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This project will work closely with existing service partners involved in street level services and focus on testing and evaluating three approaches for street level interventions for youth who are homeless and who have severe or moderate mentally illness. Youth will be asked to choose their preferred service approach:
Housing First related initiatives focused on interventions designed to move youth to appropriate and available housing and ongoing housing supports.
Treatment First initiatives to provide Mental Health/Addiction supports and treatment solutions, and; Simultaneous attention to both Housing and Treatment Together
Our primary objective is to understand the service delivery preferences of homeless youth and understand the outcomes of these choices. Our research questions include:
1. Which approaches to service are chosen by youth?
2. What are the differences and similarities between groups choosing each approach?
3. What are the critical ingredients needed to effectively implement services for homeless youth from the perspectives of youth, families and service providers?
Focus groups with staff and family members will occur to assist in understanding the nature of each of service approach, changes that evolve within services, & facilitators and barriers to service delivery. This work will be important in determining which approach is chosen by youth and why. Evaluating the outcomes with each choice will provide valuable information about outcomes for the service options chosen by youth. This assist in better identifying weaknesses in the services offered and inform further development of treatment options that youth will accept.
Non-adherence to psychosocial and behavioral treatment is a significant public health problem that presents a barrier to recovery and effective treatment. An estimated 20-70% of individuals who initiate psychosocial mental health services discontinue treatment prior to the clinicians’ recommendation. Empirically supported, evidence-based stand alone or adjunctive psychosocial interventions treat an increasingly wide range of mental health conditions; however, a core underlying assumption of most, if not all, interventions is that clients will fully and actively engage in the treatment protocol. While the influence of medication adherence has been more fully investigated, psychosocial treatment adherence has received less scientific attention.
Study aims include: (1) conceptualize and categorize psychosocial treatment adherence, (2) examine predictors that influence adherence to psychosocial treatments, (3) identify treatment response patterns that relate to adherence, (4) summarize measures of adherence, and (5) describe existing interventions to enhance psychosocial treatment adherence.
Peer-reviewed publications on psychosocial and behavioral treatment adherence were searched using Medline and PsycINFO electronic databases between 1980 and 2013.
It is crucial that clinicians and researchers systematically consider the role of adherence in their intervention protocols, including: (1) identifying and assessing barriers that may place clients at higher risk for non-adherence; (2) measuring multiple forms of adherence in their work; (3) addressing identified barriers with their clients; (4) considering factors within their practice or approach that can be modified to reduce barriers to adherence; and (5) adding adjunctive adherence strategies or interventions to prospectively promote psychosocial treatment adherence.
The Anglo-Irish writer Elizabeth Bowen has always presented a problem to critics who have wished to place her. Politically conservative but socially liberated, Irish but English, the author of novels and short stories that are experimental narratives of social life, an heir to both Virginia Woolf and Jane Austen, she wrote deeply strange narratives that can and have been understood as expressions of a permanent self-estrangement. She lived between her two countries, feeling English in Ireland and Irish in England, as one of her friends described her, and was, according to her one-time lover, the writer Sean O’Faolain, ‘heart-cloven and split-minded’ when it came to the question of national loyalty (O’Faolain 1982: 15). She is, in this sense, an intensely complex writer of mediations. How can we understand this ‘clovenness’, this ‘split’, of both body and heart, life and text, in Bowen's work? What are the material and textual ways in which it embodies this mediation?
On the question of nationality, Elizabeth Bowen was Irish by birth and English by marriage. But simply describing her as ‘Irish’ does not tell the whole story; she was Anglo-Irish, a product of the Protestant ascendancy, and grew up in one of the Big Houses that were so often targeted during the troubles, finding themselves at the business end of a torch. Even the label ‘Anglo-Irish’ did not quite suit her; Bowen stresses that her father's family, the Bowens, came from Wales, where they were the ap Owens (the name change occurred early in the reign of Elizabeth I), while her mother's people were ‘pure Irish’ – to the extent an Anglo-Irish family could be Irish-Irish (Bowen 2010: 235). This should be explained to the editors of the 1993 North Cork Anthology, who chose to include Bowen in their table of contents with a line through her name, to underscore their total rejection of her as an Irish writer. This crossing-out is just one example of a lifetime, and an afterlife, of crossings for Bowen, her work and our understanding of her as a cross-Channel writer.
Bowen's ambivalent, ambiguous relationship to Ireland may be typically Anglo-Irish, as the historian J. C. Beckett claims, though it may have been exacerbated by the times in which she lived, challenged by Irish bids for independence and two world wars.
The aim of this article is to show how water emerged as a research method nearby and within a small stream during a 9-month fieldwork carried out with preschool children. The fieldwork was informed and shaped by the preschool children’s and researcher’s situated knowledges and their questions about environmental issues concerning water, absence of water, pollution and ethics. The empirical material consists of films and photos, drawings and field notes, produced together by the preschool children and the researcher during the research. The analysis draws on relational ontology and the writings of Isabelle Stengers and Donna Haraway. The article concludes with a discussion about what can be learnt from the study and its contribution to research within the fields of Early Childhood Education and Environmental Education.
In 1958 Marcel Duchamp and a friend gained access to the modernist poet Mina Loy's apartment on stanton street near the Bowery in New York, so that they could display the art she was storing there in a one-woman show of her assemblage artwork (Burke, Becoming 433–34). The show, which Loy herself couldn't attend since she was unwell and living with family in Aspen, Colorado, was known as the Bodley Gallery Exhibition and generated considerable interest, even drawing the increasingly reclusive Djuna Barnes to its lively opening (434). The show was described by Stuart Preston in a New York Times review as a boxing match between the popular art of the time and “Mina Loy's shocking and macabre big collages, composed most graphically of refuse, and inspired by scenes near the Bowery” (qtd. in Burke, Becoming 434). Loy's dadaist assemblages, Preston's review made clear, were a formidable opponent not only of mainstream art but also of the larger politics of art at the time: the “alliance” they reflected “between Dada and social comment,” he wrote, was “downright sinister,” and they contained a slightly apocalyptic undercurrent of social critique. Loy's artwork incorporated discarded objects, such as bottles and pieces of cardboard, from New York City's liminal spaces—especially the Bowery's alleys and abandoned buildings, places where the homeless and unemployed gathered in desperate conditions. Transporting the gutter to the gallery, this body of work depended on her close relationship to the city's so-called refuse, the homeless people she befriended who helped her collect the objects she recycled as art. It has been almost impossible to know what Loy's body of assemblage artwork—carefully dusted off and hung up by Duchamp—looked like at the Bodley Gallery show. But one fellow Bowery artist, the American photographer Berenice Abbott, had photographed Loy's assemblages. Abbott and Loy had been friends since the 1920s, when they frequented the same art scene in Paris, where Abbott was Man Ray's assistant. Abbott photographed Loy's children, and the two artists are pictured together, along with Tristan Tzara, Jane Heap, and Margaret Anderson, in a famous photograph taken at a party in Constantin Brancusi's studio in 1920.1 In this image, Loy and Abbott fill the center of the frame; Abbott's eyes confront the camera, as if to say, “I know what you're up to,” her confident head emerging over Loy's right shoulder—Loy looking as ethereal as she does glamorous. Their friendship picked up again in New York in the 1940s and 1950s, where it was defined by Abbott's interest in Loy's success and well-being.
OBJECTIVES/SPECIFIC AIMS: I would like to make clinicians aware about prescription opioid use and glycemic control among patients with diabetes. This is a quality of care issue that increases the disease burden for two conditions opioid dependence and diabetic complications. Big data analytics can bring out this quality of care issue and help in changing clinical practice through precision medicine METHODS/STUDY POPULATION: This is a population health study of patients on prescription opioid pain medications in Erie county medical center and local out patient clinic. The electronic data from the hospital records and Outpatient were collected, merged and de identified. The database was saved in a protected environment and made accessible to researchers through a secure login. The data was queried for the number of patients with diabetes. The glycohemoglobin levels were collected and then the analysis was made RESULTS/ANTICIPATED RESULTS: It was found that only 63 of the 89 patients with DPN and 156 of the 570 patients without DPN had any measurement of HbA1c in our data. It was found that 86 out of 156 patients without DPN had suboptimal glycemic control with a glycohemoglobin level > 7% while 36 out of 63 patients with DPN had a glycohemoglobin > 6.7%. The odds of patients with DPN having poor glycemic control is 0.57 while the odds of having poor glycemic control without DPN is.55. The relative risk being 1.03. DISCUSSION/SIGNIFICANCE OF IMPACT: Our population study revealed suboptimal glycemic control among a large set of patients in Western New York with a diagnosis of diabetes mellitus and a concurrent prescription for an opioid pain medication. A significant percentage of patients in our study population with a diagnosis of DPN might benefit in terms of decreased painful symptoms of neuropathy from monitoring and attempting to improve glycemic control. Additionally, in our patient population, there were no patients with diabetic peripheral neuropathy prescribed pregabalin or duloxetine, the first-line FDA-approved medications for painful DPN, Based on our population study, the quality of care for diabetic patients with DPN who are prescribed opioid pain medications should be monitored closely. First-line, FDA approved anticonvulsants and antidepressants should be considered for the treatment of painful symptoms when necessary. Attention should be directed towards monitoring and improving glycemic control in patients without DPN receiving opioid pain medications to attempt to prevent or delay the microvascular complications of diabetes, including the onset of painful peripheral neuropathy.
Workers in Hong Kong made plastic flowers, incense before that, and consumer goods throughout the city's provincial, Imperial, and colonial periods. Kowloon Peninsula's deep harbour and proximity to shipping lanes gave rise to exportoriented industries long before imperialistic conflicts changed their ownership from Chinese to British, and back again. Making things in this context served to define self-motivated enterprise. Hong Kong Chinese people made most of their export goods following a low material investment, labour-intensive model. Workers hand-painted ceramics and toys more often than their employers invested in better plant to replace their work.
OBJECTIVES/SPECIFIC AIMS: Dependence and abuse of prescription opioid pain medication has substantially increased over the last decade. The consistent rise in opioid dependence contributes to the rising prescription drug overdose deaths over the last decade. The study of the distribution and determinants of opioid dependence among patients who are treated with chronic pain medications prescribed by their healthcare providers would aid in answering some key questions about potential abuse and overdose on opioids. The descriptive epidemiology of opioid dependence would help in identifying the vulnerable age group, race, ethnicity, and type of opioid pain medications that more commonly result in dependence. METHODS/STUDY POPULATION: We implemented an Observational Medical Outcomes Partnership/Observational Health Data Sciences and Informatics (OMOP/OHDSI) database, to hold structured EHR data from our Allscripts patient records. We also created a high-throughput phenotyping, natural language processing system that can parse 7,000,000 clinical notes in 1.5 hours. This runs as a web service and provides a modular component based NLP system. After the full semantic parse, we match the content against any number of ontologies. For each match we tag it as either a positive, negative, or uncertain assertion. We then perform automated compositional expressions. The codes are stored in a Berkley database (BDB) NOSQL database and the compositional expressions are stored in Neo4J (a graph database) and Graph DB (a triple store). This flexibility allows rapid retrieval of complex questions in real time. The High-Throughput Phenotyping (HTP) Natural Language Processing (NLP) Subsystem (HTP-NLP) is software that produces, given biomedical text, semantic annotations of the text. The semantic annotations identify conceptual entities—their attributes, the relations they have with other entities and the events they participate in, as expressed in the input text. The conceptual entities, relations, attributes, and events identified are specified by various knowledge representations (KRs) as documented in Coding Sources. Examples of coding sources are medical terminologies [eg, SNOMED CT, RxNorm, LOINC and open biomedical ontologies (OBO) foundry ontologies, eg, gene ontology (GO), functional model of anatomy, OBI, and others]. The annotation results may be displayed or output in formats suitable for further processing. Entity identified is assigned a truth value from 0 to 1. Values from the text are assigned to entities from ontologies such as SNOMED CT. The retrospective analysis of EHR data from local clinic patients was performed using queries on the problem list, demographic data, and medication list of all the patients in the database. The OMOP/OHDSI database was collected from Allscripts EHRs from 2010 to 2015. This common data model helps in the systematic analysis of disparate observational databases of clinic records from the primary care and family medicine clinics in Western New York region. The database contained 212,343 patient records that were parsed and deidentified. Specific research IDs were assigned to each of the patient records and stored in a secure firewall device for data analytics. The entire 212,343 records were queried for opioid dependence from the ICD-9 and 10 diagnostic codes and SNOMED CT codes mapped to both the clinical notes and the problem list for each patient based on the mapped ICD and SNOMED CT codes. In total, 1356 patients were identified as to having opioid dependence. The records were stratified into 7 age groups from age 18 to 28 and ending with age 79–89 years. RESULTS/ANTICIPATED RESULTS: Of the 212,343 patients in the database 1356 patients revealed opioid dependence on the problem list, ICD9-10 codes and prescription opioid pain medication with or without Buprenorphine and Naloxone (Suboxone) in the medication list. The prevalence of opioid dependence in the clinic population was 0.64% (95% CI: 0.61%–0.67%) over a 5-year period. The 7,000,000 patient records generated 750,000,000 SNOMED CT codes (on average 107 codes per record). The highest numbers of opioid dependence were seen in the 29 to 38 years’ age group. That comprised 39.38% (95% CI: 36.78%–41.98%) of the total opioid dependent population but accounted for only 2.03% of whole clinic population in this age group (95% CI: 1.86% to 2.2%). The subjects were then stratified by race and ethnicity. There were 1005 patients with opioid dependence, in the non-Hispanic population (total number 108,402). Among the White non-Hispanic or Latino population with opioid dependence, 41.33% (95% CI: 38.27%–44.39%) were 29–38 years old. The next common age group among the White Non-Hispanic opioid dependent subjects was 19–28 years, comprising of 22.48% (95% CI: 19.88%–25.08%) of the total number of White non-Hispanic or Latino opioid dependent population. Among the total clinic population Hispanics comprise 51.24%, but they comprise only 2.58% (95% CI: 1.74%–3.42%) of the total opioid dependent population. The non-Hispanic population comprise 51.05% of total clinic population while the percent of people who are opioid dependent is 83.26% (95% CI: 83.04%–83.48%) of the total 1356 opioid dependent population. DISCUSSION/SIGNIFICANCE OF IMPACT: The trends of opioid dependence among the clinic population in the study indicate that the prevalence is more in a certain section of the population. The predominance is among the non-Hispanic White population in the 19–38 years of age. The prevalence in younger age implies that the complications related to opioid dependence would be there for a longer duration of time. The prevalence of dependence in this clinic population would be rising if this trend continues. Interventions at curbing prescription opioid dependence is necessary for the vulnerable population. The findings suggest that a broad based approach is necessary to address this problem. The distribution of opioid dependence in this patient population indicate the need for special attention to these specific age group and race ethnicities. The young age of many of the addicted patients demonstrate the risks of legitimate opioid prescriptions in leading this age group towards addiction and implies the need for routine screening for substance abuse. The evidence of complications of opioid overdose among long-term opioid users and risk of abuse with other agents including illicit agents makes the need for an approach that uses real-time interventions in addition to effect long-term improvement in addiction rates. A potentially cost-effective approach to implement monitoring programs and clinical decision support tools would be to develop inter operable linkage from the EHRs to the state Department of Healths’ prescription monitoring programs.
OBJECTIVES/SPECIFIC AIMS: To create a new semantically correct high-throughput phenotyping (HTP) platform. To demonstrate the utility of the HTP platform for observational research and can allow clinical investigators to perform studies in 5 minutes. To demonstrate the improved accuracy of observational research using this platform when compared with traditional observational research methods. To demonstrate that patients who have Roseacea are at increased risk of having obstructive sleep apnea (OSA). METHODS/STUDY POPULATION: This population is a set of 212,343 patients in the outpatient setting cared for in the Buffalo area over a 6-year period. All records for these patients were included in the study. Structured data was imported into an OMOP (OHDSI) database and all of the notes and reports were parsed by our HTP system which produces SNOMED CT codes. Each code is designated as a positive, negative or uncertain assertion and compositional expressions are automatically generated. We store the codified data 750,000,000 codes in Berkley DB, a NOSQL database, and we keep the compositional graphs in both Neo4J and in GraphDB (a triple store). Labs are coded in LOINC and drugs using RxNorm. We have developed a Web interface in .Net named BMI Search, which allows real-time query by subject matter experts. We analyzed the accuracy of structured Versus unstructured data by identifiying NVAF cases with ICD9 codes and then looked for any additional cases based on the SNOMED CT encodings of the clinical record. This was validated by 2 clinical human review of a set of 300 randomly selected cases. Separately we ran a study to determine the relative risk of OSA with and without Rosacea using the data set described above. We compared the rates using a Pearson χ2 test. RESULTS/ANTICIPATED RESULTS: We are able to parse 7,000,000 records in an hour and a half on 1 node with 4 CPUs. This yielded 750,000,000 SNOMED CT codes. The HTP data set yielded 1849 cases using ICD9 codes and another 873 using the HTP-NLU data, leading to a final data set of 2722 cases from our population of 212,343 patients. In total, 580 patients had Rosacea;5443 patients had OSA without Rosacea and 51 patients had OSA with Rosacea. Patients with Rosaca had an 8.8% risk of OSA whereas patients without Rosacia only had a 2.6% risk of OSA. This was highly statistically significant with a p<0.0001 (Pearson χ2 test). The number needed to test was only 12. DISCUSSION/SIGNIFICANCE OF IMPACT: HTP can change how we do observational research and can lead to more accurate and more prolific investigation. This rapid turn around is part of what is necessary for both precision medicine and to create a learning health system. Patients with Rosacea are at increased risk of and should be screened for OSA.
Social life is constituted of interactions with others – others whom we must rapidly classify as friend or foe, as trustworthy or not. Gauging another's trustworthiness relies on successfully reading nonverbal signals – signals that have been selected through human evolution to serve precisely such a communicative function. These deeply ingrained signals – some part of our phylogenetic heritage and some part of our socially constructed communication system – form the unwritten “order” for cooperative encounters, enabling both individuals and societies to survive and thrive. Yet paradoxically, the same course of evolution has also remunerated, with greater prospects for survival, those who manipulate and falsely manufacture such signals; in short, those who cheat, dissemble and deceive. Put differently, the course of human development has produced a system of presumably reliable signals of veracity, authenticity, trust and trustworthiness, while simultaneously conferring advantages on sham portrayals of those same signals. The use of dishonest signals is not confined to humans; natural selection has also rewarded sophisticated forms of cheating among all manner of living organisms (Greenfield, 2006). Consequently, these nonverbal signals, many of which are universal and have similarities among other species, are among the most important for humans to produce and read and the most useful for computational methods to detect and track.
In what follows, we foreground those aspects of social signaling related to veracity that have widespread use and recognition. These are the kinds of signals that Burgoon and Newton (1991) identified as corresponding to a social meaning model in that they are recurrent expressions that have consensually recognized meanings within a given community. In this chapter, we first provide the reader background on the nature of the aforementioned signals. Next, we discuss automated methods for human nonverbal communication computing, i.e., methods we used for identifying and tracking such signals. Then, we discuss computer vision technologies using sensors operating in different wavelengths of the infrared band and not only the visible band, which is conventionally used. We conclude with recommendations for promising future research directions where the latest technologies can be applied to this elemental aspect of social signaling.
In this chapter we want to first provide a short introduction into the “classic” audio features used in this field and methods leading to the automatic recognition of human emotion as reflected in the voice. From there, we want to focus on the main trends leading up to the main challenges for future research. It has to be stated that a line is difficult to draw here – what are contemporary trends and where does “future” start. Further, several of the named trends and challenges are not limited to the analysis of speech, but hold for many if not all modalities. We focus on examples and references in the speech analysis domain.
“Classic Features”: Perceptual and Acoustic Measures
Systematic treatises on the importance of emotional expression in speech communication and its powerful impact on the listener can be found throughout history. Early Greek and Roman manuals on rhetoric (e.g., by Aristotle, Cicero, Quintilian) suggested concrete strategies for making speech emotionally expressive. Evolutionary theorists, such as Spencer, Bell, and Darwin, highlighted the social functions of emotional expression in speech and music. The empirical investigation of the effect of emotion on the voice started with psychiatrists trying to diagnose emotional disturbances and early radio researchers concerned with the communication of speaker attributes and states, using the newly developed methods of electroacoustic analysis via vocal cues in speech. Systematic research programs started in the 1960s when psychiatrists renewed their interest in diagnosing affective states, nonverbal communication researchers explored the capacity of different bodily channels to carry signals of emotion, emotion psychologists charted the expression of emotion in different modalities, linguists and particularly phoneticians discovered the importance of pragmatic information, all making use of ever more sophisticated technology to study the effects of emotion on the voice (see Scherer, 2003, for further details).
While much of the relevant research has exclusively focused on the recognition of vocally expressed emotions by naive listeners, research on the production of emotional speech has used the extraction of acoustic parameters from the speech signal as a method to understand the patterning of the vocal expression of different emotions.
The rights of users of copyrighted materials are growing in significance. This is the result of fundamental changes in the creative ecosystem that pull in opposite directions: on the one hand, the flourishing of user-generated content places individual users at the forefront of creative processes, strengthening the need to facilitate unlicensed use of creative materials. On the other hand, digital distribution, cloud computing, and mobile Internet strengthen restrictions on the freedom of users to access, experience, transform, and share creative materials.
These changes necessitate a user-rights approach to copyright law. Users’ interests are often examined through the prism of Limitations and Exceptions (L&E) to copyright. However, this narrow view overlooks the users’ critical role in serving the goals of copyright law and may therefore ultimately lead to inefficient outcomes.
A user-rights approach holds that permissible uses under copyright law should be articulated and treated as rights. It deviates from the L&E approach at the theoretical level, with some potential doctrinal implications. At the theoretical level, this approach shifts the locus of copyright analysis from author’s rights to the creative process, emphasizing the role of users as partners in promoting copyright objectives. Rather than being “parasites” that benefit – unjustly – from limits on the just rewards of authors, users actively participate in promoting the creation, dissemination, and use of cultural works. A user-rights approach further suggests that to achieve its goals, copyright law should be drafted, interpreted, and applied in ways that consider the rights and duties of both users and authors. Permissible uses that serve the objectives of copyright law should therefore be defined as rights rather than as a legal defense.
133The purpose of this chapter is to offer a theoretical framework for developing a jurisprudence of user rights. It demonstrates how the recognition of the role of users in promoting the purpose of copyright law could change our perspective on the scope of copyright protection and what should be considered permissible use. The user-rights approach does not purport to offer a detailed prescription on the desirable level of unlicensed use. It does offer, however, a theoretical framework for deciding what should be the scope of permissible use in each particular case.
Processes governing the evolution of planetesimals are critical to understanding how rocky planets are formed, how water is delivered to them, the origin of planetary atmospheres, how cores and magnetic dynamos develop, and ultimately, which planets have the potential to be habitable. Theoretical advances and new data from asteroid and meteorite observations, coupled with spacecraft missions such as Rosetta and Dawn, have led to major advances in this field over the last decade. This transdisciplinary volume presents an authoritative overview of the latest in our understanding of the processes of planet formation. Combining meteorite, asteroid and icy body observations with theory and modelling of accretion and orbital dynamics, this text also provides insights into the exoplanetary system and the search for habitable worlds. This is an essential reference for those interested in planetary formation, solar system dynamics, exoplanets and planetary habitability.