A new world a new American foreign policy: the Carter administration, Nicaragua, and the legacy of the Vietnam War, 1977-1981

The impact of the Vietnam War conditioned the Carter administration’s response to the Nicaraguan revolution in ways that reduced US engagement with both sides of the conflict. It made the countries of Latin America counter the US approach and find their own solution to the crisis, and allowed Cuba to play a greater role in guiding the overthrow of Nicaraguan dictator Anastasio Somoza Debayle. This thesis re-evaluates Carter’s policy through the legacy of the Vietnam War, because US executive anxieties about military intervention, Congress’s increasing influence, and US public concerns about the nation’s global responsibilities, shaped the Carter approach to Nicaragua. Following a background chapter, the Carter administration’s policy towards Nicaragua is evaluated, before and after the fall of Somoza in July 1979. The extent of the Vietnam influence on US-Nicaraguan relations is developed by researching government documents on the formation of US policy, including material from the Jimmy Carter Library, the Library of Congress, the National Security Archive, the National Archives and Records Administration, and other government and media sources from the United Nations Archives, New York University, the New York Public Library, the Hoover Institution Archives, Tulane University and the Organization of American States. The thesis establishes that the Vietnam legacy played a key role in the Carter administration’s approach to Nicaragua. Before the overthrow of Somoza, the Carter administration limited their influence in Nicaragua because they felt there was no immediate threat from communism. The US feared that an active role in Nicaragua, without an established threat from Cuba or the Soviet Union, could jeopardise congressional support for other foreign policy goals deemed more important. The Carter administration, as a result, pursued a policy of non-intervention towards the Central American country. After the fall of Somoza, and the establishment of a new government with a left wing element represented by the Sandinistas, the Carter administration emphasised non-intervention in a military sense, but actively engaged with the new Nicaraguan leadership to contain the potential communist influence that could spread across Central America in the wake of the Nicaraguan revolution.

The effects of copayment policies on adherence to prescription medicines in publicly insured populations

Introduction: Copayments for prescriptions are associated with decreased adherence to medicines resulting in increased health service utilisation, morbidity and mortality. In October 2010 a 50c copayment per prescription item was introduced on the General Medical Services (GMS) scheme in Ireland, the national public health insurance programme for low-income and older people. The copayment was increased to €1.50 per prescription item in January 2013. To date, the impact of these copayments on adherence to prescription medicines on the GMS scheme has not been assessed. Given that the GMS population comprises more than 40% of the Irish population, this presents an important public health problem. The aim of this thesis was to assess the impact of two prescription copayments, 50c and €1.50, on adherence to medicines.Methods: In Chapter 2 the published literature was systematically reviewed with meta-analysis to a) develop evidence on cost-sharing for prescriptions and adherence to medicines and b) develop evidence for an alternative policy option; removal of copayments. The core research question of this thesis was addressed by a large before and after longitudinal study, with comparator group, using the national pharmacy claims database. New users of essential and less-essential medicines were included in the study with sample sizes ranging from 7,007 to 136,111 individuals in different medication groups. Segmented regression was used with generalised estimating equations to allow for correlations between repeated monthly measurements of adherence. A qualitative study involving 24 individuals was conducted to assess patient attitudes towards the 50c copayment policy. The qualitative and quantitative findings were integrated in the discussion chapter of the thesis. The vast majority of the literature on this topic area is generated in North America, therefore a test of generalisability was carried out in Chapter 5 by comparing the impact of two similar copayment interventions on adherence, one in the U.S. and one in Ireland. The method used to measure adherence in Chapters 3 and 5 was validated in Chapter 6. Results: The systematic review with meta-analysis demonstrated an 11% (95% CI 1.09 to 1.14) increased odds of non-adherence when publicly insured populations were exposed to copayments. The second systematic review found moderate but variable improvements in adherence after removal/reduction of copayments in a general population. The core paper of this thesis found that both the 50c and €1.50 copayments on the GMS scheme were associated with larger reductions in adherence to less-essential medicines than essential medicines directly after the implementation of policies. An important exception to this pattern was observed; adherence to anti-depressant medications declined by a larger extent than adherence to other essential medicines after both copayments. The cross country comparison indicated that North American evidence on cost-sharing for prescriptions is not automatically generalisable to the Irish setting. Irish patients had greater immediate decreases of -5.3% (95% CI -6.9 to -3.7) and -2.8% (95% CI -4.9 to -0.7) in adherence to anti-hypertensives and anti-hyperlipidaemic medicines, respectively, directly after the policy changes, relative to their U.S. counterparts. In the long term, however, the U.S. and Irish populations had similar behaviours. The concordance study highlighted the possibility of a measurement bias occurring for the measurement of adherence to non-steroidal anti-inflammatory drugs in Chapter 3. Conclusions: This thesis has presented two reviews of international cost-sharing policies, an assessment of the generalisability of international evidence and both qualitative and quantitative examinations of cost-sharing policies for prescription medicines on the GMS scheme in Ireland. It was found that the introduction of a 50c copayment and its subsequent increase to €1.50 on the GMS scheme had a larger impact on adherence to less-essential medicines relative to essential medicines, with the exception of anti-depressant medications. This is in line with policy objectives to reduce moral hazard and is therefore demonstrative of the value of such policies. There are however some caveats. The copayment now stands at €2.50 per prescription item. The impact of this increase in copayment has yet to be assessed which is an obvious point for future research. Careful monitoring for adverse effects in socio-economically disadvantaged groups within the GMS population is also warranted. International evidence can be applied to the Irish setting to aid in future decision making in this area, but not without placing it in the local context first. Patients accepted the introduction of the 50c charge, however did voice concerns over a rising price. The challenge for policymakers is to find the ‘optimal copayment’ – whereby moral hazard is decreased, but access to essential chronic disease medicines that provide advantages at the population level is not deterred. This evidence presented in this thesis will be utilisable for future policy-making in Ireland.

Uncle Tom's Cabin and the Irish National Tale

Accepted Version

Aging African American Women and the Impact of Positive Psychological Factors on Quality of Life

Aging African-American women are disproportionately affected by negative health outcomes and mortality. Life stress has strong associations with these health outcomes. The purpose of this research was to understand how aging African American women manage stress. Specifically, the effects of coping, optimism, resilience, and religiousness as it relates to quality of life were examined. This cross-sectional exploratory study used a self-administered questionnaire and examined quality of life in 182 African-American women who were 65 years of age or older living in senior residential centers in Baltimore using convenience sampling. The age range for these women was 65 to 94 years with a mean of 71.8 years (SD = 5.6). The majority (53.1%) of participants completed high school, with 23 percent (N = 42) obtaining college degrees and 19 percent (N = 35) holding advanced degrees. Nearly 58 percent of participants were widowed and 81 percent were retired. In addition to demographics, the questionnaire included the following reliable and valid survey instruments: The Brief Cope Scale (Carver, Scheier, & Weintraub, 1989), Optimism Questionnaire (Scheier, Carver, & Bridges, 1994), Resilience Survey (Wagnild & Young, 1987), Religiousness Assessment (Koenig, 1997), and Quality of Life Questionnaire (Cummins, 1996). Results revealed that the positive psychological factors examined were positively associated with and significant predictors of quality of life. The bivariate correlations indicated that of the six coping dimensions measured in this study, planning (r=.68) was the most positively associated with quality of life. Optimism (r=.33), resilience (=.48), and religiousness (r=.30) were also significantly correlated with quality of life. In the linear regression model, again the coping dimension of planning was the best predictor of quality of life (beta = .75, p <.001). Optimism (beta = .31, p <.001), resilience (beta = .34, p, .001) and religiousness (beta = .17, p <.01) were also significant predictors of quality of life. It appears as if positive psychology plays an important role in improving quality of life among aging African-American women.

Design and Emergence in the Making of American Grand Strategy

The main research question of this thesis is how do grand strategies form. Grand strategy is defined as a state's coherent and consistent pattern of behavior over a long period of time in search of an overarching goal. The political science literature usually explains the formation of grand strategies by using a planning (or design) model. In this dissertation, I use primary sources, interviews with former government officials, and historical scholarship to show that the formation of grand strategy is better understood using a model of emergent learning imported from the business world. My two case studies examine the formation of American grand strategy during the Cold War and the post-Cold War eras. The dissertation concludes that in both these strategic eras the dominating grand strategies were formed primarily by emergent learning rather than flowing from advanced designs.

WORKS FOR HORN BY AMERICAN WOMEN COMPOSERS

This performance dissertation consists of three recitals featuring the music of American women composers of the 20th and 21st centuries. My purpose in presenting these recitals is to expose and explore the lesser known compositions of these composers through live public performances. I selected a cross section of composers whose compositions employed a wide range of musical styles, techniques and instrumentation. The instrumentation included not only the "standard" works for solo horn and horn and piano, but various chamber compositions as well. Of these chamber works, there exists a duet for horn and harp, a trio for violin, cello and horn, and a quartet for viola, horn, piano, and percussion. In addition to the published works chosen, it was my intent to further heighten the awareness of American women composers through the commissioning of a work specifically for this dissertation. The resulting piece was Arbor for horn and harp by Elisabeth Mehl Greene, which received its premiere on April 18, 2009. Through this project, it is my hope to have not only increased the public's awareness of these lesser known works but to have contributed to the performances of these ever growing number of works by American women composers.

Dust in the wind: How climate variables and volcanic dust affect rates of tooth wear in Central American howling monkeys.

OBJECTIVES: Two factors have been considered important contributors to tooth wear: dietary abrasives in plant foods themselves and mineral particles adhering to ingested food. Each factor limits the functional life of teeth. Cross-population studies of wear rates in a single species living in different habitats may point to the relative contributions of each factor. MATERIALS AND METHODS: We examine macroscopic dental wear in populations of Alouatta palliata (Gray, 1849) from Costa Rica (115 specimens), Panama (19), and Nicaragua (56). The sites differ in mean annual precipitation, with the Panamanian sites receiving more than twice the precipitation of those in Costa Rica or Nicaragua (∼3,500 mm vs. ∼1,500 mm). Additionally, many of the Nicaraguan specimens were collected downwind of active plinian volcanoes. Molar wear is expressed as the ratio of exposed dentin area to tooth area; premolar wear was scored using a ranking system. RESULTS: Despite substantial variation in environmental variables and the added presence of ash in some environments, molar wear rates do not differ significantly among the populations. Premolar wear, however, is greater in individuals collected downwind from active volcanoes compared with those living in environments that did not experience ash-fall. DISCUSSION: Volcanic ash seems to be an important contributor to anterior tooth wear but less so in molar wear. That wear is not found uniformly across the tooth row may be related to malformation in the premolars due to fluorosis. A surge of fluoride accompanying the volcanic ash may differentially affect the premolars as the molars fully mineralize early in the life of Alouatta.

NAFTA and uneven development in the North American apparel industry

The various contributions to this book have documented how NAFTA-inspired firm strategies are changing the geography of apparel production in North America. The authors show in myriad ways how companies at different positions along the apparel commodity chain are responding to the new institutional and regulatory environment that NAFTA creates. By making it easier for U.S. companies to take advantage of Mexico as a nearby low-cost site for export-oriented apparel production, NAFTA is deepening the regional division of labor within North America, and this process has consequences for firms and workers in each of the signatory countries. In the introduction to this book we alluded to the obvious implications of shifting investment and trade patterns in the North American apparel industry for employment in the different countries. In this concluding chapter we focus on Mexico in the NAFTA era, specifically the extent to which Mexico's role in the North American economy facilitates or inhibits its economic development. W e begin with a discussion of the contemporary debate about Mexico's development, which turns on the question of how to assess the implications of Mexico's rapid and pro-found process of economic reform. Second, we focus on the textile and apparel industries as sectors that have been significantly affected by changes in regulatory environments at both the global and regional levels. Third, we examine the evidence regarding Mexico's NAFTA-era export dynamism, and in particular we emphasize the importance of interfirm networks, both for making sense of Mexico's meteoric rise among apparel exporters and for evaluating the implications of this dynamism for development. Fourth, we turn to a consideration of the national political-economic environment that shapes developmental outcomes for all Mexicans. Although regional disparities within Mexico are profound, aspects of government policy, such as management of the national currency, and characteristics of the institutional environment, such as industrial relations, have nationwide effects, and critics of NAFTA charge that these factors are contributing to a process of economic and social polarization that is ever more evident (Morales 1999; Dussel Peters 2000). Finally, we suggest that the mixed consequences of Mexico's NAFTA-era growth can be taken as emblematic of the contradictions that the process of globalization poses for economic and social development. The anti-sweatshop campaign in North America is one example of transnational or crossborder movements that are emerging to address the negative consequences of this process. In bringing attention to the problem of sweatshop production in North America, activists are developing strategies that rely on a network logic that is not dissimilar to the approaches reflected in the various chapters of this book. © 2009 by Temple University Press. All rights reserved.

Reaching across organisational, sectoral and geographical boundaries: exploring the learning potential of an EU cross-border project

Research This paper outlines some of the key findings from an evaluation of the project and demonstrates that EC funded projects such as this, which seek to promote cross border collaboration and understanding (i.e. across organisational, sectoral and geographical boundaries) offer considerable learning potential – not least about variances in health politics across different communities. However, for this learning to be realised a comprehensive system of knowledge management needs to be an integral part of project planning alongside a system for sustaining embryonic professional networks. The concept of managing relationships was also a key part of the projects success. Executing a project funded by the EU demands the development of complex organisational skills to negotiate all the administrative challenges en route to successful completion and this project in particular relied for its success on the development of social relationships of trust and mutual respect across national, professional and social boundaries. Context A three–year European Commission funded project designed to exchange a wide range of staff (professional semiprofessional and voluntary staff in health and social care) project led by the University of Greenwich (UK) and the Université Catholique de Lille, France was completed this year (February 2008). The project was complex because it involved working in different national contexts, was multi-disciplinary, and demanded the negotiation of multiple boundaries. Theories A mixed method evaluation including written reports gathered immediately after each exchange visit and a post hoc series of individual interviews and focus groups was conducted in order to gain qualitative information (from the participants perspective) on their experiences and to identify any learning gained. Results Analysis of the data provided evidence of learning on a number of levels; personally, inter and intra professionally and organisationally as well as across sectors and also from a project management perspective. The learning crystallised around the extent of the differences noted by the participants between the UK and the French health and social care systems despite geographical proximity, common membership of the EU and many shared challenges in health and social care. The extent of these differences, noted at every level from policy to practice proved a rich source for reflection on organisational philosophies, ways of working, distribution of resources, professional roles and autonomy and professional registration and mobility - in short on health politics at ‘macro’ and ‘micro’ levels.

Impacts of Climate Modes on Air-Sea Heat Exchange in the Red Sea

The impacts of various climate modes on the Red Sea surface heat exchange are investigated using the MERRA reanalysis and the OAFlux satellite reanalysis datasets. Seasonality in the atmospheric forcing is also explored. Mode impacts peak during boreal winter [December–February (DJF)] with average anomalies of 12–18 W m−2 to be found in the northern Red Sea. The North Atlantic Oscillation (NAO), the east Atlantic–west Russia (EAWR) pattern, and the Indian monsoon index (IMI) exhibit the strongest influence on the air–sea heat exchange during the winter. In this season, the largest negative anomalies of about −30 W m−2 are associated with the EAWR pattern over the central part of the Red Sea. In other seasons, mode-related anomalies are considerably lower, especially during spring when the mode impacts are negligible. The mode impacts are strongest over the northern half of the Red Sea during winter and autumn. In summer, the southern half of the basin is strongly influenced by the multivariate ENSO index (MEI). The winter mode–related anomalies are determined mostly by the latent heat flux component, while in summer the shortwave flux is also important. The influence of the modes on the Red Sea is found to be generally weaker than on the neighboring Mediterranean basin.

Identidad territorial y paisaje. Evolución morfológica de los núcleos en Castilla y León.

Este estudio intenta esclarecer las transformaciones físicas y socioeconómicas de los asentamientos rurales de la región española de Castilla y León, durante la segunda mitad del siglo XX. Se analiza la evolución temporal de la forma urbana a través de un Sistema de Información Geográfico (SIG), calculando unos índices métricos y comparándolos con la información demográfica histórica. Los resultados pretenden mostrar los efectos de la especialización funcional económica, causada por la integración en las jerarquías productivas globales, sobre la estructura urbana. La pérdida gradual de las características tradicionales de los pueblos castellanos, como la compacidad y la integración en el entorno, debido a la pérdida o degradación de la arquitectura popular y la construcción de nuevas edificaciones industriales, supone un riesgo para las futuras políticas de desarrollo local. Se considera necesario preservar la identidad paisajística y evitar la destrucción del patrimonio cultural para poder revitalizar estos territorios.

Control estructural de agrietamientos poligonales en la Pedriza del Manzanares (Madrid)

Los agrietamientos poligonales representan una forma común de modelado granítico cuyo origen y evolución continúa en fase de estudio, no existiendo una sistematización de estas estructuras diversas. Algunos autores explican su origen por procesos geodinámicos internos, relacionándolo con movimientos de planos de fractura en estados tardíos de consolidación magmática. Otros autores atribuyen su formación y desarrollo a factores externos relacionados con el régimen climático. La gran variedad de agrietamientos poligonales requiere la utilización de un número mayor de variables para definir los distintos orígenes, y las posibles interrelaciones entre los factores externos e internos, así como para explicar la evolución de dichas estructuras y avanzar en la clasificación de los patrones concretos. Este trabajo pretende contribuir a sistematizar los mecanismos que intervienen en el desarrollo de agrietamientos poligonales. Para ello se estudian únicamente agrietamientos poligonales formados sobre planos de fractura verticales o subverticales. En particular se establecen relaciones entre la presencia de agrietamientos poligonales y la red de fracturación, la altura de aparición, la orientación e inclinación de la pared, la morfología de las placas y la profundidad de incisión de las grietas perimetrales. Por otra parte, establece relaciones entre procesos geodinámicos internos y procesos de meteorización externos.

A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease

OBJECTIVES: The behavioral and psychological symptoms of Alzheimer's disease (AD) are associated with significant patient and caregiver distress and increased likelihood of institutionalization. We attempted to characterize in detail these symptoms and the distress they cause to caregivers. METHODS: Patients with probable AD were assessed with the Mini-Mental State Exam (MMSE), Functional Assessment Staging (FAST), and the Neuropsychiatric Inventory With Caregiver Distress (NPI-D). RESULTS: Four hundred and thirty-five patients were recruited. Neuropsychiatric symptoms of all types were highly prevalent. The most common and most persistent symptom was apathy (75%). Delusional symptoms were the least persistent. Depressive and apathetic symptoms were the earliest to appear, and hallucinations, elation/euphoria, and aberrant motor behavior were the latest symptoms to emerge. Hallucinations were significantly more common in severe dementia. Symptoms of irritability were most prevalent in early disease. Total Neuropsychiatric Symptom score was significantly correlated with MMSE and FAST score. Caregivers rated their own emotional distress levels as moderate or severe for 10 out of 12 symptom domains. The sum total of caregiver distress was strongly correlated with total NPI-D but not cognition or functional state. Distress levels did not vary when analyzed according to the patients' place of residence. CONCLUSIONS: Potentially treatable neuropsychiatric symptoms are common in AD and represent a major source of distress among caregivers. The extent of neuropsychiatric symptomatology is seen to correlate with the level of functional and cognitive disability although some symptoms are variably persistent and related to disease stage.

Flavian laws, the railway, the newspaper and Loring’s breads

It is abound the research on the formation, rise and failure of the financial and industrial network undertaken by the Loring-Heredia-Larios triangle, bourgeois families who introduced the Industrial Revolution in the south of Andalusia. On the contrary, there are almost nonexistent studies from the perspective of the mentality that sustained their business, social and ethical model in the algid decades of their action (1850-1860). In this paper we propose some hypotheses about the ideological structures of bourgeois group and point out some keys, clues and signs for a future reconstruction of this kind, which so far has not been incardinated that early and failed malaguenan industrial revolution in streams thinking of that time.

Impaired functioning of thermolabile methylenetetrahydrofolate reductase is dependent on riboflavin status: implications for riboflavin requirements.

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR; EC 1.7.99.5) supplies the folate needed for the metabolism of homocysteine. A reduction in MTHFR activity, as occurs in the homozygous state for the 677C-->T (so-called thermolabile) enzyme variant (TT genotype), is associated with an increase in plasma total homocysteine (tHcy). OBJECTIVE: In vitro studies suggest that the reduced activity of thermolabile MTHFR is due to the inappropriate loss of its riboflavin cofactor. We investigated the hypothesis that MTHFR activity in the TT genotype group is particularly sensitive to riboflavin status. DESIGN: We studied tHcy and relevant B-vitamin status by MTHFR genotype in a cross-sectional study of 286 healthy subjects aged 19-63 y (median: 27 y). The effect of riboflavin status was examined by dividing the sample into tertiles of erythrocyte glutathionine reductase activation coefficient, a functional index of riboflavin status. RESULTS: Lower red blood cell folate (P = 0.0001) and higher tHcy (P = 0.0082) concentrations were found in the TT group than in the heterozygous (CT) or wild-type (CC) groups. However, these expected relations in the total sample were driven by the TT group with the lowest riboflavin status, whose mean tHcy concentration (18.09 micromol/L) was almost twice that of the CC or CT group. By contrast, adequate riboflavin status rendered the TT group neutral with respect to tHcy metabolism. CONCLUSIONS: The high tHcy concentration typically associated with homozygosity for the 677C-->T variant of MTHFR occurs only with poor riboflavin status. This may have important implications for governments considering new fortification policies aimed at the prevention of diseases for which this genotype is associated with increased risk.