Understanding the Relationship Between Pharmacists’ Implicit and Explicit Bias and Perceptions of Pharmacist Services Among Arab and Black Individuals

Background. Recent studies suggest that Health Care Professionals’ (HCPs) unconscious bias about race contributes to health care disparities. The objective of this research was to estimate unconscious racial bias among pharmacists in order to understand its relationship with Black and Arab individuals’ perceptions and experience of pharmacist services and their interaction with pharmacists in Ontario. Methods. Multi-method research combining both quantitative and qualitative methods was employed. A secure, web-based survey was administered to Ontario community pharmacists. The survey included two Implicit Association Tests (IATs) to assess unconscious preferences and direct questions regarding community pharmacists’ explicit attitude to race. In a qualitative study using purposive sampling, face-to-face semi-structured interviews with 27 Black and Arab individuals were conducted to explore their interactions with pharmacists and their opinions, perceptions, attitudes, and experiences about community pharmacist services. Results. A total of 407 community pharmacists (40% male, mean age 47, 57% white) completed the survey. Evidence of race/ethnicity bias toward Black and Arab individuals was evident, as determined by both explicit and implicit measures. Moderate to high levels of implicit pro-white bias were found among Ontario community pharmacists on average. Explicit pro-white bias was less evident, but apparent for measures of racial/ethnic preference and, relative warmth (amount of warmth felt toward Black/Arab individuals subtracted from the amount of warmth felt toward whites). In addition, implicit bias appeared to be associated with pharmacist characteristics such as age, racial/ethnic background, years as a pharmacist, years as a licensed pharmacist in Canada practice location, and place of birth, and explicit preferences had a weak positive correlation. The qualitative data revealed that most Black and Arab individuals felt comfortable interacting v and seeking advice from their pharmacists. However, some Black and Arab participants experienced discrimination from community pharmacists. The data also provided information about some personal and systemic issues encountered by Black and Arab individuals when they interacted with community pharmacist. Conclusions. Race and ethnicity bias exists among most Ontario community pharmacists and may be associated with Black and Arab individuals’ perceptions of pharmacist services and their interaction with pharmacists. Future work needs to employ more rigorous approaches to explore whether, and under what conditions, community pharmacists’ implicit bias about race/ethnicity affect the quality of their services toward visible minority individuals, including Black and Arab people. Interventions to reduce bias may need to be comprehensive so that they can ultimately influence an individual’s implicit and explicit biases in all measured areas

Three Essays on Water Economics

This dissertation consists of three essays that explore the impacts of changes in public water quality, reliability, and raw water source. The first essay explores the relationship between episodes of contaminated drinking water and health care expenditures in the United States. Using panel data from 48 contiguous states from 2000 to 2011 and spatial econometrics modeling methods, the results indicate that there is positive and statistically significant impact on per capita health care expenditures from the percentage of a state’s population exposed to contamination episodes. The second essay examines the problem of water supply reliability due to aging infrastructure of public water systems on residential property prices in Marion County, West Virginia. Using the issuance of boil water notices (BWN) as an indicator of water service unreliability and spatial modeling methods, the results indicate that the issuance of boil water notices one year prior to a sale leads to reduced housing prices among low to mid-range priced houses from $850 to$2,700. Overall, water supply unreliability has a substantial impact on the value of residential properties in Marion County such that a one-day reduction of BWN is equal to $4.60 million. The third essay explores the impact of access to raw water sources on residential water charges by public service districts (PSDs) in West Virginia. By comparing residential water charges per 4,500 gallons for PSDs that utilize different raw water sources, the results show that purchased water and the use of multiple sources result in higher residential water charges

PRAGMATIC DEVELOPMENTAL PATHWAYS BY SAUDI LEARNERS OF ENGLISH DURING STUDY ABROAD

Recently, it has become increasingly popular among Saudi students to study abroad. There are, for example, currently 58,726 Saudi students studying at the university level in the United States. During their study abroad (SA) journey, when they wish to say something to someone, they need to determine the situationally-appropriate utterances: What can be said, to whom, where, when, and how. From the interlanguage pragmatic (ILP) perspective, the SA context is assumed to provide more opportunities to communicate with native speakers, and these opportunities are believed to lead to pragmatic gains (Kinginger, 2008, 2009).Guided by five research questions, this study investigated the development of pragmatic competence among Saudi second language (L2) learners of English during their SA experiences in the United States. The main areas of investigation in this study are: 1) assessing three aspects of pragmatic competence pragmatic appropriateness judgment perception, production, and comprehension with a focus on the speech acts of request, refusal and apology as well as implicature and 2) exploring the pragmatic developmental pathways of how their pragmatic competence develops while studying abroad in the United States.The study utilized an explanatory sequential mixed method design, with a quantitative phase followed by a qualitative phase. Seventy Saudi L2 students completed three pragmatic measures, namely, multiple-choice-discourse completion test (MDCT), written completion test (WDCT), and implicature listening test (ILT) that were administered electronically through a software for gathering data called Qualtrics. This was followed by semi-structured interviews with a sample of eight students who participated in the quantitative phase of the research.Several major findings were uncovered. In phase one, findings revealed that Saudi L2 learners were relatively competent in identifying, producing, and understanding appropriate language in contexts. Interview data suggested that there is a need to have a broader focus in language learning, including, beside grammar structure and vocabulary accuracy, the considerations of speech appropriateness and the different cultural issues. The interview data also discussed the participants acquisitional and developmental pathways of pragmatic competence as well as the sources they utilized to gain and develop their pragmatic competence in the SA context. Finally, the study concluded that almost all participants perceived SA in the native country to be helpful for developing pragmatic skills

A qualitative Assessment of Practice Experiences of Certified Diabetes Educator (CDE) pharmacists in Saskatchewan

ABSTRACT Background: Pharmacists are a rapidly growing segment of certified diabetes educators (CDEs) in Canada; however, little is known about their practice experiences. Objective: This study aimed to describe the practice experiences of CDE pharmacists and the impact of the CDE designation. Methods: A qualitative research approach was used. A purposive sample of 14 CDE pharmacists in Saskatchewan was selected to obtain data by means of in-depth semi-structured interviews. Data were analysed using thematic analysis and NVivo10 software. Findings: Four themes emerged from the data: (1) CDE pharmacists engage in a multitude of diabetes-related activities, (2) becoming a CDE has been beneficial, (3) certain challenges still exist when trying to provide diabetes-related education, and (4) strategies were proposed to try and overcome these challenges. CDE pharmacists are engaging in both broad and focused diabetes management, such as insulin starts and adjustments. Pharmacists are satisfied that the CDE designation has helped achieve some of their goals and have benefited from improved relationships with other health care professionals. Although some solutions were offered, CDE pharmacists still face challenges in putting their knowledge to full use with respect to devoting time to diabetes management and remuneration for providing diabetes services. Conclusions: CDE pharmacists in Saskatchewan report enhanced diabetes-related activities prior to becoming a CDE and that designation has had a positive impact on them and perhaps their patients. This information could prove useful to employers and payers as the number of CDE pharmacists continues to increase. However, more information is necessary to describe CDE pharmacist practice experiences across Canada

An Approach to Quantifying Uncertainty in Estimates of Intensity Duration Frequency (IDF) Curves

Generally urban drainage systems are built to protect urban property and control runoff. Moreover, these systems collect the runoff for storage purposes to serve society through sufficient water supply to meet the needs of demand, irrigation, and drainage. Urban environments are exposed to risks of extreme hydrological events. Therefore, urban water systems and their management are critical. Precipitation data are crucial, but may be prone to errors due to the lack of information e.g., short length of records. In this thesis, a Monte Carlo simulation and regional frequency analysis based on L-moments approach were utilized during the research in order to estimate the uncertainty in the Intensity Duration Frequency (IDF) curves by using historical precipitation data from Environment Canada (EC) weather stations and simulating a new series of data through a weather generator (WG) model. The simulations were then disaggregated from daily into hourly data for extraction of the annual maximum precipitation for different durations in hours (1, 2, 6, 10, 12, and 24). Regional frequency analysis was used to form the sites into groups based on homogeneity test results, and the quantile values were computed for various sites and durations with the return periods (T) in years (2, 10, 20, and 100). As a result, the regional frequency analysis was used to estimate the regional quantile values based on L-moment approach. Moreover, the box and whisker plots were utilized to display the results. When the return periods and durations increased, the uncertainty slightly increased. The historical IDF curves of London site falls within the regional simulated IDF curves. Furthermore, 1000 runs have been generated by using the weather generator

Shear behaviour of steel fibre-reinforced high strength lightweight concrete beams without web reinforcement

The main objective of this investigation was to determine the influence of adding two different shapes with different lengths of steel fibres on the shear behaviour of lightweight and normal weight concrete beams with normal and high concrete grades. Thirty-six prisms of (100 mm wide, 100 mm deep, and 400 mm long) and seventy two cylindrical samples of (100 mm diameter 200 mm high) were cast and tested to determine the concrete mechanical properties for specimens. These samples were tested in order to discover the role of steel fibres on enhancing concrete properties in general. The modulus of rupture, flexural toughness, toughness, compressive strength and splitting tensile strength were inspected based on the small-scaled material samples. In the structural experiment, a group of twelve large-scaled reinforced concrete beams without shear reinforcement were primarily analyzed, designed and tested in the structures lab at Memorial University of Newfoundland (MUN). These specimens were built to study the load-deflection curves, shear and flexural behaviour, concrete and steel strains and the ultimate load resistance. Simply supported beams with dimensions of (200 mm wide, 400 deep, and 2900 mm long) were structurally tested, analyzed and discussed. in order to investigate the previous responses. Three factors were proposed in this experiment. The first factor was the type of the aggregates and the second parameter taken into consideration was the concrete compressive strength that divided the beams into two groups of high and normal strengths. Thirdly, two different lengths of steel fibres with different end-shapes were considered as the third variable in order to evaluate the effects of the length of the steel fibres on the shear behaviour. All beams contained 1.46% of longitudinal tension reinforcement ratio. Besides this, a fixed concrete cross section was suggested for all beams. Testing specimens were setup on a specified constant shear span-to-depth ratio of 3. According to a recommendation by ACI, a fixed volume fraction of 0.75% of steel fibres was added to SFRC beams. The specimens with long fibres resisted higher shear stresses and were more ductile than the ones reinforced with shorter fibres. Overall, the presence of both short and long steel fibres improved beams shear resistance by a range varied from 35% to 72% compared to reference RC beams. However, shear strength of beams with long steel fibres enhanced more by an average amount of 10% in contrast with short SFs beams

Theoretical and Experimental Study of Fuel Injector Tip Wetting as a Source of Particulate Emissions in Gasoline Direct-Injection Engines

Gasoline fuel film deposited on the tip of a fuel injector, i.e. injector tip wetting, has been identified as a significant source of particulate emissions at some operating conditions of gasoline direct-injection engines. The liquid film on the injector tip can be reduced by either mitigating the initial fuel film that deposits on the tip during injection or by evaporating all or most of the fuel film before ignition takes place. The former process requires a clear understanding of the dependence of the fuel film formation on injector design, operating conditions and fuel flow conditions through the injector nozzle, which impose difficulties in the understanding due to the complex and interrelated processes involved. The liquid film evaporation process, i.e. injector tip drying, however depends mainly on engine operating conditions, and less on hardware or fuel flow dynamics. Understanding of the physics of injector tip drying is therefore less ambiguous but remains a challenge. Clear understanding of the tip drying physics can lead to significant reductions in PN emissions due to tip wetting. This work developed an analytical model for liquid film evaporation on the injector tip during an engine cycle for the mitigation of injector tip wetting. The model explains theoretically how fuel films on the injector tip evaporate with time from end of injection to spark. The model takes into consideration engine operating conditions, such as engine speed, engine load, tip and fuel temperatures, gas temperature and pressure, and fuel properties. The model was able to explain for the first time the observed trends in particulate number (PN) emissions due to injector tip wetting at different operating conditions. Engine experiments were used to validate the theoretical model by correlating the film mass predicted at the time of spark to PN and tip deposit volume measurements at different conditions. A new experimental technique was developed to measure the volume of tip deposit for this purpose since tip deposits are good indicators of tip wetting. In addition, an evaporation time constant was defined and was also found to correlate well with measured PN for all conditions tested. Injector manufacturers can use this time constant to maximize liquid film evaporation by correlating the variables in the time constant equation to changes in hardware and calibration. The results indicate that the liquid film evaporation on the injector tip follows a first order, asymptotic behavior. Additionally, the initial film mass after end of injection was confirmed to increase linearly with the injected fuel mass, i.e. engine load. Furthermore, the observed increasing exponential trend in PN emissions with engine load was due to the exponential nature of injector tip drying. As the initial film mass after injection increased linearly with engine load, the film mass at the time of spark increased in an exponential manner. A parametric study was also performed to understand the influence of the different initial and boundary conditions on fuel film evaporation. The liquid film evaporation on the injector tip was found to be highly sensitive to most of the injector initial and boundary conditions including the initial film mass after end of injection, the wetted surface area, the available time for tip drying and the injector tip temperature. The initial film temperature had the least effect on film mass evaporation.PHDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/155041/1/fahadmz_1.pd

Drinking Water Quality Impacts on Health Care Expenditures in the United States

This paper explores the relationship between episodes of contaminated drinking water and health care expenditures in the United States. The analysis relies on panel data from the 48 contiguous states from 2000 to 2011. We use the population served by public water systems that violate health-based standards of the Safe Drinking Water Act as a proxy for contaminated drinking water. We estimate spatial and non-spatial models and control for factors that may affect per capita health care expenditures including variables that reflect air quality violations along with ability to pay plus demand for and supply of health care services. The results from a Spatial Durbin Model indicate that a 1% decrease in the percentage of population exposed to drinking water quality violations is associated with reductions in in-state and regional effects equal to 0.005% ($0.32) and 0.035$2.26) of per capita health care expenditures, respectively. Drinking water violations have a larger impact on expenditures than air quality violations (whose effects are not statistically different from zero). However, compared to other factors, such as Medicare enrollment and income, the impact of these violations on health care expenditures is relatively small. We find that regional health care expenditure impacts from drinking water violations are substantially greater than in-state impacts. Thus, a regional approach is recommended to addressing drinking water quality improvements

E-learning and the Development of L2: the Case of EFL Visually-impaired Students

The number of visually-impaired students (VIS) enrolled in higher education institutions worldwide is increasing. In the second language (L2) classroom, a range of barriers and challenges have been reported to encounter by VIS. With the global demand to shift many schools and colleges to online learning and teaching, the challenges of VIS have begun to increase. This study aims to explore the experiences of VIS in learning and studying English as a foreign language (EFL) in the realm of online education. Guided by three main research questions, this study adopts an exploratory sequential mixed method design, and the examination is based on a thematic analysis of eight semi-structured student interviews that were followed by online surveys. Results indicated that the online environment could be advantageous for learning, yet VIS encountered considerable challenges during the online mode and was confronted with multiple language learning barriers related to the language instructor, the online environment, and remote assessment and methods. For example, the highest barriers to language e-learning related to the instructor were incompetency in e-teaching and learning and assistive technology, followed by the lack of appropriate assessment tools and methods. Accordingly, a few language skills were targeted and developed. Furthermore, prior training and degree of impairment were the most important indicators affecting EFL learning and development during e-education. The findings could help to develop a strategic plan for successful learning experiences and the implementation of appropriate tools and assessment methods in e-learning