In recent years Puerto Rico has faced a series of unfavorable events including financial turmoil, massive population loss, earthquakes, and droughts. These events had significantly impacted its resources and capacity to confront a major public health crisis. As such, Puerto Rico was expected to poorly manage the ongoing pandemic. Despite this, nearly all data surrounding the COVID-19 pandemic in Puerto Rico has indicated the contrary. The purpose of this study was to explore and understand the COVID-19 response in Puerto Rico. The Conservation of Resources theory guided the analysis of resource consumption and management of the Puerto Rican government and community level during the year of 2021 which is when most of the disbursement of the COVID-19 vaccines occurred. A Discourse Analysis was used to investigate various national news organizations and wire feeds to acquire information surrounding the reasonings of Puerto Rico's success. The analysis conducted resulted in four themes that explain the reasoning behind the success of Puerto Rico throughout the pandemic; the themes included Distrust in Government, Government Involvement, Depoliticization and Community Involvement. The results indicated that individual and community involvement of the people, their efficient usage of the resources gained by the federal government and nonprofit organizations, as well as their own resources of resilience and social networks, created the success that Puerto Rico has seen throughout the COVID-19 pandemic.

With marijuana use being at an all-time high, it is important to further analyze the factors associated with use. Utilizing the 2015-2019 National Survey on Drug Use and Health (N=205,083), the current study assesses marijuana use among LGB adults, as well as possible mediating (health-related measures) and moderating (criminal legal system exposure) factors. Findings using a chi-square analysis showed that overall, bisexual and lesbian/gay adults were more likely to use marijuana, while those who reported "not sure" were less likely to use. For the mediation analysis, when health measures were introduced to the logistic regression model, the outcome remained the same for all respondents, except for males who identified as gay did not maintain significance. As for those exposed to the criminal legal system, the moderation analysis with logistic regression showed respondents who identified as a lesbian/gay were less likely to use marijuana. Interestingly, when examining only female respondents those who were involved in the criminal legal system and responded to not being sure of their sexual identity had increased odds of using marijuana. This study offers evidence of differences in marijuana use among LGB+ individuals and factors that impact substance use behaviors, having important implications for inclusion of "other" individuals in the LGBTQIA+ as well as the criminal legal system.

On September 20th, 2017, Hurricane Maria made landfall on the island of Puerto Rico causing devastating results. An Island with a history of decades of economic recession, inadequate infrastructure, and a negative effect of a century of colonial rule by the United States, Hurricane Maria unquestionably intensified the catastrophic circumstances in Puerto Rico. (Cons 2017; Torres 2018; Gay et al 2019). The aftermath of Hurricane Maria left thousands homeless and without basic resources in the Island. The study examines the effects of disparate social factors on individual responses to trauma before, during, and after the disaster and illuminates the circumstances affecting migratory decisions and displacement to Central Florida. To accomplish this, I analyzed 16 in-depth interviews about individuals' experiences with Hurricane Maria and subsequent displacement to Central Florida immediately following the storm. First, consistent with the fundamental premise of the Model of Conservation of Resources (COR), the individual's aim to retain, protect, and build resources after a natural disaster significantly affected trauma responses by Hurricane Maria survivors. The storm had a major impact on the individual's ability to preserve, safeguard, and restore critical resources after the storm. Second, individuals use narratives to create meaning, alleviate stress, and increase group identification as coping mechanisms after the traumatic event. Finally, experience with discrimination and prejudice and difficulties with English language proficiency once in the US, affected individual responses to trauma. Overall, pre-disaster social inequalities had a significant effect on trauma responses during and after the storm.

Under realistic scenarios, data are often incomplete, asymmetric, or of high-dimensionality. More intricate data structures often render standard approaches infeasible due to methodological or computational limitations. This monograph consists of four contributions each solving a specific problem within model-based clustering. An R package is developed consisting of a three-phase imputation method for both elliptical and hyperbolic parsimonious models. A novel stochastic technique is employed to speed up computations for hyperbolic distributions demonstrating superior performance overall. A hyperbolic transformation model is conceived for clustering asymmetrical data within a heterogeneous context. Finally, for high-dimensionality, a framework is developed for assessing matrix variate normality within three-way datasets. All things considered, this work constitutes a powerful set of tools to deal with the ever-growing complexity of big data / Dissertation / Doctor of Science (PhD)

Objective: In 2018, 11.1% of American households were food insecure at least once. Annual reports on food insecurity conducted by the United States Department of Agriculture study the prevalence of household food insecurity; however, they fail to conceptualize the consequences that are associated with being food insecure. The objective of this study is to analyze the impacts of food insecurity on academic performance of children currently enrolled in an Orange County, Florida, K-12 public school. Methods: One focus group and 10 one-on-one interviews were conducted with parents who have at least one child currently enrolled in a K-12 public school in Orange County, Florida, to capture the concerns that they have regarding food and their children's academic performance. In addition to this qualitative approach, a quantitative survey was administered to the respondents to measure the extent to which they are food insecure. Results: The data from this study show that food insecurity can impact a child's ability to perform to their fullest potential in school. Mainly parents reported that their household's access to food impacts their children's ability to concentrate in school. Further, more salient findings emerged, such as the costs of living in Orange County, a need for greater government assistance, reliance on outside sources of food to feed their children, transportation issues, and health issues. Conclusion: Sociodemographic factors are known to have an effect on a child's academic performance. The findings represented in this paper suggest that social factors related to poverty disadvantage children in their pursuit of succeeding academically.

In 2017, only 56% of births in Orange County, Florida, received adequate prenatal care - care that has been shown to prevent maternal and infant death. The Florida Department of Health uses the Kotelchuck Index to determine care adequacy. This index rates care adequacy based on when the mother first receives care, and how many recommended appointments she attends. Prenatal care is rated "inadequate" if it starts after the fourth month of pregnancy, and/or if less than half of the recommended appointments are attended. Receiving earlier and consistent prenatal care has been shown to be an effective way to improve birth outcomes. In Florida, counties that have low adequate prenatal care rates like Orange County's tend to be less populous and rural. However, Orange County stands out with its large population of 1.3 million and more urban environment; other Florida counties similar in population and environment to Orange tend to have rates like that of the state's, at approximately 70%. The objective of this study is to determine which factors contribute most significantly to prenatal care inadequacy in Orange, Duval, Hillsborough, Miami-Dade, and Pinellas counties; determine the differences between the most significant factors in Orange County and those in the other four counties; and to determine if residing in Orange County in of itself a risk factor for inadequate prenatal care, using logistic regression. By identifying factors that may lead to low adequacy rates, interventions intended to increase care adequacy in Orange County can be better targeted towards populations in need.

Drawing has long been known to show the thought process of the artist because of its physical immediacy and the way it encourages fast, informal iteration. In contrast the history of programming has been toward a universal language so that common challenges can be addressed in the same way. This MFA Thesis uses the principles of rule-based and generative art to cross the borders between drawing and coding. / Master of Fine Arts

Background: The gap between evidence and practice is an important problem that may, in part, be exacerbated by language barriers. Methods: We surveyed members of the Japanese Society for Fracture Repair regarding their self-perceived familiarity with evidence-based medicine, and barriers to keeping up with evidence relevant to their practice. We subsequently enrolled these same orthopedic surgeons in a randomized trial to explore the impact of providing 20 electronic links to English or Japanese OrthoEvidence summaries on whether surgeons accessed the link. Results: A total of 106 participants were enrolled in the study, and 105 completed the pre-trial survey. Fifty-seven participants acknowledged barriers to adopting EBM; the three most prominent reasons were lack of time (77%), lack of training in critical appraisal (100%), and language barriers (95%). The mean EBM familiarity score on a 4-point scale, higher scores indicating greater familiarity, was 2.59 (standard deviation [SD] 0.38, 95% confidence interval [CI] 2.52 to 2.66). Our randomized trial found no significant difference in the number of evidence summaries that were accessed whether they were provided in Japanese (median 9, interquartile range[IQR] 5 to 15; n = 52) or English (median 3, IQR 2 to 15; n = 53) (p=0.06). Conclusion: Although most Japanese orthopaedic surgeons acknowledge barriers in adopting EBM into clinical practice, and highlighted language as a key barrier, providing evidence summaries in Japanese did not significantly increase the number that were accessed. / Thesis / Master of Science (MSc) / Evidence-based medicine (EBM) incorporates current best evidence into clinical decision-making. The volume of new publications presents a challenge to staying on top of research findings in practice. Further, as most research is published in English, language barriers may hinder adoption into practice by non-English clinicians. We administered a survey to Japanese orthopedic surgeons to assess their familiarity with EBM, and perceived barriers to incorporating EBM into clinical practice. We subsequently conducted a randomized trial to explore the effect of providing electronic links to Japanese or English research summaries to Japanese orthopedic surgeons on whether or not they accessed summaries. Participants endorsed several barriers to incorporating EBM into practice, including lack of time, lack of training in critical appraisal, and language barriers; however, there was no difference in the number of evidence summaries accessed in our trial whether research reports were provided in English or Japanese.

September 20th, 2017 was a devastating day for many Puerto Ricans as Hurricane Maria made landfall in Puerto Rico. A majority of people were left without electricity, water, transportation, and communication between friends and family. In addition, many experienced losses such as destruction of their home and personal belongings as well as the death of family members and friends. This resulted in a decline in mental health. According to previous literature, key indicators of poor mental health in Puerto Rico after Hurricane Maria were increased diagnoses of depression, anxiety, and Post Traumatic Stress Disorder (PTSD). This study provides a comprehensive literature review that examines differences in mental health and trauma between those who, after Hurricane Maria, migrated to Florida compared to those that remained in Puerto Rico. I also used interviews from a previous study and various newspaper articles to answer my research question. Preliminary findings suggest that trauma and anxiety have been identified in both groups. Finally, I was able to interview a mental health counselor from Puerto Rico via Zoom. Findings from the literature review and other data sources explored several contextual differences related to mental health including trauma, PTSD, resilience, depression, anxiety, as well as medical and psychological needs.

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