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      • "Drowned in Nihilism": Dignity and health among older adults displaced by conflict in the Repuiblic of Georgia

        Perrin, Paul Clayton The Johns Hopkins University 2013 해외박사(DDOD)

        RANK : 247343

        Conflict in the post-Soviet Republic of Georgia in both the early 1990s and again in 2008 has left sizeable populations of both "protracted" and shorter-term internally displaced persons (IDPs) living in both urban and non-urban environments. In contrast to many other displaced persons situations in the world, nearly one-third of Georgian IDPs are older adults, persons over the age of 60. The ultimate goal of this study was to foster a better understanding of dignity among the displaced population and thereby provide policy makers and program practitioners with measurement tools and evidence to inform improved response to older adults, especially in protracted situations of displacement in urban areas. The research proceeded in an incremental process that included the phases of instrument development, instrument validation, and instrument implementation in a prevalence study of physical and mental health indicators, including dignity in the population. Instrument development entailed an eight-step sequential approach that began with a set of qualitative data generated during an earlier phase of the larger study. The steps were domain identification, existing instrument selection, extraction of qualitative language, matching of qualitative language, creation of additional scales, addition of explanatory variable sections, creation of visual aids, and questionnaire refinement. The questionnaire then underwent a validation study through a convenience sample of 100 older adults. The instrument showed acceptable psychometric properties and was only minimally adapted for the prevalence phase of the study, involving 900 older adults in the regions of Samegrelo, Shida Kartli, Mtskheta-Mtianeti, and Tbilisi. The data suggest that among older adult displaced persons in Georgia, the strongest predictor of dignity scores was depressive symptom scores, followed by function, anxiety, health status, and cognitive ability. What might be considered more traditional humanitarian indicators, such as accommodation type, current socioeconomic status, and lack of household items were weaker predictors, after being controlled for the other predictors in the model. The implications for such findings are discussed, including the need for increased attention to mental and physical health in the overall assistance package to older adult IDPs, as well as a discussion on the implications of using dignity as an outcome measure.

      • Increasing the Supply of Donor Milk: The Impact of Lactation-Duration Based Exclusion Criteria and Internet Milk Sharing

        Perrin, Maryanne Tigchelaar North Carolina State University 2015 해외박사(DDOD)

        RANK : 247343

        Pasteurized human donor milk is an important functional first food for the preterm infant who does not have access to their mother's own milk, significantly improving health outcomes and lowering health care costs. Despite a renaissance in donor milk banking in North America that has resulted in the opening of 5 new milk banks since 2012, the demand for donor milk currently outpaces supply. This dissertation uses quantitative and qualitative methods to research potential solutions for expanding the supply of pasteurized donor milk available through the Human Milk Banking Association of North America (HMBANA). In study 1, the composition of human milk was examined longitudinally during the second year of lactation to evaluate the current guideline that prohibits milk donation beyond one year postpartum. Nineteen mothers provided monthly milk samples (N=131) from eleven months postpartum (the control) until 17 months postpartum. Milk samples were analyzed for macronutrients, minerals, and bioactive proteins. There was no evidence of a change in the lactose, total fat, iron, and potassium content of the milk over the study period. Total protein, lactoferrin, lysozyme, immunoglobulin A (IgA), and sodium increased over time, and there was a gradual decrease in zinc and calcium (P < 0.05). Milk samples beyond one year postpartum were also compared to pooled milk samples (N=33) provided by two HMBANA milk banks. In this analysis, late lactation samples contained significantly more total protein, lactoferrin, lysozyme, and IgA, and significantly less zinc, calcium, and iron than milk bank samples (P < 0.05). There was no evidence of a difference in total fat, lactose, potassium, and sodium. These findings suggest that human milk beyond one year postpartum provides stable or increasing concentrations of macronutrients and bioactive factors, and may require mineral fortification to meet the unique needs of the preterm infant. In study 2, an observational approach was used to describe the nature of online milk sharing communities that facilitate the direct exchange of unpasteurized human milk between milk seekers and donors. The purpose of this study was to quantify the different segments of the human milk market in the United States. Three months of data were extracted from nine public Facebook pages that facilitate the exchange of human milk. The number of participants, interactions and comments were analyzed. We observed 954 individuals participating in milk sharing, with 532 of the participants (55.8%) offering milk and 413 participants (43.3%) seeking milk. The top reasons participants requested milk was "Lactation Problems" (69.4%). Nearly half of the donors were offering 100 ounces or more. This is the minimum donation volume to be eligible to donate to many HMBANA milk banks, suggesting that donors who participate in online milk sharing communities may also be a potential pool of donors for non-profit milk banks. Additionally, the study raises questions about the root of lactation problems that are prompting mothers to seek milk. In study 3, in-depth telephone interviews were conducted with 27 women who had shared milk with a peer, but not with a milk bank. A Grounded Theory approach was used to analyze content and develop a preliminary theoretical model that describes the process of becoming a peer-to-peer milk donor. Our findings suggest that an unexpected surplus of expressed milk prompts donation. Information about donation options comes predominantly from social circles, not from health care providers. Donors are concerned about milk bank costs, convenience of donation, and community impact. Insights from this model can be used to develop strategies to address the public health call for increasing the availability of pasteurized donor milk including developing prenatal promotion and screening programs to increase the number of milk bank donors. Funding Sources: North Carolina State University CALS Dean's Enrichment Grant; American Society of Nutrition's Gerber Foundation Predoctoral Fellowship Award; United States Department of Agriculture Kannapolis Scholars Training Grant; Mothers' Milk Bank, San Jose, California; Mothers' Milk Bank, Denver, Colorado; Mothers' Milk Bank Northeast, Newton Upper Falls, Massachusetts.

      • Crime and order in San Antonio during the Civil War and Reconstruction (Texas)

        Perrin, Teresa Thomas The University of Texas at Austin 2001 해외박사(DDOD)

        RANK : 247343

        Most historians have characterized the Civil War and Reconstruction as a lawless, nearly chaotic period of social, civil, political, and economic turmoil. Yet few studies of this time period offer evidence of the types and the extent of social change and disorder at the local level. This work offers a case study of crime and the criminal justice system in one community, San Antonio, Texas, from 1861 to 1877. The turmoil of the 1860s and 1870s presented the people of San Antonio with a complex set of problems and challenges that threatened their stable existence. This study explores the patterns of crime and criminal activity, and investigates the various elements of the criminal justice system that operated within the city to meet the challenges presented by the upheaval of war. The first half of the study examines the institutions and agencies entrusted with insuring order in San Antonio: law enforcement, the courts, judges, juries, legal procedures and processes, and the law. The second half of the study analyzes nearly 3,500 criminal offenses indicted and tried in the Bexar County District Court and the Criminal Court of the City of San Antonio during the period 1861 to 1877, inclusive. It explains the factors, both cultural and structural, that contributed to maintaining order in a community that experienced significant social, political, demographic and economic changes as a result of the Civil War and Reconstruction.

      • Pennsylvania public schools: The fiscal landscape. A descriptive analysis 2008-2013

        Perrin, Jason C The Pennsylvania State University ProQuest Dissert 2016 해외박사(DDOD)

        RANK : 247343

        This research study examined public school district responses in Pennsylvania, through analysis of fiscal patterns, given decreased revenues and increased mandatory expenditures from 2008-2013. This descriptive quantitative study examined both revenues and expenditures for the aggregate group of Pennsylvania school districts and further explores fiscal patterns by average wealth through the use of deciles. The study was organized around the following four research questions: (1) How did school district revenues change? (2) How did school district expenditures change? (3) Did revenues and expenditure patterns vary by wealth? (4) What were the major legislative events in education and fiscal factors that occurred during this time period and how did they impact the fiscal pattern for revenues and expenditures?. The methodology used was primarily quantitative incorporating descriptive statistics specific to revenue and expenditure data from 2008-2013. Fiscal data was collected from the Pennsylvania Department of Education web site for all five hundred public school districts in the state. Secondary sources were also utilized to determine the impact of policy, legislative actions, and overall economic variables on fiscal elements specific to the public school finance landscape during the period of study. Analysis of key fiscal elements and secondary information was completed for all public school districts and further examined by average district wealth through decile information. This study found that between 2008-2013, fiscal responses and patterns changed due to revenue and expenditure variables for the aggregate group of Pennsylvania districts and differed for these districts based on average wealth. Key findings of this study included: (1) State policy decisions and legislative actions, specifically the reduction of state funding and lack of full restoration that coincided with the infusion and elimination of federal ARRA funding, had adverse effects on total school district revenues, especially 2011-12. (2) The recession of 2007-2009, along with limitations on local real estate tax increases imposed by Act 1 of 2006, restricted the ability for school districts to raise local revenue in order to counterbalance state revenue decreases, especially in 2011-12 when the Act 1 base index reached a five year low of 1.4%. (3) Increased benefit expenditures, due primarily to increased mandatory payments to PSERS, constrained the ability for school districts to meet overall obligations and forced challenging decisions, especially from 2011-13, when employer contribution rates increased from 5.54% to 12.36%. (4) State policy decisions and legislative actions, with regards to the interaction of state and federal revenues, adversely affected poorer districts to a greater degree than wealthy districts, counter to the intent of how those revenues were designed to be allocated. (5) The decrease of total revenue and increase of mandatory expenditures, specific to benefits, adversely affected poorer districts to a greater degree than wealthy districts, in the ability to meet rising costs associated with staff, more often forcing decisions fiscally necessary, but not educationally sound. (6) With mandatory expenditures projected to rise, as employer contribution rates to PSERS continues to rise, school districts will face further challenges in the future in an Act 1 environment, unless future policy and legislative actions provide relief in the form of increased state funding, equitable allocation and overall pension reform. Findings assert that long-range fiscal planning is paramount when addressing school district fiscal needs and that managing costs such as collective bargaining agreements and competing in a choice environment, given Charter School Costs, are important in managing the balance between revenues and expenditures. Future research aligned to further exploration of legislative impacts on school funding along with possible reform efforts specific to the state pension system and revenue generated through local real estate taxes will emerge in the coming years as key focus areas for understanding and practice.

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