Recent increases in opioid overdose rates have changed the role of first responders on the front lines of this national crisis. The present study used a semi-structured qualitative interview to investigate how the increase in opioids, opioid-related harm, and opioid-related death within Tennessee has affected the first responder population. Law enforcement officers, firefighters, and paramedics (N = 30) from rural-serving counties in Tennessee completed a semi-structured interview. Eight themes emerged from the interviews: (1) mental health symptoms, including posttraumatic stress disorder and secondary traumatic stress symptoms; (2) coping behaviors; (3) available resources; (4) barriers to accessing resources; (5) recommendations for what is needed; (6) hardest circumstances; (7) discrepant thoughts and feelings; (8) perception of role in reducing the impact of the epidemic. This study provides novel insights into the impact of the opioid epidemic on Tennessee first responders, and can inform future efforts to reduce adverse outcomes in these care providers.

Background: Digital transformation was a process that most companies in the digitalage nowadays must go through. However, the global economy was dreary due to theabrupt epidemic, which let companies around the world were facing challenges forchange. Meanwhile, as the major economy, China was the only country in the worldthat keep economy increasing during the epidemic. Purpose: The purpose of this research is to answer the question of how Chinesebeverage stores have formulated strategies for digital transformation amiduncertainties caused by the epidemic. The research results should be able to be usedby various organizations within the industry to develop effective strategies during theepidemic. Method: This thesis was conducted by qualitative research with interpretivism. Themulti-case approach is used for analysis, semi-structured interviews with eightbeverage store managers were obtained in Chinese. Conclusion: The finding of this research suggested that: in order to transformdigitally successfully, enterprises need to complete the three key factors: evaluatingthe conditions, implementation, and forming mode, under 2 specific preconditionswhich are the driving force of the times and the impact of the epidemic on the overallbusiness.

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Over the last two decades, the Opioid Epidemic has caused immense harm to communities nationwide. Over 400,000 fatal opioid overdoses occurred in the United States between 1999 and 2017 (CDC, 2019). Professional counselors are among the front-line treatment providers addressing substance use, including Opioid Use Disorders. Professional counselors have a unique professional identity that is built upon humanistic values, a commitment to social justice, and client empowerment. These values align closely with contemporary approaches to substance use treatment, including harm reduction strategies. Harm reduction is an approach to substance use treatment that involves mitigating risks and improving the quality of life of individuals, regardless of their willingness or ability to stop using substances. There are several harm reduction strategies that reduce the risk of fatal opioid overdose or secondary harms of opioid use specifically, including medication-assisted treatment and the distribution of naloxone for overdose reversal. This study examined the acceptability of harm reduction strategies for Opioid Use Disorder among addiction treatment professionals, with a focus on professional counselors. In addition to measuring the level of acceptance of harm reduction for Opioid Use Disorder among professional counselors, counselors were also compared to other professionals who treat substance use. Predictors of acceptability of harm reduction for Opioid Use Disorder were examined based on overlapping components of professional counseling identity and harm reduction philosophy among professional counselors as well. The results of this study provided a baseline for the level of harm reduction acceptance among counselors who treat substance use. Counselors did not have higher levels of harm reduction acceptance for OUD compared to social workers with advanced degrees or bachelor's level substance use treatment providers. Social justice attitudes and empathy were statistically significant predictors of acceptance among counselors. This research indicates that these two factors are key components of counselor identity that explain harm reduction acceptance. The findings of this study highlight a need for more research about harm reduction acceptance for OUD among counselors, including further examination of provider factors that influence acceptance and examination of a broader array of professionals. This research contributed to the understanding of how professional counselors perceive novel approaches for addressing Opioid Epidemic. / Doctor of Philosophy / The Opioid Epidemic is a public health crisis that has led to hundreds of thousands of overdose deaths over the last two decades. Counselors are among the treatment professionals addressing substance use in the United States, including responding to the Opioid Epidemic. Harm reduction is a unique approach to substance use treatment that focuses on keeping people who use substances alive and healthy, regardless of their ability or intent to stop using substances. The current study sought to explore the perceptions of harm reduction strategies for people who use opioids among counselors, including comparing their attitudes to other professionals and exploring the impact of their professional identity. Counselors were not found to be more accepting of harm reduction than other professionals who treat substance use and social justice and empathy were key aspects of counselor professional identity that predicted accepting attitudes towards harm reduction. More research is needed to understand how counselor identity affects harm reduction perceptions.

Most epidemiological systems described in the literature are built for evaluation and analysis of specific diseases, such as Influenza-like-illness. The modeling environments that support these systems are implemented for specific diseases and epidemiological models. Hence they are not reusable or extendable. This thesis focuses on the design and development of an integrated analytical environment with flexible data integration methodologies and multi-level web services for evaluation and forecasting of various epidemics in different regions of the world. The environment supports analysis of epidemics based on any combination of disease, surveillance sources, epidemiological models, geographic regions and demographic factors. The environment also supports evaluation and forecasting of epidemics when various policy-level and behavioral interventions are applied, that may inhibit the spread of an epidemic. First, we describe data integration methodologies and schema design, for flexible experiment design, storage and query retrieval mechanisms related to large scale epidemic data. We describe novel techniques for data transformation, optimization, pre-computation and automation that enable flexibility, extendibility and efficiency required in different categories of query processing. Second, we describe the design and engineering of adaptable middleware platforms based on service-oriented paradigms for interactive workflow, communication, and decoupled integration. This supports large-scale multi-user applications with provision for online analysis of interventions as well as analytical processing of forecast computations. Using a service-oriented architecture, we have provided a platform-as-a-service representation for evaluation and forecasting of epidemics. We demonstrate the applicability of our integrated environment through development of the applications, DISIMS and EpiCaster. DISIMS is an interactive web-based system for evaluating the effects of dynamic intervention strategies on epidemic propagation. EpiCaster is a situation assessment and forecasting tool for projecting the state of evolving epidemics such as flu and Ebola in different regions of the world. We discuss how our platform uses existing technologies to solve a novel problem in epidemiology, and provides a unique solution on which different applications can be built for analyzing epidemic containment strategies. / Ph. D.