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Laws surrounding the possession, use, and distribution of marijuana have undergone many changes for over a century. Political pressures and social prejudices have most often been the cause of these changes, rather than scientific research or rational thinking. As a result, the law has sometimes lagged behind social practice as in the current case in much of the U.S., including Colorado. In such an environment, it often falls on a police officer's definition, interpretation, and reaction to the laws to determine the extent to which certain laws and sanctions are enforced. Drawing on the work of Weick (1976), this dissertation utilizes the theoretical framework of sensemaking to examine two research questions. First, what sense are police officers in Colorado making of new legalization of marijuana laws? Second, how are officers defining, interpreting, and reacting to marijuana laws in Colorado? Semi-structured interviews were conducted with 22 Denver police officers. Findings suggest that the lack of bright line policies regarding marijuana enforcement play a role in officers making sense of the law in different ways. Officers' definition and interpretation of marijuana law seems to be founded upon their experiences, as well as the experiences of their peers. Several unintentional consequences of marijuana legalization were identified by officers, and appear to play a substantial role in the sensemaking process. Theoretically, this research contends that the four key components of sensemaking (Weick 1976) (i.e., social process, ongoing process, reliant on extracted cues, and based off of plausibility rather than accuracy) are interwoven with the aspects of defining, interpreting, and reacting to laws. As such, a call exists for the elaboration or construction of a theory combining the intertwined elements of defining, interpreting, and reacting to organizational change with the interwoven elements of sensemaking. Findings suggest several policy implications. The call for Colorado and all states that are considering legalization for recreational purposes is to create bright line policies in an effort to reduce confusion among officers. The construction of such policies will reduce the grey area in which officers operate thereby ensuring that users are treated fairly across all jurisdictions and states.

Conventionally, children are depicted finding comfort in the sensory appeal of food, as part of experiences that eventually will become sources of adult nostalgia. Polly Horvath's novels provide narratives that depict the creation of such moments without the accompanying nostalgia. This essay analyzes two of Horvath's most successful and food-focused novels, Everything on a Waffle and The Canning Season, using the disciplinary and theoretical frames of children's literature, food studies, social science research on comfort food as well as literary scholarship on nostalgia and on Proust's À la recherche du temps perdu, pursuing a counter-argument to the conventional view of children's literature as a locus of nostalgia.

Purpose The purpose of this study was to determine if children engaged in equal amounts of physical activity during an established gross motor skill intervention (the Children's Health Activity Motor Program (CHAMP)) and outdoor free play. Design Cross-sectional study; sample: Ninety-nine children (Mage = 4.21, 51% boys) were randomly divided into two movement environments: CHAMP (n = 55) or control/outdoor free play (n = 44). Measures Physical activity was assessed using GT3X+ Actigraph accelerometers worn on the waist across four mornings. Average physical activity across the four days during either CHAMP or outdoor free play was extracted and categorized as light, moderate, vigorous, or MVPA. Physical activity data were reduced in the Actilife software using the cutpoints from Evenson et al. Analysis A 2 (treatment) x 2 (sex) mixed measures ANOVA was used to compare the amount of time children spent in light, moderate, vigorous, and MVPA. Results There was a significant main effect for treatment for light PA (F(3,95) =13.60, P<.001, partial η2=.125), and post hoc t-tests support that children in the control/outdoor free play group engaged in more light PA compared with children in CHAMP (t95 = −3.75, P<.001). Conclusions Results show that children in CHAMP engaged in less light PA but equal amounts of all other physical activity behaviors than their peers in outdoor free play.

ObjectiveEstimates of CD4 response to antiretroviral therapy (ART) obtained by averaging data from patients in care, overestimate population CD4 response and treatment program effectiveness because they do not consider data from patients who are deceased or not in care. We use mathematical methods to assess and adjust for this bias based on patient characteristics.DesignWe examined data from 25,261 HIV‐positive patients from the East Africa IeDEA Consortium.MethodsWe used inverse probability of censoring weighting (IPCW) to represent patients not in care by patients in care with similar characteristics. We address two questions: What would the median CD4 be "had everyone starting ART remained on observation?" and "were everyone starting ART maintained on treatment?"ResultsRoutine CD4 count estimates were higher than adjusted estimates even under the best‐case scenario of maintaining all patients on treatment. Two years after starting ART, differences between estimates diverged from 30 cells/µL, assuming similar mortality and treatment access among dropouts as patients in care, to over 100 cells/µL assuming 20% lower survival and 50% lower treatment access among dropouts. When considering only patients in care, the proportion of patients with CD4 above 350 cells/µL was 50% adjusted to below 30% when accounting for patients not in care. One‐year mortality diverged 6–14% from the naïve estimates depending on assumptions about access to care among lost patients.ConclusionsIgnoring mortality and loss to care results in over‐estimation of ART response for patients starting treatment and exaggerates the efficacy of treatment programs administering it.

BackgroundA major obstacle facing many lower‐income countries in establishing and maintaining HIV treatment programmes is the scarcity of trained health care providers. To address this shortage, the World Health Organization has recommend task shifting to HIV‐infected peers.MethodsWe designed a model of HIV care that utilizes HIV‐infected patients, community care coordinators (CCCs), to care for their clinically stable peers with the assistance of preprogrammed personal digital assistants (PDAs). Rather than presenting for the standard of care, monthly clinic visits, in this model, patients were seen every three months in clinics and monthly by their CCCs in the community during the interim two months. This study was conducted in Kosirai Division, western Kenya, where eight of the 24 sub‐locations (defined geographic areas) within the division were randomly assigned to the intervention with the remainder used as controls.Prior to entering the field, CCCs underwent intensive didactic training and mentoring related to the assessment and support of HIV patients, as well as the use of PDAs. PDAs were programmed with specific questions and to issue alerts if responses fell outside of pre‐established parameters. CCCs were regularly evaluated in six performance areas. An impressionistic analysis on the transcripts from the monthly group meetings that formed the basis of the continuous feedback and quality improvement programme was used to assess this model.ResultsAll eight of the assigned CCCs successfully passed their training and mentoring, entered the field and remained active for the two years of the study. On evaluation of the CCCs, 89% of their summary scores were documented as superior during Year 1 and 94% as superior during Year 2. Six themes emerged from the impressionistic analysis in Year 1: confidentiality and "community" disclosure; roles and responsibilities; logistics; clinical care partnership; antiretroviral adherence; and PDA issues. At the end of the trial, of those patients not lost to follow up, 64% (56 of 87) in the intervention and 52% (58 of 103) in the control group were willing to continue in the programme (p = 0.26).ConclusionWe found that an antiretroviral treatment delivery model that shifted patient monitoring and antiretroviral dispensing tasks into the community by HIV‐infected patients was both acceptable and feasible.Trial registrationClinicalTrials.gov ID NCT00371540

We thank our editor, J. A. Lau, associate editor K. E. Lotterhos, as well as two anonymous reviewers whose suggestions greatly improved this work. We greatly appreciate S. Avery, J. Callahan, S. Duffy, S. Hann, L. Pike, R. Solomon, and A. Walsh for their indispensable help with fieldwork. We thank Parks Canada for allowing us access to the Torngat Mountains National Park and the Nunatsiavut Government for allowing us to collect samples from their lands. We thank A. Belay at Mount Sinai Hospital for help with sequencing, A. Messmer for help with genotyping, and S. Lehnert for insightful data analysis suggestions. We also thank the Institute for Biodiversity, Ecosystem Science, and Sustainability of the Department of Environment and Conservation of the Government of Labrador and Newfoundland for funding for this project; the Natural Sciences and Engineering Research Council of Canada for the Strategic Grant STPGP 430198 and Discovery Grant awarded to D.E.R. and for the Canada Graduate Scholarships–Doctoral awarded to S.J.S.; the Killam Trust for the Level 2 Izaak awarded to S.J.S.; and the Government of Nova Scotia for the graduate scholarship awarded to S.J.S. ; Peer reviewed ; Publisher PDF

Objective: Taxi drivers carry significant risks related to occupational health and safety. Exposure to second-hand tobacco smoke is known to be one of those health risks. As legislations for smoke-free taxis become more widespread throughout the world, this study aimed to assess knowledge and attitude of taxi drivers on the new legislation for tobacco control introduced in Turkey recently. Methodology: The study population consisted of 135 taxi drivers from 22 different taxi stations in Ankara Turkey. Data of the descriptive study was collected in October, 2008 through face-to-face interviews with a standart questionnaire. Descriptive statistics were used to summarize data, whereas chi-square was used to compare groups. Results: All the study participants were male with a mean age of 47.2+/-11.8 years. More than half of the taxi drivers (59.3%) were found to be current smokers. Although level of knowledge and attitude of taxi drivers on the new legislation were favorable in general, some difficulties and barriers were found to be present in implementation of the ban. Most of the smoking drivers were found to continue smoking in their taxis. About 80.0% of the drivers stated their concern of losing out on clients' satisfaction if they restrict smoking in their taxis. Conclusion: Taxi drivers and clients' knowledge, attitudes and behaviors are important determinants in successful implementation of legislations for smoke-free taxis.

AbstractIntroductionAdolescence and pregnancy are potential risk factors for loss to follow‐up (LTFU) while on antiretroviral therapy (ART). We compared adolescent and adult LTFU after ART initiation to quantify the impact of age, pregnancy, and site‐level factors on LTFU.MethodsWe used routine clinical data for patients initiating ART as young adolescents (YA; 10 to 14 years), older adolescents (OA; 15 to 19 years) and adults (≥20 years) from 2000 to 2014 at 52 health facilities affiliated with the International epidemiology Databases to Evaluate AIDS (IeDEA) East Africa collaboration. We estimated cumulative incidence (95% confidence interval, CI) of LTFU (no clinic visit for ≥6 months after ART initiation) and identified patient and site‐level correlates of LTFU, using multivariable Cox proportional hazards models for all patients as well as individual age groups.ResultsA total of 138,387 patients initiated ART, including 2496 YA, 2955 OA and 132,936 adults. Of these, 55%, 78% and 66%, respectively, were female and 0.7% of YA, 22.3% of OA and 8.3% of adults were pregnant at ART initiation. Cumulative incidence of LTFU at five years was 26.6% (24.6 to 28.6) among YA, 44.1% (41.8 to 46.3) among OA and 29.3% (29.1 to 29.6) among adults. Overall, compared to adults, the adjusted hazard ratio, aHR, (95% CI) of LTFU for OA was 1.54 (1.41 to 1.68) and 0.77 (0.69 to 0.86) for YA. Compared to males, pregnant females had higher hazard of LTFU, aHR 1.20 (1.14 to 1.27), and nonpregnant women had lower hazard aHR 0.90 (0.88 to 0.93). LTFU hazard among the OA was primarily driven by both pregnant and nonpregnant females, aHR 2.42 (1.98 to 2.95) and 1.51 (1.27 to 1.80), respectively, compared to men. The LTFU hazard ratio varied by IeDEA program. Site‐level factors associated with overall lower LTFU hazard included receiving care in tertiary versus primary‐care clinics aHR 0.61 (0.56 to 0.67), integrated adult and adolescent services and food ration provision aHR 0.93 (0.89 to 0.97) versus nonintegrated clinics with food ration provision, having patient support groups aHR 0.77 (0.66 to 0.90) and group adherence counselling aHR 0.61 (0.57 to 0.67).ConclusionsOlder adolescents experienced higher risk of LTFU compared to YA and adults. Interventions to prevent LTFU among older adolescents are critically needed, particularly for female and/or pregnant adolescents.

AbstractIntroductionDolutegravir is being scaled up globally as part of antiretroviral therapy (ART), but for people with HIV and tuberculosis co‐infection, its use is complicated by a drug–drug interaction with rifampicin requiring an additional daily dose of dolutegravir. This represents a disadvantage over efavirenz, which does not have a major drug–drug interaction with rifampicin. We sought to describe HIV clinic practices for prescribing concomitant dolutegravir and rifampicin, and characterize virologic outcomes among patients with tuberculosis co‐infection receiving dolutegravir or efavirenz.MethodsWithin the four sub‐Saharan Africa regions of the International epidemiology Databases to Evaluate AIDS consortium, we conducted a site survey (2021) and a cohort study (2015–2021). The cohort study used routine clinical data and included patients newly initiating or already receiving dolutegravir or efavirenz at the time of tuberculosis diagnosis. Patients were followed from tuberculosis diagnosis until viral suppression (<1000 copies/ml), a competing event (switching ART regimen; loss to program/death) or administrative censoring at 12 months.ResultsIn the survey, 86 of 90 (96%) HIV clinics in 18 countries reported prescribing dolutegravir to patients who were receiving rifampicin as part of tuberculosis treatment, with 77 (90%) reporting that they use twice‐daily dosing of dolutegravir, of which 74 (96%) reported having 50 mg tablets available to accommodate twice‐daily dosing. The cohort study included 3563 patients in 11 countries, with 67% newly or recently initiating ART. Among patients receiving dolutegravir (n = 465), the cumulative incidence of viral suppression was 58.9% (95% confidence interval [CI]: 54.3–63.3%), switching ART regimen was 4.1% (95% CI: 2.6–6.2%) and loss to program/death was 23.4% (95% CI: 19.7–27.4%). Patients receiving dolutegravir had improved viral suppression compared with patients receiving efavirenz who had a tuberculosis diagnosis before site dolutegravir availability (adjusted subdistribution hazard ratio [aSHR]: 1.47, 95% CI: 1.28–1.68) and after site dolutegravir availability (aSHR 1.28, 95% CI: 1.08–1.51).ConclusionsAt a programmatic level, dolutegravir was being widely prescribed in sub‐Saharan Africa for people with HIV and tuberculosis co‐infection with a dose adjustment for the drug–drug interaction with rifampicin. Despite this more complex regimen, our cohort study revealed that dolutegravir did not negatively impact viral suppression.