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Three Chapters in International Macroeconomics: Navigating Risk, Development, and Policy with Emphasis on Low-Income Economies
Get PDFThis dissertation explores how structural vulnerabilities and external shocks interact with economic policy tools in shaping development outcome. Each chapter addresses a distinct dimension of risk—environmental, macroeconomic, and political—and evaluates mechanisms through which these challenges can be mitigated or amplified. The focus on low-income economies ensures their unique vulnerabilities are integrated into the research question, addressing critical gaps in economic literature.
Chapter 1 addresses how the Sub-Saharan African regions can balance sustainability and development. It uses a time-series methodology to estimate the impact of trade in “green goods” on environmental outcomes. It finds that increases in the trade of environmentally-friendly goods reduce environmental effects. This result has implications for policymakers seeking to align economic growth with environmental preservation in resource-dependent economies.
Chapter 2 challenges the assumption that low inflation is always benign for development. Using a nonlinear methodology and updated data, results find that inflation rates negatively impact growth at lower rates of inflation that previously estimated, and even modest inflation rates strongly and adversely affect populations in poverty. The analysis underscores that central banks in these economies face a dual mandate: stabilizing prices is not just about growth but directly protecting vulnerable populations from impoverishment.
Chapter 3 investigates how political risk reshapes financial lifelines for fragile economies through remittances. Remittances respond asymmetrically to global versus domestic political shocks. Migrants increase flows to home countries facing instability, offsetting consumption declines by 0.4% of GDP. This highlights remittances’ unique role as an informal safety net, urging policymakers to leverage these flows in crisis response strategies.
Together, these chapters provide empirical insights into how risk factors affect macroeconomic outcomes with emphasis on low-income economies. The findings highlight the importance of evidence-based policies that recognize the unique constraints and opportunities across the globe
Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative
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Reassessing Hourly Neurological Assessments: A Quality Improvement Initiative
Haley Lynne Johnson, BSN, RN
Background: Stroke and brain injuries remain among the leading causes of mortality in the United States, accounting for 162,890 deaths in 2021 (Centers for Disease Control and Prevention [CDC], 2021). Although frequent neurological assessments are essential for monitoring patient status, limited evidence supports the prolonged use of hourly neuro-checks (LaBuzetta et al., 2022). Excessive neuro-check frequency has been linked to sleep deprivation, an increased risk of delirium, and inefficient resource utilization (Kishore et al., 2021).
Purpose: This project aimed to assess the impact of a nurse-driven neuro-check protocol in the Neurocritical Care Unit (NCCU) by decreasing the frequency of neuro-checks and reducing patient disruptions to help mitigate ICU delirium and enhance workflow efficiency.
Methods: This project was conducted in the NCCU at J.W. Ruby Memorial Hospital, a Level 1 trauma center and Joint Commission-certified Comprehensive Stroke Center. Participants included adult patients requiring neuro-checks and NCCU nursing staff. Data on total patients with hourly neuro-check orders, protocol adherence, usage, patient length of stay (LOS) averages, CAM-ICU delirium scores, and staff workload satisfaction were collected before and after the intervention. Quantitative data were analyzed using Epic’s SlicerDicer software and Excel software, while staff perspectives were assessed through Qualtrics surveys. [HT1]
Interventions: A nurse-driven neuro-check protocol was introduced, allowing for a stepwise reduction in neuro-check frequency, starting with hourly assessments, transitioning to every two hours, and eventually every four hours, depending on patient stability after 48 hours of admission. Patients were eligible if they had an unchanging GCS motor score and were hemodynamically appropriate, as determined in collaboration with NCCU providers. Exclusion criteria targeted patients with spontaneous subarachnoid hemorrhage (SAH) due to the unpredictable risk of rebleeding within 14 days of the initial injury. The protocol was reinforced through comprehensive staff education, Epic integration, and interdisciplinary collaboration to ensure safe and effective implementation.
Results: Hourly neuro-check orders decreased by 19.1% (from 372 to 301) following implementation. CAM-ICU delirium scores showed an 8.1 percentage point drop, with pre-intervention delirium rates at 39.8% and post-intervention rates at 31.7%, indicating a 35.6% relative reduction. The distribution of length of stay (LOS) shifted, showing fewer patients with the shortest (2 days) and prolonged hospital stays (9 days), along with an increase in intermediate stays (5–7 days). Additionally, staff surveys indicated greater confidence in patient safety and improved workflow efficiency.
Conclusions: These findings indicate that a structured neuro-check protocol may decrease assessment frequency, reduce patient interruptions, and lower delirium rates while ensuring patient safety. The results are consistent with research supporting nurse-driven neuro-monitoring methods to enhance sleep hygiene and lessen ICU delirium. Given its practicality and positive effects, the protocol could be sustainable for ongoing use and scalable across critical care environments. Future research might include investigating long-term impacts of decreased neuro checks on cognitive recovery and patient outcomes in ICU settings at multiple hospital sites
Do Dung Beetles Sink or Swim: Exploring Dung Beetle Response to Precipitation
Get PDFGlobal climate change constitutes a major threat to biodiversity and ecosystem services of many taxa. The Mid-Atlantic region of the US is expecting to see an increase in extreme precipitation events and flooding. Dung beetles (Scarabaeinae) can tunnel below the soil surface allowing for water to dissipate into the soil rather than sit on the surface and add to flooding conditions. They also can decrease methane emission by burying dung and reduce outbreaks of pests that prefer the moist environment of dung. They contribute roughly $380 million in ecosystem services annually in the United States, yet their services may be stunted by the rainfall and subsequent flooding they help mitigate. To understand the threshold at which dung beetles can maintain their services during rainfall, in Chapter 2, we captured dung beetles twice a week for 24 h and recorded the precipitation amounts for the 24 h period they were captured. The larger tunneling dung beetles (Scarabaeinae) that nest in the soil below the dung pat, responded negatively to increased rainfall, while there was no effect on dung dwelling beetles (Aphodiinae) that live directly in the pat. In Chapter 3, we conducted a field experiment to understand which species would colonize dung at varying amounts of water starting from the amount used in successful lab breeding, to a full flood state where the dung was completely submerged in water. The results of the field experiment indicate that the month in which we conducted the study had an influence on dung beetles present, as well as the amount of water. We saw negative effects of flooding levels of water on dwelling dung beetles (Aphodiinae) in how they colonized and emerged from the dung. The effect of flooding on dung beetles is particularly important because dung beetles already face declines due to anthelmintic treatments used on cattle in conventional farming. Their services are necessary in combatting the effects of climate change on pastures, and bolstering their communities is paramount in securing viable farmland for the future
Reconciling Tenure and Faculty Accountability
No full textPart of the very identity of the American university is its insulation from society—a crucial contributor, at least in some instances, toward facilitating the search for knowledge and the disruption of established orthodoxies. Yet American higher education does not exist and cannot function separately from societal pressures. This is most obviously true in the context of public institutions that directly rely on state governmental entities for financial support and that may be subject to some mechanisms of control by governmental actors or their appointees. But it is also obviously true in the context of private institutions that may rely on various forms of governmental support, and that are no less subject to the pressures of applicant, student, and alumni preferences—especially if the latter may impact potential financial gifts. Higher educational institutions are thus subject to a duality in their institutional self-image, and they are subject to a continual, uneasy tension between competing pressures to stand apart from and to be more prominent within broader society. My goal in this Article is to illuminate one crucial aspect of this duality by focusing on a topic that is a core part of internal university practices, but that also carries with it a host of broader consequences. Namely, I examine the employment practices regarding tenured faculty members. More precisely, my focus is on the absence of sufficient accountability mechanisms for professional incompetence by tenured faculty members, and I critically assess this concern with an eye toward its potential consequences for the health and vitality of higher educational institutions. Tenure is the most distinctive facet of American higher education compared to other employment contexts. The conventional defenses of tenured employment for faculty members generally focus on the systemic benefits that ensue from it toward the creation and dissemination of knowledge and the laudable goal of seeking to incentivize talented individuals to forego potentially more lucrative careers for the academy. I am persuaded by these arguments. However, I would also assert that tenured employment for faculty numbers in practice has functioned to eliminate sufficient accountability for this privileged subset of the academic community—a striking aberration within the context of American employment that would probably be recognized immediately by nearly anyone who was not a tenured faculty member. In this Article, I highlight the specific cultural and institutional elements that preclude greater accountability for tenured faculty members and offer some plausible pathways of reform that might be capable of both preserving academic freedom protections while also increasing the opportunity for holding tenured faculty members accountable for unprofessional and/or incompetent performance. I proceed as follows: in Section II, I address the conventional arguments about academic freedom which supply the strongest, most principled support for shielding academics from adverse employment consequences. In Section III, however, I discuss the problem posed by professionally incompetent tenured faculty in American higher education and the present-day challenges that especially necessitate some form of remediation. In Section IV, I detail the precise ways in which the scholarly, teaching, and institutional citizenship or service obligations of tenured faculty members may escape appropriate scrutiny and remediation due to various cultural and institutional factors. Finally, in Section V, I offer some suggestions on potential reforms that may provide for greater accountability for the performance of tenured faculty members, while also preserving the academic freedom benefits commonly linked to tenure
Expanding Drug Courts and Alternative Justice Courts in West Virginia: Implementing Innovative and Restorative Justice Practices
Get PDFThe United States has the highest incarceration rate of any country in the world. Alarmingly, West Virginia’s incarceration rate is even higher. West Virginia’s staggering incarceration rate can largely be attributed to the increased criminalization and prosecution of individuals experiencing addiction. This Note considers what actions can be taken to limit incarceration and recidivism in West Virginia. The solutions proposed by this Note also aim to limit the collateral consequences of incarceration in West Virginia because many of West Virginia’s current issues are only exacerbated by incarceration. This Note reviews alternative justice methods and notable alternative justice courts across the United States as a potential path to a solution. From this review, this Note identifies one limitation of many alternative justice courts across the United States, including the drug courts in West Virginia—individuals with the highest risk of recidivism are largely excluded from participation in alternative justice courts. This Note advocates for the expansion of drug courts, alternative justice courts, and restorative justice practices in West Virginia. This Note also advocates for adopting a community court model similar to courts in other jurisdictions that will address the needs of individuals who commit property offenses and quality-of-life crimes. The solutions this Note advocates for are critical to address the problems West Virginia currently faces regarding incarceration, substance use, and the well-being of the state
“A Cruel System Indeed”: Extending the Statute of Limitations for Claims by the Harmed Youth of West Virginia’s Mismanaged Foster Care System
Get PDFThe current statutes of limitations in West Virginia pose a barrier for harmed youth to bring suits to recover. A child who experiences sexual abuse will have 18 years to bring a civil suit. However, a child who experiences another form of abuse (e.g., psychological or emotional abuse) must bring a suit within two years. In a novel argument, this Note proposes that state legislatures, and the West Virginia State legislature in particular, should extend the statute of limitations for civil suits by former foster youth harmed while in state care. A two-year statute of limitations is an insurmountable barrier to relief for many former foster youth due to their unique situation. This Note examines the state of foster care and potential plaintiffs’ avenues to legal relief. Then, it reviews medical research regarding other forms of abuse before comparing child sexual abuse cases with other forms of abuse that children suffer while in state care. Ultimately, this Note concludes that statutes of limitations should be extended for claims based on other forms of child abuse to promote access to justice, prompt institutional reform, and to afford victims time to process their harms before their window of opportunity to sue slams shut
Legalized Sports Betting and Mental Health
Get PDFSince the Supreme Court declared the Professional and Amateur Sports Protection Act of 1992 unconstitutional in 2018, 38 states and the District of Columbia legalized face to face and/or on-line betting on sports. A potential unintended consequence of legalized sports betting is an increased risk for mental health disorders and problem gambling. Using a staggered difference-in differences framework, we exploit variation in timing of adoption of legal sports betting across states to evaluate the impact of these laws on mental health outcomes. We combine data on when states passed laws to legalize gambling with data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2013-2022 for the analysis. The results show that BRFSS participants reported worse mental health in terms of the fraction of the sample reporting one or more bad mental health days, the reported number of bad mental health days in the past month, and the number of people reporting suffering from depressive disorders. Increased access to sports betting reduces mental health. These results can help stake holders to assess the risk of legalized sports betting on mental health
Measuring Activity Demands on Fatigue in Individuals with Parkinson\u27s Disease
Get PDFThe functional presentation of those with Parkinson\u27s disease (PD) are complex, varying depending on cognition, physiological deficits, and support network. This study assesses the perceptions of fatigue across individuals with Parkinson\u27s disease with different clinical presentations to guide clinicians in their selection of evidence-based interventions to facilitate greater functional outcomes. A mixed-methods design was used to collect data on the mental and physiological perceptions of fatigue, utilizing surveys and physiological measures such as heart rate. Participants were recruited from a community group targeting those with PD with inclusion criteria being a diagnosis of PD. Results for both heart rate and perceived exertion demonstrated an individualized response and perception related to any given activity regardless of discipline or physiological basis. Results for qualitative data yielded tiring events and caregiver support as primary themes and were determined to be factors contributing to fluctuating fatigue levels on a weekly basis. The individualized nature of Parkinson’s disease requires clinicians to be mindful when tailoring interventions to one’s specific needs, especially with consideration of fatigue levels. Understanding activity responses can help clinics account for the overall demands of activity when designing a treatment group or program.
Keywords: capacity, fatigue, multidisciplinary, neurodegenerative, neuromuscula
Benefits and Barriers of Using Prefilled Precedex Syringes in the Operating Room: A Cost Comparison
Get PDFAccording to a report published by the Institute of Medicine, at least 44,000 and possibly up to 98,000 Americans die each year because of medical errors in hospitals. More than 7,000 of those deaths are from medication errors alone (Stucki et al., 2013). Anesthesia providers in the operating room (OR) are at even greater risk to commit medication errors due to their easy access to medications and their autonomy to make independent choices for medication administration. A small rural community hospital in Pennsylvania lacks a protocol for Precedex preparation. Evidence-based research show the benefit of prefilled ready-to-administer syringes, but the cost of this medication preparation versus traditional vial and syringe preparation is of concern of administration at this facility. A PICO question was developed for this project: In operative patients receiving Precedex (P), how does the use of pre-filled Precedex syringes prepared in the pharmacy or purchased from a pharmaceutical company (I) compared to current practice of a nurse anesthetist mixing multi-use Precedex bags and 5mL individual syringes (C) affect safety and cost (O)? Evaluation of safety and cost of the current Precedex preparation method at this facility, a pharmacy preparation method, and pharmaceutical prefilled syringes was completed. Results showed that a pharmacy preparation method proved to be the least expensive method. Pharmacy prepared and pharmaceutical company preparation were the safest methods for medication administration