This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (<18 years of age) from 2011. One state from each of the nine US census regions with substantial rural representation and varying degrees of community vulnerability was selected. An area deprivation index was constructed and used in conjunction with rurality to examine differences in the rate of ACSC hospitalizations among children in the sample states. A mixed model with both fixed and random effects was used to test influence of rurality and area deprivation on the odds of a pediatric hospitalization due to an ACSC within the sample. Of primary interest was the interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes.

The City of Ottawa is situated in an area known as the Champlain Sea, 17,000 years before present (BP) the entire area was covered with sea water. This area deposited marine clays which are known to be highly sensitive. The City of Ottawa needs to expand land use to allow for the expansion of infrastructure and housing to support its growth. This study is intended to assist the City of Ottawa’s geotechnical engineers in their decision-making by identifying future sensitive areas prone to landslides due to rainfall based on future climate model data. The project incorporates rainfall intensities from downscaled climate model data in the Transient Rainfall Infiltration and Grid-based Regional Slope-Stability (TRIGRS) model to investigate areas sensitive to landslides, then within a GIS platform, the future landslide susceptibility maps were created based on Factor of Safety (FS) values showing the areas prone to landslides. The data input for the model includes climate model data, topography, hydrogeology, geology and geophysical data obtained from a previous study. These data were prepared using ArcGIS software and converted into ascii format for TRIGRS model. The model was calibrated using historical rainfall intensities and validated by comparing to historical landslide areas. Sensitivity analysis were performed to ranges of geotechnical properties found within sensitive marine clays in the area to find the values best to create the ideal scenario, normal scenario and worst-case model scenario for the prediction. Rainfall intensities from projected climate data Intensities Duration Frequency (IDF) of 10 years and 50 years returning period and rainfall intensities of 12 hr, 24 hr, and 48 hr were selected for the model. Results from simulations find the projected climate rainfall intensity do not have impact or has minimal impact to slope stability in sensitive marine clay areas in Ottawa directly. However, higher rainfall runoff is expected from projected rainfall RCP8.5 than the RCP4.5. The infiltration rate remains constant throughout each simulation, which is the same value as the hydraulic conductivity. The time when the slope becomes unstable varies depending on initial water levels. Results from the ideal and normal scenario show no areas prone to slope failure after 48 hours of rainfall duration. However, the factor of safety decreases as the rainfall duration increases and is expected to decrease with longer rainfall durations. The worst-case scenario shows some areas prone to slope failure (FS < 1) with 2% probability of slope failure at 48 hours of rainfall duration. The distribution of these unstable areas are located along the Ottawa River, Rideau River, Carp River, Mississippi River and valleys along their tributaries, the majority of the area prone to slope instability from rainfall are in the east part of the City of Ottawa. While there are many uncertainties and limitations which contribute to the model results, this study is useful to engineers and planners in initial implementation of mitigation strategies to mitigate the damages and cost from landslides events. The susceptibility maps can also assist in decision making for planners in developing into these areas.

South Africa has one of the world’s highest burdens of TB, HIV/TB co-infection, and drug-resistant TB. Second-line TB treatment is less effective, more expensive, and more toxic than treatment for drug-sensitive TB. Nearly 1 in every 5 persons who starts treatment for drug-resistant TB in South Africa will die; 1 in every 3 persons who survives treatments experiences permanent, profound hearing loss. For decades there was little progress in TB research, however, and so treatment with old regimens continued despite safety concerns. In 2012 the US and European regulatory authorities approved a new drug, bedaquiline, but only for treatment in cases with no other options. In 2015, the South African Medicines Control Council approved bedaquiline for drug-resistant TB, but only a limited number of doses were approved in the 2016/2017 annual budget and the focus, again, was only for the patients who had no other options. In order to inform policy makers in planning and budgeting for drug-resistant TB treatment, the aim of this thesis was to determine whether the simple calculation that bedaquiline was too expensive relative to standard regimens using kanamycin was too simple. Particularly, given the high burden of adverse drug reactions (ADR) associated with kanamycin, would the inclusion of the cost and burden of ADR affect the incremental cost effectiveness ratio of a new treatment regimen where bedaquiline replaces kanamycin? Analysis of the national drug-resistant TB case register showed that mortality during second-line treatment was early, primarily in the first 6 months of treatment, even when patients do not have extensive drug resistance. HIV-positive patients not on anti-retroviral therapy (ART) at initiation of drug-resistant TB treatment have the highest risk of mortality. The high early mortality is a real risk that clinicians have to balance when deciding to initiate ART and effective second-line TB treatment both as quickly as possible. Daily injections coupled with taking more than 10 pills each day are a heavy burden for patient compliance, but also pose concerns in terms of overlapping and compounding toxicities; this burden was confirmed through a meta-analysis of the pooled frequency of adverse events among cohorts with at least 25% of the patients HIV-positive. A competing risk analysis of a cohort of drug-resistant TB patients from Johannesburg – addressing the reality that patients may not have experienced an ADR because they died rather than because they were at lower risk – indicated that HIV-infected patients who are not yet stable on ART and second-line TB treatment are at the highest risk of ADR. A Markov model built and parameterized using the data from the South African national TB programme indicates that bedaquiline for all drug-resistant TB led to a small gain in effectiveness at a cost that was under the costs of the drug itself, due to savings from daily injection visits. While cost-effective, it was not clear that South African policy makers needed to move beyond the offer of bedaquiline for patients with extensive drug resistance. However, the calculation, and the decision point, were different once the costs and disability associated with ADRs was included in the analysis. Bedaquiline-based regimens offer a cost-saving and more effective alternative to an injection-based regimen for drug-resistant TB patients treated in the public sector in South Africa.

Abstract Sleep Apnea (SA) is a common disorder that affects approximately 2% of middle-aged women and 4% of middle-aged men. It is characterized by repetitive cessation of breathing during sleep. SA has significant health and social consequences such as daytime sleepiness, impaired quality of life, and in the worst case, myocardial infarction and sudden cardiac death. It has been estimated that approximately 80% of individuals with moderate to severe SA syndrome have not been diagnosed. The lack of patient sleep histories has caused low identification of SA and referral rates, especially in primary care facilities. Moreover, due to the inadequate prevalence of overnight polysomnography (PSG) as a standard clinical test of SA, patients suspected of having this sleep disorder have to wait several months for diagnosis and treatment. The costly and time-consuming nature of PSG and the lack of sleep clinics have created a demand for suitable home-based health monitoring devices. Over the years, several devices have been developed to monitor sleep unobtrusively, while an individual is lying in bed. However, most of these devices would either disrupt the sleep of the patient or be disrupted by the patient during routine bed sheet changes. Pressure measurement using a Pressure Sensitive Mat (PSM) enables a non-contact approach for monitoring patient vital signs such as respiration rate. The PSM has the potential to replace obtrusive breathing sensors in the sleep lab and to be used as a pre-screening tool for patients suspected of having sleep apnea. This thesis proposes multiple algorithms applicable to PSM in order to assess sleep quality. First, fusion techniques are proposed to extract a breathing signal from PSM. Second, a wide range of machine learning approaches including a simple threshold-based algorithm, a linear support vector machine (SVM) and two deep learning methods (i.e., a temporal convolutional network (TCN) and a bidirectional long short-term memory (BiLSTM) network) are compared to find a good- iii performing method for automatically detecting central sleep apnea (CSA) events from PSM signals. The results show that the accuracy of the model with the best performance is 95.1% and it is achieved by the BiLSTM network. Finally, by applying SVM, personalized systems are optimized to investigate long-term sleep pattern changes such as central apnea index (CAI), bed occupancy (BO), day-clock, and night-clock from previously recorded data.

Research tools to identify sensitive topics and thus new opportunities to design for have grown in popularity in the last twenty years within HCI, with many projects and areas to note. However, the research tools used are still underdeveloped (Crabtree, 2003), and many universal designs of the 20th century have failed to develop for more sensitive areas, bar the conventional young, non-disabled, white, cis-male (Clarkson, 2003). The topics discussed in the thesis are reviews and arguments for the use of an adapted cultural probe’s place to research sensitive topics, identify perhaps previously hidden “sensitive-HCI” (Waycott et al. 2015) design spaces. The focus is on the tools to gather data, and discover design opportunities, rather than the particular and actual findings from the study.

Background: The pervasiveness of hypertension (HTN), morbidity, and mortality in Haitians immigrants are frightening. Nonadherence with hypertensive medications, disease management, lifestyle modifications, and cultural and spiritual beliefs, including prayer; faith healing; use of herbal teas; and a diet that is deficient in potassium, rich in sodium, high in fat, cholesterol, and carbohydrates result in increased prevalence of HTN and disability in the Haitian community. Purpose: The purpose of this quality improvement project was to examine the existing system for adherence to hypertensive medications, standardized clinical practice guidelines, identify patients at risk for nonadherence to hypertensive medications, disease management, medical follow-up, and incorporate standardized clinical guidelines into existing medical practice at a primary care office. Theoretical Framework: Theory of transnationalism was used. The transnationalism theoretical framework presents the impact of migration and transnational activities on the health of immigrants. Methods: The mixed model research with exploratory design was used. Results: The implementation of the resource guide was effective as evidenced by improved blood pressure readings and increase adherence to hypertensive medications as well as follow-up appointments. Conclusion: The prevalence of HTN in Haitian immigrants necessitate a different approach to health care delivery. Health care providers need to be aware of Haitian culture to deliver culturally competent care to improve health outcomes in Haitian immigrants.

Background: Data analysis for biomedical research often requires a record linkage step to identify records from multiple data sources referring to the same person. Due to the lack of unique personal identifiers across these sources, record linkage relies on the similarity of personal data such as first and last names or birth dates. However, the exchange of such identifying data with a third party, as is the case in record linkage, is generally subject to strict privacy requirements. This problem is addressed by privacy-preserving record linkage (PPRL) and pseudonymization services. Mainzelliste is an open-source record linkage and pseudonymization service used to carry out PPRL processes in real-world use cases. Methods: We evaluate the linkage quality and performance of the linkage process using several real and near-real datasets with different properties w.r.t. size and error-rate of matching records. We conduct a comparison between (plaintext) record linkage and PPRL based on encoded records (Bloom filters). Furthermore, since the Mainzelliste software offers no blocking mechanism, we extend it by phonetic blocking as well as novel blocking schemes based on locality-sensitive hashing (LSH) to improve runtime for both standard and privacy-preserving record linkage. Results: The Mainzelliste achieves high linkage quality for PPRL using field-level Bloom filters due to the use of an error-tolerant matching algorithm that can handle variances in names, in particular missing or transposed name compounds. However, due to the absence of blocking, the runtimes are unacceptable for real use cases with larger datasets. The newly implemented blocking approaches improve runtimes by orders of magnitude while retaining high linkage quality. Conclusion: We conduct the first comprehensive evaluation of the record linkage facilities of the Mainzelliste software and extend it with blocking methods to improve its runtime. We observed a very high linkage quality for both plaintext as well as encoded data even in the presence of errors. The provided blocking methods provide order of magnitude improvements regarding runtime performance thus facilitating the use in research projects with large datasets and many participants.

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第18074号 / 理博第3952号 / 新制||理||1569(附属図書館) / 30932 / 京都大学大学院理学研究科物理学・宇宙物理学専攻 / (主査)教授 谷森 達, 教授 鶴 剛, 准教授 市川 温子 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(地球環境学) / 甲第19875号 / 地環博第149号 / 新制||地環||30(附属図書館) / 32911 / 京都大学大学院地球環境学舎地球環境学専攻 / (主査)教授 藤井 滋穂, 教授 岡﨑 健二, 准教授 西前 出 / 学位規則第4条第1項該当 / Doctor of Global Environmental Studies / Kyoto University / DFAM

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