Patient Retention in Antiretroviral Therapy Programs in Sub-Saharan Africa: A Systematic Review

Paper published in PLoS Medicine in 2007.

Sleep Patterns in Elementary School Children (Grades 2-5) and Adolescents (Grade 10)

Background: To date, there is limited research examining sleep patterns in elementary school children. Previous researchers focused on parental responses rather than student responses to determine factors that affect sleep. The presented study surveyed sleep patterns and examined external factors affecting total sleep time among elementary school children and adolescents. Methods: Students in grades 2-5 (n=885) and grade 10 (n=190) enrolled in a public school system in the Northeast, completed a district administered survey that included questions on sleep duration and hygiene. Results. Average reported sleep duration decreased with increasing grade level. Children in grades 2-5 woke up earlier (31.7-72.4%) and on their own in comparison to adolescents in grade 10 (6.8%). Significantly shorter sleep durations were associated with having a television (grades 2, 4, 5, p< 0.01) or a cell phone in the room (grades 3, 4; p < 0.05), playing on the computer or video games (grades 3, 4, p<.001) before going to bed. In contrast, students in grade 2, 3, & 4 who reported reading a book before going to bed slept on average 21 minutes more per night (p=.029, .007, .009, respectively). For tenth graders, only consumption of energy drinks led to significant reduction in sleep duration (p<.0001). Conclusion. Sleep is a fundamental aspect in maintaining a healthy and adequate life style. Understanding sleep patterns will assist parents, health care providers, and educators in promoting quality sleep hygiene in school-aged children.

Inclusive education policy, the general allocation model and dilemmas of practice in primary schools

Background: Inclusive education is central to contemporary discourse internationally reflecting societies’ wider commitment to social inclusion. Education has witnessed transforming approaches that have created differing distributions of power, resource allocation and accountability. Multiple actors are being forced to consider changes to how key services and supports are organised. This research constitutes a case study situated within this broader social service dilemma of how to distribute finite resources equitably to meet individual need, while advancing inclusion. It focuses on the national directive with regard to inclusive educational practice for primary schools, Department of Education and Science Special Education Circular 02/05, which introduced the General Allocation Model (GAM) within the legislative context of the Education of Persons with Special Educational Needs (EPSEN) Act (Government of Ireland, 2004). This research could help to inform policy with ‘facts about what is happening on the ground’ (Quinn, 2013). Research Aims: The research set out to unearth the assumptions and definitions embedded within the policy document, to analyse how those who are at the coalface of policy, and who interface with multiple interests in primary schools, understand the GAM and respond to it, and to investigate its effects on students and their education. It examines student outcomes in the primary schools where the GAM was investigated. Methods and Sample The post-structural study acknowledges the importance of policy analysis which explicitly links the ‘bigger worlds’ of global and national policy contexts to the ‘smaller worlds’ of policies and practices within schools and classrooms. This study insists upon taking the detail seriously (Ozga, 1990). A mixed methods approach to data collection and analysis is applied. In order to secure the perspectives of key stakeholders, semi-structured interviews were conducted with primary school principals, class teachers and learning support/resource teachers (n=14) in three distinct mainstream, non-DEIS schools. Data from the schools and their environs provided a profile of students. The researcher then used the Pobal Maps Facility (available at www.pobal.ie) to identify the Small Area (SA) in which each student resides, and to assign values to each address based on the Pobal HP Deprivation Index (Haase and Pratschke, 2012). Analysis of the datasets, guided by the conceptual framework of the policy cycle (Ball, 1994), revealed a number of significant themes. Results: Data illustrate that the main model to support student need is withdrawal from the classroom under policy that espouses inclusion. Quantitative data, in particular, highlighted an association between segregated practice and lower socioeconomic status (LSES) backgrounds of students. Up to 83% of the students in special education programmes are from lower socio-economic status (LSES) backgrounds. In some schools 94% of students from LSES backgrounds are withdrawn from classrooms daily for special education. While the internal processes of schooling are not solely to blame for class inequalities, this study reveals the power of professionals to order children in school, which has implications for segregated special education practice. Such agency on the part of key actors in the context of practice relates to ‘local constructions of dis/ability’, which is influenced by teacher habitus (Bourdieu, 1984). The researcher contends that inclusive education has not resulted in positive outcomes for students from LSES backgrounds because it is built on faulty assumptions that focus on a psycho-medical perspective of dis/ability, that is, placement decisions do not consider the intersectionality of dis/ability with class or culture. This study argues that the student need for support is better understood as ‘home/school discontinuity’ not ‘disability’. Moreover, the study unearths the power of some parents to use social and cultural capital to ensure eligibility to enhanced resources. Therefore, a hierarchical system has developed in mainstream schools as a result of funding models to support need in inclusive settings. Furthermore, all schools in the study are ‘ordinary’ schools yet participants acknowledged that some schools are more ‘advantaged’, which may suggest that ‘ordinary’ schools serve to ‘bury class’ (Reay, 2010) as a key marker in allocating resources. The research suggests that general allocation models of funding to meet the needs of students demands a systematic approach grounded in reallocating funds from where they have less benefit to where they have more. The calculation of the composite Haase Value in respect of the student cohort in receipt of special education support adopted for this study could be usefully applied at a national level to ensure that the greatest level of support is targeted at greatest need. Conclusion: In summary, the study reveals that existing structures constrain and enable agents, whose interactions produce intended and unintended consequences. The study suggests that policy should be viewed as a continuous and evolving cycle (Ball, 1994) where actors in each of the social contexts have a shared responsibility in the evolution of education that is equitable, excellent and inclusive.

Broadening public input into science policy decision making: can the democratic model for science communication influence scientific, innovation and technological trajectories?

This PhD thesis investigates the potential use of science communication models to engage a broader swathe of actors in decision making in relation to scientific and technological innovation in order to address possible democratic deficits in science and technology policy-making. A four-pronged research approach has been employed to examine different representations of the public(s) and different modes of engagement. The first case study investigates whether patient-groups could represent an alternative needs-driven approach to biomedical and health sciences R & D. This is followed by enquiry into the potential for Science Shops to represent a bottom-up approach to promote research and development of local relevance. The barriers and opportunities for the involvement of scientific researchers in science communication are next investigated via a national survey which is comparable to a similar survey conducted in the UK. The final case study investigates to what extent opposition or support regarding nanotechnology (as an emerging technology) is reflected amongst the YouTube user community and the findings are considered in the context of how support or opposition to new or emerging technologies can be addressed using conflict resolution based approaches to manage potential conflict trajectories. The research indicates that the majority of communication exercises of relevance to science policy and planning take the form of a one-way flow of information with little or no facility for public feedback. This thesis proposes that a more bottom-up approach to research and technology would help broaden acceptability and accountability for decisions made relating to new or existing technological trajectories. This approach could be better integrated with and complementary to government, institutional, e.g. university, and research funding agencies activities and help ensure that public needs and issues are better addressed directly by the research community. Such approaches could also facilitate empowerment of societal stakeholders regarding scientific literacy and agenda-setting. One-way information relays could be adapted to facilitate feedback from representative groups e.g. Non-governmental organisations or Civil Society Organisations (such as patient groups) in order to enhance the functioning and socio-economic relevance of knowledge-based societies to the betterment of human livelihoods.

The Ford administration, Angola and the perception of Post-Vietnam US credibility, 1974-1976

This thesis is a study of how the Gerald Ford administration struggled to address a perceived loss of US credibility after the collapse of Vietnam, with a focus on the role of Secretary of State Henry Kissinger in the formulation, implementation and subsequent defence of US Angolan policy. By examining the immediate post-Vietnam period, this thesis shows that Vietnam had a significant impact on Kissinger’s actions on Angola, which resulted in an ill conceived covert operation in another third world conflict. In 1974, Africa was a neglected region in Cold War US foreign policy, yet the effects of the Portuguese revolution led to a rapid decolonization of its African territories, of which Angola was to become the focus of superpower competition. After South Vietnam collapsed in April 1975, Kissinger became fixated on restoring the perceived loss of US prestige, Angola provided the first opportunity to address this. Despite objections from his advisors, Kissinger methodically engineered a covert program to assist two anti-Marxist guerrilla groups in Angola. As the crisis escalated, the media discovered the operation and the Congress decided to cease all funding. A period of heated tensions ensued, resulting in Kissinger creating a new African policy to outmanoeuvre his critics publicly, while privately castigating them to foreign leaders. This thesis argues that Kissinger’s dismissal of internal dissent and opposition from the Congress was influenced by what he perceived as bureaucrats being affected by the Vietnam syndrome, and his obsession with restoring US credibility. By looking at the private and public records – as expressed in government meetings and official reports, US newspaper and television coverage and diplomatic cables – this thesis addresses the question of how the lessons of Vietnam failed to influence Kissinger’s actions in Angola, but the lessons of Angola were heavily influential in the construction of a new US-African policy.

The impact of host-microbe interactions on murine colonic secretomotor function

The overall objective of this thesis was to gain further insight into the mechanisms underlying commensal microbial influences on intestinal ion transport. In this regard, I examined the impact of commensal host-microbe interactions on colonic secretomotor function in mouse. I first examined the influence of two different probiotic (microorganisms which, when given in adequate amounts, can confer health benefits upon the host) strains, Bifidobacterium infantis 35624 and L. salivarius UCC118 on active colonic ion transport in the mouse, using the Ussing Chamber. I found that both probiotics appear to have converging effects on ion transport at a functional level. However, L. salivarius UCC118 may preferentially inhibit neurally-evoked ion transport. Next I examined the impact of the host microbiota itself on both baseline and stimulated colonic secretomotor function as well as probiotic induced changes in ion transport. I provide further evidence that the microbiota is capable of mediating alterations in colonic ion transport, and specifically suggests that it can influence cAMP-mediated responses. Finally, it has been well documented that many probiotics elicit their effects via secreted bioactives, therefore, I studied the effects of microbially produced GABA, contained in supernatants from the commensal microbe Lactobacillus brevis DPC6108, on colonic secretomotor function. In conclusion, I believe that commensal microbes have an important and strain specific functional influence on colonic ion transport and secretomotor function and these effects can be mediated via extracellular bioactives. Moreover, I believe that functional ex-vivo studies such as those carried out in this thesis have a critical role to play in our future understanding of host-microbe interactions in the gut.

Feasibility of combined wind-wave energy platforms

The European Union has set out an ambitious 20% target for renewable energy use by 2020. It is expected that this will be met mainly by wind energy. Looking towards 2050, reductions in greenhouse gas emissions of 80-95% are to be sought. Given the issues securing this target in the transport and agriculture sectors, it may only be possible to achieve this target if the power sector is carbon neutral well in advance of 2050. This has permitted the vast expansion of offshore renewables, wind, wave and tidal energy. Offshore wind has undergone rapid development in recent years however faces significant challenges up to 2020 to ensure commercial viability without the need for government subsidies. Wave energy is still in the very early stages of development so as yet there has been no commercial roll out. As both of these technologies are to face similar challenges in ensuring they are a viable alternative power generation method to fossil fuels, capitalising on the synergies is potentially a significant cost saving initiative. The advent of hybrid solutions in a variety of configurations is the subject of this thesis. A singular wind-wave energy platform embodies all the attributes of a hybrid system, including sharing space, transmission infrastructure, O&M activities and a platform/foundation. This configuration is the subject of this thesis, and it is found that an OWC Array platform with multi-MegaWatt wind turbines is a technically feasible, and potentially an economically feasible solution in the long term. Methods of design and analysis adopted in this thesis include numerical and physical modelling of power performance, structural analysis, fabrication cost modelling, simplified project economic modelling and time domain reliability modelling of a 210MW hybrid farm. The application of these design and analysis methods has resulted in a hybrid solution capable of producing energy at a cost between €0.22/kWh and €0.31/kWh depending on the source of funding for the project. Further optimisation through detailed design is expected to lower this further. This thesis develops new and existing methods of design and analysis of wind and wave energy devices. This streamlines the process of early stage development, while adhering to the widely adopted Concept Development Protocol, to develop a technically and economically feasible, combined wind-wave energy hybrid solution.

What Have We Learned from the Deepwater Horizon Disaster? An Economist’s Perspective

This paper outlines what we have learned about the impacts of the Deepwater Horizon (DWH) oil disaster from the economics discipline as well as what effect the DWH disaster has had on the economics discipline. It appears that what we know about the economic impact of the DWH spill today is limited, possibly because such analysis is tied up in the federal Natural Resource Damage Assessment (NRDA) process and other state-led efforts. There is evidence, however, that the NRDA process has changed over time to de-emphasize economic valuation of damages. There is also evidence that economists may be producing fewer outputs as a result of the DWH relative to scholars from other disciplines because of an apparent absence of funding for it. Of the research that has taken place, this paper provides a summary and highlights the main directions of future research. It appears that the most pressing topic is addressing the incentives and policies in place to promote a culture of safety in the offshore oil industry. Also, it appears that the most prominent, and challenging, direction of future research resulting from the DWH is the expansion of an ecosystems services approach to damage assessment and marine policy. Lea el abstracto en español 请点击此处阅读中文摘要

Are State legislatures responding to public opinion when allocating funds for tobacco control programs?

This study explored the factors associated with state-level allocations to tobacco-control programs. The primary research question was whether public sentiment regarding tobacco control was a significant factor in the states' 2001 budget decisions. In addition to public opinion, several additional political and economic measures were considered. Significant associations were found between our outcome, state-level tobacco-control funding per capita, and key variables of interest including public opinion, amount of tobacco settlement received, the party affiliation of the governor, the state's smoking rate, excise tax revenue received, and whether the state was a major producer of tobacco. The findings from this study supported our hypothesis that states with citizens who favor more restrictive indoor air policies allocate more to tobacco control. Effective public education to change public opinion and the cultural norms surrounding smoking may affect political decisions and, in turn, increase funding for crucial public health programs.

Toward the development of national telehealth services: the role of Veterans Health Administration and future directions for research.

The Veterans Health Administration (VHA) in the Department of Veteran Affairs (VA) has emerged as a national and international leader in the delivery and research of telehealth-based treatment. Several unique characteristics of care in VA settings intersect to create an ideal environment for telehealth modalities and research. However, the value of telehealth experience and initiatives in VA settings is limited if telehealth strategies cannot be widely exported to other public or private systems. Whereas a hierarchical organization, such as VA, can innovate and fund change relatively quickly based on provider and patient preferences and a growing knowledge base, other health provider organizations and third-party payers may likely require replicable scientific findings over time before incremental investments will be made to create infrastructure, reform regulatory barriers, and amend laws to accommodate expansion of telehealth modalities. Accordingly, large-scale scientifically rigorous telehealth research in VHA settings is essential not only to investigate the efficacy of existing and future telehealth practices in VHA, but also to hasten the development of telehealth infrastructure in private and other public health settings. We propose an expanded partnership between the VA, NIH, and other funding agencies to investigate creative and pragmatic uses of telehealth technology. To this end, we identify six specific areas of research we believe to be particularly relevant to the efficient development of telehealth modalities in civilian and military contexts outside VHA.

Innovation in business groups

Using novel data on European firms, this paper investigates the relationship between business groups and innovation. Controlling for various firm characteristics, we find that group affiliates are more innovative than standalones. We examine several hypotheses to explain this finding, focusing on group internal capital markets and knowledge spillovers. We find that group affiliation is particularly important for innovation in industries that rely more on external funding and in groups with more diversified capital sources, consistent with the internal capital markets hypothesis. Our results suggest that knowledge spillovers are not the main driver of innovation in business groups because firms affiliated with the same group do not have a common research focus and are unlikely to cite each other's patents. © 2010 INFORMS.

Application description and policy model in collaborative environment for sharing of information on epidemiological and clinical research data sets.

BACKGROUND: Sharing of epidemiological and clinical data sets among researchers is poor at best, in detriment of science and community at large. The purpose of this paper is therefore to (1) describe a novel Web application designed to share information on study data sets focusing on epidemiological clinical research in a collaborative environment and (2) create a policy model placing this collaborative environment into the current scientific social context. METHODOLOGY: The Database of Databases application was developed based on feedback from epidemiologists and clinical researchers requiring a Web-based platform that would allow for sharing of information about epidemiological and clinical study data sets in a collaborative environment. This platform should ensure that researchers can modify the information. A Model-based predictions of number of publications and funding resulting from combinations of different policy implementation strategies (for metadata and data sharing) were generated using System Dynamics modeling. PRINCIPAL FINDINGS: The application allows researchers to easily upload information about clinical study data sets, which is searchable and modifiable by other users in a wiki environment. All modifications are filtered by the database principal investigator in order to maintain quality control. The application has been extensively tested and currently contains 130 clinical study data sets from the United States, Australia, China and Singapore. Model results indicated that any policy implementation would be better than the current strategy, that metadata sharing is better than data-sharing, and that combined policies achieve the best results in terms of publications. CONCLUSIONS: Based on our empirical observations and resulting model, the social network environment surrounding the application can assist epidemiologists and clinical researchers contribute and search for metadata in a collaborative environment, thus potentially facilitating collaboration efforts among research communities distributed around the globe.

Impact of economic, regulatory, and patent policies on innovation in cancer chemoprevention.

Chemoprevention agents are an emerging new scientific area that holds out the promise of delaying or avoiding a number of common cancers. These new agents face significant scientific, regulatory, and economic barriers, however, which have limited investment in their research and development (R&D). These barriers include above-average clinical trial scales, lengthy time frames between discovery and Food and Drug Administration approval, liability risks (because they are given to healthy individuals), and a growing funding gap for early-stage candidates. The longer time frames and risks associated with chemoprevention also cause exclusivity time on core patents to be limited or subject to significant uncertainties. We conclude that chemoprevention uniquely challenges the structure of incentives embodied in the economic, regulatory, and patent policies for the biopharmaceutical industry. Many of these policy issues are illustrated by the recently Food and Drug Administration-approved preventive agents Gardasil and raloxifene. Our recommendations to increase R&D investment in chemoprevention agents include (a) increased data exclusivity times on new biological and chemical drugs to compensate for longer gestation periods and increasing R&D costs; chemoprevention is at the far end of the distribution in this regard; (b) policies such as early-stage research grants and clinical development tax credits targeted specifically to chemoprevention agents (these are policies that have been very successful in increasing R&D investment for orphan drugs); and (c) a no-fault liability insurance program like that currently in place for children's vaccines.

Integrated vector management for malaria control in Uganda: knowledge, perceptions and policy development.

BACKGROUND: Integrated vector management (IVM) is increasingly being recommended as an option for sustainable malaria control. However, many malaria-endemic countries lack a policy framework to guide and promote the approach. The objective of the study was to assess knowledge and perceptions in relation to current malaria vector control policy and IVM in Uganda, and to make recommendations for consideration during future development of a specific IVM policy. METHODS: The study used a structured questionnaire to interview 34 individuals working at technical or policy-making levels in health, environment, agriculture and fisheries sectors. Specific questions on IVM focused on the following key elements of the approach: integration of chemical and non-chemical interventions of vector control; evidence-based decision making; inter-sectoral collaboration; capacity building; legislation; advocacy and community mobilization. RESULTS: All participants were familiar with the term IVM and knew various conventional malaria vector control (MVC) methods. Only 75% thought that Uganda had a MVC policy. Eighty percent (80%) felt there was inter-sectoral collaboration towards IVM, but that it was poor due to financial constraints, difficulties in involving all possible sectors and political differences. The health, environment and agricultural sectors were cited as key areas requiring cooperation in order for IVM to succeed. Sixty-seven percent (67%) of participants responded that communities were actively being involved in MVC, while 48% felt that the use of research results for evidence-based decision making was inadequate or poor. A majority of the participants felt that malaria research in Uganda was rarely used to facilitate policy changes. Suggestions by participants for formulation of specific and effective IVM policy included: revising the MVC policy and IVM-related policies in other sectors into a single, unified IVM policy and, using legislation to enforce IVM in development projects. CONCLUSION: Integrated management of malaria vectors in Uganda remains an underdeveloped component of malaria control policy. Cooperation between the health and other sectors needs strengthening and funding for MVC increased in order to develop and effectively implement an appropriate IVM policy. Continuous engagement of communities by government as well as monitoring and evaluation of vector control programmes will be crucial for sustaining IVM in the country.

Archaeological Excavations at 18AP14: The Victualling Warehouse Site, 77 Main Street, Annapolis, Maryland, 1982 - 1984

The Victualling Warehouse Site, located at 77 Main Street in Annapolis, Maryland, was excavated by Archaeology in Annapolis during the summers of 1982 and 1983 and the fall of 1984. Funding was provided by Historic Annapolis, Incorporated (now Historic Annapolis Foundation), the University of Maryland, the Maryland Committee for the Humanities, and the Maryland Commission on the Capital City. This site has been used for commercial and residential purposes since the 1740's. During the Revolution the warehouses were used as a victualling office to supply American troops. A fire in 1970 destroyed these buildings and the present structure, also used as a store, was built about twenty years later. Over the three years of excavation, a total of 36 5 foot by 5 foot units were excavated revealing several features, including the foundations of one of the eighteenth century warehouses.