Assessing the Oral Health Needs of Public Housing Residents

Objectives: “Tooth Smart Healthy Start” is a randomized clinical trial which aims to reduce the incidence of early childhood caries (ECC) in Boston public housing residents as part of the NIH funded Northeast Center for Research to Evaluate and Eliminate Dental Disparities. The purpose of this project was to assess public housing stakeholders' perception of the oral health needs of public housing residents and their interest in replicating “Tooth Smart Healthy Start” in other public housing sites across the nation. Methods: The target population was the 180 attendees of the 2010 meeting of the Health Care for Residents of Public Housing National Conference. A ten question survey which assessed conference attendees' beliefs about oral health and its importance to public housing residents was distributed. Data was analyzed using SAS 9.1. Descriptive statistics were calculated for each variable and results were stratified by participants' roles. Results: Thirty percent of conference attendees completed the survey. The participants consisted of residents, agency representatives, and housing authority personnel. When asked to rank health issues facing public housing residents, oral health was rated as most important (42%) or top three (16%) by residents. The agency representatives and housing authority personnel rated oral health among the top three (33% and 58% respectively) and top five (36% and 25% respectively). When participants ranked the three greatest resident health needs out of eight choices, oral health was the most common response. Majority of the participants expressed interest in replicating the “Tooth Smart Healthy Start” program at their sites. Conclusion: All stakeholder groups identified oral health as one of the greatest health needs of residents in public housing. Furthermore, if shown to reduce ECC, there is significant interest in implementing the program amongst key public housing stakeholders across the nation.

Systematic Review of Supported Housing Literature 1993 – 2008

Supported housing for individuals with severe mental illness strives to provide the services necessary to place and keep individuals in independent housing that is integrated into the community and in which the consumer has choice and control over his or her services and supports. Supported housing can be contrasted to an earlier model called the “linear residential approach” in which individuals are moved from the most restrictive settings (e.g., inpatient settings) through a series of more independent settings (e.g., group homes, supervised apartments) and then finally to independent housing. This approach has been criticized as punishing the client due to frequent moves, and as being less likely to result in independent housing. In the supported housing model (Anthony & Blanch, 1988) consumers have choice and control over their living environment, their treatment, and supports (e.g., case management, mental health and substance abuse services). Supports are flexible and faded in and out depending on needs. Results of this systematic review of supported housing suggest that there are several well-controlled studies of supported housing and several studies conducted with less rigorous designs. Overall, our synthesis suggests that supported housing can improve the living situation of individuals who are psychiatrically disabled, homeless and with substance abuse problems. Results show that supported housing can help people stay in apartments or homes up to about 80% of the time over an extended period. These results are contrary to concerns expressed by proponents of the linear residential model and housing models that espoused more restrictive environments. Results also show that housing subsidies or vouchers are helpful in getting and keeping individuals housed. Housing services appear to be cost effective and to reduce the costs of other social and clinical services. In order to be most effective, intensive case management services (rather than traditional case management) are needed and will generally lead to better housing outcomes. Having access to affordable housing and having a service system that is well-integrated is also important. Providing a person with supported housing reduces the likelihood that they will be re-hospitalized, although supported housing does not always lead to reduced psychiatric symptoms. Supported housing can improve clients’ quality of life and satisfaction with their living situation. Providing supported housing options that are of decent quality is important in order to keep people housed and satisfied with their housing. In addition, rapid entry into housing, with the provision of choices is critical. Program and clinical supports may be able to mitigate the social isolation that has sometimes been associated with supported housing.

Characteristics of WWW Client-based Traces

The explosion of WWW traffic necessitates an accurate picture of WWW use, and in particular requires a good understanding of client requests for WWW documents. To address this need, we have collected traces of actual executions of NCSA Mosaic, reflecting over half a million user requests for WWW documents. In this paper we describe the methods we used to collect our traces, and the formats of the collected data. Next, we present a descriptive statistical summary of the traces we collected, which identifies a number of trends and reference patterns in WWW use. In particular, we show that many characteristics of WWW use can be modelled using power-law distributions, including the distribution of document sizes, the popularity of documents as a function of size, the distribution of user requests for documents, and the number of references to documents as a function of their overall rank in popularity (Zipf's law). Finally, we show how the power-law distributions derived from our traces can be used to guide system designers interested in caching WWW documents.

Client-based Logging: A New Paradigm of Distributed Transaction Management

The proliferation of inexpensive workstations and networks has created a new era in distributed computing. At the same time, non-traditional applications such as computer-aided design (CAD), computer-aided software engineering (CASE), geographic-information systems (GIS), and office-information systems (OIS) have placed increased demands for high-performance transaction processing on database systems. The combination of these factors gives rise to significant challenges in the design of modern database systems. In this thesis, we propose novel techniques whose aim is to improve the performance and scalability of these new database systems. These techniques exploit client resources through client-based transaction management. Client-based transaction management is realized by providing logging facilities locally even when data is shared in a global environment. This thesis presents several recovery algorithms which utilize client disks for storing recovery related information (i.e., log records). Our algorithms work with both coarse and fine-granularity locking and they do not require the merging of client logs at any time. Moreover, our algorithms support fine-granularity locking with multiple clients permitted to concurrently update different portions of the same database page. The database state is recovered correctly when there is a complex crash as well as when the updates performed by different clients on a page are not present on the disk version of the page, even though some of the updating transactions have committed. This thesis also presents the implementation of the proposed algorithms in a memory-mapped storage manager as well as a detailed performance study of these algorithms using the OO1 database benchmark. The performance results show that client-based logging is superior to traditional server-based logging. This is because client-based logging is an effective way to reduce dependencies on server CPU and disk resources and, thus, prevents the server from becoming a performance bottleneck as quickly when the number of clients accessing the database increases.

DNS-based Internet Client Clustering and Characterization

This paper proposes a novel protocol which uses the Internet Domain Name System (DNS) to partition Web clients into disjoint sets, each of which is associated with a single DNS server. We define an L-DNS cluster to be a grouping of Web Clients that use the same Local DNS server to resolve Internet host names. We identify such clusters in real-time using data obtained from a Web Server in conjunction with that server's Authoritative DNS―both instrumented with an implementation of our clustering algorithm. Using these clusters, we perform measurements from four distinct Internet locations. Our results show that L-DNS clustering enables a better estimation of proximity of a Web Client to a Web Server than previously proposed techniques. Thus, in a Content Distribution Network, a DNS-based scheme that redirects a request from a web client to one of many servers based on the client's name server coordinates (e.g., hops/latency/loss-rates between the client and servers) would perform better with our algorithm.

Changes in Web Client Access Patterns: Characteristics and Caching Implications

Understanding the nature of the workloads and system demands created by users of the World Wide Web is crucial to properly designing and provisioning Web services. Previous measurements of Web client workloads have been shown to exhibit a number of characteristic features; however, it is not clear how those features may be changing with time. In this study we compare two measurements of Web client workloads separated in time by three years, both captured from the same computing facility at Boston University. The older dataset, obtained in 1995, is well-known in the research literature and has been the basis for a wide variety of studies. The newer dataset was captured in 1998 and is comparable in size to the older dataset. The new dataset has the drawback that the collection of users measured may no longer be representative of general Web users; however using it has the advantage that many comparisons can be drawn more clearly than would be possible using a new, different source of measurement. Our results fall into two categories. First we compare the statistical and distributional properties of Web requests across the two datasets. This serves to reinforce and deepen our understanding of the characteristic statistical properties of Web client requests. We find that the kinds of distributions that best describe document sizes have not changed between 1995 and 1998, although specific values of the distributional parameters are different. Second, we explore the question of how the observed differences in the properties of Web client requests, particularly the popularity and temporal locality properties, affect the potential for Web file caching in the network. We find that for the computing facility represented by our traces between 1995 and 1998, (1) the benefits of using size-based caching policies have diminished; and (2) the potential for caching requested files in the network has declined.