BACKGROUND: Evidence suggests complementary and alternative medicine (CAM) therapies can be effective in treating certain chronic, recurrent, and incurable conditions. Use of CAM in pediatric populations is increasing considerably and uptake is especially evident among hospitalized children. Further, burnout among healthcare providers is increasing, affecting both their wellbeing and patient outcomes. At Banner Children's Diamond Children's Hospital, patients, families, and staff can receive CAM through the Integrative Touch for Kids™ (ITK) Hospital Heroes (HH) program. SIGNIFICANCE: Further study to evaluate HH is vital to understanding the quality of care delivered and recommendations for improvement. OBJECTIVES: Assess feasibility of evaluation of HH by Aim 1: Describing the vision and programmatic structure of the HH program. Aim 2: Achieving therapist consensus on referral, care coordination, and debriefing processes; Aim 3: Evaluating session impact on pain, fear/distress/anxiety, global/overall well-being, and satisfaction. Describe retrospective case studies to highlight valuable outcomes otherwise not represented. FRAMEWORKS & METHODS: The Centers for Disease Control & Prevention Framework for Program Evaluation in Public Health, elements from the Ethnographic Assessment of Evaluation Systems, and elements from Donabedian's Quality Framework were used to create a novel, theory-based, whole practice, program evaluation framework to evaluate HH via the following aims. Aim 1: Structure- Key- informant ethnographic interviews with ITK management (N=2) and self-completed questionnaires by HH therapists (N=4) were used to describe the program vision and structural elements. Interviews were transcribed and all data was de-identified, described, and summarized. Transcripts were converted into culturally-appropriate word clouds validated by participants. Univariate and descriptive statistics were used to assess questionnaire items related to human resources and quality rankings were assigned based on ITK standards. Aim 2: Process- The Delphi method was used by administering self-administered ethnographic questionnaires (N=3) to all HH therapists (N=4) to generate consensus on referrals, care coordination, and debriefing processes. Concept Maps were created for each element and validated by participants. Aim 3: Outcomes- Evaluation instruments were developed and piloted in collaboration with ITK stakeholders and data was collected over a two-month period representing nearly 50% of sessions administered by the HH therapists, from Aims 1 and 2, for 2017. Session and recipient characteristics for all sessions (N=95), regardless of recipient ability to report, were summarized. Pre/post changes were calculated using validated scales for pain, fear/distress/anxiety, global/ overall well-being, and likelihood to recommend the hospital. Session satisfaction rankings were collected post-session. Wilcoxon matched-pair signed-rank tests were done to calculate significant differences between median changes pre/post session for recipients able to respond and stratified by recipient type. Retrospective case studies (N=4) were described from data in the electronic health record and/or ITK records, as well as interviews with HH therapists. RESULTS: The program structure was described and quality of human resources met or exceeded criteria for most indicators of quality. Expert consensus on therapist interactions related to referrals, care-coordination, and debriefing was achieved. Evaluation of the HH program was determined feasible and in alignment with the program model and short-term vision. Strong evidence to support decreases in pain and fear/distress/anxiety, as well as increases in global overall well-being were observed in recipients able to report. High levels of satisfaction (mean≥9.0) and top-box rankings for likelihood to recommend the hospital overall, were reported. Retrospective case studies (N=4) highlighted additional outcomes from multiple perspectives. CONCLUSION: These results help to support ethnographic evaluation of the HH program, a holistic and integrative model of care, as ITK continues expanding and replicating the HH program within and beyond the current setting. Knowledge reported provides a new theory-based, whole practice, program evaluation model and expands existing evidence on CAM use in hospitalized pediatric patients.

PhD / The present healthcare system in South Africa suffers from a number of serious deficiencies. Whilst orthodox bio-medicine is well established in most first world countries, its total introduction and implementation into all communities within South Africa faces many obstacles. The cost of diagnostic techniques, investigative procedures and pharmaceutical products, the availability of competent medical staff in the non-urban areas, and the lack of acceptance of the philosophy and practice of orthodox bio-medicine in rural regions are but some of the factors which conspire against the general application of this orthodox medical paradigm. Another problem confronting healthcare and medical practice in South Africa, particularly at this stage of our historical development, is the absolute focus on orthodox bio-medicine, often to the detriment of other medical paradigms that also have advantages to offer. Can the integration of another medical paradigm, such as Unani-Tibb, enhance the practice of orthodox bio-medicine in this country? The aim of the thesis was to investigate the possibility of integrating Unani-Tibb with orthodox biomedicine (also termed conventional, Western or allopathic medicine) and assess its potential for improving delivery of an effective, affordable and appropriate healthcare system in South Africa. The research questions which the thesis seeks to answer is whether this integration is possible and whether the delivery of healthcare to the South African population can be enhanced. Changes in the provision of medical education are necessary, and occupy a pivotal role in allowing for this integration. Unani-Tibb is a traditional medical system practiced extensively on the Indian sub-continent and in other parts of the world. At present, however, it is minimally practiced in South Africa. Its primary principle is the energetic promotion of health maintenance behaviour and the prevention of disease, through effective application of dietotherapy, pharmacotherapy and other interventions, as well as the empowerment of the patient towards adopting behavioural changes and lifestyle adaptations. One positive aspect of Unani-Tibb is that it has many features in common with both orthodox biomedicine and African Traditional medicine. These commonalities should allow for greater acceptance by orthodox healthcare professionals, as well as the general population.

In the years since the 9/11 attacks the incidence of terrorism has been on the rise. At the same time, news media coverage of major terrorist attacks has reached epic proportions, greatly expanding the number of individuals psychologically affected by terrorism. The goal of this dissertation is to better understand how individuals cope with terrorism experienced at a distance. Specifically, this investigation focuses on the impact of stress on integrative complexity (IC; a measure of cognitive processing; Suedfeld, Tetlock, & Streufert, 1992) during and shortly after a major terrorist event. Taken together, the findings from the three studies reported in this dissertation provide several insights into this process. Study 1 replicates and extends results from an earlier study of television newscasters reporting live on 9/11 (Jhangiani & Suedfeld, 2005), in the context of the 2005 London bombings and the medium of radio. In doing so, it provides the first empirical evidence outside of the research laboratory for the curvilinear relationship between stress and IC. Specifically, during the early stages of reports concerning the London bombings, a positive relationship is found between negative emotion and IC. However, once the nature and extent of the event become clearer, increases in negative emotion are related to decreases in IC (the disruptive stress hypothesis). Study 2 replicates this curvilinear relationship in the short-term reactions of two prominent political leaders to 9/11 and the 2005 London bombings. For one of these political leaders, the magnitude of his psychological reaction is moderated by the psychological distance between him and the victims of the attacks. Finally, Study 3 finds that two key personality variables, neuroticism and empathy, play important roles in determining the magnitude of the short-term psychological reactions to 9/11 of more than 250 students from Canada and the United States. This finding is particularly true for those students who were psychologically closer to the victims of the attacks. Implications, strengths and limitations of this research, and possible future directions are discussed. / Arts, Faculty of / Psychology, Department of / Graduate

The Wrinkle-lipped free-tailed bat (T. plicata) in Thailand and the Brazilian free-tailed bat (T. brasiliensis) in south-central Texas are integral in the control of agricultural pests. The effect on the production of rice and cotton is determined by the bats consumption of a particular pest species in that region. In Thailand, it is the White-Backed Planthopper (Sogatella furcifera), while in south-central Texas, it is the cotton bollworm (Helicoverpa zea). The ecological service these bat species provide is measured in millions of dollars saved by farmers each year. Finally, a conclusion was made about which species had a greater effect on the economy when compared to each other.

O desenvolvimento de metodologias sobre integração de dados na área de biologia de sistemas é de grande importância devido ao aumento contínuo de dados resultantes de análises globais que são depositados em bancos de dados públicos. Poucas metodologias e ferramentas de bioinformática levam em consideração a diferenciação entre drivers e passengers, fundamental para a identificação de genes importantes para o desenvolvimento e progressão tumoral. Os perfis de expressão gênica têm possibilitado a identificação de assinaturas genéticas em uma grande variedade de tumores humanos. Além disso, as alterações epigenéticas, como a expressão de microRNAs (miRNA) e a metilação do DNA, também contribuem para o desenvolvimento de diversos tipos de doenças. Entretanto, a grande maioria destes estudos não mostra integração dos resultados obtidos pelas diferentes estratégias utilizadas, o que teria maior impacto na identificação de drivers moleculares. Neste estudo foi realizada a integração de quatro níveis de alterações em 31 amostras de câncer de pênis (CaPe): alteração do número de cópias do DNA, metilação de ilhas CpGs, expressão de miRNAs e expressão de transcritos codificadores. O conhecimento das alterações genéticas e epigenéticas relacionadas ao desenvolvimento de câncer de pênis é bastante limitado, devido principalmente a sua rara incidência. Uma parcela significativa dos casos de CaPe tem sido associada com a infecção pelo Papilomavírus Humano (HPV). A metodologia para integração de dados foi aplicada utilizando duas abordagens: (1) estudo das alterações em câncer de pênis (tumor e normal) independente da infecção pelo HPV e (2) estudo das alterações relacionadas à infecção pelo HPV. A análise foi dividida em duas etapas, com a seleção de genes alvos específicos da doença e inferência de módulos a partir desses alvos. Destacam-se na metodologia a seleção de genes candidatos a driver utilizando a atribuição de pesos para cada alteração seguindo critérios pré-determinados, e.g. se o gene estava presente em uma região rara, após classificação pelo DGV (Database of Genomic Variants) e a utilização desses genes como alvos para identificação das possíveis relações entre eles e os módulos. Também foi realizada a adaptação da metodologia de redes em módulos, com a inclusão de genes passengers e interação proteína-proteína (PPI) como um critério para seleção dos módulos. Essa análise se mostrou eficaz na identificação de módulos gênicos bem relacionados com os drivers, resultando na escolha de vias biológicas potencialmente responsáveis pelo desenvolvimento do tumor. Os genes identificados após a comparação entre amostras tumorais e normais (SOX17, TWIST1, CAV1, PPARG, FLI1 e TNFSF10) e no estudo entre amostras positivas e negativas para infecção pelo HPV (PCNA, SOX14 e RFC4) foram validados in situ por técnicas independentes. Para validação in silico das alterações encontradas na metodologia de integração de dados e para validação da metodologia de redes em módulos foram utilizadas 255 amostras de glioblastoma multiforme obtidas no banco de dados TCGA (The Cancer Genome Atlas). Foram identificadas vias biológicas importantes relacionadas ao processo tumoral, como regulação do crescimento celular (GO:0001558, p=0,0062), homeostase (GO:0048872, $p=0,0082) e regulação da transcrição (GO:0003700, p=0,00089). Também foi realizada uma meta-análise utilizando amostras do TCGA, que encontrou um perfil similar de expressão para os genes CAV1, DLC1,FLI1, MSX1, NRN1, PML, PPARG e SOX17 (T vs N) e PCNA e RFC4 (HPV+ vs HPV-). Para o nosso conhecimento, esse é o primeiro estudo em CaPe utilizando análise integrada de quatro níveis de alteração. Além disso, foram encontradas alterações não randômicas capazes de modificar transcritos específicos e contribuir para o conhecimento da patobiologia dos tumores de pênis. / Methodologies for data integration in systems biology area have great importance due to continuous increase of public data resulting from large-scale analysis, which are deposited in public databases. Few methodologies and bioinformatics tools take into consideration the differentiation between drivers and passengers, fundamental for the identification of important genes for tumor development and progression. The gene expression profiles have allowed the identification of genetic signatures in a wide variety of human tumors. In addition, epigenetic changes, such as the expression of microRNA (miRNA) and DNA methylation, also contribute to the development of a veriety of diseases. However, most of these studies did not show integration of results obtained by different strategies used, which would have increased impact to identify molecular drivers. This study provides a methodology for integration of four levels of changes in 31 samples of penile cancer (PeCa): copy number alterations, DNA methylation of CpG islands, miRNA expression and gene expression of coding transcripts. Knowledge about genetic and epigenetic changes related to the development of penile cancer is very limited, mainly due to its rare incidence. A significant portion of PeCa samples has been associated with infection by Human papillomavirus (HPV). The methodology for integrative data was applied using two approaches: (1) the study considering alterations in penile carcinoma (tumor and normal), independent of HPV infection and (2) the study considering alteration related to HPV infection in PeCa. In each study, the methodology was divided into two stages, with the selection of target genes and the inference of disease specific modules from these targets. It is highlighted in the methodology the selection of candidate genes using the driver assigning weights to each change following predetermined criteria, e.g if the gene was present in a rare region after classification using the DGV database (Database of Genomic Variants) and the use of these genes as seeds for identification of possible relationships between them and the modules. For this, another contribution of this study was the adaptation of module network methodology, with the inclusion of passengers genes and protein-protein interaction (PPI) as a criteria to select the modules. This analysis was effective in identifying gene modules and related drivers, resulting in the choice of biological pathway potentially responsible for the tumor development. The genes identified after comparing tumor and normal samples (SOX17, TWIST1, CAV1, PPARG, FLI1 and TNFSF10) and the genes identified in the study of positive and negative samples for HPV infection (PCNA, SOX14 and RFC4) were validated in situ by independent techniques. For in silico validation of the changes found in the integrative methodology and the modules network were used 255 samples of glioblastoma multiforme obtained at TCGA database (The Cancer Genome Atlas). Biological pathways have been identified related to the tumoral process, such as cell growth regulation (GO:0001558, p=0,0062), homeostasis (GO:0048872, p=0,0082) and transcription regulation (GO:0003700, p=0,00089). Also, a meta-analysis was performed using samples from TCGA, who found a similar expression profile for CAV1, DLC1, FLI1, MSX1, NRN1, PML, PPARG and SOX17 (T vs N) and PCNA and RFC4 genes (HPV + vs HPV-). To our knowledge, this is the first integrative analysis in PeCa using a four-level of gene alterations. In addition, it was found non-random alterations capable to modifying specific transcripts and contribute to the knowledge about the pathobiology of penile tumors.

Chinese Herbal Medicine has been mainstream practice for hundreds of generations, however the merits of herbal therapeutics have been debated in the era of modern medicine. With a shift towards scientific analysis and rigorous testing of conventional pharmaceuticals in the past century, critics have questioned the proclaimed effects of herbal concoctions. Nonetheless, herbal medicines are still used frequently and have spawned clinical studies meant to determine their therapeutic efficacy. This paper aims to evaluate many aspects of Chinese Herbal Medicine applications that have already been analyzed in other papers, then propose a study which explores the effects of the herbal concoction Ban Xia Bai Zhu Tian Ma Pian in lowering blood pressure. Hypertension was chosen as the focus of the study due to its extensive presence in the population and the impact a significant outcome can provide given its prevalence. The ultimate goal is to find a balance between both eastern and western practices of medicine, thus preserving Chinese medical traditions that are concurrently buttressed by scientific research.

This study examines the existing policy and planning frameworks in relation to tourism and local development in Namibia and the level of integration for the respective rural communities. The focus is on the Torra Conservancy in the north-western part of Namibia. The specific objectives are to assess the relative degree to which the local communities have had control in the community-based tourism (CBT) through the community-based natural resource management (CBNRM) programme in terms of rights, empowerment and economic benefits. The study involves a retrospective review of literature on integrative tourism and rural local development and through a survey of key community based tourism (CBT) actors in Bergsig and in Windhoek, Namibia. This study is mainly based on quantitative approach. In addition, thematic interviews were used, where possible, to understand and deepen the views expressed in the survey results. Respondents representing the three main clusters of the tourism industry; government, private sector and the host local communities were examined on their interpretation of the current development of the tourism industry in Namibia. Analysis of Variance (ANOVA) and factor analysis indicated statistical significant differences between different groups. The research findings revealed that the extent to which local communities participate in the tourism development process depends on the idealistic, and perhaps to some degree unrealistic, expectations, of community-based tourism in the national tourism policy spectrum. Since community perceptions match what is on the ground from development, problems are socially real and necessitated a viable solution for amelioration. Implications are discussed for building a more integrative policy approach that could help guide research, planning, development and evaluation of community-based tourism projects. / Thesis (PhD)--University of Pretoria, 2014. / tm2015 / Tourism Management / PhD / Unrestricted

A central assumption of extant mHealth literature is that the technology empowers health care staff and leads to increased efficiency in service delivery. This assumption foregrounds the transformative potential of mHealth and the active appropriation of the technology, but obscures how it integrates with existing workplace arrangements. To interrogate the limitations of this dominant assumption, this research examines how mHealth is coordinated in the workplace in practice, and the perceptions and experiences of health care staff of the place mHealth takes in their daily concerns. In this way the research reveals how existing workplace arrangements influence the way that mHealth operates in practice, and builds on extant research to clarify how this can shift responsibility for the success of the implementation onto those staff with the least recognition and security. An interpretive case study explores the coordination of mHealth in the workplace, and analyses unexpected outcomes to identify their implications for theory and practice. In order to highlight this phenomenon the research focussed on the experiences of the clinic staff who were responsible for mHealth implementation, but were not the end users and who did not receive direct benefits themselves. The analysis drew on coordination studies to identify social and artefact-based coordination mechanisms, as well as the significance of relationships in mHealth in the workplace, yielding robust evidence that social coordination mechanisms rather than the fitness for purpose of the specific technology shaped the coordination process. Issues arising from the specific setting also influenced coordination in important ways that were not predicted in the official training material. The research makes three theoretical contributions that advance understanding of mHealth in the workplace through abduction. First, it identifies two novel coordination mechanisms: role flexibility and covert routines. Second, through the novel concept of multiple accountability, it challenges one of the key integrative principles proposed in the coordination studies perspective, problematising it and proposing that relationships between health intermediaries and local communities are far more influential for the coordination of mHealth than extant theory has so far proposed. Third, it carries important implications for future mHealth (and, more broadly, technology coordination) scholarship, providing evidence that existing coordination mechanisms and relationships may be as influential as the transformative potential of the technology itself. The research also contributes to practice by enhancing understanding of how health intermediaries may be empowered to effectively employ mHealth in the workplace. In a context of policy and funding uncertainty, this research contributes to an emerging literature identifying the practical mHealth issues primary health care staff face in a resource-poor environment, interrogating approaches that fail to recognise these realities.

Orientador: Alfredo Pereira Junior / Banca: Maria de Lourdes Spazziani / Banca: Sissy Veloso Fontes / Resumo: Este estudo é uma revisão teórica e uma reflexão crítica que tem como objetivo investigar o campo da psicossomática, incluindo fundamentos teóricos, bases fisiológicas e as implicações na Saúde Coletiva. Ao longo da história, as concepções sobre saúde e doença, assim como o pensamento médico, incluem suposições filosóficas a respeito do problema mente-corpo, que se configuram em perspectivas monistas ou dualistas. O desenvolvimento das neurociências e da psiconeuroimunologia têm sugerido complexas interações bidirecionais entre os sistemas nervoso, imune e endócrino, assim como um papel central dos aspectos emocionais e cognitivos no processo saúde-doença, que questionam a perspectiva dualista. As crescentes pesquisas em psiconeuroimunologia trazem consigo a necessidade de se discutir uma abordagem mais ampla em saúde, para que se possa maximizar os benefícios das intervenções e proporcionar uma maior qualidade de vida. O modelo biopsicossocial proposto por George Engel, que contempla uma abordagem centrada na integralidade do ser humano, demanda estratégias de intervenção que promovam o bem estar físico e psíquico, melhorem as relações sociais e as condições de vida e trabalho, atuando no âmbito da macroestrutura econômica, social e cultural. Estudos no campo da psicossomática mostram-se importantes para fortalecer as bases científicas que contribuirão para a construção e a implementação do paradigma biopsicossocial na Saúde Coletiva, tendo em vista a efetivação do princípio da integralidade / Abstract: This study is a theoretical review and a critical reflection that aims to investigate the major studies in the psychosomatic field, including theoretical foundations, physiological basis and implications in public health. Throughout history, the concepts of health and illness, as well as the medical thinking, have been influenced by the philosophical discussion of the mind-body problem, which leads to a monistic or dualistic perspective. Development of the neurosciences and psychoneuroimmunology has shown complex bidirectional interactions among the nervous, immune and endocrine systems, as well as the role of emotional and cognitive aspects for the healthdisease process, thus questioning the dualistic concept. Research in psychoneuroimmunology implies the need to discuss a broader approach to health, in order to maximize the benefits of interventions and provide a higher quality of life. The biopsychosocial model proposed by George Engel, an approach that considers the whole of the human being, demands interventional strategies that promote physical and mental well being, improve social relations, living and work conditions and also act within the economic, social and cultural macrostructure. Studies in the psychosomatic field are important to strengthen the scientific basis that will contribute to the building and implementation of the biopsychosocial paradigm in public health, moving towards the realization of the principle of integrality / Mestre

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