveault formylation and hydride reduction has been optimized using a rational, mechanistic-based approach. This approach enabled telescoping of the two steps into a single efficient process, readily amenable to scaleup.