Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.

Ruminants are considered the commonest animal reservoir for human infection of Coxiella burnetii, the Q fever causative agent. Considering the recently described importance of human Q fever in Greece, we aimed at providing the first comprehensive direct evidence of C. burnetii in dairy cows in Greece, including the genetic characterization of strains. The 462 examined dairy farms represented all geographical areas of Greece. One bulk tank milk sample was collected from every farm and tested for the presence of C. burnetii. Molecular genotyping of strains, performed directly on samples, revealed the existence of two separate clades characterized by single nucleotide polymorphism (SNP) genotypes of type 1 and type 2. The two clades were clearly distinguished in multiple locus variable-number tandem repeat analysis (MLVA) by two discriminative loci: MS30 and MS28. Whereas MLVA profiles of SNP-type 2 clade were closely related to strains described in other European cattle populations, the MLVA profile observed within the SNP type 1 clade highlighted a peculiar genetic signature for Greece, related to genotypes found in sheep and goats in Europe. The shedding of C. burnetii bearing this genotype might have yet undefined human epidemiological consequences. Surveillance of the genetic distribution of C. burnetii from different sources is needed to fully understand the epidemiology of Q fever in Greece.

This study aims to research the progress and evolution of the Swedish medical discourse regarding childbed fever. Several texts that are considered to be part of said discourse have been chosen, the earliest being Dr. Joseph Elliot's book regarding childbed fever from 1844 and the latest being two articles from the Swedish midwifery and women's health journal Jordemodern from 1903. During this time several discoveries on the subject of hygiene and antiseptics took place in Europe, leading to a quick development in the medical field eventually making its way to Sweden. This knowledge led to a hypothesis that the definition, belived causes and desirable measures taken to control the outbreaks of childbed fever, would change from 1844 to 1903.  By analyzing these sources through a genus theoretical framework a change was indeed found. The disease was originally belived to be airborne and none of the taken measures had any effect. By 1903 the germ theory had arrived and settled in the Swedish medical discourse and it became widely known that the disease was transmitted from doctors and midwifes to the patient by contact and appropriate measures could be taken.  Lastly the studiy aims to present a viable way to use this information in a classroom situation related to the syllabus for both primary and upper secondary school.

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Blood-feeding mosquitoes, by transmitting parasites and viruses to their hosts, kill several hundred thousand people every year. Mosquito populations are currently developing raising levels of insecticide resistance, and there is a need for a better understanding of their behavior so that new control solutions can be imagined, and existing ones can be improved. There has been a vast number of studies examining the host seeking behavior of mosquitoes, however there is a lack of knowledge concerning how mosquitoes are evading the threats their hosts pose via their defensive behaviors. Female mosquitoes are indeed in this unique position where their fitness and reproduction depend on them being able to locate hosts as well as evade them. In order to do this, they rely on sensory cues that they must be able to continuously re-evaluate during host tracking to potentially decide to quickly escape at any point during these interactions. Host seeking is mediated by multiple sensory modalities such as vision, olfaction, and thermosensation. However, it is not clear whether mosquitoes may also be using some of these same cues to identify that their host is turning into a threat. Focusing solely on visual cues in the context of escape behavior, we used a looming stimulus to elicit escape responses from the Yellow Fever mosquito, Aedes aegypti. A virtual reality environment was adapted from previous work, to display the looming stimulus while the mosquito is in a variety of conditions (i.e., landed, in free or tethered flight). Results from these experiments allowed us to characterize the escape responses of mosquitoes, by determining the angles and distances to the stimuli that will most likely trigger an avoidance response. / Master of Science in Life Sciences / Mosquitoes are the deadliest animals in the world because of the several diseases they can transmit. Females are the only ones that bite, since they require a blood meal in order to produce offspring. The task of obtaining this blood meal from a mobile, and defensive host can be extremely dangerous. The females must find a host, approach it, land, feed, and flee without being killed so they can reproduce. At any point, the host might detect the mosquito and try to kill it, typically by swatting at it. For this reason, mosquitoes have evolved the ability to navigate in close proximity to the host, while assessing their level of defensiveness and avoiding these threats. Insects, in general, are well known to display escape behaviors in response to visual, predator-like, looming stimuli. However, in spite of great epidemiological importance, very little is known about the mechanisms that allow mosquitoes to evade their predators, as well as swatting from their hosts. Mosquitoes use visual, olfactory, and thermal cues to track their hosts but what kinds of sensory cues are being used to avoid threats? As a first step towards bridging this knowledge gap, we analyzed the behavioral responses of the Yellow Fever mosquito, Aedes aegypti, to looming visual stimuli. For this, we used a virtual-reality environment designed for mosquitoes, where we displayed looming squares to mosquitoes in a variety of conditions (for example: landed, in flight). Results from these experiments allowed us to characterize the escape responses of mosquitoes, by determining the angles and distances to the stimuli that will most likely trigger an avoidance response. Ultimately, better understanding mosquito vision in the context of their escape behavior, can help us improve the design of control tools, such as traps, to increase their efficiency.

Twenty Holsteins, ten pregnant heifers and ten pregnant cows (third or greater pregnancy) were subdivided and fed either a low calcium (Ca) or Ca-supplemented ration for four weeks prepartum to determine the influence of age and prepartum Ca intake on hormonal control of peripartum Ca homeostasis. Jugular blood samples were taken on a fixed schedule from 21 days prepartum through 21 days postpartum for parathyroid hormone (PTH), calcitonin (CT), Ca, magnesium (Mg), and phosphorus (P) analysis. Heifers and cows receiving the high Ca ration prepartum tended to have higher prepartum serum Ca. Cows fed the high Ca ration prepartum (hi-Ca cows) exhibited severe hypocalcemia (6.1 mg/dl) at parturition and remained hypocalcemic for three days. Serum PTH concentration increased prepartum (-5 to -3 days) and at parturition, followed by an increase in CT, in all groups except high-Ca cows. Circulating CT was lower in high-Ca cows throughout the experiment. Serum concentrations of PTH and Mg increased from 7 to 21 days in all except high-Ca cows. Feed intake corrected for metabolic bodyweight was similar for both dietary treatments and ages. Milk production was greater for the first week in cows fed low Ca prepartum. There was no correlation between hypocalcemia and increased milk Ca concentration. In conclusion, heifers were able to achieve calcium homeostasis despite the high Ca ration, while high-Ca cows exhibited subclinical milk fever. / M.S.

Situating the 1878 yellow fever epidemic in Memphis's long history shows how concern over Memphis's national reputation influenced how city leaders dealt with crisis. Throughout its history, Memphis government officials and business leaders promoted Memphis as a good city to do business, free from disease and racial strife. Despite their best efforts, they could not deny explosive incidents of racially-based violence or disease outbreaks. Instead, they tried to mitigate negative repercussions on the local economy during times of crisis. When the 1878 yellow fever epidemic struck, the Citizen's Relief Committee, the impromptu government formed by business leaders after outbreak, promoted Memphis as a functioning white city that was operating the best it could under terrible circumstances so the city could resume normal economic activity once the fever passed. This became the dominant narrative, repeated by newspapers across the country in 1878 and historians today. This narrative is problematic because it ignores black Memphians, who composed of 80% of the city's population after outbreak. Instead of recognizing black Memphians participation in relief activities, they promoted stories in the media about lazy or riotous African Americans to justify denying sufficient aid to the black community. Catholics had better luck earning the gratitude of Memphis's leaders. They worked with the white government and charities as nurses and fundraisers, and earned a glowing reputation in national newspapers. The inclusion of African Americans and Catholics in this thesis tells a more complete story and challenges white Memphians' carefully cultivated narrative. / Master of Arts / The summer of 1878 proved to be one of the deadliest periods in Memphis’s history. The yellow fever epidemic struck Memphis with ferocity, causing white Memphians to flee, the local economy to collapse, and 5,150 people to die. The city government quickly collapsed upon outbreak and a group of white businessmen stepped forward to create an impromptu government, the Citizens’ Relief Committee. Like governments before it, the CRC promoted Memphis as a functioning white city that was trying its best to survive. To support this narrative, they largely ignored the contributions of black Memphians, who comprised 80% of the city, and denied them sufficient aid. This thesis situates the epidemic within Memphis’s longer history to analyze how Memphis’s white leaders’ actions were motivated by longstanding economic and racial tensions.