Dis/abling mobilities: urban-rural experiences of impairment & well-being

This dissertation is comprised of three papers that, as a unit, study the geographic patterns and processes that influence the well-being and mobility of people with disabilities in the U.S. The first paper investigates the relationship between welfare reform and the geographies of disability across the U.S. Using GIS and statistical methods to analyze aggregated county-level data, I examine enrollment trends in the Supplemental Security Income (SSI) program in 2000 and 2010, two points in time in the post-1996 welfare reform period. I produce empirical evidence to support the medicalization of welfare, in which access to welfare-related benefits is increasingly contingent on a medical diagnosis of disability. I also uncover SSI hot spots in parts of the southeast, Appalachia, and northern California, and these hot spots are largely rural. The findings suggest that political and economic conditions specific to these rural localities are driving spatial concentrations of disability, poverty, and un(der)employment. The second and third papers investigate the individual experiences of residents in the San Francisco Bay Area who have vision loss as they navigate the urban built environment. In the second paper, I utilize a qualitative space-time framework to analyze interview transcripts, seeking to understand how the combined effects of space and time impact the everyday mobilities of individuals who are visually impaired (VI). I find that people who are VI negotiate significant space-time constraints that are conditional on their access to transportation, assistive technology, and mobile devices. The temporal dimension of mobility is especially notable, as the timing of transit schedules, work hours, and social events shapes when and where people can travel and what activities they can participate in. In the third paper, I evaluate the applicability of well-established activity space measures for representing the mobilities of people who are visually impaired. First, I employ GIS to map and visualize the activity spaces of participants based on three measures: standard deviational ellipse, network buffer, and potential path area. Then, I use statistical methods to compare the area sizes of these three types of activity spaces. Finally, I compare the activity space results to a qualitative analysis of individuals’ travel behaviors and their perceptions about the accessibility of their environments. A comparison of results from both quantitative and qualitative methods reveals that popular activity space measures have significant shortcomings for summarizing the daily travels of individuals who are VI. Widely-used activity space models assume that individual accessibility depends only on distance and time from locations and travel routes, overlooking other factors that cause many urban and suburban environments to be inaccessible to individuals with vision loss. This dissertation contributes to the existing disability literature by foregrounding the influence of geographic context in mobility and access, applying and evaluating spatial analytic techniques for understanding the geographies of disability, and studying the structural and individual dynamics affecting welfare enrollment, personal well-being, and mobility. The findings suggest a need for developing policies specific to people with disabilities that: (1) improve their employment outcomes to reduce their need for welfare assistance and (2) expand their transportation options to increase their daily mobilities and access to resources. Future research directions include in-depth case studies to better understand how the medicalization of welfare is experienced in rural localities, activity space modeling that combines quantitative and qualitative methods, and mapping (in)accessible spaces to better address the spatial obstacles faced by people with disabilities

Carbohydrate Induced Self-Assembly of Curcumin Nanocapsules as Drug Carriers for Breast Cancer Therapy

The hydrogen bonding displayed by fructose was discovered to induce the self-assembly of hydrophobic molecules such as curcumin into well-ordered nanoparticles; a phenomenon observed for the first time. Simply by mixing an aqueous solution of fructose and curcumin in an open vessel leads to the generation of well-defined capsules based on covalent forces with sizes ranging between 100 and 150 nm independent of the initial concentrations used. Transmission electron microscope (TEM) analysis and small-angle X-ray scattering (SAXS) confirm the presence of capsules. Fundamental understanding of the molecular interactions at play was provided by theoretical studies, which reveal the thermodynamic driving force for curcumin dissolution in water originate from capsule formation and fructose plays a stabilizing role. The self-assembly serves as a simple and virtually instantaneous way of making nanocapsules from curcumin in water with the potential for template polymerization and nanocarriers for drug delivery. Extraordinarily, the formation of these self-assembled structures by small molecules do not involve chemical modifications nor covalently bound materials i.e. surfactants and polymeric amphiphiles, which contradicts and defies traditional nanoparticle self-assembly approaches. The structural integrity of these non-covalently bound nanocapsules is further enhanced via polydopamine coating that protect curcumin as a model drug from premature release. Different shell thicknesses were prepared via varying dopamine deposition time and thin-shelled polydopamine-fructose-curcumin (PDA-Fru-CCM) nanoparticles preserved the cytotoxicity of curcumin in breast cancer cells (MCF-7) in 2D cell culture models. Importantly, healthy human fibroblasts (Hs-27) retain their cell viability after nanoparticle treatment. However, curcumin alone is not a suitable drug for cancer therapy, the cytotoxicity and cellular uptake of curcumin was limited by the concentrations used within the window of nanocapsule range. The encapsulation of a second therapeutic agent is required to achieve greater therapeutic efficacy, and a library of anti-cancer drugs were investigated to prepare dual drug nanoparticles for co-delivery and combination chemotherapy. Drugs with similar polarity to curcumin co-assemble into hollow nanocapsules and nanospheres dependent on drug loading via dominant hydrogen bonding interactions

Whose Week Is It Anyways?: A Case Study of Collaboration Between Student Affairs and Student Volunteers

Student Affairs organizations are becoming the heartbeat of campus as the complex issues facing universities encourage Student Affairs professionals to seek out strategies to ensure they meet their purpose within their institution. In order to support the mission of the institution and serve the educational and personal needs of students, Student Affairs staff must collaborate with student volunteers to facilitate the delivery of services and programs. This study explored the nature of the relationship and the experiences of collaboration between Student Affairs staff and student volunteers in the context of Orientation. Through interviews with staff and student volunteers, the findings from this research suggest that while Federation Orientation Committee (FOC) members (student volunteers) and their Orientation Advisors (staff) experienced a close and collaborative relationship, there were several organizational factors such as structure and leadership that impacted their experience of collaboration, ultimately influencing student volunteer-management relationships. The findings also reveal the dynamics of collaboration, including factors that influence how well the staff and student volunteers work together and how they experience meaning through their interactions. This study suggests that organizational structure plays a large role between Student Affairs staff and student volunteers. Centralized and decentralized structures existed between different groups, and their ability to collaborate was dependent on how well the staff and student volunteers communicated and trusted each other. Although organizational structures was not expected to play such a role in this study initially, further research on how these structures impact collaboration, especially on the student experience outside of the classroom, would be of value to university administrators, Student Affairs professionals, and future student volunteers

Hyperglycemia and Insulin Management in Critically Ill Patients

Hyperglycemia is a leading cause of increased morbidity and mortality in critically ill diabetic and nondiabetic patients in the ICU. Stricter control should be implemented in this setting in order to reduce mortality as well as other complications caused by hyperglycemia. Because hypoglycemia is associated with an increased risk of adverse effects, the optimal intensity of glucose control has been extensively investigated. Hyperglycemia is better controlled through continuous glucose infusions than with intermittent injections or IV infusions because it is easier to titrate the concentration of insulin to achieve a target glucose range. Pharmacists in acute-care and ambulatory-care settings are able to adjust insulin therapy and educate patients about hypoglycemia or hyperglycemia in order to optimize patient outcomes

Community-Based Health and Exposure Study around Urban Oil Developments in South Los Angeles.

Oilfield-adjacent communities often report symptoms such as headaches and/or asthma. Yet, little data exists on health experiences and exposures in urban environments with oil and gas development. In partnership with Promotoras de Salud (community health workers), we gathered household surveys nearby two oil production sites in Los Angeles. We tested the capacity of low-cost sensors for localized exposure estimates. Bilingual surveys of 205 randomly sampled residences were collected within two 1500 ft. buffer areas (West Adams and University Park) surrounding oil development sites. We used a one-sample proportion test, comparing overall rates from the California Health Interview Survey (CHIS) of Service Planning Area 6 (SPA6) and Los Angeles County for variables of interest such as asthma. Field calibrated low-cost sensors recorded methane emissions. Physician diagnosed asthma rates were reported to be higher within both buffers than in SPA6 or LA County. Asthma prevalence in West Adams but not University Park was significantly higher than in Los Angeles County. Respondents with diagnosed asthma reported rates of emergency room visits in the previous 12 months similar to SPA6. 45% of respondents were unaware of oil development; 63% of residents would not know how to contact local regulatory authorities. Residents often seek information about their health and site-related activities. Low-cost sensors may be useful in highlighting differences between sites or recording larger emission events and can provide localized data alongside resident-reported symptoms. Regulatory officials should help clarify information to the community on methods for reporting health symptoms. Our community-based participatory research (CBPR) partnership supports efforts to answer community questions as residents seek a safety buffer between sensitive land uses and active oil development

Defining the Binding Region in Factor H to Develop a Therapeutic Factor H-Fc Fusion Protein against Non-Typeable Haemophilus influenzae

Non-typeable Haemophilus influenzae (NTHi) cause a range of illnesses including otitis media, sinusitis, and exacerbation of chronic obstructive pulmonary disease, infections that contribute to the problem of antibiotic resistance and are themselves often intractable to standard antibiotic treatment regimens. We investigated a strategy to exploit binding of the complement inhibitor Factor H (FH) to NTHi as a functional target for an immunotherapeutic containing the NTHi binding domain of FH fused to the Fc domain of IgG1. Chimeric proteins containing the regions that most FH-binding bacteria use to engage human FH, domains 6 and 7 (FH6,7/Fc) and/or 18 through 20 (FH18-20/Fc), were evaluated for binding to NTHi. FH6,7/Fc bound strongly to each of seven NTHi clinical isolates tested and efficiently promoted complement-mediated killing by normal human serum. FH18-20/Fc bound weakly to three of the strains but did not promote complement dependent killing. Outer-membrane protein P5 has been implicated in FH binding by NTHi, and FH6,7/Fc binding was greatly diminished in five of seven P5 deficient isogenic mutant strains tested, implicating an alternative FH binding protein in some strains. Binding of FH18-20/Fc was decreased in the P5 mutant of one strain. A murine model was used to evaluate potential therapeutic application of FH6,7/Fc. FH6,7/Fc efficiently promoted binding of C3 to NTHi exposed to mouse serum, and intranasal delivery of FH6,7/Fc resulted in significantly enhanced clearance of NTHi from the lung. Moreover, a P5 deficient mutant was attenuated for survival in the lung model, suggesting that escape mutants lacking P5 would be less likely to replace strains susceptible to FH6,7/Fc. These results provide evidence for the potential utility of FH6,7/Fc as a therapeutic against NTHi lung infection. FH binding is a common property of many respiratory tract pathogens and FH/Fc chimeras may represent promising alternative or adjunctive therapeutics against such infections, which are often polymicrobial

The Quality of Life of a Multidiagnosis Group of Special Needs Children: Associations and Costs

Purpose. To determine the quality of life, associations, and costs of a multidiagnosis group of special needs children. Methods. In this cross-sectional survey families were identified from the Children's Treatment Network, a Canadian multisector program for children with special needs. Families were eligible if the child was aged 2–19 years, resided in Simcoe/York, and if there were multiple child/family needs. Quality of life was measured using the PedsQL (n = 429). Results. Quality of life scores were lower in this group compared to published healthy and single disorder groups of children. Quality of life scores decreased with advancing age. Child psychosocial well-being was more strongly associated with child/family variables compared to physical well-being. Health Utilization costs were higher in children with greater physical challenges. Conclusions. Further research is needed in other complex needs child samples to confirm the decrease in quality of life found in these children into adolescence. Investigations into the interactions of child and family variables are needed

Ethical issues concerning the experience of representational predicaments at work

Representational predicaments refer to situations in which job incumbents believe that dominant authorities are holding incomplete or otherwise incorrect work-related assumptions about them. We carried out qualitative interviews with a diverse and gender-balanced sample of 55 Hong Kong Chinese job incumbents, from whose perspective we identified three broad categories of representational predicament: (1) doing unvalued work; (2) doing thankless work; and (3) being subject to distorted representation. Each category of representational predicament was reported both by female and male informants, with females reporting more representational predicaments than males. Stories of unvalued work referred either to unnoticed and unvalued work, which entailed voluntary care work, or to noticed but unvalued work. Stories of thankless work fell into four subcategories: carrying out a superior’s request believed to be illegitimate; pacifying uncivil service recipients; dealing with subterranean internal obstacles; and conducting informal negotiations with troublesome service recipients/suppliers. Stories about being subject to distorted representation fell into six subcategories: being publicly ridiculed or humiliated; having flaws spotlighted but merits downplayed; receiving misattributed blame; being subject to false or misleading uncorrected allegations; suffering prejudicial stereotyping; and receiving reprimands perceived as unfounded. All but two of the representational predicament stories alleged or implied at least one type of ethical problem that concerned breaches of interpersonal justice; violations of, or threats to procedural justice; or indifference toward, or neglect of, the ethics of care. It is inferred that representational predicaments are symptoms of poor ethical climates

Development of a Bamlanivimab Infusion Process in the Emergency Department for Outpatient COVID-19 Patients

The coronavirus disease 2019 (COVID-19) pandemic has prompted the creation of new therapies to help fight against the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bamlanivimab is a SARS-CoV-2 monoclonal antibody that is administered as an intravenous infusion to ambulatory patients with mild or moderate COVID-19, but a concern that arose was deciding the optimal location for patients to receive the medication. This report describes the development and implementation of a bamlanivimab infusion center in the emergency department of three hospitals in Orange County, California, shortly after bamlanivimab received emergency use authorization. As a result, a total of 601 patients received bamlanivimab in one of these three emergency departments between December 2020 to April 2021. The emergency department was shown to be an optimal setting for administration of bamlanivimab due to its convenience, accessibility, and capabilities for monitoring patients