Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

U.S. utilities' experiences with the implementation of energy efficiency programs

In the U.S., many electric utility companies are offering demand-side management (DSM) programs to their customers as ways to save money and energy. However, it is challenging to compare these programs between utility companies throughout the U.S. because of the variability of state energy policies. For example, some states in the U.S. have deregulated electricity markets and others do not. In addition, utility companies within a state differ depending on ownership and size. This study examines 12 utilities’ experiences with DSM programs and compares the programs’ annual energy savings results that the selected utilities reported to the Energy Information Administration (EIA). The 2009 EIA data suggests that DSM program effectiveness is not significantly affected by electricity market deregulation or utility ownership. However, DSM programs seem to generally be more effective when administered by utilities located in states with energy savings requirements and DSM program mandates.

United States certificate programs in technical communication : a feminist-sophistic investigation

Technical communication certificates are offered by many colleges and universities as an alternative to a full undergraduate or graduate degree in the field. Despite certificates’ increasing popularity in recent years, however, surprisingly little commentary exists about them within the scholarly literature. In this work, I describe a survey of certificate and baccalaureate programs that I performed in 2008 in order to develop basic, descriptive data on programs’ age, size, and graduation rates; departmental location; curricular requirements; online offerings; and instructor status and qualifications. In performing this research, I apply recent insights from neosophistic rhetorical theory and feminist critiques of science to both articulate, and model, a feminist-sophistic methodology. I also suggest in this work that technical communication certificates can be theorized as a particularly sophistic credential for a particularly sophistic field, and I discuss the implications of neosophistic theory for certificate program design and administration.

Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Multidimensional preventive home visit programs aim at maintaining health and autonomy of older adults and preventing disability and subsequent nursing home admission, but results of randomized controlled trials (RCTs) have been inconsistent. Our objective was to systematically review RCTs examining the effect of home visit programs on mortality, nursing home admissions, and functional status decline. METHODS: Data sources were MEDLINE, EMBASE, Cochrane CENTRAL database, and references. Studies were reviewed to identify RCTs that compared outcome data of older participants in preventive home visit programs with control group outcome data. Publications reporting 21 trials were included. Data on study population, intervention characteristics, outcomes, and trial quality were double-extracted. We conducted random effects meta-analyses. RESULTS: Pooled effects estimates revealed statistically nonsignificant favorable, and heterogeneous effects on mortality (odds ratio [OR] 0.92, 95% confidence interval [CI], 0.80-1.05), functional status decline (OR 0.89, 95% CI, 0.77-1.03), and nursing home admission (OR 0.86, 95% CI, 0.68-1.10). A beneficial effect on mortality was seen in younger study populations (OR 0.74, 95% CI, 0.58-0.94) but not in older populations (OR 1.14, 95% CI, 0.90-1.43). Functional decline was reduced in programs including a clinical examination in the initial assessment (OR 0.64, 95% CI, 0.48-0.87) but not in other trials (OR 1.00, 95% CI, 0.88-1.14). There was no single factor explaining the heterogenous effects of trials on nursing home admissions. CONCLUSION: Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination. Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors, program characteristics, and health care setting.

Effects of a 6-Week Jump Training Program Combined with Two Lifting Programs

We evaluated the effects of a 6-week jump training program on 12 college basketball players using strength training programs. The Leg Press (LP) group participated in a strength program using the leg press, and the Power Clean group (PC) used the power clean exercise instead of the leg press. Both groups participated in a 6-week jump training program. Pre-program measurements recorded jump scores for one-foot take off and two-foot take offs. The LP group had an average pre-program vertical of 72.60 and 88.05 cm for the 2-foot and 1-foot take-off for an increase of about 1.7 cm. The PC group had an average post-program vertical of 76.2 cm for the 2-foot take-off for an increase of 3.6 cm, and 90.81 cm for the 1-foot take-off for an increase of about 2.75 cm. The comparison of average increases between the LP and PC groups was not significant for either the 2-foot or 1-foot take off.

Tuberculosis in antiretroviral treatment programs in lower income countries: availability and use of diagnostics and screening

OBJECTIVES In resource-constrained settings, tuberculosis (TB) is a common opportunistic infection and cause of death in HIV-infected persons. TB may be present at the start of antiretroviral therapy (ART), but it is often under-diagnosed. We describe approaches to TB diagnosis and screening of TB in ART programs in low- and middle-income countries. METHODS AND FINDINGS We surveyed ART programs treating HIV-infected adults in sub-Saharan Africa, Asia and Latin America in 2012 using online questionnaires to collect program-level and patient-level data. Forty-seven sites from 26 countries participated. Patient-level data were collected on 987 adult TB patients from 40 sites (median age 34.7 years; 54% female). Sputum smear microscopy and chest radiograph were available in 47 (100%) sites, TB culture in 44 (94%), and Xpert MTB/RIF in 23 (49%). Xpert MTB/RIF was rarely available in Central Africa and South America. In sites with access to these diagnostics, microscopy was used in 745 (76%) patients diagnosed with TB, culture in 220 (24%), and chest X-ray in 688 (70%) patients. When free of charge culture was done in 27% of patients, compared to 21% when there was a fee (p = 0.033). Corresponding percentages for Xpert MTB/RIF were 26% and 15% of patients (p = 0.001). Screening practices for active disease before starting ART included symptom screening (46 sites, 98%), chest X-ray (38, 81%), sputum microscopy (37, 79%), culture (16, 34%), and Xpert MTB/RIF (5, 11%). CONCLUSIONS Mycobacterial culture was infrequently used despite its availability at most sites, while Xpert MTB/RIF was not generally available. Use of available diagnostics was higher when offered free of charge.

The Effect on Meat Quality of Integrating Pasturing Systems into Cattle Finishing Programs

The effect on meat quality of integrating pasturing systems into cattle finishing programs was observed over a two-year period. Year one consisted of 84 fall born calves and 28 spring born calves and year two consisted of 116 fall born calves. The effect of using Rumensinâ for cattle on bromegrass pasture was incorporated into year one. In year two cattle on pasture received bromegrass pasture, and one treatment group received switchgrass during the warm season. In both years there was a control group of calves that went directly to the feedlot with the remaining calves going to pasture for varying periods of time before being finished in drylot. At the conclusion of the feeding trial, cattle were processed into beef, and a ribeye steak was removed from each carcass for sensory evaluation. In year one cattle that were on pasture the longest had the lowest (P<0.05) average quality grades. In year two this trend was reversed, and cattle placed directly into drylot had the lowest (P<0.05) average quality grades. In both years cattle carcasses in all treatments averaged yield grade 2. Warner Bratzler shear force values were not affected by treatments. Sensory panel evaluations indicated tenderness was unaffected by treatments, and in year two flavor and flavor intensity were unaffected by treatments. In year one flavor intensity was lowest (P<0.05) for steaks derived from cattle that were on pasture the longest and received Rumensinâ. Inclusion of Rumensinâ for cattle on pasture did not influence yield and quality grades or affect tenderness, juiciness, and flavor. Results of this study indicate that steer calves placed on cool and warm season pastures prior to being finished in drylot, can produce carcasses with acceptable yield and quality grades and that the meat eating qualities will be largely unaffected by the inclusion of pasture.

Integration of Pasturing Systems for Cattle Finishing Programs

A 3-year study, using 84 fall-born and 28 spring-born calves of similar genotypes, was conducted to integrate pasturing systems with drylot feeding systems. Calves were started on test following weaning in May and October. Seven treatments were imposed: 1) fall-born calves directly into feedlot; 2 and 3) fall-born calves put on pasture with or without ionophore and moved to the feedlot at the end of July; 4 and 5) fall-born calves put on pasture with or without ionophore and moved to the feedlot at the end of October; 6 and 7) spring-born calves put on pasture with or without ionophore and moved to the feedlot at the end of October. A bromegrass pasture consisting of 16 paddocks, each 1.7 acre in size, was available. Each treatment group had access to 1 paddock at a time and was rotated at approximately 3-day intervals. In the feedlot, steers were provided an 82% concentrate diet containing whole-shelled corn, ground alfalfa hay, and a protein, vitamin and mineral supplement containing ionophore and molasses. As pens of cattle reached about 1150 lb. average live weight, they were processed and carcass traits were evaluated. Pasture daily gains were highest for cattle on pasture for the longest duration (P < .03), and overall daily gains were highest for drylot cattle (P < .01) and decreased with increased time spent on pasture. Although differences among treatments existed in numerical scores for yield and quality grades (P < .05 and P < .03, respectively), all treatments provided average yield grade scores of 2 and quality grades of low Choice or higher. Use of four production costs and pricing scenarios revealed that fall-born calves placed on pasture for varying lengths of time were the most profitable (P < .04) among the treatments. Furthermore, employing a 5% price sensitivity analysis, indicated that fed-cattle selling price had great impact on profit potential and was followed in importance by feeder purchase price and corn grain price. Overall, these findings should provide significant production alternatives for some segments of the cattle feeding industry and also lend substantial credence to the concept of sustainable agriculture.

Integration of Pasturing Systems for Cattle Finishing Programs: A Progress Report

A three-year study was conducted to integrate pasturing systems with drylot feeding systems. Each year 84 fall-born and 28 spring-born calves of similar genotypes were used. Fall-born calves were started on test in May, and spring-born calves were started in October. Seven treatments were imposed: 1) fall-born calves directly into the feedlot (28 steers); 2 and 3) fall-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of July (14 steers in each treatment); 4 and 5) fall-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of October (14 steers in each treatment); and 6 and 7) spring-born calves put on pasture with or without an ionophore and moved to the feedlot at the end of October (14 steers in each treatment). Cattle on pasture receiving an ionophore gained faster (P=.009), but lost this advantage in drylot (P>.10). Overall, cattle started directly in the feedlot had higher gains (P<.001). Cattle receiving an ionophore on pasture had lower KPH than those that did not receive an ionophore (P<.01). Treatment influenced yield grade (P<0.001), although all treatments were YG 2. The percentage of cattle grading Prime and Choice was 75 % or higher for all treatment groups. The results show that using an ionophore improved pasture gains and that pasture treatments did not adversely influence yield and quality grades.

Integration of Pasturing Systems for Cattle Finishing Programs: A Progress Report

This progress report presents the findings of the first two years of a multi-year study. Each year 84 fall-born and 28 spring-born calves of similar genetic background were used to evaluate the incorporation of rotational pasturing systems into cattle finishing programs. The fall-born calves were started on test on May 7, 1996, and May 8, 1997, whereas the spring-born calves were started on test on October 1, 1996, and September 13, 1997. A total of seven treatments were imposed: 1) fall-born calves directly into the feedlot; 2) fall-born calves put on pasture and receiving an ionophore and moved to the feedlot on July 30, 1996, and July 29, 1997 in the first and second years, respectively; 3) fall-born calves put on pasture without an ionophore and moved to the feedlot on July 30, 1996 and July 29, 1997, in the first and second years, respectively; 4) fall-born calves put on pasture and receiving an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; 5) fall-born calves put on pasture without an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; 6) spring-born calves put on pasture and receiving an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively; and 7) spring-born calves put on pasture without an ionophore and moved to the feedlot on October 22, 1996, and October 21, 1997, in the first and second years, respectively. Cattle receiving an ionophore on pasture gained more rapidly; however, cattle without access to an ionophore gained more rapidly in drylot thus negating the advantage obtained on pasture. Overall daily gains and feed conversions in drylot only, improved with increasing numbers of days fed in drylot; however, this may not be very cost effective. At similar end weights no real differences were observed in yield grades among the treatments; however, for fall-born calves the percentage grading Prime and Choice was higher for cattle fed longer in drylot.

Integration of Pasturing Systems for Cattle Finishing Programs: A Progress Report

In this study, 84 fall-born and 28 spring-born calves of similar genetic background were used to evaluate the incorporation of rotational pasturing systems into cattle finishing programs. Because the second-year trial is not complete, this report will include only the first year of the five-year study. Seven treatments were imposed: 1) fall-born calves put directly into the feedlot on May 7, 1996; 2) fall-born calves put on pasture and receiving an ionophore and moved to the feedlot on July 30, 3) fall born calves put on pasture on May 7 and not receiving an ionophore and moved to the feedlot on July 30; 4) fall-born calves put on pasture on May 7 and receiving an ionophore and moved to the feedlot on October 22; 5) fall-born calves put on pasture on May 7 and not receiving an ionophore and moved to the feedlot on October 22; 6) spring-born calves put on pasture on October 1 and receiving an ionophore and moved to the feedlot on October 22; and 7) spring-born calves put on pasture on October 1 and not receiving an ionophore and moved to feedlot on October 22. Performance data showed that cattle on pasture receiving an ionophore had higher gains than those not receiving an ionophore on pasture. This trend was reversed in the feedlot period. Yield grades were not greatly influenced by treatment, although quality grades tended to be higher for older cattle and those cattle that were in drylot for a longer period of time.