Thesis (M.S.)--University of Michigan, 1993.

Thesis (M.S.)--University of Michigan, 1993.

Source water protection (SWP) is defined as a land use management and planning process aimed at the protection of surface and groundwater sources from contamination. Currently in Saskatchewan, the Water Security Agency is leading much of the planning and management with the goal of safe drinking water sources and reliable water supplies. The Water Security Agency has developed SWP planning initiatives across the southern portion of the province. Rates of SWP plan implementation in Saskatchewan are uneven and dependent on multiple factors. Using document review and key informant interviews, this study identifies factors facilitating and constraining source water protection plan implementation in selected areas and describes capacity building needs for SWP plans implementation in Saskatchewan. Results are discussed based on four capacity areas: financial, institutional, technical and social capacity. The results in this study show that capacity areas in need of improvement include stable financial resources, training opportunities for local watershed groups, public awareness, adequate stakeholder involvement, SWP plan re-evaluation, and information/data access. The result of this research contributes to the understanding of SWP plan implementation relating to capacity building needs at the watershed scale in the prairie region.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Thesis (M.S.P.H.)--University of Michigan, 1941.

Este estudo desenvolveu-se no município de Bananal, São Paulo, uma área endêmica para esquistossomose com prevalência menor que 10% e baixa carga parasitária dos infectados. Teve como objetivo a identificação de formas clínicas da esquistossomose mansônica entre 109 pacientes diagnosticados parasitoscopicamente e medicados com oxamniquine, durante a realização do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica (1998-2000). Utilizou-se a ultra-sonografia abdominal e o exame de fezes (Kato-Katz) realizado, em média, quatro anos após o término do plano. Nesta casuística, foram identificados cinco pacientes com imagens ultra-sonográficas abdominais compatíveis com fibrose periportal periférica e central e hipertensão portal que tinham diagnósticos clínicos de esquistossomose na sua forma intestinal. A ultra-sonografia é um método de diagnóstico sensível, incruento, que possibilitou a identificação de casos de esquistossomose com comprometimento hepático mais extenso do que se expressava pelo exame físico. Mesmo considerando uma prevalência baixa de alterações hepáticas e de circulação portal nesta casuística, evidencia-se a importância do emprego do método ultra-sonográfico na avaliação individual dos pacientes esquistossomóticos, por permitir a detecção de alterações morfológicas e funcionais que podem ter conseqüências clínicas relevantes. Deve-se assinalar ainda que, no momento do exame, todos os pacientes tiveram coproscopias negativas, revelando a efetividade das ações de controle no médio prazo. Devemos considerar que a realização do estudo ultra-sonográfico em média quatro anos após o tratamento específico dessa população, provavelmente detectou menos alterações do que aconteceria se o estudo fosse feito no momento do diagnóstico parasitológico, pois se sabe que a involução, ainda que parcial da fibrose e de alterações funcionais conseqüentes a ela, ocorre após tratamento específico. Por fim, apesar do pequeno número de casos avaliados, a estratégia utilizada no presente trabalho começou a preencher a lacuna de avaliação do impacto da esquistossomose sobre a saúde do cidadão bananalense, percebida durante o desenvolvimento do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica, período de 1998 a 2000. / This study was developed in the municipality of Bananal, São Paulo, an endemic area for schistosomiasis with prevalence of less than 10% and low parasite load among infected individuals. The objective was to identify the clinical forms of intestinal schistosomiasis among 109 patients who had been diagnosed through parasitological tests and medicated with oxamniquine at the time of the Plan for Intensification of Schistosomiasis Control Actions (1998-2000). Abdominal ultrasonography and feces examination (Kato-Katz) were utilized: this was on average done four years after the ending of the plan. In this sample, five patients were identified whose abdominal ultrasound images were compatible with peripheral and central periportal fibrosis and portal hypertension who had had a clinical diagnosis of schistosomiasis in its intestinal form. Ultrasonography is a sensitive noninvasive diagnostic method that enables identification of the extent of liver involvement in schistosomiasis cases better than through its expression in physical examination. Even considering that there was a low prevalence of liver abnormalities and portal circulation in this sample, the importance of utilizing the ultrasound method for individual evaluations on the schistosomiasis patients was demonstrated. Through this, it was possible to detect morphological and functional alterations that could have important clinical consequences. It also should be noted that, at the time of the ultrasound examination, all the patients presented negative coproscopic test results, thus showing the effectiveness of the control actions over the medium term. It needs to be borne in mind that, because the ultrasound study was carried out on average four years after the specific treatment of this population, it is likely that fewer abnormalities were detected than there would have been if this study had been performed at the time of the parasitological diagnosis. This comes from the knowledge that involution occurs following specific treatment, even if only partially with regard to fibrosis and its consequent functional alterations. Finally, despite the small number of cases evaluated, the strategy utilized in the present study has started to fill the gap regarding assessing the impact of schistosomiasis on the health of the citizens of Bananal that was perceived during the development of the Plan for Intensification of Schistosomiasis Control Actions between 1998 and 2000.

Este estudo desenvolveu-se no município de Bananal, São Paulo, uma área endêmica para esquistossomose com prevalência menor que 10% e baixa carga parasitária dos infectados. Teve como objetivo a identificação de formas clínicas da esquistossomose mansônica entre 109 pacientes diagnosticados parasitoscopicamente e medicados com oxamniquine, durante a realização do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica (1998-2000). Utilizou-se a ultra-sonografia abdominal e o exame de fezes (Kato-Katz) realizado, em média, quatro anos após o término do plano. Nesta casuística, foram identificados cinco pacientes com imagens ultra-sonográficas abdominais compatíveis com fibrose periportal periférica e central e hipertensão portal que tinham diagnósticos clínicos de esquistossomose na sua forma intestinal. A ultra-sonografia é um método de diagnóstico sensível, incruento, que possibilitou a identificação de casos de esquistossomose com comprometimento hepático mais extenso do que se expressava pelo exame físico. Mesmo considerando uma prevalência baixa de alterações hepáticas e de circulação portal nesta casuística, evidencia-se a importância do emprego do método ultra-sonográfico na avaliação individual dos pacientes esquistossomóticos, por permitir a detecção de alterações morfológicas e funcionais que podem ter conseqüências clínicas relevantes. Deve-se assinalar ainda que, no momento do exame, todos os pacientes tiveram coproscopias negativas, revelando a efetividade das ações de controle no médio prazo. Devemos considerar que a realização do estudo ultra-sonográfico em média quatro anos após o tratamento específico dessa população, provavelmente detectou menos alterações do que aconteceria se o estudo fosse feito no momento do diagnóstico parasitológico, pois se sabe que a involução, ainda que parcial da fibrose e de alterações funcionais conseqüentes a ela, ocorre após tratamento específico. Por fim, apesar do pequeno número de casos avaliados, a estratégia utilizada no presente trabalho começou a preencher a lacuna de avaliação do impacto da esquistossomose sobre a saúde do cidadão bananalense, percebida durante o desenvolvimento do Plano de Intensificação das Ações de Controle da Esquistossomose Mansônica, período de 1998 a 2000. / This study was developed in the municipality of Bananal, São Paulo, an endemic area for schistosomiasis with prevalence of less than 10% and low parasite load among infected individuals. The objective was to identify the clinical forms of intestinal schistosomiasis among 109 patients who had been diagnosed through parasitological tests and medicated with oxamniquine at the time of the Plan for Intensification of Schistosomiasis Control Actions (1998-2000). Abdominal ultrasonography and feces examination (Kato-Katz) were utilized: this was on average done four years after the ending of the plan. In this sample, five patients were identified whose abdominal ultrasound images were compatible with peripheral and central periportal fibrosis and portal hypertension who had had a clinical diagnosis of schistosomiasis in its intestinal form. Ultrasonography is a sensitive noninvasive diagnostic method that enables identification of the extent of liver involvement in schistosomiasis cases better than through its expression in physical examination. Even considering that there was a low prevalence of liver abnormalities and portal circulation in this sample, the importance of utilizing the ultrasound method for individual evaluations on the schistosomiasis patients was demonstrated. Through this, it was possible to detect morphological and functional alterations that could have important clinical consequences. It also should be noted that, at the time of the ultrasound examination, all the patients presented negative coproscopic test results, thus showing the effectiveness of the control actions over the medium term. It needs to be borne in mind that, because the ultrasound study was carried out on average four years after the specific treatment of this population, it is likely that fewer abnormalities were detected than there would have been if this study had been performed at the time of the parasitological diagnosis. This comes from the knowledge that involution occurs following specific treatment, even if only partially with regard to fibrosis and its consequent functional alterations. Finally, despite the small number of cases evaluated, the strategy utilized in the present study has started to fill the gap regarding assessing the impact of schistosomiasis on the health of the citizens of Bananal that was perceived during the development of the Plan for Intensification of Schistosomiasis Control Actions between 1998 and 2000.

Oral health promotion interventions (OHPI) seek to achieve sustainable oral health improvements through actions directed at the underlying determinants of oral health. Clinical trials often promise levels of effectiveness which are not actually achieved in general use, indicating problems with implementation. This study set out to identify an OHPI for which there was strong evidence of effectiveness and then aimed to explore issues that arose in the implementation of that intervention. Research methods A sequential portfolio design was utilised. The first phase involved systematic reviews of literature to identify existing community based OHPI and interventions shown to be effective in reducing dental caries. These were also examined to determine whether the existing evidence base was informative about the process of implementing best evidence. Systematic reviews were undertaken on effectiveness of: supervised toothbrushing with fluoridated toothpastes, supervised fluoridated mouthrinsing and promotion of dietary behaviours, all, in school children. MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE and BNI electronic databases were searched for articles published between 1990 and 2013. In total, 47 studies were included in the reviews: 21 studies on supervised toothbrushing with fluoridated toothpastes, 12 on fluoridated mouthrinsing and 14 studies on healthy dietary behaviours towards caries prevention. The second phase was a qualitative research study, which was undertaken to explore the experiences, and perceptions of participants involved in decision-making, planning and delivery of one specific community based OHPI (supervised toothbrushing) in the North East of England. Nineteen participants (NHS and school staff) participated in the qualitative study. Knowledge translation in oral health promotion One-to-one interviews and focus groups interviews were conducted with the participants. Normalisation Process Theory constructs informed the development of the interview guides and was also used in data analysis. In the third phase of the study, an integration of the findings of the first and second phases of the study was conducted. Results In the systematic reviews of literature conducted, the various levels of clinical effectiveness identified were influenced by appropriate and regular fluoride use, involvement of OHP specialists, supervision by parents and the free provision and availability of materials. There was however a general lack of comprehensive information on all aspects of implementation of OHPI. In the second phase of the study, an exploration of barriers to implementation of an OHPI revealed the following: -inadequate utilisation of research evidence -gaps in leadership and management structures -non- investment in engagement and ownership of the intervention -challenges with partnership working and evaluation of implementation of OHPI. Conclusions Availability of evidence of effectiveness of an intervention does not imply that the intervention will be successful when rolled out. Published articles on evidence-based interventions do not have comprehensive information on the mechanisms and workability of the processes required for effective implementation of OHPI. Normalisation Process Theory (NPT) enabled the exploration of factors that could facilitate knowledge translation and successful implementation of OHPI. In previous studies, NPT was used to evaluate effectiveness of interventions; in this study it was used to explore the implementation process of an OHPI and has highlighted the need for Knowledge translation in oral health promotion oral health promotion strategy makers and commissioners to revisit the “sense-making” aspect of evidence implementation, to reflect on the need for investing in all members of the team, to encourage the ‘ownership’ of interventions being implemented. In addition, there is a need to review existing leadership and management structures and to re-examine and amend the processes by which OHPI are monitored and reported. These measures would enable maximised effectiveness and sustainability of clinically effective OHPI.

For  a  long  period  of  time  it  has  been  known  that  detailed  development  plans  contain provisions that are difficult to implement. In 2011, the Swedish government assigned the cadastral authority to identify the gravity of the problem by sending out 384 questionnaires to cadastral surveyors. These cadastral surveyors specified whether the detailed development plans  contained  provisions  that  could  be  difficult  to  implement.  In  this  thesis,  the questionnaires are reviewed, and in order to have a deeper understanding of the reasons why these provisions are still used, interviews were carried out with five detailed development planners in different municipalities. The results from the questionnaires illustrates the following: two percent of the detailed development plans contain land that is reserved for a joint facility and for a public purpose, and five percent was for land that was not localized. In five percent there were no special reasons for the municipality for not mandating public places. The description of the plans lacked information about how the plan could be carried out in 35 percent of the plans. From the interviews it appears that the land reservation which were not localized were used because they did not want to lock the plan to existing conditions. Through the land reserve for a joint facility and for public land the municipality wanted to secure public access to private land and at the same time not have to pay for the public area. In many of the detailed development  plans  the  municipalities  did  not  mandate  for  public  spaces  because  the neighbourhood had private mandating. According to one municipality they gave priority to the design of the plan before the implementation. Another one said that it was hard to decide which questions they had to solve in the plan and which ones belonged to the cadastral authority.  However,  the  development  planners  consider  the  consultation  as  a  pragmatic method to get input on the plan. In summary, the municipalities need more guidance to enforce the plan and the know-how of the provisions needed to implement the plan efficiently. / Under en längre tid har det framkommit att detaljplaner innehåller planbestämmelser som är svåra att genomföra. Lantmäteriet fick därför år 2011 i uppdrag av regeringen att utreda hur omfattande problemen är. En enkät skickades ut till förrättningslantmätare som i och med sitt samrådsyttrande till kommunen fick ange ifall detaljplanen innehöll planbestämmelser som kunde bli svåra att genomföra. I examensarbetet sammanställs de 384 enkätsvaren varav ett urval  presenteras  och  för  att  få  en  djupare  förståelse  för  av  vilka  anledningar  dessa planbestämmelser används har även fem planhandläggare på olika kommuner intervjuats. Resultatet av enkätsvaren visar att två procent av detaljplanerna innehåller gx/ gz områden och  olokaliserade  markreservat  till  ett  första  plansamråd.  Särskilda  skäl  för  ett  enskilt huvudmannaskap fattas i sju procent av detaljplanerna och 35 procent av planerna innehåller andra brister som många gånger handlar om att planbeskrivningen inte innehåller tillräcklig information om hur planen ska genomföras. Av intervjusvaren med planförfattarna framgår att de olokaliserade markreservaten användes för att inte låsa planen till befintliga förutsättningar och genom gx-området säkerställdes allmänhetens tillträde till kvartersmark samtidigt som kommunen undgick det ekonomiska ansvaret för området. I flera av detaljplanerna har kommunen avsagt sig huvudmannaskapet eftersom att  det av tradition varit enskilt. Enligt en av planförfattarna prioriterar kommunen att behandla frågor om detaljplanens gestaltning till samrådet framför genomförandefrågor och en annan planförfattare menar att det är svårt att avgöra vad som är deras frågor att behandla och vad som är Lantmäteriets. Dessutom framfördes att samrådet var till för att få in bra  synpunkter  och  att  många  frågor  löstes  efter  att  det  genomförts.  Slutsatsen  av examensarbetet är att kommunerna behöver mer stöd när det gäller genomförandefrågor och bättre  kunskaper   i   vad   nämnda   planbestämmelser   innebär   för   det   fastighetsrättsliga genomförandet.

Adaptive management is an approach to problem solving that acknowledges uncertainty. Adaptive management involves a systematic and rigorous process of learning from the outcomes of management actions, accommodating change and improving management. Plans, policies or management strategies influenced by new information and learning, are modified. This study examines the implementation of adaptive management for endangered and threatened species covered in Habitat Conservation Plans (HCP). Introduced in 1982 as an amendment to the Endangered Species Act (ESA), Habitat Conservation Plans are negotiated agreements that mitigate the incidental "take" (killing, harming) of endangered and threatened species during a development or resource extraction project. However, scholars found the scientific basis of approved HCPs to be inadequate and the efficacy of prescribed mitigation measures untested implying the need for adaptive management during implementation. This case study evaluation investigates HCP landowner compliance and progress within the parameters of the federal 1994 "No Surprises" policy. That policy limits landowner liability and responsibility for additional conservation action due to failed mitigation measures during HCP implementation. "No Surprises" assumes we can predict all the consequences of implementing a HCP. The policy seems to work against the objectives of adaptive management to improve scientific knowledge and modify action. The cases include the Central Cascades HCP implemented in the Central Cascades of Washington and the Orange Central Coastal County HCP implemented within a nature reserve in Orange County, California. The study assesses the strengths and weaknesses of adaptive management implementation for protecting endangered species and their habitat, and 2) recommends mid-course corrections for improving adaptive management before HCP maturity. / Ph. D.