Search results for: Frederick Appiah Afriyie

Authors: Ka Ho Yau, Jan Frederick Engels, Kwok Kei Lai, Reinhard Renneberg

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Lateral flow test is a prevalent technology in various sectors such as food, pharmacology and biomedical sciences. Colloidal gold (CG) is widely used as the signalling molecule because of the ease of synthesis, bimolecular conjugation and its red colour due to intrinsic SPRE. However, the production of colloidal gold is costly and requires vigorous conditions. The stability of colloidal gold are easily affected by environmental factors such as pH, high salt content etc. Silica nanoparticles are well known for its ease of production and stability over a wide range of solvents. Using reverse micro-emulsion (w/o), silica nanoparticles with different sizes can be produced precisely by controlling the amount of water. By incorporating different water-soluble dyes, a rainbow colour of the silica nanoparticles could be produced. Conjugation with biomolecules such as antibodies can be achieved after surface modification of the silica nanoparticles with organosilane. The optimum amount of the antibodies to be labelled was determined by Bradford Assay. In this work, we have demonstrated the ability of the dye-doped silica nanoparticles as a signalling molecule in lateral flow test, which showed a semi-quantitative measurement of the analyte. The image was further analysed for the LOD=10 ng of the analyte. The working range and the linear range of the test were from 0 to 2.15μg/mL and from 0 to 1.07 μg/mL (R2=0.988) respectively. The performance of the tests was comparable to those using colloidal gold with the advantages of lower cost, enhanced stability and having a wide spectrum of colours. The positives lines can be imaged by naked eye or by using a mobile phone camera for a better quantification. Further research has been carried out in multicolour detection of different biomarkers simultaneously. The preliminary results were promising as there was little cross-reactivity being observed for an optimized system. This approach provides a platform for multicolour detection for a set of biomarkers that enhances the accuracy of diseases diagnostics.

Keywords: colorimetric detection, immunosensor, paper-based biosensor, silica

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Authors: S. K. Appiah, E. N. Aidoo, D. Asamoah Owusu, M. W. Nuonabuor

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Urbanization remains one of the unique predominant factors which is linked to the destruction of urban environment and its associated cases of soil contamination by heavy metals through the natural and anthropogenic activities. These activities are important sources of toxic heavy metals such as arsenic (As), cadmium (Cd), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), and lead (Pb), nickel (Ni) and zinc (Zn). Often, these heavy metals lead to increased levels in some areas due to the impact of atmospheric deposition caused by their proximity to industrial plants or the indiscriminately burning of substances. Information gathered on potentially hazardous levels of these heavy metals in soils leads to establish serious health and urban agriculture implications. However, characterization of spatial variations of soil contamination by heavy metals in Ghana is limited. Kumasi is a Metropolitan city in Ghana, West Africa and is challenged with the recent spate of deteriorating soil quality due to rapid economic development and other human activities such as “Galamsey”, illegal mining operations within the metropolis. The paper seeks to use both univariate and multivariate geostatistical techniques to assess the spatial distribution of heavy metals in soils and the potential risk associated with ingestion of sources of soil contamination in the Metropolis. Geostatistical tools have the ability to detect changes in correlation structure and how a good knowledge of the study area can help to explain the different scales of variation detected. To achieve this task, point referenced data on heavy metals measured from topsoil samples in a previous study, were collected at various locations. Linear models of regionalisation and coregionalisation were fitted to all experimental semivariograms to describe the spatial dependence between the topsoil heavy metals at different spatial scales, which led to ordinary kriging and cokriging at unsampled locations and production of risk maps of soil contamination by these heavy metals. Results obtained from both the univariate and multivariate semivariogram models showed strong spatial dependence with range of autocorrelations ranging from 100 to 300 meters. The risk maps produced show strong spatial heterogeneity for almost all the soil heavy metals with extremely risk of contamination found close to areas with commercial and industrial activities. Hence, ongoing pollution interventions should be geared towards these highly risk areas for efficient management of soil contamination to avert further pollution in the metropolis.

Keywords: coregionalization, heavy metals, multivariate geostatistical analysis, soil contamination, spatial distribution

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Authors: Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail, Brian Davies

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Aim: This study aims to identify the barriers and challenges hindering the implementation of effective controls and the adoption of safe work practices to protect workers from respirable crystalline silica (RCS) exposure. Problem or Situation: Tunnelling is one of many occupations that expose workers to the harmful effects of respirable crystalline silica. Despite various control measures, such as engineering controls and personal protective equipment, exposures remain inadequately controlled, leading to incurable silicosis and other severe illnesses, such as lung cancer. Methods: The research involved surveying tunnel construction workers, conducting interviews, and facilitating focus group discussions. Additionally, site observations and content analysis of work procedures and instructions were performed. Results: Preliminary data analysis reveals notable findings. While there is a commendable level of knowledge and commitment among management and workers concerning RCS exposure in tunnelling, there is a striking lack of prioritization regarding dust control. Moreover, the risks associated with dust exposure are not sufficiently acknowledged. Additionally, the data suggests that engineers and supervisors responsible for implementing dust controls often possess limited knowledge regarding the factors influencing the effectiveness of these measures. These findings emphasise the need for a paradigm shift, including higher prioritisation of dust control, adoption of holistic dust reduction strategies, and enhanced knowledge about effective control measures. Conclusion: This research shed light on tunnel construction workers' barriers and challenges in protecting themselves from RCS exposure. This knowledge will be essential in developing interventions and strategies to enhance dust exposure and prevent the adverse health effects of respirable crystalline silica exposure in tunnelling and similar industries.

Keywords: respirable crystalline silica, dust control, worker practices, exposure prevention, silicosis

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Authors: Frederick M. Dumisani Xaba, Nokuthula G. Khanyile

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There is a growing demand for greater accountability, transparency and ethical conduct based on sound governance principles in the developing world. Funders, donors and sponsors are increasingly demanding more transparency, better value for money and adherence to good governance standards. The drive towards improved governance measures is largely influenced by the need to ‘plug the leaks’, deal with malfeasance, engender greater levels of accountability and good governance and to ultimately attract further funding or investment. This is the case with the Non-Profit Organizations (NPOs) in South Africa in general, and in the province of KwaZulu-Natal in particular. The paper draws from the good governance theory, stakeholder theory and systems thinking to critically examine the requirements for good governance for the NPO sector from a theoretical and legislative point and to systematically looks at the contours of governance currently among the NPOs. The paper did this through the rigorous examination of the vignettes of cases of governance among selected NPOs based in KwaZulu-Natal. The study used qualitative and quantitative research methodologies through document analysis, literature review, semi-structured interviews, focus groups and statistical analysis from the various primary and secondary sources. It found some good cases of good governance but also found frightening levels of poor governance. There was an exponential growth of NPOs registered during the period under review, equally so there was an increase in cases of non-compliance to good governance practices. NPOs operate in an increasingly complex environment. There is contestation for influence and access to resources. Stakeholder management is poorly conceptualized and executed. Recognizing that the NPO sector operates in an environment characterized by complexity, constant changes, unpredictability, contestation, diversity and divergent views of different stakeholders, there is a need to apply legislative and systems thinking approaches to strengthen governance to withstand this turbulence through a capacity development model that recognizes these contextual and environmental challenges.

Keywords: good governance, non-profit organizations, stakeholder theory, systems theory

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Authors: Keith T. S. Tung, H. W. Tsang, Rosa S. Wong, Frederick K. Ho, Patrick Ip

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Objectives: Atopic diseases are increasingly prevalent among children and adolescents, both locally and internationally. One of the possible contributing factors could be the hypercholesterolemia which leads to cholesterol accumulation in macrophages and other immune cells that would eventually promote inflammatory responses, including augmentation of toll-like receptor (TLR). Meanwhile, physical activity is well known for its beneficial effects against the condition of hypercholesterolemia and incidence of atopic diseases. This study, therefore, explored whether atopic diseases were associated with increased cholesterol levels and whether physical activity habit influenced this association. Methods: This is a sub-study derived from the longitudinal cohort study which recruited a group of children at five years of age in Kindergarten 3 (K3) to investigate the long-term impact of family socioeconomic status on child development. In 2018/19, adolescents (average age: 13 years old) were asked to report their physical activity habit and history of any atopic diseases. During health assessment, peripheral blood samples were collected from the adolescents to study their lipid profile [total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol]. Regression analyses were performed to test the relationships between variables of interest. Results: Among the 315 adolescents, 99 (31.4%) reported to have allergic rhinitis. There were 45 (14.3%) with eczema, 17 (5.4%) with a food allergy, and 12 (3.8%) with asthma. Regression analyses showed that adolescents with a history of any type of atopic diseases had significantly higher total cholesterol (B=13.3, p < 0.01) and LDL cholesterol (B=7.9, p < 0.05) levels. Further subgroup analyses were conducted to examine the effect of physical activity level on the association between atopic diseases and cholesterol levels. We found stronger associations among those who did not meet the World Health Organization recommendation of at least 60 minutes of moderate-to-vigorous activities each day (total cholesterol: B=15.5, p < 0.01; LDL cholesterol: B=10.4, p < 0.05). For those who met this recommendation, the associations between atopic diseases and cholesterol levels became insignificant. Conclusion: Our study results support the current research evidence on the relationship between an elevated level of cholesterol and atopic diseases. More importantly, our results provide preliminary support for the protective effect of regular exercises against elevated cholesterol level due to atopic diseases. The findings highlight the importance of a healthy lifestyle for keeping cholesterol levels in the normal range, which can bring benefits to both physical and mental health.

Keywords: atopic diseases, Chinese adolescents, cholesterol level, physical activity

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Rosa S. Wong, Keith T.S. Tung, H.W. Tsang, Frederick K. Ho, Patrick Ip

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Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and hyperactive-impulsive behavior. Evidence shows that ADHD and mood problems such as depression and anxiety often co-occur and yet not everyone with ADHD reported elevated emotional problems. Given that cholesterol is essential for healthy brain development including the regions governing emotion regulation, reports found lower cholesterol levels in patients with major depressive disorder and those with suicide attempt behavior compared to healthy subjects. This study explored whether ADHD adolescents experienced more emotional problems and whether emotional problems correlated with cholesterol levels in these adolescents. This study used a portion of data from the longitudinal cohort study which was designed to investigate the long-term impact of family socioeconomic status on child development. In 2018/19, parents of 300 adolescents (average age: 12.57+/-0.49 years) were asked to rate their children’s emotional problems and report whether their children had doctor-diagnosed psychiatric diseases. We further collected blood samples from 263 children to study their lipid profile (total cholesterol, high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol). Regression analyses were performed to test the relationships between variables of interest. Among 300 children, 27 (9%) had ADHD diagnosis. Analysis based on overall sample found no association between ADHD and emotional problems, but when investigating the relationship by gender, there was a significant interaction effect of ADHD and gender on emotional problems (p=0.037), with ADHD males displaying more emotional problems than ADHD females. Further analyses based on 263 children (21 with ADHD diagnosis) found significant interaction effect of ADHD and gender on total cholesterol (p=0.038) and low LDL-cholesterol levels (p=0.013) after adjusting for the child’s physical disease history. Specifically, ADHD males had significantly lower total cholesterol and low lipoprotein-cholesterol levels than ADHD females. In ADHD males, more emotional problems were associated with lower LDL-cholesterol levels (B = -4.26, 95%CI (-7.46, -1.07), p=0.013). We found preliminary support for the association between more emotional problems and lower cholesterol levels in ADHD children, especially among males. Although larger prospective studies are needed to substantiate these claims, the evidence highlights the importance of healthy lifestyle to keep cholesterol levels in normal range which can have positive effects on physical and mental health.

Keywords: attention-deficit hyperactivity disorder, cholesterol, emotional problems, adolescents

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Authors: Desmond Appiah, Fan Zhang, Shouqi Yuan, Wei Xueyuan, Stephen N. Asomani

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The side channel pump has distinctive hydraulic performance characteristics over other vane pumps because of its generation of high pressure heads in only one impeller revolution. Hence, there is soaring utilization and application in the fields of petrochemical, food processing fields, automotive and aerospace fuel pumping where high heads are required at low flows. The side channel pump is characterized by unstable flow because after fluid flows into the impeller passage, it moves into the side channel and comes back to the impeller again and then moves to the next circulation. Consequently, the flow leaves the side channel pump following a helical path. However, the pressure fluctuation exhibited in the flow greatly contributes to the unwanted noise and vibration which is associated with the flow. In this paper, a side channel pump prototype was examined thoroughly through numerical calculations based on SST k-ω turbulence model to ascertain the pressure fluctuation behavior. The pressure fluctuation intensity of the 3D unstable flow dynamics were carefully investigated under different working conditions 0.8QBEP, 1.0 QBEP and 1.2QBEP. The results showed that the pressure fluctuation distribution around the pressure side of the blade is greater than the suction side at the impeller and side channel interface (z=0) for all three operating conditions. Part-load condition 0.8QBEP recorded the highest pressure fluctuation distribution because of the high circulation velocity thus causing an intense exchanged flow between the impeller and side channel. Time and frequency domains spectra of the pressure fluctuation patterns in the impeller and the side channel were also analyzed under the best efficiency point value, QBEP using the solution from the numerical calculations. It was observed from the time-domain analysis that the pressure fluctuation characteristics in the impeller flow passage increased steadily until the flow reached the interrupter which separates low-pressure at the inflow from high pressure at the outflow. The pressure fluctuation amplitudes in the frequency domain spectrum at the different monitoring points depicted a gentle decreasing trend of the pressure amplitudes which was common among the operating conditions. The frequency domain also revealed that the main excitation frequencies occurred at 600Hz, 1200Hz, and 1800Hz and continued in the integers of the rotating shaft frequency. Also, the mass flow exchange plots indicated that the side channel pump is characterized with many vortex flows. Operating conditions 0.8QBEP, 1.0 QBEP depicted less and similar vortex flow while 1.2Q recorded many vortex flows around the inflow, middle and outflow regions. The results of the numerical calculations were finally verified experimentally. The performance characteristics curves from the simulated results showed that 0.8QBEP working condition recorded a head increase of 43.03% and efficiency decrease of 6.73% compared to 1.0QBEP. It can be concluded that for industrial applications where the high heads are mostly required, the side channel pump can be designed to operate at part-load conditions. This paper can serve as a source of information in order to optimize a reliable performance and widen the applications of the side channel pumps.

Keywords: exchanged flow, pressure fluctuation, numerical simulation, side channel pump

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Authors: Keith T. S. Tung, Frederick K. Ho, Rosa S. Wong, Camilla K. M. Lo, Wilfred H. S. Wong, C. B. Chow, Patrick Ip

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Objectives: Underage drinking is an important public health problem both locally and globally. Conventional prevention/intervention relies on unidirectional knowledge transfer such as mail leaflets or health talks which showed mixed results in changing the target behaviour. Previously, we conducted a school internet-based intervention which was found to be effective in reducing alcohol use among adolescents, yet the underlying mechanisms have not been properly investigated. This study, therefore, examined the mechanisms that explain how the intervention produced a change in alcohol drinking behaviours among Chinese adolescent as observed in our previous clustered randomised controlled trial (RCT) study. Methods: This is a cluster randomised controlled trial with parallel group design. Participating schools were randomised to the Internet intervention or the conventional health education group (control) with a 1:1 allocation ratio. Secondary 1–3 students of the participating schools were enrolled in this study. The Internet intervention was a web-based quiz game competition, in which participating students would answer 1,000 alcohol-related multiple-choice quiz questions. Conventional health education group received a promotional package on equivalent alcohol-related knowledge. The participants’ alcohol-related attitude, knowledge, and perceived behavioural control were self-reported before the intervention (baseline) and one month and three months after the intervention. Results: Our RCT results showed that participants in the Internet group were less likely to drink (risk ratio [RR] 0.79, p < 0.01) as well as in lesser amount (β -0.06, p < 0.05) compared to those in the control group at both post-intervention follow-ups. Within the intervention group, regression analyses showed that high quiz scorer had greater improvement in alcohol-related knowledge (β 0.28, p < 0.01) and attitude (β -0.26, p < 0.01) at 1 month after intervention, which in turn increased their perceived behavioural control against alcohol use (β 0.10 and -0.26, both p < 0.01). Attitude, compared to knowledge, was found to be a stronger contributor to the intervention effect on perceived behavioural control. Conclusions: Our internet-based intervention has demonstrated effectiveness in reducing the risk of underage drinking when compared with conventional health education. Our study results further showed an attitude to be a more important factor than knowledge in changing health-related behaviour. This has an important implication for future prevention/intervention on an underage drinking problem.

Keywords: adolescents, internet-based intervention, randomized controlled trial, underage drinking

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Authors: Frederick Ferguson, Dehua Feng, Yang Gao

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No doubt, current CFD tools have a great many technical limitations, and active research is being done to overcome these limitations. Current areas of limitations include vortex-dominated flows, separated flows, and turbulent flows. In general, turbulent flows are unsteady solutions to the fluid dynamic equations, and instances of these solutions can be computed directly from the equations. One of the approaches commonly implemented is known as the ‘direct numerical simulation’, DNS. This approach requires a spatial grid that is fine enough to capture the smallest length scale of the turbulent fluid motion. This approach is called the ‘Kolmogorov scale’ model. It is of interest to note that the Kolmogorov scale model must be captured throughout the domain of interest and at a correspondingly small-time step. In typical problems of industrial interest, the ratio of the length scale of the domain to the Kolmogorov length scale is so great that the required grid set becomes prohibitively large. As a result, the available computational resources are usually inadequate for DNS related tasks. At this time in its development, DNS is not applicable to industrial problems. In this research, an attempt is made to develop a numerical technique that is capable of delivering DNS quality solutions at the scale required by the industry. To date, this technique has delivered preliminary results for both steady and unsteady, viscous and inviscid, compressible and incompressible, and for both high and low Reynolds number flow fields that are very accurate. Herein, it is proposed that the Integro-Differential Scheme (IDS) be applied to a set of vortex-shockwave interaction problems with the goal of investigating the nonstationary physics within the resulting interaction regions. In the proposed paper, the IDS formulation and its numerical error capability will be described. Further, the IDS will be used to solve the inviscid and viscous Burgers equation, with the goal of analyzing their solutions over a considerable length of time, thus demonstrating the unsteady capabilities of the IDS. Finally, the IDS will be used to solve a set of fluid dynamic problems related to flow that involves highly vortex interactions. Plans are to solve the following problems: the travelling wave and vortex problems over considerable lengths of time, the normal shockwave–vortex interaction problem for low supersonic conditions and the reflected oblique shock–vortex interaction problem. The IDS solutions obtained in each of these solutions will be explored further in efforts to determine the distributed density gradients and vorticity, as well as the Q-criterion. Parametric studies will be conducted to determine the effects of the Mach number on the intensity of vortex-shockwave interactions.

Keywords: vortex dominated flows, shockwave interactions, high Reynolds number, integro-differential scheme

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Authors: Rosa S. Wong, Keith T. S. Tung, Frederick K. Ho, Winnie W. Y. Tso, King-wa Fu, Nirmala Rao, Patrick Ip

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As technology advances, exposures in early childhood are no longer confined to stimulations in the surrounding physical environments. Children nowadays are also subject to influences from the digital world. In particular, early access to game consoles can cause risks to child development, especially when the game is not developmentally appropriate for young children. Overstimulation is possible and could impair brain development. On the other hand, recreational parent-child activities, including outdoor activities and visits to museums, require child interaction with parents, which is beneficial for developing adaptive emotion regulation and social skills. Given the differences between these two types of exposures, this study investigated and compared the independent effects of early exposure to a game console and early play-based parent-child activities on children’s long-term psychosocial outcomes. This study used data from a subset of children (n=304, 142 male and 162 female) in the longitudinal cohort study, which studied the long-term impact of family socioeconomic status on child development. In 2012/13, we recruited a group of children at Kindergarten 3 (K3) randomly from Hong Kong local kindergartens and collected data regarding their duration of exposure to game console and recreational parent-child activities at that time. In 2018/19, we re-surveyed the parents of these children who were matriculated as Form 1 (F1) students (ages ranging from 11 to 13 years) in secondary schools and asked the parents to rate their children’s psychosocial problems in F1. Linear regressions were conducted to examine the associations between early exposures and adolescent psychosocial problems with and without adjustment for child gender and K3 family socioeconomic status. On average, K3 children spent about 42 minutes on a game console every day and had 2-3 recreational activities with their parents every week. Univariate analyses showed that more time spent on game consoles at K3 was associated with more psychosocial difficulties in F1 particularly more externalizing problems. The effect of early exposure to game console on externalizing behavior remained significant (B=0.59, 95%CI: 0.15 to 1.03, p=0.009) after adjusting for recreational parent-child activities and child gender. For recreational parent-child activities at K3, its effect on overall psychosocial difficulties became insignificant after adjusting for early exposure to game consoles and child gender. However, it was found to have significant protective effect on externalizing problems (B=-0.65, 95%CI: -1.23 to -0.07, p=0.028) even after adjusting for the confounders. Early exposure to game consoles has negative impact on children’s psychosocial health, whereas play-based parent-child activities can foster positive psychosocial outcomes. More efforts should be directed to propagate the risks and benefits of these activities and urge the parents and caregivers to replace child-alone screen time with parent-child play time in daily routine.

Keywords: early childhood, electronic device, parenting, psychosocial wellbeing

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Authors: Frederick Huie, Lauren Fusfeld, William Burchenal, Scott Howell, Alyssa McVey, Thomas F. Goss

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Alzheimer’s Disease (AD) is a degenerative brain disease characterized by memory loss and cognitive decline that presents a substantial economic burden for patients and health insurers in the US. This study evaluates the payer budget impact of the DISCERN™ test in the diagnosis and management of patients with symptoms of dementia evaluated for AD. DISCERN™ comprises three assays that assess critical factors related to AD that regulate memory, formation of synaptic connections among neurons, and levels of amyloid plaques and neurofibrillary tangles in the brain and can provide a quicker, more accurate diagnosis than tests in the current diagnostic pathway (CDP). An Excel-based model with a three-year horizon was developed to assess the budget impact of DISCERN™ compared with CDP in a Medicare Advantage plan with 1M beneficiaries. Model parameters were identified through a literature review and were verified through consultation with clinicians experienced in diagnosis and management of AD. The model assesses direct medical costs/savings for patients based on the following categories: •Diagnosis: costs of diagnosis using DISCERN™ and CDP. •False Negative (FN) diagnosis: incremental cost of care avoidable with a correct AD diagnosis and appropriately directed medication. •True Positive (TP) diagnosis: AD medication costs; cost from a later TP diagnosis with the CDP versus DISCERN™ in the year of diagnosis, and savings from the delay in AD progression due to appropriate AD medication in patients who are correctly diagnosed after a FN diagnosis.•False Positive (FP) diagnosis: cost of AD medication for patients who do not have AD. A one-way sensitivity analysis was conducted to assess the effect of varying key clinical and cost parameters ±10%. An additional scenario analysis was developed to evaluate the impact of individual inputs. In the base scenario, DISCERN™ is estimated to decrease costs by $4.75M over three years, equating to approximately $63.11 saved per test per year for a cohort followed over three years. While the diagnosis cost is higher with DISCERN™ than with CDP modalities, this cost is offset by the higher overall costs associated with CDP due to the longer time needed to receive a TP diagnosis and the larger number of patients who receive a FN diagnosis and progress more rapidly than if they had received appropriate AD medication. The sensitivity analysis shows that the three parameters with the greatest impact on savings are: reduced sensitivity of DISCERN™, improved sensitivity of the CDP, and a reduction in the percentage of disease progression that is avoided with appropriate AD medication. A scenario analysis in which DISCERN™ reduces the utilization for patients of computed tomography from 21% in the base case to 16%, magnetic resonance imaging from 37% to 27% and cerebrospinal fluid biomarker testing, positive emission tomography, electroencephalograms, and polysomnography testing from 4%, 5%, 10%, and 8%, respectively, in the base case to 0%, results in an overall three-year net savings of $14.5M. DISCERN™ improves the rate of accurate, definitive diagnosis of AD earlier in the disease and may generate savings for Medicare Advantage plans.

Keywords: Alzheimer’s disease, budget, dementia, diagnosis.

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Authors: Frederick Gooding

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This paper explores how many Hip Hop artists have intentionally and strategically invoked sustainability principles of people, planet and profits as a means to create community, compensate for and cope with structural inequalities in society. These themes not only create community within one's country, but the powerful display and demonstration of these narratives create community on a global plane. Listeners of Hip Hop are therefore able to learn about the political events occurring in another country free of censure, and establish solidarity worldwide. Hip Hop therefore can be an ingenious tool to create self-worth, recycle positive imagery, and serve as a defense mechanism from institutional and structural forces that conspire to make an upward economic and social trajectory difficult, if not impossible for many people of color, all across the world. Although the birthplace of Hip Hop, the United States of America, is still predominately White, it has undoubtedly grown more diverse at a breath-­taking pace in recent decades. Yet, whether American mainstream media will fully reflect America’s newfound diversity remains to be seen. As it stands, American mainstream media is seen and enjoyed by diverse audiences not just in America, but all over the world. Thus, it is imperative that further inquiry is conducted about one of the fastest growing genres within one of the world’s largest and most influential media industries generating upwards of $10 billion annually. More importantly, hip hop, its music and associated culture collectively represent a shared social experience of significant value. They are important tools used both to inform and influence economic, social and political identity. Conversely, principles of American exceptionalism often prioritize American political issues over those of others, thereby rendering a myopic political view within the mainstream. This paper will therefore engage in an international contextualization of the global phenomena entitled Hip Hop by exploring the creative genius and marketing appeal of Hip Hop within the global context of information technology, political expression and social change in addition to taking a critical look at historically racialized imagery within mainstream media. Many artists the world over have been able to freely express themselves and connect with broader communities outside of their own borders, all through the sound practice of the craft of Hip Hop. An empirical understanding of political, social and economic forces within the United States will serve as a bridge for identifying and analyzing transnational themes of commonality for typically marginalized or disaffected communities facing similar struggles for survival and respect. The sharing of commonalities of marginalized cultures not only serves as a source of education outside of typically myopic, mainstream sources, but it also creates transnational bonds globally to the extent that practicing artists resonate with many of the original themes of (now mostly underground) Hip Hop as with many of the African American artists responsible for creating and fostering Hip Hop's powerful outlet of expression. Hip Hop's power of connectivity and culture-sharing transnationally across borders provides a key source of education to be taken seriously by academics.

Keywords: culture, education, global, hip hop, mainstream music, transnational

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Authors: Frederick W. Gooding, Jr., Mark Beeman

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Nearly a century ago, the groundbreaking 1915 film ‘The Birth of a Nation’ popularized the way Hollywood made movies with its avant-garde, feature-length style. The movie's subjugating and demeaning depictions of African American women (and men) reflected popular racist beliefs held during the time of slavery and the early Jim Crow era. Although much has changed concerning race relations in the past century, American sociologist Patricia Hill Collins theorizes that the disparaging images of African American women originating in the era of plantation slavery are adaptable and endure as controlling images today. In this context, a comparative analysis of the successful contemporary film, ‘Bringing Down the House’ starring Queen Latifah is relevant as this 2004 film was designed to purposely defy and ridicule classic stereotypes of African American women. However, the film is still tied to the controlling images from the past, although in a modern hybrid form. Scholars of race and film have noted that the pervasive filmic imagery of the African American woman as the loyal mammy stereotype faded from the screen in the post-civil rights era in favor of more sexualized characters (i.e., the Jezebel trope). Analyzing scenes and dialogue through the lens of sociological and critical race theory, the troubling persistence of African American controlling images in film stubbornly emerge in a movie like ‘Bringing Down the House.’ Thus, these controlling images, like racism itself, can adapt to new social and economic conditions. Although the classic controlling images appeared in the first feature length film focusing on race relations a century ago, ‘The Birth of a Nation,’ this black and white rendition of the mammy figure was later updated in 1939 with the classic hit, ‘Gone with the Wind’ in living color. These popular controlling images have loomed quite large in the minds of international audiences, as ‘Gone with the Wind’ is still shown in American theaters currently, and experts at the British Film Institute in 2004 rated ‘Gone with the Wind’ as the number one movie of all time in UK movie history based upon the total number of actual viewings. Critical analysis of character patterns demonstrate that images that appear superficially benign contribute to a broader and quite persistent pattern of marginalization within the aggregate. This approach allows experts and viewers alike to detect more subtle and sophisticated strands of racial discrimination that are ‘hidden in plain sight’ despite numerous changes in the Hollywood industry that appear to be more voluminous and diverse than three or four decades ago. In contrast to white characters, non-white or minority characters are likely to be subtly compromised or marginalized relative to white characters if and when seen within mainstream movies, rather than be subjected to obvious and offensive racist tropes. The hybrid form of both the older Jezebel and Mammy stereotypes exhibited by lead actress Queen Latifah in ‘Bringing Down the House’ represents a more suave and sophisticated merging of past imagery ideas deemed problematic in the past as well as the present.

Keywords: African Americans, Hollywood film, hybrid, stereotypes

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