Health care utilization behavior of elders in a multicultural urban environment

The objective of this research is to determine the influences of social, environmental, behavioral, and economic forces on the health care service utilization of four racial/ethnic groups of non-institutionalized elders in a multicultural urban environment. To address these issues this dissertation examines three intertwined themes of culture, aging, and health, using a sample of elders residing in Miami-Dade County, FL in four racial/ethnic groups: white non-Hispanic; black non-Hispanic English speakers; Cuban; and non-Cuban Hispanic. ^ The research questions were analyzed using both quantitative and qualitative data. Data for the quantitative component uses telephone survey data from the Dade County Needs Assessment. The purpose of this component is to develop a more comprehensive model of elder health care utilization behavior. The qualitative component uses data from focus groups from Dade County Needs Assessment, archival data and a literature review of previous ethnographic research. The purpose of this component is to gain a better understanding of the social construction of the terms “age”' and “aging,” as well as to place issues of health and health care in the lives of elders. ^ The findings raised several important issues. First, just because people share a common chronological age does not mean that they are the same in every other respect. Examining elders as a homogeneous group of users of formal health care services in a community is simplistic. Placing “aging” and “health” in a cultural context is important. My findings confirm that the meaning of “aging” and “old” are socially constructed. Further, the term “aging” is NOT synonymous with ill health or frailty. This was a consistent finding in both the quantitative and qualitative results. ^ While all aging individuals share a mutual orientation toward aging (i.e., biological process), they do not age the same way (i.e., social construction of “aging”). Thus, policymakers and others serving the elder population must be aware of the particular cultural context, as well as the previous life experiences of the individuals that they serve. This analysis documents the importance of culture and geographic community in understanding health care service utilization of elders. ^

A multi-scale assessment of physiological processes in arctic tundra plants under natural and simulated climate change scenarios

Climate warming is predicted to cause an increase in the growing season by as much as 30% for regions of the arctic tundra. This will have a significant effect on the physiological activity of the vascular plant species and the ecosystem as a whole. The need to understand the possible physiological change within this ecosystem is confounded by the fact that research in this extreme environment has been limited to periods when conditions are most favorable, mid June–mid August. This study attempted to develop the most comprehensive understanding to date of the physiological activity of seven tundra plant species in the Alaskan Arctic under natural and lengthened growing season conditions. Four interrelated lines of research, scaling from cellular signals to ecosystem processes, set the foundation for this study. ^ I established an experiment looking at the physiological response of arctic sedges to soil temperature stress with emphasis on the role of the hormone abscisic acid (ABA). A manipulation was also developed where the growing season was lengthened and soils were warmed in an attempt to determine the maximum physiological capacity of these seven vascular species. Additionally, the physiological capacities of four evergreens were tested in the subnivean environment along with the potential role anthocyanins play in their activity. The measurements were scaled up to determine the physiological role of these evergreens in maintaining ecosystem carbon fluxes. ^ These studies determined that soil temperature differentials significantly affect vascular plant physiology. ABA appears to be a physiological modifier that limits stomatal processes when root temperatures are low. Photosynthetic capacity was limited by internal plant physiological mechanisms in the face of a lengthened growing season. Therefore shifts in ecosystem carbon dynamics are driven by changes in species composition and biomass production on a per/unit area basis. These studies also found that changes in soil temperatures will have a greater effect of physiological processes than would the same magnitude of change in air temperature. The subnivean environment exhibits conditions that are favorable for photosynthetic activity in evergreen species. These measurements when scaled to the ecosystem have a significant role in limiting the system's carbon source capacity. ^

A multi-method approach for the assessment of composite indices and rankings

There is growing popularity in the use of composite indices and rankings for cross-organizational benchmarking. However, little attention has been paid to alternative methods and procedures for the computation of these indices and how the use of such methods may impact the resulting indices and rankings. This dissertation developed an approach for assessing composite indices and rankings based on the integration of a number of methods for aggregation, data transformation and attribute weighting involved in their computation. The integrated model developed is based on the simulation of composite indices using methods and procedures proposed in the area of multi-criteria decision making (MCDM) and knowledge discovery in databases (KDD). The approach developed in this dissertation was automated through an IT artifact that was designed, developed and evaluated based on the framework and guidelines of the design science paradigm of information systems research. This artifact dynamically generates multiple versions of indices and rankings by considering different methodological scenarios according to user specified parameters. The computerized implementation was done in Visual Basic for Excel 2007. Using different performance measures, the artifact produces a number of excel outputs for the comparison and assessment of the indices and rankings. In order to evaluate the efficacy of the artifact and its underlying approach, a full empirical analysis was conducted using the World Bank's Doing Business database for the year 2010, which includes ten sub-indices (each corresponding to different areas of the business environment and regulation) for 183 countries. The output results, which were obtained using 115 methodological scenarios for the assessment of this index and its ten sub-indices, indicated that the variability of the component indicators considered in each case influenced the sensitivity of the rankings to the methodological choices. Overall, the results of our multi-method assessment were consistent with the World Bank rankings except in cases where the indices involved cost indicators measured in per capita income which yielded more sensitive results. Low income level countries exhibited more sensitivity in their rankings and less agreement between the benchmark rankings and our multi-method based rankings than higher income country groups.

Assessment of the occurrence and potential risks of antibiotics and their metabolites in South Florida waters using liquid chromatography tandem mass spectrometry

An automated on-line SPE-LC-MS/MS method was developed for the quantitation of multiple classes of antibiotics in environmental waters. High sensitivity in the low ng/L range was accomplished by using large volume injections with 10-mL of sample. Positive confirmation of analytes was achieved using two selected reaction monitoring (SRM) transitions per antibiotic and quantitation was performed using an internal standard approach. Samples were extracted using online solid phase extraction, then using column switching technique; extracted samples were immediately passed through liquid chromatography and analyzed by tandem mass spectrometry. The total run time per each sample was 20 min. The statistically calculated method detection limits for various environmental samples were between 1.2 and 63 ng/L. Furthermore, the method was validated in terms of precision, accuracy and linearity. ^ The developed analytical methodology was used to measure the occurrence of antibiotics in reclaimed waters (n=56), surface waters (n=53), ground waters (n=8) and drinking waters (n=54) collected from different parts of South Florida. In reclaimed waters, the most frequently detected antibiotics were nalidixic acid, erythromycin, clarithromycin, azithromycin trimethoprim, sulfamethoxazole and ofloxacin (19.3-604.9 ng/L). Detection of antibiotics in reclaimed waters indicates that they can't be completely removed by conventional wastewater treatment process. Furthermore, the average mass loads of antibiotics released into the local environment through reclaimed water were estimated as 0.248 Kg/day. Among the surface waters samples, Miami River (reaching up to 580 ng/L) and Black Creek canal (up to 124 ng/L) showed highest concentrations of antibiotics. No traces of antibiotics were found in ground waters. On the other hand, erythromycin (monitored as anhydro erythromycin) was detected in 82% of the drinking water samples (n.d-66 ng/L). The developed approach is suitable for both research and monitoring applications.^ Major metabolites of antibiotics in reclaimed wates were identified and quantified using high resolution benchtop Q-Exactive orbitrap mass spectrometer. A phase I metabolite of erythromycin was tentatively identified in full scan based on accurate mass measurement. Using extracted ion chromatogram (XIC), high resolution data-dependent MS/MS spectra and metabolic profiling software the metabolite was identified as desmethyl anhydro erythromycin with molecular formula C36H63NO12 and m/z 702.4423. The molar concentration of the metabolite to erythromycin was in the order of 13 %. To my knowledge, this is the first known report on this metabolite in reclaimed water. Another compound acetyl-sulfamethoxazole, a phase II metabolite of sulfamethoxazole was also identified in reclaimed water and mole fraction of the metabolite represent 36 %, of the cumulative sulfamethoxazole concentration. The results were illustrating the importance to include metabolites also in the routine analysis to obtain a mass balance for better understanding of the occurrence, fate and distribution of antibiotics in the environment. ^ Finally, all the antibiotics detected in reclaimed and surface waters were investigated to assess the potential risk to the aquatic organisms. The surface water antibiotic concentrations that represented the real time exposure conditions revealed that the macrolide antibiotics, erythromycin, clarithromycin and tylosin along with quinolone antibiotic, ciprofloxacin were suspected to induce high toxicity to aquatic biota. Preliminary results showing that, among the antibiotic groups tested, macrolides posed the highest ecological threat, and therefore, they may need to be further evaluated with, long-term exposure studies considering bioaccumulation factors and more number of species selected. Overall, the occurrence of antibiotics in aquatic environment is posing an ecological health concern.^

Multiplex PCR for Assessment of Tetracycline Resistance (tet) Genes in Antibiotic-Resistant Soil Bacteria and the Ecological Implications

Antibiotics are becoming increasingly prevalent in bacterial communities due to clinical and agricultural misuse and overuse in their environment. As exposure increases, so does the incidence of microbial resistance. Such is the case with bacterial resistance to tetracyclines, a phenotype often acquired through the horizontal gene transfer of tet genes between bacteria. The objective of this project was to analyze the bacterial diversity of tet resistance genes in soil from Miami-Dade County. Bacterial isolates were Gram-stained and the Kirby-Bauer antibiotic disk diffusion test was performed to determine each bacterium’s degree of resistance. The 16S rRNA gene from antibiotic-resistant isolates was amplified by PCR and sequenced to identify the isolates. All isolates’ tet genes were amplified by multiplex PCR, sequenced, and compared. Among eight isolates, three distinct species were positively identified based on their 16S rRNA sequences and four distinct tet genes were identified, though all tested susceptible to tetracycline via the Kirby-Bauer test. This project clarifies some aspects of the ecology of antibiotic resistance genes, their natural ecological function and the potential for the expansion of intrinsic multi-antibiotic resistance into new ecosystems and/or hosts.

Integrated Performance Assessment of Engineering Projects at the Interface of Emergent Properties and Uncertainty

Investigation of the performance of engineering project organizations is critical for understanding and eliminating inefficiencies in today’s dynamic global markets. The existing theoretical frameworks consider project organizations as monolithic systems and attribute the performance of project organizations to the characteristics of the constituents. However, project organizations consist of complex interdependent networks of agents, information, and resources whose interactions give rise to emergent properties that affect the overall performance of project organizations. Yet, our understanding of the emergent properties in project organizations and their impact on project performance is rather limited. This limitation is one of the major barriers towards creation of integrated theories of performance assessment in project organizations. The objective of this paper is to investigate the emergent properties that affect the ability of project organization to cope with uncertainty. Based on the theories of complex systems, we propose and test a novel framework in which the likelihood of performance variations in project organizations could be investigated based on the environment of uncertainty (i.e., static complexity, dynamic complexity, and external source of disruption) as well as the emergent properties (i.e., absorptive capacity, adaptive capacity, and restorative capacity) of project organizations. The existence and significance of different dimensions of the environment of uncertainty and emergent properties in the proposed framework are tested based on the analysis of the information collected from interviews with senior project managers in the construction industry. The outcomes of this study provide a novel theoretical lens for proactive bottom-up investigation of performance in project organizations at the interface of emergent properties and uncertainty

Loaxahatchee Impoundment Landscape Assessment (LILA): Tree Island Experiments and Management; May 1, 2005 to September 4, 2009: Final Report

Hydrologic modifications have negatively impacted the Florida Everglades in numerous significant ways. The compartmentalization of the once continuously flowing system into the Water Conservation Areas (WCAs) caused disruption of the slow natural flow of water south from Lake Okeechobee through the Everglades to Florida Bay. The ponding of water in the WCAs, the linking of water flow to controlled water levels, and the management of water levels for anthropogenic vs. ecological well-being has caused a reduction in the spatial heterogeneity of the Everglades leading to greater uniformity in topography and vegetation. These effects are noticeable as the degradation in structure of the Everglades Ridge and Slough environment and associated Tree Islands. In aquatic systems water flow is of fundamental importance in shaping the structure and function of the ecosystem. The organized patterns of parallel orientation of ridges, sloughs, and tear-drop shaped tree islands along historic flow paths attest to the importance of water movement in structuring this system. Our main objective was to operate and manage the LILA facility to provide a broad potential as a research platform for an integrated group of multidisciplinary, multi-agency scientists collaborating on multifunctional studies aimed primarily at determining the effects of CERP water management scenarios on the ecology of tree islands and ridge and slough habitats. We support Everglades water management, CERP, and the Long-Term Plan by defining hydrologic regimes that sustain healthy tree islands and ridge and slough ecosystems. Information gained through this project will help to reduce the uncertainty of predicting the tree island and ridge and slough ecosystem response to changes in hydrologic conditions. Additionally, we have developed the LILA site as a visual example of Everglades restoration programs in action.

English Language Learners: A Correlational Study of the Relationship Between A Proficiency Level Assessment and End of Course Test Scores at one Georgia High School

Understanding the language of one’s cultural environment is important for effective communication and function. As such, students entering U.S. schools from foreign countries are given access to English to Speakers of Other Languages (ESOL) programs and they are referred to as English Language Learner (ELL) students. This dissertation examined the correlation of ELL ACCESS Composite Performance Level (CPL) score to the End of Course tests (EOCTs) and the Georgia High School Graduation Tests (GHSGTs) in the four content courses (language arts, mathematics, science, and social studies). A premise of this study was that English language proficiency is critical in meeting or exceeding state and county assessment standards. A quantitative descriptive research design was conducted using Cross-sectional archival data from a secondary source. There were 148 participants from school years 2011-2012 to 2013- 2014 from Grades 9-12. A Pearson product moment correlation was run to assess the relationship between the ACCESS CPL (independent variable) and the EOCT scores and the GHSGT scores (dependent variables). The findings showed that there was a positive correlation between ACCESS CPL scores and the EOCT scores where language arts showed a strong positive correlation and mathematics showed a positive weak correlation. Also, there was a positive correlation between ACCESS CPL scores and GHSGT scores where language arts showed a weak positive correlation. The results of this study indicated that that there is a relationship between the stated variables, ACCESS CPL, EOCT and GHSGT. Also, the results of this study showed that there were positive correlations at varying degrees for each grade levels. While the null hypothesis for Research Question 1 and Research Question 2 were rejected, there was a slight relationship between the variables.

Development of a Lab-on-a-Chip Device for Rapid Nanotoxicity Assessment In Vitro

Increasing useof nanomaterials in consumer products and biomedical applications creates the possibilities of intentional/unintentional exposure to humans and the environment. Beyond the physiological limit, the nanomaterialexposure to humans can induce toxicity. It is difficult to define toxicity of nanoparticles on humans as it varies by nanomaterialcomposition, size, surface properties and the target organ/cell line. Traditional tests for nanomaterialtoxicity assessment are mostly based on bulk-colorimetric assays. In many studies, nanomaterials have found to interfere with assay-dye to produce false results and usually require several hours or days to collect results. Therefore, there is a clear need for alternative tools that can provide accurate, rapid, and sensitive measure of initial nanomaterialscreening. Recent advancement in single cell studies has suggested discovering cell properties not found earlier in traditional bulk assays. A complex phenomenon, like nanotoxicity, may become clearer when studied at the single cell level, including with small colonies of cells. Advances in lab-on-a-chip techniques have played a significant role in drug discoveries and biosensor applications, however, rarely explored for nanomaterialtoxicity assessment. We presented such cell-integrated chip-based approach that provided quantitative and rapid response of cellhealth, through electrochemical measurements. Moreover, the novel design of the device presented in this study was capable of capturing and analyzing the cells at a single cell and small cell-population level. We examined the change in exocytosis (i.e. neurotransmitterrelease) properties of a single PC12 cell, when exposed to CuOand TiO2 nanoparticles. We found both nanomaterials to interfere with the cell exocytosis function. We also studied the whole-cell response of a single-cell and a small cell-population simultaneously in real-time for the first time. The presented study can be a reference to the future research in the direction of nanotoxicity assessment to develop miniature, simple, and cost-effective tool for fast, quantitative measurements at high throughput level. The designed lab-on-a-chip device and measurement techniques utilized in the present work can be applied for the assessment of othernanoparticles' toxicity, as well.

A State and Territorial Survey Regarding Utilization of Environmental Health Shelter Assessments during Disasters, and a Secondary Analysis of Available Shelter Assessment Data

Disasters are complex events characterized by damage to key infrastructure and population displacements into disaster shelters. Assessing the living environment in shelters during disasters is a crucial health security concern. Until now, jurisdictional knowledge and preparedness on those assessment methods, or deficiencies found in shelters is limited. A cross-sectional survey (STUSA survey) ascertained knowledge and preparedness for those assessments in all 50 states, DC, and 5 US territories. Descriptive analysis of overall knowledge and preparedness was performed. Fisher’s exact statistics analyzed differences between two groups: jurisdiction type and population size. Two logistic regression models analyzed earthquakes and hurricane risks as predictors of knowledge and preparedness. A convenience sample of state shelter assessments records (n=116) was analyzed to describe environmental health deficiencies found during selected events. Overall, 55 (98%) of jurisdictions responded (states and territories) and appeared to be knowledgeable of these assessments (states 92%, territories 100%, p = 1.000), and engaged in disaster planning with shelter partners (states 96%, territories 83%, p = 0.564). Few had shelter assessment procedures (states 53%, territories 50%, p = 1.000); or training in disaster shelter assessments (states 41%, 60% territories, p = 0.638). Knowledge or preparedness was not predicted by disaster risks, population size, and jurisdiction type in neither model. Knowledge: hurricane (Adjusted OR 0.69, 95% C.I. 0.06-7.88); earthquake (OR 0.82, 95% C.I. 0.17-4.06); and both risks (OR 1.44, 95% C.I. 0.24-8.63); preparedness model: hurricane (OR 1.91, 95% C.I. 0.06-20.69); earthquake (OR 0.47, 95% C.I. 0.7-3.17); and both risks (OR 0.50, 95% C.I. 0.06-3.94). Environmental health deficiencies documented in shelter assessments occurred mostly in: sanitation (30%); facility (17%); food (15%); and sleeping areas (12%); and during ice storms and tornadoes. More research is needed in the area of environmental health assessments of disaster shelters, particularly, in those areas that may provide better insight into the living environment of all shelter occupants and potential effects in disaster morbidity and mortality. Also, to evaluate the effectiveness and usefulness of these assessments methods and the data available on environmental health deficiencies in risk management to protect those at greater risk in shelter facilities during disasters.

Development of a lab-on-a-chip device for rapid nanotoxicity assessment in vitro

Increasing useof nanomaterials in consumer products and biomedical applications creates the possibilities of intentional/unintentional exposure to humans and the environment. Beyond the physiological limit, the nanomaterialexposure to humans can induce toxicity. It is difficult to define toxicity of nanoparticles on humans as it varies by nanomaterialcomposition, size, surface properties and the target organ/cell line. Traditional tests for nanomaterialtoxicity assessment are mostly based on bulk-colorimetric assays. In many studies, nanomaterials have found to interfere with assay-dye to produce false results and usually require several hours or days to collect results. Therefore, there is a clear need for alternative tools that can provide accurate, rapid, and sensitive measure of initial nanomaterialscreening. Recent advancement in single cell studies has suggested discovering cell properties not found earlier in traditional bulk assays. A complex phenomenon, like nanotoxicity, may become clearer when studied at the single cell level, including with small colonies of cells. Advances in lab-on-a-chip techniques have played a significant role in drug discoveries and biosensor applications, however, rarely explored for nanomaterialtoxicity assessment. We presented such cell-integrated chip-based approach that provided quantitative and rapid response of cellhealth, through electrochemical measurements. Moreover, the novel design of the device presented in this study was capable of capturing and analyzing the cells at a single cell and small cell-population level. We examined the change in exocytosis (i.e. neurotransmitterrelease) properties of a single PC12 cell, when exposed to CuOand TiO2 nanoparticles. We found both nanomaterials to interfere with the cell exocytosis function. We also studied the whole-cell response of a single-cell and a small cell-population simultaneously in real-time for the first time. The presented study can be a reference to the future research in the direction of nanotoxicity assessment to develop miniature, simple, and cost-effective tool for fast, quantitative measurements at high throughput level. The designed lab-on-a-chip device and measurement techniques utilized in the present work can be applied for the assessment of othernanoparticles' toxicity, as well.^

Assessment of the Occurrence and Potential Risks of Antibiotics and their Metabolites in South Florida Waters Using Liquid Chromatography Tandem Mass Spectrometry

An automated on-line SPE-LC-MS/MS method was developed for the quantitation of multiple classes of antibiotics in environmental waters. High sensitivity in the low ng/L range was accomplished by using large volume injections with 10-mL of sample. Positive confirmation of analytes was achieved using two selected reaction monitoring (SRM) transitions per antibiotic and quantitation was performed using an internal standard approach. Samples were extracted using online solid phase extraction, then using column switching technique; extracted samples were immediately passed through liquid chromatography and analyzed by tandem mass spectrometry. The total run time per each sample was 20 min. The statistically calculated method detection limits for various environmental samples were between 1.2 and 63 ng/L. Furthermore, the method was validated in terms of precision, accuracy and linearity. The developed analytical methodology was used to measure the occurrence of antibiotics in reclaimed waters (n=56), surface waters (n=53), ground waters (n=8) and drinking waters (n=54) collected from different parts of South Florida. In reclaimed waters, the most frequently detected antibiotics were nalidixic acid, erythromycin, clarithromycin, azithromycin trimethoprim, sulfamethoxazole and ofloxacin (19.3-604.9 ng/L). Detection of antibiotics in reclaimed waters indicates that they can’t be completely removed by conventional wastewater treatment process. Furthermore, the average mass loads of antibiotics released into the local environment through reclaimed water were estimated as 0.248 Kg/day. Among the surface waters samples, Miami River (reaching up to 580 ng/L) and Black Creek canal (up to 124 ng/L) showed highest concentrations of antibiotics. No traces of antibiotics were found in ground waters. On the other hand, erythromycin (monitored as anhydro erythromycin) was detected in 82% of the drinking water samples (n.d-66 ng/L). The developed approach is suitable for both research and monitoring applications. Major metabolites of antibiotics in reclaimed wates were identified and quantified using high resolution benchtop Q-Exactive orbitrap mass spectrometer. A phase I metabolite of erythromycin was tentatively identified in full scan based on accurate mass measurement. Using extracted ion chromatogram (XIC), high resolution data-dependent MS/MS spectra and metabolic profiling software the metabolite was identified as desmethyl anhydro erythromycin with molecular formula C36H63NO12 and m/z 702.4423. The molar concentration of the metabolite to erythromycin was in the order of 13 %. To my knowledge, this is the first known report on this metabolite in reclaimed water. Another compound acetyl-sulfamethoxazole, a phase II metabolite of sulfamethoxazole was also identified in reclaimed water and mole fraction of the metabolite represent 36 %, of the cumulative sulfamethoxazole concentration. The results were illustrating the importance to include metabolites also in the routine analysis to obtain a mass balance for better understanding of the occurrence, fate and distribution of antibiotics in the environment. Finally, all the antibiotics detected in reclaimed and surface waters were investigated to assess the potential risk to the aquatic organisms. The surface water antibiotic concentrations that represented the real time exposure conditions revealed that the macrolide antibiotics, erythromycin, clarithromycin and tylosin along with quinolone antibiotic, ciprofloxacin were suspected to induce high toxicity to aquatic biota. Preliminary results showing that, among the antibiotic groups tested, macrolides posed the highest ecological threat, and therefore, they may need to be further evaluated with, long-term exposure studies considering bioaccumulation factors and more number of species selected. Overall, the occurrence of antibiotics in aquatic environment is posing an ecological health concern.