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Translating evidence into policy in low-income countries: lessons from co-trimoxazole preventive therapy
Hutchinson,Eleanor; Droti,Benson; Gibb,Diana; Chishinga,Nathaniel; Hoskins,Susan; Phiri,Sam; Parkhurst,Justin;
Bulletin of the World Health Organization , 2011, DOI: 10.1590/S0042-96862011000400015
Abstract: in the april 2010 issue of this journal, date et al. expressed concern over the slow scale-up in low-income settings of two therapies for the prevention of opportunistic infections in people living with the human immunodeficiency virus: co-trimoxazole prophylaxis and isoniazid preventive therapy. this short paper discusses the important ways in which policy analysis can be of use in understanding and explaining how and why certain evidence makes its way into policy and practice and what local factors influence this process. key lessons about policy development are drawn from the research evidence on co-trimoxazole prophylaxis, as such lessons may prove helpful to those who seek to influence the development of national policy on isoniazid preventive therapy and other treatments. researchers are encouraged to disseminate their findings in a manner that is clear, but they must also pay attention to how structural, institutional and political factors shape policy development and implementation. doing so will help them to understand and address the concerns raised by date et al. and other experts. mainstreaming policy analysis approaches that explain how local factors shape the uptake of research evidence can provide an additional tool for researchers who feel frustrated because their research findings have not made their way into policy and practice.
Understanding the correlations between wealth, poverty and human immunodeficiency virus infection in African countries
Parkhurst,Justin O;
Bulletin of the World Health Organization , 2010, DOI: 10.1590/S0042-96862010000700011
Abstract: objective: to investigate the relationships between the prevalence of human immunodeficiency virus (hiv) infection and underlying structural factors of poverty and wealth in several african countries. methods: a retrospective ecological comparison and trend analysis was conducted by reviewing data from demographic and health surveys, acquired immunodeficiency syndrome (aids) indicator surveys and national sero-behavioural surveys in 12 sub-saharan african countries with different estimated national incomes. published survey reports were included in the analysis if they contained hiv testing data and wealth quintile rankings. trends in the relation between gender-specific hiv prevalence and household wealth quintile were determined with the x2 test and compared across the 12 countries, and also within one country (the united republic of tanzania) at two points in time. findings: the relationship between the prevalence of hiv infection and household wealth quintile did not show consistent trends in all countries. in particular, rates of hiv infection in higher-income countries did not increase with wealth. tanzanian data further illustrate that the relationship between wealth and hiv infection can change over time in a given setting, with declining prevalence in wealthy groups occurring simultaneously with increasing prevalence in poorer women. conclusion: both wealth and poverty can lead to potentially risky or protective behaviours. to develop better-targeted hiv prevention interventions, the hiv community must recognize the multiple ways in which underlying structural factors can manifest themselves as risk in different settings and at different times. context-specific risks should be the targets of hiv prevention initiatives tailored to local factors.
Franz Baermann Steiner: Wegbereiter des Postkolonialismus
Isabella Parkhurst-Atger
Trajectoires , 2010,
Abstract: L’article présente Franz Baermann Steiner, un auteur d’exil juif des années trente encore peu connu. Dans le postcolonial turn auquel nous assistons aujourd’hui, par exemple dans l’Exilforschung, ce poète anthropologue devrait occuper une position-clef. Issu du milieu des juifs pragois et sioniste culturel convaincu, Steiner développe dès les années quarante, au sein de la British Social Anthropology,un discours aux accents postcoloniaux qui peut s’expliquer par la combinaison de son expérience pragoise de juif assimilé et de son appartenance à l’école d’anthropologie d’Oxford. Il existe en effet une analogie structurelle entre les fonctionnaires hybrides dans l’Empire britannique et les juifs pragois qui s’explique, d’une part, par leur statut d’altérité et, d’autre part, par leur position interstitielle à l’intérieur de leurs sociétés respectives. Les écrits de Steiner, où la méthode comparative et la critique de la langue et du langage tiennent une place importante, dénoncent l’eurocentrisme et développent une théorie qui anticipe par certains c tés la pensée d’Aimé Césaire, son contemporain. Tous deux postulent un lien entre les actes de violence perpétrés dans les colonies pendant l’esclavagisme, et le sort tragique des juifs européens durant le Troisième Reich . En outre, dans ses écrits scientifiques sur la notion de tabou, Steiner met à nu la violence épistémique des catégories comparatives de l’anthropologie du XIXe siècle. Il retrace le processus qui aboutit à cette violence en s’appuyant sur les cas des tabous polynésien et juif, pour finalement libérer le concept de tabou de toute connotation primitive et en faire un comportement d’évitement face au danger, commun à tous les hommes. Ainsi, son profil hybride, sa critique culturelle et ses recherches dans le domaine anthropologique font de lui un précurseur important du postcolonialisme. Im folgenden Artikel wird das Werk von Franz Baermann Steiner, einem kaum bekannten deutsch-jüdischen Exilautor der drei iger Jahre, vorgestellt. Im Rahmen des postcolonial turn der Exilforschung wird diesem Autor eine besondere Bedeutung zuteil. Als Prager Jude und überzeugter Kulturzionist hat Steiner in den vierziger Jahren innerhalb der britischen Sozialanthropologie einen Diskurs mit postkolonialen Akzenten entwickelt, der aus seiner Herkunft und aus seinen Forschungen am Oxforder Antrhopologieinstitut zu erkl ren ist. Tats chlich besteht eine strukturelle Analogie zwischen den Prager Juden und den hybriden Beamten im britischen Kolonialreich, die einerseits auf den Alterit tsstatus und anderersei
HIV prevention, structural change and social values: the need for an explicit normative approach
Justin O Parkhurst
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.3.17367
Abstract: Background: The fact that HIV prevention often deals with politicised sexual and drug taking behaviour is well known, but structural HIV prevention interventions in particular can involve alteration of social arrangements over which there may be further contested values at stake. As such, normative frameworks are required to inform HIV prevention decisions and avoid conflicts between social goals. Methods: This paper provides a conceptual review and discussion of the normative issues surrounding structural HIV prevention strategies. It applies political and ethical concepts to explore the contested nature of HIV planning and suggests conceptual frameworks to inform future structural HIV responses. Results: HIV prevention is an activity that cannot be pursued without making value judgements; it is inherently political. Appeals to health outcomes alone are insufficient when intervention strategies have broader social impacts, or when incidence reduction can be achieved at the expense of other social values such as freedom, equality, or economic growth. This is illustrated by the widespread unacceptability of forced isolation which may be efficacious in preventing spread of infectious agents, but conflicts with other social values. Conclusions: While no universal value system exists, the capability approach provides one potential framework to help overcome seeming contradictions or value trade-offs in structural HIV prevention approaches. However, even within the capability approach, valuations must still be made. Making normative values explicit in decision making processes is required to ensure transparency, accountability, and representativeness of the public interest, while ensuring structural HIV prevention efforts align with broader social development goals as well.
Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review
Marco Liverani, Benjamin Hawkins, Justin O. Parkhurst
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077404
Abstract: Background There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making. Methods We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review. Findings 56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies. Conclusions This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.
Psychology as an Associational Science: A Methodological Viewpoint  [PDF]
Sam S. Rakover
Open Journal of Philosophy (OJPP) , 2012, DOI: 10.4236/ojpp.2012.22023
Abstract: Unlike the sciences (physics), psychology has not developed in any of its areas (such as perception, learning, cognition) a top-theory like Newtonian theory, the theory of relativity, or quantum theory in physics. This difference is explained by a methodological discrepancy between the sciences and psychology, which centers on the measurement procedure: in psychology, measurement units similar to those in physics have not been discovered. Based on the arguments supporting this claim, a methodological distinction is made between the sciences and psychology as an associational science. It is suggested that that these two kinds of science generate two different classes of technologies. The possibility that in psychology there is a connection between the issue of measurement and the unsolved consciousness/brain problem is discussed.
A Case of Meningitis? What’s Your Diagnosis?  [PDF]
Pollach Gregor, Kampondeni Sam
Open Journal of Modern Neurosurgery (OJMN) , 2012, DOI: 10.4236/ojmn.2012.24014
Abstract: The five year old, somnolent girl from Mozambique with no medical history was presented with fever, neckstiffness, headaches, an almost complete paraplegia and a septic picture. Malaria parasites and HIV testing was negative. The lumbal puncture revealed staphylococcus. Subsequently a MRI scan showed no sign of meningitis but an extensive posterior epidural collection from C3 to the level of S1. Moreover it showed a vertebral osteomyelitis at L1. Bacteria in CSF were seen as an artefact and the child was treated by multilevel (purely) epidural punctures with drainage, rinsing and instillation of ceftriaxon. The epidural puncture proved acid fast bacilli in the pus, so that an anti-tuberculotic therapy was given. The child recovered quickly from sepsis and was able to walk several steps without help after three months.
The role of YY1 in reduced HP1α gene expression in invasive human breast cancer cells
Jason G Lieberthal, Marissa Kaminsky, Christopher N Parkhurst, Naoko Tanese
Breast Cancer Research , 2009, DOI: 10.1186/bcr2329
Abstract: We used transient transfection assays to investigate the mechanism of differential transcriptional activity of the human HP1α gene promoter in different cell lines. Mutational analysis of putative transcription factor binding sites in an HP1α gene reporter construct was performed to identify transcription factors responsible for the differential activity. SiRNA-mediated knockdown and chromatin immunoprecipitation experiments were performed to determine the role of a specific transcription factor in regulating the HP1α gene.The transcription factor yin yang 1 (YY1) was found to play a role in differential transcriptional activity of the HP1α gene. Examination of the YY1 protein and mRNA levels revealed that both were reduced in the invasive cell line HS578T compared with MCF7 cells. YY1 knockdown in MCF7 cells resulted in a decreased level of HP1α mRNA, indicating that YY1 positively regulates HP1α expression. Chromatin immunoprecipitation experiments verified YY1 occupancy at the HP1α gene promoter in MCF7 cells but not HS578T cells. Overexpression of YY1 in HS578T cells decreased cell migration in a manner independent of HP1α overexpression.Our data suggests that a reduction of YY1 expression in breast cancer cells could contribute to the acquisition of an invasive phenotype through increased cell migration as well as by reduced expression of HP1α.Heterochromatin protein 1 (HP1) was first identified in Drosophila as a non-histone component of chromatin [1]. Mutations in the HP1 gene resulted in suppression of position-effect variegation, a result that implicated HP1 in chromatin structure and gene expression [2]. Mutation of the gene encoding HP1 in Drosophila resulted in larval lethality [3]. Examination of HP1 mutant embryos revealed defects in chromosome segregation and telomere maintenance [4,5]. Therefore, HP1 is thought to play an essential role in heterochromatin-dependent processes in Drosophila. HP1 can also be found in certain euchromatic loci, implying i
A Potential Benefit of Albinism in Astyanax Cavefish: Downregulation of the oca2 Gene Increases Tyrosine and Catecholamine Levels as an Alternative to Melanin Synthesis
Helena Biland?ija, Li Ma, Amy Parkhurst, William R. Jeffery
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080823
Abstract: Albinism, the loss of melanin pigmentation, has evolved in a diverse variety of cave animals but the responsible evolutionary mechanisms are unknown. In Astyanax mexicanus, which has a pigmented surface dwelling form (surface fish) and several albino cave-dwelling forms (cavefish), albinism is caused by loss of function mutations in the oca2 gene, which operates during the first step of the melanin synthesis pathway. In addition to albinism, cavefish have evolved differences in behavior, including feeding and sleep, which are under the control of the catecholamine system. The catecholamine and melanin synthesis pathways diverge after beginning with the same substrate, L-tyrosine. Here we describe a novel relationship between the catecholamine and melanin synthesis pathways in Astyanax. Our results show significant increases in L-tyrosine, dopamine, and norepinephrine in pre-feeding larvae and adult brains of Pachón cavefish relative to surface fish. In addition, norepinephrine is elevated in cavefish adult kidneys, which contain the teleost homologs of catecholamine synthesizing adrenal cells. We further show that the oca2 gene is expressed during surface fish development but is downregulated in cavefish embryos. A key finding is that knockdown of oca2 expression in surface fish embryos delays the development of pigmented melanophores and simultaneously increases L-tyrosine and dopamine. We conclude that a potential evolutionary benefit of albinism in Astyanax cavefish may be to provide surplus L-tyrosine as a precursor for the elevated catecholamine synthesis pathway, which could be important for adaptation to the challenging cave environment.
心里发展与教育 , 1988,
Abstract: 近来有关同伴排斥行为基础的研究,强调把攻击性作为决定儿童在同伴团体中地位低下的一个因素.被排斥儿童有许多子群,除攻击性被研究过外,其它子群还没有得到研究.本文将讨论一个在中学进行的研究.它把被排斥的学生分成两组:一组为高攻击性组,另一组为易被驱使组.在研究中,我们使用了由asher、hymel和renshaw(1984)发展起来的测量孤独和社会不满(socialdissatisfaction)的方法.
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