Appendix B (leaves 217-218), Appendix M (leaves 239-247) and Appendix O (leaves 253-259) in English and Amharic / The purpose of this research was to develop HIV testing Health Belief Scale (HTBS) that contains the constructs of Health Belief Model (HBM), and also to analyse HIV testing intention and behaviour among university students. The mixed method approach was used in phases. First, Literature review and in-depth interviews were conducted to develop item pool for HTBS, which was followed by content validity assessment by experts. In the second phase, a pilot survey was conducted on randomly selected 318 university students to refine the HTBS using item analysis and Exploratory Factor Analysis (EFA). Lastly, cross-sectional survey was conducted on representative sample of 612 students in order to further refine the HTBS using Confirmatory Factor Analysis (CFA) and also analyse predictors of HIV testing intention and behaviour. A total of 61 items was written for the HTBS and 23 of these were generated from the in-depth interviews. Content validity assessment by three experts indicated that the average content validity index (CVI) for the 61 items was 91.2% which was more than the recommended cut off point of 90%. The HTBS, after experts review, contained 64 items. EFA indicated that a five factor model which was roughly consistent with HBM was identified and 44 items were retained based on factor loading and reliability analysis. The Cronbach’s alpha for all the six constructs of HBM and HIV testing intention in the HTBS were >0,70. (susceptibility, benefit, self-efficacy and HIV testing intention) fitted the sample data based on chi-square test. However, all the seven constructs demonstrated RMSEA value of less than 0.08 and GFI value of >0.90 indicating acceptable fit. The final HTBS was reduced to 39 items based on factor loading and reliability assessment. All the constructs demonstrated a Cronbach’s alpha value >0.70 except for perceived susceptibility and cues to action. Analysis of multiple linear regression indicated that class year, perceived benefit, perceived self-efficacy and cues to action were significant predictors of HIV testing intention. However, only marital status and cues to action were significant predictors of recent history of HIV testing through analysis of binary logistic regression. / Health Studies / D.Litt. et Phil. (Health Studies)

At the Ottawa Hospital in Ontario, Canada, clinicians use full body immersion virtual reality to treat a variety of health conditions, including: traumatic brain injuries, post- traumatic stress disorder, acquired brain injuries, complex regional pain syndrome, spinal cord injuries, Guillain-Barré syndrome, and lower limb amputations. The system is shared between military and civilian patient populations. Viewed by clinicians and the system’s designers as a value neutral medical technology, clinical virtual reality’s sights, sounds, movements, and smells reveal cultural assumptions about universal patient experiences. In this dissertation I draw from reflexive feminist research methodologies, visual anthropology and sensory ethnography in a hospital to centre the body in current debates about digital accessibility in the 21st Century. 40 in-depth interviews with practitioners and patients, 210 clinical observations, and film and photography ground research participant experiences in day-to-day understandings of virtual reality at the hospital. In this dissertation I address an ongoing absence of the body as a site of analytical attention in anthropological studies of virtual reality. While much literature in the social sciences situates virtual reality as a ‘post-human’ technology, I argue that virtual reality treatments are always experienced, resisted and interpreted through diverse body schemata. Furthermore, virtual reality cannot be decoupled from the sensitivities, socialities and politics of particular bodies in particular places and times. The Ottawa Hospital’s Computer Assisted Rehabilitation Environment (CAREN) system features a digitally enhanced walk-in chamber, treadmills on hydraulic pistons, surround sound audio, advanced graphics and user feedback utilizing force plates and a dynamic infrared motion capture system. The CAREN system utilizes hardware and software reliant on specific assumptions about human bodies. For example, these assumptions are echoed in depictions of race, gender, class, and indigeneity. Patients using virtual reality technologies can experience more than one disability or health condition at a time, further disrupting the idea of universal user experiences. As clinicians and patients confront the limitations of body normativity in the CAREN system’s interface design, they improvise, resist, and experience virtual reality in ways that defy design agendas, ultimately shaping patient treatments and unique paths to healing and health. / Graduate

A study was undertaken of plants used for treatment of diabetic symptoms by traditional healers of the Eeyou Istchee Cree (Canada), Lukomir Highlanders (Bosnia & Herzegovina), and Q’eqchi’ Maya (Belize). All antidiabetic plants were ranked by syndromic importance value (SIV) based on 15 symptoms, all of which were recognized by the Cree and Maya and 8 by the Highlanders. The Cree used only 18 species, the Highlanders 41, and the Maya 150, numbers which reflect the diversity of flora in their region. Vaccinium (Ericaceae) was one of the few genera in all three regions and the only consensus genus between the Cree and Highlander study sites. The Q’eqchi’ Maya ethnobotany did not present any cross-cultural consensus genera with Cree or Highlander medicinal plants, perhaps due to major biogeographic differences. In ethnopharmacological studies, Vaccinium species and Q’eqchi’ antidiabetic plants were tested in an assay relevant to diabetes, the advanced glycation endproduct (AGE) inhibition assay. Boreal and tropical Vaccinium species were potent inhibitors of AGEs and demonstrated concentration dependent inhibition, with a half maximal inhibitory concentration (IC50) range of 5.93–100 µg/mL. Phenolic content ranged from 80.3 to 201 µg/mL in boreal samples and from 1470 to 2170 µg/mL in tropical samples. Tropical species have a greater phenolic content and AGE inhibition. Seven Q’eqchi’ antidiabetic plant species were tested and all plant extracts showed AGE-inhibition. The IC50s ranged from 40.8 to 733 µg/mL, and the most active was Tynanthus guatemalensis Donn.. Tynanthus guatemalensis IC50 was about fives times greater (less active) than the mean ± SE IC50 reported for six tropical Vaccinium species of Vaccinium (8.77 ± 0.79 μg/mL). The highest consensus and most active Maya antidiabetic plant, Tynanthus guatemalensis Donn. Sm. was discovered to be an important plant recorded in archeological artifacts from the Late Classic Maya period (~750 CE). Ancient Maya used a cross shaped sign (k’an glyph) as a decorative element on Late Classic polychrome vessels and murals. The sign was believed to be the xylem template for a plant used as a flavouring in cacao drinks. However, the plant was incorrectly identified in the literature as Pimenta dioica (L.) Merr. (common name: Allspice) based on a common name and aromatic plant quality – not from a botanical voucher specimen. Pimenta dioica wood does not have a cross shape visible in the xylem but a unique character visible after a cross section of T. guatemalensis, is the xylem's cross shape organization. Wood of T. guatemalensis' also has an "allspice" aroma. Tynanthus guatemalensis is most likely the true botanical template behind the ancient Maya k’an glyph and this finding would show the continuity of use of this medicinal plant from ancient to modern times. Vaccinium was selected for an in depth phytochemical analysis using modern metabolomic methods. Nuclear magnetic resonance (1H NMR) was used to evaluate leaf extract spectra to provide information on (1) the taxonomic identity and (2) quantities of bioactive metabolites across multiple sites. Spectra clearly differentiated leaf samples of V. angustifolium, V. boreale, V. corymbosum, V. macrocarpon, V. myrtilloides, V. myrtillus, V. ovalifolium, and V. uliginosum according to generic, subgeneric, specific, phenotypic circumscriptions. Quantification of chlorogenic acid and hyperoside were replicated with a method that is highly reproducible across multiple sites with different NMR equipment. This methodology provides an important new approach to taxonomy and quality control for plants and natural health products.

[ES] Los centros biomédicos de la Comunitat Valenciana investigan mucho sobre salud, pero se sabe menos sobre quiénes desarrollan y financian esa investigación biomédica, objeto de estudio de la presente tesis. Nuestro trabajo analiza indicadores bibliométricos, que ofrecen resultados estadísticamente significativos cuando la muestra es grande, verificables y reproducibles. Ahora bien, son meramente cuantitativos, parciales, convergentes y relativos. Quienes trabajan en centros de investigación de Alicante, Castellón o Valencia publican cada año cerca de 2.000 artículos y revisiones incardinados en las 68 disciplinas más estrechamente vinculadas a la salud, de acuerdo con el análisis de los registros publicados entre 2008 y 2015. Los investigadores de la Comunitat Valenciana escriben más artículos que revisiones (91% frente a 9%) y, en 6 de cada 10 casos, se indica la fuente de financiación. La producción científica crece año tras año no solo por el aumento del número de revistas que salen al mercado o porque cada vez se indizan más. Ese incremento se apoya sobre todo en los artículos, no tanto en las revisiones. La investigación biomédica se escribe en inglés (88% de las publicaciones analizadas). El predominio de la lengua de Shakespeare va a más año tras año. El segundo idioma, sobre todo en los documentos sin financiación, es el español. Los artículos y revisiones con autoría valenciana se publicaron entre 2008 y 2015 en 2.359 revistas de 50 países diferentes (sólo 37 de ellas se editan en España). La revista española con más artículos publicados durante el periodo de estudio es Nutrición Hospitalaria. La revista extranjera, Food Chemistry. Estados Unidos e Inglaterra son los países que editan más revistas con producción de autoría valenciana aunque, cuando no hay financiación, es España. Los 17.437 trabajos descargados de la WoS y publicados entre 2008 y 2015 los firman autores/as adscritos a 343 centros de investigación (33% es del sector privado y el 25% se relaciona con la sanidad pública). Ahora bien, el mundo académico, no el hospitalario, es la cuna del saber biomédico, con la Universitat de València como centro que más producción científica acumula en el periodo. La autoría corresponde a un único centro de investigación en tres de cada cuatro trabajos y lo más habitual es que haya varios firmantes, no uno solo. La investigación biomédica valenciana la paga la administración pública, asociaciones, la Universidad, la banca, los laboratorios o las sociedades científicas¿ unas 3.400 agencias financiadoras entre 2008-2015. La que más producción biomédica sufraga es el Instituto de Salud Carlos III. La financiación alternativa no se refleja todavía en la WoS. Respecto a la influencia de sus obras, la Universitat de València es la que más citas acumula, pero los más eficientes son el Instituto de Neurociencias de Alicante y el Centro de Investigación Príncipe Felipe (CIPF). Casi todos los documentos estudiados (89%) han recibido al menos una cita. Para documentos con financiación, la revista que más citas acumula, en términos absolutos, es Blood y, en términos relativos, Autophagy. Cuando no hay fondos, las revistas que destacan son Journal of Hypertension en términos absolutos y Annual Review of Cell and Development Biology, respectivamente.Las revistas editadas en Estados Unidos e Inglaterra son las que tienen más visibilidad e impacto. Además, la mitad de los trabajos estudiados se sitúan en los tres primeros cuartiles. Finalmente, las áreas temáticas con más artículos publicados son Bioquímica y Biología Molecular y Oncología, campos donde trabajan grupos potentes de profesionales. Sobre indicadores los mixtos, destaca el peso de las instituciones investigadoras privadas en la provincia de Valencia cuando, en término autonómicos, la sanidad pública y el mundo académico concentran el 82% de producción y el 34% de citas. Además, Castellón supera a Alicante en número absoluto de citas. / [CA] Els centres biomèdics de la Comunitat Valenciana investiguen molt sobre salut, però se sap menys sobre qui desenvolupa i financia els treballs de recerca biomèdica, objecte d'estudi de la present tesi. El nostre treball analitza indicadors bibliomètrics, que ofereixen resultats estadísticament significatius quan la mostra és gran, verificables i reproduïbles. Ara bé, són merament quantitatius, no qualitatius, parcials, convergents i relatius. Els profesionals que treballen en centres d'investigació d'Alacant, Castelló o València publiquen cada any prop de 2.000 articles i revisions incardinats en les 68 disciplines més estretament vinculades a la salut, d'acord amb l'anàlisi dels registres publicats entre 2008 i 2015. Els investigadors de la Comunitat Valenciana escriuen més articles que revisions (91% enfront de 9%) i, en 6 de cada 10 casos, s'indica la font de finançament. La producció científica creix any rere any no sols per l'augment del nombre de revistes que ixen al mercat o perquè cada vegada s'indexen més. Aqueix increment es recolza sobretot en els articles, no tant en les revisions. La investigació biomèdica s'escriu en anglés (és la llengua del 88% de les publicacions analitzades). El predomini de la llengua de Shakespeare va a més any rere any. El segon idioma, especialment en els documents sense finançament, és l'espanyol. Els articles i revisions amb autoria valenciana es van publicar entre 2008 i 2015 en 2.359 revistes de 50 països diferents (només 37 d'elles s'editen a Espanya). La revista espanyola amb més articles publicats durant el període d'estudi és Nutrició Hospitalària. La revista estrangera, Food Chemistry. Els Estats Units i Anglaterra són els països que editen més revistes amb producció d'autoria valenciana encara que, quan no hi ha finançament, és Espanya. Els 17.437 treballs descarregats de la WoS i publicats entre 2008 i 2015 els signen autors/as adscrits a 343 centres d'investigació (33% és del sector privat i el 25% es relaciona amb la sanitat pública). Ara bé, el món acadèmic, no l'hospitalari, és el bressol del saber biomèdic, amb la Universitat de València com a centre que més producció científica acumula en el període. L'autoria correspon a un únic centre d'investigació en tres de cada quatre treballs i el més habitual és que hi haja diversos signants, no un només. La investigació biomèdica valenciana la paga l'administració pública, associacions, la Universitat, la banca, els laboratoris o les societats científiques¿ unes 3.400 agències finançadores entre 2008-2015. La que més producció biomèdica sufraga és l'Institut de Salut Carles III. El finançament alternatiu no es reflecteix encara en la WoS. Respecte a la influència de les seues obres, la Universitat de València és la que més cites acumula, però els més eficients són l'Institut de Neurociències d'Alacant i el Centre d'Investigació Príncep Felip (CIPF). Quasi tots els documents estudiats (89%) han rebut almenys una cita. Per a documents amb finançament, la revista que més cites acumula, en termes absoluts, és Blood i, en termes relatius, Autophagy. Quan no hi ha fons, les revistes que destaquen són Journal of Hypertension en termes absoluts i Annual Review of Cell and Development Biology, respectivament. Les revistes editades als Estats Units i Anglaterra són les que tenen més visibilitat i impacte. A més, la meitat dels treballs estudiats se situen en els tres primers quartils. Finalment, les àrees temàtiques amb més articles publicats són Bioquímica i Biologia Molecular i Oncologia, camps on treballen grups potents de professionals. Respecte als indicadors mixtos, destaca el pes de les institucions investigadores privades a la província de València quan, en terme autonòmics, la sanitat pública i el món acadèmic concentren el 82% de la producció i el 34% de les cites. A més, Castelló supera a Alacant en nombre absolut de cites. / [EN] Biomedical centres in the Valencian Community do a lot of health research, but less is known about who develops and finances this biomedical research, which is the subject of this thesis. Our work analyses bibliometric indicators, which offer statistically significant results when the sample is large, verifiable and reproducible. However, they are merely quantitative, not qualitative, partial, convergent and relative. Those working in research centres in Alicante, Castellón and Valencia publish around 2,000 articles and reviews each year in the 68 disciplines most closely linked to health, according to an analysis of the records published between 2008 and 2015. Researchers in the Valencia Region write more articles than reviews (91% compared to 9%) and, in 6 out of 10 cases, the source of funding is indicated. Scientific production is growing year after year not only because of the increase in the number of journals that come onto the market or because they are increasingly indexed. This increase is mainly based on articles, not so much on reviews. Biomedical research is written in English (the language of 88% of the publications analysed). The predominance of Shakespeare's language is increasing year by year. The second language, especially in unfunded papers, is Spanish. Articles and reviews with Valencian authorship were published between 2008 and 2015 in 2,359 journals from 50 different countries (only 37 of them are published in Spain). The Spanish journal with the most articles published during the study period is Nutrición Hospitalaria. The foreign journal, Food Chemistry. The United States and England are the countries that publish the most journals with Valencian authorship, although when there is no funding, it is Spain. The 17,437 papers downloaded from WoS and published between 2008 and 2015 are signed by authors attached to 343 research centres (33% are from the private sector and 25% are related to public health). However, the academic world, not the hospital world, is the cradle of biomedical knowledge, with the University of Valencia as the centre that accumulated the most scientific production in the period. Authorship corresponds to a single research centre in three out of every four papers, and it is most common for there to be several authors, not just one. Valencian biomedical research is paid for by the public administration, associations, universities, banks, laboratories and scientific societies... some 3,400 funding agencies between 2008-2015. The agency that funds most biomedical production is the Instituto de Salud Carlos III. Alternative funding is not yet reflected in the WoS. Regarding the influence of its works, the University of Valencia is the one that accumulates the most citations, but the most efficient are the Instituto de Neurociencias de Alicante and the Centro de Investigación Príncipe Felipe (CIPF). Almost all the documents studied (89%) have received at least one citation. For funded papers, the journal with the most citations in absolute terms is Blood and, in relative terms, Autophagy. When there is no funding, the journals that stand out are the Journal of Hypertension in absolute terms and the Annual Review of Cell and Development Biology, respectively. Journals published in the United States and England have the highest visibility and impact. In addition, half of the papers studied are in the first three quartiles. Finally, the subject areas with the most articles published are Biochemistry and Molecular Biology and Oncology, fields in which powerful groups of professionals work. Concerning the mixed indicators, the weight of private research institutions in the province of Valencia stands out, when, in regional terms, public health and the academic world account for 82% of the production and 34% of the citations. Moreover, Castellón exceeds Alicante in the absolute number of citations. / Garzón Rams, V. (2022). Tendencias de producción y financiación de la investigación biomédica en la Comunitat Valenciana. Análisis bibliométrico 2008-2015 [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/183880

Indiana University-Purdue University Indianapolis (IUPUI) / Magnetic resonance (MR) spectroscopy is a neuroimaging technique. It is widely used to quantify the concentration of important metabolites in a brain tissue. Imbalance in concentration of brain metabolites has been found to be associated with development of neurological impairment. There has been increasing trend of using MR spectroscopy as a diagnosis tool for neurological disorders. We established statistical methodology to analyze data obtained from the MR spectroscopy in the context of the HIV associated neurological disorder. First, we have developed novel methodology to study the association of marker of neurological disorder with MR spectrum from brain and how this association evolves with time. The entire problem fits into the framework of scalar-on-function regression model with individual spectrum being the functional predictor. We have extended one of the existing cross-sectional scalar-on-function regression techniques to longitudinal set-up. Advantage of proposed method includes: 1) ability to model flexible time-varying association between response and functional predictor and (2) ability to incorporate prior information. Second part of research attempts to study the influence of the clinical and demographic factors on the progression of brain metabolites over time. In order to understand the influence of these factors in fully non-parametric way, we proposed LongCART algorithm to construct regression tree with longitudinal data. Such a regression tree helps to identify smaller subpopulations (characterized by baseline factors) with differential longitudinal profile and hence helps us to identify influence of baseline factors. Advantage of LongCART algorithm includes: (1) it maintains of type-I error in determining best split, (2) substantially reduces computation time and (2) applicable even observations are taken at subject-specific time-points. Finally, we carried out an in-depth analysis of longitudinal changes in the brain metabolite concentrations in three brain regions, namely, white matter, gray matter and basal ganglia in chronically infected HIV patients enrolled in HIV Neuroimaging Consortium study. We studied the influence of important baseline factors (clinical and demographic) on these longitudinal profiles of brain metabolites using LongCART algorithm in order to identify subgroup of patients at higher risk of neurological impairment. / Partial research support was provided by the National Institutes of Health grants U01-MH083545, R01-CA126205 and U01-CA086368

Indiana University-Purdue University Indianapolis (IUPUI) / The objective of this research is to examine the development of the California alcohol outlets over time and the relationship between neighborhood characteristics and densities of the alcohol outlets. Two types of advanced analyses were done after the usual preliminary description of data. Firstly, fixed and random effects linear regression were used for the county panel data across time (1945-2010) with a dummy variable added to capture the change in law regarding limitations on alcohol outlets density. Secondly, a Bayesian spatio-temporal Poisson regression of the census tract panel data was conducted to capture recent availability of population characteristics affecting outlet density. The spatial Conditional Autoregressive model was embedded in the Poisson regression to detect spatial dependency of unexplained variance of alcohol outlet density. The results show that the alcohol outlets density reduced under the limitation law over time. However, it was no more effective in reducing the growth of alcohol outlets after the limitation was modified to be more restrictive. Poorer, higher vacancy rate and lower percentage of Black neighborhoods tend to have higher alcohol outlet density (numbers of alcohol outlets to population ratio) for both on-sale general and off-sale general. Other characteristics like percentage of Hispanics, percentage of Asians, percentage of younger population and median income of adjacency neighbors were associated with densities of on-sale general and off sale general alcohol outlets. Some regions like the San Francisco Bay area and the Greater Los Angeles area have more alcohol outlets than the predictions of neighborhood characteristics included in the model.