Gene transfer plays an important role in bacterial evolution. Especially in an under explored species like Rhodococcus, a type of bacteria found in the soil. Rhodococcus has several applications in the pharmaceutical industry and in the production of antibiotics. Rhodococcus possess several unique sets of properties which makes it beneficial to have a reliable method of producing mutants of Rhodococcus. The goal of the experiment was to find an efficient way of forming Rhodococcus colonies with kanamycin resistant genes. The project began from an unexpected observation from an earlier experiment with Rhodococcus strain MTM3W5.2. where I attempted to transform this strain with a transposon via electro-transformation. The colonies that grew/ appeared transformants were screened to confirm the presence of kanamycin gene, however there was no amplified DNA seen on the PCR gel (i.e. absence of the kanamycin gene). The electro-transformant colonies were selected on LB plates containing different higher concentrations of kanamycin. Then the appeared transformants were again screened via disk diffusion assay and were classified into 3 different kanamycin resistant phenotypes. Majority of the “C” phenotypic colonies (i.e., high level resistance to kanamycin) appear to contain the kanamycin gene, but these colonies were less in numbers. This led us to try another method of gene transfer which is conjugation. Conjugation was carried on a double selection antibiotic plate containing both chloramphenicol (30 µg) and kanamycin (100 µg). The transconjugate colonies that appeared on the double selection plates were also screened by PCR, but none of the colonies had amplified DNA suggesting absence of the kanamycin gene. The colonies seen on the double selection plate were possibly due to spontaneous mutation or some type of unknown phenotypic variation. However, in the future, double selection plates with higher concentrations of antibiotics can possibly give us transconjugants with kanamycin genes.

Older adults, especially those who are of low socioeconomic status, experience higher rates of mortality and chronic disease. As a result, older adults are frequent users of emergency medical service (EMS), comprising approximately 38-48% of all EMS calls. In response to higher EMS demands, community paramedicine has recently emerged as a non-traditional model whereby paramedics provide care in a community- based setting. CP@clinic is a community paramedicine programme that focuses on disease prevention and health promotion with the goal of reducing EMS demand. Given the knowledge that older adults who live in subsidized housing have poorer health outcomes, CP@clinic has been implemented in several subsidized housing building across Ontario. A program evaluation of CP@clinic is currently underway to make recommendations to paramedic partner stakeholders regarding program delivery. As part of this evaluation, I sought to understand the association of the number of CP@clinic sessions held per month and EMS calls per apartment unit. De-identified EMS call data were collated from 9 paramedic services across Ontario from February 2015 to December 2019. I conducted a three-level multilevel regression analysis, with EMS calls per apartment unit as the outcome. The primary analysis found that a one-session increase in the number of sessions held per month was associated with an average 2.4% higher incident rate of EMS calls, adjusted for building size. A secondary analysis, with the number of sessions per month as a categorical variable, revealed that two CP@clinic sessions per month had the smallest association with EMS calls, adjusted for building size. Based on these results, it is recommended that paramedic services offer two or more CP@clinic sessions per month. Future research should investigate the factors that impact each services’ ability to offer the CP@clinic programme. / Thesis / Master of Science (MSc) / Older adults experience high rates of chronic diseases, especially older adults living in subsidized housing. Community paramedicine has recently emerged as a way of addressing the healthcare needs of older adults living in subsidized housing, while simultaneously decreasing the burden on EMS. CP@clinic is a community paramedicine programme aimed at improving the health of older adults and reducing the demand on EMS. To make recommendations to the paramedic services operating CP@clinic, I sought to understand the association between the frequency of CP@clinic sessions and the number of EMS calls per apartment unit in Ontario. Based on the results, CP@clinic sessions were associated with higher incident rate of EMS calls, after accounting for building size, reflecting the trend of rising EMS calls in Ontario. Overall, paramedic services may see improved EMS call outcomes with two or more CP@clinic sessions per month but should offer the programme according to their organizational capacity.

Book Summary: JPHMP's 21 Public Health Case Studies on Policy & Administration , compiled by the founding editor and current editor-in-chief of the Journal of Public Health Management and Practice, provides you with real-life examples of how to strategize and execute policies and practices when confronted with issues such as disease containment, emergency preparedness, and organizational, management, and administrative problems.Feautures: Each case is co-written by a professional writer and tells a “story,” using characters, conflicts, and plot twists designed to compel you to keep reading. Case elements include the core problem, stakeholders, steps taken, challenges, results, conclusions, and discussion questions for analysis. More than 60 contributors—experts in public policy, clinical medicine, pediatrics, social work, pharmacy, bioethics, and healthcare management. Ideal for public health practitioners as well as students in graduate and undergraduate public health and medical education programs. Tracks 2016 CEPH (Council on Education for Public Health) accreditation criteria. These cases can be used as tools to develop competencies designated in the new CEPH (Council on Education for Public Health) accreditation criteria.

Throughout the Appalachian Region, smoking is a common health risk that contributes to significantly higher rates of tobacco-related disease and lower life expectancy compared to the rest of the United States. Drawing on the research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to smoking. This brief: ■ summarizes statistics on smoking and related diseases in Appalachian communities, ■ discusses key strategies and resources for reducing tobacco use, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Prevent smoking initiation among youth. 2. Increase access to tobacco cessation interventions. 3. Launch anti-tobacco communication campaigns. 4. Reduce exposure to secondhand smoke.

The Appalachian Region continues to experience higher rates of opioid misuse and overdose deaths than other parts of the country. While the impact of the burgeoning epidemic is being felt nationwide, states and counties within the Appalachian Region are particularly hard hit, with opioid overdose rates more than double national averages. Drawing on the research presented in the health disparities and Bright Spot reports, this brief: ■ summarizes statistics on opioid misuse and overdose deaths in Appalachian communities, ■ discusses key strategies and resources for addressing opioid misuse and overdose deaths, and ■ provides recommendations for community leaders, funders, and policymakers. This brief features promising practices, intervention strategies, and policy development and implementation ideas to reduce health disparities related to opioid misuse and overdose deaths. This brief discusses five recommendations in detail: 1. Prevent opioid misuse. 2. Increase access to treatment for opioid use disorder. 3. Implement harm reduction strategies to reduce the consequences of opioid use disorder. 4. Support long-term recovery of opioid use disorder. 5. Implement community-based solutions to prevent substance misuse.

Obesity, which is both a chronic disease and a risk factor for other chronic diseases, contributes to higher rates of premature mortality in Appalachia. Drawing on research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to obesity. This brief: ■ summarizes statistics on obesity and related disease in Appalachian communities, ■ discusses key strategies and resources for preventing and reducing obesity, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Establish healthy behaviors among children and youth to prevent childhood obesity. 2. Increase the availability of affordable healthy foods and beverages in communities. 3. Create safe communities that support physical activity. 4. Increase physical activity and healthy eating among adults.

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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

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