There has been a growing conviction on the part of medical and nursing staff in the Homes for the Aged in British Columbia, which provide psychiatric care for the aged, that some of the residents have sufficient physical and mental health to be discharged. This study makes an analytical survey of some of the needs and resources of a group of patients considered to be ready to leave one of these institutions (the Port Coquitlam Unit). The purpose of the survey was to determine what kinds of resources these people would require to maintain an optimal level of adjustment in the community, as well as to describe the possible contribution social services could make in facilitating their discharge. The areas selected for assessment were grouped into two broad categories, (1) the patient's needs which resulted directly from his hospitalization and (2) the personal and social resources which he could employ upon discharge. There are two steps involved in selecting the group for study. First, through the use of a questionnaire submitted to the medical and nursing staff in order to determine which patients were judged to be mentally and physically ready for discharge, and second, from this larger number of patients, through the use of routine sampling procedure, a smaller group was selected for study. This final group was assessed by the clinical team in the institution primarily through the use of rating scales. An examination of the needs and resources of these patients revealed that all of these patients could benefit from the assistance of social work in one or more of the areas evaluated. Although the needs and resources of the group varied considerably, there were some indications that the patient's length of stay had a marked effect upon the type of social work service they could use. Those remaining in hospital for a period of less than two years had usually retained some resources in their former community which could be mobilized to assist them in discharge. On the other hand, the indications for these patients is that they would need an extension of hospital services after they were discharged. The patients who had remained in hospital for a longer period of time, had less need for out-patient hospital services, yet had little in the way of social resources or contacts in their former community to assist them once they had left the hospital. This group also evidenced less motivation for discharge and seemed to regard their hospitalization as a permanent living arrangement. In conclusion, the study points out the need for further definitive assessments of the areas of function of a social worker in an institution where the aged, psychiatrically ill are treated. Also pointed out is the need for social work programme planning in the light of these assessments, as well as the insurance of adequate provisions for further research to help develope it. Treatment programmes in other psychiatric institutions are mentioned, indicating that with the use of more advanced therapies, an increasing number of geriatric patients with mental illnesses are responding to treatment and are, therefore, eligible for discharge. Thus, there is a growing need for social work contributions in planning with the older person who is leaving hospital. Some indications of community concern in planning for these people are cited as evidence of awareness on the part of both the institutions for the geriatric patient and the community that the change from hospital life to community life must be an uninterrupted process. / Arts, Faculty of / Social Work, School of / Graduate

Problems experienced by individuals in institutions tend to be hidden from the public gaze. This is so for inmates of prisons where regulations and bureaucratic structure conceal the daily life situation of prisoners from public view. Anonymity and concealment are enhanced by the widespread misperception of prisoners as an homogenous group. As a result, problems of vulnerable groups, such as people with disabilities, can be ignored. One such group is prisoners with impaired hearing. This descriptive study utilized a multidisciplinary approach to investigate the problems experienced by prisoners within the context of social control. Drawing from selected literature in health, sociology and criminology, the theoretical framework merges the labelling perspective [interactionism] with macro-level theories of social control. The study provides, for the first time, an examination of the percentage, degree and social import of hearing loss in federal prisoners in the Pacific Region of the Correctional Service of Canada. Through the use of survey, audiometric measurement, and interview techniques, an examination was undertaken of the presence and implications of partial hearing loss in inmates of federal penitentiaries in British Columbia. Interview subjects were identified through hearing testing of volunteers in eight federal penitentiaries. Data were gathered through interviews with prisoners with impaired hearing, a comparison group of prisoners with normal hearing, and a selection of custodians. Of 114 prisoners screened, 69% had some degree of impaired hearing, often previously unidentified. Custodians, 86% of the time, labelled behaviours characteristic of the hard of hearing as deviant, and often aggressive, behaviours. Prisoner accounts revealed that failure to test hearing at time of incarceration has harmful effects on performance in programmes and encounters with the justice system. A social activist approach is recommended, to address structural inequalities among prisoners and barriers for prisoners in general. This work indicates that lower-class, lower-status persons may be more susceptible to negative labelling. Prisoners with partial hearing loss, due to the often invisible nature of their condition, are particularly vulnerable to negative labelling. Study recommendations include: 1] Routine hearing screening of all prisoners at time of incarceration. 2] Education of custodians to understand behaviours and communication needs of persons with impaired hearing. 3] A partnership effort between correctional services, the disabled consumer group, and professionals, to improve the situation of prisoners who are hard of hearing. / Graduate and Postdoctoral Studies / Graduate

Evidence-based Medicine (EBM) is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patient. Billions of dollars are spent annually on the conduct of randomized clinical trials (RCT), one type of experiments widely regarded as yielding the most valuable evidence. Yet, the number of studies is growing exponentially, and most experiment results are published only as text-based articles in the medical journal, causing difficulties for both practitioners and researchers in searching, synthesizing, and ultimately, translating the best available evidence to the patient care. To address the problem, I aim to develop a unified information extraction framework for medical evidence, and build novel computational approaches based upon it to make evidence from research more accessible in Evidence-based Medicine. In this dissertation, I (i) present a unified conceptual model and coordinated workflow for evidence representation, (ii) develop open-source NLP tools for supporting EBM tasks (evidence extraction, retrieval, and synthesis), (iii) develop a medical evidence base to cater various information needs, and (iv) present a new machine reading comprehension model for answering clinical questions.

Precision medicine is defined as the use of genomics and big data approaches to health to better tailor the diagnosis and treatment of disease to patients. Precision medicine was conceived in the National Research Council’s 2011 report Towards Precision Medicine and was picked up by the Obama Administration in its 2015 launch of the Precision Medicine Initiative. Central to this is the All of Us Research Program, which seeks to sequence the genomes and conduct a longitudinal study of 1 million individuals to advance knowledge about various health outcomes. Precision medicine has been taken up by governments and organizations around the world, notably in China, where the term was incorporated in national plans in 2016 such as the 13th Five Year Plan and Healthy China 2030. Precision medicine became a “key strategy”, and a large amount of funding was pledged to finance the start of precision medicine projects at a range of research organizations, such as the Chinese Academy of Sciences and BGI. My dissertation investigates why precision medicine attracted the attention of scientists, policymakers, and clinicians in the 2010s. It also traces how the precision medicine bandwagon gained so many allies globally, and what precision medicine means for stakeholders located at different positions in the emerging field. To answer these questions, I apply the concepts of global field and scientific capital to trace the emergence of precision medicine at the global and national levels. My argument analytically distinguishes between global scientific capital and national scientific capital in order to show how varying combinations of scientific capital orients actors towards different goals and priorities of precision medicine. More generally, I demonstrate how hybrids and “off-label” forms of science appear in the process of scientific globalization. In the introduction of the dissertation, I look to Bourdieu’s writing on scientific fields to lay out my theoretical framework of fields and capitals as it applies to global science. The dissertation is then organized into three substantive chapters. In Chapter 1, I trace the emergence of the global field of precision medicine drawing on two sources of data: first, a bibliometric analysis of scientific publications in precision medicine, and a further analysis of the key institutions and actors behind its global push. This chapter charts the contours of the global scientific field of precision medicine and the logics of accruing global scientific capital. In Chapter 2, I examine the differentiation of the national field of precision medicine in China from the global field, and trace the logics of accumulation for a national scientific capital. In this chapter, I draw on documentary analysis to tell the recent history of genomics in China, as well as interviews with scientists and participant observation of scientific conferences. In doing this, I shed light on two hybrid forms of precision medicine in China: Chinese Precision Medicine or the use of genomics to identify “Chinese DNA” and to cure “Chinese diseases”, and Precision Chinese Medicine or the use of genomics to open the “black box” of traditional Chinese medicine. In Chapter 3, I take the case of genetic talent testing in China to show how precision medicine is understood by the public. Making use of social media data, and a content analysis of news articles and marketing material, I argue against the “deficit model” of science used to paint parents who use genetic talent tests as scientifically illiterate. Instead, I show how this “off-label” use of genomics responds to broader social, political, and economic pressures of parenting in contemporary China, and argue that scientific capital continues to shape the circulation of genetic talent testing as it encounters the public. I conclude with notes on how the imaginary of precision medicine is affecting the practice of precision governance in China and observations of how the ongoing U.S.-China uncoupling may shape global science.

As Medicaid moves toward a system of managed care, Aid for Families with Dependent Children (AFDC) recipients often are assigned to an organization that assumes responsibility for managing their annual receipt of health care. This study reports the results of an investigation into the patterns of medical care utilization by AFDC recipients and their children under reformed Medicaid. The issues explored include whether or not medical care utilization patterns vary by race, and if there are identifiable factors that determine the utilization patterns of AFDC recipients and their children. We conclude that racial differences in medical care utilization do exist for AFDC recipients, but not for their children. Policy makers involved in reforming Medicaid should recognize that certain cohorts continue to exhibit undesirable medical care utilization patterns, and implement measures to rectify this situation.

Individuals with Down syndrome have an increased risk formany conditions, including cardiovascular disease, cancer, infections, and osteoporosis, and endocrine, neurological, orthopedic, auditory, and ophthalmic disorders.They also are at increased risk for abuse and human rights violations and receive fewer screenings and interventions than the population without Down syndrome. In this literature review, the most common health conditions associated with Down syndrome are examined, along with the topics of sexual abuse, menstrual hygiene, contraception, and human rights. Clinical guidelines for this population are summarized in an effort to assist practicing physicians in improving their provision of health care to the adult patient with Down syndrome.

Include bibliographical refrences / Aim: The aim of this study is to determine the level of perceived and actual knowledge of Cape Town emergency care personnel when dealing with children who acutely disclose incidents of sexual abuse. Method: Operational EMS personnel and emergency medicine registrars in emergency centres located in the Cape Town metropolitan area were asked to complete a quantitative questionnaire with an optional qualitative portion. Informed consent was obtained and the participants' anonymity was guaranteed. A total of 120 voluntary participants - made up of 30 doctors, 30 Advanced Life Support personnel, 30 Intermediate Life Support personnel and 30 Basic Life Support personnel - took part in the study. Findings: This study reveals that EMS personnel and emergency medicine registrars believe that they are inadequately trained and equipped to deal with situations in which a child discloses abuse. They remain capable of treating physical injuries but feel inadequate, frustrated and helpless when confronted by incidents of child abuse. The current EMS syllabus (with particular reference to its teaching and application in the Western Cape metropolitan area) is limited in the coverage of this subject. The syllabus only addresses types of abuse and how to treat the physical injuries relating to abuse, leaving many gaps in the knowledge of medical personnel. With specific reference to sexual abuse, there is a paucity of information in the syllabus relating to how children who disclose their experiences of abuse should be managed. The current training syllabus does not include any information that could lead to an understanding of disclosure, the manner in which it evolves, why children are not always forthcoming with disclosure and more importantly, what to say to children when they disclose abuse. Conclusion: When EMS personnel are called to a scene of child abuse they are uniquely first person the child encounters directly after the abuse is frequently an EMS member. This person is afforded a unique opportunity to observe the behaviour of the victim as well as that of the child's caregivers. They are also able to corroborate the mechanism of injury and verify aspects of the story as given to them by the caregivers, thus being more easily able to identify situations of suspected child abuse. More comprehensive training is required to enable EMS members to effectively and confidently deal with cases involving suspected or confirmed child abuse as well as disclosures of abuse by the patient.

Thesis (M.S.)--Boston University

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No description available.