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Compared to their cisgender counterparts, transgender, and gender diverse youth (TGDY) disproportionately experience an increased risk for poor patient safety and healthcare disparities. TGDY report poorer mental and physical health and lower rates of utilization of preventive medicine. These health and healthcare disparities may be due to a lack of access to gender-affirming care – an integrative approach to providing developmentally appropriate healthcare and facilitating conversation and exploration of gender identity with patients and their families in a supportive environment. Gender-affirming care is associated with increased healthcare utilization, quality of life, and decreased rates of depression and suicidality among TGDY. In the United States, TGDY report difficulty finding gender-affirming providers as well as trans-specific healthcare. To meet the healthcare needs of TGDY, in 2018, the American Academy of Pediatrics (AAP) issued the policy statement, “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” to provide clinical practice guidelines for physicians to provide gender-affirming care to youth. However, little is known about physicians’ knowledge, agreement, or perceived barriers to implementing the AAP recommendations. Further, TGDY in rural and fringe urban areas face unique healthcare challenges and experience greater discrimination and negligence in the healthcare setting, such as receiving delayed medical care. The specific aims of this study were: To assess (1a) pediatrician’s knowledge, agreement with, and perceived barriers of the AAP recommendations as well as provision of gender-affirming care (i.e., psychoeducation, patient interaction, providing care in a safe environment, and referrals) and (1b) if this differs based on practice setting urbanization level; to examine the role of provider characteristics and practice setting in explaining the variability in: (2a) AAP policy knowledge; (2b) agreement with the AAP Policy; and (2c) perceived implementation barriers of the AAP policy; and to examine the role of provider characteristics and practice setting in explaining physician’s provision of: (3a) total GAC; (3b) GAC psychoeducation; (3c) GAC patient interaction; (3d) GAC safe environment; and (3e) GAC referrals; when accounting for AAP policy knowledge, agreement, and perceived implementation barriers. In this study, 199 physicians were recruited to participate in an online survey. Findings from this study will inform efforts to improve healthcare safety, accessibility, and equitability for TDGY by informing the future development of a context-tailored, theory-based intervention to promote gender-affirming care in diverse geographical areas.
Facility layout planning can be addressed from several perspectives, such as operational excellence or the well-being of occupants. These two stances are known to be conflicting since an improvement in one is likely to have a negative impact on the other. Some situations might also require additional requirements to be incorporated into the layout plan that can affect its performance. There are three avenues that drive this research because of these issues, including coping with computational complexity, consideration of infectious diseases for layout planning problems, and increasing the applicability of exact methods for layout practitioners. The first research avenue considers a specific layout problem known as the double-row layout problem. By modifying existing formulations in the literature, the number of binary variables are reduced by at least 25%, thus improving the overall tractability. The primary focus of the second research avenue is to assist restaurant owners in maximizing the expected revenue when operating under pandemic conditions in consideration of the probability distribution of party sizes using stochastic programming. For the final research avenue, a two-phase optimization framework is proposed for generating block layouts and aisle networks for further refining the quality of layout alternatives early in the pre-design phase.
The goal of this thesis is to enumerate the number of oriented rational knots and the number of oriented rational links with any given crossing number and minimum genus. This allows us to obtain a precise formula for the average minimal genus of oriented rational knots and links with any given crossing number.
Pressures associated with accountability testing have resulted in a narrowing of both the curriculum and pedagogy that does not meet the needs of high ability learners. This study proposed that either a different measurement (an above-level computer adaptive assessment) or a different model (Tobit model) should be used to more accurately demonstrate high ability student achievement and growth in order to lessen the pressures on teachers and therefore create an environment better suited for high ability student learning. To answer the research questions under study, a two-part design was used. The first part of the study used an above-level assessment and imposed an artificial ceiling at grade-level with the goal of using Tobit modeling to reproduce uncensored growth estimates using censored data. The second part of the study used naturally censored data with the goal of increasing growth estimates through Tobit modeling. Ultimately, the Tobit models using artificially censored data were able to come close to replicating the uncensored growth estimates under certain conditions. The results indicated that Tobit regression was necessary when examining homogeneous groups of high ability students. Finally, the Tobit regression models were able to increase the growth estimates for high ability students using naturally censored data. The degree to which the models increased, and under which conditions the increases existed are described in detail.
Given the key role of parents in the establishment of health habits among children, the current study aims to (1) explore the nature of weight talk among families, (2) understand the correlates and consequences of various forms of family weight talk, and (3) examine the caregiving context (i.e., parenting practices and family wellbeing) as a potential moderator of the associations among parent experiences/beliefs, family weight talk, and child physical and social-emotional health. Parents and their 10- to 12-year-old children responded separately to an online survey assessing family weight talk, child health, and the caregiving context. Parents completed a daily questionnaire about family weight talk for five consecutive days.
Consistent with past research (Berge et al., 2016; Pudney et al., 2019), we found that families engaged in various forms of weight talk over the study period and that this weight talk served a variety of functions. Additionally, this engagement in health and weight-related conversations varied by several parent and child socio-demographic factors, including parent gender, parent and child BMI, race/ethnicity, and parental educational attainment. As expected, more negative parental weight-related experiences/beliefs were associated with more conversations about the child’s, the parent’s, and others’ weight. Health related conversations among families were most strongly related to greater child fruit/vegetable consumption, while weight-related conversations were associated with more snacking, worse quality of life, and worse social-emotional well-being among children. Finally, we found that weight talk can help explain the relations between parent experiences/beliefs and child health outcomes, and that the caregiving context matters for these relations. This work may contribute meaningfully to continued investigation and intervention on how to best support families in working toward greater health and well-being.
The writhe is a quantity calculated from crossing signs of a link diagram. It is known that the writhe calculated from any reduced alternating link diagram of the same alternating link has the same value. That is, it is a link invariant if we restrict ourselves to reduced alternating link diagrams. This is due to the fact that reduced alternating link diagrams of the same link are obtainable from each other via flypes and flypes do not change writhe.
This dissertation introduces new invariants for the class of reduced alternating links. It also analyzes the strength of these invariants, called writhe-like invariants, in comparison to a few general link invariants. It examines how these quantities can be used in solving other knot theory problems. A part of the dissertation is dedicated to describing the computer program that computes a few writhe-like invariants and to reporting on the computed data of several alternating knots and links.
Police departments located in states allowing payday lending report 14.34% more property crimes than the police departments located in states not allowing payday lending. I also find that the police departments located in counties bordering with states allowing payday lending report more property crimes. Those results are driven by the financial pressure induced by payday loans. Furthermore, the impact of payday lending concentrates in areas with a higher proportion of the minority population.
Using a large sample over the period 1986 to 2017, we show that companies with higher exposure to climate change risk induced by sea-level rise (SLR) tend to acquire firms that are unlikely to be directly affected by SLR. We find that acquirers with higher SLR exposure experience significantly higher announcement-period abnormal stock returns. Post-merger, analyst forecasts become more accurate and environmental-related as well as overall ESG scores improve.
In this paper, we examine the impact of shareholder-creditor conflict on firm hedging behavior. We use mergers between corporate shareholders and creditors as exogenous shocks and find a positive causal relationship between reduced shareholder-creditor conflicts and corporate hedging behavior. Specifically, we find that treated firms that experience shareholder and creditor consolidation are not only more likely to hedge using financial instruments, but also hedge more in terms of the notional value of the hedge contract. In a cross-sectional test, we find that the results are stronger for firms in financial distress.
