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Embarking on a quest to uncover the shared experiences of Latinos with diabetes in the Central San Joaquin Valley is the principal issue discussed in this body of work. Diabetes is estimated to become a serious public health problem, with a current estimate of more than 30 million already afflicted. Engaging in participant-observation at a local clinic serving patients in a Diabetes Education Program and semi-structured interviews with Latinos attending the program, this research explores cultural experiences of diabetes. The primary aim of this research is to answer how health education information is accepted and interpreted based on cultural definitions of diabetes to inform diabetes management strategies.

The research endeavoured to voice the told and untold stories of adolescents living with HIV undergoing continual disease management at the Kalafong Hospital Paediatric HIV Clinic. Through the telling of their stories the adolescents had the opportunity to make sense of their illness experiences. Some of the participating adolescents had limited opportunities to discuss their experiences with friends or family members. The research was completed within the qualitative social constructionist narrative approach. Six adolescents from the clinic participated voluntarily in the research. The participants attended the clinic regularly for disease management and were on ART. The study explored the experiences of the adolescents by means of two semi-structured individual interviews. Expressive art in the form of drawings and poetry were used to aid storytelling. Through collaborative exploration of the adolescents‟ stories, it became possible to co-construct the meanings that they attached to their experiences of HIV, which informs their identity. The interview transcripts were analysed, re-storied, and placed within a narrative framework of understanding, based on the three-dimensional space approach by Clandinin and Connelly (2000). The framework of understanding aided the researcher to look at the different contexts, identities, and social significant aspects found in the adolescents‟ stories. Multiple identities were constructed in their stories such as patient, scholar, friend, family, and athlete identities. These were constructed based on their experiences in the family and cultural, school and social, and medical contexts. The adolescents attributed different meanings to their stories of living with HIV such as that of normality, sameness, realism, and difference. The unique and similar aspects that were found in the adolescents‟ stories were identified and discussed with reference to various concepts such as disclosure, adherence, and ART. It was found that status disclosure was done by staff at the clinic and it occurred during young adolescence. All the adolescents, except one who was not aware of her status, showed insight into the chronic nature of their disease. Five adolescents‟ statuses have not been disclosed to anyone outside the families. In only one instance, the family was not aware of his status. Most adolescents assumed primary responsibility for ART. They expressed conflicting ideas about the role of ART. Some adolescents had to cope with side effects, the possibility of accidental status disclosure and non-adherence, and fears of rejection. The research, employing a narrative approach, endeavours to contribute to create a holistic understanding of HIV/AIDS in the context of health care. Lack of communication and impersonal staff interactions with patients were identified as barriers to disease management. The research recommends that the clinic should provide ongoing support to the adolescents with regards to disclosure of their status to friends, family, and partners, and adherence to medication. The social significant aspects found in the adolescents‟ stories will be disseminated to the staff at the clinic. This will assist the multi-disciplinary team to gain a better understanding of the reality of the adolescent and how these experiences inform their identity. / Dissertation (MA)--University of Pretoria, 2010. / Psychology / unrestricted

[ES] Las plantas de vid (Vitis vinifera L.) están expuestas a una gran variedad de patógenos. En la actualidad, las enfermedades fúngicas de la madera de la vid (GTDs) se encuentran entre los principales factores que limitan la productividad de este cultivo. Una vez las vides están infectadas, la productividad de la planta disminuye, provocando una muerte lenta o apoplética. La investigación de agentes de control biológico (BCAs) capaces de prevenir, o al menos minimizar, el impacto de las GTDs, se considera una prioridad de investigación. En esta Tesis Doctoral se caracterizó un agente de biocontrol potencial y, junto con un producto comercial biológico ya registrado, fueron probados contra varios patógenos agentes causales de GTDs, en invernadero bajo condiciones controladas, y también durante el proceso de propagación de la vid en vivero. Los resultados del análisis genómico completo de Bacillus subtilis PTA-271 muestran un sistema funcional de motilidad de enjambre, una fuerte capacidad de supervivencia y un conjunto de genes que codifican sustancias bioactivas conocidas por estimular el crecimiento o las defensas de las plantas, influir en la microbiota beneficiosa y contrarrestar la agresividad de los patógenos. Cuando Bs PTA-271 se probó contra Neofusicoccum parvum BT67 en plantas injertadas de invernadero, Bs PTA-271 y Ta SC1 demostraron que el cultivar contribuye a los efectos beneficiosos de Bs PTA-271 y Ta SC1 contra Np-Bt67. La aplicación simultánea de ambos BCAs demostró ser beneficiosa contra este patógeno en vides del cultivar Tempranillo. El análisis transcriptómico de las mismas muestras mostró ampliamente los cambios en la fisiología de la planta inducidos tanto por Bs PTA-271 como por Ta SC1 para proteger la vid ante la infección por Np-Bt67. En Chardonnay, las plantas infectadas con Np-Bt67 presentan genes sobreexpresados que están implicados en las vías de señalización del acido absicico (ABA). En Tempranillo, la infección con Np-Bt67 provoca cambios de expresión en más de 200 genes, relacionados sobre todo con la importación de aminoácidos, procesos relacionados con el cloroplasto y el fotosistema, respuestas de la planta a estímulos bióticos y biosíntesis de metabolitos secundarios. La protección de Ta SC1 en las plantas de Tempranilllo implica un mayor número de cambios, que abarcan tanto el metabolismo primario como el secundario, relacionados con cambios en las señales hormonales, como con el aicdo absicico (ABA). Durante el proceso de producción de la vid en vivero, los resultados demostraron una reducción significativa del porcentaje de plantas infectadas con los patógenos asociados a las enfermedades de decaimiento por Botryosphaeria y Pie negro en el material de vivero tratado con Ta SC1 y Bs PTA-271 respectivamente. Los tratamientos simultáneos con ambos BCAs presentaron una reducción en el porcentaje de plantas infectadas con ambos tipos de patógenos. Al probar el efecto de Bs PTA-271 y Ta SC1 en el microbioma de la rizosfera de la vid de dos suelos diferentes infectados con patógenos del pie negro, los resultados muestran que la inoculación de los BCAs parece mejorar las redes del microbioma de la rizosfera y el estado de saneamiento, sin embargo, el efecto beneficioso de los BCAs puede ser dependiente del suelo. En general, este estudio aportó nuevos conocimientos sobre el uso de uno o más BCAs contra varios patógenos asociados a las GTDs, tanto en el vivero como en vides adultas (viñedo). Además, se destacó el modo de acción de ambos BCAs en la protección de la vid. Por lo tanto, estos hallazgos proporcionan, no sólo una mejor comprensión de las interacciones entre los BCAs, la vid y los patógenos, sino que también son una fuerte contribución a una estrategia de gestión sostenible de las GTDs. / [CA] Les plantes de vinya (Vitis vinifera L.) estan exposades a una gran varietat de patògens. En l'actualitat, les malalties fúngiques de la fusta de la vinya (GTDs) es troben entre els principals factors que limiten la productivitat d'aquest cultiu. Una vegada les vinyes estan infectades, la productivitat de la planta disminueix, provocant una mort lenta o apoplética. La investigació d'agents de control biològic (BCAs) capaços de previndre, o almenys minimitzar, l'impacte de les GTDs, es considera una prioritat d'investigació. En aquesta Tesi Doctoral es va caracteritzar en profunditat un agent de biocontrol potencial i, juntament amb un producte comercial biològic ja registrat, tots dos BCAs van ser provats contra diversos patògens agents causals de GTDs, en hivernacle sota condicions controlades, i també durant el procés de propagació de la vinya en viver. Els resultats de l'anàlisi genòmica completa de Bs PTA-271 mostren un sistema funcional de motilitat d'eixam, una forta capacitat de supervivència i un conjunt de gens que codifiquen substàncies bioactivas conegudes per estimular el creixement o les defenses de les plantes, influir en la microbiota beneficiosa i contrarestar l'agressivitat dels patògens. Quan Bs PTA-271 es va provar contra Np BT67 en plantes empeltades d'hivernacle, Bs PTA-271 i Ta SC1 van demostrar que la cultivar contribueix als efectes beneficiosos de Bs PTA-271 i Ta SC1 contra Np-Bt67. L'aplicació simultània de tots dos BCAs va demostrar ser beneficiosa contra aquest patogen en vinyes del cultivar Ull de llebre. L'anàlisi transcriptómico de les mateixes mostres va mostrar àmpliament els canvis en la fisiologia de la planta induïts tant per Bs PTA-271 com per Ta SC1 per a protegir la vinya davant la infecció per Np-Bt67. En Chardonnay, les plantes infectades amb Np-Bt67 presenten gens sobreexpresados que estan implicats en les vies de senyalització de l'acidifique absicico (ABA). En Ull de llebre, la infecció amb Np-Bt67 provoca canvis d'expressió en més de 200 gens, relacionats sobretot amb la importació d'aminoàcids, processos relacionats amb el cloroplast i el fotosistema, respostes de la planta a estímuls biòtics i biosíntesis de metabòlits secundaris. La protecció de Bs PTA-271 en Chardonnay implica gens relacionats amb la biosíntesi d'ABA, les vies dels fenilpropanoides, els metabòlits secundaris, i l'estructura i organització de la paret cellular. La protecció de Ta SC1 en les plantes de Tempranilllo implica un major nombre de canvis, que abasten tant el metabolisme primari com el secundari, relacionats amb canvis en els senyals hormonals, com amb l'acid abcísic (ABA). Durant el procés de producció de la vinya en viver, els resultats van demostrar una reducció significativa del percentatge de plantes infectades amb els patògens associats a les malalties de decaïment per Botryosphaeria i Peu negre en el material de viver tractat amb Ta SC1 i Bs PTA-271 respectivament. Els tractaments simultanis amb tots dos BCAs van presentar una reducció en el percentatge de plantes infectades amb tots dos tipus de patògens. En provar l'efecte de Bs PTA-271 i Ta SC1 en el microbioma de la rizosfera de la vinya de dos sòls diferents infectats amb patògens del Peu negre, els resultats mostren que la inoculació dels BCAs sembla millorar les xarxes del microbioma de la rizosfera i l'estat de sanejament, no obstant això, l'efecte beneficiós dels BCAs pot ser dependent del sòl. En general, aquest estudi va aportar nous coneixements sobre l'ús d'un o més BCAs contra diversos patògens associats a les GTDs, tant en el viver com en vinyes adultes. A més, es va destacar la manera d'acció de tots dos BCAs en la protecció de la vinya. Per tant, aquestes troballes proporcionen, no sols una millor comprensió de les interaccions entre els BCAs, la vinya i els patògens, sinó que també són una forta contribució a una estratègia de gestió sostenible de les GTDs. / [EN] Grapevine (Vitis vinifera L.) plants are exposed to a wide variety of pathogens. Nowadays, grapevine fungal trunk diseases (GTDs) are amongst the main constraints for the productivity of this crop. Once infected, plant productivity is decreased, leading to a plant slow or apoplectic death. Investigation of biocontrol agents (BCAs) capable to forestall or at least to minimize the impact of GTDs, while being a sustainable treatment, is viewed as a research priority. One potential BCA was deeply characterized, and together with a biological commercial product, both BCAs were tested against several GTD pathogens, in greenhouse under controlled conditions, and during the grapevine propagation process. Results from the full genomic analysis of Bacillus subtilis PTA-271 (as BCA with a potential) show a functional swarming motility system, strong survival capacities and a set of genes encoding for bioactive substances known to stimulate plant growth or defenses, influence beneficial microbiota, and counteract pathogen aggressiveness. When tested against Neofusicoccum parvum Bt67 (thereafter Np-Bt67) in greenhouse cuttings, B. subtilis PTA-271 (Bs PTA-271) and T. atroviride SC1 (Ta SC1) proved that the cultivar contributes to their beneficial effects against Np-Bt67. The simultaneous application of both BCAs was further proved to be even more effective to protect Tempranillo cuttings. Moreover, the transcriptomic analysis from the same samples showed extensively the plant physiology changes induced by the pathogen but also by each BCA, Bs PTA-271 on Chardonnay and Ta SC1 on Tempranillo, to protect grapevine from Np-Bt67 infection. Thus, Chardonnay cuttings infected with Np-Bt67 showed overexpressed genes implicated on abscisic acid (ABA) biosynthesis and signaling pathways. In Tempranillo, the infection with Np-Bt67 leads to more substantial changes in gene expression, related mostly with amino acid import, chloroplast and photosystem related processes, plant responses to biotic stimulus, and biosynthesis of secondary metabolites. Protection induced by Bs PTA-271 in Chardonnay targets genes related to ABA biosynthesis, phenylpropanoid pathways and secondary metabolites, and cell wall structure/organization in relationship with carbohydrate metabolism that requires much more consideration. Protection with Ta SC1 in Tempranilllo requires a larger number of changes related to transporters, cell wall integrity and extension, cell division and pathogen induced cell death, multidirectional active proteins, and microbiome interactions. During the grapevine nursery process, the results demonstrated a significant reduction on the percentage of infected plants with Botryosphaeria dieback and Black-foot pathogens in the material treated with Ta SC1 and Bs PTA-271 respectively. The simultaneous treatments with both BCAs presented a reduction on infected plants with both Botryosphaeria dieback and Black foot pathogens. When testing the effect of Bs PTA- 271 and Ta SC1 in grapevine rhizosphere microbiome of two different soil infected with Black foot pathogens, results show that the inoculation of BCAs seems to improve the rhizosphere microbiome networks and sanitation status, however, the beneficial effect of BCAs can be soil-dependent. Moreover, as observed in the other experiments, the combination of both BCAs improves their beneficial effect in the rhizosphere microbiome. Overall, this study brought new insights on the use of one or more BCAs against several GTD pathogens, from nursery to adult grapevines. Moreover, highlighted both BCAs mode of action in grapevine protection. Thus, these findings provide, not only a better understanding of BCAs, grapevine, and pathogens interactions, but are also a strong contribution for the future development of sustainable GTDs management strategies. / Cunha Maia Leal, CD. (2022). Sustainable Management of Grapevine Trunk Diseases in Vineyard: Deliver Biocontrol Agents and Associated Molecules [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/191261

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<p dir="ltr">Agricultural biosecurity is a global concern, with implications for food security, public health, and economic and ecological stability. Through education and technology, threats can be predicted and better managed. Existing educational materials and spatial analysis predominantly cater to larger facilities, leaving smaller producers at a disadvantage as they often lack financial means to implement prevention strategies and have less resources at their disposal. In this dissertation, two novel uses of education and technology within agricultural biosecurity were researched: educational curricula for young and beginning farmers and the potential impact of geospatial information systems (GIS) tools in understanding the spread of avian influenza viruses (AIV). I extend my deepest gratitude to Dr. Shawn Ehlers, Clinical Assistant Professor, for his unwavering guidance and mentorship throughout my dissertation work. Special appreciation goes to my committee members, Dr. Pamela Aaltonen, Dr. William Field, and Dr. Roger Tormoehlen, for their valuable insights and constructive feedback. Collaborative efforts with Melissa Rudolph and the support from ABE GSA and QGSA greatly enriched my research experience. Heartfelt thanks to my family, including Glen Jr. Morris, Melodie Morris, Moranda Morris, Marissa and Ian Pringle, and my partner Adam Dachowicz, as well as Adam’s family Steven, Lori, Alyssa, and Holly, for their constant support. I acknowledge the contributions of Gearing Up for Safety, IN-PREPared, Indiana Board of Animal Health (BOAH), Indiana Department of Natural Resources (DNR), and United States Department of Agriculture (USDA) for their help in my research investigations and express my appreciation to Purdue libraries and ABE faculty and staff for constant support with crucial resources and facilities.</p><p><br></p>

Text in English / This study sought to evaluate the implementation of an HIV and AIDS workplace policy at Sappi-Ngodwana mill. Employing process evaluation, and adopting a qualitative approach, the study evaluated the intervention process, the perceptions of the policy implementers, the strengths and weaknesses of the policy implementation, and suggests possible strategies for addressing the challenges. A systems approach was the theoretical point of departure and guiding framework of the research study. Research data was gathered through in-depth interviews with key informants and theory-driven and data-driven inductive reasoning was adopted in analysing the data. The general findings were that although the Sappi-Ngodwana mill implements a comprehensive HIV and AIDS programme that are in line with national and international benchmarks, there were challenges identified. Recommendations are that the company redesign the HIV and AIDS policy implementation plan with a specific focus on improving the peer educators` system. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)

Managed care plans purport to improve the health of their members with chronic diseases. How has the growing adoption of Medicare Advantage (MA), the managed care program for Medicare beneficiaries, affected the progression of chronic disease? The literature is rich with articles focusing on managed care organizations' impacts on quality of care, access, patient satisfaction, and costs. However, few studies have analyzed these impacts with respect to market penetration of Medicare managed care. The objective of this research has been to analyze the relationships between the market penetration of MA plans and the progression of chronic diseases among Medicare beneficiaries. The Chronic Disease Severity Index scale (CDSI) was constructed to represent beneficiaries' overall chronic disease states for survey or claims-based data, when more direct clinical measures of disease progression are not available. Using the CDSI on the MEPS survey dataset from AHRQ, we sought to assess the impacts of MA market penetration and other covariates on the overall chronic disease state of Medicare beneficiaries from 2004 through 2008. Though the model explains much of the variation in CDSI change, the author expected the multilevel model would show that MA penetration explains a significant level of variation in CDSI change. However, this hypothesis was not substantiated, and the findings suggest that unmeasured factors may be contributing to additional unexplained heterogeneity. Policymakers should explore opportunities to refine the current MA program. The MA program costs the federal government more than the Traditional Fee-for-Service Medicare program, and there is no definitive evidence that outcomes differ. Within both programs, there is opportunity to experiment with different models of payment, healthcare service delivery and care coordination. The Patient Protection and Affordable Care Act (ACA) contains provisions for innovative demonstration projects in delivery and payment. The effectiveness of these ACA initiatives must be monitored, both for impacts on health outcomes and for economic effects. This research can inform future approaches to outcomes assessment using the CDSI, and multilevel modeling methodologies similar to those employed here. Firms offering MA health plans would be prudent to proactively demonstrate their value to beneficiaries and taxpayers. They should explore means of better monitoring and reporting the longitudinal outcomes of their enrolled beneficiaries. Demonstrating that they can bring value in terms of improved health outcomes will help insure their long-term survival, both in the marketplace and in the political arena. / Graduation date: 2012

Text in English / This study sought to evaluate the implementation of an HIV and AIDS workplace policy at Sappi-Ngodwana mill. Employing process evaluation, and adopting a qualitative approach, the study evaluated the intervention process, the perceptions of the policy implementers, the strengths and weaknesses of the policy implementation, and suggests possible strategies for addressing the challenges. A systems approach was the theoretical point of departure and guiding framework of the research study. Research data was gathered through in-depth interviews with key informants and theory-driven and data-driven inductive reasoning was adopted in analysing the data. The general findings were that although the Sappi-Ngodwana mill implements a comprehensive HIV and AIDS programme that are in line with national and international benchmarks, there were challenges identified. Recommendations are that the company redesign the HIV and AIDS policy implementation plan with a specific focus on improving the peer educators` system. / Sociology / M.A. (Social Behaviour Studies in HIV/AIDS)