A shift in medical paradigm, from a focus on curing disease to a focus on preventing it, demands a totally new type of medical infrastructure. Through an analysis of the preventative paradigm, two key architectural implications of disease prevention are revealed: the need to reach out to the healthy population; and the system nature of preventative care, which links seemingly unrelated lifestyle factors to health. The site of the former Queen Elizabeth High School, on the Halifax peninsula in Halifax, Canada, is chosen as the site to explore the programmatic and spatial implications of preventative care. Through attention to the concepts of habitat and flow, a design is created which blurs the boundaries between building and landscape, between diverse programs, and between patient and passer-by.

The work contained in this thesis explores the economic issues of screening women, and the subsequent use of hormone replacement therapy (HRT), for the prevention of osteoporosis. The thesis is divided into five sections. In the first section the background to the problem is described as are the relevant economic evaluation techniques. In addition, the relevant economic literature is reviewed. The second section of the thesis, contains the results of research aimed at estimating the costs of population screening followed by treating the women at highest risk. The three chapters in this section address the following issues: estimating total screening costs; developing an economic definition of at risk status; and describing the HRT compliance rate after screening and its associated costs. In the third section the consequences of screening are examined. Hence, the osteoporosis risk profile of non attenders is described and the effects of HRT on women's quality of life is explored. Finally, this section is completed with a study looking at the predictive value of bone density screening. The fourth section is a synthesis of all the costs and consequences described in the preceding sections with relevant additional information from the literature. This section shows that screening perimenopausal women will be very expensive in terms of cost per quality adjusted life years (QALY) gained. In contrast, screening women and treating them when they are aged 70 appears to generate a relatively low cost per QALY. The final, fifth section, of the thesis describes outstanding research issues which need to be addressed before any screening programme is implemented.

To evaluate preventive aerial coyote hunting as a depredation management technique, I compared sheep losses to coyote (Canis latransl predation and the hours of corrective predation management required on summer grazing areas with and without hunting the prior winter from helicopters. Correlations were used to test for relationships between the extent, intensity, and timing of aerial hunting and lamb losses to coyote predation. Data on the age, sex, and reproductive status of coyotes killed using aerial hunting, traps, snares, and calling-and-shooting were used to test for differential coyote vulnerability to damage management tools, and to assess the impact of aerial hunting on coyote populations. Winter aerial hunting reduced confirmed and estimated lamb losses to coyote predation and the hours of effort required for corrective predation management the subsequent summer. Aerial hunting increased the number of coyotes killed annually per grazing area, but did not reduce summer coyote removal. There were no consistent relationships between the extent, intensity, or timing of aerial hunting and sheep losses to coyote predation. The male: female ratio for coyotes captured with calling-and-shooting was higher than that for traps or aerial hunting. More juvenile coyotes were killed with aerial hunting than with traps or shooting. However, there was no difference in the age of adult coyotes {>1.5 years old) removed using any control method or between the age of coyotes from areas with and without consistent aerial hunting. Confounding factors in the data and the high number of uncontrolled variables prohibited clear identification of the mechanism making aerial hunting effective. I also examined financial compensation programs as an alternative to lethal control. Nineteen states and 7 Canadian provinces had compensation programs. Compensation programs appeared to be established when wildlife problems were of recent origin, resulted from government actions, and/or were caused by highly valued species. Compensation programs for coyote damage had been established in 4 states/provinces in eastern North America where coyotes are a new problem, but are unlikely to be a acceptable tool for the western U.S.

Children’s health outcomes are affected by multiple variables, including biological, environmental, psychological and social factors. Many determinants are decided after birth depending on the surrounding physical, psychological and social environment that the child enters. Elements such as socioeconomic status, marital status, race, education level and access to healthcare greatly affect a mother’s health literacy, and, thus, her ability to adequately care for her child(ren). This project examines the impact of maternal health literacy training on the knowledge of mothers, who have been homeless. Ninety-one women completed a six-hour maternal health literacy training. A pre-posttest design was used to measure maternal knowledge change as the result of the training. The same measure was used at both time points, and the measure was designed in a multiple-choice format. Outcomes indicate that the maternal health literacy training positively impacted reported maternal child health knowledge. Additionally, a follow-up survey was given to 11% of the total sample, to examine the sustainability of the knowledge gains 2-4 months post-training. Findings indicate that the women who took the follow-up survey retained a considerable amount of health literacy knowledge. This is a first step into research examining how maternal health literacy training improves short and long term knowledge in a high risk sample of mothers. The positive outcomes suggest that this program could be beneficial to agencies across the country serving maternal needs in similar circumstances. Recommendations for further research are discussed.

The CGRP monoclonal antibodies are the first class of medication developed specifically for migraine prevention, in contrast to previous preventative medications, that were in the anti-hypertensive, anti-epileptic and anti-depressant class. There are two notable divisions within the CGRP inhibitor class: the CGRP monoclonal antibodies (CGRP mAbs), and the small molecule CGRP antagonists (gepants). This thesis conducts a retrospective analysis of notable clinical trials such as the ACHIEVE I, ACHIEVE II, LIBERTY, ARISE, STRIVE, PREEMPT, and COMPEL studies to determine the efficacy of CGRP inhibitors. In ACHIEVE I, 38.6% of participants in the 50 mg ubrogepant group experienced pain freedom 2 hours post dose (p=0.002) and in ACHIEVE II trial in the 50 mg ubrogepant group, 21.8% reported pain freedom 2 hours. In participants that received Rimegepant at a 75mg dose, 21%of participants reported more freedom from pain at 2 hours than placebo (p<0.0001).^40 In another study, participants received placebo, 50 mg and 100 mg of sumatriptan.^43 Results of the study showed that more than half of participants, 57%, in the 100 mg Sumatriptan group and exactly half of participants in the 50 mg group had pain relief at 2 hours post-dose.^43 In the LIBERTY trial, at 12 weeks, 30% of individuals that received erenumab reported a fifty percent or more reduction in the monthly number of migraine days than individuals in the placebo group (p=0.002).^45 In the STRIVE trial, the average number of migraine days experienced by the participant at baseline was 8.3, and was assessed by the 4th month through the 6th month. This baseline decreased to 5.1 days (a 3.2 difference) in the participants that received an injection of 70 mg of erenumab (p<0.001).^46 The participants that received an injection of 140 mg erenumab, decreased from the baseline to 4.6 days of migraine (a 3.7 difference) (p<0.001) . 46 Participants that received placebo reported the least change from baseline, only a 1.8 day change (p<0.001).46 In the ARISE Trial patients receiving erenumab experienced a change of 2.9 monthly migraine days, a 1.1 increase from the reported change of 1.8 days reported by study participants for the monthly migraine days in the placebo group (p<0.001).^47 The PREEMPT1 trial did not meet statistical significance for their primary endpoint or study measure, which was to assess for a mean change in monthly mean headache episode frequency between baseline and week 24 of the trial (p=0.344)^48. Participants in the PREEMPT2 trial experienced a reduction by 9 days when compared to placebo for the primary end point, frequency of headache days per 28 days relative to baseline (p<0.001)^49. In the COMPEL study, participants experienced -10.7 day reduction in headache days by 108 weeks (p<0.0001).^50 There are several advantages to CGRP mAbs. Patients are more likely to adhere to CGRP mAbs medication and tolerate this medication than other medication options^17, CGRP mAbs do not give rise to toxicity in the liver because these medications do not interact with the liver^17, and CGRP mAbs have a long duration in the human body as they have a half-life of 20 to 30 days which provides patients with the opportunity to not take the medication as frequently.^51 Another reason why CGRP mAbs are advantageous compared to traditional treatment options is that they have a strong affinity and specificity for the CGRP receptor or CGRP molecule. This high specificity prevents the medication from causing undesirable effects on other receptors^51.

Well-Child Examinations are an integral part of monitoring growth and development for children. These visits allow for establishment of a therapeutic relationship between patient and caregiver, and provide opportunities to screen for underlying conditions while simultaneously following growth and development milestones. Well-child examinations provide opportunities for parents to voice concerns and help to identify those children at risk for delays or underlying medical conditions. When these conditions are identified early, they tend to have an improvement of outcomes. Since the core items to be included in wellness examinations vary by age, insurance provider, and risk factors, our aim is to measure and improve the knowledge and comprehension of examination components among a group of Family Medicine resident physicians that provide primary care to a pediatric population. Provider knowledge and understanding was measured by means of a set of multiple-choice questions prior to an educational session. A post-educational examination was then administered to assess recruitment and retention of information. There appeared to be an overall positive trend toward increased knowledge base following the education session, indicating and improvement of understanding and medical knowledge.

A thesis submitted to the Faculty of Arts in fulfillment of the requirements for the Degree of Doctor of Philosophy in the Department of African Languages at the University Of Zululand, South Africa, 2017 / This research looks into details different ways of circumcision and the teachings of different Zulu communities and their role in fighting the spread of Sexually Transmitted Diseases. It also looks at the role of the society and royal house in the fight against STDs. This research also investigates the advantages and disadvantages of cultural circumcision and medical circumcision so that there would be necessary recommendations that will make men to be willing to circumcise. It looks at good cultures that can be followed to decrease STDs and also the procedures that are followed if a man wants to get married. It looks into details the channels to be followed to prevent teenage pregnancy and prevent STDs. It also investigates the present dangers in people who are homosexual. The research looks closely the reasons that lead people to homosexuality. The study will listen to the views of different societies in regards to STD’s especially AIDS. This research has seven chapters: Chapter one: It is the introduction where the drive of the research is looked, the purpose of the study, methods of research, scope of the study, different critics, beneficiaries of the study and organization of study. Chapter two: Looks at the history of men circumcision, the circumcision and its role in reducing STD’s and the symptoms of the STD’s in a person. Chapter three: Looks at advantages and disadvantages of cultural circumcision and medical circumcision during circumcision and after circumcision. While that is looked after there is going to be the testing of the good that can be done to save the Zulu Nation, and the bad will also be looked at so that the recommendations will be made. Chapter four: Looks at the training of the circumcised men and their behaviour, structures that are supposed to train circumcised men about how to handle themselves. Structures like parents, education, health, traditional leaders and religion. Chapter five: Looks at the results of good behaviour of circumcised men, those who are going to benefit by good behaviour during the first periods of a girl, coming of age, virginity testing to male and female, reed dance, and channels to be followed by men until they get married. Chapter six: It analyses in details the information that has been taken from different structures of communities. Questions concerning circumcising and non-circumcising, age, married and single, ethnical groups, society belief, employment and unemployment, educated and not educated, patients availability and nationality. The second list of question is about believing in removing certain body parts, information about the culture of circumcision and ways of circumcising. It analyses what can be done to reduce the rate of sex in youth. Chapter seven: It is the analysis of research where recommendations are made and concluded.

Yes

This study determined whether pre-operative exercise and education (PREHAB) improves the frailty status and physical activity behaviour of older adults undergoing elective cardiac surgery, more than standard care (StanC). Using a subset of patients from a multi-centre trial (NCT02219815), twenty-six patients over the age of sixty were randomized to receive StanC (n=12) or PREHAB (n=14). Blinded research assistants collected data at baseline prior to randomization and one week pre-operatively. Changes in frailty were assessed using a 30-item functional frailty index (FFI); whereas, changes in physical activity behaviour were assessed using accelerometers. Baseline data was not different between groups. Frailty status improved by 17%, 5% and 35% amongst StanC, PREHAB “non-completers” and PREHAB “completers”, respectively. No changes in moderate to vigorous physical activity were found pre-operatively. These data suggest that the PREHAB intervention is feasible to implement and may result in improved frailty status amongst frail older adults awaiting elective cardiac surgery. / October 2016

Magister Psychologiae - MPsych / There are many theories as to why adolescents engage in substance abuse. These theories have formed the basis of various substance abuse prevention programmes aimed at reducing this problem. Evaluation of these interventions is needed in order to assess their effectiveness and to improve on future prevention strategies. The literature highlights tensions and differences between the primary preventative approaches to substance abuse and the harm reduction model. It also suggests that psychosocial or life skills programmes and interventions employing a harm reduction approach tend to be viewed as more suitable for adolescents than other approaches. This study focuses on a high school intervention programme running since 1996, which has not yet been evaluated. It aimed to identify the programme's strengths and weaknesses, as well as participants' perception of the intervention. A qualitative research method was used, employing focus groups as the tool for data gathering. The sample for the study was made up of 30 volunteers from three grade 10 classes that completed the programme two years prior to this study. Data was transcribed verbatim and analyzed using thematic analysis. Links were made to the two approaches referred to above. Analysis of the data indicated that although stories used to warn and frighten people were shown to have a shocking impact on the participants, pupils found it difficult to make the connection between the speakers' horrific stories and their own experimentation with drugs and alcohol. It was found that participants appreciated the fact that they were being informed about the dangers of substance use, and that they were encouraged to take responsibility for their own decisions regarding this behaviour. The informal, non-judgemental stance of the speakers served to reinforce this message. In conclusion, the study indicated that the different methods used in the various prevention programmes are in fact not altogether different. It is suggested that the various models are potentially compatible, and can perhaps work together to establish an effective preventative strategy.