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Three Essays on Misinformation, Mistrust and their Influence on Public Health Policy
Get PDFIn the first chapter I identify the impact of fentanyl exposure misinformation- namely, the erroneous belief that momentary, passive contact with the potent opioid fentanyl can be seriously harmful- on first responder behavior during overdose events, and on overall opioid-related mortality. I examine changes in opioid-related mortality following one particularly well-covered episode involving an Ohio police officer in 2017, wherein the officer appeared to experience an acute opioid overdose after touching what was believed to be fentanyl. Employing a synthetic differences-in-differences identification strategy, I find areas with greater media exposure to this misinformation exhibit marked increases in opioid overdose deaths; as well as preliminary evidence to suggest that overdose interventions performed by first responders were less effective and argue that this represents an increased hesitancy to render aid due to the potential presence of fentanyl. These results point to the existence of a heretofore unrecognized driving factor behind the current opioid epidemic, as well as to the need for policy intervention to counteract further dissemination of such adverse misinformation. The second chapter builds on these initial findings from the preceding chapter andprincipally examines the effects of misinformation on the actions of first responders in responding to opioid overdoses in New York State. By utilizing data that distinguishes naloxone administrations across law enforcement officers, emergency medical services, and community opioid overdose programs groups, I examine the relative change in first responder behavior by type following a well-covered media event credited with popularizing the erroneous belief that momentary contact with the opioid fentanyl is lethal. I find evidence to suggest that law enforcement officer resuscitations using naloxone following this event decreased significantly in frequency, and argue that this represents an increasedhesitancy to render aid due to unfounded fears of fentanyl exposure. These results highlight the potential adverse effects that misinformation pose to public health outcomes, and offer an alternative perspective to understand previous empirical research which has shown inconsistent results regarding the effectiveness of harm reduction policies. In the third chapter I employ microdata from the Census Bureau’s experimental Household Pulse Survey to examine Medicaid participation impacts on the COVID-19 vaccination decision and find that program recipients exhibited lower proclivities to be vaccinated relative to demographically-similar households insured through some alternative provider. Additionally, I observe that administrative burden, measured by state-level easements in the program enrollment process, is associated with significant declines in self-reported vaccination hesitancy. These results suggest the psychic and time costs accompanying the enrollment or benefits utilization processes may be negatively influencing other health behaviors, and highlight the significant policy implications of loosening Medicaid enrollment protocols on public health outcomes
The Relationship between Social Justice Attitudes and Compassion in Preservice Teachers: A Critically Compassionate Intellectualism Framework
Get PDFThis dissertation aims to gain further knowledge about the implementation of the Critically Compassionate Intellectualism (CCI; Cammarota & Romero, 2003) framework in teacher education. This framework, originally developed to provide a better education for Latine students who were being silenced in their original schools, emphasizes authentic caring, critical pedagogy, and social justice content. CCI aims to provide students with an education that better equips them to be part of our democratic society and is supposed to lead to an increase in students’ critical consciousness through developing compassionate relationships and making content related to students’ experiences. Based on the success of the CCI framework in secondary education, Rector-Aranda (2017, 2019a) argued that the framework can also be applied to teacher education. However, there is a lack of research investigating the framework holistically which this dissertation aims to do.
To gain the most knowledge about the CCI framework in teacher education, I analyzed the framework through three studies which are presented in this dissertation as three manuscripts. The first manuscript describes a mixed-method study where I analyzed students’ quantitative change from pre- to post-semester on their compassion, empathy, critical consciousness, and social justice beliefs. In addition to these quantitative outcomes, I collected post-semester qualitative data to investigate whether students’ responses could provide context for the quantitative findings. For the second manuscript, I analyzed how my students were responding to the social justice curriculum and how I, as the instructor of the CCI-based course, responded to resistant and non-resistant students. Together with my critical friends, we analyzed critical incidents to learn about students’ resistance and how I could frame my teaching in more critical compassion. The purpose of the final manuscript was to dive deeper into the perspectives of the students in the CCI-based course to better understand their experiences with CCI.
The findings underscored the potential of the CCI framework in fostering social justice beliefs among preservice teachers and emphasized the importance of classroom culture and student-centered teaching approaches. Additionally, the self-study illuminated possibilities for enhancing the CCI framework through the integration of additional social justice-oriented pedagogies, such as the pedagogy of discomfort. Furthermore, students\u27 perspectives indicated that classroom activities, materials, and the instructor’s philosophical stance facilitated the development of greater critical consciousness. In summary, the dissertation highlights the effectiveness of the CCI framework in teacher education, while also suggesting the value of implementing supportive changes to promote social justice teaching among preservice teachers
Abuse Liability of Electronic Cigarettes in Non-Smoking Electronic Cigarette Users
Get PDFElectronic cigarettes (ECIGs) are devices designed to aerosolize nicotine and are increasing in popularity among both former cigarette smokers and naïve tobacco users. Extant research has shown the dependence potential of ECIGs, though there is not a consensus on the severity of nicotine dependence caused by ECIG use. As a result of becoming dependent on nicotine, individuals may experience withdrawal symptoms (i.e., irritable, craving, depressed mood) when abstaining from nicotine. The majority of previous research on ECIG use has included samples of ECIG users who are former or current smokers. The present study evaluated ECIG withdrawal suppression among a population of ECIG users who were never smokers (N=14). Using a within-subjects design, participants completed 3 randomized conditions differing by product used: own brand ECIG, 4mg nicotine gum, or placebo gum. In each experimental session, participants experienced two product use bouts completing subjective and behavioral economics tasks after each bout. Cognitive tasks were administered at the start and conclusion of each session. Results suggest that ECIG use decreases intention to vape and anticipated relief from withdrawal symptoms better than active and placebo gums. ECIGs had the highest levels of satisfaction and relief from withdrawal symptoms as well as the highest crossover point (i.e., point at which money is chosen over product) for the multiple-choice task. Few significant findings were revealed for the cognitive tasks, potentially due to the small sample size. Overall, the results from the present study suggest that ECIGs are better able to relieve withdrawal symptoms and are more satisfying to the user compared to nicotine and placebo gums
Impact of Tiered Implementation of Clinical Decision Support System for Acute Kidney Injury and Nephrotoxin Exposure in Cardiac Surgery Patients
No full textBackground: Nephrotoxin exposure may worsen kidney injury and impair kidney recovery if continued in patients with acute kidney injury (AKI).
Objective: To determine if tiered implementation of a clinical decision support system (CDSS) would reduce nephrotoxin use in cardiac surgery patients with AKI.
Methods: We assessed patients admitted to the cardiac surgery intensive care unit at a tertiary care center from January 2020 to December 2021, and August 2022 to September 2023. A passive electronic AKI alert was activated in Jul 2020, followed by an electronic nephrotoxin alert in March 2023. In this alert, active nephrotoxic medication orders resulted in a passive alert, while new orders were met with an interruptive alert. Primary outcome was discontinuation of nephrotoxic medications within 30 hours after AKI. Secondary outcomes included AKI specific clinical actions, determined through modified Delhi process and patient centered outcomes. We compared all outcomes across five separate eras, divided based on the tiered implementation of these alerts.
Results: 503 patients met inclusion criteria. Of 114 patients who received nephrotoxins before AKI, nephrotoxins were discontinued after AKI in 6 (25%) patients in pre AKI-alert era, 8 (33%) patients in post AKI-alert era, 7 (35%) patients in AKI-alert long-term follow up era, 7 (35%) patients in pre nephrotoxin-alert era, and 14 (54%) patients in post nephrotoxin-alert era (p=0.047 for trend). Among AKI specific consensus actions, we noted a decreased use of intravenous fluids, increased documentation of goal mean arterial pressure of 65 mmHg or higher, and increased use of bedside point of care echocardiogram over time. Among patient centered outcomes we found a decrease in proportion of stage III AKI, need for dialysis, and length of hospital stay over time.
Conclusions: Tiered implementation of CDSS for recognition of AKI and nephrotoxin exposure resulted in a progressive improvement in the discontinuation of nephrotoxins
State Estimation and Economic Analysis for Electrochemical Sensor-Based Corrosion Monitoring
No full textCoal is currently the third-largest source of electricity production in the U.S. However, renewables are projected to be the primary source of electricity production in the future. Though coal-fired power plants (CFPPs) are rapidly retiring in the U.S., many CFPPs worldwide are expected to stay operational for a while due to factors like easy and cheap access to comparatively inexpensive coal. Therefore, non-renewable sources like coal are still expected to be prevalent and be used to ensure the stability of the electric grid in the foreseeable future. The existing coal-fired power plants generally designed to operate at base-loaded conditions are subjected to load-following conditions. Damage to equipment in power plants by corrosion is a leading cause of equipment failure and subsequent forced outage. This work primarily aims to estimate equipment corrosion and its remaining useful life using a nonlinear state estimator across multiple sensor networks. Subsequently, economic analysis is conducted considering market elasticity to assist in decision-making for sensor network placement investments. One key boiler component that undergoes corrosion damage is the waterwall (WW). The high metal temperature in the WW section of supercritical pulverized coal-fired (SCPC) power plants, coupled with the presence of corrosive gases like SO2 and O2, leads to equipment damage primarily by Type II hot corrosion. The key factors influencing the corrosion rate are identified, and a mechanistic model is developed to calculate the thickness of the fireside corrosion scale formed due to the hot corrosion in the waterwall section of the boiler in CFPPs. The proposed corrosion model is validated using the electrochemical corrosion sensor data collected from an operating industrial boiler. As corrosion dynamics are significantly slow compared to temperature and gaseous species concentration dynamics, a multi-scale model is developed where data-driven models are developed for the algebraic states that affect corrosion rate. Equations for the algebraic states and the differential equation of corrosion depth are used to form the differential-algebraic equation (DAE) system. The DAE system is solved by using the dynamic boundary values of the algebraic states to yield spatial and temporal profiles of all states along the WW. Noise is prevalent in almost every physical quantity measurement. Also, the novel corrosion sensors can be costly and impossible to place at all locations, especially due to the high temperature and harsh operating conditions in the WW section. This dissertation investigates corrosion estimation by placing sensors for the algebraic state variables, the measurement of which is comparatively more mature and considerably cheaper than the corrosion sensors. To this end, a nonlinear estimator is investigated. Unlike many systems that are represented by differential only or differential-algebraic equations, in this particular system, differential equations do not affect the algebraic states, but the algebraic states affect the differential states. A modified unscented Kalman filter (UKF) algorithm is developed for nonlinear state estimation of this specific class of differential-algebraic equations system. The performance of the UKF algorithm is evaluated with different configurations of the sensor network by simulating the boiler with various operating conditions, as expected during load-following operation. iii Implementing condition-monitoring-based predictive maintenance strategies increases power plant’s availability by preventing forced outages. Utility owners would like to ensure a positive return on investment when investing in sensors in ailing coal-fired plants. This dissertation investigates the economic impact of corrosion monitoring on equipment in coal-fired power plants through sensor placement for measuring corrosion and operating conditions like metal temperature and concentrations of O2 and SO2. The estimated time taken for the metal surface to rupture due to corrosion is calculated under multiple distinct corrosion networks. The performance of each network is analyzed by comparing the corresponding estimated time to failure to the true time taken to failure. The electricity produced by coal-fired power plants in the future in the U.S. under uncertainties in the energy market is calculated using an energy system model, The Integrated MARKAL-EFOM System (TIMES), and the database EPAUS9rT. Changes in energy trends, like the increased availability of coal-fired power plants due to sensor placement, are incorporated into the database through scenarios. All technologies and corresponding factors affecting coal-fired power plant’s electricity production are identified, and the individual degree of impact of each of these technologies on electricity production is demonstrated. A set of alternate energy futures, which include near-random scenarios involving key technologies, are created using the Latin Hypercube Sampling. The electricity produced from coal-fired power plants with and without improved availability under alternate futures is calculated and compiled to estimate the improved revenue gained by plants due to the anticipated reduction in forced outages due to corrosion monitoring. The initial investment cost for sensors under each network is calculated and compared to the improved revenue gained to calculate the change in net present value (NPV) under the increased availability of coal-fired power plants. The sensitivity of the change in NPV to factors like the type and cost of the sensor, the fraction of coal-fired power plants with sensors installed, and the number of operating plants in the installation year are analyzed
Investigation of the ecological interactions and host specificity of Verticillium nonalfalfae, a proposed biological control agent against the invasive tree-of-heaven (Ailanthus altissima)
Get PDFTree-of-heaven (Ailanthus altissima) is a highly invasive tree species with a cosmopolitan distribution, including an expansive range in North America. In the U.S., tree-of-heaven has established populations in more than 40 states and is considered among the most notorious of invasive plant species. The discovery of Verticillium nonalfalfae and V. dahliae causing acute wilt and mortality of Ailanthus in the mid-Atlantic in the 2000s has resulted in numerous studies evaluating the utility of these fungi as potential biocontrol agents. Recent efforts to commercialize V. nonalfalfae have raised additional questions about its widespread use and factors influencing long-term efficacy. Efforts of this study focused on: 1) investigating the ecological interactions of V. nonalfalfae and V. dahliae with mycorrhizal fungi that may influence Verticillium wilt of Ailanthus disease progression; 2) evaluating the temperature constraints of both Verticillium spp. and the resultant impact on disease development; 3) sequencing of Verticillium genomes and the generation of baseline genomic resources to aid in understanding inter-species and intra-species variation; and 4) conducting cross-pathogenicity assays to evaluate host specificity and adaptation. The presence of a pre-existing mutualistic partnership between Ailanthus and arbuscular mycorrhizal fungi (AMF) impacted Verticillium wilt disease development, though the extent to which varied by species and increasing temperatures. Cross-pathogenicity assays revealed that V. nonalfalfae strains were more virulent in their respective hosts of origin than in other known hosts of the fungus, providing further evidence of host adaptation. Sequencing of V. nonalfalfae and V. dahliae genomes confirmed that genes involved in the regulation of mating and putative biosynthetic gene clusters are highly conserved. These genomic resources can be leveraged for the continued investigation of V. nonalfalfae strains being considered for registration, along with V. dahliae strains from Ailanthus that have been historically excluded. Taken together, these results indicate that V. dahliae may serve as an effective biocontrol in the southern U.S., but in-depth host range studies and comparative pathogenicity assays are needed for strains isolated from Ailanthus. In addition, these results suggest that V. nonalfalfae strains isolated from Ailanthus are highly effective and host-specific and, thus, support ongoing efforts to register this fungus as a biocontrol agent against the invasive tree-of-heaven
Clinical Significance of Gutta Percha Variability
Get PDFIntroduction: The production of gutta percha points as root canal therapy filling materials vary from hand processing to machine processing with a range of acceptable levels of error (tolerance). Similarly, endodontic files manufactured to complement corresponding gutta percha points exhibit specified levels of tolerance. Investigations into the consistency among manufacturers of files and gutta percha points is limited. The aim of this study is to see how variability in apical gauge and taper of gutta percha points affected the clinical performance during cone try in. The null hypothesis of this study is that there is no difference in two gutta percha brands’ abilities to reach the working length after instrumentation and fill. The alternative hypothesis is that variability in the manufacturing process leads to gutta percha points failing to be within an acceptable range of working length at cone try in.
Materials and Methods. Gutta percha points selected for this study included Vortex Blue ® (VB) Conform Fit TM Gutta Percha, and EdgeFile® (EE) X7.06 Bioceramic Gutta Percha points. It is desirable for gutta percha points to fit as closely to the obturated shape of a root canal thus allowing the gutta percha and sealer to create the most hermetic seal possible at both ends of the canal system. This seal is pertinent to the overall success of root canal therapy. Ten extracted human maxillary canine teeth and
ten maxillary lateral incisor teeth were instrumented using VB files. The same method was also utilized with EE files (n=40 teeth). Vortex Blue and EE gutta percha points were tried in each instrumented tooth. Radiographic analysis was performed to evaluate fit (the amount of difference from the master apical file terminated in each canal compared to the master apical points terminated in each canal). The acceptable tolerance was - 0.5 mm (0.5 mm short) to 0 mm of the instrumented length.
Results: There was no significant difference in the average acceptable tolerance of each group tested.
Conclusions: There was no statistical difference amongst brands or combinations of brands in regard to outcomes. The null hypothesis is thereby accepted. As a clinical consideration, although it is practical to use the same brand of file and gutta percha point, a clinician can effectively use a similarly sized gutta percha point from either of these two brands
Venus Balloon Localization: A Map-Aided Navigation Approach Supported by a Single-Satellite
Get PDFAlthough Venus and Earth began as twins, possessing comparable size, mass, and composition, past exploration missions have revealed that Venus is now hellishly hot, devoid of oceans, and enveloped in a carbon dioxide-filled atmosphere. To understand when and why this evolutionary divergence occurred, further exploration is required. Today, there is a growing interest in the use of aerial platforms to circumvent the harsh conditions at the surface, which limit the lifetime of landed instruments. In this concept, a single balloon, propelled by the ambient wind field, would operate in the atmosphere at an altitude between 50 and 70 km, where the temperature and pressure are akin to those on Earth. Concurrently, a single satellite would be deployed in a well-defined orbit to provide real-time positioning updates. During the balloon\u27s operation, it would encounter persistent cloud cover, super-rotation winds, and intermittent satellite communication.
Localization, defined as the ability to estimate position and orientation in relation to one\u27s surroundings, is a fundamental aspect of the balloon\u27s mission. While proprioceptive sensors, such as an inertial measurement unit, can provide continuous data regarding the balloon’s internal state, they are insufficient for accurate long-term localization due to the integration of sensor error over time. In contrast, exteroceptive sensors measure the state of the surrounding environment. For this specific problem, a barometric altimeter and radar altimeter could be used to measure the ground elevation and compare it against a known topographic map, in a form of map-aided navigation. However, due to the self-similarity in natural terrains, this may not provide a unique solution. Alternatively, single-satellite positioning offers direct position measurements, but only when communication is possible.
In this thesis, a novel solution to balloon localization in the atmosphere of Venus is proposed. Initially, a Rao-Blackwellized Particle Filter (RBPF), which is capable of handling multi-modality, integrates map-aided navigation with the inertial solution in real time. Following intermittent observations of the orbiter, factor graph optimization smooths single-satellite positioning with the preliminary RBPF result. Through a MATLAB simulation, the algorithm was shown to enhance localization performance in comparison to its inertial counterpart. Furthermore, a sensitivity analysis demonstrates the algorithm’s performance with varying sensor quality, map resolution, observation frequency, and operational height
Pilot Quality Improvement Project to Update Surgeon Preference Cards of a Community Hospital\u27s Orthopedic Service
Get PDFAbstract
Implementation of a Pilot Quality Improvement Project to Update Surgeon Preference Cards
of a Community Hospital’s Orthopedic Service
Jessica R. Mitchell
Problem Statement: Over time, surgeons change preferences for surgical equipment, and their preference cards need updating. Failure to update preference cards leads to impaired staff communication, opening of unnecessary equipment, excess waste, increased cost to patients and facilities, and potential threats to patient safety.
Background: Members of the orthopedic surgical team in a community hospital in suburban West Virginia wanted to establish a process to regularly update outdated surgeon preference cards (SPC) for several common orthopedic procedures. The preference cards convey important information to operating room (OR) staff to promote efficient and safe intraoperative care of patients. Outdated or inaccurate information may increase wasting of supplies, decrease efficiency of OR time, increase costs, and potentially decrease safety for patients.
Project Goal: The purpose of this project was to establish a process for reviewing and updating surgeon preference cards for the orthopedic service in the operating room of a community hospital in suburban West Virginia.
Project Aims: 1) Evaluate the current process for updating surgeon preference cards
2) Implement a pilot project to update and standardize surgeon preference cards 3) Evaluate the usefulness of the pilot project to update and standardize surgical preference cards
Methods: The project director met with three orthopedic surgeons, physician assistants, and service line coordinators to review and update surgeon preference cards to implement and standardize their preferences for knee arthroplasty, hip arthroplasty, and shoulder arthroscopy. Pre and post intervention costs of each procedure were compared, and surveys administered to OR registered nurses, surgical technicians, physician assistants, and surgeons were analyzed.
Results: Pre and post intervention mean cost analysis was completed per surgeon evaluating each surgical procedure using a paired t-test for evaluation of post intervention savings. Surgeon A results indicated that there was no significant difference when the SPCs were updated (p = 0.476). Surgeon B results indicated that there was a significant difference with cost post implementation (p = 0.022). Surgeon C results indicated that there was not significant difference in cost post implementation (p = 0.405). Survey results were analyzed using a Likert scale to evaluate sense of preparedness with updated SPCs. The participants (n=25) all felt very prepared for the surgical case post implementation.
Conclusion: Evidence suggests costs savings when SPCs are maintained with input from providers. This quality improvement project did not demonstrate consistent cost savings for all procedures and surgeons, however there were cost savings associated with surgeon B for all three procedures that were updated. Surgeon A had a cost savings for knee arthroplasty. Surgeon C had a cost savings for hip arthroplasty, and shoulder arthroscopy. Staff that completed post implementation surveys felt satisfied with the updates to SPCs and felt prepared to perform the surgical cases
A Mixed Methods Approach to Evaluation and Modeling of Ergonomic Stressors due to Mass Decedent Handling
No full textWork-related injuries, illnesses, and musculoskeletal disorders (MSDs) significantly impact the U.S. healthcare industry, leading to lost working days, high medical costs, and increased turnover rates among healthcare workers (HCWs). Increased physical and mental health risks due to the handling of deceased during COVID-19 pandemic has exacerbated these issues. While the ergonomic risks of patient handling are well-studied, limited research exists on the ergonomic risks of manual handling of the deceased. Therefore, the primary objective of this study was to explore the challenges associated with decedent handling so that effective safety interventions to reduce the risk of injury and mental distress among decedent handlers can be developed.
This study used an exploratory sequential mixed-methods research approach, combining both qualitative and quantitative data, to evaluate/assess and model the risks of mass decedent handling. A total of 206 decedent handlers participated in a cross-sectional survey study designed to explore the challenges of mass decedent handling during the COVID-19 pandemic. The most common safety concerns reported by HCWs included no access to PPE, inadequate PPE, physical overexertion, exposure to COVID-19, unclear guidelines, and mental distress from working in mass fatality environments. The second phase of the study investigated the impact of decedent handlers\u27 subjective (rating of) workload on their mental health and willingness to continue in the healthcare industry. The modeling results showed that increased perceived workload among HCWs led to worsening mental health and reduced willingness to continue in the healthcare profession. One of the key takeaways from the survey study was that HCWs experienced elevated physical overexertion when performing decedent handling tasks, many attributing that to the poor designs of the body bags. These findings led to the development of the second study, a biomechanical lab-based experiment where 24 participants performed simulated decedent-handling tasks with 2 types of body bags. Results showed that differences in body bag grasp points (i.e., handle position) significantly affected peak joint angles (twisting, flexion/extension, and adduction/abduction) at the hips, shoulders, chest, elbows, and knees. Additionally, the handler\u27s relative position with respect to the deceased (i.e., standing at the head or foot of the body) significantly affected different body joints (left and right sides of the body, along the sagittal plane). The body joints located closer to the goal-forward direction of the transfer task were more affected, resulting in peak joint angles being observed on opposite sides for participants performing the two-person task at the head and foot of the mannequin.
Overall, the study findings provide a holistic perspective on the challenges and risks of handling deceased during mass fatalities. The survey study provides the foundation for developing robust emergency response plans to address the multifaceted challenges of mass decedent handling. The biomechanical study results have implications for body bag design recommendations and task rotation strategies. Overall, this study provides equipment and task design recommendations to reduce the risk of injury and create a safer and healthier work environment for healthcare workers