Cultural competence in an HIV dedicated dental clinic: Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

This dissertation investigated perspectives on cultural competence among African-American women patients, staff, and the administrator of a dental clinic serving people living with HIV/AIDS; and evaluated the role of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) in advancing the provision of culturally competent care in the clinic. ^ The study was qualitative with data collection via focus groups and individual interviews with a sample of African-American women patients, and individual interviews with a sample of staff and the clinic administrator. Transcripts were coded and themes identified using the software program ATLAS.ti. A cultural audit template was developed and applied to evaluate cultural competency. ^ Among attitudes and behaviors that contributed to the provision of culturally competent care at the clinic were respect and empathic communication. Formal cultural competency was not featured strongly in the methods by which the staff learned to work with diverse populations. Instead cultural competence among the staff was based on thoughtful hiring practices, natural aptitude and a climate that encouraged learning through informal sharing of experiences. The staff and administrator felt that an African-American dentist would be an asset in improving culturally competent care at the clinic. Previous research and national policy also promote the provider-patient racial/ethnic concordance to improve care. In this study, however, the patients were happy with the care provided regardless of the race/ethnicity of the staff, probably reflecting the well developed cultural competence skills of clinic staff overall. ^ The clinic administrator was unaware of the CLAS standards although the clinic was implicitly operated under their mandates. This occurred because the clinic is supported by federal funding and the CLAS standards were incorporated into the requirements. Incorporation into and monitoring of the CLAS standards in federally funded programs therefore appears to be an effective means for ensuring that they are implemented. ^ This study illustrates that cultural competence, though not universally understood, can be systematically investigated to identify what constitutes appropriate care and the factors that support or inhibit it. Among important elements of culturally competent care are respect and empathic communication. ^

A descriptive study on Hurricanes Katrina and Rita evacuees participating in the Harris County Housing Authority Disaster Housing Assistance Program

Natural disasters occur in various forms such as hurricanes, tsunamis, earthquakes, outbreaks, etc. The most unsettling aspect of a natural disaster is that it can strike at any moment. Over the past decade, our society has experienced an alarming increase of natural disasters. How to expeditiously respond and recover from natural disasters has become a precedent question for public health officials. To date, the most recent natural disaster was the January 12, 2010 earthquake in Haiti; however the most memorable was that of Hurricane Katrina (“Haiti Earthquake”, 2010). ^ This study provides insight on the need to develop a National Disaster Response and Recovery Program which effectively responds to natural disasters. The specific aims of this paper were to (1) observe the government’s role on federal, state and local levels in assisting Hurricanes Katrina and Rita evacuees, (2) assess the prevalence of needs among Hurricanes Katrina and Rita families participating in the Disaster Housing Assistance Program (DHAP) and (3) describe the level of progress towards “self sufficiency” for the DHAP families receiving case management social services. ^ Secondary data from a cross-sectional “Needs Assessment” questionnaire were analyzed. The questionnaire was administered initially and again six months later (follow-up) by H.A.U.L. case managers. The “Needs Assessment” questionnaire collected data regarding participants’ education, employment, transportation, child care, health resources, income, permanent housing and disability needs. Case managers determined the appropriate level of social services required for each family based on the data collected from the “Needs Assessment” questionnaire. ^ Secondary data provided by the H.A.U.L. were analyzed to determine the prevalence of needs among the DHAP families. In addition, differences measured between the initial and follow-up (at six months) questionnaires were analyzed to determine statistical significance between case management services provided and prevalence of needs among the DHAP families from initial to 6 months later at follow-up. The data analyzed describe the level of progress made by these families to achieve program “self sufficiency” (see Appendix A). Disaster assistance programs which first address basic human needs; then socioeconomic needs may offer an essential tool in aiding disaster affected communities quickly recover from natural disasters. ^

Patenting genes and gene sequences: Analysis of public health implications and the law

At issue is whether or not isolated DNA is patent eligible under the U.S. Patent Law and the implications of that determination on public health. The U.S. Patent and Trademark Office has issued patents on DNA since the 1980s, and scientists and researchers have proceeded under that milieu since that time. Today, genetic research and testing related to the human breast cancer genes BRCA1 and BRCA2 is conducted within the framework of seven patents that were issued to Myriad Genetics and the University of Utah Research Foundation between 1997 and 2000. In 2009, suit was filed on behalf of multiple researchers, professional associations and others to invalidate fifteen of the claims underlying those patents. The Court of Appeals for the Federal Circuit, which hears patent cases, has invalidated claims for analyzing and comparing isolated DNA but has upheld claims to isolated DNA. The specific issue of whether isolated DNA is patent eligible is now before the Supreme Court, which is expected to decide the case by year's end. In this work, a systematic review was performed to determine the effects of DNA patents on various stakeholders and, ultimately, on public health; and to provide a legal analysis of the patent eligibility of isolated DNA and the likely outcome of the Supreme Court's decision. ^ A literature review was conducted to: first, identify principle stakeholders with an interest in patent eligibility of the isolated DNA sequences BRCA1 and BRCA2; and second, determine the effect of the case on those stakeholders. Published reports that addressed gene patents, the Myriad litigation, and implications of gene patents on stakeholders were included. Next, an in-depth legal analysis of the patent eligibility of isolated DNA and methods for analyzing it was performed pursuant to accepted methods of legal research and analysis based on legal briefs, federal law and jurisprudence, scholarly works and standard practice legal analysis. ^ Biotechnology, biomedical and clinical research, access to health care, and personalized medicine were identified as the principle stakeholders and interests herein. Many experts believe that the patent eligibility of isolated DNA will not greatly affect the biotechnology industry insofar as genetic testing is concerned; unlike for therapeutics, genetic testing does not require tremendous resources or lead time. The actual impact on biomedical researchers is uncertain, with greater impact expected for researchers whose work is intended for commercial purposes (versus basic science). The impact on access to health care has been surprisingly difficult to assess; while invalidating gene patents might be expected to decrease the cost of genetic testing and improve access to more laboratories and physicians' offices that provide the test, a 2010 study on the actual impact was inconclusive. As for personalized medicine, many experts believe that the availability of personalized medicine is ultimately a public policy issue for Congress, not the courts. ^ Based on the legal analysis performed in this work, this writer believes the Supreme Court is likely to invalidate patents on isolated DNA whose sequences are found in nature, because these gene sequences are a basic tool of scientific and technologic work and patents on isolated DNA would unduly inhibit their future use. Patents on complementary DNA (cDNA) are expected to stand, however, based on the human intervention required to craft cDNA and the product's distinction from the DNA found in nature. ^ In the end, the solution as to how to address gene patents may lie not in jurisprudence but in a fundamental change in business practices to provide expanded licenses to better address the interests of the several stakeholders. ^

Bottom water properties observed during Nathanial B. Palmer cruises NBP00-08 and NBP04-08 to the Southern Ocean

We report on observations of dense shelf water overflows and Antarctic Bottom Water (AABW) formation along the continental margin of the Adelie and George V Land coast between 140°E and 149°E. Vertical sections and bottom layer water mass properties sampled during two RVIB Nathaniel B Palmer hydrographic surveys (NBP00-08, December 2000/January 2001 and NBP04-08, October 2004) describe the spreading of cold, dense shelf water on the continental slope and rise from two independent source regions. The primary source region is the Adelie Depression, exporting high-salinity dense shelf water through the Adelie Sill at 143°E. An additional eastern source region of lower-salinity dense shelf water from the Mertz Depression is identified for the first time from bottom layer properties northwest of the Mertz Sill and Mertz Bank (146°E-148°E) that extend as far as the Buffon Channel (144.75°E) in summer. Regional analysis of satellite-derived ice production estimates over the entire region from 1992 to 2005 suggests that up to 40% of the total ice production for the region occurs over the Mertz Depression and therefore this area is likely to make a significant contribution to the total dense shelf water export. Concurrent time series from bottom-mounted Microcats and ADCP instruments from the Mertz Polynya Experiment (April 1998 to May 1999) near the Adelie Sill and on the upper continental slope (1150 m) and lower continental rise (3250 m) to the north describe the seasonal variability in downslope events and their interaction with the ambient water masses. The critical density for shelf water to produce AABW is examined and found to be 27.85 kg/m**3 from the Adelie Depression and as low as 27.80 kg/m**3 from the Mertz Depression. This study suggests previous dense shelf water export estimates based on the flow through the Adelie Sill alone are conservative and that other regions around East Antarctica with similar ice production to the Mertz Depression could be contributing to the total AABW in the Australian-Antarctic Basin.

Sr/Ca ratios and oxygen isotopes from sclerosponges

We investigate aragonitic skeletons of the Caribbean sclerosponge Ceratoporella nicholsoni from Jamaica, 20 m below sea level (mbsl), and Pedro Bank, 125 mbsl. We use d18O and Sr/Ca ratios as temperature proxies to reconstruct the Caribbean mixed layer and thermocline temperature history since 1400 A.D. with a decadal time resolution. Our age models are based on U/Th dating and locating of the radiocarbon bomb spike. The modern temperature difference between the two sites is used to tentatively calibrate the C. nicholsoni Sr/Ca thermometer. The resulting calibration points to a temperature sensitivity of Sr/Ca in C. nicholsoni aragonite of about -0.1 mmol/mol/K. Our Sr/Ca records reveal a pronounced warming from the early 19th to the late 20th century, both at 20 and 125 mbsl. Two temperature minima in the shallow water record during the late 17th and early 19th century correspond to the Maunder and Dalton sunspot minima, respectively. Another major cooling occurred in the late 16th century and is not correlatable with a sunspot minimum. The temperature contrast between the two sites decreased from the 14th century to a minimum in the late 17th century and subsequently increased to modern values in the early 19th century. This is interpreted as a long-term deepening and subsequent shoaling of the Caribbean thermocline. The major trends of the Sr/Ca records are reproduced in both specimens but hardly reflected in the d18O records.

U-Th, 14C and d11B results for Holocene North Atlantic deep sea corals (Lophelia pertusa), 2011

Sediment Core MD01-2454G SW Rockall BANK 747m water depth on Logatechev Mounds (Core was taken during Marion Dufresne Cruise Geosciences 2001 at 55°31'N and 15°39'W) ENAM corals from BoxCores of SW Rockall Bank and Porcupine Bank water depth 725 and 750m (Box cores ENAM 9915 and ENAM 9910 were taken from 725 m bsl on the Southwest Rockall Bank (55,32°N, 15,40°W), and ENAM 9828 from 745 m bsl on the Porcupine Bank (53,48°N, 13,54°W))

New Constructive Solutions to Improve Energy Efficiency in Existing Buildings and their Economic Viability

The improvement of energy efficiency in existing buildings is always a challenge due to their particular, and sometimes protected, constructive solutions. New constructive regulations in Spain leave a big undefined gap when a restoration is considered because they were developed for new buildings. However, rehabilitation is considered as an opportunity for many properties because it allows owners to obtain benefits from the use of the buildings. The current financial and housing crisis has turned society point of view to existing buildings and making them more efficient is one of the Spanish government’s aims. The economic viability of a rehabilitation action should take all factors into account: both construction costs and the future operative costs of the building must be considered. Nevertheless, the application of these regulations in Spain is left to the designer’s opinion and always under a subjective point of view. With the research work described in this paper and with the help of some case-studies, the cost of adapting an existing building to the new constructive regulations will be studied and Energetic Efficiency will be evaluated depending on how the investment is recovered. The interest of the research is based on showing how new constructive solutions can achieve higher levels of efficiency in terms of energy, construction and economy and it will demonstrate that Life Cycle Costing analysis can be a mechanism to find the advantages and disadvantages of using these new constructive solutions. Therefore, this paper has the following objectives: analysing constructive solutions in existing buildings - to establish a process for assessing total life cycle costs (LCC) during the planning stages with consideration of future operating costs - to select the most advantageous operating system – To determine the return on investment in terms of construction costs based on new techniques, the achieved energy savings and investment payback periods.

Leakage and temperature aware server control for improving energy efficiency in data centers

Reducing the energy consumption for computation and cooling in servers is a major challenge considering the data center energy costs today. To ensure energy-efficient operation of servers in data centers, the relationship among computa- tional power, temperature, leakage, and cooling power needs to be analyzed. By means of an innovative setup that enables monitoring and controlling the computing and cooling power consumption separately on a commercial enterprise server, this paper studies temperature-leakage-energy tradeoffs, obtaining an empirical model for the leakage component. Using this model, we design a controller that continuously seeks and settles at the optimal fan speed to minimize the energy consumption for a given workload. We run a customized dynamic load-synthesis tool to stress the system. Our proposed cooling controller achieves up to 9% energy savings and 30W reduction in peak power in comparison to the default cooling control scheme.

Greenfield shopping center development. The integration between environmental features, building design and investment analysis at the decision making stage

The Shopping centre is a long term investment in which Greenfield development decisions are often taken based on risks analysis regarding construction costs, location, competition, market and an expected DCF. Furthermore, integration between the building design, project planning, operational costs and investment analysis is not entirely considered by the investor at the decision making stage. The absence of such information tends to produce certain negative impacts on the future running costs and annual maintenance of the building, especially on energy demand and other occupancy expenses paid by the tenants to the landlord. From the investor´s point of view, this blind spot in strategy development will possibly decrease their profit margin as changes in the occupancy expenses[ ] have a direct outcome on the profit margin. In order to try to reduce some higher operating cost components such as energy use and other utility savings as well as their CO2 emissions, quite a few income properties worldwide have some type of environmental label such as BREEAM and LEED. The drawback identified in this labelling is that usually the investments required to get an ecolabel are high and the investor finds no direct evidence that it increases market value. However there is research on certified commercial properties (especially offices) that shows better performance in terms of occupancy rate and rental cost (Warren-Myers, 2012). Additionally, Sayce (2013) says that the certification only provides a quick reference point i.e. the lack of a certificate does not indicate that a building is not sustainable or efficient. Based on the issues described above, this research compares important components of the development stages such as investments costs, concept/ strategy development as well as the current investor income and property value. The subjects for this analysis are a shopping centre designed with passive cooling/bioclimatic strategies evaluated at the decision making stage, a certified regional shopping centre and a non-certified standard regional shopping centre. Moreover, the proposal intends to provide decision makers with some tools for linking green design features to the investment analysis in order to optimize the decision making process when looking into cost savings and design quality.

O USO DAS TECNOLOGIAS DA INFORMAÇÃO E COMUNICAÇÃO NO CAMPO OPERACIONAL DA GUARDA CIVIL METROPOLITANA DE SÃO PAULO DESAFIOS À GESTÃO DE PESSOAS

Esta dissertação apresenta um estudo exploratório sobre a experiência de implantação de um sistema digital de segurança. O estudo teve como locus a Guarda Civil Metropolitana de São Paulo e o objetivo geral da pesquisa é analisar o uso das tecnologias da informação e comunicação no campo operacional da organização. Primeiramente foi realizada a pesquisa bibliográfica para rastreamento de temas análogos. Foi possível verificar a escassez de estudos sobre as tecnologias da informação e comunicação na Segurança Pública no Brasil. Dos raros trabalhos encontrados o que deu inspiração para essa pesquisa foi o experimento realizado em Brasília, na área de Gestão do Conhecimento e da Tecnologia da Informação, que investigou a integração de sistemas de info rmações na Segurança Pública do Distrito Federal. Para a realização deste estudo de caso adotou-se a metodologia qualitativa com pesquisas bibliográfica, documental e de campo (entrevistas e observações diretas). Os resultados obtidos demonstram a necessidade de investimentos em tecnologias da informação e comunicação, objetivando a integração e a interoperabilidade das organizações de Segurança Pública. Os resultados também confirmaram os achados em pesquisas e estudos sobre a violência urbana que apontam que só os investimentos na estrutura técnica, em pessoal, em gestão de segurança, chamada política de combate à violência e à criminalidade, não resolve. É preciso urgência na gestão de políticas públicas integradas para combater as causas provocativas da violência e da criminalidade que são a miséria crescente, o desemprego, a falta de serviços públicos eficientes, em especial no setor da saúde e da educação e a ausência de políticas sociais, todos entendidos como violência.(AU)

O USO DAS TECNOLOGIAS DA INFORMAÇÃO E COMUNICAÇÃO NO CAMPO OPERACIONAL DA GUARDA CIVIL METROPOLITANA DE SÃO PAULO DESAFIOS À GESTÃO DE PESSOAS

Esta dissertação apresenta um estudo exploratório sobre a experiência de implantação de um sistema digital de segurança. O estudo teve como locus a Guarda Civil Metropolitana de São Paulo e o objetivo geral da pesquisa é analisar o uso das tecnologias da informação e comunicação no campo operacional da organização. Primeiramente foi realizada a pesquisa bibliográfica para rastreamento de temas análogos. Foi possível verificar a escassez de estudos sobre as tecnologias da informação e comunicação na Segurança Pública no Brasil. Dos raros trabalhos encontrados o que deu inspiração para essa pesquisa foi o experimento realizado em Brasília, na área de Gestão do Conhecimento e da Tecnologia da Informação, que investigou a integração de sistemas de info rmações na Segurança Pública do Distrito Federal. Para a realização deste estudo de caso adotou-se a metodologia qualitativa com pesquisas bibliográfica, documental e de campo (entrevistas e observações diretas). Os resultados obtidos demonstram a necessidade de investimentos em tecnologias da informação e comunicação, objetivando a integração e a interoperabilidade das organizações de Segurança Pública. Os resultados também confirmaram os achados em pesquisas e estudos sobre a violência urbana que apontam que só os investimentos na estrutura técnica, em pessoal, em gestão de segurança, chamada política de combate à violência e à criminalidade, não resolve. É preciso urgência na gestão de políticas públicas integradas para combater as causas provocativas da violência e da criminalidade que são a miséria crescente, o desemprego, a falta de serviços públicos eficientes, em especial no setor da saúde e da educação e a ausência de políticas sociais, todos entendidos como violência.(AU)

Supremo Tribunal Federal e a concretização dos direitos fundamentais no sistema constitucional tributário brasileiro

Este trabalho trata do papel desempenhado pelo Supremo Tribunal Federal na apreciação de questões relativas ao Sistema Constitucional Tributário brasileiro à luz dos direitos fundamentais. Com efeito, o STF é responsável por guardar os direitos fundamentais também quando decide controvérsias constitucionais tributárias, o que significa considerar o delicado equilíbrio entre a proteção dos contribuintes e a necessidade de o Estado arrecadar os recursos suficientes à concretização dos direitos fundamentais. Assim, a tese tem dois objetivos. Por um lado, pretende identificar se o Supremo Tribunal Federal adota algum parâmetro condizente com os direitos fundamentais ao julgar questões constitucionais relativas ao sistema tributário. Nessa perspectiva, diversos acórdãos do Supremo Tribunal Federal, proferidos na égide da CF/1988, são analisados com vistas a examinar se a Corte tem cumprido bem suas responsabilidades constitucionais. Por outro lado, sugere o Estado Fiscal como parâmetro adequado aos direitos fundamentais e ao sistema constitucional tributário, considerando sua preocupação tanto com a proteção dos contribuintes quanto com a existência de meios mínimos para o financiamento das atividades públicas.

Public Lawyers and Marijuana Regulation

Although 23 states and the District of Columbia have now legalized marijuana for medical purposes, marijuana remains a prohibited substance under federal law. Because the production, sale, possession and use of marijuana remain illegal, there is a risk of prosecution under federal laws. Furthermore, those who help marijuana users and providers put themselves at risk — federal law punishes not only those who violate drug laws but also those who assist or conspire with them to do so. In the case of lawyers representing marijuana users and businesspeople, this means not only the real (though remote) risk of criminal prosecution but also the more immediate risk of professional discipline. Elsewhere, we wrote about the difficult place in which lawyers find themselves when representing marijuana clients. We argued that while both the criminal law and the rules of professional conduct rightly require legal obedience from lawyers, other countervailing factors must be considered when evaluating lawyers’ representation of marijuana clients. In particular, we asserted that considerations of equity and access to justice weigh dispositively in favor of protecting lawyers who endeavor to help their clients comply with state marijuana laws, and we suggested means of interpreting relevant criminal law provisions and rules of professional conduct to achieve this result. This article builds on that analysis, taking on the particular issue of the public lawyer’s’ role in marijuana regulation. For government lawyers, the key issues in exercising discretion in the context of marijuana are not clients’ access to the law and equality but rather determining the clients’ wishes and serving them diligently and ethically. Lawyers representing state agencies, legislatures and the executive branch of government draft and interpret the rules and regulations regarding marijuana. Lawyers for federal, state and local governments then interpret those rules to determine the obligations and responsibilities of those they represent and to help their clients meet those obligations and carry out their required tasks. Both state and federal prosecutors are charged with determining what conduct remains illegal under the new rules and, perhaps more importantly, with exercising discretion regarding whom to prosecute and to what extent. Marijuana regulation is not a niche area of government regulation; it will influence the practice of virtually every public lawyer in the years to come. Public lawyers must understand the changes in marijuana law and the implications for government clients. Given the pervasiveness of the modern regulatory state, the situation is no easier — and, in many ways, it is more complicated — for public lawyers than it is for private ones. Public lawyers face myriad practice challenges with respect to marijuana law reform, and while we do not purport to identify and resolve all of the issues that are sure to arise in this short paper, we hope that the article helps alert public lawyers to some of the risks involved in participating in marijuana regulation so that they can think carefully about their obligations when these issues arise.

Renewable Energy Systems in the City of Northglenn: Draft Zoning Ordinance and Resident Pamphlet

Recent federal incentives and increased demand for home photovoltaic and small wind electrical systems highlights the need for consistent zoning ordinances and guidance materials for Northglenn residents. This Capstone Project assesses perceived impacts related to renewable energy systems, like noise, safety, aesthetics, and environmental considerations, and provides a model ordinance intended to mitigate these issues. It was concluded a model ordinance would ease and stimulate additions of alternative energy systems in Northglenn. Additionally, this research concluded development of public information could stimulate homeowners into positive decisions. The project also identifies potential financial and environmental benefits of installing such systems in an effort to promote sustainable and clean energy production within the city.

Review and Recommendations for Fast-Track Wetland Permitting for Petroleum Pipeline Maintenance

The petroleum pipeline industry in the United States is challenged with maintaining the integrity of their pipelines, while also protecting the environment during any pipeline repairs. This project provides information on the activities relating to the industry Integrity Management Program, assesses the process that federal agencies are developing to create streamlined permitting processes, and if the necessary federal, state, and local wetland permits can be obtained in the time frame required by the law. Recommendations are also made for implementation of a fast-track wetland permitting process and what pipeline companies can do to speed up the permitting process. This project focuses on the refined petroleum pipelines that originate near the Gulf of Mexico and terminate in the Northeastern United States.