Background and Rationale: Rural Hispanic Veterans in the Southern Arizona region with type 2 diabetes mellitus (T2DM) are at risk for diabetes related complications. The Southern Arizona Veterans Administration Health Care System (SAVAHCS) care coordination home tele-health (CCHT) program serves as a useful tool in T2DM management in addition to services through primary care. CCHT has not been evaluated to determine effectiveness in this uniquely vulnerable demographic - rural Hispanic Veterans with T2DM in the Southern Arizona region. Purpose: The purpose of this DNP project was to evaluate the effectiveness of a nurse managed and nurse ran program known as the SAVAHCS CCHT T2DM program in achieving successful diabetes self-management and related biological measures among male and female Hispanic veterans who reside in rural Arizona counties and receive their health care through SAVAHCS. Project Aims: Aim I: Evaluate the effects of the SAVAHCS CCHT T2DM program among rural Hispanic veterans on the biological measure of glycosylated hemoglobin A1C (HbA1C) at three different time periods, initially at admission, three months after admission, and six months after admission. Aim II: Evaluate the effects of the SAVAHCS CCHT T2DM program among rural Hispanic veterans on the other quality measures of diabetes management including Body Mass Index (BMI), blood pressure (BP) and low density lipoprotein (LDL) cholesterol at three different time periods (see Aim I). Methods: A descriptive study design was used to evaluate the SAVAHCS CCHT program. The Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation in Public Health was used to examine the effectiveness of the tele-health program. Data were collected from the Veterans Health Administration data warehouse. Biological measures were collected and analyzed at three different time points. Results: Descriptive data analysis of the veterans (n=12) demonstrated minimal intervention improvement of 0.1 units on A1C (8.3% of veterans), BP (16.7%) and BMI (16.7%). Due to missing data the results may not be due to the CCHT program but to structure and process issues related to collection of reliable data. A more robust program evaluation is recommended.

After the forced sterilizations of low-income and minority women were exposed in the 1970’s, new Medicaid policies were put into place in order to protect vulnerable populations. The revised policy included a mandatory consent form and a waiting period of 30 days between consent and procedure, as well as a presentation of the form at time of procedure. Although these policies were enacted to protect vulnerable populations, research has shown they are ineffective and act as barrier to women receiving the post-partum tubal sterilization that they desire. The policy has been shown to have a disproportionate detrimental impact on minority populations, and it has created a two-tiered health care system in terms of sterilization. The unfulfilled requests lead to many inadvertent consequences, including higher rates of unintended pregnancies, abortions, loss of self-efficacy, and higher costs for the Medicaid system. In order to ensure equitable treatment of Medicaid patients in regards to tubal sterilization, the 30-day waiting period should be rescinded. Additionally, to confirm that patients are fully knowledgeable of the implications of the tubal sterilization, the form and any ensuing consent should be rewritten to meet literacy standards for the target demographic. This analysis will include a history of the issue, an examination of relevant research, a policy analysis and recommendations to enhance healthcare equity.

abstract: The transition experience for students who are transferring from community college to university can be an overwhelming experience for any typical student, but can be even greater for students with vulnerable backgrounds. This phenomenological action research study followed the five-month community college to the university transition experience of five students in a scholarship program. The students participated in a three-part intervention in support of their transition experience. Three theoretical perspectives framed the study: community cultural wealth, transition theory, and transfer student capital. This framework enabled me to first identify the strengths the students possessed, despite their vulnerable backgrounds, through participation in individual interviews. The students then participated in pre- and post-focus groups and completed pre- and post-questionnaires. Through these, they identified which transition coping skills were their strongest and which transfer capital they possessed from their community college experience. They also shared how they applied those prior learned skills and capital at the university. This study revealed how these students utilized their strengths at moments when they lacked certain coping skills and transfer capital during their transition experience. One particular strength was how the students accessed the resources of the scholarship program at the center of this study to help them with their sense of the ability to succeed at the university. / Dissertation/Thesis / Doctoral Dissertation Leadership and Innovation 2019

Ce travail vise à étudier la vie des femmes indigènes du Brésil, dans l'État du Mato Grosso do Sul et les femmes indigènes de la communauté Yaqui dans l'État du Sonora au Mexique. Bien que distantes sur le continent américain, ces communautés montrent que la lutte qu’elles mènent, chacune de leur côté, pour la défense de leur territoire et de leurs droits repose sur une stratégie commune de survie. Les conditions de travail dans les champs et l’exploitation qui y est inhérente, les différences de traitements (indigène et femme) rendent la situation des femmes encore plus critique. Aussi, dans une perspective comparatiste, entre les deux nations, Brésil et Mexique, mon travail traitera également de la question du statut des indigènes, des femmes bien sûr, de leur accès à l’emploi. L’intérêt de procéder à une étude comparative entre ces deux communautés et, tout spécialement, d’axer mes recherches sur les populations « vulnérables » qui la composent, à savoir les femmes et de me focaliser sur le thème du travail et, par-là, leur participation au sein du foyer, dans les champs, le travail artisanal… consiste à montrer comment il leur faut désormais assumer de nouveaux rôles, sans pour autant abandonner ce qui fait l’identité de leur ethnie, à laquelle les deux communautés sont très fortement attachées. / This work aims to be a comparative study between the Terena Indians of Brazil and the Yaqui Indians of Mexico, focusing on the indigenous women of both ethnic groups. Although they are far away on the American continent, these communities show that their struggle for the defence of their territory and their rights is based on a common survival strategy. In this way, the conditions of work and exploitation inherent in them are highlighted, strengthened by differences in treatment (indigenous and feminine) that make the situation of women even more critical. In addition, this paper will address the issue of gender relations within and outside communities, relating to the challenges of indigenous women in the 21st century, such as female empowerment and gender equality. The interest in conducting a comparative study and, more specifically, focusing the research on "vulnerable" populations, in this case indigenous women, is to show how they are now taking on new roles without abandoning their ethnic identity.

Este plan de negocios busca impactar en una población vulnerable, que tiene además un nicho bastante atractivo ya que el crecimiento de esta población se viene dando desde hace varios años, inclusive a nivel mundial, pero aun así tiene una oferta bastante limitada de productos y servicios, por lo tanto, cuenta con necesidades desatendidas. Con este proyecto queremos llegar a esta población con un servicio innovador, exclusivo y que brinde toda una experiencia, consiste en ofrecer un servicio de acompañamiento al adulto mayor a nivel de Lima Moderna del NSE A y B, conectando por medio de una página web dinámica y sencilla a adultos mayores con personas que tengan los mismos intereses y gustos, para poder acompañarlos pero de una manera distinta, compartiendo con ellos estos gustos que de cierta manera los vinculan para finalmente ayudar a mejorar su calidad de vida, trabajando en mejorar su salud mental y condición física de una manera recreacional. La presente idea de negocio nace de la necesidad que tienen algunas familias de buscar personas que los ayuden con el cuidado del adulto mayor de la casa porque no disponen del tiempo necesario para el cuidado de este ser tan importante en la vida de cada familia. Esta idea se hace más interesante después de corroborar por medio de un análisis, que no existen empresas que trabajen particularmente en un servicio que vaya más allá de un servicio de simple cuidado supervisando al adulto mayor y a esto se le suma que la mayoría de problemas que sufre esta población se puede mejorar con hábitos activos y saludables. Gracias a un gran análisis del problema detectado y las opciones que se encuentran en el mercado nace MatchCare, un servicio que busca dar más que un servicio de acompañamiento, buscamos generar vínculos con el adulto mayor y aportar a su mejora en su salud mental y condición física, haciendo que tengan una vida activa y feliz, mientras que damos tranquilidad a su familia. / This business plan seeks to impact a vulnerable population, which has a very attractive niche because it has experienced a steady growth for several years worldwide, but still has a fairly limited supply of products and services, leaving needs unmet. With this project, we want to reach this population with an innovative, exclusive service that provides a whole experience. It consists of offering an accompaniment service to the elderly, targeting those who live in the area of Modern Lima of the NSE A and B, connecting them through a web page with other people who have the same interests and hobbies. Through this differentiated accompaniment not only will they share likes that link one another in a certain way, but also help improve their quality of life, mental health and physical condition in a recreational way. The present business idea arises from the need of some families to look for people who help with the care of the elderly at home, because they do not have enough time to look after such an important family member. This idea becomes more interesting after corroborating by means of an analysis that there are no companies that offer beyond a simple care service supervising the elderly. Plus, there is the fact that the majority of problems suffered by this Population can be improved with active and healthy habits. Having detected this problem and analyzing the options in the market, Match Care was born, a service that seeks to give more than an accompaniment service. We seek to create links with the elderly and contribute to a healthy mental and physical condition, promoting an active and happy life, while giving peace of mind to their family. / Trabajo de investigación

Land surface temperature (LST) and mean radiant temperature (MRT) are commonly used as proxies to evaluate urban heat environments. Many scholars use one of them to represent heat exposure when assessing the urban thermal environment. This research fills a research gap by analyzing two meteorological parameters simultaneously through correlation analysis, hotspot analysis, and the distinctive information they respectively express with the results of vulnerable population distribution based on the case of Linköping. Scatter plots are used to explore the correlation between LST and MRT, and hot spot analysis is applied to investigate their spatial patterns through the clusters of hot and cold spots. Furthermore, the distribution of vulnerable populations is assessed and visualized through a vulnerability index. The results show that there is a moderate positive linear correlation between the mean values of LST and MRT for the whole study area. They have different spatial patterns based on the results of the hot spot analysis. The comparison of different meteorological parameters to the vulnerability index also shows variations in high heat risk areas. All of these conclude that LST or MRT could, to some extent, be presented as references to each other; however, they cannot be used interchangeably as proxies for urban heat exposure. When developing urban thermal adaptation strategies, it is necessary for municipalities to select the parameters appropriately according to the purpose and requirements and to understand what the chosen parameters can and cannot convey.

The overarching goal of this dissertation is to examine the spatial, temporal, and modal disparity of access across America. This is achieved by posing three research objectives. The first objective determines the spatial and temporal disparity of transit and automobile access gap, its impact on transit use, and its socioeconomic and built environment correlates. The second objective examines the spatial and temporal disparity of slightly and extremely risky bike infrastructure and measures the social inequity of access to bike infrastructure. The third objective indicates spatial transit access mismatch between high- and low-wage employment across metropolitans. Three findings are discerned. First, the access gap between transit and automobile has a disproportionate effect on African Americans, low-income households, millennials, and car-free households. Second, socially vulnerable communities residing African Americans, Hispanics, and car-free households have the least access to slightly risky bike infrastructure and yet the least prioritized in urban planning and bike infrastructure investments. Third, transit acts as a catalyst to widen spatial mismatch and discriminate socially vulnerable population particularly African Americans and car-free households

<p>The importance of citizen’s psychological need for community, amenities, and the feeling of equitable distribution of the varied impacts from urban change are gaining recognition as important factors in evaluating sustainable urban change. The inclusion of indicators that capture the equitable distribution of urban change impacts are a rare addition to the vast list of sustainability indicator sets available to researchers. Rarer still is the application of Integrated Urban Models (IUMs) and sustainability indicators in assessing the sustainability of land use and transportation policies which impact not only the form and structure of cities, but also the health and wellbeing of the city residents. Using three land use scenarios relevant to the study area: the City of Hamilton, scenarios which simulate alternative residential density patterns, the suburbanization of employment and the closure of elementary and secondary schools are projected into the medium term future using an integrated GIS-based model for simulating the consequences of demographic changes and population ageing on transportation (IMPACT), a sustainability indicator module and a set of indicators measuring the degree to which the urban change is just. The sustainability values generated from the use of IMPACT and SUSTAIN offer valuable insight to the literature related to each scenario. More importantly, the justice indicators add value information as to the impact of urban change on vulnerable population groups. The combination of IMPACT and SUSTAIN offers new avenue and method for future research on the sustainability of urban change.</p> / Master of Arts (MA)

O objetivo neste estudo foi avaliar a relação entre o uso de psicoativos, envolvimento em bullying e problemas relacionados em adolescentes escolares. Trata-se de estudo de corte transversal com abordagem quantitativa. Desenvolvido com 1.192 adolescentes, matriculados do 6º ao 9º ano, de escolas públicas e privadas de um município do sul de Minas Gerais. Seguiram-se neste estudo os aspectos éticos preconizados. Os instrumentos utilizados foram: questionário de caracterização da amostra, Drug Use Screening Inventory e a Escala de Violência Escolar - versão estudantes. Constatou-se que houve predomínio de adolescentes do sexo feminino, com média de idade de 12,9 anos (desvio-padrão=1,3), variando entre 11 e 15 anos, de cor branca, que cursavam o 6º ano do ensino fundamental II, residiam em casa própria, católicos, moravam com pai e mãe, tinham relacionamento familiar classificado como muito bom, frequentavam festas de uma a duas vezes por semana, de escolas públicas e localizadas na zona urbana. Da amostra, 33,1% dos estudantes consumiram algum tipo de droga; 18,3%, drogas ilícitas; 23,8%, álcool; e 5%, tabaco. Quanto ao envolvimento em bullying, 26,4% foram classificados como autores; 33,4%, vítimas; e 10,3%, alvo/autor do fenômeno. O Sistema Familiar e a Saúde foram os problemas mais evidentes na vida dos adolescentes. O uso de drogas foi associado à idade (14 e 15 anos), religião (ateu), bom relacionamento familiar, morar com amigos/instituições, frequentar festa (uma vez ao mês, de uma a duas vezes por semana, e de três a quatro vezes por semana). O consumo de álcool e cocaína foram associados à autoria de bullying, ser vítima e usar algum tipo de droga (exceto álcool e tabaco), enquanto ser alvo/autor foi relacionado à maconha. Adolescentes com características como: ter idade (12 anos), ser ateu e morar em zona urbana aumentam as razões de chances para ser vítima; ter 15 anos e morar na zona urbana, para ser alvo/autor e ter idade de 13 anos para autor de bullying. Adolescentes que foram alvo/autores de bullying apresentaram maiores problemas de comportamento quando comparados aos adolescentes não envolvidos no fenômeno. Os dados fornecem subsídios para tomada de decisão em ações voltadas para prevenção a comportamentos de risco durante a adolescência / The objective of this study was to evaluate the relationship between use of psychoactive substances, involvement in bullying and related problems in school adolescents. This is a quantitative cross-sectional study. It was conducted with 1192 adolescents attending between the 6thand 9thgrade of public and private schools of a municipality in the south of Minas Gerais. The study was in accordance with ethical aspects. The following instruments were used: sample characterization questionnaire, Drug Use Screening Inventory (DUSI) and School Violence Scale - students\' version. There was a predominance of female adolescents, mean age of 12.9 years (SD = 1.3), ranging from 11 to 15 years old, white race, attending 6thgrade of primary education, living in their own homes, Catholics, living with their father and mother, a family relationship classified as very good, attending parties once or twice a week, of public schools located in the urban area.Of the sample, 33.1% used some type of drug, of which 18.3% used drugs except alcohol and tobacco, 23.8% consumed alcohol, and 5% used tobacco. Regarding involvement in bullying, 26.4% were classified as perpetrators, 33.4% were victims and 10.3% were both the victim/perpetrator of the phenomenon. The family system and health were the most evident problems in adolescents\' lives. Drug use was associated with age (14 and 15 years), religion (atheist), good family relationship, living with friends/institutions, attending parties (once a month, once or twice a week, and three to four times a week). The consumption of alcohol and cocaine were associated with being a bullying perpetrator; being a victim with the use some type of drug (except alcohol and tobacco); and being the victim/perpetrator with the use of marijuana. Adolescents with characteristics such as age of 12 years, atheist and who live in urban areas have increased odds of being a victim; being 15 years old and living in the urban area increases the odds of being a victim/perpetrator; and being 13 years old increases the odds of being a bullying perpetrator. Adolescents who were victims/perpetrators of bullying presented greater behavior problems compared to adolescents not involved in the phenomenon. These data provide support for decision-making in actions aimed at preventing risky behaviors during adolescence

O objetivo neste estudo foi avaliar a relação entre o uso de psicoativos, envolvimento em bullying e problemas relacionados em adolescentes escolares. Trata-se de estudo de corte transversal com abordagem quantitativa. Desenvolvido com 1.192 adolescentes, matriculados do 6º ao 9º ano, de escolas públicas e privadas de um município do sul de Minas Gerais. Seguiram-se neste estudo os aspectos éticos preconizados. Os instrumentos utilizados foram: questionário de caracterização da amostra, Drug Use Screening Inventory e a Escala de Violência Escolar - versão estudantes. Constatou-se que houve predomínio de adolescentes do sexo feminino, com média de idade de 12,9 anos (desvio-padrão=1,3), variando entre 11 e 15 anos, de cor branca, que cursavam o 6º ano do ensino fundamental II, residiam em casa própria, católicos, moravam com pai e mãe, tinham relacionamento familiar classificado como muito bom, frequentavam festas de uma a duas vezes por semana, de escolas públicas e localizadas na zona urbana. Da amostra, 33,1% dos estudantes consumiram algum tipo de droga; 18,3%, drogas ilícitas; 23,8%, álcool; e 5%, tabaco. Quanto ao envolvimento em bullying, 26,4% foram classificados como autores; 33,4%, vítimas; e 10,3%, alvo/autor do fenômeno. O Sistema Familiar e a Saúde foram os problemas mais evidentes na vida dos adolescentes. O uso de drogas foi associado à idade (14 e 15 anos), religião (ateu), bom relacionamento familiar, morar com amigos/instituições, frequentar festa (uma vez ao mês, de uma a duas vezes por semana, e de três a quatro vezes por semana). O consumo de álcool e cocaína foram associados à autoria de bullying, ser vítima e usar algum tipo de droga (exceto álcool e tabaco), enquanto ser alvo/autor foi relacionado à maconha. Adolescentes com características como: ter idade (12 anos), ser ateu e morar em zona urbana aumentam as razões de chances para ser vítima; ter 15 anos e morar na zona urbana, para ser alvo/autor e ter idade de 13 anos para autor de bullying. Adolescentes que foram alvo/autores de bullying apresentaram maiores problemas de comportamento quando comparados aos adolescentes não envolvidos no fenômeno. Os dados fornecem subsídios para tomada de decisão em ações voltadas para prevenção a comportamentos de risco durante a adolescência / The objective of this study was to evaluate the relationship between use of psychoactive substances, involvement in bullying and related problems in school adolescents. This is a quantitative cross-sectional study. It was conducted with 1192 adolescents attending between the 6thand 9thgrade of public and private schools of a municipality in the south of Minas Gerais. The study was in accordance with ethical aspects. The following instruments were used: sample characterization questionnaire, Drug Use Screening Inventory (DUSI) and School Violence Scale - students\' version. There was a predominance of female adolescents, mean age of 12.9 years (SD = 1.3), ranging from 11 to 15 years old, white race, attending 6thgrade of primary education, living in their own homes, Catholics, living with their father and mother, a family relationship classified as very good, attending parties once or twice a week, of public schools located in the urban area.Of the sample, 33.1% used some type of drug, of which 18.3% used drugs except alcohol and tobacco, 23.8% consumed alcohol, and 5% used tobacco. Regarding involvement in bullying, 26.4% were classified as perpetrators, 33.4% were victims and 10.3% were both the victim/perpetrator of the phenomenon. The family system and health were the most evident problems in adolescents\' lives. Drug use was associated with age (14 and 15 years), religion (atheist), good family relationship, living with friends/institutions, attending parties (once a month, once or twice a week, and three to four times a week). The consumption of alcohol and cocaine were associated with being a bullying perpetrator; being a victim with the use some type of drug (except alcohol and tobacco); and being the victim/perpetrator with the use of marijuana. Adolescents with characteristics such as age of 12 years, atheist and who live in urban areas have increased odds of being a victim; being 15 years old and living in the urban area increases the odds of being a victim/perpetrator; and being 13 years old increases the odds of being a bullying perpetrator. Adolescents who were victims/perpetrators of bullying presented greater behavior problems compared to adolescents not involved in the phenomenon. These data provide support for decision-making in actions aimed at preventing risky behaviors during adolescence