African wastes reclaimed : illustrated in the story of the Lovedale Mission

http://books.google.com/books?vid=OCLC09108077

Rationing Antiretroviral Therapy for HIV/AIDS in Africa: Efficiency, Equity, and Reality

Background: Rationing of access to antiretroviral therapy already exists in sub-Saharan Africa and will intensify as national treatment programs develop. The number of people who are medically eligible for therapy will far exceed the human, infrastructural, and financial resources available, making rationing of public treatment services inevitable. Methods: We identified 15 criteria by which antiretroviral therapy could be rationed in African countries and analyzed the resulting rationing systems across 5 domains: clinical effectiveness, implementation feasibility, cost, economic efficiency, and social equity. Findings: Rationing can be explicit or implicit. Access to treatment can be explicitly targeted to priority subpopulations such as mothers of newborns, skilled workers, students, or poor people. Explicit conditions can also be set that cause differential access, such as residence in a designated geographic area, co-payment, access to testing, or a demonstrated commitment to adhere to therapy. Implicit rationing on the basis of first-come, first-served or queuing will arise when no explicit system is enforced; implicit systems almost always allow a high degree of queue-jumping by the elite. There is a direct tradeoff between economic efficiency and social equity. Interpretation: Rationing is inevitable in most countries for some period of time. Without deliberate social policy decisions, implicit rationing systems that are neither efficient nor equitable will prevail. Governments that make deliberate choices, and then explain and defend those choices to their constituencies, are more likely to achieve a socially desirable outcome from the large investments now being made than are those that allow queuing and queue-jumping to dominate.

Camera Canvas: Image Editing Software for People with Disabilities

Poster is based on the following paper: C. Kwan and M. Betke. Camera Canvas: Image editing software for people with disabilities. In Proceedings of the 14th International Conference on Human Computer Interaction (HCI International 2011), Orlando, Florida, July 2011.

Ubuntu, Jesus, and Earth: Integrating African Religion and Christianity in Ecological Ethics

Africa faces problems of ecological devastation caused by economic exploitation, rapid population growth, and poverty. Capitalism, residual colonialism, and corruption undermine Africa's efforts to forge a better future. The dissertation describes how in Africa the mounting ecological crisis has religious, political, and economic roots that enable and promote social and environmental harm. It presents the thesis that religious traditions, including their ethical expressions, can effectively address the crisis, ameliorate its impacts, and advocate for social and environmental betterment, now and in the future. First, it examines African traditional religion and Christian teaching, which together provide the foundation for African Christianity. Critical examination of both religious worldviews uncovers their complementary emphases on human responsibility toward planet Earth and future generations. Second, an analysis of the Gwembe Tonga of Chief Simamba explores the interconnectedness of all elements of the universe in African cosmologies. In Africa, an interdependent, participatory relationship exists between the world of animals, the world of humans, and the Creator. In discussing the annual lwiindi (rain calling) ceremony of Simamba, the study explores ecological overtones of African religions. Such rituals illustrate the involvement of ancestors and high gods in maintaining ecological integrity. Third, the foundation of the African morality of abundant life is explored. Across Sub-Saharan Africa, ancestors' teachings are the foundation of morality; ancestors are guardians of the land. A complementary teaching that Christ is the ecological ancestor of all life can direct ethical responses to the ecological crisis. Fourth, the eco-social implications of ubuntu (what it means to be fully human) are examined. Some aspects of ubuntu are criticized in light of economic inequalities and corruption in Africa. However, ubuntu can be transformed to advocate for eco-social liberation. Fifth, the study recognizes that in some cases conflicts exist between ecological values and religious teachings. This conflict is examined in terms of the contrast between awareness of socioeconomic problems caused by population growth, on the one hand, and advocacy of a traditional African morality of abundant children, on the other hand. A change in the latter religious view is needed since overpopulation threatens sustainable living and the future of Earth. The dissertation concludes that the identification of Jesus with African ancestors and theological recognition of Jesus as the ecological ancestor, woven together with ubuntu, an ethic of interconnectedness, should characterize African consciousness and promote resolution of the socio-ecological crisis.

Making Sadza with Deaf Zimbabwean Women: A Missiological Reorientation of Practical Theological Method toward Self-Theologizing Agency among Subaltern Communities

Missiological calls for self-theologizing among faith communities present the field of practical theology with a challenge to develop methodological approaches that address the complexities of cross-cultural, practical theological research. Although a variety of approaches can be considered critical correlative practical theology, existing methods are often built on assumptions that limit their use in subaltern contexts. This study seeks to address these concerns by analyzing existing theological methodologies with sustained attention to a community of Deaf Zimbabwean women struggling to develop their own agency in relation to child rearing practices. This dilemma serves as an entry point to an examination of the limitations of existing methodologies and a constructive, interdisciplinary theological exploration. The use of theological modeling methodology employs my experience of learning to cook sadza, a staple dish of Zimbabwe, as a guide for analyzing and reorienting practical theological methodology. The study explores a variety of theological approaches from practical theology, mission oriented theologians, theology among Deaf communities, and African women’s theology in relationship to the challenges presented by subaltern communities such as Deaf Zimbabwean women. Analysis reveals that although there is much to commend in these existing methodologies, questions about who does the critical correlation, whose interests are guiding the study, and consideration for the cross-cultural and power dynamics between researchers and faith communities remain problematic for developing self-theologizing agency. Rather than frame a comprehensive methodology, this study proposes three attitudes and guideposts to reorient practical theological researchers who wish to engender self-theologizing agency in subaltern communities. The creativity of enacted theology, the humility of using checks and balances in research methods, and the grace of finding strategies to build bridges of commonality and community offer ways to reorient practical theological methodologies toward the development of self-theologizing agency among subaltern people. This study concludes with discussion of how these guideposts can not only benefit particular work with a community of Deaf Zimbabwean women, but also provide research and theological reflection in other subaltern contexts.

Camera Canvas: Image Editor for People with Severe Disabilities

Camera Canvas is an image editing software package for users with severe disabilities that limit their mobility. It is specially designed for Camera Mouse, a camera-based mouse-substitute input system. Users can manipulate images through various head movements, tracked by Camera Mouse. The system is also fully usable with traditional mouse or touch-pad input. Designing the system, we studied the requirements and solutions for image editing and content creation using Camera Mouse. Experiments with 20 subjects, each testing Camera Canvas with Camera Mouse as the input mechanism, showed that users found the software easy to understand and operate. User feedback was taken into account to make the software more usable and the interface more intuitive. We suggest that the Camera Canvas software makes important progress in providing a new medium of utility and creativity in computing for users with severe disabilities.

Camera-Based Interfaces and Assistive Software for People with Sever Motion Impairments

Intelligent assistive technology can greatly improve the daily lives of people with severe paralysis, who have limited communication abilities. People with motion impairments often prefer camera-based communication interfaces, because these are customizable, comfortable, and do not require user-borne accessories that could draw attention to their disability. We present an overview of assistive software that we specifically designed for camera-based interfaces such as the Camera Mouse, which serves as a mouse-replacement input system. The applications include software for text-entry, web browsing, image editing, animation, and music therapy. Using this software, people with severe motion impairments can communicate with friends and family and have a medium to explore their creativity.

A Customizable Camera-based Human Computer Interaction System Allowing People With Disabilities Autonomous Hands Free Navigation of Multiple Computing Task

Many people suffer from conditions that lead to deterioration of motor control and makes access to the computer using traditional input devices difficult. In particular, they may loose control of hand movement to the extent that the standard mouse cannot be used as a pointing device. Most current alternatives use markers or specialized hardware to track and translate a user's movement to pointer movement. These approaches may be perceived as intrusive, for example, wearable devices. Camera-based assistive systems that use visual tracking of features on the user's body often require cumbersome manual adjustment. This paper introduces an enhanced computer vision based strategy where features, for example on a user's face, viewed through an inexpensive USB camera, are tracked and translated to pointer movement. The main contributions of this paper are (1) enhancing a video based interface with a mechanism for mapping feature movement to pointer movement, which allows users to navigate to all areas of the screen even with very limited physical movement, and (2) providing a customizable, hierarchical navigation framework for human computer interaction (HCI). This framework provides effective use of the vision-based interface system for accessing multiple applications in an autonomous setting. Experiments with several users show the effectiveness of the mapping strategy and its usage within the application framework as a practical tool for desktop users with disabilities.

Experiences and desires of people with tetraplegia living with and without electronic aids to daily living: an Irish focus group study

This qualitative descriptive study explores the lived experience for persons with a high cervical spinal cord injury who have Electronic Aids to Daily Living (EADLs), and for persons who have no EADLs. Fifteen people with cervical spinal cord injuries attended four focus groups. Data analysis uncovered a novel framework of several themes that were organised into three categories: experiences, desires and meanings of living with EADL. Users’ and non users’ groups revealed homogenous themes. Experiences and desires are explored further in this paper. Themes within the category of experiences included: EADL devices, supply support and training, abandonment, mouthsticks and powered wheelchairs. Desires included: simple stuff, reliability, aesthetics and voice activation. Findings offer valuable personal insights about life with EADL to be considered by all involved with EADL.

The meaning of environmental control systems (ECS) for people with spinal cord injury: An occupational therapist explores an intervention

Environmental Control Systems (ECS), enable people with high cervical Spinal Cord Injury (high SCI) to control and access everyday electronic devices. In Ireland, however, access for those who might benefit from ECS is limited. This study used a qualitative approach to explore the insider experience of an ECS starter-pack developed by the author, an occupational therapist. The primary research questions: what is it really like to live with ECS, and what does it mean to live with ECS, were explored using a phenomenological methodology conducted in three phases. In Phase 1 fifteen people with high SCI met twice in four focus groups to discuss experiences and expectations of ECS. Thematic analysis (Krueger & Casey, 2000), influenced by the psychological phenomenological approach (Creswell, 1998), yielded three categories of rich, practical, phenomenological findings: ECS Usage and utility; ECS Expectations and The meaning of living with ECS. Phase 1 findings informed Phase 2 which consisted of the development of a generic electronic assistive technology pack (GrEAT) that included commercially available constituents as well as short instructional videos and an information booklet. This second phase culminated in a one-person, three-week pilot trial. Phase 3 involved a six person, 8-week trial of the GrEAT, followed by individual in-depth interviews. Interpretative Phenomenological Analysis IPA (Smith, Larkin & Flowers, 2009), aided by computer software ATLAS.ti and iMindmap, guided data analysis and identification of themes. Getting used to ECS, experienced as both a hassle and engaging, resulted in participants being able to Take back a little of what you have lost, which involved both feeling enabled and reclaiming a little doing. The findings of this study provide substantial insights into what it is like to live with ECS and the meanings attributed to that experience. Several practical, real world implications are discussed.

Rallying to a cause: the plays of Zakes Mda 1979-1989

Zakes Mda, dubbed one of South Africa's most prolific playwrights, produced his richest and most powerful theatre work during the 70s and 80s. Ironically, it is only in the 90s that he has been acknowledged in his own country as one of its foremost dramatists - ironic since he has recently moved away from drama into the realms of fiction. Fortunately Mda has accumulated a worthy canon of dramatic works, spanning radio and film, as well as theatre, and there is no reason to believe that he will not return to play writing. Mda has worked extensively in theatre in various capacities but most notably in the area of theatre-for-development. For example, he worked as director with Maratholi Travelling Theatre in Lesotho, an experience which contributed, in part, towards his book "When People Play People: Development Communication Through Theatre". Mda's plays have been produced in the United States, Britain, Spain, France and Russia as well as in southern Africa. "The Nun's Romantic Story" has been translated into Castilian and Catalan and "We Shall Sing for the Fatherland" and "Dark Voices Ring" have both been translated into Russian and French. In South Africa he won the Merit Award of the Amstel Playwright of the Year Society for "We Shall Sing for the Fatherland" in 1978 and in 1979 he was Amstel Playright of the Year for "The Hill". For his novel "She Plays with the Darkness", he won the Sanlam Literary Award in 1995.

People and place in the new frontier: an examination of Han and Uyghur ethnic identities

This thesis demonstrates how Han and Uyghur ethnic identities are constructed in urban Xinjiang, how they have evolved over time and how both identities gain their meaning largely from a process of interaction with the ‘other’. It shows that the boundaries that exist between Uyghur and Han hugely influence the identity content of both. Based on over 120 interviews carried out over 3 years, it brings a clear analytical framework and conceptual clarity to the questions of how ethnic identities are constructed and maintained in Xinjiang

Accommodating interruptions: a grounded theory of young people with asthma

Background: Accommodating Interruptions is a theory that emerged in the context of young people who have asthma. A background to the prevalence and management of asthma in Ireland is given to situate the theory. Ireland has the fourth highest incidence of asthma in the world, with almost one in five Irish young people having asthma. Although national and international asthma management guidelines exist it is accepted that the symptom control of asthma among the young people population is poor. Aim: The aim of this research is to investigate the lives of young people who have asthma, to allow for a deeper understanding of the issues affecting them. Methods: This research was undertaken using a Classic Grounded Theory approach. It is a systematic approach to allowing conceptual emergence from data in generating a theory that explains behaviour in resolving the participant’s main concern. The data were collected through in-depth interviews with young people aged 11-16 years who had asthma for over one year. Data were also collected from participant diaries. Constant comparative analysis, theoretical coding and memo writing were used to develop the theory. Results: The theory explains how young people resolve their main concern of being restricted, by maximizing their participation and inclusion in activities, events and relationships in spite of their asthma. They achieve this by accommodating interruptions in their lives in minimizing the effects of asthma on their everyday lives. Conclusion: The theory of accommodating interruptions explains young people’s asthma management behaviours in a new way. It allows us to understand how and why young people behave the way they do in order minimise the effect of asthma on their lives. The theory adds to the body of knowledge on young people with asthma and challenges some viewpoints regarding their behaviours.

Lower extremity amputation in people with diabetes: Trends and determinants

Introduction: The prevalence of diabetes is rising rapidly. Assessing quality of diabetes care is difficult. Lower Extremity Amputation (LEA) is recognised as a marker of the quality of diabetes care. The focus of this thesis was first to describe the trends in LEA rates in people with and without diabetes in the Republic of Ireland (RoI) in recent years and then, to explore the determinants of LEA in people with diabetes. While clinical and socio-demographic determinants have been well-established, the role of service-related factors has been less well-explored. Methods: Using hospital discharge data, trends in LEA rates in people with and without diabetes were described and compared to other countries. Background work included concordance studies exploring the reliability of hospital discharge data for recording LEA and diabetes and estimation of diabetes prevalence rates in the RoI from a nationally representative study (SLAN 2007). To explore determinants, a systematic review and meta-analysis assessed the effect of contact with a podiatrist on the outcome of LEA in people with diabetes. Finally, a case-control study using hospital discharge data explored determinants of LEA in people with diabetes with a particular focus on the timing of access to secondary healthcare services as a risk factor. Results: There are high levels of agreement between hospital discharge data and medical records for LEA and diabetes. Thus, hospital discharge data was deemed sufficiently reliable for use in this PhD thesis. A decrease in major diabetes-related LEA rates in people with diabetes was observed in the RoI from 2005-2012. In 2012, the relative risk of a person with diabetes undergoing a major LEA was 6.2 times (95% CI 4.8-8.1) that of a person without diabetes. Based on the systematic review and meta-analysis, contact with a podiatrist did not significantly affect the relative risk (RR) of LEA in people with diabetes. Results from the case-control study identified being single, documented CKD and documented hypertension as significant risk factors for LEA in people with diabetes whilst documented retinopathy was protective. Within the seven year time window included in the study, no association was detected between LEA in patients with diabetes and timing of patient access to secondary healthcare for diabetes management. Discussion: Many countries have reported reduced major LEA rates in people with diabetes coinciding with improved organisation of healthcare systems. Reassuringly, these first national estimates in people with diabetes in the RoI from 2005 to 2012 demonstrated reducing trends in major LEA rates. This may be attributable to changes in diabetes care and also, secular trends in smoking, dyslipidaemia and hypertension. Consistent with international practice, LEA trends data in Ireland can be used to monitor quality of care. Quantifying this improvement precisely, though, is problematic without robust denominator data on the prevalence of diabetes. However, a reduction in major diabetes-related LEA rates suggests improved quality of diabetes care. Much controversy exists around the reliability of hospital discharge data in the RoI. This thesis includes the first multi-site study to explore this issue and found hospital discharge data reliable for the reporting of the procedure of LEA and diagnosis of diabetes. This project did not detect protective effects of access to services including podiatry and secondary healthcare for LEA in people with diabetes. A major limitation of the systematic review and meta-analysis was the design and quality of the included studies. The data available in the area of effect of contact with a podiatrist on LEA risk are too sparse to say anything definitive about the efficacy of podiatry on LEA. Limitations of the case-control study include lack of a diabetes register in Ireland, restricted information from secondary healthcare and lack of data available from primary healthcare. Due to these issues, duration of disease could not be accounted for in the study which limits the conclusions that can be drawn from the results. The model of diabetes care in the RoI is currently undergoing a re-configuration with plans to introduce integrated care. In the future, trends in LEA rates should be continuously monitored to evaluate the effectiveness of changes to the healthcare system. Efforts are already underway to improve the availability of routine data from primary healthcare with the recent development of the iPCRN (Irish Primary Care Research Network). Linkage of primary and secondary healthcare records with a unique patient identifier should be the goal for the future.

Substance misuse in young people in Ireland - a focus on benzodiazepines

Benzodiazepines are a class of drugs that are prescribed for the treatment of anxiety and insomnia. Due to the powerful tolerance that can develop as a result of sustained use, benzodiazepines can also be dependence-forming. Benzodiazepine dependence can occur from prescribed and from recreational use, and is a significant issue for young people. The consequences of benzodiazepine dependence include cognitive and learning impairment, depressive symptoms, and increased suicide risk. Despite these risks, the nature of youth benzodiazepine use has not been explored to the same extent as other drugs. A review of existing Irish literature revealed that benzodiazepines are one of the five most recreationally-used drugs among young people. Analyses of young people attending a treatment centre indicated that young attendees from urban areas were more likely to be referred to the centre because of benzodiazepines than rural attendees. Further examination of the centre’s attendees showed that regular benzodiazepine users experienced more paranoia, loss of interest in sport, and pallor than non-regular users. Analysis of benzodiazepine prescribing to young people revealed that approximately one in seven young people were prescribed benzodiazepines for periods greater than recommended by national guidelines. Young benzodiazepine users discussed in interviews that they took benzodiazepines to escape from negative feelings and that they are generally taken in a social setting. Further interviews with youth counsellors and general practitioners highlighted that both family and community attitude to benzodiazepine use can impact on a young person’s benzodiazepine usage. Suggestions for reducing benzodiazepine use such as psychological alternatives to medication, public awareness campaigns and prescribing restrictions are provided. Future research can elaborate upon this work to determine other methods of reducing youth benzodiazepine use and the damage that it causes to the young people themselves, but also to their families, their community, and society at large.