Living on the Edge: the Influence of Marginalization on Mental Health Needs and Service Use

Background: Persons with severe mental illnesses are a small portion of the population that require a disproportionate amount of health and social services to meet their complex needs. This group is particularly vulnerable to experiencing marginalization and adverse social circumstances such as homelessness and incarceration. The literature recognizes that marginalization is a multidimensional social construct that influences mental health; however, its conceptualization and measurement remain unclear. In the mental health context, evidence suggest that both individual and contextual factors influence the use of services and mental health status of individuals. While most research on this area has focused on studying the individual level, the contextual level evidence is more limited. Purpose: This dissertation aims to explore how the social context of where persons with mental illness live influences their mental health status and service use. Three distinct studies are employed to examine empirical patterns of area-level marginalization regarding mental health, the measurement and conceptualization of marginalization at the individual-level, and finally, the influence of context on inpatient mental health readmissions among marginalized persons. Methods: This research linked data from a Canadian Census-derived index of marginalization, the Ontario Marginalization Index (ON-Marg), to clinical data from the Ontario Mental Health Reporting System (OMHRS); a dataset consisting of clinical and administrative data from every person admitted to a psychiatric hospital in Ontario. For the first study, bivariate and multivariate analyses on a sample admitted between January 1, 2006 and December 31, 2016 (N=150,600), examined the likelihood of residing in the most marginalized areas based on demographic, clinical, and service use characteristics using Statistical Analysis Software version 9.4 (SAS). For the second study, items that reflected the concept of marginalization were manually selected from the Resident Assessment Instrument-Mental Health (RAI-MH). Principal Component Analysis (PCA) and cluster analysis of these items was performed on a sample of patients admitted into psychiatric care between January 1, 2011 and December 31, 2016 (N=81,232) to identify dimensions being measured. Different weights and scoring methods were tested to assess convergent validity on multiple outcomes of marginalization. Receiver Operating Characteristic (ROC) curve analysis was utilized to determine optimal cut-offs for the index by modeling the likelihood of being homeless. For the third study, OMHRS data between January 1, 2006 and December 31, 2015, were used to identify persons with mental health conditions experiencing marginalization and who are at a high risk of homelessness (N=37,852). Standardized readmission rates at different points in time were calculated and mapped using the Forward Sortation Area geographic unit. Proximity to supportive housing services were measured using a 20-km radius buffer in ArcGIS software. Multilevel mixed-effects models were then built to test the influence of the different variables created, on readmissions to inpatient psychiatry in SAS. Results: The first study found that the majority of persons admitted to inpatient psychiatry lived in the most marginalized areas of the Ontario. Those with little education, involved with the criminal system, on government assistance, diagnosed with schizophrenia, experiencing economic hardships, living alone, and those who lacked social support were the most likely to reside in areas with high marginalization. Patients in northern health regions were most likely to reside in areas with the most material deprivation while persons in resource intensive health regions like Toronto Central, resided in areas with the most residential instability. In the second study, 15 items were identified for the development of the Marginalization Index (MI). PCA and cluster analysis showed that these items measured 5 dimensions. ROC curve analysis for the most marginalized group, homeless individuals, identified an Area Under the Curve of 0.76 and an optimal cut-off of 5 on the MI. The frequency of homeless individuals, frequent mental health service users, persons with a history of violence and police intervention, and persons with addictions issues increased as scores on the MI increased, further confirming the convergent validity of the index. In the third study, readmission rates for those with high MI scores were 7.4% for short-term (within 30 days), 6.2% for the medium-term (31-90 days) and 13.1% for the long-term (91-365 days). While admissions to inpatient psychiatry occurred in 94% of Ontario’s FSAs, short term readmission only occurred in 20% of FSAs, medium-term in 11% of FSAs, and long-term in 41% of FSAs. Intraclass Correlation Coefficients showed that hospitals account for 3.8% of variance in readmissions within 30 days of discharge. Fixed effects β-parameter estimates of the models show that area level marginalization and proximity to supportive housing services increased the logs odds of readmissions. Conclusion: This research identified factors that differentiated living in areas of low versus high marginalization among psychiatric inpatients. These findings are important for informing the equitable planning and distribution of evidence-based mental health services and supports to create social contexts that enable and support opportunities for improved mental health. Additionally, the Marginalization Index derived as part of this project proved to be a valid measure of marginalization and a strong predictor of risk of homelessness among psychiatric inpatients. The MI increases the visibility of the marginalized in inpatient psychiatry and provides a resource that can be used for supporting social and health policy decisions and evaluation. Finally, this research provided evidence that system structures influence readmissions in a variety of ways, while hospitals account for more variance among short-term readmission, area level marginalization accounts for more variance over longer-term readmissions. The findings contribute to the limited research that is currently available on the influence of contextual level factors on mental health service use by showing that contextual factors have various effects on readmissions at different points in time from discharge. These findings indicate that psychiatric readmissions may relate to social inequities at the area level and proximity to services

Incorporating User Preferences Within an Optimal Traffic Flow Management Framework

The effectiveness of future decision support tools for Traffic Flow Management in the National Airspace System will depend on two major factors: computational burden and collaboration. Previous research has focused separately on these two aspects without consideration of their interaction. In this paper, their explicit combination is examined. It is shown that when user preferences are incorporated with an optimal approach to scheduling, runtime is not adversely affected. A benefit-cost ratio is used to measure the influence of user preferences on an optimal solution. This metric shows user preferences can be accommodated without inordinately, negatively affecting the overall system delay. Specifically, incorporating user preferences will increase delays proportionally to increased user satisfaction

Aplicación móvil TecnoWilly

Desarrollar aplicación móvil Android para la publicación de productos y servicios de la Empresa TecnoWilly de manera que los clientes puedan solicitarlos de forma simple y eficiente contando con información actualizada.La empresa TecnoWilly realiza la presentación de sus productos por medio de documentos en Word y pdf, durante el proceso cada usuario interesado en un producto debe solicitar la cotización por medio telefónico y esperar al envió de la información; de acuerdo con los pasos agigantados que da la comunidad digital actualmente este proceso manual ocasiona una serie de reprocesos y reduce la satisfacción del cliente por los tiempos de espera. Teniendo como base lo antes descrito el desarrollo del proyecto móvil para tecnowilly brinda un acercamiento más ágil y con una experiencia de usuario mucho más amena al momento de presentar los productos y servicios, adicionalmente el catálogo de productos esta actualizado constantemente y las personas que realicen uso de la aplicación móvil pueden solicitar información del producto y/o servicio a través de la plataforma móvil y ser contactados por medio telefónico por el dueño de la compañía para llegar un acuerdo en la venta del bien y/o servicio. Con la implementación de esta mejora en la experiencia de usuario Tecnowilly espera lograr la fidelización de muchos más clientes en la ciudad de Medellín y a futuro lograr la expansión de su catálogo de productos y servicios para brindar mayor satisfacción al consumidor final

Aplicación móvil TecnoWilly

Desarrollar aplicación móvil Android para la publicación de productos y servicios de la Empresa TecnoWilly de manera que los clientes puedan solicitarlos de forma simple y eficiente contando con información actualizada.La empresa TecnoWilly realiza la presentación de sus productos por medio de documentos en Word y pdf, durante el proceso cada usuario interesado en un producto debe solicitar la cotización por medio telefónico y esperar al envió de la información; de acuerdo con los pasos agigantados que da la comunidad digital actualmente este proceso manual ocasiona una serie de reprocesos y reduce la satisfacción del cliente por los tiempos de espera. Teniendo como base lo antes descrito el desarrollo del proyecto móvil para tecnowilly brinda un acercamiento más ágil y con una experiencia de usuario mucho más amena al momento de presentar los productos y servicios, adicionalmente el catálogo de productos esta actualizado constantemente y las personas que realicen uso de la aplicación móvil pueden solicitar información del producto y/o servicio a través de la plataforma móvil y ser contactados por medio telefónico por el dueño de la compañía para llegar un acuerdo en la venta del bien y/o servicio. Con la implementación de esta mejora en la experiencia de usuario Tecnowilly espera lograr la fidelización de muchos más clientes en la ciudad de Medellín y a futuro lograr la expansión de su catálogo de productos y servicios para brindar mayor satisfacción al consumidor final

Global Gene Expression Analysis Identifies Age-Related Differences in Knee Joint Transcriptome during the Development of Post-Traumatic Osteoarthritis in Mice.

Aging and injury are two major risk factors for osteoarthritis (OA). Yet, very little is known about how aging and injury interact and contribute to OA pathogenesis. In the present study, we examined age- and injury-related molecular changes in mouse knee joints that could contribute to OA. Using RNA-seq, first we profiled the knee joint transcriptome of 10-week-old, 62-week-old, and 95-week-old mice and found that the expression of several inflammatory-response related genes increased as a result of aging, whereas the expression of several genes involved in cartilage metabolism decreased with age. To determine how aging impacts post-traumatic arthritis (PTOA) development, the right knee joints of 10-week-old and 62-week-old mice were injured using a non-invasive tibial compression injury model and injury-induced structural and molecular changes were assessed. At six-week post-injury, 62-week-old mice displayed significantly more cartilage degeneration and osteophyte formation compared with young mice. Although both age groups elicited similar transcriptional responses to injury, 62-week-old mice had higher activation of inflammatory cytokines than 10-week-old mice, whereas cartilage/bone metabolism genes had higher expression in 10-week-old mice, suggesting that the differential expression of these genes might contribute to the differences in PTOA severity observed between these age groups

Monitoring Backbone Hydrogen-Bond Formation in β-Barrel Membrane Protein Folding

β-barrel membrane proteins are key components of the outer membrane of bacteria, mitochondria and chloroplasts. Their three-dimensional structure is defined by a network of backbone hydrogen bonds between adjacent β-strands. Here, we employ hydrogen-deuterium (H/D) exchange in combination with NMR spectroscopy and mass spectrometry to monitor backbone hydrogen bond formation during folding of the outer membrane protein X (OmpX) from E. coli in detergent micelles. Residue-specific kinetics of interstrand hydrogen-bond formation were found to be uniform in the entire β-barrel and synchronized to formation of the tertiary structure. OmpX folding thus propagates via a long-lived conformational ensemble state in which all backbone amide protons exchange with the solvent and engage in hydrogen bonds only transiently. Stable formation of the entire OmpX hydrogen bond network occurs downhill of the rate-limiting transition state and thus appears cooperative on the overall folding time scale

Methodologically Grounded SemanticAnalysis of Large Volume of Chilean Medical Literature Data Applied to the Analysis of Medical Research Funding Efficiency in Chile

Background Medical knowledge is accumulated in scientific research papers along time. In order to exploit this knowledge by automated systems, there is a growing interest in developing text mining methodologies to extract, structure, and analyze in the shortest time possible the knowledge encoded in the large volume of medical literature. In this paper, we use the Latent Dirichlet Allocation approach to analyze the correlation between funding efforts and actually published research results in order to provide the policy makers with a systematic and rigorous tool to assess the efficiency of funding programs in the medical area. Results We have tested our methodology in the Revista Medica de Chile, years 2012-2015. 50 relevant semantic topics were identified within 643 medical scientific research papers. Relationships between the identified semantic topics were uncovered using visualization methods. We have also been able to analyze the funding patterns of scientific research underlying these publications. We found that only 29% of the publications declare funding sources, and we identified five topic clusters that concentrate 86% of the declared funds. Conclusions Our methodology allows analyzing and interpreting the current state of medical research at a national level. The funding source analysis may be useful at the policy making level in order to assess the impact of actual funding policies, and to design new policies.This research was partially funded by CONICYT, Programa de Formacion de Capital Humano avanzado (CONICYT-PCHA/Doctorado Nacional/2015-21150115). MG work in this paper has been partially supported by FEDER funds for the MINECO project TIN2017-85827-P, and projects KK-2018/00071 and KK2018/00082 of the Elkartek 2018 funding program. This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 777720. No role has been played by funding bodies in the design of the study and collection, analysis, or interpretation of data or in writing the manuscript

Non-Intrusive Assessment of COVID-19 Lockdown Follow-Up and Impact Using Credit Card Information: Case Study in Chile

In this paper, we propose and validate with data extracted from the city of Santiago, capital of Chile, a methodology to assess the actual impact of lockdown measures based on the anonymized and geolocated data from credit card transactions. Using unsupervised Latent Dirichlet Allocation (LDA) semantic topic discovery, we identify temporal patterns in the use of credit cards that allow us to quantitatively assess the changes in the behavior of the people under the lockdown measures because of the COVID-19 pandemic. An unsupervised latent topic analysis uncovers the main patterns of credit card transaction activity that explain the behavior of the inhabitants of Santiago City. The approach is non-intrusive because it does not require the collaboration of people for providing the anonymous data. It does not interfere with the actual behavior of the people in the city; hence, it does not introduce any bias. We identify a strong downturn of the economic activity as measured by credit card transactions (down to 70%), and thus of the economic activity, in city sections (communes) that were subjected to lockdown versus communes without lockdown. This change in behavior is confirmed by independent data from mobile phone connectivity. The reduction of activity emerges before the actual lockdowns were enforced, suggesting that the population was spontaneously implementing the required measures for slowing virus propagation.This work has the support of CONICYT-PFCHA/DOCTORADO BECAS CHILE/2019-21190345. This work has been partially supported by FEDER funds through the MINECO project TIN2017-85827-P. This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 777720. Instituto Milenio para la Investigacion Imperfecciones de Mercado y Politicas Publicas IS130002

Oxidative stress indicators in populations of the gastropod Buccinanops globulosus affected by imposex

The gastropod Buccinanops globulosus is commonly used as a bioindicator of tributyltin (TBT) contamination due to its high imposex incidence in maritime traffic areas. The aim of this study was to evaluate both oxidative stress in B. globulosus at three sites with different maritime activity, and imposex incidence in Nuevo Gulf, Argentina. Oxidative stress parameters in digestive glands, like superoxide dismutase (SOD) and glutathione-S-transferase (GST) activities, reduced glutathione levels (GSH), and oxidative damage to lipids, estimated as thiobarbituric acid reactive substances (TBARs) as well as imposex parameters (% imposex and female penis length (FPL)) were measured in females. Gastropods from the harbour area showed 100% imposex, the highest FPL and TBARs content, as well as GSH levels and SOD activity.The different oxidative stress responses and high imposex incidence at the harbour site may indicate a negative effect on the organism's physiological state due to environmental pollution.Fil: Primost, Monica Angelina. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Biologia de Organismos Marinos; ArgentinaFil: Sabatini, Sebastian Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Di Salvatore, Pablo. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Departamento de Biodiversidad y Biología Experimental; ArgentinaFil: Rios, Maria del Carmen. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Bigatti, Gregorio. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Instituto de Biologia de Organismos Marinos; Argentina. Universidad Nacional de la Patagonia "San Juan Bosco"; Argentin

Instrumento para evaluar percepción de trabajo en equipo en estudiantes de psicología

La presente investigación consiste en la construcción y validación de un instrumento que permita explorar la percepción de los estudiantes que estén cursando énfasis de Psicología en la Pontificia Universidad Javeriana, sobre su formación en la competencia interdisciplinar, específicamente en uno de sus componentes, el trabajo en equipo y su proyección al mundo laboral. Para llevar a cabo la construcción del presente instrumento, se tuvieron en consideración diferentes elementos: un rastreo bibliográfico acerca de los principales hitos que reconfiguran el mundo laboral, la relevancia de la educación para la formación de un modelo de competencias y a la definición de la competencia interdisciplinar brindada por el currículum de la facultad, en la que implícitamente se habla de trabajo en equipo. Este proceso facilitó la construcción de las variables y de los ítems que, posteriormente, fueron evaluados a través de expertos con el fin de determinar su validez. Se encontró que estos procesos de validación y la voz de los expertos son un complemento que permite ajustar el instrumento de una forma más adecuada.This investigation consist in the construction and validation of an instrument, that allows to explore the perception of students that are studying Psychology emphasis in the Pontificia Universidad Javeriana, inquiring about interdisciplinary competence training, specifically in one of its components, the team work and its projection to the labor world. For the construction of the present instrument, different elements were taken into consideration: a bibliographic tracking of the principal history events that reconfigure the labor world; the relevance of education formation in a competency model and the definition of interdisciplinary competence provided by the curriculum of the faculty, which implicitly speaks of teamwork. This process facilitated the construction of the variables and items that were subsequently evaluated by experts in order to determine their validity and in the same way, it was found that the validation processes including the experts voice is a complement that allows an instrument to be adjusted in a more appropriate way.Psicólogo (a)Pregrad