The African Communities, especially those that are living in the rural tribal areas have been undergoing traditional male circumcision for many decades. The traditional male circumcision is a passage from boyhood to manhood. In the process of this transition, there have been incidents of botched circumcisions which resulted in the deaths of initiates, dehydration, penile mutilation and in worse situations even penile amputation. These adverse events have been attributed to problems such as ill-trained traditional surgeons, the use of unsterile surgical equipment, harsh winter conditions, underlying diseases that were not diagnosed prior to circumcision, among others. In response, the government introduced the male medical circumcision as an alternative to traditional male circumcision with the aim to curb the problems associated with the latter. This was at the same time that the World Health Organisation adopted male medical circumcision as one of the strategies for the prevention of the spread of HIV and AIDS. These two decisions assisted to accelerate the need to introduce the male medical circumcision by working with relevant stakeholders. The purpose of the paper is to look at how the male medical circumcision was introduced with a special focus on the three districts in Limpopo province. The paper looks at the impact of the interface between the traditional leaders and the district health management offices during the introduction of the male medical circumcision. The former is regarded as the custodian of the traditional male circumcision while the latter takes the lead in the introduction of the male medical circumcision. A qualitative research method was used to undertake this study. The relevant literature was reviewed and used to understand the extent of the practice of male circumcision in both traditional and medical settings. The key role players in Vhembe, Mopani and Sekhukhune districts in Limpopo province, and from other sectors were interviewed for the purpose is learning more about the male medical circumcision. The major findings of the study are that the traditional leaders expected to be consulted during the introduction of the male medical circumcision because they saw it as encroaching on the traditional male circumcision which they see as their domain. This is because for the traditional leaders, male circumcision is more than just the cutting of the foreskin but it is a traditional, spiritual and necessary ritual that ensures proper transition from boyhood to manhood. They also needed to be consulted because for them traditional circumcision is a sacred practice that women and those who have not undergone it are not allowed to participate in. On the other hand, the department of health was convinced that male medical circumcision is one of the key strategies to prevent the spread of HIV and AIDS and as such needed to be introduced. The introduction of male medical circumcision was also aimed to reduce the number of botched circumcisions through strict practice of aseptic techniques. In the final analysis, it became clear that there is an increased intake of the male medical circumcision where there is cooperation between the traditional leaders and the district health management offices. This is more evident in the areas where traditional leaders have influence. This happened over time as the two parties gained each other’s trust and confidence.

<p> This study examined the relationships among stress, differentiation of self (DoS), and burnout in Child Protection Services (CPS) workers. Bowen defined DoS as the capacity of an individual to modulate emotional responses, stay calm in the midst of crisis, maintain emotional responses in highly charged situations, maintain a coherent sense of self, and maintain balance between independence and closeness within relationships. This nonexperimental correlational and comparative study sought to determine whether stress predicts burnout when controlling for DoS and whether DoS moderates the relationship between stress and burnout. Furthermore, the study examined the differences between male and female as well as novice and veteran CPS workers&rsquo; level of stress, DoS, and burnout. Data from a sample of 243 CPS workers showed that stress significantly predicted burnout when controlling for DoS, and DoS did not significantly moderate the relationship between stress and burnout. The results also found that there are no significant differences between male and female, novice and veteran workers&rsquo; level of stress, DoS, and burnout. A major finding was that the overall model for the domains of burnout showed stress and DoS to significantly predict emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Stress significantly positively predicted EE (<i>&beta;</i> = 0.56, <i>t</i> = 10.18, <i>p </i> &lt; .001), whereas DoS significantly negatively predicted EE (<i> &beta;</i> = -0.18, <i>t</i> = -3.22, <i>p</i> = .001). Stress significantly positively predicted DP (<i>&beta;</i> = 0.29, <i>t</i> = 4.53, <i>p</i> &lt; .001), whereas DoS significantly negatively predicted DP (<i>&beta;</i> = -0.24, <i> t</i> = -3.83, <i>p</i> &lt; .001). Stress significantly negatively predicted PA (<i>&beta;</i> = -0.24, <i>t</i> = -3.65, <i> p</i> &lt; .001), whereas DoS significantly positively predicted PA (<i> &beta;</i> = 0.21, <i>t</i> = 3.17, <i>p</i> = .002). In other words, those who reported high stress tend to have high level of EE and DP, and reduced PA. Conversely, those who reported high DoS tend to have low level of EE and DP, and higher PA. Despite limitations, the study sheds new light on the relationship between DoS and burnout and indicates the need for further research on the explicit role of Dos in predicting burnout. </p>

acase@tulane.edu / Health systems globally are faced with failed ethical commitment to their patients and financial extinction if they fail to consistently provide clinically efficacious, societally equitable, cost-effective healthcare. Despite the known causal link between the nutrition-related chronic disease epidemics and the world’s top morbidity cause, cardiovascular disease, there is no evidence-based, cost effective, scalable model of nutrition education intervention for and with medical trainees and professionals and their patients. Similarly, there is no known demonstrated case successfully applying artificial intelligence (AI)driven Big Data within a population health management framework for such an intervention to optimally refine it. Therefore, the medical school-based teaching kitchen, The Goldring Center for Culinary Medicine (GCCM) at Tulane University School of Medicine, launched the largest known multi-site cohort study with nested Bayesian adaptive randomized controlled trial (BA-RCTs) across 30 medical centers and 3,785 medical trainees/professionals. Cooking for Health Optimization with Patients (CHOP) with its four sub-studies features not only the first known systematic review and metaanalysis on this subject to determine best practices. CHOP also serves as the first known nutrition education study utilizing the latest AI-based machine learning (ML) techniques to complement the traditional statistical approaches to provide real-time, precise treatment estimates for causal inference and assessment of hands-on cooking and nutrition education for medical professionals and trainees’ patient counseling competencies, and improved patient psychometric and biometric outcomes. (1) The first sub-study, CHOP-Meta-analysis, demonstrated that though the average effect size (ES) across the 10 eligible nutrition education studies among medical trainees was 10.36 (95%CI 6.87-13.85; p<0.001), the only study meeting the STROBE criteria for high quality, the phase I sub-study of CHOP-Medical Students below, had significantly triple the ES (31.67; 95%CI 29.91-33.43). (2) CHOP-Medical Students demonstrated in inverse variance-weighted fixed effects meta-analysis of propensity score-adjusted fixed effects multivariable regression across 2,982 students that GCCM versus traditional clinical education significantly improved trainees’ total mastery counseling patients in 25 nutrition topics (OR 1.64; 95%CI 1.53-1.76; p<0.001). (3) CHOP-CME demonstrated that among 230 medical professionals, GCCM education significantly increased these odds, but by 159% more than the trainees’ improvement (OR 2.66; 95%CI 2.26-3.14; p<0.001) in addition to significantly increasing the odds of counseling most patients on nutrition in their clinical practices (OR 5.56; 95%CI 2.124-14.18; p<0.001). (4) CHOPCommunity demonstrated that GCCM education versus the standard of care significantly increased patient adherence to the Mediterranean diet (MedDiet) (OR 1.94; 1.04-3.60; p=0.038) and greater connectedness in their social networks (p=0.007). The pilot RCT for diabetes patients, CHOP-Diabetes, nested in this sub-study demonstrated superior improvements in diastolic blood pressure (-4 versus 7 mmHg, p=0.037) and cholesterol (14 versus 17 mg/dL, p=0.044) for patients randomized to GCCM versus the standard of care. The nested Phase II BA-RCT, CHOP-Family, demonstrated that GCCM versus standard of care had significantly greater MedDiet adherence based on their grocery receipts (OR 4.92; 95%CI 1.78-13.56; p=0.002). Using the Random Forest Multiple Imputation ML algorithm, the simulated Phase III BA-RCT predicted 93 hospital admissions and $3.9 million would be saved providing GCCM versus standard of care for congestive heart failure (CHF) exacerbation-risk patients primarily from underserved communities. Among 41 tested ML algorithms, the top performing Iterative Classifier Optimizer was comparable to the estimated traditional statistical model for the trainees’ primary endpoint for (1) (RMSE 0.314 versus 0.282), and the top performing Kstar was superior to the traditional model for the professionals’ primary endpoint (RMSE 0.431 versus 0.414). The four sub-studies within CHOP taken together provide the first known multi-site cohort and BA-RCT evidence for superiority of hands-on cooking and nutrition education compared to the standard of education and medical care for improved trainee/professional nutrition counseling competencies and patient outcomes. CHOP utilized the state-of-the-art in causal inference-based statistics, randomized trials for causal assessment, and ML to provide robust, precise estimates of comparative treatment effectiveness. This research infrastructure was scaled up to meet GCCM’s growing programmatic needs as it has since grown over 5 years to 30+ medical centers providing 53,674+ teaching hours to 4,171+ medical trainees/professionals and patients. CHOP has utilized the latest rigorous study design and analysis methodologies to provide a blueprint to optimize health systems through sustainable improvements as population health management that is clinically and cost effective, reducing health inequities while improving individual outcomes. / 1 / Dominique J Monlezun Jr

<p> Encounters between civilian law enforcement (CLE) and combat veterans may end in incarceration. Police Chiefs should consider this when allocating resources. The Sequential Intercept Model (SIM) is a conceptual framework designed to provide a guide to Police Chiefs for decision-making particularly for the benefit of combat veteran encounters. The qualitative method with case study research design utilized for this study was intended to examine the decision-making processes of law enforcement leaders regarding resource allocation. The University of Phoenix Library was the primary source for research of scholarly work. The target audience for the research was 26% of the Police Chiefs in police agencies with 25 members or less in Beaver County, Western Pennsylvania. The perception of Police Chiefs was examined in individual telephone interviews. The data collected during interviews were analyzed for trends in perception and decision-making processes. Data included interviews, training records and budgetary documents. The results are intended as a resource for police leaders for decision-making processes and for the benefit of public safety, officer safety and the individual combat veterans. Field notes and transcribed interviews were downloaded into NVivo software for analysis and emerging themes. Four emerging themes were: Need for decision-making processes, more funding is needed for training, training for police related to combat veteran encounters may help with jail diversion for combat veterans, and organizational efficiency through maintaining training records of police officers is necessary. Without changes based on emerging themes, a reduction in the veteran incarceration rate may not occur.</p><p>

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

<p>Purpose: The purpose of this study was to discover and describe how exemplary leaders establish common ground and produce breakthrough results in the mental health field by utilizing the 6 domains of conflict transformation: collaboration, communication, problem solving, process, emotional intelligence, and ethics. Methodology: This thematic, phenomenological study was accomplished through examination of the lived experiences of exemplary leaders with firsthand experience transforming conflict and finding common ground. The target population for this study included executive-level leaders of nonprofit organizations, governmental institutions, state and national associations, and private businesses serving adults and children with mental illness, developmental or behavioral disabilities, and/or substance use disorders in the United States. Exemplary leaders were selected through criterion sampling to comprise the sample. In-depth, one-to-one interviews were conducted as the primary method for data collection. Findings: The findings from this study illustrate that exemplary leaders in the mental health field use key aspects of the 6 domains of conflict transformation as a set of intersecting behaviors that facilitate transforming conflict and finding common ground. Conclusions: It is concluded that leaders in the mental health field must have command of key aspects of the 6 domains of conflict transformation in order to achieve breakthrough results toward parity in the mental health field. Recommendations: Further research is advised: A replication of this study, a multiple-case study, and a mixed-method study are recommended to deepen understanding of finding common ground. Phenomenological studies exploring the unexpected findings in this research are also recommended. Developing the findings in this study will be useful for shaping policy, practice, and professional development in order to impact transformational change in the mental health field.

Master of Science / Department of Chemical Engineering / Larry Erickson / Urban soils contaminated with lead can pose a health risk if vegetables and fruits from the garden are consumed. In general, we don’t think our gardens as dangerous or toxic, but unfortunately some garden soils do contain toxic levels of lead. Chipping paint around older structures will raise the lead level in the soils directly adjacent to the building. Restrictions to lead paint started in the 1950’s. Today lead paint content has been reduced; however paint companies are allowed to mix up to 0.05% lead in paints. Lead use has been reduced significantly, but not entirely eliminated. Soil can be contaminated with lead from other sources such as industrial sites, industrial sludge with heavy metals, auto emissions, old lead plumbing pipes or even old orchard sites in production when lead arsenate was in use. The main concern with lead in firing ranges is the fate and transport of heavy metals from bullets fragments accumulating in soil. Of these metals, lead is the predominant contaminant. Lead is considered the top environmental threat to children’s health. The U.S. military alone has cleaned up more than 700 firing ranges across the country over the past several years. The U.S. Air Force conducted a study at Shaw Air Force base to determine the lead concentrations in ground water and soil collected from the Small Arms Firing Range in 1992. The purpose of this study was to determine the levels of contamination in the soil in order to develop a restoration plan. The goal of the restoration plan was to clean up the land for future use. The Defense Environmental Restoration Program (DERP) conducted a project at Beale Air Force Base to clean up contaminated lead soil and to prevent any future fine and environmental expenses for the base. The main goal was to protect the base population from the lead and other contaminants hazards. In 1992 the Air Force conducted an investigation that included environmental sampling of soil and lead of the Tyndall Elementary School grounds. The Air Force collected lead samples in areas where children play on the school ground. Because lead concentrations results were below the toxic levels for lead, the Air Force concluded that no further action was needed. Further investigation for soil removal took part in 1992 and 2009. Under the Critical Removal Action field activities included site preparation, waste characterization, investigative sample chemical analysis, contaminated soil excavation, dust control, disposal, backfill and grading, and site restoration. Over the years the Air Force has been able to educate the military community on health hazards in the base facilities especially lead exposure and have been able to implement programs dedicated to prevent any lead overexposure.

yes / The on-going changes in England and Wales health policy that aimed to promote competition, provide enhanced performance information and create small health organisations produce significant attention within management. As the organisation of health system has moved from what a ‘loose-coupled’ system to an integration control system, there is an issue regarding the roles of healthcare providers as professionals and mangers roles as leaders of healthcare organisations. It could be concluded that the financial challenge for staff and the institution besides the pressure of expectation influence the healthcare leadership. This resulted in involves them fully and without bias in this process whilst being pragmatic enough to develop ideas, theories and techniques despite pronounced resistance. Therefore to engage with these changes and the policy, which underpins it, this paper explore the behavioural aspect of leadership style and its effect on management practice. It also considers the management of change and the impact of leadership during the change process. / From email attached when submitting to Bradford Scholars on 10th Mar 2017: 22-Feb-2017 Dear Dr. McIntosh: Thank you for submitting a paper to Health Services Management Research. I am emailing to confirm that your manuscript entitled "The crisis of management in the NHS - The absence of leadership" has been successfully submitted online and is presently being given full consideration for publication in Health Services Management Research. We aim to complete peer review and make a decision on papers within 12 weeks". 10/03/2017 - sm / Val queried this is not in the journal yet. If it isn't we can discuss with Satu whether we keep the entry. Pre-prints are allowed by the publisher, but are we keeping them in Bradford Scholars. - sm 08/12/2017 / Pre-print submitted for peer-review.

Thesis (D.P.H.)--University of Michigan.