Houseboat is the first part of a novel-in-progress set in the coastal town of Apollo, Maine during the Opioid Epidemic.

No description available.

No description available.

In this thesis, health care policy issues for prevention and cure of cervical cancer have been considered. The cancer is typically caused by Human Papilloma Virus (HPV) for which individuals can be tested and also given vaccinations. Policymakers are faced with the decision of how many cancer treatments to subsidize, how many vaccinations to give and how many tests to be performed in each period of a given time horizon. To aid this decision-making exercise, a stochastic dynamic optimal control problem with feedback was formulated, which can be modeled as a Markov decision process (MDP). Solving the MDP is, however, computationally intractable because of the large state space as the embedded stochastic network cannot be decomposed. Hence, an algorithm was proposed that initially ignores the feedback and later incorporates it heuristically. As part of the algorithm, alternate methodologies, based on deterministic analysis, were developed, Markov chains and simulations to approximately evaluate the objective function. Upon implementing the algorithm using a meta-heuristic for a case study of the population in the United States, several measures were calculated to observe the behavior of the system through the course of time, based on the different proposed policies. The policies compared were static, dynamic without feedback and dynamic with feedback. It was found that the dynamic policy without feedback performs almost as well as the dynamic policy with feedback, both of them outperforming the static policy. All these policies are applicable and fast for easy what-if analysis for the policymakers.

Inaug.-Diss.--Bonn. / Vita. "Literaturverzeichnis": p. 95-100.

In order to model epidemics of infectious diseases, particularly to estimate probable numbers of cases with onset at any particular time, it is necessaiy to incorporate a term for the incubation period frequency distribution. Sartwell's hypothesis states that the incubation period frequency distribution for infectious disease is generally a log-normal distribution, based on his examination of disease with short incubation periods. However, it may not apply to diseases with long incubation periods. During the course of an epidemic of a disease with a long incubation period, left and right censoring makes direct observation of the frequency distribution highly unreliable; in addition, time of infection is often unknown. Therefore, for a previously undescribed disease, methods other than direct observation must be employed. One method is to extrapolate from information available for other diseases. In evaluation of Sartwell's hypothesis as applied to diseases with long incubation periods, examination of transfijsion-associated AIDS data was inconclusive. Examination of data for experimental transmissible spongiform encephalopathy (TSE)/prion disease in several species suggests that it may not apply. For natural TSE/prion disease, age at onset is used generally as a 'proxy' for incubation period since infection time is rarely known; the validity of this may vary with the disease type and species being examined. Using this measure, again Sartwell's hypothesis was not confirmed. For both incubation period and age at onset, evidence presented suggests that observed frequency distribution coefficient of skewness is associated with modal age at onset (and thus indirectly with prior age at infection, where appropriate), an earlier modal age at onset resulting in a larger observed coefficient of skewness. The relationship of this association with Sartwell's findings is discussed; they are not incompatible. In addition, an association between observed coefficient of skewness and sample size is demonstrated and the implications discussed.

No description available.

The abuse of heroin and opiates in the Northeast United States has grown to reach epidemic proportions over the past fifteen years. As this epidemic rages on, many victims of addiction are unable to find or afford treatment, and unfortunately, most insurance companies only fund 30 to 60 days of treatment although it can often take that long to clear the drugs from an addict's system. This can lead to a lifelong cycle of recovery and relapse. For a solution to this problem of recovery, many recovery therapists look to Abraham Maslow's Hierarchy of needs. At the peak of Maslow's Hierarchy of Needs pyramid is the need for self-actualization: the desire "to become everything that one is capable of becoming." This "need" aligns with the predominant goal of the mental health recovery paradigm, which is for people to "strive to reach their full potential" (Henwood et. all). It is typically understood how architecture provides for basic physiological needs and safety for people in need, but how might it provide for "upper-level" needs, such as Maslow's concept of self-actualization? This idea of self-actualization relies heavily on the notion of individuality, creativity, and inspiration, so providing a framework for a user to work and create within could be beneficial to their growth and betterment as an individual. According to Kenney Miller, cofounder of the Maine Harm Reduction Alliance, "Using the arts, particularly story telling, may help rehumanize people and empower them to feel they have a voice and they have something worth saying... The more we can empower people in the recovery process, the more successful it can be" (MacQuarrie). Because addiction affects not only individuals, but rather their entire community, providing opportunity for empowerment on a personal scale must be able to lead to empowerment and reconstruction on a community scale as well. In a city such as Lewiston, Maine, which has lost its former textile-making based identity, residents have lost hope for job opportunity and have turned t drug and alcohol abuse as a coping mechanism. A new movement towards arts and skilled crafts has recently erupted in the downtown area, which is starting to bring back Lewiston's Identity as a maker-based community. This thesis will contribute to and solidify Lewiston's maker-based movement forward, while simultaneously looking backward, learning and growing from the scars that history has embedded in the city. It will also focus on the ways in which the physical environment affects not only creativity and self improvement, but the restoration of the human mind from an unhealthy state through internally-focused spaces as well as peripheral links to context and community. / 0 / SPK / specialcollections@tulane.edu

No description available.

Intro: Opioids and their role in medicine, their use and abuse, have become a topic of intense scrutiny and interest over the last several years. Since 1999, the number of opioid overdose deaths has quadrupled, while the amount of prescription opioids sold in the U.S has increased by the same factor. Federal lawmakers, law enforcement, pharmaceutical companies, and investigative journalists have all become involved in what is often called “the opioid epidemic”, a stage where the issues of pain management, drug abuse, regulation, and autonomy are in seeming opposition. Physicians are uniquely positioned on this stage, both as healers and healthcare providers, professionals tasked with managing pain, preventing and treating addiction and overdose, and advocating for the needs of the population they serve. Paradoxically, issues related to pain management, addiction, and abuse are widely underrepresented in the educational curricula of most physicians’ formal training. This study aims to assess the attitudes and knowledge related to opioids in family medicine residents in a rural Appalachian residency program; as well as measure how these attitudes and knowledge change in the cohort after a limited course of education in issues surrounding opioid use, prescription, and abuse. It is our hope that this intervention will edify the residents, and they will feel more prepared to confront issues surrounding opioids as they move forward in their careers. Methods: Residents were given a ten-item questionnaire that assessed their knowledge of current Tennessee and Virginia state laws with regards to the prescription of opioids: The questionnaire also included an open-ended question where residents were asked to express how they felt about prescribing opioids: opinions they had formed, things they learned, things that they wished were different. Responses were uniquely identified by a paired code that abstracted the identity of the respondent from subsequent analysis. After anonymous collection of the completed questionnaire and open-ended response, a 30 minute didactic session was administered by the authors outlining common issues with opioid prescriptions, an overview of current TN and VA state law regarding opioid prescription, clinic policy, and discussion with residents of current thinking regarding best practices. The questionnaire was then administered again, responses were anonymously gathered and paired with their pre-didactic identification number. The responses were then analyzed to assess the impact of the didactic on understanding of current opioid prescribing law, and the open ended responses were examined for common themes in residents’ perception of prescribing opioids while in residency. - Conclusions: In general, short and focused didactic education regarding current state laws regarding opioid prescription appears to benefit residents understanding of how to prescribe opioids appropriately. Residents generally find the processes surrounding opioid prescription challenging, medically and emotionally, and are interested in more education about the topic.