Adverse Childhood Experiences, Homeless Chronicity, and Age at Onset of Homelessness

Childhood adversity is associated with numerous negative outcomes across multiple domains, including mental and physical health, interrelationships, and social functioning. Notably, research suggests that childhood adversity has a dose-response relationship with these outcomes; that is, greater numbers of adverse experiences in childhood are associated with worse outcomes. These outcomes overlap with many risk factors of homelessness. This study sought to address two questions: 1) Does a dose-response relationship exist between childhood adversity and chronic homelessness? 2) Does childhood adversity negatively predict the age at which homelessness first occurs? Adults experiencing homeless who are accessing homeless services in the Tri-Cities area of Northeast Tennessee responded to a brief instrument that includes measures of homeless chronicity, Adverse Childhood Experiences (ACEs), and age of onset of homelessness. Although relationships between ACEs and homeless chronicity was not observed, a relationship did emerge between number of ACEs and number of episodes and number of ACEs and age at initial onset of homelessness

Application of Mathematical and Computational Models to Mitigate the Overutilization of Healthcare Systems

The overutilization of the healthcare system has been a significant issue financially and politically, placing burdens on the government, patients, providers and individual payers. In this dissertation, we study how mathematical models and computational models can be utilized to support healthcare decision-making and generate effective interventions for healthcare overcrowding. We focus on applying operations research and data mining methods to mitigate the overutilization of emergency department and inpatient services in four scenarios. Firstly, we systematically review research articles that apply analytical queueing models to the study of the emergency department, with an additional focus on comparing simulation models with queueing models when applied to similar research questions. Secondly, we present an agent-based simulation model of epidemic and bioterrorism transmission, and develop a prediction scheme to differentiate the simulated transmission patterns during the initial stage of the event. Thirdly, we develop a machine learning framework for effectively selecting enrollees for case management based on Medicaid claims data, and demonstrate the importance of enrolling current infrequent users whose utilization of emergency visits might increase significantly in the future. Lastly, we study the role of temporal features in predicting future health outcomes for diabetes patients, and identify the levels to which the aggregation can be most informative

Optimization of hospital emergency department

This thesis is centered around the topic of emergency department(ED) optimization. Working in conjunction with the Thunder Bay Regional Health Sciences Centre a simulation model was developed to determine an optimal physician schedule for the high acuity portion of the ED. The simulation uses patients generated based on the data provided. The simulation accounts for resource usage and coordinating physician patient interaction. As a secondary component to the thesis the minimum cut problem is investigated, as it has potential in aiding physicians in the ED. During this investigation a local search algorithm is proposed and the effects of parallelization are investigated

Improving Data Infrastructure to Reduce Firearms Violence

In the fall of 2020, Arnold Ventures, a philanthropy dedicated to maximizing opportunity and minimizing injustice, and NORC at University of Chicago, an objective nonpartisan research institution, released the Blueprint for a US Firearms Infrastructure (Roman, 2020). The Blueprint is the consensus report of an expert panel of distinguished academics, trailblazing practitioners, and government leaders. It describes 17 critical reforms required to modernize how data about firearms violence of all types (intentional, accidental, and self-inflicted) are collected, integrated and disseminated. This project, which is also supported by Arnold Ventures, takes the conceptual priorities described in the Blueprint and proposes specific new steps for implementation.The first step in building a better firearms data infrastructure is to acknowledge where we currently stand. In The State of Firearm Data in 2019 (Roman, 2019), the expert panel found that while there are a substantial number of data sources that collect data on firearms violence, existing datasets and data collections are limited, particularly around intentional injuries. There is some surveillance data, but health data on firearms injuries are kept separately from data on crimes, and there are few straightforward ways to link those data. Data that provide context for a shooting--where the event took place, and what the relationship was between victim and shooter--are not available alongside data on the nature of injuries. Valuable data collections have been discontinued, data are restricted by policy, important data are not collected, data are often difficult to access, and contemporary data are often not released in a timely fashion or not available outside of specialized settings. As a result, researchers face vast gaps in knowledge and are unable to leverage existing data to build the evidence base necessary to adequately answer key policy questions and inform firearms policymaking.In the Blueprint, the expert panel developed a set of recommendations organized around a reconceptualization of how data are collected and who collects data. The broad themes from the Blueprint are as follows:Almost all surveillance data in health and criminal justice is generated locally. It is a high priority to provide information, technical assistance, implementation supports, and funding to state and local governments to improve their collections.Comprehensive monitoring of all federal data collections is needed to ensure that important data elements are being collected, data gaps are being addressed, and quality issues are quickly resolved.Timely dissemination of key data is important, including the development of guidelines to ensure consistency across collections and that resources are made available to speed reporting for collections with historical delays.Improvement is needed in strategic communication about the purpose and use of data to federal agencies, researchers and to the general public.The current report builds on the Blueprint by developing implementation guidance for key recommendations. Where the Blueprint included actionable recommendations, such as naming discontinued surveys that should be resurrected, this report develops specific recommendations for implementation. The report is centered on three topics that were the highest priority for the expert panel but that required additional research before guidance could be disseminated. The research findings from that additional investigation are reported here, and recommendations to facilitate implementation are described. The three topic areas are as follows:The creation of a nonfatal firearms injury databaseIncreasing the quality, availability, and usefulness of firearms data for research and policyPractical steps for building state capacity and infrastructure to use data for evidence-based decision-makin

Medically unexplained symptoms in neurology

AIMS - To estimate the proportion of new patients with medically unexplained symptoms (MUS) that present to neurology out -patient services and to examine the impact of such symptoms on the patients in terms of disability, distress and outcome. Methods- Historical (MUS from 2 000 BC to 1965), narrative (non -neurological MUS) and systematic (MUS in neurology 1960 - 2000) reviews of the previous literature were conducted. A prospective cohort study of 300 newly referred out- patients was carried out in the regional neurology service in Lothian, Scotland. Patients were examined at the time of initial presentation and re- examined eight months later. Both primary and secondary care case -note were reviewed at follow up. Measures- Neurologists rated degree to which the patients' symptoms were explained by organic disease. Health status was measured using the SF -36. Anxiety and depressive disorders were examined using the PRIME MD and HAD. Outcome was measured on a Clinical Global Improvement (CGI) scale.RESULTS - The historical review of the literature found that MUS have been described since the first written texts of medicine. The narrative review showed that MUS affected both sexes, all ages, and all cultures. The systematic review of MUS in neurology found that between 30-40% of cases in neurology had MUS and the rate of misdiagnosis was less than 5%. In the field of neurology there was no information on disability, limited information on co- morbid anxiety and depressive disorders, and outcome studies were confined to conversion hysteria only. In the prospective cohort study 30% of new patients presenting to neurology out -patient clinics had MUS. They were as physically disabled by their symptoms as those with neurological disease were by theirs. They suffered from increased levels of pain and increased rates of anxiety and depression. At eight months follow up more than half the MUS patients were `just the same' or `worse'. There were no cases where unexpected neurological disease was diagnosed during the follow up which explained the patient's presenting symptoms. The patients with MUS had had multiple referrals to other specialist services as a result of MUS.CONCLUSIONS - One third of new referrals to general neurology clinics have medically unexplained symptoms. These patients are disabled and distressed. Over half of these patients remain symptomatic at eight months follow up

The Comprehensive Cancer Center

This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators

Knowledge and Civil Society

This open access book focuses on the role of civil society in the creation, dissemination, and interpretation of knowledge in geographical contexts. It offers original, interdisciplinary and counterintuitive perspectives on civil society. The book includes reflections on civil and uncivil society, the role of civil society as a change agent, and on civil society perspectives of undone science. Conceptual approaches go beyond the tripartite division of public, private and civic sectors to propose new frameworks of civic networks and philanthropic fields, which take an inclusive view of the connectivity of civic agency across sectors. This includes relational analyses of epistemic power in civic knowledge networks as well as of regional giving and philanthropy. The original empirical case studies examine traditional forms of civic engagement, such as the German landwomen’s associations, as well as novel types of organizations, such as giving circles and time banks in their geographical context. The book also offers insider reflections on doing civil society, such as the cases of the Umbrella Movement in Hong Kong, epistemic activism in the United States, and the #FeesMustFall movement in South Africa

Field Scale Application of Nanoscale Zero Valent Iron: Mobility, Contaminant Degradation, and Impact on Microbial Communities

This thesis began by verifying that nanoscale zero valent iron (nZVI) synthesis methods could be scaled up and implemented at the field scale in a safe manner. This led to successful demonstration of nZVI injection and mobility under constant head gravity injection into a contaminated utility corridor in Sarnia, Ontario. Where field studies have fallen short in the past was linking the somewhat qualitative field geochemical parameters to other evidence of nZVI transport. Definitive nZVI detection was elusive in previous field studies due to the highly reactive nature of the particles caused by their high surface area. nZVI was detected and characterized in this study using UV/Vis spectrophotometry, Dynamic light scattering, zeta potential, Transmission Electron Microscopy, and energy dispersive x-ray spectroscopy, proving that field mobility was reliably achieved. The second study provides the first insight into the interactions and reaction that occur on an active field site immediately following nZVI injection. A fine temporal resolution of samples was used to define chlorinated ethene, ethane, and methane (cVOC) degradation among nZVI impacted zones, showing that these zones were distinct from areas that were not affected by nZVI. Building upon previous indirect evidence that nZVI enhances organohalide-respiring microorganisms, this study set out to prove that microbiological communities on sites were enhanced following injection. Quantitative polymerase chain reaction (qPCR) was used to target Dehalococcoides spp. (dhc) and vinyl chloride reductase genes (vcrA). The distinct zones where nZVI treatment was applied subsequently had high abundances of dhc and vcrA. The qPCR methods presented in the second study can act as a template for future field investigation on nZVI. Finally, the long-term effects of the injection amendments nZVI and Carboxymethyl-cellulose were monitoring on the microbial communities on site. It was hypothesized that the organohalide-respiring species on site would be enriched and cVOC degradation would be sustained due to the polymer amendments that accompany nZVI injection. Over a two year period next-generation pyrosequencing, qPCR, and cVOC degradation were monitored, providing the first ever phylum level microbiological evaluation at a field site undergoing remediation

Knowledge and Civil Society

This open access book focuses on the role of civil society in the creation, dissemination, and interpretation of knowledge in geographical contexts. It offers original, interdisciplinary and counterintuitive perspectives on civil society. The book includes reflections on civil and uncivil society, the role of civil society as a change agent, and on civil society perspectives of undone science. Conceptual approaches go beyond the tripartite division of public, private and civic sectors to propose new frameworks of civic networks and philanthropic fields, which take an inclusive view of the connectivity of civic agency across sectors. This includes relational analyses of epistemic power in civic knowledge networks as well as of regional giving and philanthropy. The original empirical case studies examine traditional forms of civic engagement, such as the German landwomen’s associations, as well as novel types of organizations, such as giving circles and time banks in their geographical context. The book also offers insider reflections on doing civil society, such as the cases of the Umbrella Movement in Hong Kong, epistemic activism in the United States, and the #FeesMustFall movement in South Africa