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Esophageal and biliary stents are indwelling devices used in the treatment of selected gastrointestinal and biliary disorders. Stenting is accepted as a standard procedure for palliation of malignant obstruction of the esophagus and biliary system. Review of the early and late complications associated with these devices is made with emphasis on the clinical and radiographic features. A suggested approach to diagnosis and treatment recommendations are made for each complication that the emergency department physician may encounter.

BACKGROUND: Maternal mortality remains a persistent public health concern in Sub-Saharan African countries such as Ethiopia. The Ethiopian Ministry of Health has made it a priority to improve maternal health outcomes within the country. Health information technology (HIT) solutions are a flexible and low-cost method for improving health outcomes and have been proven beneficial in low-to-middle income countries, like Ethiopia. The aims of this dissertation were: (a) to characterize the use of HIT usability evaluations in Africa; (b) to quantify facility clinical readiness for obstetric emergencies; (c) to explore the obstetric emergency supply chain dynamics and information flow; (d) to create a visualization dashboard to monitor obstetric emergency readiness; and (e) to evaluate the usability of the dashboard. METHODS: This dissertation comprised six studies with a variety of quantitative and qualitative methods: (1) a scoping review of the literature to identify the types and timing of HIT evaluations occurring in Africa; (2) a prospective, cross-sectional, facility-level comparison of obstetric emergency clinical readiness in Amhara, Ethiopia as measured by the Signal Functions and Clinical Cascades methods; (3) qualitative semi-structured interviews to gain an understanding of the current supply chain in the region, communication flow, and the current barriers and facilitators to success; (4) a case study summarizing the process for the development of the dashboard prototype through integrating existing technology, current literature, and qualitative interview findings; (5) user-centered design sessions with individuals who interact with the obstetric emergency supply chain to create an electronic dashboard prototype to monitor facility readiness to manage obstetric emergencies; and (6) expert review of the dashboard including sessions with a domain expert and information visualization experts and a heuristic usability evaluation with human-computer interaction experts to evaluate and improve the ease of use and usefulness of the prototype. RESULTS: The scoping review found that many usability evaluations in Africa lacked theoretical frameworks to support their work, and that most studies occurred later in the development process when the HIT was close to implementation in practice. The quantitative analysis of facility readiness found that many facilities were missing critical supplies for managing obstetric emergencies and identified a 29.6% discrepancy between the Signal Function tracer items and the Clinical Cascades readiness classifications indicating that the former, which is recommended by the World Health Organization, overestimates facility readiness. The qualitative interviews identified several locations within the current obstetric emergency supply chain where barriers such as bridging the gap of data availability between facilities and regional hubs could be addressed to improve overall facility-level readiness and pointed towards a dashboard as a potential solution. Once a prototype dashboard was developed, user-centered design sessions refined the terminology and colors that should be used throughout the dashboard screens and identified critical graphics and data elements that users believed should be included. Following domain and visualization expert review and iterative refinement of the dashboard, human-computer interaction experts rated the dashboards highly usable. CONCLUSIONS: Dashboards are a novel method for promoting facility-level readiness to manage obstetric emergencies. By exploring the existing supply chain and including targeted end-users and experts in the design process the author was able to tailor the dashboard to meet user needs, fit into the existing integrated pharmaceutical logistics system, and ensure that it follows best practices. Consequently, these studies contribute to strategies to address maternal mortality in Ethiopia.

This dissertation investigates the pressing issue of education in cardiac arrest during pregnancy, an emergency of life-threatening significance that necessitates a coordinated response from maternal and neonatal healthcare teams. The study encompasses three primary chapters, each addressing a crucial facet of this intricate scenario. In the chapter titled "Cardiac Arrest in Pregnancy: A Scoping Review on Knowledge and Confidence in a Maternal & Neonatal Response," an extensive examination of existing literature illuminated substantial knowledge gaps in the resuscitation of pregnant individuals, a concern that has persisted for over a decade. These gaps encompass critical domains, including a dearth of high-quality research with a heavy reliance on limited experimental designs, small sample sizes that curtail the generalizability of findings, a lack of comprehensive comparisons among various teaching strategies for enhancing knowledge and confidence, an emphasis on short-term outcomes without adequate longitudinal assessments of knowledge retention and clinical impact, a need for tailored education programs catering to diverse healthcare professionals, and a scarcity of research on collaborative learning experiences, particularly concerning neonatology teams. These identified gaps offer valuable opportunities for future research aimed at fortifying the evidence base, refining educational approaches, and ultimately enhancing the management of cardiac arrest during pregnancy and neonatal resuscitation. This manuscript underscores the pressing need to expand educational initiatives beyond obstetrical units and to foster interdisciplinary collaboration among healthcare teams. The chapter titled, "Escaping PowerPoint: Enhancing Knowledge, Satisfaction, and Self-Confidence in Cardiac Arrest in Pregnancy," introduces an innovative teaching strategy known as the Virtual Escape Room (VER). The randomized controlled study compares the effectiveness of this virtual gamified approach with a traditional online PowerPoint method in improving knowledge acquisition, learner satisfaction, and self-confidence. The findings demonstrate the statistically significant superiority of the VER in enhancing these critical outcomes, highlighting the potential of immersive learning experiences in healthcare education. Notably, the data reveal a substantial increase in mean scores from the knowledge pre-test (M = 59.58, SD = 16.30) to the knowledge post-test (M = 68.24, SD = 17.42), t(64) = 5.635, p < .001 . The assessment tools employed included a knowledge quiz and The National League for Nursing (NLN) Student Satisfaction and Self-Confidence instruments. The chapter titled "Puzzling Out the Correlates of Learner Engagement and Exploring Motivational States within a Virtual Escape Room," delves into the intricate aspects of learner engagement within the gamified learning environment of the VER. It uncovers the relationships between engagement, learner satisfaction, and specific engagement components such as enjoyment, creative thinking, and dominance. This manuscript underscores the multifaceted nature of engagement and highlights the imperative need for further research to achieve a more profound comprehension of its role in shaping learning outcomes. The study employed the Gameful Experience Scale (GAMEX) and the Telic/Paratelic State Measure (TPSI) instrument. Notably, statistically significant positive correlations were observed, including r = 0.346 (p = 0.005) between the Enjoyment Score and knowledge post-test, r = 0.305 (p = 0.013) between the Creative Thinking Score and knowledge post-test, and r = 0.255 (p = 0.04) between the Dominance Score and knowledge post-test. Additionally, a significant interaction effect emerged between the T/PSI score (pre vs. post) and the educational intervention (VER vs. control group). T/PSI score increased from 35.83 (SD = 8.67) before the intervention to 38.86 (SD = 9.91) after the intervention, indicating a substantial change. In contrast, there was no statistically significant difference in T/PSI scores before and after the traditional PowerPoint intervention for the control group, where the mean scores changed from 35.89 (SD = 7.02) to 35.57 (SD = 7.94). These findings strongly suggest that the VER condition contributes to a paratelic state among participants when compared to the control condition. This dissertation underscores the paramount importance of effective education in managing cardiac arrest during pregnancy, given the persistent knowledge gaps among resuscitation teams. The introduction of the VER as an innovative educational strategy represents a significant advancement in addressing these deficits. Furthermore, the exploration of engagement and motivational states within the gamified learning environment offers valuable insights into the complexities of learner engagement, paving the way for more effective educational strategies in healthcare settings. Ultimately, these findings have the potential to empower healthcare teams, potentially reducing maternal mortality rates and improving neonatal outcomes in the face of this critical emergency.

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Complex humanitarian emergencies have posed a challenge for the ethical project behind traditional humanitarianism. The humanitarian action field is under permanent scrutiny over its motivations, efficiency and impact. Altruism, compassion, humanity and other ethical values have supported the development of contemporary humanitarianism, but something is missing. This thesis is an attempt to understand the roots of the ethical project behind humanitarianism by analysing the concept of vulnerability through the lens of different theoretical frameworks that can add new perspectives with the objective of proposing a new interpretation in accordance to the context of a contemporary complex humanitarian emergency: Venezuela.

There has been a recent increase in the adoption of point-of-use (POU) household water filters as an alternative to untreated tap water or bottled water. POU filters certified for lead removal have recently been distributed by the hundreds of thousands in communities amid water lead crises, as a temporary solution to protect consumers from elevated water lead levels. This thesis rigorously examines the efficacy of POU lead certified filters in removing lead under a wide range of conditions, and evaluates premature clogging due to iron and associated impacts on the cost analysis of using filters instead of bottled water. In testing ten brands of POU devices against up to four different waters for lead removal, most devices consistently removed lead to below the 5 µg/L FDA bottled water standard. However, several failures were documented, including manufacturing flaws, premature clogging, and inconsistency between duplicate filters. When waters containing more difficult to treat lead particulates were synthesized, treated water often had lead concentrations greater than the 5 µg/L bottled water standard and sometimes were even over the 15 µg/L EPA action level. In some cases, less than 50% of the particulate lead was removed by the filter, thereby replicating some problems with these devices identified in the field. While POUs usually reduced water lead concentrations by at least 80%, a combination of manufacturing issues and difficult to treat waters can cause treated water to exceed expectations. Consumers often purchase POU devices to remove particles and lead in waters that also contain high iron, prompting studies to examine the role of iron on filter performance. When we exposed two brands of pour-through POUs to waters with both high lead and iron, lead removal performance was generally not compromised, as treated water typically had lead concentrations less than 5 µg/L. One case was observed in which lead passed through a set of filters at high levels in association with iron, confirming expectations that in some waters iron could cause formation of lead particulates that are difficult to remove. High levels of iron sometimes rapidly clogged the POU filters, preventing them from reaching their rated capacity and increasing operational costs and time to filter water. Specifically, 50% (3/6) of the filters tested clogged prematurely at an iron concentration of 0.37 mg/L, 66% (4/6) at 1 mg/L and 100% (6/6) at 20 mg/L. A cost analysis for POUs vs. bottled water demonstrated that in waters with higher iron, store-brand bottled water was often the more cost-effective option, especially when iron levels were significantly higher than the EPA Secondary Maximum Contaminant Level (0.3 mg/L). The lower costs of bottled water in these situations was even more apparent if consumer time was factored into the analysis. / Master of Science / There has been a recent increase in the use of household water filters as an alternative to tap water or bottled water. Filters that are certified for lead removal have recently been distributed by the hundreds of thousands in communities amid water lead crises, as a temporary solution to protect consumers from elevated water lead levels. This thesis rigorously examines the effectiveness of these filters under a wide range of conditions. When tested against up to four different waters for lead removal, most filters consistently reduced lead to below the concentrations allowed in bottled water. In cases where the filters did not perform as expected, several filter failure modes were identified, including manufacturing flaws, filter clogging, and inconsistency between duplicate filters. In addition to these failures, when a water that contained particulate lead that was difficult to filter, as little as 50% of the lead was removed. While household filters often significantly reduce water lead concentrations, a combination of manufacturing issues and difficult to treat waters can cause poor performance. In many cases, consumers purchase filters to remove particles or lead in waters that also contain iron, which caused us to investigate the effect of iron on filter performance. When two brands of pour-through filters were tested against waters with both lead and iron, lead removal performance was generally not compromised. One exceptional case was observed where both high levels of lead and iron passed through the filters, leading us to believe that iron in some waters could create conditions where lead is more difficult to remove. In many cases, the presence of iron caused filters to dramatically slow down or clog. Premature clogging due to iron prevented filters from reaching their rated capacity and, in doing so, significantly increased cost and filter times. A cost analysis for filters vs. bottled water demonstrated that in waters with higher iron, store-brand bottled water was often the more cost-effective option, especially in waters with higher levels of iron. The lower costs of bottled water in these situations was even more apparent if consumer time was factored into the analysis.

The emergence of regional security organisations during the 1990s in Africa proved to be of great significance for the lives of many Africans, including those living in conflict-torn countries such as Liberia, Sierra Leone, Côte d’Ivoire or the Democratic Republic of Congo, but, at the same time, this phenomenon has been understudied. This dissertation explores why regional security organisations with an agenda of democratic governance emerged in Africa in the 1990s. This question is answered with two in-depth case studies on the Economic Community of West African States (ECOWAS) and the Southern African Development Community (SADC). Driven by an empirical puzzle, this study is both hypothesis-testing and hypothesis generating. The study starts by laying out the different possible factors put forward by several bodies of theory in international relations to explain the emergence of ECOWAS and SADC as security organisations. These hypotheses are then tested throughout the history and the evolution of ECOWAS and SADC in order to highlight the circumstances of their creation and their qualified failure as economic communities. This is followed by a comparative analysis of the security and democracy mandates entrusted to ECOWAS and SADC by its member states based on the study of the legal texts that outline the specific objectives of each regional security organisation and the tools they were given to implement their mandates. The study finally analyses the implementation records of ECOWAS and SADC in order to assess the commitment of their member states to their new democracy and security mandate. The research concludes with the two following hypotheses: 1) A security agenda cannot emerge without the involvement of the regional hegemon. 2) What the regional hegemon can do, including affecting the speed of the transformation, is constrained by the acceptance of its leadership by its neighbours (legitimacy) and by state weakness (capability).