To see the other types of publications on this topic, follow the link: Environmental Medicine.
Dissertations / Theses on the topic 'Environmental Medicine'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Environmental Medicine.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Farrow, Alexandra. "Miscarriage and environmental factors." Thesis, University of Bristol, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295036.
Full text
2
Hanna, Bridget Corbett. "Toxic Relief: Science, Uncertainty, and Medicine after Bhopal." Thesis, Harvard University, 2014. http://dissertations.umi.com/gsas.harvard:11346.
Full textAbstract:
This dissertation is a study of science and medicine after the gas disaster in1984 in Bhopal, India. It looks at the discourses, debates, suspicions, and entangled events that have shaped the narratives of causality following the catastrophe, and the ways that ideas about relief, treatment, and illness have been constructed by experts, lay activists, and survivors. In it I address the issues of suspicion, research, and power by looking at the "cyanide controversy" in the early years after the disaster, and at the ways that the consequences of uncertainty affect patients and doctors within the hospital system designed to provide "gas relief" in the aftermath. I also describe the range of ways gas survivors have categorized and produced as subjects and citizens through an analysis of epidemiological, legal, and political discussions. I take on the history of medical research after the event, and show how a vast corpus of scientific work has remained dispersed and underutilized, leaving room for sometimes-dangerous narratives of certain illness or death. Finally, I look at the consequences of this indeterminacy for care and healing. I assess access to treatments, the diversity of medical care, the undermining of the status of the gas exposed, and the ways that detoxification has been approached through notions of dosage, potency, and traditional medicine. I produce a sociology of knowledge about the catastrophe and contribute to literatures on the problem of epistemic uncertainty and risk after disasters, the production of medicalized subjects, and the politicization of knowledge. I argue that interventions that have tried to encompass the disaster within a unitary framework have been persistently inadequate, and illustrate how attempts to reduce or subsume the consequences of the disaster - through recourse to scientific indeterminacy, under reductionist legal mechanisms, by imprecise categorization schema, within flawed research methodologies, and among hollow medical infrastructures - have not only failed to meaningfully represent it but also resulted in predictable forms of reductionist violence and social suffering, through obfuscation as often as through action.Anthropology
3
Runeson, Roma. "Personality, Stress, and Indoor Environmental Symptomatology." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5899.
Full text
4
McCann, John. "Management and control of environmental hazards in industry." Thesis, Heriot-Watt University, 1985. http://hdl.handle.net/10399/1079.
Full text
5
Nazir, Muhammad Shahid. "DNA persistence and preservation following environmental insult." Thesis, University of Central Lancashire, 2012. http://clok.uclan.ac.uk/6744/.
Full textAbstract:
This research was conducted to provide empirical evidence to supplement advice available to the forensic community for the collection of muscle tissue for forensic analysis. This type of collection is normally carried out to determine the identity of individuals following mass disasters, such as plane crashes or natural disasters. DNA degradation was assessed in two model organisms, pig and rabbit (with human DNA as a control), over various time points. Rabbit recombination activating gene (RAG 1) was aligned to identify conserved regions in pig, rabbit and human. Primers were designed and optimised to create a 4-plex PCR multiplex that can amplify 70 bp, 194 bp, 305 bp and 384 bp in three species. The 4-plex multiplex was found to work efficiently in all three species down to 0.3 ng of DNA template. The multiplex was used to assess whether DNA degradation can be predicted by accumulated degree-days (ADD), which provides a measure of both time and temperature. A series of field studies were performed to assess DNA persistence in pig and rabbit soft muscle tissues using a combination of whole animals, suspended muscle tissues (insect activity free) and muscle fragments. Field studies were carried out in: August-September 2009; February-May 2010; May-June 2010; June-July 2010 and September-November 2010. Soft muscle tissue samples were collected at different ADD. 4-plex multiplex results showed that DNA was more persistent in pig tissues compared to rabbit tissues. In the September 2010 experiments, full multiplex amplification was obtained from rabbit until 137 ADD (whole carcases) and 210 ADD (body fragments and suspended tissues), while in the August 2009 experiments, full multiplex amplification was obtained until 112 ADD (whole carcases and body fragments) and until 141 ADD (suspended tissues). In the June 2010 experiments, full multiplex amplification was possible until 64 ADD. Pig whole carcases which were placed in the field in February 2010, showed multiplex amplification until day 90 (603 ADD), followed by September 2010 (until day 44 (490 ADD)) and May 2010 (until day 27 (338 ADD)). During the September 2010 project, body fragments produced full amplification until muscles were collected (342 ADD), while in case of whole carcases and suspended tissues; the amplification was possible until 490 ADD. There was complete failure of amplification of 305 bp and 384 bp in pig whole carcases after 342 ADD, while in suspended tissues, the amplification of 305 bp and 384 bp was possible until 420 ADD. The statistical analysis showed that amplification success of larger amplicons (194 bp, 305 bp and 384 bp) reduces with increase in ADD in pig and rabbit whole carcases, body fragments and suspended tissues while 70 bp was more persistence. The results showed that there was no significant difference in DNA persistence between whole carcases verses suspended tissues (Z=0.57, p>0.05) and whole carcases verses body fragments (Z=1.71, p>0.05), There was however a significant difference (Z=2.31, p<0.05) in DNA persistence in suspended tissues and body fragments with increase in ADD. The results from field experiments suggested that muscle tissues, if available, should be collected for DNA profiling, since even if degraded, a profile can be obtained. The results also suggested that the isolation of tissues from insect activity as quickly as possible (even if immediate storage is not possible) may be beneficial for DNA persistence. Seasonal variation in DNA persistence was observed due to maggot mass growth which increases carcase decomposition and ultimately effect on DNA persistence. Controlled incubation experiments were also performed at 27 °C, 37 °C and 47 °C until 21 days to assess DNA persistence, as these temperatures were not available under field conditions. The results showed that the amplification of 70 bp was more persistent compared to larger amplicons (194 bp, 305 bp and 384 bp). The drop-out in amplification of larger amplicons occurred more rapidly in samples incubated under laboratory conditions compared to the field samples. The statistical analysis showed species, ADD and temperature have strong effect (p<0.05) on DNA persistence under controlled conditions. The appearance of 70 bp amplicons in all samples collected from field and in most samples from controlled incubation experiments suggested that soft muscle tissues exposed to different environments can be used to perform SNP analysis. The full 4-plex multiplex amplification obtained from rabbit and pig preserved and dehydrated samples suggested that 96% ethanol, cell lysis solution (with and without 1% sodium azide) and dehydration can be used to preserve fresh and partially decomposed soft muscle tissues at room temperature for one year. The drop-out in amplification of larger amplicons in tissues preserved in 10% buffered formalin suggested that formalin was not suitable for long term storage. This system should therefore be considered as an additional method during Disaster victim identification (DVI) work to preserve fresh and partially decomposed samples. This study also suggested that the developed multiplex (4-plex) can be used to assess DNA persistence in human decomposing bodies and in experimental studies.
6
Mitchell, David Ross. "Environmental factors relevant to the rising incidence of gastro-oesophageal reflux disease." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30793/.
Full textAbstract:
Gastro-oesophageal reflux disease (GORD) is one of the commonest chronic conditions in the western world with a reported prevalence of 10-20% in Europe and the USA. The disease involves an interplay between factors promoting reflux of gastric juice and failure of defensive forces designed to neutralise the resulting acidity. Transient lower oesophageal relaxations, the acid pocket and the presence of a hiatus hernia are important factors. Acid reflux can cause benign oesophageal injury, including oesophagitis, oesophageal ulceration and peptic structuring, as well as malignant complications like Barrett’s oesophagus and oesophageal adenocarcinoma (OAC). GORD, Barrett’s and OAC rates have been rising over the last few decades in the Western World and the reasons for this are unclear. Helicobacter pylori (H. pylori) is a common bacterial infection of the stomach present in the majority of the world’s human population. It is known to cause chronic gastritis, and can be complicated by the development of peptic ulcer disease, gastric adenocarcinoma and gastric MALT lymphoma. An unexplained observation regarding H. pylori infection is its negative association with gastro-oesophageal reflux disease and its malignant complications. The prevalence of H. pylori infection appears to be falling, especially within the Western World. It is possible that H. pylori infection is protecting against the development of oesophageal disease from acid reflux and one possible explanation is the infection causing a reduction in gastric acid secretory function. For this to be true, the protective effect from H. pylori must be apparent in the majority of those infected. There is little available data on the effect of H. pylori infection within the general population. The few previous studies assessing gastric acid secretion have used H. pylori infected healthy volunteers, rather than subjects representative of the general population. The incidence of central obesity is rising in both children and adults across the world. Obesity is strongly associated with gastro-oesophageal reflux and its complications of Barrett’s oesophagus and OAC. Central adiposity seems to be of particular importance. The nature of this association is incompletely understood and both mechanical and humoral effects of central obesity may be important. In the first study we investigated whether the incidences of OAC and gastric adenocarcinoma, as well as their time trends, may be inversely related pointing to a common environmental factor exerting opposite effects on these cancers. We used cross-sectional data from “Cancer Incidence in Five Continents” (CI5) Volume X and GLOBOCAN 2012. Relevant ICD-10 codes were used to locate oesophageal and gastric cancers anatomically, and ICD-O codes for the histological diagnosis of OAC. For longitudinal analyses, age standardized rates (ASRs) of OAC and total gastric cancer (TGC) were extracted from CI5C-Plus. Estimated (2012) ASRs were available for 51 countries and these showed significant negative correlations between OAC and both TGC (males: correlation coefficient (CC) = −0.38, P =0.006, females: CC= −0.41, P =0.003) and non-cardia gastric cancer rates (males: CC= −0.41, P =0.003 and females: CC= −0.43, P =0.005). Annual incidence trends were analysed for 38 populations through 1989–2007 and showed significant decreases for TGC in 89% and increases for OAC in 66% of these, with no population showing a fall in the latter. Significant negative correlation between the incidence trends of the two cancers was observed in 27 of the 38 populations over the 19–50 years of available paired data. Super-imposition of the longitudinal and cross-sectional data indicated that populations with a current high incidence of OAC and low incidence of gastric cancer had previously resembled countries with a high incidence of gastric cancer and low incidence of OAC. The negative association between gastric cancer and OAC in both current incidences and time trends is consistent with a common environmental factor predisposing to one and protecting from the other. In our second study we assessed the gastric acid secretory capacity in different anatomical regions in H. pylori positive and negative volunteers in a Western population. We studied 31 H. pylori positive and 28 H. pylori negative volunteers, matched for age, gender and body mass index. Jumbo biopsies were taken at 11 predetermined locations from the gastro-oesophageal junction and stomach. Combined high-resolution pHmetry (12 sensors) and manometry (36 sensors) was performed for 20 min fasted and 90 min postprandially. The squamocolumnar junction was marked with radio-opaque clips and visualised radiologically. Biopsies were scored for inflammation and density of parietal, chief and G cells immunohistochemically. Under fasting conditions, the H. pylori positives had less intragastric acidity compared with negatives at all sensors >1.1 cm distal to the peak lower oesophageal sphincter (LOS) pressure (p<0.01). Postprandially, intragastric acidity was less in H. pylori positives at sensors 2.2, 3.3 and 4.4 cm distal to the peak LOS pressure (p<0.05), but there were no significant differences in more distal sensors. The postprandial acid pocket was thus attenuated in H. pylori positives. The H. pylori positives had a lower density of parietal and chief cells compared with H. pylori negatives in 10 of the 11 gastric locations (p<0.05). 17/31 of the H. pylori positives were CagA-seropositive and showed a more marked reduction in intragastric acidity and increased mucosal inflammation. In conclusion, H. pylori positives have reduced intragastric acidity which most markedly affects the postprandial acid pocket. In the third and final study we investigated the effect of increasing abdominal pressure by waist belt on reflux in patients with reflux disease. We performed a prospective study of patients with oesophagitis (n = 8) or Barrett's oesophagus (n = 6); median age was 56 years and median body mass index was 26.8. Proton pump inhibitors were stopped at least 7 days before the study and H2 receptor antagonists were stopped for at least 24 hours before. The severity of upper GI symptoms was assessed, and measurements of height, weight, and waist and hip circumference taken. Combined high-resolution pH measurements and manometry were performed in fasted state for 20 minutes and for 90 minutes following a standardized meal. The squamocolumnar junction was marked by endoscopically placed radio-opaque clips. The procedures were performed with and without a waist belt (a weight-lifter belt applied tightly and inflated to a constant cuff pressure of 50 mmHg). Without the belt, intragastric pressure correlated with waist circumference (r = 0.682; P = .008), with the range in pressure between smallest and largest waist circumference being 15 mmHg. The belt increased intragastric pressure by a median of 6.9 mmHg during fasting (P = .002) and by 9.0 mmHg after the meal (P = .001). Gastro-oesophageal acid reflux at each of the pH sensors extending 5.5 cm proximal to the peak lower oesophageal sphincter pressure point was increased by approximately 8-fold by the belt (all P < .05). Following the meal, the mean number of reflux events with the belt was 4, vs 2 without (P = .008). Transient lower oesophageal sphincter relaxations were not increased by the belt, but those associated with reflux were increased (2 vs 3.5; P = .04). The most marked effect of the belt was impaired oesophageal clearance of refluxed acid (median values of 23.0 seconds without belt vs 81.1 seconds with belt) (P = .008). The pattern of impaired clearance was that of rapid re-reflux after peristaltic clearance. In conclusion we found belt compression increased acid reflux following a meal. The intragastric pressure rise inducing this effect is well within the range associated with differing waist circumference and likely to be relevant to the association between obesity and reflux disease.
7
Miskelly, Francis G. "Environmental factors and symptoms in infants at high risk of allergy." Thesis, Queen's University Belfast, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.334472.
Full text
8
Nilsson, Charlotte. "Studies on the effects of 2,3,7,8-tetrachlorodibenzo-p-dioxin on vitamin A homeostasis /." Stockholm, 1999. http://diss.kib.ki.se/1999/91-628-3427-4/.
Full text
9
Luo, Yi. "Chinese Medicine's Commercialization and its Social and Environmental Impact." Scholarship @ Claremont, 2015. http://scholarship.claremont.edu/cmc_theses/1214.
Full text
10
Cunningham, Thomas K. "The effect of environmental, physical, and nutritional factors on in vitro fertilisation." Thesis, University of Hull, 2016. http://hydra.hull.ac.uk/resources/hull:14051.
Full textAbstract:
Folliculogenesis, fertilisation and implantation of a human embryo requires unity of many different pathways. The literature review discusses folliculogensis, implantation and the potential affect that endocrine disrupting agents (EDAs) and Vitamin D can have on infertility and Polycystic Ovary Syndrome (PCOS). Can physical and immune-modulating treatments such as Endometrial scratching (ES) and intralipid aid in the treatment of recurrent implantation failure (RIF)? EDAs were detected in the PCOS and controls, only the polyfluoroalkyl-agent (PFAA) perfluorooctane sulfonate (PFOS) had a significantly higher concentration in the PCOS group, (4.11±1.62 ng/ml vs. 3.11±1.05ng/ml, p=0.03). Whole group analysis showed PFAAs demonstrated significant positive correlations with testosterone. PFAAs, Polychlorinated Biphenyls and Dichlorodiphenyldichloroethylene (p,p-DDE) demonstrated significant positive correlations with cleavage rates (p=0.01 to 0.04), thus these chemicals may disrupt cell division in early embryo development. There was no correlation between EDAs and pregnancy in either group. A pilot study was designed to see what effects Vitamin D levels had on IVF outcomes in PCOS and control subjects. A linear trend was observed between Vitamin D levels and fertilisation rates in the PCOS group suggesting a possible relationship between Vitamin D and oocyte maturation in this distinct population of women. An observational study was designed to assess the effect of ES on women undergoing IVF. No increase in clinical pregnancy rates (p=0.54) was demonstrated in women with RIF, however clinical pregnancy rates were significantly reduced (p=0.04) in women undergoing their second cycle of IVF. These findings suggest that this treatment is not effective in the treatment of RIF. The effect of intralipid to aid implantation in women with RIF has been postulated but not confirmed. A pilot study was designed to observe the effect of intralipid on NK-cell populations of women with RIF and controls undergoing IVF. The findings demonstrated no effect of intralipid on NK-cell populations in women with RIF.
11
Sundberg, Carina. "Nitrifyers in constructed wetlands treating landfill leachates." Doctoral thesis, Linköping : Department of Clinical and Experimental Medicine, Linköping University, 2008. http://www.bibl.liu.se/liupubl/disp/disp2008/med1067s.pdf.
Full text
12
lopez, Kimber. "Natural Medicine: Personal Responsibility and Self-Empowerment." Scholarship @ Claremont, 2009. http://scholarship.claremont.edu/pomona_theses/113.
Full textAbstract:
Although most “alternative” medical practices have existed far longer than conventional healthcare, modern allopathic continues to be the dominant system of medicine used in the United States. Herbal medicine is one of the oldest healing practices known to humankind and continues to be practiced today despite the numerous challenges modern society poses. As Julie Stone and Joan Mathews illuminate in Complimentary Medicine and the Law, “Plant-based remedies have been the principal source of medicines in healing traditions around the world and, as the World health Organization is at pains to remind us, 80 percent of the world’s population still depends primarily on plant medicine." Another statistic cited by Larry Dossey in Reinventing Medicine illustrates, “…researchers have found that adverse reactions to drugs kill over 100,000 people a year in US hospitals. That is the equivalent of a passenger jet crashing everyday. If this level of death were seen in any other field, it would probably be considered a national scandal." These facts reveal that American citizens have come to believe in a form of healthcare that is not widely accepted by the rest of the world, and that has some surprisingly dangerous characteristics hidden within. The question thus arises as to why biomedicine continues to be the standard form of healthcare in the US, and why alternative forms of medicine are devalued and failed to be justifiably recognized and incorporated into treatment strategies.
13
Mawhinney, Jacqueline. "Determination of trace elements in hair for monitoring environmental and occupational exposure." Thesis, Sheffield Hallam University, 2000. http://shura.shu.ac.uk/3147/.
Full textAbstract:
Hair has a number of advantages over more conventional sample types, such as serum, whole blood and urine, as an indicator of the intake and exposure to trace elements. While the analysis of these conventional sample types can only be used as a measure of recent exposure, hair, in contrast, can provide an historical record of exposure episodes. Furthermore the levels of trace elements in hair are higher than in blood and as a result small changes in intake are magnified. In addition, the collection of hair samples is non-invasive and the samples are easy to store. However, the difficulty in differentiating surface bound contamination from trace elements incorporated into the hair matrix complicates the interpretation of the hair analysis results. A review of the literature showed that a variety of washing procedures to remove external contamination have been proposed but as yet no standardised procedures are available. In this study, methods for the pretreatment and determination of antimony, arsenic, cadmium, chromium, lead, mercury and selenium in human hair by ICP-MS were developed. Chemical speciation of mercury and methyl mercury in hair was also achieved using LC-ICP-MS. For the digestion of hair samples the optimum method for these elements was found to be a digestion mixture of nitric acid and hydrogen peroxide. Certified reference materials CRM 397 and CRM 07601 were digested using this method and the values obtained were seen to be in good agreement with the certified values. Investigations of various washing procedures to remove external contaminants showed that in unexposed hair samples cadmium, lead and mercury were significantly removed from hair using a 0.1M HCl wash, with 87%, 73% and 5% respectively being washed off. Whilst the removal of antimony, arsenic and chromium from unexposed hair was more efficient with 1% v/v sodium lauryl sulphate, with 43%, 40% and 13% of each element respectively being washed off. Selenium could not be removed from the hair by any of the washing methods studied. Experiments with simulated sweat spiked with each of the elements showed that exogenously bound chromium, cadmium and lead could be removed after washing with 0.1M HC1. In contrast, antimony, arsenic, selenium and mercury were irreversibly bound and could not be removed with any of the washing solutions investigated. Using a LC-ICP-MS system it was possible to separate inorganic mercury and methyl mercury in hair, without any modifications to the existing instrumentation. The results showed that in order to determine methyl mercury the sample had to be cold digested in 2: 1 HNO3: H202 and that a minimum of 0.1g of hair is required. Using this method of analysis it was seen that with spiked simulated sweat solutions exogenously bound methyl mercury could be removed from hair after washing with 0.1M HCI, whereas the inorganic mercury was irreversibly bound to the hair. It was also found that inorganic mercury was the major mercury species in hair from dental subjects. The results of a six week selenium supplementation study of 29 subjects showed an increase in hair selenium levels of 19%, confirming that hair concentrations of selenium can give a good reflection of selenium status in the body. A control group of 40 unexposed samples were analysed to determine normal levels of antimony, arsenic, cadmium, chromium, lead, mercury and selenium in human hair. Occupational studies were then carried out and the data obtained from these studies showed a significant increase in the elements of exposure. Hair samples from dental workers (n = 43) showed a mean mercury level of 813 ng g-1 compared to a control value of 287 ng g-1; hair samples from semiconductor workers (n = 24) showed a mean arsenic level of 208 ng g'1 compared to a control value of 34 ng g'1; hair samples from chromium platers (n = 7? showed a mean chromium level of 2201 ng g-1 compared to a control value of 985 ng g-1 ; and hair samples from lead foundry workers (n = 13) showed a mean lead level of 124337 ng g-1 compared to a control value of 1030 ng g-1. The lead levels in the foundry workers' hair samples were reduced by 94% after washing with 0. IM HCl from 124 000 to 7440 ng g-1, which was still above the normal group mean hair lead level of 1030 ng g-1.
14
Nguyen, Khanh Hoang. "Analysis of emerging environmental contaminations using advanced instrumental tools : application to human and environmental exposure." Thesis, University of Birmingham, 2018. http://etheses.bham.ac.uk//id/eprint/8662/.
Full textAbstract:
High throughput analytical methods based on UPLC-APCI-HRMS and/or UPLC-ESI-HRMS were developed for the multi-residue analysis of pharmaceuticals, personal care products (PPCPs), brominated flame retardants (BFRs) and their degradation/transformation products. The PPCPs method was successfully applied to analysis of freshwater samples from Egypt. Target PPCPs were ubiquitous in the Egyptian aquatic environment and displayed relatively high concentrations in an effluent sample from a hospital wastewater treatment plant. The BFRs method was applied to screen for legacy BFRs, novel BFRs and their potential degradation/transformation products in simulated landfill leachate samples. In vitro bioassays were developed to study for the first time the metabolism of the novel BFRs TBECH by human liver microsomes and EH-TBB and FM550 by human skin S9 fractions. TBECH was metabolised by hepatic CYP450-mediated enzymes to produce a complex mixture of hydroxylated, debrominated and α-oxidation metabolites. EH-TBB and TPhP (in the FM550 mixture) underwent biotransformation by carboxylesterases in human skin S9 fractions. Kinetic modelling of the studied hepatic and dermal human biotransformation reactions revealed that exposure to multiple chemicals significantly influences the metabolic rates of target compounds. In vitro – in vivo extrapolations were also modelled to investigate the xenobiotic clearance capacities of human liver and skin.
15
Goldberg, Debora Goetz. "The Influence of Environmental Factors and Organizational Characteristics on Innovations in Family Medicine Practices in Virginia." VCU Scholars Compass, 2008. https://scholarscompass.vcu.edu/etd/5724.
Full textAbstract:
Family medicine practices are currently threatened by factors such as poor reimbursement, physician stress, shortage of providers, and difficulties in providing prompt access and reliable continuity of care. The external environment faced by family medicine practices is extremely complex and characterized by high pressure from regulatory sources, decreasing reimbursement levels, an increasing rate of change in technologies and care delivery processes, and increasing patient and community expectations. Over the last several years there have been many efforts in family medicine to respond to the challenges presented by the external environment. The majority of these efforts focus on redesigning the delivery of health care services and improving business functionality at the practice level. These innovations include incorporating a patient-centered team approach to providing care, increasing use of advanced technologies, improving functional office space, emphasizing quality and outcomes, and enhancing practice finances.
This study explored innovations in family medicine practices to redesign the delivery of health care services and improve business functionality. This research also examined whether environmental factors and organizational characteristics influence strategies to redesign the practice of family medicine. The study employed an integrated set of theoretical frameworks from organizational sociology in evaluating the environmental influences on innovative efforts. Institutional theory was used to provide a conceptual framework to explain the connection between innovations in family medicine practices and three institutional forces within the environment: coercive forces, mimetic forces, and normative forces. Resource dependency theory was used to explain physician practice motivators for change based on a dependence on scarce financial, human, and information resources.
The study utilized multiple secondary data sets to define the external environment and an organizational survey of family medicine practices to understand the utilization of innovations and environmental influences. Descriptive statistics and multivariate analysis were used to reveal innovations and to determine the impact of environmental factors on the implementation of redesign strategies. The study results provide essential information on innovations undertaken by family medicine practices in Virginia and how environmental factors and organizational characteristics influence efforts to redesign.
16
Konya, Judit. "The influence of dietary and other environmental changes on vascular risk markers in type 2 diabetes." Thesis, University of Hull, 2014. http://hydra.hull.ac.uk/resources/hull:11448.
Full textAbstract:
Introduction: Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance, impaired glycaemia, endothelial, clotting and platelet dysfunction, resulting in increased cardiovascular risk. Cardiovascular parameters are influenced by various environmental and dietary factors. Methods: Two separate studies were undertaken to explore the effect of different soy and/or cocoa dietary interventions on cardiovascular risk makers in type 2 diabetes, and to determine the underlying mechanism. A third study was organized to explore the effect of hypoxia and low humidity on platelet function and clotting indices in addition to microparticle concentration in patients with type 2 diabetes compared to healthy volunteers. Results: We have shown that the addition of soy with isoflavones improves overall glycaemia, while soy protein alone or either of these two preparations in combination with cocoa are ineffective. The underlying mechanism could be the improvement in postprandial glycaemia as fasting insulin and glucose remained unchanged. Endothelial function did not change as a result of the dietary interventions. We have found that a simulated flight environment increased basal platelet activity in type 2 diabetes patients compared to healthy volunteers, while there was no difference in endothelial function. Discussion: These studies showed that dietary soy might modulate glycaemic control through a mechanism, which alters postprandial hyperglycaemia. The effects were dependent on a combination of soy protein with isoflavones as soy protein alone was ineffective. It was shown that mimicking the parameters of a commercial flight affected T2DM with an increase in platelet reactivity that may theoretically increase the risk of a venous thromboembolic episode.
17
Khani, Jazani Reza. "Occupational noise as an indicator of environmental quality, political change, and management practice in Tehran." Thesis, University of Salford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.301439.
Full text
18
Finer, Sarah. "Epigenetic variation associated with genetic and environmental factors in the aetiology of Type 2 diabetes." Thesis, Queen Mary, University of London, 2013. http://qmro.qmul.ac.uk/xmlui/handle/123456789/8677.
Full textAbstract:
Type 2 diabetes, as a complex disease, has a range of genetic and environmental factors that underpin its aetiology. It is hoped that the emerging study of epigenetic processes will provide the necessary mechanistic insight into the genetic and environmental interactions that, to date, are poorly understood. This thesis considers the role of DNA methylation, an epigenetic modification, in the aetiology of type 2 diabetes. A range of different genome-wide and whole genome techniques are applied to a study of established type 2 diabetes and experimental models (human and animal) of fetal programming. Samples from a recent genome-wide association study of type 2 diabetes were used to identify DNA methylation patterns at areas of genetic variation associated with disease risk. Analysis of data from methylated DNA immunoprecipitation and microarray identified a genetic-epigenetic interaction in the FTO gene. At this locus, the presence or absence of a SNP created or abrogated a CpG site capable of methylation and further analyses highlighted possible functional relevance via enhancer activity. Models of fetal programming were then used to identify whether variation in DNA methylation may underlie the ‘programmed’ phenotype of diabetes and related cardiometabolic disease. Pre-existing human models of programming via maternal vitamin B12 deficiency and maternal famine exposure have been used to generate exploratory evidence of such mechanisms. Whole genome-based techniques (Medip-seq and Illumina 450k methylation array) were used to profile DNA methylation in whole blood samples from the offspring born to each of these studies. Custom bioinformatic analysis was performed to identify differences in methylation between offspring exposed versus unexposed to the in utero environmental insult. Technical replication and validation studies are ongoing to confirm or refute the presence of regions of differential methylation. Finally, this thesis considers whether a state of ‘over nutrition’ gestational diabetes, may play a role in fetal programming. This condition is of increasing prevalence across the world and is characterised by maternal hyperglycaemia and insulin resistance, often resulting in fetal overgrowth. A mouse model using an inbred strain (Lepr) of mice induced a programmed phenotype of glucose intolerance and obesity in aged offspring born to mothers with gestational diabetes. Medip-seq performed on the livers of late gestation mouse embryos identified differential methylation in cases vs. controls, located at genomic regions with potential functional relevance. A human cohort of women with gestational diabetes was collected to develop further hypothesis around the multiple environmental factors that could interact in pregnancy. Prevalent nutritional deficiencies of vitamin D, iron and one-carbon metabolites were found in women with and without gestational diabetes recruited from a local antenatal clinic. This thesis presents preliminary findings that variation in DNA methylation may be involved in the genetic and environmental risk of type 2 diabetes. The work presented highlights how future studies must incorporate integrated genetic, epigenetic and functional analysis with sufficient sample size if their results are to be translatable to diverse populations at risk of diabetes.
19
PETROPOULOS, KONSTANTINOS. "Development of bio-sensing platforms for applications in sport medicine and in real-time environmental monitoring." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2016. http://hdl.handle.net/2108/201736.
Full textAbstract:
My research activity, carried out during the period of the doctorate, concerned the development of specific bio-sensing platforms to be used for applications in sport medicine and in real-time environmental monitoring. During the first year of my doctorate I developed a disposable biosensor for lactate determination in saliva. The biosensor has been evaluated in terms of analytical performance and then tested with real saliva specimens. I also proposed a new, simple and effective protocol for saliva sample pretreatment which could be used for measurements outside the laboratory. The lactate biosensor was also compared to a commercial portable lactate analyzer, demonstrating a good correlation. This study was published in SENSORS AND ACTUATORS B, CHEMICAL, ISSN: 0925-4005. Throughout the second year I was engaged in the development of a biosensing assay for the detection of microcystins (MCs). This study makes part of a national project called "Acquasense" (Ministero per lo Sviluppo Economico, Industria 2015, Bando Nuove Tecnologie per il Made in Italy), which deals with the determination of chemical pollutants in drinking water, including MCs. Based on the purposes of the project for a simple and sensitive assay, I proposed an enzyme inhibition colorimetric method that uses the protein phosphatase type 2A (PP2A) as recognition element. The colorimetric assay has been applied in surface water, drinking water and a culture medium selective for cyanobacterial growth, with consequent release of MCs. The results obtained were compared to a standard chromatographic technique (UHPLC-DAD). This research, made in collaboration with the Departments of Biology and Inorganic Chemistry of the University of Rome, “Tor Vergata”, was the subject of two publications: BIOSENSORS & BIOELECTRONICS, ISSN: 0956-5663 and PROCEDIA ENGINEERING, ISSN: 1877-7058. From the half of the second year until the end of the third year of my doctorate, I have also been involved in a European project entitled “Sensing toxicants research in Marine waters make Sense using biosensors”, whose acronym is SMS and deals with the determination of marine water contaminants in coastal areas, including algal toxins. My concern was to develop novel sensing platforms, to be integrated in sensing devices, for the determination of two marine toxins, Okadaic Acid (OA) and Domoic Acid (DA), directly in marine water. My original idea was to develop an aptamer-based sensor for OA detection. To do this, I functionalized and tested different specific aptamers for OA. Unfortunately, none of these aptameric sequences demonstrated high affinity for its target. For this reason, I had to relinquish the idea to use aptamers as recognition elements to detect low levels of the mentioned toxins. Considering that OA is a potent inhibitor of the enzyme PP2A, I proposed the same colorimetric method, mentioned above, for its determination. After applying the assay in different seawater samples, I have been actively participated in its integration within a miniaturized automated apparatus (prototype colorimetric device) able to perform real-time monitoring of the toxin. The prototype device was tested and compared to the non-automated enzymatic assay. The results correlate well. As for the detection of DA, I focused my attention on the development of a competitive ELIMC (Enzyme-Linked Immuno-Magnetic Colorimetric) assay that uses antibodies as recognition elements. I proposed a format based on a single step competition procedure, which guarantees a short incubation time, combined with a colorimetric detection. The integration of the ELIMC assay in an automated apparatus and recovery experiments are still in progress.
20
Leischner, Julia A. "Exploring Yoga as a Holistic Lifestyle for Sustainable Human and Environmental Health." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/360.
Full textAbstract:
Improved health indicators, mental and physical health outcomes, and sustainable lifestyle practices have been found among yoga practitioners. The purpose of this study was to examine the impact of mixed styles of yoga practice on the health and behaviors of yoga practitioners. The relationship between yoga and body mass index (BMI), self-reported disease diagnosis, participation in other types of physical activity, adoption of healthy and sustainable lifestyle and dietary behaviors, perceived improvements in medical conditions that yoga was used to treat, quality of life resulting from yoga practice, and the reasons for beginning and continuing yoga were observed and tested in this study. Participants (N = 383) were adult yoga practitioners who were recruited using systematic sampling in Facebook social media. Data were analyzed using multiple linear regression, ANOVA, McNemar Chi square, and Spearman's correlation. Mean BMI for all yoga styles were in the normal range; however, ashtanga yoga was a significant predictor of low BMI. Self-reported disease diagnosis was significantly lower after beginning yoga practice. The majority of participants also engaged in other types of physical activity and adopted many healthy lifestyle practices. However, general/hatha and other styles of yoga were associated with adopting a greater number of other physical activities and general/hatha, ashtanga, and yoga therapy styles were associated with adopting a greater number of healthy and sustainable lifestyle and dietary behaviors. Medical conditions that yoga was used to treat and quality of life were perceived to be improved as a result of yoga practice. Results of this study confirm previous research findings that demonstrate numerous positive health outcomes from yoga practice.
21
Patel, Jenishkumar. "ENVIRONMENTAL RESPONSES OF TWO-COMPONENT SYSTEMS IN STREPTOCOCCUS SANGUINIS." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2270.
Full textAbstract:
The gram-positive bacterium Streptococcus sanguinis is a member of human indigenous oral microbialflora and has long been recognized as a key player in the bacterial colonization of the mouth. S. sanguinis is also the most common viridians streptococcal species implicated in infective endocarditis. Although many studies have focused on two-component systems in closely related Streptococcus species such as S. mutans, S. pneumoniae and S. gordonii; the mechanism of the response regulator in S. sanguinis is still unknown. The ability of S. sanguinis to adapt and thrive in hostile environments suggests this bacterium is capable of sensing and responding to various environmental stimuli. The present study clearly demonstrates that a number of RR genes, SSA_0204, SSA_0217, SSA_1810, SSA_1794, and SSA_1842, in S. sanguinis are essential to the recognition and response to various environmental stresses. Results from this study also identified genes SSA_0260, SSA_0261, and SSA-0262, involved in acidic tolerance and suppressed by SSA_0204 response regulator.
22
Clay, Elizabeth. "The effects of environmental oxygen on CD4+ T lymphocyte activation and responses." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5795/.
Full textAbstract:
The organs in which lymphocytes function are low in oxygen (<5% oxygen) and even lower oxygen levels may be more prevalent in inflammatory tissues. In this thesis the effects of environmental oxygen on human CD4+ memory T lymphocyte function in vitro have been investigated. The level of oxygen in normal air (21%) which historically has been used for most in vitro experiments with immune cells was found result in suboptimal responses of this cell type, especially with regards to proliferation. At physiologically more appropriate oxygen levels of 8.5%, optimal proliferation was observed which coincided with an increase in Th2-associated markers. At 3% oxygen, the average level found in the inflamed joint in rheumatoid arthritis, a more sustained pro-inflammatory response was observed. In 1% oxygen, cytokine production was not maintained over time paralleling observations of CD4+ T lymphocyte behaviour in both the tumour and chronic inflammatory environment. This comparison was further supported by the increased expression of the activation marker CD69 and the depression of CD4+ T lymphocyte proliferation. A model of reperfusion injury also highlighted the effect that varying oxygen levels can have on CD4+ memory T lymphocytes. Proximal T cell receptor signalling was found to be altered after equilibration at different oxygen levels, and preliminary experiments investigating the potential role that redox plays in regulating CD4+ memory T lymphocyte functions were performed. It is concluded that environmental oxygen levels significantly influence CD4+ memory T lymphocyte responses, have implications for their function in inflammatory sites in vivo, and need to be considered when designing or interpreting in vitro experiments.
23
Brooks, Billy, David Blackley, and Megan Quinn. "Appalachian Environmental Cancer Communication Workshop." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/etsu-works/3193.
Full text
24
Kinnafick, Florence-Emilie. "Social contextual and environmental determinants of physical activity adoption, adherence and well-being." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4430/.
Full textAbstract:
Over two thirds of the UK population do not meet physical activity (PA) recommendations set by the Department of Health (2011) to improve or maintain health. It is therefore essential to focus research on effective and efficient methods to promote autonomous reasons to engage and persist in PA. Employing a variety of research designs this thesis explores the social contextual and environmental determinants, predominantly from a Self-Determination Theory perspective, of PA adoption, persistence and psychological well-being (Study 1; qualitatively). Study 2 and 3 examined unique sources of support from within and beyond a PA programme including human and non-human sources (i.e., technology). Study 3 employed an intervention focusing on the effect of autonomy supportive text messages on PA behaviour and well-being. Deriving from findings of Study 1, the final study (4) investigated the effect of the physical environment and PA levels on affective states. Results highlight the importance and relevance of socio-contextual (considering each unique contribution of individual sources of support) and environmental determinants (moderate intensity PA within a natural outdoor environment being key for positive high activation) in the promotion of PA. Findings carry important practical implications for those involved in promotion of long-term PA behaviour.
25
Wood, Alice Margaret. "The role of genetic and environmental variation in the respiratory phenotype of alpha 1 antitrypsin deficiency." Thesis, University of Birmingham, 2010. http://etheses.bham.ac.uk//id/eprint/764/.
Full textAbstract:
Alpha 1 antitrypsin deficiency (AATD) is the only established genetic predisposition to chronic obstructive pulmonary disease (COPD). The development of COPD in AATD is highly variable, probably relating to complex interactions between multiple genetic and environmental factors. This thesis will describe the COPD phenotypes observed in AATD and their inter-relationships, forming the basis for examining phenotypic associations with specific candidate genes and HLA class II type. Finally it examines the potential role of ambient air pollution. Associations were seen for TNFA with chronic bronchitis, SFTPB with FEV1, TGFB with small airways disease and GC with bronchiectasis, consistent with the role of protein products in pathogenesis. Of four MMPs studied, association with gas transfer occurred in two. HLA-DQA1*0301 and HLA-DRB1*04 contributed significantly to gas transfer in regression models, and anti elastin antibodies were higher in HLA-DRB1*04 and HLA-DQA1*0301 homozygotes. Ozone levels contributed to the burden of disease in cross sectional and longitudinal models of pollution exposure, whilst PM10, NO2 and SO2 were associated only in the longitudinal model. In conclusion this thesis demonstrates the importance of genetic variation and environmental factors in determining respiratory phenotype in AATD. It also suggests a key role for adaptive immunity in pathogenesis of emphysema.
26
Noggle, Jessica Joy. "Eastern mosquitofish as a bioindicator of pulp and paper mill effluents." [Gainesville, Fla.] : University of Florida, 2005. http://purl.fcla.edu/fcla/etd/UFE0009720.
Full textAbstract:
Thesis (Ph.D.)--University of Florida, 2005.Typescript. Title from title page of source document. Document formatted into pages; contains 277 pages. Includes Vita. Includes bibliographical references.
27
Carey, Iain Miller. "The cross-sectional and longitudinal effects of environmental tobacco smoke, fresh fruit and adiposity on lung function in children and adults." Thesis, St George's, University of London, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.367519.
Full text
28
Hooper, Paul Nicholas. "The resistance of liquid extended boar semen to environmental stress encountered during air transport." Thesis, University of Reading, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.333488.
Full text
29
Gunnbjörnsdóttir, María Ingibjörg. "Asthma and Respiratory Symptoms in Nordic Countries, Environmental and Personal Risk Factors." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-7076.
Full textAbstract:
The overall aims of our studies were to identify risk factors for respiratory symptoms and asthma in indoor environment but even to look at some personal risk factors such as body mass index and gastroesophageal reflux. The study population is based on participants of the European Community Respiratory Health Survey I and II.
In the first study, water damage and visible moulds were reported in 7.4% and 17% of the homes respectively. The combination of water damage and visible moulds was independently associated with attacks of breathlessness when resting and after activity and also to long term cough. In the second study, the prevalence of nocturnal GER increased with higher BMI and the same pattern could be seen for habitual snoring. Reported onset of asthma, wheeze and night-time symptoms increased in prevalence along with the BMI gradient. In the multivariable analysis, obesity and nocturnal GER were independent risk factors for onset of asthma, wheeze and night-time symptoms. Habitual snoring was an independent risk factor for onset of wheeze and night-time symptoms, but not for onset of asthma. In the third study, a total of 18% of the subjects reported indoor dampness in the last 12 months and 27% of the subjects reported indoor dampness since the previous survey. Respiratory symptoms and asthma were significantly more prevalent in individuals exposed to indoor dampness and indoor dampness was a risk factor for respiratory symptoms and asthma after adjusting for possible confounders. Indoor dampness was an independent risk factor for onset of respiratory symptoms but not for asthma onset. Remission of respiratory symptoms was less likely to occur if subjects reported indoor dampness. In the fourth study, the lowest prevalence of atopy and the lowest levels of all indoor allergens, bacteria and moulds were found in Iceland. A positive association was found, between cat allergen exposure and asthma symptoms and between bronchial hyperresponsiveness and the amount of viable mould in indoor air.
30
Dosumu, Adekunle A. "The environmental impacts and wellbeing benefits of sport : assessing spectator and participant dominated sports in England." Thesis, University of Essex, 2016. http://repository.essex.ac.uk/16441/.
Full textAbstract:
Greenhouse gas (GHG) emissions from waste and transportation are of environmental concern. Globally, every year, waste contributes an estimated 5% and transport approximately 23% of the total anthropogenic GHG emissions. Sport contributes to GHG emissions by spectators and participants travelling to/from sporting venues and generating waste. Whilst a small reduction in an individual’s travel and waste may be perceived as having negligible impact, if these are aggregated over a population, the resultant GHG emissions can be significant. Although there is scientific evidence of the environmental impact of major sporting events there is limited research on it at the grassroots level. In addition watching and participating in sport results in wellbeing benefits such as improved self-esteem and mood. This research quantitatively examined both the environmental impacts and wellbeing benefits of sport at the grassroots level focusing on both spectator-dominated and participant-dominated sports in England. Three studies were conducted examining spectator-dominated sport: 1) GHG emissions relating to travel to and from football games; 2) GHG emissions relating to waste at football games and 3) the effects of watching football on mental wellbeing. Two further studies were also conducted assessing participant-dominated sport: 4) GHG emissions from travel to and from running location; and the effects of sport (running) on mental wellbeing and connection with nature and 5) the effects of running outdoors on mental wellbeing (pre and post study). The research showed that both spectators and participants’ sport considerably generated GHG emissions from travel and waste when extrapolated nationally. However, engaging in spectator-dominated or participant-dominated sports resulted in wellbeing benefits. Watching football resulted in better mental wellbeing, while running particularly outdoors resulted in improvements in wellbeing such as improved mood and increase in self-esteem after participating in sport. This research suggests that participating in sport can initiate a positive change in a person’s relationship with the natural world. These findings on the environmental impact and wellbeing benefits of both spectator-dominated and participant-dominated sports have implications for individuals, private sectors, sporting organisations, policy makers and government authorities.
31
Smethurst, Daniel George Jan. "The dynamic status of actin in the regulation of environmental sensing and homeostatic control in Saccharomyces cerevisiae." Thesis, University of Kent, 2014. https://kar.kent.ac.uk/47991/.
Full textAbstract:
Actin is a highly conserved protein in eukaryotes which forms dynamic cytoskeletal structures. Rapid remodeling of actin filaments is important for the regulation of a broad range of critical cellular processes. The cytoskeleton is acutely responsive to stresses and there are multiple interactions between actin and signaling pathways, positioning it centrally to a cells ability to adapt and respond to their environment. Here I provide further evidence that a dynamic actin cytoskeleton regulates processes including endocytosis, mitochondrial respiration, and signal transduction. Results presented here show that actin is embedded in the signaling networks which control the responses to environmental change. Change to the dynamic status of actin modulates the activity of the transcription factor Ste12p which regulates both the mating and filamentous/invasive growth responses. The activity of these pathways are linked to cortical patch organisation, and our data suggests that there is crosstalk between multiple pathways. I propose that the links between actin dynamics and environmental sensing pathways leave it well positioned for a role as a biosensor. Actin dynamics is altered by changes in internal or external conditions, leading to adapted of cellular responses which may provide a protective function for a population.
32
Larsson, Robert W. "Water supply and Dracunculus medinensis in Africa." Thesis, Loughborough University, 1994. https://dspace.lboro.ac.uk/2134/6763.
Full textAbstract:
The thesis examines control and eradication of Guinea worm in West Africa and investigates factors, especially water supply, related to the incidence of Guinea worm. The study was carried out in North Zou, Benin between 1987 and 1990 and in Nigeria between 1989 and 1993 during water supply and Guinea worm eradication programme execution. About 5% of villages in Nigeria, located in one half the LGAs were infected. The number of annual cases in a region was related to the previous year's cases, although 5-10% of the regions changed between infected and non-infected. Cases were not statically focused in villages. The relative risk of infection in a village based on the previous year's infection was 1.74 in North Zou. Incidence varied inversely and endemicity varied directly with village population. Villages of all sizes were infected. Prevalence varies seasonally by region. Incidence was low at high altitudes, in sandy and alluvial soils, in areas with high or low annual rainfall and in densely populated areas. Incidence was not otherwise related to rainfall, vegetation, altitude, soils, geology or distance to rivers. Incidence among Muslims and Christians was the same but varied by ethnic group. Incidence in an area was strongly related to the ratio of females to males. School attendance in endemic areas fell during the transmission period. Losses in Nigeria in 1990/91 were £16 million. Provision of improved water supply lowered incidence by 50%. Endemicity was 20% lower in villages in North Zou with water supply but endemicity did not fall immediately following provision and a difference was not seen in Nigeria. Water supply to all infected villages in Nigeria identified in 1990/91 would cost £23 million. Three possible water supply strategies were examined. Ten water supply options were considered and roof rainwater catchment was found the most promising. Factors that reduce the effective use of water supply were examined. Water supply coverage in endemic countries is 27%. The countries are among the poorest and least developed in the world. The lack of static focus of cases in villages, the low impact of water supply, and the difficulty of supplying water to all endemic areas make Guinea worm eradication by 1999 unlikely.
33
Pundziute-Lyckå, Auste. "Incidence trends and environmental determinants of type 1 diabetes in Lithuania and Sweden." Doctoral thesis, Umeå University, Clinical Sciences, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-114.
Full textAbstract:
Variation of diabetes incidence over time in countries with different incidence levels and socio-economic conditions, and in an age span beyond the childhood years, may give clues for diabetes causes.
Materials: Data from prospective type 1 diabetes registers in Sweden and Lithuania in children (0-14 years) and young adults (15-34 and 15-39 years, respectively). Number of infections recorded in health care booklets (117 cases; 270 controls); interview about the dietary intake one-year before the diagnosis and routinely recorded growth data (99 cases; 180 controls).
Results: The incidence of type 1 diabetes in Sweden and Lithuania differed most in the younger age groups, 28.9 and 7.5/100,000/year in 0-14-year group, respectively. During 1983-2000 incidence increased in 0-14-year old children in both countries, but the pattern of change differed. During 1983-1998 the incidence increased in Swedish children, but tended to decrease in young adults, with no increase in the age group below 35 years, indicating that the increase of childhood diabetes may be due to a shift towards a younger age at diagnosis. Within a low-incidence country Lithuania there was an urban-rural gradient of incidence, especially in the younger age groups, that seemed to follow poverty distribution: incidence in the 0-39-year group was 7.1, 9.0 and 8.8/100,000/year in rural areas, towns and cities, respectively, p<0.001.
Exposure to one or more non-specific infection during the first half-year of life reduced diabetes risk: odds ratios (95%-CI) in 0-14 and 5-14-year groups were (0.60; 0.37-0.98) and (0.47; 0.26-0.87), respectively. Higher energy intake and weight-for-age were independent diabetes risk factors: odds ratios for medium and high levels of energy were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), and for weight-for-age 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, disaccharides and sucrose in particular, increased diabetes risk independently of the high intake of energy.
Conclusion: Environmental factors associated with socio-economic conditions in childhood may be important for the occurrence of type 1 diabetes. Lack of exposure to microbial antigens early in life, higher intake of energy and more rapid growth may contribute to the increase of childhood-onset diabetes observed in many countries.
34
Robinson, Lenora M. "Posthurricane Environment's Impact on Childhood Cancer Rates in Louisiana, 2004-2010." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4556.
Full textAbstract:
Childhood cancer is the second leading cause of death in children aged 0-19 years. Research efforts to identify factors associated with or influencing this growing health problem are limited. The purpose of this research study was to examine, in reference to Louisiana during the period 2004-2010, the annual number of children diagnosed with cancer; the types of cancers; the possible effects of the environmental aftermath resulting from Hurricanes Katrina, Rita, and Gustav; and any correlation between environmental contaminants following these hurricanes with the number of children diagnosed with cancer. This study employed correlational quantitative methodology using archival data from the Louisiana Tumor Registry that identified childhood cancer types and incidence for the years 2004-2010. Data were analyzed using logistic regression. Data analysis demonstrated statistically significant differences in the number of children diagnosed with cancer in Louisiana following Hurricanes Katrina, Rita, and Gustav, more specifically between the northern (p = .011) and southern (p =.013) regions. However, this may have no or limited practical significance. The sample size was large in this study, and given a large enough sample, regardless of insignificant population differences, almost any difference or any correlation will be statistically significant. The positive social change implication of this study is that it may lead to the development of preventive tools/measures for healthcare professionals and parents to help reduce childhood cancers associated with exposure to adverse environmental factors.
35
Joseph, Cesar Margolite. "Poverty Rate and Occurrence of Foodborne Illness Risk Factors in Retail Facilities." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4926.
Full textAbstract:
Despite the efforts of food safety regulations and rules, food contamination remains a public health concern and prevalent vehicle of pathogens. This study identifies the predictors of food risk in different types of food establishments in Miami Dade County, Florida during the period November 2014 - November 2016. Guided by the epidemiologic triangle model, this correlational study analyzed the log number of risk factor violations and failure rates controlling for US Census sociodemographic data (2010 to 2014) for the food establishment neighborhoods by using linear and logistic regression. Results indicated that most of food entity types are significant predictors of risk violations. Among all the significant predictor food establishments, grocery stores (b = 2.877. p < 0.001) had a higher increase in violations. For the demographic variables, the only significant variable was the number of single parent households (B = .001, p = 0.022). The result reveals a significant association between food entity types and failing inspection (p < 0.005). Among all the entity types, convenience store with significant food service and/or packaged ice (22.2 %) have the highest percentage fail rate within inspection rate outcome. Findings indicate that a risk-based approach to food risk factor violations frequency could reduce the number of violations, particularly in convenience and grocery stores with the most violations and failing rate.
36
Schafer, D. Sue. "Environmental Scanning Behavior in Physical Therapy Private Practice Firms: its Relationship to the Level of Entrepreneurship and Legal Regulatory Environment." Thesis, University of North Texas, 1988. https://digital.library.unt.edu/ark:/67531/metadc331736/.
Full textAbstract:
This study examined the effects of entrepreneurship level and legal regulatory environment on environmental scanning in one component of the health services industry, private practice physical therapy. Two aspects of scanning served as dependent variables: (1) extent to which firms scrutinized six environmental sectors (competitor, customer, technological, regulatory, economic, social-political) and (2) frequency of information source use (human vs. written). Availability of information was a covariate for frequency of source use. Three levels of entrepreneurship were determined by scores on the Covin and Slevin (1986) entrepreneurship scale. Firms were placed in one of three legal regulatory categories according to the state in which the firm delivered services. A structured questionnaire was sent to 450 randomly selected members of the American Physical Therapy Association's Private Practice Section. Respondents were major decision makers, e.g., owners, chief executive officers. The sample was stratified according to three types of regulatory environment. A response rate of 75% was achieved (n = 318) with equal representation from each stratum. All questionnaire subscales exhibited high internal reliability and validity. The study used a 3x3 factorial design to analyze the data. Two multivariate analyses were conducted, one for each dependent variable set. Results indicated that "high" entrepreneurial level firms scanned the technological, competitor and customer environmental sectors to a significantly greater degree than "middle" or "low" level groups, regardless of type of legal regulatory environment. Also, "high" level firms were found to use human sources to a significantly greater degree than did lower level groups. Empirical evidence supporting Miles and Snow's (1978) proposition that "high" level entrepreneurial firms (prospectors) monitor a wider range of environmental conditions when compared to "low" level (defender) firms was presented. The results also confirmed that market and technological environments were scanned most often. Finally, the results added to the construct validity of the Covin and Slevin entrepreneurship scale and provided evidence of its generalizability to small businesses.
37
Meyers, Jacquelyn. "Elucidating Genetic and Environmental Influences on Alcohol-Related Phenotypes." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2830.
Full textAbstract:
Decades of work has led researchers to believe that risk for complex behavioral phenotypes, such as alcohol use disorders, is likely influenced by multiple genes of small effect acting in conjunction with each other and the environment. Currently, the field of psychiatric genetics is developing methodologies for the identification of genetic risk variants that predispose individuals to the development of complex behavioral disorders. Several challenges related to the complex and polygenic nature of these phenotypes, must be considered. This dissertation study attempts to address these important challenges in the context of alcohol use disorders and related phenotypes. A rich twin and family study literature has indicated that 40-70% of the variance in alcohol use disorders (AUDs) is influenced by genetics. Recent attempts to identify specific x genetic risk variants associated with AUDs have been met with limited success. Meanwhile, evidence of the moderating effects of the environment on AUDs has been mounting, providing a strong rationale for examining gene-environment interaction. In the following chapters several studies will be described that integrate established twin methodologies into gene identification projects in an effort to reduce heterogeneity (both phenotypic and genotypic), elucidate environmental constructs that moderate genetic influences, and to enhance statistical power to detect the subtle genetic influences on alcohol related phenotypes.
38
Tung, Ho-shan. "Development of analytical methodologies for the determination of metals and organic acids in environmental and traditional Chinese medicine studies by capillary electrophoresis." Hong Kong : University of Hong Kong, 2000. http://sunzi.lib.hku.hk/hkuto/record.jsp?B22424921.
Full text
39
Creech, Cody F. "Effects of Planting Date, Harvest Date, and Environmental Conditions on Germination of Forage Kochia Accessions." DigitalCommons@USU, 2012. https://digitalcommons.usu.edu/etd/1264.
Full textAbstract:
Forage kochia (Bassia prostrata, [L.] A. J. Scott) (Synonym = Kochia prostrata [L.] Schrad.) is a perennial semi-shrub that is valued for its forage quality and ability to restore degraded rangeland. However, establishment success of forage kochia plantings in western North America has been erratic. These failures leave the land vulnerable to erosion and invasion of undesirable plants. This research focused on the germination dynamics of forage kochia accessions as it relates to harvest date, planting date, age of seed, and environmental conditions. The effect of planting date, age of seed, and environmental conditions on forage kochia germination was elucidated by planting recently harvested (2010) and year-old, cold-stored seed (2009) monthly, during a four-month period at two locations. Two entries were tested, Immigrant, the standard subspecies virescens cultivar, and an experimental line, Sahsel, of subspecies grisea. Regardless of planting date, location, or age of seed, Sahsel exhibited higher germination percentages than Immigrant. The age of the seed lots used also significantly affected (P<0.05) the germination percentage. Field germination averaged over location and planting date of year-old Immigrant seed was 89.5% less than the current-year fresh seed, and similarly year-old Sahsel seed had 83.6% less germination than current-year seed. Although the two locations were subjected to very different weather patterns, the germination percentage of seeds at each location was not significantly different (P=0.3156). In the year we conducted our study (2011), the germination percentage from planting in February was significantly higher (P<0.05) than January, which was significantly higher (P<0.05) than both March and April. In the final set of trials, different harvest dates were tested by collecting seed in October, November, and December from seven forage kochia accessions. Measurements for total seed yield, 100-seed weight, and germination were collected from seed harvested each month. The month of harvest, accession, and month × accession interaction were significant (P<0.05) for each measurement in the study. Two accessions, Pustsel and KZ6Xsel, matured the earliest and had peak seed production at the October harvest (15.1 and 13.4 g plant-1, respectively). The remaining accessions had maximum yield and viable seed from the November harvest.
40
Caldwell, Lydia Kathleen. "The Influence of Acute Flotation-Restricted Environmental Stimulation Therapy on Recovery from High Intensity Resistance Exercise." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1574672585011734.
Full text
41
Ramage, Lindsay. "Expression of pro-inflammatory proteins in the lung epithelial cell line A549, in response to cytokine, and environmental particle exposure." Thesis, Edinburgh Napier University, 2003. http://researchrepository.napier.ac.uk/Output/2778.
Full textAbstract:
This thesis investigates the effects of various inflammatory stimuli, including cytokines and air pollution particles, on the expression and secretion of various proinflammatory proteins in the lung epithelial cell line A549. The pro-inflammatory proteins investigated were C-reactive protein (CRP), fibrinogen, and heat shock protein 70 (Hsp70), all of which are known to be produced during inflammation and are also known risk factors for cardiovascular disease. These proteins were investigated because inhalation of particulate air pollution has been associated with increased cardiovascular disease and mortality. The production of these proteins in the lung may be involved in a systemic inflammatory response which increases the plasma levels of these proteins and other cardiovascular risk factors therefore increasing the susceptibility for cardiovascular events. Alternatively, localised CRP functions as an opsonin, while fibrinogen and its degradation products are involved in the recruitment of neutrophils and leukocytes to the lung. Both CRP and fibrinogen are known to be produced in hepatocytes in response to cytokines. Chapter 3 investigates the effect of cytokine treatment of the A549 cells which shows that CRP and fibrinogen can be induced in this cell line by various cytokines. CRP was found to be induced by the cytokines ILI P, EL6, IL8, TNF(x and IFN7 with increased effects shown by simultaneous treatment with two cytokines. Fibrinogen was found to be induced mainly by IL6, but fibrinogen levels were also slightly increased by ILlp; simultaneous treatments of IL6 with either ILlP or TNF(x reduced the effect of IL6 treatment. Treatment of A549 cells with IL6 and IL8 simultaneously induced a synergistic effect. After establishing that cytokines induce the expression of CRP in A549 cells, the effects of particulate air pollution on pro-inflammatory protein expression were then investigated (chapter 4). The cells were treated with carbon black (CB), ultrafine CB (ufCB), and iron chloride (FeC13) to find out what effect these air pollution components and PM10 would have on the expression of CRP, fibrinogen, Hsp70 and the transcription factor NFKB and its inhibitor IKB. NFKB is known be activated by PM10 and is involved in the signalling of pro-inflammatory responses. All the particulate treatments induced a pro-inflammatory response with expression and secretion of CRP, fibrinogen, and Hsp70, whereas the soluble metal treatment had little effect. The metal salt FeC13w as used to treat the cells since it has been suggested that PM10 may mediate its effect through the presence of transition metals which are implicated in oxidant generation. The particulate exposures were also associated with the activation and nuclear translocation of NFKB indicating the involvement of NFKB and IxB in the induction of the pro-inflammatory response. Investigations into the mechanisms by which the particles induced the proinflammatory response are discussed in chapter 5. Firstly, investigations into the effect of particles on the secretion of the pro-inflammatory proteins were carried out; these indicated that particles were capable of inducing the secretion of CRP, flbrinogen and Hsp70. Investigations into the transcriptional mechanisms of proinflammatory protein expression were carried out using specific inhibitors. CRP and fibrinogen were induced in an NFKB dependent manner, while Hsp70 was produced as a result of activation of the JAK/STAT pathway. The effect of oxidative stress being induced as a result of particle exposure was investigated using antioxidants. This showed a reduction in the amount of intracellular and secreted CRP, fibrinogen and Hsp70 in the presence of antioxidants, indicating that oxidative stress was involved. This correlated with a reduction in the levels of intracellular ATP. Finally in chapter 6 the effects of proteins secreted from A549 cells on the monocytelike cell line MM6 were examined. This was carried out as a model of the effects of secreted pro-inflammatory proteins from the lung epithelium on other cells. It was found that CRP and fibrinogen were able to induce the activation of NFkB in MM6 cells, indicating that secretion of these proteins during lung inflammation could have an effect on other resident lung cells. Conditioned medium from A549 cells was also found to induce the expression of pro-inflammatory proteins including CRP, fibrinogen, Hsp70, IL6, IL8 and TNFcc. The A549 conditioned medium also appeared to induce a stress response and cellular damage in MM6 cells, thereby potentially exacerbating the inflammatory response. These results indicate that pro-inflammatory proteins can be produced in lung epithelial cells in response to particle exposure as a result of oxidative stress. They may be involved in the progression of localised lung inflammation and in the systemic response to particulate air pollution.
42
Lindgren, Torsten. "Cabin Air Quality in Commercial Aircraft : Exposure, Symptoms and Signs." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3462.
Full text
43
Forster, Markus. "One man’s medicine, another man’s poison : Environmental pollution from pharmaceutical manufacturing in Andhra Pradesh, potential sustainability measures and the role of Swedish actors." Thesis, Linköpings universitet, Tema vatten i natur och samhälle, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-106927.
Full textAbstract:
Outsourcing of pharmaceutical manufacturing processes from developed countries to emerging economies such as India and China, has become increasingly frequent during the last decade. Simultaneously, impacts and risks associated with pharmaceuticals in the environment, particularly from manufacturing of Active Pharmaceutical Ingredients (APIs), have gained recognition as major threats to sustainable development, locally (due to pollution of ground- and surface water) as well as globally (due to risks with antibiotic resistance development). The purpose with this study is to examine the pollution situation in two main locations for API manufacturing in Andhra Pradesh, and its challenges, as well as the eventual possibilities and barriers to improve the situation. Based on semi-structured interviews with local stakeholders from industry, government and NGOs, site observations and community visits in affected areas, as well as a literature review, a critical examination of the situation and its potential sustainability measures was made. Furthermore, the connection to- and role of Swedish actors were explored. The study finds that there are major institutional challenges rather than technological ones, obstructing substantial improvements from taking place. Potential possibilities for pollution abatement include local initiatives e.g. alternative regulatory approaches as well as initiatives by international actors, such as large procurers of pharmaceuticals e.g. the Swedish county councils, which with policy instruments such as Green Public Procurement (GPP), pro-active and internationally coordinated efforts, could contribute to an improved situation.
44
Hamann, Melissa M. "Integrative Environmental and Public Health Policy: The Case of Leishmania in Kenya’s Game Reserves." Miami University Honors Theses / OhioLINK, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=muhonors1115415504.
Full text
45
Olowokure, Babatunde. "The impact of Hib conjugate vaccine on the epidemiology of invasive Haemophilus influenzae disease in the West Midlands and the effect of deprivation and other environmental risk factors : an ecological study, 1990-1994." Thesis, University of Warwick, 1999. http://wrap.warwick.ac.uk/38287/.
Full textAbstract:
Objective: To describe the epidemiology of invasive Haemophilus influenzae (HI) disease, and to explore the relationship between socioeconomic disadvantage and invasive HI disease in the two years immediately before (October 1990 to September 1992), and following (October 1992 to September 1994) the introduction of HI type b (Hib) conjugate vaccine. Design: Multiple sources of case ascertainment were used to identify children with invasive HI disease in the West Midlands Health Region (WMHR) and compile a case register. An ecological study examined socioeconomic disadvantage using selected socioeconomic census data for enumeration districts, and the Townsend index of material deprivation. Setting: WMHR, England from October 1990 to September 1994. Subjects: Children under 5 years of age with invasive HI present on the West Midlands invasive HI case register (HICARE). Results : The incidence of invasive HI disease in the WMHR fell from 28.3/105 (95% CI=24.5 to 32.6) children <5 years of age in the pre-conjugate vaccine period to 5.4/105 (3.8 to 7.4) after the vaccine had been introduced. Nine vaccine failures were identified. Those aged 6-11 months were most at risk in the pre-conjugate vaccine period (OR=2.69,95% CI=1.14 to 6.55). In the post-conjugate vaccine period those aged 24-35 months were at most risk (OR=2.64,1.16 to 5.94). More cases of meningitis were identified in girls than boys but the difference was not statistically significant. Significantly more cases of invasive HI seen in children of South Asian origin aged less than 12 months than in non-South Asian children (OR=2.88,1.07 to 7.86). Children from affluent areas were at significantly reduced risk of disease compared to children from the more deprived areas (OR=0.73,0.54 to 0.99). In the second period of the study a number of significant risk factors were identified. Children living in areas containing predominantly rented accommodation (p=0.0025), mobile populations (p=0.013) and a low density of children aged <5 years per km2 (p=0.039) were at increased risk of invasive HI disease. Following meningitis, children from deprived areas were more likely to suffer sensorineural hearing loss (p=0.035). Case fatality was higher in the second period of the study, although not significantly so (OR=3.64,0.88 to 15.05). Conclusion: This four year study provides the first detailed account of the relationship between deprivation, , socioeconomic risk factors, ethnic group, and invasive HI disease in Britain. The incidence of the disease fell dramatically in the post-conjugate vaccine period. A number of socioeconomic risk factors were identified in the second period of the study. The data suggest that although Hib conjugate vaccine has greatly reduced the incidence of disease, children from deprived areas remain at greater risk than children in more affluent areas. They also indicate that the disease is still responsible for considerable sequelae and mortality.
46
Clauson, John. "Cryptococcus neoformans Serotype Groups Found in Clinical and Environmental Isolates." TopSCHOLAR®, 1993. http://digitalcommons.wku.edu/theses/1888.
Full textAbstract:
Cryptococcus neoformans is an encapsulated yeast responsible for severe meningoencephalitis. The importance of epidemiological studies on cryptococcosis has increased since the beginning of the AIDS epidemic. C. neoformans exists in two varieties containing four serotypes, C. neoformans var. neoformans (serotypes A and D) and C. neoformans var. gattii (serotypes B and C). Locally C. neoformans var. neoformans has been associated with pigeon feces during those months having an average temperature of 64.2°F j(17.8°C) and above. Clinical and environmental isolates of C. neoformans obtained from regional hospitals and environmental samplings, respectively, have been grouped into their variety status utilizing canavanine-glycine-bromthymol blue agar. Polyclonal antisera against C. neoformans serotypes A, B, C and D were isolated from challenged rabbits. Serotyping C. neofromans isolates using the polyclonal antisera resulted in 57% (20 of 35) of the serotypes confirmed with a direct immunofluorescent assay utilizing a single monoclonal antibody (E1). Data from the immunofluorescence assay suggest all C. neoformans obtained from regional hospitals (26 of 26) and those isolated from the environment (9 of 9) belong to the A serotype group. These data have provided information leading to the origin of infection for cryptococcosis in our region, which may be beneficial to immunocompromised individuals.
47
Pardue, Miranda Taylor. "Comparing Heatwave Related Mortality Data from Distressed Counties to Affluent Counties in Central and Southern Central Appalachia." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/honors/583.
Full textAbstract:
The Appalachian Mountains are home to some of the most culturally rich places in the United States, but also some of the most impoverished communities as well. Several recent events support climate change across the globe. It is expected that Appalachian communities may suffer more dire consequences, as many communities lack strategies to help relieve some of the worst effects of climate change. Heatwaves are predicted to increase in duration and frequency over time, and communities that are not well prepared for the damaging effects of heatwaves can suffer unduly. This study aims to quantify the likelihood that people living in economically distressed counties in the Central and Southern Central regions of Appalachia will face heatwave related mortality more intensely than those who live in more affluent counties in the same regions. Twelve counties from each socioeconomic group have been selected based on the county economic status to analyze climate and mortality data over thirty-eight years starting in 1981 and ending in 2018. Data was collected during the warm season for each county, May 1st to September 30th, and compared to the mortality data from the same county during the same warm season. This study used all-cause mortality numbers from each of the twenty-four counties for the mortality data. The relative risk for each county in both the distressed and affluent categories was calculated. The average relative risk for each socioeconomic status were then compared. The results of this study did not show statistical significance in the likelihood that being in a socioeconomically distressed county increases one's chances of succumbing to heatwave related mortality in the Central and Southern Central regions of Appalachia. More research with larger sample sizes and more attention paid to the factors driving socioeconomic status is needed to better assess the relationship of heatwave mortality to socioeconomic status.
48
Pierce, Katherine E. "The Effects of 53 Hours of Sleep Deprivation on the Thermoregulatory, Hormonal, Metabolic, and Cognitive Responses of Young Adult Males to Multiple Bouts of Acute Cold Exposure." Kent State University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=kent1227391359.
Full text
49
Roy, Senjooti. "Himalayan Older Adults' Views on Indigenous Medicine: Uses, Availability, and Effects on Health and Well-Being." Miami University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=miami1532695051816212.
Full text
50
Childress, Cynthia. "THE IMPACT OF WAR ON MILITARY HOSPITAL PERFORMANCE: A STUDY OF ORGANIZATIONS’ RESPONSE TO AN ENVIRONMENTAL JOLT." VCU Scholars Compass, 2013. https://scholarscompass.vcu.edu/etd/3171.
Full textAbstract:
The prolonged wars in Iraq and Afghanistan have taken a toll on the United States as a whole and the United States military in particular. The primary aim of this research is to determine what impact the wars in Iraq and Afghanistan have had on the performance of military hospitals over the fiscal years 2001-2006. Specifically, what direct effect has the war in Iraq and Afghanistan had on the productivity and quality of military hospitals, and, do productivity and quality trends differ based on hospital characteristics? Since observations over multiple time periods are nested within hospitals, multilevel mixed effects regression and Poisson regression models are used to evaluate changes in productivity and quality while accounting for differences within hospitals. Using a contingency theory framework, this study fills the gap in looking at the impact of war on permanent military hospitals’ productivity and quality using nationally developed and implemented quality indicators (Agency for Healthcare Quality and Research Inpatient Quality Indicators and Patient Safety Indicators). Structural characteristics of the hospital, teaching status and branch of Armed Service influenced productivity and certain quality indicators. The structural components were not able to reliably predict differences in productivity and all quality indicators, but overseas hospitals and non-teaching hospitals were most likely to differ from major teaching hospitals. The wars in Iraq and Afghanistan, denoted by the variables for wounded discharges and deployed staff, were only partially related to the productivity of military hospitals. Only an increase in the percentage of wounded discharges was related to productivity of military hospitals, and none were related to the quality indicators. In essence, the war affected the workload and productivity of military hospitals, but it did not affect the quality provided in the hospitals, as measured by AHRQ inpatient and patient safety quality indicators. Structural characteristics account for more of the variation in quality among military hospitals than the impact of war within the timeframe studied.