Thesis. 1979. Ph.D.--Massachusetts Institute of Technology. Dept. of Economics. / Bibliography: leaves 331-348. / Ph.D.

Over the past decade, a significant shift has taken place in British drug policy. The publication of the 2010 drug strategy shifted the primary focus of treatment away from attracting and retaining drug users in services, towards encouraging individuals to complete and exit treatment in 'recovery'. The introduction of the recovery agenda emerged alongside widespread reform to the public health system and during a period of sustained economic downturn that has witnessed the introduction of pervasive austerity measures by successive UK governments. With the reorientation towards recovery in this climate, important questions have been raised over the shape of drug treatment provision on the ground. However, despite much speculation, there remains a lack of empirical research in this area. This thesis presents a qualitative, exploratory study of the impact of the shift to recovery in two local authorities in the north of England. Through a total of 36 semi-structured interviews with drug treatment commissioners, staff and service users, this research provides an original contribution to the field by demonstrating the impact of the shift to recovery on local level policy and practice during a time of reform and economic austerity. It is argued that cuts to funding and changes to the commissioning of drug treatment services have created a highly competitive treatment system in which the success of providers is measured primarily through their ability to record successful completions of drug treatment. This has generated perverse incentives within the sector, giving rise to risky practices performed by treatment providers in the aim of demonstrating success. It is argued that these developments are best understood as the manifestation of neoliberal notions of competition, risk, choice and responsibility at the level of practice. This thesis concludes by offering important policy and practice recommendations.

More than 80 per cent of wastewater from human activities is discharged into the rivers or sea without any pollution removal, and the Sustainable Development Goals (SDGs) aim to halve this proportion and increase recycling and reuse globally by 2030. Treatment plants in Sub-Saharan Africa often fail due to lack of operating funds, poor regulation and poor design that does not take into account human factors. The failure of treatment plants can also be put down partly to the funding structures for management, which are often dependent on the disposal tariffs charged. Without sufficient regulation and enforcement, which is often lacking in Sub-Saharan Africa, this often leads to illegal disposal of faecal sludge. Due to the nutrient content and energy potential of wastewater, there is increasing focus on reuse of faecal sludge in ways that can contribute funds for maintenance and incentivise good management of treatment facilities. This research investigates potential designs for the re-use of faecal sludge in small cities in Sub-Saharan Africa to ensure proper treatment. Conducting two case studies using qualitative and quantitative methods, the research looks at the potential for re-use to be scaled up in Sunyani, Ghana and Mzuzu, Malawi, and whether different designs can ensure good management. Building upon the research investigation into how previous designs have failed in case studies, the research also investigates the use of agent-based modelling (ABM) as a modelling approach to explore social and technical aspects of sanitation systems to predict how different designs and management approaches can work. In Sunyani, biogas was the most acceptable option to customers whilst also providing a good business model to fund faecal sludge treatment, either as a decentralised system at public toilets where the fresh sludge is better for biogas production, or centrally at the existing disposal site. The success of biogas as a model that can fund maintenance and ensure good management would depend on the faecal sludge quality of public toilet sludge in the city and the investment level required and how any operating approach would work between the government and private sector. In Mzuzu, two main approaches to faecal sludge re-use exist currently: the implementation of Skyloos as above ground household toilets which provide compost, and a central disposal site from which compost is illegally harvested. At disposal, farmers remove sludge from the ponds and apply it untreated directly onto agricultural land. At times, private sector emptying services do not use the ponds, but also apply untreated sludge to agricultural land. Skyloos were found to have varying levels of success from different Non- Governmental Organisation (NGO) projects, with key sustainability issues being the availability of financing mechanisms, management between landlords and tenants and the trust of and engagement with implementing organisations. Existing approaches to waste management and re-use were found to be inaccessible and not working when implemented for the poorest and people with disabilities. Adopting re-use of faecal sludge in agriculture in Malawi would require improved marketing of sanitation options, financing options for households to incentivize adopting the technology, not targeting to poorest households and people with disabilities, and an improved management model for the treatment site to ensure safe disposal and production of compost. Looking at ABM as a way of modelling faecal sludge treatment systems in Sub- Saharan Africa, two models of different approaches in Mzuzu were developed to look at scaling up Skyloo toilets and managing the treatment plant. Both models demonstrate the potential of ABM to incorporate social and technical aspects into predicting the performance of different designs and approaches. The success and use of modelling depends on the quality of data that can be collected before implementing system approaches. Overall the thesis presents different models of treatment and re-use that can work and contribute to operating and maintenance of systems. It is unlikely that any design system will be so profitable that the treatment and re-use of sludge will be able to ensure good management without regulation, so the success of designs depends on relationships between the government and private sector and households in small cities.

Distal radius fracture is a common injury. The majority of people recover well but a proportion have ongoing pain, stiffness, deformity and functional limitation. Associations between these outcomes, injury characteristics and treatment methods are inconsistent, for example a deformed wrist is not always painful, stiff and functionally limiting. The psychological response to fracture and the role that psychological factors play in recovery are complex and poorly understood. Identification and treatment of those psychological factors that might influence disability and symptom intensity could improve outcomes in this large group of patients. The aim of this thesis is to explore the influence of psychological factors on outcome following fracture of the distal radius. To investigate these relationships further a literature review was carried out looking at the association between psychological factors and outcomes in distal radius fracture patients. Prospective studies were then performed in order to identify associations between demographic factors, injury severity, treatment and psychosocial factors and symptom intensity and disability after fracture and to identify predictors of psychological response to injury. A prospective randomised controlled trail (RCT) was then carried out to compare the impact of an additional psychological workbook intervention versus an information workbook in the otherwise routine management of distal radius fracture. The literature review identified evidence to support the association between psychological factors and outcome after acute injury in general but limited evidence specifically pertaining to distal radius fracture. The first prospective study of 216 patients found psychosocial factors to be more strongly associated with disability (Disability of Arm Shoulder and Hand score, DASH) and pain intensity after distal radius fracture than any injury or treatment factor. The second prospective study of 153 patients found that psychological traits are relatively stable in this cohort and that no demographic, injury or treatment factors were associated with the small changes in psychological scores up to 10 weeks following injury. The RCT demonstrated that use of a psychological workbook did not significantly improve disability six weeks after injury compared to an information workbook in a cohort of patients with distal radius fracture (DASH 38 vs 35, p = 0.949). The importance of psychosocial factors in recovery from distal radius fracture has been demonstrated. Following this injury, psychological factors remain stable over time or fluctuate to a small degree with distinct trends. In cohorts with stable psychological responses to fracture, the individual psychological response cannot be reliably predicted by demographic, injury or treatment factors. Use of a psychological workbook intervention does not improve outcomes in patients with a good initial psychological response to injury. Future work should investigate less psychologically stable and well adapted cohorts, establish how best to identify patients at risk of poor outcome and whether, indeed, these specific groups are amenable to treatment and if so what form this intervention should take. It should address limitations identified in this work, primarily, reduce questionnaire fatigue with more focused psychological questionnaires. Ultimately, it should work towards creating a structure where patients can be screened with a recognised psychological scoring system at initial presentation to fracture clinic and allow a sub-group of psychologically mal-adpted patients to be referred on to a dedicated psychology service, that would work to optimise the psychological conditions for recovery.

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Reading Recovery is a first-grade literacy intervention program with notable short-term benefits, but there are sustainability studies that highlight inconclusive evidence of its enduring success. It was unclear if formerly enrolled Reading Recovery students continue to have long-term literacy skill retention after exiting the literacy intervention. The problem was essential to this rural district because Reading Recovery was costly to implement, and the literacy standardized test scores remained low. The purpose of this quantitative study was to determine if formerly enrolled Reading Recovery students had sustainable literacy skills. The theoretical framework was the literacy processing theory, which entails how emergent learners develop literacy processing systems. The research question was to determine if there was a significant difference in the Indiana Statewide Testing for Educational Progress standardized test scores between the 73 formerly enrolled and 38 nonenrolled students. The independent variable was enrollment in Reading Recovery, and the dependent variable was ISTEP+ standardized literacy scores. The independent sample t-test results showed no statistically significant difference in ISTEP+ standardized literacy scores. The results were the basis for the creation of the 3-day professional development training for educators in grades 2 and 3. The training will promote positive social change since it will support the continued literacy progress of formerly enrolled Reading Recovery students. Students with solid literacy skills will have better future employment opportunities and higher social engagement in American society.

Magister Artium (Development Studies) - MA(DVS) / A prepaid water metering project was implemented in various high density suburbs around the city of Harare in 2015 with the intention of spreading the project throughout the whole country. It was anticipated that the use of prepaid water meters as a water management device would improve the social, health, hygiene and general well-being of the poor households in the Sunningdale high density suburb. This study will investigate the social implications that were caused by the use of prepaid water meters as a tool for water management among poor households in this high density suburbs. The impact of prepaid water meter technology has been felt by water consumers in Sunningdale who have shared their experiences and attitudes towards this recently introduced innovation in water service delivery within Harare high density suburbs. The study examines the implications of using prepaid water meters as a water conservation measure and considers the behaviour, health and hygiene as well as home-based livelihoods of low-income water users. This study also provides answers for the premature abandonment of the expansion of the prepaid water meter project into other surrounding cities in Zimbabwe.

acase@tulane.edu / Worldwide, more than two billion people rely on onsite sanitation technologies for excreta treatment and/or disposal. The proper management of domestic septage remains a challenge in most cities in developing countries. A field experiment was conducted in Kinshasa/DR Congo from June 2013 to September 2015 to explore the effectiveness of lagoon treatment for the disinfection and the stabilization of domestic septage. Four lagoons were designed by combining two design factors: Total Solids content (< 5% versus 8% - 12%) and the protection from rainfall (Yes versus No). Each lagoon was a truncated pyramid with a usable volume of 28 m3 and 3m depth. The monitoring of pathogens inactivation was conducted from September 2014 over 12,4 months using coliforms bacteria and Ascaris lumbricoides eggs in sentinel chambers as indicator organisms, respectively with the multiple tubes technique and the Tulane Method. Local climate conditions and abiotic characteristics of the stored septage were monitored monthly. Four-log reduction of fecal coliforms organisms were observed within 10 months of septage storage in the two types of lagoons. At the end of this study, 3-log and less than 2-log reductions of Ascaris eggs were observed, respectively in the lagoons with high and low solids content. The inactivation curve of Ascaris eggs was characterized by a lag phase with a slight inactivation followed by an active inactivation phase. The inactivation rate constants for the active phase were 0.071 and 0.034 day-1, respectively in the lagoons with high and low solids content. Multiple linear regression model showed that the storage time, pH, and TS were significantly associated with percent Ascaris eggs inactivation. Trace elements concentrations in the final product were below threshold ceiling values for their reuse in agriculture. Total volatile solids concentration reduction in the lagoons with high solids content was below the stabilization limit set at 38% by USEPA. In conclusion, lagoon storage of domestic septage with at least 8% TS for 12 to 15 months is an effective option for the disinfection of domestic septage under the conditions of this study. The resulting biosolids constitute a value-added product which can be safely reused in agriculture. / 1 / Konde, Nkiama N.

Compulsory schooling, such as exists in Australia, does not guarantee literacy in the nation. The literature has established that a minority of children do fail to learn to read and write effectively. Failure to learn to read presents a serious disability to those concerned. Programs such as Reading Recovery are used in schools to try and identify at risk children and work with them to reduce illiteracy. Traditional methods of addressing the literacy problem have not proven to be effective. Studies in New Zealand, the U.S.A. and in Australia have established that Reading Recovery is an effective program. However, there is no longitudinal evidence to establish whether it is effective in the long run in the A.C.T. This study sought to establish the long term effectiveness of the program in the A.C.T. It has compared discontinued Reading Recovery children three and five years after they had been discontinued from the program with two 'average ' children from their current class. The discontinued Reading Recovery sample was drawn by random. The two classmate control children were selected by the teachers as performing in the average band of class achievement in reading. Four research instruments were chosen to collect the data. These were, interviews with class teachers and the children themselves, running records, a modified standardized test and an oral retell. The study confirmed that Reading Recovery is effective in the A.C.T. and that gains made whilst on the program were sustained in subsequent years. This being the case, every child who is being diagnosed as 'at risk' should have access to Reading Recovery .

The research study described in this report was conducted in 2007 at a Kindergarten to Year 12 College, situated in the remote Kimberley region of Western Australia. Using case study methods, this research aimed to examine the scaffolding techniques used by two Reading Recovery teachers as they supported the language and literacy learning of two Indigenous Reading Recovery students. And further, to examine the impact of this scaffolding on each student’s language and literacy learning. / Multiple data sets were collected and examined with results discussed throughout this study. Transcripts and direct quotes were used to support the reporting of emergent themes and patterns with the convergence of the data used to support the internal validity of this small scale study. / This paper takes the position that generalisations, assumptions and stereotypical negative images of Indigenous students as disengaged and noncompliant students can be curtailed when teachers acknowledge that Indigenous students are active language learners with rich cultural and linguistic ‘funds of knowledge’ (Moll & Greenberg, 1990). These funds can support students’ new learning of literate discourse which is defined and used throughout this study as: the language used in schools to read, write and talk about texts used for educational purposes. Significantly, difficulties Indigenous students experience with literate discourse have been identified as contributing to the educational underachievement of this group of Australian students (Gray, 2007; Rose, Gray & Cowey, 1998, 1999). / The findings from this small scale study indicate that within the context of Reading Recovery teaching, teacher-student interaction and contingent teacher scaffolding, centred on text reading and writing experiences can support Indigenous students to code-switch between home languages and dialects, Standard Australian English and literate discourse.