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Scaling Up Health Innovations in Africa: Prospects and Challenges
Get PDFDrawing from evidence-based global health innovations, this book elucidates how implementation science can support the scale-up of innovations in Africa.
Health practitioners have successfully developed evidence-based health innovations to solve public health problems. However, challenges remain in translating and scaling up these innovations to save and improve lives in Africa. Scaling Up Health Innovations in Africa focuses on the lessons learned from scaling up health innovations across the continent.
Obidimma Ezezika provides engaging and insightful evidence on the challenges and triumphs of taking health innovations to scale, drawing from hundreds of interviews with practitioners on the ground. The book includes stories, anecdotes, and lessons from experiences in eleven African countries, including Kenya, Rwanda, Tanzania, Nigeria, Burkina Faso, Uganda, and Mozambique. It addresses the unique socio-cultural, financial, and logistical constraints faced in these regions, alongside insights, successes, and next steps for scaling innovations within the African context.
The book critically emphasizes the importance of understanding how implementation science can aid in scaling up innovations in Africa. While there have been disparate works on scaling specific health innovations in Africa, a unified series of cases is needed from an implementation science perspective to create generalizable lessons and principles. Ultimately, Scaling Up Health Innovations in Africa offers valuable insights around implementation strategies that translate health innovations to achieve broad impact
An Investigation in Quantifying Molar Hypomineralization using Non-invasive Light Spectrophotometry Approaches
Get PDFEnamel hypomineralization is a developmental enamel defect that increases susceptibility to sensitivity, decay, and structural breakdown. Diagnosis of enamel hypomineralization remains subjective. This study evaluated optical coherence tomography (OCT) and photothermal radiometry with modulated luminescence as quantitative, non-invasive diagnostic tools, validated against microcomputed tomography (µCT). Twenty-five extracted first permanent molars were classified using the mDDE index and imaged with clinical photography, radiography, OCT, PTR/LUM, and µCT. Visual and OCT classifications showed substantial inter- and intra-rater agreement when evaluated using Fleiss’ kappa (κ = 0.61-0.70). OCT A-scan slope analysis revealed significant group differences (p<0.001), and µCT confirmed reduced mineral density in lesions. PTR/LUM demonstrated high sensitivity (0.80) but low specificity (0.20). Co-localized imaging identified distinct lesion characteristics, including high-contrast organic-rich regions. These findings support OCT’s ability to quantitatively differentiate lesion types and PTR/LUM’s sensitivity to lesion severity, offering strong potential for objective diagnosis of enamel hypomineralization.M.Sc
Functional MRI During Active Deep Brain Stimulation: Advancements in Personalized Treatment for Parkinson's Disease.
Get PDFDeep brain stimulation (DBS) is recognized as a safe and effective therapy for a growing number of neurological conditions. For nearly half a century its use in treating the motor symptoms of Parkinson’s Disease (PD) has been studied. Despite being the topic of intense investigation our knowledge of the therapeutic mechanism of DBS remains unclear. With expanding indications for DBS and a greater awareness of the delayed effects of stimulation, there is a desire to uncover biomarkers of stimulation success to predict long-term outcomes. Several highly powered studies fail to explain more than 20% of outcome variance using stimulation location information, indicating a need for a deeper understanding of this therapy’s mechanism of action and improved biomarkers. Functional magnetic resonance imaging (fMRI) during active stimulation may serve as a promising method of probing the mechanism of DBS by revealing the whole-brain response to stimulation. This response may function as a biomarker of stimulation success for the personalization of therapy. This thesis explores the potential of using fMRI during active DBS to optimize and personalize treatment. The thesis is structured around three major components: i) investigating the therapeutic mechanism of DBS by comparing the fMRI response under unilateral and bilateral stimulation conditions; ii) Further characterizing the fMRI response to stimulation by mapping out symptom and disease-specific associations predictive of long-term outcomes; and iii) prospectively validating the use of fMRI as a DBS programming technique, demonstrating its non-inferiority to the current time-consuming clinical optimization method. Our findings indicate that fMRI can serve as a powerful tool for optimizing DBS therapy, potentially reducing the time required for programming and enhancing the precision of treatment. The results support the development of prospective studies to further investigate fMRI-based DBS programming and its role in personalizing therapy for PD patients. This approach may lead to improved patient outcomes, more efficient clinical workflows, and a deeper understanding of DBS mechanisms.Ph.D
Characterizing the effects of simulated microgravity on human Natural Killer cells
Get PDFHuman space exploration is rapidly evolving, with future missions aiming to surpass current limits in both distance and duration. Both governmental and private sectors are working towards missions back to the Moon and to neighboring planets, such as Mars, within the next decade. Simultaneously, the growth of commercial spaceflight is introducing space as a novel platform for innovation in healthcare, technology, and hospitality industries. However, our current understanding of how spaceflight affects human health remains limited. Space is a complex, harsh environment that impacts human physiology in many ways. Microgravity, the condition of “weightlessness”, is one aspect of this environment that plays a substantial role in affecting human biology in space. Moreover, studying the effects of spaceflight on the immune system are of great importance, given that (i) latent viral reactivation is seen in astronauts during spaceflight, and (ii) increased radiation exposure may lead to malignancy especially during deep space missions. Likewise, Natural Killer (NK) cells are an important immune cell type to study in this context, given that they directly kill virus-infected and cancer cells. Given the current limitations of conducting biological research in space, several options exist for inducing real microgravity and simulated microgravity (SMG) on Earth. Here, a 2D clinostat, otherwise known as a “rotating wall vessel (RMW) bioreactor” is used to subject NK cell culture to SMG. Previous studies have demonstrated a decrease in NK cytotoxic function against cancer cell line targets after both real spaceflight and SMG exposure, but little is known about why this occurs. The current thesis focuses on assessing NK cell function and physiology after SMG exposure, with specific emphasis on first establishing a method for subjecting NK cells to SMG, and then measuring their resulting cytotoxicity, surface receptor profile expression, and underlying metabolic capacity after SMG exposure. These insights may inform future space missions and help mitigate concerns related to spaceflight-mediated immune dysregulation. Additionally, knowledge gained about immune responses in space may provide novel insights into disease processes on Earth, including latent viral infections, age-associated immune deficiency and stress-related immune dysfunction.Ph.D
Dynamically Downscaled Climate Change Impacts in the Great Lakes Basin of North America and the Mediterranean Basin and Northern Africa of Europe
No full textHigh-resolution regional climate modeling is an effective method for investigating climate over specific regions of interest. A state-of-the-art dynamical downscaling pipeline that simulates regional climate was established in previous works by the Earth, Atmospheric and Planetary Physics (EAPP) group in the University of Toronto Department of Physics. This work introduces a major upgrade to this downscaling pipeline, and its application to two distinct regions that are characterized by the presence of significant bodies of water. The first region is the Laurentian Great Lakes Basin of North America, over which the pipeline extends from a previous study that focuses on extreme precipitation events, by addressing extreme heat events and their modulation by the presence of the lakes in severity, frequency, and regional coverage. The second region is the Mediterranean Basin and northern Africa, over which the upgraded pipeline is applied to investigate its transition in the Mid-Holocene when northern Africa was covered by vegetation and lakes in contrast to the Sahara desert as it exists today. This investigation involves three steps. The first step is to enhance the pipeline with the Regional Ocean Modeling System, then employ it to reconstruct modern climate over the target region, so that the pipeline may be verified against the modern observational record. In the second step, a representation of northern Africa mid-Holocene land surface vegetation boundary conditions, obtained from a global analysis work produced by the EAPP group, is employed in the Weather Research and Forecast atmospheric model within the downscaling pipeline. In the third step, the nature of the climate change impacts, which are expected when northern Africa transitioned from Green Sahara boundary conditions into the fully desertified state that is characteristic of modern climate conditions, is discussed. The upgraded downscaling pipeline produced high-quality regional climate simulations in each of the three steps, which are aligned with measurements during modern periods and with proxy reconstructed climate records during Mid-Holocene. Results from the Mid-Holocene Green Sahara regional simulations lead to the conclusion that the recession of vegetation cover over northern Africa would have triggered retreat of forest cover in the Levant, a region that is effectively downstream of the northern Africa region.Ph.D
Does Money Really Matter? On the Matter of Cognition, Emotion and Resultant Functioning in Patients with Mild Traumatic Brain Injury During and After Litigation Settlement in a Medico-Legal Context
Get PDFApproximately 75 -80% of traumatic brain injuries (TBIs) are classified as mild. Most individuals recover entirely from mTBI within the acute phase (1 - 3 months post-injury). A minority of individuals may experience persisting cognitive, psychological, and somatic symptoms with consequent functional impairments beyond the acute phase. Litigation has been identified as a significant predictor for persisting symptoms and functional impediment after mTBI. The mechanisms by which it does, however, have yet to be elucidated. In the present study, we sought to examine cognitive, psychological and functional outcome in patients with mTBI during litigation and after settlement, using a longitudinal within-groups research design.We recruited 10 patients who sustained a mTBI who previously completed comprehensive neuropsychological examinations whilst in litigation. Patients completed a second neuropsychological examination after litigation settlement. Changes between the two examinations were analysed at the individual (reliable change indices) and group level (t-tests). Improvements in anxiety (W = 35, p = 0.021, r = 0.55) and depression (t(8) = 4.83, p = 0.001, Cohen’s d = 0.78) were observed. Whilst being mindful of our sample size, there were no significant group level cognitive or functional changes, but reliable change indices were examined to identify individual trends. Exploratory correlational analyses suggested that motivation played a key role in the improvement of functioning. Overall, our research challenges the traditional "money-matters" narrative. Despite our small sample size, financial compensation and settlement alone are not enough to attenuate symptoms and functional disability, whilst money is seemingly not all that matters post litigation outcome.M.A
Aucubin alleviates osteoarthritis by inhibiting chondrocyte ferroptosis via regulation of the Keap1/NRF2 pathway
Get PDFOsteoarthritis (OA) is a degenerative joint disorder characterized by chondrocyte dysfunction and progressive cartilage destruction, with ferroptosis emerging as a key contributor to disease pathogenesis. This study investigates the therapeutic potential of Aucubin, a natural iridoid glycoside, in OA treatment through modulation of the Keap1/NRF2 pathway and ferroptosis inhibition. Using an in vitro OA model established by IL-1β treatment of immortalized human chondrocytes (HCs), we demonstrate that Aucubin significantly improves cell viability, colony formation capacity, and migratory potential while promoting cell cycle progression. Aucubin also reduces ferroptosis-associated oxidative damage by decreasing MDA, GSSG, Fe2+, and ROS levels while increasing GSH content. Fer-1 ferroptosis inhibitor further supports this result. Molecularly, qPCR and Western blot analyses reveal that Aucubin upregulates NRF2 expression while suppressing Keap1 and modulating the levels of ferroptotic markers. These findings are further corroborated in a surgically induced OA rat model, where Aucubin administration attenuates cartilage degradation, restores Keap1/NRF2 expression, and normalizes ferroptosis-related protein expression. Our preliminary findings suggest that aucubin exerts its chondroprotective effects by inhibiting ferroptosis, at least partially through activation of the Keap1/NRF2 pathway, and may represent a potential therapeutic agent for osteoarthritis.The presentation of the authors' names and (or) special characters in the title of the pdf file of the accepted manuscript may differ slightly from what is displayed on the item page. The information in the pdf file of the accepted manuscript reflects the original submission by the author
Polysubstance Use Disorders in Individuals with Cannabis Use Disorder: Results from a Nationally Representative Sample (NESARC)
Get PDFAbstractObjective: Cannabis use disorder (CUD) is a common substance use disorders (SUD) worldwide and is often associated with polysubstance use. This study aims to examine social and clinical characteristics of adults diagnosed with CUD and comorbid polysubstance use disorders (PUD). It also aims to assess whether psychiatric disorders are linked to higher odds of PUD among individuals with CUD.
Methods: Using a nationally representative U.S. dataset, we assessed 972 individuals with past-year DSM-5 CUD, grouped as CUD only, CUD individuals with one additional SUD (CUD+1), and CUD individuals with two or more SUDs (CUD+2).
Results: After adjusting for controls, personality disorders were associated with membership in the CUD+1 group (OR: 1.88, p=0.01); mood disorders were associated with a higher likelihood of being in the CUD+1 group (OR: 1.50, p=0.049) and CUD+2 group (OR: 2.58, p=0.005).
Conclusion: Mood and personality disorders were prevalent and may contribute to PUD development.M.Sc
Scenes from the Domestic Sphere: The Ambivalent Experiences of Enslaved Women in the Fourteenth-Century Crown of Aragon
Get PDFThe documented history of enslaved women in medieval Iberia is sparce. This project is attempting to address that specific gap through a close reading of slave sale documents and manumission contracts. These are found in the archives of Barcelona, and primarily take place in the latter half of the 14th century. The female slaves in these texts, largely of non-Christian religious origin, are revealed to be closely intertwined with the dominant households in sexual and emotional ways. The body of the enslaved wet-nurse is especially salient in this discussion, as she often becomes a particularly important figure in the complex emotional dynamics of the household.M.A
Band in a Box: Techniques of Solo Jazz Piano 1921-1940
Get PDFThis dissertation presents a comparative analysis of four influential pianists from the early eras of jazz piano performance: Ferdinand “Jelly Roll” Morton, James P. Johnson, Earl Hines, and Art Tatum. Through detailed examination of representative recordings from 1921-1940, and over 200 musical examples, this study traces foundational stylistic developments in solo jazz piano during what is widely recognized as the genre's golden age.Despite solo jazz piano's vital role in jazz performance, it has received relatively little comprehensive scholarly attention compared to ensemble jazz. This research addresses that gap by analyzing the harmonic, rhythmic, and pianistic characteristics demonstrated in twenty selected recordings spanning nearly two decades. The study examines both shared techniques among these pianists and their distinctive individual approaches, tracking how their styles developed throughout the period and identifying elements that remain audible in contemporary jazz piano performance.
Using transcription-based analysis supported by historical and biographical context, this research documents the transition from ragtime-influenced styles toward increasingly complex harmonic and rhythmic approaches. The comparative methodology reveals how these pianists developed distinct solutions to the unique constraints and possibilities of solo performance while collectively establishing fundamental techniques that would influence subsequent generations.
Findings include a clear trajectory from the largely diatonic harmonic vocabulary and syncopated eighth-note rhythmic patterns of early recordings toward the chromatic harmony and varied rhythmic approaches evident in later performances, particularly those of Hines and Tatum. The analysis traces technical innovations including the development of tritone substitution, polyrhythmic syncopation patterns, and pianistic techniques informed by other instruments and genres.
This study contributes to jazz scholarship by providing a broad comparative analysis of solo jazz piano from this crucial period. The research offers new perspectives on individual pianists’ contributions while illuminating broader patterns of stylistic development that shaped jazz piano's development. These findings have implications for jazz pedagogy, performance practice, and our understanding of how solo traditions influenced the broader trajectory of jazz as an art form.D.M.A