A Macro Social Examination of the Relationship Between Disabilities and Crime Using Neighborhood and County Level Data

Over the last few decades, there has been a consistent increase in mental illnesses in the US population. This has also lead to increased interactions of those with mental illnesses and/or disabilities with law enforcement and the criminal justice system. Despite these instances, there is limited research on the relationship between disabilities, mental health issues and crime in the large body of criminological research. Further, the current extant research is a) outside the field of Criminology, b) primarily focuses on those with only intellectual or developmental disabilities and/or c) does not examine this relationship at the macro level, despite evidence of high disability levels in areas of high disadvantage. In addition, prior research does not provide a theoretical explanation of the link between disabilities, mental health issues and crime. The purpose of this dissertation is to address these knowledge gaps and examine the relationship between functional disabilities (mobility, cognitive, hearing, vision, independent living, employment or self-care), mental health issues and crime rates. Furthermore, this dissertation is the first to apply Agnew’s Macro Strain (MST) to examine the relationships between disabilities and crime and mental health issues and crime. These relationships are examined through two separate macro level analyses. First, the relationship between functional disabilities and crime is examined in the city of Boston using neighborhood-level data from the US Census Bureau and crime rates from the Boston Police Department. The analyses are conducted examining bivariate relationships across the seven types of disabilities and crimes, Ordinary Least Regression models controlling for neighborhood level factors and utilizing a neighborhood disadvantage index. Second, the relationship between mental health issues and county-level crime rates is examined using data from the Florida Department of Law Enforcement and involuntary commitment petition data from the Baker Act Reporting Center in 67 Florida counties from 2000 to 2018. Involuntary commitment petitions initiated by law enforcement, health professionals and judges (utilized as a proxy for those experiencing a mental health crisis) and crime rates are examined. The analyses are conducted examining key summary statistics, time series plots of involuntary exam petitions and crime rates overtime, and county and year fixed effects regression models. Several key findings emerged from the results that advance research on the disabilities, mental health issues and crime rates relationship. First, neighborhood analyses showed a significant positive relationship between cognitive, sensory, and physical disabilities with property and violent crime rates in neighborhoods. Second, county-level analyses from involuntary commitment exams initiated by law enforcement, health officials, and judges and crime rates showed a negative effect of health official initiated involuntary exam petitions on county level crime rates. The findings provide evidence for macro level relationship between cognitive, sensory and physical disabilities and violent crime rates in neighborhoods. Further, county level analyses may provide precursory evidence towards the efficacy of involuntary commitment petition laws, when initiated by health professionals. The findings underscore the need of neighborhood and county level initiatives to provide resources for individuals with disabilities and those experiencing mental health crises. In addition, it highlights the need for training for law enforcement as interactions between those experiencing mental health issues and criminal justice system rise. The dissertation concludes with implications for health and criminal justice policy and directions for future research

A Macro Social Examination of the Relationship Between Disabilities and Crime Using Neighborhood and County Level Data

Over the last few decades, there has been a consistent increase in mental illnesses in the US population. This has also lead to increased interactions of those with mental illnesses and/or disabilities with law enforcement and the criminal justice system. Despite these instances, there is limited research on the relationship between disabilities, mental health issues and crime in the large body of criminological research. Further, the current extant research is a) outside the field of Criminology, b) primarily focuses on those with only intellectual or developmental disabilities and/or c) does not examine this relationship at the macro level, despite evidence of high disability levels in areas of high disadvantage. In addition, prior research does not provide a theoretical explanation of the link between disabilities, mental health issues and crime. The purpose of this dissertation is to address these knowledge gaps and examine the relationship between functional disabilities (mobility, cognitive, hearing, vision, independent living, employment or self-care), mental health issues and crime rates. Furthermore, this dissertation is the first to apply Agnew’s Macro Strain (MST) to examine the relationships between disabilities and crime and mental health issues and crime. These relationships are examined through two separate macro level analyses. First, the relationship between functional disabilities and crime is examined in the city of Boston using neighborhood-level data from the US Census Bureau and crime rates from the Boston Police Department. The analyses are conducted examining bivariate relationships across the seven types of disabilities and crimes, Ordinary Least Regression models controlling for neighborhood level factors and utilizing a neighborhood disadvantage index. Second, the relationship between mental health issues and county-level crime rates is examined using data from the Florida Department of Law Enforcement and involuntary commitment petition data from the Baker Act Reporting Center in 67 Florida counties from 2000 to 2018. Involuntary commitment petitions initiated by law enforcement, health professionals and judges (utilized as a proxy for those experiencing a mental health crisis) and crime rates are examined. The analyses are conducted examining key summary statistics, time series plots of involuntary exam petitions and crime rates overtime, and county and year fixed effects regression models. Several key findings emerged from the results that advance research on the disabilities, mental health issues and crime rates relationship. First, neighborhood analyses showed a significant positive relationship between cognitive, sensory, and physical disabilities with property and violent crime rates in neighborhoods. Second, county-level analyses from involuntary commitment exams initiated by law enforcement, health officials, and judges and crime rates showed a negative effect of health official initiated involuntary exam petitions on county level crime rates. The findings provide evidence for macro level relationship between cognitive, sensory and physical disabilities and violent crime rates in neighborhoods. Further, county level analyses may provide precursory evidence towards the efficacy of involuntary commitment petition laws, when initiated by health professionals. The findings underscore the need of neighborhood and county level initiatives to provide resources for individuals with disabilities and those experiencing mental health crises. In addition, it highlights the need for training for law enforcement as interactions between those experiencing mental health issues and criminal justice system rise. The dissertation concludes with implications for health and criminal justice policy and directions for future research

Study on communication reliability in VANETs

Connected vehicles have become an emerging topic in the technology communities. With the increasing urban population, it is essential to have an approach for managing and simplifying the technology services for the citizens. Radio propagation plays an essential role in Vehicular Ad Hoc Networks (VANET) connectivity. Performance of these wireless technologies depends on the nature of the channel environment and on the type of VANETs equipment. Therefore they require to have efficient mechanisms for all the aspects related to reliability. The major objective of this work is to investigate the packet success rate in the existing technologies of VANETs by giving a more realistic characterization of the traffic scenario and radio models

ICU outcomes and survival in patients with severe COVID-19 in the largest health care system in central Florida.

BackgroundObservational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States.MethodsRetrospective cohort study of patients admitted to ICU due to severe COVID-19 in AdventHealth health system in Orlando, Florida from March 11th until May 18th, 2020. Patients were characterized based on demographics, baseline comorbidities, severity of illness, medical management including experimental therapies, laboratory markers and ventilator parameters. Major clinical outcomes analyzed at the end of the study period were: hospital and ICU length of stay, MV-related mortality and overall hospital mortality of ICU patients.ResultsOut of total of 1283 patients with COVID-19, 131 (10.2%) met criteria for ICU admission (median age: 61 years [interquartile range (IQR), 49.5-71.5]; 35.1% female). Common comorbidities were hypertension (84; 64.1%), and diabetes (54; 41.2%). Of the 131 ICU patients, 109 (83.2%) required MV and 9 (6.9%) received ECMO. Lower positive end expiratory pressure (PEEP) were observed in survivors [9.2 (7.7-10.4)] vs non-survivors [10 (9.1-12.9] p = 0.004]. Compared to non-survivors, survivors had a longer MV length of stay (LOS) [14 (IQR 8-22) vs 8.5 (IQR 5-10.8) pConclusionsOur study demonstrates an important improvement in mortality of patients with severe COVID-19 who required ICU admission and MV in comparison to previous observational reports and emphasizes the importance of standard of care measures in the management of COVID-19

Dynamics of IgG antibody responses to SARS-CoV-2 reveals insight into immunity during the early pandemic period in Pakistan

Background: COVID-19 related disease morbidity and mortality has varied worldwide. We investigated antibody and T cell responses to SARS-CoV-2 in COVID-19 cases and exposed but healthy individuals further compared with pre-pandemic controls in a high infectious disease burden setting.Methods: IgG antibodies against Spike and Spike Receptor Binding Domain (RBD) were determined by ELISA in a Health Care cohort (HC; n=304), COVID-19 cases (n=163) and Pre-Pandemic Controls (PPC; n=114). Neutralizing antibody assays and T cell ELISpot assays were also conducted.Findings: IgG anti Spike proteins and RBD were present in all three groups albeit at varying levels. The highest rate of positivity was observed in COVID-19 cases (87.7% to Spike; 53.9% to RBD); followed by HC (35% to Spike; 21.3% to RBD) and PPC (12.2% to Spike; 10.50% to RBD). Antibody positivity in HC rose from 4.5% in October 2020 to 61% in January 2021. Levels of IgG antibodies to Spike and RBD strongly correlated in COVID-19 and HC but not in PPC. IgG to RBD was associated with neutralizing activity against SARS-CoV-2. Spike reactive T cells were identified in COVID-19 patients (6/18), HC (2/7) and but only one PPC (1/6).Interpretation: IgG to Spike and RBD in pre-pandemic sera is likely associated with cross-protection induced by other pathogens. The increasing percentage of IgG antibody positivity in HCC over the pandemic period may be due to expansion of cross-reactive B cells as observed in PPC, due either to exposure or asymptomatic subclinical infection with SARS-CoV-2. Neutralizing activity of RBD IgG antibodies and reactive T cells to Spike in PPC suggests the presence of memory B and T cells to cross-reactive epitopes that can expand quickly, jumpstarting protection against SARS-CoV-2.Funding Information: This work was supported by the Provost’s Academic Priorities Fund, Aga Khan University. Funding support was also received through Swedish Research Council project SRL 4-182/2019. We acknowledge the support for recombinant protein provided by IBET, NOVA University, Portugal. MV was supported by the European Union H2020 ERA project (No 667824 – EXCELLtoINNOV). Declaration of Interests: The authors have no competing interests to declareEthics Approval Statement: This study was approved by the Ethical Review Committee of The Aga Khan University (projects #2020-5152-11688 and 2020-3687-10181)

Humoral and T cell responses to SARS-CoV-2 reveal insights into immunity during the early pandemic period in Pakistan

Background: Protection against SARS-CoV-2 is mediated by humoral and T cell responses. Pakistan faced relatively low morbidity and mortality from COVID-19 through the pandemic. To examine the role of prior immunity in the population, we studied IgG antibody response levels, virus neutralizing activity and T cell reactivity to Spike protein in a healthy control group (HG) as compared with COVID-19 cases and individuals from the pre-pandemic period (PP).Methods: HG and COVID-19 participants were recruited between October 2020 and May 2021. Pre-pandemic sera was collected before 2018. IgG antibodies against Spike and its Receptor Binding Domain (RBD) were determined by ELISA. Virus neutralization activity was determined using a PCR-based micro-neutralization assay. T cell - IFN-γ activation was assessed by ELISpot.Results: Overall, the magnitude of anti-Spike IgG antibody levels as well as seropositivity was greatest in COVID-19 cases (90%) as compared with HG (39.8%) and PP (12.2%). During the study period, Pakistan experienced three COVID-19 waves. We observed that IgG seropositivity to Spike in HG increased from 10.3 to 83.5% during the study, whilst seropositivity to RBD increased from 7.5 to 33.3%. IgG antibodies to Spike and RBD were correlated positively in all three study groups. Virus neutralizing activity was identified in sera of COVID-19, HG and PP. Spike reactive T cells were present in COVID-19, HG and PP groups. Individuals with reactive T cells included those with and without IgG antibodies to Spike.Conclusions: Antibody and T cell responses to Spike protein in individuals from the pre-pandemic period suggest prior immunity against SARS-CoV-2, most likely from cross-reactive responses. The rising seroprevalence observed in healthy individuals through the pandemic without known COVID-19 may be due to the activation of adaptive immunity from cross-reactive memory B and T cells. This may explain the more favourable COVID-19 outcomes observed in this population

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline