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Dissertations / Theses on the topic 'Health gap'

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Published: 10 December 2022
Last updated: 28 January 2023

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1

Whitehead, Margaret. "Bridging the gap : working towards equity in health and health care /." Sundbyberg, 1997. http://diss.kib.ki.se/1997/19970926whit.

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2

Boehler, Christian Ernst Heinrich. "Mind the gap! : geographic transferability of economic evaluation in health." Thesis, Brunel University, 2013. http://bura.brunel.ac.uk/handle/2438/7170.

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Background: Transferring cost-effectiveness information between geographic domains offers the potential for more efficient use of analytical resources. However, it is difficult for decision-makers to know when they can rely on costeffectiveness evidence produced for another context. Objectives: This thesis explores the transferability of economic evaluation results produced for one geographic area to another location of interest, and develops an approach to identify factors to predict when this is appropriate. Methods: Multilevel statistical models were developed for the integration of published international costeffectiveness data to assess the impact of contextual effects on country-level; whilst controlling for baseline characteristics within, and across, a set of economic evaluation studies. Explanatory variables were derived from a list of factors suggested in the literature as possible constraints on the transferability of costeffectiveness evidence. The approach was illustrated using published estimates of the cost-effectiveness of statins for the primary and secondary prevention of cardiovascular disease from 67 studies and related to 23 geographic domains, together with covariates on data, study and country-level. Results: The proportion of variation at the country-level observed depends on the appropriate multilevel model structure and never exceeds 15% for incremental effects and 21% for incremental cost. Key sources of variability are patient and disease characteristics, intervention cost and a number of methodological characteristics defined on the data-level. There were fewer significant covariates on the study and country-levels. Conclusions: Analysis suggests that variability in cost-effectiveness data is primarily due to differences between studies, not countries. Further, comparing different models suggests that data from multinational studies severely underestimates country-level variability. Additional research is needed to test the robustness of these conclusions on other sets of cost-effectiveness data, to further explore the appropriate set of covariates, and to foster the development of multilevel statistical modelling for economic evaluation data in health.
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3

Samuelsson, Jonas. "Partner age gap and child health in Sub-Saharan Africa." Thesis, Stockholms universitet, Sociologiska institutionen, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-186304.

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This thesis explores the association between the age gap between parents and health outcomes for children in Sub-Saharan Africa. An average man-older age gap between partners has been observed all over the world and is the largest in many Sub-Saharan African countries. A large age gap is common in patriarchal societies and has been associated with less female autonomy and impeded decision-making for the couple, resulting in less contraceptive use and a possible higher risk of interpersonal violence. This thesis examines another association with age gaps by focusing on the health outcomes for children in families with large and small age gaps between the mother and her partner. It is hypothesized that children will have worse health outcomes in families where the age gap between the mother’s partner and the mother herself is larger than average. Using data from the Demographic and Health Surveys (DHS), multilevel logistic regression is run to test the association between three health indicators while controlling for confounding variables such as mother’s age, education level and wealth. The health indicators are treatment of fevers, vaccination against measles and underweight. The results show some statistically significant associations, with all three variables supporting the hypothesis that children in age heterogamous families are doing worse. Children of couples with a larger than average age gap have lower likelihood of being treated for fever or cough, and a higher likelihood of being underweight, and children of couples with a smaller than average age gap have a higher likelihood of having received the first measles vaccination. The results show that the age gap between parents is a factor to take into consideration when studying child health and family structures in Sub-Saharan Africa.
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4

Courtney, Claire. "The Pleasure Gap: Harnessing Pleasure to Increase Global Condom Use." Scholarship @ Claremont, 2014. http://scholarship.claremont.edu/scripps_theses/354.

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The state of global health and wellbeing is threatened by the pervasive and dangerous decision to engage in unprotected sex. Only male or female condoms can prevent the spread of both sexually transmitted infections and unintended pregnancies. Despite this, condoms remain dangerously underused because of the perception that they diminish sexual pleasure. The pleasure gap in the design and promotion of condoms cripples sexual health outcomes. Acknowledging and harnessing the power of pleasure in sexual-decision making is key to increasing condom use.
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5

McKenzie, Fiona G. "Health and environmental protection in international trade law : bridging the gap." Thesis, University of Edinburgh, 2005. http://hdl.handle.net/1842/24153.

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The international trading system has a role to play in ensuring that its primary objective of trade liberalisation does not come at the expense of environmental and health concerns. The goal of this thesis is to evaluate the efforts that have been made by the WTO to integrate environmental/health issues in the international trade system and to propose ways of achieving greater linkage between these areas by performing both a legal and economic analysis of the subject. The various ways in which linkage occurs in the WTO are analysed, in particular, through the exceptions to the most-favoured-nation standard contained in Article XX of the General Agreement on Tariffs and Trade, the Sanitary and Phytosanitary Agreement and Technical Barriers to Trade Agreement, scientific assessments, the acceptance of eco-labelling initiatives, the interpretation of WTO rules in the light of rules of public international law, the incorporation of environmental principles and overarching norms, as well as the coherence between the TWO and multilateral environmental agreements. The WTO’s legislative arm and the Dispute Settlement Body (DSB) are both crucial in providing coherence between environmental/health and free trade goals. It is argued, however, that linkage through the legislative arm would enable WTO members to retain more control over the WTO agreements and achieve the highest degree of coherence between environmental/health protection and free trade goals despite the fact that due to the high transaction costs of clarifying existing rules or devising new ones, linkage through the interpretations given by the DSB is a less burdensome way of filing the gaps of an incomplete contract. Although coherence between environmental/health and free trade goals can and should be increased, it is concluded that it would be unrealistic to expect that the international trading system achieve a degree of linkage that is acceptable to all WTO Members in all circumstances. In this respect, the question of whether Members should be able to maintain WTO inconsistent measures, if compensation is paid or if concessions are suspended or withdrawn is examined.
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6

Roberts, Max T. "Contributors to Wisconsin’s Persistent Black-White Gap in Life Expectancy." DigitalCommons@USU, 2017. https://digitalcommons.usu.edu/etd/6756.

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For decades, blacks have faced shorter life expectancy than their white counterparts. This persistent disparity has led to a gap in life expectancy between the two groups. Nationally, this gap has decreased over the last 40 years. However, this is not the case at the state-level as some states have experienced little or no improvement in the life expectancy gap. Such is the case in Wisconsin, where the life expectancy gap is the largest in the nation for males, and the gap actually has grown for females over the last two decades. This study seeks to examine this persistent gap in Wisconsin by looking at different causes of death and the ages when they contribute most to the gap. Additionally, this study will examine how the contribution of certain causes of death have changed over time, both between blacks and whites, and also within each group. Using 1999-2001 and 2009-2011 data from the National Center for Health Statistics, this study found that heart disease and malignant neoplasms (cancer) contributed most to the life expectancy gap between blacks and whites and also over time within each group. For females, diabetes and perinatal conditions were found to be top contributors to the black-white gap. Diabetes contributed most after the age of 50. For males, homicide was found to be a top contributor to the black-white gap, particularly among youth aged 15 to 29. Homicide among males frequently ranked near heart disease and malignant neoplasms as a leading contributor to the gap. These findings tell us that by reducing death rates from these causes at particular moments in the life course, the life expectancy gap between blacks and whites can be reduced. This study provides important evidence that health policy makers can use to address racial disparities in life expectancy.
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7

Bhandari, Ramjee. "Mind the gap : geographical inequalities in health during the age of austerity." Thesis, Durham University, 2018. http://etheses.dur.ac.uk/12803/.

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Background: Stockton-on-Tees has the highest geographical inequalities in health in England, with the life expectancy at birth gap between the most and deprived neighbourhoods standing at over 17 years for men and 11 years for women. It is well acknowledged that place can create inequalities in health but there is a debate within geographical research as to whether the health and wellbeing of an individual are determined by their own attributes (the compositional theory) or the political economy and environmental attributes of the area where they live (contextual approach). More recently, it has been argued that these determinants interact with each other, signifying that they are ‘mutually reinforcing’. Method This is one of the first studies that provides the detailed empirical examination of the geographical health divide by estimating the gap and trend in physical and general health (as measured by EQ5D, EQ5D-VAS and SF8PCS) between the most and least deprived areas. It uses a novel statistical technique to examine the causal role of compositional and contextual factors and their interaction during a time of economic recession and austerity. Using a longitudinal survey that recruited a stratified random sample, individual-level survey data was combined with secondary data sources and analysed using multi-level models with 95 percent confidence intervals obtained from nonparametric bootstrapping. In addition, trend analysis was performed to explore the role of austerity. Results The main findings indicate that there is a significant gap in health between the two areas, which remained constant throughout the study period, and that compositional level material factors, contextual factors and their interaction appear to explain this gap. Contrary to the dominant policy discourse in this area, individual behavioural and psychosocial factors did not make a significant contribution towards explaining health inequalities in the study area. Austerity measures are exacerbating inequalities in general and physical health by disproportionately impacting those in deprived areas. The findings are discussed in relation to geographical theories of health inequalities and the context of austerity. The study concludes by exploring the avenues for further research and key policy implications.
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8

Alatinga, Kennedy A. "Poverty and access to health care in Ghana: the challenge of bridging the equity gap with health insurance." Thesis, University of the Western Cape, 2014. http://hdl.handle.net/11394/3852.

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Philosophiae Doctor - PhD
This study addresses the issue of the low participation in or enrolment of the poor in Ghana’s National Health Insurance Scheme (NHIS). The low enrolment of the poor in the NHIS is attributed to the difficulty in identifying who qualifies for exemptions from paying health insurance premiums. In an attempt to address this problem, the purpose of this study was, therefore, to develop a model for identifying very poor households for health insurance premium exemptions in the Kassena-Nankana District of Northern Ghana in an effort to increase their access to equitable health care
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9

Jansen, Maria Wilhelmina Jacoba. "Mind the gap: collaboration between practice, policy and research in local public health." [Maastricht] : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=8851.

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10

Hoffer, Ga'bor. "Defining and exploring the gap in undertaking essential public health functions in Hungary." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.407385.

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11

Arnold, Kathryn. "The Clinical Scholar Model| A strategy to bridge the theory-practice gap." Thesis, Florida Atlantic University, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3571441.

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The purpose of this study was to evaluate student outcomes following implementation of a clinical scholar model of clinical education in one of four placement sites of a college of nursing grounded in a caring philosophy. The question guiding the study was to determine if the clinical scholar model has an influence on student perceptions and outcomes when used with second-degree accelerated BSN students.

Watson’s Human Caring theory, based on ten caritas processes, serves as the theoretical framework for this study (Watson, 2007). A sequential mixed-methods approach that combined quantitative and qualitative data collection techniques was implemented using a pre-experimental, post-test only design with non-equivalent groups to determine differences between the Traditional Model (TM) and Clinical Scholar Model (CSM) in clinical nursing education.

Participants in this study completed four scales to assess their perception of: 1) caring efficacy using the Caring Efficacy Scale (Coates, 1997), 2) clinical learning environment using the Student Evaluation of the Clinical Education Environment (Sand-Jecklin, 2009), 3) clinical faculty caring through the Nursing Students’ Perceptions of Instructor Caring (Wade & Kasper, 2006), and 4) socialization to the professional role, measured by the Lawler-Stone Health Care Professional Attitude Inventory (Lawler, 1988). T-tests were completed on data to determine differences between CSM and TM students on the scales. Additionally, a focus group of four CSM students was completed, transcribed and analyzed for qualitative themes.

There were no significant differences between CSM and TM students on caring efficacy, overall perceptions of the clinical learning environment, and overall socialization to the professional role. There were significant differences between scores on instructor facilitation of learning, perceptions of instructor caring, compassion, superordinate and impatience for change.

Limitations of this study include low sample size and are partially due to limitations of the class size and low survey participation. Additionally, only CSM students attended a focus group, which prevented comparisons of qualitative feedback between groups. Even with these limitations CSM students scored as well or better than TM students, indicating that the CSM could be a viable model for nursing clinical education.

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12

Richter, Sundberg Linda. "Mind the Gap : exploring evidence-based policymaking for improved preventive and mental health services in the Swedish health system." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118179.

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Background: The challenges in the utilization of scientific findings in the fields of prevention and mental health are well documented. Scholars have found significant gaps between the knowledge available and the knowledge applied in healthcare. Studies have suggested that about half of the patients receive the recommended care for their medical condition. In order to address this gap, health systems at global, national, regional and local levels have made diverse efforts to facilitate the uptake of research for example through evidence-based health policy processes. In Sweden, government agencies and health policy actors such as the National Board of Health and Welfare support and control the health care system through evidence-based policies amongst other steering tools. The overall aim of this thesis is to explore evidence-based policy processes, and to further understand barriers to implementation of policies in the fields of preventive and mental health services. Methods: A multiple case study approach was used, and data were collected from several sources. Qualitative content analysis methodology was used. Case 1 comprises the development and early implementation of national guidelines for methods of preventing disease managed by the National Board of Health and Welfare during 2007–2014. Case 2 covers the effort to improve health care for the older population that was undertaken through an agreement between the Swedish government and the Swedish Association of Local Authorities and Regions during 2009–2014. Case 3 involves an effort to implement an adapted version of a systematic review from the Swedish agency for health technology assessment and assessment of social services on treatment of depression in primary health care. Data was collected between 2007 and 2010. In Paper 1, the policies from Case 1 and 2 were studied using a longitudinal, comparative case study approach. Data were collected through interviews, documents and observations. A conceptual model was developed based on prior frameworks. The model was used to organize and analyse the data. In Paper 2, the guideline development process (Case 1) was studied through interviews and the collection of documents. A prior framework on guideline quality was used in order to organize the data. Paper 3 investigated decision-making processes during guideline development using a longitudinal approach. Qualitative data were collected from questionnaires, documents and observations and analysed using conventional and summative content analysis. In Paper 4, the barriers to implementation were investigated through interviews and the collection of documents. Data were analysed using qualitative content analysis with a conceptual model to structure the analysis. Results: The sources and procedures for policy formulation differed in Case 1 and 2, as did the approaches to promote the implementation of the policies. The policy processes were cyclical, and phases overlapped to a large degree. The policy actors intended to promote implementation, both during and after the policy formulation process. The thesis shows variation in how the key policy actors defined and used research evidence in the policy processes. In addition, other types of knowledge (e.g. politics, context, experience) served as alternative or multiple sources to inform the health policies. The composition of sources that informed the policies changed over time in Cases 1 and B. During the policy formulation and implementation process, efforts to integrate research evidence with clinical experiences and values were associated with tension and recurrent dilemmas. On the local level (i.e. primary health care centres), barriers to implementation were found related to the innovation and among health professionals, patients, in social networks as well as in the organizational, economic and political contexts. Conclusion: The concept of evidence holds a key position in terms of goals and means for knowledge based policymaking in the Swedish health system. Broad definitions of evidence – including research and non-research evidence - were requested and to various extents utilized by the policy actors in the studied cases. An explicit terminology and systematic, transparent methodology to define, identify, and assess also non-research evidence in policy processes would potentially strengthen the clarity and validity of these processes and also enhance policy implementation. Particular determinants to implementation, such as the interventions characteristic, are to a considerable degree established early in the policy process, during agenda setting and policy formulation. This early phase offers unique opportunities to assess and build capacity, initiate and facilitate implementation. Early analysis and considerations of target populations and contexts and other implementation determinants related to the specific policy scope (e.g. disease preventive guidelines) could enhance the forth-coming implementation of the policy.
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13

Tollman, Stephen M. "Closing the gap : applying health and socio-demographic surveillance to complex health transitions in South and sub-Saharan Africa." Doctoral thesis, Umeå : Epidemology and Public Health Sciences, Departmet of Public Health and Clinical Medicine, Umeå University, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1909.

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14

Yuan, Haige. "Essays on higher education and gender gap in investments in children's health and education." Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/43059.

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Chapter 1 addresses the observation that higher education participants from low socio-economic status (SES) backgrounds on average attend less competitive universities than their high SES peers. Taking advantage of a unique set of administrative data, which is linked to data reflecting SES measures for each student's postal code of residence, we are able to decompose observed differences in type of university attended. We find that the majority of the observed difference in the type of university attended can be attributed to the application stage: conditional on having the same predicted grades, low SES students apply to less competitive universities than do high SES students. Chapter 2 seeks answer to the question of how maternal years of schooling influence the gender gap in the nurture of children. Empirical results show that although parents believe that girls are capable of getting a higher score in exams than boys, and that girls are more conscientious about their school work, they invest more in boys' health and pay more for boys' education. The exciting bit of the results is that higher maternal education has the effect of narrowing the gender gap in postnatal health investment and education investment of children. Chapter 3 exploits the fact that Family Planning Policy only applies to Han people but that ethnic minority couples' fertility is not affected, to investigate how breastfeeding patterns with respect to gender and birth order differs across ethnic background. Empirical results indicate that legal control for family fertility greatly restrains breastfeeding for children in low parities, especially for girls, and exacerbate the gender gap in middle parity. These effects are most remarkable among large families.
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15

Cordell, Laura Michele Portune. "Bridging the Gap, Transitioning Vocalists from Academia to Career." The Ohio State University, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=osu1311268981.

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16

Ozano, K. A. "Mind the gap! : an investigation into the optimisation of public health skills, knowledge and practices of health workers in Cambodia." Thesis, Liverpool John Moores University, 2017. http://researchonline.ljmu.ac.uk/6975/.

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Universal health coverage (UHC) has been identified as a priority in the sustainable development goals (SDG3), but it is argued here that this is only possible if the health workforce is educated in, and values a public health approach at the primary health care (PHC) level. Encouraging community participation by developing a critical awareness of the social determinants of health and supporting communities to take action is needed. Community health workers (CHWs) have the potential to act as agents for social change to improve the health of rural communities if trained and supported appropriately. This study investigates the optimization of public health skills, knowledge and practices of health workers at the PHC level in rural Cambodia. It is anticipated that this study will afford new insights to inform stakeholders of the factors impacting on the development of public health workforce capacity. The research engaged twenty CHWs over two studies using a participatory action research approach. Over eight participatory workshops and a two-day training session CHWs identified (using photovoice), implemented and reflected on solutions to community health problems. In addition, ten semi-structured interviews were undertaken with key stakeholders from government and non-government organisations (NGOs) to gain an understanding of current methods used to develop the public health capacity of health workers in Cambodia. The public health skills gaps identified at provincial and community levels included planning, communication, community engagement techniques and using initiative to identify and implement solutions. These gaps are intrinsically linked to Cambodian social and political structures, and cultural values which promote a hierarchical working environment. In addition, aid dependency and a lack of ownership has created a new patronage which encourages further disempowerment and an apathetic approach to independently tackling community health issues. Fragmented public health training mainly directed by international agents and a lack of financial support to develop sustainable training, supervision and monitoring negatively impacts public health skill development. Health promotion and prevention training is provided to health facility workers, but there is a ‘know-do’ gap. They view their role as purely curative and removed from the community public health agenda, thus devaluing the application of new public health skills. The implementation of community participation policies in Cambodia is hindered by a reliance on external agencies and cultural norms of respect, obedience and fear of challenging the elite. The capacity for CHWs to act as agents of social change is unlikely given the current policy structure and implementing environment. The health workforce in Cambodia has the potential to contribute significantly to the goal of UHC, however factors affecting their desire and ability to implement a public health approach need addressing. Although many health systems are hierarchical in nature, the degree to which people can innovate, openly analyse processes and procedures and suggest solutions needs to be considered. Identifying ways of supporting CHWs to mobilise and enable communities to be empowered within the contextual environment is required, as is a better understanding of how to close the know-do gap in health facility workers.
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17

Liu, Chaojie (George), and c. liu@latrobe edu au. "Closing the gap between policy and reality: a study of community health services in Chengdu and Panzhihua." La Trobe University. Public Health, 2003. http://www.lib.latrobe.edu.au./thesis/public/adt-LTU20050303.102952.

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The development of community health services (CHS), characterised in particular by the emergence of general practitioners and the establishment of community health centres, is one of the top priorities on the policy agenda for urban health reform in China. The primary and secondary levels of hospitals are being urged to change functions, shifting from traditional hospital services to CHS. This study aimed to contribute to the development of training strategies for CHS through documenting the policy, administrative and institutional arrangements of the CHS programs, identifying performance problems, and analysing relevant determinants that underpin the practice and performance of CHS. Document analysis, indepth interview and questionnaire survey were adopted as main methodological approaches. The study was undertaken in Chengdu and Panzhihua, which included observation of 14 community health centres, interview with 23 general practitioners and managers, and a random sample survey among 1041 residents. This study revealed that the top priority of the CHS programs was to try to stay alive through competing with other health institutions for consumers who could afford medical charges and to provide clinical services that would generate good revenues. The accessibility to medical care for the community residents had not been improved significantly. Poor response to local population health issues, inefficient use of resources and poor quality of services were amongst the key performance problems. There was little prospect of the CHS institutions achieving sustainable development. There was a widespread agreement among the CHS managers and practitioners that training is an essential strategy in improving the CHS performance. However, when policy, system, and cultural barriers are not properly addressed, training means little. There were evident organisational failings and lack of inter-governmental collaborations and leaderships in developing CHS. The lack of policy coherence with respect to organisational incentives impeded the achievement of the goals of CHS. There was also a lack of consumer participation and support. These findings have implications for both policy development and training arrangements. The development of CHS needs to be considered as a system change rather than in terms of isolated institutional developments. Training arrangements for CHS need to offer competencies for a wide range of organisations and professionals to enable them to improve their daily works and also to contribute to solving some of the system problems. The training programs developed for governmental officials, hospital and CHS managers, general practitioners, community nurses, public health workers, pharmacists and other CHS practitioners need to be aligned with a unified goal and facilitate the development of the supportive environments and inter-organisational collaborations (partnerships).
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18

Liu, Chaojie. "Closing the gap between policy and reality : a study of community health services in Chengdu and Panzhihua /." Access full text, 2003. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050303.102952/index.html.

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19

Zeelie, Andrea. "Closing the gap: a review of factors affecting quality improvement interventions at the primary care level." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/14364.

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Objective: The aim of this review is to analyse quality improvement interventions at the primary care level. Quality improvement interventions attempt to close the gap between clinical research and practice. The objectives of this review are to identify, synthesise and evaluate research literature relevant to primary care regarding quality improvement interventions; as well as identify the enabling and constraining factors impacting quality improvement at the primary care level. Design: This review involved a qualitative, systematic review of previously undertaken qualitative research. Data sources: Data was sourced from electronic databases PubMed and CINAHL. Study selection: Articles were selected based on their relevance and published in English in an academic journal between June 2001 and June 2011, using qualitative data collection and analysis methods to assess a quality improvement intervention at the primary care level. Data extraction: Data was extracted from the articles' 'findings' and 'discussion' sections. Data synthesis: 110 articles were identified, 11 of which were included. Thematic analysis occurred in three stages: line-by-line coding, creation of descriptive themes, and creation of analytical themes. Conclusion: Interventions aimed at quality improvement in primary care do not experience uniform ease of implementation. It is possible to create the conditions necessary for success by harnessing human capital; creating a nurturing, supportive and collaborative working environment; and providing inspirational leadership through management.
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Carney, Caitlin. "Clinical Simulation Laboratories: Bridging the gap between academia and the private care hospital setting." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/honors/41.

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Many academic medical programs present students with the chance to experience scenario based learning. This is often achieved through the use of clinical simulation laboratories which utilize computer-based scenarios that realistically imitate the human body and how it responds to various situations. This interactive style of learning has proven to be successful at integrating theories taught in textbooks and practice gained through clinical experience without posing any harm to human patients. Literature has shown documentation of the effectiveness of using clinical simulation laboratories in both the academic and clinical setting; however, some clinical facilities have been slow to adapt the use of this technology. The purpose of this study was to determine what factors are deterring the use of clinical simulation labs for the purpose of continuing education in the hospital setting. The study was limited to the field of respiratory therapy. The study was conducted by sending surveys to respiratory therapists and administrators working in acute care facilities in the Northeast region of Tennessee and the Southwest region of Virginia. The surveys included various questions concerning knowledge and perceptions of clinical simulation labs. The surveys were coded using a modified Likert scale, and the data was input into SPSS Version 18.0. Sample t-tests were then run where appropriate. Therapists indicated a preference for learning through the use of clinical simulation labs as opposed to learning through textbooks alone. Administrators indicated a knowledge of the benefits of clinical simulation labs even though the majority are not currently using the technology in their facilities.
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21

Monaghan, Karen R. "Mind the gap| The integration of physical and mental healthcare in federally qualified health centers." Thesis, University of Massachusetts Boston, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=3706472.

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In the United States, approximately 50 percent of people experience mental illness during their lifetimes (Cunningham, 2009). However, previous studies estimate that up to 80 percent of people living with a mental illness do not access services (Mackenzie et al., 2007). While there are numerous explanations for such disparity, this study posited that stigma associated with mental illness is a significant contributory factor.

In an attempt to address the gap between prevalence of mental illness and access to services, the Patient Protection and Affordable Care Act (PPACA), 2010 (US Government Printing Office, (a) 2011) mandated that Federally Qualified Health Centers (FQHCs) integrate physical and mental healthcare. This research employed case study methods to examine the implementation of this federal policy in FQHCs, focusing on what role, if any, stigma plays in such implementation. Analyzing data obtained from in-depth interviews and direct observations at two case study sites, as well as key informant interviews, and background information, this research explores the following questions: Does stigma impact the implementation of mental health policy and affect access to treatment in FQHCs for people living with mental illness? And, if stigma does impact mental health policy implementation and access to mental healthcare in FQHCs, how does this occur?

Study findings include: multiple definitions of and approaches for integrating physical and mental healthcare; mental healthcare being subsumed into, rather than integrated with, the medical model; and institutional stigma persisting in the agencies studied, resulting in the reinforcement of exclusionary policies and practices and limited access to mental healthcare for FQHC patients.

Empirical findings inform a new theoretical framework that identifies the role of institutional stigma in mental health policy development and implementation in FQHCs. Policy recommendations include: the adoption of non-stigmatizing practices in FQHCs; the inclusion of a single clear definition of integration within enabling legislation; restructuring of mental healthcare funding streams to facilitate agencies' access to resources; and federally mandated reporting of mental health outcomes to improve FQHC accountability. These recommendations aim to promote the equitable implementation of integration policy within FQHCs and increase access to mental healthcare for those persons in need.

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22

Patel, Suraj Jagdish. "Identification of a gap junction communication pathway critical in innate immunity." Thesis, Massachusetts Institute of Technology, 2010. http://hdl.handle.net/1721.1/62520.

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Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2010.
Page 84 blank. Cataloged from PDF version of thesis.
Includes bibliographical references.
The innate immune system is the first line of host defense, and its ability to propagate antimicrobial and inflammatory signals from the cellular microenvironment to the tissue at-large is critical for survival. In a remarkably complex microenvironment, cells are constantly processing external cues, initiating convoluted intracellular signaling cascades, and interacting with neighboring cells to generate a global, unified response. At the onset of infection or sterile injury, individual cells sense danger or damage signals and elicit innate immune responses that spread from the challenged cells to surrounding cells, thereby establishing an overall inflammatory state. However, little is known about how these dynamic spatiotemporal responses unfold. Through the use GFP reporters, in vitro transplant coculture systems, and in vivo models of infection and sterile injury, this thesis describes identification of a gap junction intercellular communication pathway for amplifying immune and inflammatory responses, and demonstrates its importance in host innate immunity. The first section describes development of stable GFP reporters to study the spatiotemporal activation patterns of two key transcription factors in inflammation and innate immunity: Nuclear factor-KappaB (NFKB) and Interferon regulatory factor 3 (IRF3). Stimulation of NFKB-GFP reporters resulted in a spatially homogeneous pattern of activation, found to be largely mediated by paracrine action of the pro-inflammatory cytokine TNFa. In contrast, the activation of IRF3 was spatially heterogeneous, resulting in the formation of multicellular colonies of activated cells in an otherwise latent background. This pattern of activation was demonstrated to be dependent on cell-cell contact mediated communication between neighboring cells, and not on paracrine signaling. The second section describes the discovery of a gap junction intercellular communication pathway responsible for the formation of IRF3 active colonies in response to immune activation. Cell sorting and gene expression profiling revealed that the activated reporter colonies, collectively, serve as the major source of critical antimicrobial and inflammatory cytokines. Using in vitro transplant coculture systems, colony formation was found to be dependent on gap junction communication. Blocking gap junctions with genetic specificity severely compromised the innate immune system's ability to mount antiviral and inflammatory responses. The third section illustrates an application of the gap junction-induced amplification of innate immunity phenomenon in an animal model of sterile injury. Drug-induced liver injury was shown to be dependent on gap junction communication for amplifying sterile inflammatory signals. Mice deficient in hepatic gap junction protein connexin 32 (Cx32) were protected against liver damage, inflammation, and death in response to hepatotoxic drugs. Co-administration of a selective pharmacologic Cx32 inhibitor with hepatotoxic drugs significantly limited hepatocyte damage and sterile inflammation, and completely abrogated mortality. These finds suggests that co-formulation of gap junction inhibitors with hepatotoxic drugs may prevent liver failure in humans, and potentially limit other forms of sterile injury. In summary, this thesis demonstrates the development of novel tools for investigating the spatiotemporal dynamics of cellular responses, describes how these tools were utilized to discover a basic gap junction communication pathway critical in innate immunity, and provides evidence for the clinical relevance of this pathway in sterile inflammatory injury.
by Suraj Jagdish Patel.
Ph.D.
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23

Li, Zehua, and Dan Luo. "A Web- and App- Based Interaction System Bridging the Gap between Patients and Doctors." Thesis, Mittuniversitetet, Avdelningen för informations- och kommunikationssystem, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-22515.

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In modern society, people are lack of physical activity and have a poor eating habit. A sedentary lifestyle causes an increase of disease and death rate among European Union. Compared to the general population, people with Several Mental Illness(SMI) suffer more from poor health condition. Thus the project, as a part of the LIFEHOPE.EU, is established to ameliorate to this circumstances through encouraging people with SMI to regularly attend physical exercises and eat a balanced diet. However, most patients with SMI who participate in the program live in remote areas. It is inconvenient to hold face-to-face meetings with either doctors or group menmbers. Therefore, it is necessary to develop a system to solve this problem. The system contains an Android application for patients and an administrative website for doctors to keep contact with patients in order to monitor and assist patients' recovery. In this paper, the system is based on Apache Web Server and Android. How the functions of this system are created and realized will be  elaboratly introduced and illustrated. In addition, CakePHP framework applies in website development. After design and implementaion, tests will be run on both the the Android app and the website to evaluate security and performance.
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24

Sörlin, Ann. "Health and the elusive gender equality : Can the impact of gender equality on health be measured?" Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-46298.

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Background: All over the world men and women show different health patterns, and therecan be many and various reasons for these differences. This thesis therefore evaluates theimpact of gender equality on health. To do this, we must be able to measure gender equality.In this thesis, we develop two new measurements of gender equality and evaluate the relationshipbetween gender equality and health. Methods: Two cross-sectional studies, one register-based and one survey study, are used tocompare different measurements of gender equality and different measurements of health,and the relationship between them. Differences between men and women in relation to healthoutcome are also discussed in the thesis. The register study, comprising 1 097 202 individuals,is based on public registers and includes information on workplace, income, sickness absence,full-time/part-time work, level of education, parental leave and temporary parental leave.A gender equality measurement, the Organizational Gender Gap Index or OGGI, was constructedand 123 companies in two sectors were ranked using the index. Employees in 21 of the mostand least gender-equal companies were invited to participate in a survey. A second genderequality index was constructed based on respondents’ own reports regarding gender equalityin their partner relationship. The variables measured were income, full-time/part-time work,educational level, and responsibilities for and sharing of household duties and parental leave.Both indices were evaluated using the single question: How gender equal is your workplace/your relationship with your partner? The four measurements were dichotomized and testedfor a relationship to health. Health was measured by three different measurements: registerbasedsickness absence, self-reported sickness absence in the past year, and self-rated health. Results: The thesis has produced two new measurements of gender equality, described above.On gender equality in the partner relationship, we found a difference between men and women.Men perceive higher gender equality than they report, while women report more gender equalitythan they perceive. When it comes to gender equality at work, we found that employees perceivetheir company to be more gender equal than the OGGI index shows. This thesis confirms thefindings that men have better health than women regardless of measurement. However, inthis study we also found that increased gender equality decreases these differences. If employeesperceive their company to be gender equal, they have higher odds of rating their health asgood, and this is especially so for women. Conclusion: This thesis supports the hypothesis that differences in health between men andwomen can be related to a lack of gender equality. When men and women have differentpossibilities and power to shape society and their own lives, their health will be affected throughembodiment of both biological and sociological determinants in accordance with the eco-socialtheory. Increased gender equality will decrease the differences in health between men andwomen through convergence. The theory of convergence explains why men and women areaffected differently by greater gender equality. Greater gender equality will also decrease thesocial injustice between men and women and improve justice in accordance with the theoryof justice to gender.The differences found between the indices and the single question on perceived genderequality make clear the need for “hard facts” as an complement to people’s own views on gender equality.
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Crawford, Cecelia L. "Using a collaborative center for integrative reviews and evidence summaries to narrow the education-practice-research gap." Thesis, Western University of Health Sciences, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=3557774.

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The overarching purpose of this dissertation project was to design a collaborative center for integrative reviews and evidence summaries (CCIRES) to advance the state of the art and science of nursing knowledge and narrow the education-practice-research gap. The CCIRES program was created as a web-based platform embedded in the Kaiser Permanente Southern California infrastructure. The specific purpose of this project was to implement CCIRES via that infrastructure, and evaluate the implementation, structures, processes, and usability of CCIRES. The Diffusion of Innovations was the theoretical framework, as supported by the Model of Diffusion in Service Organizations and the Colorado Patient-Centered Interprofessional Evidence-Based Practice Model. These theoretical perspectives and models informed the structures and processes for the design, implementation, and evaluation of the CCIRES innovation. The literature captured the history of the education-practice-research gap and the use of translational research to support evidence-based nursing practice. A rigorous methodology involving formative and summative evaluation structured data collection and analyses. Four expert members of CCIRES comprised the sample targeted for voluntary participation in the SWOT web-based survey and construction of a logic model providing the data outcomes. NVIVO was the qualitative software program chosen for SWOT data storage and management. The SWOT analysis identified nine individual themes, with three themes spanning all categories and four themes populating four separate categories. These data results allowed deep examination of the essential core functions needed to achieve CCIRES' goals and succeed as a program. Group consensus during a webinar meeting was the data analysis technique for the construction of the 2012 CCIRES logic model. CCIRES members analyzed the alignment of multiple model components to understand the gaps, commonalities, and interrelated elements needed for a successful academic-service partnership program. Secondary outcomes included increased membership, website design, increased evidence review competencies, development of resources, and tool testing. CCIRES' goal of narrowing the education-practice-research gap facilitates the delivery of meaningful knowledge into the caring hands of professional nurses. CCIRES next bold step is to partner with other influential groups seeking to increase the breadth, depth, and rigor of the evidence. By heeding this call to action, CCIRES can translate, diffuse, and disseminate 21st Century nursing knowledge that has meaning for the two people who seek it and need it most—the nurse and the patient.

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Penney, Lauren. "Mind the Gap: The Dynamics and Work of Aging and Caring at Home." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/301552.

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In the United States, a growing proportion of the population is aged 65 and older. Associated with this demographic transition is a rise in the number of people who are aging with chronic disease. While there is a cultural ideal for older adults to remain in the community and out of institutional settings ("aging in place"), there is little recognition of the work and experience of trying to accomplish this. In the following papers, I draw on 12 months of ethnographic research in the Southwest US to describe the work of "aging in place." As a starting point, I use Medicare-funded home health care (HHC), which stands at the crossroads of acute-based institutional care and custodial, long-term care. In the first paper, using definitions of place from cultural geography, I explore the work of aging from the perspective of chronically ill older adult HHC users. I illustrate how bodies, practices, and places shift as processes of disease and medicalization inscribe them with risk, and the ways in which people accept, resist, and negotiate these changes. The second paper extends the work on audit culture to describe how Medicare's audit system has structured the organization and practice of HHC, and how this has reinforced the commodification of patients. I note how HHC nurses can draw on personal and professional logics in their documentation practices as a means of resisting rationalizing forces and opening up eligibility for care. The third paper uses case studies to push the literature on family caregiver burden to include the fraught, yet highly meaning-filled experience of caregiving. The cases show the difficulties and ambivalence in providing care to a chronically ill family member. Throughout these articles, underlying the tensions, uncertainties, and gaps I explore questions about what type of care is needed, who is worthy of care, and how responsibilities are distributed. I focus on how people's worlds and work are structured by larger scale social, cultural, and economic forces, and attend to the ways in which they reproduce, contend, and negotiate these forces from their unique positions, in effort to protect what they value.
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Frankovic, Ivan, and Michael Kuhn. "Access to health care, medical progress and the emergence of the longevity gap: A general equilibrium analysis." Elsevier, 2019. http://dx.doi.org/10.1016/j.jeoa.2019.01.002.

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We study skill- and income-related differences in the access to health care as drivers of longevity inequality from a theoretical life-cycle as well as from a macroeconomic perspective. To do so, we develop an overlapping generations model populated by heterogeneous agents subject to endogenous mortality. We model two groups of individuals for whom differences in skills translate into differences in income and in the ability to use medical technology effectively in curbing mortality. We derive the skill- and age-specific individual demand for health care based on the value of life, the level of medical technology and the market prices. Calibrating the model to the development of the US economy and the longevity gap between the skilled and unskilled, we study the impact of rising effectiveness of medical care in improving individual health and examine how disparities in health care utilisation and mortality emerge as a consequence. In so doing, we explore the role of skill-biased earnings growth, skill-bias in the ability to access state-of-the art health care and to use it effectively, and skill-related differences in health insurance coverage. We pay attention to the macroeconomic feedback, especially to medical price inflation. Our findings indicate that skill-bias related to the effectiveness of health care explains a large part of the increase in the longevity with earnings-related differences in the utilisation of health care taking second place. Both channels tend to be reinforced by medical progress.
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Cooper, S. "Prising open the black box : the production of knowledge on the mental health 'treatment gap' in Africa." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2531621/.

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In this research I surface the epistemological assumptions underpinning thinking on the apparent high numbers of people with mental illness in Africa not receiving care, known as the ‘treatment gap’. I thus prise open the ‘black box’ of this knowledge, scrutinising its underlying meaning codes and capillaries of power. I explore knowledge produced on the ‘treatment gap’ at three different sites: 1) Mental health research in Africa published over the last decade; 2) National mental health policies of 14 African countries; 3) Narratives of 28 psychiatrists all working in public mental health care provision in South Africa, Uganda, Ethiopia or Nigeria. For my analysis I develop a theoretical toolbox which draws on concepts from two broad and multidisciplinary fields, namely Science and Technology Studies (STS) and Postcolonial Studies. What emerged was that knowledge on the ‘gap’ in mental health care is deeply inserted within the episteme of European Colonial Modernity, and thus saturated with Eurocentric tendencies. In particular, two paradigms are playing a fundamental role, those of evidence-based science (including biomedicine) and human rights. I destabilise the inevitability of these paradigms by putting them in historical perspective, and shedding light on the many questionable certainties and binary oppositions upon which they are based. I show how they have become the gatekeepers of knowledge, ultimately occluding ‘other’ ways of knowing which are based upon alternative epistemological codes. The somewhat singular voice of scholarly authority was, however, at times softened by certain quieter and more marginalised voices. These suggested avenues out of which more decolonised, ‘Africa-focused’ models of scholarship might potentially grow. To sum up, I surface particular tensions and hold them up to the light, with the hope of disturbing certain intellectual reflexes and creating a space for potential alternatives. Ultimately, this might help foster different sorts of conversations on the ‘treatment gap’ from those created by current seats of power.
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29

Choden, Phuntsho. "Gender gap in household investment : a study on Bhutan." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/52725/1/Phuntsho_Choden_Thesis.pdf.

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Differing parental considerations for girls and boys in households are perceived as one of the primary causes of the gender gap in school enrolment and educational attainment in developing countries, particularly in the countries in Sub-Saharan Africa and South Asia. While there are a number of studies on the gender gap focusing on education and health provision in the countries in South Asia, little is known about Bhutan. This thesis aims to explore the gender gap in the intra-household allocation of resources on schooling and health provision for children in Bhutan. This thesis investigates whether boys are shown preference by their parents in terms of educational opportunities, including enrolment and spending on schooling as well as health. To conduct examination, this study makes use of household data from the Bhutan Living Standard Survey of 2007. Using cross-sectional as well as household fixed and random effect approaches, this study attempts to analyse the gender gap in allocation of resources across households as well as within households. The analysis includes characteristics of children and households such as gender and age of children, family wealth, education and gender of household head, number of dependents and the area of residence. The findings reveal a significant gender gap in schooling of children aged six to sixteen in Bhutan. However, no robust evidence of a gender gap has been found in the allocation of health expenditure on children aged less than sixteen. Policy recommendations to alleviate the gender bias in educational opportunities of females are proposed.
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30

Delshad, Meti Jennifer, and Mariam Abbas. "Sexuell hälsa och kardiovaskulära sjukdomar – “A Silent Gap”. : - en kvantitativ litteraturöversikt." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-47489.

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Background: Cardiovascular disease (CVD) are some of the most common illnesses globally. It has been proven that there is a connection between CVD and sexual concerns. Patients sexual health is a fundamental factor and should be provided with proper care from a nursing perspective. Aim: To describe factors that influence the nurse’s work on sexual health for patients with cardiovascular disease. Method: A quantitative literature review with an inductive approach was implemented and based on 13 scientific articles. Results: The analysis resulted in two main themes; “The nurses’ perspective affects” and “Organizational obstacles affects” that are followed by six subthemes; “Attitudes, beliefs and emotions”, “Experience, knowledge and education”, “Responsibility”, “Patients’ gender and age”, “Guidelines and routines” and lastly “Lack of time and prioritizing”. Conclusion: Based on nurses globally, there should be a development of the area sexual health among patients with CVD. There are several obstacles that persuades the area into being secluded. Negative attitudes, incompetence, prejudice and organizational barriers are some of the common mentioned difficulties.
Bakgrund: Kardiovaskulära sjukdomar är några av de vanligaste sjukdomarna runtom i världen. Det är påvisat att det finns en koppling mellan kardiovaskulära sjukdomar och sexuell ohälsa. Den sexuella hälsan är en väsentlig del av individens liv och bör behandlas med respekt utifrån sjuksköterskans ansvarsområde. Syfte: Att beskriva faktorer som påverkar sjuksköterskans arbete med sexuell hälsa för patienter med kardiovaskulär sjukdom. Metod: En kvantitativ litteraturöversikt med induktiv ansats sammanställdes utifrån 13 vetenskapliga artiklar. Resultat: Analysen resulterade i två huvudteman; “Sjuksköterskans perspektiv påverkar” och “Organisatoriska hinder påverkar” som följs av sex subteman; ”Attityder, värderingar och känslor”, “Erfarenhet, kunskap och utbildning”, “Ansvar”, “Patientens ålder och kön”, “Riktlinjer och rutiner” samt “Tidsbrist och prioritering”. Slutsats: Baserat på sjuksköterskor globalt, bör det ske en utveckling kring området sexuell hälsa hos patienter med kardiovaskulära sjukdomar. Det finns flera hinder i arbetet som leder till att området hamnat i skymundan. Negativa attityder, inkompetens, fördomar och organisationsrelaterade faktorer är några av de barriärer som framkommer bland sjuksköterskor.
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31

Enochs, Shannon. "Bridging the Gap between Emotional Trauma Practice Guidelines and Care Delivery in the Primary Care Setting." Thesis, Brandman University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13428017.

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When patients present with complaints of anxiety or depression, providers in the primary care setting often prescribe anxiolytics or antidepressants without conducting an early emotional trauma or adverse childhood experiences assessment. Several studies demonstrate the link between early emotional trauma (EET) or adverse childhood experiences (ACEs) and the increased risk of anxiety or depression as adults. This Clinical Scholarly Project (CSP) implemented the use of the Adverse Childhood Experience (ACE) Questionnaire with patients who had a diagnosis of anxiety or depression in the primary care setting to increase patient access to resources and align clinical practice with practice guidelines. Participants included eight primary care providers, 30 patients and 21 chart review patients. The CSP utilized a quasi-experimental design to determine if the use of the ACE Questionnaire by patients with anxiety or depression would result in patients receiving more community resources (to include counseling), strengthen the provider-patient relationship, increase provider comfort in discussing ACEs with their patients and result in patients receiving care that was evidence based. Patient sample participants received significantly more resources (M = 8.27, SD = 2.27) than the chart audit sample (M = 0.90, SD = 0.30). Patient sample members received an average of eight resources (M = 8.27) and utilized an average of five resources (M = 5.07). Use of the ACE Questionnaire resulted in more trust in provider-patient relationship by patients (80.0%) and the majority of the provider sample more comfortable discussing ACEs after the project (85.7%).

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Gretak, Leal Alyssa P. "A Gap Analysis of Reentry Services for Corrections-Involved Populations in Rural East Tennessee." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3954.

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Returning citizens face a host of barriers when attempting to reintegrate into society; thus, services for these concerns are imperative for successful reintegration. Unfortunately, services are often lacking, particularly in rural communities which tend to be overlooked in reentry research. In order to better determine service need for justice-involved populations in rural communities, the current study completed a gap analysis, both inspired and supplemented, by qualitative information collected from mental health providers (MHPs) in a rural Appalachian region of Tennessee. To complete the gap analysis, an estimation of need was collected via local crime statistics. Using this data, a two-sample t-test revealed that increased rurality was related to a significantly higher percentage of substance use related crimes, but not to crimes against persons or sexual crimes. Service availability data was then collected for local providers in the domains of general mental health, substance abuse, anger management (or anger management aligned), and sex offender treatment. It was found that nine of the ten counties in the identified region are considered mental health professional shortage areas (MHPSAs) for general mental health care. Using average caseload data from local MHPs, a calculation of provider shortfall was completed for specialty services for returning citizens. For the identified 10-county region, provider shortfalls were existent in all treatment domains. The largest gap identified was for anger management aligned services, while the smallest gap identified was for sex offender treatment services. An increase in rurality did not ensure an increased provider shortfall across domains. Overall, MPHs in the area identified similar needs in treatment services via two major qualitative themes and five subthemes. The findings from the current study provide a specific example of what services are missing for rural returning citizens. It is hoped that the results of this study help inform policy and programming efforts in rural communities as they attempt to close the service gap and successfully reintegrate rural returning citizens.
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Oberoi, Pankaj. "In vivo physiology of gap junctions between supporting cells in the organ of Corti." Thesis, Massachusetts Institute of Technology, 1999. http://hdl.handle.net/1721.1/85264.

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Thesis (Ph.D.)--Harvard--Massachusetts Institute of Technology Division of Health Sciences and Technology, February 1999.
Includes bibliographical references (p. 188-195).
by Pankaj Oberoi.
Ph.D.
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34

He, Dingsheng. "Connexins 40 and 43 form heteromeric gap junction channels in vascular smooth muscle cells." Diss., The University of Arizona, 1999. http://hdl.handle.net/10150/284991.

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Gap junction channels connect the cytoplasms of adjacent cells and provide a pathway for the exchange of materials between cells. The nature of the materials exchanged is determined by the biophysical characteristics of the channels. The functional gap junction channel is composed of paired hemichannels (connexons) from each cell. Connexons are hexamers of protein subunits called connexins (Cx). Of the 15 connexin genes found in the mammalian genome, the products of only two, Cx40 and Cx43 have been localized in vascular smooth muscle cells (SMC) (1;2). We have been interested in identifying the role of gap junctions in cardiac rhythmic activity and vascular function. Like many other cell types, mammalian heart and blood vessels express multiple gap junction connexins (3). These connexins may form heteromeric channels. A7r5 cells, a cell line derived from embryonic rat aortic smooth muscle cells, provide a good model because they express both connexins 40 and 43. From the previous studies in this laboratory, Moore and Burt reported the presence of channels with a wide range of unitary conductance with major peaks at 75, 110 and 145 pS. One explanation for the wide range of unitary conductance could be the presence of heteromeric Cx40 and Cx43 channels. Thus, the goal of this study was to investigate gating behaviors of gap junction channels in A7r5 cells to determine whether heteromeric Cx40/43 channels are formed. I will demonstrate that Cx40 and Cx43 form heteromeric channels with unique unitary conductances, voltage-dependent gating properties and enhanced sensitivity to halothane induced closure.
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35

Henry, Jade Vu. "Theorising the design-reality gap in ICTD : matters of care in mobile learning for Kenyan community health workers." Thesis, University College London (University of London), 2018. http://discovery.ucl.ac.uk/10058036/.

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This thesis examines the sociomaterial relations of "design practice" in order to advance new perspectives on success and failure in Information and Communication Technology for Development (ICTD). I conduct an ethnographic case study of an academic research intervention and update the widely-cited theory of design-reality gaps (Heeks, 2002). Using methods from classic actor-network theory and post-structural material-semiotic tools, the analysis: 1) disentangles the entwined sociomaterial practices around design, production, and use of technology; and 2) integrates these insights into more elaborate conceptualisations of gaps, sustainability, scalability, and project failure. In doing so, my study answers the research question: What are the sociomaterial relations of "design practice" in a globally-distributed, multi-stakeholder, and technologicallymediated ICTD project for poverty alleviation? My research narrative describes how an array of humans and non-humans participated as designers in a transnational, interdisciplinary Participatory Action Research project to train Kenyan health workers using mobile phones. At least six different patterns of sociomaterial relations operated through a given set of people and things, enacting the material-discursive apparatuses (Barad, 1998) of educational research, healthcare, the market, the state, and the local community. I assert that in this Participatory Action Research project for mobile learning, the design-reality gap was not so much a matter of geographic or socio-cultural divides, but was instead constituted as fluid space (Mol, 2002) separating the educational researchers' designerly practices from the multiplicity of ways in which health workers, mobile phones, and other actors lived in relation to one another. I conclude that these ontological politics enacted design as an empirical matter of care - an affective and morally-charged sociomaterial practice with an ethico-political commitment to the marginalised (Puig de la Bellacasa, 2011). I therefore present a conceptual model of success and failure in participatory ICTD projects that explicitly incorporates the affective and material dimensions of care, and conceptualises social justice - not solely in terms of universal claims or global standards - but as embodied, sociomaterial enactments.
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36

Ren, Xiaoyuan S. M. (Xiaoyuan Charlene) Massachusetts Institute of Technology. "Mining the gap : pathways towards an integrated water, sanitation and health framework for outbreak control in rural India." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/111396.

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Thesis: S.M. in Technology and Policy, Massachusetts Institute of Technology, School of Engineering, Institute for Data, Systems, and Society, Technology and Policy Program, 2017.
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 173-176).
The scientific connection between sanitation, water quality and health is well established. However, in the present Indian scenario, monitoring and governance of the three sectors is handled separately. At present, the need to integrate sanitation, water quality, and health is felt during waterborne disease outbreaks such as large-scale diarrhea, typhoid or cholera. Despite the general interest shown for a cross-sector integrated framework in outbreak control, numerous administrative and technical gaps exist preventing the implementation of this framework. This study attempts to address these implementation barriers through the analysis of governing institutions and data integration of large public databases for the selected districts of Gujarat, India. Interagency collaboration barrier is analyzed through a comprehensive institutional analysis on the water, sanitation and health monitoring sectors. The lack of administrative incentive due to the narrow definition of monitoring targets is identified as the primary barrier for collaboration. Districts that already achieved 100% open-defecation-free status are identified as key entry points for potential pilot implementation of an integrated framework. National Informatics Center and Water and Sanitation Management Organization (WASMO) are considered key nodal points for building channels of interagency connections. Data integration and utilization barriers are analyzed through habitation-level matching of the 3 separate monitoring databases - namely, Swatch Bharat Mission (SBM) database for sanitation, Integrated Management Information System (IMIS) database for rural drinking water quality and Integrated Disease Surveillance Programme (IDSP) for outbreak data. The most critical data barrier is the discrepancy between administrative units across the databases, resulting in 25% mismatched habitation data and variables with 30% contradictory data entries. Quality concerns over inconsistent and missing data are also raised, especially for data collected by grassroots workers. A decision support model based on the integrated database is constructed through a Driver-Pressure- State-Exposure-Effect-Action (DPSEEA) framework. A significant correlation is observed between chains connecting sanitation initiatives and water quality. Significant risk factors associated with outbreak occurrence cannot be identified at the current stage. Even though implementing this model is within reach, and doing so promises to offer an efficient tool for integrated governance of the three sectors, incomplete datasets is currently the key barrier to a comprehensive assessment of model effectiveness.
by Xiaoyuan "Charlene" Ren.
S.M. in Technology and Policy
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Wang, Yunmei. "Bridging the medical knowledge and practice gap: antecedents of successful scientist-physician collaboration." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1396616643.

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38

Saleh, Mahvash. "A collaborative model to assist in bridging the gap between nursing education and nursing service in Iran." Thesis, Glasgow Caledonian University, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241883.

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Anderson, LaKesha Nichole. "Bridging the Gap between Medical Science and Communication: An Interpretive Analysis of Messages Portrayed on Endometriosis Websites." [Johnson City, Tenn. : East Tennessee State University], 2004. http://etd-submit.etsu.edu/etd/theses/available/etd-0329104-223652/unrestricted/AndersonN041204.pdf.

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Thesis (M.A.)--East Tennessee State University, 2004.
Title from electronic submission form. ETSU ETD database URN: etd-0329104-223652. Includes bibliographical references. Also available via Internet at the UMI web site.
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Abrams, Widdicombe Aimee Samantha. "State-Provided Paid Family Leave and the Gender Wage Gap." Scholarship @ Claremont, 2016. http://scholarship.claremont.edu/scripps_theses/792.

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The U.S. is the only OECD country that does not offer any form of federal paid parental leave. Only three states—California, New Jersey and Rhode Island—have state paid parental leave policies; implemented in 2004, 2009 and 2014, respectively. Through descriptive statistics and a regression analysis of women and men’s wages in those three states, before and after the implementation of the policies, we assess the effects of paid leave programs on the gender wage gaps in those states. Our results show us that California’s paid family leave policy had greater effects on decreasing the gender wage gap than the policies in New Jersey and Rhode Island. In addition, our regression analysis shows us that women of childbearing age (19-45 years) saw an increase in their wages after the policy implementations, while men of childbearing age saw a decrease in their wages. This led us to the conclusion that paid family leave policies may be effective in decreasing the gender wage gap; however it is problematic that men’s wages decreased, implying that the policies may not be totally welfare optimizing. However, we came to an important conclusion that will hopefully entice more states and the federal government to implement policies to better support working parents.
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Diamond-Caravella, Monica L. Diamond-Caravella. "Reopening a Dialog on Open Airways for Schools: Closing the Educational Gap Using a Multi-Site Academic-Practice Partnership." Case Western Reserve University Doctor of Nursing Practice / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=casednp1512210590712455.

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Molnar, Frank J. "The development of "clinically sensible" tools to screen for cognitive impairment in community-dwelling elderly persons. Bridging the gap between research and clinical practice by balancing discriminant ability vs. practicality." Thesis, University of Ottawa (Canada), 2001. http://hdl.handle.net/10393/9434.

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Background. Despite its prevalence and clinical relevance, cognitive impairment typically remains undetected in 50% of cases. Objective. To develop clinically sensible (quick, simple, acceptable), accurate and readily recalled screens for cognitive impairment based on easily reproducible analytic strategies. Methods. The Canadian Study of Health and Aging (CSHA-1) served as the derivation data set. 3MS cognitive screening questions which were judged as most likely to be employed by busy clinicians and which were significantly associated (via chi2 analysis) with cognitive impairment were selected as independent variables for multivariate analysis. The screening tests derived from logistic regression and recursive partitioning analyses which most closely approximated the sensitivity and specificity of the entire 3MS were externally validated. Results. Two logistic regression based scales and two recursive partitioning algorithms demonstrated sensitivities and specificities approaching those of the complete 3MS (approximately 80% and 60% respectively). The sensitivity was superior to that of the MMSE. Conclusion. Readily reproducible multivariate analysis based strategies can be developed which generate practical screening tests with psychometric properties approaching those of the 3MS. Given the existence of verification bias, these screens as well as screens with higher sensitivity and lower specificity must be validated prospectively before they can be clinically employed.
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Kołtowska-Häggström, Maria. "Quality of Life in Adult Patients with Growth Hormone Deficiency : Bridging the gap between clinical evaluation and health economic assessment." Doctoral thesis, Uppsala University, Department of Pharmacy, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8353.

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The goals of this thesis are to evaluate quality of life (QoL) in adult patients with growth hormone deficiency (GHD) in relation to population normative data, to construct a preference-weighted index (utility) from a disease-specific QoL measure and to assess it in a clinical context.

The study included samples from the general population and patients with GHD from four European populations: England & Wales, the Netherlands, Spain and Sweden. The country-specific patient cohorts were retrieved from KIMS (Pfizer International Metabolic Database).

A questionnaire was developed that contained items from existing QoL questionnaires including, among others, Quality of Life Assessment in Growth Hormone Deficiency in Adults (QoL-AGHDA) and the EQ-5D. The QoL-AGHDA is a disease-specific measure for use in adults with GHD. The EQ-5D is a generic instrument which describes health states for which country-specific preference-based weights are available. Thus, it was possible to generate preference-weighted indices (utilities) based on data generated by both instruments.

This thesis reports QoL-AGHDA normative values for the populations of England & Wales, the Netherlands, Spain and Sweden, and confirms the extent of QoL impairment in patients with GHD in comparison with the general population. Long-term GH replacement resulted in sustained improvements in overall QoL towards normative country-specific values, as well in most of the dimensions that were impaired before treatment.

For use in health economic evaluations, models for generating utilities (QoL-AGHDAutility) from QoL-AGHDA were developed. It is believed that these models may facilitate medical decision making, given that they provide a tool for obtaining utilities in the absence of directly collected preference-weighted indices.

QoL-AGHDAutility effectively monitored treatment effects in patients with GHD. Moreover, this study confirmed a QoL-AGHDAutility deficit before treatment and a gain after starting GH replacement.

The novel aspect of the present approach was to apply preference-weighted indices derived from a disease-specific measure to assess QoL in the clinical context, together with patient demographic and clinical characteristics. The robustness of this analysis is reinforced by the fact that utilities in both general and patient populations were generated using the same methodology.

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Kołtowska-Häggström, Maria. "Quality of life in adult patients with growth hormone deficiency : bridging the gap between clinical evaluation and health economic assessment /." Uppsala : Acta Universitatis Upsaliensis, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8353.

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Njozing, Barnabas N. "Bridging the Gap : implementing tuberculosis and HIV/AIDS collaborative activities in the Northwest Region of Cameroon." Doctoral thesis, Umeå universitet, Institutionen för folkhälsa och klinisk medicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-43847.

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Introduction The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV. Methods The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration. Results The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials Conclusion TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal.
Introduction L’épidémie du virus de l’immunodéficience humaine (VIH) a conduit à une augmentation globale  de la tuberculose(TB), particulièrement dans les régions à forte prévalence du VIH. Il y’avait par le passé un manque de coordination tant sur le plan mondial que national, des programmes de lutte contre la TB et le VIH pour freiner les effets dévastateurs liés à la co-infection des deux pathogènes. Cependant, l’initiative pilote “ProTEST”  conduite en 1997 en Afrique sub-saharienne  a démontré que les programmes de lutte contre le VIH et la TB pouvaient collaborer avec succès en combinant leurs services. Cette étude pilote a inévitablement incité a un changement de politique du bureau intérimaire a l’Organisation Mondiale de la Santé (OMS), de lutte contre le VIH/TB  à mettre sur pieds en 2004 des objectifs pour la réduction de l’impact du VIH/TB parmi les populations atteintes des deux infections. Cette thèse explore comment la collaboration entre les activités des programmes  de lutte VIH/TB a été établie au Cameroun, et comment son application se fait  dans la région du nord ouest. Il est également mis en exergue et les réalisations les difficultés que rencontrent les services combinés lors de la dispensation des soins aux malades de TB avec une coïnfection au VIH. Méthodes L’étude a été faite dans la région du nord ouest, une des 10 régions du Cameroun, avec le taux de prévalence au VIH le plus élevé. L’étude utilise le système de recherche en santé combinant des méthodes qualitatives et quantitatives pour explorer les objectifs de la recherche. Les méthodes qualitatives ont été utilisées pour enregistrer les données suivantes: i) centre offrant les services combinés; les personnes en charge au niveau central, régional, et des districts, qui sont responsables de l’intégration au processus et qui d’autre part veillent a ce que les malades de TB bénéficient des services du VIH ; et ii) les malades de TB qui considèrent le dépistage du VIH  comme porte d’entrée dans les services VIH. Des méthodes quantitatives ont été utilisées  pour confirmer  l’accès des malades de TB aux soins de services VIH offerts par la collaboration. Résultats L’étude a démontré que bien qu’il y ait  plusieurs niveaux de collaborations entre les programmes de VIH et TB depuis le sommet jusqu’ à la base du  système de santé, la provision de services combinés  est faisable. Malgré les difficultés rencontrées par les malades de TB pour avoir accès au dépistage du VIH, l’application en somme de la collaboration des activités entre les programmes de VIH et de TB a augmenté l’acceptation et l’accessibilité des malades de TB aux services de VIH. Ceci fut facilité par l’amélioration de la coopération au niveau des opérations des deux programmes permettant ainsi  la facilitation de l’établissement d’une alliance entre le personnel de soin et le patient, alliance qui fut primordiale dans l’élaboration du rapport de confiance que le malade doit avoir à l’endroit du system de santé. La collaboration a également conduit  à un travail d’équipe et une formation croisée entre les équipes des deux programmes, il a été également établi une amélioration du réseau d’échange entre les personnels de soins et toutes personnes actives dans le secteur du VIH et TB.    Néanmoins, il a été relevé des défis dans le système de santé telle une insuffisance dans le leadership et la gestion de fréquente interruption dans la chaine de distribution des médicaments essentiels et du matériel de laboratoire. Conclusion La collaboration des activités des programmes VIH/TB a amélioré la qualité des soins et services  avec pour résultante une meilleure accessibilité des malades de TB aux services de VIH. Néanmoins, une conduite appropriée qui garantie une planification mixte, une évaluation et un suivi des activités essentielles, ainsi qu’une gestion fiable a tous les niveaux du système de santé est indispensable. Outre, les difficultés liées au système de santé identifiées par cette étude et qui méritent une évaluation, du fait  qu’elles pourraient affecter négativement l’application effective du but recherché et la collaboration durable entre les deux services.
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Munodawafa, Memory Nyasha Lynnette. "Filling the gap: development and qualitative process evaluation of a task sharing psycho-social counselling intervention for perinatal depression in Khayelitsha, South Africa." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29776.

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Perinatal depression is a major public health issue which contributes significantly to the global burden of disease, especially in low resource settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. Task sharing of psycho-social interventions for perinatal depression has been shown to be feasible, acceptable and effective in low and middle-income countries. However; there are limited data on process evaluations of task shared interventions for perinatal depression. This thesis attempts to address this gap by presenting four papers based on a study that undertook a qualitative process evaluation on a task shared psycho-social intervention. The thesis integrates all the papers under one primary aim (a process evaluation) which triangulated data from four sources which were published literature, perspectives of local depressed women, and perspectives of the counsellors in the trial and recipients of the intervention in the trial. The thesis will be presented in six chapters. The first chapter provides a background with current issues in global mental health, psycho-social interventions, task sharing in low and middle income countries and the United Kingdom (UK) Medical Research Council (MRC) framework for developing and evaluating interventions. A second chapter presents a systematic review on qualitative evidence of process evaluations of task sharing interventions for perinatal depression in LAMICs in relation to the UK MRC framework for conducting process evaluations. The systematic review reveals a paucity of qualitative evidence of process evaluations together with several crucial factors related to context, implementation and mechanisms of an intervention including: content and understandability, counsellors facilitating trust and motivation to conduct the intervention and participant factors such as motivation to attend the sessions and willingness to learn and change their behaviour. The third chapter provides information on development of the intervention and determining the feasibility in line with the MRC framework. Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa. The feasibility study showed that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that a clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual. The fourth chapter, presents the first of two perspectives of the post-intervention qualitative process evaluations, with lay counsellors. Post intervention qualitative semi-structured interviews were conducted with six counsellors from the AFrica Focus on Intervention Research for Mental Health (AFFIRM-SA) randomized controlled trial on their perceptions of delivering a task shared psycho-social intervention for perinatal depression. These interviews revealed that facilitating factors in the delivery of the intervention included intervention related factors such as: the content of the intervention, ongoing training and supervision, using a counselling manual, conducting counselling sessions in the local language (isiXhosa) and fidelity to the manual. Counsellor factors including counsellors’ confidence and motivation to conduct the sessions and participant factors included older age, commitment and a desire to be helped. Barriers included contextual factors such as poverty, crime and lack of space to conduct counselling sessions and participant factors such as the nature of the participant’s problem, younger age, and avoidance of contact with counsellors. Fidelity ratings and dropout rates varied substantially between counsellors. The fifth chapter presents the second of two perspectives of post intervention qualitative process evaluation with participants. Stratified purposeful sampling based on non-attendance, partial attendance and complete attendance of the intervention resulted in 34 participants being selected for semi-structured interviews. All interviews were recorded, transcribed and translated. Transcripts were analysed using a framework analysis in NVivo v11. Several factors acted as either barriers or facilitators of the participants’ context, mechanisms of the intervention and the implementation of the intervention. Contextual factors included the nature of problem such as unplanned pregnancy, interpersonal difficulties and location of the counselling. Mechanisms included participant factors such as willingness to learn new skills and change behaviour, counsellor factors such as motivation and empathy and intervention factors such as the content of the intervention. Implementation factors included the perception of the use or inability to use material such as the counselling manual, homework book and relaxation CD. The majority of the participants found the following sessions to be most valuable; “psycho-education for depression”, “problem solving” and “healthy thinking”, although a few participants did not have good recall of the sessions. The final chapter presents a discussion of key findings together with their implications for researchers, policy makers and other stakeholders. The chapter concludes with recommendations for future research in order to understand the contextual, participant, counsellor and intervention factors involved in the implementation of task sharing interventions.
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Bjärntoft, Sofie. "Uppfattningar kring hälsofrämjande ledarskap : En mixad studie om jämförelsen mellan första linjens chefers och medarbetares uppfattning av hälsofrämjande ledarskapsaspekter och dess relation till medarbetarnas välbefinnande." Thesis, Högskolan i Gävle, Avdelningen för arbets- och folkhälsovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-21737.

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Ledarskap har visat sig vara en utav de viktigaste faktorerna för att främja hälsa i arbetslivet. Tidigare forskning betonar att ett hälsofrämjande ledarskap där chefen bland annat är engagerad i de anställdas arbete och tillåter inflytande i beslutstagande ökar medarbetarnas trivsel och välbefinnande i arbetet, samt kan minska risken för sjukskrivning. Det är dock inte alltid chefen når ut med alla delar av sitt ledarskap, vilket kan resultera i ett ”gap” mellan chefens och medarbetarnas uppfattning. Medarbetarna kan då bli omotiverade i arbetet, vilket påverkar såväl individens välbefinnande som företagets och samhällets ekonomi. Syftet med denna studie var att utifrån begreppet hälsofrämjande ledarskap undersöka hur första linjens chefer på ett kommunalt helägt aktiebolag inom energisektorn uppfattade sitt eget ledarskap i jämförelse med medarbetarnas uppfattning av ledarskapet, samt om detta relaterade till medarbetarnas välbefinnande i arbetet. Denna studie är en fördjupning av ett tidigare projekt, GodA och är baserad på tvärsnitts design där både kvantitativa och kvalitativa metoder användes. För att jämföra chefens och medarbetarnas uppfattning av ledarskap användes ett urval av enkätfrågor från GodA. Chefens värdering av sitt ledaskap utifrån hälsofrämjande aspekter undersöktes genom semistrukturerade intervjuer. Resultatet visade att det fanns en bred uppfattning kring innebörden av ett hälsofrämjande ledarskap hos cheferna. De upplevde även en viss svårighet i rollen som första linjens chef. Jämförelsen mellan chefens och medarbetarnas uppfattning av ledarskapet resulterade i ett gap, då hälften av grupperna hade en signifikant skillnad. Det fanns även en positiv signifikant korrelation mellan gapet och medarbetarnas välbefinnande, där en större skillnad resulterade i sämre välbefinnande. Då tidigare forskning visat att chefer ofta överskattar sitt ledarskap och att ett gap kan påverka medarbetarnas välbefinnande, är det viktigt att vidare undersöka vad skillnaden kan bero på och hur gapet kan minskas. Det är även relevant att skapa en tydlig definition av ett hälsofrämjande ledarskap i syfte att utveckla hälsofrämjande strategier i arbetet.
Aim: Based on the concept of health promotion leadership, the purpose is to examine how the first-line managers perceive their own leadership in comparison to employees' perceptions of the leadership, and whether this relates to employee well-being at work. Methods: This study is a recess of the project GodA and it’s based on a cross-sectional design with both quantitative and qualitative methods. To make a comparison between managers and employees perception of leadership, a selection of survey questions from GodA was used. The manager’s valuation of the health promotive leadership aspects were examined through semi-structured interviews. Main results: The results shows that there was a wide perception of health promotive leadership among managers. Although it can be interpreted that the managers work from the health promoting leadership aspects, there was a gap between the manager and employee perception of leadership. In half of the groups there was a significant difference. There was also a positive significant correlation between gap and employee well-being, then a larger gap resulted in a lower estimated well-being. Summary: Previous research shows that managers often overrate their leadership and a gap can affect employee well-being. It is therefore important to further investigate what the differences between the manager and the employees can depend on and how the gap can be reduced. It is also important to create a clear definition of a health promotive leadership in order to develop health promotion strategies at work.
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Adams, Ubanesia Lolita. "Reinterpreting the implementation gap : a case based analysis of District Health System implementation in the Western Cape Province in South Africa." Thesis, University of Sussex, 2011. http://sro.sussex.ac.uk/id/eprint/6921/.

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This dissertation examined an implementation gap through a case study on implementing a District Health System (DHS) in the Western Cape Province of South Africa between October 2001 and April 2006. The research project explored why this implementation gap existed and what could be learnt about public policy implementation from studying this implementation gap. The main data collection methods included interviews, public and other documents and observations on the public health system in the Western Cape Province. I argue that implementation gaps could be interpreted as a signal of policy change instead of implementation failure. The key finding is that the Provincial Government of the Western Cape shifted its intentions regarding DHS implementation. The initial intention was to decentralise primary health care services to a metropolitan municipality. The decision, which was actively implemented, however centralised these services within the provincial government and started the process of the provincialisation of personal primary health care services in the Western Cape Province. This dissertation contributes to public policy implementation and public policy process literatures. It demonstrates why policy change is an alternative interpretation of implementation gaps to implementation failure and how policy change occurs during implementation. Policy change and public policy implementation are commonly two separate research themes within Public Policy Studies. The persuasion framework developed through this research project is an analytical tool that may be applied in research on implementation processes to examine whether an implementation gap is signalling policy change. The central theoretical elements in this framework that link policy change and implementation processes are the interactive effects of ideas and interests and the role of argument as a persuading factor that leads to policy change. The dissertation emphasises the role of language in public policy processes and argument and persuasion were deemed important elements in public policy processes.
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Phan, Vernon Truong. "The Ras-GAP proteins Ira2 and neurofibromin are negatively regulated by ubiquitin-associated proteins Gpb1 in yeast and ETEA/UBXD8 in human cells." Diss., Search in ProQuest Dissertations & Theses. UC Only, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3297797.

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SWAISGOOD, ERIN K. "A STUDY OF THE RANDOM GAP DETECTION TEST-A TEST USED TO IDENTIFY DISORDERS OF AUDITORY TIMING." University of Cincinnati / OhioLINK, 2001. http://rave.ohiolink.edu/etdc/view?acc_num=ucin990633500.

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