Global surgery describes the systematic way to reduce health disparities and realize accessibility and sustainability in surgical care. Nearly five billion individuals lack access to adequate and necessary surgical and peri-surgical care. The contemporary model of global surgery is that of short-term surgical trips, which have origins in European and North American colonialism. The current state of global surgery in the surgical subspecialty of otolaryngology and head & neck surgery (OHNS) care fails to meet an adequate ethical threshold based on traditional bioethical principles. In order to improve the system of global OHNS care to promote sustainability and long-term impact, global OHNS care needs to shift away from providing direct clinical care. This work presents an ethical framework composed of four primary domains—(1) preparation and understanding the local context, (2) education, (3) partnership and exchange, (4) research and evaluation. This model can be used to shephard a future with stronger ethical global OHNS care. / Urban Bioethics

This paper uses the Woodmere Art Museum in Philadelphia as a case study to examine the origins and institutional evolution of American regional art museums, identify some of the challenges they currently face, and the important civic and cultural roles they play in their communities. The chapter “Origins” provides a basic overview of Woodmere’s founding and history and considers how, within an American context, such museums eventually evolved from private galleries to publicly engaged nonprofit organizations over the course of the twentieth century as their missions, stakeholders, and audiences evolved. Like other regional art museums that demonstrate the same model, Woodmere’s regional identity and its focus on local art deepen the ties between itself and the community it serves and creates cultural resonances that make regional art museums an irreplaceable part of the American museum industry. However, small regional art museums face important challenges as their finances are more vulnerable, and they must deal with some of the same social, institutional, and ethical issues faced by larger public-facing institutions with a smaller pool of resources. The chapter “Present Challenges” looks at the need to develop sustainable management and financial structures and inclusive strategies to understand and build on audience relationships as a way to survive and grow. The final chapter of the paper “Imagined Futures” concludes and specifically addresses the challenges and possibilities presented by the pandemic, various social justice movements, and the call for institutions to reckon with their own histories in order to form a clear path for the future of regional art museums. / Art History

Supports to improve self-care or self-management are beneficial for many people living with health issues, especially chronic conditions. Yet, socioeconomically marginalized groups have often been neglected from self-management initiatives, despite experiencing an increased prevalence of chronicity and multimorbidity. To this end, there are several established critiques within the self-management literature that are addressed through this dissertation. First, limited attention has been given to equity considerations within self-management, thus there remain gaps in the evidence base around disadvantaged groups. Second, there is a lack of understanding about the mechanisms that make self-management supports work, as well as little evidence to explain the wide extent of non-participation, including understanding the impact of structural barriers. Third, the social embeddedness of self-care has received little attention, despite people highlighting social roles as important concerns within self-care. In addition, the grassroots history of self-care has been neglected, which has resulted in minimal recognition of the role of mutual aid/self-help groups. This dissertation includes two exploratory, qualitative studies that attend to these knowledge gaps: the first explored self-care experiences among people who use drugs with chronic health issues, and the second explored mutual support among people experiencing homelessness within the context of encampments during the COVID-19 pandemic. The study findings are also contextualized by worsening overdose and housing crises. I employed community-based participatory research methods and the transformative framework to contend with social injustice and power imbalance and amplify the worldviews of marginalized groups. We conducted in-depth interviews and reflexive thematic analysis to analyze data. Overarching findings demonstrate the importance of agency in shaping how marginalized groups manage their health and social needs, the critical structural limitations they face in doing so, and the substantial influence of their formal and informal social supports. Thus, findings show the importance of recognizing these groups’ alternative and holistic practices of care, the need to address structural and systemic barriers that inhibit their capacity for care, and the immense value of harnessing social support networks to meet care needs. Programs intended to support self-care among marginalized communities would benefit from incorporating a relational autonomy lens and community-centered approach.

Current models of hospital-to-home transitions for older adults do not typically include a rehabilitation perspective, which led to the endeavor of this thesis. Chapter 2 (Paper 1) is a scoping review that summarized current literature related to slow-stream rehabilitation (SSR) for older adults. Chapter 3 (Paper 2) was a descriptive prospective cohort study that examined frequency, intensity, type and time (FITT) parameters for cardiovascular and resistance exercises completed by older adult participants in a community-based, SSR, hospital-to-home transition program; and to compare FITT parameters of completed exercises to established guidelines. Chapter 4 (Paper 3) was a qualitative study that examined perspectives of those working in or referring to the community-based, SSR, hospital-to-home transition program to identify factors that act as barriers or facilitators to successful implementation and function of an enhanced, community-based, SSR, hospital-to-home transition program. The scoping review found that SSR programs in single payer healthcare systems improved physical and functional outcomes, decreased hospital readmission and institutionalization for older adults with complex healthcare needs. SSR programs were multidisciplinary, ranged in program and session length, and only took place in institutional settings. The prospective cohort study found that older adults with complex healthcare needs participating in a community-based, SSR, hospital-to-home transition program were able to meet many of the cardiovascular and resistance frequency, intensity, and time (FIT) guideline parameters for community-dwelling older adults. Exercise interventions should be tailored to older adult needs and preferences, at the appropriate FIT to allow for functional gains. The qualitative study found the current program’s services e.g., rehabilitation, education, and nursing care were of benefit. Most of the stated barriers were at a macro or meso level and were out of the study participants’ control, while all the facilitators were at a micro level. Community-based, SSR, hospital-to-home transition programs can serve as a holistic model of care that address identified gaps in the literature. / Dissertation / Doctor of Philosophy (PhD) / Hospital-to-home transition care models do not often include a rehabilitation ‘lens’ which led to this thesis. Chapter 2 was a scoping review of slow-stream rehabilitation (SSR) for older adults; Chapter 3 looked at exercises older adults completed during an SSR hospital-to-home program; and, Chapter 4 studied facilitators and barriers to enhancing a current community-based, SSR, hospital-to-home program. These studies found: 1) SSR programs in healthcare systems like Canada were geared towards older adults with many health problems, only took place in hospital or long-term care settings, and were of benefit; 2) Older adults participating in a SSR hospital-to-home program should exercise at the appropriate intensity, time and frequency to see gains in function; 3) The current program’s services e.g., rehabilitation, education, and nursing care were beneficial, but barriers to enhancing the program were out of the participants’ control. Community-based, SSR, hospital-to-home transition models of care that include rehabilitation are very important for older adults.

Older adults, especially those who are of low socioeconomic status, experience higher rates of mortality and chronic disease. As a result, older adults are frequent users of emergency medical service (EMS), comprising approximately 38-48% of all EMS calls. In response to higher EMS demands, community paramedicine has recently emerged as a non-traditional model whereby paramedics provide care in a community- based setting. CP@clinic is a community paramedicine programme that focuses on disease prevention and health promotion with the goal of reducing EMS demand. Given the knowledge that older adults who live in subsidized housing have poorer health outcomes, CP@clinic has been implemented in several subsidized housing building across Ontario. A program evaluation of CP@clinic is currently underway to make recommendations to paramedic partner stakeholders regarding program delivery. As part of this evaluation, I sought to understand the association of the number of CP@clinic sessions held per month and EMS calls per apartment unit. De-identified EMS call data were collated from 9 paramedic services across Ontario from February 2015 to December 2019. I conducted a three-level multilevel regression analysis, with EMS calls per apartment unit as the outcome. The primary analysis found that a one-session increase in the number of sessions held per month was associated with an average 2.4% higher incident rate of EMS calls, adjusted for building size. A secondary analysis, with the number of sessions per month as a categorical variable, revealed that two CP@clinic sessions per month had the smallest association with EMS calls, adjusted for building size. Based on these results, it is recommended that paramedic services offer two or more CP@clinic sessions per month. Future research should investigate the factors that impact each services’ ability to offer the CP@clinic programme. / Thesis / Master of Science (MSc) / Older adults experience high rates of chronic diseases, especially older adults living in subsidized housing. Community paramedicine has recently emerged as a way of addressing the healthcare needs of older adults living in subsidized housing, while simultaneously decreasing the burden on EMS. CP@clinic is a community paramedicine programme aimed at improving the health of older adults and reducing the demand on EMS. To make recommendations to the paramedic services operating CP@clinic, I sought to understand the association between the frequency of CP@clinic sessions and the number of EMS calls per apartment unit in Ontario. Based on the results, CP@clinic sessions were associated with higher incident rate of EMS calls, after accounting for building size, reflecting the trend of rising EMS calls in Ontario. Overall, paramedic services may see improved EMS call outcomes with two or more CP@clinic sessions per month but should offer the programme according to their organizational capacity.

The most common goal of professional sociology is to describe and or explain the social world. However, recognizing the performative aspects of science, and in keeping with Burawoy’s (2005) emphasis on “organic public sociology,” I ague that there is latitude within the discipline to design research with the aim of linking knowledge production and social change. I also argue that the discipline’s understanding of effecting change need not be limited to outcomes such as teaching, publication, or the creation of policy; the research process itself has social effects (Hesse-Biber, Leavy, and Yaiser 2004). Importing a performative research design from human geography (Community Economies Collective 2001, Cameron and Gibson 2001, 2005, Gibson-Graham 2006b), I co-designed a participatory action research (PAR) project with a graduate student in Geography. We hired 23 artists and artisans from Franklin County, Massachusetts forming a research team. Our goal was to act on the world in real-time through the use of peer-to-peer interviewing. In this paper I explore the outcomes, including the challenges, of researching from this approach. The research design and the ensuing process—training members of the research team, conducting interviews, and collaborating on projects—is the focus of my analysis. I discuss how aiming for transformation shaped our research decisions. Through my analysis of the research process, and in contrast to decision-making processes from a common sense epistemology, I argue that the interactions and connections engendered by the process itself matter just as much as the ensuing sociological understanding.

This research project is a study of 227 Christian Churches (Disciples of Christ) in Indiana. These 227 churches were identified by the Regional Office of the Christian Church (Disciples of Christ) in Indiana as being fully cooperative with the work within the Region. The project was conducted in two parts or phases. Phase 1 was a study of the churches based upon statistical data which the churches reported to the Yearbook. Phase 2 was a study of the attitudes of selected leaders within these 227 churches. It should be noted in the beginning that this study does not tell the complete story of the Christian Church (Disciples of Christ) in Indiana. Any such attempt to tell all the story must take into account the churches which have withdrawn from the relationship with the Regional and National ministry. This study concerns only the 227 churches currently involved and seeks to tell the story of these churches. This report seeks to be descriptive in character. One section in Chapter 2 dealing with anomia is analytical. The funds for this project were made available by Christian Theological Seminary with money provided by the Lilly Endowment, Inc. 1

京都大学 / 新制・課程博士 / 博士(地球環境学) / 甲第24766号 / 地環博第238号 / 新制||地環||46(附属図書館) / 京都大学大学院地球環境学舎地球環境学専攻 / (主査)教授 小林 広英, 准教授 落合 知帆, 准教授 深町 加津枝 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DFAM

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Magister Public Health - MPH / Disparity in health service delivery between Ghana’s urban and rural areas has been noted to have contributed significantly to the huge gap that exists in health status between the rural and urban areas in the country. Consequently, since the Alma Ata Conference in 1979, Ghana has had a policy of making community-based services available to all, through community-based care and has adopted the Community-based Health Planning and Services (CHPS) Initiative as a national health reforms strategy to mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. The successful implementation of the CHPS initiative rests heavily on the participation and involvement of the communities.