63 research outputs found
Is it who you are or where you live? A mixed-method exploration of associations between people and place in the context of HIV in rural Malawi
No full textIn Malawi, approximately 1 million people are infected with Human Immunodeficiency Virus (HIV). Infection rates are decreasing in urban areas; the opposite is true for rural populations. Individual-level risk factors influence patterns of HIV in Malawi. However, area-level socio-economic and access factors may play critical roles in driving HIV, and these factors are rarely investigated. To address this gap, this research uses a nationally-representative probability sample of rural Malawians linked to spatially-oriented, area-level socio-economic and access data to address two specific aims: 1) to reveal relationships between area-level factors and individual HIV status and determine whether individual risk behaviors mediate these associations using logistic regression; and, 2) to explore how relationships between area- and individual-level risks and individual HIV status vary in space using geographically weighted regression. Analysis is stratified to examine the role of gender. Area-level factors include income inequality and absolute poverty as well as proximity to roads, cities, and health clinics. Mediators include condom use, sexually transmitted infections, multiple partnerships, and, for men, paid sex. Results indicate that both people and place matter in the context of HIV in rural Malawi. Among women, high income inequality and proximity to a major road are associated with increased odds of HIV while the negative association between distance to healthcare and HIV status is mediated by individual behavior. For men, living further from a health clinic decreases the odds of HIV infection. Spatial models provide additional detail, illustrating local-level variation in these associations. Women further from health clinics, major roads, and major cities are less likely to be infected in specific geographic areas. HIV status among men is closely associated with migration patterns in distinct locations. As informed by the Political Economy of Health theory, this study confirms that area-level socio-economic and access factors influence HIV in rural Malawi. Associations vary by gender and in space and are largely not mediated by individual behavior. The findings suggest that inequality has deleterious effects on women, and that spatial isolation may lead to social isolation for both genders, decreasing HIV risk. These results could inform tailored HIV prevention efforts in rural Malawi
The sense of a beginning : Bakhtinian dialogic criticism on 'the gospel' in Mark.
No full textContemporary literary approaches have caused paradigm shifts in Biblical Studies in the last two decades as it appears in a great deal of Markan studies using narrative, reader-response, deconstructive, feminist, and new historicist approaches. However, literary studies on the Gospel of Mark have not taken into account theoretical questions underlying those approaches. As a result biblical critics are driven by new trends without ever having a chance to examine the critical baggage of the approaches. Consequently, there is a gap of communication between the old and the new one. Therefore this thesis is an attempt to meet the need of enhancing the quality of critical endeavour in biblical studies. In the light of most recent competing critical theories of literature, the first contribution of this thesis is the methodological finding that Bakhtinian dialogic criticism contains the most profound philosophical and practical foundations for solving some crucial theoretical problems in contemporary literary theories. It is a critique to a Saussurian linguistic system of language which becomes the very foundation of modern and postmodern literary criticism. Bakhtinian literary theory shifts the foundation of literary criticism on linguistic signs into the creative activity of the socio-cultural production of human communication. The shift into socio-cultural reality of language communication makes the notion of 'genre' very important to unlock the problem of text and context in literary studies. Since the Gospel of Mark has fascinated most literary critics in Biblical Studies, the problem of 'genre' of this gospel is chosen as the focus of this study. Secondly, as no agreement is reached as to what 'genre' the Gospel of Mark belongs, this thesis makes its contribution to the discussion by locating the problem of 'genre' of Mark in the context of genre theories and argues that the Bakhtinian suggestion to find genre in the socio-cultural sphere by analysing artistic intercourse between narrative agents in Mark has freed the competing analysis from the unresolved problem between the kerygmatic (content oriented) approach and the analogical (form oriented) approach. To achieve finding 'genre' in the socio-cultural sphere, this thesis focuses on Bakhtinian analysis of the process of artistic intercourse between narrative agents. The narrative communicative interrelationships between narrative agents is constructed in this thesis as a 'stereophonic' Bakhtinian model of dialogic communication. This model is an original contribution of this thesis for revising the traditional two dimensional model of narrative communication. Based on this dialogical model of communication, a special role is given to the Bakhtinian 'author-creator' in the realization process of genre through the interaction of polyphonic voices. Through the interaction of voices of the author-artist and the hero we are led to discover a relatively stable type of portraying and controlling reality in Mark, known as the genre of Roman 'satire'. The closest literary affinity is Satyrica by Petronius. This narrative strategy of 'satire' in Mark has its root in the prophetic discourse of the Old Testament which is saturating the speech of the narrator, John the Immerser, the centurion, the people, and even Jesus. Finally, the whole search for Markan 'genre' culminates in the analysis of the realization of genre through the analysis of Bakhtinian chronotope. The reality of the genre of Mark is its social reality that is in its role as dpxrj/ 'beginning'. As the Gospel of Mark proclaims itself as 'a beginning', it defines its claim of socio-cultural 'authority' in early Christianity. It is this 'sense of beginning' which enables the narrating and the narrated world of Mark to interact dialogically
Out-siders: Auteurs in Place.
No full textOut-Siders: Auteurs in Place, incorporates media authorship theory, cultural geography and ethnographic methods to examine media authorship and its functioning in relationship to place (specific local practices and identities in a given location). More specifically, I focus on filmmakers with distinct and consistent relationships to urban places who have either accepted or self-applied the “auteur” label. By “auteur” I mean a culturally recognized author of a media text. I study authorship through examining the process of making texts, instead of focusing on a singular authorial agency. Studying authorship, then, becomes less about assigning credit to an individual and instead a process of accounting for authorial practices and functions amongst larger production strategies. I argue that auteurs self-identify, manage and sustain their authorial images through relationships to places.
All three of the filmmakers examined in case studies use cities, and places within cities, as molding, sustenance and protection for their maverick authorial identities. Chapter 2 looks at the lifelong relationship between John Waters and Baltimore, MD, where he is known as the ultimate hometown hero. Residents throughout the city refer to him as its “true” symbol. Chapter 3 examines Robert Altman’s nomadic yet focused attention to place throughout his career. On location shoots Altman and his team consistently worked with communities instead of just in them, transitioning him from outsider to neighborly friend. Finally, Chapter 4 studies Robert Rodriguez’s private industrial uses of Austin, TX. While he does not represent Austin in his films, his production practices do productively align with the cultural environment that surrounds him. The diverse relationships represented here shows us both the mutability of authorship but also its importance. These three filmmakers all base their careers on negotiating their authorial identity through place in distinct ways. Similarly, the cities all cultivate lively cultural identities in relationship to these filmmakers’ associations with them. Attention to place provides a way to examine how auteurs attempt to control their own author-identity and how this identity becomes accepted, submerged, altered and dismantled by communities. This project utilizes archival research and textual analysis as well as site analysis and ethnographic interviews.PhDScreen Arts and CulturesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/113297/1/nkoob_1.pd
Looking under the hood of a hybrid two-way texting intervention to improve early retention on antiretroviral therapy in Malawi: an implementation fidelity evaluation
No full textAbstract Background While key to interpreting findings and assessing generalizability, implementation fidelity is underreported in mobile health (mHealth) literature. We evaluated implementation fidelity of an opt-in, hybrid, two-way texting (2wT) intervention previously demonstrated to improve 12-month retention on antiretroviral therapy (ART) among people living with HIV (PLHIV) in a quasi-experimental study in Lilongwe, Malawi. Methods Short message service (SMS) data and ART refill visit records were used to evaluate adherence to 2wT content, frequency and duration through the lens of the Conceptual Framework for Implementation Fidelity. Message delivery and 2wT participant interactions were considered across four core 2wT components: 1) weekly motivational SMS messages; 2) proactive SMS appointment reminders; 3) SMS reminders after missed appointments; and 4) interactive messaging with 2wT staff about transfers and appointment rescheduling. Using mixed-effects logistic regression models adjusted for participant demographics, we examined the effect of core 2wT component fidelity on a) on-time appointment attendance and b) timely return to care after a missed appointment, presenting adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results The 468 2wT participants had a median of 52 study weeks (interquartile range [IQR] 34 – 52) with 6 ART appointments (IQR 4—7) of which 2 (IQR 1 – 3) were missed. On average, participants received a motivation message for 75% (IQR 56%—83%) of enrolled weeks, a reminder before 83% (IQR 67%—100%) of appointments, and after 67% (IQR 0%—100%) of missed appointments. Participants reported 9 transfers and rescheduled 46 appointments through 2wT prompts; 196 appointments were changed via unprompted interaction. Participants with 10% higher expected motivation message delivery were more likely to attend clinic appointments on time (aOR: 1.08; 95%CI: 1.01 – 1.16, p = 0.03). Receiving and responding to an appointment reminder in any way were also associated with increased on-time appointment attendance (aOR: 1.35; 95%CI: 1.03 – 1.79, p = 0.03 and aOR: 1.47, 95%CI: 1.16 – 1.87, p = 0.001, respectively). No associations were found for 2wT messages and timely return to care following a missed appointment. Conclusion Greater 2wT implementation fidelity was associated with improved care outcomes. Although implementation fidelity monitoring of mHealth interventions is complex, it should be integrated into study design
Barthes, Bakhtin, Structuralism: A Reassessment
No full textPhDThe thesis is a comparative analysis of the shared ideas and concerns in the works of
Mikhail Bakhtin and Roland Barthes from the point of view of differences between
French and Slavic literary structuralisms. Its background argument is that the
structuralism developed in the later works of the Russian Formalists and by Prague
Structuralists and Soviet Semioticians is more historically and socially oriented than its
French version, defining the structure of a literary work as a system of all of its
elements and effects (even those that take us outside of the text, like literary tradition
and historical and political circumstances). In this sense, Bakhtin can be seen as a part
of the Slavic structuralist tradition (and not opposed to it as is often claimed), and
Barthes (seen throughout his career) is on the whole perhaps closer to the Slavic
structuralism than he is to the French.
The particular problems discussed are those of the relationship between
literature and ideology, the notions of intertextuality, heteroglossia, dialogism and
polyphony and the differences between them, and the role of the author.
Barthes and Bakhtin shared a lifelong interest in the role of ideology in literature
and the influence of authoritarian language or myth on culture in general and the literary
text in particular. They looked for ways in which the deadening effect of the
mythological (epic, monological) thought and word can be counteracted through
literature, and different versions of what Kristeva termed 'intertextuality' played an
important part in their treatment of the subject. They also both discussed the role of the
author and their voice in the literary text, and the question of their power over the text,
its characters (Bakhtin) and the reader (Barthes).
The main thread of Barthes and Bakhtin's thought focuses on the problem of
counteracting authoritarian language through literature, and the solutions they proposed
can fruitfully be seen in the light of Slavic structuralism's notions of literary structure
Configurations of mothering in post-war British women's playwriting
No full textWhile examining a selection of plays centred on the phenomenon of mothering, my
thesis also investigates the interaction between theatre and feminism in post-war
Britain, aiming to highlight mutual correspondences between women's theatre
making and feminist agendas. I focus mainly on the period of second-wave
feminism, but I also discuss the decade preceding the appearance of the Women's
Liberation Movement, as well as its aftermath up to the mid-nineties. Scrutinising
proto-feminist, feminist and post-feminist stances, I argue that several fifties women
dramatists anticipated key concerns of the late sixties and seventies; and equally, that
many playwrights active after the heyday of second-wave feminism revisited the
climate of the seventies in an attempt to evaluate the transformations that have since
occurred in women's lives. In this manner, I not only contextualise some of the
major achievements and shortcomings of successive feminist interventions, but also
elaborate on key changes that have taken place in the negotiation of dramatic form
and content.
Rather than privileging one dominant theoretical position and adopting its
perspective for the purposes of my analysis, I connect the work of playwrights
informed by different artistic positions and political convictions, in order to pinpoint
the principle of co-existence and multiplicity. This aesthetic and ideological diversity
in women's writing for the stage, characteristic of the past five decades, has been
confirmed not only by the primary and secondary sources that I drew upon but also
by the playwrights themselves, whom I interviewed. For most present-day female
dramatists, as this thesis argues, contemporary British women's theatre is a space of
experimentation and of confluence - in which the broad range of individual voices
can situate themselves next to one another, without the urge to replicate an ultimate
direction imposed by hegemonic political constraints or artistic platforms
Reading acts of narrative appropriation: four instances of fraudulent memoir
No full textPhDThis thesis examines acts of narrative appropriation, the telling of purportedly‘authentic’ life stories by those for whom the stories are not theirs to tell. This
misuse or subversion of genre - the discipline of historical writing and the category
of autobiography - becomes a means for cultural, social and political dissimulation,
and the analysis focuses both on the act: the event, trespass, or ‘theft’ of another’s
life story, and on the cultural meaning that this event reveals. These narrative acts
are approached theoretically through discussions of what it means to be an author, a
reader, and through the consideration of literary and social genre, category and form.
In exploring identities at particular risk of appropriation, this thesis shows how
fraudulent appropriated narratives affect our reading of the world, and in turn
influence our perception of already marginalized social groups. My primary
examples include prostitution ‘narratives’, Native North American ‘memoir,’ and
fraudulent Holocaust survivor ‘testimony,’ with each text providing decoded
evidence of ‘genre-bending’ exhibiting a social and political intent. These works
seek to be read as authentic personal narratives, as autobiography, and that is how
they have been presented to the reader. However, they are imposters – fictional tales
desiring the elevated status of historical authenticity and willing to bend the rules
and contracts of genre to achieve their end. Here the appearance of authenticity is
achieved through the use of cultural and social ‘myth,’ or perceptions of cultural
identity, and as such its fraudulent construction is first and foremost a social act,
with a social and economic motivation. As this thesis concludes, these texts are
most successful when their own political and social ideologies echo and confirm that
of the readership; when their subjects, the fraudulent ‘I’ at the center of the text is
also a performative elaboration of cultural belief
Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi
No full textBackground: Integrating family planning (FP) services into human immunodeficiency virus (HIV) clinical care helps improve access to contraceptives for women living with HIV. However, high patient volumes may limit providers’ ability to counsel women about pregnancy risks and contraceptive options. Objectives: To assess trends in the use of contraceptive methods after implementing an electronic medical record (EMR) system with FP questions and determine the reasons for non-use of contraceptives among women of reproductive age (15–49 years) receiving antiretroviral therapy (ART) at the Martin Preuss Center clinic in Malawi. Methods: In February 2012, two FP questions were incorporated into the ART EMR system (initial FP EMR module) to prompt providers to offer contraceptives to women. In July 2013, additional questions were added to the FP EMR module (enhanced FP EMR) to prompt providers to assess risks of unintended pregnancies, solicit reasons for non-use of contraceptives and offer contraceptives to non-pregnant women . We conducted a retrospective, longitudinal cohort study using the EMR routinely collected data. The primary outcome was the use of any modern contraceptive method. Descriptive statistics were used to describe the study population and report trends in contraceptive use during the initial and enhanced study periods. Results: Between February 2012 and December 2016, in HIV clinics, 20,253 women of reproductive age received ART, resulting in 163,325 clinic visits observations. The proportion of women using contraceptives increased significantly from 18% to 39% between February 2012 and June 2013, and from 39% to 67% between July 2013 and December 2016 (chi-square for trend p < 0.001). Common reasons reported for the non-use of contraceptives among those at risk of unintended pregnancy were: pregnancy ambivalence (n = 234, 51%) and never thought about it (n = 133, 29%). Conclusion: Incorporating the FP EMR module into HIV clinical care prompted healthcare workers to encourage the use of contraceptives
Polyphony and the anxiety of influence in the fiction of Henry James
No full textJames's fiction, especially in the Middle Phase, centres
on the figure of the artist and is characterized by, the two
interrelated aspects which previous criticism has largely
overlooked: the Bakhtinian 'polyphonic' -creation of
'author-thinkers'; and the conflict between ephebes and
precursors, for which Harold-Bloom's concept of 'the-anxiety of
influence' is the most illuminating model. Polyphony is the
narrative mode, and influence is the intra-artistic, theme.
These, as the Introduction to the thesis makes clear, are
rehearsed in James's inaugural novel, Roderick Hudson. Rowland
Mallet is an author-thinker, and his failure is caused by
authorial limitations. His monologism -is impaired by his
mistaking empathy for the authorial sympathy. Likewise,
Hudson's failure does not arise from a mercurial temperament,
but from a polyphonic shortcoming: not possessing the power of
fiction to contain the fiction of power in, his mentor. And the
relationships among the three artists - Gloriani, Hudson and
Singleton - perfectly exemplify the Bloomian-theme. It is these
two concepts, polyphony and influence, which are the major
preoccupation in the Middle Phase; as, the works chosen
demonstrate. These are a novella, a novel, and a number of
short stories all of which have been unjustifiably neglected.
Chapter One, on The Aspern Papers, argues that Tina Bordereau,
far from being, the artless victim seen by many critics,
actually challenges and defeats the narrator by the very form
of her narrative. Her 'realist' discourse undermines his
language of 'romance', and shows up its internal unstability.
Chapter Two is an extensive study of the critical reception of
The Tragic Muse. The most common areas of critical attention
have been its contemporary topicality, its relation to previous
novels on similar themes, and the possible genealogy of Gabriel
Nash. Those have all missed the core of the work. - Chapter Three
demonstrates how polyphony and the anxiety of influence make
the novel what it really is. Influence arises from the
juxtaposition of, and the wrestling between, artistic ephebes
and their precursors (Nick and Nash,, Miriam and Madame Carre).
The dialogic quality defined by Bakhtin is crucial to the
proper, and even-handed, characterization of all, the conflicts
in the novel. And since most of James's tales in the eighties
and nineties -are about 'masters - and acolytes, the anxiety of
influence remains central. Chapter Four is a study of 'The
Author of Beltraffiol' and 'The Lesson of the Master'. Again the
characters' manipulations are a crucial focus in a way that
G6rard Genette's terminology helps to illuminate. The fact that
the ephebe is the author-thinker emphasizes the inextricability
of the Bakhtinian and the Bloomian in James. Just as
polyphony offers a different focus for explicating the poetics
of James's fiction; so the ephebal conflict provides the basis
for a fresh perception of James's own artistic struggle
Writing from the shadowlands: how cross-cultural literature negotiates the legacy of Edward Said
No full textThis thesis examines the impact of Edward Said's influential work Orientalism and its legacy in respect of contemporary reading and writing across cultures. It also questions the legitimacy of Said's retrospective stereotyping of early examples of cross-cultural representation in literature as uncompromisingly 'orientalist'.
It is well known that the release of Edward Said's Orientalism in 1978 was responsible for the rise of a range of cultural and critical theories from multiculturalism to postcolonialism. It was a study that not only polarized critics and forced scholars to re-examine orientalist archives, but persuaded creative writers to re-think their ethnographic positions when it came to the literary representations of cultures other than their own. Without detracting from the enormous impact of Said, this thesis isolates gaps and silences in Said that need correcting. Furthermore, there is an element of intransigence, an uncompromising refusal to fine-tune what is essentially a binary discourse of the West and its other in Said's work, that encourages the continued interrogation of power relations but which, because of its very boldness, paradoxically disallows the extent to which the conflict of cultures indeed produced new, hybrid social and cultural formations.
In an attempt to challenge the severity of Said's claim that 'every European, in what he could say about the Orient, was consequently a racist, an imperialist, and almost totally ethnocentric', the thesis examines a number of different discursive contexts in which such a presumption is challenged. Thus while the second chapter discusses the 'traditional' profession-based orientalism of nineteenth-century E. G. Browne, the third considers the anti-imperialism of colonial administrator Leonard Woolf. The fourth chapter provides a reflection on the difficulties of diasporic 'orientalism' through the works of Michael Ondaatje while chapter five demonstrates the effects of the dialogism used by Amitav Ghosh as a defence against 'orientalism'. The thesis concludes with an examination of contemporary writing by Andrea Levy that appositely illustrates the legacy of Said's influence.
While the restrictive parameters of Said's work make it difficult to mount a thorough-going critique of Said, this thesis shows that, indeed, it is within the restraints of these parameters and in the very discourse that Said employs that he traps himself. This study claims that even Said is susceptible to 'orientalist' criticism in that he is as much an 'orientalist' as those at whom he directs his polemic
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