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INTRODUCTION: The“vulnerable plaque" is defined as the“precursor lesion" that ultimately ends in acute coronary thrombi (clots) that create a heart attack. Macrophages and inflammatory cells, found preferentially in vulnerable plaque, sustain their activity in the plaque through anaerobic metabolism and lactate production. The ultimate goal is to assess anaerobic metabolism in-vivo by measuring tissue pH and lactate concentration in atherosclerotic plaques using optical spectroscopy. The proposed in-vitro optical probe design, experimental method, and spectroscopic data analysis methodology are established in this research. METHODS: A fiber optic probe was designed and built based on both Monte Carlo simulations and bench testing with the goal to collect light from a small volume of tissue. A simulation of the depth penetration of the proposed probe was performed on normal and atherosclerotic aortic tissue, and the final probe was bench tested using normal aorta. A method was developed to preserve plaque metabolic status of tissue harvested from patients. Human atherosclerotic tissue obtained immediately after carotid endarterectomy was placed in Minimum Essential Medium (MEM) with non-essential amino acids supplement, bubbled with 75%O2/20%N2/5%CO2 at 37°C. Tissue pH, pCO2, pO2 and temperature with (n=7) and without (n=2) the media preparation over time were reviewed to assess plaque viability and maintenance of physiological conditions. Additional plaques placed in media were used for development of chemometric methods to measure pH and lactate. Areas of each plaque were randomly chosen for analysis. Reflectance spectra were collected with a dispersive spectrometer (400-1100 nm) and a Fourier-transform near-infrared spectrometer (1100-2400 nm) using the fiber optic probe. Reference measurements for tissue pH and lactate were made with glass microelectrodes and micro-enzymatic assay, respectively. Partial least-squares (PLS) data analysis was used to develop multivariate calibration models on an initial set of 5-6 plaques relating the optical spectra to the reference tissue pH (n=20) or the lactate concentration (n=21) to assess data quality. The coefficient of multiple determination (R2), the standard error of cross-validation (SECV), and the number of factors were used to assess the model performance. Additional points were collected from ~14 plaques and added to preliminary data. Pre-processing techniques were then used to see if preliminary data results could be improved by reducing different sources of variability with the introduction of more points. RESULTS: Monte Carlo simulations and depth penetration tests with the final probe design showed light is collected from ~1 mm3 volume of tissue using a 50 micron source-receiver separation. Tissue pH, pCO2, pO2 and temperature values demonstrated that the plaques were viable and stable in the media preparation for a maximum of 4 hours. Data from the first six plaques collected for lactate analysis showed that for seventeen points, a six-factor model produced adequate results (R2=0.83 SECV=1.4 micromoles lactate/gram tissue). Data from the first five plaques collected for tissue pH analysis, showed for seventeen different points, a three-factor model produced adequate results (R2=0.75 SECV=0.09 pH units). When additional points were added to either data set, model results were degraded. CONCLUSIONS: The in-vitro optical probe design and experimental procedures was established and the feasibility of the optical method demonstrated with preliminary data. However, with the addition of more data points, different sources of tissue and spectral variability were observed to affect calibration. The gross pathology type and mismatched optical volume to reference measurement volume limited the tissue pH determination. The reference measurement precision, the spatial resolution of the reference lactate measurement, and unmodeled tissue variability (water and proteins) limited the lactate determination. Large variability in all optical measurements was observed. Additional in-vitro data collection would be required such that the variability due to the tissue is reduced and any spectrometer variability adequately compensated to be able to use the optical calibration in-vivo.

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

This session will provide practitioners working with children 0-3 information about the importance of and strategies for “bathing” young children in language. Research shows that by age 3 children who live in poverty are likely to have heard 30 million fewer words than their wealthiest peers. For children with disabilities from less affluent homes, this is an important issue. This session will provide practitioners working with these families and/or working directly with these children with strategies demonstrated through video clips on how to envelop these very young children in rich language in order to help close this gap.

Mental illness among homeless populations is a significant public health issue. Community-based programs that assist the homeless are most often developed to meet local housing needs, not the needs of mental health populations. Transitional housing, a model frequently utilized to address homelessness in communities, provides program-based housing with supportive services. The purpose of this study was to examine the associations between participant- and program-level factors on the utilization of community-based transitional housing by homeless veterans diagnosed with a mental illness. The study tested a revised framework of the behavioral model of utilization for vulnerable populations theory. The sample was comprised of male homeless veterans diagnosed with a mental illness who participated in community-based transitional housing programs in 2004 and 2005 (n = 2,502). Data were collected on 288 programs throughout the United States, operated by local nonprofit or local government agencies and monitored by the U.S. Department of Veterans Affairs under the Homeless Providers Grant and Per Diem Programs. Success was defined as either completion of a course of treatment as determined by a master's prepared clinician, or if housing was obtained upon discharge, as reported by the participant. Initial bivariate results indicated that both demographic and situational variables predicted success in transitional housing. However, upon further statistical analyses, limited predictors were revealed. Participants were more likely to be successful if they were white, reported combat experience, were interested in the program prior to admission, and were enrolled in cognitive behavioral models. Participants were more likely to be housed upon discharge if they were white, received some type of public support, were homeless less than 30 days before admission, and showed interest in the program at the time of the initial interview. Participants were less likely to be successful if they were diagnosed as schizophrenic. There was an indication that participants enrolled in programs designated as faith-based were less likely to be housed than those enrolled in secular programs. No statistically significant associations were found between the level of services offered in the transitional housing programs with either successful completion or participants' housing upon discharge.

Introduction: Cigarette preference increases as a function of nicotine content, but preference can be shifted by manipulating cigarette cost. The aim of the present study is to model whether the behavioral-economic metric of unit price (cigarette cost/nicotine content) accounts for cigarette preference shifts and whether preference changes to very low nicotine content cigarettes (VLNCs) are associated with corresponding changes in smoking rate. Methods: 169 daily smokers from populations vulnerable to smoking completed sessions in which choices between smoking normal nicotine content (NNC) (15.8mg/g) and VLNC (0.4mg/g) cigarettes were concurrently available. In Condition 1, choices for both products were available ad-lib at an equal cost of 10 responses/choice. In Condition 2, VLNCs were again available ad-lib at 10 responses/choice, but NNCs were available on a progressive-ratio (PR) schedule wherein response cost (and unit price) increased following each NNC choice (10,160,320…8400 responses/choice). Results were analyzed using ANOVAs and a binomial test (p<.05). Results: Participants preferred NNCs over VLNCs in Condition 1, but shifted preference to VLNCs in Condition 2 (p<.001) immediately before the point in the PR progression where unit price for NNCs exceeded unit price for VLNCs (p<.001). Additionally, this preference shift corresponded with reduced total cigarette consumption compared to Condition 1 levels (p<.001). Conclusions: These results suggest that unit price of nicotine underpins cigarette preference and may provide a metric by which regulators can predict product preference and potentially impact it through policy. These results also demonstrate that VLNCs sustain lower smoking rates than NNCs even under acute laboratory conditions.

Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

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U.S. military service members who are discharged from service for misconduct are at high risk for mental health and substance use disorders, homelessness, mortality, and incarceration. The purpose of this dissertation was to investigate the pre- and post-discharge experiences and characteristics of this highly vulnerable population in order to inform improved prevention and intervention strategies. Administrative data from the Department of Defense and Veterans Health Administration for veterans of recent conflicts were used to conduct 3 related retrospective cohort studies. These included (1) an evaluation of the demographic and military service characteristics and service-connected disabilities associated with discharge for misconduct; (2) an examination of post-discharge health status and healthcare utilization among misconduct-discharged veterans; and (3) the development of predictive models for homelessness and mortality among misconduct-discharged veterans. Several demographic and military service characteristics were associated with increased risk for misconduct discharge, as were exposure to sexual trauma, and post-discharge designation of service-connected disabilities related to mental illness. Misconduct-discharged veterans were found to have significant and complex healthcare needs, and used clinical services at approximately double the rate of routinely discharged veterans. Several risk factors for homelessness and mortality among this population were identified. Risk stratification models showed good predictive accuracy for homelessness, and fair predictive accuracy for mortality. Targeted counter-attrition strategies and an increased focus on health-related determinants of misconduct, including rehabilitative approaches to behavioral problems, may help to reduce misconduct-related attrition. Efforts to transition post-discharge care from specialty settings to integrated primary care settings may be successful in mitigating adverse outcomes. Risk stratification techniques can facilitate the efficient targeting of resources.

Magister Legum - LLM / The Cape Flats is known for poverty, gangsterism, over population and a general lack of basic necessities. What is often overlooked is where this negative perception emanates from. Generational poverty is an existent issue and has been influential in shaping the Cape Flats to what it is today. What this study aims to do, is to provide a background on a possible theory for this typecast that accompanies the areas broadly known as the Cape Flats. The study will show how the Apartheid era created a ripple effect for future generations, and how this may be the cause of these vulnerable groups of children being failed by a system which have long forgotten about them. The study demonstrates how vulnerable groups on the Cape Flats, struggling and pleading for State intervention in the delivery of basic human rights, have fallen on deaf ears. The study further reveals that the State has not fulfilled its constitutional mandate, neither has it lived up to the enabling provisions contained in international instruments which has been adopted by the South African government, and confirms that all three spheres of government have lacked in the accomplishments it set out to achieve upon the adoption of various pieces of legislation, notwithstanding the proclamation of domestic laws to help the State realise its socioeconomic rights obligations. The study was a particularly challenging task to undertake, as research topics on the issue of socioeconomic rights realisation on the Cape Flats is not a well-studied subject. The intention behind the study is to make an important contribution towards awareness of the issue under discussion, paving the way for future knowledge sharing and an open dialogue focusing on the role of the State in the realisation of socioeconomic rights of children on the Cape Flats.