95038 research outputs found
Sort by
AT THE EDGES OF EUROPE: MIGRATION, CARE WORK AND EMBODIED INTERVENTIONS IN CYPRUS’ BORDERSCAPE
Get PDFCyprus, like other islands in the Mediterranean Sea, has come to be at the heart of pressing struggles over freedom of movement and belonging. In recent decades, Cyprus as a critical destination for asylum seekers reaching Europe has clashed with the island’s position at the edge of ‘Fortress Europe’ – a concept capturing the racialized underpinnings of who is welcome in Europe, and making already treacherous migration journeys more dangerous. This dissertation engages with the politics of borders and asylum seeking at the edges of Europe in Cyprus through a lens of intimate and embodied life. Working with the concept of the ‘borderscape’ throughout each of my chapters, I focus on how borders present in daily life as mobile, relational and lived. My first two chapters engage materials and learning developed through in-depth ethnographic and qualitative fieldwork with migrant support organizations in Nicosia, Cyprus’ partitioned capital city, where I closely observed the day-to-day activities of care workers – a collection of social workers, lawyers, translators, psychologists, employment specialists, language teachers and aid distributors. Local migrant support organizations were key spaces of intimate geopolitical negotiation in which care workers and migrants repeatedly came up against institutional, legal, and funding constraints endemic to border spaces and humanitarian projects. Care workers and migrants navigated – often incompletely and imperfectly – the pressures of a border regime designed to be opaque, dysfunctional and hostile. Rather than abstract policies, the ‘border regime’ was intimately felt, produced and contested in day-to-day interactions and shaped by a borderscape formed over time through Cyprus’ multiple colonial occupations and its own ‘Green Line’ dividing the island since 1974. Beyond care encounters, my final chapter examines how those living in Nicosia’s borderscape, including migrants, experiment with other ways to process and contest the island’s borders through creative interventions in music and art. This dissertation contributes to geographical understandings of borderscapes by centering embodied experiences and care encounters as sites where borders are made, felt, and contested. In doing so, it also documents the quiet, imaginative ways that migrants, care workers, and artists work against the grain of hostile border regimes in everyday life.Doctor of Philosoph
BAYESIAN STATISTICAL METHODS FOR ADAPTIVE BIOSIMILARITY CLINICAL TRIALS AND JOINT MODELS
Get PDFMany methods exist to jointly model either recurrent and related terminal survival events or longitudinal outcome measures and related terminal survival event. However, few methods exist which can account for the dependency between all three outcomes of interest, and none allow for the modeling of all three outcomes without strong correlation assumptions. We propose a joint model which uses subject-specific random effects to connect the survival model (terminal and recurrent events) with a longitudinal outcome model. In the proposed method, proportional hazards models with shared frailties are used to model dependence between the recurrent and terminal events, while a separate (but correlated) set of random effects are utilized in a generalized linear mixed model to model dependence with longitudinal outcome measures. All random effects are related based on an assumed multivariate normal distribution. The proposed joint modeling approach allows for flexible models, particularly for unique longitudinal trajectories, that can be utilized in a wide range of health applications. We evaluate the model through simulation studies as well as through an application to data from the Atherosclerosis Risk in Communities (ARIC) study. Separately, we consider approaches for clinical trials for biosimilars. Biosimilars are biological products with no clinically meaningful difference in safety, purity, and potency when compared to an approved biologic. Biosimilars are interchangeable when the biosimilar has the same expected risk, in terms of safety and efficacy, when compared to the reference biologic. The FDA regards biosimilarity and interchangeability approval based on totality of evidence approaches. The nature of biosimilars, and their comparison in clinical trials to reference products (RP), leads to a natural utilization of historical information on the RP in the elicitation of prior distributions as well as the efficient utilization of study participants in an adaptive clinical trial for both biosimilarity and interchangeability designations. We thus propose a two-stage clinical trial. Stage 1 consists of a 2-arm randomized clinical trial with clinical efficacy endpoint, utilizing an informative robust Meta-Analytic-Predictive (MAP) prior on the reference product arm estimated with historical information on the RP, allowing for a reduction in the RP arm. Stage 2 consists of a 2-arm randomized switching study, where participants with clinical success from the RP arm of Stage 1 are carried forward to determine interchangeability. We similarly utilize an informative robust MAP prior on the RP arm with available PK data. We demonstrate the methodology for the design and analysis of a biosimilar clinical program through simulation. We consider the Rheumatoid Arthritis clinical space, as might be feasible for a biosimilar to adalimumab. Additionally, we will consider a two-stage adaptive clinical trial for biosimilarity and interchangeability involving multiple therapeutic indications. We will utilize a correlated mixture prior to induce information sharing across both indications and trial stages, while also incorporating informative robust MAP priors based on historical data of the reference product. We demonstrate the methodology for the design and analysis of a biosimilar clinical program through simulation and consider a trial emulation as might be feasible for a biosimilar to adalimumab.Doctor of Philosoph
IMPLEMENTING A STANDARDIZED OPIOID USE DISORDER SCREENING AND REFERRAL CARE MODEL IN A NORTH CAROLINA ADULT PRIMARY CARE OFFICE
Get PDFPurpose: North Carolina has experienced significant impacts of the opioid epidemic, with rates of use disorder and unintentional overdose on the rise annually. Despite this, screening and referral for opioid use disorder (OUD) is typically not part of routine primary care. Methods: This pilot implements a standardized OUD screening and referral pathway in an adult primary care office aiming to increase identification of OUD and access to treatment in the patient population. The process was standardized as a clinical pathway, directing screening to be conducted for all adult patients in the practice annually, and offering contact information for local treatment resources and a prescription for Narcan for those who screened positive. Results: The screening portion of the pathway had a 77.86% success rate, indicated by 292 patients receiving the screening of the total 375 patients seen by the NP during the pilot period. Screening rates for OUD increased by roughly 22.6% in comparison to pre-intervention rates for the NP's full patient panel, with the rate at a pre-intervention of 3.4%, and a post-intervention of 26%. There were no patients who screened positive for OUD in this pilot; therefore, the treatment resource portion of the pathway was not administered to any patients. Conclusions: Findings demonstrate that implementation of a standardized OUD screening and referral pathway is highly effective at increasing the rate of screening in the patient population but has consistently low yield. Future research is needed to address potential causative factors of low yield and assess methods to overcome them. Still, increasing rates of OUD screening more adequately assesses the holistic needs of the adult primary care patient population, and better addresses a stigma and shame-carrying condition that is undoubtedly present in the community. Implementation of the standardized pathway starts the conversation about OUD for those who otherwise would not seek help from their primary care, allowing them to feel safe in their disclosure. Medical professionals have an opportunity to further ensure the health and safety of their patients and provide harm reduction interventions, ultimately contributing to a healthier population.Doctor of Nursing Practic
Neighbourhood inequities in the availability of retailers selling tobacco products: a systematic review
Get PDFOBJECTIVE: To examine inequities in tobacco retailer availability by neighbourhood-level socioeconomic, racial/ethnic and same-sex couple composition. DATA SOURCES: We conducted a 10 November 2022 search of PubMed, PsycINFO, Global Health, LILACS, Embase, ABI/Inform, CINAHL, Business Source Complete, Web of Science and Scopus. STUDY SELECTION: We included records from Organisation for Economic Co-operation and Development member countries that tested associations of area-level measures of tobacco retailer availability and neighbourhood-level sociodemographic characteristics. Two coders reviewed the full text of eligible records (n=58), including 41 records and 205 effect sizes for synthesis. DATA EXTRACTION: We used dual independent screening of titles, abstracts and full texts. One author abstracted and a second author confirmed the study design, location, unit of analysis, sample size, retailer data source, availability measure, statistical approach, sociodemographic characteristic and unadjusted effect sizes. DATA SYNTHESIS: Of the 124 effect sizes related to socioeconomic inequities (60.5% of all effect sizes), 101 (81.5%) indicated evidence of inequities. Of 205 effect sizes, 69 (33.7%) tested associations between retailer availability and neighbourhood composition of racially and ethnically minoritised people, and 57/69 (82.6%) documented inequities. Tobacco availability was greater in neighbourhoods with more Black, Hispanic/Latine and Asian residents (82.8%, 90.3% and 40.0% of effect sizes, respectively). Two effect sizes found greater availability with more same-sex households. CONCLUSIONS: There are stark inequities in tobacco retailer availability. Moving beyond documenting inequities to partnering with communities to design, implement, and evaluate interventions that reduce and eliminate inequities in retail availability is needed to promote an equitable retail environment. PROSPERO REGISTRATION NUMBER: CRD42019124984
Development of ROBUST-RCT: Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials
Get PDFRecent innovations in evidence based medicine methods, in particular instruments assessing risk of bias in randomised trials, have focused on methodological rigour at the expense of simplicity and practicability. Such a focus could lead to challenges in application and loss of reliability of instruments. To deal with these shortcomings, the Risk Of Bias instrument for Use in SysTematic reviews-for Randomised Controlled Trials (ROBUST-RCT) was created—a rigorously developed, simply structured, and user friendly instrument for assessing risk of bias of randomised controlled trials included in systematic reviews. This paper describes the development of ROBUST-RCT and provides associated documents and a manual of instructions
Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment
Get PDFBackground People who smoke cigars often have misperceptions about the associated risks, contributing to rises in smoking rates. This study investigates the perceived warning effectiveness (PWE) of health warning labels (HWLs) on cigar packages. We tested the impact of warning type and warning size in the HWLs on PWE and other health outcomes. Data and methods In a between-subjects experimental design, participants (n=809) who used little cigars or cigarillos in the past 30 days were randomly assigned to one of four conditions: text-only at 30% size, pictorial+text warning at 30% size, text-only at 50% size and pictorial+text warning at 50% size. In each condition, participants rated six cigarillo HWLs on PWE, self-reported learning, thinking about risks, new knowledge, perceived enjoyment and negative affect. Reactance to the labels was also measured. Data were analysed with mixed-effects models. Results Pictorial+text cigarillo HWLs were deemed more effective than text-only HWLs in PWE ( b =0.34, SE=0.08, p<0.001), self-reported learning ( b =0.20, SE=0.08, p=0.01), thinking about risks ( b =0.18, SE=0.08, p=0.03) and new knowledge ( b =0.34, SE=0.12, p<0.01). They also elicited more negative affect than text-only warnings ( b =0.39, SE=0.08, p<0.001). Warning size did not impact outcomes, and neither warning type nor size predicted perceived enjoyment of smoking cigarillos or reactance to the warnings. Conclusion Including images with text warning statements for cigarillos can increase PWE. Our findings provide important insights for the US Food and Drug Administration and international regulatory agencies in designing new HWLs for cigars that can more effectively communicate smoking risks, address misinformation and potentially reduce cigar smoking
Improvement of Detection of Lead in Drinking Water using Affordable Lead Test Strips- SURF Slides
No full textLead in drinking water is a serious health issue, and many forms of lead detection are very expensive for the average person. Lead test strips are an affordable way to test for lead at home, but these have their own issues which affect their accuracy. As part of the SURF, the researcher experimented with using citric acid and digital image analysis to improve the effectiveness of these strips. It was found that these methods increase the accuracy of lead test strips, which could improve the ability of homeowners to test for lead in their water using affordable means
Evaluation of the new blood-pool CT contrast agent VivoVist in mouse models
Get PDFSmall animal CT imaging provides high resolution imaging of bone structure, lungs, and gross anatomy. However, it is limited in its ability to provide high soft tissue contrast. Several blood pool CT contrast agents have been developed to enhance vascular and tissue contrast for preclinical imaging with varying enhancement capabilities. VivoVistTM is the most recent commercially available blood pool CT contrast agent for preclinical applications. This study independently evaluated its radiopacity and tissue enhancement compared to two existing preclinical CT contrast agents, Mvivo-Au, and Fenestra-HDVC. Healthy nude mice were administered one of the three contrast agents. CT imaging was performed before and at 5 minutes, 1 hour, 4 hours, 24 hours, 48 hours, 96 hours, and 7 days post-injection. Tissue intensity and the enhancement ratio relative to pre-injection levels were quantified for each contrast agent at each time point. VivoVist demonstrated significantly higher blood enhancement compared to Mvivo-Au and Fenestra-HDVC at 5 minutes and 1 hour post-injection. However, the enhancement at 4 hours and later time points was inferior to that of Mvivo-Au. VivoVist exhibited the fastest blood clearance among the three contrast agents, with a blood half-life of 3.1 hours and was largely cleared from the blood by 24 hours post-injection. In CT imaging after 24 hours post-injection, VivoVist showed the highest liver enhancement, which remained high over the 7-day imaging period. Biodistribution assessment showed that the splenic uptake of VivoVist was extremely high. Histological examination of the tissues identified abundant contrast agent accumulation in the liver and spleen. No overt pathological changes were observed in either organ one month after the injection of VivoVist. Overall, the evaluation confirmed that VivoVist is an effective CT contrast agent for vascular and liver imaging with low toxicity. However, its relatively short blood half-life limits its use as a vascular contrast agent for a prolonged period
BRIDGING CULTURES THROUGH HERITAGE INTERPRETATION: THE ROLE OF STORYTELLING, LIBRARIES, MUSEUMS, AND AI IN REFUGEE INCLUSION IN NORTH CAROLINA
Get PDFMigration to the United States has risen significantly, especially among individuals from crisis-affected countries such as Syria, Sudan, and Iraq. These communities often face isolation due to language and cultural barriers, limiting integration and belonging. This study explores how cultural engagement, through storytelling, museum and library visits, handouts, and historic site experiences, supports social inclusion and language development. Artificial intelligence tools were incorporated to generate historical interpretation images, enhance storytelling visuals, and improve multilingual accessibility, highlighting technology’s role in cultural engagement. Using a qualitative approach, data were collected through participant observations, interviews, and feedback during a community-based program for refugees and immigrants in North Carolina. Findings indicate these activities improve English skills, foster trust, and enhance emotional well-being. Participants reported feeling safer, connected, and valued. Culturally immersive programs reduce isolation, promote integration, and strengthen social cohesion by amplifying voices and creating spaces for shared experiences.Master of Science in Library Scienc
Evaluating Picture Description Speech for Dementia Detection using Image-text Alignment
Get PDFUsing picture description speech for dementia detection has been extensively studied. However, past research has concentrated on distinguishing speech patterns between healthy individuals and dementia patients without directly utilizing the picture content. This paper introduces the first dementia detection models using images and description texts, leveraging knowledge from pre-trained image-text alignment models. It explores the distinction between dementia and healthy samples based on the text’s relevance to the image and its focused area, suggesting this approach could improve dementia detection accuracy. Specifically, we use the text’s relevance to the picture to rank and filter the sentences of the samples. We also identified focused areas of the picture as topics and categorized the sentences according to the focused areas. We propose three advanced models that pre-processed the samples based on their relevance to the picture, sub-image, and focused areas. The evaluation results show that our advanced models, with knowledge of the picture and large image-text alignment models, achieve state-of-the-art performance with the best detection accuracy at 83.44%, which is higher than the text-only baseline model at 79.91%. Lastly, we visualize the sample and picture results to explain the advantages of our models